MariaCatEMT
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Here is the study guide/vocabulary I made for the first six chapters of the EMT-Basic text, I can't find the rest of it! For anyone who wants it, help yourself.
--Maria
EMS 110 STUDY GUIDE QUESTIONS & VITAL VOCABULARY
Chapter 1 (Introduction to Emergency Medical Care)
1. Describe the 5 phases of EMS care:
Early Access – 911, Enhanced 911 (shows location to the dispatcher), Designated 7-digit number (22%)
Emergency Medical Dispatch
First Responder Care – police, firefighters
EMT Care
Emergency Department Care (2nd Level)
2. Describe the basic components of the EMS system:
Access – early access in an emergency is essential.
Administration – policies and procedures are essential (Dave Stone, EMS Coordinator)
Medical Direction – must have a medical director (Dr. Jim Ellis, DO)
Quality Control & Improvement – assures quality patient care.
Regulation – EMS systems are subject to state regulation.
Equipment – properly maintained equipment is essential.
Working With Hospital Staff – EMS is part of the whole continuum of care.
Working With Public Safety Agencies – understand their roles and responsibilities.
Training – essential part of quality care.
The Ambulance – must be well-stocked and clean at all times.
Specialty Centers – EMT’s should know what resources are available for special situations.
3. Describe the 8 primary responsibilities of the EMT-Basic:
Safety – self, crew, others.
Response to Calls
Patient Assessment
Patient Care Based On Assessment
Patient Packaging
Patient Transport
Transfer of Care
Record Keeping
4. Differentiate between the levels of EMT:
Lay Rescuer – CPR, babysitters, teachers, coaches, parents, etc.
First Responder – police, firefighters, park rangers, etc.
EMT-Basic – 110 hours of training in basic skills
EMT-Intermediate – additional training (IV’s, read heart rhythms, airway management)
EMT-Paramedic – further training to master basic skills, provides a wide range of ALS.
5. Explain the ways that an EMT-Basic displays professionalism:
Prioritize patient needs
Response to calls
Composure (self-confidence)
Understanding (compassionate)
Non-judgmental
Professional appearance
CONFIDENTIALITY
6. Define medical direction:
Medical direction is the process by which physicians monitor care provided by EMS personnel.
Online Direction – direct, real-time communication (phone, radio).
Offline Direction – protocols.
Prospective Direction – training, protocols (before).
Concurrent Direction – online direction.
Retrospective Direction – documentation & quality control (after).
7. Define Continuous Quality Improvement and discuss the EMT-Basic’s role in the process:
Quality improvement is a continual evaluation and improvement of the care provided within an EMS system, and is accomplished by:
Documentation review
Training & Development
Continuing education, updates & recertification
8. State specific statutes and regulations regarding EMS in Illinois:
National Standard Curriculum (Department of Transportation/DOT)
Illinois Department of Public Health (IDPH)
Region 6 (East Central IL protocols & care guidelines)
Provena Regional EMS System
9. Discuss the history & development of EMS:
Early military development
Pre-EMS
1966 Report “Accidental Death & Disability: the Neglected Disease of Modern
Society” also known as “The White Paper”
DOT – Department of Transportation
NHTSA – National Highway Traffic & Safety Administration
IDPH – Illinois Department of Public Health
EMS Act – 1971
Chapter 2 (The Well-Being of the EMT-B)
1. Identify the major concerns of the dying, critically ill, or injured patient:
Anxiety
Pain & Fear
Anger & Hostility
Depression
Dependency
Guilt
Mental health problems
Receiving unrelated bad news
2. Discuss the 5 stages of the grieving process:
Denial – refusal to accept
Anger – blaming others
Bargaining – promise to change
Depression – open expression of grief
Acceptance – of the inevitability of death
3. Explain how to help a patient’s family members deal with death and dying:
Act in a calm manner
Be gentle but direct
Take time to answer questions
Show concern about privacy
Respect family’s wishes
Be honest
Don’t create false hope
4. Discuss the incidence of Critical Incident Stress:
Developed in the 1980’s
Process designed to help EMS personnel deal with responses to critical incidents
Composed of trained peers & mental health professionals
5. Discuss the perks/pitfalls of the Emergency Worker/Rescue Personality:
Feels responsible
Obsessive/Compulsive
Detail-orientated
Second guesses mistakes
Risk takers
Desires control
Action orientated
Easily bored
Dedicated
Group orientated
Vulnerable
6. Describe types of critical incidents:
Death/Injury of a coworker
Death/Injury of a child
Death/Injury of a relative
Mass casualty situations
Fear of physical and/or psychological injuries
Death/Injury of a bystander
Emotion charged incidents
Unusual or distressing circumstances
7. Recognize the signs and symptoms of critical incident stress:
Physical – increased respiration, increased pulse, nausea, vomiting, sweating, chest pain, sleep disturbance
Emotional – anger, denial, fear, feeling overwhelmed, panic reactions
Mental – confusion, disorientation, decreased awareness, indecisiveness, distressing dreams, memory problems, poor concentration
Behavioral – changes in eating habits, crying episodes, hyperactivity, withdrawal, isolation, loss of interest in work, loss of interest in sex, increased alcohol use, increased tobacco use
8. State the possible steps the EMT-B may take to reduce or alleviate stress:
Proper diet
Exercise
Plenty of sleep
Contact friends
Avoid caffeine
Avoid Alcohol
Reestablish a normal schedule
Don’t fight dreams/flashbacks
Talk with loved ones
Seek counseling
9. Describe the services provided by a Critical Incident Stress Debriefing Team:
Pre-incident stress education
On-scene peer support
Demobilization/Disaster support
Defusing
Debriefing
Services for spouse/family
10. Outline how to contact a CISD:
800 numbers
Provide call back number/contact person
Best if 48-72 hours post incident
Personnel available 1-3 hours
Quiet, non-threatening location
Volunteer vs. mandatory
Confidentiality/Only those involved with the incident
(410)-313-2473
icisf@erols.com
11. List 4 routes of disease transmission with examples of how each can occur:
Contact (Direct) – contact, directly with either the person or with sprayed droplets. The source is ordinary or sexual contact. (measles, mumps, chickenpox, bacterial meningitis, influenza, diphtheria, herpes simplex, syphilis, gonorrhea, HIV/AIDS, hepatitis B & C)
Airborne – residues after partial evaporation of droplets (body fluids) or small particles of dust/soil that may carry fungal spores. The source is droplet nuclei and dust/soil. (TB, bacterial meningitis, chickenpox, measles, histoplasma, coccidioides, mycobacterium-avium intracellulare)
Vehicle (Indirect) – spread by inanimate objects such as food, needles, clothing, and transfused blood. Sources could be food, water and blood. (Hepatitis A, B, & C, salmonella, shigella, poliomyelitis, HIV/AIDS, measles, tetanus)
Vector Borne – simple carriage by insects (Mechanical) or transmission by insects (Biological). Sources are houseflies, ticks, mosquitoes. (shigella, lyme’s disease, rocky mountain spotted fever, malaria, equine encephalitis)
Sources of infectious disease (illness caused by various biological agents):
Bacteria, viruses, fungi & parasites
Immune system:
Skin, white blood cells, lymphatic system
Diseases of Special concern:
HIV/AIDS, Hepatitis, Meningitis, TB, Syphilis, Whooping Cough
12. Describe the importance of BSI practices to prevent the transmission of airborne/blood-borne pathogens:
Hand-washing (30 seconds)
Gloves & eye protection
Masks & gowns
Resuscitation devices
BSI vs. Universal precautions
BSI differs from universal precautions in that it is designed to approach all body fluids as being potentially infectious. Universal precautions assume only blood and certain body fluids pose a risk.
13. List the guidelines for personal protection against disease transmission:
Vaccination
Testing
Equipment clean-up
Hand-washing
Scene safety
14. Explain the importance of scene safety:
Shoulder harnesses/seatbelts
Visibility of the EMT at the scene
Parking at the scene
Stability of vehicles at the scene
Identifying possible hazards
Scene Hazards:
Hazardous materials – never approach an object marked with placards
Electricity – never touch downed power lines
Fire – do not approach unless trained and protected
Violent situations – civil disturbances, domestic disputes, behavioral emergencies, crime scenes, large gatherings
15. Identify protective equipment and procedures needed for various hazardous situations:
Cold weather clothing – dress in 3 layers
Turnout gear – provides head-to-toe protection
Gloves – use proper gloves for the job being performed
Helmets – must be worn in any fall zone
Boots – should protect your feet, fit well, be flexible, non-skid, steel/reinforced toe
Eye/Ear protection – should be used on rescue operations
Skin protection – sun block
Chapter 3 (Medical, Legal & Ethical Issues)
1. Differentiate between scope of practice and standard of care:
Scope of Practice – (letter of the law) legally authorized medical acts that may be performed within established state law (1997 IDPH EMS Act), defined by protocols, and delegated through medical direction.
The 1997 IDPH EMS Act defines specific procedures that can be provided by various levels of care, and establish specific requirements for licensure.
Standard of Care – (reasonable, prudent EMT-B) state and regional statutes and guidelines, protocols, policies and procedures. Specific rules and procedures of the service of organization to which you are attached to, and local custom.
Basic Principles: First, DO NO HARM
Second, WHEN IN DOUBT, ACT
2. State the conditions necessary for the EMT-B to have a duty to act:
You are charged with an emergency medical response (dispatched)
Your service or department’s policy states that you must assist in an emergency
3. Define negligence and describe the 4 elements that must be present to prove it:
Negligence – the failure to provide the same care that a person with similar training would provide. Failure to follow accepted practice, as defined by that expected of a reasonable and prudent person.
4 Criteria for Proving Negligence:
Duty To Act – responsibility to act reasonably based on standard of care
Breach of Duty – failure to act within expected & reasonable standard of care
Existing Damage – physical/psychological harm created in a noticeable way
Proximate Cause – existing damage was caused by a failure to act
4. Define abandonment as it relates to the EMT-B:
Abandonment – the unilateral termination of care by the EMT-B without the patient’s consent and without making any provisions for continual care by a medical professional with equal or higher skills.
5. Define consent and discuss the methods for obtaining consent:
Consent – permission to give treatment
Methods of obtaining consent:
Expressed Consent – patient gives express consent (authorization) for the provision of care and/or transport.
Implied Consent – patient is unable to give consent, and is given treatment under the legal assumption that he/she would want treatment.
Minors – the law requires that the parent or legal guardian give consent. Exceptions are minors that are: pregnant, married, emancipated minors, in the military. If no parent or legal guardian is present or available, implied consent exists or the injury or illness is threatening to life or limb.
Mentally Incompetent Adults – (mentally ill, in psychological crisis, under the influence of drugs/alcohol, developmentally delayed) consent should be obtained from the legal guardian or conservator. Implied consent exists with life saving care, if the guardian is not present or available.
Forcible Restraint – CALL MEDICAL CONTROL! Forcible restraint is the act of physically preventing someone from treating any physical action. Legal restraint is authorized if the person is believed to be a harm to self or others. Some states require law enforcement for restraint.
6. Define consent as it applies to minors:
The law requires that the parent or legal guardian give consent. Exceptions are minors that are emancipated, in the military, minors who are parents, minors who are married or pregnant. If no parent or legal guardian is present or available (call medical control!), implied consent exists if the injury or illness is threatening to life or limb.
7. Describe the conditions where use of force, including restraint, is acceptable:
Use of force (legal, forcible restraint) is authorized when the patient is believed to be a harm to themselves, or others. Call medical control! Know your protocols concerning forcible restraint. Some states allow only law enforcement officials to use forcible restraint.
8. Identify the steps to take if the patient refuses care:
Mentally competent adults have the right to refuse or withdraw from treatment at any time.
Make sure the patient is informed about potential risks, benefits, treatments, and alternatives to treatment.
Make sure the patient is fully informed about the consequences of refusing treatment, encourage the patient to ask questions.
Assess the patient’s mental condition.
Obtain the signature of the person refusing treatment on an official release form. Document assessment findings, and obtain a witness (family member, firefighter, police officer….you or your partner are not the best choice for a witness signature), call medical control.
Follow your local protocols.
9. Differentiate between assault and battery and describe how to avoid each:
Assault – unlawfully placing a person in fear of immediate bodily harm without the person’s consent. Identify yourself. Explain what you need to do. Obtain consent.
Battery – unlawfully touching a person, this includes providing emergency care without consent. Explain to the patient what you are doing, obtain consent.
Make sure express consent is obtained! If expressed consent cannot be obtained, make sure the situation allows for implied consent!
10. Define advanced directives and describe the EMT-B’s responsibilities concerning them:
Advanced Directive – written document that specifies medical treatment for a competent patient, should he/she become unable to make decisions.
DNR – do not attempt resuscitation
A DNR must meet all of the following requirements:
Clearly state the medical problem
Be signed by the patient or legal guardian
Be signed by one, or more physicians
Be dated in the preceding 12 months
A living will alone is not sufficient to withhold treatment. Call medical control. The DNR orders must be physically present. Verbally advising you of a DNR order is not sufficient to withhold treatment.
Living wills and durable power of attorneys (POA’s)
DNR orders
Termination of resuscitative efforts
Triple Zero Criteria:
Rigor mortis
Lividity
Decomposition
Mummification
Decapitation
Full arrest for at least 20 minutes without intervention
11. Explain the importance, necessity, and legality of patient confidentiality:
Communication between you and the patient is considered confidential and generally cannot be disclosed without permission from the patient or a court order. This includes patient history, assessment findings, treatment provided, patient identification and mental/physical condition. You may relay this information to those directly involved in the care of the patient (but do so discreetly, within the confines of the treatment area, do not communicate this information in a public arena). Confidentiality covers both verbal and written communication.
12. Identify situations that require the EMT-B to notify law enforcement:
Child abuse
Elderly abuse
Rape
Injury during the commission of a felony
Drug/alcohol related injury
Childbirth
13. Describe the actions that must be taken to preserve evidence at a crime scene:
Notify law enforcement (if first on the scene/police not present)
Make sure the scene is safe
Do not disturb the scene more than is necessary
If you move something, tell officers
Confer with officers about actions you should take at the scene
If possible, do not cut through holes in clothing made by weapons
14. Discuss the EMT-B’s responsibilities regarding resuscitation efforts for potential organ donors:
Consult medical control
Treat the donor as any other patient
Use all means necessary to keep the patient alive
The priority is to save the patient’s life
There is no difference in treatment of donors vs. non-donors
Chapter 4 (The Human Body)
1. Describe the six basic body positions:
Anatomic – facing you, arms down, palms out
Prone – face down
Supine – face up, flat on back
Fowler’s – sitting up (45 degrees), position of comfort
Trendelenburg – (whole body) feet elevated 8”-12” (generally used with a backboard)
Shock (or modified Trendelenburg) – (waist down) feet elevated 8”-12”
Recovery – left lateral recumbent
2. Describe the terms (divisions, directional, body regions, abdomen quadrants) that are used in topographical anatomy:
Divisions (planes) of the body:
Midline – line drawn through nose and umbilicus, dividing the body exactly in half (vertically)
Midaxillary – between the anterior and posterior aspects, from axilla (armpit), parallel to midline
Midclavicular – middle of the clavicle, parallel to midline
Transverse – horizontally through umbilicus
Anterior – front
Posterior – back
Directional Terms:
Right – patient’s right
Left – patient’s left
Lateral – farther from midline
Medial – closer to midline
Superior – closer to head (higher)
Inferior – closer to feet (lower)
Proximal – closer to midline/closer to trunk
Distal – farther from middling/closer to free end (extremity)
Dorsal – toward spine/back
Ventral – toward abdomen/front
Palmar – palms
Planter – soles
Apices – top of
Bilateral – both sides
Regions of the Body:
Cranial – brain
Spinal – spinal column/cord
Thoracic – lungs, heart
Pelvic – urinary/reproductive
Abdominal – digestive/excretion
Quadrants of the Abdomen:
Right Upper Quadrant (RUQ) – liver, gallbladder, transverse colon
Left Upper Quadrant (LUQ) – stomach spleen, transverse colon
Right Lower Quadrant (RLQ) – appendix, ascending colon
Left Lower Quadrant (LLQ) – descending colon
3. Describe the anatomy and function of the major body systems:
Musculoskeletal
Respiratory
Circulatory
Nervous
Integumentary
Endocrine
Digestive
Urinary
Reproductive (male/female)
Musculoskeletal System
Provides form, support and protection
Skeleton – gives us human form, protects vital organs, 206 bones, framework for muscle attachment, designed for motion of the body
Muscles – skeletal (voluntary/striated), smooth (involuntary), cardiac (heart)
Joints – connects bones to each other, allows for motion
Types of joint motion – flexion, extension, rotation, adduction, abduction
Sections of the skull – frontal (forehead), parietal (top/back), temporal (above ears), occipital (back/rear)
Bones of the face – orbital (around eyes), nasal (nose), zygoma (cheekbones), maxillae (above teeth), mandible (jaw)
Sections of the spinal column – 33 stacked vertebrae
Cervical – supports the head (7 vertebrae)
Thoracic – rib anchor points (12 vertebrae)
Lumbar – largest vertebrae (spine terminates at the end of the lumbar) (5 vertebrae)
Sacrum – foundation of the pelvis (5 fused vertebrae)
Coccyx – tailbone (4 fused vertebrae)
C1 – atlas
C2 – axis
Bones of the thorax (ribcage) – 12 vertebrae, 12 pair (24) of ribs
Bones of the pelvis:
Ilium – part of the pelvis ring
Ischium – part of the pelvis ring
Pubic Symphysis – bony prominence, midline lower most part of abdomen
Sacrum – part of the pelvis ring, foundation of pelvis, 5 fused vertebrae
Lower Extremities:
Pelvis
Hip
Femur (thigh)
Knee
Patella (knee cap)
Fibula (leg)
Tibia (leg)
Tarsals (ankle)
Metatarsals (foot)
Phalanges (toes)
Upper Extremities:
Shoulder girdle
Glenohumeral joint
Humerus
Lateral condyle (elbow)
Medial condyle (elbow)
Ulna
Radius
Radial styloid
Ulnar styloid
Carpals
Carpometacarpal joints
Metacarpals
Phalanges (fingers, digits)
Thumb
Index
Long
Ring
Small
Respiratory System
The respiratory system takes oxygen from the air to the blood for transport to cells and rids the body of excess carbon dioxide.
Upper Airway:
Nasopharynx
Oropharynx
Epiglottis
Larynx
Vocal cords
Lower Airway:
Trachea (carina)
Bronchi
Bronchioles
Alveoli
5 lobes
Characteristics of the Diaphragm:
Dome shaped muscle
Both voluntary and involuntary muscles
Divides thorax from abdominal cavity
Contracts during inhalation
Relaxes during exhalation
Characteristics of Normal Breathing:
Normal rate and depth
Regular pattern
Good breath sounds bilaterally
Regular rise and fall movement
Movement of the abdomen
Children vs. adults:
Proportionately larger tongue
Narrower and shorter trachea
Trachea easily kinked by improper positioning
Larynx is more anterior
Weaker intercostal muscles
Requires more use of abdominal muscles
Circulatory System
Carries oxygenated blood and sugar to all cells and tissues. Carries CO2/waste products from all cells and tissues of the body.
Heart (pump):
Four chambers – R/L atrium, R/L ventricle
Four vessels – Superior/inferior vena cava, pulmonary artery/vein, aorta
Four valves – tricuspid, pulmonic, bicuspid (mitral), Aortic
Electrical System – sinoatrial node (SA), atrioventricular node (AV), purkinjie
fibers
Trace a drop of blood through the heart:
Superior/inferior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary artery
Pulmonary vein
Left atrium
Bicuspid (mitral) valve
Left ventricle
Aortic valve
Aorta
Major Arteries (pipes):
Aorta
Pulmonary
Carotid
Femoral
Brachial
Radial
Major Veins (pipes):
Superior vena cava
Inferior vena cava
Pulmonary
Jugular
Blood Components (fluid):
Red blood cells (hemoglobin)
Platelets (clotting factor)
Plasma (carries cells and platelets, yellowish liquid)
White blood cells (fights infection)
Pulse – forceful pumping of blood out of the heart
Perfusion – process of delivering blood to the organs, delivering oxygen and blood, and removing wastes
Blood pressure – amount of force exerted against the walls of the arteries
Systole (systolic) – left ventricle contracts
Diastole (diastolic) – left ventricle relaxes
Nervous System
Controls all bodily functions.
Central Nervous System (CNS) – brain, spinal cord
Peripheral Nervous System:
Motor nerves (from the brain)
Sensory nerves (to the brain)
Connective nerves
Somatic Nervous System (voluntary) – regulates voluntary body activities
Autonomic Nervous System (involuntary/2 divisions) – controls involuntary functions
Sympathetic Response – fight/flight, increases heart rate, blood vessels constrict,
bronchi dilate
Parasympathetic Response – decreases heart rate, promotes digestion, constricts
pupils
Integumentary System (skin)
Environmental barrier, prevents bacterial/viral invasion, temperature regulation, sensory organ
Epidermis:
Outer layer of the skin, made up of cells that are sealed together to form a watertight protective covering for the body
Dermis:
Inner layer of skin, containing hair follicles, sweat glands, nerve endings and blood vessels
Subcutaneous:
Tissue, largely fat, that lies directly under the dermis and serves as an insulator for the body
Endocrine System
Complex message and control system that works with the nervous system to control bodily functions. Made up of 7 glands that produces and release hormones.
Glands:
Adrenal
Ovary
Pancreas
Parathyroid
Pituitary
Testes
Thyroid
Digestive System
Processes food to nourish cells.
Mouth – lips, cheeks, gums, teeth and tongue
Salivary Glands – 2 glands under tongue, 1 gland inside each cheek, 98% water, 2% mucous, salts, organic compounds, binder and lubricant.
Oropharynx – extends to trachea and esophagus, pharynx lifts larynx to permit epiglottis to close during swallowing
Esophagus – connects pharynx to stomach
Stomach – LUQ, receives, stores and releases food to the small bowel
Pancreas – under and behind liver and stomach, secretes digestive juices and insulin
Liver – RUQ, largest organ in the body, filters toxins, stores sugars and starch, aids in immune responses
Bile Ducts – connects liver to intestines, out-pouching of the bile ducts, called the gall bladder, stores and releases bile
Small Intestine – major hollow organ, does 90% of food processing
Large Intestine – forms stools
Appendix – RLQ, no known function
Rectum – ends at anus, controls escape of liquid, gasses, and solids from digestive tract
Urinary System
Controls discharge of certain waste materials filtered through the blood by the kidneys
Kidneys – 2, located in the retroperitoneal space (muscular wall of the abdomen, posterior, behind the peritoneum), rids the body of toxins, controls the balance of water and salts
Renal Pelvis – connects kidneys to ureters
Ureters – passes from renal pelvis to bladder, peristalis (wave like contraction of smooth muscle) moves urine to the bladder
Urinary Bladder – stores and empties urine
Urethra – where urine passes from the body
Reproductive (Genital) System
Controls reproduction
Male:
Testicle
Vas Deferens
Seminal Vesicles
Semen
Prostate Gland
Penis
(mostly external)
Female:
Ovaries
Fallopian Tubes
Uterus
Cervix
Vagina
(mostly internal)
Chapter 5 (Vital Signs & SAMPLE History)
1. Define signs, symptoms, chief complaint, baseline vital signs and trending:
Signs – any medical/trauma condition displayed by the patient and identified by the EMT-B
Symptoms – Any condition described by the patient that cannot be observed
Chief Complaint – The major sign/symptom a patient reports (the reason you are dispatched)
Baseline Vital Signs – The first set of vital signs against which all other sets are compared
Trending – the process of comparing sets of vital signs or other assessment information over time.
2. Identify six components of vital signs:
Level of Consciousness (LOC)
Respirations
Pulse
Skin
Pupils
Blood Pressure
3. Explain the importance of accurately reporting and recording baseline vitals:
The first set of vital signs obtained is called the baseline vital signs. By periodically reassessing the vital signs and comparing the findings with the baseline set, you will be able to identify any significant trends in the patient’s condition, particularly whether the patient’s condition is worsening.
4. Describe and demonstrate methods for measuring level of consciousness (LOC) using the AVPU scale:
A – Alert & awake, aware of time, place, date and person
V – Responds to verbal stimuli
P – Responds to painful stimuli, does not respond to verbal stimuli
U – Unresponsive (unconscious), does not respond to any stimuli
A – Ask person questions about time, place, date and person
V – Normal voice?
Loud verbal stimulation?
Note how the patient responds and what patient responds to
P – No verbal response
Pinch nail bed
Rub sternum
Pinch Skin
Note type/location of stimulus and patient response, try both sides
U –No reaction to any verbal/painful stimulus
Note what stimulus attempted/No Response
5. Describe and demonstrate methods for measuring breathing rate, quality and depth:
Rate – per minute, count number of breaths in 30 seconds, multiply by 2 (12-20 is normal for adults)
Quality – character of respirations (normal, shallow, labored, noisy)
Rhythm – if the time from one peak to the next is consistent, respirations are
considered normal (patients tend to breathe faster when injured or
frightened, and may attempt to slow their breathing if they are aware
they are being monitored)
Effort – normally effort to breathe does not affect with the patient’s speech,
posture, or positioning. Patients having a markedly difficult time
breathing will assume a posture that eases their breathing (tri-pod
position, sniffling position). That is called labored breathing. In
infants and small children cardiac arrest is generally caused by
respiratory arrest
Noisy Breathing – may be audible, or heard with a stethoscope
Depth – depends on rate and tidal volume (amount of air that is exchanged with each breath).
Shallow – chest wall movement is less than normal
Normal
Deep – chest wall movement is greater than normal
6. Describe and demonstrate methods for measuring pulse rate and quality:
Pulse – pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.
Key Pulse Points:
Carotid
Brachial
Radial
Femoral
Dorsalis Pedis
Posterior Tibial
Rate – per minute, count number of pulses in 30 seconds, multiply by 2.
A weak or irregular pulse should be counted for a full minute.
The pulse rate for most adults at rest is 72 beats/min, but 60-100 beats/min is
considered normal.
Tachycardia – rate greater than 100 beats/min.
Bradycardia – rate less than 60 beats/min.
Quality:
Strength – bounding (stronger than normal), normal, weak/thready
Regularity – regular, irregular (intervals between contractions)
7. Describe and demonstrate methods of measuring skin color, temperature, and condition:
Perfusion – the process of distributing blood to the organs, delivering oxygen, and removing wastes. Skin condition is a good indicator of adequate vs. inadequate perfusion.
Skin Color – check nail beds, mucous membranes in the mouth, the lips, underside of the arms, palms, and conjunctiva (delicate membrane lining the eyelids). In children and infants, hands and soles should be assessed.
Pink, pale, blue (cyanotic), flushed, jaundiced
Skin Temperature – feel the patient’s forehead with the back of your hand.
Warm, hot, cool, cold
Skin Condition – dry, wet & moist, abnormally dry, clammy, diaphoretic (very wet)
Normal skin color/temp/condition is: pink, warm and dry
8. Demonstrate how to measure capillary refill in children and infants:
Capillary Refill – evaluates the ability of the circulatory system to restore blood to the capillary system.
Compress thumbnail, then release, count seconds it takes to restore to pink color
It is not an accurate indicator for patients over 6 years old.
It can indicate poor perfusion.
Normal CRT is 2 seconds or less.
9. Describe how to measure pupils:
First, evaluate in ambient light for constriction or dilation.
Next, pass a light source across each pupil and note the response.
Each pupil should constrict in the same manner.
P – pupils
E – equal
A – and
R – reactive to
L – light, and midsize
10. Define systolic and diastolic blood pressure:
Blood Pressure (BP) – pressure of circulating blood against the walls of the arteries.
Systolic – increased pressure caused by contraction of the left ventricle (CONTRACTION)
Diastolic – residual pressure that remains in the arteries when the left ventricle is at rest (RELAXATION)
11. Demonstrate how to measure blood pressure using auscultation and palpation:
Auscultation – method of listening to sounds within organs with a stethoscope
Put BP cuff on patient’s upper arm (arm extended, palm up) about 1 inch from the elbow crease. Make sure center of bladder (usually marked with an arrow) lies over the brachial artery. Once the cuff is in place the arm should be held at about the same level as the heart. Palpate the brachial artery. Place the diaphragm of the stethoscope over the brachial artery. Close the valve and pump the ball-pump until you no longer hear pulse sounds, then increase by another 20 mm Hg. Slowly release the air and watch the needle drop, listen carefully. Systolic pressure is the reading on the gauge when you FIRST hear thumps of pulse. Diastolic pressure is the reading on the gauge when the thumps of pulse DISAPPEAR. Once the pulse sounds stop, quickly release the remaining air in the cuff.
Palpation – examination by touch, used in very noisy environments.
Put BP cuff on patient’s upper arm (arm extended, palm up) about 1 inch from the elbow crease. Make sure center of bladder (usually marked with an arrow) lies over the brachial artery. Once the cuff is in place the arm should be held at about the same level as the heart. Palpate the patient’s radial pulse (same arm cuff is on), then close the valve and pump to 200 mm Hg. As you inflate the cuff the radial pulse will disappear. Begin slowly releasing air and watch the gauge. When you again feel the radial pulse, note the reading on the gauge. This is the systolic pressure, and will be written as systolic (the reading)/P (example: 120/P).
12. Identify components of a SAMPLE history:
S – signs and symptoms
A – allergies
M – medications
P – pertinent past medical history
L – last oral intake
E – events leading to injury/illness
Chapter 6 (Lifting and Moving)
1. Define body mechanics:
Body Mechanics – the principles of effective, safe movement used in lifting and moving patients. The use of proper mechanics reduces the EMS provider’s chances of becoming injured.
2. Discuss the guidelines and safety precautions that need to be followed when lifting a patient:
Use a minimum of 2 people
Call for additional help if necessary
Use an even number of people to maintain balance
Know the weight limitations of your equipment
Know your own limitations
If the lifting is unsafe, don’t move the patient
Keep weight as close to your body as possible
3. Describe the safe lifting of cots and stretchers:
General Guidelines – know the weight to be lifted and the team’s limitations, constantly communicate to coordinate actions, don’t twist your body, keep weight as close to your body as possible, flex at your hips and bend knees, and keep back straight.
Cots/Backboards – tighten your back in normal, upright position, spread your legs about 15 inches apart, bend at the knees to lower your torso, use power grip to grasp cot/backboard, adjust position until weight is balanced, make sure feet are about 15 inches apart with one slightly forward than the other, keep feet flat and your weight on the balls of your feet, lift by straightening your legs until you are fully standing, keep back locked in, make sure your upper body rises before your hips.
Stretchers – please read Chapter 6, Pages 172-175 for complete information
4. Discuss the guidelines and safety precautions for carrying patients and equipment:
First rule of lifting is to keep your back in an upright position
Never twist or jerk
The power lift is the safest and most powerful way to lift
Maintain a proper hold with the power grip
It is always best to move a patient on a device that can be rolled
Coordinate your movements with your team with constant communication
Use correct lifting techniques
Make sure patient is tightly secured (strapped in)
Always carry patient feet end first
Team leader is responsible for coordinating moves
Use at least two people, but try to use at least four when resources allow
Call for additional help as needed! Immediately!
Train and practice often
5. Discuss one-handed carrying techniques:
6. Describe correct and safe carrying procedures on stairs:
Use a stair chair if possible. If you must use a backboard or stretcher, be sure the patient is anatomically secured to the device to prevent sliding when the device is held at an angle.
Properly secure the patient
When carrying downstairs, go feet first.
When carrying upstairs, go head first.
Use stair chair or sturdy kitchen chair
Keep back in locked position
Flex at hips, not waist
Keep weight as close to body as possible
7. State the guidelines for reaching and their application:
Keep back straight when leaning over a patient
Lean from the hips
Use shoulder muscles to help
Avoid twisting while reaching
Avoid hyper-extended position when reaching overhead
8. Describe correct reaching for log rolls:
Kneel as close to the patient’s side as possible
When you lean forward, keep back straight
Lean solely from hips
Use shoulder muscles to help with the roll
Roll patient without stopping until patient is resting on his/her side
9. State guidelines for pushing and pulling:
Whenever possible, PUSH, rather than PULL!
10. Discuss the general considerations of moving patients:
Emergency Moves
Urgent Moves
Non-Urgent Moves
Emergency Moves:
Fire or danger of fire.
Explosives or hazardous materials.
Inability to protect patient from hazards.
Inability to access others requiring life-saving care.
Other situations that have potential for causing injury.
Inability to provide life-saving care due to patient location/position.
Examples of Emergency Moves:
Clothes Drag
Blanket Drag
Arm Drag
Arm-to-arm Drag
Under arm carry
Front Cradle
Firefighter’s Drag
One-person walking assist
Firefighter’s Carry
Pack Strap
Urgent Moves:
An urgent move may be necessary for moving a patient with an altered LOC, inadequate ventilation, shock, or extreme weather conditions. A patient sitting in a vehicle must be urgently moved (rapid extrication technique), as they very often cannot be properly assessed
Rapid Extrication Technique – please read Chapter 6, Pages 164-165 for detailed instructions. This technique is a method to move a patient from a sitting position inside a vehicle to a supine position on a backboard in less than one minute, when conditions do not allow for standard immobilization.
Non-Urgent Moves:
Scene and patient are stable.
Follow lifting/moving guidelines
Three general movements are generally used:
Direct ground lift
Extremity lift
Transfer moves:
Direct carry
Draw sheet method
11. State three situations that may require the use of an emergency move:
Fire
Explosives/Hazardous Materials on scene
Unable to gain access to others (in a vehicle, for example) needing lifesaving care
12. Identify various carrying devices:
Wheeled stretcher
Portable stretcher
Scoop stretcher (does not provide C-spine immobilization)
Flexible stretcher
Basket stretcher
Stair chair
Long backboard (C-spine immobilization)
Short backboard/KED
Child safety seat
Section 1, Chapters 1-6, Vital Vocabulary
Chapter 1:
Advanced Life Support (ALS) – advanced life-saving procedures, some of which are now being provided by the EMT-B.
Americans with Disabilities Act (ADA) – comprehensive legislation that is designed to protect individuals with disabilities against discrimination.
Continuous Quality Improvement (CQI) – a system of internal and external reviews and audits of all aspects of an EMS system.
Emergency Medical Services (EMS) – a multidisciplinary system that represents the combined efforts of several professionals and agencies to provide prehospital emergency care to the sick and injured.
EMT-Basic – an EMT who has training in basic emergency care skills, including automated external defibrillation, use of a definitive airway adjunct, and assisting patients with certain medications.
EMT-Intermediate – an EMT who has training in advanced life support, including IV (intravenous) therapy, interpretation of cardiac rhythms and defibrillation, and orotracheal intubation.
EMT-Paramedic – an EMT who has extensive training in advanced life support, including IV (intravenous) therapy, pharmacology, cardiac monitoring, and other advanced assessment and treatment skills.
First Responder – the first trained individual, such as a police officer, firefighter, or other rescuer, to arrive at the scene of an emergency to provide initial medical assistance.
Medical Control – physician instructions that are given directly by radio (online/direct) or indirectly by protocols/guidelines (off-line/indirect), as authorized by the medical director of the service program.
Medical Director – the physician who authorizes or delegates to the EMT the authority to perform medical care in the field.
Primary Service Area (PSA) – the designated area in which the EMS service is responsible for the provision of prehospital care and transportation to the hospital.
Quality Control – The responsibility of the medical director to ensure that the appropriate medical care standards are met by EMT’s on each call.
Chapter 2:
Body Substance Isolation (BSI) - an infection control concept and practice that assumes that all body fluids are potentially infectious.
Burnout – a condition of chronic fatigue and frustration that results from mounting stress over time.
Carrier –an animal or person who may transmit an infectious disease but may not display any symptoms of it.
Communicable Disease –any disease that can be spread from person to person, or animal to person.
Contamination –the presence of infectious organisms on or in objects such as dressings, water, food, needles, wounds, or a patient’s body.
Cover – the tactical use of an impenetrable barrier to conceal EMS personnel and protect them from projectiles (bullets, bottles, rocks).
Critical Incident Stress Debriefing (CISD) – a confidential group discussion of a severely stressful incident that usually occurs within 24-72 hours of the incident.
Critical Incident Stress Management (CISM) – a process that confronts the responses to critical incidents and defused them, directing the emergency services personnel toward physical and emotional equilibrium.
Dependent Lividity – blood settling to the lowest point of the body, causing discoloration of the skin.
Designated Officer – the individual in the department who is charged with the responsibility of managing exposures and infection control issues.
Direct Contact – Exposure or transmission of a communicable disease from one person to another by physical touching.
Exposure – a situation in which a person has had contact with blood, body fluids, tissues, or airborne particles in a manner that suggests that disease transmission may occur.
Exposure Control Plan – a comprehensive plan that helps employees t reduce their risk of exposure to, or acquisition of, communicable diseases.
General Adaptation Syndrome – the body’s three-stage response to stress. First, stress causes the body to trigger an alarm response, followed by a stage of reaction and resistance, and then recovery, or if the stress is prolonged, exhaustion.
Hepatitis – an infection of the liver, usually caused by a virus, that causes fever, loss of appetite, jaundice, fatigue and altered liver function.
HIV Infection – infection with the human immunodeficiency virus (HIV) that can progress to acquired immunodeficiency syndrome (AIDS).
Host – the organism or individual that is attacked by the infecting agent.
Indirect Contact – exposure or transmission of disease from one person to another by contact with a contaminated object.
Infection – the abnormal invasion of a host or host tissues by organisms such as bacteria, viruses, or parasites, with or without signs or symptoms of disease.
Infection Control – procedures to reduce transmission of infection among patients and health care personnel.
Infectious Disease – a disease that is caused by infection, in contrast t one caused by faulty genes, metabolic disturbances, emotional trauma, or other cause.
Meningitis – an inflammation of the meningeal coverings of the brain, it is usually caused by a virus or a bacterium.
Occupational Safety and Health Administration (OSHA) – the federal regulatory compliance agency that develops, publishes, and enforces guidelines concerning safety in the workplace.
Pathogen – a microorganism that is capable of causing disease in a susceptible host.
Personal Protective Equipment (PPE) – protective equipment that OSHA requires to be made available to the EMT. In the case of infection risk, PPE blocks entry of an organism into the body.
Posttraumatic Stress Disorder (PTSD) – a delayed stress reaction to a prior incident. This delayed reaction is the result of one or more unresolved issues concerning the incident that might have been alleviated with the use of critical incident stress management.
Putrefaction – decomposition of body tissues.
Rigor Mortis – stiffening of the body, is a definitive sign of death.
Transmission – the way in which an infectious agent is spread: contact, airborne, by vehicles, or by vectors.
Tuberculosis – a chronic bacterial disease, caused by Mycobacterium tuberculosis that usually affects the lungs but can also affect other organs such as the brain or kidneys.
Universal Precautions – Protective measures that have traditionally been developed by the Centers for Disease Control and Prevention (CDC) for use in dealing with objects, blood, body fluids, or other potential exposure risks of communicable disease.
Virulence – the strength or ability of a pathogen to produce disease.
Chapter 3:
Abandonment – unilateral termination of care by the EMT-B without the patient’s consent and without making provisions for transferring care to another medical professional with skills at the same level or higher.
Advanced Directive – written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions, also called a living will.
Assault – unlawfully placing a patient in fear of bodily harm.
Battery – touching a patient or providing emergency care without consent.
Certification – a process in which a person, an institution, or a program is evaluated and recognized as meeting certain predetermined standards to provide safe and ethical care.
Competent – able to make rational decisions about personal well-being.
Consent – permission to render care.
DNR (Do Not Resuscitate Orders) – written documentation giving permission to medical personnel not to attempt resuscitation in the event of cardiac arrest.
Duty To Act – a medicolegal term relating to certain personnel who either by statute or by function have a responsibility to provide care.
Emergency – a serious situation, such as injury or illness that threatens the life or welfare of a person or group of people and requires immediate intervention.
Emergency Medical Care – immediate care or treatment.
Expressed Consent – a type of consent in which a patient gives express authorization for provision of care of transport.
Forcible Restraint – the act of physically preventing an individual from treating any physical act.
Good Samaritan Laws – statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care, unless there is wanton, gross, or willful negligence.
Implied Consent – type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment.
Informed Consent – permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained.
Medicolegal – a term relating to medical jurisprudence (law) or forensic medicine.
Negligence – failure to provide the same care that a person with similar training would provide.
Standard Of Care – written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.
Chapter 4:
Abdomen – the body cavity that contains the major organs of digestion and excretion.
Abduction – motion of a limb away from the body.
Acetabulum – the depression on the lateral pelvis where it’s three component bones join, in which the femoral head fits snugly.
Adam’s Apple – the firm prominence in the upper part of the larynx formed by the thyroid cartilage. It is more prominent in men than in women.
Adduction – motion of a limb toward the midline.
Agonal Respirations – slow, gasping respirations, sometimes seen in dying patients.
Alveoli – the air sacs of the lungs in which the exchange of oxygen and carbon dioxide take place.
Anatomic Position – the position of reference in which the patient stands facing you, arms at the side, with palms of the hands forward.
Angle of Louis – a ridge of the sternum that lies at the level where the second rib is attached to the sternum; provides a constant and reliable body landmark on the anterior chest wall.
Anterior – the front surface of the body; the side facing you in the standard anatomic position.
Anterior Superior Iliac Spines – the bony prominences of the pelvis (ilium) at the front on each side of the lower abdomen just below the plane of the umbilicus.
Aorta – the principal artery leaving the left side of the heart and carrying freshly oxygenated blood to the body.
Apex (plural: Apices) – the tip or the topmost portion of a structure.
Appendix – a small tubular structure that is attached to the lower border of the cecum in the lower right quadrant of the abdomen.
Arteriole – the smallest branch of an artery leading to the vast network of capillaries.
Atrium – upper chamber of the heart.
Autonomic Nervous System – the part of the nervous system that regulates functions, such as digestion and sweating that are not controlled voluntarily.
Ball-And-Socket Joint – a joint that allows internal and external rotation as well as bending.
Biceps – the large muscle that covers the front of the Humerus.
Bilateral – a body that appears on both sides of the midline.
Bile Ducts – ducts that convey bile between the liver and the intestines.
Blood Pressure (BP) – the pressure that the blood exerts against the walls of the arteries as it passes through them.
Brachial Artery – the major vessel in the upper extremity that supplies blood to the arm.
Brain – the controlling organ of the body and center of consciousness; functions include perception, control of reactions to the environment, emotional responses and judgment.
Brain Stem – the area of the brain between the spinal cord and the cerebrum, surrounded by the cerebellum; controls functions that are necessary for life, such as respiration.
Capillary Vessels – the find end-divisions of the arterial system that allow contact between the cells of the body tissues and the plasma and red blood cells.
Carotid Artery – the major artery that supplies blood to the head and brain.
Carpometacarpal Joint – the joint between the wrist and the metacarpal bones; the thumb joint.
Cecum – the first part of the large intestine, into which the ileum opens.
Central Nervous System (CNS) – the brain and spinal cord.
Cerebellum – one of the three major subdivisions of the brain, sometimes called the “little brain”, coordinates the various activities of the brain, particularly body movements.
Cerebrum – the largest part of the three major subdivisions of the brain, sometimes called “gray matter”, made up of several lobes that control movement, hearing, balance, speech, visual perception, emotions and personality.
Cervical Spine – the portion of the spinal column consisting of the first seven vertebrae that lie in the neck.
Circulatory System – the complex arrangement of connected tubes, including the arteries, arterioles, capillaries, venules and veins that moves blood, oxygen, nutrients, carbon dioxide and cellular waste throughout the body.
Clavicle – the collar bone; it is lateral to the sternum and medial to the scapula.
Coccyx – the last three or four fused vertebrae of the spine, the tailbone.
Connecting Nerves – nerves that connect the sensory and motor nerves.
Costal Arch – a bridge of cartilage that connects the ends of the sixth through tenth ribs with the lower part of the sternum.
Costovertebral Angle – an angle that is formed by the junction of the spine and the tenth rib.
Cranium – the area of the head above the ears and eyes; the skull. The cranium holds the brain.
Cricoid Cartilage – a firm ridge of cartilage that forms the lower part of the larynx.
Cricothyroid Membrane – a thin sheet of fascia that connects the thyroid and cricoid cartilages and make up the larynx.
Deep – further inside the body and away from the skin.
Dermis – the inner layer of the skin, containing hair follicles, sweat glands, nerve endings and blood vessels.
Diaphragm – a muscular dome that forms the undersurface of the thorax, separating the chest from the abdominal cavity. Contraction of the diaphragm (and the chest wall muscles) brings air into the lungs. Relaxation allows the air to be expelled from the lungs.
Diastole – the relaxation, or period of relaxation, of the heart, especially of the ventricles.
Digestion – the processing of food that nourishes the individual cells of the body.
Distal – structures that are farther from the trunk or nearer to the free end of the extremity.
Dorsal – the posterior surface of the body, including the back of the hand.
Dorsalis Pedis Artery – the artery on the anterior surface of the foot between the first and second metatarsals.
Endocrine System – the complex message and control system that integrates many body functions, including the release of hormones.
Epidermis – the outer layer of skin, which is made up of cells that are sealed to form a watertight protective covering for the body.
Epiglottis – a thin, leaf-shaped valve that allows air to pass into the trachea but prevents food or liquid from entering.
Esophagus – a collapsible tube that extends from the pharynx to the stomach; contractions of the muscle in the wall of the esophagus propel food and liquids through it to the stomach.
Extend – to straighten.
Fallopian Tube – long, slender tube that extends from the uterus to the region of the ovary on the same side, and through which the ovum passes from ovary to uterus.
Fascia – a sheet or band of tough fibrous connective tissues; lies deep under the skin and forms an outer layer for the muscles.
Femoral Artery – the principal artery of the thigh, a continuation of the external iliac artery. It supplies blood to the lower abdominal wall, external genitalia, and legs. It can be palpated in the groin area.
Femoral Head – the proximal end of the femur, articulating with the acetabulum to form the hip joint.
Femur – the thighbone; the longest and one of the strongest bones in the body.
Flex – to bend.
Floating Ribs – the eleventh and twelfth ribs, which do not attach to the sternum through the costal arch.
Foramen Magnum – the large opening at the base of the skull through which the brain connects to the spinal cord.
Fowler’s Position – The position in which the patient is sitting up with the knees bent, also known as the position of comfort.
Gallbladder – a sac on the undersurface of the liver that collects bile from the liver and discharges it into the duodenum through the common bile duct.
Genital System – the male and female reproductive systems.
Greater Trochanter – a bony prominence on the proximal lateral side of the thigh, just below the hip joint.
Hair Follicles – the small organs in the skin that produce hair.
Heart – a hollow muscular organ that receives blood from the veins and propels it into the arteries.
Heart Rate (Pulse) – the wave of pressure that is created by the heart’s contracting and forcing the blood out the left ventricle and into the major arteries.
Hinge Joints – joints that can bend and straighten but cannot rotate; they restrict motion to one plane.
Humerus – the supporting bone of the arm.
Hypoxic Drive – a “backup system” to control respiration; senses drop in the oxygen level of the blood.
Iliac Crest – the rim, or wing, of the pelvic bone.
Ilium – one of three bones that fuse to form the pelvic ring.
Inferior – the part of the body, or any body part, nearer to the feet.
Inferior Vena Cava – one of the two largest veins in the body; carries blood from the lower extremities and the pelvic and the abdominal organs into the heart.
Inguinal Ligament – the tough, fibrous ligament that stretches between the lateral edge of the pubic Symphysis and the anterior superior iliac spine.
Involuntary Muscle – muscle that continues to contract, rhythmically, regardless of the conscious will of the individual (also known as smooth muscle).
Ischium – one of the three bones that fuse to form the pelvic ring.
Joint (Articulation) – the place where two bones come into contact.
Joint Capsule – the fibrous sac with synovial lining that encloses a joint.
Kidneys – two retroperitoneal organs that excrete the end products of metabolism as urine and regulate the body’s salt and water content.
Large Intestine – the portion of the digestive tube that encircles the abdomen around the small bowel, consisting of the cecum, the colon, and the rectum; produces stools.
Lateral – parts of the body that lie farther away from the midline, also called outer structures.
Ligament – a band of fibrous tissue that connects bones to bones. It supports and strengthens a joint.
Liver – a large solid organ that lies in the upper right quadrant immediately below the diaphragm; it produces bile, stores sugar for immediate use by the body, and produces many substances that help regulate the immune response.
Lumbar Spine – a lower part of the back, formed by the lowest five non-fused vertebrae; also called the dorsal spine.
Lumbar Vertebrae – the five vertebrae of the lumbar spine.
Mandible – bone of the lower jaw.
Manubrium – the upper quarter of the sternum.
Mastoid Process – a prominent bony mass at the base of the skull behind the ear.
Maxillae – the upper jawbones that assist in the formation of the orbit, the nasal cavity, and the palate, and lodge the upper teeth.
Medial – parts of the body that lie closer to the midline; also called inner structures.
Metabolism – the sum of all the physical and chemical processes of living organisms; the process by which energy is made available for the uses of the organism.
Midaxillary Line – an imaginary vertical line drawn through the middle of the axilla (armpit), parallel to midline, separating the anterior and posterior aspects.
Midclavicular Line – an imaginary vertical line drawn through the middle portion of the clavicle, parallel to midline.
Midline – an imaginary vertical line drawn from the middle of the forehead through the nose and the umbilicus (naval) to the floor.
Motor Nerves – nerves that carry information from the central nervous system to the muscles of the body.
Mucous Membranes – the lining of body cavities and passages that communicate directly or indirectly with the environment outside the body.
Musculoskeletal System – the bones and voluntary muscles of the body.
Myocardium – the heart muscle.
Nasopharynx – the part of the pharynx that lies above the level of the roof of the mouth, or soft palate.
Nervous System – the system that controls virtually all activities of the body, both voluntary and involuntary.
Occiput – the most posterior portion of the cranium.
Orbit – the eye socket, made up of the maxilla and zygoma.
Orophar
--Maria
EMS 110 STUDY GUIDE QUESTIONS & VITAL VOCABULARY
Chapter 1 (Introduction to Emergency Medical Care)
1. Describe the 5 phases of EMS care:
Early Access – 911, Enhanced 911 (shows location to the dispatcher), Designated 7-digit number (22%)
Emergency Medical Dispatch
First Responder Care – police, firefighters
EMT Care
Emergency Department Care (2nd Level)
2. Describe the basic components of the EMS system:
Access – early access in an emergency is essential.
Administration – policies and procedures are essential (Dave Stone, EMS Coordinator)
Medical Direction – must have a medical director (Dr. Jim Ellis, DO)
Quality Control & Improvement – assures quality patient care.
Regulation – EMS systems are subject to state regulation.
Equipment – properly maintained equipment is essential.
Working With Hospital Staff – EMS is part of the whole continuum of care.
Working With Public Safety Agencies – understand their roles and responsibilities.
Training – essential part of quality care.
The Ambulance – must be well-stocked and clean at all times.
Specialty Centers – EMT’s should know what resources are available for special situations.
3. Describe the 8 primary responsibilities of the EMT-Basic:
Safety – self, crew, others.
Response to Calls
Patient Assessment
Patient Care Based On Assessment
Patient Packaging
Patient Transport
Transfer of Care
Record Keeping
4. Differentiate between the levels of EMT:
Lay Rescuer – CPR, babysitters, teachers, coaches, parents, etc.
First Responder – police, firefighters, park rangers, etc.
EMT-Basic – 110 hours of training in basic skills
EMT-Intermediate – additional training (IV’s, read heart rhythms, airway management)
EMT-Paramedic – further training to master basic skills, provides a wide range of ALS.
5. Explain the ways that an EMT-Basic displays professionalism:
Prioritize patient needs
Response to calls
Composure (self-confidence)
Understanding (compassionate)
Non-judgmental
Professional appearance
CONFIDENTIALITY
6. Define medical direction:
Medical direction is the process by which physicians monitor care provided by EMS personnel.
Online Direction – direct, real-time communication (phone, radio).
Offline Direction – protocols.
Prospective Direction – training, protocols (before).
Concurrent Direction – online direction.
Retrospective Direction – documentation & quality control (after).
7. Define Continuous Quality Improvement and discuss the EMT-Basic’s role in the process:
Quality improvement is a continual evaluation and improvement of the care provided within an EMS system, and is accomplished by:
Documentation review
Training & Development
Continuing education, updates & recertification
8. State specific statutes and regulations regarding EMS in Illinois:
National Standard Curriculum (Department of Transportation/DOT)
Illinois Department of Public Health (IDPH)
Region 6 (East Central IL protocols & care guidelines)
Provena Regional EMS System
9. Discuss the history & development of EMS:
Early military development
Pre-EMS
1966 Report “Accidental Death & Disability: the Neglected Disease of Modern
Society” also known as “The White Paper”
DOT – Department of Transportation
NHTSA – National Highway Traffic & Safety Administration
IDPH – Illinois Department of Public Health
EMS Act – 1971
Chapter 2 (The Well-Being of the EMT-B)
1. Identify the major concerns of the dying, critically ill, or injured patient:
Anxiety
Pain & Fear
Anger & Hostility
Depression
Dependency
Guilt
Mental health problems
Receiving unrelated bad news
2. Discuss the 5 stages of the grieving process:
Denial – refusal to accept
Anger – blaming others
Bargaining – promise to change
Depression – open expression of grief
Acceptance – of the inevitability of death
3. Explain how to help a patient’s family members deal with death and dying:
Act in a calm manner
Be gentle but direct
Take time to answer questions
Show concern about privacy
Respect family’s wishes
Be honest
Don’t create false hope
4. Discuss the incidence of Critical Incident Stress:
Developed in the 1980’s
Process designed to help EMS personnel deal with responses to critical incidents
Composed of trained peers & mental health professionals
5. Discuss the perks/pitfalls of the Emergency Worker/Rescue Personality:
Feels responsible
Obsessive/Compulsive
Detail-orientated
Second guesses mistakes
Risk takers
Desires control
Action orientated
Easily bored
Dedicated
Group orientated
Vulnerable
6. Describe types of critical incidents:
Death/Injury of a coworker
Death/Injury of a child
Death/Injury of a relative
Mass casualty situations
Fear of physical and/or psychological injuries
Death/Injury of a bystander
Emotion charged incidents
Unusual or distressing circumstances
7. Recognize the signs and symptoms of critical incident stress:
Physical – increased respiration, increased pulse, nausea, vomiting, sweating, chest pain, sleep disturbance
Emotional – anger, denial, fear, feeling overwhelmed, panic reactions
Mental – confusion, disorientation, decreased awareness, indecisiveness, distressing dreams, memory problems, poor concentration
Behavioral – changes in eating habits, crying episodes, hyperactivity, withdrawal, isolation, loss of interest in work, loss of interest in sex, increased alcohol use, increased tobacco use
8. State the possible steps the EMT-B may take to reduce or alleviate stress:
Proper diet
Exercise
Plenty of sleep
Contact friends
Avoid caffeine
Avoid Alcohol
Reestablish a normal schedule
Don’t fight dreams/flashbacks
Talk with loved ones
Seek counseling
9. Describe the services provided by a Critical Incident Stress Debriefing Team:
Pre-incident stress education
On-scene peer support
Demobilization/Disaster support
Defusing
Debriefing
Services for spouse/family
10. Outline how to contact a CISD:
800 numbers
Provide call back number/contact person
Best if 48-72 hours post incident
Personnel available 1-3 hours
Quiet, non-threatening location
Volunteer vs. mandatory
Confidentiality/Only those involved with the incident
(410)-313-2473
icisf@erols.com
11. List 4 routes of disease transmission with examples of how each can occur:
Contact (Direct) – contact, directly with either the person or with sprayed droplets. The source is ordinary or sexual contact. (measles, mumps, chickenpox, bacterial meningitis, influenza, diphtheria, herpes simplex, syphilis, gonorrhea, HIV/AIDS, hepatitis B & C)
Airborne – residues after partial evaporation of droplets (body fluids) or small particles of dust/soil that may carry fungal spores. The source is droplet nuclei and dust/soil. (TB, bacterial meningitis, chickenpox, measles, histoplasma, coccidioides, mycobacterium-avium intracellulare)
Vehicle (Indirect) – spread by inanimate objects such as food, needles, clothing, and transfused blood. Sources could be food, water and blood. (Hepatitis A, B, & C, salmonella, shigella, poliomyelitis, HIV/AIDS, measles, tetanus)
Vector Borne – simple carriage by insects (Mechanical) or transmission by insects (Biological). Sources are houseflies, ticks, mosquitoes. (shigella, lyme’s disease, rocky mountain spotted fever, malaria, equine encephalitis)
Sources of infectious disease (illness caused by various biological agents):
Bacteria, viruses, fungi & parasites
Immune system:
Skin, white blood cells, lymphatic system
Diseases of Special concern:
HIV/AIDS, Hepatitis, Meningitis, TB, Syphilis, Whooping Cough
12. Describe the importance of BSI practices to prevent the transmission of airborne/blood-borne pathogens:
Hand-washing (30 seconds)
Gloves & eye protection
Masks & gowns
Resuscitation devices
BSI vs. Universal precautions
BSI differs from universal precautions in that it is designed to approach all body fluids as being potentially infectious. Universal precautions assume only blood and certain body fluids pose a risk.
13. List the guidelines for personal protection against disease transmission:
Vaccination
Testing
Equipment clean-up
Hand-washing
Scene safety
14. Explain the importance of scene safety:
Shoulder harnesses/seatbelts
Visibility of the EMT at the scene
Parking at the scene
Stability of vehicles at the scene
Identifying possible hazards
Scene Hazards:
Hazardous materials – never approach an object marked with placards
Electricity – never touch downed power lines
Fire – do not approach unless trained and protected
Violent situations – civil disturbances, domestic disputes, behavioral emergencies, crime scenes, large gatherings
15. Identify protective equipment and procedures needed for various hazardous situations:
Cold weather clothing – dress in 3 layers
Turnout gear – provides head-to-toe protection
Gloves – use proper gloves for the job being performed
Helmets – must be worn in any fall zone
Boots – should protect your feet, fit well, be flexible, non-skid, steel/reinforced toe
Eye/Ear protection – should be used on rescue operations
Skin protection – sun block
Chapter 3 (Medical, Legal & Ethical Issues)
1. Differentiate between scope of practice and standard of care:
Scope of Practice – (letter of the law) legally authorized medical acts that may be performed within established state law (1997 IDPH EMS Act), defined by protocols, and delegated through medical direction.
The 1997 IDPH EMS Act defines specific procedures that can be provided by various levels of care, and establish specific requirements for licensure.
Standard of Care – (reasonable, prudent EMT-B) state and regional statutes and guidelines, protocols, policies and procedures. Specific rules and procedures of the service of organization to which you are attached to, and local custom.
Basic Principles: First, DO NO HARM
Second, WHEN IN DOUBT, ACT
2. State the conditions necessary for the EMT-B to have a duty to act:
You are charged with an emergency medical response (dispatched)
Your service or department’s policy states that you must assist in an emergency
3. Define negligence and describe the 4 elements that must be present to prove it:
Negligence – the failure to provide the same care that a person with similar training would provide. Failure to follow accepted practice, as defined by that expected of a reasonable and prudent person.
4 Criteria for Proving Negligence:
Duty To Act – responsibility to act reasonably based on standard of care
Breach of Duty – failure to act within expected & reasonable standard of care
Existing Damage – physical/psychological harm created in a noticeable way
Proximate Cause – existing damage was caused by a failure to act
4. Define abandonment as it relates to the EMT-B:
Abandonment – the unilateral termination of care by the EMT-B without the patient’s consent and without making any provisions for continual care by a medical professional with equal or higher skills.
5. Define consent and discuss the methods for obtaining consent:
Consent – permission to give treatment
Methods of obtaining consent:
Expressed Consent – patient gives express consent (authorization) for the provision of care and/or transport.
Implied Consent – patient is unable to give consent, and is given treatment under the legal assumption that he/she would want treatment.
Minors – the law requires that the parent or legal guardian give consent. Exceptions are minors that are: pregnant, married, emancipated minors, in the military. If no parent or legal guardian is present or available, implied consent exists or the injury or illness is threatening to life or limb.
Mentally Incompetent Adults – (mentally ill, in psychological crisis, under the influence of drugs/alcohol, developmentally delayed) consent should be obtained from the legal guardian or conservator. Implied consent exists with life saving care, if the guardian is not present or available.
Forcible Restraint – CALL MEDICAL CONTROL! Forcible restraint is the act of physically preventing someone from treating any physical action. Legal restraint is authorized if the person is believed to be a harm to self or others. Some states require law enforcement for restraint.
6. Define consent as it applies to minors:
The law requires that the parent or legal guardian give consent. Exceptions are minors that are emancipated, in the military, minors who are parents, minors who are married or pregnant. If no parent or legal guardian is present or available (call medical control!), implied consent exists if the injury or illness is threatening to life or limb.
7. Describe the conditions where use of force, including restraint, is acceptable:
Use of force (legal, forcible restraint) is authorized when the patient is believed to be a harm to themselves, or others. Call medical control! Know your protocols concerning forcible restraint. Some states allow only law enforcement officials to use forcible restraint.
8. Identify the steps to take if the patient refuses care:
Mentally competent adults have the right to refuse or withdraw from treatment at any time.
Make sure the patient is informed about potential risks, benefits, treatments, and alternatives to treatment.
Make sure the patient is fully informed about the consequences of refusing treatment, encourage the patient to ask questions.
Assess the patient’s mental condition.
Obtain the signature of the person refusing treatment on an official release form. Document assessment findings, and obtain a witness (family member, firefighter, police officer….you or your partner are not the best choice for a witness signature), call medical control.
Follow your local protocols.
9. Differentiate between assault and battery and describe how to avoid each:
Assault – unlawfully placing a person in fear of immediate bodily harm without the person’s consent. Identify yourself. Explain what you need to do. Obtain consent.
Battery – unlawfully touching a person, this includes providing emergency care without consent. Explain to the patient what you are doing, obtain consent.
Make sure express consent is obtained! If expressed consent cannot be obtained, make sure the situation allows for implied consent!
10. Define advanced directives and describe the EMT-B’s responsibilities concerning them:
Advanced Directive – written document that specifies medical treatment for a competent patient, should he/she become unable to make decisions.
DNR – do not attempt resuscitation
A DNR must meet all of the following requirements:
Clearly state the medical problem
Be signed by the patient or legal guardian
Be signed by one, or more physicians
Be dated in the preceding 12 months
A living will alone is not sufficient to withhold treatment. Call medical control. The DNR orders must be physically present. Verbally advising you of a DNR order is not sufficient to withhold treatment.
Living wills and durable power of attorneys (POA’s)
DNR orders
Termination of resuscitative efforts
Triple Zero Criteria:
Rigor mortis
Lividity
Decomposition
Mummification
Decapitation
Full arrest for at least 20 minutes without intervention
11. Explain the importance, necessity, and legality of patient confidentiality:
Communication between you and the patient is considered confidential and generally cannot be disclosed without permission from the patient or a court order. This includes patient history, assessment findings, treatment provided, patient identification and mental/physical condition. You may relay this information to those directly involved in the care of the patient (but do so discreetly, within the confines of the treatment area, do not communicate this information in a public arena). Confidentiality covers both verbal and written communication.
12. Identify situations that require the EMT-B to notify law enforcement:
Child abuse
Elderly abuse
Rape
Injury during the commission of a felony
Drug/alcohol related injury
Childbirth
13. Describe the actions that must be taken to preserve evidence at a crime scene:
Notify law enforcement (if first on the scene/police not present)
Make sure the scene is safe
Do not disturb the scene more than is necessary
If you move something, tell officers
Confer with officers about actions you should take at the scene
If possible, do not cut through holes in clothing made by weapons
14. Discuss the EMT-B’s responsibilities regarding resuscitation efforts for potential organ donors:
Consult medical control
Treat the donor as any other patient
Use all means necessary to keep the patient alive
The priority is to save the patient’s life
There is no difference in treatment of donors vs. non-donors
Chapter 4 (The Human Body)
1. Describe the six basic body positions:
Anatomic – facing you, arms down, palms out
Prone – face down
Supine – face up, flat on back
Fowler’s – sitting up (45 degrees), position of comfort
Trendelenburg – (whole body) feet elevated 8”-12” (generally used with a backboard)
Shock (or modified Trendelenburg) – (waist down) feet elevated 8”-12”
Recovery – left lateral recumbent
2. Describe the terms (divisions, directional, body regions, abdomen quadrants) that are used in topographical anatomy:
Divisions (planes) of the body:
Midline – line drawn through nose and umbilicus, dividing the body exactly in half (vertically)
Midaxillary – between the anterior and posterior aspects, from axilla (armpit), parallel to midline
Midclavicular – middle of the clavicle, parallel to midline
Transverse – horizontally through umbilicus
Anterior – front
Posterior – back
Directional Terms:
Right – patient’s right
Left – patient’s left
Lateral – farther from midline
Medial – closer to midline
Superior – closer to head (higher)
Inferior – closer to feet (lower)
Proximal – closer to midline/closer to trunk
Distal – farther from middling/closer to free end (extremity)
Dorsal – toward spine/back
Ventral – toward abdomen/front
Palmar – palms
Planter – soles
Apices – top of
Bilateral – both sides
Regions of the Body:
Cranial – brain
Spinal – spinal column/cord
Thoracic – lungs, heart
Pelvic – urinary/reproductive
Abdominal – digestive/excretion
Quadrants of the Abdomen:
Right Upper Quadrant (RUQ) – liver, gallbladder, transverse colon
Left Upper Quadrant (LUQ) – stomach spleen, transverse colon
Right Lower Quadrant (RLQ) – appendix, ascending colon
Left Lower Quadrant (LLQ) – descending colon
3. Describe the anatomy and function of the major body systems:
Musculoskeletal
Respiratory
Circulatory
Nervous
Integumentary
Endocrine
Digestive
Urinary
Reproductive (male/female)
Musculoskeletal System
Provides form, support and protection
Skeleton – gives us human form, protects vital organs, 206 bones, framework for muscle attachment, designed for motion of the body
Muscles – skeletal (voluntary/striated), smooth (involuntary), cardiac (heart)
Joints – connects bones to each other, allows for motion
Types of joint motion – flexion, extension, rotation, adduction, abduction
Sections of the skull – frontal (forehead), parietal (top/back), temporal (above ears), occipital (back/rear)
Bones of the face – orbital (around eyes), nasal (nose), zygoma (cheekbones), maxillae (above teeth), mandible (jaw)
Sections of the spinal column – 33 stacked vertebrae
Cervical – supports the head (7 vertebrae)
Thoracic – rib anchor points (12 vertebrae)
Lumbar – largest vertebrae (spine terminates at the end of the lumbar) (5 vertebrae)
Sacrum – foundation of the pelvis (5 fused vertebrae)
Coccyx – tailbone (4 fused vertebrae)
C1 – atlas
C2 – axis
Bones of the thorax (ribcage) – 12 vertebrae, 12 pair (24) of ribs
Bones of the pelvis:
Ilium – part of the pelvis ring
Ischium – part of the pelvis ring
Pubic Symphysis – bony prominence, midline lower most part of abdomen
Sacrum – part of the pelvis ring, foundation of pelvis, 5 fused vertebrae
Lower Extremities:
Pelvis
Hip
Femur (thigh)
Knee
Patella (knee cap)
Fibula (leg)
Tibia (leg)
Tarsals (ankle)
Metatarsals (foot)
Phalanges (toes)
Upper Extremities:
Shoulder girdle
Glenohumeral joint
Humerus
Lateral condyle (elbow)
Medial condyle (elbow)
Ulna
Radius
Radial styloid
Ulnar styloid
Carpals
Carpometacarpal joints
Metacarpals
Phalanges (fingers, digits)
Thumb
Index
Long
Ring
Small
Respiratory System
The respiratory system takes oxygen from the air to the blood for transport to cells and rids the body of excess carbon dioxide.
Upper Airway:
Nasopharynx
Oropharynx
Epiglottis
Larynx
Vocal cords
Lower Airway:
Trachea (carina)
Bronchi
Bronchioles
Alveoli
5 lobes
Characteristics of the Diaphragm:
Dome shaped muscle
Both voluntary and involuntary muscles
Divides thorax from abdominal cavity
Contracts during inhalation
Relaxes during exhalation
Characteristics of Normal Breathing:
Normal rate and depth
Regular pattern
Good breath sounds bilaterally
Regular rise and fall movement
Movement of the abdomen
Children vs. adults:
Proportionately larger tongue
Narrower and shorter trachea
Trachea easily kinked by improper positioning
Larynx is more anterior
Weaker intercostal muscles
Requires more use of abdominal muscles
Circulatory System
Carries oxygenated blood and sugar to all cells and tissues. Carries CO2/waste products from all cells and tissues of the body.
Heart (pump):
Four chambers – R/L atrium, R/L ventricle
Four vessels – Superior/inferior vena cava, pulmonary artery/vein, aorta
Four valves – tricuspid, pulmonic, bicuspid (mitral), Aortic
Electrical System – sinoatrial node (SA), atrioventricular node (AV), purkinjie
fibers
Trace a drop of blood through the heart:
Superior/inferior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary artery
Pulmonary vein
Left atrium
Bicuspid (mitral) valve
Left ventricle
Aortic valve
Aorta
Major Arteries (pipes):
Aorta
Pulmonary
Carotid
Femoral
Brachial
Radial
Major Veins (pipes):
Superior vena cava
Inferior vena cava
Pulmonary
Jugular
Blood Components (fluid):
Red blood cells (hemoglobin)
Platelets (clotting factor)
Plasma (carries cells and platelets, yellowish liquid)
White blood cells (fights infection)
Pulse – forceful pumping of blood out of the heart
Perfusion – process of delivering blood to the organs, delivering oxygen and blood, and removing wastes
Blood pressure – amount of force exerted against the walls of the arteries
Systole (systolic) – left ventricle contracts
Diastole (diastolic) – left ventricle relaxes
Nervous System
Controls all bodily functions.
Central Nervous System (CNS) – brain, spinal cord
Peripheral Nervous System:
Motor nerves (from the brain)
Sensory nerves (to the brain)
Connective nerves
Somatic Nervous System (voluntary) – regulates voluntary body activities
Autonomic Nervous System (involuntary/2 divisions) – controls involuntary functions
Sympathetic Response – fight/flight, increases heart rate, blood vessels constrict,
bronchi dilate
Parasympathetic Response – decreases heart rate, promotes digestion, constricts
pupils
Integumentary System (skin)
Environmental barrier, prevents bacterial/viral invasion, temperature regulation, sensory organ
Epidermis:
Outer layer of the skin, made up of cells that are sealed together to form a watertight protective covering for the body
Dermis:
Inner layer of skin, containing hair follicles, sweat glands, nerve endings and blood vessels
Subcutaneous:
Tissue, largely fat, that lies directly under the dermis and serves as an insulator for the body
Endocrine System
Complex message and control system that works with the nervous system to control bodily functions. Made up of 7 glands that produces and release hormones.
Glands:
Adrenal
Ovary
Pancreas
Parathyroid
Pituitary
Testes
Thyroid
Digestive System
Processes food to nourish cells.
Mouth – lips, cheeks, gums, teeth and tongue
Salivary Glands – 2 glands under tongue, 1 gland inside each cheek, 98% water, 2% mucous, salts, organic compounds, binder and lubricant.
Oropharynx – extends to trachea and esophagus, pharynx lifts larynx to permit epiglottis to close during swallowing
Esophagus – connects pharynx to stomach
Stomach – LUQ, receives, stores and releases food to the small bowel
Pancreas – under and behind liver and stomach, secretes digestive juices and insulin
Liver – RUQ, largest organ in the body, filters toxins, stores sugars and starch, aids in immune responses
Bile Ducts – connects liver to intestines, out-pouching of the bile ducts, called the gall bladder, stores and releases bile
Small Intestine – major hollow organ, does 90% of food processing
Large Intestine – forms stools
Appendix – RLQ, no known function
Rectum – ends at anus, controls escape of liquid, gasses, and solids from digestive tract
Urinary System
Controls discharge of certain waste materials filtered through the blood by the kidneys
Kidneys – 2, located in the retroperitoneal space (muscular wall of the abdomen, posterior, behind the peritoneum), rids the body of toxins, controls the balance of water and salts
Renal Pelvis – connects kidneys to ureters
Ureters – passes from renal pelvis to bladder, peristalis (wave like contraction of smooth muscle) moves urine to the bladder
Urinary Bladder – stores and empties urine
Urethra – where urine passes from the body
Reproductive (Genital) System
Controls reproduction
Male:
Testicle
Vas Deferens
Seminal Vesicles
Semen
Prostate Gland
Penis
(mostly external)
Female:
Ovaries
Fallopian Tubes
Uterus
Cervix
Vagina
(mostly internal)
Chapter 5 (Vital Signs & SAMPLE History)
1. Define signs, symptoms, chief complaint, baseline vital signs and trending:
Signs – any medical/trauma condition displayed by the patient and identified by the EMT-B
Symptoms – Any condition described by the patient that cannot be observed
Chief Complaint – The major sign/symptom a patient reports (the reason you are dispatched)
Baseline Vital Signs – The first set of vital signs against which all other sets are compared
Trending – the process of comparing sets of vital signs or other assessment information over time.
2. Identify six components of vital signs:
Level of Consciousness (LOC)
Respirations
Pulse
Skin
Pupils
Blood Pressure
3. Explain the importance of accurately reporting and recording baseline vitals:
The first set of vital signs obtained is called the baseline vital signs. By periodically reassessing the vital signs and comparing the findings with the baseline set, you will be able to identify any significant trends in the patient’s condition, particularly whether the patient’s condition is worsening.
4. Describe and demonstrate methods for measuring level of consciousness (LOC) using the AVPU scale:
A – Alert & awake, aware of time, place, date and person
V – Responds to verbal stimuli
P – Responds to painful stimuli, does not respond to verbal stimuli
U – Unresponsive (unconscious), does not respond to any stimuli
A – Ask person questions about time, place, date and person
V – Normal voice?
Loud verbal stimulation?
Note how the patient responds and what patient responds to
P – No verbal response
Pinch nail bed
Rub sternum
Pinch Skin
Note type/location of stimulus and patient response, try both sides
U –No reaction to any verbal/painful stimulus
Note what stimulus attempted/No Response
5. Describe and demonstrate methods for measuring breathing rate, quality and depth:
Rate – per minute, count number of breaths in 30 seconds, multiply by 2 (12-20 is normal for adults)
Quality – character of respirations (normal, shallow, labored, noisy)
Rhythm – if the time from one peak to the next is consistent, respirations are
considered normal (patients tend to breathe faster when injured or
frightened, and may attempt to slow their breathing if they are aware
they are being monitored)
Effort – normally effort to breathe does not affect with the patient’s speech,
posture, or positioning. Patients having a markedly difficult time
breathing will assume a posture that eases their breathing (tri-pod
position, sniffling position). That is called labored breathing. In
infants and small children cardiac arrest is generally caused by
respiratory arrest
Noisy Breathing – may be audible, or heard with a stethoscope
Depth – depends on rate and tidal volume (amount of air that is exchanged with each breath).
Shallow – chest wall movement is less than normal
Normal
Deep – chest wall movement is greater than normal
6. Describe and demonstrate methods for measuring pulse rate and quality:
Pulse – pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries.
Key Pulse Points:
Carotid
Brachial
Radial
Femoral
Dorsalis Pedis
Posterior Tibial
Rate – per minute, count number of pulses in 30 seconds, multiply by 2.
A weak or irregular pulse should be counted for a full minute.
The pulse rate for most adults at rest is 72 beats/min, but 60-100 beats/min is
considered normal.
Tachycardia – rate greater than 100 beats/min.
Bradycardia – rate less than 60 beats/min.
Quality:
Strength – bounding (stronger than normal), normal, weak/thready
Regularity – regular, irregular (intervals between contractions)
7. Describe and demonstrate methods of measuring skin color, temperature, and condition:
Perfusion – the process of distributing blood to the organs, delivering oxygen, and removing wastes. Skin condition is a good indicator of adequate vs. inadequate perfusion.
Skin Color – check nail beds, mucous membranes in the mouth, the lips, underside of the arms, palms, and conjunctiva (delicate membrane lining the eyelids). In children and infants, hands and soles should be assessed.
Pink, pale, blue (cyanotic), flushed, jaundiced
Skin Temperature – feel the patient’s forehead with the back of your hand.
Warm, hot, cool, cold
Skin Condition – dry, wet & moist, abnormally dry, clammy, diaphoretic (very wet)
Normal skin color/temp/condition is: pink, warm and dry
8. Demonstrate how to measure capillary refill in children and infants:
Capillary Refill – evaluates the ability of the circulatory system to restore blood to the capillary system.
Compress thumbnail, then release, count seconds it takes to restore to pink color
It is not an accurate indicator for patients over 6 years old.
It can indicate poor perfusion.
Normal CRT is 2 seconds or less.
9. Describe how to measure pupils:
First, evaluate in ambient light for constriction or dilation.
Next, pass a light source across each pupil and note the response.
Each pupil should constrict in the same manner.
P – pupils
E – equal
A – and
R – reactive to
L – light, and midsize
10. Define systolic and diastolic blood pressure:
Blood Pressure (BP) – pressure of circulating blood against the walls of the arteries.
Systolic – increased pressure caused by contraction of the left ventricle (CONTRACTION)
Diastolic – residual pressure that remains in the arteries when the left ventricle is at rest (RELAXATION)
11. Demonstrate how to measure blood pressure using auscultation and palpation:
Auscultation – method of listening to sounds within organs with a stethoscope
Put BP cuff on patient’s upper arm (arm extended, palm up) about 1 inch from the elbow crease. Make sure center of bladder (usually marked with an arrow) lies over the brachial artery. Once the cuff is in place the arm should be held at about the same level as the heart. Palpate the brachial artery. Place the diaphragm of the stethoscope over the brachial artery. Close the valve and pump the ball-pump until you no longer hear pulse sounds, then increase by another 20 mm Hg. Slowly release the air and watch the needle drop, listen carefully. Systolic pressure is the reading on the gauge when you FIRST hear thumps of pulse. Diastolic pressure is the reading on the gauge when the thumps of pulse DISAPPEAR. Once the pulse sounds stop, quickly release the remaining air in the cuff.
Palpation – examination by touch, used in very noisy environments.
Put BP cuff on patient’s upper arm (arm extended, palm up) about 1 inch from the elbow crease. Make sure center of bladder (usually marked with an arrow) lies over the brachial artery. Once the cuff is in place the arm should be held at about the same level as the heart. Palpate the patient’s radial pulse (same arm cuff is on), then close the valve and pump to 200 mm Hg. As you inflate the cuff the radial pulse will disappear. Begin slowly releasing air and watch the gauge. When you again feel the radial pulse, note the reading on the gauge. This is the systolic pressure, and will be written as systolic (the reading)/P (example: 120/P).
12. Identify components of a SAMPLE history:
S – signs and symptoms
A – allergies
M – medications
P – pertinent past medical history
L – last oral intake
E – events leading to injury/illness
Chapter 6 (Lifting and Moving)
1. Define body mechanics:
Body Mechanics – the principles of effective, safe movement used in lifting and moving patients. The use of proper mechanics reduces the EMS provider’s chances of becoming injured.
2. Discuss the guidelines and safety precautions that need to be followed when lifting a patient:
Use a minimum of 2 people
Call for additional help if necessary
Use an even number of people to maintain balance
Know the weight limitations of your equipment
Know your own limitations
If the lifting is unsafe, don’t move the patient
Keep weight as close to your body as possible
3. Describe the safe lifting of cots and stretchers:
General Guidelines – know the weight to be lifted and the team’s limitations, constantly communicate to coordinate actions, don’t twist your body, keep weight as close to your body as possible, flex at your hips and bend knees, and keep back straight.
Cots/Backboards – tighten your back in normal, upright position, spread your legs about 15 inches apart, bend at the knees to lower your torso, use power grip to grasp cot/backboard, adjust position until weight is balanced, make sure feet are about 15 inches apart with one slightly forward than the other, keep feet flat and your weight on the balls of your feet, lift by straightening your legs until you are fully standing, keep back locked in, make sure your upper body rises before your hips.
Stretchers – please read Chapter 6, Pages 172-175 for complete information
4. Discuss the guidelines and safety precautions for carrying patients and equipment:
First rule of lifting is to keep your back in an upright position
Never twist or jerk
The power lift is the safest and most powerful way to lift
Maintain a proper hold with the power grip
It is always best to move a patient on a device that can be rolled
Coordinate your movements with your team with constant communication
Use correct lifting techniques
Make sure patient is tightly secured (strapped in)
Always carry patient feet end first
Team leader is responsible for coordinating moves
Use at least two people, but try to use at least four when resources allow
Call for additional help as needed! Immediately!
Train and practice often
5. Discuss one-handed carrying techniques:
6. Describe correct and safe carrying procedures on stairs:
Use a stair chair if possible. If you must use a backboard or stretcher, be sure the patient is anatomically secured to the device to prevent sliding when the device is held at an angle.
Properly secure the patient
When carrying downstairs, go feet first.
When carrying upstairs, go head first.
Use stair chair or sturdy kitchen chair
Keep back in locked position
Flex at hips, not waist
Keep weight as close to body as possible
7. State the guidelines for reaching and their application:
Keep back straight when leaning over a patient
Lean from the hips
Use shoulder muscles to help
Avoid twisting while reaching
Avoid hyper-extended position when reaching overhead
8. Describe correct reaching for log rolls:
Kneel as close to the patient’s side as possible
When you lean forward, keep back straight
Lean solely from hips
Use shoulder muscles to help with the roll
Roll patient without stopping until patient is resting on his/her side
9. State guidelines for pushing and pulling:
Whenever possible, PUSH, rather than PULL!
10. Discuss the general considerations of moving patients:
Emergency Moves
Urgent Moves
Non-Urgent Moves
Emergency Moves:
Fire or danger of fire.
Explosives or hazardous materials.
Inability to protect patient from hazards.
Inability to access others requiring life-saving care.
Other situations that have potential for causing injury.
Inability to provide life-saving care due to patient location/position.
Examples of Emergency Moves:
Clothes Drag
Blanket Drag
Arm Drag
Arm-to-arm Drag
Under arm carry
Front Cradle
Firefighter’s Drag
One-person walking assist
Firefighter’s Carry
Pack Strap
Urgent Moves:
An urgent move may be necessary for moving a patient with an altered LOC, inadequate ventilation, shock, or extreme weather conditions. A patient sitting in a vehicle must be urgently moved (rapid extrication technique), as they very often cannot be properly assessed
Rapid Extrication Technique – please read Chapter 6, Pages 164-165 for detailed instructions. This technique is a method to move a patient from a sitting position inside a vehicle to a supine position on a backboard in less than one minute, when conditions do not allow for standard immobilization.
Non-Urgent Moves:
Scene and patient are stable.
Follow lifting/moving guidelines
Three general movements are generally used:
Direct ground lift
Extremity lift
Transfer moves:
Direct carry
Draw sheet method
11. State three situations that may require the use of an emergency move:
Fire
Explosives/Hazardous Materials on scene
Unable to gain access to others (in a vehicle, for example) needing lifesaving care
12. Identify various carrying devices:
Wheeled stretcher
Portable stretcher
Scoop stretcher (does not provide C-spine immobilization)
Flexible stretcher
Basket stretcher
Stair chair
Long backboard (C-spine immobilization)
Short backboard/KED
Child safety seat
Section 1, Chapters 1-6, Vital Vocabulary
Chapter 1:
Advanced Life Support (ALS) – advanced life-saving procedures, some of which are now being provided by the EMT-B.
Americans with Disabilities Act (ADA) – comprehensive legislation that is designed to protect individuals with disabilities against discrimination.
Continuous Quality Improvement (CQI) – a system of internal and external reviews and audits of all aspects of an EMS system.
Emergency Medical Services (EMS) – a multidisciplinary system that represents the combined efforts of several professionals and agencies to provide prehospital emergency care to the sick and injured.
EMT-Basic – an EMT who has training in basic emergency care skills, including automated external defibrillation, use of a definitive airway adjunct, and assisting patients with certain medications.
EMT-Intermediate – an EMT who has training in advanced life support, including IV (intravenous) therapy, interpretation of cardiac rhythms and defibrillation, and orotracheal intubation.
EMT-Paramedic – an EMT who has extensive training in advanced life support, including IV (intravenous) therapy, pharmacology, cardiac monitoring, and other advanced assessment and treatment skills.
First Responder – the first trained individual, such as a police officer, firefighter, or other rescuer, to arrive at the scene of an emergency to provide initial medical assistance.
Medical Control – physician instructions that are given directly by radio (online/direct) or indirectly by protocols/guidelines (off-line/indirect), as authorized by the medical director of the service program.
Medical Director – the physician who authorizes or delegates to the EMT the authority to perform medical care in the field.
Primary Service Area (PSA) – the designated area in which the EMS service is responsible for the provision of prehospital care and transportation to the hospital.
Quality Control – The responsibility of the medical director to ensure that the appropriate medical care standards are met by EMT’s on each call.
Chapter 2:
Body Substance Isolation (BSI) - an infection control concept and practice that assumes that all body fluids are potentially infectious.
Burnout – a condition of chronic fatigue and frustration that results from mounting stress over time.
Carrier –an animal or person who may transmit an infectious disease but may not display any symptoms of it.
Communicable Disease –any disease that can be spread from person to person, or animal to person.
Contamination –the presence of infectious organisms on or in objects such as dressings, water, food, needles, wounds, or a patient’s body.
Cover – the tactical use of an impenetrable barrier to conceal EMS personnel and protect them from projectiles (bullets, bottles, rocks).
Critical Incident Stress Debriefing (CISD) – a confidential group discussion of a severely stressful incident that usually occurs within 24-72 hours of the incident.
Critical Incident Stress Management (CISM) – a process that confronts the responses to critical incidents and defused them, directing the emergency services personnel toward physical and emotional equilibrium.
Dependent Lividity – blood settling to the lowest point of the body, causing discoloration of the skin.
Designated Officer – the individual in the department who is charged with the responsibility of managing exposures and infection control issues.
Direct Contact – Exposure or transmission of a communicable disease from one person to another by physical touching.
Exposure – a situation in which a person has had contact with blood, body fluids, tissues, or airborne particles in a manner that suggests that disease transmission may occur.
Exposure Control Plan – a comprehensive plan that helps employees t reduce their risk of exposure to, or acquisition of, communicable diseases.
General Adaptation Syndrome – the body’s three-stage response to stress. First, stress causes the body to trigger an alarm response, followed by a stage of reaction and resistance, and then recovery, or if the stress is prolonged, exhaustion.
Hepatitis – an infection of the liver, usually caused by a virus, that causes fever, loss of appetite, jaundice, fatigue and altered liver function.
HIV Infection – infection with the human immunodeficiency virus (HIV) that can progress to acquired immunodeficiency syndrome (AIDS).
Host – the organism or individual that is attacked by the infecting agent.
Indirect Contact – exposure or transmission of disease from one person to another by contact with a contaminated object.
Infection – the abnormal invasion of a host or host tissues by organisms such as bacteria, viruses, or parasites, with or without signs or symptoms of disease.
Infection Control – procedures to reduce transmission of infection among patients and health care personnel.
Infectious Disease – a disease that is caused by infection, in contrast t one caused by faulty genes, metabolic disturbances, emotional trauma, or other cause.
Meningitis – an inflammation of the meningeal coverings of the brain, it is usually caused by a virus or a bacterium.
Occupational Safety and Health Administration (OSHA) – the federal regulatory compliance agency that develops, publishes, and enforces guidelines concerning safety in the workplace.
Pathogen – a microorganism that is capable of causing disease in a susceptible host.
Personal Protective Equipment (PPE) – protective equipment that OSHA requires to be made available to the EMT. In the case of infection risk, PPE blocks entry of an organism into the body.
Posttraumatic Stress Disorder (PTSD) – a delayed stress reaction to a prior incident. This delayed reaction is the result of one or more unresolved issues concerning the incident that might have been alleviated with the use of critical incident stress management.
Putrefaction – decomposition of body tissues.
Rigor Mortis – stiffening of the body, is a definitive sign of death.
Transmission – the way in which an infectious agent is spread: contact, airborne, by vehicles, or by vectors.
Tuberculosis – a chronic bacterial disease, caused by Mycobacterium tuberculosis that usually affects the lungs but can also affect other organs such as the brain or kidneys.
Universal Precautions – Protective measures that have traditionally been developed by the Centers for Disease Control and Prevention (CDC) for use in dealing with objects, blood, body fluids, or other potential exposure risks of communicable disease.
Virulence – the strength or ability of a pathogen to produce disease.
Chapter 3:
Abandonment – unilateral termination of care by the EMT-B without the patient’s consent and without making provisions for transferring care to another medical professional with skills at the same level or higher.
Advanced Directive – written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions, also called a living will.
Assault – unlawfully placing a patient in fear of bodily harm.
Battery – touching a patient or providing emergency care without consent.
Certification – a process in which a person, an institution, or a program is evaluated and recognized as meeting certain predetermined standards to provide safe and ethical care.
Competent – able to make rational decisions about personal well-being.
Consent – permission to render care.
DNR (Do Not Resuscitate Orders) – written documentation giving permission to medical personnel not to attempt resuscitation in the event of cardiac arrest.
Duty To Act – a medicolegal term relating to certain personnel who either by statute or by function have a responsibility to provide care.
Emergency – a serious situation, such as injury or illness that threatens the life or welfare of a person or group of people and requires immediate intervention.
Emergency Medical Care – immediate care or treatment.
Expressed Consent – a type of consent in which a patient gives express authorization for provision of care of transport.
Forcible Restraint – the act of physically preventing an individual from treating any physical act.
Good Samaritan Laws – statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care, unless there is wanton, gross, or willful negligence.
Implied Consent – type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment.
Informed Consent – permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained.
Medicolegal – a term relating to medical jurisprudence (law) or forensic medicine.
Negligence – failure to provide the same care that a person with similar training would provide.
Standard Of Care – written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.
Chapter 4:
Abdomen – the body cavity that contains the major organs of digestion and excretion.
Abduction – motion of a limb away from the body.
Acetabulum – the depression on the lateral pelvis where it’s three component bones join, in which the femoral head fits snugly.
Adam’s Apple – the firm prominence in the upper part of the larynx formed by the thyroid cartilage. It is more prominent in men than in women.
Adduction – motion of a limb toward the midline.
Agonal Respirations – slow, gasping respirations, sometimes seen in dying patients.
Alveoli – the air sacs of the lungs in which the exchange of oxygen and carbon dioxide take place.
Anatomic Position – the position of reference in which the patient stands facing you, arms at the side, with palms of the hands forward.
Angle of Louis – a ridge of the sternum that lies at the level where the second rib is attached to the sternum; provides a constant and reliable body landmark on the anterior chest wall.
Anterior – the front surface of the body; the side facing you in the standard anatomic position.
Anterior Superior Iliac Spines – the bony prominences of the pelvis (ilium) at the front on each side of the lower abdomen just below the plane of the umbilicus.
Aorta – the principal artery leaving the left side of the heart and carrying freshly oxygenated blood to the body.
Apex (plural: Apices) – the tip or the topmost portion of a structure.
Appendix – a small tubular structure that is attached to the lower border of the cecum in the lower right quadrant of the abdomen.
Arteriole – the smallest branch of an artery leading to the vast network of capillaries.
Atrium – upper chamber of the heart.
Autonomic Nervous System – the part of the nervous system that regulates functions, such as digestion and sweating that are not controlled voluntarily.
Ball-And-Socket Joint – a joint that allows internal and external rotation as well as bending.
Biceps – the large muscle that covers the front of the Humerus.
Bilateral – a body that appears on both sides of the midline.
Bile Ducts – ducts that convey bile between the liver and the intestines.
Blood Pressure (BP) – the pressure that the blood exerts against the walls of the arteries as it passes through them.
Brachial Artery – the major vessel in the upper extremity that supplies blood to the arm.
Brain – the controlling organ of the body and center of consciousness; functions include perception, control of reactions to the environment, emotional responses and judgment.
Brain Stem – the area of the brain between the spinal cord and the cerebrum, surrounded by the cerebellum; controls functions that are necessary for life, such as respiration.
Capillary Vessels – the find end-divisions of the arterial system that allow contact between the cells of the body tissues and the plasma and red blood cells.
Carotid Artery – the major artery that supplies blood to the head and brain.
Carpometacarpal Joint – the joint between the wrist and the metacarpal bones; the thumb joint.
Cecum – the first part of the large intestine, into which the ileum opens.
Central Nervous System (CNS) – the brain and spinal cord.
Cerebellum – one of the three major subdivisions of the brain, sometimes called the “little brain”, coordinates the various activities of the brain, particularly body movements.
Cerebrum – the largest part of the three major subdivisions of the brain, sometimes called “gray matter”, made up of several lobes that control movement, hearing, balance, speech, visual perception, emotions and personality.
Cervical Spine – the portion of the spinal column consisting of the first seven vertebrae that lie in the neck.
Circulatory System – the complex arrangement of connected tubes, including the arteries, arterioles, capillaries, venules and veins that moves blood, oxygen, nutrients, carbon dioxide and cellular waste throughout the body.
Clavicle – the collar bone; it is lateral to the sternum and medial to the scapula.
Coccyx – the last three or four fused vertebrae of the spine, the tailbone.
Connecting Nerves – nerves that connect the sensory and motor nerves.
Costal Arch – a bridge of cartilage that connects the ends of the sixth through tenth ribs with the lower part of the sternum.
Costovertebral Angle – an angle that is formed by the junction of the spine and the tenth rib.
Cranium – the area of the head above the ears and eyes; the skull. The cranium holds the brain.
Cricoid Cartilage – a firm ridge of cartilage that forms the lower part of the larynx.
Cricothyroid Membrane – a thin sheet of fascia that connects the thyroid and cricoid cartilages and make up the larynx.
Deep – further inside the body and away from the skin.
Dermis – the inner layer of the skin, containing hair follicles, sweat glands, nerve endings and blood vessels.
Diaphragm – a muscular dome that forms the undersurface of the thorax, separating the chest from the abdominal cavity. Contraction of the diaphragm (and the chest wall muscles) brings air into the lungs. Relaxation allows the air to be expelled from the lungs.
Diastole – the relaxation, or period of relaxation, of the heart, especially of the ventricles.
Digestion – the processing of food that nourishes the individual cells of the body.
Distal – structures that are farther from the trunk or nearer to the free end of the extremity.
Dorsal – the posterior surface of the body, including the back of the hand.
Dorsalis Pedis Artery – the artery on the anterior surface of the foot between the first and second metatarsals.
Endocrine System – the complex message and control system that integrates many body functions, including the release of hormones.
Epidermis – the outer layer of skin, which is made up of cells that are sealed to form a watertight protective covering for the body.
Epiglottis – a thin, leaf-shaped valve that allows air to pass into the trachea but prevents food or liquid from entering.
Esophagus – a collapsible tube that extends from the pharynx to the stomach; contractions of the muscle in the wall of the esophagus propel food and liquids through it to the stomach.
Extend – to straighten.
Fallopian Tube – long, slender tube that extends from the uterus to the region of the ovary on the same side, and through which the ovum passes from ovary to uterus.
Fascia – a sheet or band of tough fibrous connective tissues; lies deep under the skin and forms an outer layer for the muscles.
Femoral Artery – the principal artery of the thigh, a continuation of the external iliac artery. It supplies blood to the lower abdominal wall, external genitalia, and legs. It can be palpated in the groin area.
Femoral Head – the proximal end of the femur, articulating with the acetabulum to form the hip joint.
Femur – the thighbone; the longest and one of the strongest bones in the body.
Flex – to bend.
Floating Ribs – the eleventh and twelfth ribs, which do not attach to the sternum through the costal arch.
Foramen Magnum – the large opening at the base of the skull through which the brain connects to the spinal cord.
Fowler’s Position – The position in which the patient is sitting up with the knees bent, also known as the position of comfort.
Gallbladder – a sac on the undersurface of the liver that collects bile from the liver and discharges it into the duodenum through the common bile duct.
Genital System – the male and female reproductive systems.
Greater Trochanter – a bony prominence on the proximal lateral side of the thigh, just below the hip joint.
Hair Follicles – the small organs in the skin that produce hair.
Heart – a hollow muscular organ that receives blood from the veins and propels it into the arteries.
Heart Rate (Pulse) – the wave of pressure that is created by the heart’s contracting and forcing the blood out the left ventricle and into the major arteries.
Hinge Joints – joints that can bend and straighten but cannot rotate; they restrict motion to one plane.
Humerus – the supporting bone of the arm.
Hypoxic Drive – a “backup system” to control respiration; senses drop in the oxygen level of the blood.
Iliac Crest – the rim, or wing, of the pelvic bone.
Ilium – one of three bones that fuse to form the pelvic ring.
Inferior – the part of the body, or any body part, nearer to the feet.
Inferior Vena Cava – one of the two largest veins in the body; carries blood from the lower extremities and the pelvic and the abdominal organs into the heart.
Inguinal Ligament – the tough, fibrous ligament that stretches between the lateral edge of the pubic Symphysis and the anterior superior iliac spine.
Involuntary Muscle – muscle that continues to contract, rhythmically, regardless of the conscious will of the individual (also known as smooth muscle).
Ischium – one of the three bones that fuse to form the pelvic ring.
Joint (Articulation) – the place where two bones come into contact.
Joint Capsule – the fibrous sac with synovial lining that encloses a joint.
Kidneys – two retroperitoneal organs that excrete the end products of metabolism as urine and regulate the body’s salt and water content.
Large Intestine – the portion of the digestive tube that encircles the abdomen around the small bowel, consisting of the cecum, the colon, and the rectum; produces stools.
Lateral – parts of the body that lie farther away from the midline, also called outer structures.
Ligament – a band of fibrous tissue that connects bones to bones. It supports and strengthens a joint.
Liver – a large solid organ that lies in the upper right quadrant immediately below the diaphragm; it produces bile, stores sugar for immediate use by the body, and produces many substances that help regulate the immune response.
Lumbar Spine – a lower part of the back, formed by the lowest five non-fused vertebrae; also called the dorsal spine.
Lumbar Vertebrae – the five vertebrae of the lumbar spine.
Mandible – bone of the lower jaw.
Manubrium – the upper quarter of the sternum.
Mastoid Process – a prominent bony mass at the base of the skull behind the ear.
Maxillae – the upper jawbones that assist in the formation of the orbit, the nasal cavity, and the palate, and lodge the upper teeth.
Medial – parts of the body that lie closer to the midline; also called inner structures.
Metabolism – the sum of all the physical and chemical processes of living organisms; the process by which energy is made available for the uses of the organism.
Midaxillary Line – an imaginary vertical line drawn through the middle of the axilla (armpit), parallel to midline, separating the anterior and posterior aspects.
Midclavicular Line – an imaginary vertical line drawn through the middle portion of the clavicle, parallel to midline.
Midline – an imaginary vertical line drawn from the middle of the forehead through the nose and the umbilicus (naval) to the floor.
Motor Nerves – nerves that carry information from the central nervous system to the muscles of the body.
Mucous Membranes – the lining of body cavities and passages that communicate directly or indirectly with the environment outside the body.
Musculoskeletal System – the bones and voluntary muscles of the body.
Myocardium – the heart muscle.
Nasopharynx – the part of the pharynx that lies above the level of the roof of the mouth, or soft palate.
Nervous System – the system that controls virtually all activities of the body, both voluntary and involuntary.
Occiput – the most posterior portion of the cranium.
Orbit – the eye socket, made up of the maxilla and zygoma.
Orophar
I crack open the books late at night and early in the morning before anyone around here is up and running around. Though having three kids is a great way to check infant, toddler, and pre-school aged children's pulse for the heck of it.
