Some things the book didn't seem to explain...

[ksquared]

So, I'm taking my EMT-B test in a little more than two weeks. I have already passed the phsychomotor examination, but the book has a NUMBER of things I can't explain. These are really specific questions.. I don't have any idea where to look some of this stuff up. I thus have a mutant grab bag of questions of things that the book said I should know but either didn't explain (or I somehow missed it.) I would certainly no expect anyone to answer ALL of those, but if those of you who really know what your doing want to chime in on the explanations to these questions, a thousand thank yous in advance.

What causes pulseless Electrical Activity? Is there any set of circumstances I should be particularly wary of this? When do we check the pulse?

When we practiced CPR in the classroom, the only time I recall checking the pulse is initially, when we first get to the patient. I know that we don't put the AED on if the victim may have been pulseless more than 4 or 5 minutes but otherwise I'm not sure about this. I was trained as a lifeguard for a very long time NEVER to check the pulse (other than first application), but that training makes some assumptions, such as "we got to them really fast." I'll obviously check before putting it on

If I am by myself trying to run a code, when do I apply oxygen or the AED first?

I mean, I hope I'm not doing a triage job my first day, but just in case. I would put a higher priority on the AED unless I have reason to suspect he's been down a while.

What is the difference between a "gel" and a "suspension"?

Is it that the gel IS itself the medicine, or is it a suspension with a gel instead of a non-viscious liquid?

Child with an airway problem.. no obvious history. What now?

Let's say we have a child with an airway problem. I know that it is important to determine if this is a reaction of some sort of a medical issue. Trying to treat a swelling case as a blockage would be ineffective, (or if my manual maneuver touches the back of the throat, worse) and trying to treat a blockage as a medical case (ie, force it down with the BVM) might be worse than useless. How likely am I to have a hard time figuring out how to approach this case? What do I do if I just don't have any information about the cause? Some passerby calls for a kid in the park then leaves, for example?

Metered dose inhalers have to be room temperature. Uh-oh. How do I ensure this?

So, I come up on a patient and want to admister their MDI.. from their freezing handbag. How badly am I screwing up if I give it to them cool? What is the reason for this? How do I warm it up and how long?

Our book clearly differentiates "average" values for RR, HR, and BP from "normal" values, but we never see them used concurrently. When do I consider this?

For example: "Normal" for an adult is 70. The average is somewhere in-between 60 and 100. When do I worry more about one or the other? I was more considered about a normal RANGE, so why do we have to know the normal VALUE (if I didn't mix these two up?) It never used the two together in the same chapter.

Poor Muscle tone: what does this look like?

I can get good youtube examples for accessory muscles during breathing, but I can't seem to find anything for poor muscle tone, especially in the infant. What the heck am I looking for? I mean, when I was out of shape, you couldn't see much evidence of any of my muscles...

I insert an NPA because my patient has clenched teeth. Then he vomits. Now what do I do!?

I can't suction it normally because of the clenched teeth. Do I try to pry them apart at the expense of his teeth? I don't see any good options here.

Has anyone ever seen combined medical/blocakge in airway cases?

Say, a kid has a breathing problem, but he's hungry, so now he has a breathing problem AND he's choking..

The book says that for non-spinal CPR, start oxygen ASAP. However, in spinal CPR, if we have not already attached oxygen by the time we start compressing, do a full minute first.

...Wait, what? Why are we supposed to wait before giving air to the spinal patient? I can't glean what else this means for our CPR, other then we don't bother to attach O2 until we have done 1 minute on CPR.

Like I said, thanks a lot to anyone who even reads this!

 

[Akulahawk]

I'm going to try to reply in-line...

So, I'm taking my EMT-B test in a little more than two weeks. I have already passed the phsychomotor examination, but the book has a NUMBER of things I can't explain. These are really specific questions.. I don't have any idea where to look some of this stuff up. I thus have a mutant grab bag of questions of things that the book said I should know but either didn't explain (or I somehow missed it.) I would certainly no expect anyone to answer ALL of those, but if those of you who really know what your doing want to chime in on the explanations to these questions, a thousand thank yous in advance.

What causes pulseless Electrical Activity? Is there any set of circumstances I should be particularly wary of this? When do we check the pulse?

When we practiced CPR in the classroom, the only time I recall checking the pulse is initially, when we first get to the patient. I know that we don't put the AED on if the victim may have been pulseless more than 4 or 5 minutes but otherwise I'm not sure about this. I was trained as a lifeguard for a very long time NEVER to check the pulse (other than first application), but that training makes some assumptions, such as "we got to them really fast." I'll obviously check before putting it on
The short cause of PEA is the myocardium is either mostly dead or stunned sufficiently that it won't contract when a stimulus is applied to it. You see the electrical waveform on the monitor because the conduction system of the hear is still working but the rest of the myocardium just isn't doing the job. Occasionally you'll see what you think is PEA but the myocardium is barely contracting and just not moving anything.
If I am by myself trying to run a code, when do I apply oxygen or the AED first?

I mean, I hope I'm not doing a triage job my first day, but just in case. I would put a higher priority on the AED unless I have reason to suspect he's been down a while.
If you're by yourself, you're pretty much hosed as for what you can do effectively. Do compressions, try to do some ventilations, if an AED is nearby, attach it after a couple minutes of CPR. Supplemental oxygen could be added during ventilation IF you can connect the BVM to your oxygen tank quickly. Minimize the amount of time your hands are off the chest because circulation rapidly slows and stops when you stop doing compressions. It's a whole lot easier if you have another set of trained hands...
What is the difference between a "gel" and a "suspension"?

Is it that the gel IS itself the medicine, or is it a suspension with a gel instead of a non-viscious liquid?

Child with an airway problem.. no obvious history. What now?

Let's say we have a child with an airway problem. I know that it is important to determine if this is a reaction of some sort of a medical issue. Trying to treat a swelling case as a blockage would be ineffective, (or if my manual maneuver touches the back of the throat, worse) and trying to treat a blockage as a medical case (ie, force it down with the BVM) might be worse than useless. How likely am I to have a hard time figuring out how to approach this case? What do I do if I just don't have any information about the cause? Some passerby calls for a kid in the park then leaves, for example?
Your assessment of the patient should show you that there's likely some kind of airway problem. At your level you're going to treat it like any other breathing problem.
Metered dose inhalers have to be room temperature. Uh-oh. How do I ensure this?

So, I come up on a patient and want to admister their MDI.. from their freezing handbag. How badly am I screwing up if I give it to them cool? What is the reason for this? How do I warm it up and how long?
This is something you should ask a pharmacist or look up in a drug reference for the MDI. Your assessment (like the above question) will be what tells you that you might want to assist the patient in administration of their MDI.
Our book clearly differentiates "average" values for RR, HR, and BP from "normal" values, but we never see them used concurrently. When do I consider this?

For example: "Normal" for an adult is 70. The average is somewhere in-between 60 and 100. When do I worry more about one or the other? I was more considered about a normal RANGE, so why do we have to know the normal VALUE (if I didn't mix these two up?) It never used the two together in the same chapter.

Poor Muscle tone: what does this look like?

I can get good youtube examples for accessory muscles during breathing, but I can't seem to find anything for poor muscle tone, especially in the infant. What the heck am I looking for? I mean, when I was out of shape, you couldn't see much evidence of any of my muscles...
Poor muscle tone in a patient makes the patient look floppy. There's really nothing like it and it's pretty unmistakable.
I insert an NPA because my patient has clenched teeth. Then he vomits. Now what do I do!?

I can't suction it normally because of the clenched teeth. Do I try to pry them apart at the expense of his teeth? I don't see any good options here.
Roll the patient to the side, suction out what you can, hope the patient's airway reflexes are intact... There really aren't many good options even for medics that don't have RSI as an option but at the point where you have a vomiting trismus patient, it's just not good regardless.
Has anyone ever seen combined medical/blocakge in airway cases?

Say, a kid has a breathing problem, but he's hungry, so now he has a breathing problem AND he's choking..
Possible, yes. Haven't seen one.
The book says that for non-spinal CPR, start oxygen ASAP. However, in spinal CPR, if we have not already attached oxygen by the time we start compressing, do a full minute first.

...Wait, what? Why are we supposed to wait before giving air to the spinal patient? I can't glean what else this means for our CPR, other then we don't bother to attach O2 until we have done 1 minute on CPR.

Like I said, thanks a lot to anyone who even reads this!

 

[DesertMedic66]

1: There are a lot of causes of PEA. Off the top of my head I believe the top 2 are hypovolemia and hypoxia (look up ACLS H's and T's to get info on why a patient might be in cardiac arrest). As an EMT you will treat it all the same. CPR and AED. They AED will not shock PEA. PEA means the heart is receiving an electrical impulse but there is no contraction of the heart muscle.
1A: You should be checking for a pulse every 2 minutes as per AHA standards.

2: The 2 most important things in CPR are compressions and AED so that pretty much sums it up.

3: Gels? Normally books cover solutions vs suspensions. Solutions the medication will not seperate during storage (the majority of IV medications) while suspensions will seperate over time and need to be mixed (best example is activated charcoal)

4: That is the interesting part about medicine. You will have to try to identify what is going on. Is the patient able to talk? Cough? What were they doing when the issue started? Have they ever had this before? What are vitals? What are the lung sounds?

5: You can't. If they have the medication and it is theirs then use it if it is indicated.

6: Averages are/were used to create a normal range of vital signs. So normal = average. You are more likely to just hear normal or stable.

7: You hold the baby and it flops all over the place. Pretty much like it is dead. Video:

8: If you can't open the mouth with your fingers then leave it. Use a soft suction cath to make your best attempt. You can also roll the patient on their side.

9: No. Mine have either been one or the other.

10: For CPR compressions should always be the first thing started. The only difference between a suspected neck injury and a non-injury is the head-tilt chin-lift and the jaw-thrust.