Transcript for:
Comprehensive EMT Basics Study Guide

hey everyone my name is Mario Martinez and this is amateur EMS So today we're going to be making a comprehensive study guide over the nrtb so the National Registry for EMT Basics but if you're a civilian that wants to learn a little bit more about EMS if you're taking the aemt National Registry test or the paramedic test this will really help build some Foundation that you may think you know but you actually don't really know now we uh I help tutor a lot of students at times whenever it comes to National Registry test uh helped through different programs through different teaching opportunities and I find that people they get into the nitty-gritty questions and by the way I have to talk into this mic uh they get into the nitty-gritty questions where they start to learn like the little tricky questions like for instance to learn things like kodio ctis or whatever with like the blunt trauma causing the heart to stop that's great to know but hey maybe we need to take a step back maybe we need to learn Vital Signs right maybe we need to learn about our medications what medications you Minister what are your Baseline Vital Signs so I think that people get a little bit too lost into it uh whenever they really need to just need to take a step back build up your foundation have developed strong foundational knowledge and then utilize that for the National Registry so that's what we're here to do today in the description you're going to see that there is a downloadable version of the study guide please click that link it's going to be a Microsoft Word document I'll figure out a way to make it so you guys can view it and write in it and it's going to have some parts filled in some parts not filled in the rationale behind that is that if you see the answer you're just going to think that you know without recognizing hey maybe I don't know the answer uh so instead try to fill it out to the best of your ability I'm going to Tim stamp some of where where some of the answers are at it'll flow pretty nicely once it's all done and I'm going to go kind of down the list there's going to be five main topics for the National Registry and we're going to go over each one of those topics along with some other nitty-gritty stuff and some things where I'm not going to say 100% of the time that's going to be one of your questions but the National Registry does need to ask you these questions so those are freebies if you know it and if you don't know it well then you just lost a point right and sometimes these these students like yourself maybe May score like a 920 a 930 but if they just knew this little bit of information I'm going to give you in these next two to three hours that'll push you over the edge to where you're going to have let's say a 950 a 960 which is the passing score that's all we want right so with that being said special thanks to individuals like Kevin Ramone who played a big part in helping me with pulling up some of this information uh Gabrielle Everett and Robert tiow they both assisted with kind of helping review it and then kind of helping me a tiny bit with revisions so I really appreciate all of your help if you do like this kind of content please consider liking and subscribing also we just created a channel membership if you want your name to be at the end of the video please check it out I have a link below with that being said for Vital Signs what are your Baseline Vital Signs Now for these videos I'm going to have kind of like some way to indicate you should pause the video please pause the video and write what you think your normal ranges for your blood pressure are heart rate all six year main vital signs for aemts and paramedics there's a couple more but we're focusing on the nrtb right now I want you to not just write let's say for students they always make this mistake where I'll ask you what's your normal blood pressure I want you to say it out loud before I tell you the answer pause the video say out out loud what you think the normal range the normal range for your blood pressure is for the top number and the bottom number go ahead say it out loud okay have you done it otherwise you're not going to learn anything if you just wait for the answer okay for blood pressure the normal range is going to be between 100 to 139 on the top number or the systolic number and then for the diastolic number it's going to be less than 100 okay that's how you should memorize it and it's like millimeters per Mercury some students will make the mistake or some instructors will teach individuals that 130 to 139 is not a good blood pressure number that's correct if you're thinking clinically wise where they are potentially prehypertensive but realistically all we care about for the National Registry is are they hypotensive do they have low blood pressure are they hypertensive do they have high blood pressure and anything in between that's technically in the normal range if I gave you a patient that's blood pressure pressure is 120 over 80 and you see this range is that good or bad right and I just want you to say good or bad it's good if somebody's blood pressure is good or bad if they are at 136 over 82 is that good or bad Common Sense you're thinking bad the answer is good why because it falls in the normal range I do not care what and the National Registry does not care what common sense you may use to piece together well it's kind of bad no figure out what's good and bad and then move on figure out what's in the normal range what's not in the normal range and then move on because you can say they're hypotensive well now I know I have to restrict certain drugs they're hypertensive okay I may need to consider these type of techniques but you need to know your ranges and you need to know the maximum and the minimums okay if I tell you somebody's blood pressure is 102 over 64 is that good or bad don't answer ah it's a little low it's a little low I didn't ask that good or bad uh I say it's bad why would you say it's bad the normal ranges here is between 100 to 139 I see students answering that incorrectly all the time the diastolic number is less than 100 we can use some common sense and you can say oh well what is if it's a 40-year-old male patient and they weigh 400 lb and they're 102 over 68 that's not really that good it's within the normal range move on okay I understand your rational there are certain exceptions but the National Registry is not going to trick you that way you may think that it does but trust me they'll make it very obvious whenever someone's hypertensive or hypotensive so that's for blood pressure the next for your heart rate what is the normal range please fill out the rest of that sheet and then once you make your mistakes we're going to go over it together okay and if your instructor says something a little bit different that's fine listen to your instructor they know more than I do your normal heart rate is going to be between 60 to 99 beats per minute now some text or most text will say 60 to 100 beats per minute I don't really like that because that caus the question well what sign is Tac cardia what's a fast heart rate what's 100 to 149 beats per minute but didn't you just say 60 to 100 beats per minute is a normal heart range a lot of text say that just because it makes it more simple we're going to say 60 to 99 beats per minute is the normal heart rate range okay for sbo2 what is the normal range the normal range for spo2 is going to be between 94 to 100% some texts will say 95 to 100% that's fine uh however I've learned recently that they've updated it and changed it to 94 to 100% so let's go over this really quick this concept if a patient patient a has an spo2 at 98% patient B has an spo2 at 96% who has a better spo2 the one at 98% or the one at 96% % I'll give you 5 Seconds to think about it neither one they're both in the normal range who are you to dictate whether somebody's SP2 at 98% is better than somebody at 96% all you have are these ranges that I'm giving to you right now utilize these ranges understand what's good what's bad and then move on if I see somebody sting at 95% fantastic they're profusing perfectly fine at least just just that little bit I don't know the rest of their information but that's what I would be thinking if I saw that SP2 if I saw someone at 100% good right they're profusing at the normal range that's fine and just move on and you really have to break past that okay now for the respiratory rate what is the range for that and you should have already filled out the section by the way again we're just going over the answers now it's going to be between 12 to 24 breads per minute okay if it's less than that that okay they're potentially going towards agonal respirations where it's slow respirations if it's faster than that if let's say we have uh breaths at 30 breaths per minute okay now we're thinking that this patient may be having a panic attack or something or something's going on and they're not going to be able to peruse properly so we need to know that the next Vital sign is our temperature and we're going to say that the normal range is between 96.8 to 9 98.9 de F now the national whenever you have a patient who has an elevated temperature it's not going to say like oh is it 99.2 degrees fenhe it's going to say 101.2 or something it should be very obvious whenever somebody's hypothermic right we're going to see something like a temperature at 95 degrees Fahrenheit it's not going to say 96.4 or something because I usually teach it it's 96.5 to 98.9 just know your ranges 96.8 to 98.9 de F that should carry you through the national for your blood sugar this is a big one the range is going to be between 70 to 120 units okay you need to know that it's going to be between 70 to 120 high blood sugar is bad and and once we get around like let's say 350 units to 400 units plus and it's like okay well now we really need to consider like going to the hospital doing something if somebody's at 140 or so it's not the end of the world any blood sugar below 70 units bad that's bad we need to fix that immediately okay and to fix that we have a medication that we can administer that we're going to go over in a tiny bit that an emtb can administer do you know what it is if you don't you should know what it is before you take the national for this next part we're going to go over nine EMT basic medications that you can consider administering and it should be generally within your scul of practice now one of them we're going to talk about it it's kind of going to the Wayside but it's still is a medication that you should at least be aware of so please pause the video try to fill in as much as you can we're going to go over these medications okay I cannot stress it enough if you do not pause the video and fill this in and then recognize hey I only wrote down one answer oh hey I actually didn't write any answer you're not going to learn to pass the National Registry and I can't be there in person to show all of you to do that so I can only trust that you're going to pause the video here for a moment fill it out and then move forward but okay all right so I'm going to assume that you guys pause the video I sure hope you did but it is up to you the next part right here we're going to start with is aspirin another medication here is nitroglycerin two other ones we're going to talk about is Albuterol and atrient next we have epinephrine but only as an auto injector next we have some more Niche drugs like like Naran nxone we have oral glucose we have activated charcoal which is kind of going towards the Wayside but it's still important to know and then we have Tylenol or a sopin okay so I actually wrote it down in this pattern because it makes it easier to teach right so the first two medications number one we have aspirin here what is it used for well it's utilized for chest pain right so we think of the heart you want to consider administering up to 324 MGR for a patient who's experiencing chest pain but you want to make sure that they're not allergic to salicylates I have a whole video going more into depth on medications but just know the general idea of why you consider administering this medication for nitroglycerin we are considering it the next medication here is nitroglycerin it is utilized for patients who have chest pain but there are contraindications for it please pause the video and I want you to think and go ahead and say what are the contraindications for nitroglycerin think about it please pause the video okay I'm going to trust that you did it the answer is hypotension and Ed medications in the last 24 hours or erectile dysfunction medications some of them include things such as uh Viagra sedil Calis some say tadalfil I think is one of them now whenever I checked the National Registry I had a patient who had chest pain they had a normal blood pressure let's say it was 114 over 74 so it checks off one of the two main contraindications for nitroglycerin but if I looked at the medication list whenever I was going to consider administering let's say aspirin along with nitroglycerin I noticed that the patient does take sedil so I didn't choose that answer and I end up passing the National Registry afterwards along with like some more questions I think I had like 70 or 68 questions or so but watch out for nitroglycerin you can kill somebody if you end up administering it incorrectly the next three have to do with the airway abon atrain you would think think of that whenever you think of a patient who has asthma sometimes later on after you save somebody who has anaphylaxis later down the line you can also consider administering Abol if they have Broncho constriction if they have trouble breathing if they're having wheezing if they have an asthma attack so for Albuterol and atrient the dosing is going to be 2.5 milligrams per 3 MLS for Albuterol for atrient it's going to be 0.5 mg per 3 MLS that just means that there's a powder and you mix saline with it it creates a liquid and you can administer it via what route how do you administer AOL or atrient to a patient what Airway device do you use please pause the video think about it for a moment and then continue it afterwards well the airway device that you can utilize is called a nebulizer and what setting can we set a nebulizer at pause the video again think about it and if you don't know the answer I'm about to tell you it the answer to that is going to be at 6 to 8 per minute this azes the medication and creates a fine Mist remember you need to pause this video whenever I tell you to otherwise you're not going to properly test yourself and you're going to think you know this when you actually don't um more than likely the next medication also for a atrient I talk about in my medication tier list or my medication video but atrient sometimes the mixture contains peanut mix I don't know why so if you're trying to help somebody with breathing problems why don't you always just use alol it depends on your protocol CA but check allergies epinephrine you have access to epinephrine and auto injector you generally the epinephrine Auto injectors are going to be3 Mig for an adult and 0.15 Mig for a pediatric patient some agencies will ask you to draw up and mix the medication or really just drop the medication and if that's the case for an adult patient it's. 3 milligrams and for a pediatric patient it's 01 Mig per kilogram but it's going to depend on where you work at at the same time you want to make sure that you are picking the Epi the 1: one or the 1 to 1,000 mix you don't want to do the Epi 1 to 10,000 that is for cardiac arrest that's a whole different medication it's epinephrine but it's diluted more in a different concentration we want to give the straight concentrate whenever we're dealing with anaphylaxis what are some signs and symptoms of anaphylaxis we can see hives but the National Registry is not going to tell you hives it's going to tell you ticaria it's u r t i c a r i a and it's at the bottom of this whole study guide as names or definitions that you need to know you need to understand the National Registry is not going to tell you your patient that's highes they're going to say they have ticaria and you need to be able to identify that or you're going to miss a free question the next one here is Naran or nxone you can administer that via inasal through a mucosal atomizer device also known as a mad device what is Naran or nxone used for it is used for a patient who's experiencing an opioid overdose and how can we tell if somebody is experiencing an opioid overdose well we can look at their eyes now are their pupils going to be constricted oh constricted or are they going to be dilated which one are they going to be if I go up to a patient they're unconscious they're having slow respiration so we need to fix that to uh help them profuse better what style of their pupil is it going to appear as is it going to be dilated or constricted is going to be wide or small well it's going to be constricted that's because for the pupils the way I like to think of it is whenever you take an upper you're going to you want to see everything right you want to visualize everything there's not much we can do for these type of patients except for transporting them to the nearest hospital and trying to keep them calm and comfortable their blood pressure is probably going to be elevated too their heart rate's going to be elevated but for a patient that's eligible for Narin nxone they're going to be going through an opioid over dose and their pups are going to be really small they're not really visualizing anything They Don't Really Care on what's going on and I have a list of opioids that people can overdose on at the bottom of this list or the bottom of the study guide I highly suggest you review and study over it the National Registry is not going to tell you somebody's suffering through an opioid overdose what do you do they're going to give you their pupil size and they may give you a medication that they took like hydrocodone or traod dool or something and you need to be able to identify through the skills that you've obtained the next medic it's oral glucose what is that used for well oral glucose is used for a patient who's hypoglycemic and if we remember our ranges that's going to be between 70 to 120 units right so if they're hypoglycemic it's going to be below 70 that's our normal range so if somebody has uh blood sugar at 69 they're considered hypoglycemic if it's at 40 they are considered hypoglycemic we need to raise that up that could be the reason why they're having this medical emergency so one of your medications is oral glucose that's fantastic but there's some big contraindications for it now your instructor may say differently but please listen to what I'm going to say here the biggest contraindication is the patient needs to be able to protect their own Airway and they need to be a and o * 4 alert and oriented times 4 they need to know their person place time and event some medics were taught differently where if a patient's unconscious you can get it the oral glucose on your fingertip and rub it against their cheek stop that stop thinking that that's correct you are missing a question get that out of your head that is detrimental to your success in EMS career how does that make any sense you're going to tell me that you have a semiconscious patient you're going to put some oral glucose on your fingertip and rub the inside of their cheek so it can slowly absorb you're going to R first first off the patient aspirating you're also going to risk them potentially biting your fingers no what do you need to do instead you need to request ALS intercept request ALS intercept and a paramedic such as myself can show up on the scene you can be say hey thanks for not potentially choking the patient with oral glucose I'll take it from here and I can administer a drug via IM or intramuscularly IV or intra osus if I need to access uh in some way to get their blood sugar up do not administer a patient with oral glucose if they have any signs of an alter mental status if they are not a No Time 4 and if they can't protect their own Airway a lot of people mess that up because they think of the fingertip past thing where they can rub it on the side of the cheeks don't do that why are you risking killing your patient for virtually nothing okay please do not do that the next medication is activated charcoal Sometimes some ambulances carry it some some of them don't it's kind of going towards the Wayside but the whole thought process is your patient has to have paint in Airway they have to be able to swallow they have to be a no times 4 because it's the same thing we're administering a paste it's a tube and it's if somebody took any type of pills or something and it's still within their system if they try to overdose on pills if they if it's like a child or something or if it's someone who let's say they took a bottle of aspirin and they took like the whole 30 pills well what we can do is we can administer activated charcoal it'll coat the mouth it'll coat coat the esophagus it'll coat the stomach lining and it'll surround the pills and it'll stop the body from digesting them anymore this is kind of a time limit on activated charcoal like if it's already digested well it's too late just goes to to the hospital but for activated charcoal it can coat the medication coat the things that can surround it and can keep the patient from further absorb absorbing the medication to cause the toxicity effect a side effect that may happen is that patients may have potentially tried to overdose in the past and so whenever you administer the activated charcoal they may dislike it it tastes nasty it feels nasty and they may puke while we don't want our patients to puke if they're AO Time 4 and they're able to somewhat protect their own Airway if they're puking they're kind of removing some of the contents that we want to remove anyway so it's not the end of the world contact Poison Control you should have poison controls number and if I'm smart I will link it or I will put it right here and I will type out poison controls number you should have that saved into your contact list that'll make you a better emtb or a better Medic or a Mt just a better person in general for medical emergencies blah blah blah the final medication is Tylenol or a camenen some agencies allow you to administer it as an emtb some actually wait for paramedics to administer it why do we use this medication is for a patient who has an elevated fever and we try to bring that fever down normally it's if a patient has a temperature at 101 degrees 102 degrees you can try administering cold packs you can remove excessive clothing and you can consider administering Tylenol or cenin the nurses will love you if you administer it before you go to the hospital vice versa they will not like you if you did not administer it however if your patient has an alter mental status this is usually a medication and for your case where you administer it via the mouth so if they have an altered mental status at all they can't protect their own Airway we cannot administer these three medications okay now as an EMT basic what are four different Airway devices that you can use utilize go ahead and think about it so I'm going to assume that you pause the video we're going to go ahead and start with our first one and that's going to be a nasal canula and this is going to be set between 2 to 6 L per minute the next one that we have is going to be a non-rebreather we have a non-rebreather mask that's set between 10 to 15 lers per minute the airway device afterwards is a nebulizer and that is set between 6 to8 8 L per minute that way it can aeriz the medication that you can utilize with it the last one is a bag valve mask and you're going to set that at 15 L per minute now we have these four different devices there's some things that we need to think about first for a nasal canula when do we use that device over these other three devices well if a patient in my personal opinion is sing between 93% to 88% then I'm going to go ahead and use a nasal canula on them and I'll set it between between 2 to 6 L per minute they need to be conscious their respiratory rate needs to be in the normal range they need to be able to control their breathing their oxygen level just needs to be a little bit low then I use a nasal canula they need to be alert and oriented Time 4 next if somebody's spo2 is between I would say usually 70 to 88% around there so 70 to 87% then I'm going to go ahead and say you know what an exoc Canal is going to do it there's still alert and oriented times 4 the respiratory rate is still good it's between 12 to 24 breaths per minute let's go ahead and use a non-rebreather mask so I'll attach it on them and I'll go from either 10 L per minute up to 15 L per minute depending on how bad it is there are occasions where a patient may have a slightly lower SP2 and then we can still consider a nonre breather but really the key term here is that they're alert and oriented times 4 but their sb2 is getting a little too low so we're going to use a non breather mask the next one here is a nebulizer and a nebulizer is set between 6 to 8 lers per minute and we can utilize it with two medications do you remember what those medications are it is for Albuterol and atrovent also known as AEP Tropi bromide and those medications need to be aerosolized at 6 to 8 L per minute it's usually used for asthmatic patients uh patients that are wheezing that have some bronchial constriction and we want to cause Bronco dilation where it opens up the last one is a back valve mask we want to use this device at 15 l per minute and this is for somebody who can't control their own Airway who needs assistance they need us to ventilate for them usually these are unconscious patients is just generally a good way to think about it if you're working a call let's say at least on the nrmt if they're unconscious more than likely if you're choosing an airway device it's going to be a back valve mask their respirations generally are going to be low they're going to be below 12 so around like 10 8 Le I mean eight breaths per minute that's going to be agonal respirations at that point let's go ahead and start bagging for them they're spo2 I would assume it' be 93% or lower and the respiratory rate is low it can potentially be high at 30 breaths per minute and then you might may need to ventilate somebody but that's more so if they have an altered mental status as well so we have our four different Airway devices we have a reasoning behind it or the reasoning behind why we would administer one of the other so nature can non breather it's usually for ano Time 4 people who can protect their own Airway who are breathing or they're respire respirating fine but their sbo2 is getting lower and lower nebulizer same thing they're * 4 but we're worried about wheezing asthma patients a bag valve mask they're unconscious they're not able to control their own uh breathing so we're going to go ahead and ventilate for them they usually have low respirations low spo2 that's why we consider that okay so we got through some of the tricky parts now we're going to move on to our first section and I'm just going to kind of read these off but feel free to go ahead and Skip ahead to the questions parts that I don't have filled in yet but we have the head tilt chin method versus the jaw thrust method why do we use either one well we use the head tilt chin lift method whenever we have a patient who needs to open we need to open up their Airway but they were not in a trauma the big thing here is trauma okay if we suspect a trauma though while maintaining SE spine but we need to open up their Airway because they're not breathing properly or we can't ventilate them properly with the BVM then we can use a jaw thrust to pop open their jaw without messing with the spine with the neck right so head tilt chin lift look at how I'm inating my spine here or my neck whenever I tilt the CH uh the head back and the chin but with the jaw thrust you see how my head isn't moving at all I'm not going to pop out my jaw but that's what you can do there's no movement in my spine here and that's because we want to use the jaw thrust method on a patient with a spinal injury or a trauma one thing know for air how much oxygen is inside of air well it's actually about 21% so usually the way to think about it is air is one part oxygen four parts nitrogen and just a little bit of something else another thing you may want to know is that air has approximately 21% of oxygen another topic to discuss is capillary refill so if a patient is potentially not profusing properly one of the first things to go is their upper and lower extremities specifically the fingers you're going to see some cyanosis some bluing these areas bluing of the lips or cyanosis of the lips what you can do is you can actually check the profusion by performing capillary refill where we go and we squeeze the fingertip and we release it and it should turn whitish or whatever color and then go back to its normal color if it takes less than two seconds that's considered a good capillary refill and it's one of the ways that we can check somebody's profusion quickly but if it takes longer than 2 seconds then we can say okay this patient may not be profusing properly at least to this limb or maybe to both upper limbs maybe they were in shock and maybe they lost some blood volume and now the body's focusing on perfusing the other major organs and not so much the upper and lower extremities because those usually go first for the formula Co equals SV * HR or cardiac output equals stroke volume time heart rate do I ever use that on an actual call no do you need to know it for the national yes because the national only has a select pool to reach from for the Cardiology section or the airway section and did something that they asked me they were like in Co equals SV * HR what does the SV stand for uh stroke volume or what does Co stand for uh cardiac output you need to learn this for the national after you finish the national do you need to know this formula I have never used it I have never found a reason for it another important formula is minute volume equals tital volume times respiratory rate it's something that I didn't have during my national but it may be another formula that you want to consider and these are all notes that you can uh visualize on one of your pages so on this next section you can see we went more into detail about the BVM versus non breather I might actually change this up Mario remember change this up now when someone has a facial trauma and a suspected basilar skull fracture what Airway device is contraindicated you think about a facial trauma and two other Airway devices that we haven't really talked about yet is an Opa where you insert inserted in the mount the oral Fingal device and the NPA which is a nasal Fingal device or a nasal V fenal Airway adjunct so you can either stick it uh an Opa in the mouth or an NPA in the nose so if somebody has a facial trauma with a suspected basil skull fracture what Airway device is contraindicated well it would be a NPA or a nasopen Airway device so when suctioning a patient how long would suction for an adult or a child some text Will kind of vary on this go ahead and pause the video write out your guess and then we'll go over it together well the answer is for adult patients it's a 15 seconds at the max where you insert the suction uh tubing like a Yonker tip you insert it in you press down to start uh the suction and then while you're pulling up slowly you can spend up to a maximum of 15 seconds for an adult for a pediatric patient it's up to 10 seconds against Max so it's important that you know those two distinctions if someone has snoring respirations what can you suspect may be in the way it's the tongue so you may need to manipulate their Airway you may need to insert an Opa to maneuver the tongue out of the way what is paradoxical motion mean in the chest well it means when one side of the chest Rises while the other one Falls this is usually indicated for something like a flow chest segment where someone got into a trauma part of their rib cage broke and so you'll see this chest Rising while this one is staying flat and then vice versa it's a flail chest segment if you osculate somebody's lung sounds and you can only hear breathing from one side of their lungs and let's just say they were in trauma right so I can listen to this side I can hear air flow I listen to this side I can't hear anything I listen to this side I can hear air flow this side I can't hear anything what could you suspect is going on it's potentially a pneumothorax and you need to request aless intercept because they can do something about it you really can is an EMT basic if you go into a household and somebody has cherry red skin right they call they're feeling a little dizzy maybe they have a headache maybe they even vomited they don't know what's going on maybe it was cold outside and inside their house so they turn on a gas stove what should you suspect it's carbon monoxide poisoning most likely you need to get that patient yourself and get out of that house otherwise you're going to start feeling the effects and if you check a pulseox on a patient because carbon monoxide side it takes over the molecules of heem or the iron molecules in the body because unlike oxygen carbon monoxide acts pretty much the same way but it binds 200 times more effective than oxygen will to your uh molecules of heem that go throughout your body your molecules will still present with the carbon monoxide so that's why they have the cherry red skin that's why if you put aulo on them it'll say oh they're sting at 98% but if you look at your patient you'll say no I don't think they're breathing properly go ahead and put them on high flow O2 head over to the hospital they're going to need to take care of that maybe through a hyperbaric chamber you need to know two very important respiratory issues for children the first one is cro it's a viral infection and you need to know that it's noted by a seal bark-like cough and the other one is epiglottitis it's caused by a bacterial infection a very obvious symptom is the child will be sitting down they kind of be leaning forward a little bit in their chair and they'll be drooling they'll be drooling everywhere be extremely careful with these patients be careful getting with blood pressure or pul Sox if it starts to irritate them take all of that off you want to keep the kid in a position of comfort preferably with their parent too and set them up on the stretcher secure them on the stretcher and head code one to the hospital but very carefully you don't want to irritate this kid I would not recommend starting an IV because they epiglottis is swollen and if you irritate them and start to cause them to Panic by getting an IV or chicking Vital Signs potentially their Airway will completely seal up and it'll close and you won't be able to open it again and it'll go into an even more extreme respiratory like failure where they'll go into respiratory arrest shortly after so be very careful with epiglottitis you need to know which one's viral and bacterial epiglottitis being bacterial crout being uh viral and you need to know the Hallmark signs again drooling you see a child they drooling epiglottitis that should EAS that should be easy lock the same thing for C seal bark like cough that's C the tripod position as I talked about earlier if you have a question and it mentions the patient is in a tripod position it's whenever they're sitting and they're kind of leaning forward a little bit and they're trying to catch their breath that's a tripod position if you see a patient and they're sitting down you got called over to them they may have an alter mental status and you assess them and you see that they're taking deep deep rapid desperate uh respirations or they're like they're taking deep rapid respirations what do you think could be going on well if they're diabetic they may be experiencing kousal respirations where the body's trying to offload all the excessive CO2 and trying to regulate the pH that's a phenomenon known as kusma respirations now are these patients that are experiencing kusma respirations hyperglycemic or hypoglycemic well these patients are hyperglycemic because again again they're experiencing T diabetic keto acidosis and extremely high blood sugar it's causing all this acid to build up it's causing the CO2 to build up and that's they're trying to regulate their pH balance by offloading excessive CO2 stabilizing their pH okay for this next section we're going to be going over Cardiology and resuscitation which is one of the five major categories for the National Registry test so we need to know first how to trace a drop of blood all of this is nice to know but realistically they're really going to try to trip you up on asking about pulmonary arteries versus pulmonary veins as since they have a distinguishing Factor unlike other arteries and veins in the body so we first start off at the Supra Vena and the infra Vena this dumps blood into the right atrium I like to draw my heart like a box if you've seen in past videos I highly recommend checking out the EKG series and it dumps deoxygenated blood to the right atrium which pushes blood from the right atrium through the tricuspid into the right ventricle the right ventricle then pushes blood whenever it squeezes from the right ventricle towards the lungs and it does this by transporting it through pulmonary arteries this is pulmonary arteries are the only arteries that transport deoxygenated blood throughout the body it because if you think about it arteries move blood away from the the heart veins bring blood toward the heart now normally what happens is as blood pushes from my heart over to let's say my right arm it'll push oxygenated blood to my right arm through my arteries then once it per perfuses this and it obtains CO2 or carbon dioxide it'll come back to my heart with veins that's because arteries take blood away from the heart veins bring blood toward the heart that's how you should remember all arteries and veins that makes pulmonary arteries and pulmonary veins make sense because a pulmonary artery is taking blood away from the heart towards the lungs even though it's carrying deoxygenated blood so a lot of students mess up on that do not forget that from there it takes deoxygenated blood it transfers throughout the alvioli does gas exchange where it'll release its CO2 obtain O2 so it'll go from deoxygenated to oxygenated blood it'll go to the left atrium which then goes through the bicuspid valve I remember it because tricuspid and bicuspid valve try before you buy also known as the bicuspid valve or the Metro valve which goes to the left ventricle which then has a lot more muscular tissue than the right ventricle because instead of pushing to the lungs it pushes all the way to the upper and lower extremities so it'll give a good squeeze and then it'll profuse all the way up to the upper and lower extremity so it's got to go pretty far away through the arteries the arterials to the capillaries where it CH exchanges oxygen molecules for CO2 within tissue and then the process repeats all over again and I have it colorcoded on the word document if you are transporting a patient and they go into cardiac arrest what do you need to do first if I'm if your partner's driving and you're in the back in the box with the patient and all of a sudden they go unconscious and they you feel for a pulse no pulse no breathing what do you do first what you need to do first is tell your partner hey pull over once they're pulling over then you can start CPR if the national gives you two options it says to either pull over or start CPR pull over first it's like as if you are somebody who certified in BLS right or basic life support and somebody codes right in front of you the first thing you need to do is you need to say hey call for 911 activate the emergency response system then you work on compressions it's the same thing or the same idea you need help you can't run an entire code by yourself that'd be ridiculous if you're doing compressions on a patient and you apply the AED on them the AED says that it's going to shock the patients it's going to start charging you're still doing CPR and then you shock the patient what do you do next well what you're supposed supposed to do next is you're supposed to immediately start back over on compressions you don't check for a rhythm at that time you don't check for a pulse check you just start straight away with compressions that gets a lot of students so make sure as soon as you deliver a shock with the AED you go straight into compressions whenever you're doing compressions while getting good dep is a good idea or going deep enough on a patient and we'll go over the ranges with that in a little bit it's also extremely important to pull back against the heart right so we push push push we don't stay in a shallow range we want to make sure we get a good push and then we pull back at the same time that's because we want the heart to refill by recoiling with our chest compressions okay now for a chest pain call what are some medications that an emtb can consider administering uh for these patients well I'm going to go ahead and give you guys a moment pause the video the medications that you can consider administering are aspirin nitroglycerin and oxygen so you you do have to remember if they're allergic to salicylates or aspirin you can't administer aspirin if they have hypotension or if they've taken erectile dysfunction medication the last 24 hours and you need to know which ones they are they're going to be at the bottom the very bottom of the study guide then you cannot administer nitroglycerin what is the range for a hypotension uh patient it's whenever their blood pressure for their cic number is below 100 units and you can also consider administering oxygen now congestive heart failure is where fluid builds up in the lungs and it may be caused by left-sided heart failur so if you see left-sided heart failure then you should consider that they may have fluid in their lungs or congestive heart failure pedal edema is where fluid builds up in the lower extremity and that may be caused by right-sided heart failure so if you look back at our heart over here and I know it's a pretty bad drawing what we can see here is that the lungs feed oxygenated blood to the left atrium so if you have left-sided heart failure then the blood's going to get back back up into the lungs and cause pulmonary edema if the right atrium the inferior vena due to gravity is pulled from deoxygenated blood from the veins of the lower extremity specifically back to the right atrium if somebody has right-sided heart failure and it's not pumping properly they make it a fluid buildup back back in the lower extremities known as pedal edema another important thing to note you have the sympathetic and the parasympathetic nervous system the sympathetic nervous system is what we use for our fight or flight system so it's like if somebody were to punch me or something I wake up right I would lose my wanting or desire for like digestion for my bowel movements things like that my heart rate would increase and more so just be active waking up but if I'm at home if I'm relaxing I go more into my parasympathetic nervous system what is a drug that a patient can take that can cause them to go into a sympathetic nervous system response it's an upper right but some downers for instance is like hydrocodone Tramadol they're opioids and there's other ones listed below in the study guide those can trigger the parasympathetic nervous system or the parasympathetic response where along with a bunch of other things their pupils will become constricted while in the sympathetic nervous system your pupils will dilate right and whenever this happens we can consider administering an EMT basic drug which drug can we consider administering well we can consider administering Narcan or Noone for a heartbeat sometimes instructors will talk about it that there are four sounds S1 S2 S3 and S4 realistically you just need to know what S1 and S2 stand for S1 is the love noise when the atrio ventricular valve closes and S2 is the dub noise when the semi lunar valve closes S3 and S F4 are more so just abnormal sounds that we aren't really going to talk about right now now what death do you want in compressions for an adult patient and for a child or an infant patient whenever it comes to compressions well for an adult we want to go about 2 to three inches in depth and for a child or an infant we want to go oneir the depth of their chest you want to aim for 100 to 120 compressions a minute and if you're doing CPR by yourself what rate should you do it at regardless of the patient's age should do it at a rate of 30 to two where you do 30 compressions and two ventilations so you do 30 compressions and you pull out your back Val mask it's hooked up at 15 lers per minute then you do two breaths 30 compressions two breaths and keep on cycling till the a tells you that it's ready to shock the patient or it needs to inspect the Rhythm if and only if you have a partner with you and you have an infant so it's a two rescuer CPR attempt then you can Implement a different ratio for compressions versus ventilations what is that ratio I'll give you guys a second and then I'll give you the answer well it's going to be 15 compressions to two ventilations if you're placing the AED on a patient and you notice that they have an implanted a device or they have a pacemaker uh device where do you want to place the ad pads well you want to move it just a couple inches away you put want to put it in the general same spot but just watch out for any mechanical tools that you see implanted in the patient simply just go around them you don't want to place them directly on top also if somebody has any patches or something like any type of medication patches go ahead and remove those before applying the AED as well if somebody's pulled out of a pool prior to placing the AED what do we want to consider to do first well we want to consider drying them off first because if we apply the pads it may not attach properly to a patient if they're slippery free and wet and who knows what abnormalities can cause a conduction to uh to occur if they're wet so we want to try to dry them off as best as possible and then go ahead and apply the pads when we get a pulse back during a CPR called what is this called I'm going to give you guys a moment to think about it go ahead and pause the video try to give you me your best answer give you like 5 Seconds well it is called Ros or return of spontaneous circulation if we shock someone with the a what's the very next thing we do we already talked about it we want to start see PR again for 2 minutes right and we want to do our compressions where we do 30 compressions two breaths when do we change that up whenever we have two Rescuers and it's an infant then we can do 15 compressions two breaths next up we have the in my opinion the biggest section medical Obstetrics and Gynecology this is the part that I struggle the most with whenever I took the national I felt it twice before I pass it the third time on my nrtb then I passed my paramedic on the first try so there are three types of Strokes there are es schic Strokes there are transient esic attack strokes and there are hemorrhagic Strokes four esic strokes so whenever a clot is in the brain where the arteries are at that peruse it and it Blocks part of the brain from getting profused that's an es schic stroke esic meaning a lack of oxygen a transient esic stroke is the exact same thing but over time in less than 24 hours the clot dissipates on its own and the Brain starts to reuse and there's no long-term effects on the patient we should never expect a transient eseicinquantasei swelling where you're compressing the brain more and more and cutting off the circulation to the brain intracranial pressure is going to rise so a huge Hallmark is an increased blood pressure when it comes to hemorrhagic Strokes you need to know this you need to know if a patient is having stroke like symptoms and their blood pressure it's not just high it's like almost like 200 over 108 or something like their blood pressure is increasing like crazy to like in the 200 range usually or like 190 that whenever you read that on the test you should be able to say you know what that's probably hemorrhagic stroke and then choose that as your option of course they also need to have unilateral weakness right so normally what happens in the brain is let's say on the right side of their face on the right side of their brain they have something that's causing a lack of oxygen to the brain it causes the right side of their face to appear weak they could be talking like this with the right side kind of sagging while the left is uptight for the mouth you could see that their eye isn't blinking as much on the right as it is on the left you can determine that doing a different type of stroke exam but on the right side of the face it's like that but on the left arm it's not moving the left leg isn't moving but the right arm still has regular motion the right leg has regular motion you can check to see their coordination are they lifting up this arm at all their leg are they moving it at all check for pulse motor sensation is it equal on both sides and that can help you determine whether they're having a stroke or not now we can't tell besides the hypertension or the high blood pressure what type of stroke the patient may be happening and that's only like somewhat a decent way to guess if it's a hemorrhagic stroke versus an es schic stroke it's really the blood pressure if it's incredibly elevated I'm talking 190s 200s plus we should think that it's a hemorrhagic stroke for these type of patients we want to figure out what they're like when they're normal we want to find out any deficits and then we want to go quickly to the hospital we want to go code three to the hospital now for a stroke patient we can utilize three different stroke exams we can check a Cincinnati Stroke Scale we can check a fast stroke assessment and we can check a van assessment I do a mixture of all three of them you can look on the word document that you should have opened up by now and that gives you more of an idea of what we're looking for whenever we check those Different Stroke exams but they have generally hemiparesis again which is weakness on one side of the body right so if it says left-sided brain weak uh stroke then we would see left-sided facial weakness and we'd see them having weakness in their right arm so it' be like left-sided facial weakness we can see that they're not moving their right arm their right leg they're kind of dragging it around or they're just unconscious and they're moving their left arm their left leg fairly normally for these patients we want to get them to the hospital as fast as possible but make sure you are on scene Gathering the necessary pertinent information otherwise if you bring a patient to the hospital and the ER physician or the nurses say when were they last seem normal if you can't answer that if you can't answer how they're like when they're normal also then you have just made this problem 10 times worse instead of spending an extra minute or two on scene Gathering info you also need to say figure out from the family or whoever called name one in the first place hey how are they like normally do they have are they able to walk just fine are they able to talk just fine do they actually have some neurological deficits from a previous stroke we need to know that are they on any blood thinners these are all good questions to ask if somebody has stroke symptoms that were less than 3 to 4.5 hours when they arrive at the ER depending on the ER that you bring them to they need to have access to a CT scan they may be eligible for thrombotic drugs to break up the clot as long as there's no evidence of a hemorrhagic stroke and this can potentially reperfuse the area of the brain to where they're not going to have any long-term effects but that's always the goal if someone is having a seizure as an EMT basic what should you do if somebody's seizing on the the floor what should you do pause the video write out your answer we're going to see if you got a right or wrong and I'll give you the right answer so somebody's seizing on the floor pause the video okay so the answer is you want to request ALS intercept you do not have a medication to help with sedating the patient instead just kind of clear the area around them you don't want to try to put something in their mouth that's an outdated thing that we don't uh want to do anymore and we want to make sure that we just protect our patient move stuff around from them and request Al intercept where they can administer a sedative to a patient so in this next section we talk more so about like hyperglycemia versus hypoglycemia we already discussed that earlier though I just leave it there just in case you want some more information one really big thing though is we want to be able to check if somebody is a and o times4 so if they are alert to their person place time and event we need you to know that if they're not AO Time 4 and let's say somebody's hypoglycemic and you want to consider administering oral glucose or raising up their blood sugar you can't do that because you'll potentially cause them to aspirate so what do you need to do instead if you can't administer oral glucose and you're an EMT basic give you a moment to think about it pause the video well you need to request ALS intercept if you give these patients oral glucose they can potentially choke on it and pass away and you cause a hypoglycemic patient to become a choking patient to where a patient could potentially pass away now for the abdomen it is cut into four different sections you need to know that there is the right upper quadrant the left upper quadrant the right lower quadrant and the left lower quadrant there are important organs in each one of these but realistically if you're taking the National Registry there are some key uh organs that you need to know about for instance somebody's having right lower quadrant abdominal pain what do we think is potentially going on they may be suffering from appendicite that's a huge test question if you see right lower quadrant in your head you should be like ding ding ding it's probably a pentis that's going on if somebody has left upper quadrant abdominal pain and they have shoulder pain what are we thinking may be occurring they may have some type of spleen injury so you should suspect that the spleen may be involved in some way that is a huge test question somebody messaged me just recently and they said Mario I remember whenever you're tutoring me going over the National Registry you War me about this that's literally what popped up on the on the registry so be wary when palpating the abdomen as well let's say somebody goes up to me and they say hey oh I have right lower quadrant abdominal pain and of course we're thinking okay maybe they have appendicitis well we need to palpate the abdomen to see if there's pain anywhere else do we start by palpating the right lower quadrant or do we palpate somewhere else where should we go I'll give you a second to think about it and then I'll tell you the answer the answer is the left upper quadrant so we want to start with the opposite side of whatever is affected so if the right lower quadrant is affected we're going to palpate the left upper quadrant and then from there we can go to the left lower quadrant or the right lower quadrant it doesn't matter we'll go to vice versa and then we'll P palate the right lower quadrant last because if somebody has pain let's say it's a 10 out of 10 we think it may be appendicitis and we start on the right lower quadrant they're going to bend down they're going to start guarding the area they're not going to let you touch them anymore and now you've lost out on assessing the other three qu of the abdomen if somebody or some text it says that a patient has a tearing sensation in their abdomen that radiates to their back what should you consider that they're experiencing I'll give you a moment pause the video give yourself 10 15 seconds try to write out an answer what do you think it is a tearing sensation in the abdomen it's extremely obvious if you've done any of these questions before it is a triple A or an abdominal aortic and ISM you need to go CO3 to the nearest appropriate trauma facility because if they're having this they can potentially pass away quickly they may also feel a pulsating mass in their abdomen but the tearing is the most important part do you see a tearing sensation in their abdomen as soon as you see the word tearing you should be this is probably a AAA this is probably an abdominal aortic aneurysm I need to go to the hospital immediately if somebody has a stiff neck they have fever a headache what should you suspect that they potentially are suffering from especially if it's a child stiff neck fever headache the key term here is stiff neck what do you think it is well it's going to be menitis you should suspect menitis for this even if it's not the case that's always something we want to Ru out first if somebody has hepatitis C or some form of liver failure what will you generally be looking for you're going to be looking for jaundice yellowing of the skin yellowing of the white of the eye known as the Scara if somebody starts coughing up bloody sputum or pink frothy sputum what should you expect that they're going to have this is a huge test question by the way it's extremely important that you know this the national should ask you this because it's dangerous for you to not know it it is tuberculosis if you see this back away and apply or wear proper PPE use facial equipment goggles wear a tiic suit if you have it some type of actual gown you want to be extremely careful it's very contagious if somebody's suffering through excited delirium it's where they become an extremely erratic maybe like a schizophrenic or behavioral disorder kind of state where not only are they like irrational uh but or in like a frenzy bizarre behavior but they're potentially going to hurt themselves as long as others what do you need to do give you a second to think about that what are you going to do for a patient that's acting a rate like this what do you need a request you need to request ALS intercept this patient requires a sedative that you cannot administer as an EMT basic for heat related emergencies there's two main types that you need to worry about technically there's three if you count heat cramps there is heat exhaustion where the patient is still able to sweat while the body trying to cool itself off but still you need to pull them out of the environment either way try to pull them down and then there's heat stroke the patient is no longer able to sweat an altered mental status may occur as as well as hypotension if somebody's experiencing these type of emergencies we try to pull them out of the environment remove excess clothing potentially consider cool packs but get them into an AC regulated medic unit you need to know the difference between heat exhaustion versus heat stroke heat exhaustion they can sweat heat stroke they no longer can sweat that's a big thing if you pull somebody out of a uh pool or a body of water and they were potentially drowning but now they saying that they're okay they don't want to go to the hospital what should you do next well you should highly encourage them to go to the hospital they can potentially have second near drowning I think it's called second drowning or something like that or near drowning where they could still have fluid accumulated around the lungs and whenever they lay down and try to go to bed they may actually start to drown again while they're above water and they could pass away that way also at the same time they became exposed to all that bacteria in their lungs that they normally should have be and you may end up dealing with the a very severe case of pneumonia so you need to encourage these people to go to the hospital to the best of your ability first snake bites if somebody's bitten by a potential poisonous snake and let's say it's right here on their forearm what do we need to do we need to keep their arm below where their heart is at you don't want to elevate it because you're letting gravity push the poison down you do not apply ice to the snake bites that's because you don't want to cause tissue necrosis to the area you don't want to use a tourniquet above here you're just going to cause more harm than good to like for stopping the spread of the Venom do not apply a tourit you want to circle the affected area but that's literally all you're going to do and keep the arm down away from the heart but you're going to keep it below the level of the heart you need to know this some but not all ticks can transmit Rocky mounted Spotted Fever causing nausea vomiting headaches weakness and paralysis 7 to 10 days after the individual is bitten or lime disease which can occur days to weeks after the bite causing joint pain and a ring around the bite you need to know this the national likes to put in some filler questions this is a great one where somebody was out in the field maybe like two weeks ago now they're experiencing fever nausea vomiting what do you think may have happened they were in that key term is like Tall Grass they're exposed to tall grass right then you should think oh man maybe they got bitten by a tick they need to go to the hospital focusing more so on OB or obstetrics you need to know how para and gravita or gravita and para what are those terms well for gravita it's how many times a patient has been pregnant for para it's how many times a patient has given birth for instance if a female patient has been pregnant three times and has one child you would say that the female patient has three gravada and one parody or one para extremely important that you need to know that the national definitely will want to ask you that kind of question everything I've said so far it's great you need to know this before you take the national if somebody is experiencing placenta Privia it's described after 20 weeks of pregnancy where the placenta is formed at a normal location you need to know the signs and symptoms for these next two it's extremely important for placenta Privia they're going to be experiencing painless bright red vaginal bleeding it's painless they're going to have bright red vaginal bleeding after after 20 weeks of pregnancy you need to know that that's placenta Privia there's no excuse the other one abruptio placenta when the placenta separates itself from the uterine wall it's usually found in traumas you'd be looking for a painful abdomen with vaginal bleeding okay this is painful versus placenta preia which is painless you need to be able to distinguish the two another important one is when the fertilized egg implants itself on the fallopian tube so it can properly well that's considered ectopic pregnancy you need to know what preclampsia is versus eclampsia when a female patient is pregnant and they have hypertension and they also have like like swelling of the legs uh you're they're saying that they have a horrible headache what are you concerned about you're potentially concerned about this patient potentially seizing so you need to request ALS intercept because they have a medication that they can administer if a pregnant female patient is hypertensive so you need to request alss intercept if your patient is preeclamptic where they are pregnant usually it's 20 weeks or greater and they have high blood pressure that's not a good thing they may be having impending eclampsia on the way eclampsia will have the same symptoms of preclampsia but instead the pregnant female will begin seizing this is extremely dangerous that's why we call ALS intercept for a pregnant patient that's hypertensive so they can consider administering a medication that I'm not going to even mention right now but but if the patient is seizing again and they're pregnant contact and request aless intercept they can administer a medication that can help with this you're not able to at the time just clear up the surroundings what is moonium staining well it's amniotic fluid that's greenish or brownish yellow and it results as fetal defecation that can appear over a newborn's face as the mom's giving birth some meconium staining can occur on the patient's face if this is the case do you suction the mouth or the nose first going to give you guys a moment to think about it please pause the video so which one do you suction first the mouth or the nose it's the mouth you want to suction the mouth first usually with the bulb syringe kind of clean up the area maybe with cloth and then you want to suction with the bulb syringe the nose and you squeeze you bring it in and then you release to pull in some of the fluids and you want to clean up the mouth then the nose it's very important that you know that you will probably get asked that when a female patient is pregnant and you suspected imminent delivery with less than 2 minutes of contractions usually they'll feel an urge to defecate or to push you need to tell your partner to pull over and prepare for imminent childbirth you're going to need your partner's help so now we're going to look at what are some delivery emergency for a patient that's giving birth so one of them is the nucal cord it's the umbilical cord that's wrapped around the baby's neck there's enough slack we can try unwrapping the cord for the baby's neck but if there's no slack we need to clamp the cord appropriately and cut the the cord appropriately there can be a prolapsed cord so when the umbilical cord presents itself first and it's being squeezed by the vaginal wall and the child's head this is the only the only time where we can insert a gloved hand inside the vagina and lift the baby's head off the cord this is the only time we can consider doing that we can also try raising the mom's pelvis to slightly try to alleviate some pressure then you need to go code to the hospital if there is a limb presentation it's complicated depending on what limbs are present if we have both legs or the Butt Talks presenting first we could potentially deliver this on the field but it's not ideal however that is considered like a breach delivery however we cannot deliver a single limb presentation such as like one arm presenting or one leg presenting that's considered a limb presentation and you just need to go cod to the hospital so again you can consider raising the p for the mother to maybe help gravity push back the baby a little bit but besides that you just need to go to the hospital you also need to know about the appg guard scale we're going to talk about it more near the end of this video but just note that there are two times whenever we want to check for an appar scale what do you think those two times are go ahead and give yourself a moment pause the video try to fill it out and then we'll talk about it the two times that we want to check for an appar score is during the first minute of birth and at five minutes after birth and we want to compare the two normally they're not at a straight 10 on the first one but then later on hopefully we're at like a nine or a 10 on the second one but it is a scale from 0 to 10 where you measure the activity and the potential susceptibility of a pediatric patient or like a neonate or newborn whenever again they're first born all right so you guys may be familiar with ABC's or Airway breathing circulation but there's actually a fourth one where where it's X X ABC so what does The X stand for in X ABC whenever it's related to trauma well that's going to be uation or exu I'm not really too good at it but it's basically whenever we're checking for somebody's Airway breathing circulation if we see somebody with a critical life bleed where they're spurting out bright red blood so we're thinking oh no they're having an arterial bleed it doesn't matter if they have Airway breathing circulation at the moment because if we don't stop that critical life bleed either via compression or with a tourniquet later if compression doesn't work well then they're just going to end up passing away anyway so the others don't matter so we need to watch out for that if I were to have gotten stabbed in my chest or let's just say I got stabbed in my arm right here and it's a penetrating trauma what should we do with this should we pull it out or should we bandage around it well we should bandage around the area keep it nice and secured if we pull it out we're going to disrupt any clot maybe tear up anything in between we just need take them to the nearest appropriate trauma facility if somebody's injured in their eye let's say it's their left eye and they got stabbed in the left eye we want to go ahead and bandage the area and keep it compact as well but we also want to take a goau pad or something and blind them on their right eye by just putting some compression and keeping it so they can't see in both eyes that's because if I only have one eye that has a stab wound or the knife in it and I look to the right I may accidentally look to the right with my left eye and that can cause the knife or whatever is penetrating the eye to move around against the eye and cause further disruption next know that traumatic injuries to the brain may take up to several days whether it's a subdermal hematoma or something along those Natures so uh be careful a hematoma may take days to develop and it's something that you should watch out for for traumas know what the coupe counter Coupe injury of the brain is so somebody's driving and they hit they get hit or they actually rear end somebody one thing that you can look for or visualize is spidering of the windshield you can see maybe some damage on the steering wheel they can maybe hit the steering wheel with their head and then go backwards the coupe injury is the when the anterior part of the brain slams against the skull so if I move forward like this it's going to slam against the front part or the anterior part of the Skool that's the coupe then the counter Coupe is whenever it rebounds back usually there's like a tearing motion almost and the posterior part of the brain hits the back of the skull so the brain if it's in between here it goes boop boop the coupe or the front injury then the counter coup the back part of the brain we generally think of this is when someone hits a steering wheel it gets into a crash or more so with spidering like I mentioned earlier you want to know the different types of fractures that's extremely important to know uh there's a couple different ones but realistically basically the one that I always see in test questions is a green stick fracture and what that is is halfway through they have half of a fracture but it's not completely all the way across the the bone where it goes from a hairline fracture to a fullon break so again you can call this a hairline fracture but just know when only part of the bone has a fracture but it isn't all the way across that's called a green stick fracture so be very aware of these so if somebody has a closed femur fracture it's a closed femur fracture what's something that we can consider utilizing this is a huge test question I'm going to give you a moment go ahead and pause the video you can consider administering and utilizing a traction splint right to relieve pressure when can't we use a traction splint when it comes to femur fraction fractures is whenever somebody has an opened femur fracture so basically if this is the femur they have an open femur fracture you can imagine that bones are going to be sticking out like so and there may be some little bits and pieces of bones in between I can't actually tell if you can visualize this well till afterwards but regardless whenever you try to pull apart the area to release some tension and some pressure these bones May Nick some more of the skin they may Nick an artery or something causing a huge arterial bleed so we don't want to do this a traction splint for a open femur fracture but we want to utilize it for a closed femur fraction if we see bright red spading blood we talked about it earlier what's the first thing we want to do if they're bleeding out what do we want to do I'll give you a moment for that well what we want to do first is we want to compress the area and if compressing the area doesn't work the next thing that we want to do is we want to apply tourniquet above the injured sight we don't want to place it on a bone we want to place it above the injured site though approxim two inches away from the bone and away from the sight make it more proximal versus distal where the injuries at and we want to tighten it until the bleeding has stopped one other thing that's not really too important for you guys to know for the national but it may pop up potentially know what a paracardial tampen not or a cardiac tampen not is it's when fluid builds up around the heart making it more difficult for it to beat and every time that it beats it gets clo or more enclosed and more enclosed until they potentially can go into cardiac arrest now let's talk about Burns there are three main types of burns we have first-degree burns the way we differentiate this is they have reading of the skin and it just hurts you may have experienced a first-degree burn in your lifetime I know I have experienced a couples this is just like a sunburn nothing too serious it's just uncomfortable this skin is going to be red and it's going to be painful the next one is a second degree burn it's going to be the same thing but there's going to be a a blistering around the area right the important thing to note is that it still hurts around the area so a third degree burn is whenever the skin may appear white gray or even leathery and the patient doesn't feel pain around the general area right so if like let's say there's a third degree burn that you suspect right here they're going to feel pain on this side it may be this side of the area but they're not going to feel any pain around this side and more so it's really like they're only going to feel pain here depending on if it's a full circum circumferential burn where it's all the way around this area here and we don't want to see this we need to take them immediately to a burn center or at least set it up to where they can be transported to one but third degree burns are the worst type of burns it's where they can't feel pain anymore we don't want that one other quick little term that's going to be at the bottom where I discuss about the terms that you need to know the term is called eimos I always struggle pronouncing it so that's why I all these Cuts anyway all that it means is bruising but if you don't know what that means and you see somebody has ecosis you may potentially panic when all that is saying is hey this patient's bruised up think trauma okay guys so finally we made it to EMS operations this one a lot of people kind of bypass it they think oh these aren't tooo important so it's more so about like legal terms and things like that but it'd be horrible if you failed this section after you passed all the other ones because you underestimated the importance of knowing EMS operations so really quick we're going to start with the NFPA 704 tetrahedron here which is the the four different sections I don't have the markers for like yellow but we have our blue section our red section our yellow section and our white section here you need to know what each of the hazards pertain to so we have our blue for health for our Hazard our red for fire hazards our yellow for instability hazards or reactivity and our white is for a specific uh Hazard so for red yellow and blue it goes from four to zero with four being the worst and zero being generally acceptable and white will have special symbols I highly recommend looking up on your own free time the NFPA 704 tetrahedron but it's an easy question because they only can think of so many things for EMS operations so you might just get what is the blue in the NFPA 704 tetrahedron it's like blue you think health and you're done but uh it's a very easy thing to know if you know it if you don't know it well sh I mean you may just lose a point for nothing next most ambulance crashes occur where it's very simple I give you a moment to think about it most ambulance crashes occur at an intersection you need to be very wary whenever you're uh at an intersection that's where a lot of people end up getting hurt or passing away you should utilize what when reversing it's a spotter for a helicopter landing Zone the site needs to be at least 100 ft F by 100 ft regarding radios they love to ask about radios it's always the the repeater they like to ask about that every time I don't know why so a repeater is What receives signals from lower powered radios from either a mobile or a portable radio then it sends them out at higher strengths so what is a mobile radio it's a radio mounted inside ambulances or another apparatus so it's the one that we can use to relay to the hospital that's a Mobile Radio a portable radio is one that will be carried on to me usually I have my radio strap and I'll have my portable radio and I can let anybody know like hey if I'm doing treeage or something this is what I have this is what I have also another really important thing to note is the simplex and the duplex radio system the Simplex radio system only allows one person to transmit at a time so if I'm talking you can't relay information at the same time a duplex radio system kind of like a cell phone allows both users to talk and transmit and receive information or voice communication at the same time so a huge thing you need to know these legal terms you need to know them there is battery it's when you place that your hands on someone without consent causing physical harm assault to whenever you cause harm verbally with verbal threats or intimidation aband abandonment this is a huge one you initiate care then ding ding the patient provider relationship it can also be like let's say if you're an EMT basic and you're with a patient you're working on them and then an emergency medical responder and EMR uh arrives on scene which is a lower standard of care than you technically even though they may be uh fairly proficient at their job and you're like you know what I don't want to work with this patient anymore here you can take him you can't do that by giving somebody like let's say like a paramedic for instance giving your patient off to an EMT basic is considered abandonment the same thing with an EMP basic once you start working on them you can't give up your patient to a lower level of care that's why it's okay for us to transfer our care to let's say an RN or registered nurse because it's considered to be the same level if not a higher level of care which is acceptable there's negligence which is deviation from the accepted standards of care resulting in injury to your patient there are Advanced directives there's instructions that are given in advance such as the DNR or do not resuscitate there is implied consent so let's say if I'm at a restaurant and I do this motion to you that's generally considered an implied consent for hey I'm choking I'm not saying anything but I'm doing this and I need your help you have implied consent now you know you can come and start doing the himl maneuver towards me or to me uh it can be inferred from a person's actur G gestures or or in actions like if let's say somebody were to pass away right in front of us we don't have an obvious DNR that's available or present we should assume that there's implied consent that they want to be saved and then we can go ahead and start working our Cardiac Arrest algorithm or we can start doing CPR and request Al intercept on the way next for HazMat responses this is a easy test question to miss if you don't know what you're what you're doing so EMS is set up in the cold zone so if we're looking at a Hazmat te we have The Hot Zone which is this little circle then we have the warm Zone okay this is where decontamination or Decon occurs okay we shouldn't be in that area for EMS we should be in the cold Zone this is where you're going to be at so EMS operations occur in the cold Zone decontamination occurs in the warm Zone and Hazmat technicians will go into The Hot Zone we're not going to go in The Hot Zone know where the cold zone is know where the warm zone is or you're going to miss an easy question okay remember to always stay uphill up wind if we have a potential let's say a tinker that collapsed or that crashed on a road we don't know if it's emitting any type of hazardous materials or something of course like calls like call Hazmat technicians call Hazmat teams and if possible if you're going to be around the scene at all let's just say this is you this is horrible uh then we need you to stay uphill and up wind if possible uphill and up wind is where you want to be parked at if you're dealing with a hazardous response you need to know the command system this is more so important for fire fighter operations but it's still something you need to know the span of control is whenever you have three to seven people uh per leader or if like I'm working on scene and I have some people that are under me or under me we're working on the same thing right if I'm the leader of the group I can have a group between three to seven individuals and the preferred optimal number is five people per unit right where one leader is leading five people you need to know about the unified command unified command is several agencies working independently but cooperatively so while we're working we may work with a firefighter Department we may work with a police department and we're all working as a unified CA command together in a large mass casualty incident towards kind of like the same goal your safety comes first in every operation it's life safety incident stabilization and then property conservation you need to also briefly understand the start triage system so I marked it on there but basically it's if somebody is marked as red they're considered Critical with life-threatening injuries and they're Priority One if they are tagged yellow they have not life-threatening injuries but it can potentially go into a critical State they are a priority to Patient if they're green then they are walking wounded patient and they are priority three if they are black they are dead or fatally injured they are a priority for patient now we've done all five of the different sections we're going to look at some extra important information that you still need to know because there's definitely going to be a questions on on these type of things so the first one is a Glasco Coma Scale or a GCS scale it's used to assess a patient's mental status and we check three different things with 15 being the greatest three being the lowest please look at your word document while I'm talking and the first thing is eye opening right so we want to see if it opens spontaneously if they're looking around on their own or if you have to go up to somebody and say hey can you hear me and then they look at you and then they look away that's a three two is if I go up to the patient and I do some type of painful stimulate stimuli like I do a sternal rub or I use a pen on their fingernail something like that then they kind of look towards me maybe my partner is starting an IV if they're a paramedic or an aemt uh if they open up their eyes to the pain that's a two if they don't respond to anything that we do it's A1 for not responding for verbal responsiveness they're a no times 4 if they're oriented to their person place time and event they are a five if they're confused if you ask them something and they uh they can't answer all of your questions properly if they're less than a no * 4 they are a four if you talk to somebody and they have inappropriate words like it's just kind of nonsense that is a three if you can't even understand if it's engl you don't know what language they're speaking it's just mumbled garbage that is a two if they don't respond at all that is a one that's the lowest score four motor response if I tell you to raise up your arm and you raise up your right arm fantastic good job if I do painful stimuli and you move towards the area and you're like hey stop it right you kind of move towards it and kind of push away a little bit that's a five at least if let's say I'm working on an IV or something or like my paramedic is working on an IV and they Flex to withdraw from pain so they kind of move their body away from the pain then we're thinking okay that's a four if I'm doing painful stimuli on a patient and they move their arm kind of towards the general area well at least it's moving towards where the pain is at that's abnormal flexion that's a three it's also known as decorticate posturing where somebody's going towards the core of their body if you do painful stimuli and they're sticking their arms out like this like what the heck is going on this is decate posturing so decorticate they're moving towards their core the separate posturing also known as abnormal extension that's a two at least they're responding to the painful stimuli but we don't like this when we're doing a stal rub right like H that doesn't make any sense number one is we do pain uh painful stimuli and there's no response so that's the GCS score the next one like we talked about earlier is the appar score now for the appar score you need to know like we talked about earlier that it is going to be a scale between 0 to 10 for a neonate newborn either one is fine where the baby is just born and we need to assess their activity right or more so their appar so we check their activity their pulse their grimage their appearance their respiration you can see I have a points listed from zero points one point and two point you will get a question on this you need to learn this if you do not learn this SC if you don't know how to properly identify because they're going to they're going to be tough they're going to say you have a patient who has who is actively moving they're going to have a heart rate less than 100 beats per minute they're going to say that they have minimal response uh stimuli they're going to have pink body but blue sinosis to their arms and legs they're going to have slow irregular respirations you need to be able to read that and say I think that the appar is like a uh I think the way I constructed it is 2 3 4 5 six I think it's a six for the appar scale they're going to give you four numbers and it's not going to be easy it's going to be like 5 six seven 8 and you're going to be able to need be able to read the description of the patient and say that's an appar of six that's an appar of seven an appar of eight and then in five minutes you need to repeat that you will most likely be asked to create an appar score I've never heard of anyone not having to do that be ready for that that for anatomy we're going to briefly discuss anatomy in regards to a couple different things such as the anatomical plane so if you guys are familiar with it there is medial where it's closer to the middle of the body and then there is lateral further away from the body if you look at yourself right now and you're looking at your own thumb I want you to say out loud is is your thumb currently medial or is it lateral to your pinky with this being the outside being more lateral medial being the inside if you look at me right now if you look at me right now and I ask you what's uh what's medial and what's lateral uh if I compare my thumb to my pinky is my thumb medial or is it lateral you're always going to say your thumb is lateral how does that make any sense well that's because we need to imagine every single person in the anatomical plane with them standing up straight and their palms out like so and if you can look my thumb is the furthest part away from my body from my core or from my midline that's going to be lateral compared to my pinky so it's really important that you notice the difference between medial and lateral in regards to the anatomical plane on the next section I have like a quick little example about what you should think about whenever it comes to proximal versus distal the next thing that we need to know there's an extremely low chance that they're going to ask this but they may ask what is the upper Airway considered what is considered the lower airway right so the upper Airway is the nasal cavity the oral cavity the nasal fairings the oral fairings the Loreno fairings the epiglottis and the L larynx I can't pronounce it correctly that's kind of hard to remember you know it's easy to remember the four different things for the lower airway which is the trachea the bronchi the bronchioles and the alvioli knowing that that cons of the lower airway will help carry you through trying to figure out what the upper Airway is and you can be like well it's not those four things so it must be the upper Airway for a burn patient what rule can we utilize to assess the surface area of a burned patient we can either utilize the rule of nines or the rule of Palms so the rule of nines is different depending on if you're going to do it on an adult patient versus a pediatric patient so if you were to look at me right now we can estimate the body surface area of where the burn is so let's say my right arm is burned right and let's say it's a second degree burn so what does that mean I have blistering around the area but I still feel painful stimuli and it's around my entire right arm what percentage would you give me if you're using the rule of nines well we can see on this little sheet that I have here that the head and neck is considered 9% the entire thing each arm is 9% so if I only say the anterior or the front part of the right arm is uh has a second degree burn is going to be 4.5% if I say the circumferential area of the right arm is burned I'm talking about the entire area of the right arm so it's going to be 9% for each leg it's considered 18% right or 9% in the front 9% in the back 9% in the front 9% in the back the Torso the chest is going to be 9% the abdomen is going to be 9% the back the top half is going to be 9% the bottom half is going to be 9% your genitalia is going to be considered 1% now if an adult patient let's say has second degree burns on their right arm and their chest what percentage of the body surface are we considering burned according to the rule of nines well the chest is going to consist of the 9% portion right here and the right arm is going to be considered 9% so in total it's going to be 18% unless they different and they say the anterior portion of the right arm and that's going to be 4.5% now for a pediatric patient it's almost the exact same but you need to know that their heads and their mouths are proportionally different compared to an adult where they're going to have larger heads you're going to have a larger tongue so because of this abnormal proportion we need we need to know that the head and neck for a baby patient or a pediatric patient is going to be at 18% each arm is going to be considered 9% % still with 4.5% in the front 4.5% in the back each leg is going to be considered 13.5% now some people say 14% I think that it's incorrect because you're whenever you add up the total it's 101% 13.5% makes more sense to me uh the front of the Torso we have nine for the chest nine for the abdomen or the Torso being 18% the back being 18% or nine on the top nine in the back and the genitalia is going to be considered 1% and I did make a note of that also just about the special note but for the rule of Palms can be utilized when let's say they only have like a small little Mark here that's burned and it's a first or like let's say a second degree burn where we only have one little blister here they might have touched a hot pan or something and they recoiled back before anything else got burned well we can use the rule of Palms where we can look at the patient's Palms not including the wrist or the fingers so it should just be something like so and I can imagine it over the burned area and it looks like oh that's just 1% so according to the rule of Palms they have a 1% burn uh that's a second degree burn on their left arm 99% of the time they're going to only ask you about the rule of nines the rule of Palms is just something to note if you're working at an EMS agency but know the rule of nines you're going to be asked that most likely I went ahead and I put the age ranges because I figured it might be nice to like be able to differentiate the differences between the different pediatric States versus an adult patient so we have here a neonate or a newborn is from birth to 28 days old an infant is 1 month to 1 year old a toddler is 1 to 3 years old a preschooler is 3 to 5 years old a school AG child is from 6 to 12 years old an adolescent is from 13 to 18 years old however you can still sometimes in some text consider a child to be an adolescent or a teenager as soon as they grow or start to develop pubic hair or uh start to mature like this start to have their periods things like uh that and for an adult patient it's 18 years old and up now one special thing to note for the child the younger they get the higher the respiratory rate the higher the the heart rate and the lower the average blood pressure if you really wanted a formula I can go ahead and write it and as you can see here I went ahead I wrote the three different ranges where we have let's say 80 + H * 2 that's going to be the their normal blood pressure range now we want to know okay when are they normally hypotensive or hypertensive well anything below 70 plus h * 2 so let's say if they're 2 years old we would do H * 2 so that would be 4 plus 70 so that's going to be 74 anything for their SI stolic number or their top number that's less than 74 is going to be considered a hypotensive child for for a patient or a pediatric patient that is 90 + H * 2 if we say that it's a 2-year-old we'll say 90 plus parentheses 2 + 2 so it's going to be or 2 * 2 so it's four so it's going to be 94 if their blood pressure the cystolic number is greater than 94 millimet per Mercury then we're going to say okay this patient or this pediatric patient is hypertensive and then we kind of move away towards it once we start to deal with uh adolescent or adult patients but just note that their heart rates are going to be extremely elevated compared to what you're normally seeing like they can even have for a neonate or a newborn a heart rate at approximately 160 beats per minute and that's normal for them their respiratory rate is going to be greatly increased too I think it's between like 40 to 60 breaths per minute I'm going to have to look at that later but uh it's an incredibly High rate so don't panic on that if you're seeing a neonate or newborn and as they start to progress into regular adulthood you're going to see the numbers start to change back to normal some acronyms that you may want to know there is sample or signs and symptoms allergies medications past medical history last oral intake and events it's an extremely useful acronym the other ones are more so just kind of filler knowledge if you want to know it like let's say there is opqrst for an acren utilizing uh trying to describe what a patient is experiencing pain wise we have slud and dumbbell they're both the same thing so whenever a patient is exposed to a possible nerve agent poisoning and you see it talks about like salivation laceration which is excessive tearing of the eyes we have urination defecation GI or gastrointestinal emosis and my I think it's meiosis yes meiosis or muscle twitching meiosis being constricted in of pupils if you see a patient suffering from uh any of these symptoms you may want to consider requesting ALS intercept because there is a medication that ALS providers can administer to help diminish these effects uh dumbbells pretty much the exact same thing it's just another uh acronym that you can use there is Decap btls I have never been a fan of the acronym Decap btls but if you're unfamiliar with assessing a a trauma patient and you want to be able to have an idea of what you're looking for dcap btls can take you along the way I don't think the national is going to ask you anything about it but it's it's good to just know in the backand like you're looking for deformities contusions abrasions punctures or penetrations Burns tenderness lacerations swelling some important terms to know you need to know this you have to know this anaphylaxis it's a severe life-threatening allergic reaction you need to know that you can administer a drug for that what drug is it it's epinephrine the auto injector the 1 to 1,000 mix you need to know what osis is which is bruising you need need to know what ticaria is that means hives diaphoresis that means sweating priapism that is a non- aroused erection that occurs with spinal injuries epistasis all that means is nose bleeds hemiparesis one side of weakness jaundice yellowing of the skin or the eyes usually associated with uh liver abnormality or liver failure or hepatitis words that end with the prefix itis is extremely important to know it means inflammation like menitis or inflammation of the menes another example is hepatitis which is inflammation of the liver or like swelling of the liver now one last special little thing that I put in here is I'm briefly going to discuss maintenance medications now the national is going to tell you that somebody's hypertensive you're going to say that they're taking a medication like linil and hydrochlorizide which is linil usually a medication that treats high blood pressure and hydrochlor siide is a diuretic medication so it helped with the swelling of like edema things like that or pedal edema I worked at a clinic for approximately 8 years or so I have a fairly good understanding of how to differentiate different medications please understand I am not a physician I'm going to give you a brief list of medications to to interpret and understand that I think are going to be imperative for your success on the national because they're not going to give you their past medical history but they're going to give you medication and if you know medications you can determine a lot of a patient past medical history so I'm not a physician these drugs are a lot more complicated than I'm making them sound I'm not going over the dose I'm not going over the type they are because I don't think you need to know what an Ace inhibitor is like linil or a beta blocker blocker or something you don't really need to know that okay that's more so for like uh the hospital staff to know RNs Physicians for clinicians to know but for the sake of the National Registry for the emtb just know it as basic as I'm going to describe it here okay so just letting you know for high blood pressure medications they consist of linil amlodipine lartin LOLOL and metalol which can either be succinate or tartrate at the end does it matter for the National Registry but you do need to know like if you're actually looking at a patient's med list in real life you want to differentiate whether it's seate or tartrate because that's how many times they take it per day usually what are some other medications that we need to know how about diabetic medications we have metformin Genovia Humalog novalog we have novalin lantis tuo these are just some of the diabetic medications a couple of these are oral pills that you can take some are insulin that you can take you need to know this because if you have a patient who has a weakness and let's say they're taking Humalog or tuo okay well without any other information right off the back I'm going to say you know what this patient's diabetic look they take Humalog hey maybe they're experiencing a hypoglycemia maybe they took it without eating anything maybe I need to consider or a glucose if they are aod Time 4 and they're able to protect their own Airway if not I need to request an alss intercept all that should be going through your head whenever you catch these medications some blood thinners you need to know are elois Plavix and zalto some erectile dysfunction medications you need to know Viagra Calis sedil it was on my national test when I took it years ago and to dalail there and there are other ones by the way why do you need to know this because let's say if somebody is taking one of these medications what drug can we not administer as an EMT basic well it would be nitroglycerin opioids we need to watch out for hydrocodone or Norco Tramadol oxycodone morphine fentin okay so those are all very important ones to know cuz what medication can we administer if somebody's taking that well we can administer Naran or in a lock Zone miscellaneous note super quick little tidbit no Cushings Triad it's three signs of intracranial pressure it's often a warning sign of a brain herniation they are hypertensive they can be braic cartic which means a slow heart rate what's a slow heart rate considered well our normal heart rate is between 60 to 99 beats per minute we talked about in the beginning so a braidic cardic heart rate would be something less than 69 beats per minute so 59 or less and irregular respirations with that being said guys thank you guys so much for watching I hope you enjoyed this this took a lot longer than I thought it would but I feel like it's a great free resource that anybody should be able to have access to after they complete like an EMT basic course and so you know I was like you know what I have the knowledge I tutor these people all the time on from different agencies uh to help them pass the national why don't I just give this to people you know so uh I hope you enjoy it uh if you did like this video please like And subscribe uh really helps out a ton check out in the description you can see the download link again for the word document I hope you've been working on it this whole time I'm going to leave a couple spots blank but I'm also going to leave timestamps in the word document to make it as easy for you as possible because all I want you to do is pass the natural because it makes me look better too uh if you have questions go ahead check out the Discord too uh we love to have you guys there it's a lot of fun also I just started I just made it possible for you to join as a member if you'd like there's no requirement for you to do so you did make it to the end maybe you pass the national or something you want to say hey Mario here's here's some chump change just to help you out uh thanks for helping me pass hey I'm walking around with the hat I'll gladly take it but uh with that being said thank you guys so much for your time really appreciated all of it uh I really appreciate it working with you guys and I will see you on the next one yeah oh that was too much too much words