EMR Responsibilities and Standards of Care

EMS and EMR Responsibilities

• An EMR's medical-legal responsibilities include prioritizing patient well-being, providing care in good faith, delivering consistent and compassionate care, and maintaining composure.
• Duty to Act: if an EMR is employed by an agency and dispatched to a scene, they have a legal obligation to provide care.

Ethical Responsibilities

• EMRs must maintain professional standards, staying updated on skills and knowledge, reviewing performance and techniques, evaluating response time, attending continuing education, and participating in quality improvement.

Vital Signs

• Key vital signs to assess include blood pressure, heart rate, respiratory rate, pupil condition, and skin condition.

Standard of Care

• The standard of care defines how an EMR should act and requires them to treat patients to the best of their ability, providing care that a reasonable, prudent person with similar training would in similar circumstances.

Scope of Practice

• An EMR's scope of practice is defined by the Department of Transportation's emergency medical responder education standards, medical protocols, and standing orders.

Patient Consent

• Expressed Consent: Consent can be given verbally.
• For patients under 18, consent must be obtained from a parent or guardian
• For unconscious patients, implied consent allows for treatment.
• When patients are mentally incapacitated, law enforcement involvement might be necessary.
• Patients have the right to refuse care, but EMRs should help them understand the treatment, reasoning, risks of refusal, and alternative treatments, documenting the refusal.

Advance Directives

• These documents specify a person's wishes regarding medical treatment if they cannot make their own decisions.
• Examples include living wills, which can be written by the patient, lawyer, or physician.
• A durable power of attorney for healthcare allows a designated person to make medical decisions for someone else.

Pulse Points

• It's crucial to know the pulse points and the minimum blood pressure required to palpate them.

• Adults: Usually 60-90 bpm, but can be higher in younger individuals.

• Carotid: 60 systolic pressure

• Radial: 80 systolic pressure

• Brachial: Infants 60-100 bpm

• Femoral: 70 systolic pressure

• Pedal: 90-100 systolic pressure

• Count the pulse for 15 seconds and multiply by 4.

AVPU Score

• After scene size-up, use the AVPU scale to assess the patient's level of consciousness.
• Alert: Eyes open and responsive.
• Voice: Responds to verbal stimuli (talking).
• Pain: Responds to painful stimuli (e.g., sternal rub).
• Unconscious: Unresponsive to any stimuli.

Airway Opening

• Know how to open an airway using the head-tilt-chin-lift maneuver or the jaw-thrust maneuver.
• For suspected C-spine injury, use jaw thrust and do NOT use the head-tilt-chin-lift.
• The jaw-thrust maneuver involves placing thumbs alongside the patient's face and lifting the jaw and shift to open and allow breathing.

Airway Obstructions

• Clear obstructions like vomit, blood, mucus, candy, food, dirt, or false teeth.
• Sweep or suction to clear debris, and use an airway device if the airway is clear.

Airway Adjuncts

• Manual vs machine suction should not be used for more than 15 seconds
• Wait to use suction until correctly position
• Suction of by manually pressing the device
• Oral and nasal airways help with the protection of the airway
• Do not use if there is a gag reflex

Oral Airway

• How To measure the proper size
• Must have no gag reflex present
• Measure from edge of the mouth to angle
• Pull the jaw and insert airway just past the teeth
• Turn the device 180 degrees and continue to insert

Nasal Airway

• Use only when a gag reflex is present
• Measure from nosril largest diameter, to the earlobe
• Use surgical lube
• Use twisting motion as you insert
• Up straight when inserting an NPA

Oxygen Delivery

• Understand what FiO2 means and how it applies to oxygen delivery systems.

• FiO2 estimates the oxygen concentration a person inhales and is involved in gas exchange at the alveolar level.

• The amount of oxygen delivered depends on the device and oxygen flow rate, which can be adjusted based on the device.

• A-Airway

• B- Breathing

• C-Circulation

Golden Hour

• "Golden hour" refers to the concept where critically injured patients need to receive intervention within 60 minutes.
• The odds of mortality significantly incease after that time
• Acting quickly and efficiently is vital

Phases of Blast Injuries

• Primary: Blast lung, ruptured eardrums, hollow organ injuries.
• Secondary: Penetrating trauma, flying debris.
• Tertiary: Fractures, traumatic amputations, brain injuries.
• Quaternary: Burns, inhalation injuries, asphyxiation, worsening of chronic illness.

Trauma Assessment Vocabulary

• Tacny-fast
• hyper-above
• Thurm-heat
• Hypo-low
• ICP intercranial pressure
• MAP mcan arturial pressure
• Prica breathing

Scene Size-Up

1. Personal Protective Equipment
2. Scene Safety
3. Initial Triage
4. More Help
5. Mechanism of Injury

Trauma Patient Assessment

• In primary, control and treat:
  • Engsanguinating Hemorrhage
• Establish Airway
  • Obstructions, Device if Necessary
• Breathing
  • Chest, Breathing Rate, Breath Sounds
• Circulation
  • Signs of Shock, Bleeding Control, Check Injury
• Repeat initial exam
• Vital Signs and Monitors
• Reassess Abdomen
• Check Injuries

Glasgow Coma Scale

Table scoring system is used to easily assess a patients status

• Best Eye Opening Response: Spontaneous (4), To Voice (3), To Pain (2), Silent (1)
• Best Verbal Response: Oriented (5), Confused (4), Inappropriate Words (3), Incromprehensible sounds (2), Silent (1)
• Best Motor Response: Obeys Commands (6), Localizes to Pain (5), Withdraws From Pain (4), Abnormal Flexion (3), Abnormal Extention (2), Posturing (2), No Movement (1)

Lung Sounds

• Rhonchi: mucus build up sounds like underwater
• Wheezes: asthma, COPD, air is trapped
• Rales crackles: Pulmonary edema, CHF sounds like ice in a cup
• Strider: Sounds like squeaky sounds and death

Primary Survey Stop Reasons

• Scene becomes unsafe
• Exsanguinating hemorrhage
• Airway obstruction
• Cardiac Arrest

Initial Assessment

1. Rapid Trauma Survey
2. Diligent Innervations

Secondary Assessment

• Detailed, look for mental status, pupils, and ABC's
• Use the SAMPLE documentation
• Frequent reassurance and communication
• Interventions

Secondary Assessment Reassessment

• Condition changes
• You Move the Patient
• Complete Intervention

DCAP-BTLS-TIC

Mnemonic to assess trauma: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling, Tenderness, Instability, Crepitus (bone).

OPQRST

Mnemonic to assess pain: Onset, Provocation, Quality, Region/Radiation, Severity, Time.

Shock

• Definition: Occurs when there is a lack of proper blood flow to the body and its cells, which deprives the body's cells of oxygen and other nutrients to function.
• Compensated Shock: The body tries to maintain blood pressure and blood flow, usually an early stage but issues are quickly approaching.
• Decompensated Shock: Blood Volume continues to drop, and the body starts to deplete its resources and lose the ability to maintain.
• Irreversible Shock: Severe organ and multiple organ failures are imminent, body is unable to provide sufficient support via organ.

Flail Chest

• 2 or more ribs that are fractured in two or more places
• asymmetric movement of the chest wall
• risk for pneumothorax
• Treatment -apply pressure, stabilize, and wrap with compression

Open pnuemothorax

• there is a wound in the chest that causes air to leak in from the lungs.
• Treatment -Ashurment chest seal , or inclusive dressing

Respiratory Distress

When to Apply High-Flow Oxygen

• Asthma
• Acute Respiratory Syndrome
• Lung sounds

Tension Pneumothorax and Cardiac Tamponade

• Air builds within pleural space and collapses lungs where pressure moves away from where injury took place, noticable absence in lung sounds and sustanined teychardia
• Treatment is needle thoractomy

Treatment vs Shock

• Treatment for hypovolemic/heumorragic shock is sit up versus trendelengure position
• Cardoigenic shock is not trendelengure but instead sit up
• For shock, the heart wont faint

Shock Types

• Cardiogenic: heart attack

• Neurogenic: damage to the spinal cord

• Sepsis: immune response to infection

• Anaphlactic: allergic

• Obstructive/Mechanical: pulminary or heart issue

• Skin cool - treat hypovolemit, heart has heat stroke

• Anaphylaxis - first thing its trunk and throat

• Epi pen, always check does no known allergies

• Epi pen dose is 0.3-0.5mg

• Insulin always has a pseido effect even with no food

Head Injury Assessment - Cerebral Herniation

• Increase pressure due to bleeding or swelling of the tumors
• Assessment includes LOC, pupil dilation, and posturing with treatment being aggressive and a ventilation rate of over 20 a minute

Ami Assessment

• Assessment for Acute myocardial infarction includes high blood pressure, shortness of breath, and the level sign
• Treatment includes not breathing or CPR at 2-4 liters. Aspirin dose is 324mg and the treatment is Cath lab with Nitroglycerin

Agina Vs Supra Ventricular Tachycardia

Agina

• Pain in sternum
• assess with vital signs

SV Tachycardia

• Heart rate in the upper 750s
• Chest pain can occur
• perform with vital nerve stimulus

When to use c collar

How to treat patients who helmets

• Never use soft material
• Adjust, flex and tape after neck assessment
• Remove pads if its an actual accident, or adjust pads of should can be move

Spinal Injuries

• Patients with Spinal Injuries that are suspected: When treating a patient with a spine injury, the goal is to limit movement of the head and neck. Your manual stabilization of the patient’s head will minimize the risk of further injury, such as paralysis. You will support the head in the position that you find it while assessing the patient.
• Long spinal board
• Vest-type extrication device
• Short spinal device
• Extrication rescue tool

Cerebrovascular accident Versus transient

How to treat with terms:

• Hemiplegia= paralysis
• Syncope= faint
• Dysphasia= speaking impair
• Treat with medication and stroke center assistance

Tone Clonic Seizure Versus Muscle Stiffness

Treatment includes letting them shake with guidance to safety With abcsence and myoclonic make sure to secure the body to a firm surface

Kehrs Sign

• Diaphragm causes referred left shoulder pain due to a ruptured spleen

• treat by placing a device to stop fluid loss for a better outcome, such as steri strips and cloth

• Infection, trauma and autoimmune can trigger Kehr's sign

• Check for a history of infection

Abdominal Eviscerations

You're looking for damage in and around the abdomen For treatment, make sure to sterilely apply moisture and never touch.