EMS Cheat Sheet

Credit to Bobby.

EMT Cheat Sheet

This is a quick reference guide over skills, procedures, medications, and assessment that an EMT is capable of doing. You have to remember that not everyone is a medical professional so go off of what you are given in regards to signs, symptoms, and vitals.

Assessment

The assessment is something that can be done as you are walking up on a scene by taking in the initial patient presentation. Everyone has heard of the ABCs in EMS and assessing a patient's ABCs you don’t even have to touch them.

Airway: When you walk up to a patient and start talking to them, if they are conscious and see what is going on and what the problem is, and if they talk back to you or are having a hard time talking in general you know there is an airway problem. If they are unconscious, it’s simple to just RP check the patient’s airway.

Breathing: When assessing someone's breathing you can also easily do this by talking to them and usually by the way they are talking you can adequately tell if they are breathing ok or not.

Circulation: Circulation is essentially the presentation of the patient. Do they look pale? What’s their temperature? What circulation means is the patient’s blood going throughout their body adequately.

At Patient:

The second thing that should be determined is the patients level of consciousness or LOC. If the ABCs don’t show an immediate life threat then the LOC can help with solving the medical mystery or give clues to the severity of injury. This can usually help determine severity of patients overall. This is done using the AVPU scale:

• A: Alert patients are patients that are awake and able to communicate with you. These patients can still have severe injuries that are life threatening but due to shock or adrenaline have yet to go unconscious or have a decrease in LOC. This category is subdivided by orientation. To determine this ask the patient basic questions: Who are you? Do you know where you are? Can you tell me what happened? And also the “with it” questions, which are used to determine how the patients reasoning is affected. Those questions are usually one of the following: how many quarters are in a dollar and fifty cents (6)? What kind of Cat or Dog is Minnie Mouse (subjective answer but accept anything that isn’t dog or cat related)? Who is the president (accept a name or a insult correct to the current administration)? [the political question may not work in all situations due to not following politics or national identity of the civilian behind the character]

• • A/O x4: the patient is alert and oriented to who they are, where they are, what’s happening, when it is, and a “with it”question. This is determined by asking the patient the basic questions.

  • A/O x3: this patient may be alert and oriented but slightly confused on one of the basic questions. This could be due to mild head injury, an unknown or untreated medical issue, lack of knowledge of the source, or light intoxication.

  • A/O X2: this patient is moderately confused. This could be due to injury, medical emergency, age related issues (dementia or Alzheimer’s), or heavy intoxication.

  • A/O x1: this patient is deeply confused. This could be due to severe injury, age related issues, medical emergency, or intoxication with a heavy narcotic or intoxicant.

  • A/O x0: this patient is alert but completely confused. They are unable to answer questions. This could be due to extremely severe injury, bad head wound, severe age related issues, or medical emergency (blood sugar, dehydration, delirium, etc.)

• Verbal: this patient only responds to verbal stimuli. If you say their name or attempt to get their attention via speaking they may turn to you and open their eyes but that’s about it.

• Pain: if the patient doesn’t respond to verbal stimulation then a pain stimulation is needed. This comes in three waves: first attempt to use light pain (pinch earlobe or finger tip), then moderate pressure (pinch the pressure point located between shoulder and neck), and then finally the most severe stimulus is to be used. This is the eternal rub. To perform this make a fist and allow one knuckle to rise above the rest, rub that knuckle vigorously up and down the patient's sternum a couple times. This is painful and will look harsh to bystanders so use discrimination. The patient should react to one for these stimuli by either moving away from pain, groaning, or attempting to swat the source (moving hand towards provider's hand to remove stimulation). Should the patient react like this then they are reactive to pain. Should the patient wake up and verbal reassess LOC.

• unresponsive: these patients do not respond to any stimuli. Begin immediate efforts to determine what could cause this (respiratory arrest, cardiac arrest, severe injury, blood sugar emergency, temperature emergency {hypo/hyperthermia, fever, etc.}). You may not be able to determine the cause. However immediate transport is always the best treatment as our role is not to cure but to attempt to stabilize in route to the highest level of care (hospitals).

The next thing you should do when you get to a patient is get a baseline set of vitals, because depending on what is wrong this will dictate what you do going forward. This can be done by hooking the pt up to the monitor or getting a manual set. Most important part of patient assessment is talking to your patient. A lot of the information that will help determine what is wrong with them can be gained from just talking to them. When at a patient, you may not always receive accurate info, and that is okay because not everyone is a medical professional or has the knowledge needed for anything in the medical field.

Ex. You ask for a patient's vitals and you recieve words and not numbers just use it; do not keep asking to check vitals. Usually words may be low and decreasing, low but stable, stable, stable but high, or high and increasing.

• For low and decreasing this may mean bleeding uncontrolled, not breathing or not breathing enough, etc.

• low and stable may mean controlled bleed, stabilized respiratory distress (still not adequately breathing but maintaining enough oxygenation for now, etc.

• stable/normal

• Stable but high may be due to shock (treat for shock by laying the patient down, keeping warm, ensuring adequate respirations and oxygen exchange), previously intense exercise or muscle use, fever/illness, etc.

• high and increasing could be signs of early internal bleeding, early shock, worsening end stage sepsis or illness, etc.

History:

Something that can help determine what’s going on with the patient is by gaining a SAMPLE history from them.

SAMPLE is an acronym used to get basic information from your patient to help further diagnose what is wrong with them and help you as the EMS provider take better action when treating your patient.

S: Signs and Symptoms

A: Allergies

M: Medications

P: Past History

L: Last Intake and Output

E: Events To Present

Based on what you get with your patient you can accurately help treat them as well as it will help the doctors later on in patient hand off at the hospital. There may be times in which you may not be able to obtain a whole patient history and that is ok. The main thing to remember is that you have to go with what you are given in regards to when patients answer any questions or /me.

Pain:

When it comes to pain some injuries may be obvious that are causing the pain, but when a patient is in pain and there is not an obvious injury obtaining some info in regards to that pain may be required. The best way to do this is using a mnemonic called OPQRST what that means is what it stands for is…

O: Onset

When did the pain start?

P: Provocation

Do you know what caused the pain? Q: Quality

Is the pain sharp or dull? Can you describe it? R: Radiating

Does it seem to radiate anywhere else besides the initial spot? S: Severity

On a scale of 1-10 can you rate your pain 1 being the least and 10 being the most painful thing you have ever felt? T: Time

About how long has the pain lasted?

Vitals:

The vital signs you need to look for are Blood Pressure, Pulse and what’s their Respiratory rate and are they breathing adequately.

Level of consciousness: The way to score a patient's level of consciousness is by using the Glasgow coma scale. Also to see if a patient is alert and oriented is by asking them simple questions

Hyper/Hypo glycemic shock

Hyper >250 or Hypo <60

As an EMT you are able to obtain a blood glucose on a patient and is in good practice to obtain one on every patient. If the level of blood glucose falls below 60 and a pt is showing signs of Hypoglycemic shock then as an EMT you can give Oral Glucose, which is like a paste, if the patient is alert and oriented and able to protect their own airway. If they are unconscious due to Hypoglycemia, call for an ALS-qualified personnel to proceed and rapid transport. For anything above 250, transport to the nearest hospital due to one of the only things that can be done is the patient is to be given fluids.

Mass-Casualty Incidents (MCI):

A Mass-Casualty Incident, or MCI, is a scene with multiple patients and not enough resources or personnel to provide one-on-one patient care. A MCI will be declared by the first arriving unit at the scene of the incident after they conduct a basic survey of the scene; specifically looking at how many patients are on-scene and what is a rough idea of injuries. This information will then be relayed to Fire Control who in turn will notify responding units. Once additional units arrive on-scene, they will conduct a further sweep and examine patient injuries. When patient injuries are determined, the patients will then be given a colour code (Reference the Colour Code System below).

GREEN - Minimal: Patients who are able to ambulate out of the incident area to a treatment area.

YELLOW - Delayed: Patients who have non-life-threatening injuries, but are unable to walk or exhibit an altered mental status.

RED - Immediate: Patients who have major life-threatening injuries, but are salvageable given the resources available.

GREY - Expectant: Patients whose injuries make survival unlikely with resources available.

BLACK - Deceased: Patients who show no signs of life.

Once codes are determined, this will be relayed to the Incident Commander who will then arrange appropriate transportation and will remain in communication with Fire Control (Fire Comm)

Patient Care

As an EMT, you are able to do a basic level of care for that patient. Essentially, as an EMT, your job is to stabilize the patient to the best of your ability and transport them to the hospital. Your job is to provide the most basic amount of care; this involves bandaging and splinting, as well as giving a basic amount of Medications.

Bandaging and Splinting:

When working on bandaging and splinting your first job is to stop any kind of bleeding that the patient may be having before focusing on anything else. If the cuts to the patient are minor all you have to do is just clean it with some saline.

Shock:

Shock is the body's response to trauma or severe illness. This is the bodies fighting attempt to keep an equilibrium of normal. Initially this is a winning fight and the body can compensate, but without treatment the body begins to lose and enters decompensated shock. To treat shock: keep the patient laying down, keep a blanket on the patient, provide Oxygen therapy. Compensation is noted by increasing Heart Rate and Blood Pressure. Decompensated shock is noted by rapidly decreasing blood pressure, increasing heart rate, increasing respiratory rate. Decompensated shock requires rapid transport and ALS interventions If available. Paramedics can provide IV fluid to maintain a blood pressure, cardiac monitoring to watch for dangerous Tachycardia, etc.

Cervical Spine:

Depending on the mechanism of injury (what happened) should depend on if you should use a C-collar and backboard or not. If a patient is critical don’t bother putting them on a backboard before you put them on a stretcher, just flat out put them on the stretcher.

Medication:

EMTs can give the most basic medication available, this will outline when to use as well as when to use them.

Oxygen: Used when the patient’s O2 sats are below 92% or any kind of low. It can also be used in some cases of chest pain. Administered via Nasal Canula at 1-6 LPM or Non-Rebreather Mask at 10-15LPM.

Oral Glucose: Oral Glucose is to be used in diabetic emergencies when the patients blood glucose is low. It’s like a paste that can be used on a patient that is alert and oriented and can support their own airway. This comes in a single dose tube.

Aspirin: Anti- inflammatory agent and anti-fever agent that prevents blood from clotting, can be used with mild pain, headache, muscle ache: chest pain of cardiac origin. For a patient with a suspected Cardiac Incident, administer 4 81mg tabs with the instructions to chew and swallow.

Nitroglycerin: to be used for individuals whose blood pressure is very high you will typically use it for an individual that has chest pain. This comes in the form of 1 .4mg tablet that the are to allow to dissolve under the tongue. {do not give to PTs who have a known sensitivity to nitrate medications. Have taken erectile dysfunction medications within the past 24 hours, such as Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil or vardenafil. Are hypotensive (typically <90 SBP)}

Albuterol: Used when a patient is having difficulty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by asthma. Comes in 250mg ampules can be used 1 every 3 min as needed. Take the ampule and empty the contents into a nebuliser. Connect the nedbulizer to an Oxygen source at 6LPM and allow patient to inhale the dosage as they breathe.

Atrovent: Used for a bronchospasm (narrowing airway) with patients with COPD, can be used in conjunction with albuterol and comes in 500mg ampules given only once. Take the ampule and empty the contents into a nebuliser. Connect the nedbulizer to an Oxygen source at 6LPM and allow patient to inhale the dosage as they breathe.

Epipen: To be used in cases of anaphylactic shock it is .3 mg of epinephrine with a Junior pen having .15 mg of epi. EPIPENS are to not be used during Bradycardia (low pulse) emergencies. To administer follow instructions on the device. Remove the safety tab, press the device firmly to the thigh of the patient, push down and hold the position for 10seconds to allow full dosage administration, then message the site for a further 30 seconds to allow for accelerated absorption. Once complete dispose of the device in the sharps container.

Narcan: To be used intranasally in a pre-loaded dose syringe and is to be given to pt who have overdosed on opioids. This is administered via a pre-filled syringe that is connect to a MAD device. Place the vial of 2mg Narcan in the MAD device and administer 1mg per nostril in a rapid push to aerosolise the medication. If the patient is not breathing adequately then BVM must be used to help the patient breathe and push the aerosolised medication into the lungs.

Green Whistle: Basically it's a form of pain relief inhaled through the "whistle", The initial dose is either 1.5ml or 3ml. The patient will generally get pain relief after 6 to 8 breathes and it will last for 25 mins after treatment with it has stopped. If a second dose is needed which is at 3ml it will last an hour after. It's used for managing acute traumatic pain so sporting injuries mostly it can even be used after procedures for pain relief. There are side effects but their mostly benign usually just a good high and if you give someone more than 6ml a day or 15ml a week it can cause kidney damage.

Zofran ODT(Ondansetron): this is the dissolvable tablet version of the IV,IM medication the Paramedics carry. This is given for moderate to severe nausea and vomiting. To administer give the patient one 8mg tablet and instruct them to allow it to dissolve on the tongue.

Equipment: A comprehensive list of common equipment we use, and how/why they are used when they are is listed in EMS Equipment. While this isn’t gospel it will go a long way in helping make your use of them correct, and bring knowledge of them to you for use when they are appropriate or not.