Larissa McDonald

NREMT Study Guide Project

Reasons to stop compressions are:

The scene becomes unsafe, Too exhausted, Additional help arrives to relieve you, Patient
wakes up and the AED tells you to check for a pulse or patient has a pulse.

Adult compressions:
100-120 chest compressions per minute, 30 > 2 breaths.
2 minutes per round and 5 sets of chest compressions, 20 seconds.

AED:
Automated External Defibrillator: Power, Pads, Plugs
1) Check the scene for safety
2) Call for help
3) Check for consciousness
4) Check pulse
5) Check breathing

Rescue Breathing:
12-20 breaths per minute for the average adult, once every 5 seconds breathe for patient, check
pulse in carotid artery

BVM:
Bag Valve Mask

Pediatrics:
For 2 rescuers is 15 compressions > 2 breaths
For 1 rescuer is 30 compressions > 2 breaths
Same as 2 hand compression with 1.5 depth
Check carotid artery for pulse

Infants:
For 2 rescuers is 15 compressions > 2 breaths
For 1 rescuer is 30 compressions > 2 breaths
Same as 2 hand compression with 2-2.5 depth
Check brachial artery for pulse
1 rescuer use 2 fingers straight down
2 rescuer triangle thumb
EMS is a system that consists of:
A- Doctors
B- Nurses
C- Nursing Homes and Hospitals
D- EMT and Paramedics
E- Patients and Bystanders
F- Firefighters and Police

You cannot move the patient until they are stable or have a pulse and must do at the scene.
The patient is brain dead after 10 minutes without 02

EMR: First responder/ CPR/ First Aide/ cannot transport- 60 hour class
EMT: Can transport and administer certain meds- 100-150 hour class
AEMT: Start IV's, administer medications, Drill bone for IV access- 100-150 hour class
Paramedic: Airways, IV's, read EKG, administer medications, intubate- 1,000 hour class

Patient-level of conscious:
A- Alert
V- Verbal
P- Painful
U- Unresponsive

Patient Airway should be no distress

Capillary refill:
Pediatrics- squeeze fingernail and if it takes more than 2-4 seconds to refill then it is serious

O- Onset of symptoms
P- Provocation
Q- Quality (feel like)
R- Radiation
S- Severity
T- Time

Overdose has pinpoint pupils

Stimulants have large pupils

Blood Pressure:
Systolic is the top number
Diastolic is the bottom number
MAP is Mean Arterial Pressure
If you cannot get BP you can use radial pulse by applying bp cuff and just get systolic pressure

S- Signs and symptoms

A- Allergies
M- Medications
P- Past medical history
L- Last oral intake
E- Events leading up to the emergency

Consents:
Expressed is verbal consent
Impaired is unconsciousness and cannot make decision
EMS is allowed to enter residence under emergency circumstances
Drug overdose cannot refuse treatment even if they are awake

ECO:
Emergency Custody Order is for mental, abuse and drugs
TDO:
Temporary Detain Order

EMS can search patient's during care and take weapons

Minors can refuse care at 14

Pregnant teens can refuse care until the baby is born then she is a minor again once the baby is
born

Incompatible with life is decapitation

The body will decomposition in 6 to 12 hours
Pooling is the first sign of death within 20-30 minutes

Ask patients open and closed-ended questions

Ethnocentrism is the evaluation of other cultures according to preconceptions originating in the

standards and customs of one's own culture

PCR:
Patient Care Reports
Base Station is where information comes from
The repeater is the person that repeats information
Mobile Radio is in the truck and radios are two-way
Repeaters have a special based radio
MCI- Mass Casualty Incident
EMD- Emergency Medical Dispatch

Communication World consists of:

Dispatcher
EMS
EMT
Priority Dispatch:
ALS is for vomiting emergencies
BLS is for a stubbed toe
Patient Report:
Call on the radio to hospital in an ambulance with the report that should last 1-2 minutes
In the hospital when arrive give full report up to 5 mins

Medical Direction:
Call on radio Dr in the ER when you have questions about medications
Dispatch should tell you hazards and how many casualties before arriving on the scene

Types of Ambulances:
Type I:
Conventional with space between the cab and the back, truck front and box back
Type II:
Standard Van like G&W or transport vans
Type III:
Speciality Van Cab, van front and box back

Recheck your stable patient every 15 minutes in ambulances

Recheck your unstable patient every 5 minutes on ambulance
No names over the radio

Glasco Coma State Scale:

3 is bad with no response and 15 is good and the patient is alert

NPA:
Nasal Pharagenal Airway
Nasal trumpet
Sizing is ear lobe to the side of the nose
For airway, overdose, bagging
Bevel faces in and use lube, place in the nose and twist in on the right side

OPA:
Oropharyngeal Airway
Goes in mouth
Sizing is the corner of the mouth to the ear lobe
For unresponsive patients but not if they have a gag reflex
Put the thumb on the tongue to put in the mouth, no lube and insert curve facing pallet turn

Directional terms:
Flexion- Move into or towards the body
Extention- Move outward away from the body
Adduction- Move body part towards the body
Abduction- Move body part away from the body

4 Quadrants:
RIght upper quadrant- RUQ consists of liver, gallbladder, intestines, pancreas
Right lower quadrant- RLQ consists of intestines, appendix, kidneys, ovary
Left upper quadrent- LUQ consists of stomach, intestines, spleen
Left lower quadrant- LLQ consists of kidneys, ovary, intestines

Transport patients in 45 degrees Semi-Fowler position

Skull has 4 cranium bones, 14 facial bones and the hyoid bone which is the only bone that does
not connect to any bone and supports the tongue
Spinal column has 33 bones. Divided into 5 sections: Cervical, Thoracic, Lumbar, Sacrum and
Coccyx
Cervical is the most important spinal area becuase if damaged can stop a person breathing
Thorax is formed by 12 vertebrae and 12 pair of ribs
Thoracic Cavity consists of heart, lungs, esophagus and aorta/two venae cavae
Shoulder Girdle consists of clavicle, scapula and humerus
Pelvis consists of sacrum and 2 pelvic bones formed by fusion of the ilium, ischium, and pubis

Inferior Vena Cava is blue on left

Descending Aorta is red on right
There is one in each leg and a fractured pelvis is a concern because bleeding out from hitting
arteries

There are 3 types of muscle:

Skeletal
Smooth
Cardiac

Upper Airway consits of:

Nose
Mouth
Tongue
Jaw
Larynx

Pharynx:
Nasopharynx
Oropharynx
Laryngopharynx
Trachea:
Epiglottis
Esophagus ends below the chin

Lower Airways exchanges O2 and consists of:

Thyroid Cartilage which is Adams Apple
Cricoid Cartilage is below thyroid cartilage and cricoid membrane
Trachea ends by the diaphragm
Lungs are divided into 5 lobes, contain bronchi, bronchioles, alveoli, and allow for gas
exchange. There are 2 left lobes and 3 right loves.
Diaphragm and intercostal muscles are the primary muscles of breathing.
Other muscles involved in breathing are:
Neck, abdominal and pectoral
Negative pressure when the diaphragm gets bigger
Intercostal Retractions is sinking in of the chest and ribs
Labor breathing: Getting more air in

Respiratory System:
Gets oxygen and gets rid of carbon dioxide and H2O
Ventilation is the physical aspect of breathing and respiratory is a chemical aspect
Chemical exchange of O2 in alveoli and tissues
Cappillaries happens with gas exchange and alveoli are little ballons
Respiration provides O2 to cells and removes CO2.
Diffusion is the passive process which O2 mo;ecules move from the area with a higher
concentration of molecules to an area of lower concentration
The brain stem controls breathing
COPD patients retain to much CO2

Ventilation is simple air movement into and out of lungs

Tidal Volume is breathing in and out 500 mL
Residual Volume is extra O2
Dead Space is air that just sits between lungs 150 mL
Minute Volume is how many breaths we take per minute 500mL x 12-20 = 6,000
Labored Breathing (Hypoperfusion) consists of muscle retractions, pale, cyanotic, cool, damp
skin, tripod position (leaned over) Agonal gasps and Agonal rhythm on EKG is not beating
enough to retain life.

Heart muscle blood supply comes from aorta blood flow always starts in the heart.
4 Parts of the heart:
RA-LA
RV-LV
VC empties into RA then empties into RV then lungs get oxygen then pulmonary veins
, LA empties into LV then Aorta to the body. S-Node fires electricity and is the bodies
(Pacemaker)
The left ventricle is the majority of the heart, blood enters through the vena cava, right atrium
then the right ventricle
There are four valves:
Tricuspid
Pulmonary
Mitral (Bicuspid)
Aortic

Automacty is two places cells, brain and heart and able to generate it's own impulses
The heart is made up of cardiac muscle and works as two paired pumps
The septum divides right and left sides and each side is divided

Circulation:
Left and right atrium receives blood and left and right ventricles push blood out of body. Left to
body and right to lungs
Heart receives blood from aorta
Right side receives deoxygenated blood from veins
Left side receives oxygenated blood from lungs
Pulmonary edema is where lungs fill up with blood
Normal heart rate is 60-100 beats per minute
Stroke Volume (SV) is blood moved by one beat
Cardiac Output (CO) CO = HR x SV 60-100 BPM

Neck- Carotid
Arm- Brachial
Wrist- Radial
Pelvic- Femoral
Pedis- Top of foot
Tibial- Inside ankle

Vein- Returns oxygenated blood

Spleen is on left side under rib cage, filters blood and can lead to severe internal bleeding
Plasma transports and holds nutrients (river)
Red blood cells- Carrying O2 erythrocytes (boat)
White blood cells- Cells leukocytes (machine gun) protection
Platelets- Blood clots (beavers)
Systole- Left ventricle contracts
Diastole- Left ventricle relaxes
Hypoperfusion is shock
Functions of blood:
Perfusion
Transport oxygen
Transport CO2
Transport waste and nutrients
Clotting

Nervous System:
Most complex organ in the body
Two main portions:
CNS-Spinal cord and brain
PNS- Everything else
Autonaumic is involuntary (fight or flight) Sympatic and Parasympathetic
Somatic is voluntary and heart needs to be preloaded before it can contract

Skin:
Largest organ in the body
Layers:
Epidermis (superficial)
Dermis
Subcutaneous (fat)
Functions are protection and regulate temperature
Burns:
Thin 1st degree, Partial 2nd degree, Full thickness 3rd degree

Enzymes are added to food by salivary glands, stomach, liver, pancreas and small intestines
Immune system-Lymphatic circulate and gets rid of toxins, carries oxygen and nutrients to the
cells and waste products away

Factors that impair ventilation is a blocked airway, impairment of breathing muscles, physiologic
obstruction of airway and asthma
Shock is when the body is not getting enough blood or oxygen
Impairment of cellular:
Aerobic-Oxygen
Anaerobic- Without oxygen
Can result in inability to properly use oxygen and glucose at the cellular level, cells create
energy through anaerobic metabolism, can result in metabolic acidosis, brain cells cannot use
alternative fuels, cells injury may be irreversible, muscles sore and tired because of lactic acid

ABC: Airway, Breathing and Compressions

Cardiac arrest is a spiked number for capnography
94-100% O2 is normal
Capnography- 35-45 which is CO2 left inside after breathing
Normal PH 7.35-7.45
Capnography rectangle is good, unusal shapes is asthma, forcing air out and peirce lip
breathing
Color-yellow perfect, Chemical Colorimetric Analysis
Capnography Waveforms- Low # is septic or infection-fighting, high # is trapped toxins
Carbon Dioxide poisoning is increased in red and blood pressure is the last thing to change

Airway:
Use IGel
Size 1 for infants
Size 2 for pediatrics
Size 3 for elderly
Size 4 is for normal
Size 5 is for obese
Use Combitube for IGel and King's
LMA- Laryngeal Mask Airway
Tongues and epiglottis is bigger in babies than adults

Stage 1 of compensated shock

HR < 100
BP normal
RR normal
Skin normal
Bowel sounds decreased
Mental status normal
Urine normal
Blood loss 750 mL
Percent < 15%

Stage 2 of compensated mild shock

HR 100 <
BP normal
RR increased
Skin pale
Bowel sounds decreased
Mental status anxious
Urine 20-30
Blood loss 750-1500 mL
Percent 15-30
Stage 3 of late decompensated
HR 120<
BP drop < 90
RR high
Skin Pale and cold
Bowel sounds absent
Mental status altered and confused
Urine < 20
Blood loss 1500-2000 mL
Percent 30-40

Stage 4 of severe irreversible

HR 140 <
BP < 80
RR increased then decreased
Skin grey and blue
Bowel sounds absent
Mental status unconcious
Urine none
Blood loss over 2000 mL
Percent 40-50

Cardiogenic hypo obstructive shock is pale and blue

Neurogenic diaprentic shock is red, hot, sweaty and flush
Anaphylactic shock is hot, flushed and red

Glucagon- 1 mg IM
ASA- 324 mg oral
EpiPen- 0.3 mg Peds and 0.5 adults IM
Nitroglycerin- 0.4 mg Sublingual up to 3 but do not use if the patient is on erectile dysfunction
drugs
Narcan- 2 mg IN and IM
Activated Charcol- 25-100 g Oral
O2- 2 liters pm to 15 liters pm nasal cannuela, BVM, non-re-breather
Oral Glucose- 15 g oral
Inhaler (MDI)
Albuterol- 2.5 mg Neb, mask, peds non-re-breather

Suction on the way out for no more than 15 seconds for adults, 10 pediatrics and 5 for infants

Anaphylaxis patients increased HR, increased RR, increased BP, dyspnea, decreased O2,
airway compromised. Treatment is EpiPen every 5 mins and O2 on transport
COPD patients wheezing, rales (crackles) low SPO2, smoking hx, decreased HR, increased
HR, need CPAP, nasal O2 if SPO2 lower than 90 %, O2 stats are different from normal people
and transport
Asthma patients have wheezing on astatation, airways constricted, low SPO2, dyspena, needs
EpiPen, CPAP, Albuterol, Neb O2 and transport
Pulmonary Edema patients have rales, increased RR, increased BP and needs CPAP and
transport
Choking patients needs hemlic until become unconscious then need CPR
Overdose patients need Narcain, BVM and suction along with transport
Pneumonia patients have respiratory destress, increased RR, increases BP, increased P and
need O2 and transport
Pulmonary Embolism patients have blood clots in lungs, SOB, pain in chest, pale, cynotic and
needs immediate transport, O2, elevate head
Epiglottis in children patients are cynotic, have swollen airways, dyspnea. Do not move them,
maintain airway and O2, then transport
RSV in children you give O2 and transport
Pertussis Whooping Cough in children you give them O2 and transport
TB patients cough blood, need to wear mask and providers need to wear mask, gloves and give
O2 and transport
Carbon Monoxide Poisoning patients are unconscious, dizzy, nausea, vomiting, delirium and
patient needs O2, maintain airway and transport
CHF patients need to be elevated, O2, CPAP and transport
Cardiogenic Shock patient needs ALS, keep warm, O2 and transport
AMI-STEMI-NSTEMI patients need ASA, transport and O2
Tamponade- Beck's Triad
Angina patients need ASA
AA Aortic Aneyrysm patients have distended abdomin and need transport and BVM
Pneumothorax patients need ALS transport and O2
Ischemic Stroke and Hemorrhagic patients need VAN assessment, 12 lead, O2, vitals, BS and
transport
Seizure patients need Suction, ABC's, NPA, call ALS
Hypoglycemia patients need oral glucose 15 mg or Glucagon 1 mg

12 Leads:
Limb Leads:
Left Leg
Left Arm
Right Leg
Left Arm
Chest Leads:
V1 4th Intercoastal Space Right
V2 4th Left
V3 Splits V2 and V4 Left
V4 5th mid-clavicle Left
V5 splits V4 and V6 Left
V6 5th mid-axillary
Posterior ( V 7,8,9)
V7 is V5 next to 6
V8 is V4 Mid-Clavicle
V9 is V3 Near Spine
Abruptio Placenta is when the placenta detaches from the inner wall of the womb before
delivery
Placenta Previa is when the placenta covers the opening in the mothers cervix

Rule of 9's:
Starts at head and neck: Adults 9%, Children 12%, Infants 18%
Anterior Chest and Abd: 18%, 18%, 18%
Posterior Chest and Abd: 18%, 18%, 18%
Entire left leg: 18%, 14%, 13.5%
Entire right leg: 18%, 14%, 13.5%
Entire left arm: 9%, 9%, 9%
Entire right arm: 9%, 9%, 9%
Groin: 1%, 1%, 1%
Total: 100%, 100%, 100%

Grey Turner is injury internal bleeding around kidney, spleen, bruising downsides and abd full of
blood
Collins is injury internal bleeding that causes bruising around the belly button
McBurners is appendix injury