EMS SYSTEM LEGAL RIGHT TO FUNCTION AS AN EMT-B UPON MEDICAL

DIRECTION
STAR OF LIFE (6 SYSTEM FUNCTIONS OF EMS) 1. Follow standing orders and protocols
1. Dedication/ Detection 2. Establish telephone and radio communications
2. Reporting 3. Communicate clearly and completely and follow orders given in
3. Response response
4. Care on scene 4. Consult medical direction for any question about the scope and
5. Care on transit direction of care
6. Transfer to definitive care
ETHICAL RESPONSIBILITIES
COMPONENTS OF EMS 1. Serve the needs of the patient with respect
1. Regulation and Policy 2. Maintain skill mastery
2. Resource Management 3. Keep abreast of changes in EMS that effect patient care
4. Critically review performances
3. Human Resource and Training
5. Report with honesty
4. Transportation 6. Work harmoniously with others
5. Communications
6. Public Information and Education TYPES OF CONSENT
7. Medical Direction 1. Expressed/ Formal/ Informed Consent
8. Trauma Systems 2. Implied Consent
9. Evaluation 3. Consent to treat a minor or a mentally incompetent adult

ROLES AND RESPONSIBILITIES OF AN EMT ADVANCE DIRECTIVES

1. Personal Safety 1. Do Not Attempt Resuscitate
2. Safety of the Crew, Patient, and Bystanders 2. Durable Power of Attorney
3. Patient Assessment 3. Living Will
4. Patient Care 4. Surrogate decision makers
5. Lifting and Moving a) Spouse
6. Transport b) Adult child
7. Transfer of Care c) Parents
8. Patient Advocacy d) Any relative
e) Person nominated by the person caring for the
PROFESSIONAL ATTRIBUTES OF AN EMT incapacitated person
1. Appearance f) Specialized care professional as defined by law
2. Knowledge and Skills
3. Physical Demands REQUIREMENTS FOR FORMAL CONSENT
4. Temperament and Abilities 1. Legal age; emancipated minor
2. Competent, conscious, coherent, alert, oriented
COMPONENTS OF EMS SYSTEM 3. Patient not suffering from serious injury
1. Communication 4. Guardian/ parents have the psychological capacity to decide
2. Training 5. Patient is not under the effect of alcohol, chemical substance that
3. Manpower alter thought process
4. Mutual Aid
5. Transportation ABANDONEMENT – one stopped providing care without ensuring that
6. Accessibility equivalent care would be provided
7. Facilities
8. Critical Care Units NEGLIGENCE – care one provides deviates from the accepted standard of
9. Transfer of Care care thus causing further injury
10. Consumer Participation
11. Public Education PROTECTING YOURSELF BEFORE LEAVING THE SCENE
12. Public Safety Agencies 1. Try again to persuade the patient to accept treatment of transport to
13. Standard Medical Records a hospital
14. Independent Review and Evaluation 2. Make sure that the patient is able to make a rational informed
15. Disaster Linkages decision
3. Consult medical direction as required by local protocol
4. If the patient still refuses, have him sign the refusal form
5. Before you leave the scene encourage the patient to seek help if
MEDICAL, ETHICAL AND LEGAL ISSUES certain symptoms develop.
ETHICS – science of right & wrong, moral duties, ideal behavior IN ORDER TO ESTABLISH NEGLIGENCE
1. The EMT – B had the duty to act
MEDICAL ETHICS – part of ethics that deals with health care of man 2. The patient was injured, either physically or psychologically
3. The EMT – B violated the standard of care expected
DUTY TO ACT – obligation to provide care (implied or formal) 4. The EMT – B action or lack of action caused or contributed to the
patient’s injury
LEGAL DUTIES

 DUTY TO ACT INSTANCES WHEN AN EMT-B IS ALLOWED TO RELEASE

CONFIDENTIAL INFORMATION
 On-Duty – Legally Obligated 1. Another health care provider need to know the information to
 Off-Duty continue medical care
- May stop and help 2. As requested by the police as a part of a potential criminal
- May pass the scene and call for help investigation
- May pass the scene and make no attempt to 3. As required on a third party billing form
call for help 4. As required by legal subpoena

ASSISTING IN ORGAN HARVESTING

PATIENT’S BILL OF RIGHTS
1. Identify the patient as a potential donor
1. right to considerate and respectful care
2. Communicate with medical direction regarding the possibility of
2. right to refuse treatment
organ donation
3. right to confidentiality of all communications and record of care
3. Provide emergency care that will maintain the vital organs
4. right to expect continuity of care
CRIME SCENE RESPONSIBILITIES DISEASES THAT POSE A RISK TO HEALTH PROVIDERS
1. Scene safety 1. HIV
2. Administer immediate care/ emergency care 2. Hepatitis B & C
3. Preserve evidences if possible 3. Tuberculosis
4. Touch only what you need to touch 4. Syphilis
5. Move only what you need to move 5. Meningitis
6. Do not use the phone unless authorized by the police 6. Rabies
7. Observe and document anything unusual at the scene
8. If possible, do not cut through holes in the patients clothing EXPOSURE CONTROL PLAN
9. Do not cut through any knot in a rope or tie 1. Determination of exposure
10. If rape, do not allow the patient to wash, change clothing, use the 2. Education and training
bathroom or take anything P.O. 3. Hepatitis vaccine program
4. Personal protective equipment
SPECIAL REPORTING SITUATIONS 5. Changing and disinfecting practices
1. Abuse 6. Post exposure management
2. Crime
3. Drug – related injuries BODY FLUIDS WHICH POSE RISK FOR HEPATITIS B AND HIV
4. Communicable diseases  PRIMARY RISK
1. Blood
TRAITS OF A GOOD EMT 2. Semen
1. Neat and clean 3. Vaginal secretions
2. Physically fit  SECONDARY RISK
3. Emotionally and mentally fit 1. Synovial fluid
2. Cerebrospinal fluid
HEALTHY LIFESTYLE OF AN EMT 3. Amniotic fluid
1. Nutrition  NO RISK
2. Exercise and relaxation 1. Sweat
3. Balancing work, family, and health 2. Tears
3. Saliva
PURPOSE OF BODY MECHANICS 4. Urine
1. Facilitate safe and efficient use of appropriate groups of muscles 5. Feces
2. Prevent strain, fatigue and injury 6. Vomitus
7. Nasal secretions
BASIC ELEMENTS OF BODY MECHANICS 8. Sputum
1. Body alignment (posture)
2. Balance (stability) RESERVIOR – PORTAL OF EXIT
3. Coordinated body movement  RESPIRATORY TRACT
 Nose & mouth – through sneezing. Coughing,
breathing, talking, ET tubes & tracheostomies
INFECTION CONTROL  GASTRO-INTESTINAL TRACT
1. Mouth
INFECTION CONTROL – procedures to reduce infection in patients and 2. Saliva
health care personnel 3. Vomitus
4. Anus
INFECTION - growth of an organism in a susceptible host with or without
signs and symptoms of illness 5. Feces
6. Drainage tubes
COMMUNICABLE DISEASE - any disease that can be spread person to 7. Ostomies
person or thru contaminated objects or secretions  URINARY TRACT
1. Urethral meatus
CHAIN OF INFECTION 2. Urine
1. Etiologic agent
2. Reservoir 3. Urinary diversion
3. Portal of exit from the reservoir 4. Ostomies
4. Method of transmission
5. Portal of entry to the susceptible host  REPRODUCTIVE TRACT
6. Susceptible host 1. Vaginal discharge
2. Vagina
STAGES OF INFECTION
3. Semen
1. INCUBATION PERIOD – entrance of pathogen; 1st symptoms
2. PRODROMAL STAGE – onset of non specific to more specific 4. Urine
symptoms  BLOOD
3. ILLNESS STAGE – manifest signs and symptoms to type of 1. Open wound
infection 2. Needle puncture sight
4. CONVALESCENCE STAGE – acute symptoms of infection 3. Any disruption of intact skin or mucous membrane
disappear
SUSCEPTIBLE DEFENSES OF A SUSCEPTIBLE HOST
METHOD OF TRANSMISSION 1. Hygiene
1. Direct contact 2. Immunization
2. Contact with contaminated materials 3. Nutrition
3. Inhalation of infected droplet 4. Fluid
4. Punctured by a contaminated needle 5. Rest and sleep
5. Bite of infected animal, insect and human 6. Stress
6. Transfusion of contaminated blood product
VACCINE NEEDED BY THE EMT
DEFENSES AGAINST INFECTION 1. Hepatitis B & C
1. Normal flora 2. Meningitis vaccine
2. Body system defenses 3. BCG
3. Inflammation
4. Immune response
PERSONAL PROTECTIVE EQUIPMENT 1. AEROBIC METABOLISM
1. Vinyl latex gloves ->insufficient amount of O2 ->cell ->pyruvate ->ATP
2. Heavy duty gloves for cleansing 2. ANAEROBIC METABOLISM
3. Protective eyewear ->insufficient amount of O2 ->cell -> pyruvate ->lactic acid ->ATP
4. Mask 10%
5. Cover gown
6. Ventilatory equipment CELL COMPONENTS
1. CYTOPLASM – jelly like substance of protoplasm
PURPOSES OF HANDWASHING - Site of most intermediary metabolism
1. to reduce the number of microorganisms onto the hands 2. NUCLEUS – contains nucleoplasm, DNA and chromatin
2. to reduce the risk of transmission of infectious organisms to one’s - Responsible for cell division and growth
self 3. MITOCHONDRIA – power house of the cell
3. to reduce the risk of transmission or microorganisms and cross 4. CENTROSOME – participates in mitosis
contamination to patients 5. GRANULES
6. VACUOLES – are cavities of watery materials

ANATOMY AND PHYSIOLOGY ACTIVE TRANSPORT

1. CHANNELS – take in solute and expel it to the other side of the
ANATOMICAL TERMS: membrane by changing shape and by closing the outer end and
1. SUPERIOR – above the reference point opening the inner and freeing the molecules into the cells.
2. INFERIOR – below the reference point 2. ENDOCYTOSIS AND PHAGOCYTOSIS – engulfing large
3. MIDLINE – imaginary vertical line down the middle of the front substances such as bacteria and large proteins.
surface of the body
4. ANTERIOR – toward the front PASSIVE TRANSPORT
5. POSTERIOR – toward the back 1. OSMOSIS – movement of water from an area of low solute
6. MEDIAL – nearer the midline of the body concentration to an area of high solute concentrations
7. LATERAL – farther from the midline 2. DIFFUSION – movement of solutes from an area of higher
8. PROXIMAL – nearer the point of attachment concentration to an area of lower concentration
9. DISTAL – farther to the point of attachment 3. FACILITATED DIFUSSION – uses carriers to transport large
10. INTERNAL – inside molecules and non lipid soluble, like glucose
11. EXTERNAL – outside
12. SUPERFICIAL – near the surface TISSUES – a combination of cells forming specialized parts of the body’s
13. DEEP – remote from surface structures

PATIENT’S POSITION TYPES:

1. ERECT – standing upright 1. EPITHELIAL – provides coverings and lining membranes
2. RECUMBENT – lying down 2. CONNECTIVE – supports and binds together all other tissues
3. SUPINE – lying face up 3. NERVOUS – receives stimulus inside and outside the body and
4. PRONE – lying face down rapidly carriers impulse to other tissues
5. LATERAL – lying on side 4. MUSCLES – specialized for contractions and thereby produce
6. LEFT LATERAL – pregnant/ unconscious movement
7. TRENDELBURG (MODIFIED) – lying with feet elevated 8-12 5. FLUID – 60% of the body; 70% inside the body cells and 30% is
inches; shock position in the body fluids
8. FOWLER’S – head elevated 45-90°; stroke; head injury
SQUAMOUS – smooth, thin and inactive lining to organs
MAIN BODY CAVITIES 1. Heart
1. HEAD 2. Blood vessels
a) CRANIUM 3. Alveoli
i. Brain 4. Lymphatic vessels
ii. Origins of the cranial nerves
iii. Inner and middle parts of the ear COLUMNAR CILIATED EPITHELIUM – columnar cylindrical with cilia
iv. Major blood vessels 1. Nose
b) ORBITS/EYES 2. Larynx
c) NASAL CAVITIES 3. Trachea
d) M OUTH 4. Pharynx
5. Bronchi
2. THORAX 6. Uterine tubules
a) Lungs
b) Heart STRATIFIED EPITHELIUM – deepest cells are columnar with flattened
c) Esophagus superficial cells
d) Major blood vessels 1. Conjunctiva of the eyes
3. ABDOMEN 2. Epidermis
a) Stomach 3. Lining of the mouth
b) Small intestines 4. Lining of the pharynx and esophagus
c) Large intestines
d) Spleen TRANSITIONAL EPITHELIUM – pear shaped cells and flattened
e) Kidneys superficial layer
f) Ureters 1. Kidneys
g) Liver 2. Lining of ureters
h) Gall bladder 3. Lining of urinary bladder
i) Pancreas 4. Pelvis
4. PELVIC
a) Bladder AREOLAR - elastic and connects organ
b) Urethtra 1. Under the skin
c) Reproductive organs 2. Between muscles
d) Rectum 3. Blood vessels
4. Nerves
CELLS – basic construction unit of all living things 5. Submucous coat in digestive tract
6. Interior of organs
METABOLISM – chemical and energy transformations which occur in the
body
ADIPOSE TISSUES – fat cells supporting organs 5. small intestine
1. Kidneys 6. bladder
2. Eyes between bundles of muscle fibers
SKELETAL SYSTEM
WHITE FIBROUS TISSUES – protective covering - made up of 206 bones
1. Bone
2. Kidneys TWO TYPES:
3. Lymphatic glands 1. COMPACT – hard and solid
4. Muscle fascia 2. CANCELLOUS – has a spongy appearance; contains bone
5. Blood vessels marrow
6. Brain
CLASSIFICATION OF BONES
YELLOW ELASTIC TISSUE – capable of extension and recoil 1. LONG BONES – consist of elongated shaft of compact tissues
1. Arteries with 2 extremities made mainly of cancellous bone surrounded by
2. Bronchi compact bones
3. Lungs a) Humerus
4. Trachea b) Radius
c) Phalanges
LYMPHOID TISSUES – collection of specialized cells and lymphocytes d) Tibia
1. Lymph nodes e) Fibula
2. Spleen f) Ulna
3. Tonsils g) Femur
4. Adenoids
5. Appendix 2. SHORT BONES – consist of smaller masses of cancellous bone
surrounded by compact bone but no shaft
BLOOD a) Carpal
1. Plasma b) Tarsal
2. Erythrocytes
3. Leukocytes 3. FLAT BONES – consist of 2 layers of compact bone with a thin,
4. Platelets cancellous layer in between
a) Skull
SKELETAL MUSCLE TISSUE – voluntary and under the control of b) Pelvis
somatic nervous system c) Scapula
1. Bones
4. IRREGULAR BONES – more complex in shape
CARDIAC MUSCLE –capable of self excitation and automaticity a) Vertebrae
1. Heart b) Some bones in face

SMOOTH MUSCLE – under the control of autonomic nervous system 5. SESAMOID BONES – small bones developed in the tendons
1. around arterioles around certain joints
2. Bronchioles
BASIC PARTS
NINE REGIONS OF THE ABDOMEN
1. PELVIC GIRDLE

2. VERTEBRAL COLUMN ORRACHIS

4 QUADRANTS OF THE ABDOMEN

SOLID ORGANS
1. diaphragm
2. spleen
3. liver
4. pancreas
5. kidneys
HOLLOW ORGANS
1. stomach
2. gallbladder
3. duodenum
4. large intestine
3. SKELETAL SYSTEM JOINTS – junction of 2 or more bones

TYPES:
1. IMMOVABLE (FIBROUS) – bones of the skull and pelvis
2. SLIGHTLY MOVABLE (CARTILAGINOUS) – symphysis pubis
and intervertebral
3. FREELY MOVABLE (SYNOVIAL)
a) Elbow
b) Hip
c) Wrist
d) Knee
1. HINGE JOINT – allows flexion and extension in one direction only
i) Elbow
ii) Knees

2. GLIDING JOINT – bones for glide on one another

i) Carpal
ii) Tarsal

3. PIVOT JOINT - allows for rotation

i) Radius
ii) Ulna

4. BALL AND SOCKET – bones can move freely in all directions

i) Hip
ii) Shoulder

5. DOUBLE HINGE JOINT – allows movement in 2 directions

i) Lower jaw
4. CRANIAL BONES
LIGAMENTS – hold bones together at the movable and slightly movable
joints

TENDONS – attach muscles to bone surface

MUSCLES – contact in response to nerve stimulus to create movement

RESPIRATORY SYSTEM

FUNCTIONS:
1. Extract O2 from the atmosphere and transfer it to the lungs
2. Excrete H2O vapour and CO2
3. Maintain acid-base balance
4. Ventilate the lungs

INSPIRED AIR
5. AUDITORY OSSICLES 1. 78% Nitrogen
2. 21% O2 (atmospheric concentration)
3. 0.04 % Carbon dioxide
4. 1 % inert gases
5. water vapour - variable

EXPIRED AIR
1. 78% Nitrogen
2. 17% O2
3. 4 % Carbon dioxide
4. 1 % inert gases
5. water vapour - increased amount to saturation

COMPONENTS OF RESPIRATORY TRACT

6. FACIAL BONES
EXTERNAL RESPIRATION 3 LAYERS OF THE HEART
-takes place in the lungs (alveolar level)

INTERNAL RESPIRATION
-takes place in the tissues (circulatory/ cellular level)

MECHANISM OF RESPIRATION
1. INSPIRATION (BREATHING IN) – contracted diaphragm and
intercoastal muscles; (-) pressure
2. EXPIRATION (BREATHING OUT) – relaxed diaphragm and
intercoastal muscles; (+) pressure; more gas exchange

MEDULLA OBLANGATA – control of respiration

TYPES OF ABNORMAL RESPIRATION

1. BRADYCARDIA – breathing is slow < 10bpm PATHWAY OF BLOOD
2. TACHYCARDIA – breathing is fast >24bpm
3. HYPERPNEA – respiration increased in depth and rate
4. HYPERVENTILATION – rate and depth increased by excessive air
in the lungs
5. HYPOVENTILATION - rate and depth decreased by excessive air
in the lungs
6. CHEYNE STOKES – irregular by alternating period of apnea and
hyperventilation
7. BIOT’S – shallow breathing with apnea
8. KUSSMAUL’S – deep respiration with sighing expiration “air
hunger”
9. ORTOPNEA – unable to breathe comfortably when in supine
10. APNEA – cessation of respiration
11. DYSPNEA – difficult or labored breathing
12. EUPNEA – normal respiration

CHARACTERISTICS OF ADEQUATE BREATHING

1. Rate (within normal)
2. Quality
3. Depth
4. Rhythm

CIRCULATORY SYSTEM

BLOOD VESSELS

COMPONENTS OF CIRCULATION
PATHWAY OF ELECTRICAL ACTIVITY
1. BLOOD – Adult: 5liters
-Child: weight x 80cc =volume
2. HEART
3. BLOOD VESSELS

4 CHAMBERS OF THE HEART

SUBDIVISION OF THE SYSTEM MENINGES: membranes of the brain
1. SYSTEMIC – carries oxygenated blood to the tissues and returns 1. DURAMATER – tough outer membrane
deoxygenated blood to the heart 2. ARACHNOID MATER – middle membrane which has blood
supply of its own
2. PULMONARY – carries blood to and from the lungs for 3. PIA MATER – delicate inner membrane richly supplied with blood
reoxygenation vessels, rest on the surface of the brain

3. PORTAL – carries blood to and from the liver FUNCTION OF MENINGES

1. Protect the brain and spinal cord
BLOOD CLOTTING 2. Absorb CSF
1. PLATELETS - -thrombokinase --prothtombokinase and 3. Supply blood to the brain surface
calcium
2. SALTS - - thrombin (activating enzyme) --fibrinogen CEREBROSPINAL FLUID: 150-200ml
3. CLOT 1. Lubricates brain and spinal cord
2. Supports brain
FUNCTION OF SPLEEN 3. Shock absorber
1. Produce new white blood cells 4. Nourishes and cleanses by washing away toxins
2. Stored red blood cells
3. Destroy old red blood cells CRANIAL NERVES: 12 cranial nerves
1. Carry sensory info
NERVOUS SYSTEM 2. Control motor function of muscles around the head and neck
3. Initiate autonomic control of heart rate (VAGUS) and breathing
FUNCTION: (PHRENIC)
1. Coordinates bodily activities
2. Convey instructions from the brain to the muscles through the motor
nerves PATIENT ASSESSMENT
3. Transmit information from the outside world and parts of the body to
the brain by the sensory nerves INITIAL ASSESSMENT
CABD
COMPONENTS 1. Safety/ BSI
1. BRAIN 2. Check LOC
a. CEREBRUM – motor center and sensory center  Alertness
- Consciousness, memory intelligence, reasoning  Verbal response
 Pain response
i. THALAMUS – receives more of the sensory impulses  Unresponsiveness
1. Circulation – capillary refill/ O2 saturation
ii. HYPOTHALAMUS – heat regulator,hunger center, thirst 2. Airway - adequacy
and emotional changes 3. Breathing – look, listen and feel
4. Defibrillation (PRN)
b. CEREBELLUM – maintenance of balance, muscle coordination and
tone CABDE
1. Safety/ BSI
c. BRAIN STEM 2. Check LOC
3. Circulation – capillary refill/ O2 saturation
i. MID BRAIN – relays motor and sensory messages 4. Airway – C-spine stabilization
between them and pons varolii and cerebellum 5. Breathing – look, listen and feel
6. Disability – DCAP BTLS/ PMS/6P’s
ii. PONS VAROLII – a link joining various parts of the 7. Exposition – head to toe
brain
PONTIN pinpoint pupils LIFE THREATS OBVIOUS DURING GENERAL IMPRESSION
1. Airway compromised by blood, vomits, secretions, tongue, bone
iii. MEDULLA OBLANGATA – link between the brain 2. Obvious open wound
and spinal cord 3. Flail chest
-vital center (respiratory, cardiac, vasomotor) 4. Major bleeding
-reflex center (swallowing, vomiting, coughing,
sneezing) CRITERIA FOR SCOOP AND RUN
1. a poor general impression
2. SPINAL CORD AND PERIPHERAL NERVES (sensory and motor) – 2. unresponsive; with altered mental status; (-) gag/ cough reflex to
link the brain and the nerves (center of reflex action)
protect their on airway
a. PERIPHERAL NERVES
i. SENSORY 3. responsive but can’t obey command
ii. MOTOR 4. inability to establish patent airway
5. patient who has DOB with signs of respiratory distress
3. AUTONOMIC NERVOUS SYSTEM – supplies nerves to all the internal 6. (-) or inadequate breathing
organs (self-controlled) and blood vessels; (pupils, heart rate, breathing, 7. Pulse less
peristalsis) 8. hemorrhage
a. SYMPATHETIC NERVES – have a stimulating and quickening 9. In state of shock
effect on the heart, circulatory and respiratory system but a slowing 10. With open wound to the chest or flail chest
effect on digestion 11. Severe chest pain; SBP of <100mmHg
12. Severe pain anywhere
b. PARASYMPATHETIC NERVES – stimulating the digestion and 13. Complicated child birth
slowing the heart, circulation and respiration 14. Severe allergic reaction
15. Poisoning or overdose of unknown substance
MEDICAL CONDITIONS
1. PARAPLEGIA – paralysis of lower limbs, may involve rectum 16. Hypo/hyperthermia
and bladder
2. QUADRIPLEGIA – paralysis of all four limbs VITAL SIGNS
3. HEMIPLEGIA – complete or partial paralysis of one side of the 1. BREATHING
body (lateral) a. NORMAL RATES
4. MONOPLEGIA – paralysis of one limb  ADULT – 12-20cpm
5. MENINGITIS – inflammation of the meninges  CHILD – 15-30cpm
 INFANT – 25-50cpm
 b. DETERMINING ADEQUACY B. UNRESPONSIVE
 Quality 1. Safety/BSI
 Rate 2. General impression
 Rhythm 3. NOI
 Depth 4. LOC (AVPU)
5. CAB – existing problem (rectify)
2. PULSE CAB – threat (eliminate)
a. NORMAL RATES 6. Rapid assessment (head to toe)
 ADULT – 60-100 bpm 7. Baseline vital signs including GCS
 ADOLESCENCE – 60-105 bpm 8. S-A-M-P-L-E
 SCHOOL AGE – 60-120 bpm 9. Transport
 PRE-SCHOOLER – 80-150bpm 9. On going assessment
 INFANT – 120-150bpm  Reassess Stable patient every 15 minutes
 Reassess UNSTABLE patient every 5 minutes
b. PULSE SITES  ROSC every 30 seconds
 CENTRAL – carotid, femoral
 PERIPHERAL – radial, brachial, posterior tibial, SECONDARY SURVEY
dorsalis pedis 1. Obtain chief complaint
2. Evaluate chief complaint
3. SKIN – condition, color, capillary refill (2seconds) 3. Conduct physical exam
4. PUPILS 4. Obtain vital signs
 PEARRLA
 Normal size – 3-7mm FOCUSED HISTORY AND PHYSICAL EXAM
 Re-evaluate MOI
DILATED – cardiac arrest, drug use (shabu), increase ICP - Unconscious/ disoriented patients
CONSTRICTED – CNS disorder, narcotics (marijuana) - Under influence of alcohol/ drugs
UNEQUAL - stoke, head injury, artificial eye
SIGNIFICANT MOI
1. BLOOD PRESSURE 1. Motorcycle crash
a. NORMAL RATES 2. Unresponsive/ altered mental status patient
3. Penetrating trauma (head, chest, abdomen)
PATIENT SYSTOLOC DIASTOLIC 4. Ejection from vehicle
Patient’s age + 100 5. Death in passenger compartment
Adult MALE 60-90mmHg 6. Fall >15-20 feet
(up to 150mmHg)
Patient’s age + 90 7. Vehicle roll over
Adult FEMALE 50-80mmHg 8. High speed collision
(up to 140mmHg)
90 mmHg (lower limit 9. Previous slide (bicycle crash, fall 2-3x their height for the child)
ADOLESCENT
of Normal)
CHILD (1-10years old) HIDDEN INJURIES
1. Seatbelts
a. PULSE PRESSURE - SBP-DBP 2. Airbags
b. OBTAIN BP >3 YEARS OLD – 70mmHg SBP
HEAD-TO-TOE ASSESSMENT (60-90 seconds)
2. PULSE OXIMETRY – O2 saturation and heart rate 1. Head
a. SITE – fingers, earlobe, heel (neonate) 2. Neck
3. Chest
b. O2 SATURATION 4. Abdomen
 NORMAL - 95-100% 5. Pelvis
 MILD HYPOXEMIA – 91-94% 6. Lower Extremities
 MODERATE HYPOXEMIA – 85-90% 7. Back – if no supine injury
 SEVERE HYPOXEMIA - <85% 8. Deformity
9. Contusions
*Consider oxygenation if 92% below (15lpm) 10. Abrasions
11. Penetrations
PATIENT ASSESSMENT (WITH SECONDARY SURVEY) 12. Burns
13. Tenderness
A. RESPONSIVE 14. Laceration
1. Safety/BSI 15. swelling
2. General impression
3. NOI EXTREMITIES - PMS
4. LOC (AVPU)
5. CAB – existing problem (rectify) SCENE SAFETY PRIORITIES
CAB – threat (eliminate) 1. personal safety
6. Chief complaint – present illness 2. crew
 Onset 3. other responding personnel
 Provocation 4. patient
 Quality 5. bystanders
 Radiation
 Severity UNSAFE SCENES
 Timing 1. crash and rescue scenes
7. Pertinent past history – present illness 2. toxic substance / HAZMAT
 Signs and symptoms 3. crime scene
4. unstable surfaces
 Allergies
5. violent/ hostile environment
 Medications
6. unstable structures
 Past medical history
7. farm emergencies
 Last oral intake
 Events leading to illness
PHASES OF PATIENT’S ASSESSMENT
8. On going assessment
1. dispatch info review
 Reassess Stable patient every 15 minutes
2. scene survey
 Reassess UNSTABLE patient every 5 minutes
 3. initial assessment
4. focused history and physical exam
5. detailed physical exam OXYGENATION
6. on going assessment
7. communication CYLINDER TYPES, CONTENTS & CALCULATION
8. documentation  D (psi x 0.16) = 350ml
*MAXIMUM TIME ON SCENE FOR TRAUMA IS 10 MINUTES  E (psi x 0.28) = 625ml
 G (psi x 2.41) = 5300ml
PRESENTING MEDICAL INFORMATION  H (psi x 3.14) = 6900ml
A. INFORMATIONS FROM PATIENT OR BYSTANDERS  K (psi x 3.14) = 6900ml
1. age/ sex  M (psi x 1.56) = 300ml
2. chief complaint  Store at 125 degrees Farenheight
3. history of present illness
4. other medical history MINIMUM VOLUME REQUIREMENTS FOR PEDIATRICS:
a. significant other illnesses  1yr/old = 120ml
b. medications  2yr/old = 156ml
c. allergies  3-4yrs/old = 170ml
d. usual doctor or hospital  5-6yrs/old = 200ml
 7-10yrs/old = 270ml
B. DIRECT OBSERVATIONS  11-12yrs/old = 380ml
PHYSICAL FINDINGS  13-14yrs/old = 420ml
1. General appearance  15yrs/old = as adult
- position
- LOC TYPES OF REGULATORS:
- Degree of distress 1. High pressure regulator
- Skin condition - Has only one guage
2. Vital signs - Can provide 50psi
3. Head to toe survey
- Do not use w/o ATV
4. ECG findings, if any
Parts: cylinder content cage, ATV port, pin index, step down regulator,
flow meter
C. INTERVENTIONS DONE
1. Treatment given in the field
2. Therapy regulator
2. Condition of patient while in your care
- Has 2 guages
- Position in which the patient was transported
- Any changes in vital signs condition - 0-15LMP
- Long distance emergency (>1hr) – use humidifier
D. MAJOR DIVISIONS IN ASSESSMENT - Short distance (<1hr) – do not use humidifier
1. Safety / BSI, general impression - Step down regulator – 2K psi
2. ABC (problems now) – rectify immediately
3. ABC threats BASIC AIRWAY ADJUCNTS
4. Non life threatening injuries/ conditions  OPA (oropharyngeal airway) – mouth
- Length measurement: corner of mouth-earlobe
- 2 types: GUEDEL (tubular) & BERMAN ( with channel on
both sides)
EMERGENCY MEDICAL DISPATCH  NPA (nasopharyngeal airway) – nose
Task
- Length measurement: nares-earlobe
1. Interrogate caller & assign priority call
2. Provide pre-arrival medical instructions to callers & info to the
ADVANCED AIRWAY ADJUNCTS
crew
 ENDOTRACHEAL (ET) – should stay for 3 days only
3. Dispatch & coordinate EMS resources
 COMBITUBE (ESOPHAGEAL TRACHEAL
4. Coordinate with other public safety agencies
AIRWAY/PHARYNGEAL AIRWAY)
 KING LTD (LARYNGEAL TRACHEAL AIRWAY DEVICE)
Info to be obtained:
 LMA (LARYNGEAL MASK AIRWAY)
1. Exact location of the patient
 SALT
2. Call back number
3. Patient’s problem
OXYGEN DELIVERY EQUIPMENTS:
4. Patient’s age, sex
 Nasal cannula
5. Is the patient responsive, breathing
o Very limited O2 concentration
Guidelines of Dispatch Life Support: o 24-44% O2
1. Seizure/convulsion maybe a symptom of the onset of cardiac  Pediatric Simple Mask
arrest. 35yrs/old & older with CC of seizure should be assumed to o No reservoir
be in cardiac arrest, until proven otherwise o Up to 60% O2
2. Cardiac arrest in previously healthy child should be considered to  Adult Simple Mask
be caused by FBAO, until proven otherwise o Has a reservoir & one way valve
3. Dispatchers should be trained o 15Lpm/100% O2
4. If secondary caller could not identify unconscious & breathing, it is  Pediatric Non-rebreather Mask
assumed to be in cardiac arrest o Has a reservoir & one way valve
5. Heimlich maneuver should be the primary treatment for choke pts o 8Lmp O2
 Partial Non-rebreather Mask
PHASES OF AMBULANCE CALL: o Has a reservoir & two way valve
1. DAILY PRE-RUN o 35-60% O2
2. DISPATCH REVIEW  Venture Mask
3. EN ROUTE TO THE SCENE o Low flow oxygen system
4. AT THE SCENE o Dependent function of EMT
5. EN ROUTE TO THE RECEIVING FACILITY
(Improvised cone is used)
6. AT THE RECEIVING FACILITY
 Oxygenation in PREMATURE NEONATE is 2Lpm-3Lpm
7. EN ROUTE TO THE STATION
 Ways in ventilating pts who don’t breathe adequately
8. POST RUN
o By mouth
o By BVM
o By ATV
o By mask
 8. U WAVE – present (abnormal findings)

 Breathing terms for (-) breathing: ECG COMPLEX:

- Agonal  P WAVE (atrial depolarization) – 0.04-0.12sec (1-2 small
- Apnea squares)
- Respiratory arrest  PR INTERVAL (SA node-AV node conduction) – 0.12-0.20sec
 Do not use DYSPNEA to describe inadequate breathing instead (3-5 small squares)
use RESPIRATORY DISTRESS  QRS INTERVAL (ventricular depolarization) – 0.04-0.12sec
 CO2 normal level is 35-45mmHg (1-2 small squares)
 150mils – dead air space, amount of O2 not reaching alveoli  ST SEGMENT (isoelectric/plateau phase ventricular
 50mils reach alveoli depolarization)
 Unguarded airway – 2 breaths every 5-6secs, 10-12b/min  T WAVE (ventricular repolarization)
 Guarded airway – 1 breath every 6-8secs, 8-10b/min  QT INTERVAL (total duration ventricular depolarization) –
 BVM (w/ reservoir) + O2 0.33-0.42sec (8-10 small squres)
- 1,600ml (adult)
- 700ml (child) CLASSIFIED ACCORDING TO:
- 240ml (infant/neonate)  Rate
 BVM for neonate/infant should have pressure relief valve  Site of origin
 Safest ventilation according to ILCOR is:  Mechanism
- 600ml for ADULT  Rate of Atrial – Ventricular Depolarization
- Per wt. (kg) of the pt, 6-7ml of O2
4 BASIC TYPES OF RHYTHMS AN EMT MUST KNOW:
1. ASYSTOLE – non shockable
CONDITIONS MAY REQUIRE OXYGEN:
2. PEA – non shockable
1. Respiratory or Cardiac Arrest
3. PULSELESS VTAC – shockable
2. Heart Attacks & Strokes
- 3 or more PVC’s occur in immediate succession at a
3. Shock
4. Blood Loss rate greater than 100/min, & may occur <30sec or
5. Lung Disease persist >30sec
6. Broken Bones, Head Injuries, Burns
7. Unconscious w/ no gag reflex & (-) breathing 4. VFIB – shockable
- Disorganized/chaotic beating of the myocardium in
HYPOXIA – insufficient supply of oxygen to body’s tissues & may take which each muscle fiber contracts & relaxes
place: independently, producing rapid, tremulous, &
1. Pt trapped on fire ineffective contraction
2. Pt has emphysema
3. Pt takes a drug overdose which has depressing effect on the PRINCIPLE OF EARLY DEFIB:
respiration  All EMT should be trained & equipped with AED & operate it as
4. Pt has heart attack professional activities require it

O2 CONTRAINDICATIONS FRIST RESPONDERS:

1. PARAQUAT 1. Lay rescuer
2. ZINC PHOSPHIDE 2. First responder
3. WATUSI 3. Police
4. Fire fighters
5. Volunteer emergency personnel
6. Physicians
BASIC ECG & AED 7. Nurses
8. EMTs
ELECTROCARDIOGRAM – records potential (voltage) differences 9. Paramedics
between “neutral” ground & recording electrodes 10. Respiratory therapist
- Recordings are obtained w/ paper speeds
25mm/sec & signal calibration of 1.0mv/1cm PURPOSE OF DEFIB:
 To produce temporary asystole & attempts to depolariza the
 3 LEAD ECG – monitoring purposes myocardium & provide an opportunity for the natural pacemaker
 12 LEAD ECG – diagnosis purpose centers of the heart to resume normal activity
 P-QRS-T complex of normal ECG represents electrical activity
over 1 cycle IMPORTANCE OF DEFIB:
 Single most important factor in determining the survival rate from
PACEMAKERS: cardiac arrest
1. SA node – 60-100 beats
 Dominant pacemaker of the heart at the right TYPES OF DEFIB:
atrium 1. Manual Defibrillators – 5 or 10 to 360j (mono 260j, bi 150j
2. AV Junction (AV node & Bundle of His) 40-60 beats 2. Automated internal Defibrillators
3. Ventricular (Bundle branches & Purkinje Fibers) – 20-40 3. Automated External Defibrillators – 200-360j
beats - Fully automated
- Semi automated
LEADS: 4. Implanted Defibrillators
 Standard Leads – I, II, III
 Augmented Leads – aVL, aVR, aVF ADVANTAGES OF AED:
 Precordial Leads – V1-V6 1. Speed of operation
2. Safer, more effective
Depolarization – excitation phase 3. More efficient monitoring
Repolarization – resting phase
WHEN & WHEN NOT TO USE AED:
ARRYTHMIA INTERPRETATION: 1. Intended to adult pt in cardiac arrest
1. RATE – normal range/tachycardia/bradycardia 2. Not intended to pts <12y/o & <90lbs in wt.
2. RHYTHM – regular/irregular 3. Not intended to trauma pts except electrical shock
3. P WAVES – present or not/inverted/precedes QRS 4. Not intended for children
4. QRS COMPLEXES – normal/widened/narrow/present 5. Do not use in moving ambulances – stop to defibrillate
5. ST SEGMENT – elevated/depressed/normal
6. T WAVES – inverted/elevated PLACEMENT OF ELECTRODES:
7. Q WAVE – lengthened (MI)  Negative electrode – right upper anterior chest wall
  Positive electrode – left lower anterior chest wall (apex)
 If pacemaker is present: STAGES OF HYPOTHERMIA ACCORDING TO ILCOR:
- Negative electrode – right anterior axillary line just 1. MILD HYPOTHERMIA – 36C-34C
above axilla o S/S
- Positive electrode – apex/left lower anterior chest wall 1. Shivering
2. Pain from cold
MONOPHASIC – 360joules 3. Alert
BIPHASIC – 200joules 4. Tachypnea
5. Unable to do complex motor function but can walk &
Factors to cause electrical conduction in AED operation: talk
1. Water
2. Metal 2. MODERATE HYPOTHERMIA – 34C-30C
3. Nitroglycerine patches o S/S
4. Implanted pacemaker 1. Slurred speech
2. Violent shivering
3. Hallucination
BODY TEMPERATURE 4. Loss of motor coordination
5. Irrational behavior
CORE TEMPERATURE: 37C/98.6F 6. Dazed consciousness

EUTHERMIA: WARM BLOODED 3. SEVER HYPOTHERMIA - <30C

o S/S
EXCELLENT ROUTE OF GETTING TEMP.: ORAL 1. Coma
2. Dysrythmia
TEMPERATURE REGULATORS: 3. Cardiac arrest
1. Central thermoregulator ( hypothalamus) 4. Pale skin
 Conserving heat by: 5. Muscle rigidity
1. Peripheral vessels constriction 6. Increase lactic acid
2. Limiting perspiration 7. Absent shivering
3. Increased metabolism 8. Bradycardia
4. Shivering
5. Piloerection (hair erection) STAGES OF FROSTBITE
1. FROSTNIP (1st degree) – victim is unaware unless sees himself in
 Cooling oneself/conserving cold by: the mirror then notice unusual pallor
1. Dilating peripheral vessels - Warmth is signaled by redness & tingling sensation
2. Increase perspiration
3. Increase heart rate 2. SUPERFICIAL FROST (2nd degree) – appears waxy & white,
4. Increase breathing rate skin is stiff but underlying tissue is soft, there’s numbness & when
thawing occurs area turned to mottled blue. There’s edema &
2. Peripheral thermoregulator (skin & mucous membrane) blisters few hours.
- S/S: blanching, loss of feeling, tingling sensation
COMORBID FACTORS TO HYPERTHERMIA:
1. Climate – heat loss by radiation 3. DEEP FROSTBITE (3rd degree) – appears white, mottled
2. Exercise & activity – can loose fluid more than 1L/hr blue/white hard cold. Tissue feels like hard wood. When thawed
3. Age – elderly & newborn there’s soothing pain, burning, throbbing, & joint pains. Gangrene
4. Pre-existing illness/conditions in few days & possible amputation
a. Heart disease - S/S: firm to frozen feeling on palpation, swelling,
b. Dehydration blisters, if thawed area appears flushed with areas of
c. Obesity purple & blanching cyanotic skin
d. Fever
e. Fatigue
f. Diabetes
5. Drugs/medications – beta blockers/diuretics ENVIRONMENTAL EMERGENCIES
CAUSES OF HYPERTHERMIA: DROWNING – death from suffocation due to submersion
1. Temperature-regulating mechanisms are overwhelmed by increase - Survival at least 24hrs from near suffocation
temperature in the environment/excessive exercise in moderate to
extremely high temperature CAUSES:
2. Temperature regulating centers fail (i.e elderly with disease 1. Exhaustion on water
2. Losing control & getting swept into water too deep
MECHANISM OF HEAT LOSS: 3. Losing support (sinking boat)
1. Convention 4. Getting trapped in water
2. Radiation 5. Using drugs/alcohol before getting into water
3. Respiration 6. Suffering trauma
4. Evaporation 7. Suffering hypothermia
5. Conduction 8. Having a diving accident
HYPOTHERMIA – body temperature falls <35C (deep normothermic) PREVENTING DROWNING ACCIDENTS: WARNINGS
1. Children must be under constant supervision if a lake, pool or
PREDISPOSING FACTORS: water size is nearby
1. Cold environment – immersion or non immersion 2. Water sports& alcoholic beverages should not mix
2. Age – old & young 3. Life preserves or life jackets should always be worn when boating
3. Drugs/alcohol/poisons
4. Medical conditions PATHOPHYSILOGY OF DROWNING:
a. Head injury 1. Victim goes under water, water enters the airway, coughing &
b. Shock gasping starts. Victim swallows water
c. Burns 2. Small amount of water enters larynx & causes laryngospasm.
d. Generalized infection Breathing ceases & metabolic acidosis occurs. Dry drowning 10-
e. Injuries to spinal cord 15% gases
f. Diabetes/hypoglycemia 3. Laryngeal muscles becomes hypoxic & relaxes allowing water to
enter the lungs, triggering peripheral airway resistance &
 pulmonary vessels constriction resulting in “stiff lung” where the - Pruritus, subcutaneous emphysema, mottled rashes,
lung ceases to be compliant] scarlatiniform
4. Victim’s hypercarbic/hypoxic drives further stimulate inhalation of - Localized swelling or peau’d’ orange result from
water which mixes with air& chemical residue in the lungs to form lymphatic involvement
froth. Brain damage & death follows.
2. DECOMPRESSION SICKNESS – JOINT
Stages of water rescue: - Musculoskeletal/joint DCS (“bends”)
1. Reach & pull - Deep dull ache in muscles & joints
2. Throw - Movement worsens pain, fatigue
3. Tow - Inflating cuff over the area relieves pain
4. Go
3. DECOMPRESSION SICKNESS – CNS
BAROTRAUMA - 4mins – deadly
- An injury in the body’s “air spaces” caused by compression or - Brain involvement (CVA like Sx, paresthesia,
expansion of gases. “staggers”)
- Spinal cord involvement (paralysis)
BAROTRAUMA OF DESCENT:
1. EXTERNAL EAR SQUEEZE – happens due to occlusion of the
4. DECOMPRESSION SICKNESS – CHOKES
external canal
- Chest pain, cough (pinkish frothy sputum), dyspnea,
pulmonary edema
2. MIDDLE EAR SQUEEZE – pressure does not equalize in middle
ear through Eustachian tube. Common when diving with upper
TREATMENT FOR DECOMPRESSION SICKNESS:
respiratory tract infection. High potential for ear drum rupture
1. CAB’s
2. 100% oxygen as required
3. INTERNAL EAR SQUEEZE – is rare but more serious than
3. Advise hospital needs for hyperbaric facility
external and middle ear squeeze. Typically results from forced
4. Lateral recumbent position if air embolism is suspected
valsalva
5. Transport to recompression chamber
6. Do not give ENTONOUX for analgesia
4. SINUS SQUEEZE – pressure does not equalize in frontal or
NITROGEN NARCOSIS/NARCS
maxillary sinus. Common when diving with URTI
1. Ruptures of the deep
2. Pressurized nitrogen toxic effects on CNS
3. Anaesthetic effect due to lipid solubility of nitrogen
BAROTRAUMA OF ASCENT:
4. Usually on dive 70-100ft
 LUNG TRAUMA(POPS)
- Pulmonary over-pressurization syndrome
S/S
- Breath holding during ascent
1. Euphoria
- Compressed air in lungs expands 2. Confusion
- May occur in shallow depths 3. Disorientation
- Lung tissue ruptures resulting: 4. Slowed motor response
 Pneumothorax/Tesnion Pneumothorax
 Pneumomediastinum TREATMENT: Surfacing
 Subcutaneous Emphysema
 Arterial Air Embolism DIVING INCIDENT ASSESSMENT:
1. When was the last dive?
S/S 2. How many dives that day?
1. Respiratory distress with gradual increasing hoarseness 3. What depth/s?
2. Substernal chest pain a few hours after diving 4. Did diver ascend quickly? Why?
3. Diminished breath sounds 5. Did diver make decompression stops during ascent?
4. Hemoptysis 6. What are the symptoms? Onsent of Sx?
5. Subcutaneous emphysema 7. Diver’s appearance immediately after dive?

Tx
1. Rest INFECTIOUS DISEASE
2. Oxygenation
3. Recompression in serious cases especially where arterial air
SYPHILIS – acute &chronic disease caused by the spiral shaped bacterium
embolism is present
(Treponema Pallidum)
ARTERIAL AIR EMBOLISM:
3 STAGES:
 Rapid onsent of
1. Primary – characterized by painful chancre with indurated borders
1. Altered LOC w/in 10mins
on the penis, vulva or other area with sexual contact
2. Hemiplegia
3. Unequal pupils
2. Secondary – occurs 3-6weeks after the end of the primary stage.
4. Cardiopulmonary failure
Sx: rash(trunks & Flexor surfaces, palms & soles) &
5. Vertigo
Lymphadenopathy
6. Visual disturbances
3. Tertiary – CVS & nervous involvement. Characteristics of this
 Treatment and management:
stage occur years after the initial infection. S/S: acute meningitis,
1. CAB’s
dementia, neuropathy to thoracic aneurysm
2. Transport to decompression chamber
3. 100% oxygen, assist ventilation as needed
TUBERCULOSIS (TB) – transmission of the bacteria Myobacterium by
droplet. Communicable period last as long as infective tubercle bacilli are
DECOMPRESSION SICKNESS
being discharged in the sputum that is until about 24-48 hours after antibiotic
1. Gas bubbles trapped deep in the tissues, particularly
treatment
slow circulated tissues
S/S: night sweats, headache, cough & weighted loss
2. Excessive nitrogen dissolve in blood & tissues
oversaturating
RABIES – caused by an RNA containing RHABDOVIRUS & is transmitted
3. Diver does not surface at correct rate to allow nitrogen
by inoculation with infectious saliva from an animal
to escape from blood & tissues
- Incubation period shortest is 12 days & longest is 700 days
TYPES:
- NEGRIBODIES are the characteristics histologic findings
1. DECOMPRESSION SICKNESS – SKIN
- Cutaneous bends
S/S
 1. EARLY STAGE – fever, malaise, headache, anorecia, sore throat, DRUG – presumed to have some therapeutic effects when given under
cough & pruritis & paresthesia on the bite site appropriate dosage and circumstances
2. LATE STAGE – restlessness, agitation, altered mental status,
painful bulbar & peripheral muscular spasm, opisthotonous, 3 leading cause of Poisoning
hypersensitive to sensory stimuli, & hydrophobia results from 1. Alcohol intoxication
bulbar spasm that occur until swallowing 2. Methamphetamine
3. Izoniazid
TREATMENT:
1. Safety/BSI APPROACH
2. CAB’s C – Maintain adequate circulation
3. Scrubbing and cleansing of wound to remove rabies A – Maintain adequate airway
4. Transport to medical center for HUMAN IMMUNO GLOBULIN B – Provide adequate breathing
& HYUMAN DIPLOID VACCINE D – Manage drug induced CNS depression
E – Manage electrolyte imbalance
MENINGITIS – inflammation of the meninges which is caused by Neiseria
Meningitidis History taking
1. What was ingested?
S/S: fever, severe headache, stiff neck, changes in state of consciousness, 2. When was the poison ingested?
vomiting, blotchy red or bluish rash 3. How much was ingested?
HEPATITIS – is an infection that cause an inflammation if the liver 4. What else had been taken?
5. Did the patient vomited?
4 Forms of Hepatitis: 6. Why was it taken? (Optional)
1. Hepatitis A
2. Hepatitis B 1. INGESTED POISON– process in which poison enters to the mouth
3. Hepatitis C
4. Hepatitis D Liquefaction necrosis – alkalis

HEPATITIS A – is known as infection hepatitis. Spread by oral fecal route. Coagulation necrosis – acid
Virus is excreted in large amount in feces for 2 weeks before and 1 week after
onset of symptoms Signs / symptoms
1. Papillary changes
HEPATITIS B – is known as serum hepatitis. Spread through contact with 2. Salivation
infectious blood or blood products 3. Sweating
- Incubation period is 45-180 days 4. Respiratory distress
- Complete recovery will take 3-4weeks or may persist a 5. Burn or blister on the lips
lifetime 6. Unusual breath odor
7. Vomiting
HIV-AIDS – caused by HIV. AIDS is the set of conditions that results when 8. Diarrhea
the immune system has been attacked by HIV 9. Nausea
10. Altered mental status
INCUBATION PERIOD: 11. Seizure
1. FIRST – from the time of exposure to the time a person’s blood
test positive for AIDS maybe anywhere from few weeks to a few Management
months. Person who had an accidental exposure to AIDS should be 1. Maintain airway
tested within 2-3weeks after the exposure & then again at 6weeks, 2. NPO
3 months, 6months & year after 3. Collect sample of vomit
2. SECOND – time between documented infection, & the contracted 4. Antihistamine or antiemetic
AIDS from contaminated blood transfusion, incubation period is
approximately 8 years for adults & 2 years for children Note: Do not give high flow O2 for watusi, zinc phosphate and paraquat

MODE OF TRANSMISSION: Cyanide - bitter almond

1. Sexual contact Garlic - arsenic, organophosphate
2. Parenterally Acetone - phosphorous, methyl and isopropyl alcohol,
3. Across the placenta aspirin, acetone

S/S Poison Antidote

1. Persistent low grade fever Acetaminophen N – acetylcesteine
2. Night sweats Atropine Physostimine
3. Swollen lymph glands Benzodiazipine Flumazenil
4. Loss of appetite Carbon Monoxide O2
5. Nausea Cyanide Amyl nitrite
6. Persistent diarrhea Sodium nitrite
7. Headache Sodium thiosulfate
8. Sore throat Opiates Naloxone
9. Fatigue Organophosphate Atropine
10. Weighted loss
11. Shortness of breath 2. INHALED POISON – taken in form of gases, vapor or spray
12. Muscle & joint aches
13. Rashes Signs / symptoms of Cholinergic Poisoning
14. Various opportunistic infections D – defecation
U – urination
M – miosis
B – bronchorrhea
POISONING E – emesis
L – lacrimation
POISONING – a substance, if taken insufficient quantity, can cause S – salivation
temporary or permanent damage.
S – salivation
POISON – overdose of drugs, medicaments or biological substance L – lacrimation
U – urination
TOXICITY – various effects when poison enters the body D – defecation
G – gastro-intestinal irritability
 E – emesis ACTIVATED CHARCOAL – absorbs poisonous compound, effective in
aspirin, amephetamin, strychinine, dilantine, theophyline and Phenobarbital

Management: Contraindications:
1. Remove patient from environment 1. Methanol
2. Open airway 2. Caustic acids
3. BLS 3. Akalis
4. 02 by NRM 4. Altered Mental Status

Dosage: 1 gm / kg body weight

3. INJECTED POISON – injected thru the skin into the blood stream. Adult: 25 – 50gms
Child: 12.5 – 25gms
Signs / symptoms
1. Local reaction: Side effects:
a. Sharp burning pain 1. Nausea
b. Itch 2. Vomiting
c. Edema 3. Constipations
4. Abdominal cramping
2. Systemic reaction
i. Mild Note: Will not bind on the following:
a. Diffuse itching 1. Cyanide
b. Urticaria (hives) 2. Iron
c. Flushing of skin 3. Magnesium
4. Lithium
ii. Severe 5. Caustic alkali
a. Laryngeal edema 6. Mineral acid
b. Severe bronchospasm 7. Alcohol
c. Profound hypotension secondary to vasodilation 8. petroleum

Management:
1. Follow protocol PATHOPHYSIOLOGY of ANAPHYLAXIS
2. Maintain open airway
3. Remove jewelry Sting / bite
4. Transport immediately

4. ABSORBED POISON – taken into the body thru unbroken skin Antigen introduced into the body

Management:
1. Move the patient away from the source Antigen – antibody reaction
2. Flood with water
3. Transport
Mast cell release chemical mediator
Watusi Poisoning – yellow phosphorous (Histamine)

Signs / symptoms
1. Direct cardiotoxic effect Chemical mediator exert their efforts on
2. Hypotension END ORGANS
3. Hepatic toxicity
4. Burn
5. Burning pain in the throat (garlic odor) LUNGS
6. Nausea HEART
7. Vomiting BLOOD VESSEL
8. Diarrhea SKIN
9. Abdominal pain HYPOTHERMIA
10. Shock

Management: Core temperature: 37 C or 98.6 F

1. Do not induce vomiting
2. Egg whites Signs / symptoms
i. Adult: 8 – 12 eggs Generalized
ii. Children: 6 – 8 eggs
3. Dermal exposure – PERLA or IVORY 1. Overall decrease in core temperature
4. Transport immediately 2. Inadequate thermogenesis
3. Excessive shivering
4. Flushed skin (early signs)
SYRUP of IPECAC – induces vomiting 5. Pale cold clammy skin (late signs)

Contraindications Mild
1. Unconscious or no gag reflex S – Shivering
2. Seizures T – tachypnea
3. Pregnancy A – Ambulatory / alert
4. Acute Myocardial Infarction P – Pain
5. Infants < 6mos P – Peripheral vasoconstriction
6. Volatile hydrocarbon
7. Iodides Moderate
S – slurred speech
Dosage: H –Hallucinations
Adult: 30cc or 1 – 2tbsp I – irrational behavior
Child: 15cc or 3 – 5tsp L – Loss of fine motor skills
D – Dazed
Note: Must be taken with water.
Severe
 R – Rigid muscles Management:
A – Assumes fetal position 1. Move patient to a cool dry place
B – bradycardia 2. Give H2O
I – increase lactic acid and CO2 3. ORESOL
D – Dilated pupils 2. HEAT EXHAUSTION
S – Skin is pale / shivering stops Signs / symptoms
1. Headache
2. Extreme weakness
PATHOPHYSIOLOGY 3. Dizziness
EXPOSURE TO COLD 4. Syncope
5. Decrease appetite
6. Rapid pulse
Shivering (400x energy is used) vasoconstriction 7. Dilated pupils
8. Diaphoresis
Release in thyroxine release of nor
epinephrine and Management
epinephrine 1. Move patient to a cool dry place
2. Give H2O
Increase metabolism increase RR, PR, BP 3. ORESOL
4. Elevate leg to 8” – 10”
Decreased in blood glucose 5. Assess VS

3. HEAT STROKE
Shivering stops Types
1. Exertional – prolong exposure to hot places
2. Classic – elderly, alcoholic, obese, CVD, phenothiazine users
Rapid cooling
Signs / symptoms
1. Headache
Decreased in O2 demand 2. Dizziness
3. Irritability
4. Decrease LOC
Cardiac irritability 5. Seizure
6. Bounding pulse
7. No sweat
Hypoxia 8. Dilated pupils
9. Decrease blood pressure
10. Hot red skin
Ventricular fibrillation
Management:
1. Move patient to a cool dry place
DEATH 2. Check CAB
3. Monitor cardiac rhythm
Managemnt: 4. Ice packs
1. Keep it frozen
2. Protect from trauma Preventive measures
3. Do not massage 1. Maintain adequate fluid intake
4. If partly thawed rewarm at 38 – 42 C 2. Allow time to acclimatization
5. transport 3. Limit exposure to hot environment

Methods of Rewarming
1. Active External ACUTE ABDOMEN
a. apply hot pacts to groin, armpits, chest, knees
b. cover with blankets NOTE: Can be referred pain to cardiac emergencies
c. increase body temp gradually (not > 1 C / hr)
d. do not immerse Signs / symptoms
1. Pain
2. Active Internal 2. Tenderness
a. Warmed oxygen 3. Anxiety and Fear
b. Cardiopulmonary bypass 4. Decrease LOC
5. Guarding position
3. Passive 6. Rapid shallow breathing
a. Move patient to warm environment 7. Rapid pulse
8. Nausea Vomiting and Diarrhea
Mechanism of Heat Loss 9. Rigid or tender abdomen
1. Conduction 10. Abdominal Distension
2. Convection
3. Respiration Causes:
4. Radiation 1. Appendicitis – rebound tenderness
5. Evaporation 2. Cholecystitis
3. Instestinal Obstruction
4. Hernia BLEEDING
HEAT EMERGENCIES 5. Pancreatitis
6. UlceR
1. HEAT CRAMPS – sudden painful stiffening of the muscles. 7. Esophageal varices
Sign / symptoms 8. Abdominal Aortic Anuerysm
1. Severe cramping on the abdomen or leg
2. Dizziness Management:
3. Periods of fainting 1. BSI / safety
4. Tachycardia 2. CAB
5. Diaphoresis 3. NPO
4. Watch out for shock
 5. Transport comfortably 3. PELVIC INFLAMMATORY DISEASE – caused by bacteria from
vagina (vaginosis)

PATHOPHYSIOLOGY OF REFERRED PAIN

Signs / symptoms
Heart deterioration 1. Profuse discharge from vagina
2. Fever
3. Malaise
Stimulates parasympathetic 4. Lower abdominal pain
5. Difficulty passing urine
6. Irregular vaginal bleeding
Vagus nerve stimulation
4. DYSFUNCTIONAL UTERINE BLEEDING – caused by estrogen
imbalance. Abnormal uterine bleeding
Production of hydrochloric acis
Signs / symptoms
Abdominal pain 1. Vaginal bleeding
a. Longer than normal period
b. Unrelated period
URINARY COLIC – nephrolithiasis – formation of stones in the kidney c. Between periods
d. After menopause
Factors in stone formation e. In young girls
1. Supersaturation of urine 2. Abnormal spotting
2. Nidus
3. Stasis GENERAL MANAGEMENT:
4. PH 1. Check
o LOC
Signs / symptoms o C unstable – rapid physical exam
1. Pain
o A stable – focused physical exam
2. Renal colic
o B
Management 2. Administer O2
3. NPO
4. Anticipate vomiting
1. Increase fluid intake
5. Monitor Vital Sign
2. Complete bathroom privileges
6. Trasport LEFT LATERAL RECUMBENT
3. Analgesic as per protocol
4. Transport
Frees VENA CAVA from compression

GYNAECOLOGICAL EMERGENCIES
OBSTETRICAL EMERGENCIES
1. ECTOPIC PREGNANCY – pregnancy outside the uterus. 50% of cases
have history of salphingitis or PID FALSE TRUE
Irregular Regular, predictable
Signs / symptoms From Lower back to
Abdomen
1. Abdominal pain Contractions Abdomen
2. Abnormal vaginal bleeding Disappears in
Continues
3. Amenorrhea ambulation
4. Breast tenderness Duration
5. Low back pain Frequency constant Increases
6. Nausea intensity
Cervical Dilatation none increases
If abnormal pregnancy ruptures and bleeds
1. Fainting Stages of labor
2. Shoulder pain 1st stage - 1st contraction to full dilatation of the cervix
3. Severe sharp, sudden abdominal pain 2nd stage -full dilatation of the cervix to birth of the neonate
4. Shock 3rd stage -birth of the neonate to the expulsion of the placenta
a. Rapid thread pulse
b. Pale, cold clammy skin COMPLICATION OF PREGNANCY
c. Decrease BP 1. (FIRST TRIMESTER)ABORTION– vaginal bleeding less than 28 weeks
of AOG
Management a. Spontaneous
1. Adequate airway i. Threatened – priority 1
2. Assist in ventilation ii. Inevitable – cervix is open
3. NPO iii. Incomplete
4. Anticipate vomiting iv. Missed
5. IV lines large bore b. Criminal
6. Recumbent position c. Therapeutic
7. Assess vital signs
2. (THIRD TRIMESTER) ANTENATAL BLEEDING - vaginal bleeding
2. RUPTURED OVARIAN CYST more than 28 weeks of AOG
Signs/ symptoms a. Abruptio Placenta – premature separation of placenta
1. Sharp piercing pain b. Placenta previa – placenta covers cervical opening.
2. Fever c. Uterine rupture
3. Nausea 3. PREECLAMPSIA/ECLAMPSIA
4. Vomiting Signs / symptoms
5. Weakness
6. Dizziness 1. swelling of the face, hands and feet
7. Fainting 2. weight gain
8. Internal bleeding 3. hypertension
4. headache
5. sensitive to light
 6. visual blurring 4. Cutting of the cord
7. pain in upper abdomen

4. HYDATIDIFORM MOLE – is an abnormal form of pregnancy, wherein

a non-viable, fertilized egg implants in the uterus, and thereby converts normal Preterm
pregnancy processes into pathological ones. It is characterized by the presence 1. Keep the baby warm
of cyst. 2. Airway – suction mouth then nose
3. O2
5. INCOMPETENT CERVIX – is a medical condition in which a pregnant 4. 100 – 120 bpm - 2 – 3 lpm
woman's cervix begins to dilate (widen) and efface (thin) before her 5. 60 – 100 bpm - ventilate BVM
pregnancy has reached term. 6. 60 below - CPR 3:1
 consider cervical cerclage
High Risk Babies
1. Mother
6. SUPINE HYPOTENSIVE SYNDROME – caused when the mother is in
a. Age over 35
a supine position and the weight of the uterus, infant, placenta, and amniotic
b. Diabetes
fluids compress the inferior vena cava, reducing return of blood to the heart
c. Alcohol
and cardiac output.
d. Drug abuse
e. Smoking
Signs / symptoms
f. History of still birth
1. Pallor
2. Pregnancy
2. Tachycardia (early sign)
a. Antepartum Hemorrhage
3. Bradycardia (very late sign)
b. Pre eclampsia
4. Sweating
c. Multiple pregnancy
5. Nausea
3. During delivery
6. Hypotension
a. Abnormal Presentation
7. Dizziness
b. Preterm or Post term
8. Edema of the lower extremities
c. Prolonged Labor
9. Sings of fetal hypoxia or distress (seen through CTG in hospital)
d. Umbilical Cord Presentation
10. Decreased femoral pulse
e. Meconium Stained Amniotic Fluid
f. Fetal Distress (FHT < 120 / min)
Abstinence Postpartum
1. NSD - 6 weeks
NEONATAL RESUSCITATION
2. CS - 8 weeks
Normal values
RR - 30 – 50
Positioning during transport
PR - 120 – 160
 > 12 weeks AOG - supine
Bp sys - > 60
 < 12 weeks AOG - (L) side lying
Steps to follow during Resuscitation
ABNORMAL DELIVERIES
1. Body temp
1. Breech presentation
2. Airway
2. Face or limb presentation
3. Breathing
3. Prolapsed umbilical cord
4. Cardiac massage
a. Knee chest position
b. 02
NEONATAL SHOCK
c. Wrap cord with moist dressing
Risk Factors
4. Multiple births
1. Low birth weight
a. Clamp cord of 1st baby
2. Maternal sepsis
b. Twin B may come before or after twin A’s placenta
3. Prolapsed cord
5. Premature birth
4. Acute onset of maternal vaginal bleeding
a. > 2.5 kg
Signs / symptoms
b. > 38 weeks AOG
1. Pallor
2. Tachycardia
3. Mottling of skin
NEONATAL CARE 4. Poor capillary refill – sole of the foot
5. Thready pulse
FETAL CIRCULATION a. < 45 mmhg - 1000gms(premature)
Mother’s Circulation b. < 60mmhg - Term
6. Metabolic acidosis
Placenta
NEONATAL SEIZURE – primarily CNS disease or metabolic disorder
Umbilical vein Lower Extremities Types
1. SUBTLE - ocular, facial, oral, lingual or stutortous breathing
Ductus Venosus Hypogastric Arteries 2. TONIC - decerebrate or decorticate
3. MULTIFOCAL CLONIC – one limb first then other parts
Inferior Vena Cava Descending Aorta 4. FOCAL CLONIC – localized
5. MYOCLONIC – single or multiple jerk and flexion of upper and
Right Atrium Pulmonary Artery lower extrmities

Foramen Ovale Right ventricle Causes:

1. Hypoxia – ischemic Encephalopathy
Left atrium Right Atrium 2. Metabolic Disturbance
3. Meningitis or Encephalitis
Left ventricle Superior Vena Cava 4. Developmental Abnormalities
5. Drug Withdrawal
Ascending Aorta Brain / Upper Extremities 6. Maternal Anesthesia
7. Stroke

ROUTINE CARE Management:

Term 1. Safety / BSI
1. Keep the baby warm 2. LOC
2. Airway – suction mouth then nose 3. Keep warm
3. Positioning – head downward to drain
 4. Monitor HR
5. Proper documentation of seizure activity

TYPE I – hyperinsulemia
DIABETIC EMERGENCIES -insulin shock
-DKA  acetone breathe odor  ketone breath  end-products of
NORMAL BLOOD GLUCOSE LEVEL: 70-110mg/dl fats
SIGNS AND SYMPTOMS: polyuria
Polydypsia EVALUATION
Polyphagia 1. TYPE I – have you injected yourself with insulin?
TYPE II – have you taken your tablet?
1. HYPERGLYCEMIA 2. Have you taken your medication?
 May die because of dehydration 3. After eating, have you vomited?
CAUSES 4. Have you increased your activity other than your routine?
1. Diabetic condition is not been diagnosed and/or treated
2. Has not taken insulin
3. Overeaten, flooding the body with a sudden excess of
carbohydrates PEDIATRIC EMERGENCIES
4. Suffers an infection that disrupts glucose/insulin balance
1. CROUP LARYNGOTRACHEOBRONCHITIS)
SIGNS AND SYMPTOMS Signs / symptoms
1. gradual onset of signs and symptoms over a period of days 1. Seal bark
2. patient complains of dry mouth and intense thirst 2. Whooping sound during inhalation
3. abdominal pain and vomiting common 3. Nasal flaring
4. increase restlessness, confusion followed by stupor and coma 4. Tracheal tagging
5. weak, rapid pulse 5. Retractions
6. signs of air hunger-deep sighing respirations, breath smells of a. Intercostals
acetone-sickly sweet b. Suprasternal
7. warm , red, dry skin 6. Cyanosis
8. normal or slightly low BP
9. sunken eyes Management:
10. kussmauls breathing 1. 02 by mask
2. Do not attempt to examine the throat
EMERGENCY CARE 3. Place in a comfortable position
1. glucogel 4. Transport
2. D50W
3. Packet of sugar 2. EPIGLOTITIS
4. Pulse oximeter: 93% - O2 Signs / symptoms
95% - give sugar/ glucogel 1. Cherry red epiglottis
90% - O2  94% - sugar 2. Odynophagia
5. O2 – 15lpm NRM 3. Dysphagia
6. Responsive:orange juice or glucose drink 4. Drooling
7. Transport immediately 5. High fever
8. ALS assistant
Management:
2. HYPOGLYCEMIA 1. O2
 May be delayed for days 2. NPO
CAUSES 3. Do not suction
1. Patient has taken too much insulin 4. Transport in a comfortable position
2. Patient has not eaten enough to provide his normal sugar intake
3. Has over-exercised or overexerted, reducing glucose evel 3. ACUTE ASTHMA ATTACK - characterized by spasm and constriction
4. Vomited a meal of the bronchi, Pulmonary edema and
Hypersecretion of mucus.
SIGNS AND SYMPTOMS
1. Rapid onset of s/sx over a period of minutes Signs / symptoms
2. Copious saliva, drooling
3. Intense hunger 1. Dyspnea
4. Dizziness, headache, sudden fainting, seizures 2. Increase PR
5. Full rapid pulse 3. Shallow RR
6. Normal respiration, no odor 4. Decrease BP
7. Skin cold, pale, clammy profuse perspiration 5. Wheezing, sometimes crakles
8. Normal BP 6. Agitated, anxious and restless
9. Eyes normal
10. Abnormal hostile or aggressive behavior Management
1. O2 by mask
EMERGENCY CARE 2. Aerosolized nebulizer
1. Conscious – administer granular sugar, honey, orange or glucose 3. Semi sitting position
2. Unconscious – glucogel under tongue 4. Transport
3. Recovery position 5. Bronchodilator as per protocol
4. High O2
5. Transport immediately 4. BRONCHIOLITIS – inflammation of bronchioles characterized by low
6. ALS assistant grade fever, runny nose and poor appetite

SIGNS AND SYMPTOMS OF DEHYDRATION Management

1. Decreased fluid – HYPOVOLEMIA 1. O2 NRM 3 – 8 lpm
2. Decreased LOC 2. Monitor cardiac rhythm
3. Weak/ thread pulse
4. Poor skin turgor ILCOR 2010 – CHAIN of SURVIVAL
5. Poor elasticity of the skin 1. Prevention of Cardiopulmonary Arrest
6. Sunken eyeballs 2. Early CPR
7. Long furrud tongue 3. Prompt Access to Emergency Response System
8. Dcreased urine output 4. Rapid Pediatric ALS
 5. Integrated Post Cardiac care 14. Loss of bladder and bowel control

Emergency care:
NEUROLOGIC EMERGENCY
1. Conscious patient:
a. Ensure open airway
TRANSIENT ISCHEMIC ATTACK - Disorientation of a particular b. Keep patient warm
cerebral artery and vertebral basilar artery and last anywhere from a few c. Give high flow oxygen – check 1st SpO2
seconds to 12 hours. d. Monitor v/s
e. Transport in Semi Fowlers
f. NPO
Signs and symptoms:
g. Sit in front of the patient, maintain eye contact, and
1. Hemiparesis or hemiplegia speak slowly and clearly
2. Unilateral numbness
3. Phasia 2. Unconscious
4. Confusion, coma a. Maintain open airway
5. Convulsion b. Give high flow of oxygen and assist ventilation if
6. Sometimes incontinence necessary – check SpO2
7. Numbness of the face
8. Slurred speech
Classification:
9. Dysphagia
10. Posterior head ache 1. TIA
11. Dizziness or vertigo 2. Reversible ischemic neurologic deficit
3. Stroke in evolution/completed stroke

SEIZURE - Injury, infection, or disease to the normal function of the brain -> Pathomechanism:
the electrical activity becomes irregular -> sudden changes in sensation, Thrombosis, embolism, hemorrhage  impaired cerebral blood flow 
behavior, or movement called -> seizures cerebral ischemia

Types: Types of stroke by etiology:

1. Generalized seizures 1. Ischemic stroke
 Tonic-clonic-postictal (grandma)  Thrombosis
 Absence (petitmal)  Embolism

2. Partial seizures 2. Hemorrhagic stroke

 Simple partial seizure (jacksonian)  Intracerebral
 Complex partial seizure (psychomotor)  Subarachnoid

Causes of seizure: Risk factors:

1. Brain tumor 1. Hypertension
2. Congenital brain deficits 2. Smoking
3. Febrile 3. Elevated serum cholesterol
4. Idiopathic 4. Obesity
5. Infection 5. Heart disease
6. Metabolic 6. TIA
7. Toxic 7. Asymptomatic carotid bruit secondary to carotid stenosis
8. Trauma 8. Diabetes
9. Diseases such as epilepsy, CVA, hypoglycemia, eclampsia, 9. Increase blood viscosity
measles, mumps, and other childhood diseases. 10. Age: higher the age the greater the risk
11. Sex: men > women (except after menopausal)
12. Previous stroke
Emergency medical care:
1. Protect, guard airway, and don’t put anything on the mouth
7 D’s of stroke management:
2. Do not restrain, remove objects from his path and guide the pt
away from danger 1. Detection – recognition and activation of EMS
3. Loosen obstructive clothing 2. Dispatch – prioritize of suspected stroke
4. Take vital signs and monitor respirations closely 3. Delivery – transport immediately to stroke center
4. Door – fibrinolytic therapy within 3 hours
5. Data – hospital obtaining CT scan
STROKE/CEREBROVASCULAR ATTACK (CVA) - Sudden onset of
6. Decision – identifying eligible patient for treatment
focal neurological deficit caused by non traumatic brain injury resulting in 7. Drug – treatment with fibrinolytic therapy
occlusion or rupture of the cerebral blood vessel.
Stroke chain of survival:
Causes: 1. Rapid detection of stroke’s early warnings
1. Cerebral thrombosis (ischemic) –blockage in the arteries 2. Rapid prehospital care
2. Cerebral hemorrhage (hemorrhagic)- aneurism or weakened area of 3. Rapid transport and pre-alert of the receiving facility
an artery ruptures 4. Rapid hospital treatment and diagnosis

Signs and symptoms: 3 types of cerebral edema:

1. Confusion and/or dizziness 1. Cytotoxic
2. Loss of function or paralysis of extremities (one side of the body) 2. Vasogenic
3. Impaired speech 3. Interstitial
4. Numbness (one side of the body)
5. Collapse When brain edema is suspected:
6. Facial flaccidness and loss of expression (one side of the body) 1. Modest fluid restriction
7. Head ache 2. Elevate head if the bed ( 20° - 30°)
8. Unequal pupil size 3. Support with oxygen and ventilation
9. Impaired vision 4. Control agitation and pain
10. Rapid, full pulse
11. Difficult respiration, snoring
Causes of altered mental status (AEIOU TIPS)
12. Convulsions
13. Coma A – Alcohol and other drugs
 E – Epilepsy, endocrine and exocrine (liver)
I – Insulin, hypoglycemia, Hyperglycemia
0 – Oxygen intoxication, overdose, opiates
U – Uremia SCENE SIZE UP
T – Trauma and temperature Is the EMT’s initial evaluation of a scene to which he/she has been called?
I – Infection (sepsis or meningitis)
P – Poisons and psychiatric Sequence of scene size up:
S – Shock, strokes, or space occupying lesion 1. Obtain dispatch information
2. Determine scene safety
NOTE: We are not allowed to give thrombolytic drug pre hospital because we 3. Take body substance isolation precautions
can’t tell the difference between ischemic and hemorrhagic stroke. 4. Consider scene characteristics

Pre hospital treatment: Common scenes:

1. Load and go (3 hour window of treatment) 1. Crash scenes
2. Safety, BSI a. Is the vehicle stable?
3. Ensure open airway b. Are power lines involved?
a. (+) gag reflex – do not do anything c. Does jagged metal or broken glass pose threat?
b. ( - ) gag reflex – Left side lying with head slightly d. Is there a fuel break?
raised e. Is there fire?
4. Oxygen (SpO2, EtCO2)
5. V/S (frequently) 2. Other rescue scenes
6. Monitor cardiac monitor (set to beep tone on bradycardia and a. Heights
PVC’s) b. Underground areas
7. Protect paralyze extremities c. Collapses/ cave in
8. Provide comfort and honest reassurance d. Storage tanks
9. Always assume that the patient always and can understand you e. Silos/ bins
even if they cannot communicate ( reach out to the patient ) f. Farm equipment

ISCHEMIC CASCADE 3. Unstable surfaces and slopes

a. Securing the patient
b. Securing a vehcle if one is involved
c. Beware of loose rocks/ stones

4. Protect the patient

a. Discomfort
b. Determination of condition
c. Curiosity of the public
d. Risk of hypothermia / hyperthermia

5. Protect the by standers

Keep them away by:
a. Involved crowd members in crowd control
b. Instruct crowd to rope off a barrier
c. Utilization of resources and involves people in a positive
way (good EMT)

Control the scene

1. Provide light
2. Consider moving furniture or other obstacle
3. Consider moving the patient
4. Maintain an escape route
5. Stay calm
6. Use tract and diplomacy
7. Be flexible
8. Be open minded
9. Be alert
10. Be compassionate towards other

Procedure to follow at the crime scene:

1. Do not allow bystanders to touch or disturb the patient or his
surroundings
2. Be alert, patient at a crime scene may not be a victim but also a
perpetrator
3. Have one colleague keep a constant watch on the bystanders and
the surrounding while you work on the patient
4. Take extreme care not to disturb any evidence that is not directly
on the patient’s body
5. Never touch or move suspected weapon unless it is necessary
6. Wear gloves throughout the treatment
7. Do not cut through a knife or bullet holes on clothing
8. If strangled do not untie, cut a point away from the knot
9. If responsive, do not burden them with questions about the crime
(treatment 1st)
10. Handle; properly patients that will show extreme conditions
11. Determine who is on the crime scene when you arrive
12. Obvious dead, do nothing to disturb nothing
Assessment of the crowd
1. Is the scene chaotic?
2. Is the scene hysterical?
3. Does the crowd seem hostile to your presence?
 Types of force:
Approaching the scene: 1. Direct
-When already completed the initial evaluation and see no 2. Twisting
immediate danger, leave the ambulance to approach the scene. However, to 3. Forced flexion or hyperextension
the possibility that the scene could suddenly become dangerous, be prepared 4. Indirect
to retreat if it does.
Direct downward blow:
4 A’s 1. Clavicle
 Approach 2. Scapula
 Assess
 Analyze Direct lateral blow:
 Action 1. Clavicle
2. Scapula
TRAUMA 3. Shoulder girdle
4. Humerus
Is a physical injury or wound caused by external force of violence? 5. Knee
6. Hip
Common situations that could create trauma injuries: 7. Femur
1. Falls 8. Very forceful
2. Automobile crashes
3. Recreational vehicle crashes Foiled flexion/hyperextension:
4. Contact sports 1. Elbow
5. Recreational sports 2. Wrist
6. Pedestrian collision 3. Fingers
7. Blast injuries 4. Femur
8. Stabbings 5. Knee
9. Shootings 6. Foot
10. Burns 7. Cervical spine

Mechanism of Injury Twisting:

-The factors that cause traumatic injuries that the patients have 1. Hip
experienced. 2. Femur
3. Knee
Common MOI: 4. Tibia/fibula
1. Vehicular collisions 5. Ankle
2. Falls 6. Shoulder girdle
3. Penetrating gunshots 7. Elbow
4. Stabbing 8. Ulna/radius
5. Explosions 9. Wrist

Significant MOI: Indirect blow:

1. Ejection from automobile 1. Pelvis
2. Death or patient with altered mental status in same passenger 2. Hip
compartment 3. Femur
3. Extrication >20 minutes 4. Knee
4. Falls >20 feet 5. Tibia/fibula
5. Roll over 6. Shoulder
6. High speed automobile crash (initial speed of >10mph) 7. Humerus
7. Major automobile deformity 8. Elbow
8. Intrusion into passenger compartment 9. Ulna/ radius

Mechanism of spinal injury: Trauma triage criteria indicating nedd for immediate transport:
1. Hyperextension -Excessive posterior movement of head or neck MOI:
a. Face into windshield in MVC 1. Falls >20 ft (3x the victim’s height)
b. Elderly person falling to the floor 2. Pedestrian/ bicyclist vs auto collision
c. Foot ball tackler a. Struck by a vehicle traveling over 5 mph
d. Dive into shallow water b. Thrown or run over by vehicle
3. Motorcyclist impact >20 mph
2. Hyperflexion - Excessive anterior movement of head onto chest 4. Ejection from the vehicle
a. Rider thrown off from the horse or motorcycle 5. Severe vehicle impact
b. Dive into shallow water a. Speed at impact ?40 mph
b. Intrusion of >20 inches into occupants compartment
3. Compression - Weight of head or pelvis driven into stationary c. Vehicle deformity >20 inches
neck or torso 6. Rollover with signs of serious impact
a. Dive into shallow water 7. Death of another occupant in the vehicle
b. Fall of > 10 – 20 feet into head or legs 8. Extrication time >20 mins
Infants and children:
4. Rotation - Excessive rotation of the torso or head and neck, 1. fall >10 ft (3x the victim’s height)
moving one side of the spinal column against the other 2. bicycle/vehicle collision
a. Rollover MVC 3. any vehicle collision where the infant or child was unrestrained
b. Motorcycle accident
Physical findings:
5. Lateral stress - Directly lateral force on spinal column 1. revised trauma score <11
a. T bone MVA 2. GCS <14
b. Fall 3. SBP <90
4. PR <50 or >120
6. Distraction - Excessive stretching of column and cord 5. Penetrating trauma (except distal extremities)
a. Hanging 6. 2 or more paroxysmal long bone fractures
b. Child inappropriately wearing shoulder belt around neck 7. Flail chest
c. Snowmobile or motorcycle under rope or wire
 8. Pelvic fractures  Clavicle
9. Limb paralysis  Shoulder
10. Burns >15% of BSA  Hip hits door
11. Burns to face or airway  Head or femur driven through acetabulum
 Pelvic fractures
 C spine injury
 Head injury
KINEMATICS
 Lateral compression
1. Physics of trauma  Ruptured diaphragm, spleen rupture, aortic injury
2. Predictions of injuries based on forces motion involved in injury event
4. Rotational collision (38%)
 Off the center impact
Physical principles:  Car rotates around impact
 Kinetic energy (1/2 mass x velocity)  Patient thrown toward impact point
 Energy in motion  Injuries combination of head on and lateral
 Major factor is velocity  Point of greatest damage(worst patient)
 Speed kills
 Newton’s 1st law of motion 5. Roll over collision (6%)
 Body in motion stays in motion unless acted on by outside  Multiple impacts each time vehicle rolls
motion  Injuries unpredictable
 Body at rest stays at rest unless acted by an outside force  Assume presence of severity of injury
 Law of conservation energy  Justification for:
 Energies are cannot be created or destroyed  Transport priority one
 Only changed from 1 form to another  Trauma team activation
 25x the risk when injected
Types of trauma:
1. Penetrating In each collision there are 3 impacts that can occur:
2. Blunt 1. Vehicle
a. Deceleration 2. Occupant
b. Compression 3. Occupant’s organs

Motor vehicle collision: Restrained vs unrestrained

5 major types:  Ejection
1. Head on collision (32%) 1. 27% of MVC deaths
 Vehicle stops and occupants continue to move forward 2. 1 in 13 suffers a spinal injury
3. Probability of death increase six fold
 2 pathways
a. Down and under pathway Restrained with improper positioning
 Body traverse down and under the steering wheel 1. Seatbelts above iliac crest
 Knees impacts dash  Compression injuries to abdominal organs
 Knee dislocation/patella fracture  T12 – L2 compression fractures
 Force fractures femur, hip, posterior rim of
acetabulum(hip socket) 2. Seatbelt too low
 Pneumothorax  Hip dislocation
 Aortic tear from deceleration
 Head thrown forward 3. Seatbelts alone
 C spine injury  Head, c spine, maxillofacial injuries
 Tracheal injury
4. Shoulder straps alone
b. Up and over pathway  Neck injuries
 Body traverse up and over the steering wheel  Decapitation
 Chest/ abdomen hit the steering wheel
 rib fracture Pedestrians
 flail chest 1. Child
 cardiac/pulmonary contusions  Faces incoming vehicle
 aortic tear  Waddel’s triad
 abdominal organ ruptures  Bumper – femur fracture
 diaphragm rupture  Hood – chest injuries
 liver/miscenteric laceration  Ground – head injuries
 head impacts wind shield
 scalp lacerations 2. Adult
 skull fractures  Turns away from incoming vehicle
 cerebral contusions/hemorrhages  O’donohue’s triad
 c spine fracture  Bumper – tibia/fibula fracture, knee ligament tears
2. Rear end collision (9%)  Hood – femur/pelvic fractures, chest injuries
 Car and everything touching it moves forward
 Body moves, head does not causing whiplash Falls
 Vehicle may strike other object causing frontal impact
 Critical factors
 Hyperextension and hyperflexion
1. Height and surface (decrease stopping distance increase risk for
injury)
3. Lateral collision (15%)
 Increase height = increase injury
 Car appears to move from under patient
 Always note and report
 Patient moves toward point of impact
2. Assess body part that impact 1st
 Chest hit door
3. Follow path of energy through the body
 Lateral rib fractures
 Lateral flail chest
 Pulmonary contusion
 Abdominal solid organ rupture Fall onto buttocks
1. Pelvic fracture
 Upper extremity fracture/dislocations 2. Coccygeal (tailbone) fracture
 3. Lumbar compression fracture 4. Loss of bone fragment
5. Swelling
Fall onto feet 6. Bleeding
 Don juan syndrome 7. Bruises
1. Bilateral heel fracture
2. Compression fracture of vertebrae Brain injury - Traumatic insult to the brain
3. Bilateral coles fracture (radial)
Epidural hematoma
Stab wound  Bleeding between duramater and skull
1. Damage confined to wound track  Involves artery (middle meningeal artery)
 4 inch to 9 inch  Rapid bleeding and decrease tissue perfusion
 Herniates brain toward foramen magnum
2. Gender of attacker  Usually at temporal lobe area
 Male (upward force) female (downward force)
Subdural hematoma
3. Chest/abdomen overlap  Bleeding within meninges
 Chest 4th ICS (abdomen)  Above pia mater, beneath dura within arachnoid
 Abdomen above iliac crest (chest)  Slow bleeding
 Signs progress over several days even weeks (slow deterioration of
4. Consider: mentation)
 Length of blade
 Angle of entry
Intracerebral hemorrhage
 Medical emergency
Gunshot wound
 Ruptured BV within the brain
1. Damage cannot be determine by location of entry/exit wounds
a. Missiles tumble
Intracranial Perfusion
b. Secondary missiles from bone impacts
c. Remote damage from  Compensating for pressure
i. Blast effect  Compress BV
ii. Cavitation  Reduction of free CSF
2. Severity cannot be evaluated in the field or ER only at OR
Cushing’s triad (sign of increase ICP)
 Conclusions:  HPN
 Look at the MOI  Irregular respiration
 The increase index of suspicion will lead to:  Bradycardia
 Fewer missed injuries
 Increase patient survival rate Hypervent  decrease CO2  vasoconstriction  cerebral ischemia

Hypovent  increase CO2  vasodilates  cerebral edema

HEAD INJURIES
Inside cranium:
1. Brain CHEST INJURIES
2. CSF
Major cause:
3. Blood
 Blunt trauma
Meninges  Penetrating injury
 Compression injury – caught between the forces
1. Dura mater
2. Arachnoid mater
3. Pia mater Common chest injuries:
1. Simple open pneumothorax
MOI  Most common cause penetrating injury
S/sx:
1. Blunt injury
1. Sudden chest pain
2. MV collision
2. Decrease lung sound
3. Assaults
3. Severe SOB
4. Falls
4. Red bubble from the wound
5. Sucking chest wound
Penetrating head injury 6. Subcutaneous emphysema (from neck and lung injury)
1. Gunshot wound  Neck to groin
2. Stabbing  Treat the underlying condition
3. Explosions
Treatment:
Scalp injury 1. CAB
1. Contusions 2. High flow of 02 (94%-98% SpO2)
2. Lacerations 3. Maintain 35-45 mmHg EtC02
3. Avulsions 4. Occlusive dressing with 3 sides close and leave 1 side open
4. Significant hemorrhage 5. Monitor the lung sounds and listen for any changes
6. Notify ALS or the Hospital ASAP
Cranial injury
1. Linear 2. Tension pneumothorax
2. Depression  Most common Cause blunt trauma (close injury)
3. Open  Paper bag syndrome (air is trapped)
4. Impaled object  Can lead to obstructive shock (tx: needle decompression)
S/Sx:
1. Decrease breath sound
2. DOB
3. SOB
Signs and symptoms 4. Cyanosis
1. Deformity 5. Decrease BP
2. Inability to move jaw 6. Rapid weak pulse
3. Irregular bite
 7. Distended neck vein (decrease venous return) 2. High flow 02
8. Possible tracheal deviation 3. Treat for shock

Treatment: ABDOMINAL TRAUMA

1. Maintain open airway
2. High flow of 02
3. CPR Occlusive dressing
4. Treatment for shock 1. Sterile
5. Notify the receiving facility of what you suspect for them to be 2. Plastic on one side and gauze on the other side
prepared 3. For evisceration to maintain moistness
4. To avoid necrosis of the organ exposed to the air (put normal saline
3. Massive hemothorax solution)
 Pleural space filled with blood
 1.5 L of blood on both lungs (capacity) 3 categories of patient move:
 Can lead to obstructive and hypovolemic shock 1. Emergency move
S/Sx: (depending on blood loss)  Used when there is immediate threat to the patient and the
1. Rapid shallow breathing EMT
2. Rapid Heart rate 2. Urgent move
3. Decrease BP  Used when a patient is suffering an immediate threat to life,
4. ( - ) breath sounds and must be moved quickly
5. Flat neck vein 3. Non urgent move
6. Weak thready pulse  Used when there is no immediate threat to life, and the
7. Frothy or bloody sputum patient can be moved in a normal manner

Treatment Hallow organs – moves freely and slippery, can absorb impact due to trauma
1. Secure airway
but can rupture (release toxins)
2. High flow 02, assist vent if necessary
3. Rapid transport (if possible)
4. Notify hospital or ALS ASAP Solid organs – has major blood vessel, if ruptured it can lead to hypovolemic
shock (ex. Kidney 25 % of CO)

4. Flail Chest (true emergency) NOTE: Use tape measure in cm to monitor abdominal distension
 2 or more ribs in 2 or more places Closed abdominal trauma
 Paradoxical movement
 Blunt trauma
 Most common – sternum
 Patient tends to under breath due to pain
S/Sx
 Can lacerate blood vessels and puncture lung
1. Large or intense contusion on the abdomen
S/Sx:
2. Coffee ground vomitus
1. SOB
3. Rigid and tender abdomen (abdominal guarding)
2. Paradoxical movement
4. Distended abdomen
3. Bruising and swelling
5. Lies drawn up in an effort to reduce the tension on abdominal
4. Signs of shock
muscles
5. Crepitus (sound of bone grinding)
6. Pain that starts mild then to intolerable pain
7. Indications of developing shock
Treatment:
1. Apply bulky dressing or small pillow position inward – to
immobilizethe injured part and to move together with the chest Open abdominal trauma
2. Have the patient lie on the back  Evisceration
3. CAB, high flow of 02  Protruding of abdominal organ through the wound opening
4. Treatment for shock
5. Monitor V/S Emergency care tips for abdominal trauma
1. Stay alert for vomiting and keep airway open
5. Cardiac tamponade 2. Place the patient on his back, legs flexed at the knees to reduce
 Most common cause – penetrating injury/ruptured AMI pain by relaxing the abdominal muscle
 Blood leaks to pericardial sac 3. Administer high concentration of 02 (Sp02)
 Cardiogenic and obstructive shock 4. Monitor V/S
S/Sx: 5. Immediate transport ASAP
1. Distended neck vein 6. Do not touch or try to replace any evisceration or exposed
2. Increase HR organs (cover with occlusive dressing moistened with PNSS)
3. Increase RR 7. For impaled object, leave it to stabilize with bulky dressing and
4. Trachea midline leave the patient’s legs in the position which you found them to
5. lung sound normal avoid muscular movement that may move the impaled object

Treatment REPRODUCTIVE SYSTEM

1. open airway
2. high flow 02 Muscle damage  myoglobin  destroy nephrons  renal failure
3. control bleeding
4. notify hospital and ALS
Blood on the penis  possible ruptured urethra  don’t let patient urinate
5. rapid transport (no field treatment)

6. Transection of the great vessels Newly injured  cold compress  vasoconstriction

 Trauma (MVA) – heart can be ripped from aortic arch
 Chance of survival is very thin Massive vaginal bleeding  possible uterine rupture  shock position
S/Sx (CABD)
1. Burning and tearing sensation in front and back
2. Decrease BP
3. Increase RR
4. Rapid loss of consciousness EXTREMITY INJURIES
5. Profound and uncorrectable shock
Types of fracture
Treatment 1. Greenstick
1. Rapid transport (surgery) 2. Transverse
 3. Spiral 1. keep your backed in locked-in position
4. Comminuted 2. avoid twisting while reaching
5. Depressed 3. avoid reaching more than 15-20 inches in front of your body
6. Compressed oblique
4. avoid prolonged reaching when strenuous effort is required
7. Avulsion
8. Open
9. Closed WHEN PUSHING AND PULLING
10. Dislocation 1. push rather than pull, whenever is possible
11. Sprain 2. keep your back locked in
12. Strain 3. keep the line of pull through the center of your body by bending
knees
S/Sx of fracture 4. keep the weight close to your body
1. Deformity 5. if the weight is below waist level, push or pull from kneeling
2. Swelling
position
3. Tenderness discoloration
4. Shortening 6. avoid pushing or pulling overhead
5. Bleeding 7. keep your elbows bent with arms close to your side
6. Loss of movement
TYPES OF CONTRACTION
1. ECCENTRIC – lengthening
6 P’s in compartment syndrome 2. CONCENTRIC – shortening
 Pain 3. ISOMETRIC – same
 Pallor
 Paresthesia EMERGENCY MOVES – there is a danger to the rescuer and the patient
 Paresis
1. The scene is hazardous
 pulselessness
 puffiness 2. Care of life threatening condition requires repositioning
3. Must reach other patient
General rules in splinting
1. check distal pulse, motor, and sensory before and after splinting KINDS OF EMERGENCY MOVES
(PMS) 1. ONE RESCUER DRAG
2. open wound should be covered with sterile dressing before a. Clothes drag
applying splint b. Incline drag
3. use a splint that would immobilize one joint above and below the c. Shoulder drag
injury
d. Foot drag
4. do not attempt to push bone back under the skin
5. if extremity is severely injured, or angulated and ( - ) pulse, you e. Fireman’s drag
should apply gentle traction in attempt to straighten it f. Blanket drag

Importance of splinting 2. ONE RESCUER MOVES

1. to prevent close fracture from becoming operated a. One rescuer assist/ human crutch method
2. to minimize damage to nerves, muscles and blood vessels b. Cradle carry
3. to prevent further blood loss c. Pack strap carry
4. to lessen the pain d. Fireman’s carry
e. Piggy back carry
Management of impaled object
1. do not try to remove impaled object
3. TWO RESCUER MOVES
2. control hemorrhage by applying direct compression but do not
apply pressure on the impaled object a. Two rescuer assist/ double crutch move
3. do not try to shorten an impaled object unless it is cumbersome
4. stabilize the object in place with a bulky dressing and splint URGENT MOVE – if there is a danger for the patient

Preservation of an amputated part NON-URGENT MOVE – there is no danger; can do secondary survey
1. rinse the amputated part free from debris (PNSS)
2. wrap the part loosely in sterile gauze (moistened) PATIENT CARRYING DEVICES
3. seal the amputated part inside a plastic bag and place it in a cool 1. Wheeled stretcher (trolleycot)
container
2. Portable stretcher
4. never warm, place in water, place directly on ice or dry ice to cool
amputated part 3. Carry chair/ stair chair
4. Spine boards
LIFTING AND MOVING 5. Scoop (orthopedic) stretcher
6. Basket stretcher
7. Flexible stretcher
BODY MECHANICS – is the proper use of your body to facilitate lifting and
8. Vacuum mattress
moving
9. Moving patient onto carrying device
10. Patients with suspected spine injury
PRINCIPLES OF BODY MECHANICS
11. Patient with no suspected spine injury
1. keep the weight of the object as close to the body as possible
a. Extremity lift (top and Tail)
2. to move a heavy object use the leg, hip, and gluteal muscle plus
b. Direct ground lift
contracted abdominal muscle
c. Draw sheet method
3. STACK
d. Direct carry
4. Reduce the height or distance through which the object must be
moved
CRITICAL SITUATIONS TO MOVE PATIENT PRIOR TO
ASSESSMENT AND CARE
METHODS TO PREVENT INJURY
1. Fire or threats of fire at the accident scene
1. power lift
2. Explosive and other hazardous materials involved
2. power grip
3. You are unable to protect the accident scene from oncoming traffic,
downed electrical wires, toxic, fumes or other hazards
WHEN REACHING
 4. You are unable to reach patient who needs lifesaving care without 1. By agent and source
moving one or more of the victims  Chemicals
5. You are unable to properly treat the patient without moving him  Electricity
 Thermal
 Radiation
POSTURE AND FITNESS 2. By depth
1. EXCESSIVE LORDOSIS (SWAYBACK)– abnormal anterior a. Superficial (1st degree)
convexity of the spine  involves epidermis and pain at the site ( 3-6 days
2. EXCESSIVE KYPHOSIS (SLOUCH) – abnormal curvature of healing)
the spine with convexity backward b. Partial thickness ( 2nd degree)
 Involves epidermis and dermis with deep intense pain,
noticeable reddening, blisters and mottled appearance
BODY ALIGNMENT
(7-21 days healing)
1. Center of gravity c. Full thickness (third degree)
2. Line of gravity  Involves all the layers of the skin, patient may feel
severe pain or may not due to damaged nerves,
(requires skin grafting)
INDICATION TO LEAVE THE HELMET IN PLACE d. By severity – consider
1. Good fit, little movement  Agent or source
 Body regions burned
2. No current or expected airway problems
 Circumference burn
3. Removal would be the cause of further injury  Depth of the burn
4. Proper immobilization  Extent of the burn (BSA estimation)
5. No airway or breathing concerns  Rule of nines
 Rule of palm
INDICATION FOR REMOVING THE HELMET 3. Age of the patient (<5 or >55)
1. inability to assess or treat airway and breathing problems 4. Other illnesses and injuries
 Existing respiratory illness
2. improper fit/ movement within helmet
 Patients with heart disease
3. inability to immobilize spine
4. cardiac arrest Infants and children – greater fluid and heat loss, higher the risk of shock,
airway problems and hypothermia
STEPS IN REMOVING THE HELMET
1. stabilize head (EMT – 1) Types of burns
2. fingers should be on patients mandible 1. Dry burn
2. Scald burn (steam, hot liquids)
3. loose strap (EMT – 2)
3. Electrical burn
4. transfer of stabilization to EMT – 2 4. Freeze burn
5. carefully remove the helmet 5. Chemical burn
6. prevent head from falling one helmet is removed 6. Radiation burn
7. begin routine stabilization and immobilization
Classification of burn severity: adults
ADVANTAGE OF VACMAT 1. Minor burns
 Full thickness burn of <2%, excluding face, hands, feet,
1. IT IS COMFORTABLE, LESS PRESSURE ON THE BODY
genitalia or respiratory tract
PARTS IN CONTACT WITH THE MATTRESS  Partial thickness burns or less than 15%
2. IT IS ADAPTED TO ALL TRAUMA, SPECIALLY SPINE  Superficial burns of 50% or less
AND FEMORAL TRAUMA 2. Moderate burns
3. THEVICTIM IS SECURED AS COMPARED TO  Full thickness burns of 2% - 10%, excluding face, hands,
BACKBOARDS (LESS OR NO MOVEMENT) feet, genital or respiratory tract
4. PROVIDES THERMAL INSULATION; DECREASED THE  Partial thickness burns of 15% - 30%
 Superficial burns that involve more than 15%
POTENTIAL FOR HYPOTHERMIA
3. Critical burns
5. FOLLOWS THE CONTOUR OF THE BODY  All burns complicated by injuries of the respiratory tract,
other soft tissue injuries and injuries to the bones
BURN EMERGENCIES  Partial or thickness burns involving the face, hands, feet,
Burn genitalia or respiratory tract
 Is when the body, or a body part, receives more energy that it can  Full thickness burns of >10%
absorb without injury  Partial thickness burns of >30%
 Among the most serious and painful of all injuries  Burns complicated by musculoskeletal injuries
 Circumferential burns
Function of the skin 4. Moderate burns should be considered critical in person <5 y/o
1. Protection or >55 y/o
2. Water balance
3. Temperature regulation Classification of burn severity: children >5 y/o
4. Excretion 1. Minor burns
5. Shock absorption  Partial thickness burns of <10% BSA
2. Moderate burns
Layers of the skin  Partial thickness burns of 10% - 20% BSA
 Epidermis 3. Critical burns
 Dermis  Full thickness burns or partial thickness burns of more than
 Subcutaneous layer 20% BSA

Care for thermal burns

1. Stop the burning process
Structures involve below the skin 2. Flame – wet down, smoother, then remove clothing
1. Muscles 3. Semi-solid (grease, tar wax) – cool with water. Do not remove
2. Bones substance.
3. Nerves 4. Ensure an open airway (assess breathing)
4. Blood vessels 5. Look for signs of airway injury: soot deposits, burnt nasal hair,
facial burns
Evaluation and classification of burns 6. Complete the initial assessment
 7. Treat for shock, provide high concentration of 02. Treat serious 2. Links between mobile unit
injuries. 3. Links between hospitals
8. Evaluate burns by depth, extent (rule of 9/rule of palm), and
severity Components to a radio communications
9. Do not clear debris. Remove clothing and jewelry 1. Base station – 2 way radios and are fixed
10. Wrap with dry sterile dressing 2. Mobile radios – affixed in a vehicle
11. Burns on hands or feet – remove rings and jewelries that may 3. Transport radios – handheld
constrict with swelling. Separate fingers or toes with sterile gauze 4. Reporters
pads. 5. Cellular phones – airwaves
12. Burns to the eyes – do not open eyelids if burned. Be certain burn 6. Other radio devices
is thermal, not chemical. Apply sterile gauze pads to both eyes to
prevent sympathetic movement. If burn is chemical, flush eyes for Radio medical report
20 mins en route to the hospital 12 parts of a radio medical report
1. Units identification and level provider
Specific chemical burns – when possible, find out the exact chemical or 2. ETA (exact time of arrival)
mixture that was involved in the accident. 3. Age and sex
 Mixture or strong acids or unidentified substances 4. Chief complaint
 Mixed acids, combined action can be severe and immediate. 5. Brief, pertinent Hx of the present illness
Pain produced from initial burn may mask pain caused by 6. Major past illness
renewed burning. 7. Mental status
 Strong acids (hydrochloric acid, sulfuric acid) continue 8. Baseline V/S
washing even after patients claims he is no longer in pain 9. Pertinent finding of the PE
 Dry lime 10. Emergency medical care given
 do not wash with water so as not to create a corrosive liquid. 11. Response to emergency medical care
 Brush dry lime from patient’s skin 12. Contact medical direction if you have questions
 Sulfuric acid
 Heat is produced when water is added to concentrated Verbal report
sulfuric acid, but it still preferable to wash rather than to Summary of info given over the radio
leave the contaminant on the skin. 1. CC
 Hydrofluoric acid 2. Hx that was not given previously
 Burns from this product may be delayed, treat even though 3. Additional Tx given en route
burns are not in evidence. 4. Additional V/S taken en route
 Inhaled vapors
 Provide high concentration of 02 and transport ASAP 3 C’s to establish effective face to face communications
 Bases (alkali)  Competence
 Liquefaction necrosis  Confidence
 Compassion
Management
1. Remove chemical The successful EMT communicator is able to
2. Wash immediately (medial to lateral) 1. Use common sense
 Liquid – wash with copious amount of water 2. Listen carefully
 Dry – brush before flushing (20-30 mins flushing to remove 3. Follow instruction and protocols
chemical) 4. Communicate so that he is understood
3. Remove clothes 5. Use all communication equipment available

Communication System in the EMS Ten golden rule in communicating with the patient
1. Make and keep eye contact
EMS communication system 2. Use the patient’s proper name
 Is a system that coordinates the many interdependent agencies and 3. Be honest
facilities involved in emergency response and care. 4. Use the language the patient can understand
5. Confidentiality
Basic function of EMS communication system 6. Be aware of your body language
1. Detecting and reporting accidents 7. Speak slowly, clearly and distinctly
2. Assigning personnel to respond 8. If patient hearing is impaired, speak clearly, and face the patient so
3. Maintaining contact between personnel that he/she can read your lips
4. Alerting other personnel as needed 9. Allow time for the patient to answer
5. Relaying patient information and receiving information for 10. Act and speak calm, confident manner while caring
treatment
6. Determining which hospital to transport Emergency medical dispatcher
7. Informing emergency department personnel about numbers, type of  A person in the EMS responsible for assigning of emergency
accident, and severity of injury medical resources to a medical emergency

Provision of the EMS communication system Role portrayed by EMD

1. Notification 1. Interrogate the caller and assign priority to the call
 Where and how the incident took place 2. Provide pre arrival medical instruction to callers and information to
2. Dispatch the crews
 A means by which emergency resources are directed to the 3. Dispatch and coordinate EMS resources
scene 4. Coordinate with other public safety agencies
3. Communications between dispatcher and emergency vehicle
4. Communication between rescue personnel and medical control

3 types of EMS communications Phonetics

1. Radio communication A. Alpha
2. Verbal report at the hospital B. Bravo
3. Interpersonal communication C. Charlie
D. Delta
Radio communication E. Echo
 one of the key contributors to improvement in the EMS over the F. Foxtrot
years G. Golf
3 linkages developed H. Hotel
1. Links between dispatchers I. India
 J. Juliet
K. Kilo Types of error
L. Lima 1. Omission – written but not done
M. Mama 2. Commission – actions that are wrong and improper
N. November
O. Oscar
P. Papa BEHAVIORAL EMERGENCIES
Q. Quebec Psychiatric emergency
R. Romeo  Patient’s behavior is disturbing to himself, his family, or his
S. Sierra community.
T. Tango
U. Utah Behavioral changes
V. Victor  Never assume patient has psychiatric illness until all possible
W. Whisky causes are ruled out
X. X-ray
Y. Yankee Causes
Z. Zulu 1. Low blood sugar
2. Hypoxia
3. Inadequate cerebral blood flow
DOCUMENTATION 4. Head trauma
Pre hospital care report 5. Drugs, alcohol
 A document in the EMS that an EMT produce during contact with 6. Excessive heat, cold
the patient 7. CNS infection

Functions Psychiatric problems

1. Serves as a record of patient care 1. Anxiety
2. Serves as a legal document 2. Panic attack
3. Provide information for administrative functions 3. Phobias
4. Aids education and research 4. Depression
5. Allows continuity of care 5. Bipolar disorder
6. Paranoia
Elements: 7. Schizophrenia
1. Minimum data set (patient information) 8. Violence
 CC a. Suicide
 LOC  Women attempt more often
 SBP (>3 y/o)  Men succeed more often
 Skin perfusion (<6 y/o)  50% who succeed attempted previously
 Skin color and temp  75% gave clear warning of intent
 PR  Take all suicidal acts seriously!!!
 RR and effort  Risk factors
2. Administrative information  Men > 40 y/o
 Time the incident was reported  Single, widowed, divorced
 Time the unit was notified  Drug, alcohol abuse Hx
 Time of arrival at the patient’s side  Severe depression (loss of loved one)
 Time the unit left the scene  Previous attempts, gestures
 Time the unit arrive at its destination  Highly lethal plans
 Time of transfer of care b. Violence to others
 Warning signs
3. Patient data  Nervous pacing
 legal name, age, sex, and birth date  Shouting
 home address  Threatening
 location  Cursing
 any care before the EMT’s arrival  Throw objects
 Clenched teeth and/or fist
Legal concerns
1. confidentiality Dealing with behavioral emergencies
2. Refusal to Tx 1. Techniques
3. Falsification a. Respond honestly
b. Never threaten, challenge, belittle, argue
Special situations: triage tags are used c. Always tell the truth
1. MCI d. Do not play along with hallucinations
2. MVC e. Techniques
3. Plane crash f. Involve trusted family, friends
g. Be prepared to spend time
Special situation reports h. Never leave patient alone
1. Exposure to infection dse i. Avoid using restraints if possible
2. Injury to self or to another EMT j. Do not force patient to make decisions
3. Hazardous or unsafe scene k. Techniques
4. Referrals to social services agencies l. Encourage patient to perform simple, non competitive tasks
5. Mandatory report for child abuse, battered women, and elderly m. Disperse crowds that have gathered
abuse
Broad categories of documentation 2. Management
1. Taped recorded radio transmission a. Your safety comes first
2. Written reports b. Trauma, medical problems have priority
c. Calm the patient; never leave him alone
d. Use restraints as needed to protect yourself, the patient and others
e. Transport to facility with appropriate resources
Elements of good documentation
1. It has to be accurate 3. Restraining a patient
2. It has to be complete a. You may restrain patient in there is danger to:
3. It has to be legible and audible  You
4. It has to be free of extraneous or non professional information  Himself
  Other people
b. Have sufficient manpower MEDICAL EMERGENCIES
c. Have a plan; know who will do it 1. CARDIOVASCULAR
d. Use only as much as force as needed a. Acute MI
e. When the time comes, act quickly; take the patient by surprise b. Congestive Heart Failure
f. At least 4 rescuers; one for each extremity
g. Use humane restraints (soft leather, cloth) on limbs 2. RESPIRATORY
h. Secure patient to stretcher with straps at chest, waist and thighs a. Pulmonary edema
i. If patient splits, cover face with surgical mask b. Pulmonary embolism
j. Once restraints are applied, never remove them c. Pneumonia
d. COPD

GERIATRIC EMERGENCIES TRAUMA IN ELDERLY

1. Falls
2. MVA/RTA
GERONTOLOGY – scientific studies of the effects of aging and age related
diseases on human TYPES OF TRAUMA
1. Head injury
GERIATRICS – study and treatment of diseases of the aged 2. Cervical injury
a. Osteoporosis
EFFECTS OF AGING/ ATTRIBUTES OF THE ELDERLY PATIENTS b. Arthritic changes
1. Many physiologic functions are diminished c. Decreased pain sensation may mask pain of fracture
2. Typical signs and symptoms of disease maybe absent
3. Physical illness often present as mental disorder DEMENTIA
4. Multiple problems coexist in the same patient  Chronic, slowly progressive development
5. Adverse reactions to drugs occurs very commonly  Irreversible disorder
a. Change in drug metabolism – hepatic function  Greatly impairs memory
b. Change in drug elimination – kidney/renal function
 Global cognitive deficit
c. Body tissue changes
 Most common cause of alzheimer’s disease
d. Change in response of the CNS
 Does not need immediate treatment
6. Psychosocial effects have a dramatically increased in health
a. Depression
DELIRIUM
b. Retirement
 Rapid in onset, fluctuating course
c. Bereavement
 May be reversed especially when treated
d. Loss of love one
 Greatly impairs attention
 Focal
GENERALIZED CHANNGES
 Systemic disease
1. Decreased total body water
 Need immediate treatment
2. Decreased total body mass
3. Progressive development of tissue fibrosis
4. Progressive loss of the systematic ability to adjust
DEATH AND MANAGEMENT IN THE FIELD OF EMS
PHYSICAL CHANGES
1. Height – because of compression DEATH – termination of life complete cessation of all vital organ without
2. Weight – male: increased in weight (>45 years old); female: resuscitation
increased in weight (>50 years old)
3. Skin TYPES OF DEATH
1. BRAIN DEATH – deep irreversible coma
COMPLICATING ASSESSMENT 2. CARDIOPULMUNARY DEATH – when there is a continuous and
1. Variability persistent cessation of heart action and respiration and is pronounced by the
2. Response to illness physician to family members.
3. Presence of multiple pathologies
4. Altered presentation WITHHOLDING RESUSCITATIVE EFFORTS
5. Communication problems 1. Determining the death in the field without initiating resuscitative
6. Poly pharmacy efforts should be considered in the ff conditions:
a. Patient qualifies as a DNR patient
HISTORY TAKING b. Decapitation
1. Probe for significant complaint c. Separation of torso
a. Chief complaint may be trivial, non specific d. Rigor mortis – post mortem stiffening of the involuntary muscles of
b. Patient may not volunteer information the body and develops at a variable period after death
e. Decomposition
2. Dealing with communication difficulties f. Dependent lividity
a. Talk to patient first g. Pulseless, apneic drowning patient with confirmed underwater for an
b. Talk to patient alone hour or more
c. Formal, respectful approach h. Pulseless, apneic patient in a MCI r multiple patient scene where the
d. Position yourself near middle of visual field resources of the system are required for stabilization of living patients
e. Do not assume deafness or shout i. Penetrating head wound injuries with no vital signs
f. Speak slowly, enunciate clearly
2. Traumatic cardiac arrest – must be declared dead at the scene if there is
3. Obtain thorough medication history evidence of major trauma and there’s no signs of life
a. More than onedoctor/pharmacy
b. Multiple medication 3. Medical cardiac arrest
c. Old vs. urrent medcation a. Begin CPR
d. Shared medicine b. Apply cardiac monitor – if shockable rhythm
e. OTC
EMT’s CONCERN
PHYSICAL EXAM 1. Assist in minimizing the effect of livor mortis: head and neck must be
1. In warm area elevated and hands placed on top of the body
2. May fatigue easily 2. Assist in placing a rolled towel to prop up a flaccid jaw is necessary
3. May have difficulty with position to avoid the possibility of leaving the family to view their loved
4. Consider modesty one with a grotesque fixed and gaping jaw
5. Decreased pain sensation requires thorough exam
6. Misleading findings STRESS MANAGEMENT IN EMS
HIGH STRESS SITUATIONS
1. Serious injury or death of an emergency team member in line of
duty
2. Suicide of an emergency team member
3. Injury or death of a family member and friend
4. Death of a patient under especially tragic or emotional
circumstances or after a prolonged intense rescue procedures
5. Sudden death of an infant or child
6. injuries to children caused by child abuse
7. injuries or death to civilians that are caused by EMS personnel
8. event that threatens your life
9. event that has distressing sights, sounds or smells
10. event that attracts unusual media attention
11. multiple casualty incident

EMOTIONAL STAGES
1. denial
2. anger
3. bargaining
4. depression
5. acceptance

GUIDELINES TO PREVENT DISTRESS

1. take care of your health
2. give yourself “me” time everyday
3. learn how to relax
4. do not make unreasonable demands to others
5. do not make unreasonable demands to yourself
6. stay in touch with your own feelings
7. learn techniques for shedding stress while on duty
8. debrief after tough calls

CISD = process to release stress ideally held within 24 to 72 hours of a critical

incident

SEVEN PHASE OF CISD

1. Introduction
2. Facts phase
3. Reaction phase
4. Symptom description
5. Teaching phase
6. Re-entery
7. Follow up

DEFUSING – CISD held within 1-4 hours after critical incident

STRESSORS
1. Vomit
2. Unfairness
3. Absence thrown at you, the rescuers, by them, the rescued
4. Interminable waiting
5. Death and dying
6. Administrative insensitivities
7. Long hours and inappropriate pay
8. Demand on you by the ambulance corps

SIGNS AND SYMPTMS OF PSYCHOLOGICAL EMERGENCIES

1. Fear
2. Anxiety
3. Confusion
4. Behavioral deviance
5. Anger
6. Mania
7. Depression
8. Withdrawal
9. Loss of contact with reality