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Contents 1 Introduction 1.1 Preface 1.2 Scope of care 1.2.1 Skills practiced 1.2.2 Tools used 1.2.3 Body of knowledge 2 Standard protocols 2.1 Scene Survey 2.2 Primary survey 2.3 Critical interventions 2.4 Transport decision 2.5 Patient history 2.6 Process flow 3 Spinal immobilization 4 Measuring vitals 4.1 Respirations 4.2 Pulse 4.3 Blood pressure 4.4 Skin condition Pink Warm Dry 4.5 Pupils PERRL 4.6 Blood glucose 80-120 (Or 3.0mmol/l - 8.0mmol/l) 4.7 Pulse oximetry 90-100% 4.8 Level of Consciousness 4.9 Temperature (Tympanic Thermometer) 5 Moving the patient 5.1 Maintaining spinal immobilization 5.1.1 Spine board 5.1.2 Scoop stretcher 5.2 Body mechanics 5.3 When to move a patient 5.4 Lifts and carries 5.5 Stretchers 5.5.1 Ambulance stretcher 5.5.2 Chair stretcher 6 Identifying and treating illness and injury 6.1 Medical 6.1.1 Respiratory emergencies 6.1.2 Cardiovascular emergencies 6.1.3 Abdominal emergencies 6.1.4 Diabetic emergencies 6.1.5 Anaphylactic emergencies 6.1.6 Drug and poison emergencies 6.1.7 Heat related emergencies 6.1.8 Cold related emergencies 6.1.9 Prevention 6.1.10 Diagnosis 6.1.11 Treatment 6.2 Trauma 6.2.1 Shock 6.2.2 Soft tissue injuries 6.2.3 Musculoskeletal injuries 6.2.4 Spine injuries 6.2.5 Head injuries 6.3 External links

[edit] Introduction

Please note that the EMR module is incomplete. Currently no units are completed.

Emergency medical responders can range from bystanders with Cardiopulmonary Resuscitation (CPR) certification to trained professional rescuers such as First Responders, EMT-Basics/Intermediates, Paramedics, Nurses, or Doctors. Usaully the most important tool used by these people is their brain.

[edit] Preface

[edit] Scope of care

[edit] Skills practiced

• Primary and reassessment surveys
• Basic airway management
• Oxygen therapy
• Ventilation support
• Circulation support
• Automated defibrillation
• Cardiopulmonary resuscitation
• Spinal immobilization
• Vital sign evaluation
  • Respirations
  • Pulse
  • Blood pressure
  • Skin condition
  • Pupils
  • Blood glucose
  • Pulse oximetry
• Splinting
• Bandaging
• Stretcher Operation

[edit] Tools used

The typical tools used by an EMR include but are not limited to the following:

• Airway management tools:
  • Oropharyngeal airways (all sizes).
  • Nasopharyngeal airways (all sizes).
  • Electric suction, or, V-Vac.
  • Yankeur suction tubing.
  • Bulb suction.

• Oxygen therapy tools:
  • Easyseal mask.
  • Simple face mask.
  • Non-rebreathing mask (NRB).
  • Nasal cannulae.
  • Oxygen tubing.
  • Compressed, medical grade, oxygen with regulator.

• Ventilation support tools:
  • Bag valve mask (BVM).
  • Pocket mask.
• Circulation support tools:
  • Automated external defibrillator (AED).

• Spinal immobilization tools:
  • Long Back board.
  • Short Spine board.
  • KED.
  • C-collar.
  • Head roll.
  • Scoop stretcher.

• Vital sign evaluation tools:
  • Stethoscope.
  • Sphygmomanometer.
  • Pediatric BP cuff.
  • Adult BP cuff.
  • Large BP cuff.
  • Penlight.
  • SPO2 meter.
  • Blood glucose meter.

• Other tools:
  • Traction splint.
  • Assorted splints.
  • Assorted bandages.
  • Stretcher.

[edit] Body of knowledge

• Human anatomy
  • See main unit Human anatomy for the EMR
• Pharmacology
  • See main unit Pharmacology for the EMR

[edit] Standard protocols

The most important thing for any EMR is the systemic approach. For every scene and every patient one must follow the same protocol. This protocol is designed to ensure that all life threatening injuries and illnesses are stabilised with a priority sequence and that none are missed. Failure to follow this protocol could result in the loss of a patient and the revocation of an EMR licence.

[edit] Scene Survey

Upon arriving on scene at any call, an EMR will be required to take certain measures prior to approaching the patient(s) to ensure Responder safety Remember the first priority of every Rescuer/EMR is safety of self and team.

Study the EMR scene/patient assessment module.

[edit] Primary survey

The primary survey is a systemic approach to analyzing the patient in order to rapidly find any life threatening injury or illness. The sequence to be followed is reviewed in the EMR primary survey module and should not be interrupted with the exception of to perform a critical intervention.

Study and master the EMR primary survey module before moving on.

[edit] Critical interventions

During the primary survey an EMR may find an immediate life threatening emergency. In these cases the EMR will interrupt the primary survey to perform a critical intervention.

Learn what is and is not classified as a critical intervention and how to carry out a critical intervention in the EMR critical interventions module

[edit] Transport decision

After the primary survey, an EMR must decide whether it is essential to load and go (load the patient into the ambulance immediately and begin transport), or if the EMR can stay on the scene to stabilize the patient.

Study the protocol for the transport decision in the EMR Transport decision module.

[edit] Patient history

An EMR must retrieve the same medical history for the patient regardless of the suspected method of injury or illness (MOI).

Study the EMR patient history module.

[edit] Process flow

[edit] Spinal immobilization

[edit] Measuring vitals

[edit] Respirations

The respiratory rate (number of respirations the patient makes in one minute) should be measured. Place one hand on the patient’s solar plexus and if the patient is unconscious, hover an ear a few inches above the patient’s mouth. Watch the chest rise and fall while listening to the quality of the breaths. Count the number of breaths taken over one (1) minute, if expedience is necessary, count the breaths over fifteen (15) seconds and multiply the number by four (4).

The number of breaths per minute should be as follows:

• For an adult;
  • 12 to 24 breaths per minute.
    • If the patients breaths per minute exceed 24 or are below 10 a critical intervention is required.
• For an adolescent aged 11 to 14;
  • 12 to 20 breaths per minute.
• For a child aged 6 months to 10 years;
  • 15 to 30 breaths per minute.
• For an infant;
  • 25 to 50 breaths per minute.

Sounds to listen for in a patients breathing are.

• Snoring: Indicates a partial blockage of the airway.
• Wheezing: Indicates inflammation in the patient’s airway.
• Gurgling: Indicates fluids in the airway.

Breath quality may be observed by looking for the following

• Normal: a normal rise and fall of the chest without accessory muscle use.
• Shallow: a very slight rise and fall of the chest.
• Labored: use of accessory muscles while breathing. In a conscious patient this can be identified by a complaint of “having trouble breathing”.

[edit] Pulse

The pulse should be measured from the carotid artery in an adult or child, and from the brachial artery in an infant. Place the index and middle figure on the artery to feel the pulse. Count the number of beats per minute, just as the breaths are counted.

A normal pulse rate should be as follows:

• For an adult or adolescent older than 11;
  • 60 to 105 beats per minute.
• For a child aged 3 to 10;
  • 70 to 130 beats per minute.
• For an small childe aged 6 months to 3 years;
  • 80 to 140 beats per minute.
• For an infant aged 6 months or less;
  • 90 to 140 beats per minute.
• For a newborn;
  • 120 to 160 beats per minute.

[edit] Blood pressure

[edit] Skin condition Pink Warm Dry

[edit] Pupils PERRL

Pupils Equal Round Responsive to Light

[edit] Blood glucose 80-120 (Or 3.0mmol/l - 8.0mmol/l)

[edit] Pulse oximetry 90-100%

Pulse oximetry uses a light emitter with red and infrared LEDs that shines through a reasonably translucent site with good blood flow. On adults you should place the pulse oximeter on the finger tip(one without finger nail polish if possible). This device measures oxygen saturation in the blood(SpO2). The reading should be in the range of 90-100% for healthy persons. 95% or higher is an ideal SpO2 reading. This device can tell you whether or not oxygenated blood is being circulated through the body.

[edit] Level of Consciousness

AVPU [A-Alert] [V-Alert to verbal stimuli] [P-Alert to pain (sternal rub, pinch)] [U=Unresponsive]

[edit] Temperature (Tympanic Thermometer)

[edit] Moving the patient

[edit] Maintaining spinal immobilization

[edit] Spine board

[edit] Scoop stretcher

aka. "Butt Pincher" [1]

[edit] Body mechanics

[edit] When to move a patient

[edit] Lifts and carries

[edit] Stretchers

[edit] Ambulance stretcher

[edit] Chair stretcher

[edit] Identifying and treating illness and injury

[edit] Medical

[edit] Respiratory emergencies

[edit] Cardiovascular emergencies

[edit] Abdominal emergencies

[edit] Diabetic emergencies

[edit] Anaphylactic emergencies

[edit] Drug and poison emergencies

[edit] Heat related emergencies

[edit] Cold related emergencies

Cold related emergencies are no where near as dangerous as heat related emergencies. But these emergencies usaully occur in a backcountry or wilderness settings rather than an urban setting. Cold related emergencies can range anywhere from moderate (1st degree) frostbite to Severe (3rd degree) frostibite and to Hypothermia.

[edit] Prevention

[edit] Diagnosis

Diagnosis is the single biggest thing an EMR can do. In the case of severly hypothermic patients a pulse is present but not felt by the EMR in most cases. Leading them to believe this person has had a Myocardial Infarcation. If a good history is available it will show that this person has not had heart failure but rather is severely hypothermic. If a good history is not taken or available EMR's might try to begin CPR, in doing so they are killing the person. Any rough handling such as CPR can cause the heart to go into a cardiac arrhythmia such as Ventricular Fibrillation(V-Fib).

[edit] Treatment

Treatment for the cold injured is dependent upon the condition (frostbite or hypothermia) and severity of the condition. Generally the EMR is not going to treat severe cases of cold injury. The most likely course of action is to bring the patient in to a hospital.

[edit] Trauma

[edit] Shock

3 Stages of Shock

Compensated Pale Skin Slightly rapid heart rate Normal blood pressure Anxiety Delayed capillary refill in the infant or child

Decompensated Thirst Rapid heart rate Decreased blood pressure Cool and moist skin that is pale, grey, or bluish and mottled. Major changes in the patient's mental status.

Irreversible Cells start too die. Very low blood pressure Extremley rapid pulse

TYPES OF SHOCK: 1.Hypovolaemic shock- Patient has lost enough blood to send them into shock. If not treated immediately, it is fatal. Treat the sourceof the bleeding and transport them to ER. Blood volumizers can be administered through IV(large bore if possible). Hextend or hetastarch can buy time until transfusions and surgical care can be arranged.

2.Cardiogenic shock- This is cardiac pump failure. The heart has been damaged by an acute myocardial infarction, and isn't healthy enough to perfuse the organs of the body. This could lead to cardiac arrest and other organ failure. Patient should be taken to cardiac surgery hospital.

3.Anaphylactic shock- This occurs when a patient comes into contact with something that he/she is severely allergic to. Patient will appear swollen, red and splotchy skin legions, contact dermatitis. The problem is that when this occurs, the patients airway can close up. If the patient can't breathe, they will be dead within minutes. Responder should administer epinephrine immediately, and contact EMS or transport to nearest emergency center. Epi pins or so they are called are emergency auto injectors that people carry, especially if they know they are allergic to certain insect bites. Look for a medical allergy tag. This also tells of medications that the patient is allergic to. If Patient's airwary is closed, EMT must intubate the patient. The Combitube may be a good choice, because it is a blind insertion. Even if you miss the trachea, you can inflate a balloon fixed to the device and your bag valve mask will force O2 down the bronchial main tubes, and into the lungs.(always check for bi-lateral chest movement, and gastric distention)

4.Septic shock - Severe infection starts to shut down the body's organs. Perfusion is decreased to all parts of the body, and if not treated patient will die. Doctors must treat patient with antibiotics and anti-viral medications to save the patients life. However, once a patient has entered septic shock, they are in serious medical trouble.

5.Psychogenic shock - The body loses control over its ability to contract and dilate blood vessels. This could cause a patient to faint, because inadequate levels of blood and oxygen are reaching the brain. This can be cause by shocking news or other traumatic event. The first thing you can do is prevent the patient from injuring themselves when they fall. The skin may appear pale, and the patient may feel lightheaded and confused. Try to reassure them, and transport to hospital if needed.

6.Insulin shock - The patient has become hypoglycemic(low blood sugar). Patient will be confused, light headed, combative(possibly) and have redder than usual skin(if light skinned). The medic should administer oral glucose (sub-lingual). This helps raise the patients blood sugar. They may begin to come out of shock, however they may still need to see a physician. Always check blood sugar if your diabetic.

[edit] Soft tissue injuries

[edit] Musculoskeletal injuries

[edit] Spine injuries

[edit] Head injuries

[edit] External links

• Pulse Oximeter 101