Final Paramedic Fisdap Study Guide

Ems Operations - Page 1

OB/Gynecology - Page 11

Pediatrics - Page 20

Airway - Page 30

Medical Emergencies - Page 39

Trauma - Page

Cardiology - Page - Page 54

EMS OPERATIONS

1. Airbags Safety During Extrication (2228)

• Un-deployed airbags may deploy during extrication and cause harm to the patients and

rescuers.

• Look for airbag badging or labeling system

• A vehicles airbags system comes equipped with an energy capacitor that can store power for

up to 30 mins in some models

• Remove key from ignition

4. Criteria for Transferring Care of Patient (154)

• In your documentation of care, it is important that you were able to show in whose care you

left the patient with, otherwise you could face allegations of abandonment. some agencies have

begun to require physician or nurse signatures to verify that the patient was left with a medical

professional of a higher level of training. Another situation that may require you to document a

transfer of care is when you hand over your patient to another agency such as a paramedic

transport crew or an air medical team.

5. Decontamination of Airway Equipment

• Sanitize and disinfect everything after a call

• Any piece of equipment that is intended for single use should be discarded in an appropriate

hazardous materials bag. For any reusable piece of equipment that has had direct contact

with the patient or patients bodily fluids, use a commercial disinfecting agent for

decontamination. Bleach diluted in water (1:10) can also be used as disinfecting agent.

6. Documenting Medication Administration (471)

• Documentation is everything, if you did not document it, you didn’t do it. Always document

your actions and the patients response on the on the patient care report after administering a

medication. This includes...

- Name

- Dose

- Time

- Route

- Persons name who administered it

- Patients response to the medication, whether positive or negative

7. Indications for N95 Mask

• 95 (Heppa) Mask on you, surgical or normal mask on patient

8. Indications for Rapid Extrication (1677-1699) (2226)

• Patient can be moved from sitting in a car to laying supine on a backboard in 2 mins.

Indications listed below

- The vehicle or scene is unsafe

- The patient cannot be properly assessed before being removed from the car

- The patient needs immediate intervention that requires a supine position

- The patients condition requires immediate transport to the hospital

- The patient blocks your access to another seriously injured patient

• A team member should remain with the patient to direct the rescuers who are preforming the

disentanglement. For example, unless there is an immediate threat to fire, explosion, or other

danger, you should preform a primary assessment and perform and critical interventions before

disentanglement begins. This may include providing c-spine immobilization, opening airway,

providing O2, ventilations, or controlling significant bleeding. Once life threats have been

treated, disentanglement can begin. Sometimes a patient must be removed quickly (Rapid

extrication) because his or her general condition is deteriorating and time does not permit

meticulous splinting and dressing procedures. Quick removal may also occur if hazardsare

present, such as as spilled gas or other materials that could endanger the patient orrescue

personnel. The only time the patient should be moved prior to completion of initialcare,

assessment, stabilization, and treatment is when the patient’s or emergency responders life is

in immediate danger.

10. Making Decisions Regarding a Patients Request to Refuse Care (96-99)

• Patients with decision-making capacity have the right to refuse all or part of the emergency

medical care offered to them

• Refusing care - Needs to be informed consent.

• Need to use your “People skills” and just talk to the patient

· Ensure your pt is fully informed about their current situation, his or her right to

receive or refuse medical care, and the consequences of a refusal of care

· Unresponsive patients may be treated under implied consent

· Involve online medical control if pt have severe injuries but refusing care

· Document carefully and have pt sign AMA

Minors - Because minors have no legal status, they can neither refuse no consent to medical

care. In the case of children and adults who have legal guardians, consent must be obtained, if

possible, from a parent or legal guardian of the patient. If the parent or guardian is not available,

emergency treatment to sustain life may be undertaken without direct consent under the doctrine

of implied consent. You should also be aware of the legal principle known as “In loco parentis”.

This term literally means “In place of the parent”. This principle may apply in school, day care, or

summer camp situations if a parent is unavailable. The school administrator or day care director

may make treatment and transportation decisions on behalf of the minor.

A particularly difficult circumstance can arise if a parent or legal guardian refuses to grant consent

to treat a minor who clearly requires lifesaving or limb-saving treatment. Although adultsclearly

have the right to refuse treatment for themselves, state laws generally do not permit a parent or

guardian to deny treatment to a minor child. In fact, the failure of a parent to allowsuch

treatment may constitute neglect. When confronted with such a circumstance, the paramedic

should notify law enforcement and medical control. State law may permit the state to

assume custody of the child for purpose of ensuring that necessary emergency treatment be

provided.

Emancipated Minors - are under legal age in a given state but can be treated as legal adults

because certain circumstances. By court order. Marriage, pregnancy, or active military service.

They can accept or deny care.

12. Operations within a HazMat Scene

Responding to Hazmat incidents

· Look for warning signs such as patient S/S, placards, labels, etc.

· Placards or labels may be found on building, trucks/railway cars, drums/storage

vessels

· Intentional ingestion of chemicals and activities occurring at illicit labs or potential

terrorist activities may have no obvious signs

· Some chemicals are odorized (propane, methane) where other dangerous

substances are odorless (carbon monoxide)

· If you approach a scene where more than one person has collapsed due to

respiratory distress, suspect the presence had a hazardous material

· When arriving, you should stop at a safe distance, uphill and upwind from the scene

· Items to report include:

o Exact location

o Atmosphereic conditions

o Size/shape of containers

o Chemical ID number or symbols

o # of victims with S/S

o Type and number of additional resources

18. Stress Management (42-43)

• Fight or flight mode S/S - heart palpitations, rapid breathing, chest tightness, sweating, rapid

breathing, unnecessary shouting.

1. Control breathing

2. Progressive Relaxation - tighten/relax muscle groups to initiate muscle relaxation throughout

the body. Stupid.

3. Professional Assistance - Seek therapist

• Focus on immediate situations while on duty, remind yourself “I will do my very best, but what i

can do may not be enough”

• Avoid excessive amounts of stimulants such as caffeine or alcohol, cigs, or sleeping aids after

a stressful event.

• Stages of Stress

· Acute reaction – occurs during stressful situations

· Delayed reaction – manifests after stressful situations

· Cumulative reaction – when you are exposed to prolonged/excessive stress

19. Treating a Patient with Advance Directives

An advance directive is usually a written document (but can be also an oral statement) that

expresses the wants, needs, and desires of a patient in reference to his o her future medical care.

Advance directives state what medical care the patient wants or does not want when the

patient is unable to express his or her wishes. Living wills, DNR’s, and organ donation orders

are all advance directives. DNR’s can also be called Resuscitation Directive

Living Wills and Health Care Power of Attorney are types of advance directives in which a patient

can express wishes regarding end-of-life medical care. These directives are sometimes called

health care “durable” power of attorneys because they remain in effect once a patient loses

“decision making capacity”. The person who carries the Health Care Power of Attorney is often

called the “Surrogate Decision Maker”. They are legally obligated to make decisions as thepatient

would want, and has presumably discussed these decisions with the patient. It isimportant to keep

in mind that the “Surrogate Decision Maker” has no authority until the patient becomes incapable

of making decisions. If the “Surrogate Decision Maker” is attempting tomake decisions that

conflict with a competent patients decisions, the patients decisions are always the ones to be

followed.