Overview
This lecture prepared students for EMT medical skills day, covering core patient assessment, vital signs, medication administration, scene safety, documentation, and hands-on equipment use.
Scene Safety & PPE
- Always start with scene safety: ensure the environment is safe before approaching the patient.
- Use appropriate PPE (gloves, protective glasses, N95 mask) and upgrade as required by the situation.
- Remain aware of hazards such as weapons, animals, environmental dangers, and bystanders.
- Stage until law enforcement secures scenes involving violence or weapons.
Patient Assessment & Vital Signs
- Begin each scenario with BSI (Body Substance Isolation) and scene safety.
- Assess Airway, Breathing, and Circulation (ABCs) first; intervene immediately if issues are present.
- Take baseline vital signs: respiratory rate (12-20 adults), pulse (rate, rhythm, quality), blood pressure, temperature, and check capillary refill.
- Use pulse oximetry (goal: ≥94%, adjust for conditions like COPD) and capnography (normal 35-45 mmHg).
- Always check blood glucose in altered mental status; normal is 80-120 mg/dL.
Lung Sounds & Respiratory Assessment
- Auscultate for abnormal lung sounds:
- Crackles/rales: fluid in lower airways (e.g., pulmonary edema).
- Rhonchi: coarse sounds, upper airways (e.g., pneumonia).
- Wheezing: airway constriction (e.g., asthma, COPD).
- Stridor: upper airway obstruction (common in pediatrics).
- CPAP is used for CHF, COPD with adequate mental status and blood pressure.
EKG & Equipment Use
- Be able to place 4-lead and 12-lead EKGs; transmit 12-leads to the ER if cardiac event is suspected.
- Assemble and use oxygen tanks, nasal cannulas (2-6 L/min), and non-rebreathers (10-15 L/min).
- Use glucometers, thermometers, and airway adjuncts appropriately.
Medication Administration
- Know the Six Rights: right patient, medication, dose, route, time, documentation.
- Nitroglycerin: 0.4 mg SL, up to 3 doses (hold if BP <100 systolic or recent ED meds).
- Aspirin: 324 mg for chest pain, unless bleeding or allergy.
- Oral glucose: 15-30 g for hypoglycemia if airway intact.
- Narcan: 2 mg IN for opioid overdose with respiratory depression.
- Albuterol: 2.5 mg nebulized for wheezing/bronchospasm.
- Epinephrine: 0.3 mg IM for anaphylaxis involving ≥2 systems; reassess after use.
- Activated charcoal rarely used; consult Poison Control for ingestions.
Documentation & Legal Considerations
- Use SOAP or CHART format for patient care reports: thorough documentation is critical for legal protection.
- Always document findings, treatments, changes, and transport decisions.
- Maintain professional conduct at all times, both on scene and in records.
Pediatric & OB Assessment
- Pediatric assessment triangle: appearance, work of breathing, circulation.
- APGAR scores at 1 and 5 minutes for newborns.
- For OB emergencies like prolapsed cord, relieve cord pressure and transport rapidly.
Skills & Testing Process
- Skills days include hands-on practice (oxygen assembly, medication, airway management, assessment).
- Oral boards occur after skills practice and final exam, before clinical internships.
- Clinicals require specified number of adult, geriatric, and pediatric patient contacts.
Key Terms & Definitions
- BSI (Body Substance Isolation) — PPE used to prevent exposure to bodily fluids.
- ABCs — Airway, Breathing, Circulation: the primary focus of initial assessment.
- Capnography — Measurement of exhaled CO₂, normal 35-45 mmHg.
- CPAP — Continuous Positive Airway Pressure to treat respiratory distress.
- APGAR — Newborn assessment scoring for Appearance, Pulse, Grimace, Activity, Respiration.
- SOAP/CHART — Standardized patient documentation formats.
Action Items / Next Steps
- Review medication dosages and indications for EMT scope.
- Practice setting up and using all assessment and oxygen delivery equipment.
- Complete virtual prep and skills days before in-person practice.
- Prepare for oral boards after skills days and final exam.
- Ensure clinical ride requirements are met (20 patient contacts, age group minimums).
- Complete all documentation thoroughly, using provided templates.