Updated State Exam Study Guide PDF

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Authored by: David Chudd, RN, NRP

This review was compiled from many sources Please study and Good Luck on your state exams

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EMT-B Study Guide Emergency Medical Services (EMS): Consists of a team of health care professionals who administer aid to a person at home or in the street, through the time they are discharged. Levels of the EMT

NYS

National

CFR: Certified First Responder EMT-B: Basic EMT-I: Intermediate EMT-CC: Critical Care (old version EMT-P: Paramedic

EMR: Emergency Medical Responder EMT: Emergency Medical Technician AEMT: Advanced Emergency Medical Technician Paramedic: Paramedic

Components of the EMS System Ambulances either Basic Life Support (BLS) or Advanced Life Support (ALS) Equipment Dispatch EMT’s Medical Director: The physician who authorizes or delegates to the EMT the authority to provide medical care in the field. Quality Control: The responsibility of the medical director to ensure that the appropriate medical care standards are met by EMT’s on each call. Rules & Responsibilities Drive to the patient safely Have directions and know how to get to location Patient Care Patient Packaging Look & Act Professional Medical Direction On-Line Direction: On the phone with MD. Off-Line Direction: Pre-written or standing orders (Protocols – Standing orders) Definitive Signs of Death 1. Obvious Mortal Injury (i.e. Decapitation) 2. Rigor Mortis (RM) stiffness occurs within 2 to 12 hours after death. 3. Dependent Lividity: blood settling to the lowest point of the body, causing discoloration of the skin. 4. Purification: decomposition of body tissue. Occurs between 40 to 96 hours after death. Other times when an EMT does not do CPR is in the case of a Do Not Resuscitate order or a MOLST, which is Medical Orders for Life Sustaining Treatment.

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Stages of Grieving Process 1. 2. 3. 4. 5.

Denial Anger Bargaining Depression Acceptance

Dealing with Dying Patients 1. 2. 3. 4. 5. 6. 7.

Maintain patient dignity Show respect for the patient Communicate with the family Allow family members to express themselves Do Not give false assurances Listen to the family Use a gentle tone of voice Stress Warning Signs

Irritability Unable to concentrate Anxiety Loss of appetite or over eating Isolation Loss of interest in work, sex, etc. Increased alcohol use Dealing with Stress Critical Incident Stress Debriefing: (CISD) program in which severely stressful job-related incidents are discussed. These meeting are held within 24 to 72 hours after an incident. Medical/Legal/Ethical Standard of Care: The way another equally trained person would act to treat a patient Scope of Practice: The skills you are allowed to use Duty to Act: an EMT has a duty to act only when on duty. Public Health Law 800: EMT cannot be held liable unless negligence is proven. Good Samaritan Law: does not cover EMT’s in New York State. Negligence: failure to provide same level of care as another equally trained EMT. Abandonment: termination of patient care without transferring care to equal or higher medical Authority Refusal of Care: (RMA) or Refuse Medical Assistance is when anyone over the age of 18 & competent refused care. Also applies if under the age of 18 if patient is pregnant, married or an emancipated minor or seeking treatment for a sexually transmitted disease Assault/Harassment: unlawfully placing a patient in fear of bodily harm. Confidentiality: anything discussed between EMT and patient cannot be disclosed unless to designated individuals such as hospital personnel involved in patients care.

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Negligence: v Deviating from the standard of care resulting in further injury to the patient Not performing as reasonable person would act given the same circumstances v Breach of duty (act of omission or commission) Ø Breach of Duty by Omission § Nonfeasance: EMT Failed to perform his/her duties Ø Breach of Duty by Commission § Misfeasance: The EMT performed an approved action IMPROPERLY. § Malfeasance: The EMT performs a action above their level of training. v Damages v Proximate Cause: Your Negligence DIRECTLY caused pain/suffering/injury Liability: Legal responsibility. Plaintiff: Individual bringing suit. Defendant: Individual being sued. Assault: Unlawfully placing a person in fear of immediate bodily harm without the person’s consent. Battery: Unlawfully touching a person; this includes providing emergency care without consent False Imprisonment: Transporting a competent patient against their will. Consent Expressed or Actual: when patient speaks or acknowledges that they want you to provide care and transport. Informed: patient is explained everything that is going to be done and they have provided Consent for the EMT to provide care. Implied: when a person is unconscious and unable to give consent or a serious threat to life or limb exists. Special Reporting Special Reporting must be done in the case of Child Abuse (DSS 2221A) also known as a S.C.A.M. report (Suspected Child Abuse and Maltreatment) Types of Positions Supine: Laying face up, body flush to ground.

Prone: Laying face down, on stomach.

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Lateral: lying on patient’s side.

Recovery: patient is on side, usually left side.

Fowler: sitting upright with legs extended.

Semi-Fowlers: sitting at a 45-degree angle with legs extended.

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Directions Cephalic: at the head. Caudal: at the feet. Abduction: Moving away from the midline Adduction: Moving toward the midline Body Locations Anterior: front Posterior: back Right: the patient’s right Left: the patients left Lateral: towards the outside Medial: towards the inside or middle Superior: closer to the head, higher Inferior: farther from the head, lower Proximal: closer to the torso Distal: farther from the torso Dorsal: towards the spine Respiratory System

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The human body inhales 21% oxygen, and exhales 16% oxygen Alveoli: are where oxygen and carbon dioxide exchange Diaphragm: is the muscle that controls breathing. The Brain: is the organ that controls breathing. The Digestive System

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Abdominal Quadrants & Cavity

Vocabulary Aorta: largest artery in the body. Artery: carries oxygenated blood away from the heart. Capillary: smallest blood vessels. Connects arterioles and venules for the exchange of O2 & CO2. Contusion: swollen, raised and warm to the touch. Ecchymosis: a bruise. internal bleeding but does not break skin. Epistaxis: nose bleed. Hematoma: a mass of blood or pooling of blood in the soft tissues beneath the skin. Perfusion: the circulation of blood through the tissue or organ. Hypovolemic Shock: bleeding shock, due to loss of fluid (blood or plasma). Vena Cava: largest vein in the body. Veins: carries blood from the tissues back to the heart. Cardiovascular System: the heart and vessels. Arterial Blood: bright red in color. Spurts with each heartbeat. Venous Blood: dark maroon in color. Flows steadily. Capillary Blood: oozes from the wound. Color in between vein and artery.

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Bleeding & Blood There are 5 to 6 liters of blood in the average adult body. There are 10 to 12 pints of blood in the average adult body. Blood consists of: • White Blood Cells (leukocytes): fight infection. • Red Blood Cells (erythrocytes): carry O2 • Platelets: clot the blood. • Plasma: fluid that carries the formed elements of blood Types of Blood Vessels: • Arteries: carry blood away from the heart. • Veins: carry blood to the heart. • Arterioles: smaller arteries in the body. • Venules: smaller veins in the body. • Capillaries: smallest vessels that connect arterioles and venules. Shock Shock refers to the state of collapse and failure of the Cardiovascular System, which leads to inadequate perfusion (Hypoperfusion). As the body loses perfusion, the body compensates by redirecting blood flow from non-essential organs to essential ones. As the • • • • • • • • • • • •

body compensates with blood loss the following occurs: Heart beats faster (Tachycardia) Skin becomes pale, cool, sweaty Rapid Breathing Decreased blood pressure Cyanotic (Skin turning blue due to lack of blood and oxygen) AMS (Altered Mental Status) LOC (Loss of Consciousness) Coma Major organs begin to shut down starting with the Kidneys. Lungs shut down Heart shuts down Brain shuts down Types of Shock Types of Shock Examples of Potential Causes Sign & Symptoms Anaphylactic * Extreme life threatening allergic * Can develop within seconds reaction * Mild itching or rash * Burning skin * Vascular dilation * Generalized edema * Coma * Rapid death Cardiogenic * Inadequate heart function * Chest Pain * Disease of muscle tissue * Irregular pulse * Impaired electrical system * Weak pulse * Disease or injury * Low blood pressure * Cyanosis (lips, under nails) * Cool, clammy skin * Anxiety

Treatment * Manage the area * Assist ventilations * Administer high-flow oxygen * Determine cause *Epinephrine * * * * * *

Transport promptly Position of comfort Administer oxygen (if needed) Assist ventilations Transport promptly Consider ASA (324mg)

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Hypovolemic

* Loss of blood or fluid

* * * * * *

Rapid, weak pulse Low blood pressure Change in mental status Cyanosis (lips, under nails) Cool, clammy skin Increased respiratory rate

* * * * * *

Secure airway Assist ventilations Administer high-flow oxygen Control external bleeding Keep warm Transport promptly

Respiratory Insufficiency

* Severe chest injury * Airway obstruction

Secure airway Clear air passage Assist ventilations Administer high-flow oxygen Transport promptly

* Damaged cervical spine, which causes widespread blood vessel dilation

Rapid, weak pulse Low blood pressure Change in mental status Cyanosis (lips, under nails) Cool, clammy skin Increased respiratory rate Bradycardia (slow pulse) Low blood pressure Signs of neck injury

* * * * *

Neurogenic

* * * * * * * * *

Psychogenic (fainting)

* Temporary, generalized vascular * Rapid pulse dilation * Normal or slow BP * Anxiety, bad news, sight of injury, or blood prospect of medical treatment, severe pain, illness, tiredness

Septic

* Severe infection

* Warm skin * Tachycardia * Low blood pressure

* Secure airway * Spinal stabilization * Assist ventilations * Administer high-flow oxygen * Preserve body heat * Transport promptly * Determine duration of unconsciousness * Record initial vital signs and mental status * Suspect head injury if patient is confused or slow to regain consciousness * Transport promptly * Transport promptly * Administer oxygen enroute * Provide full ventilatory support

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Progression of Shock Compensated: higher pulse, pale, cool, clammy, nauseous, anxious and rapid breathing. Decompensated: BP below 90mmhg systolic, labored breathing, cyanotic skin, dull eyes, absent peripheral pulses (Pulses found in extremities), AMS (Altered Mental Status), LOC (Loss of Consciousness). Terminal Stage: vital organs begin to fail. Kidneys, lungs, heart and brain. Types of Burns Thermal: caused by fire, steam or hot objects. Chemical: caused by acid or alkaline. Radiation: caused by nuclear or some similar source. Electrical: caused by lightning or electrical wiring. Light: caused by sunlight or artificial UV lamps. Depths of Burns

Adults

Children

Anatomic structure

Surface area

Anatomic structure

Surface area

Head and neck

9%

Head and neck

18%

Anterior torso

18%

Anterior torso

18%

Posterior torso

18%

Posterior torso

18%

Each leg

18%

Each leg

13.5%

Each arm

9%

Each arm

9%

Genitalia/perineum

1%

Genitalia/perineum

1%

Superficial: redness of skin, Epidermis involved Partial Thickness: blisters on the skin, surrounded by redness, waxy appearance, Dermis involved Full Thickness: charring of the skin, surrounded by blisters and redness. Nerves destroyed full dermis and possibly underlying tissues involved

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CLASSIFICATION OF

CLASSIFICATION OF

BURNS IN ADULTS BURNS IN INFANTS/CHILDREN Critical Burns Critical Burns * Full thickness burns involving the hands, feet * Full thickness or partial thickness burns face, upper airway, genitalia, or circumferential

covering more than 20% of the body's total

burns of other areas. surface area. * Full thickness burns covering more than 10% * Burns involving the hands, feet, face, airway of the body's total surface area. or genitalia. * Partial thickness burns covering more than

Moderate Burns

30% of the body's total surface area. * Burns associated with respiratory injury (smoke inhalation or inhalation injury)

* Partial thickness burns covering 10% to 20% of the body's total surface area. Minor Burns

* Burns complicated by fractures.

* Partial thickness burns covering less than 10%

* Burns on patients younger than 5 years or older than 55 years that would be classified as "moderate" on younger adults.

of the body's total surface area.

Moderate Burns * Full thickness burns involving 2% to 10% of the body's total surface area (excluding hands, feet, face, genitalia, or upper airway) * Partial thickness burns covering 15% to 30% of the body's total surface area. * Superficial burns covering more than 50% of the body's total surface area. Minor Burns * Full thickness burns covering less than 2% of the body's total surface area. * Partial thickness burns covering less than 15% of the body's total surface area. * Superficial burns covering less than 50% of the body's total surface area. Treatment of Burns Less than 10% of the body: Moist dressing may be used to augment pain. More than 10% of the body: use dry, sterile dressing. 1. Follow BSI precautions to help prevent infection. (Remove hot clothing and jewelry as necessary. 2. Move patient away from the burning area. 3. Remove smoldering clothing that is not adhering to the patient’s skin 4. Provide high flow oxygen as needed. 5. Rapidly estimate the burn severity. 6. Check patient for traumatic injuries or other medical conditions. 7. Treat the patient for shock. 8. Prevent further heat loss by covering the patient with warm blankets. 9. Provide prompt transport.

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Chemical Burns 1. Stop the burning process. Safely remove any chemical from the patient, always brushing off dry chemicals. 2. Remove patient clothing, cut clothing off if you have to. 3. Irrigate with copious amounts of water for 20 minutes. Electrical Burns 1. Ensure scene is safe. 2. If indicated, begin CPR and apply the AED. 3. Treat soft tissue areas by placing dry, sterile dressings, on all burn wounds and splinting fractures. Soft Tissue Injury Anatomy of the skin: • Epidermis: tough external layer, that forms a watertight seal. • Dermis: layer that consists of hair follicles, sweat glands, etc. • Subcutaneous: tissue above the bone. Functions of the skin: • Keep bacteria out. • Keep water in. (Human body is made up of 80% water) • Regulate temperature (When too hot, we sweat, too cold, skin tightens) Skin Colors 1. 2. 3. 4.

Pale (Pallor): shock (mucous membranes) Cyanosis: lack of oxygen to the tissue. (Blue/Grey) Jaundiced: hepatitis (liver problem)(yellow skin) Flushed: red (allergic reaction, fever or high blood pressure) Open Injuries

Abrasion: rubbing of the skin/scraping. Laceration: jagged cut. (Treat with bleeding control) 1. Direct Pressure to the wound. 2. Consider the use of hemostatic gauze 3. Wrap with pressure bandage. 4. Tourniquet 5. Treat for shock and transport. Avulsion: a flap of tissue either hanging or falling off. Incision: straight, clean cut. (Treat with bleeding control) Puncture: wound that is deeper than it is wide. (Treat with bleeding control) Evisceration: internal organs are outside of the body. 1. Cover with moistened sterile gauze. 2. Occlusive Dressing- tape all four sides.

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Amputation: 1. 2. 3. 4. 5.

Wrap the stump with moist sterile dressings. Cover the dressed stump with a dry bandage. Preserve the amputated part as follows: Moisten an appropriately sized sterile dressing with sterile saline solution. Wrap the severed part in the moistened sterile dressing, preserving all amputated material. 6. Place the severed part in a water-tight container (i.e. sealed plastic bag). 7. Place the container on ice or cold packs (if available). Do not freeze or use dry ice! Do not immerse the amputated part directly in water! Do not allow the amputated part to come in direct contact with ice! 8. Immobilize the limb to prevent further injury. Transport the amputated part with the patient. Impaled Object: object is still in wound. 1. Do not attempt to remove the impaled object. Stabilize the object. Note that the only time you

should remove an impaled object is when it goes through the cheek 2. Control the bleeding and stabilize the object in place by using soft dressing, gauze and or tape. 3. Tape a rigid item over the stabilized object to protect it from movement during transport. Ecchymosis: bruise, internal bleeding, but does not break skin. Contusion: swollen, raised skin and warm to the touch. Hematoma: pooling of blood below the skin. Musculoskeletal System Axial Skeleton: composed of skull, spine, ribs and sternum. Appendicular Skeleton: composed of upper and lower extremities. (UE and LE) The human body consists of 206 total bones. There are 14 bones in the face/skull There are 33 bones in the spine: • 7 Cervical (most susceptible to injury) • 12 Thoracic • 5 Lumbar (most susceptible to injury) • 5 Sacral • 4 Coccyx (Sacral and Coccyx are fused together) Spinal Cord ends between L1 and L2, Cord itself is protected by 20-21 Vertebrae Muscles Voluntary: muscles you have control over. Skeletal muscles. Involuntary: smooth muscles (digestive tract). Cardiac: involuntary muscle only found in the heart. Upper Extremities include: scapula, humerus, radius/ulna, carpals, metacarpals, and phalanges. Lower Extremities include: femur, patella, tibia/fibula, tarsal, metatarsals, and phalanges. Calcaneus: heel bone.

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2 Types of Joints Ball & Socket Joint: located in the hip and shoulder (Permits 180 degree motion). Hinge Joint: fingers, elbow, knee (Permits back and forth motion only). Ligament: fibrous tissue connects bone to bone. Tendon: fibrous tissue connects muscle to bone. An injured ligament is called a sprain. An injured tendon is called a strain. If sprain, strain or fracture, treat all as a fracture. Treat all painful, swollen or deformed extremities as a fracture. Fractures Open: refers to broken skin or compound. Closed: refers to inside the skin or simple. Greenstick: (Hairline) a non-displaced fracture that usually occurs in children. Displaced: an angulated fracture.

With fractures, you will hear Crepitus (bones scraping together) when you palpate the patient. Signs & Symptoms of a Fracture Deformity Tender Guarding Swelling Crepitus Bruising In a fracture, look for the following: • Look for a pulse: if there is no pulse, that means there is no blood flow. • Can the patient move it? • Does the patient have any sensation? If the patient can feel...