What organizations first developed EMS training programs?

"Off line" Medical Direction consists of standing medical orders and protocols.  These orders are used in "routine" medical care for anticipated medical emergencies/situations. 

"On-line" is when you need to contact medical control for a situation that is outside of standard protocols and SMO's.

• Only move a pt. you can handle safely; get additional help if needed
• Move forward instead of backward if possible
• Take short steps
• bend at the hips and knees NEVER THE WAIST
• Lift with your legs
• Keep the load close (18" or less) to your body
• Communitcate

• Alarm reaction
• fight or flight
• autonomic nervous system
• coordinated by hypothalamus
• BP up, HR up, Pupils dialate, Bronchus dialate

• Resistance
• You get used to it and nolonger have alarm react.

• Exhaustion
• Coping fails, person may become ill or psycological breakdown

Describe "Diffusing" and "Debriefing."

Diffusing is done immediately (same shift, before sleeping) and is designed to let people involved in the incident "blow off steam" and to assure them that their feelings are normal.

Debriefing is done normally within 72 hours and is a chance for people both involved and uninvolved to discuss their feelings and how the event affected them and to provide contact info for agencies that can provide counseling if necessary.

List the 5 stages of grief in order.

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

What is and is not a "teachable moment?"

A teachable moment is "The time after an injury has occurred when the patient and observers remain acutely aware of what has happened and may be more receptive to being taught ways that the event or illness could have been prevented."

Not days or weeks later, not DURING an emergency.

1) Administrative Law

             Regs developed by a government agency, to provide details about the function and process of a law.

2) Civil Law

          Deals with "private" complaints brought by one person (plaintiff) against another person (defendant) aka tort law.

3) Legislative Law

       Laws made by legislative branches of government. (Congress)

4) Common law

         Societal acceptance of customs or norms over time, aka case law, aka judge made law

5) Criminal law

         When a federal, state or loval government prosecutes people for violating a law

The range of duties and skills that paramedics are ALLOWED and EXPECTED to perform when necessary.

1. Child Abuse
2. Elder Abuse

1. Duty to Act - required to help
2. Breach of Duty- did not maintain "standard of care"
3. Damage or harm to Pt occured
4. Proximate cause - my actions caused the damage/harm

1. Malfeasance - performing wrongful or unlawful act
2. Misfeasance - performing a legal act in a harmful manner
3. Nonfeasance - failure to perform a required act or duty

What is the relationship between a Medical director and a paramedic?

What are the types of consent?

1. Informed Consent/Expressed Consent - based on full disclosure of risks, pt knows, understands and agrees to treatment. Expressed is verbal or written aggreance. (Expressed also counts if patient allows care to be provided after understanding, even without speaking or signing.)
2. Implied Consent - based on assumption that a reasonable person in same situation would consent. (this is what you get in the case of an unconsious pt.)
3. Involuntary Consent - Consent is granted by authority of law. Obtained for pts held involuntarily for mental health evaluation and pts who are under arrest or in custody.
4. Special Consent situations - Emancipated Minors (under 18 but declared an adult by a judge, a pregnant female, living away from home and financially self supporting.)
   

What are some types of crimes paramedics can be charged with?

1. Abandonment - terminating medical care without legal excuse or turning pt care over to people with equal or higher medical training.
2. False Imprisonment - Intentional and unjustifiable detention of a person.
3. Assult - Creating apprehension; also unauthorized handling and treatment of a patient.
4. Battery - Physical contact with a person without consent and without legal justification.

DO NOT RESUSCITATE

• Valid Signed Original DNR order present
• Obvious Death (decapitation, rigormortis etc)
• Unsafe scene

RESUSCITATE

• all other situations
• In presence of DNR but family insists on resuscitative efforts

"What is in the patient's best interest?"

• Apply the Impartiality Test - "Would you accept the action if you were in the patients place?"
• Apply the Universibility Test - "Would you feel comfortable having this action performed in all relavantly similar circumstances?"
• Apply the Interpersonal Justifiability Test - "Are you able to provide good reasons to justify and defend your actions to others?"

Seek the opinion of others if time allows, but do not allow others opinions alone to dictate your actions.

What are the anatomical direction terms and what do they mean?

It is the central controlling body of the cell. Contains DNA.

The nucleus controls cell division and control of genetic information.

What are the major muscles for IM injection and where are they located?

• Skin
• Hair
• Nails
• Sense Receptors
• Sweat Glands
• Oil Glands

What makes up the Nervous system?

Brain

Spinal cord

Nerves

• Pituitary gland
• Pineal gland
• Hypothalamus
• Thyroid gland
• Parathyroids
• Thymus
• Adrenals
• Pancreas
• Ovaries
• Testes

Heart

Blood Vessels

Blood

What makes up the Lymphatic System?

Lymph nodes

Lymph vessels

Thymus

Spleen

Tonsils

• Nose
• Pharynx
• Larynx
• Trachea
• Bronchi
• Lungs

Kidneys

Ureters

Urinary Bladder

Urethra

Gonads

Testes

Vas Deferens

Urethra

Prostate

Penis

Scrotum

Gonads

Ovaries

Uterus

Fallopian tubes

Vagina

Vulva

Mammary Glands (breasts)

Heart rate - Increase

Most Blood Vessels - constrict

Skeletal muscle Blood Vessels - Dialate

Digestive Tract - Slows/stops/decreases juices secretion

Anus - closes

Bladder - relaxes (decreases desire to urinate)

Eye - Dialates pupils

Skin - Goose bumps and sweat

Adrenals - secrete epinepherine

Heart Rate - Slows

Most Blood Vessels - NO EFFECT

Skeletal Muscle Blood Vessels - NO EFFECT

Digestive Tract - Increases digestion and juice secretion

Anus - opens for defecation

Urinary Bladder - Stimulates/Constricts Bladder (want to urinate)

Eye - Constricts Pupils

Adrenals - NO EFFECT

Skin - NO EFFECT , NO SWEAT

Name the valves and chambers of the Heart and the path of blood flow through it (including travel to and from the lungs).

Vena Cava →No Valve→Right Atrium→Tricuspid Valve→

Right Ventricle→Pulmonary SemiLunar Valve→Pulmonary

Artery→Lungs→Pulmonary Vein→No Valve→Left Atrium→

Bicuspid (Mitral) Valve→Left Ventricle→Aortic Semilunar Valve→Aorta to body

1. SA Node (60-100/min)
2. AV Node (40-59/min)
3. Bundle of His (0)
4. Purkinje Fibers (1-39/min)

What is an acceptable time frame for capillary refill?

Bradycardia  < 60 bpm

Tachycardia > 100 bpm

Normal 60 - 100 bpm

What are the priorities in scene assessment?

Is the scene safe?

Do we need additional resources?

Determine NOI / MOI

IV/IO - Immediate

Sublingual - Rapid

Endotrachael - Rapid

Pulmonary - Rapid

IM - Moderate

Topical - Moderate

Subcutaneous - Slow

Enteral (absorbed at any point along the GI tract) - Slow

A large bore needle (10 or 14 gauge) is inserted into the affected plural space either anteriorly in the 2nd intercostal space in the mid-clavicular line just above the rib, or in the 4th or 5th intercostal space, laterally on the involved side, just above the rib.

An audible rush of air will be noted if treatment is effective.  The needle should be removed, but the catheter should remain in place and taped to secure.

• Anxiety
• Cyanosis
• Increasing Dyspnea
• Trachael Deviation (a late sign)
• Tachycardia
• Hypotension and unexplained signs of shock
• Diminished or absent breath sounds on the injured side
• Distended neck veins (unless pt is hypovolemic)
• Unequal expansion of the chest
• Subcutaneous emphysema

• Eye Opening
• Verbal Response
• Motor Response

Only partial (2nd degree) and full thickness (3rd degree) burns are considered to count toward the "rule of nines."

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• Thermal
• Chemical
• Radiological
• Electrical

• Direct Pressure
• Immobilization (splinting)
• Pneumatic antishock garments
• Tourniquet

(slide 106 says pressure points & elevation no longer recomended.)

Compartment Syndrome is a result of crush injury, and less often a result of electrical injury, High Pressure injection (dry cleaner accident). Edema and internal hemorage and swelling lead to decreased blood supply to extremity.

Crush Syndrome can be caused by prolonged Compartment syndrome.  More often caused by prolonged (4-6 hours) compression injuries (ie building collapse, earthquake). When pt is released from entrapment, blood that had been displaced rushes back into extremety causing hypovolemia, toxic waste products of anarobic metabolism enter blood stream causing metabolic acidosis, and Myoglobin is released from damaged muscle cells causing renal failure

Hypovolemic

Cardiogenic

Neurogenic

Anaphylactic

Septic

Inadequet volume most often through blood loss, but also possible because of dehydration.

Treat with IV Fluids

Consider Pneumatic Antishock Garment

Bad pump. Heart is not pumping effectively enough to move blood through cardiovascular system to maintain perfusion.

Treat with IV Fluids

Drugs such as Antidysrhythmics, vasopressors, vasodilators, inotropic drugs

Be aware of potential tension pneumothorax and cardiac tamponade as causes of cardiogenic shock

Most often caused by head injury. Swelling causes ICP which presses down on brain stem causing loss of sympathetic impulses leading to vasodilation and increased container size.  Increased container size means that "normal" amount of blood volume is no longer enough to fill the container, leading to hypoperfusion.

Treatment is similar to Hypovolemic shock

Monitor lung sounds for wet lungs

Caused by severe allergic reaction.  Arterioles and Capillaries dilate and capillary membrane becomes more permeable. Intravascular fluid leaks into interstitial space and leads to decreased volume.

Treatment IM Epinepherine

IV or IM Benadryl

Bronchodilators (Albuterol)

Steroids to reduce inflammatory response

Caused by infection

Treatment includes IV Fluids

Correction of Acid/Base balance

Vasopressors to improve cardiac output

Respiratory Support

What are the signs and symptoms of Compensated vs. Uncompensated (Decompensated) shock?

1. Primary - Pressure wave hits person
2. Secondary - Flying debris hits person
3. Tertiary - Person hit object (like a building)
4. Quaternary/Miscellaneous - All other injuries caused by blast (ie building falls on person/radiation exposure/inhalation of dust and toxic gasses)

Motor Vehicle Accidents

$255.7 Billion

1. Vehicle hits something
2. Person hits vehicle
3. Organs hit inside of body cavity