Friday, March 24, 2017

Your still a first respondent

ere are people other there that will try to get you to believe that you are not a First Responder if you are not employed by the Fire Department, Police Department, a city based ambulance company, a privately based ambulance company, a privately owned air rescue unit. 

In truth there are more Emergency Medical Technicians in other sectors of healthcare that there are in any of the top five sectors of emergency health care. If you have obtained your certification and are unable to find placement in the top sectors then do not fret. There are other places to shine as an Emergency Medical Technician.

Hospitals
I recently had a spike in my blood glucose level that had me admitted to intensive care. As I interacted with each staff member, I noticed that more and more were not Registered Nurses. Many were level one or level to Emergency Medical Technicians.

This can be a blessing to many new graduates who actually do not want to be out in the elements day after day. Many hospitals will hire Emergency Medical Technicians to work in intensive care and medical clinics.

Medical Clinics
With the training that EMT's go through, how could they not be an asset to a local Medical Clinic. I'm sure much of the experience will have to do with taking vitals and making initial reports

Homeless Shelters
I have nearly six years experience with being a First Responder at local Homeless Shelters. Sadly the pay is not the same as with working in the major known sectors of Emergency Medicine but the responsibilities are the same. In my six years of experience I have had to deal from everything from the common cold to complications due to overdose.

City Events
City events and concerts bring a large amount of people together. Most city events are handled by the local ambulance companies. The best thing to do is search around or contact the local event locations and ask them what company they use.

Bottom line. If you have been certified by your state as a First Responder or EMT. Don't let anyone tell you any different. Some people only think Fire and Police when it comes to public safety. This world is so much bigger.

EMT open ended questions vs closed ended questions

An EMT is at a scene and has a lot of information to collect. Many questions can be straight close ended questions like name, age, and medical history. There are open ended questions where patients will have to answer in their own words. 

The difficulty comes when an EMT asks an open ended question and the patient is unable to answer it. At times if may become difficult to not turn one question into a closed question. 

Examples of open ended questions:
Explain the pain to me?
Where is the pain located?
What were you doing before you passed out?

Examples of closed questions:
Have you taken any medications in the past 12 hours?
Do you have history of asthma?
Do you have a history of heart attack?

EMT's and nonverbal communicating patients

A patient may speak another language. Or they may not speak at all. There are still ways an EMT can communicate with a patient and get there job done. There are five tips that an EMT can perform or look for within a patient.


  •  Posture
  • Distance
  • Gestures
  • Eye Contact
  • Haptics 
Open arms, hands, relaxed shoulders convey a message of concern, confidence, safety, and care.

Do your best to not enter patients intimate zone without asking the patient. Observe nonverbal cues with each culture. 

Smiling can actually open up communication with a patient but some cultures process smiling as a bashful gesture. Be sure to at least make and keep eye contact when communicating with a patient.

Haptics are a study of touch. You will be surprise how many patients will accept a pat on the shoulder or someone holding their hand. I once had a patient wrap themselves around my calf because they felt comfortable. 

As always be careful of age, gender and culture of the patient

Automated Chest Compressions

Emergency Medical Technicians and Paramedics have some many tools to work with on scene. Every one has it's own advantage and disadvantage. Automated Chest Compressions, Mechanical Piston Device, Long Distributing Band CPR, and Impedance Threshold Device. Which do you use and what do you like the best as an EMT?

Automated Chest Compressions
  • Able to maintain good depth
  • Able to maintain rate
  • Able to maintain good sequence
  • Efficiency of this device not yet proven
I believe that I have an older copy of the Brady. Several institutions are using ACC's. This includes my favorite medics on Nightwatch. 

Mechanical Piston Devices
  • Can be attached to a back brace
  • Configured to a specific rate and compression
  • Useless if runs out of compressed gas
  • Large, heavy, and cumbersome
Long Distributing Band CPR
  • Band that can attach to a back board
  • Lighter than the Mechanical Piston Device
  • Improved results compared to CPR
Impedance Threshold Device
Prevents air from rushing in during ventilation relaxation mode

EMT 411! AED VS Pacemakers

An EMT and partner arrive on the scene. A patient is in cardiac arrest, CPR has been performed, and defibrillation is needed. Can an AED be used on a patient who has an automatic implanted cardio defibrillator? Where should the pads go on a patient who has a cardiac pacemaker?

An AED can be used with a patient that has a cardiac pacemaker. Be sure to not place the pads over the pacemaker. Why? That would be like giving a car a jump. While it's needed to start the car, EMT's should not apply 
electricity to the pacemaker.

If the patient is unresponsive look for scars on the chest or upper abdomen to assess if the patient has a pacemaker. Also look for medical identification tags like the one above. Treatment for an implanted cardio defibrillator is the same as any other cardiac patient. 

If the patient is responsive then let the ICD operate, do not use an AED, stabilize the patient and prepare the patient for transport.

EMT's and AED maintenance/certification

All skills and tools have to be maintained. What's the biggest issue with AED maintenance? How often should an EMT or Paramedic update their skills using an Automated Electronic Defibrillator? 

An AED should have a scheduled maintenance plan to insure that the machine is functioning properly. It would be a horrible scene if a AED is needed and the batteries no energy in them. Battery failure is the biggest issue when it comes to AED maintenance. Either the connections become to old or the batteries have not been changed. With all batteries, rust may become an issue if they are not changed often enough.

As for the EMT, skills should be refreshed with this device every 90 days. This will give the EMT the chance to practice and learn new AED products. 

Speaking of refreshing skills. There are some great applications that are in beta or are out on the market that keep track of when EMT and Paramedic skills have to be tested again. In the near future, I plan to provide links to local and worldwide test sites.

EMT Safety precautions around Automatic Electonic Defibullators

So your team has arrived at a scene where an AED is needed. What rules should you follow to keep yourself, your partner, other EMS providers, the patient and by standards safe. What should you look for while doing scene assessment?

When using an Automated Electronic Defibullator:

  • Do not be in direct contact with the patient when using an AED
  • Call "I'm clear, your cleared, everyone clear."
  • Make sure that everyone is cleared from the patient
  • Make sure that your not in or near water
  • Make sure patient is not diaphoretic (sweating heavily)
  • Be careful of metal. This includes equipment, flooring, catwalks and other surroundings.
  • Watch for nitroglycerin, nicotine, and analgesic patches
Follow these rules as an EMT and you will keep yourself safe.

When an EMT should call ALS

When should an EMT contact Advance Cardiac Life Support? Who is considered ACLS? Does your state and city protocol influence when ACLS can be contacted?

Contacting Advance Cardiac Life Support is important. It's the fourth step in a patient surviving a Cardiac Arrest. An EMT on scene should always follow city and state protocol when dealing with any trauma or injury. This includes contacting ACLS.

Who can the ACLS be?
  • Higher level EMS provider
  • Paramedic
  • Hospital
  • Clinic with a Doctor present

EMT what is Ventricular Fibrillation, Ventricular Tachycardia, Asystole, and Pulseless Electrical Activity?

Tachycardia is a rapid heart beat. So Ventricular Tachycardia (VT/V-Tach) is a very fast heart rhythm. This rhythm produces a ventricle mode instead of a sinoatrial mode. Should only be applied to patients that are pulseless.

Ventricular Fibrillation (VF or V-Fib)
Disorganized cardiac that produces no pulse or cardiac output.

Asystole
Absence of any electrical activity in the heart.

Pulseless Electrical Activity (PEA)
Heart generate relatively normal electrical rhythms but fails to perfuse the body due to decreased or absent cardiac activity

EMT Equipment: AED functions, advantages, disadvantages, and precautions

If a person has ever called emergency dispatch more than likely they probably have been asked if there is an Automated External Defibrillator available. Not everyone is going to have one because they are quite expensive and a person has to be trained to use one. It's always a suggestion that if the building is a large public building then an AED would be a good investment. 


  • Features of an Automated External Defibrillator are:
  • Fully automated
  • Can be semiautomated
  • Record operators use of device and EKG
  • Has several memory modules

What are the advantages of Automated External Defibrillators?
  • Faster than manual Defibrillators
  • Safer
  • More effective delivery of current
  • More effective monitoring
  • Ease of use
Now AED are not perfect and they do have disadvantages. AED seem not to work well with children. Do not use pads on children who are less than 8 years of age unless pediatric AED pads are available.

EMT Critical Thinking: Auto accident with cardiac arrest

At the scene of a vehicle crash, EMS find the driver in cardiac arrest. "Give him a shock" begs his wife. Why would you not apply the AED to this patient.

My answer:
As an EMT coming on scene we don't know how long the patient has been in a cardiac arrest. Using an AED when the heart has too much oxygen or glucose would render the AED useless. It would be more important to render CPR to the patient. Also we don't know if the patient has a medical or trauma patient. An AED should not be used on a trauma patient.

Your answer as an EMT student?

EMT's Muscular Skeletal Injury Keywords

We're in Chapter 30 this week. The week that an EMT deals with muscles, tendons, ligaments, and more. Some muscular skeletal keywords will give a person insight to what they are dealing with but some a person may not come across very often. It's important to know them because an EMT will never know when what medical information will be needed.

Pathologic Fracture
A broken bone resulting from a disease that causes bone degeneration.

Osteoporosis
A degenerative bone disorder associated with an accelerated loss of minerals, primarily calcium from the bone.

Direct Force
Direct blow, injuries from direct force occur at the point of impact.

Indirect Force
A force that causes injury some distance away from the point of impact.

Twisting Force
A force that twists a bone while one end is held stationary

Crepitus
The sound or feel of broken fragments of bone grinding against each other.

Splint
Any device used to immobilize a body part.

Paresthesia
A prickling or tingling feeling that indicates some loss of sensation.

Compartment Syndrome
Tissue pressure in a confined space causing decreased blood flow, leading to hypoxia and possible muscle, nerve, and vessel impairment.

EMT key points for dealing with muscular skeletal injuries and fractures

For a first year EMT, a skeletal fracture can be a scary thing. There have been many EMS who have nearly fallen out because there was a bone exposed with a fracture to the arm, leg, or extremities. There are actually several key points for an EMT to remember. 

1. An open fracture has an associated open would that is vulnerable to contamination and infection. 

2. A fracture is considered a "distracting injury" because it may draw attention away from other more serious problems.

3. Always check a patients distal pulses, motor function and sensation both before and after the splint. Document your findings

4. Some splints are more suitable to certain types of injuries; others are interchangeable. Follow your local protocols about which splints to use in a given situation.

5. A long spine board is a full body splint and provides some stabilization when individual fractures can not be splinted.

How an EMT can understand the body process for skeletal fractures

An EMT comes to a scene with a suspected fractured pelvis or femur with severe bleeding. Should the EMT think that the bleeding is coming from the fracture or a vessel outside of the bone? It truth, severe bleeding associated with a fractured pelvis or femur often occurs from the bone itself and not from a lacerated vessel outside the bone.

What is one of the reasons why an EMT would use a traction splint with a femur injury? A traction splint is thought to reduce the compartment that the femur can bleed into thereby decreasing the amount of blood loss associated with the fracture.

Why should an EMT as if a patient has pain elsewhere when the patient also has a fracture injury? The severe pain associated with a fracture to an extremity may distract the patient from complaining of other more significant pain This could be abdominal pain or spinal pain. For this reason, fractures are referred to as distracting injuries.

What other two tips will help an EMT out in the field?
Suspect a dislocation when deformity and pain are found at a joint.

If the foot or ankle is injured, have the patient push down and pull back with the big toe. This will give you the same result as if the entire foot were tested for injuries.

EMT and the structure of the Muscular skeletal system

Before an EMT can work on the musculoskeletal system they must know about this intricate system. This post will be about the muscles, tendons, ligaments, cartilage and extremities that make up this system. This post will also discuss the movement of the skeletal system itself and what an EMT will come across.

The function of the musculoskeletal system is:
To give the body shape
To protect the internal organs
To provide movement
To store salts and other materials neede for metabolism
To produce red blood cells necessary for oxygen transport

The Muscles
Voluntary, Involuntary, and cardiac muscles make up the musculo part of the musculoskeletal system. Most voluntary muscles are connected to the bones by tendons.

Tendons and ligaments
These are the two elements that keep pretty much everything in place. Ligaments connect bone to bone. Tendons attach muscle to bone. 

Cartilage
As an extension of the bone, cartilage is a strong, smooth, flexible, slippery substance that allows two bones to move against each other without the bones grinding again each other and causing damage. 

Joints
Joints such as the extremities, ankles, knees, shoulders, elbows, and wrist allow for movement. There are several ranges of motion that the body can achieve. Flexion is a bending motion that moves the extremities toward the body. Extension is the bending motion that moves the extremities away from the body. Adduction is movement of a body part toward the midline of the body. Abduction is the movement of a body part away from the midline of the body. Rotation is a turning along the axis of the bone or joint. Circumduction is the movement through an arc of a circle or in a circular motion from the central point.

The skeletal system consists of the skull, spinal column, thorax, pelvis lower extremities and upper extremities. The upper extremities consist of 
Clavicle (Collarbone)
Scapula (Shoulder Blade)
Humerus
Radius
Ulna (including the olecranon)
Carpal bones
Metacarpals
Phalanges

The olecranon is that bump at the back of the elbow which is the proximal end of the ulna.

The lower extremities consist of the pelvis, thigh, and foot. These are:
Pelvis (including the ilium, ischium, and pubis)
Femur
Patella (kneecap)
Tibia
Fibula
Calcaneus (heel bone)
Tarsals
Metatarsals
Lower Phalanges

Fractures, strains, sprains, and dislocations oh EMT!

A first year EMT will come to a scene and have to deal with many different types of musculoskeletal injuries. Many of these injuries will include fractures, strains, sprains, and dislocations in different parts of the body. This will be especially true if the area an EMT is working in has a high population of children or elderly citizens.

Fractures
Fractures are a break in the bone. These can result in a variety of mechanisms of injury. Ultimately a fracture will come from direct force, indirect force, and twisting force. A fracture can also be considered open or closed. An open fracture is when the broken bone protrudes from the skin. This then introduces bacteria and other ways of adding infection to the wound. 

Displacement of the bones can cause damage to the surrounding nerves, blood vessels, muscles, ligaments and tendons surrounding the injury. The signs and symptoms of a fracture are:

Pain
Tenderness
Deformity
Discoloration
Paresthesia distal to the fracture site (this could mean nerve damage)
Anesthesa distal to the fracture site (loss of feeling, possible nerve injury)
Paresis (weakness)
Paralysis (Loss of muscle control)
Inability to move the extremity
Decrease pulse amplitude, increased capillary refill time, paresthesia, pale cool skin distal to the fracture site.

There are six types of fractures that an EMT should know. They are the comminuted, impacted, greenstick oblique, spiral, and transverse fracture. 

A strain happens to a patients muscles or tendons. Possible causes of a strain can be overextension, overstretching, and overuse. 

Sprain
First year Emergency Medical Technicians will see injury to the ligaments. These usually involve injury to the shoulder, knee, elbows, and ankles. The joint will be come swollen and warm to the touch. There may be some discoloration to the injured area.

Dislocation
EMT's will see a displacement of a bone from its normal position in a joint. The deformity will be obvious and swelling will be involved. Dislocations happen in the following areas. 

Acromioclavicular
Sternoclavicular
Shoulder
Elbow
Wrist
Hand
Metacarpal Phalangeal
Hip
Knee
Ankle
Foot 
Metatarsal phalangeal

Thursday, March 23, 2017

EMT and burn injuries

A first year Emergency Medical Technician may think that a burn only affects the layer of skin that is burned. In truth burns can damage so much more than just skin. Burns are not skin deep because along with damaging the layers of skin burns can also affect the other body systems in some form or fashion. 

These body systems include the circulatory system, respiratory system, renal system, nervous/muscular skeletal system and gastrointestinal system. 

Circulatory system
Burns can cause burn shock
This can occur with moderate to major burns that cover a sufficient part of the body. 
This also explains the extensive swelling seen in burn patients. In the first 24 hours after a burn injury, fluid lost in the vessels causes edema. The fluid loss can lead to shock.

Respiratory System
Swelling in the face or throat may cause airway closure. Smoke and toxic gas may cause respitory arrest or poisoning. Burns on chest can cause a decrease in chest expansion.

Renal System
Decrease blood flow from fluid loss will decrease blood flow to the kidneys. Burn injury can cause waste to build in the body. Especially due to cell destruction such as myoglobin from muscle destruction. A blockage of the kidneys may also be a result.

Nervous and musculoskeletal Systems
Burns destroy nerve endings. Extreme burns may cause loss of function, long term muscle wasting and possible psychological problems due to burn locations. Burns that are visible to the public can be more stressful to deal with than burns that can be hidden by clothing.

Gastrointestinal System
Nausea or vomiting are common when burns are greater than 10% of the body surface area. Ulcers may also happen if stress continues.

About Emergency Medical Technician Refresher

It seems that I have gotten a few nasty messages about putting EMT notes on the web for everyone to read. Some have called me foolish for sharing medical information that only an Emergency Medical Technician should use. Some say that I am putting people in danger by giving then access to this medical information. 

In response, I have to say that these people are being hard headed. I wouldn't be surprised that some of the people who are doing the name calling are people who are making money off of EMT's and First Respondents who are trying to keep their knowledge current and refreshed. That is not my point at all. I am not here to earn a buck off of my brother's and sisters.

I write about Emergency Medical Technician patient care because it helps me refresh the information in my own mind. Sure it takes me a little longer to learn stuff but by writing it down, typing it, and putting it on audio, I'm making sure that I learn the information that I need to know.

I don't think that my brothers and sisters should have to pay to refresh on things that they have already paid to learn. Public servants pay to learn the skills that they have. Why should they have to pay again to brush up on past EMT skills. 

Honestly, some of this information can be useful to those who are not in the medical field. For example, I am speaking with local shelters to increase their cold weather shelter regulations to a higher temperature than 32 degrees. I believe that information on wind chill and how the body reacts to cold will enlighten people who run homeless shelters.

What about the ads on the site? It does look like I'm trying to make a profit doesn't it. The truth is that I'm not trying to make a profit off of Emergency Medical Technicians, Paramedics, Firefighters, Police Officers, Correctional Officers and the rest of the family. In truth I am trying to help first responders. All profit that comes from readerships of this blog and other avenues is used to help both two legged and four legged First Responders. 

What an EMT should know about cardiac arrest

Contractile cells
Contract in response to the electrical responses. They help eject blood from the heart. The conduction cells and working cells work together for one purpose that is to push blood out of the heart

Right atrium receives deoxygenated blood from the inferior and superior venue cavae
Right Ventricle, deoxygenated blood ejects through the pulmonic semilunar valve and into the pulmonary arteries.

Describe depolarization and repolarize and explain normal ECG waves and intervals and physiological events they represent.
Two distinct components of electrical activity. Depolarization and repolarization. Depolarization is when the electrical charges of the heart muscle change from positive to negative. This causes the heart muscle to contract. Repolarization is when the electrical charges in the heart return to positive charges and cause relaxation

P-Wave
This is the first waveform of the EKG and represents the depolarization (contraction) of the artria

QRS Complex
Second waveform of the EKG. This represents the depolarization of the ventricles and main contraction of the heart.

T-Wave
The third wave form represents the repolarization (relaxation) of the ventricles.

List the signs of adequate positive pressure ventilation and the steps to take if ventilation is inadequate.
If a Pt has adequate positive pressure ventilation, the Pt will be without color change, their pain will lessen,  and their breathing pattern will change, and the heart beat will return to normal. The SpO2 will be above 95%

If SpO2 is below 95% apply positive pressure ventilation with a nonbreather mask

Discuss the relationship between hypoxia, damage to the cardiac conduction system, premature ventricular contractions, ventricular tachycardia and ventricular fibrillation.
Each of these will show up as the EKG a steep peaks close together. Ventricular tachycardia can degenerate into ventricular fibrillation which shows up as smaller uneven disorganized peaks and valleys.

Describe the roles of the heart and blood vessels in maintaining normal blood pressure.
Blood pressure is the amount of pressure exerted against the arterial wall during circulation. Blood vessel size play a major role. A smaller vessel will result in a higher blood pressure. Larger blood pressure will produce a lower blood pressure. Vasodilation (Dilation of vessels) will cause the resistance to decrease and blood pressure to fall.

Explain the importance of early recognition of signs and symptoms and the early treatment of Pt. with cardiac emergencies.
Aggressive management including early recognition and expeditious transport will reduce the death rate of a Pt. improve the pumping function of the heart, reduce the area of the heart muscle that is damaged and reduce heart failure.

Explain the pathophysiological and the appropriate assessment and management of conditions that may be classified as cardiac compromise or acute coronary syndrome.

Atherosclerosia
Also known as hardening of the arteries. Causes the smallest of arterial structures to become stiff and less elastic.

Acute Coronary Syndrome
Coronary arteries are narrowed or they can be filled with plaque, clots, or spasms. Two associated – Unstable angina and myocardial infraction (heart attack)

Angina Pectoris
Inadequate oxygen supply to the heart muscle

Assessment
Steady discomfort in middle of chest
Pressure, tightness, aching, crushing, heavy
Discomfort that radiates to the shoulders, arms, neck, jaw, back or upper center abdomen
Cool clammy skin/anxiety, dyspenia, diaphoresis, nausea, vomiting, complaint of indigestion pain

Explain the typical presentation of myocardial ischemia or infraction in females.
Classic findings such as:
Steady discomfort usually located in the center of the chest.
Pressure tightness, aching, crushing, heavy feeling
Discomfort that radiates to the shoulder, neck, jaw, back and upper center abdomen
Cool clammy skin
Anxiety
Dyspnea (shortness of breath)
Nausea/vomiting
Indigestion pain
Dull substernal chest pain or discomfort
Respiratory distress

Explain the special considerations in assessing and managing pediatric and geriatric Pt. with cardiac emergencies.
The best treatment for cardiac arrest in a pediactric Pt is to prevent it entirely by ensuring an open airway, adequate breathing, and oxygen supplementation. Pediactrics die the most from heart failure because the attack comes after long periods of other illnesses.

Geriatric Pt will represent the highest number of Pt. you treat for some form of acute coronary syndrome.



Explain the assessment based approach to assessment and emergency medical care for cardiac compromise and acute coronary syndrome.
Unresponsive Pt. with no respiration and no pulse.
Responsive Pt. who appear to be in minor, moderate, or severe distress
Perform CPR

With responsive Pt. ensure:
Adequate airway, breathing, oxygenation and circulation.

Apply oxygen if any of these are present
Signs of respitory distress or dyspnea
Signs of hypoxia
Signs or symptoms of heart failure
Signs or symptoms of shock
An altered mental status
An SpO2 reading of <94%

Discuss the indications and contraindications for fibrinolytic therapy in Pt with cardiac emergencies.
History
Onset – What brought the chest pay on
Provocation or palliation – What makes the chest discomfort worse. What makes it better.
Quality – Describe the chest discomfort
Radiation
Severity
Time

Define the cardio vascular system
Also known as the cardiac conduction system. This consists of the heart, blood vessels and blood. The system that delivers blood (oxygen) to every part of the body.

Explain the exchange that takes place between the capillaries and the body’s cells
Blood comes out of the arteries into the bodies capillaries through the arterioles. Blood low in oxygen and high in carbon dioxide leaves the venules, travels through the veins back to the heart.

Define perfusion and shock (thypoperfusion)
Delivery of oxygen and other nutrients to the cells resulting from the constant adequate circulation of blood through the capillaries. Profound compression of cell profusion is Hypoperfusion.

Name the common signs and symptoms of cardiac compromise
Cardiac compromise is reduce heart function caused by any condition, disease, or injury affecting the heart. Signs consist of:
Discomfort substernal or across the chest. Radiation to the neck, jaw, arms, back, shoulders. Dull or heavy discomfort with a pressure or squeezing sensation.
Perspiration
Pale gray color
Nausea
Weakness
Dizziness and lightheadedness
Describe the standard emergency medical treatment for Pt. with signs and symptoms of cardiac compromise.
If Pt is unresponsive with no breathing, quickly assess the carotid pulse. If no pulse apply AED without interruption to chest compressions.
If Pt. is responsive Decrease Anxiety by using calming reassurance and put them in a comfortable position. Begin oxygen to Pt.

List the major signs and symptoms of breathing difficulty
Abnormal breathing sounds such as wheezing, Rhonchi, and crackles
There is trauma to the chest or lungs
Pt membranes are turning blue
Pt. is in tripod sitting position
Pt. mental status is decreasing

Explain the dosage of asprin in a cardiac emergency and how it is administered
The dosage of asprin is 160 to 325 mg as soon as possible with the onset of chest discomfort.
Obtain approval from medical direction
Pt should be alert and oriented
Have Pt. chew and swallow (no water)
Reassess Pt and record vital signs
Reassure Pt.

Explain under what conditions the administration of Nitroglycerin is indicated.
The Pt. exhibits signs and symptoms of chest pain
The Pt has physician prescribed nitroglycerin

The EMT has received approval from medical direction, whether online or offline, to administer medication.

How should an EMT administer a medication by metered dose inhaler and by small volume nebulizer

With many illnesses affecting the lungs, an EMT will eventually have to administer medication through a metered dose inhaler or by a small volume nebulizer. There may be times when an Emergency Medical Technician may just need to stand in waiting while a patient takes a prescribed does of their medication and see what the results are. There is a right way and wrong way for everything. So what is the right way to administer these types of medications?

  • Ensure that it is the right Pt, medication, dose and route.
  • Determine if Pt. s alert enough to use an inhaler.
  • Where any previous doses been given?
  • Obtain an order, either online or offline from the medical directive.

EMT can you see the early signs of infant inadequate breathing

While going to school to become an Emergency Medical Technician, there are signs and symptoms that are drilled into the memory. It's important to recognize them as an EMT. The faster that a medic does recognize them, the quicker he or she can provide help. So what are the early signs of inadequate breathing in an infant or child?


  • Increased use of accessory muscles to breath
  • Sternal and intercostal retractions
  • Tachypnea (fast breathing rate)
  • Tachycardia (Increased heart rate)
  • Nasal flaring
  • Prolonged exhalation
  • Frequent coughing
  • Cyanous to the extremities
  • Anxiety
  • Altered mental state – Inadequate tidal volume
  • Bradycardia (slow heart rate)
  • Hypotension
  • Extreme breathing patterns
  • Cyanous to extremities
  • Loss of muscle tone
  • Diminished breathing sounds
  • Head Bobbing
  • Seesaw breathing
  • Decreased response to pain