Medicine EMR Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.
EMT Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.
AEMT Applies fundamental knowledge to provide basic and selected advanced emergency care and transportation based on assessment findings for an acutely ill patient.
Paramedic Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.
Medical Overview EMR Simple depth, simple breadth Assessment and management of a medical complaint.
• Overview of Medical Complaints o Assessment Follow a systematic assessment approach • Scene size-up • Primary assessment • History-taking • Secondary assessment • Reassessment o Manage life-threatening problems as they are discovered
EMT: EMR Material PLUS: Simple depth, foundational breadth Pathophysiology, assessment, and management of a medical complaints to include transport mode and destination decisions
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Assessment Factors o Scene Safety o Environment o Chief Complaint Primary reason for EMS response Verbal or non-verbal Possibly misleading o Life-Threatening Conditions o Non-Life Threatening Conditions o Distracting Injuries o Tunnel Vision o Patient Cooperation o EMT Attitude Biases Labeling • Major Components of the Patient assessment o Standard Precautions o Scene Size-Up o General Impression o Initial Assessment o SAMPLE History Importance of a Thorough History Unresponsive patient Responsive patient OPQRST mnemonic for evaluation of pain • O – onset • P – provoke • Q – quality • R - region/radiate • S – severity • T – time o Baseline Vital Signs o Secondary Assessment May not be appropriate to perform a complete secondary assessment on all medical patients Designed to identify any signs or symptoms of illness that may not have been revealed during the initial assessment o Continued Assessment When practical, transport the patient in the recovery position to help ensure a patent airway Consider the need for ALS backup
AEMT: EMT Material PLUS: Fundamental depth, foundational breadth Pathophysiology, assessment, and management of a medical complaint to include transport mode and destination decisions
The AEMT Instructional Guidelines are the same as the EMT Instructional Guidelines as listed above.
Paramedic: AEMT Material PLUS: Complex depth, comprehensive breadth Pathophysiology, assessment, and management of medical complaints to include transport mode and destination decisions
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Assessment Factors o Scene safety o Environment o Chief complaint Primary reason for EMS response Verbal or non-verbal Possibly misleading o Life threatening conditions o Non-life threatening conditions o Distracting injuries o Tunnel vision o Patient cooperation o EMT attitude • Major components of the patient assessment o Standard Precautions o Scene Size-Up o General Impression o Initial Assessment -- airway, ventilation, respiration and circulation o SAMPLE history Importance of a thorough history Unresponsive patient Responsive patient OPQRST Mnemonic for evaluation of pain • O – Onset • P – Provoke • Q – Quality • R - Region/Radiate • S – Severity • T – Time o Baseline vital signs o Secondary assessment May not be appropriate to perform a complete secondary assessment on all medical patients Designed to identify any signs or symptoms of illness that may not have been revealed during the initial assessment. o Continued assessment • Forming a Field Impression o Formation of differential diagnosis Integration of history and physical assessment findings Past experience “Gut instinct” o Differentiation of the underlying cause of the patient’s condition from other possible causes o Patient presentation often leads to a recognizable pattern common to multiple conditions with similar presentations o Assess for clues to determine minor differences in patient presentation o Determine field differential diagnosis based on available information o Realize the differential diagnosis may change as the patient condition changes or additional information becomes available
Neurology EMR Simple depth, simple breadth Anatomy, presentations, and management of • Decreased level of responsiveness • Seizure • Stroke
• Review of Anatomy and Functions of the Brain, Spinal Cord, and Cerebral Blood Vessels • Altered Mental Status o Inadequate oxygenation or ventilation o Poisoning or overdose o Infection o Head injury o Behavioral illness o Diabetic conditions • Seizures o Causes o Assessment Findings Spasms, muscle contractions Bite tongue, increased secretions Sweating Cyanosis Unconscious gradually increasing level of consciousness Shaking or tremors and no loss of consciousness Incontinent Amnesia of event o Management Safety of patient/position ABCs, consider nasopharyngeal airway Oxygen/suction Assist ventilation if indicated Emotional support • Stroke o Causes Hemorrhage Clot o Assessment Findings and Symptoms Confused, dizzy, weak Decreasing or increasing level of consciousness Combative, uncooperative, or restless Facial droop, inability to swallow, tongue deviation Double vision or blurred vision Difficulty speaking or absence of speech Decreased or absent movement of one or more extremities Headache Decreased or absent sensation in one or more extremities or other areas of body Coma o Management of Patient With Stroke Assessment Findings or Symptoms Scene safety and PPE ABCs/position Oxygen/suction Emotional support
EMT: EMR Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of • Stroke/ transient ischemic attack • Seizure • Status epilepticus • Headache
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Stroke/TIA o Causes Hemorrhage Clot o Review of Anatomy and Function of the Brain and Cerebral Blood Vessels o Assessment Findings and Symptoms Confused, dizzy, weak Decreasing or increasing level of consciousness Combative or uncooperative or restless Facial drooping, inability to swallow, tongue deviation Double vision or blurred vision Difficulty speaking or absence speech Decreased or absent movement of one or more extremities Headache Decreased or absent sensation in one or more extremities or other areas of body Coma o Stroke Alert Criteria Cincinnati Prehospital Stroke Scale Other stroke scales o Management of Patient With Stroke Assessment Findings or Symptoms o Scene Safety and Standard Precautions ABCs /position Oxygen/suction Pulse oximetry Emotional support Rapid transport o Transient Ischemic Attack (TIA) • Seizures o Incidence o Causes o Types of Seizures Generalized tonic – clonic Partial seizures Status epilepticus o Assessment Findings Spasms, muscle contractions Bite tongue, increased secretions Sweating Cyanosis Unconscious gradually increasing level of consciousness May cause shaking or tremors and no loss of consciousness Incontinent Amnesia of event o Management Safety of patient/position ABCs, consider nasopharyngeal airway Oxygen/suction Pulse oximetry Emotional support • Headache o As a Symptom o As a Neurological Condition o Assessment Findings and Symptoms o Management • Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatrics Epidemiology Anatomic and physiologic differences in children Pathophysiology Causes of altered mental status in children Assessment Meningitis Seizures Altered mental status Management o Geriatrics – Stroke Common in This Age Group • Communication and Documentation • Transport Decisions -- Rapid Transport to Appropriate Facility
AEMT: EMT Material PLUS: Complex depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of seizure
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Stroke/TIA o Causes Hemorrhage Clot o Review of Anatomy and Function of the Brain and Cerebral Blood Vessels o Assessment Findings and Symptoms Confused, dizzy, weak Decreasing or increasing level of consciousness Combative or uncooperative or restless Facial drooping, inability to swallow, tongue deviation Double vision or blurred vision Difficulty speaking or absence speech Decreased or absent movement of one or more extremities Headache Decreased or absent sensation in one or more extremities or other areas of body Coma o Stroke Alert Criteria Cincinnati Prehospital Stroke Scale Other stroke scales o Management of Patient With Stroke Assessment Findings or Symptoms o Scene Safety and Standard Precautions ABCs /position Oxygen/suction Pulse oximetry Emotional support Rapid transport o Transient Ischemic Attack (TIA) • Seizures o Incidence o Caused by Hypoglycemia Pathophysiology Assessment Management o Types of Seizures Generalized tonic-clonic Partial seizures Status epilepticus o Assessment Findings Spasms, muscle contractions Bite tongue, increased secretions Sweating Cyanosis Unconscious gradually increasing level of consciousness May shaking or tremors and no loss of consciousness Incontinent Amnesia of event o Management Safety of patient/position ABCs, consider nasopharyngeal airway Oxygen/suction Pulse oximetry Emotional support • Headache o As a Symptom o As a Neurological Condition o Assessment Findings and Symptoms o Management • Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatrics Epidemiology Anatomic and physiologic differences in children Pathophysiology Causes of altered mental status in children Assessment Meningitis Seizures Altered mental status Management o Geriatrics - Stroke Common in This Age Group • Communication and Documentation • Transport Decisions—Rapid Transport to Appropriate Facility
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of Complex depth, comprehensive breadth • Stroke/intracranial hemorrhage/transient ischemic attack • Seizure • Status epilepticus • Headache Fundamental depth, foundational breadth • Dementia • Neoplasms • Demyelinating disorders • Parkinson’s disease • Cranial nerve disorders • Movement disorders • Neurologic inflammation/infection • Spinal cord compression • Hydrocephalus • Wernicke’s encephalopathy
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction—overview of neurological conditions o Epidemiology o Pathophysiology • Central Nervous System o Brain o Spinal cord o Autonomic and peripheral nervous systems • Neurological assessment- normal and abnormal findings o General Appearance o Speech o Skin o Posture/Gait o Mental Status o Mood, thought, perception, judgment, memory and attention o Cranial nerve assessment o Glasgow coma scale • General management considerations o Airway, ventilation, respiration, circulation o Emotional support o Transport decisions • Neurological conditions o Altered mental status AEIOUTIPS Assessment findings and symptoms for AMS Pharmacological and non-pharmacological management o Stroke, intracranial hemorrhage, and Transient Ischemic Attacks (TIA) Incidence, mortality, morbidly, complications Types • Occlusive stroke • Hemorrhagic Transient ischemic attack Assessment findings and symptoms • Stroke assessment scales/scores • Stroke alerts/protocols Pharmacologic and non-pharmacologic management • Consistent with current ILCOR consensus statement o Seizures Incidence, mortality, morbidly, complications Types • Generalized • Partial • Status epilepticus Assessment findings and symptoms Pharmacologic and non-pharmacologic management o Headache Types • Tension • Sinus • Migraine • Cluster • Headache as symptom Assessment findings and symptoms Pharmacologic and non-pharmacologic management o Dementia Alzheimer’s Pick’s disease Huntington’s disease Creutzfeldt-Jakob disease Wernicke’s encephalopathy Assessment findings and symptoms Pharmacologic and non-pharmacologic management o Central nervous system neoplasm Brain tumors Spinal tumors Incidence, mortality, morbidly, complications Assessment findings and symptoms Pharmacologic and non-pharmacologic management Demyelinating Neurological Disorders • Multiple Sclerosis • Guillain-Barré Syndrome Parkinson’s disease • Incidence, mortality, morbidly, complications • Assessment findings and symptoms • Pharmacological and non-pharmacological management o Cranial nerve disorders Trigeminal neuralgia Hemifacial spasm Acoustic neuroma Glossopharyngeal neuralgia Vertigo Ménière's disease Disorders of the facial nerve Assessment findings and symptoms Prehospital implications o Movement disorders—dystonia Assessment findings and symptoms Pharmacologic and non-pharmacologic management o Neurological infections/inflammation Encephalitis Meningitis Assessment findings and symptoms Pharmacologic and non-pharmacologic management o Spinal Cord Compression o Hydrocephalus o Wernicke’s Encephalopathy • Age-related variations o Pediatrics Epidemiology Anatomic and physiologic differences in children Pathophysiology Causes of altered mental status in children Assessment Meningitis Febrile seizures Altered mental status Ventricular shunts Management o Geriatrics- stroke risk high in this age group • Communication and documentation • Transport decisions • Patient education and prevention of complications or future neurological emergencies.
Abdominal and Gastrointestinal Disorders
EMR Simple depth, simple breadth Anatomy, presentations and management of shock associated with abdominal emergencies • Gastrointestinal bleeding
• Define Acute Abdomen • Organs of the Abdominopelvic Cavity o Stomach o Intestines o Esophagus o Spleen o Urinary bladder o Liver o Gall bladder o Pancreas o Kidneys o Reproductive organs • Assessment and Symptoms o Techniques Inspection Palpation o Normal findings Soft Non-tender o Abnormal findings Nausea, vomiting, diarrhea Pain Signs of shock Fever • General Management for Patients With Abdominal Pain o Scene safety and PPE o Airway, ventilatory, and circulation o Position of comfort o Emotional support • Specific Acute Abdominal Conditions o Gastrointestinal Bleeding Causes Assessment findings and symptoms Management • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatrics -- vomiting/diarrhea can cause shock o Geriatric -- abdominal pain may be related to heart attack
EMT: EMR Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment, and management of • Acute and chronic gastrointestinal hemorrhage Simple depth, simple breadth • Peritonitis • Ulcerative diseases
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Define Acute Abdomen • Anatomy of the Organs of the Abdominopelvic Cavity o Stomach o Intestines o Esophagus o Spleen o Urinary Bladder o Liver o Gall Bladder o Pancreas o Kidney o Reproductive Organs • Assessment and Symptoms o Techniques Inspection Palpation o Normal Findings—Soft Non-Tender o Abnormal Findings Nausea/vomiting Change in bowel habits/stool Urination Weight loss Belching/flatulence Concurrent chest pain Pain, tenderness, guarding, distension Other • General Management for Patients With an Acute Abdomen o Scene Safety and Standard Precautions o Airway, Ventilatory, and Circulation o Position o Emotional Support • Specific Acute Abdominal Conditions—Definition, Causes, Assessment Findings and Symptoms, Complications, and Specific Prehospital Management o Acute and Chronic Gastrointestinal Hemorrhage o Peritonitis o Ulcerative Diseases • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management • Pediatrics o Anatomic and Physiologic Differences in Children o Pathophysiology o Assessment History Physical findings Management o Geriatric May not exhibit rigidity or guarding Abdominal pain related to cardiac conditions • Communication and Documentation for Patients With an Abdominal or Gastrointestinal Condition or Emergency • Transport Decisions
AEMT: Same as Previous Level
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of:
Complex depth, comprehensive breadth • Acute and chronic gastrointestinal hemorrhage • Liver disorders • Peritonitis • Ulcerative diseases
Fundamental depth, foundational breadth • Irritable bowel syndrome • Inflammatory disorders • Pancreatitis • Bowel obstruction • Hernias • Infectious disorders • Gall bladder and biliary tract disorders
Simple depth, simple breadth • Rectal abscess • Rectal foreign body obstruction • Mesenteric ischemia
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Epidemiology Incidence Mortality/ morbidity Risk factors Prevention strategies • General pathophysiology, assessment and management o Pathophysiology of abdominal pain Bacterial contamination Chemical irritation Types of abdominal pain o Assessment findings Focused history Focused physical examination Assessment tools o Management/ treatment plan Airway and ventilatory support. Circulatory support Pharmacologic interventions for pain management Non-pharmacologic interventions Transport consideration-- gentle but rapid transport Psychological support • Specific Injuries/ illness: causes, assessment findings and management for each condition o Upper gastrointestinal bleeding Ulcerative diseases Esophagogastric varices Other causes o Lower gastrointestinal bleeding Common causes o Liver Diseases Hepatitis -- See infectious disease Cirrhosis Hepatic encephalopathy o Infectious Disorders Pathophysiology Signs and symptoms Peritonitis Gastroenteritis Ulcerative Disorders Irritable bowel syndrome Inflammatory bowel disease Bowel obstruction Hernias Rectal foreign body obstruction Rectal Abscess Mesenteric Ischemia • Consider age-related variations o Pediatrics Epidemiology Anatomic and physiologic differences in children Pathophysiology Assessment Vomiting Lower GI Bleeding Gastrostomy tube dysfunction Neonatal Jaundice Management o Geriatrics AAA more common May not exhibit rigidity or guarding Abdominal pain related to cardiac conditions • Communication and documentation • Transport decisions • Patient education and prevention
Immunology EMR Simple depth, simple breadth Recognition and management of shock and difficulty breathing related to anaphylactic reactions
• Introduction o Anaphylaxis Definition (Allergy versus anaphylaxis) o Common Substances That Cause Anaphylaxis • Assessment Findings o Respiratory system -- severe respiratory distress, wheezing o Cardiovascular -- rapid pulse, low blood pressure o Skin -- pale, red, or cyanotic; hives, itching, swelling around eyes, mouth, tongue o Other -- altered mental status, nausea, vomiting • Management o Maintain Airway o Administer Oxygen o Position o Vitals o Remove Allergen If Possible o Ask If Patient Has Used His/Her Epinephrine Auto injector • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management
EMT: EMR Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment, and management of hypersensitivity disorders and/or emergencies • Anaphylactic reactions
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Introduction o Definition of Terms Allergic reaction Anaphylaxis o Risk Factors and Common Allergens • Basic Immune System’s Response to Allergens o The Purpose of the Response o The Type of Response (Local versus Systemic) o The Speed of the Response • Fundamental Pathophysiology o Increased Capillary Permeability o Vasodilation o Bronchoconstriction o Increased Mucus Production • Assessment Findings for Allergic Reaction o Respiratory System—Sneezing, Tightness in Chest, Cough, Rapid and Labored Breathing, Wheezing, Stridor o Cardiovascular—Increased Heart Rate o Skin—Pale or Redness, Hives, Swelling Locally or Generalized, Itching o Other—Anxiety, Itchy and Watery Eyes, Dizziness • Assessment Findings for Anaphylaxis o Respiratory System—Severe Respiratory Distress, Wheezing to Silent Chest o Cardiovascular—Rapid Pulse, Hypotension o Skin—Pale, Red, or Cyanotic o Other—Decreasing Mental Status • Management o ABCs o Position o Oxygen o Emotional Support o Vitals o Assist With Patient’s Auto injector o Remove Allergen If Possible • Epinephrine as a Treatment for Allergic Reaction o Indications – Severe Allergic Reaction or Hypersensitivity to Exposed Substance o Contraindications – Not Patient’s Drug, Expired, or Discolored o Actions – Slows Allergic Response, Raises B/P, Dilates the Bronchioles o Side Effects – Increased Pulse Rate and B/P, Anxiety, Cardiac Arrhythmias o Auto injection Systems Physician order Expiration date and patient prescription Prep site, remove needle cover Lateral thigh; push against thigh; hold until drug fully injected Monitor patient response Dispose properly • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric – Pediatric Weight-Based Auto injector Available o Geriatric – Possible Contraindication in Coronary Artery Disease • Communication and Documentation • Transport Decisions
AEMT: EMT Material PLUS: Complex depth, comprehensive breadth Anatomy, physiology, pathophysiology, assessment, and management of hypersensitivity disorders and/or emergencies • Allergic and anaphylactic reactions
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Introduction o Definition of Terms Allergic reaction Anaphylaxis o Risk Factors and Common Allergens • Basic Immune System’s Response to Allergens o The Purpose of the Response o The Type of Response (Local versus Systemic) o The Speed of the Response • Pathophysiology o Allergic Reaction Antigens Antibodies Mast cells and basophils Histamine, leukotrienes, and other mediators Local reactions Reactions • Assessment o Mild Allergic Reaction Cutaneous Other o Moderate Allergic Reaction Upper airway Lower airway Cardiovascular Cutaneous Gastrointestinal Neurological o Severe Allergic Reaction/Anaphylaxis Upper airway Lower airway Cardiovascular Cutaneous Gastrointestinal Neurological • Managing Anaphylaxis o Provide Treatment Specific to Assessment Findings and Severity of Reaction o Remove Allergen If Possible o Protect the Airway o Oxygenate the Patient o Ventilate If Needed Apneic patient Dyspneic patient Patient with airway edema o Medication Administration Epinephrine administration Bronchodilation o Fluid Administration • Age-Related Considerations o Pediatric Epinephrine Dosing o Use of Epinephrine in the Geriatric Patient
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major immune system disorders and/or emergencies
Complex depth, comprehensive breadth • Hypersensitivity • Allergic and anaphylactic reactions • Anaphylactoid reactions
Fundamental depth, foundational breadth • Collagen vascular disease • Transplant related problems
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Incidence, morbidity, mortality of common or major immune system disorders o Collagen vascular disease o Allergic reaction and anaphylaxis o Hypersensitivity o Transplant disorders • Pathophysiology o Immunity Natural Acquired o Immune response Humoral Cell-mediated o Allergic reaction Antigens Antibodies Mast cells and basophils Histamine, leukotrienes, histamine and other mediators Local reactions Systemic reactions • Assessment o Mild allergic reaction Cutaneous Other o Moderate allergic reaction Upper airway Lower airway Cardiovascular Cutaneous Gastrointestinal Neurological o Severe allergic reaction/ anaphylaxis Upper airway Lower Airway Cardiovascular Cutaneous Gastrointestinal Neurological • Anaphylactoid Reaction • Managing an allergic reaction o Provide treatment specific to assessment findings and severity of reaction o Remove allergen if possible o Protect the airway -- Consider intubation o Ventilate if needed o IV access Fluid administration Medication administration o Pharmacologic interventions Oxygen Epinephrine Antihistamines Corticosteroids Vasopressors Beta agonists Magnesium sulfate Bronchodilators • Collagen vascular disease o Systemic lupus erythmatosis Effects on body Prehospital implications o Scleroderma Effects on body Prehospital implications • Transplant-related problems o Types of solid organ transplant o Assessment considerations o Common complications related to immunosuppression Infection Rejection Drug toxicity • Consider age-related variations in pediatric and geriatric patients • Communication and documentation • Transport decisions • Patient education and prevention
Infectious Diseases EMR Simple depth, simple breadth Awareness of a patient who may have an infectious disease and how to decontaminate equipment after treating a patient
• Infectious Disease Awareness o Definitions Infectious disease Communicable disease o Transmission Routes Direct contact Coughing and sneezing Blood borne Other body fluids o Standard Precautions (Review content in Preparatory: Workforce Safety) • Equipment Decontamination (Review Content in Preparatory: Workforce Safety)
EMT: EMR Material PLUS: Simple depth, simple breadth Assessment and management of a patient who may have an infectious disease and how to decontaminate the ambulance and equipment after treating a patient
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Causes of Infectious Disease o Infectious Agents Bacteria Viruses Fungi Protozoa Helminths (worms) • Body Substance Isolation, Personal Protective Equipment, and Cleaning and Disposing of Equipment and Supplies o Principles of Body Substance Isolation o Hand Washing Guidelines o Recommendations for PPE o Recommendations for Cleaning or Sterilization of Equipment o Recommendations for Disposing of Contaminated Linens and Supplies Including Sharps o Recommendations for Decontaminating the Ambulance • Consider Age-Related Variations in Pediatric and Geriatric Patients as They Relate Assessment and Management of Patients With a Gastrointestinal Condition or Emergency • Communication and Documentation for a Patient With a Communicable or Infectious Disease • Transport Decisions Including Special Infection Control Procedures • Legal Requirements Regarding Reporting Communicable or Infectious Diseases/Conditions o Exposure of Health Care Provider Current recommended treatment modalities and follow-up Prevention of exposure or immunizations/vaccines • Required Reporting to the Health Department or Other Health Care Agency
AEMT: EMT Material PLUS: Fundamental depth, foundational breadth Assessment and management of • A patient who may be infected with a bloodborne pathogen • HIV • Hepatitis B • Antibiotic resistant infections • Current infectious diseases prevalent in the community
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Causes of Infectious Disease o Infectious Agents Bacteria Viruses Fungi Protozoa Helminths (worms) • Standard Precautions, Personal Protective Equipment, and Cleaning and Disposing of Equipment and Supplies o Principles of Standard Precautions o Hand Washing Guidelines o Recommendations for Personal Protective Equipment o Recommendations for Cleaning or Sterilization of Equipment o Recommendations for Disposing of Contaminated Linens and Supplies Including Sharps o Recommendations for Decontaminating the Ambulance • Specific Diseases and Conditions o HIV and AIDS Incidence, morbidity, mortality, risk factors, modes of transmission Pathophysiology Body systems affected Progression of disease including opportunistic infections Healthcare worker susceptibility and transmission Assessment findings and symptoms Management for a patient with HIV or AIDS-related conditions Immunization and treatment of exposure o Hepatitis Introduction--Pathophysiology, incidence, types, causes, risk factors, methods of transmission, complications General assessment findings and symptoms Treatments for exposure/prevention; immunizations Types • Hepatitis A • Hepatitis B • Hepatitis C • Hepatitis D • Hepatitis E • Hepatitis G • Other Management for a patient with hepatitis • Consider Age-Related Variations in Pediatric and Geriatric Patients as They Relate Assessment and Managements of Patients With a Gastrointestinal Condition or Emergency • Communication and Documentation for a Patient With a Communicable or Infectious Disease • Transport Decisions Including Special Infection Control Procedures • Legal Requirements Regarding Reporting Communicable or Infectious Diseases/Conditions o Exposure of Health Care Provider Current recommended treatment modalities and follow up Prevention of exposure or immunizations/vaccines o Required Reporting to the Health Department or Other Heath Care Agency
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, reporting requirements, prognosis, and management of:
Complex depth, comprehensive breadth • HIV-related disease • Hepatitis • Pneumonia • Meningococcal meningitis
Fundamental depth, foundational breadth • Tuberculosis • Tetanus • Viral diseases • Sexually transmitted disease • Gastroenteritis • Fungal infections • Rabies • Scabies and lice • Lyme disease • Rocky Mountain Spotted Fever • Antibiotic resistant infections
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Public health principles and agencies responsible for public health o Demographic o Epidemiology diseases Endemic Epidemic Pandemic • Pathophysiology of Infectious Disease o Infectious agents Bacteria Viruses Fungi Protozoa Helminths (worms) o Factors that affect agent’s ability to cause disease o Chain of infection Infectious agent Reservoir Portal of entry Mode of transmission Portal of exit Factors that affect susceptibility o Body’s response Barriers • External • Internal barriers o Stages of infectious disease Latent Incubation period Communicability period Disease period • Standard Precautions, personal protective equipment, and cleaning and disposing of equipment and supplies. o Principles of standard precautions o Current hand washing guidelines o Current recommendations for standard precautions o Current recommendations for cleaning or sterilization of equipment o Current recommendations for disposing of contaminated linens and supplies including sharps • Specific diseases and conditions o HIV and AIDS o Hepatitis o Pneumonia o Meningitis o Meningococcal meningitis o Tuberculosis o Tetanus o Viral diseases Chickenpox Mumps Rubella Measles Pertussis (Whooping cough) o Other viral diseases Influenza Mononucleosis Herpes simplex virus type 1 Hantavirus Sexually transmitted diseases o Gastroenteritis Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for gastroenteritis caused by an infectious agent • Rotavirus • Parasites • Bacteria • Other General assessment findings and symptoms for patients with gastroenteritis caused by an infectious agent General management for a patient with gastroenteritis caused by an infectious agent Antiemetic IV for fluid replacement o Drug resistant bacterial conditions Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for a patient with a drug resistant bacterial condition General assessment findings and symptoms for patients with a drug resistant bacterial condition General management for a patient with a drug resistant bacterial condition Common conditions • MRSA – methycillin resistant staphylococcus aureus • VRSA – vancomycin resistant staphylococcus aureus • VRE -- Vancomycin Resistant Enterococcus • Other o Fungal infections Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for a patient with a fungal infections General assessment findings and symptoms for a patient with fungal infections General management for a patient with fungal infections o Rabies Definition: Epidemiology Prognosis: • Good, if treated with early post-exposure prophylaxis • Fatal when signs and symptoms appear Transmission • Infected saliva of a host is passed to an uninfected animal. • Bite with virus-containing saliva of an infected host. • Contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission • Corneal transplantations. Incubation Signs and Symptoms • Autonomic instability • Dysphagia • Hydrophobia • Paresis • Parethesia • Progressive worsening of neurologic signs is characteristic of rabies and should be considered as a positive indicator for rabies Treatment • Clean wound and treat injuries associated with injury first • Consider potential for infection with all potential exposures • Early post exposure prophylaxis Documentation • Type of exposure o Bite o Mucosal o Scratch o Unknown • Duration of exposure if non-bite o Scabies/Lice Scabies • Definition: infestation of the skin with the microscopic mite Sarcoptes scabei. • Epidemiology • Signs and Symptoms: • Onset of Signs and Symptoms • Treatment Lice • Definition: infestation of the skin under the hair on people’s head, bodies, or pubic areas. • Types • Epidemiology • Spread by close person to person contact • Life-span • Signs and Symptoms • Treatment o Lyme Disease Originally identified in Lyme, Ct, now most cases in North and Northeast Caused by the bacteria borrelia burgdorferi, spread by ticks Antibiotic treatment during phase I prevents progression o Antibiotic Resistant Infections Epidemiology Pathophysiology Psychosocial impact Reporting requirements Prognosis Assessment Management • Consider age-related variations in pediatric and geriatric patients • Communication and documentation for a patient with a communicable or infectious disease • Transport decisions including special infection control procedures. • Patient and family teaching regarding communicable or infectious diseases and their spread. • Legal requirements regarding reporting communicable or infectious diseases/conditions o Exposure of health care provider Current recommended treatment modalities and follow up Prevention of exposure or immunizations/vaccines o Required reporting to the health department or other health care agency
Endocrine Disorders EMR Simple depth, simple breadth Awareness that diabetic emergencies cause altered mental status.
• Diabetic Conditions o Introduction Definition of terms • Diabetes • Low blood glucose • High blood glucose Role of glucose – fuel for body cells to produce energy High blood glucose • History and Assessment findings • Management Low blood glucose • History and assessment findings • Management • Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatrics – seizures o Geriatrics -- strokes
EMT: EMR Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of acute diabetic emergencies
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Introduction o Definition of Terms Diabetes—types I and II Hypoglycemia Hyperglycemia, diabetic ketosis o Anatomy and Function of the Pancreas o General Assessment Findings and Symptoms Confusion, vertigo, headache, syncope Decreasing level of consciousness Combative or uncooperative or restless Increasing level of consciousness Visual changes Speech changes Movement and sensation changes • Diabetes o Overview of Condition Incidence Explanation of relationship of glucose and insulin Normal Blood Glucose Levels (BGL) Types • Type 1 (formerly known as Insulin Dependent Diabetes or Type I) • Type 2 (formerly known as Non-Insulin Dependent Diabetes or Type II) Diabetic medications • Insulins • Oral agents Complications o Hyperglycemia/Diabetic Ketoacidosis Pathophysiology Causes History and assessment findings Management o Hypoglycemia Causes History and assessment findings Management Oral glucose o Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management Pediatric Geriatric • Communication and Documentation • Transport Decisions—Rapid Transport for Altered Level of Consciousness
AEMT: EMT Material PLUS: Complex depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of acute diabetic emergencies
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Diabetic Emergencies o Related Anatomy of the Pancreas and Organs Supporting Blood Sugar Regulation o Physiology of the Pancreas o Hormones Related to Blood Sugar Regulation o Pathophysiology of Diabetes Mellitus Long-term complications Types of diabetes • Type I • Type II • Gestational o Drugs to Manage Diabetes Insulins Oral antihyperglycemics • Assessment o Impact of Disease on Prehospital Assessment o Alterations of Findings in Long-Term Diabetics o Hypoglycemia Physical findings Blood sugar level Causes o Hyperglycemia/DKA Physical findings Blood sugar level Causes o Treatment Oxygenation and ventilation requirements Blood glucose determination Oral glucose Glucagon administration IV placement and fluid therapy for • Hyperglycemia • Hypoglycemia D50 Administration o Reassessment and Evaluation for Other Underlying Acute Illness in the Hyperglycemic Patient • Age-Related Considerations o Pediatric patients Usually type I diabetes Late stages of hyperglycemia may have cerebral edema Prone to seizures Prone to dehydration in hyperglycemia o Geriatric patients Masking of illness through changes in pain perception Prone to dehydration and sepsis • Communication and Documentation
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of:
Complex depth, comprehensive breadth • Acute diabetic emergencies • Diabetes
Fundamental depth, foundational breadth • Adrenal disease • Pituitary and thyroid disorders
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Overview of endocrine conditions o Anatomy and Physiology-- Endocrine Glands Thyroid Hypothalamus Pineal Thymus Pituitary Parathyroids Adrenals Pancreas Ovary Testis o Hormones Cortisol Aldosterone Estrogen Progesterone Testosterone Insulin Parathyroid hormone • Pathophysiology, causes, Incidence, morbidity, and mortality, assessment findings, management for endocrine conditions o Pancreas disorders--Diabetes mellitus Insulin—relationship with glucose Pathophysiology of diabetes Diabetes Drugs to manage diabetes Diabetic ketoacidosis Hyperglycemic Hyperosmolar nonketotic coma Hypoglycemia Other disorders of pancreas o Thyroid disorders Hyperthyroidism Hypothyroidism Myxedema Thyroid storm Thyrotoxicosis Grave’s disease o Adrenal disorders Addison disease Cushing syndrome o Other endocrine disorders • Consider age-related variations o Pediatric Usually Type 1 diabetes Late stages of hyperglycemia may have cerebral edema Prone to seizures Prone to dehydration Congenital adrenal hyperplasia Panhypopituitarism Inborn errors of metabolism o Geriatric Can mask signs and symptoms of myocardial infarction Prone to dehydration and infections • Communication and documentation • Transport decisions • Patient education and prevention
Psychiatric EMR Simple depth, simple breadth Recognition of behaviors that pose a risk to the EMR, patient, and/or others
• Define • Assessment o General Appearance o Speech o Skin o Posture/Gait o Mental Status o Mood, Thought, Perception, Judgment, Memory, and Attention • Behavioral Change o Factors That May Alter a Patient’s Behavior—May Include Situational Stresses, Medical Illnesses, History, Psychiatric Problems, Alcohol or Drugs, Patient Not Taking Psychiatric Medication o Common Causes of Behavioral Alteration Low blood sugar Lack of oxygen Shock Head trauma Mind altering substances Psychiatric Excessive cold Excessive heat Brain infection Seizure disorders Poisoning or overdose Withdrawal from drugs or alcohol o Behavioral Emergencies That Can Be a Danger to the EMR, Patient or Others Agitation Bizarre thinking and behavior (i.e. hallucinations, paranoia) Danger to self—self-destructive behavior, suicide attempt Danger to others—threatening behavior, violence, weapons o Assessment for Suicide Risk Depression Risk factors/signs or symptoms Important questions • Methods to Calm Behavioral Emergency Patients o Acknowledge That the Person Seems Upset. Restate That You Are There to Help o Inform the Patient About What You Are Doing o Ask Questions in a Calm, Reassuring Voice o Maintain a Comfortable Distance o Encourage the Patient to State What Is Troubling Him o Do Not Make Quick Moves o Respond Honestly to Patient’s Questions o Do Not Threaten, Challenge, or Argue With Disturbed Patients o Tell the Truth; Do Not Lie to the Patient o Do Not “Play Along” With Visual or Auditory Disturbances of the Patient o Involve Trusted Family Members or Friends o Be Prepared to Stay at Scene for a Long Time; Always Remain With the Patient o Avoid Unnecessary Physical Contact; Call Additional Help if Needed o Use Good Eye Contact o Avoid Threatening Postures o Other Assessment Techniques to Keep in Mind Always try to talk patient into cooperation Do not belittle or threaten patients Be calm and patient Reassure the patient Lower distressing stimuli, if possible Avoid restraints unless necessary Treat the patient with respect Protect the patient and yourself • Emergency Medical Care o Scene Size-Up, Personal Safety o Establish Rapport Interviewing techniques Avoid threatening actions, statements, and questions Approach slowly and purposefully o Patient Assessment Ability to make decisions Delusions, hallucinations Unusual worries, fears Anxiety, depression, elation, agitation o Calm the Patient—Do Not Leave the Patient Alone, Unless Unsafe Situation; Consider Need for Law Enforcement o Assist Other EMS Responders With Restraint If Necessary • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Behavioral Emergencies -- teenage suicide concerns o Geriatrics -- suicide issues/depression common
EMT: EMR Material PLUS: Simple depth, simple breadth • Basic principles of the mental health system
Fundamental depth, foundational breadth Assessment and management of: • Acute psychosis • Suicidal/risk • Agitated delirium
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Define o Behavior o Psychiatric Disorder o Behavioral Emergency • Epidemiology of Psychiatric Disorders • Assessment o General Appearance o Speech o Skin o Posture/Gait o Mental Status o Mood, Thought, Perception, Judgment, Memory, and Attention • Behavioral Change o Factors That May Alter a Patient’s Behavior – May Include Situational Stresses, Medical Illnesses, Psychiatric Problems, and Alcohol or Drugs o Common Causes of Behavioral Alteration Low blood sugar Lack of oxygen Hypoperfusion Head trauma Mind altering substances Psychogenic – resulting in psychotic thinking, depression or panic Excessive cold Excessive heat Meningitis Seizure disorders Toxic ingestions – overdose Withdrawal of drugs or alcohol • Psychiatric Emergencies o Acute Psychosis o Assessment for Suicide Risk Depression Risk factors/signs or symptoms Important questions o Agitated Delirium Emergency medical care • Medical-Legal Considerations o Types of Restraints o Transport Against Patient Will • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Behavioral Emergencies Teenage suicide concerns Aggressive behavior may be a symptom of an underlying disorder or disability o Geriatrics -- suicide issues/depression common
AEMT: Same as Previous Level
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of:
Complex depth, comprehensive breadth • Acute psychosis • Agitated delirium
Fundamental depth, foundational breadth • Cognitive disorders • Thought disorders • Mood disorders • Neurotic disorders • Substance-related disorders /addictive behavior • Somatoform disorders • Factitious disorders • Personality disorders • Patterns of violence/abuse/neglect • Organic psychoses
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Prevalence o Medical legal considerations o Safety • Pathophysiology o Biological/Organic o Environment Psychosocial Socio-cultural o Injury and illness o Substance-related Abuse Dependence Intoxication Medication non-compliance • Understanding Behavior o Normal o Abnormal o Overt o Violent • Acute psychosis o Pathophysiology Related to mental illness Organic psychosis o Signs and symptoms o Prehospital management Non-pharmacologic Pharmacologic • Agitated delirium o Pathophysiology o Risk factors o Signs and symptoms o Management • Specific Behavioral/Psychiatric Disorders o Cognitive Disorders o Thought Disorders Schizophrenia Psychosis o Mood Disorders Bipolar Depression o Neurotic disorders o Substance-Related Disorders/Addictive behavior o Somatoform Disorders o Factitious Disorders o Fastidious Disorders o Impulse Control Disorders o Personality Disorders o Suicide o Patterns of Violence, Abuse, and Neglect • Assessment findings for behavioral/psychiatric patients o Mental Status Exam (MSE) Consciousness Orientation Activity Speech Thought Memory Affect and Mood Perception o Physiological changes o Medical/social history o Consider if patient is danger to self and/or others o Consider medical causes of acute crises • Providing Empathetic and Respectful Management o Communication techniques o Crisis intervention skills o Use of force/restraints (chemical, physical, Tasers®) • Medications o Pharmacodynamics of prescribed medications for behavioral/psychiatric disorders Amphetamines Antidepressants Antipsychotic Phenothiazines o Problems associated with non-compliance o Emergency use • Consider age-related variations in pediatric and geriatric patients • Communication to medical facility and documentation • Transport decisions
Cardiovascular EMR Simple depth, simple breadth Anatomy, signs, symptoms and management • Chest pain • Cardiac arrest
• Chest Pain o Causes Decrease in blood supply to part of the heart muscle Assessment and management of both conditions is the same for EMR o Assessment Chest discomfort/pain Pain Shortness of breath may occur Skin Other findings Vital signs o Management High-concentration oxygen Place in position of comfort Encourage the patient to rest Ask if patient has taken any medicine for pain • Consider Age-Related Variations for Pediatric and Geriatric Patients for Assessment and Management of Cardiac Compromise o Pediatric Heart problems often related to congenital heart condition Cardiac arrest is often caused by a primary respiratory problem o Geriatric -- may not have chest discomfort with heart attack • Cardiac Arrest (Refer to Shock and Resuscitation section)
EMT: EMR Material PLUS: Anatomy, physiology, pathophysiology, assessment, and management of:
Fundamental depth, foundational breadth • Acute coronary syndrome • Angina pectoris • Myocardial infarction • Aortic aneurysm/dissection • Thromboembolism
Simple depth, simple breadth • Heart failure • Hypertensive emergencies
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Anatomy of the Cardiovascular System o Heart Chambers Valves Blood supply to myocardium Myocardial muscle cells Specialized electrical cells Automaticity Autonomic system control o Vessels Aorta Arteries Arterioles Capillaries Venules Veins Vena cava o Blood Red blood cells White blood cells Platelets Plasma • Physiology o Cardiac Cycle Systole Diastole o Pulses Peripheral Pulses Central pulses o Blood Pressure Systolic Diastolic o Blood Circulation Through a Double Pump Respiratory system Body o Cardiac Output Heart rate X blood volume ejected/beat o Perfusion Function of red blood cells in oxygen delivery Factors governing adequate perfusion o Oxygenation of Tissues Delivery of oxygenated blood Removal of tissue wastes • Pathophysiology o Cardiac Compromise Inadequate circulation of blood and/ or perfusion of vital processes or organs Atherosclerosis Rate-related compromise Inadequate pumping Inappropriate circulating volume • Assessment o Primary Survey Level of responsiveness Airway Breathing Circulation o History Chief complaint History of the present illness Past medical history o Secondary Survey • Management (refer to the current American Heart Association guidelines) o Place in proper position o Evaluation and appropriate management of ventilations/respirations Oxygen saturation evaluation Pulse oximetry o May be unreliable in cardiac arrest, toxic inhalation Appropriate management of any related ventilatory/respiratory compromise Appropriate oxygen therapy o Evaluation and appropriate management of cardiac compromise Manual and auto BP Mechanical CPR AED o Pharmacological interventions Aspirin Nitroglycerin Oral glucose o Consider AEMT/Paramedic assistance at the scene o Appropriate transportation • Specific Cardiovascular Emergencies (refer to current American Heart Association guidelines) o Acute Coronary Syndromes (ACS) Heart Failure o Hypertensive Emergencies Systolic BP greater than 160 mmHg Diastolic BP greater than 94 mmHg Signs and symptoms Assessment o Cardiogenic Shock o Cardiac Arrest • Pharmacological Agents o Aspirin Generic and trade names Indications Contraindications Actions Side effects Precautions Expiration date Dosage Administration o Nitroglycerin Generic and trade names Indications Contraindications Actions Side effects Precautions Expiration date Dosage Administration o Role of Medical Oversight in Medication Administration o Patient Assisted Administration o Documentation • Consider Age-Related Variations for Pediatric and Geriatric Patients for Assessment and Management of Cardiac Compromise o Pediatric Cardiac problems typically associated with congenital heart condition Cardiovascular compromise often caused by respiratory compromise o Geriatric -- typical MI presentation often related to other underlying disease processes Diabetes Asthma COPD
AEMT: EMT Material PLUS: Anatomy, physiology, pathophysiology, assessment, and management of
Complex depth, foundational breadth • Acute coronary syndrome • Angina pectoris • Myocardial infarction
Fundamental depth, simple breadth • Heart failure • Hypertensive emergencies
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Anatomy of the Cardiovascular System o Location Layers Chambers Valves Myocardial blood supply Electrical and conduction system o Vessels Aorta Arteries Arterioles Capillaries Venules Veins Vena cava o Blood Red blood cells White blood cells Platelets Plasma • Physiology o Cardiac Cycle Systole Diastole o Pulses Peripheral pulses Central pulses o Blood Pressure Systolic Diastolic o Blood Circulation Through a Double Pump Respiratory system Body o Cardiac Output o Perfusion Function of red blood cells in oxygen delivery Factors governing adequate perfusion o Oxygenation of Tissues Delivery of oxygenated blood Removal of tissue wastes • Angina Pectoris/Acute Coronary Syndrome o Epidemiology o Precipitating Causes Atherosclerosis Vasospastic (Prinzmetal's) o Morbidity/ Mortality Not a self-limiting disease Chest pain may dissipate, but myocardial ischemia and injury can continue A single anginal episode may be a precursor to myocardial infarction May not be cardiac in origin Must be diagnosed by a physician Related terminology o Primary Survey Findings Airway/ breathing Circulation o History of the Present Illness/Sample History Chief complaint Denial Contributing history o Secondary Survey Findings Airway Breathing Circulation o Management Refer to American Heart Association guidelines Rapid transport • Acute Myocardial Infarction o Epidemiology o Precipitating Causes (as With Angina) Atherosclerosis Persistent angina Occlusion Non-traumatic Trauma o Morbidity/Mortality Sudden death Extensive myocardial damage May result in ventricular fibrillation o Primary Survey Findings Airway/breathing Circulation o History of the Present Illness/Sample History Chief complaint Contributing history Denial o Secondary Survey Findings Airway Breath sounds Circulation o Management Refer to American Heart Association guidelines • Scope of practice includes o Oxygen o Aspirin o Nitroglycerin o Nitrous Oxide • Transport • Irregularity of Pulse
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of:
Complex depth, comprehensive breadth • Acute coronary syndrome • Angina pectoris • Myocardial infarction • Heart failure • Non-traumatic cardiac tamponade • Hypertensive emergencies • Cardiogenic shock • Vascular disorders • Abdominal aortic aneurysm • Arterial occlusion • Venous thrombosis • Aortic aneurysm/dissection, • Thromboembolism • Cardiac rhythm disturbances
Fundamental depth, foundational breadth • Infectious diseases of the heart • Endocarditis • Pericarditis • Congenital abnormalities
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Anatomy of the Cardiovascular System o Location Layers Chambers Valves Papillary muscles Chordae tendineae Myocardial blood supply Conduction system Vascular system • Physiology o Cardiac cycle Consists of systole and diastole of atria and vemtricles Cycle occurs in about 0.8 seconds and 70-80 cycles/minute average Events that occur in 1 cardiac cycle: • Atrial systole • Isovolumetric contraction • Ejection -- Initial, shorter, rapid ejection followed by longer phase of reduced ejection • Isovolumetric relaxation • Rapid ventricular filling • Reduced ventricular filling (diastasis) o Cardiac output Heart rate X stroke volume • Electrophysiology o Characteristics of myocardial cells Automaticity Excitability Conductivity Contractility o Electrical potential Action potential – important electrolytes Excitability Neurotransmitters o Autonomic nervous system relationship to cardiovascular system Medulla Carotid sinus and baroreceptor Parasympathetic system Sympathetic system • Epidemiology o Incidence Prevalence of cardiac death outside of a hospital Prevalence of prodromal signs and symptoms Increased redognition of the need for early reperfusion o Morbidity/mortality Reduced with early recognition Reduced with early access to the EMS system o Risk factors Age Family history Hypertension Lipids Gender Smoking Carbohydrate intolerance o Possible contributing risks Diet Gender Obesity Oral contraceptives Sedentary living Personality type Psychosocial tensions o Prevention strategies Early recognition Education Alteration of life style • Primary survey for cardiovascular assessment o Level of responsiveness o Airway Patent Debris, blood o Breathing Absent Present Rate and depth o Circulation Pulse Skin Blood pressure • History and physical/ SAMPLE format o Chief complaint o Pain OPQRST • Onset/ origin • Provocation • Quality • Region/ radiation • Severity • Timing Dyspnea Cough Related signs and symptoms Past medical history • Secondary survey for cardiovascular assessment o Inspection Tracheal position Neck veins Thorax Epigastrium o Auscultation Neck Breath sounds Heart sounds o Palpation Areas of crepitus or tenderness Thorax Epigastrium • Electrocardiographic (ECG) monitoring o Electrophysiology and wave forms Origination Production Relationship of cardiac events to wave forms Intervals Segments o Leads and electrodes Electrode Leads Surfaces of heart and lead systems Artifact o Standardization Amplitude Height Rate o Wave form analysis Isoelectric Positive Negative Calculation of ECG heart rate o Lead systems and heart surfaces ECG rhythm analysis Heart surfaces Acute signs of ischemia, injury and necrosis o Cardiac arrhythmias Approach to analysis Interpretation of the ECG Arrhythmia originating in the sinus node Arrhythmias originating in the atria Arrhythmias originating within the AV junction Arrhythmias sustained or originating in the AV junction Arrhythmias originating in the ventricles Abnormalities originating within the bundle branch system Differentiation of wide QRS complex tachycardia Pulseless electrical activity Other ECG phenomena ECG changes due to electrolyte imbalances ECG changes in hypothermia • Management of the patient with an arrhythmia o Assessment Symptomatic Hypotensive Hypoperfusion Mechanical Vagal maneuvers - if the heart rate is too fast Stimulation - If heart rate is too slow Cough o Pharmacological interventions Gases Sympathomimetic Anticholinergic Antiarrhythmic Beta blocker Vasopressor Calcium channel blocker Purine nucleoside Platelet aggregate inhibitor Alkalinizing agents Cardiac glycoside Narcotic/ analgesic Diuretic Nitrate Antihypertensive o Electrical interventions Purpose Methods • Synchronized cardioversion • Defibrillation • Cardiac pacing o Transport Indications for rapid transport Indications for no transport required Indications for referral o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Acute coronary syndrome o Epidemiology o Precipitating causes Atherosclerosis Vasospastic (Prinzmetal's) o Morbidity/ mortality Not a self-limiting disease Chest pain may dissipate, but myocardial ischemia and injury can continue A single anginal episode may be a precursor to myocardial infarction May not be cardiac in origin Must be diagnosed by a physician Related terminology Differential diagnoses o Primary survey findings Airway/ breathing • Labored breathing may or may not be present Circulation • Peripheral pulses • Peripheral perfusion o History of the present illness/SAMPLE history Chief complaint • Typical - sudden onset of discomfort, usually of brief duration, lasting three to five minutes, maybe 5 to 15 minutes; never 30 minutes to 2 hours • Typical - usually relieved by rest and/or medication • Epigastric pain or discomfort • Atypical Denial Contributing history o Secondary survey findings Airway Breathing Circulation • Alterations in heart rate and rhythm may occur • Peripheral pulses are usually not affected • Blood pressure may be elevated during the episode and normalize afterwards • ECG Devices • Findings o Management Position of comfort Refer to ILCOR Consensus for treatment ECG Indications for Rapid Transport • Sense of urgency for reperfusion • No relief with medications • Hypotension/hypoperfusion with CNS involvement • Significant changes in ECG No transport • Patient refusal • Referral o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Acute myocardial infarction/Angina o Epidemiology o Precipitating causes (as with angina) Atherosclerosis Persistent angina Occlusion Non-traumatic Trauma o Morbidity/ mortality Sudden death Extensive myocardial damage May result in ventricular fibrillation o Primary survey findings Airway/ breathing Circulation o History of the present illness/SAMPLE history Chief complaint Contributing history Denial o Secondary survey findings Airway Breath sounds Circulation o Management Position of comfort Refer to ILCOR Consensus for treatment Transport Indications for “no transport” Support and communications strategies • Heart failure o Epidemiology o Precipitating causes Left-sided failure Right-sided failure Myocardial infarction Pulmonary embolism Hypertension Cardiomegaly High output failure Low output failure o Related terminology Preload Afterload Congestive heart failure Chronic versus acute o Morbidity/ mortality Pulmonary edema Respiratory failure Death o Primary survey Airway/ breathing Circulation o History of the present illness/SAMPLE history Chief complaint o Secondary survey findings Level of consciousness Airway/ breathing Circulation o Complications Pulmonary edema (signs and symptoms) o Management Position of comfort Refer to ILCOR Consensus for treatment Transport o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Non-Traumatic Cardiac tamponade o Pathophysiology Defined as impaired diastolic filling of the heart caused by increased intrapericardiac pressure o Precipitating causes Gradual onset with neoplasm or infection Acute onset with infarction Trauma Secondary to renal disease Hypothyroidism o Morbidity/ mortality o Primary survey Airway/ breathing Circulation o History of the present illness/SAMPLE history (consider precipitating causes listed above) o Secondary survey Airway/ breathing Circulation o Management Airway management and ventilation Refer to ILCOR Consensus for treatment Rapid transport for pericardiocentesis o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Hypertensive emergencies o Epidemiology o Precipitating causes History of hypertension Non-compliance with medication or any other treatment Toxemia of pregnancy o Morbidity/ mortality Hypertensive encephalopathy Stroke o Primary examination Airway/ breathing Circulation o History of the present illness/SAMPLE history (consider precipitating causes listed above) Chief complaint Medication history Home oxygen use o Secondary survey Airway Circulation Diagnostic signs/symptoms o Management Position of comfort Airway and ventilation Refer to ILCOR Consensus for treatment Rapid transport o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Cardiogenic shock o Pathophysiology o Precipitating causes Myocardial infarction Age Trauma o Primary survey Airway/ breathing Circulation o History of the present illness/SAMPLE history (consider precipitating causes listed above) Chief complaint Medication history o Secondary survey Critical findings o Management Position of comfort Refer to ILCOR Consensus for treatment Transport o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Cardiac arrest o Pathophysiology o Precipitating causes Trauma Medical conditions (for example) o Primary survey critical findings Unresponsive Apneic Peripheral pulses absent Heart rate/ rhythm o History of the present illness/SAMPLE history (consider precipitating causes listed above) Witnessed event Witnessed by EMS personnel Bystander cardiopulmonary resuscitation (CPR) Time from discovery to activation of CPR Time from discovery to activation of EMS Past medical history o Management Related terminology Indications for WITHHOLDING resuscitation efforts Advanced airway management and ventilation Circulation IV therapy as appropriate Refer to ILCOR Consensus for treatment Rapid transport o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician o Termination of resuscitation efforts Inclusion criteria (for example) • 18 or older • Arrest is presumed cardiac in origin and not associated with a condition potentially responsive to hospital treatment (for example - hypothermia, drug overdose, toxicologic exposure, etc.) • Endotracheal intubation has been successfully accomplished and maintained • Standard advanced cardiac life support (ACLS) measures have been applied throughout the resuscitative effort • On-scene ALS resuscitation efforts have been sustained for 25 minutes or the patient remains in asystole through four rounds of appropriate ALS drugs • Patient has a cardiac rhythm of asystole or agonal rhythm at the time the decision to terminate is made and this rhythm persists until the arrest is actually terminated • Victims of blunt trauma in arrest whose presenting rhythm is asystole, or who develop asystole while on scene Exclusion criteria (for example) • Under the age of 18 years • Etiology for which specific in-hospital treatment may be beneficial • Persistent or recurrent ventricular tachycardia or fibrillation • Transient return of pulse • Signs of neurological viability • Arrest was witnessed by EMS personnel • Family or responsible party opposed to termination Criteria NOT to be considered as inclusionary or exclusionary • Patient age - for example, geriatric • Time of collapse prior to EMS arrival • Presence of a non-official do-not-resuscitate (DNR) order • "Quality of life" valuations Procedures (according to local protocol) • Direct communication with medical oversight • Vascular disorders o Epidemiology Trauma Non-traumatic Precipitating causes • Atherosclerosis • Aneurysm • Marfan's syndrome • Inflammation • Occlusive disease • Venous thrombosis o Morbidity/ mortality Pulmonary occlusion Cerebral occlusion Mesenteric occlusion Hypoperfusion state Death o Primary survey Airway/ breathing Circulation (distal to or over the affected area) Skin o History of the present illness/SAMPLE history (consider precipitating causes listed above) Chief complaint Contributing history o Secondary survey Airway Breath sounds Circulation o Management Position of comfort Refer to ILCOR Consensus for treatment Transport o Support and communications strategies Explanation for patient, family, significant others Communications and transfer of data to the physician • Aortic Aneurysm/Dissection o Thoracic o Abdominal • Thromboembolism o Arterial Occlusion o Venous Thrombosis • Congenital Heart Disease o Pulmonary Stenosis Stenosis of pulmonary valve Increased Resistance to Outflow Elevates Right Ventricular Pressure Limits pulmonary blood flow o Septal Defects Atrial -- Blood from left atrium passes into right atrium Ventricular -- Blood from left ventricle passes into right ventricle o Patent Ductus Arteriosus Ductus Arteriosus fails to close during embryonic development Blood flow continuously from aorta through ductus into the pulmonary artery Increases workload of left ventricle • Valvular Heart Disease o Stenosis o Regurgitation • Coronary Artery Disease o Atherosclerosis o Intravascular Lesion Coronary Vasospasm Plaque rupture • Infectious Diseases of the Heart o Result from intravascular contamination by pathogen Endocarditis Pericarditis Myocarditis o Damages heart valves o Damages heart muscle o Embolizes • Cardiomyopathy o Dilated o Hypertrophic • Specific Hypertensive Emergencies o Accelerated and Malignant Hypertension o Hypertensive Encephalopathy o Intracranial Hemorrhage o Acute Left Ventricular Failure o Acute Cardiac Ischemia o Acute Aortic Dissection o Eclampsia • Infectious Diseases of the Heart o Epidemiology Incidence Morbidity and mortality Risk factors Prevention strategies o Pathophysiology Chronic versus acute Involvement o Specific Disease Endocarditis Pericarditis Rheumatic Fever Scarlet Fever o Assessment Primary exam Secondary exam o Management (refer to ILCOR consensus treatment) Initial general therapy Management of arrhythmias Adjunctive prehospital therapy o Consider age-related variations for pediatric and geriatric patients • Congenital Abnormalities and Age-Related Variations o Epidemiology Incidence Morbidity and mortality Risk factors Prevention strategies o Pathophysiology Causes Altered embryonic development of heart structures Malformations lead to altered cardiac function and hemodynamics o Specific Diseases Left to right shunt Valvular and vascular lesions Transposition Congenital Arrhythmias o Assessment Primary exam Secondary exam o Management (refer to ILCOR consensus treatment) Initial general therapy Management of arrhythmias Adjunctive prehospital therapy • Integration o Apply pathophysiological principles to the assessment of a patient with cardiovascular disease o Formulation of field impression; decisions based on: Primary examination History of the present illness/SAMPLE history Secondary examination o Develop and execute a patient management plan based on field impression Initial management Re-assessment Transport criteria Non-transport criteria Advocacy Communications Prevention Documentation Quality assurance
Toxicology EMR Simple depth, simple breadth • Recognition and management of • Carbon monoxide poisoning • Nerve agent poisoning • How and when to contact a poison control center
• Introduction o Define Poisoning o National Poison Control Center Role When to call National Telephone Number 1-800-222-1222 • Carbon Monoxide Poisoning • Poisoning by Nerve Agents o Define Nerve Agents o Exposure Routes Inhaled gas Absorbed through skin Ingested from liquid or food o Onset of Signs and Symptoms o Assessment Findings Salivation, lacrimation (tearing), urination, defecation, emesis, pupil constriction Blurred or dim vision Difficulty breathing Slow or fast heart rate Muscle twitching, weakness or paralysis Slurred speech Sweating Seizures Loss of consciousness Death o General Management Considerations Scene safety/special resources Remove patient from contaminated environment as soon as safely possible PPE Decontamination by appropriately trained personnel if indicated Remove clothing Airway control Oxygenate and ventilate Position Administer nerve agent antidote auto injector kit to self or other rescuer if indicated and available • Nerve Agent Antidote Autoinjector Kit o Types Mark I -- two autoinjector syringes each contain a separate drug DuoDote o Administer a Nerve Agent Autoinjector Kit If You or a peer has serious signs or symptoms that indicate the presence of nerve agent poisoning You are authorized to do so by medical direction o Do Not Give the Nerve Agent Autoinjector Kit If Mild signs and symptoms such as tearing or runny nose are the only signs of nerve agent poisoning present Drugs in the nerve agent autoinjector kit o Administration of MARK I ™ Kit Wear appropriate PPE Confirm that serious signs and symptoms of nerve agent poisoning are present Confirm correct drug Check expiration date Grasp the atropine syringe Remove the protective yellow cap Press the green end of the injector very firmly against the outer aspect of the patient’s upper leg (thigh) at a 90 degree angle Hold for 10 seconds Check for the presence of a needle at the tip to ensure the drug was injected Dispose of syringe appropriately Grasp the pralidoxime chloride syringe Remove the gray protective cap Press the black end of the injector firmly against the outer aspect of the patient’s upper leg (thigh) at a 90 degree angle Hold for 10 seconds Check for the presence of a needle at the tip to ensure the drug was injected Dispose of syringe appropriately Reassess the patient’s signs and symptoms o Administration of the DuoDote™ Kit Wear appropriate PPE Confirm that serious signs and symptoms of nerve agent poisoning are present Confirm correct drug Check expiration date Grasp the syringe with your dominant hand Remove the gray protective cap Press the green (needle) end of the injector very firmly against the outer aspect of the patient’s upper leg (thigh) at a 90 degree angle Hold for 10 seconds Check for the presence of a needle at the green tip to ensure the drug was injected Dispose of syringe appropriately Reassess the patient’s signs and symptoms • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Toddler-aged prone to ingestion of toxic substances Adolescent prone to experimentation with drugs of abuse o Geriatric Medication errors are common for many reasons May cause life threatening conditions
EMT: EMR Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment, and management of • Inhaled poisons • Ingested poisons • Injected poisons • Absorbed poisons • Alcohol intoxication and withdrawal
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Introduction o Define Toxicology, Poisoning, Overdose o National Poison Control Center o Routes of Absorption Ingestion Inhalation Injection Absorption • Poisoning by Ingestion o Examples o Assessment Findings o General Management Considerations • Poisoning by Inhalation o Examples o Assessment Findings o General Management Considerations • Poisoning by Injection o Examples o Assessment Findings o General Management Considerations • Poisoning by Absorption o Examples o Assessment Findings o General Management Considerations • Drugs of Abuse o Opiates/Narcotics Common causative agents Assessment findings and symptoms Management for a patient using opiates o Alcohol Overview of alcoholism including long-term effects Alcohol abuse Alcohol withdrawal Assessment findings and symptoms for patients with alcohol abuse and alcohol withdrawal Management for a patient using alcohol or withdrawing from alcohol — airway, ventilation, and circulation o Common Causative Agents, Assessment Findings and Symptoms, Management Cannabis Hallucinogens Stimulants Barbiturates/sedatives/ hypnotics • Poisonings and Exposures o Scene Safety Issues o Common Causative Agents, Assessment Findings and Symptoms, Management Pesticides Chemicals Household cleaning poisonings Poisonous plants • Medication Overdose o Common Causes of Overdoses (Other Than Drugs of Abuse) Cardiac medications Psychiatric medications Non-prescription pain medications including Salicylates and Acetaminophen Other o Assessment Findings and Symptoms for Patients With Medication Overdose o Management for a Patient With Medication Overdose • General Treatment Modalities for Poisonings o Scene Safety o Standard Precautions and Decontamination o Airway Control o Ventilation and Oxygenation o Circulation o Use of Activated Charcoal Indications/contraindications/side effects Physician order Dose • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Toddler-aged prone to ingestions of toxic substance Adolescent prone to experimentation with drugs of abuse o Geriatric -- Alcoholism is common in elderly • Communication and Documentation for Patients With Toxicological Emergencies • Transport Decisions
AEMT: EMT Material PLUS: Fundamental depth, foundational breadth • Opiate toxidrome
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Introduction o Define Toxicology, Poisoning, Overdose o National Poison Control Center o Routes of Absorption Ingestion Inhalation Injection Absorption • Poisoning by Ingestion o Examples o Assessment Findings o General Management Considerations • Poisoning by Inhalation o Examples o Assessment Findings o General Management Considerations • Poisoning by Injection o Examples o Assessment Findings o General Management Considerations • Poisoning by Absorption o Examples o Assessment Findings o General Management Considerations • Drugs of Abuse o Opiates/Narcotics Common causative agents Assessment findings and symptoms Management for a patient using opiates o Alcohol Overview of alcoholism including long term effects Alcohol abuse Alcohol withdrawal Assessment findings and symptoms for patients with alcohol abuse and alcohol withdrawal Management for a patient using alcohol or withdrawing from alcohol o Common Causative Agents, Assessment Findings and Symptoms, Management Cannabis Hallucinogens Stimulants Barbiturates/sedatives/ hypnotics • Poisonings and Exposures o Scene Safety Issues o Common causative agents, assessment findings and symptoms, management Pesticides Chemicals Household Cleaning poisonings Poisonous Plants • Medication Overdose o Common Causes of Overdoses (Other Than Drugs of Abuse) Cardiac medications Psychiatric medications Non-prescription pain medications including Salicylates and Acetaminophen Other o Assessment Findings and Symptoms for Patients With Medication Overdose o Management for a Patient With Medication Overdose • General Treatment Modalities for Poisonings o Scene Safety o Standard Precautions and Decontamination o Airway Control o Ventilation and Oxygenation o Circulation o Use of Activated Charcoal Indications/contraindications/side effects Physician order Dose • Toxic Syndromes o Introduction Definition of a toxic syndrome (toxidrome) Incidence of opiate abuse o Opiate Intoxication/Poisoning Common causative agents Assessment findings specific to opiate intoxication/poisoning Management specific to opiate intoxication/poisoning • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Toddler-age prone to ingestions of toxic substance Adolescent prone to experimentation with drugs of abuse o Geriatric Alcoholism is common in elderly Drug dependency Consequences of narcotic antagonist use in the chronic pain patient • Documentation and Communication o Documentation of the Opiate Overdose Specific Patient o Communication Hospital personnel Family Law enforcement personnel o Transport Decisions
Paramedic: AEMT Material PLUS: Complex depth, comprehensive breadth Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of the following toxidromes and poisonings: • Cholinergics • Anticholinergics • Sympathomimetics • Sedative/hypnotics • Opiates • Alcohol intoxication and withdrawal • Over-the-counter and prescription medications • Carbon monoxide • Illegal drugs • Herbal preparations
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Epidemiology of toxicology emergencies o Review of epidemiology of poisoning Local Regional National o National Resources for Poisoning National Poison Control Center National Courses in Toxicology Centers for Disease Control and Prevention (CDC) o Types of toxicological emergencies Unintentional poisoning Drug/ alcohol abuse Intentional poisoning/ overdose o Pharmacokinetics o Routes of absorption Ingestion Inhalation Injection Absorption o Poisoning by ingestion Examples Anatomy and physiology review Assessment findings General management considerations o Poisoning by inhalation Examples Anatomy and physiology review Assessment findings General management considerations o Poisoning by injection Examples Anatomy and physiology review Assessment findings General management considerations o Poisoning by absorption Examples Anatomy and physiology review Assessment findings General management considerations • Toxic syndromes (Toxidromes) including drugs of abuse o Introduction--Pathophysiology, incidence, toxic agents, risk factors, methods of transmission, complications o Cholinergics Common causative agents - pesticides (organophosphates, carbamates) and nerve agents (Sarin, Soman) Assessment findings and symptoms for patients with exposure to cholinergics Management for a patient with exposure to cholinergics o Anticholinergic Common causative agents Assessment findings and symptoms for patients with exposure to anticholinergics Management for a patient with exposure to anticholinergics o Marijuana and cannabis compounds Common causative agents Assessment findings and symptoms for patients with exposure/use of cannabis Management for a patient with exposure to cannabis o Sympathomimetics/Stimulates Common causative agents Assessment findings and symptoms for patients with exposure to/use of Sympathomimetics/Stimulates Management for a patient with exposure to/use of Sympathomimetics/Stimulates o Barbiturates/sedatives/hypnotics Common causative agents Assessment findings and symptoms for patients with exposure to/use of Barbiturates/sedatives/ hypnotics Management for a patient with exposure to/use of Barbiturates/sedatives/hypnotics o Hallucinogens Common causative agents Assessment findings and symptoms for patients with exposure to/use of Hallucinogens Management for a patient with exposure to/use of Hallucinogens o Opiates Common causative agents Assessment findings and symptoms for patients with exposure to/use opiates Management for a patient with exposure to/use of opiates o Huffing Agent (Halogenated Hydrocarbons) Common causative agents Assessment findings and symptoms for patients with exposure to/use of Huffing agents Management for a patient with exposure to/use of huffing agents • Alcoholism o Introduction—Epidemiology, risk factors, morbidity/ mortality complications o Pathophysiology of long term and acute alcohol abuse and withdrawal End organ damage Assessment findings and symptoms for patients with acute and chronic alcohol abuse and withdrawal Management for a patient with exposure to/use of with acute and chronic alcohol abuse and withdrawal • Poisonings and exposures o Chemicals Agents Assessment findings and symptoms for patients with chemical poisoning/exposure Management for a patient with chemical poisoning/exposure • Household Poisons o Pesticides Organophosphates Carbamates Warfarins Pyrethrums (Raid) o Household Cleaning poisonings Bleach Cleaning agents Pine oil products o Poisonous Plants China Berry Foxglove Mistletoe Dieffenbachia Others o Assessment findings and symptoms for patients with poisoning/exposure to household poisons o Management for a patient with chemical poisoning/exposure to household poisons Airway and ventilation and circulation Pharmacological Non-pharmacological • Medication overdose-- Introduction--Pathophysiology, incidence, toxic agents, risk factors, complications o Cardiac medications o Psychiatric medications o Non-prescription pain medications including Salicylates and Acetaminophen o Other o Assessment findings and symptoms for patients with medication overdose o Management for a patient with medication overdose Airway and ventilation and circulation Pharmacologic Non-pharmacologic • General Treatment modalities for Poisonings o Facilitated Airway Control o Respiratory Support o Circulation Support o Antidote Therapy Methylene Blue Cyanide Antidotes Physostigmine Alkalization and Sodium Bicarbonate Atropine and Pralidoxime (2-PAM) Narcan Sedatives Solu-medrol, Decadron Beta Agonist Ipecac Haldol Glucagon Flumazenil Dimercapel Digibind Calcium Gluconate Activated Charcoal o Decontamination • Communication and documentation for patients with toxicological emergencies • Transport decisions with toxicological emergencies • Age-related variations for pediatric and geriatric patients • Patient education and prevention of toxicological emergencies and drug and alcohol abuse
Respiratory EMR Simple depth, simple breadth Anatomy, signs, symptoms and management of respiratory emergencies including those that affect the • Upper airway • Lower airway
• Anatomy of the Respiratory System o Upper Airway o Lower Airway o Lungs and Accessory Structures • Normal Respiratory Effort o Assessment Findings and Symptoms and Management for Respiratory Conditions Respiratory distress Shortness of breath Restlessness Increased pulse rate Changes in respiratory rate or rhythm Skin color changes Abnormal sounds of breathing (i.e. wheezing) Inability to speak Accessory muscle use Altered mental status Abdominal breathing Coughing Tripod position o Management of Respiratory Distress ABCs, position Oxygen/suction Emotional support • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Upper airway obstruction may be caused by respiratory infections Lower airway disease may be caused by birth problems or infections o Geriatrics—Pneumonia and Chronic Conditions
EMT: EMR Material PLUS: Anatomy, physiology, pathophysiology, assessment, and management of Fundamental depth, foundational breadth • Epiglottitis • Spontaneous pneumothorax • Pulmonary edema • Asthma • Chronic obstructive pulmonary disease • Environmental/industrial exposure • Toxic gas • Simple depth, simple breadth • Pertussis • Cystic fibrosis • Pulmonary embolism • Pneumonia • Viral respiratory infections
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Anatomy of the Respiratory System o Upper Airway o Lower Airway o Lungs and Accessory Structures • Normal Respiratory Effort • Assessment Findings and Symptoms and Management for Respiratory Conditions o Respiratory Distress Assessment Management of respiratory distress • Specific Respiratory Conditions—Definition, Causes, Assessment Findings and Symptoms, Complications, and Specific Prehospital Management and Transport Decisions o Asthma o Pulmonary Edema o Chronic Obstructive Pulmonary Disease o Pneumonia o Spontaneous Pneumothorax o Pulmonary Embolism o Epiglottis o Pertussis o Cystic Fibrosis o Environmental/Industrial Exposure/ Toxic Gasses o Viral Respiratory Infections • Metered-Dose Inhaler and Small Volume Nebulizer o EMT Role in Assisting o Indication/ Contraindications o Actions o Side Effects o Dose and Route o Medical Control Role • Communication and Documentation for Patients With Respiratory Emergencies • Consider Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatric Upper airway obstruction (i.e. foreign body aspiration or tracheostomy dysfunction) Lower airway disease (i.e. foreign body lower airway obstruction) o Geriatrics—Pneumonia and Chronic Conditions Such as COPD Common Upper airway obstruction Lower airway disease • Transport Decisions
AEMT: EMT Material PLUS: Complex depth, foundational breadth Anatomy, physiology, pathophysiology, assessment, and management of • Asthma • Obstructive/restrictive disease • Pneumonia
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Anatomy and Physiology o Anatomy of the Pulmonary System Upper airway Lower airway Gas exchange Chest wall Neurological control of breathing • Pathophysiology o Obstructive/Restrictive Lung Diseases Emphysema Chronic Bronchitis Asthma o Infectious Lung Disease Pneumonia • Assessment o Impact of Disease on Prehospital Assessment Pertinent historical questions Pertinent physical findings o Finding Associated With Specific Diseases Emphysema Chronic Bronchitis Asthma Pneumonia o Age-Related Considerations Pediatrics Geriatrics • Treatment o Oxygenation and Ventilation Requirements o Use of Inhaled Beta-Agonists o IV Fluid Therapy in Respiratory Illness o Age-Related Considerations Pediatrics Geriatrics • Communication and documentation
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, management of
Complex depth, comprehensive breadth • Acute upper airway infections • Spontaneous pneumothorax • Obstructive/restrictive lung diseases • Pulmonary infections
Fundamental depth, foundational breadth • Neoplasm • Pertussis • Cystic fibrosis
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Epidemiology Mortality/ morbidity Risk factors o Anatomy and physiology review Global physiology of the pulmonary system Anatomy of the pulmonary system • General system pathophysiology, assessment and management o Pathophysiology Specific conditions o Assessment Findings Scene size-up Initial assessment -- signs of life threatening respiratory distress Focused history and physical examination o Management Airway and ventilation Circulation—intravenous therapy Pharmacological Non-pharmacological -- Continuous positive airway pressure Monitoring and devices used in pulmonary care Transport considerations • Specific illness/injuries: causes, assessment findings and management for each condition o Acute/ adult respiratory distress syndrome o Chronic obstructive airway diseases Asthma Chronic bronchitis Emphysema o Pneumonia o Pulmonary edema High pressure (cardiogenic) High permeability (non-cardiogenic) o Pulmonary thromboembolism o Neoplasms of the lung o Pertussis o Cystic fibrosis o Upper respiratory infection o Spontaneous pneumothorax o Hyperventilation syndrome • Consider age-related variations o Pediatric Anatomic and physiologic differences in children Pathophysiology Upper airway obstruction Lower airway disease • Communication and documentation for patients with a respiratory condition or emergency • Transport decisions • Patient education and prevention of complications or future respiratory emergencies.
Hematology EMR No knowledge related to this competency is applicable at this level.
EMT Simple depth, simple breadth Anatomy, physiology, pathophysiology, assessment, and management of • Sickle cell crisis • Clotting disorders
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Anatomy and Physiology o Blood Red blood cells White blood cells Platelets o Plasma o Blood-Forming Organs Red cell production Red cell destruction • Pathophysiology of Sickle Cell • Sickle Cell Crisis o General Assessment Level of consciousness Skin Visual disturbances Gastrointestinal Skeletal Cardiorespiratory Genitourinary o General Management Airway, ventilation, and circulation Oxygen Transport considerations Psychological/communication strategies • Clotting Disorders • Consider Age-Related Variations o Pediatrics o Geriatrics
AEMT: EMT Material PLUS: Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of • Sickle cell crisis
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Introduction o Epidemiology of Blood Disorders Incidence Morbidity/mortality o Anatomy And Physiology Blood Plasma Blood forming organs Normal red cell production, function, destruction • Sickle Cell Disease o Definition, Pathophysiology, Epidemiology, Mortality and Morbidity Types of emergent presentations Patient management • Assessment o Types of Presentation o Specific Signs and Symptoms • Management o Airway and Oxygenation Requirements o IV Access • Age-Related Considerations o Types of Crisis Specific to the Pediatric Patient o Special Considerations in Treatment • Documentation and Communication
Paramedic: AEMT Material PLUS: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major hematological diseases and/or emergencies
Complex depth, foundational breadth • Sickle cell disease
Fundamental depth, foundational breadth • Blood transfusion complications • Hemostatic disorders • Lymphomas • Red blood cell disorders • White blood cell disorders • Coagulopathies
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Epidemiology Incidence Morbidity/mortality o Anatomy and physiology review Blood Plasma Blood-forming organs Normal red cell production, function and destruction Normal white cell production and function The inflammatory process Immunity Blood groups Hemostasis • General assessment findings and symptoms o Level of consciousness o Skin o Visual disturbances o Gastrointestinal o Skeletal o Cardiorespiratory o Genitourinary • General management for a patient with a hematological condition or emergency o Airway, ventilation, and circulation o Pharmacological o Non-pharmacological o Transport considerations o Psychological/communication strategies • Sickle Cell Disease o Definition, pathophysiology, epidemiology, mortality and morbidity Types of emergent presentations Patient management • Hematological conditions o Definitions, Pathophysiology, epidemiology , mortality and morbidity, and complications o Specific assessment findings and symptoms o Specific management considerations o Conditions Sickle Cell Crisis Anemia Leukopenia Thrombocytopenia Leukemia Lymphomas Polycythemia Disseminated intravascular coagulopathy Hemophilia Hemophilia A, deficiency in factor VIII Hemophilia B, deficiency in factor IX Multiple myeloma Homestatic Disorders • Blood Transfusion Complications o Hemolytic o Febrile o Allergic o Transfusion-related lung injury o Circulatory overload o Bacterial infection • Consider age-related variations in pediatric and geriatric patients • Patient education and prevention
Genitourinary/Renal EMR Simple depth, simple breadth • Blood pressure assessment in hemodialysis patients
• Hemodialysis o Hemodialysis Used to eliminate water and wastes from the body when the kidneys fail Dialysis machine is connected to an access site at fistula, shunt, or access port o Special Considerations for Hemodialysis Patients Do not obtain BP in the arm with the dialysis fistula or shunt o Life-Threatening Emergencies Associated With Dialysis Patients Low blood pressure Nausea/vomiting Irregular pulse, cardiac arrest Bleeding from the access site Difficulty breathing o Management of a Patient with a Dialysis Emergency Maintain airway Administer oxygen Assist ventilation if indicated Stop bleeding from shunt if present Position
EMT: EMR Material PLUS: Simple depth, simple breadth Anatomy, physiology, pathophysiology, assessment, and management of • Complications related to • Renal dialysis • Urinary catheter management (not insertion) • Kidney stones
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Anatomy and Physiology of Renal System • Pathophysiology o Kidney Failure o Kidney Stones • Dialysis o Hemodialysis Shunt Fistula Graft o Peritoneal Dialysis o Special Considerations for Hemodialysis Patients Obtaining B/P o Complications/Adverse Effects of Dialysis Hypotension Muscle cramps Nausea/vomiting Hemorrhage especially from access site Infection at access site o Missed Dialysis Treatment Weakness Pulmonary edema • Management for a Patient With a Dialysis Emergency o ABCs, Support Ventilation o Stop Bleeding From Shunt as Needed o Position—Flat If Shocky, Upright If Pulmonary Edema • Urinary Catheter Management • Consider Age-Related Variations in Pediatric and Geriatric Patients • Communication and Documentation • Transport Decisions
AEMT:EMT Material PLUS: Fundamental depth, simple breadth Anatomy, physiology, pathophysiology, assessment, and management of • Complications related to renal dialysis • Kidney stones
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Anatomy and Physiology o Urinary System Structures Functions o Pathophysiology Renal Calculi (kidney stones) Types of renal failure End-stage renal disease o Dialysis Definition of dialysis Process of dialysis Types of dialysis Complications/adverse effects of dialysis Consequences of missed dialysis treatment o Assessment Findings in renal calculi Findings in renal failure o Management Renal calculi patient Renal failure patients o Documentation o Documentation of the renal calculi patient o Documentation of dialysis complication patient
Paramedic: AEMT Material Plus: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of
Complex depth, comprehensive breadth • Complications of • Acute renal failure • Chronic renal failure • Dialysis • Renal calculi
Fundamental depth, foundational breadth • Acid base disturbances • Fluid and electrolyte • Infection • Male genital tract conditions
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Review of genitourinary System General anatomy Functions of the urinary system • Renal Diseases o Overview of renal conditions Pathophysiology Incidence, morbidity, and mortality o Assessment findings and symptoms for renal failure Acute Chronic renal failure End stage renal disease o Dialysis Hemodialysis Peritoneal dialysis Special considerations for hemodialysis patients Complications/Adverse effects of dialysis Missed dialysis treatment o Management for a patient with acute renal condition, chronic renal conditions with acute exacerbations or dialysis problems, or end stage renal disease. Management • Urinary System Conditions o Urinary retention—pathophysiology, incidence, causes Assessment findings and symptoms Management o Urinary tract infection (UTI)-- pathophysiology, incidence, causes Urinary bladder infection (cystitis) Pyelonephritis Assessment findings and symptoms Management o Renal calculi (kidney stones) - pathophysiology, incidence, causes. Assessment findings and symptoms Management o Acid base disturbances- pathophysiology, incidence, causes. Assessment findings and symptoms Management o Fluid and electrolyte- pathophysiology, incidence, causes. Assessment findings and symptoms Management o Infection- pathophysiology, incidence, causes. Assessment findings and symptoms Management • Male genital tract conditions o Review of male reproductive system anatomy and physiology. o Blunt trauma to external genitalia Assessment findings and symptoms Management o Epididymitis or orchitis-- pathophysiology, incidence, causes Assessment findings and symptoms Prehospital management o Fournier’s gangrene- pathophysiology, incidence, causes Assessment findings and symptoms Management o Structural conditions Phimosis or paraphimosis-- pathophysiology, incidence, causes Priapism- pathophysiology, incidence, causes Benign prostate hypertrophy (BPH)- pathophysiology, incidence, causes Testicular masses-- pathophysiology, incidence, causes Testicular torsion-- pathophysiology, incidence, causes • Consider age-related variations for pediatric and geriatric patients • Communication and documentation • Transport decisions • Patient education and prevention
Gynecology EMR Simple depth, simple breadth Recognition and management of shock associated with • Vaginal bleeding
• Vaginal bleeding o Causes o Assess for signs of shock o Presence of pain o Management Standard precautions Administer oxygen Position
EMT: EMR Material Plus: Anatomy, physiology, assessment findings, and management of Fundamental depth, foundational breadth • Vaginal bleeding • Sexual assault (to include appropriate emotional support)
Simple depth, simple breadth • Infections
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Introduction o Female Reproductive System Anatomy and Physiology External Genitalia Internal Organs and Structures • Assessment Findings o Abdominal Pain or Vaginal Pain o Vaginal Bleeding o Vaginal Discharge o Fever o Nausea and Vomiting o Syncope • General Management o Protect Privacy and Modesty o Communication Techniques o Consider Pregnancy and/or Sexually Transmitted Diseases • Specific Gynecological Emergencies—Definition, Causes, Risk Factors, Assessment Findings, Management o Vaginal Bleeding o Sexual Assault — Legal Issues o Infections — Pelvic Inflammatory Disease o Sexually Transmitted Diseases • Age-Related Variations for Pediatric and Geriatric Assessment and Management o Pediatrics -- Menarche could be cause of bleeding o Geriatrics -- Menopausal women can get pregnant • Communication and Documentation • Transport Decisions
AEMT: Same as Previous Level
Paramedic: AEMT Material Plus: Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major gynecological diseases and/or emergencies
Complex depth, comprehensive breadth • Vaginal bleeding • Sexual assault
Fundamental depth, foundational breadth • Infections • Pelvic Inflammatory Disease • Ovarian cysts • Dysfunctional uterine bleeding • Vaginal foreign body
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Female reproductive system anatomy review External genitalia Internal organs and structures • Physiology o Menstrual and ovarian cycles Proliferative phase Secretory phase Menstrual phase Menopause • Symptoms and Assessment findings o Abdominal pain or vaginal pain o Vaginal bleeding o Vaginal discharge o Fever o Nausea and vomiting o Syncope • General management o Protect privacy and modesty o Communication techniques o Consider pregnancy and/or sexually transmitted diseases o Oxygen and IV fluids if needed • Vaginal Bleeding o Anatomy and physiology o Epidemiology o Pathophysiology o Psychosocial impact o Assessment findings/presentation o Prognosis o Management Pharmacological Non-pharmacological • Sexual Assault o Anatomy and physiology o Epidemiology o Pathophysiology o Psychosocial impact o Assessment findings/presentations o Prognosis o Management Pharmacological Non-pharmacological • Infection (including Pelvic inflammatory disease, Bartholin’s abscess, and vaginitis/vulvovaginitis) o Pathophysiology o Assessment findings/presentation o Prehospital Management • Ovarian cyst and ruptured ovarian cyst o Pathophysiology o Assessment findings/presentation o Prehospital Management • Ovarian torsion o Pathophysiology o Assessment findings/presentation o Prehospital Management • Endometriosis o Pathophysiology o Assessment findings/presentation o Prehospital Management • Dysfunctional uterine bleeding o Pathophysiology o Assessment findings/presentation o Prehospital Management • Prolapsed uterus o Pathophysiology o Assessment findings/presentation o Prehospital Management • Vaginal foreign body o Pathophysiology o Assessment findings/presentation o Prehospital Management • Age-related variations o Pediatrics—menarche could be cause of bleeding o Geriatrics—menopausal women can get pregnant • Communication and documentation • Transport decisions
Non-Traumatic Musculoskeletal Disorders EMR No knowledge related to this competency is applicable at this level.
EMT Fundamental depth, foundational breadth Anatomy, physiology, pathophysiology, assessment and management of • Non-traumatic fractures
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Anatomy and physiology review o Bones o Muscles • Pathophysiology o Non-Traumatic Fractures (i.e. cancer or osteoporosis) • Assessment o Pain or Tenderness o Swelling o Abnormal or Loss of Movement o Sensation Changes o Circulatory Changes o Deformity • Management o Airway, Ventilation, and Circulation o Splinting o Transport Considerations o Communications and Documentation • Consider Age-Related Variations o Pediatric o Geriatric
AEMT: Same as Previous Level
Paramedic: AEMT Material Plus: Fundamental depth, foundation breadth Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major non-traumatic musculoskeletal disorders • Disorders of the spine • Joint abnormalities • Muscle abnormalities • Overuse syndromes
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Epidemiology Incidence Morbidity/mortality o Anatomy and physiology review Bones Muscles Tendons and ligaments Articulating surfaces—joints, bursa, disc, etc • General assessment findings and symptoms o Pain or tenderness o Swelling o Abnormal or Loss of movement o Sensation changes o Circulatory changes o Deformity • General Management for a patient with a common or major non-traumatic musculoskeletal disorder. o Airway, ventilation, and circulation o Pharmacological o Non-pharmacological o Transport considerations o Psychological/communication strategies • Non-traumatic musculoskeletal conditions o Bony abnormalities (including Osteomyelitis and Tumors) Epidemiology Anatomy, physiology, and pathophysiology Assessment Prehospital Management o Disorders of the spine (including Disc disorders, Low back pain (cauda equine syndrome, sprain, strain) Epidemiology Anatomy, physiology, and pathophysiology Assessment Prehospital Management o Joint abnormalities (including Arthritis (Septic, Gout, Rheumatoid, Osteoarthrosis) and slipped capital femoral epiphysis) Epidemiology Anatomy, physiology, and pathophysiology Assessment Prehospital Management o Muscle abnormalities (Myalgia/myositis, Rhabdomyolsis) Epidemiology Anatomy, physiology, and pathophysiology Assessment Prehospital Management o Overuse syndromes (including Bursitis, Muscle strains, Peripheral nerve syndrome, Carpal tunnel syndrome, Tendonitis) Epidemiology Anatomy, physiology, and pathophysiology Assessment Prehospital Management o Soft tissue infections (Fascitis, Gangrene, Paronychia, Flexor tenosynovitis of the hand) • Consider age-related variations in pediatric and geriatric patients o Pediatric--slipped femoral epiphysis juvenile arthritis o Geriatric—osteoporosis • Patient education and prevention
Diseases of the Eyes, Ears, Nose, and Throat EMR Simple depth, simple breadth Recognition and management of • Nose bleed
• Nosebleed o Causes Trauma Medical o General Assessment Findings and Symptoms Pain or tenderness Bleeding from nose Vomits swallowed blood Can block airway if patient is unresponsive o Techniques to Stop Bleeding in Conscious Patient If No Risk of Spine Injury Sit patient up and lean forward Pinch the nostrils together firmly Tell patient not to sniffle or blow nose
EMT: Same as Previous Level
AEMT: Same as Previous Level
Paramedic: AEMT Material Plus: Fundamental depth, foundational breadth Knowledge of anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, management of • Common or major diseases of the eyes, ears, nose, and throat, including nose bleed
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Introduction o Epidemiology Incidence Morbidity/mortality o Anatomy and physiology review Eye Ear Nasal bones and nasopharynx Mouth, oral cavity, oropharynx, larynx • General assessment findings and symptoms o Pain or tenderness o Swelling o Abnormal or Loss of movement o Sensation changes o Circulatory changes o Deformity o Visual or hearing changes o Airway compromise • General Management o Airway, ventilation, and circulation o Pharmacological o Non-pharmacological o Transport considerations o Psychological/ communication strategies • Diseases of the eyes, ears, nose, and throat. o Definitions, Pathophysiology, epidemiology , mortality and morbidity, and complications o Specific assessment findings and symptoms o Specific management considerations o Conditions Eye Ear Nose o Oropharynx/throat Dentalgia and dental abscess Diseases of oral soft tissue/ Ludwig’s angina Foreign body Epigottitis Laryngitis Tracheitis Oral candidiasis Peritonsillar absess Pharyngitis/tonsillitis Temporomandibular joint disorders • Consider age-related variations in pediatric and geriatric patients o Pediatric--foreign bodies of ears and nose common ear infections common, epiglottis more common in children • Patient education and prevention