lOMoARcPSD|46540738

EMT Notes

Nursing (Moi University)

Scan to open on Studocu

Studocu is not sponsored or endorsed by any college or university

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)
 lOMoARcPSD|46540738

MODULE 1: PREPARATORY
Lesson 1-1 Introduction to Emergency Medical Care
Brief History
• Before the implementation of emergency care, a
transportation-only service provided by the local funeral
home was responsible for delivering patients to hospitals.
• The Highway Safety Act (1966) established a program that
included emergency services. The Department of
Transportation led the development of the EMS through its
National Highway Traffic Safety Administration (NHTSA).
• The National Registry of Emergency Medical Technicians
(NREMT) was founded (1970)
• The EMS (Emergency Medical Services) System Act
(1973) funded the administration, training, and hiring for
the EMS system.
• The NREMT published the National Emergency Medical
Services Education and Practice Blueprint (1993) which
guided the development of a uniform national curriculum.
• The National EMS Scope of Practice Model defined four
levels of EMS licensure: EMR (Emergency Medical
Responder), EMT (Emergency Medical Technician),
AEMT (Advanced EMT) and Paramedic.
Levels of Licensure
• EMR (Emergency Medical Responder): First Responders in
an emergency. Trained to manage immediate care of an
emergency. Skills include airway management, bleeding
control, CPR and AED (automated external defibrillation),

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

and scene control. Many civilians, who are likely to be first

to arrive in an emergency, such as police officers,
firefighters, volunteers, are often trained as a first
responder.
• EMT (Emergency Medical Technician): Used to be called
EMT-Basic. In addition to the skills of a first responder, the
EMT provides transportation and more advanced medical
care using the facilities in an ambulance. The role of the
EMT is to stabilize the patient's conditions until arrival at
the hospital, where treatment will be provided.
• AEMT (Advanced EMT): Used to be called EMT-
Intermediate. In addition to the skills of an EMT, the
AEMT can administer much more medications. These
include both oral and intravenous medications.
• Paramedic: The paramedic provides the highest level of
pre-hospital care. These include advanced interventions,
administering a wide variety of medications, and advanced
life support.
EMT Responsibilities
• BSI (Body Substance Isolation) Scene Safe: Before
entering any scene, always make sure that you are not
placing yourself or your crew in danger. BSI (Body
Substance Isolation) Scene Safe is a good pneumonic to
verbalize before any practical test. It show you are properly
shielded from infectious material by wearing gloves and
that you have checked to make sure the scene is safe.
Safety is a critical criterion for the passing of any practical
exam.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Patient Assessment and Emergency Care: Assess and

evaluate the patient, recognize the problem at hand, and
provide interventions to stabilize the condition. Patient
assessment is a large section of the EMT curriculum and
will be discussed more in the appropriate section.
• Safe Lifting and Moving: Transportation of the patient
from the scene of accident to the ambulance.
• Transport and Transfer of Care: Involves ongoing
assessment and intervention while driving the ambulance to
the nearest hospital, where care will be transferred.
• Documentation: Complete the PCR (pre-hospital care
report) carefully for incident. This will ensure that you have
the proper documentation for legal issues. A copy of the
PCR will be included in both the patient's medical record
and the EMS system's permanent record.
• Patient Advocacy: Be supportive of the patient at all times
and protect the patient's confidentiality. Patient
confidentiality is an important legal issue that will be
discussed in a later section.
• QI (Quality Improvement): Also called CQI (Continuous
QI) is a system of reviews that audits the EMS that
maintains the quality of care. To ensure a high quality of
service, the EMT is to document carefully, participate in
review and feedback programs, maintain the functionality
of equipments, and participate in education programs.
• Medical oversight: Lastly, keep in mind that EMTs are the
extended arms of a doctor called the medical director, who
is in charge of and legally responsible for clinical aspects of
the EMS system under his or her authority. Everything an
EMT does follow medical direction. This includes off-line
medical direction (standing orders) that the EMT can use

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

without contact the doctor and on-line medical direction

where the EMT communicates with the doctor. As long as
an EMT follows medical direction, he or she is not legally
held responsible for medical consequences.
Access to the System
• 9-1-1: The universal number used to access emergency
services, including police, fire, and EMS.
• E-9-1-1: Enhanced 9-1-1. An advanced emergency call
tracking system that displays the caller's number and
location automatically. Provides automatic number
identification (ANI) and automatic location identification
(ALI) used to track incoming emergency calls.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Lesson 1-2 Well-Being of the EMT-Basic

Emotional Well Being
Cases with High Emotional Stress
• MCIs (Multiple-casualty incidents).
• Child abuse and neglect.
• Abuse of the elderly.
• Incident involving a friend, relative, or coworker.
• Traumatic injuries.
• Dealing with patients and family members involved in
death and dying.
Coping with Death and Dying
• For patients: Treat dying patients with dignity and respect.
Communicate to the patient what you are planning to do
and let the patient know that you are doing everything you
can to help. This will bring assurance to the patient and
establish trust. Even if the patient may look unconscious,
he or she may still be able to hear and understand what you
say.
• For family members: Be compassionate to the patient's
friends and relatives who may be around. An important
skill is to be able to listen empathetically to the grieving of
family members. Assure that you are doing everything you
can for the patient, but at the same time do not give false
assurances. Be honest with the relatives about the patient's
status, but also be tactful. Good judgment should leave the
family members with an accurate understanding of the
patient's condition and also allow them to have some hope.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• For yourself: Prepare yourself emotionally to encounter

death and dying situations and be able to cope with it. One
aspect is to recognize and understand the five stages of
denial, anger, bargaining, depression, and acceptance.
Learning to recognize and accept these emotional stages in
your patients can help you come to terms with death and
dying. Learn to realize if you are in stress and participate in
programs to relieve stress.
Recognizing and Managing Stress
• There are three stress reactions with symptoms that include
anxiety, irritability, nausea, guilt, isolation, and loss of
concentration, appetite, and interest in life. Learn to
recognize them in yourself and in others and manage them
accordingly.
• Acute Stress Reaction: occurs immediately after an
emotionally traumatic incident.
• Delayed Stress Reaction: occurs after a delayed period after
an incident. One example is the Posttraumatic stress
disorder.
• Cumulative Stress Reaction: occurs as a result of many
stressful reactions over time.
• Stress management involves both physical and mental
adaptations.
• Exercise: Activity provides an outlet for emotions, releases
positive hormones, and improves physical condition.
• Diet: Take up a healthy diet and avoid dependence on
caffeine or alcohol.
• Relax: Slow and deep breathing, yoga, and vacations all
help relieve stress.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Participate in programs of stress management such as social

networks, professional services, and programs sponsored
by your EMS for stress management.
• CISM (Critical Incident Stress Management): System to
manage the stress of EMS workers. Involves stress
education, peer support and CISD (Critical Incident Stress
Debriefing).
Physical Well Being
BSI
• Body substance isolation involves using proper equipment
to prevent the transmition of infectious diseases.
• The equipment used in BSI is called PPE (Personal
protective equipment). These include gloves, eyewear,
gowns and masks.
• Handwashing: The single most effective way to prevent the
spread of infectious diseases is by washing your hands
thoroughly after each incident, even if gloves were worn.
The guidelines for handwashing is 10-15 seconds of
vigorous scrubbing with soap and rinsing with the hottest
water that you can bear.
• Report exposure to body substances such as blood and
body fluids promptly to your supervisor by following your
local policies and protocols.
Immunizations
• Annually vaccinate against or test for PPD (Purified Protein
Derivative) tuberculin test and Influenza.
• Tetanus prophylaxis every 10 years.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Hepatitis B vaccine.
• MMR (Measles, Mumps, and Rubella).
• Varicella
• Polio
Scene Safety
• Hazmat: Look out for hazardous materials by identifying
signs and placards listed in the Emergency Response
Guidebook available inside every ambulance.
• Violence: Do not enter scenes with potential violence.
These include scenes of fights, aggression, and weapon use.
When in doubt, call law enforcement to check for scene
safety.
• Do not try to handle hazardous scenes without the proper
training and protective gear.
Lesson 1-3 Medical/Legal and Ethical Issues
Medical Issues
• Organ Donation: Only consider the patient for organ
donation if there is signed, legal documentation. Treat
organ donors the same way that you would treat all other
patients. Communicate the possibility of organ donation
with medical direction.
• Medical Identification Tag: Look for these during patient
assessment as they provide information on any medical
conditions the patient may have, including allergies,
asthma, diabetes, or epilepsy.
• Death: When in doubt, always assume the patient is alive
and begin resuscitation efforts. Signs of death include

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Absence of breathing and pulse.

o Completely unresponsive to any stimuli.
o Rigor mortis.
o Dependent lividity (skin discoloration due to the effect
of gravity on blood causing the underside to be dark
red to purple).
o Obvious signs such as decapitation, decomposition,
and suicide.
Legal Protection
• An EMT is unlikely to be sued successfully if there is
documentation proving that he or she meets the duty to act,
practice within the scope of practice, at a level the same as
or above the standard of care.
Terms to Understand and Rules to Abide By
• Duty to Act: While on-duty, EMTs are required by law to
care for a patient who requires and consents to it. Different
states have different policies for off-duty EMTs, but most
will not require an off-duty EMT to help a patient.
However, if the EMT does stop to help, then he or she is
required by law to continue helping the patient until care is
transferred to someone with the appropriate expertise, such
as a paramedic or a doctor.
• Scope of Practice: Defines what an EMT with the
appropriate licensure can and cannot do by law. It is illegal
to perform operations outside your scope of practice.
• Standard of Care: Defined as the level of care at which the
average, prudent provider in a given community would
practice.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Medical Direction: EMTs must follow medical direction at

all times. This includes off-line directions such as protocols
approved by medical direction and on-line directions
directly communicated by the doctor. When in doubt,
always ask for medical direction.
• Patient Consent: The conscious, mentally competent adult
has the right to accept or refuse emergency medical care.
Thus, always make sure that the patient consents before
beginning emergency care. There are three types of
consents: expressed, implied, and that which deals with a
minor. Expressed consent is made by conscious, mentally
competent adults. Implied consent is automatically
assumed if a patient is unresponsive or unable to make a
rational decision (e.g. altered mental status). To treat a
minor, an EMT must obtain the consent of the parent or
guardian. If the parent or guardian is unreachable, then
implied consent is assumed.
• Patient Refusal or Withdrawal of Treatment: Always ask
the patient to fill out sign a refusal form, including
documentation of what was told to the patient and his or
her response. However, before this, the EMT should have
persuaded the patient to receive care and then made certain
that the patient is indeed mentally competent and capable
of making rational decisions. When in doubt, ask for
medical direction.
• Advanced Directives: these are instructions given in
advance such as a DNR (Do Not Resuscitate) order. These
directions should be honored if clear, unambiguous
documentation exists.
• Confidentiality: laws exist that protect a patient's privacy.
The HIPAA (Health Insurance Portability and

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Accountability Act) of 1996 is a federal law that protects

the confidentiality of patient health care information.
HIPAA training is required for all EMTs. As a general rule,
do not disclose information obtained during emergency
care to family, friends, or anyone else.
• COBRA and EMTALA: The Consolidated Omnibus
Budget Reconciliation Act and the Emergency Medical
Treatment and Active Labor Act prevents hospital
discrimination of emergency patients based on the ability or
inability to pay. All patients should be transported to the
nearest medical facility regardless of their ability to pay.
Always obtain the proper documentation when transferring
patients between facilities.
• Crime Scenes: when treating patients in a crime scene,
always take steps to preserve evidence. These include
communicating with police officers, document unusual
discoveries, avoid cutting through evidence such as knife or
bullet holes in clothing, and ask the patient to avoid
washing or going to the bathroom if the crime is rape.
• Reporting: If patient assessment suggests child abuse or
crime, report to the appropriate authorities.
Offenses
• Tort: a wrongful act, injury, or damage. Negligence is an
example of a tort.
• Intentional Tort: a tort that is committed knowingly.
Examples include abandonment, assault, battery, false
imprisonment, and defamation.
• Negligence: occurs when all four of the following
conditions are met

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

1. The EMT had a duty to act.

2. The EMT breached that duty.
3. Harm or damages were caused to the patient.
4. The harm or damages were caused by the breach of
duty.
• Abandonment: When an EMT begins treating a patient, but
stops without transferring the care to someone with
appropriate expertise.
• Assault: can occur as an act or a threat to inflict harm on a
patient.
• Battery: the act of touching a patient without consent.
• False Imprisonment: keeping and transporting the patient
without consent.
• Defamation: Release of damaging information about a
patient to the public. Verbal defamation is called slander,
and the written form is called libel. The best way to avoid
defamation is to maintain patient confidentiality at all
times.
Ethical Responsibilities
• Treat all patients with dignity and respect without respect
to factors such as race, gender or creed.
• Treat all coworkers and health care workers with dignity
and respect.
• Maintain knowledge and skill competencies as an EMT.
• Exercise honesty and integrity when documenting.
• Advocate for the patient's best interest at all times, even
off-duty.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Good Samaritan Laws exist to protect an off-duty EMT

from liability when he or she provides care to patients out
of ethical responsibility.
Lesson 1-4 The Human Body
Body Positions
• Supine: Lying face up.
• Prone: Lying face down.
• Lateral Recumbent: Lying on his or her side. Can be left or
right lateral recumbent.
• Fowler's Position: Lying as in a reclining chair, with upper
body elevated at a 45 to 60 degree angle.
• Semi-Fowler's Position: Similar to a Fowler's Position, but
with the upper body elevated below a 45 degree angle.
• Trendelenburg Position: Lying supine with feet elevated
above the head.
• Shock Position: Lying supine with feet elevated
approximately 12 inches.
Anatomical Planes
Left and right (From the patient's point of reference)
• Midline, Midspinal line, and the Sagittal Plane: Vertical
line through the center of the body that divides left and
right. The midline intersects the nose and navel on the front
of the body. The midspinal line runs parallel to the spine on
the back of the body. The sagittal plane includes both the
midline and the midspinal line and divides the body into
left and right planes.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Midclavicular and Midscapular: Between the midline and

the outer side of the body (between the midline and the
armpit). Midclavicular is a vertical line bisecting the
clavicle (collarbone) on the front of the body, and
midscapular is a vertical line bisecting the scapular
(shoulder blade) on the back of the body.
• Medial and Lateral: Towards or away from the midline
(towards the middle or to the sides).
o Bilateral: both sides

o Unilateral: one side

o Ipsilateral: same side

o Contralateral: opposite side

Anterior and Posterior (Front and back)

• Ventral and Dorsal: Same as anterior and posterior.
• Midaxillary Line and Frontal Plane: Vertical line
intersecting the armpit and the ankle that divides the body
into anterior and posterior. The frontal plane includes the
•

• midaxillary line and divides the body into anterior and

posterior planes.
• Anterior Axillary Line: Vertical line between the
midaxillary line and the outer anterior (nipples).
• Posterior Axillary Line: Vertical line between the
midaxillary line and the outer posterior (back).
Superior and Inferior (Above and below )
• Transverse Line and Plane: Horizontal line at the waist that
divides the body into superior and inferior (above and

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

below). The transverse plane includes the transverse line

and divides the body into superior and inferior planes.
Other Designations
• Proximal or Distal: Near or far from the point of reference.
• Plantar and Palmar: Plantar refers to the soles of the feet
and palmar refers to the palm of the hand.
• Quadrants: From the patient's perspective, the four regions
of the abdomen. LUQ (left upper quadrant), LLQ (left
lower quadrant), RUQ (right upper quadrant), and RLQ
(right lower quadrant).

The Musculoskeletal System

• Includes muscle, bone, tendons (connecting muscle to
bone) and ligaments (connecting bone to bone).
• Functions include structural, protection, motion, mineral
storage and blood cell production. Bone injuries can result
in substantial blood loss (1-2 L from a fractured femur and
up to 2 L from a fractured pelvis).
• Refer to any anatomy text for detailed nomenclature.
The Muscular System
• Skeletal Muscle: Striated, voluntary, can be consciously
controlled. Also called skeletal muscles.
• Smooth Muscle: Smooth, involuntary, cannot be
consciously controlled.
• Cardiac Muscle: Striated, branched, involuntary.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

The Skeletal System

• Consists of six basic components: The skull, spinal column,
thorax, pelvis, upper extremities (arms), and lower
extremities (legs).
The Skull
• Cranium: brain case. Encloses the cranial cavity. Contains
flat bones.
o Occipital: back of the head.

o Parietal: the upper sides.

o Temporal: the temples.

o Frontal: forehead.

• Face: irregular bones

o Orbits: eye sockets.

o Nasal Bones: nose bed.

o Maxillae: upper jaw.

o Zygomatic: cheek bones.

o Mandible: lower jaw.

The Spinal Column

• Vertebrae: irregular bones that make up the spinal column.
33 vertebrae intercalated with intervertebral discs make up
the spinal column, which is divided into 5 parts.
o Cervical: the neck consists of 7 vertebrae C1-C7.

o Thoracic: upper back consists of 12 vertebrae T1-T12.

The 12 thoracic ribs are attached here.

o Lumbar: lower back consists of 5 vertebrae L1-L5.

These are the least mobile.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Sacral: back wall of pelvis consists of 5 fused

vertebrae S1-S5.
o Coccyx: tailbone consists of 4 fused vertebrae.
The Thorax
• The ribs: there are 24 ribs arranged into 12 pairs, which are
attached at the back to the 12 thoracic vertebrae.
o True ribs: the first 7 pairs attached at the front to the

sternum.
o The next 3 pairs attach at the front to the true ribs.

o False ribs: last 2 pairs are not attached at the front.

Also called floating ribs.

• Sternum: breastbone.
o Manubrium: the superior portion of the sternum that

attaches the clavicle.

o Body: the middle portion of the sternum that attaches

the ribs.
o Xiphoid process: the inferior portion of the sternum.

The Pelvis
• Sacrum and coccyx: the back of the pelvis.
• Ilium: from the Iliac crest (the "wings" on the sides of the
pelvis) to the formation of the acetabulum.
• Acetabulum: socket for hip joint.
• Ischium: the lower back portion. Supports weight while
sitting.
• Pubis: the lower front portion. Area of the genitals. The left
and right sides are joined at the pubic symphysis.
The Upper Extremities

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Consists of the upper limbs from the shoulder to the

fingers.
• The Clavicle, Scapula, and the Acromion: the collar bone
(clavicle) and the shoulder blade (scapula) forms the
pectoral (shoulder) girdle, which connects the upper limb.
The acromion, or acromial process is the tip on top of the
shoulder.
• The Humerus: the head of the humerus fits in the ball and
socket joint of the shoulder. The distal end of the humerus
ends at the hinge joint of the elbow.
• Olecranon: the elbow, formed by the proximal end of the
ulna.
• The Radius and Ulna: from the elbow, two bones form the
forearm. The radius is on the thumb side (lateral with palm
facing the front) and the ulna is on the pinky side (medial).
Both bones end at the wrist joint.
• Carpals, Metacarpals and Phalanges: makes up the hand
from the wrist (carpals) to the hands (metacarpals) to the
fingers (phalanges).
The Lower Extremities
• Consists of the legs from the hip to the toes.
• Femur: the head of the femur fits into the acetabulum
socket in the hip. The femur ends at the patella (the knee).
• Patella: kneecap.
• Tibia and Fibula: The bones of the lower leg. The tibia is
larger of the two and forms the shin, the distal end of which
forms the medial ankle. The fibula is parallel and lateral to
the tibia, the distal end of which forms the lateral ankle.
• Malleolus: the ankle knob. Can be medial or lateral.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Calcaneus: heel bone

• Tarsals, Metatarsals and Phalanges: makes up the foot from
the ankles (tarsals) to the foot (metatarsals) to the toes
(phalanges).
Joints
• Motion
o Flexion and Extension: bending (flexing) and

straightening (extending).
o Adduction and Abduction: movement toward (adduct)

and away from (abduct) the midline.

o Circumduction: circuluar movement. Includes all the

above motion.
o Supination and Pronation: turning the forearm to make

the palm face the front (supination) or the back

(pronation).
• Structure
o Ball-and-Socket: circular in shape, allows for

circumduction, the widest range of motion. Examples

include the shoulder and hip.
o Hinged Joint: shaped like a door hinge, allows for

flexion and extension. Examples include the elbow,

knee and finger.
o Pivot Joint: semi-circular ring shape, allows for

turning motion. Examples include the C1-C2 vertebrae

and the wrist.
o Gliding Joint: planar in shape, allows for sliding

motion. Examples include the small bones in the

hands and feet.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Saddle Joint: saddle (reciprocal concave-convex) in

shape, allows for limited circumduction without axial
rotation. An example include the carpal-metacarpal
joint of the thumb.
o Condyloid Joint: ovular in shape, allows for limited
circumduction without axial rotation. An example
include the wrist.

The Respiratory System

• The Nose and Mouth: air enters here. The nasal cavity
filters, warms and moistens incoming air.
• The Pharynx: the mouth leads to the oropharynx and the
nose leads to the nasopharynx. Both merge in the throat and
then separate into either the esophagus (for food to enter
the stomach) or the trachea (for air to enter the lungs).
• The Epiglottis: flap of cartilage that protects the trachea
from food during swallowing.
• The Larynx: houses the vocal cords, which is protected by
the thyroid cartilage (Adam's apple). The most inferior part
of the larynx is the cricoid cartilage (ring of cartilage).
• The Trachea: the wind pipe, which branches into two
bronchi.
• The Bronchi, bronchioles and Alveoli: the left and right
bronchi further branches into bronchioles, which end in
sacs of alveoli. Gas exchange takes place across the surface
of the alveoli.
• The Lungs: organ for gas exchange, which houses all of the
alveoli. The lung is lined with connective tissue called the
visceral pleura, which is in turn surrounded by the parietal

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

pleura. This double membrane creates an intermembrane

space called the pleural cavity with negative pressure that
keeps the lung from collapsing.
• The Diaphragm and Intercostal Muscles: muscles for
breathing. The diaphragm is the dome shaped muscle
beneath the lungs. Pulls down when contracting to create
the negative pressure required for breathing. The intercostal
muscles are the muscles between the ribs that expand the
rib cage when contracting, which creates the negative
pressure in the lungs required for breathing.
Notes on Respiration
• Adequate rate of breathing
o 12-20 breaths per minute for a typical adult, 20-22 for

the elderly, 15-30 for children, and 25-50 for infants.

o Effortless.

o Regular in rhythm.

o Clear of unusual sounds.

o Adequate tidal volume (chest rise, breathing sounds).

• Inadequate breathing
o unusual rate

o strained (nasal flaring, use of accessory muscles,

"seesaw" movement in infants, head bobbing due to

fatigue, gasping, grunting in newborns)
o irregular

o unusual breath sounds (airway obstruction)

o Inadequate tidal volume (unusual breath sounds,

inadequate or irregular chest expansion,

• Infants have:

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Smaller nose, mouth, and narrower airway: more

easily obstructed.
o Proportionally larger tongue: can obstruct airway.
o Softer cricoid cartilage: cricoid pressure will not help
intubation.
o Rely more on diaphragm for breathing: movement of
the abdomen as signs for respiratory distress rather
than chest movement in adults.

The Circulatory System

The Heart
• Cardiac muscle, contracts by itself, has its own pacemaker.
involuntarily regulated by the autonomic nervous system.
Consists of four chambers: left and right atria and
ventricles. Valves (Tricuspid, pulmonary, mitral, aortic)
exist to prevent the backflow of blood.
The Circulation
• Superior and Inferior Vena Cava: deoxygenated blood from
the body enters the heart via these veins.
• Right Atrium: deoxygenated blood first enters into this
chamber.
• Tricuspid Valve: valve preventing backflow between right
atrium and right ventricle.
• Right Ventricle: deoxygenated blood gets pumped to the
lungs here.
• Pulmonary Valve: valve preventing backflow between right
ventricle and pulmonary artery.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Pulmonary Artery: deoxygenated blood flows to the lungs

via this artery.
• Lungs: gas exchange occurs here.
• Pulmonary Veins: oxygenated blood carried to the heart via
this vein.
• Left Atrium: oxygenated blood first enters this chamber.
• Mitral Valve: valve preventing backflow between left
atrium and left ventricle. Also called the bicuspid valve.
• Left Ventricle: oxygenated blood gets pumped to the body
here.
• Aortic Valve: valve preventing backflow between left
ventricle and the aorta.
• Aorta: oxygenated blood flows to the rest of the body via
this artery.
• With the exception of pulmonary arteries and veins, all
arteries carry oxygenated blood and all veins carry
deoxygenated blood.
• Blood Pressure: force exerted on walls of the artery.
o Systolic: during ventricular contraction.

o Diastolic: during ventricular relaxation.

• Hydrostatic Pressure: caused by blood pressure and volume

that influences fluid migration across capillary walls. High
hydrostatic pressure pushes fluid out of capillaries causing
edema (swelling in tissues).
• Perfusion: the delivery of oxygen and other nutrients to
cells and wastes away from them. Adequate perfusion
depends on adequate blood circulation.
• Hypoperfusion: also called shock, is inadequate perfusion.
Can be caused by large loss of blood volume.
• Gas transport

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Oxygen: 97% bound to hemoglobin, 3% dissolved in

plasma.
o Carbon Dioxide: 70% as bicarbonate ion, 23%
attached to hemoglobin, 7% dissolved in plasma.
The Arteries and Pulses
• Aorta: the largest artery in the human body, carries freshly
oxygenated blood directly from the heart.
• Coronary Arteries: supplies the heart.
• Carotid Arteries: supplies the brain. Pulse on sides of the
neck.
• Femoral Arteries: supplies the groin and legs. Pulse on the
groin.
• Dorsalis Pedis Arteries: supplies the dorsal surface of the
foot. Pulse on top of the foot.
• Posterior Tibial Arteries: supplies the posterior leg and the
plantar foot. Pulse between the medial ankle and heel
(posterior to the medial malleolus).
• Brachial Arteries: supplies the arm. Pulse between elbow
and armpit.
• Radial Arteries: supplies the hand, wrist and forearm. Pulse
on the wrist proximal to the thumb.
• Pulmonary Arteries: the only artery to carry deoxygenated
blood. Carries deoxygenated blood to the lungs.
Other Blood Vessels
• Arterioles: the smallest artery. Branches off from arteries.
Supplies blood to the capillaries.
• Capillaries: the smallest blood vessels with walls the
thickness of a single-cell.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Venules: the smallest veins. Merge into veins.

• Veins: carries blood back to the heart.
Blood
• Red Blood Cells: carry oxygen, contains hemoglobin.
• White Blood Cells: part of the immune system to fight off
infection.
• Platelets: responsible for clot formation.
• Plasma: the liquid part of the blood. Contains albumin to
maintain osmotic gradient.

The Nervous System

The Central Nervous System
• Brain
o Cerebrum: largest, outermost portion, responsible for

memory, thinking, and voluntary control.

o Cerebellum: small lobe on the back of the head below

the cerebrum, responsible for muscle coordination and

balance.
o Brainstem: Includes the mesencephalon, the pons, and

the medulla oblongata. The medulla is responsible for

respiratory, cardiac and vasomotor (blood vessel
dilation or constriction) control.
• Spinal Cord: an extension of the brain stem that ends at the
L2 vertebrae. responsible for conducting nerve impulses to
and from the brain.
The Peripheral Nervous System

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Voluntary: controls skeletal muscles.

• Autonomic: controls smooth muscles and regulates cardiac
muscles.
o Sympathetic: prepares for fight or flight.

o Parasympathetic: normal body function, relaxing.

The Endocrine System

• Pituitary: master gland that regulates the activity of other
glands. Located at the base of the brain.
• Thyroid: regulates metabolism, growth and development.
Produces calcitonin, which deposits calcium from blood to
bone. Located in the anterior neck.
• Parathyroid: produces parathyroid hormone that
metabolizes bone calcium and phosphorous. Located
behind the thyroid.
• Adrenal: secretes epinephrine (adrenaline) and
norepinephrine. Also secretes other hormone that regulates
kidney function and conserves water in the body. Located
above the kidneys.
• Gonads: produces sex hormones (ovaries produce estrogen
and testes produce testosterone).
• Islets of Langerhans in the Pancreas: produces glucagon
(increase blood sugar level) and insulin (decrease blood
sugar level).

The Skin
• Three Layers

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Epidermis: outermost, contains dead and dying cells

and melanin (skin color pigment).
o Dermis: below epidermis, thicker, contains blood

vessels, hair follicles, sweat and oil glands and nerves.

The connective tissue present here gives skin its
strength and elasticity.
o Subcutaneous Layer: deepest layer, contains fatty

tissue.
• The largest organ in the body
• Protection from environment and pathogens
• Sensory: heat, cold, touch, pain and pressure.
• Regulation of water and electrolytes by sweating.

The following body systems are beyond the required curriculum

for an EMT.
The Digestive System
• Mouth: mechanical digestion starts by chewing. Limited
chemical digestion of starch.
• Stomach: hollow sac of muscle, lined on the inside with
mucus. Secretes acidic gastric juices. Starts chemical
digestion of food.
• Pancreas: produces enzymes and secrete them in pancreatic
juices.
• Liver: produces bile to emulsify fats. Participates in
metabolism of toxic substances.
• Spleen: no function
• Gallbladder: stores bile made by the liver.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Small Intestine: chemical digestion and nutrient absorption

site. Consists of the duodenum, jejunum, and ileum.
• Large Intestine: water absorption site.
Urinary System
• Kidneys: blood filtration. Makes urine.
• Ureter: carries urine from kidneys to the bladder.
• Bladder: stores urine.
• Urethra: carries urine from the bladder to outside of the
body.
Reproductive System
• Female
o Ovaries: stores immature ovum. An ovum matures

every month and is released to the fallopian tubes.

o Fallopian Tube: site of fertilization. Carries mature

ovum to the uterus.

o Uterus: Fertilized egg (zygote) implants here. Embryo

develops here.
o Vagina: Babies are delivered through the vagina.

• Male
o Testes: makes sperm.

o Epididymis: stores mature sperm.

o Vas Deferens, Ejaculatory Duct, Urethra and Penis:

Transports ejaculated sperm.

Response to Epinephrine and Norepinephrine

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Alpha 1: vasoconstriction of skin blood vessels, stimulates

sweat glands. Causes skin to become cool, pale and
clammy.
• Alpha 2: regulate the release of Alpha 1.
• Beta 1: increase the heart's rate, force of contraction, and
speed of impulse conduction.
• Beta 2: cause smooth muscles to dilate, especially in the
bronchioles.
Metabolism
• Aerobic: when oxygen level is adequate, the cells utilize
oxygen for metabolism and generate carbon dioxide water.
This is the most efficient form of metabolism and occurs
during adequate perfusion.
• Anaerobic: when oxygen level is inadequate, the cell
undergo metabolism without oxygen to generate lactic acid,
which is toxic if allowed to accumulate. Anaerobic
metabolism is inefficient and occurs during inadequate
perfusion.
aseline Vital Signs
• The first set of vital signs measured on a patient.
Vital Signs and Measurements
• Breathing: observing chest rise and fall. Count the number
of breaths in 30 sec. Multiply by 2 for breaths per min.
• Pulse: palpate the artery with the index and middle finger
tips. Count the number of beats in 30 sec. Multiply by 2 for
beats per min.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Skin: observing color, feel for temperature and condition

using the back of your hand without glove covering, and
measure capillary refill by depressing on the patient's nail
bed and observe for return of color.
• Pupils: observe size and reaction to penlight.
• Blood Pressure: Taken using a sphygmomanometer and a
stethoscope.
• Pulse Oximetry: Measured using a pulse oximeter.
Normal Vital Signs
• Breathing
o 12-20 per min for adults. 20-30 for small children. >30

for infants and newborns.

o Adequate chest expansion (1 in.).

o Clear and effortless.

• Pulse
o 60-80 per min for adults. Faster for children and the

elderly.
o Strong and regular.

• Skin
o Pink (palm and sole), Warm and dry.

o Fast Capillary refill (under 2 sec male adults and

children, 3 for females, and 4 in the elderly).

• Pupils
o Normal and equal in size.

o Respond to light.

• Blood Pressure: 120 / 80 (systolic / diastolic) in adults.

Higher in the elderly and lower in children.
• Pulse Oximetry: 97-100%

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Detailed Vital Signs and Symptoms

Breathing

Detailed Normal Rates of Breathing

Rate per
12-20 15-30 20-30 25-40 30-60
min
Age 11+ 6 - 10 6 months - 30 days - 5 0 - 30
group years years 5 years months days

• Shallow breathing: inadequate chest or abdominal wall

(children) expansion.
• Labored breathing: use of accessory muscles.
• Noisy breathing Snoring: tongue obstruction of the upper
airway at the pharynx. Wheezing: constriction of the
bronchioles. Gurgling: fluid in the upper airway. Crowing
or Stridor (harsh high pitched sound): obstruction of the
upper airway at the larynx.
Pulse

Slow Rapid
Normal
Patient (bradycardia) if (tachycardia) if
(at rest)
below above
Adult 60 60-80 100
Elderly 90
Adolescent 50 60-105 105
Child (5-12
60 60-120 120
years)
Child (1-5
80 80-150 150
years)

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Infant 120 120-150 150

Pulse characteristic Possible problems / diagnosis

Normal rate, regular rate,
Normal person at rest
and strong (full) pulse
Exertion, fright, fever, high
Rapid, regular and strong blood pressure, initial response
to injury and bleeding
Rapid, regular and weak
(also called regular and Indication of shock
thready)
Head injury, drug use
(barbiturate or narcotic),
Slow
poisons, possible cardiac
problem
No pulse Cardiac arrest
Pulsus paradoxus
Severe cardiac or respiratory
(decrease in pulse strength
injury, illness or blood loss
during inhalation)

• Pulses can be located in the major arteries- Carotid (neck),

Femoral (groin), Radial (wrist), Brachial (arm), Popliteal
(behind knee), Posterior Tibial (ankle), Dorsalis Pedis
(foot).
Skin
• Temperature
o Hot: fever, exposure to heat, localized infection.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

oWarm: normal.
o Cool: inadequate circulation, shock, or exposure to

cold.
o Cold: extreme exposure to cold.

• Condition
o Abnormally Dry: severe dehydration or spinal injury.

o Dry: normal.

o Wet or Moist: shock, or heat, cardiac, or diabetic

emergencies.
o Clammy (cool and wet / diaphoretic): indication of

shock.
• Color
o Pale or mottled: onset of shock.

o Cyanotic: late sign of shock.

o Red: anaphylactic or vasogenic shock, poisoning,

overdose or other medical condition.

o Yellow: jaundice, liver problems.

• Capillary Refill: more reliable for children under 6.

o Slow cap refill = possible hypoperfusion.

Pupils
• Dilated: cardiac arrest, use of stimulant drugs like cocaine,
amphetamine, LSD.
• Constricted: central nervous system disorder, use of
narcotics.
• Unequal: Stroke, head injury, artificial eye, eye drops.
• Nonreactive: Cardiac arrest, brain injury, drug influence.
Blood Pressure

Normal blood pressures

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Patient Systolic (mmHg) Diastolic (mmHg)

Adult Male 100 + age up to 40 60-85
Adult female 90 + age up to 40 60-85
Adolescent 90 and above 2/3 systolic
Child (1-10 yrs) 80 + (2 x age) +/- 10 2/3 systolic
Infant (1-12 mo) 70 and above 2/3 systolic

• Hypertension: high blood pressure in an adult is considered

over 140 / 85.
• Pulse pressure: the difference between systolic and
diastolic pressure. Normally falls between 25 % and 50 %
of systolic pressure.
• Narrow (low) pulse pressure: shock, cardiac tamponade
(blood filling the pericardial sac, compressing the heart),
tension pneumothorax (injury to one lung, causing pressure
on the heart and the other lung).
• Wide (high) pulse pressure: head injury.
• Measuring blood pressure: Using a sphygmomanometer
(wrapped around the arm), applying pressure (by pumping)
over the brachial artery until a radial pulse can no longer be
detected. Over pump 30 mmHg, then slowly release the
pressure. Detect for a return of pulse by either auscultation
or palpation.
• Auscultation: listening with a stethoscope for the return of
the brachial pulse. The first sound marks the systolic
pressure and the last sound (either a disappearance or a
notable drop in volume) marks the diastolic pressure.
• Palpation: palpating for the radial pulse. When the radial
pulse returns, this is the systolic pressure. The palpation
technique cannot measure diastolic pressure (a "P" is noted

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

in place of the diastolic pressure). The systolic pressure

measured is approximately 7 mmHg lower than those
obtained by auscultation.
• Do not over pump more than what is needed- it can be very
painful for the patient.
• Orthostatic Vital Signs Test (Tilt Test): Measures heart rate
and blood pressure for a patient while supine and while
standing up. A positive result occurs when the heart rate
increases 10-20 bpm and the blood pressure decreases 10-
20 mmHg up standing up. This indicates significant blood
loss.
Pulse Oximetry
• Measured over the tip of the index finger, can detect
hypoxia, which can be treated by applying oxygen via a
nonrebreather mask.
• Limitations: Directly measures hemoglobin saturation, not
oxygen level. Therefore, false readings can occur during
carbon monoxide poisoning. Errors in reading can also
occur from nail polish and excessive finger movement.

Vital Sign Reassessment

• Stable patients: every 15 min
• Unstable patients: every 5 min
The SAMPLE History
Medical history obtained from the patient, family and
bystanders

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Signs and Symptoms

o Signs: what you can observe and measure about the

patient, such as the vital signs.

o Symptoms: what the patient describes to you- pain,

numbness...etc. You cannot observe these, so you

must ask OPQRST
▪ Onset: "what were you doing when it started?"

▪ Provocation or Palliation: "does anything make it

worse? Anything makes it better?"

▪ Quality of pain: "can you describe it to me? Is it

sharp, dull, constant, intermittent?"

▪ Region and Radiation: "where exactly does it

hurt? Does the pain extend anywhere else?"

(Myocardial infarction produces pain that
radiates to the arms and jaw)
▪ Severity: "on a scale of 1 to 10, how much does it

hurt?"
▪ Time: "how long has this been going on? How

has this progressed over time?"

• Allergies: "Do you have any allergies?" This includes
medication, food, or other environmental factors. Check for
medical alert tags.
• Medications: "Are you on any medications? Have you
taken medications recently?" This includes prescriptions,
over-the-counter, birth control pills, illicit drugs (be tactful,
indicate that you are not an EMT, not a police officer, and
you need the information for treatment purposes), or herbal
medicine. Look for medical tags.
• Pertinent past history: "Have you ever had any illnesses?
Operations? Have you ever been admitted to a hospital?"
Find out medical problems and past surgical procedures.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Last oral intake: "When did you last eat or drink

something? What was it?" A diabetic patient who hasn't
consumed anything for 8 hours may be hypoglycemic.
• Events leading up to the injury or illness: "What happened?
How did this happen?" The events leading up to the injury
provide clues for the underlying cause.
Document all pertinent findings from the SAMPLE history
on the PCR (Prehospital care report)

Lesson 1-6 Lifting and Moving Patients

Body Mechanics
• The safest and most efficient way to use your body as to
prevent injury.
• Lifting and moving
o Reposition before lifting to avoid awkward positions.

o Keep the body stacked and straight. Avoid twists and

awkward positions.
o Keep weight as close to the body as possible.

o Never use your back muscles to lift (Use legs, hip, and

butt muscles with the abdominal muscles tensed).

• Proper posture: stand and sit with the back straight. The
ears, shoulders, and hips are in vertical alignment.
• Kyphosis: slouch. Hunched back.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Lordosis: swayback. Lumbar deformation causing stomach

too anterior and buttocks too posterior.
General Lifting and Moving
• The Power Lift: use of body mechanics. With the back
straight, feet apart and abs tensed, lifting is done from the
waist down. A firm "power grip" is used.
• The Power Grip: palms and fingers come in complete
contact with the object (gripping, not hooking).
• The Squat Lift: same as power lift but with one foot (the
weaker foot) slightly forward.
• One-Handed Carrying Technique: Back straight and
locked. Do not lean more than necessary to balance. Use
below the waist for lifting.
• Reaching: reach no more than 15-20 inches in front of the
body.
• Pushing and Pulling: if possible, always push. Back
straight, hands between waist and shoulders.
Emergency Moves
• Characteristics of emergency moves
o Fastest

o No spinal stabilization

o Performed when the scene is not safe, and there is an

immediate danger to both the patient and the rescuer.

• The Armpit-Forearm Drag: position behind the patient,
reach through and under their armpits, grab their forearms,
and then drag.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• The Shirt Drag: fasten the patients' hands or wrists

together, and then drag their shirt by the shoulders. Does
not work for T-shirts.
• The Blanket Drag: wrap a blanket beneath the patient, and
then drag the blanket at the patient's head.
Urgent Moves
• Characteristics of urgent moves
o Fast

o Spinal immobilization

o Performed when the scene is safe, but there is an

immediate threat to the patient's life. Common in car

accidents.
• Rapid Extrication: Getting a patient out of a car onto a
backboard while providing constant spinal immobilization.
Nonurgent Moves
• Characteristics of nonurgent moves: scene safe, patient
stable.
• If possible, and when in doubt, always suspect spinal injury
and provide full spinal immobilization onto a backboard
before moving. For example, a patient out of a car crash
should always be immobilized even if he or she appears
well. Use the techniques below only if there is no spinal
injury.
• Direct Ground lift: two or more rescuers lifting a patient
from the side (the way you would cradle a baby).
• Extremity Lift: two rescuers lifting the patient by the
extremities. One rescuer in the armpit-forearm drag
position and the other holding the patient behind the knees.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Direct Carry: similar to the direct ground lift, except that

you carry instead of lifting because the patient is not on the
ground.
• Draw Sheet: similar to a blanket drag. The rescuers drag
sideways the bedsheet beneath the patient so that both the
bedsheet and the patient is moved.
Carrying Devices
• Stretcher: a bed-like device for transportation of patients.
o Wheeled Stretcher: a stretcher with wheels.

Commonly seen in the ER, where the patient is pushed

around on beds with wheels.
o Portable Stretcher: a light stretcher without wheels.

o Scoop Stretcher: a stretcher that can split apart to

scoop up the patient on the ground from either side.

o Basket Stretcher: a stretcher with protective guards

around the circumference (like a boat).

o Flexible Stretcher: a stretcher that is flexible and can

fold.
o Bariatric Stretcher: a stretcher that can support up to

1600 pounds. For very large patients.

• Stair Chair: a chair with handles to carry a sitting patient.
• Backboard: a hard board used for spinal immobilization.
Equipped with hand holds and belts to fasten the patient.
Can float in water.
• Full Body Vacuum Mattress: a rigid mattress upon the
application of a vacuum. Can provide surface for spinal
immobilization.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• KED (Kendrick Extrication Device): a short backboard that

provides full spinal immobilization. Can be applied when
the patient is in a sitting position.
Lesson 1-7 Evaluation: Preparatory Module

MODULE 2: AIRWAY
Lesson 2-1 Airway
Teaches airway anatomy and physiology, how to maintain an
open airway, pulmonary resuscitation, variations for infants and
children and patients with laryngectomies. The use of airways,
suction equipment, oxygen equipment and delivery systems, and
resuscitation devices will be discussed in this lesson.
Lesson 2-2 Practical Skills Lab: Airway
Provides supervised practice for students to develop the
psychomotor skills of airway care. The use of airways, suction
equipment, oxygen equipment and delivery systems, and
resuscitation devices will be included in this lesson.
Lesson 2-3 Evaluation: Airway Module
Conduct a written and skills evaluation to determine the
student's level of achievement of the cognitive, psychomotor and
affective objectives from this module of instruction.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Lesson 2-2 Practical Skills Lab: Airway

Lesson 2-3 Evaluation: Airway Module

MODULE 3: PATIENT ASSESSMENTMODULE 3:

PATIENT ASSESSMENT
Steps to follow
1. BSI.
2. Scene safe.
3. MOI / NOI.
4. Number of patients.
5. Additional resources.
BSI
• BSI = Body substance isolation.
• Gloves: always wear them.
• Eye protection: protect eyes from body fluids for cases with
active bleeding.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Surgical mask.
• HEPA or N-95 mask: for tuberculosis protection.
• Gown.
• Helmet.
• Turnout gear.
Scene safe
• Never enter an unstable crash scene.
• Traffic safety and control.
o limit exposure to traffic.

o control traffic with flares or cones.

o wear reflective clothing.

o turn the wheels of your parked vehicle to point away

from the scene (if someone crashes into it, you won't
get run over by your own vehicle).
• Do not enter active crime scenes until it is under control by
law enforcement. Take extra precautions if you suspect
crime, or simply call for law enforcement.
• Take precautions for unstable surfaces and slopes.
• Ice: treat with sand, salt or gravel.
• Frozen lakes surfaces may break.
• Water: wear flotation device. Open water and moving
water rescues require specialized training.
• Toxic substances / low oxygen caused by:
o Spill, leak, or fire.

o Confined spaces such as caves require SCBA (self-

contained breathing apparatus).

o Suspect toxic environment if everyone in the area

suffer from similar symptoms.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Scene control: tell crowds to step back. Introduce yourself

to patients and always ask for their consent to any
treatment. Be courteous, let patients know you are here to
help.
• Maintain an escape route.
• If a scene turns hazardous at any point, leave.
MOI / NOI
• MOI = Mechanism of injury. For trauma patients.
• NOI = Nature of illness. For medical patients.
• Index of suspicion: your judgment of whether and how
severely the patient is injured.
• The MOI is the basis for you index of suspicion.
• High index of suspicion for trauma patients include:
o Falls.

o Crashes and collisions.

o Explosions.

o Violence.

o Burns.

• Look for signs and symptoms.

Number of patients
• Estimate the total number of patients involved. If it's more
than your unit can handle, call for backup.
Additional resources
• Can your unit handle this? If not, call for additional
resources.
• Additional EMS units.
• Law enforcement.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Fire department.
• Hazmat team.
Lesson 3-2 Initial Assessment
1. General impression
2. Mental status
3. ABCs
4. Establish priorities

General impression
• Manage immediate life threats:
o Check for airway compromises such as airway obstruction. Open their airway.
o Look for breathing abnormalities such as paradoxical movement a segment of the
chest. Provide PPV and O2.
o Control circulation problems such as major bleeding and open wounds. Direct
pressure on open wounds.
• Chief complaint: "why did you call EMS today?"
• Trauma or medical.
• C-spine for trauma patients with a high index of suspicion.

Mental status
• AVPU
• A = alert. Can talk to you normally.
• V = responds to verbal stimulus. Attempts to respond when you talk to him or her.
• P = responds to painful stimulus.
o Central stimuli
▪ Trapezius pinch: pinch between the neck and shoulder.
▪ Supraorbital pressure: press up on the upper ridge of the eye socket.
▪ Sternal rub: rub the center of the sternum with knuckles.
▪ Armpit pinch: pinch the margin of the armpit.
o Peripheral stimuli
▪ Nail bed pressure.
▪ Pinch the thumb-index finger web.
▪ Pinch the finger, toe, hand, or foot.
• U: unresponsive.
• Nonpurposeful movements
o Flexion posturing: aka decorticate posturing. Patient arches back and flexes arms
inwards. Upper brain stem compression.
o Extension posturing: aka decerebrate posturing. Patient arches back and extends
arms extends arms straight and parallel to the body. Lower brain stem
compression.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Altered mental status: Not alert, but not completely unresponsive either. Responds to
either verbal or painful stimuli.
• Open and protect the airway and administer oxygen to unresponsive or altered mental
status patients.

ABC
• Airway
o Alert and talking or crying patients have patent airway.
o Altered mental status or unresponsive patients cannot protect their airway. You
need to open their airway.
o Snoring patients: perform head-tilt chin-lift or jaw thrust, insert airway adjuncts.
o Gurgling patients: suction.
o Crowing and stridor: administer oxygen and artificial ventilation.
o ... read more on airway techniques
• Breathing
o Is the patient breathing at all? If not, give two artificial ventilations then check for
pulse.
o If breathing, is the breathing adequate (rate and volume)?
o Are there breath sounds and chest rise and fall?
o Look for signs of breathing difficulties such as retractions, use of accessory
muscles, nasal flaring, hypoxia and shock signs.
o Does the pulsox vital sign read above 95%?
o Treat inadequate breathing / hypoxia with oxygen administration and artificial
ventilation.
o ... read more on breathing
• Circulation
o Pulse: Is there a pulse at all? Check the carotid pulse if no radial pulse is felt.
o No breathing, no pulse = begin CPR: 5 cycles of 30/2 compressions/ventilations
followed by AED.
o If you just witnessed the cardiac arrest, apply AED immediately.
o Is the pulse rate normal? Is the quality strong and regular?
o Check for possible major bleeding: are there open wounds? Control any major
bleeding (spurting arterial or fast flowing venous blood).
o Assess perfusion: is the patient in shock? Shock = cool and clammy skin that
appears pale, mottled or cyanotic.
o Check skin:
▪ Pale or mottled: onset of shock.
▪ Cyanotic: late sign of shock.
▪ Red: anaphylactic or vasogenic shock, poisoning, overdose or other
medical condition.
▪ Yellow: jaundice, liver problems.
▪ Cool and clammy: shock.
▪ ... read more on skin vital signs

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Establish priorities
• Is the patient in an unstable or stable condition?
o Unstable: significant MOI, altered mental status, high index of suspicion.
▪ Vehicle crash involving death of a passenger, ejection from vehicle,
rollover or high speed collision.
▪ Vehicle striking pedestrian.
▪ Fall of 15 feet or 3 times patient height (For a child it's 10 feed and 2 times
height).
▪ Trauma resulting in altered mental status.
▪ Penetrating injuries to the head, neck, chest or abdomen.
▪ Explosions and collisions.
▪ Seat-belt injuries.
o Stable: no significant MOI, alert and orientated, low index of suspicion.
• For unstable patients, go for the rapid trauma/medical assessment. It's a "load and go"
situation. During ongoing assessment, you need to reassess unstable patients every 5
minutes.
• For stable patients, "sit and play" with a focused trauma/medical assessment. During
ongoing assessment, you need to reassess stable patients every 15 minutes.

Lesson 3-3 Focused History and Physical Exam - Trauma

Patients
Unstable trauma patient
1. Notice significant MOI, multiple injuries or altered mental status.
2. Continue holding C-spine.
3. Consider ALS intercept.
4. Reconsider transport decision.
5. Reassess mental status.
6. Rapid trauma assessment.
7. Baseline vitals.
8. SAMPLE history.
9. Transport.
10. Detailed physical exam in the ambulance enroute to the hospital.
11. Ongoing assessment.

Stable trauma patient

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

1. Notice the absence of significant MOI, no multiple injuries, no altered mental status.
2. Focused trauma assessment.
3. Baseline vitals.
4. SAMPLE history.
5. Detailed physical exam on the scene.
6. Transport.
7. Ongoing assessment

Reassess mental status

• Ask for name, time, and location to probe mental status.
• Treat diabetic emergencies (hypoglycemia) by measure blood glucose and then
administering glucose.
• Treat inadequate breathing and hypoxia-induced altered mental status with oxygen and
PPV.
• Assess for the Glasgow coma scale. In a range of 3-15, 8 or is severe.
•

Glasgow coma scale

Eye opening
Spontaneous 4
To verbal stimulus 3
To painful stimulus 2
No response 1
Verbal response
Orientated talk 5
Disorientated talk 4
Inappropriate words 3
Incomprehensible sounds 2
No response 1
Motor response
Obeys verbal commands 6
Localizes pain 5
Withdraws from pain (flexion) 4
Flexion (decorticate) 3
Extension (decerebrate) 2
No response 1

Rapid trauma assessment

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• In 2 - 2.5 minutes, rapidly assess from head to toe for DCAP-BTLS: Deformities,
Contusions, Abrasions, Punctures/penetrations, Burns, Tenderness, Lacerations,
Swelling. Always call for ALS intercept for critical findings.
• Head and Face
o Scalp, skull, ears, pupils, nose, mouth.
o Look for airway compromises.
o Also look for signs of brain damage such as CSF leakage from the ear and nose.
o Look for signs of brain herniation (altered mental status, flexion, extension, fixed
/ unequal pupils). Treat with hyperventilation (20 bpm).
• Neck
o Open wounds on the neck demands occlusive dressing to prevent air from being
sucked into a large vein.
o Jugular vein distention is a sign of heart failure and/or lung injury.
o Tracheal deviation: tension pneumothorax (lung injury with pressure build-up)
o Tracheal tugging: airway obstruction.
o Subcutaneous emphysema: bulge in skin from air getting trapped inside.
o Apply a cervical collar.
• Chest
o Open wounds on the chest demand occlusive dressing taped on three sides. Also
called a sucking wound because of air sucking into to the chest and can cause the
lung to collapse. Occlusive dressing taped on three sides to allow air to escape on
exhalation.
o Look for paradoxical movement (when a portion of the chest moves inward
during inhalation) such as flail segments (from broken ribs) and stabilize them.
o Absence of or inadequate breath sounds or chest movement: begin PPV and O2
administration.
o Muscle retractions and asymmetrical chest movement. Auscultate for chest
sounds.
• Abdomen
o Pain, tenderness (react to palpation), rigidity (tensed abdominal muscles) indicate
internal bleeding into the abdominal cavity. The patient is likely to go into shock.
Monitor ABCs and intervene appropriately.
o The heel jar test probes for internal injury by striking the patient's heel with a fist.
If the patient feels pain in the abdomen, then it's a sign of internal injury.
o Evisceration: apply sterile dressing and cover it with an occlusive dressing.
Monitor ABCs and intervene appropriately.
• Pelvis: Pain, tenderness, instability and deformations indicate a broken pelvis.
• Lower extremities
o inspect and palpate each. Assess PMS (pedal pulses, motor and sensory function).
o Control active bleeding.
o Pain, swelling, discoloration, and deformity indicate a femur fracture.
• Upper extremities
o Inspect and palpate each. Assess PMS (radial pulses, motor and sensory function).
o Control active bleeding.
o Deformations indicate bone fractures.
• Back: turn the patient on his or her side and inspect and palpate the posterior body.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Open wounds in the posterior thorax demands occlusive dressing. This is the
same as a "sucking wound" on the chest. Occlusive dressing taped on three sides
to allow air to escape during exhalation.
o Manage active bleeding.
o Note for any spinal deformations.
o Maintain in-line stabilization until patient is secured onto a backboard.

Focused trauma assessment

• Assess the injured site for DCAP-BTLS
• Injuries to the extremities without active or internal bleeding are seldom life-threatening.
• Perform necessary interventions such as splinting and immobilization of a joint.
• Check PMS before and after interventions to the extremity.
• If your index of suspicion rises during the focused trauma assessment, proceed to perform
a head-to-toe rapid trauma assessment.

Lesson 3-4 Focused History and Physical Exam - Medical

Patients
Unresponsive medical patient
1. Determine that the patient either is unresponsive or have altered mental status.
2. Rapid medical assessment.
3. Baseline vitals.
4. Position patient.
5. SAMPLE.
6. Transport.
7. Detailed physical exam in the ambulance enroute to the hospital.
8. Ongoing assessment.

Responsive
1. Determine that the patient is alert and orientated.
2. Ask questions: complaints and OPQRST.
3. SAMPLE.
4. Focused medical assessment.
5. Baseline vitals.
6. Transport decision.
7. Detailed physical exam either on scene or inside the ambulance enroute to the hospital.
8. Ongoing assessment.

Rapid medical assessment

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• In 2-2.5 minutes, rapidly assess from head to toe for signs of medical problems.
• Do not dismiss the possibility of trauma. Look for trauma signs.
• For most medical problems, all you can do is manage basic ABCs.
o Establish airway.
o Treat inadequate breathing by PPV and O2.
o Manage bleeding by applying pressure and dressing.
• Head
o Asymmetry: facial droop and unequal pupils are signs of stroke.
• Neck
o JVD (jugular vein distention): heart failure.
o Tracheal tugging: obstruction in bronchi.
o Use of neck muscles for breathing: signs of inadequate breathing possibly due to
asthma, emphysema, pneumonia... etc.
• Chest
o Retractions, use of accessory muscles, diminished breath sounds: possible asthma,
emphysema, pneumonia... etc.
o Crackles upon auscultation: capillary pressure forcing fluid into the lungs.
Possible congestive heart failure or pneumonia.
o Wheezing upon auscultation: constriction of bronchiole smooth muscles. Possible
asthma, allergic reaction, emphysema or congestive heart failure.
• Abdomen
o Pain, tenderness, rigidity, distension: internal bleeding, infection, appendicitis or
peritonitis. Assess rebound tenderness by the Markle test (what for reaction as
patient drops from a tip-toe position).
o Palpable pulsating mass in the midline of the abdomen is a sign for aortic
aneurysm (weakened area of the abdominal aorta).
o Extremely distended abdomen: pregnant or suffering from ascites (fluid build up
in abdomen).
• Pelvic region
o Distention or tenderness in the pelvic region, complaints of lower abdominal pain
and missed menstrual periods: suspect ectopic pregnancy in females of child-
bearing age. Patient in danger of shock due to bleeding within the abdominal
cavity.
• Extremities
o Check for PMS.
o Look for edema (swelling): excessive edema indicates congestive heart failure,
fluid overload, or DVT (deep vein thrombosis).
o DVT is when a blood clot forms in a deep vein, which may break off and travel
into the lungs to cause a pulmonary embolism. Symptoms include shortness of
breath, pain, redness or swelling to one calf, and pain in the when pulling back the
leg toward
• Back
o Inspect for discoloration, edema and tenderness.
o Edema in the sacral region in bedridden patients indicates possible congestive
heart failure.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Edema in the hands or feet for non-bedridden patients indicates possible

congestive heart failure.

Position patient
• If no artificial ventialtion is needed, position the patient in the recovery position (on his
or her side) to prevent aspirations.
• If artificial ventilation is needed, place the patient in the supine position.

Focused medical assessment

• Focus on the area of complaint and those associated with it.
• If the complaint is nonspecific, then perform the head-to-toe rapid medical assessment.

Lesson 3-5 Detailed Physical Exam

• Inspect from head to toe for both trauma signs (DCAP-
BTLS) and medical signs.
• Only perform the detailed exam there are no life-
threatening conditions to be managed.
• You are not required to perform a detailed physical exam
for every patient.
• Head: look for DCAP-BTLS to the skull and scalp.
• Ear
o Look inside the ear for CSF leakage, which indicates

skull fracture.
o Allow any CSF to leak onto a loose dressing.

o CSF contains glucose, which can be detected by a

glucometer.
o Look behind the ear (mastoid process). Black-and-

blue discoloration (Ecchymosis) is called the Battle's

sign, which is a late sign of head injury.
• Face
o Look for facial deformities / bleeding that may

obstruct the airway.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Burns to the face may indicate burns to the upper

airway, which may cause swelling and constriction of
the airway.
• Eyes
o Test for consensual reflex (normally, both pupils
should respond when light is shined onto one pupil).
o Pupil response to light should be fast. Sluggish

response indicates poor perfusion to the brain, high

CO2 levels and brain injuries.
o Unequal pupils indicate head injury or stroke.

o Fixed and dilated pupils indicate possible cardiac

arrest or severe head injury.

o Pinpoint pupils indicate narcotic influence.

o Check for visual acuity: "how many fingers am I

holding up?"
o Check for conjugate movement: eyes should move

smoothly and together. Jerky eye movements

(nystagmus) indicates drug influence or CNS
problems. Dysconjugate gaze indicates injuries to eye
or nerve.
• Nose
o Look for deformities and burns that may indicate

airway compromise.
o Leakage of CSF indicates skull fracture.

o Nasal flaring is a sign of inadequate breathing.

• Mouth
o Inspect for and manage injuries that may cause airway

compromise.
o Bite injuries to tongue indicate possible seizure /

epilepsy.
o Cyanosis to the oral membranes indicate hypoxia.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Pale tongue may indicate shock.

o Burns / white areas indicate ingestion of caustic

substances / poison.
o Alcoholic odors indicate alcohol intoxication.

o Fruity odors indicate a diabetic emergency.

o Unusual / chemical odors may indicate substance

abuse.
• Neck
o Open wounds need to be covered with occlusive

dressing to prevent air being sucked into vein.

o JVD indicates heart failure or compression due to

tension pneumothorax.
o Tracheal deviation is a late sign for tension

pneumothorax.
o Crepitations are caused by air under the skin called

subcutaneous emphysema. They indicate respiratory

trauma.
o Use of neck muscles to breath and tracheal tugging

indicate respiratory distress.

• Chest
o Check for retractions, which indicate respiratory

distress.
o Look and feel for equal chest rise. Unequal chest rise

indicates injuries to one side such as pneumothorax

and flail segments.
o Paradoxical movement and flail segments need

stabilization.
o Auscultate for breath sounds.

o Wheezing indicates constriction of bronchioles. When

wheezing is isolated to a specific area, it indicates a

localized infection or obstruction.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Stridor: upper airway obstruction.

o Crackles / rales are caused by fluids in the lung.

o Rhonchi (snoring sound upon auscultation) are caused

by mucus in the airway.

o Coughing blood indicates lung injury. Yellow or green

sputum indicates infection.

• Abdomen
o Patients in a defensive position complaining of

abdominal pain indicates peritoneum irritation.

o Patients who can freely move about and complains of

abdominal pain indicates bowel obstruction.

o Tenderness, rigidity, discoloration are signs of internal

bleeding.
o Guarding, rigidity, and shallow breaths are signs of

peritonitis.
o Pulsating mass in the abdomen indicates weakened

abdominal aorta.
o Cover eviscerations with most sterile dressing and seal

it with an occlusive dressing.

• Pelvis
o Assess for pelvic stability. Pelvic fractures can cause

significant internal bleeding.

o Priapism (persistent erection) is a sign of spinal cord

injury.
o Note any bleeding and loss of bladder control.

• Lower extremities
o PMS: presence dorsalis pedis pulse, both feet can push

down with equal strength, can feel both touch and pain
(pinch) to the foot and also locate which side the was
touched/pinched.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Hemiplegia: paralysis to one side. This is a sign for

stroke.
o Paraplegia: paralysis involving both legs only.

o Quadriplegia: paralysis involving both arms and both

legs.
• Upper extremities
o PMS: presence radial pulse, both hands can wiggle

their fingers and grip with equal strength, can feel and
locate both touch and pain.
o Unequal grips is a sign for stroke.

• Back
o Just like everything else, assess for trauma signs.

o Muscle spasms around the vertebrae is a sign of spinal

injury.
o Maintain an in-line stabilization.

• Reassess Vital Signs

o Every 5 minutes for unstable patients.

o Every 15 minutes for stable patients.

Lesson 3-6 On-Going Assessment

1. Assess: Repeat initial assessment, vitals, focused
assessment (if called for), check your interventions and
note any trends in the patient's condition.
2. Intervene: At any point, when the need for intervention
arises (such as a newfound complaint / injury, an
equipment failure, or problems with ABCs), act to manage
the situation.
3. Reassess: every 5 minutes for unstable patients, and 15
minutes for stable patients.
What to assess:

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

1. Repeat initial assessment.

o General impression

o Mental status

o ABCs

o Establish priorities

2. Retake vital signs.

o Breathing, pulse, skin, pupils, blood pressure, Puls-ox.

3. Focused trauma / medical assessment should be performed

any time you find new complaints and injuries.
4. Check interventions.
o Are the interventions helping the patient?

o Equipment working properly?

o ABCs effectively managed?

5. Note Trends
o Is the patient getting better or worse?

o Are your interventions helping?

o Document trends in the patient's condition and your

interventions.
Lesson 3-7 Communications
Communication with dispatch
• Dispatch
o Announce departure from station
▪ Identify your unit.
▪ Acknowledge dispatch information.
▪ Tell dispatch you're en route.
▪ Give an estimated time of arrival (ETA).
o Report any delays while en route.
• On scene
o Announce arrival
▪ Identify your unit.
▪ Give location.
o Request any necessary backup / ALS intercept.
• Departure

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Announce departure.
▪ Identify your unit.
▪ Give destination.
▪ Number of patients if more than one.
▪ Estimated time of arrival (ETA).
o Report any delays while en route.
• Arrival at medical facility
o Announce arrival
▪ Identify your unit.
▪ Give location
• Returning to base
o Identify your unit.
o Announce that you are "clear" and available for another assignment.
o Announce arrival back at base.

Communication with medical direction or receiving facility

• Identify your unit.
• Scene size-up information
o Patient's age and sex.
o MOI/NOI
• Initial assessment information
o Chief complaint.
o Mental status
• Focused history and physical exam information
o Baseline vitals
o Pertinent SAMPLE history findings, including past illnesses.
o Other pertinent findings.
• Interventions you performed and how the patient responded to them.
• Any requests for further actions/interventions.
• Estimated time of arrival at medical facility

The oral report during transfer of care to the medical

facility
• Chief complaint.
• Vital signs and trends.
• Interventions and patient's response.
• Pertinent history / findings not previously stated.

Terms and gadgets

• Base station: dispatch coordination area.
• Mobile transmitter / receivers: vehicle-based, long range.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Portable transmitter / receivers: hand-held, short range.

• Repeaters: towers that boost the range of transmissions (such as mobile and portable
transmitters) by rebroadcasting the signal.
• Digital equipment: instead of talking, you communicate by pressing buttons that transmit
messages as digital codes.
• Cellular telephones: cell phones.
• Broadcast regulations: the FCC (federal communications commission) regulates
everything from frequency to censoring.
• System maintenance: make sure things are in working condition, back-up batteries for
devices, and back-up power generators for base station and repeaters.

Radio terms and radio codes

• Come in - request the other end to talk.
• Go ahead - allow the other end to talk.
• Spell out - ask the other end to spell it out.
• Over - end of message, awaiting reply.
• Stand by - please wait.
• Copy - received and understood.
• 10-4 - received and understood.
• Clear - end of transmission.
• ETA - estimated time of arrival.
• Landline - refers to telephone communications.
• During communications, allow for breaks or pauses so the other end can interrupt if
necessary.

Lesson 3-8 Documentation

Assists the EMT-Basic in understanding the components of the written report, special
considerations regarding patient refusal, the legal implications of the report, and special reporting
situations. Reports are an important aspect of prehospital care. This skill will be integrated into
all student practices.

Lesson 3-9 Practical Skills Lab: Patient Assessment

Integrates the knowledge and skills learned thus far to assure that the student has the knowledge
and skills of assessment necessary to continue with the management of patients with medical
complaints and traumatic injuries.

Lesson 3-10 Evaluation: Patient Assessment Module

Conduct written and skills evaluation to determine the student's level of achievement of the
cognitive, psychomotor and affective objectives from this module of instruction.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

MODULE 4: EMERGENCIES & OB/GYN

Lesson 4-1 General Pharmacology
• Medications you carry and can prescribe
1. Oxygen: can prescribe for any patient, especially those with hypoxia and
inadequate breathing. Administered via inhalation.
2. Oral glucose: prescribe for diabetic patients with hypoglycemia. Administered
orally.
3. Activated charcoal: prescribe for patients who have swallowed poisons (charcoal
binds poisons and carry them out of the body through bowel movements).
Administer orally.
4. Aspirin: prescribe for chest pain related to clots blocking the coronary arteries
(Aspirin is a blood thinner, it prevents clots from forming). Administer orally.
• Medications the patient carries that you can help administer
1. Metered-dose inhaler (MDI): asthma and other patients with respiratory diseases
have this. It is used to dilate the bronchioles. Administer by inhalation.
2. Nitroglycerin (nitro): cardiac patients have these. It is a vasodilator, which lowers
blood pressure and increases blood supply to the heart. Administer by sublingual
means. Note: do not administer for patients with low blood pressure (below 90
systolic or 30 below the baseline blood pressure) or who are taking drugs for
erectile dysfunction.
3. Epinephrine (epi): patients with severe allergies (anaphylaxis) have this, usually
in the form of an epi pen (auto-injector). The epinephrine counters the effects of
anaphylaxis. Administer by injection (using the epi pen).
• Administration route.
1. Sublingual: placed under the tongue, absorbed across the mucous membrane.
2. Oral: swallowed.
3. Inhalation.
4. Injection.
• Administration form.
o Tablet / compressed powder: taken orally or sublingually. For example, aspirin or
nitro.
o Liquid for injection: for example, epi.
o Gel: taken orally. For example, glucose.
o Suspension: taken orally. For example activated charcoal.
o Fine powder for inhalation: these are mists. for example, MDIs.
o Gas: for example oxygen.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Spray: these are droplets. Some nitro is in the spray form, where droplets are
deposited with each spray.
o Nebulizer: these are aerosols. For example, MDIs.
• Medication terminology
o Indications: situations that you should administer a medication.
o Contraindications: situations that you should NOT administer a medication.
o Dose: how much medication to give.
o Administration: administration route and form.
o Actions: the effect of the drug.
o Side effects: negative effects of the drug.
• Steps to check for in administering medication
0. Right circumstance: either on-line or off-line medical direction calls for the
administration of this medication for this situation. Do NOT administer
medication without medical direction or set protocol.
1. Right patient: check prescription label to make sure it's not prescribed for
someone else.
2. Right date: make sure the drug is not past its expiration date.
3. Right medication: check to make sure that what's inside the container is indeed
the right drug. Watch out for discoloration or impurities and discard any
medication that has "gone bad".
4. Right dose: too little won't have an effect. Too much can be dangerous for the
patient.
5. Right route: make sure you can distinguish between sublingual and oral. For
example, nitro is sublingual, so place it under the tongue (don't let the patient
swallow it).

Lesson 4-2 Respiratory Emergencies

Signs and symptoms
• Inadequate breathing: inadequate rate or volume (normal breathing is 12-20 bpm, or one
breath per 3-5 seconds), inadequate chest rise and fall, little air movement from mouth
and nose, diminished breath sounds when auscultating.
• Sucking wounds.
• Altered mental status.
• Tripod position.
• Abnormal sounds: snoring, stridor, gurgling, crowing, coughing, wheezing, rhonchi,
crackles and rales.
• Use of neck muscles and retractions of the intercostal muscles during breathing.
• Head bobbing.
• See-saw motion of the chest and abdomen.
• Tracheal tugging.
• Nasal flaring.
• Diaphoretic: sweaty from effort to breath.
• Having difficulty talking.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Hypoxia signs: pallor, cyanosis, puls-ox below 95%, sluggish pupil response.
• Pursed lips during exhalation is characteristic of patients with chronic respiratory
diseases.
• Agitated, confused facial expression.
• Pulsus paradoxus: drop in blood pressure (or pulse strength) during inhalation.
• Paradoxical motion: an area of the chest moves inward during inhalation and outward
during exhalation.
• Abnormal pulse: fast at first due to anxiety, later slow because the heart is not getting
enough oxygen.

Treatment
• Oxygen at 15 lpm through non-rebreather mask.
• Positive pressure ventilation (PPV).
• Clearing the airway: Suction, Heimlich maneuver.
• For vomiting patients, position in the recovery position.
• Head-tilt chin-lift, jaw thrust, or insertion of an airway adjunct for snoring patients.
• For altered mental status patients, protect their airway with an airway adjunct.
• Stabilize any flail segments for patients with paradoxical motion.
• Assist asthma patients in administering their prescribed MDI.
• MDI administration: inhale slowly and deeply, hold for as long as possible, then exhale
slowly through pursed lips.
• Ventilate pneumothorax patients carefully and with minimal tidal volume needed. You
don't want to push more air into the pleural cavity.
• If a child does not tolerate the non-rebreather mask during oxygen administration, have
the parent hold it over the child's face.
• Sucking wounds need to be covered by occlusive dressing and sealed on 3 sides.

Medical conditions and mechanisms

• Chronic obstructive pulmonary disease (COPD): prolonged airway obstruction. Includes
emphysema and chronic bronchitis.
• Obstructive pulmonary (lung) disease: airway obstruction. Includes emphysema, chronic
bronchitis, and asthma.
• Emphysema: Decreased alveoli surface area, leading to inefficient gas exchange.
Increased distal airway resistance, making it difficult to breath.
o Pink complexion, "pink puffers".
o Nonproductive cough.
o Barrel chest.
• Chronic bronchitis: inflammation, swelling and thickening of the lining of the bronchi
and bronchioles with excessive mucus production. This narrows the airway, and the
patient find it difficult to breath.
o Cyanotic complexion, "blue bloaters".
o Productive cough.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Asthma: allergic reaction in the lower airway, causing bronchospasms that narrow the
bronchioles, edema of inner lining, and mucus obstruction.
o Nonproductive cough.
o Allergic signs such as runny nose, sneezing, red eyes, stuffy nose.
o Wheezing on auscultation.
• Pneumonia: bacterial or viral infection to the lower respiratory tract, and causes
inflammation and fluid / pus filling the alveoli. This decreases the efficiency of gas
exchange, and leads to hypoxia.
o Signs of hypoxia.
o Malaise and fever.
o Coughing.
o Chest pain.
• Pulmonary embolism: obstruction in the pulmonary arteries. The obstruction can be
caused by a clot, air bubble, fat, or other substances. High risk for patients with extended
periods of immobility, heart disease, recent surgery, DVT and any other conditions where
a blood clot is likely.
o Sharp, stabbing chest pain.
o Cough (may cough up blood).
o Signs of hypoxia.
o Jugular vein distention.
• Acute pulmonary edema: fluid between alveoli and capillaries, which decreases the
efficiency of gas exchange.
o Crackles upon auscultation.
o Signs of hypoxia.
o Frothy sputum.
o Orthopnea.
• Spontaneous pneumothorax: sudden rupture of the visceral lining and partial collapse of
the lung. Spontaneous pneumothorax is not caused by trauma, but is caused by weakened
areas of the lung that suddenly ruptures. High risk patients are those with COPD.
o Sharp chest or shoulder pain.
o Decreased breath sounds to one side of the chest.
o Subcutaneous emphysema may be found.
o Signs of hypoxia.
o Can lead to tension pneumothorax, which completely collapses the lung.
• Hyperventilation: patients suffering from panic attacks can breath too fast.
o Numbness and tingling of the mouth, hands and feet.
o Dizziness.
o Can lead to seizures for patients with the disorder.

Terms
• Respiratory distress: currently have adequate breathing rate and volume, but is having
difficulties.
• Respiratory failure: inadequate breathing.
• Respiratory arrest: not breathing / apnea.
• Dyspnea: shortness of breath.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Apnea: not breathing.

• Hypoxia: inadequate oxygen.
• Hypercarbia: too much carbon dioxide.
• Rhonchi: snoring and rattling upon auscultation. Indicates mucus obstructions.
• Crackles: also known as rales, are bubbly or crackling sounds during inhalation. Indicates
fluid in lungs. These are sounds of alveoli and terminal bronchioles "popping" open with
each inhalation.
• Bronchospasm: same as bronchoconstriction.
• Status asthmaticus: severe asthma attack that does not respond to medication.
• Nonproductive cough: no sputum.
• Productive cough: with sputum.
• Orthopnea: difficulty in breathing when lying flat.
• Subcutaneous emphysema: air bubbles under the skin.

Lesson 4-3 Cardiovascular Emergencies

Signs and symptoms
• Blood pressure: normally it's 120/80 (higher in the elderly and lower in children).
Anything over 140 systolic is hypertension, and under 90 systolic is considered low blood
pressure.
• Pulse: normally, it's strong and regular. Weak and thready pulse indicates shock.
• Skin: normal skin should be pink, warm and dray. Shock or hypoperfusion is indicated by
pale, cool and clammy skin.
• Chest discomfort or pain that radiates to the shoulders, back and jaw.
• Unresponsive, not breathing, and no pulse: cardiac arrest - begin CPR.
• Sluggish pupils indicate hypoxia and poor perfusion.
• Jugular vein distension indicates congestive heart failure or cardiac tamponade.
• Crackles when auscultating for breath sounds indicate fluid build up in the lungs, which
may have resulted from left ventricular heart failure.
• Peripheral and presacral edema suggests heart failure.
• Dyspnea and sudden onset of sweating.
• Anxiety, feeling of impending doom.
• Nausea and/or vomiting.

Treatment
• Oxygen at 15 lpm via a nonrebreather mask
• PPV
• Calm the patient to reduce anxiety.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Assist patient with administering a dose (0.3-0.4 mg) of prescribed nitroglycerin

sublingually. Reassess blood pressure after 2 minutes, and administer another dose after
3-5 minutes if needed, for a maximum of 3 doses.
o Do not administer if blood pressure is below 90 or drops over 30 over the
baseline.
o Do not administer to extreme bradycardia (<50) or tachycardia (>100).
o Do not administer for those on drugs for erectile dysfunction within 24 hours.
o Do not administer if you suspect head injury.
o Do not administer for infants and children.
• 160-325 mg of aspirin, nonenteric and ask the patient to chew it.
o Do not administer if patient is allergic.
o Follow medical direction and local protocols.
• Call ALS backup.
• CPR for cardiac arrest patients (no breathing, no pulse).

Medical conditions and mechanisms

• Angina pectoris: pain in the chest, caused by inadequate oxygen to the heart.
o Chest pain, especially during exertion, that radiates to neck, jaw, arms, back, and
shoulders.
o General discomfort, anxiety, and nausea / vomiting.
o Relief of pain if physical activity is stopped.
• Acute myocardial infarction: a portion of the heart muscle dies due to lack of oxygen.
o Chest pain and discomfort, similar to angina, that radiates to the neck, jaw, arms,
back, and shoulders.
o Lasts longer than angina and the pain and discomfort is not able to be relieved.
• Heart failure: inadequate pumping of the heart.
o Left ventricle failure: pulmonary edema, because blood is backing into the lungs.
o Right ventricle failure: peripheral edema, jugular vein distention, and liver
enlargement, because blood is backing into the venous circulation.
o Congestive heart failure: heart failure that causes edema.

Terms
• Nonenteric: not coated.
• Myocardial ischemia: cardiac cell hypoxia. Inadequate oxygen to the heart cells.
• Chain of survival: a term by the American Heart Association.
o Early access.
o Early CPR.
o Early defibrillation.
o Early ALS.
• AED: Automated external defibrillators. Used to shock the heart back to normal.
o Only shock when rhythm analysis indicate that shock is advised.
o For patients with artificial pacemakers, do not place electrodes over where the
pacemaker is implanted.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Electrocardiogram (ECG): graphical plot of the heart's electrical activity.

o P: corresponds to atrial contraction.
o QRS: corresponds to ventricular contraction.
o T: corresponds to relaxation.
• Ventricular fibrillation (V-Fib): chaotic ECG rhythm. Random twitches of the heart that
does not pump any blood. This occurs during a heart attack. V-Fib is the only rhythm
where shock is advised for the AED.
• Ventricular tachycardia (V-Tach): Rapid ECG rhythm. Very fast, but inefficient heart
beats. Can degenerate into V-Fib.
• Asystole: no ECG activity of the heart at all.
• Pulseless electrical activity: the heart has an organized ECG electrical rhythm, but either
the muscles are not pumping or there's no blood left to pump.
• Arteriosclerosis: Arteries become stiff and less elastic.
• Atherosclerosis: fatty substances deposited on the inside of arteries.
• Coronary artery disease (CAD): atherosclerosis of the coronary arteries.
• Acute coronary syndrome (ACS): obstruction of coronary arteries with a sudden onset of
symptoms. Includes unstable angina and myocardial infarction.
• Fibrinolytics: drugs that dissolve early clots.

Lesson 4-4 Diabetes/Altered Mental Status

Signs and symptoms
Diabetes

• Presence of insulin stored in the refrigerator.

• Bruising at insulin injection site on the abdomen.
• Abnormal blood glucose level.
o Normal blood glucose is 80-120 mg/dl.
o Hyperglycemia, >120 mg/dl, caused by a lack of insulin. High blood sugar level
even after long time without food.
o Severe hyperglycemia
▪ Excess urination, with glucose in urine, leads to dehydration.
▪ Frequently thirst, urination and hunger.
▪ Fruity or acetone odor in breath.
o Hypoglycemia, <60 mg/dl, caused by over administration of insulin.
o Severe hypoglycemia triggers epinephrine release.
▪ Diaphoresis.
▪ Tremors.
▪ Weakness.
▪ Hunger.
▪ Tachycardia.
▪ Dizziness.
▪ Pale, cool and clammy skin.
▪ Warm sensation.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Dehydration caused by excess glucose in the urine that causes large water loss through
osmosis. Frequent thirst, urination, and hunger.
• Patient skipped a meal, medication, or had unusually vigorous activity.

General altered mental status

• Anxiousness or combativeness.
• Trauma that indicates injury to the central nervous system.
o Mechanism of injury indicates trauma such as falls, even if it's from a medical
condition.
o Unequal pupils that indicate head injury.
o Discoloration around the eyes.
o Discoloration behind the ears.
o Flexion or extension.
• Drug abuse.
o Pinpoint pupils.
o Dilated pupils.
• Suspect hazardous gas or poisoning if multiple patients have altered mental status.
• Inadequate breathing, which leads to hypoxia.
• Signs of hypoxia.
• Shock and hypoperfusion.
o Cool and clammy skin with pallor.
o Look for internal bleeding such as rigidity and tenderness in the abdomen.
o Look for external bleeding.
o Edema in the lower extremities or posterior sacral region which indicates
congestive heart failure.
o Extreme tachycardia >160 that prevents the proper refilling of blood to the left
ventricle.
o Inadequate perfusion, heart rate, blood pressure.
• Seizure signs
o Bitten lips or tongue.
o History of seizures.
• Stroke: weakness or paralysis on one side.
• Allergies.
• Infections.

Treatment
• Stabilize the spine if you suspect the mechanism of injury indicates trauma such as a fall.
• Open and maintain airway because patients with altered mental status can not protect
their airway.
• Clear any obstructions in the airway, as it may be the cause for the altered mental status
from hypoxia.
• PPV if breathing is inadequate.
• All altered mental status patients must receive high flow oxygen to ensure adequate
perfusion to the brain.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Place in recovery position to avoid aspirations.

• Oral glucose for hypoglycemic patient.
o Do not administer glucose for patients with head injury or stroke, because when
glucose moves into the brain, it will increase the osmotic pressure of the brain and
cause any swelling to worsen.
• Rehydration treatment for those dehydrated from hyperglycemia. Follow medical
direction.

Medical conditions and mechanisms

• Conditions that can cause altered mental status.
o Diabetes.
o Stroke.
o Drug abuse or poisoning.
o Allergies.
o Head trauma.
o Shock, hypoxia, hypoperfusion.
o Seizures.
o Infections.
• Type I diabetes: acquired during childhood. Pancreas does not produce any insulin.
Patient need to have daily insulin intake.
• Type II diabetes: developed in adulthood. Either the pancreas does not secrete enough
insulin or the body does not respond to insulin secretions. Patient takes oral
hypoglycemic drugs that stimulate insulin production and the body's response to it.
• Hyperglycemia in diabetic patient is when there's a lack of insulin, blood sugar level
rises. While brain cells can access this blood glucose without insulin, the body cells are
starving because they can't get the blood glucose without insulin. In a normal person,
blood glucose rises after a meal (to 120-140 mg/dl), but falls afterwards. Diabetic patients
with inadequate insulin have high blood sugars even after an 8-12 hour fast. Symptoms
are slow to show because the brain is getting enough oxygen, and it takes a long time for
DKA or HHNS to kick in.
• Diabetic ketoacidosis (DKA) occurs after long period of severe hyperglycemia. Caused
by metabolism of fat, which makes an acid byproduct. Leads to altered mental status and
eventually coma. Commonly seen in type I diabetics. The ketone bodies produced during
their metabolism cause their breath to smell fruity or of an acetone odor.
• Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is similar to DKA, but
occurs in type II diabetics, who can manage to secrete some insulin, which helps to
prevent the metabolism of fat. Thus, no acidosis occurs, but the patient is still dehydrated,
which leads to altered mental status and seizures.
• Hypoglycemia in diabetic patient is when blood glucose level is too low. This can be
caused by administration of too much insulin. When the body cells take up all the blood
sugar, there's none left for the brain. Therefore, the patient suffers from altered mental
status. Symptoms occur very fast because the brain is very sensitive and as soon as it
doesn't get enough sugar, symptoms will kick in.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Terms
• Insulin: chemical secreted by the pancreas that promotes cells to take up blood glucose,
and thus, lowers blood glucose level.
• Glucagon: chemical secreted by the pancreas that promotes the release of glucose into the
blood stream, and thus, raises blood glucose level.
• Epinephrine (adrenalin): released by the adrenal glands that stops insulin release and
promotes release of glucose into the blood.
• The 3 Ps of diabetes:
o Polydipsia: frequent thirst.
o Polyuria: frequent urination.
o Polyphagia: feeling hungry.
• IDDM: insulin-dependent diabetes mellitus, or type I.
• NIDDM: non-insulin-dependent diabetes mellitus, or type II.

Lesson 4-5 Allergies

Signs and symptoms
• Altered mental status.
• Itchy, watery eyes.
• Runny or stuffy nose.
• Breathing difficulties.
• Wheezing, caused by bronchiole lining constriction and inflammation.
• Stridor or crowing, caused by swelling and constriction of the upper airway.
• Swelling.
• Weak and rapid (thready) pulse.
• Tachycardia.
• Low blood pressure.
• Irregular pulse.
• Shock / hypoperfusion.
• Abnormal skin coloration.
• Hives, blotches over skin.
• Nausea / vomiting.
• Abdominal problems such as cramping, diarrhea, loss of bowel control.

Treatment
• For mild reactions, maintain airway and provide oxygen. Realize that mild reactions can
progress to severe anaphylaxis.
• Suction any secretions.
• Oxygen administration.
• PPV if necessary.
• Epinephrine injection.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Metered dose inhaler prescribed for asthma patients.

• Endotracheal intubation, which maintains an airway that may otherwise shut off
completely.

Medical conditions and mechanisms

• Anaphylaxis: antigen attaches to antibodies located on MAST cells and basophils, which
causes the cell membranes to breakdown and release chemical mediators such as
histamine. The body responds with bronchoconstriction, increased mucus production,
vasodilation, and increased capillary permeability. This narrows airways, occludes
smaller bronchioles, causes swelling and lowers blood pressure. The patient may go into
shock.
• Mild allergic reactions can progress to severe anaphylaxis.
• Allergic reactions can be caused by venum from bites or stings, foods, pollen,
medications, chemicals, and latex. Exercising right after exposure of allergins can
accentuate anaphylaxis.

Terms
• Anaphylaxis: also called anaphylactic shock, is a severe allergic reaction that is life
threatening.
• Anaphylactoid reaction: same as anaphylaxis, except there is no prior exposure or
sensitization.
• Sensitization: the body's response to encountering an antigen, whereby antibodies attach
to mast cells and basophils. So, if the antigen is encountered again, the mast cells and
basophils will release histamine, which cause an allergic reaction.
• Histamine: chemical that causes allergic reactions, such as bronchoconstriction,
vasodilation, and capillary leakage.
• Urticaria: hives on skin.
• Pruritus: itching.

Lesson 4-6 Poisoning/Overdose

Signs and symptoms
• Altered mental status - look out for euphoria or drug induced "highs" which indicate drug
abuse.
• Unusual body or breath odors, due to contact or ingestion of chemicals.
• Burns around the mouth, lips, and oral mucosa indicates ingestion of poison.
• Chemical substances around the mouth or in sputum.
• Nausea and vomiting.
• Abdominal pain.
• Diarrhea.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Respiratory distress with possible coughing, stridor, wheezing, crackles, which suggest
inhalation of poisons. This may lead to signs of hypoxia.
• Inadequate breathing, pulse, and blood pressure due to nervous system depressants.
• Altered heart rate and/or blood pressure, either high or low depending on the type of
poison.
• Dilated or constricted pupils, depending on the type of poison.
• Needle tracks or marks at the site of poison entry (or injection site).
• Local swelling, irritation, redness at the site of contact with poison.
• Hypoxia possibly from carbon monoxide poisoning or lung damage from inhaling caustic
substances.
• CO poisoning will also cause the puls-ox reading to be high even though the patient is
suffering from hypoxia.

Treatment
• Open the airway and clear any obstructions.
• Suction any secretions obstructing airway.
• Maintain airway with airway adjunct.
• Administer oxygen.
• PPV if needed.
• Brush dry chemicals or solid toxins from the skin.
• For liquids, rinse with water for at least 20 minutes. Shower, garden hose, or eye wash
are some examples of the apparatus used for rinsing.
o When rinsing the eye, let the water fall to the side of the face, and not into the
other eye.
o Take care of "hidden" areas such as nail beds, creases, and remove any jewelry.
• Wash or rinse affected area to clear the poison and prevent further injury.
• Administer activated charcoal to soak up all the poison or overdosed drug - contact
medical direction.
• Bring a sample of the poison to the receiving facility.
• Narcan (naloxone) reverses the effects of a narcotic overdose. This is an ALS
intervention.
• Position in the recovery position if vomiting is likely.

Medical conditions and mechanisms

• Overdose is a special type of poisoning, where a medication is taken in such excess
quantity that it becomes toxic to the body.
• Poisons and toxins can enter the body by ingestion, inhalation, injection, or absorption
through the skin or mucous membrane.
• Ingestion: most common route of poisoning. Poison passes through the esophagus into
the stomach, where it is kept for a period of time before it empties into the small
intestines, where it is absorbed into the body. Thus, you want to treat the patient fast,
before the poison is absorbed into the body. Since the poison is held in the stomach,
severe damage can be done to the stomach lining.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Inhalation: the poison crosses the alveolar-capillary membrane and enters the
bloodstream. Lung tissue is damaged during the process, which may lead to pulmonary
edema, causing inadequate gas exchange, hypoxia and hypoperfusion.
• Injection: poison causes a local reaction at the site of injection such as edema, redness,
irritation and pain. Systemic reactions may occur after the local reaction when the poison
is distributed throughout the body via systemic circulation. Injection can occur from drug
abuse, insect bites or stings, which can lead to anaphylaxis.
• Absorption: toxins from crosses the skin or mucous membrane and enter the body. Local
irritation occurs at the site of absorption. Systemic reactions may occur when the
absorbed poison travels through systemic circulation. Poisons that absorb through the
skin include poison ivy, organophosphates, pesticides, and other chemicals.
• Carbon monoxide poisoning: hypoxia caused by CO binding to hemoglobin, which
prevents oxygen to be bound and delivered to cells. CO-bound hemoglobin turns read just
like O2-bound hemoglobin, which triggers a high puls-ox reading. This is why CO
poisoning creates hypoxia that cannot be detected by a puls-ox reading.
• Cyanide poisoning: cyanide interferes with aerobic respiration, which starves cells.
• Acids cause surface burns that cause immediate pain. They don't stick to surfaces, which
is why ingestion of acids burns the stomach more than the esophagus.
• Alkalis cause deep burns that do not cause immediate pain. Solid alkali sticks to surfaces,
which burns the esophagus. Liquid alkalis will travel to the stomach and burn there.
• Methanol: causes blindness when metabolized by the body.
• Isopropanol and ethylene glycol: toxic when metabolized by the body. Ethylene glycol is
especially toxic and can cause death in small amounts.

Terms
• Oliguria: very little urine.
• Anuria: no urine.
• Hematuria: bloody urine.

Lesson 4-7 Environmental Emergencies

Signs and symptoms
Hypothermia

• Altered mental status.

• Slow, slurred speech.
• Exhaustion, stiffness, lack of coordination.
• Loss of sensation.
• Pupils that respond slowly, and is typically dilated.
• Normal skin color does not return during palpation (blanching).
• Early signs when the body is trying to compensate:
o Shivering.
o Increased breathing rate.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Increased pulse rate.

• Late signs when the body fails to compensate:
o No shivering or movement.
o Slow and shallow breathing.
o Slow and weak pulse.
• Local cold injuries can accompany hypothermia.
• Suspect hypothermia if you note cold environment, elderly patient, those impaired with
medical or trauma conditions and those on drugs and alcohol.
• The presence of wind in addition to the cold increases the chance of hypothermia and
cold injuries.

Local cold injury

• Surface injuries produce a waxy skin that appears be gray or yellow but still soft to the
touch.
• Deep injuries produce a waxy skin that appears white with possible blisters. The affected
area is frozen solid and hard to the touch.

Hyperthermia

• Elevated core temperature.

• Muscle cramps.
• Altered mental status.
• Weakness, headache.
• Nausea or vomiting.
• Rapid, strong pulse at first, which deteriorates into thready pulse.
• Deep, rapid breathing at first, which deteriorates into shallow and weak breathing.
• Skin that is cool and moist during early stages when the body compensates.
• Skin that is hot at late stages when the body can not compensate.
• Seizures.
• Humidity in addition to heat increases the risk of heat stroke.

Bites and stings

• Symptoms of poisoning and allergy.

• Altered mental status.
• Bite or sting marks.
• Hives, flushing.
• Itching.
• Swelling.
• Breathing difficulties.

Aquatic emergencies

• Altered mental status.

• Airway obstruction from the water.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Inadequate breathing.
• Hypoxic.
• Inadequate pulse.
• Shock.
• Cardiac arrest.
• Hypothermia from the cold water.
• Decompression sickness from coming out of a dive too fast:
o Pain.
o Itching of the skin with rash.
o Severe forms can cause shock, hypoxia, bloody sputum and seizures.
• Clear or bloody discharge from the nose and ears due to the high pressure rupturing the
ear drums and sinuses during a dive.

Treatment
Hypothermia

• Prevent further heat loss.

o Remove from cold environment.
o Remove any wet clothing and dry the patient.
o Place the patient on an insulated surface.
o Wrap the patient with blankets.
• Provide oxygen.
• PPV is needed.
• CPR if pulse is absent.
• Active rewarming for alert patients: heat packs in the groin, armpits, and on the chest.
• Passive rewarming for patients with altered mental status: give the body a chance to
warm itself by keeping the patient in a warm environment and wrapping the patient in
blankets. All hypothermia patients should receive passive rewarming.
• Rewarming should be slow and gentle - never place the patient in a hot bath or shower.
• Do not allow patients to take stimulants such as tobacco, coffee or alcohol.
• Do not rub or massage the arms or legs, because it squeezes cold blood into the heart,
which can cause cardiac problems.

Local cold injury

• Remove from cold environment.

• Elevate the frozen extremity so it won't touch or rub against a surface.
• Remove any jewelry or restrictive clothing that is not frozen to the skin.
• If there's a possibility of refreezing, do not thaw.
• Thaw the affected area in water that is just above body temperature.
o The thawing should be rapid.
o The temperature should be just above body temperature - enough to thaw the ice
rapidly but not cause any burns.
o Keep the temperature of the water even and steady by monitoring with a
thermometer and stirring.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o After thawing, dress affected area with dry, sterile dressing. If hands or feet are
involved, place dressing between fingers and toes.

Hyperthermia

• Move to a cool place.

• Apply oxygen.
• Remove as much clothing as possible.
• Cool the patient by spraying mist and fanning.
• Apply moist towels to the forehead of over any cramping muscles.
• Trendenlenberg position to promote perfusion to the head and vital organs.
• Give patient cool water to drink only if patient is alert and not vomiting.
• Drastic cooling measures for patients with hot skin.
o Pour water over the patient's body. This helps evaporative cooling (avoid cold
water that can cause vasoconstriction and shivering).
o Cold packs to the groin, sides of the neck, in the armpits and behind the knees.
o Fan the patient aggressively.

Bites and stings

• Open and maintain airway.

• Suction.
• Oxygen.
• PPV if needed.
• Epinephrine for anaphylaxis.
• Remove any lodged stingers by gently scraping it with a card, along the direction of the
stinger, not against. Do not pinch the stinger with fingers or tweezers as it will squeeze
more poison into the wound.
• Wash the affected area with sterile saline solution. Do not scrub.
• Remove any restrictive clothing or jewelry as soon as possible. They may cut off
circulation if swelling occurs.
• Lower injection site below the level of the heart.
• Keep the patient calm and at rest.
• Follow medical direction if a tourniquet is needed.

Aquatic emergencies

• Stabilize spine because spinal injury may have occurred when patient fell into the water.
• Float the patient by securing on a backboard.
• Give rescue breaths if not breathing.
• Suction as needed.
• Give oxygen. Especially for decompression sickness.
• PPV as needed.
• CPR as needed.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Medical conditions and mechanisms

• Hypothermia: the body regulates the core temperature and try to keep it at 37 °C. When
the core temperature falls, the body compensates by shivering, goose bumps, and
increasing heart rate, breathing and metabolic activity. The body loses thermal control
once the core temperature drops to 35 °C (95 °F). From this point on, heart rate, breathing
and metabolic activity slows down. This leads to inadequate circulation and breathing.
The patient may go into cardiac arrest.
• Local cold injury: also called frost-bites, is when a part of the body tissue freezes,
causing tissue damage and possibly cutting off circulation. Often occurs on exposed areas
such as the hands, feet, ears, nose and cheeks. Prolonged exposure to the cold
environment will eventually lead to hypothermia.
o Early or superficial cold injury: freezing to the surface only. Skin remains soft to
the touch, but a waxy gray or yellow color.
o Late or deep cold injury: freezing beneath into the tissues. Affected area is frozen
solid and hard to the touch. Skin is white and waxy and may have blisters.
• Hyperthermia: the opposite of hypothermia, when the body has more heat than it can
regulate.
o Heat cramps: when the body loses too much salt from sweating, the muscles
cramp or experiences spasms. This is first stage of hyperthermia and the least
severe.
o Heat exhaustion: when the body is maximized on heat dissipating functions such
as sweating and vasodilation of vessels beneath the skin, circulation to the vital
organ decreases, especially if more sweat comes out than can be replaced by
drinking. This is the second stage of hyperthermia.
o Heat stroke: when the body's heat dissipating functions break down from
overload. Body heat increases from loss of regulation, which causes damage to
brain cells. This is the last stage of hyperthermia and the most severe.
• Decompression sickness: when you come out of a dive too fast, nitrogen bubbles form in
your blood. This causes embolisms to form in blood vessels, which obstruct circulation
compress or stretch blood vessels and nerves, and cause coagulation. The body responds
with an allergic reaction.
• People coming out of a diving while holding their breath can rupture their lungs, causing
arterial gas embolism, where air enters the blood stream.
• Barotrauma: divers experiencing too much pressure, or have weakened areas due to
infection, can have their eardrums or sinuses rupture during a dive.

Terms
• Immersion hypothermia: hypothermia from immersing in water.
• Urban hypothermia: hypothermia to those who have a predisposition to the illness such as
the elderly, those on alcohol, and those impaired by medical or physical conditions.
o External: cold from being without shelter.
o Internal: cold from being in a shelter not adequately heated.
• Blanching: normal skin color does not return during palpation.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• NEHS (nonexertional heat stroke): heat stroke without exertion. Occurs to the elderly or
those who are not used to heat waves.
• EHS (exertional heat stroke): heat stroke from exertion such as exercising or strenuous
activity.
• Myexdema Coma: occurs when patients with hypothyroidism have hypothermia.
• Feathering: fern pattern of on the skin of patients struck by lightning.

Lesson 4-8 Behavioral Emergencies

Signs and symptoms
• Abnormal behavior.
• Low blood sugar.
• Hypoxia.
• Hypoperfusion.
• Trauma or infection to the head.
• Drug abuse.
• Excessive heat or cold.

Treatment
• Airway, breathing and circulation interventions.
• Be accepting and listen to the patient's complaints.
• Be honest, sincere, and never make any quick movements.
• Never leave the patient alone.
• If restraint is necessary, have others to help. Always use restraints that do not inflict
harm.
o Use leather or fabric, not metal chains.
o Patient should be in a supine position.
o Arms should be secured in a position that is folded.
• Never restrain the patient in a prone position.
• Document everything to protect from false accusations.

Medical conditions and mechanisms

• When the brain does not have adequate perfusion, it can experience delirium, confusion,
combativeness, or hallucinations.
o Hypoglycemia.
o Hypoxia.
o Hypoperfusion.
• Anything that affects the brain can alter the mind:
o Head trauma or infection.
o Excessive heat or cold.
o Mind-altering drugs: alcohol, depressants, stimulants, psychedelics, narcotics.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Anxiety: a severe form is a panic attack, which is feeling of intense fear, tension and
restlessness that can cause hyperventilation.
• Phobias: irrational fears of something.
• Depression: feeling of sadness, worthlessness and discouragement.
• Bipolar disorder: also called manic-depressive disorder, and causes a patient to swing
from being elated at one moment to being depressed at the next.
• Paranoia: extreme mistrust of others to the point of being delusional.
• Schizophrenia: Delusional illness characterized by hallucinations, social withdrawal,
distortions to speech and thought, and lack of expressions.
• Mania: unrealistically optimistic.
• Suicidal: patient intentionally wants to end his or her life.

Lesson 4-9 Obstetrics/Gynecology

Signs and symptoms
Mother

• Bloody show.
• Contractions that are short intervals apart and intense.
• Patient has an urge to defecate.
• Patient has a strong urge to push.
• Crowning.
• Sudden onset of intense, sharp and constant pain that does not subside between
contractions indicate ruptured uterus.
• Painless vaginal bleeding and symptoms of shock suggests placenta previa.
• Any female of childbearing age with abdominal pain should be suspected of having
ectopic pregnancy and transported to the hospital.

Infant

• Greenish or brownish staining of the amniotic fluid.

• Poor response to stimulation.
• Lack of movement.
• Respiratory rate over 60.
• Inadequate breathing.
• Heart rate over 180 or below 100.
• Hypoperfusion, cyanosis.

Treatment
Mother

• Ensure patent airway.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Provide oxygen because pregnancy increases the demand for oxygen.

• Treat for shock by positioning the patient in Trendelenburg position if bleeding causes
hypoperfusion.
• Apply sanitary pads for vaginal bleeding.
• Place patient on her left side or in a sitting position. Avoid the supine position as it will
cause a drop in blood pressure.
• If the mother goes into cardiac arrest, begin CPR and don't stop until the baby is
surgically delivered.
• Transport patients with miscarriage, because anything that isn't passed through will result
in infection.
• Delivering a baby when delivery is imminent.
o Place patient on her back, with legs bent and spread apart.
o Suction the nose and the mouth immediately upon delivery of the head.
o Support the head to prevent explosive delivery.
o Deliver each shoulder.
o Support infant with both hands and keep above the level of the vagina.
o Cut umbilical cord: clamp umbilical cord one at 6 inches and the other at 9 inches
from the infant's abdomen.
o Allow the placenta to deliver and carry it with you to the receiving facility.
o Dry the infant and wrap in blanket.
o Allow the baby to suckle on the mother's breast as this helps the uterus to
contract.

Infant

• Treat cyanotic infants by blowing oxygen across the infant's face.

• If breathing is inadequate, give PPV at rate of 40-60 per min in addition to oxygen.
• If heart rate drops below 60, begin CPR.
• If umbilical cord presents first, protect it with a sterile dressing moistened with sterile
saline solution. Keep pressure off the cord by pushing on any parts of the infant that is
presenting. Position patient in a knee-chest or Trendelenburg position.
• If breech birth occurs, support the infant during delivery. When the body is delivered but
the head can't, provide an airway to the infant's nose and mouth. Do this by inserting your
index and middle fingers in a V shape into the vagina, along the walls, with the infant's
nose and mouth between your fingers.
• For limb presentation or shoulder dystocia, position mother in a knee-chest position.
Have the mother pant if she has the urge to push.
• If meconium staining is observed, suction the infant's mouth and nose as soon as it
presents and before the baby is stimulated to breathe.
• For premature births, provide infant with oxygen by blowing oxygen across the infant's
face. Insulate the infant to maintain body temperature. Protect the infant from contact or
exhaled breath of others who might transmit infections.
• Transport as fast as possible while stabilizing the patient.

Medical conditions and mechanisms

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Ectopic pregnancy: faulty implantation of the embryo inside the fallopian tube or outside
the uterine wall, where it can not support the growing embryo. Eventually, the tissue
ruptures, and causes massive internal bleeding.
• Pregnancy lasts for 9 months, or 3 trimesters, at the end of which, labor begins.
• Labor: contraction of the uterine wall to expel the fetus and the placenta.
o Dilation: first stage of labor, involves the dilation of the cervix. The infant's heat
can now progress to the birth canal.
o Expulsion: second stage of labor. Begins with complete cervical dilation and end
with the delivery of the baby. During this stage, the rectum is compressed, which
is why the mother feels the urge to defecate.
o Placental: begins after the delivery of the baby and ends with the expulsion of the
placenta.
• Supine hypotensive syndrome: when a pregnant patient is supine, the weight of the uterus
and fetus presses on the inferior vena cava. This drops the blood pressure and may lead to
inadequate perfusion.
• Breech birth: buttocks or lower extremities present first.
• Placenta Previa: the placenta implants over or near the opening of the cervix. Movement
of the infant or dilation of the cervix can cause the placenta to tear off the uterine wall
prematurely and produce massive bleeding.
• Abruptio placentae: abnormal separation of the placenta from the uterine wall prior to
birth. This causes bleeding and hypoperfusion to the fetus.
• Preeclampsia is where vasospasms cause an increase blood pressure, causes swelling,
headaches and visual disturbances. This can become Eclampsia when the patient
experiences seizures or coma.

Terms
• Bloody show: vaginal discharge of the cervical mucus plug, which signals the beginning
of labor.
• Crowning: appearance of the baby's head.
• Cephalic delivery: normal delivery where the head presents first.
• Obstetric: related to pregnancy and childbirth.
• Prolapsed cord: instead of the head, the umbilical cord is the first part to present.
• Knee-chest position: kneeling and bent forward with face down, chest to knees.
• Limb presentation: either the arm or leg presents first.
• Meconium: bowel movement of the fetus, staining the amniotic fluid to greenish or
brownish color. Occurs when the infant is in hypoxic distress.
• APGAR: scoring system that assesses the infant's condition. If total apgar score is 0-3,
provide oxygen, ventilate and perform CPR. If 4-6, provide stimulation and oxygen. 7-10
is healthy.
o Appearance: pink is good (2) , cyanotic is bad (0). Cyanotic only at the
extremities is in between (1).
o Pulse: fast, over 100 is good (2), no pulse is bad (0). Anything in between (1).
o Grimace: responsive with grimace and makes sounds is good (2), unresponsive is
bad (0). Facial grimace only (1).
o Activity: active movement is good (2), no movement is bad (0). Some flexion (1).

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Respiration: strong cry is good (2), apnea is bad (0). Weak cry (1).
• Braxton-Hicks contractions: also called false labor. These are painless, short and irregular
contractions as early as the 13th week of pregnancy.
• Precipitous delivery: birth with less than 3 hours of labor, which increases risks of
trauma.
• Shoulder dystocia: when the baby's shoulders are wider than the head. The head can pass
through but the shoulders can't.
• Lesson 4-10 Practical Skills Lab: Medical/Behavioral
Emergencies and Obstetrics/Gynecology
• Draws on the knowledge and skills learned thus far in this practical lab. Students will be
given the opportunity to assess and treat a variety of patients with various medical
complaints.
• Lesson 4-11 Evaluation: Medical/Behavioral
Emergencies and Obstetrics/Gynecology
• Conducts a written and skills evaluation to determine the student's level of achievement
of the cognitive, psychomotor and affective objectives from this module of instruction.

MODULE 5: TRAUMA

Lesson 5-1 Bleeding and Shock

Signs and symptoms
• Bright red, spurting blood = arterial bleed.
• Dark red, flowing blood = venous bleed.
• Slow, oozing blood = capillary bleed.
• Bleeding from the nose, ears, or mouth may be due to head injury.
• Internal bleeding signs
o Hematoma.
o Abdominal bruising.
o Discoloration.
o Tenderness.
o Rigidity.
o Distended abdomen.
o Bleeding from mouth, rectum and other body orifice.
o Vomiting blood (a red or dark color).
o Stools with blood.
• Shock signs
o Anxiety.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Altered mental status.

o Tachycardia.
o Rapid, thready pulse.
o Decreased (or normal if in the compensatory stage) blood pressure.
o Rapid, shallow respiratory rate.
o Pale, cool clammy skin.
o Poor cap refill.
o Narrow pulse pressure (low systolic, high diastolic) due to vasoconstriction.
o Altered mental status.
o Dilated pupils that are slow to respond to light.
o Thirst.

Treatment
• Direct pressure: immediately press down with the finger tips of your gloved hand. Apply
pressure over a dressing when it becomes available.
• Elevate extremity: if bone fracture or joint injury occurred, splint before elevating
extremity.
• Pressure points: brachial artery for the upper extremity and femoral artery for the lower
extremity.
• Oxygen.
• PPV if needed.
• Splinting: provides immobilization that prevents further injury.
o Traction splint: for femur fractures.
o Air splint: a splint that also applies pressure to control bleeding.
o PASG (pneumatic antishock garment): control severe bleeding in the pelvis and
lower extremities.
• Cold application to local area: ice packs wrapped with a soft covering, applied to the site
of injury can help clotting, vasoconstriction and may reduce swelling.
• Tourniquet as a last resort, as close to the injury site as possible, and follow medical
direction.
• For nose bleeds, have the patient sit and lean forward, pinch the nostrils together and
apply ice pack to the bridge of the nose.
• Do not give medications that are anticoagulants such as aspirin to patients with bleeding.
• Patients with signs of shock should be placed in a Trendelenburg position to help
maintain blood pressure.
• Keep shock patients warm so their core body temperature is maintained. Wrap patient in
blankets.
• ALS intercept can better stabilize shock patients by transfusion of saline solution.

Trauma conditions and mechanisms

• Femur fracture: up to 1500 mL of blood can be lost around each femur. The traction
splint pulls on the leg and decrease the amount of blood that can bleed into it.
• 3000 mL of blood can be lost in the thorax.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Tibia, fibula and humerus can lose up to 500 - 750 mL of blood.

• Bleeding in the nasopharynx can fall into the stomach, which results in vomiting of
blood.
• In response to loss of blood, the body responds by increasing heart rate, strength of
contraction, and vasoconstriction. Also, the adrenal glands will secrete epinephrine and
norepinephrine, which stimulate vasoconstriction and sweating. All this serves to
maintain blood pressure and gives the patient the characteristic shock signs of pale, cool
and clammy skin.
• Hemophilia: clotting disorder where bleeding can not stop.
• Shock is hypoperfusion due to a variety of factors:
o Fluid loss: from bleeding, fluid loss, or dehydration. The body's response is
vasoconstriction to maintain blood pressure.
o Pump failure: inadequate heart function.
o Vasodilation: blood pressure drops when vessels dilate.
o Hypoxia: inadequate oxygen.
• Types of shock:
o Hypovolemic shock: decreased blood volume. A type of hypovolemic shock is
hemorrhagic shock, which results from blood loss.
o Obstructive shock: something blocks perfusion to the heart. For example,
pulmonary embolism, tension pneumothorax, or cardiac tamponade.
o Distributive shock: abnormal blood distribution that leads to inadequate blood
reaching the heart.
▪ Vasogenic or neurogenic shock: nervous system injury leading to
vasodilation in the periphery. This causes inadequate perfusion to the vital
organs.
▪ Anaphylactic shock: severe allergic reaction that leads to vasodilation and
bronchoconstriction.
▪ Cadiogenic shock: inadequate pumping of the heart. Can be due to heart
disease or heart attack.
• Stages of shock:
o Compensatory shock: the body is able to maintain blood pressure by
vasoconstriction and also maintain perfusion by increasing the pulse and
respiratory rate. Perfusion to the periphery decreases as blood is shunted to
maintain perfusion to the vital organs. Thus the patients exhibits normal blood
pressure but has a high diastolic blood pressure (vasoconstriction), increased
pulse and respiratory rate, pale and cool skin (blood shunting to the vital organs)
and anxiety (epinephrine effect).
o Decompensated (progressive) shock: the body can no longer maintain adequate
perfusion to the vital organs. Blood pressure drops even though the heart attempts
to beat even faster (tachycardia) and stronger. This leads to a very weak pulse.
Vasoconstriction increases so much that it begins to shut off perfusion to vital
organs - kidney failure. Metabolic waste from poor perfusion builds up. More
epinephrine is released and the skin becomes pale, cool and clammy. Thirst
develops. As the brain experiences hypoxia, the patient experiences anxiety and
eventually altered mental status.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Irreversible shock: The body fails at this stage, and the effects can not be
reversed. Blood pressure drops so much that even the carotid and femoral pulses
are barely palpable. The heart begins to slow and eventually stop. Breathing is
ineffective (rapid, shallow). The skin mottles. Bleeding may occur from every
orifice. Patient is unresponsive.

Terms
• Epistaxis: nosebleed.
• Hematoma: a contained collection of blood.

Lesson 5-2 Soft Tissue Injuries

Continues with the information taught in Bleeding and Shock, discussing the anatomy of the skin
and the management of soft tissue injuries and the management of burns. Techniques of dressing
and bandaging wounds will also be taught in this lesson.

Lesson 5-3 Musculoskeletal Care

Reviews of the musculoskeletal system before recognition of signs and symptoms of a painful,
swollen, deformed extremity and splinting are taught in this section.

Lesson 5-4 Injuries to the Head and Spine

Reviews the anatomy of the nervous system and the skeletal system. Injuries to the spine and
head, including mechanism of injury, signs and symptoms of injury, and assessment. Emergency
medical care, including the use of cervical immobilization devices and short and long back
boards will also be discussed and demonstrated by the instructor and students. Other topics
include helmet removal and infant and child considerations.

Lesson 5-5 Practical Skills Lab: Trauma

Provides practice of the assessment and management of patients with traumatic injuries.

Lesson 5-6 Evaluation: Trauma Module

Conducts a written and skills evaluation to determine the student's level of achievement of the
cognitive, psychomotor and affective objectives from this module of instruction.

MODULE 6: INFANTS AND CHILDREN

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Lesson 6-1 Infants and Children

Presents information concerning the developmental and anatomical differences in infants and
children, discuss common medical and trauma situations, and also covered are infants children
dependent on special technology. Dealing with an ill or injured infant or child patient has always
been a challenge for EMS providers.

Differences in body structure

• Faster breathing rate, faster pulse.
• Larger head: more prone to head injuries. Need shoulder padding when in a supine
position.
• Larger tongue: more prone to airway obstruction.
• Narrower airway: more prone to airway obstruction.
• Higher Epiglottis: more prone to aspirations.
• Relies more on the diaphragm to breath: minimal chest movement, assess breathing by
looking at abdominal movement.
• More pliable ribs: less protection of internal organs.
• More fragile lung tissue: more prone to pulmonary contusion.
• Smaller blood volume: more prone to shock from blood loss.
• Faster metabolic rate: need enough oxygen to support metabolism, more prone to
hypoxia.
• Larger skin surface area to body volume ratio: more prone to hypothermia.

Treatment differences
• Keep infants and children warm.
• Elevate the shoulders with padding when in a supine position.
• Look for movement of the abdomen instead of chest movement when assessing
breathing.
• Back slaps used for infants instead of abdominal thrusts.
• Blow-by oxygen for infants who would not tolerate a mask.
• Cap refill for infants is assessed by pressing on the forearm.
• Patent airway is especially important because the airway is more prone to compromise in
infants and children.
• Report any child abuse or neglect.
• Use "baby" sized cervical collars and immobilization devices.

Respiratory distress
• Respiratory failure is the leading medical cause of cardiac arrest in infants and children.
• Early signs
o Nasal flaring.
o See-saw respirations.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

o Abnormal breathing sounds: stridor, grunting, wheezing.

o Neck muscle use.
o Retractions: neck, intercostals, below the rib cage, above the clavicles and
sternum.
• Late signs
o Cyanosis.
o Weakness and altered mental status.
o Rapid but shallow breathing.
o Head bobbing.
• Respiratory arrest
o Breathing rate less than 10 per minute.
o Irregular breathing.
o Limp and unresponsive.
o Decreased heart rate.
o Weak pulse and blood pressure.

Medical conditions
• Croup: infection of the upper airway. Signs include the "seal bark" cough, stridor, and
respiratory distress. Apply humidified oxygen to such patients.
• Epiglottitis: infection of the epiglottis. Pain upon swallowing, drooling, fever, stridor, and
respiratory distress. Do not insert anything into the airway because anything can irritate
and cause swelling that can completely block the airway. Apply oxygen and PPV if
needed.
• Asthma: airway inflammation and swelling. Administer prescribed MDIs and apply
humidified oxygen.
• Bronchiolitis: infection of the bronchioles lining. Causes wheezing, fever, rapid heart and
respiratory rate, and shortness of breath.
• Cardiac arrest: Choose an appropriate AED that is suitable for infants. For infants and
children, when heart rate drops below 60, begin chest compressions.
• Meningitis: infection of the brain and spinal cord lining. Signs include fever, infection,
lethargy, malaise, and rash. Wear a mask and use gloves and gowns if meningitis
suspected.

Terms
• Neonate: from birth to discharge from hospital.
• Infant: up to 12 months old.
• Toddler: 1-3 years old.
• Preschooler: 3-6 years old.
• School age: 6-12 years old.
• Adolescent: 12-18 years old.

Lesson 6-2 Practical Skills Lab: Infants and Children

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Provides the EMT-Basic student with the opportunity to interact with infants and children, and to
practice the knowledge and skills learned thus far concerning this special population.

Lesson 6-3 Evaluation: Infants and Children

Conduct a written and skills evaluation to determine the student's level of achievement of the
cognitive, psychomotor and affective objectives from this module of instruction.

MODULE 7: OPERATIONS
Lesson 7-1 Ambulance Operations
• Police escort: use only as a last resort such as when you are unfamiliar with the place and
location. Driving hazards are doubled when an escort is involved.
• The most common collisions involving ambulances are intersection collisions.
• Emergency lights should be on at all times during an emergency call.
• Use sirens according local protocol. Always let the patient know before activating the
siren to avoid stress and fright.
• Use air horns according to local protocol. Do not sound horn when you are really close to
another vehicle.
• Always face approaching traffic, never turn your back to it.
• Position the first ambulance on scene to create a barrier between oncoming traffic and the
scene. Turn the wheels of the ambulance such that if someone crashes into it, the
ambulance will steer away from the scene that you are working in.
• Control traffic with cones, personnel, and other emergency vehicles.
• Turn off headlights and spotlights at night so you don't blind and confuse oncoming
traffic.
• Inspect your vehicle systems daily.
• Restock, clean, and perform maintenance after each run.
• Park ambulance uphill and upstream of any wind from scenes involving hazardous
materials leakage.
• Washing hands after each run and after all cleaning procedures are complete.
• When approaching or leaving the helicopter, always do so at the pilot's direction, crouch,
and approach from the downhill side.
• Always cross the helicopter in front, not behind.
• Lesson 7-2 Gaining Access
• Provides the EMT-Basic student with an overview of rescue operations. Topics covered
include roles and responsibilities at a crash scene, equipment, gaining access, and
removing the patient.
• Lesson 7-3 Overviews
• Provides the EMT-Basic student with information on hazardous materials, incident
management systems, mass casualty situations, and basic triage.
• Lesson 7-4 Evaluation: Operations

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Conduct a written and skills evaluation will be done to determine the student's level of
achievement of the cognitive, psychomotor and affective objectives from this module of
instruction.

MODULE 8: ADVANCED AIRWAY

Lesson 8-1 Advanced Airway
• Intubation equipment
o Laryngoscope: used to hold the mouth and epiglottis open, and shine a light into
the airway so an endotracheal tube can be inserted.
▪ Straight blade: directly lifts the epiglottis.
▪ Curved blade: indirectly lifts the epiglottis by lifting the base of the tongue
next to the epiglottis.
o Tracheal tubes
▪ Adult male 8-8.5 mm.
▪ Adult female 7-8 mm.
▪ Infants and children 2.5-6 mm.
▪ A generic size is 7.5 mm. When in doubt, use the smaller size.
▪ The distal side contains an inflatable cuff that holds it in position after a
successful intubation.
o Stylet: pliable metal wire that is initially inside the tracheal tube to keep it from
kinking.
• Tracheal tube insertion
o Ventilate patient for 2 minutes before intubation attempt.
o Assemble and test equipment:
▪ Pick the right sized tube.
▪ Insert stylet into the tube.
▪ Lubricate distal end.
▪ See if cuff inflates.
o Visualize the vocal cords and glottic opening and insert tube through the vocal
cords.
o Tube should go down halfway between the carina (where the trachea branches)
and the vocal cords.
o Hold the tube in position all the time until the cuff is inflated.
o Remove laryngoscope, stylet, and inflate the cuff.
o Confirmation of successful intubation:
▪ Air sounds in lungs, but not the stomach
▪ CO2 detected in exhaled breath
▪ Equal breath sounds to both sides. If unequal, you've inserted the tube too
far.
▪ An esophageal detection device - the esophagus will collapse in response
to negative pressure and give you resistance.
▪ Exhaled condensation in the tracheal tube.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

▪ Puls-ox reading should show that the patient is getting oxygen with the
tube in place and not deteriorating into hypoxia.
o Mark the position of the successful intubation on the tracheal tube.
• Maximum time spent intubating a patient = 30 seconds. If you exceed it, stop, and
ventilate the patient for 2 minutes before re-attempting intubation.
• Always have a suction device ready during intubation in case of vomiting. Also, suction
any fluids in the airway before intubation.
• Nasalgastric insertion in infants and children: used to extract air from the stomach in case
of gastric distention that threatens to stimulate vomiting or compromise PPV.
• Orotracheal suctioning: this type of suctioning can go beyond the base of the tongue and
into the trachea up to the carina. Used for removing secretions that could block the
airway. Suction for a maximum of 15 seconds at a time for adults and ventilate the
patient for 2 minutes before repeating. Suction on the way out with twisting motion of the
catheter.
• Sellick maneuver: closes off the esophagus by applying pressure to the cricoid cartilage
to prevent aspirations. Also called cricoid pressure. Applied to unresponsive patients
without a gag reflex. Applied during an intubation attempt if enough personnel available.

• Lesson 8-2 Practical Skills Lab: Advanced Airway

• Demonstrates the skills of advanced airway techniques for the EMT-Basic. This includes
insertion of the nasogastric tube in infant and child patients and orotracheal intubation of
adults, infants and children.
• Lesson 8-3 Evaluation: Advanced Airway
• Conduct a written and skills evaluation to determine the student's level of achievement of
the cognitive, psychomotor and affective objectives from this module of instruction.
Whenever possible, supervised clinical experience will be provided to the students.

MISCELLANEOUS
Final Written Testing 3.0
The final exam is comprehensive and covers all topics listed by the national registry. The final
exam given by your EMT instructors are designed to test the same concepts as the state and
national exams for certification. Below is an outline of the important concepts you must know as
a bare minimum both for your final exam and for your certification. Everything in this outline
can be found in the notes on this website - review them if you are not sure about any particular
concept.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

Module 1: Preparatory
• BSI scene safe - as an EMT, your first and foremost priority is the safety of yourself and
your crew.
• Know about your duty to act and what constitutes as abandonment.
• Memorize the anatomy of the heart.
• Know the body positions like supine, Trendelenburg, etc.
• Know the anatomical planes, such as anterior, posterior, etc.
• Memorize your vital signs - what is considered normal and what is not.

Module 2: Airway
• Learn what is considered inadequate breathing. For example, the breathing may be fast,
but shallow, and therefore is inadequate.
• Every time you have inadequate breathing, you need PPV.
• As an EMT, you can safely administer oxygen to any patient.
• Know your suctioning techniques - how long you can suction for, how deep you can go,
and suction on your way out.

Module 3: Patient assessment

• Completely memorize the steps of patient assessment and the order they are in.
• Know what to do during each step of patient assessment.
• Be aware that at any point during patient assessment, if you spot a problem with the
ABCs, immediately stop and intervene.
• Know that the way to "cover you behind" is to document thoroughly.

Module 4: Medical/behavioral emergencies and Ob/Gyn

• Learn your signs and symptoms.
• Know your interventions.
• Know what medications you are allowed to administer as an EMT.
• Know the indications and contra-indications. For example, nitro can't be given if blood
pressure is too low. Also, it may seem dumb, but for anything given orally, you
• need to make sure the patient can swallow. If the patient is unresponsive, you can't give
anything orally.
• Be aware that any female with abdominal pain is a suspect for ectopic pregnancy - a true
emergency that requires immediate transportation.
• Review how to deliver a baby, and how to care for the ABCs. For example, suction
before stimulating the newborn and keeping the baby warm and dry.

Module 5: Trauma

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)

 lOMoARcPSD|46540738

• Again, realize that you're priority (other than your own safety) is the ABCs. If you have a
broken arm and a blocked airway, make sure you treat the airway first.
• Hold C-spine if spinal injury is suspected.
• Know how to stop bleeds - direct pressure, elevation, pressure points.
• Know how to splint - PMS before, immobilization above and below, PMS after.
• Review the signs of shock - cool and clammy skin, thready pulse.
• Review the treatment for shock - Trendelenburg and oxygen.

Module 6: Infants and children

• Review the differences between kids and adults. For example, no chest rise in kids does
not indicate that they are in respiratory distress because they use their stomach to breath.
On the other hand, if they have nasal flaring, they're in distress.
• Memorize the differences in normal vital signs between kids and adults.
• Know your signs and symptoms for infants and children.

Module 7: Operations
• Review the facts. For example, police escort actually makes transportation dangerous.
• Review MCI. For example, on the scene of an MCI, if someone is not breathing even
when you open the airway, move on to the next patient.
• Know how to triage.

Module 8: Advanced airway

• Know how to intubate.
• Review the signs that indicate a successful intubation.
• Be aware that you can only spend 30 seconds attempting to intubate before you must
ventilate the patient for 2 minutes.

Scope of Practice Evaluation 25.0

• Patient assessment: trauma.
• Patient assessment: medical.
• Bleeding and shock.
• CPR.
• Extrication.
• Splinting.

Downloaded by daniel Natwart (natwatidaniel2000@gmail.com)