The number one priority for paramedics? 

Roles and responsibilities

1. Preparation
2. Response
3.  Scene management
4.  Patient assessment and care
5. Management and disposition
6. Patient transfer
7. Documentation
8. Return to service

why do we have a quality assurance program? what’s the purpose of that?

1.   Identify any systemwide problems

2.   Conduct an in-depth review of the problems

3.   Aid the problem and develop a remedy

4.   Develop an action plan for correction of problem

5.   Enforce the plan of action

6.   Reexamine the problem

7.   Identify excellence in patient care

8.   Look for modifications that need to be made to protocols and standing orders

9.   Identify situations that are currently not addressed by protocols and standing orders

OPQRST

Onset

Provocation

Quality

Region, Radiation, Reoccurrence, Relief

Severity

Time

Provocation

 Associated symptoms

Sputum

Time, Temp

Exacerbation

how to save your back

how can culture affect a patients response to illness or injury

2.   Coordinate every list in advance

3.   Minimize the total amount of weight you have to lift

4.   Never lift with your back, not ever

5.   Don’t carry what you can put on wheels

6.   Ask for help anytime

1.   Denial

2.   Anger

3.   Bargaining

4.   Depression

5.   Acceptance

scene safety; all aspects, if scene becomes unsafe

Stand back until the police defuse the situation

Injury illness prevention

1.       Wear gloves

2.       Wash your hands

3.       Use lotion. ;)

4.       Use eye protection

5.       Consider wearing a mask

6.       Protect your body

7.       N95 respirator

8.       Clean your ambulance and equipment

9.        Properly dispose of sharps

10.    Consider wearing body armor

1.   Must be receptive to the message

2.   The scene is conductive to delivering such a message

3.   There is a definitive prevention measure that could have helped.

4.   Vague advise is less likely to have a lasting effect

tort 

negligence – occurs when:

1. When the paramedics or the EMS system had a legal duty to the patient
2. There was a breach of duty
3. The failure to act appropriately was the proximate cause that caused the plaintiffs injury
4. Harm resulted

1. Patients of different ages may have very different responses to the same drug
2. Older people tend to be much more sensitive to the effects of drugs and often require smaller doses then younger patients
3. Some drugs have different effects altogether in different age groups

Topical-hours to days

Oral – 30 to 60 minutes

Rectal – 5 to 30 minutes (unpredictable)

Subcutaneous injection – 30 to 50 minutes

Intramuscular injection – 10 to 20 minutes

Sublingual tablet – 3 to 5 minutes

Sublingual injection – 3 minutes

Inhalation – 3 minutes

Endotracheal – unknown; unpredictable

IO – 60 seconds

IV – 30 to 60 seconds

Intracardiac – 15 seconds

The action of two substances, such as drugs, in which the total effects are greater than the sum of the independent effects of this two substances

(ie 2+2=5)

1. Take BSI precautions
2. Determine the need for medication based on patient presentation
3. Obtain a focused history and physical exam, including any drug allergies and vital signs
4. Follow standing orders, or contact medical control for permission
5. Check the medication to ensure that it is the correct one, that it is not cloudy or discolored, and that the expiration date has not passed, and determine the appropriate amount and concentration for the correct dose.
6. Explain the procedure to the patient and or parent and the need for the medication
7. Assemble needed equipment, and draw up the medication. Also draw up 20 mL of normal saline for a flush.
8. Cleanse the injection port of the extension tubing with alcohol, or remove the protective cap if using the needleless system.
9. Insert the needle into the port, and clamps all the IV tubing proximal to the administration port. This is usually managed with a three way stopcock. Failure to shut off the line will result in the medication taking the pathway of least resistance and flowing into the bag instead of into the patient.
10. Administer the correct dose of the medication at the proper push rate.  Some medications must be administered very quickly, while others must be pushed slowly to prevent adverse effects.
11. Place the needle and syringe into the sharps container.
12. On clamp the IV line to flush the medication into the vein. Flush with at least a 20 mL fluid bolus of normal saline.
13. Readjust the IV flow rate to the original setting.
14. Store any unused medication properly.
15. Monitor the patient’s condition, and document the medication given, route, time of administration, and the response of the patient.

1. The purpose of the IV
2. The age of the patient
3. The location of the IV

• Loss of consciousness immediately following the injury followed by a brief period of consciousness after which the patient lapses back into unconsciousness
• Fixed and dilated pupil on the side of the hematoma

• Elderly patients
• Patients with alcoholism
• Patients with bleeding ditheses (such as hemophilia)
• Patients taking anticoagulants

• Occurs when people briefed in excess of metabolic need
• Frequently follows some emotional stressor

1. BSI precautions
2. Check, prepare, and assemble your equipment
3. Manually open the child’s airway and insert on adjunct if needed
4. Preoxygenate the child with a bag mask device and 100% oxygen for at least 30 seconds
5. Insert the laryngoscope in the right side of the mouth and sweep the tounge to the left. Lift the tounge with firm, gentle pressure. Avoid using the teeth or gums as a fulcrum.
6. Identify the vocal chords. If the courts are not yet visible, instruct your partner to apply cricoid pressure.
7. Introduce the ET tube in the right corner of the child’s mouth.
8. Pass the ET two through the vocal chords to approximately 2 to 3 cm below the vocal chords. Inflate the cuff if a cuff is used.
9. Attach an EtCO2 detector.
10. Attach the bag mask device, and auscultate for equal breath sounds over each lateral chest wall high in the axillae. Ensure absence of breath sounds over the epigastrium.
11. Secure the ET tube, noting the placement of the distance marker at the child’s teeth or gums and reconfirm its placement.

• Pediatric patients
• Esophageal trauma
• Known esophageal diseases
• Those who have ingested a caustic substance

• The straight or Miller blade is designed so that it will extend beneath the epiglottis and lift it up directly
• A useful feature in infants and small children, who often has a long, floppy epiglottis that is difficult to elevate out of the way with a curved blade
• The curved or Macintosh blade is less likely to be levered against the teeth. 
• The tip of the curve blade is placed in the vallecula, lifting the epiglottis indirectly.

Kuszmaul restorations

(deep, rapid, sighing ventilations)

1. Bright ambient light
2. Patient motion
3. Poor perfusion
4. Nail polish
5. Venus pulsations
6. Abnormal hemoglobin

The amount of energy associated with an object in motion.

KE = (Mass / 2) x Velosity²

• Shearing, avulsing, or rupturing of organs and their restraining fasca, vasculature, nerves, and other soft tissues
• The aorta, the largest blood vessel body, is the most common site of deceleration injury in the chest

• The lead point is the head
• The interior part of the neck may strike the steering wheel, causing laryngeal fracture, serious lacerations, and other soft tissue injury.
• The steering wheel can injure the lungs via generation of pressures beyond the capabilities of lung tissue, like a "paper bag being exploded". A.k.a. pneumothorax.

• Lead point is the knees
• Once the knees hit the dashboard, it transmits the energy of the deceleration up the femurs to the pelvis.

• Produced peripheral vasoconstriction
• associated with mild bronchoconstriction
• speed up metabolism

• Increased heart rate
• Cause cardiac muscle to contract
• Strengthen cardiac contraction
• Produce automaticity
• Trigger cardiac electrical conduction

• Stimulate vasodilation
• Bronchodilation

• Do not remove impaled object unless it causes an ABC issue.
• Direct pressure compression around the objects to control bleeding
• Stabilize object/prevent movement of objects and patient
• Do not cut object unless it provides an issue like transportation
• It may be necessary to remove objects to be able to do compressions, when in doubt get BHO to remove impaled object

• Stabilize objects
• Wrap both eyes

• Involves the epidermis only
• Skin is red and when you touch the color will blanch and return
• Usually no blisters
• Some pain is experienced
• Example:a sunburn

• A.k.a. second-degree burn
• Involves the epidermis and varying degrees of the dermis
• Usually blisters or moisture present
• Damage to hair follicles, sweat and sebaceous glands may be present
• Severely painful
• Often caused by hot liquids, steam or grease

• A.k.a. third-degree burn
• Involves destruction of both layers of the skin
• Including the basement membrane of the dermis that produces new skin cells
• The skin is white and pale, brown and leathery, or charred
• No refill due to destruction of capillaries
• Pain will be in area surrounding the third degree burns

The amount of water a burn patient will need in the first 24 hours

4 mL x bodyweight (in kg) x % of body surface burned

Half of this amount is given in the first eight hours

• A higher dose may be required to achieve relief.
• Their metabolism is accelerated, which creates the need for a higher dose than normal

• Difficulty with thermoregulation
• Inability to sweat from the scarred portions of the skin
• Impaired vasoconstriction and vasodilation in the areas of severe damage
• Little or no melanin (pigment) in the scar tissue, which makes the skin susceptible to sunburn

Head 18%

Torso (chest/back) 18% front, 18% back

Arms 9% each

Legs 13.5% each

Genitalia 1%

Head 12%

Torso (chest/back) 18% front, 18% back

Arms 9% each

Legs 16.5% each

Genitalia 1%

Head 9%

Torso (chest/back) 18% front, 18% back

Arms 9% each

Legs 18% each

Genitalia 1%

Trigeminal - Motor: chewing

    - Sensory: face, sinuses, teeth

Glossopharyngeal - Motor: Throught, swollowing, gland secretions

Sensory: Tongue, throat, ear

1. Place gloved hand over the injury and replace as soon as possible with a three sided occlusive dressing
2. Remove three sided dressing should a pneumothorax develop.
3. Place on high flow O2 via NRB
4. If things change, needle thoracostomy

• Originates in the SA node
• Spreads through the atria and along the internodal pathways to the AV node
• From the AV node they travel down the bundle of his and right and left bundle branches.
• There they go into the purkinje network.

And adverse condition inadvertently induced in a patient by the treatment given.

(patient develops UTI after insertion of a Foley catheter)

0-2 Children

3-4 Adult

• Seal the amputated part inside a plastic bag, and place it in a cool container.
• Keep it cool, but do not allow it to freeze
• Never warn an amputated part
• Never place an amputated part in water
• Never place an amputated part directly on ice
• Never use dry ice to cool an amputated part

• Located in the upper brainstem
• Responsible for maintenance of consciousness
• Specifically one's level of arousal

Heart rate

Blood pressure

Respirations

 Usually spinal cord injury

but may also be caused by:

Brain conditions

Tumors

Pressure on the spinal cord

Spinal bifida

Some sort of injury/illness that causes the muscles in the walls of the blood vessels to be cut off from the nerve impulses that cause them to contract.

As a result, all vessels below the level of the spinal injury dilate widely, causing blood to pool.

• Chest pain in the interior part of the chest or back between the shoulder blades that is described as ripping, caring, sharp or like a knife
• Sudden onset of pain with no pain prior to complaint
• Difference in blood pressures in both arms
• Carotid or femoral pull that is weak or missing
• Changes in the EKG as ischemia
• Symptoms resembling cardiac Tamponade

• Described as "the worst headache of my life"
• Slurred speech
• Aphasia
• Decreasing LOC
• Seizures/coma
• Vision problems
• Parethesia

• Hx of abuse
• Substance abuse by parents
• Insufficient knowledge about child development
• Not involved in the community
• Afraid or emotionally unstable to ask for help

Verbal triage

"if you can hear me and walk on your own power then move here"

Know as pink puffers.

Retain O2

AKA "Blue Bloaters"

Sputum production

Use 4x4 blocks

wedge snug loose cribbing

step blocks

box cribing

• Trigeminal
• Glossopharygeal
• Vagus
• Hypoglossal

Chlorine

Phosgene

Respiratory droplets

Also through inoculation in mucous membranes and broken skin

• Keep patient calm
• supine and motionless  
• immobilize the bitten extremity below the level of the heart

irregular respirations

widened pulse pressure

Heart rate decreases

Living wills

Durable power of attorney

Narrowed poults pressure

muffled heart tones

JVD

Temp above 104

ALOC

The old

The young

The bedridden

Polydipsia (excessive thirst)

Polyuria (excesive urine output)

Polyphagia (excessive eating)

Weakness

Weight-loss