EMT-B Exam 3

• Patient
• Time
• Dose
• Route
• Drug
• Documentation

• Hypoxia
• Overdose
• Myocardial Infarction
• Anaphylaxis
• Bronchoconstrictive disease
• Hypoglycemia

• Accessory muscle use
• Retractions
• History of respiratory disease
• Pallor
• Cyanosis
• Diminished breath sounds
• Altered or decreased LOC

• Chest pain
• Shortness of breath
• Pallor
• Diaphoresis
• Nausea
• Vomiting
• Tachycardia
• Bradycardia
• Epigastric discomfort

• Chest pain
• Sudden onset
• Brought on by activity
• Relieved by rest
• Relieved by nitroglycerin
• Short acting

Sympathomimetic

• Anaphylaxis
• Anaphylactic Shock

• Increased conduction
• Increased contractions
• Increased automaticity
• Increased irratibility
• Increased work demand
• Increashed O2 demand
• Bronchodilation
• Vasoconstriction

• Nervousness
• Tachycardia
• Palpitations
• Headache
• Nausea
• Tremors

Bronchodilation

Antianginal nitrate

Chest pain of suspected cardiac origin

• Vasodilation
• Increased venous pooling
• Decreased preload
• Decreased wall tension
• Decreased afterload
• Decreased work demand
• Decreased O2 demand
• Coronary artery dilation

• Headache
• Hypotension
• Burning sensation under the tongue
• Tachycardia
• Lightheaded

Decrease pain and dilate the vasculature

Sympathomimetic bronchodilator

Bronchoconstrictive disease

Bronchodilation

• Palpitations
• Tremors
• Nervousness
• Headache
• Tachycardia

Have patient take a deep breath while taking a puff of the inhaler then holding their breath for no less than 2 seconds

Salicylate

Chest pain of suspected cardiac origin

Inhibits platelet aggregation

160 – 325 mg

Orally

Chew the aspirin, do not swallow

Carbohydrate

• Hypoglycemia with signs and symptoms
• Altered LOC

Decreased LOC

One tube

Put it on a tongue depressor and put in their mouth between their cheek and gum, and let it absorb

• Assess the patient to determine the need (VS-Meds-allergies-LOC-Severity)
• Call medical control
• Deliver report and request medication desired
• Repeat orders that are given back to physician
• Deliver as directed
• Reassess the patient
• Document any outcomes whether they are good, bad or no changes noted

• Plasma – protein ; fibrinogen ; IG
• Red Blood Cells - Transport nutrients, waste, and oxygen
• White Blood Cells - Protection from infection, immune system
• Platelets - Clotting

• Chest pain
• Chest discomfort
• Pallor
• Diaphoresis
• Radiating pain
• Altered or decreased LOC
• Tachycardia
• Bradycardia
• Cyanosis
• Shortness of breath
• Impending sense of doom
• Hypotension
• Nausea
• Vomitting

• Acute coronary syndrome (ACS)
• Angina
• Right heart failure
• Left heart failure
• Tamponade
• Unstable angina

• A hypoxic cardiac event that can be relieved by rest or nitroglycerin
• It is a warning sign of an acute coronary syndrome (ACS)
• Pain with exertion, activity or stress
• Mild to moderate chest discomfort or pain
• Pallor
• Relieved by rest
• Relieved by nitroglycerin
• Usually short duration

• A cardiac event that leads to cardiac ischemia, injury or infarction due to coronary artery occlusion
• Chest pain or discomfort
• Pallor
• Diaphoresis
• Cyanosis
• Shortness of breath
• Radiating pain
• tachycardia
• Bradycardia
• Altered or decreased LOC
• Hypotension

A situation in which the heart muscle is damaged and is no longer able to function at a level to maintain adequate cardiac output, this can occur on the right, left, or both sides

• Shortness of breath
• Pallor
• Diaphoresis
• Chest discomfort
• Rales or crackles
• Paroxysmal Nocturnal Dyspnea (PND)
• Orthopnea
• Dyspnea
• Pulmonary edema

• Acute dyspnea appearing suddenly at night, usually waking the patient from sleep
• Caused by pulmonary congestion with or without pulmonary edema that results from left-sided heart failure following mobilization of fluid from dependent areas after lying down.

• 1st phase – shock phase (0-4 min) – perfusion pressure still adequate coarse v-fib immediate defib needed
• 2nd phase – CPR phase (4-10 min) – toxins, acids and decreased pressures, need CPR x 2 minutes then defib
• 3rd phase – metabolic phase(>10 min) – may be past the point of no return, CPR, defib

• Assessment
• Oxygen
• History
• VS
• Asparin 162-325 mg
• Nitro 0.4 mg every 5 minute to three doses
• Rapid transport
• Consider ALS rendezvous

• Early access
• Early CPR
• Early defibrillation
• Early ALS
• If used in an appropriate and timely manner it can potentially reduce death from cardiac arrest

• Subjective - What you are told
• Objective - What you find
• Assessment - What you think is wrong and the priority
• Plan - What you did

• Draw a single line through it
• Initial near the line
• Correct the notation

• Chart
• SOAP
• Timeline

• Continuity of care
• Minimum data set
• Legal record
• Administrative tool
• Research

• Patient info
• Crew info
• Narrative

Against Medical Advice

Right to Privacy

• Age
• Gender
• Chief complaint
• Medications
• Allergies
• Positive findings
• Pertinent negatives
• Suspected problem
• Interventions
• Outcomes
• Transport code

Yes; it is going to be your best defense if there is an issue, the refusal is not the best form of protection

• Your agency or squad number
• Chief complaint
• Age of patient
• Vital signs
• Mental Status
• Priority
• Treatments administered
• Outcomes of treatments
• Pertinent findings
• Ask about orders

• Diagnose
• Use abbreviations or “personal terminology”
• Use codes and/or dispatch language
• Give a complete patient history
• Exceed 1- 2 minutes for your report
• Talk excessively fast
• Walk on other peoples traffic

• Make and keep eye contact
• Position yourself at a level lower than the patient
• Be honest
• Use language the patient can understand
• Be aware of your body language
• Speak clearly, slowly, and distinctly
• Use the patient's proper name
• If a patient has difficulty hearing, speak clearly with lips visible
• Allow the patient enough time to answer
• Act and speak in a calm, confident manner.

• Radio frequencies that are assigned and licensed by FCC
• Portable radios
• Mobile radios
• Repeaters
• Base stations
• Cell phones

• Classification: Salicylate
• Actions: Inhibits platelet aggregation
• Indications: Acute chest pain, suspecting an MI
• Contraindications: Allergies, recent GI bleeds, stroke
• Side Effects: Flushing, nausea, vomiting, GI Bleed, dizziness
• Dose: 160 - 325 mg
• How supplied:2-4 81 mg children chewable tablets, 325mg adult tablet
• Route: P.O.

• Classification: Carbohydrate
• Actions: Essential for normal metabolism, increases the amount of sugar available for use in the body.
• Indications: Hypoglycemia
• Contraindications: Decreased LOC
• Side Effects: May be aspirated if no gag reflex
• Dose: One tube
• How supplied: 15 - 24 grams / tube
• Route: Buccal

• Classification: Beta 2 agonist, synthetic sympathomimetic
• Actions: Relaxation of bronchial smooth muscle, bronchodilation
• Indications: Relief of bronchospasm (asthma, COPD, anaphylaxis)
• Contraindications: Excessive tachycardia, not patient's med
• Side Effects: Anxiety, shakiness, tachycardia, headache, tremors
• Dose: 90 – 100 micrograms
• How supplied: Metered dose inhalers
• Route: Inhalation

• Classification: Antianginal Nitrate
• Actions: Smooth muscle relaxant, vasodilator, increased venous pooling, decreased preload, ventricular wall tension and afterload, decreased myocardial work, demand and O2 consumption, coronary artery dilator
• Indications: Chest pain of cardiac origin
• Contraindications: BP <100; Use of phosphdiesterase (ED) inhibitors within 24-48 hours, allergies, tachycardia, bradycardia
• Side Effects: Headache, hypotension, burning under tongue
• Dose: 0.4 mg every 3 – 5 minutes x 3
• How supplied: Tablet or metered dose spray
• Route: Sub-lingual

• Classification: Sympathomimetic; Endogenous catecholamine
• Actions: Beta 1 - Increased rate, conduction, contraction, automaticity, V-fib threshold, irritability, MVO2, workload. Beta 2 -Increased respiratory effort, bronchodilation. Alpha 1 - Increased peripheral vascular constriction, blood pressure
• Indications: Anaphylaxis, asthma
• Side effects: Tachycardia, palpitations, anxiety, headache, tremors, nausea, and vomiting
• Dose: 0.3 to 0.5 mg adult, 0.15mg child
• How supplied: 1 epinephrine pen
• Route: Intramuscular

• Classification:Narcotic antagonist
• Actions: Blocks opiate receptor sites
• Indications: Known narcotic overdose
• Contraindications: Hypersensitivity
• Side Effects: Tachycardia, hypertension, nausea, vomiting, withdrawal, use with caution
• Dose: 0.4 - 2.0mg titrated to effect, may repeat to a total of 10mg
• How supplied: Multi dose vial 10mg / 10 ml. Multi dose vial 4 mg / 10 ml pre-filled syringe 1mg / ml
• Route: IV (intravenously), ET, IM (intramuscular), SQ (subcutaneous) and nasally

• Classification: Gas
• Actions: Oxygenate the body. Increase the amount of oxygen available for the body's tissues
• Indications: Always. Hypoxia, respiratory distress, respiratory failure, all arrests, every patient.
• Contraindications: None for a patient requiring oxygen.
• Side effects: Light headed
• Dose: 100%
• How supplied: Nasal Cannula 2-6L, Nonrebreather 8-15L, Bag valve mask 15L+
• Route: Inhalation

• Chemical
• Trade

• Oral - Asparin
• Sub-lingual - Nitroglycerin
• Injectable (intramuscular) - Epinephrine
• Buccal - Glucose
• Inhaled - Inhaler and oxygen
• Intravenously - Narcan
• Subcutaneous - Narcan

• List five points to know about medications
• Class
• Action
• Indications
• Contraindications
• Side effects
• Dose
• Route

• Inhalers
• Nitroglycerin

• Oxygen
• Asparin
• Oral glucose
• Epinephrine

• Chemical Name - Chemical structure and makeup
• Generic Name - Ibuprofen
• Trade name - Advil, Motrin

• Local effect - Affect the local region around administration. Affects a limited portion of the body.
• Systemic effect - Absorbed into the blood stream, circulates around the body, and affects the entire body.

• Solid
• Liquid
• Gas
• Powder

• Document the time the drug was given
• Document any response to the drug
• Monitor the patient
• Reassess vitals
• Document changes in patient status

• Medications you can administer
• Medications you can assist administering

Hypo-perfusion in the body. Inadequate circulation of blood through tissue in the body.

• Restlessness
• Anxiety
• Altered mental status
• Pale
• Cyanotic
• Cool and clammy skin
• Rapid weak pulse
• Rapid, shallow breathing
• Nausea
• Vomiting
• Reduction in total blood volume
• Low or decreasing blood pressure

Disease of the heart and blood vessels

Disease of the coronary arteries and complications that result

Disease that slows or stops the flow of blood through the arteries to the heart

A temporary or permanent block of the coronary arteries.

• Angina
• Unstable angina
• Myocardial infarction

• Arteriosclerosis - Hardening of the coronary arternies
• Atherosclerosis - Constriction and thickening of coronary arteries

• Modifiable factors - Weight, exercise, smoking
• Non-modifiable factors - Genetics, race, age, gender, family history
• Contributing factors - Stress, depression, heavy alcohol intake

Decreased blood flow to an organ or tissue?

• It is used in patient's with a suspected MI
• M - Morphine (ALS only)
• O - Oxygen
• N - Nitroglycerin
• A - Aspirin

• Left side - Fluid backs up into the lungs
• Right side - Fluid backs up into the body system and causes congestion in organs and tissues

Unexpected death from cardiac causes very early after symptom onset, 1 minute to an hour, or without the onset of symptoms. About 2/3rds of sudden deaths are prehospital

• One-way - A one way radio, one person talks, other receives
• Simplex - One signal can be transmitted at a time
• Duplex - A dual person radio. Both can talk or receive, channel can be used simultaneously
• Multiplex - Many sources can talk at the same time

• Coronary perfusion is based on good CPR
• Supply oxygen to the myocardium
• Good chest rise is needed to the blood to go back to the heart during relaxation
• Venous blood return depends on difference in interthoracic and abdominal pressure
• Interthoracic pressure increases with chest compressions, failure to allow full chest recoil, excessive air with ventilation

Stimulates cell activity

• Contractions of the heart stop.
• Confirmed by unresponsiveness, absent breathing, absent pulses

Awareness of one's own heartbeat

• Compensating
• Decompensating
• Irreversible

• Blood returns to the five major organs for survival.
• Heart
• Brain
• Lungs
• Liver
• Kidneys
• Tachycardia - 120
• Increased respirations
• Pallor
• Diaphoresis
• Slow CR
• Altered LOC
• General Weakness
• Poor Peripheral Pulses
• Cool extremities
• Dilated Pupils

• The blood is removed from the kidneys, liver, and brain
• Mentations decreased
• Hypotension
• Tachycardia - 130-140
• Decreased urine output

• Bradycardia
• Systole under 60
• Death

A drug that initiates vasodilation. Vasodilation is widening of the blood vessels resulting from relaxation of the muscular vessel walls

The stretched condition of the heart at the end of a diastole, just before a contraction

The force against which a ventricle contracts

A drug that produces a temporary increase of the functional activity or efficiency of an organism or any of its parts.

The clumping together of platelets in the blood

A drug that interferes with a chemical reaction, or a drug that reduces the activity of another substance.

The main function of drugs.

Low blood suger. <70mg/dL in adults

Conditions caused by temporary or permanent blockage of a coronary artery. Results from coronary artery disease.

Route of drug administration under the tongue

Route of drug administration in skeletal muscle

A subjective statement made by the patient describing the most significant or serious symptoms of signs of illness that caused him/her to call for medical help.

The signs and symptoms for which a drug has documented usefulness

Condition where a drug should not be administered to a patient because doing so may cause harm to the patient or offer no improvement to their status

Expected and usually unavoidable effects of a drug other than the main action

Stimulation of physiologic activity at cell receptor sites similar to that of the normal cellular function

Nullify the physiologic activity at a cell receptor site. Blocks binding sites so function of that substance stops.

A group of sympathomimetic amines including epinephrine, norepinephrine, and dopamine.

Grouping based on similar traits

Sympathetic receptor that functions on the heart

Sympathetic receptor that functions on the lungs

Stimulation of the sympathetic nervous system in physiological responses

Relating to or causing expansion of the bronchial air passages

Prevent or relieve angina pectoris. Increases oxygen supply to the heart

Amount of medication given to a patient

Division of the autonomic nervous system that mobilizes energy such as fight or flight

Governs involuntary action such as secretions, vasoconstriction, and peristalsis. Consists of sympathetic and parasympathetic nervous systems.