EEI Paramedic Refresher 201 0

EMERGENCY EDUCATIONAL INSTITUTE INTERNATIONAL EMT and PARAMEDIC REFRESHER Copyright 2010

Florida DOE Licensed School #3252 Florida Bureau of EMS Site #115

NO REPRODUCTION OF ANY KIND MAY BE DONE WITHOUT PERMISSION FROM EEI.

Emergency Educational Institute 9381 W Sample Rd #200 Coral Springs, Fl. 33065

954-753-6869 Fax 954-755-9050 info@eeii.org www.eeii.org Todd Soard, NREMT-P, Ph,D. Sindiana Echeverri, IEMSR-P, EMT-P, MPS

PARAMEDIC REFRESHER

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EEI Paramedic Refresher 201 0

Instructions for the Refresher Program

YOU WILL NEED TO READ, SIGN, AND SEND BACK THIS PAGE WITH YOUR COMPLETED PACKET!
The module packet is for your reference. Other source material may be used to complete the worksheets.
Complete the worksheets in-depth. NO short answers will be accepted. EMTs must have the skill evaluation sheet signed and returned with the completed worksheets. The HIV portion needs to be completed as well and the worksheet returned. A copy of a current CPR card must be with your returned worksheets. A copy of an ACLS card is required for Paramedic as well. Please copy your worksheet answers and keep them until your certificate of completion is received back from us. EEI is not responsible if they are lost in the mail or in delivery to our office in any format. Remember to keep all records for 3 years. DO NOT throw away any certificates or cards used to renew. If audited, the State wishes to see what you used to renew with during this renewal period. Again, DO NOT throw your CPR, ACLS, or certificates away when you renew them later on. Remember that in an audit YOU are the one the State must hear back from. If your agency renewed for you that is good, however YOU must answer the State. (F.S. 401) It is YOUR responsibility to send in your fee and application to the State. Usually, the State sends out your application in August or September. The State must have your current address on file. That is the law! (F.S. 401 and Rule 64E-2) If you do not receive an application YOU must call them to receive one. ALL WORKSHEETS MUST BE MAILED. FYI: Check these sites out: www.eeii.org, www.fapep.org, www.naemt.org , www.iemsr.org

I have read the above information and attest that all answerers were completed by me. ___________________________ Signature _________Date Licenses FL #: _________________________ Print Name National #____________

PMD_______________

Refresher for Retest Purposes Only? _____________ Other State: ______________
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EEI Paramedic Refresher 201 0

Module 1 EEI, INC PREPARATORY

Scene Safety Body Substance Isolation (BSI) is one of the most important parts of your patient care. We need to remember that hand washing is needed even if we wear gloves. Eye protection is required in the prevention of splashes to the eyes. If prescription eyeglasses are worn than removable side shields can be applied. Gloves are required when coming into contact with a patient for any reason. We must change our gloves when dealing with multiple patients such as in a multi-trauma call. When cleaning equipment or our unit we need to have gloves on as well. Gowns are good when you may come into contact with large amount of body fluids that could splash. It is an OSHA standard that we carry an extra uniform so that we can change when our uniform becomes contaminated. Masks are a part of our BSI. They should be worn when the possibility of blood splashes may be present. A HEPA mask is required when coming into contact with a TB patient. The TB patient should wear airborne disease mask as well. If an exposure should occur you need to refer to your Policy and Procedures Manual for reporting and documentation • PERSONAL PROTECTION

Hazardous materials play a large part in our everyday world. When responding to a HazMat scene we need to observe the scene and protect those around the scene and ourselves. View the scene with binoculars and look for placards. The HazMat team should be advised of your findings and the HazMat team controls the scene. We need to keep contamination low and obtain special training for these cases. In any rescue attempt we must identify certain threats. These may include electrical wires, fire, explosions, and hazardous materials. In violent situations the scene must be controlled by law enforcement. If law enforcement is not present then you should take any necessary precautions. Do not become a patient yourself. • Quality Improvement

In Florida EMT’s and Paramedics can only operate under the direction of a Medical Director. The physician must be a M.D. or D.O. and licensed in Florida. The goal of the Medical Director is to establish and maintain Quality Assurance (Q.A.), proper education, training and certifications of EMT’s, and have oversight of medical treatment protocols. These protocols can be on-line or off-line direction. The Office of the Medical Director must do review of paperwork. Most States do have a percentage of the run reports that must be observed. • Health and Safety

Lifting Lifting is the most common cause of back injuries. We all need to use our LEGS when lifting and keep the weight of the person or object close to us as much as possible. If needed, ask for assistance 3

Stand by making sure the back is locked in and the upper body comes up before the hips. alcohol and smoking should be reduced or just avoided. but mainly it is found that our significant other is not part of the medical field. Don’t make EMS your main resident address. Stressful Situations We need to understand that the field we are in has stress. indecisiveness. abuse. I mean. Burnout only comes from you! You make your job what it is. Know your limitations and that of your partner as well. We should practice what we preach when it comes to eating out and avoid a high intake of fats. This will prevent “burnout”. I know we need to talk to each other about what goes on in our field when we are around each other. It looses its spice when we have to do this. On top of these situations we have the stress of family. But look at your significant other and/or friends. Straddle the object and keep the feet flat. Once we recognize what produces stress then we need to address it. Try pushing an object rather than pulling when ever possible and avoid overhead pushing or pulling. The power-grip makes use of all your hand power. We need to see what the problem is and make changes for the better. If it is that bad consider changes because no job is worth you health and life. isolation and loss of interest in work. bills. Always avoid bending at the waist. Always keep your back in a locked position.EEI Paramedic Refresher 201 0 and know your limitations. The palm and fingers come into full contact with the object and all are bent in the same direction. Your hands should be about 10 inches apart. We may experience this by seeing a Mass Casualty Incident. or death. and the issues of our employment. We do not feel like giving EMT 101 in order to explain what happened at the call. Understanding that things may not make us better overnight but we are moving ahead on the situation. Place your weight to the balls of the feet or just behind them. Look for irritability reactions to others. What happens is that we hold it in until we see others in our field. and loss of appetite. inability to concentrate difficulty sleeping. Naturally. GET AWAY! Don’t hang around the house or the county you live in. We also need a balance between work. You know what I mean! There is a life outside the lights and sirens. Be aware of family and friends when you are out with them. Do not twist when lifting and have your feet properly positioned. The feet are apart in a comfortable position. Stress Management We need to recognize the warning signs of stress. we speak of work and what has happened but is it the topic of conversation the whole time? You need a break from work and this causes burnout for you and those around you if this is all you talk about. Do they always want to hear what’s happening all the time? This is where balance is needed on both sides. Divorce among uniformed personnel is high and mostly due to lack of communication. anxiety. This is not stress relief. This could be for various reasons. This technique is good for those with weak knees or thighs. CISD 4 . Consider using a power-lift. We all need to watch our diet. sugar. Talk the lifting procedure over with your partner before you actually do the maneuver. Carrying/Pushing/Reaching When carrying a patient or object always think before you lift. caffeine. loss of interest in sexual activities. guilt. a traumatic injury to a child. family and friends. DO IT! Money is always a factor so do what you can but get away. Keep your arms close to your body and elbows bent. The back is tight and the abdominal muscles lock the back in a slight inward curve. Vacations are recommended but I say.

The supervisory staff is debriefed separately from the field crew so that employees are more comfortable in speaking out. Confidentiality We in the EMS field need to cautious in our view of confidentiality. They advised the patient that she needed to accompany her daughter to the hospital to find out why she would not talk to her. The patient must be informed of the procedures being conducted. in your findings. this situation falls under implied consent. The crew turned the light on but the patient still insisted her daughter was not talking to her. except to those at the hospital. Releases are not required when other healthcare workers have a need to know. because she was refusing to go. When a life-threatening situation occurs and the parents or guardians cannot be contacted. A call was related to me that come into mind. Teams are brought in to assist and to help and anything that is said is confidential. When in doubt err in favor of providing care. IMPLIED CONSENT Implied consent is active when a patient is unconscious or becomes unconscious even if he or she denied treatment while conscious. Refusal of Care The patient does have a right to refuse care and may withdraw treatment at anytime. abuse or gunshot wounds. Don’t hold things in since this is a cause of burnout. • Medical – Legal EXPRESSED CONSENT This type of consent deals with patient of legal age and sound in mind. In some cases you may run into an Emancipated minor. Third party billing forms are okay as well as legal subpoena. They have been judged by the court to be an adult and they usually have papers from the court on their person showing proof of this ruling. If assistance from law enforcement is needed than ask for it. Usually debriefings are done within 24 to 72 hours of the major incident. We cannot give out. Try to persuade the patient to going. The whole CISD procedure is to accelerate the healing process of the EMS worker. She willingly got up and left with the crew. what we have found out from our patient in the interview process. No one was in the house but it was discovered that she thought the lamp was her daughter. assisted the patient. The releasing of this information requires a signed form from the patient. Document all factors of the call including what you advised the patient upon refusal. and not under the influence. In most states a minor is considered to be anyone under the age of 18. A women called 911. This form of consent must be obtained from the patient before giving treatment. Most State laws require the reporting of rapes. you could imagine their faces. findings. The patient must be informed of the risk of their actions and sign a “release of liability” form. To get her to go to the hospital. Children and Mentally Incompetent Adults A parent or legal guardian must provide consent. and treatment rendered. Refusals must be made by mentally competent adults following the rules of expressed consent. This implied consent is based on the assumption that the person would consent to life saving interventions. On arrival her only complaint was that her daughter would not talk to her. At the hospital. Make sure that the patient is of sound mind. the real 5 . the crew placed the lamp on the stretcher and strapped it in.EEI Paramedic Refresher 201 0 Critical Incident Stress Debriefing is offered to all on the scene of a call that can affect mental stability.

In general. this requires a written order from a physician. INC Abuse and Neglect of a Child or the Elderly The definition of abuse is the improper or excessive action so as to injure or cause harm. no medication present or given CNS injuries are most lethal and are seen in shaken baby syndrome (SBS). treat the patient. This was inventive of the crew and proved beneficial since the caller was refusing to leave.e. Follow your protocol concerning proper chain of reporting since the Medical Director will need to be advised as well. not what you think is happening. EEI. In any case we do not want to accuse anyone while on the scene. Your findings need to be relayed to the facility to prevent delay of treatment to your patient. When in doubt or a DNR order is not present.EEI Paramedic Refresher 201 0 one. to a private room. The definition of neglect is giving insufficient attention or respect to someone whom has a claim to that attention. It is your obligation to report what you see and hear. Signs and symptoms of abuse are: • Multiple bruises in various stages of healing • Injury inconsistent with mechanism described • Repeated calls to the same address • Fresh burns • Parent or guardian seem inappropriately unconcerned • Conflicting stories • Fear on the part of the patient to discuss how the injury occurred Signs and symptoms of neglect are: • Lack of adult supervision • Malnourished appearance • Unsafe living environment • Untreated illness i. You need to follow your written protocol concerning this issue. Do Not Resuscitate Orders (DNRO) The patient does have the right to refuse treatment. We all need to recognize these situations. 6 .

Nasal passages should be done with a bulb suction or French catheter with low suctioning. To immobilize the head while ventilating you may use your knees.EEI Paramedic Refresher 201 0 Module II EEI. This can be difficult since we must push down and pull the head back to ventilate. Make sure the chest rises and you have good lung sounds. Techniques of Suctioning Our suctioning equipment should be inspected frequently. This is done by grasping the back of the jaw at the angle and pushing forward. A properly functioning unit with a gauge should have about 300mmHg. Techniques of Artificial Ventilation We always need to use proper equipment when ventilating our patients. 7 . bag-valvemask. When suctioning we move the catheter from side to side and suction while pulling our catheter out. If trauma is suspected be careful not to move the neck too much but an open airway is vital. Use of an oral or nasal airway can be beneficial in ventilating. If we have a battery-operated unit it should be charged and ready for operation. We should use a rigid catheter for suctioning the mouth of infants and children.B. In all airway maneuvers we need to have suctioning available. Beware of T. Having sterile water nearby will help if the catheter or tubing becomes blocked with large objects that need to be dissolved. If trauma is suspected than the jaw thrust maneuver is to be performed. and have a proper HEPA mask for yourself and your partner. and oxygen-powered devices are our tools of the trade. This is accomplished by pushing back the forehead and lifting the chin. We must practice using the BVM since the mask must be made to complete a seal. If further suctioning is required then ventilate the patient for at least 2 minutes and re-suction. Bag-valve-mask The bag volume is 1600 milliliters of air and we need to deliver at least 800 milliliters. being careful not to lift or rotate the neck. Mouth-to-mask. INC Airway Opening the Airway The head-tilt lift is the preferred method of opening an airway when NO injury to the C-spine is suspected. Suctioning should only last for 15 seconds at a time. We always need to keep in mind the use of our body substance isolation when dealing with any patient.

Remember to inflate the bag portion of the mask and adjust the liter flow as to where the bag does not collapse. We treat the patient’s needs. Nasal Cannulas are used on patients that need only a low liter flow or will not tolerate a nonrebreather mask. not machines that may show an acceptable O2 Sat. If resistance is met. Advance the OP gently until resistance is felt and turn 180 degrees. Open the patient’s mouth and look for obstructions. OXYGEN Non-Rebreather masks are used for patients that need high flow O2. Insert the tube posteriorly with the bevel toward the base of the nare or toward the septum. Liter flow is to be 10-15 liters. Insert the OP upside down with the tip towards the roof of the mouth. use the other nostril. NC is used with 2-6 liters of O2. or if the patient has a history of COPD or is a child. 8 . Rest the flange on the patient’s teeth. Another way of doing this procedure is to insert right side up. This method is preferred in infants and children. Measure the OP from the corner of the patient’s lips to the bottom of the earlobe or angle of the jaw. Nasopharyngeal Nasopharyngeal airways are less likely to stimulate vomiting and can be used on patients that are responsive. Never force the tube. Make sure you do not push the tongue back. In selecting the proper size you need to measure from the tip of the nose to the tip of the patients ear. NO evidence has been shown to prove that high flow O2 will hurt these patients.EEI Paramedic Refresher 201 0 Airway Adjuncts Oropharyngeal Airway Oropharyngeal airways may be used to assist in maintaining an open airway on unresponsive patients without a gag reflex. The diameter should be the nare. using a tongue depressor to press the tongue own. It will block the airway. Remove any of course. You do need to lubricate the tube but remember that the insertion can still be painful.

Be aware of crime scenes and make sure the one or ones that committed the crime are restrained or Police are on scene. Always have proper BSI (Body Substance Isolation) available and wear it with every patient. Bystanders need to be asked to move from the area to avoid becoming potential patients and from getting in the way. overhangs. etc. awnings. Look for toxic substances. ice. Look for unsafe surfaces such as wet areas. INC PATIENT ASSESSMENT SCENE SIZE-UP/ASSESSMENT Scene size up means that you are gathering information about your surroundings. Is it a medical or trauma? We need to be ready to obtain the information needed so that proper care can be given. INITIAL ASSESSMENT 9 . Protection of the patient needs to be considered as well. Think of scene safety. We must do this on every call since in order to give proper care to every patient on the scene and for our safety and our partners safety.EEI Paramedic Refresher 201 0 MODULE III EEI. slopes. We need to determine the true nature of the call. This needs to be done politely since we are in the public eye. Is it safe to approach the patient? Be aware of hazards in a crash situation.

difficulty in breathing. medical history. Is it soft. If the patient has no radial pulse then feel for the carotid.EEI Paramedic Refresher 201 0 Look at the general appearance of the patient. Palpate the abdomen. ventilator adjuncts are required. or distended? Assess the pelvis. Identify priority patients and triage them if you have multiple patients. If <8 or <90lbs start CPR only. Assess the pulse for circulation. If no carotid pulse is present and the patient is > or = 8 years old. Assess the skin color. If the patient is not breathing. age. Determine the problem and assess for any life threatening injuries or situations. chest pain. start CPR and apply the AED. Assess the patient’s airway. shock. Listen and look for possible obstructions and clear them if any are found. If this is the case then treat the patient as necessary to prevent further harm. Evaluate the neck for JVD and stair stepping of the back of the neck. Assess the patient’s mental status by speaking to them. Your standards locally may be different so consult your protocols. complicated childbirth. Maintain spinal immobilization and obtain an AVPU level. Check the ABC’s and include lung sounds. If the patient is experiencing an altered mental status. Responds to Verbal stimuli Responds to Painful stimuli Unresponsive-no gag or cough. Listen for breath sounds. temperature. Assess the neck area before you place a C-collar on. Obtain a SAMPLE: 10 . In trauma patients start CPR or follow your local protocol. Focused History and Physical Examination Trauma We must perform a rapid assessment with our patients. Assess the extremities and check for distal pulses. All patients breathing adequately and are responsive should receive oxygen. and evaluate to see if they are clammy or sweating heavily. Note these items in your report. hard. Determine the cause of the injury while helping your patient. Note any abnormalities. All responsive patients breathing >24 or <8 should receive high flow O2. Spinal stabilization is required and ALS treatment is no doubt a need. Assess patient’s mental status. If the patient is not breathing perform the appropriate method for opening the airway such as Chin-lift head-tilt or Jaw-thrust maneuver. Use the following assessment: DECAP-BTLS • D formities • C ontusions • A brasions • P unctures/penetrations and for breathing paradoxical movement • B urns • T tenderness • L acerations • S welling Any findings that present a life and death crisis stop and treat it or delegate the task to someone else and continue on with your assessment. and medications at the least. Alert. In any case treat your patient as per protocol until advanced care arrives. Assess the chest for paradoxical motion or crepitation. Speak to the patient and obtain their name. uncontrolled bleeding or sever pain you need to expedite transport and have ALS treatment conducted as soon as possible. rigid.

EEI Paramedic Refresher 201 0 S igns and symptoms of present illness or injury A llergies M edications P ertinent past history L ast oral intake: solid or liquid E vents leading to the injury or illness If the patient has only minor injury your focus needs to be on the specific injury. Look at the OPQRST • O nset • P rovocation • Q uality • R adiation • S everity • T ime Obtain a SAMPLE and perform a rapid assessment. Obtain a baseline of vital signs. Palpate to note deformities and assess for pulses. Look for bleeding or fluids. if possible. nose. face. Detailed Physical Exam This is also formally known as the artist Prince. Responsive Medical Patients Assess the history of the present illness. family. from bystanders. Just kidding! This is formally known as the secondary survey. and mouth. Do a head to toe survey to get the big picture. eyes. Unresponsive Medical Patients Perform a rapid assessment and obtain SAMPLE information. ears. D eformities • C ontusions • A brasions • P unctures/penetrations (in lung sounds look for Paradoxical movement) • B urns • T enderness • L acerations • S welling Assess the head. or friends. Ongoing Assessment 11 . Be aware of possible obstructions. As you inspect the patient have the DCAP-BTLS in mind. This is our more detailed exam so that we can pick up on special conditions and problems that are not life threatening but need to be noted.

Same with a patient who is old. No matter whom you work for your check comes from the payment of the care provided. Record what you see on the call such as in the case of an assault. Keep eye contact with our patient. Document properly and watch your spelling. Just make sure it is appropriate and you know what you’re using. vital signs. speaking louder will not make the translation go through any better. Use the patient’s proper name. Don’t raise your voice volume. On top of that you can loose you job and possibly have you certification revoked. Interpersonal Communication As in our everyday life we need to follow proper communication skills. Allow the patient to respond before asking the next question. Without proper billing information administration cannot collect and this can effect pay raises. Ask how they wish to be addressed. The patient is a person as you are and we need to keep their dignity in mind. history. You may use a computer pad for documentation and this is good. Never use abbreviations that are not authorized. If they speak another language. The worksheets for the Paramedic are in addition to the EMT-B worksheets. Relates the chief complaint. If your patient has difficulty hearing. Verbal Communication After you arrive at the hospital a verbal report needs to be given. Never falsify a report because it will come back to bite you later and also makes you look bad. slowly and distinctly but no to belittle the patient. rape. They can probably still hear. INC MEDICAL / BEHAVIORAL Throughout this and proceeding sections we will address the actions of the EMT-B and the Paramedic. Act and speak in a calm manner. Keep it to that. Introduce the patient by name if known. etc. Use language the patient will understand. MODULE 4 EEI. The trademark of EE5. Be aware of body language so that you not acting defensively. This will maintain control of your scene. depending on proper use. If you forgot to provide a form of treatment then state it and how it was corrected. treatment en route. Make sure that you do the check off section correctly and your handwriting is satisfactory. This is of consideration when dealing with children. The billing information section is PART OF YOUR JOB. Pre-hospital Care Report Your run report is an extension of you. If they can’t hear don’t make your partner deaf from your volume. It represents you as a person and who you are. 12 . Even though the EMT-B does not do the Paramedic skill I feel it is good for you to have the knowledge. Sometimes the use of slang that the area uses may help in obtaining information properly and quickly. Summarize what was provided over the radio report. etc. Assure that no other problems have surfaced that is critical. If you don’t they will feel that your not sure of yourself or something is wrong. Speak clearly. This will get you into trouble and can make it hard on your partner if you’re not around and they have to testify on what you wrote. They are not “The Patient”. has had a possible stroke. This may prove beneficial later on. The information in your run report must be in relation to the call. This makes you a more respected person and makes our profession professional. and additional information that have occurred. Personal opinions are not part of the report. first or last. position yourself lower than your patient. When practical. speak clearly with lips visible. or is mute.EEI Paramedic Refresher 201 0 Repeat the assessment you have done every 15 minutes for a stable patient and every 5 minutes for an unstable patient. Inc is “Giving Life Through Education” and by this education everyone benefits.

The EMT-B may use the Epinephrine auto-injector under the approval of your protocol. audible wheezing. Liquids for injection – epinephrine. Medications that the patient may have and you are approved by the Medical Director to assist with consist of Prescribed Inhaler and Nitroglycerin. lidocaine. pursing the lips. Hold it for 30 to 60 seconds. Indications = Use of the drug for its intended purpose(s). • • • • • • • Compressed powders or tablets . Document the actions that the medications performed. Gels – glucose Suspensions – activated charcoal Fine powder for inhalation – prescribed inhaler Gases – oxygen Sublingual spray – nitroglycerin spray. Be aware of how the patient is speaking.Atrovent. During administration of any medication(s) vitals and assessments need to be done with our patient on a continuos basis. You pop off the top cap and push the other end of the barrel against the patient’s skin. atropine. Contraindications = Situations in which the drug should not used due to knowledge of how it may or will harm your patient. BREATHING DIFFICULTY Signs and symptoms are shortness of breath. Albuterol All medications are in a specific form to allow proper controlled concentrations of the drug to enter the body and target the system desired. snoring. and Oxygen. aspirin. • Liquid/vaporized fixed dose nebulizers . Dose = The amount found to be needed to obtain the desired effect. DO NOT SHAKE! The medication stays at the bottom. Noisy breathing such as crowing. 13 . and increased pulse rate. Trade = Brand name the manufacturer uses in marketing the drug. The name is based on the chemical name. or stridor. The device is spring loaded and come in an adult and child dose. which is a harsh sound. Oral Charcoal. Pharmacopoeia and is the name assigned to the drug before it becomes officially listed. Oral Glucose. decreased breathing rate. It can be administrated in the thigh or upper arm. Examples are given beside each one listed. sitting upright. barrel chest. heard during breathing or an upper airway obstruction. increased breathing rate. Side Effects = Actions of the medication(s) that is not desired. pale or flushed (red). Terminology’s for medications are as follows: Generic = The name listed in the U. coughing. gurgling. etc. Tylenol.nitroglycerin. Skin color changes such as cyanotic (blue). Read the canister.EEI Paramedic Refresher 201 0 GENERAL PHARMACOLOGY Medications carried on the EMS unit for the EMT-B consists of Activated Charcoal. Actions = Desired effects of the medication.S. Medications come in different forms. restlessness. use of accessory muscles. This is used in the event of an anaphylactic reaction.

Typically you give 1 dose every 3 to 5 minutes and no more than 3 doses in 10 minutes. Infants CPR Compression to ventilation is 30 to 2. tremors. if prescribed for the patient can be given as per your protocol. Our depth of compression is 1/3 of the chest size. Watch for increased pulse rate. 2 man CPR compression to ventilation is 30 to 2. Frequent coughing may be present rather than wheezing in some children. The paramedic would follow the protocol for chest pain. which usually includes the use of Nitro spray. AUTOMATIC EXTERNAL DEFIBRILLATION As we know. Handheld inhalers are commonly used with children. 1½ to 2 inches. This dilates the bronchioles. The depth is ½ to 1 inch. (i. In infants and children remember that cyanosis is a late finding. CARDIAC EMERGENCIES If the patient is experiencing chest pain they may use Nitro if they have it.. In 2 man CPR it is 15 to 2. Remember to check the patients B. Child CPR 1 man CPR is at a compression to ventilation rate of 30 to 2. Obtain help right away and get early defibrillation present. If CPR is required we need to remember our skills and perform them adequately.) We use both hands overlapped or the heal of one hand. is that below 100 systolic. then hold it for them as they normally would and have the patient push down on the inhaler when they are ready. this comes from the Epi.. Oxygen and an inhaler.e. 1 to 1½ inches. The systolic should be greater than 100.e. Pulse check is done at the carotid artery. Remember to use barrier devices when doing ventilation’s and wear gloves. Pulse check done at the carotid artery. They are as followed: Always remember your ABC’s and check for unresponsiveness.. If you are assisting the patient with their inhaler make sure it is theirs. pain is relieved. Rescue breathing is 1 breath every 5 seconds.) We use the heels of the hand locked together keeping our fingers off the chest. will drop.P. If protocol dictates you can assist. and nervousness. The chain of survival consist of: 1) Early access 2) Early CPR 3) Early defibrillation 4) Early ACLS 14 .P. The use of Nitro will not be needed if the B.. Our depth of compression is 1/3 of the chest size. The position is one finger width below the nipple line using 2 fingers or use your thumbs in the same position overlapping each other. (i. or you have give 3 doses of Nitro. The effects will be a beta action. Adult CPR 1 man CPR compression to ventilation is 30 to 2. before and after the administration of Nitro since it dilates and the B.EEI Paramedic Refresher 201 0 The patient needs treatment in any situation of difficulty breathing. The ALS care is to give a breathing treatment via a nebulizer as per protocol.P. the use of early defibrillation saves lives. Always reevaluate your patient.

The AED evaluates the rhythm after each shock. Many police departments are placing them in patrol cars and BLS units are doing the same. 3 times at 200j. If the unit is Biphasic it may choose a lower setting on its own. Some AED’s have the rhythm screen on top so that the actual EKG can be determined and others now have a visual command screen for the hearing impaired. In the fully automated all you assess the patient for need attach the patches and turn the unit on. In any case regular checks and maintenance is required. and a rate of 180 or more. In the Semi – automated. Nitro dilates blood vessels so the patient may experience hypotension. Naturally. Shopping mall and residential security companies are making use of the AED as well. no further administration is needed. At the time. Viagra. headache.e. Written reports are also needed. AED’s are being reprogrammed to meet the new 2005 Guidelines. How these manufactures conduct this will be the responsibility of each. my 7-year-old daughter viewed the training unit and can tell you how it works. I’m not saying we let a child use the unit. If the rescue unit is moving you will need to stop for proper evaluation of the patient. these rhythms are pulseless. Under ALS treatment. Remember the spray type does NOT need to be shaken before administration. pulseless patient that weighs more than 90lbs and is over the age of 8. If the EMT gives Oral Glucose. (i. you must make sure the 15 . You must follow your protocol for the use of the AED. The unit detects the needed amount of energy required to resuscitate. spray. the computer voice prompts you throughout the rescue. the most used unit. Some units use only 150j and others begin at 140j and max out at 320j. as in Manchester. Be aware of Nito patches on the patient and ask as to when it may have been changed. Nitro should not be given if the patient is on any sildenafil citrate. Fully automated and Semi-automated. In Florida the AED is covered under the Good Samaritan Act for Laypersons. Most protocols for D50 are to administer 25mg at first and a follow-up of 25mg if needed. You no doubt have seen it on the news reports of the airlines purchasing them mostly in response to the proven need.. The unit also records the event for viewing by the medical director and is downloaded into your computer for this purpose after each rescue. The proper use of the AED is simple. if needed. Reason? More is not always better. tablet. Place the patches on the patient and make sure the unit is turned on. and pulse rate changes. During the evaluation period of the AED CPR must be stopped if it has already begun. but that is how simple it is.Lavitra tm) Nitro may come in different forms. MEDICATIONS • Nitroglycerin is used with patients experiencing chest pain. • Oral Glucose is given to patients with an altered mental status with a known history of diabetes. The unit is applied on an unconscious. that AED’s save lives due to the early access by the police and those having an AED. If needed. Always remember that if the BP is below 100 systolic or the max dose of 3 times in 10 minutes has been accomplished. At this time. Every 60 seconds the unit will advise to stand clear so that is can evaluate the patient to see if there is a shockable rhythm.EEI Paramedic Refresher 201 0 Studies have proven. After administration of Nito check the BP within 2 minutes. EKG units can be switched over with a key or key card from the Paramedic and make the unit into a regular ALS monitor/defibrillator. July 2006. Many groups and organizations are using the AED. or patch. Pulseless VTach. The AED comes in 2 different functions. 300j. The unit will shock. Always ask the patient if they have taken any Nito before your arrival. Wisconsin. after the 3rd shock the unit advises to check pulse and do CPR if no pulse. D50 via IV will be administered if called for under the protocol for any altered mental status with a low glucose level. Follow the manufacture recommendations on these procedures. and 360j. Cealis . She is now 15 and can operate it. The AED is programmed to only shock in V-Fib. Then let the AED advise you as to what to do next. For the EMT and Paramedic you need to follow your protocol on its administration.

usually about 30 to 60 seconds. The patient will need to be assessed constantly and proper treatment required for any situation that may prevail. In the ALS setting watch for arrhythmias. chills. ALS procedures would include IV. In any case try to bring the bottle or container that the substance was derived from.5 cc will be given SubQ. itching. In the ALS setting the Paramedic will administer Epi 1:1000 with a 1cc syringe. abdominal pain. Maintain you ABC’s In the ALS setting monitor the patient. Airway is of concern and proper treatment by protocol. • Place the tip of the auto-injector against the patient’s thigh. Always follow your protocol and obtain what the patient was exposed too. confusion. chest pain. The side effects can be increased heart rate. Activated charcoal may be called for and the patient needs transport to the hospital. Ingestion may cause nausea. may administer the medication via an Epinephrine auto-injector pen. . INC BEHAVIORAL EMERGENCIES 16 . dizziness. fever. Care would be to remove the patient from the contaminated environment and start O2 therapy right away. chest pain. for how long and how much. Actions will be dilation of the bronchioles with constriction of blood vessels. The same goes for any contact with the eye. • Record the time and any reactions. The Epi comes in a vial and will be drawn up in the syringe. In some cases the Epi 1:1000 will be in a pre-filled syringe and ready for use. EEI. The procedure for administration for the auto-injector is as follows: • Obtain orders or follow your protocol. Obtain what the substance the patient was exposed too and be aware that a HazMat team may need to come in to retrieve the patient. This should absorb into the patients system. cough. start an IV and transport. If a powder is the problem brush it off. We will cover each of these. If it is a liquid then about 20 minutes of irrigation is required. or an altered mental status. hoarseness. Irrigate for at least 20 minutes and in any case transport ASAP. Care includes removing any substance from the mouth that may be present. and redness. In a toxic situation the patient may experience weakness. and following proper protocol. • Remove the safety cap from the auto-injector. as per protocol. IV and O2. dizziness. pallor. vomiting. Remove any clothing and protect yourself from being contaminated. altered mental status. monitor. Protocol will be followed in any case. • Push the injector until the medication is delivered. excitability and anxiousness. vomiting. breath odor. seizures. dizziness.3 to . irritation.EEI Paramedic Refresher 201 0 patient can swallow and has a good airway. Place the gel between the check and gum. nausea. Inhalation poisoning will show difficulty breathing. Stabilize the patient by monitoring ABC’s. diarrhea. In absorption situation the patient may experience burns. Watch for arrhythmias and treat appropriately. and chemical burns around the mouth. nausea and vomiting. headache. headache. The EMT. Epinephrine (Adrenaline) is used on patients that are experiencing an allergic reaction. EMERGENCY MEDICAL CARE of POISONING / OVERDOSE There are different means of poisoning.

17 . I was on a call that the gentleman explained that he had to go to the bathroom and wanted to be left alone. altered mental status. imprisonment. Watch for depression. Loss of a job. sadness. nausea. Hypoglycemia. Be watchful of your surroundings and make sure the patient is never left alone. Document what was said and done.EEI Paramedic Refresher 201 0 Many of our EMS calls relate to some form of mental instability. clammy skin. they will need an I. Defines action of causing death. Our body can be fooled if the environment has high humidity. and provide fluids. Weak. This will assist in keeping the patient from possibly doing more harm and assists in limiting possible allegations. low BP. alcoholic. In other cases the body sweats and the person does not take in enough fluids. Recent loss of a loved one. Prior incidents of suicide attempts. Temperature – infant and child patients only. depression. This causes dehydration and an electrolyte imbalance. INC TRAUMA Shock (hypoperfusion syndrome) is defined as inadequate tissue perfusion. tachycardia. cold and clammy skin. cool. Signs and symptoms are: • • • • • • Restlessness. headache. right away. vomiting. Behind the bathroom door was a loaded shotgun.V. Treatment includes getting the person out of the heat. Recent diagnosis of serious illness. thready or no peripheral pulses. MODULE V EEI. single widowed or divorced. Purchasing of a gun or a large amount of medications prescribed or not. arrest. Altered Mental Status An altered mental status comes about from various reasons such as Stroke. When he was told he would not be left alone he became very upset. thirst. tearing. and a slight fever. Delayed capillary refill >2 seconds. If they can not keep fluids down. The body senses moisture so it does not sweat enough. Drugs and Alcohol. Heat Exhaustion Heat Exhaustion occurs when the body overheats and is dehydrated. Pale. The person will experience profuse sweating. A late sign would be BP. What do you think he wanted to be alone for? When dealing with behavioral patients never be alone. Some of the risk factors include but not limited too: • • • • • • • Males over 40. After a period of time the body over heats and now the problem begins. We need to do a complete assessment on these patients and treat them appropriately. and the speaking of death. Seizures. anxiety. Always be aware of suicide attempts or the want to do so.

Make sure pressure does not build up.EEI Paramedic Refresher 201 0 • • • • • • Increased pulse rate. They have low reserves.Severe bacterial infection Keep in mind that infants and children can sustain an adequate BP down to the point of loosing more than half their volume. In an ALS setting the patient may require needle decompression on one or both sides due to a pneumothorax. In a Secondary survey you are going over the patient in a more detailed head – to – toe. If the patient is bleeding cover the area right away. Observe for obstructions. and diarrhea Neurogenic. While looking over the body observe for bruising. The term ABC is expanded. etc. Dilated pupils. Assess pulses. Assess the airway for proper opening based on the patient’s needs. and look for extreme bleeding. Maintain C – spine. Care for our patient entails use of BSI. swelling.Excessive fluid and elecrolyte loss due to vomiting. You will learn a lot. The types of shock include: Anaphylactic.An allergic reaction Cardiogenic – Inadequate heart function Hypovolemic. Our Primary Survey encompasses ABC’s.Fainting from the site of something or pain. airways stabilization. listen for lung sounds and apply oxygen. pull the bandage up to release the pressure. bleeding control. Making sure our patient is unclothed will help in our assessment. urination. Increased shallow or labored breathing. Use of Vaseline gauze or an electrode with the sponge removed can assist in this matter. raise the extremities and attempt to keep the patient from moving around. radial and carotid. This is a BLS or ALS treatment. D eformity C repitus A brasions P unctures and Penetrations B urns L aceration S welling 18 . Pallor with cyanosis to the lips. If you have not taken a BTLS or PHTLS course please do so. If you have an open chest wound apply and occlusive bandage. Thirst Nausea and vomiting.Damaged cervical cord causing vessel dialation Psychogenic.Loss of Blood or fluids Metabolic. Look over the whole body systematically with a DCAPBLS in mind. Septic. If it does. which is an early sign. Just remember that we need to stop and treat any life-threatening situation.

nose or mouth. EEI. MODULE VI EEI. elevation. Obtain information from your patient such as: • • • Are you pregnant? How long have you been pregnant? Are there and contractions or pain? 19 . Observe the scene for dangers of any kind. O2 therapy. bleeding control is the main function.V. even intubation. Look at the mechanism of injury. This will save time while enroute to the hospital. EKG. wires. fire. Types of Trauma In any case of trauma. Be prepared to treat any complications that may arise. C-collar. Make sure the area is secure by observing if hazards are present such as chemical.EEI Paramedic Refresher 201 0 When examining any area always look for these specifics in any area of the body. Applying pressure. etc. INFANTS. How sever is the damage to the vehicle or structure? Forces radiate throughout the object to the body and then. Rapid extrication may be needed so while observing the scene relate if you need more help. You can do certain treatments while they are trapped. In nose bleeds keep the persons head forward and apply pressure. Get the big picture. and any thing that can cause injury or death. fluid spillage. While in a house be aware of other people and their actions. have a crewmember on the scene go to the unit to have the IV’s. The apparent effected area may not be the only injured area. AND CHILDREN NORMAL DELIVERY It is best to transport the mother as soon as possible unless delivery is immanent. throughout the body. and suctioning ready for the patient. The organs underneath may have been touched. I. INC Remember safety. Try to identify the width and depth of the object. and raising the extremity can provide this. Just because 911 is called not all want you present. In penetrating trauma the object must be stabilized to prevent further injury. When possible.’s. Only remove the object if the airway is compromised or CPR is required. Penetrating trauma may have underlining damage. INC OBSTETRICS. Also be aware of body fluids that may come from the ears. Be aware of injuries from blunt trauma.

Breech birth is when the buttocks or lower extremities present before the fetus is delivered. In a disaster situation you can make an incubator by using a box with shredded paper as the base and blankets around the child. After delivery of the baby be aware of possible multiple births. The placenta must be given to the hospital so that it may be evaluated for wholeness. Immediate transport is needed and your assistance. Do not let the mother go to the bathroom and do not hold the mothers or allow her to place her legs together. First. The placenta will deliver usually within 20 minutes. Evaluate your infant and keep them warm. If the heart rate is less than 80 start chest compressions. Do realize your limitations and you may deliver while enroute to the hospital. Once the head is delivered use the bulb suction and suction the mouth first. The mother will have blood loss so I. attempt to stimulate the patients breathing flicking the soles of the feet or rub the infant’s back. If breathing less than 60/min assist ventilation’s and reassess in 30 seconds. Heart rate less than 100 assist in ventilations as well and reassess in 30 seconds. If no improvement. If the rate is less than 60 start compressions and ventilation together. Uses of blankets are good. As the baby is coming out of the birth canal gently push on the head but not hard. attempt to have a sterile area with the use of your OB kit. Assist the shoulders and rotate as needed. Evaluate an APGAR score at birth and 5 minutes later. continue. raise the face off the birth canal. 10 – 15 L NRB mask. If delivery is not completed within a few minutes you will need to insert a gloved hand. Rapid transport is required.EEI Paramedic Refresher 201 0 • • • • • • Any bleeding or discharge? Is crowning occurring with contractions? You’ll need to observe this. This is where the cord presents itself before delivery of the baby and is a serious emergency. administer O2 10 – 15 L using O2 tubing as a blow by. What is the frequency and duration of contractions? Does the patient feel a bowel movement r urge to urinate? Does the patient have a need to push? Do you have a rock hard abdomen? Always use your BSI and prepare for delivery if that is the choice you are making. You are preventing an explosive presentation that could rip the vaginal area. Remember that we assist in delivery and Mother Nature does the rest. and making a V with your fingers. find the nose. Certain perimeters have been established but always follow your protocol. If poor coloring presents itself and the patient is breathing adequately. Infants take their first breath by mouth so that is why we suction the mouth first. then the nose. You’re doing this since the baby may desire to start breathing on its own and suffocate. During delivery. Keep her buttocks raised and her head down which lessens the gravity and pressure on the birth canal. therapy needs to be considered but 500cc is the usual loss and can be tolerated. 20 . Shallow or absences of breathing will call for your intervention.V. Treat you mother appropriately and apply O2 on mom. ABNORMAL DELIVERIES Prolapsed cords do happen. Resuscitation may be required. Insert a sterile gloved hand into the vagina pushing the presenting part of the fetus away from the pulsating cord.

Once corrected the child recovers. Never forget that the parents need to be kept informed and involved if at all possible. anthrax. Treat by your protocol. pale. First Aid. Maintain ABC’s and comfort the child as much as possible. and on an ALS side I. Diarrhea. Advise the mother not to push. The patient may show signs of mental status changes.V. When evaluating the child.S. O2. A nebulizer may be used even as a blow by. Croup needs to be evaluated on the first occurrence by a physician and the parents are directed as to how to handle it if the problem should arise again.EEI Paramedic Refresher 201 0 Limb presentations pose an extreme emergency. infection and abdominal injuries may cause shock. dehydration. Prevention is always the key. MEDICAL PROBLEMS in CHILDREN In most cases respiratory problems are the main problems. even though she may feel that she has too. In the ALS setting the use of a Browslow tape will assist in proper care as well as your protocol. Always evaluate the child as you would an adult for life threatening emergencies. Community education is always the best prevention. Premature births have a risk of hypothermia and respiratory problems. weak or absent peripheral pulses. Do not stimulate the infant until suctioning is complete. CPR. Care should be to keep them warm. therapy is recommended. Airway obstructions are corrected by back blows and chest thrust for infants and abdominal thrust for children. Croup shows itself with a barking cough and epiglottis produces drooling.2001 the U. 21 . Maintain a good airway and transport. After the events of September 11. Bio-Terrorism and Acts of Terrorism Bio-Terrorism has now come to the forefront. amniotic fluid that is greenish or brownish-yellow is an indication of possible fetal distress during labor. You must transport rapidly and take care of the mother. blood loss. vomiting. delayed capillary refill. Educate parents on proper home safety. became members of something that we have always feared but hoped would never come to our land. Assess the breathing effort and treat appropriately. clammy skin. cool. If cardiac arrest occurs treat as per the American Heart Association guidelines and your protocol. start at the feet and have the patient with the parent or guardian if possible. as it has in lands overseas. TRAUMA in CHILDREN This is always hard for all of us but remember that we need to treat the child. It’s now use threatens our very society and way of life. Usually moist air will relieve the problem. This will make your life easier and fulfill a proper exam without crying and distractions. Agents such as anthrax have been present for many years and have been developed and studied. Measure output by how many diapers have been used. Epiglottis needs medical attention. Remember ABC’s. decreased urine output. car seats and seatbelts. The mother will no doubt need a C – section. rapid respiratory rate. Meconium. Breathing treatments may be needed on an ALS level.

Slightly less than 1. when President Nixon stopped all offensive biological and toxin weapon research and production by executive order. Between May 1971 and May 1972. Russian troops may have used the same plague-infected corpse tactic against Sweden in 1710. The attackers hurled the corpses of those who died over the city walls. The United States conducted this research at Camp Detrick (now Fort Detrick). is a history of Bio-Terrorism from that student manual. Manchuria. and some infected people who left Kaffa may have started the Black Death pandemic. all stockpiles of biological agents and munitions from the now defunct U. plague broke out in the Tartar army during its siege of Kaffa (at present day Feodosia in Crimea). HISTORY OF BIOLOGICAL WARFARE AND CURRENT THREAT The use of biological weapons and efforts to make them more useful as a means of waging war have been recorded numerous times in history. before the animals were shipped to France. a plague epidemic in China and Manchuria followed reported over flights by Japanese planes dropping plague-infected fleas. in a laboratory complex code named “Unit 731”. as we have seen in Florida. In 1937. the United States began research into the offensive use of biological agents. so much that we all need to be diligent in our keeping alert to our surroundings. there is evidence that during World War I.000 human autopsies apparently were carried out at Unit 731. Native Americans defending Fort Carillon sustained epidemic casualties. Japan started an ambitious biological warfare program. the plague epidemic that followed forced the defenders to surrender.000 human deaths. and produced agents at other sites until 1969. Pizarro is said to have presented South American natives with variola-contaminated clothing in the 15th century. which was a small National Guard airfield prior to that time. German agents inoculated horses and cattle with glanders in the U. when the complex was leveled by burning it. located 40 miles south of Harbin.S. In 1346. the Japanese program had stockpiled 400 kilograms of anthrax to be used in a specially designed fragmentation bomb. “Biological Warfare and Terrorism”. in response to a perceived German biological warfare (BW) threat as opposed to a Japanese one. By 1945. with the Assyrians poisoning enemy wells with rye ergot. In this century. smallpox was used as a biological weapon. and Solon’s use of the purgative herb hellebore during the siege of Krissa. which directly contributed to the loss of the fort to the English. In 1940. This work was started. Provided from our other course EEC offers. Studies directed by Japanese General Ishii continued there until 1945. Unexplained illnesses and/or multiple reported exposures can be a signs of a Biological attack. A post World War II investigation revealed that numerous organisms had received Japanese research attention.EEI Paramedic Refresher 201 0 As Healthcare workers we are on the front line of possible exposure. New Jersey and New York plus in the New England area. Washington DC. Two of the earliest reported uses occurred in the 6th century BC. most on victims exposed to aerosolized anthrax. On several occasions. In 1943. and that experiments had been conducted on prisoners of war. the 22 . interestingly enough. Many more prisoners and Chinese nationals may have died in this facility -some have estimated up to 3. which spread throughout Europe. program were destroyed in the presence of monitors representing the United States Department of Agriculture. and the English did the same when Sir Jeffery Amherst provided Indians loyal to the French with smallpoxladen blankets during the French and Indian War of 1754 to 1767.S.

The final death toll was estimated at the time to be between 200 and 1.000. biological warfare research continued to flourish in many countries hostile to the United States. and the use of ricin as an assassination weapon in London in 1978. Included among the destroyed agents were Bacillus anthracis. and a small percentage of those stricken died. Venezuelan equine encephalitis virus. Brucella suis. which appeared to be an accidental release of anthrax in aerosol form from the Soviet Military Compound 19. in 1978. In 1972. The Soviet Ministry of Health blamed the deaths on the consumption of contaminated meat. In late April of 1979. Meselson’s team. The United States also had a medical defensive program. identified a total of 77 patients. In the summer of 1992. Residents living downwind from this compound developed high fever and difficulty breathing. This treaty prohibits the stockpiling of biological agents for offensive military purposes.S. All evidence available to the United States government indicated a massive release of aerosolized anthrax. that continues today at USAMRI ID. These attacks are lumped under the label “Yellow Rain”. Meselson and colleagues published an in-depth analysis of the Sverdfovsk incident (Science 266:1202-1208). and for year’s controversy raged in the press over the actual cause of the outbreak. After being exposed. despite this historic agreement among nations. and also forbids research into such offensive employment of biological agents. commonly called the Biological Weapons Convention. There were also several cases of suspected or actual use of biological weapons. and the states of Arkansas. the tiny pellet was found and determined to contain the toxin. begun in 1953. Colorado. and Staphylococcal enterotoxin B. Among the most notorious of these were the “yellow rain” incidents in Southeast Asia. an incident occurred in Sverdlovsk (now Yekaterinburg) in the former Soviet Union. including 66 fatalities and 11 survivors. U. Education. a Bulgarian exile named Georgi Markov was attacked in London with a device disguised as an umbrella. He died several days later. the United States and many other countries signed the Convention on the Prohibition of the Development. a microbiology facility. botuli n urn toxin. and Welfare. which injected a tiny pellet filled with ricin toxin into the subcutaneous tissue of his leg while he was waiting for a bus. T2 mycotoxin). Testimony from the late 1970’s indicated that planes and helicopters delivering aerosols of several colors attacked the countries of Laos and Kampuchea. Before the Sverdlovsk incident. Some of these clouds were thought to be comprised of trichothecene toxins (in particular. On autopsy. the accidental release of anthrax at Sverdlovsk. people and animals became disoriented and ill. and a large number died. In 1994. Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction. However. intelligence officials were proven correct when new Russian President Boris Yeltsin acknowledged that the Sverdlovsk incident was in fact a large-scale accident involving the escape of an aerosol of anthrax spores from the military research facility. and Maryland.EEI Paramedic Refresher 201 0 Department of Health. INC They documented that all of the 1979 cases occurred within a narrow zone extending downwind in a southerly direction from Compound 19. Francisella tularensis. Coxiella burnetll. The former Soviet Union and the government of Iraq were both signatories to this accord. EEI. The communist 23 . There has been a great deal of controversy about whether these clouds were truly biological warfare agents: some have argued that the clouds were nothing more than bee feces produced by swarms of bees.

eliminated from the face of the earth in the late 1970’s and now stored in only two laboratories at the CDC in Atlanta and the Institute for Viral Precautions in Moscow. In a report issued in November 1997.000 liters of concentrated botulinum toxin (nearly 10. The extensive program of the former Soviet Union is now controlled largely by Russia. There is also growing concern that the smallpox virus. The threat of biological warfare has increased in the last two decades. due to the potential hiring of expatriate Russian scientists. This was the first open admission of biological weapons research by any country in recent memory. 8. Iraq produced 19. botulinum toxin. 1991. and aflatoxin. It was reported in January 1998 that Iraq had sent about a dozen scientists involved in BW research to Libya to help that country develop a biological warfare complex disguised as a medical facility in the Tripoli area. Russia. and 16 with aflatoxin. In August of 1991.000 liters filled into munitions). aerial bombs. There have been cases of persons loyal to extremist groups trying to obtain microorganisms. the degree to which the program has been scaled back. aflatoxins. and chemical weapons. botulinum toxins. The Department of Defense is leading a federal effort to train the first responders in 120 American cities to be 24 . wheat cover smut. These weapons were deployed in January 1991 to four locations. it was later revealed. the Iraqis filled 100 P400 bombs with botulinum toxin. Russian president Boris Yeltsin has stated that he will put an end to further offensive biological research. and the technology to commit the crime was supplied to the Bulgarians by the former Soviet Union. Iraq. the first United Nations inspection of Iraq’s biological warfare capabilities was carried out in the aftermath of the Gulf War. many of which were destroyed during the war. representatives of the Iraqi government announced to leaders of United Nations Special Commission Team 7 that they had conducted research into the offensive use of Bacillus anthracis. may have been “bargained” away by desperate Russian scientists seeking money. and Clostridium perfringens (presumably one of its toxins). and Syria as countries “aggressively seeking” nuclear. further information on Iraq’s offensive program was made available to United Nations inspectors. biological. is not known. including rockets. Clostridium perfringens. In addition. binary biologicals and chimeras. Recent revelations from a senior BW program manager who defected from the FSU in 1992 outlined a remarkably robust biological warfare program including active research into genetic engineering. 10 with anthrax. On August 2. Iran. Iraq conducted research and development work on anthrax. Field trials were conducted with Bacillus subtilis (a simulant for anthrax).200 liters of aflatoxin (1.S. Secretary of Defense William Cohen singled out Libya. carried out this assassination.500 liters filled into munitions) and 2. Iraq had extensive and redundant research facilities at Salman Pak and other sites. All in all. and it verified many of the concerns of the U. with a number of countries working on offensive use of these agents. intelligence community publicly. 13 Al Hussein (SCUD) warheads were filled with botulinum toxin. if any. There is intense concern in the West about the possibility of proliferation or enhancement of offensive programs in countries hostile to the western democracies. In December 1990. In 1995. and 2 with aflatoxin. and spray tanks. which could be used as biological weapons.500 liters of concentrated anthrax (6. Biological agents were tested in various delivery systems. and ricin. 50 with anthrax. botulinum toxins. however.580 liters filled into munitions).EEI Paramedic Refresher 201 0 Bulgarian government. There is also an increasing amount of concern over the possibility of terrorist use of biological agents to threaten either military or civilian populations.

In comparison. drooping eyelids. An area of local edema becomes a pruritic macule or papule. black eschar usually with surrounding local edema subsequently develops. Botulism. which enlarges and ulcerates after 1--2 days. and lesions develop at the same time. symmetric descending weakness in a proximal to distal pattern. however. respiratory failure and hemodynamic collapse ensue. the vesicular/pustular rash of smallpox is typically most prominent on the face and extremities. Clinical features include symmetric cranial neuropathies (i. or face. Inhalational botulism would have a similar clinical presentation as foodborne botulism. the gastrointestinal symptoms that accompany foodborne botulism may be absent. cough with muco-purulent sputum (gram-negative rods may be seen on gram stain).. military forces is broader and more likely in various geographic scenarios than at any point in our history.e. and chest pain. such as influenza. Certainly the threat of biological weapons being used against U. usually 2--3 days after onset of illness. Followed is an explanation of the most common Bio threats: Anthrax.. cough. resulting in lesions in various stages of development and resolution. The rash of varicella is most prominent on the trunk and develops in successive groups of lesions over several days. Plague. A painless. depressed. A nonspecific prodrome (i. Small. beginning with a 2--4 day nonspecific prodrome of fever and myalgias before rash onset. and chest discomfort) follows inhalation of infectious spores. A chest radiograph will show evidence of bronchopneumonia. and difficulty swallowing or speaking). sometimes after a brief period of improvement. Inhalational anthrax also might include thoracic edema and a widened mediastinum on chest radiograph. occurring particularly on exposed areas of the hands. Smallpox (variola). The acute clinical symptoms of smallpox resemble other acute viral illnesses. Several clinical features can help clinicians differentiate varicella (chickenpox) from smallpox. hemoptysis.S. Approximately 2--4 days after initial symptoms. awareness of this potential threat and education of our leaders and medical care providers on how to combat it are crucial. dyspnea. Therefore.EEI Paramedic Refresher 201 0 prepared to act in case of a domestic terrorist incident involving WMD. blurred vision or diplopia. arms. 25 . Clinical features of pneumonic plague include fever. fever.e. weakened jaw clench. Cutaneous anthrax follows deposition of the organism onto the skin. The syndrome also may include lymphangitis and painful lymphadenopathy. and respiratory dysfunction from respiratory muscle paralysis or upper airway obstruction without sensory deficits. 1--3 mm vesicles may surround the ulcer. Gram-positive bacilli can grow on blood culture.

All for a cause or score to settle! All at the cost of humanity! Physical Acts of Terrorism Terrorist activity has occurred in this nation from New York to Oklahoma. Other signs and symptoms include nausea and vomiting. our future EMS providers. “It is better to be safe than sorry” theory goes into play in the times we are in. trash bins or trees. If one bomb has gone off then another is no doubt in the works after you have arrived and are setting up a triage area or just treating patients. and headache. and will no doubt at some point. be aware of trip wires. We must get our young ones. rise from the depth of some mad man or organization. Our schools are threatened so take threats serious even if it from a child. such as petechiae. News teams. ecchymoses. especially that of mass casualty. prominent on the trunk. interested in helping instead of hurting others. Our furtherance of our training and education in Bio-Terrorism will make us more aware of the cases that can. such as EMS. nonspecific febrile illness beginning 3--5 days after exposure. Bleeding manifestations. In drug houses that we may be called into. Inhalation of F. be aware of secondary situations.” When we respond to a call. These are aimed at the Police but the device does not determine as to whom is present in the room. and hemorrhages. develops in most patients approximately 5 days after onset of illness. Rescue. with pleuropneumonitis developing in a substantial proportion of cases during subsequent days (7). illness is characterized by abrupt onset of fever. and bystanders are present. A maculopapular rash. We all need to be prepared for the possibility that “It can happen here. tularensis causes an abrupt onset of an acute. Prevention is the key so more community involvement is needed. may just stimulate that 26 . cough.EEI Paramedic Refresher 201 0 Inhalational tularemia. Educating our parents to just communicate will assist as well. Never let your guard down and if something looks suspicious. From Georgia to Colorado. By having both child and parent involved in community involvement projects. then report it. diarrhea. It can come from nearby cars. myalgia. sensors. and the like that may be set by the criminal force. After an incubation period of usually 5--10 days (range: 2--19 days). occur as the disease progresses. chest pain. Hemorrhagic fever (such as would be caused by Ebola or Marburg viruses). Fire. abdominal pain. What a better time to have secondary devices to go off when Police. We need to be prepared and always alert. The threat we now face is from International organizations that will die for there cause. You may save many from a shooting tomorrow. and pharyngitis.

but domestic violence is on the rise. Our children our exposed to more violence on TV than ever before. but also the local news. The neighborhood environment can add to violent tendencies. in one form or another. can lead to an outburst of anger if left in for a period of time. Domestic Violence It is a shame. All it takes is stepping forward to start the cause. Family issues and a death of a loved one can cause someone to loose reality. even if for a moment. Stress.EEI Paramedic Refresher 201 0 communication. This has been attributed to the seeing of violence in the home and passing it on to children. Not just the Hollywood scene. We are Healthcare Professionals and can guide the future of our community. 27 . We see more so today than in years past.

etc location. counseling is usually productive. Make sure any prior abuses are documented with the Police and you may wish to have copies of these reports secure in that small bag. You will need this for financial stability and you may wish to build a nest egg in it. friend. trace that if they know how to do it. or that of a Mail Box. family. We need to understand that just leaving the home. • • Have a small bag always packed and ready to go if you need to leave in a hurry. Get a restraining order. the situation. Chronic abusers are. Long term counseling may help. Children may be involved and taking them out of the home environment may not be possible. or roses cannot treat persistent acts of violence. in most cases. Counseling may help some. The credit card company usually wants a physical address listed and the abuser can sometimes. within ourselves. Fear that the one inflicting harm will find them and cause even more harm or possibly kill them. but men are sometimes abused as well. Another act of violence may alter your time line or decisions. Obtain a checking account in your name only. • • • Obtain a Post Office box at the US Post office or a Mail Box provider franchise. Do not let the abuser talk you out of dropping the charge. 28 . the one being abused may not be able to sustain there self if they leave. if the abuser will allow it to change them and jail time or probation is part of the course. Domestic Violence affects mostly women. Only by court order can that physical address or change of address be obtained. The one being abused may still care for the one inflicting harm. but NOT ALL. Use the # sign for MBE box since this fulfills the law requirement. Extreme measures in counseling. Accepting words of apology. Have the order on your person at all times. as was the case in years past. If the act of violence was an isolated case. in some cases. This is so that the Police can legally remove the abuser from your presence if they violate the order. is easier said then done. court intervention and jail time is in order. Fear is the biggest obstacle. candy. These steps will assist in that decision and are in no certain order since each case is different. Usually this is for months. • • Get a credit card in your name and make sure the address you provide is that of a family member. Financially. or friends. Outcome for these types of abusers is very poor. Physical locations cannot be given out to anyone requesting it. beyond help from the one being abused. In extreme cases the one being abused needs to find a way to escape to safety. File charges against the abuser and make them stick.EEI Paramedic Refresher 201 0 The fact is that Domestic Violence is not okay and we as EMS personnel must deal with it in the community we work in and.

Herbal Supplements Peoples viewpoint on healthcare and treatments have changed dramatically over the last few years. get to know your neighbors and confide in those around you. device is always good to have so that you can possibly identify those calling. A caller I. Have your phone unlisted and unpublished. Mistakes will be made that way.D. Have a security system put in. Yes. So plan ahead. your life will need to change somewhat. and I mean anyone! Always be alert to your surrounding at all times and have friends around you when you are out. This could save your life. • • • • Safety is the key in this extreme situation. don’t act hastily. Let your employer know of the situation so that they may not give out private information on your whereabouts to anyone. you may have been together for a while so the abuser may know or have record of your Social Security Number. If the abuser somehow would get your number the child may be convinced or feel impelled to tell the abuser your address. Have younger children to never answer the phone. usual passwords you liked. 29 . Be careful on email accounts not to have a profile on yourself stored and never answer the abuser back if they would email you.EEI Paramedic Refresher 201 0 • Once you have your own home. etc. dates of birth. Get a cellular phone. they could track you down by impersonating you on the phone to the online service provider and obtain your personal information. If they are eager enough. Remember. This will assist you if the abuser finds you and the neighbors can call for help. Many security companies offer free installation with a small monitoring fee contract.

This is intended to expand your knowledge of what our patients are doing and what we need to be made aware of. which are strongest in the fruit. many herbs are put together to formulate a treatment that helps that person.EEI Paramedic Refresher 201 0 Homeopathic and Eastern Medicine have taken over many peoples way of treating ailments. alterative. 30 . In the paroxyms of consumption. rheumatism and diseases of the urinary organs. diaphoretic. In our assessment. it proves very effective. leaves and fruit possess carminative. combined with other expectorants the action of which is facilitated. Many references we derived from www. Western. Each type of medicine. wind. Many of these carry Chinese names so we may not be able to find out what they are for until the Doctor they see is contacted and explained the situation. reducing the rapidity of the pulse and inducing perspiration. colic. through the whole of the pulmonary region. and is supposed to be an antidote against poison and the bite of the rattlesnake.botanical. It is generally used as a stimulating expectorant. This is a general look and in no way is intended to make you an expert in herbal therapy or recommend treatment. has its place. plants and roots. expectorant.com and Quick study guide. In small doses. and Homeopathic. All in the right time and for the situation at hand. stomache. it is useful in children's diarrhoea. stimulant. though it should not be given to patients who have a tendency towards diabetes. Angelica is a good remedy for colds. We have put together a variety of Herbal Supplements that you may encounter in the field. Black Cohosh ---Medicinal Action and Uses---Astringent. Angelica Medicinal Action and Uses---The root stalks. acting as a diaphoretic. we need to ask. It is a useful agent for feverish conditions. is used to make a tincture. tonic and expectorant properties. dug in October. We have provided several herbal supplements for your reference. on top of everything else. and to a large extent diffused. Some though need to understand that our medicines are derived from many herbs. coughs. Eastern. The root of this plant is much used in America in many disorders. as it causes an increase of sugar in the urine. This may cause an overdose if they are taking the supplements along with prescribed medications. diuretic. are you taking any herbal supplements? As for Eastern Medicine. In whoopingcough. The fresh root. The infusion and decoction have been given with success in rheumatism. emmenagogue. pleurisy. it gives relief by allaying the cough. though the whole plant has the same virtues.

It is said to be a specific in St. Asprin and warfarin. of the herb to a pint of boiling water. May interact with thrombotic meds. As a stimulant it is usefulas an emmenagogue. and will afford relief to the face-ache or earache of a dyspeptic or rheumatic person. or fried with a little wine and oil. septicaemia. The herb. Echinacea ---Medicinal Action and Uses---Echinacea increases bodily resistance to infection and is used for boils. and estrogen therapy. erysipelas. It is said that if two teaspoonfuls of tincture are mixed with 1/2 pint of cold water. Should not be used by those with AIDS. cancer. made with boiling water and allowed to become cold. syphilis and other impurities of the blood. its action being antiseptic. the extract has been used for haemorrhoids and a tincture of the fresh root has been found beneficial in diphtheria and putrid fevers. A tincture made from Feverfew and applied locally immediately relieves the pain and swelling caused by bites of insects and vermin. wheezing and difficult breathing. it is said to purify the atmosphere and ward off disease. leucosis. A tincture of the leaves of the true Chamomile and of the German Chamomile will have the same effect. bitter. It has also useful properties as a strong alterative and aphrodisiac. TB. The cold infusion is made from 1 OZ. carminative. allowed to cool. An infusion of the flowers. A decoction with sugar or honey is said to be good for coughs. Overdoses produce nausea and vomiting.EEI Paramedic Refresher 201 0 In infantile disorders. Planted round dwellings. and is a general tonic. Is also employed in hysterical complaints. it is given in the form of syrup. and all parts of the body likely to be exposed to the bites of insects are freely sponged with it. As an injection. bruised and heated. Foxglove 31 . has been employed as a warm external application for wind and colic. collagenoses or severe allergies. will allay any distressing sensitiveness to pain in a highly nervous subject. MS. nervousness and lowness of spirits. Feverfew ---Medicinal Action and Uses---Aperient. they will remain unassailable. May affect diabetes B/P meds. and taken frequently in doses of half a teacupful. Vitus' Dance of children.

When Digitalis fails to act on the heart as desired. It increases the activity of all forms of muscle tissue. In ordinary conditions it takes about twelve hours or more before its effects on the heart muscle is appreciated. The action of Digitalis in all the forms in which it is administered should be carefully watched. the drug being apt to cause considerable digestive disturbances. which is a beneficial effect in cases of cardiac dilatation. an undesirable constituent. so that its internal capacity is reduced. After the taking of a moderate dose. the action of Digitalis on the circulation will cause various cerebral symptoms. the all-important property of the drug being its action on the circulation. with a very slow and irregular pulse. and it improves the nutrition of the heart by increasing the amount of blood. the pulse is markedly slowed. the blood-pressure low and gastro-intestinal irritation setting in. causing a very high rise in the blood pressure. Digitalis also causes an irregular pulse to become regular. In the more severe cases. In cases of poisoning by Digitalis. leads to hypertrophy of that organ. given as a hypodermic injection. with real or supposed benefits. it is a powerful diuretic and a valuable remedy in dropsy. and it must thus always be combined with other remedies to tide the patient over this period and never prescribed in large doses at first. in epilepsy. varying in different cases. indicated by the pulse becoming irregular. In small or moderate doses. and various other disturbances of the special senses. Added to the greater force of cardiac contraction is a permanent tonic contraction of the organ. This action is probably due to the Digitonin. 32 . the administration of Atropine is generally all that is necessary. The action of the drug on the kidneys is of importance only second to its action on the circulation. also. The first consequence of its absorption is a contraction of the heart and arteries. The constant use of Digitalis. and when given over a prolonged period it should be employed with caution.EEI Paramedic Refresher 201 0 ---Medicinal Action and Uses---Digitalis has been used from early times in heart cases. in inflammatory diseases. by increasing the activity of the heart. In large doses. in delirium tremens. as it is liable to accumulate in the system and to manifest its presence all at once by its poisonous action. in acute mania and various other diseases. as some patients are unable to take it. Digitalis is an excellent antidote in Aconite poisoning. It has also been employed in the treatment of internal haemorrhage. but more especially that of the heart and arterioles. with the very rapid heart-beat. especially when this is connected with affections of the heart. Lily-of-the-Valley may be substituted and will often be found of service. such as seeing all objects blue.

minor skin irritations. Should not be used in patients with intestinal obstruction. promoting flow of bile. painful spasms of bowels and stomach. May cause heartburn if used in excess. Avoid exposure to UV light. and in ulceration of the mouth and throat. and are especially valuable in diarrhoea and dysentery.EEI Paramedic Refresher 201 0 the stomach pump must be used. carminative. peptic ulcers. sunburns. Aloe Vera Wound healing. and in patients with gallstones. and when bruised with the roots and steeped in gin has diuretic properties valuable in dropsy and gravel. May alter cardiac. and Dioscorides spoke highly of them. appendicitis. Should not be used in morning sickness due to its cholagogic. A tea made of the leaves is also a remedy for diabetes if taken for a prolonged period. and children under 12. The fruit is helpful in scurvy and urinary complaints. calmative Ephedra Sinica (Ma-huang) 33 . Long oral intake may cause electrolyte depletion. The fruits are astringent. in the form of syrup. and drugs may be used which depress and diminish the irritability of the heart. diaphoretic. and as antigalactagogues. diabetes. They are also used for discharges. anti-inflammatory. Bilberry ---Medicinal Action and Uses---The leaves can be used in the same way as those of UvaUrsi. such as chloral and chloroform. Used in chronic chest complaints. dropsy with albuminaria. diuretic. Ginger ---Medicinal Action and Uses---Stimulant. Chamomile Antispasmodic. Rare dermatitis has been noticed in patients. Anti-inflammatory. acute inflamed intestinal disease. and asthma. antidiabetic and anticoagulant drugs. The ancients used them largely. A decoction of the leaves or bark of the root may be used as a local application to ulcers. Oral consumption assist with constipation. diuretic.

It is made by pouring a quart of water. It is stated that during an outbreak of infectious fever in certain poor quarters of London. will cover the pungent smell of the latter. it is said. and in many instances fell victims to the disease. they plundered the dead bodies of its victims with complete security. stimulant. It is sometimes externally applied in ointments and lotions. high BP.EEI Paramedic Refresher 201 0 Cardiac stimulant. plus many other difficulties. In olden days. Vinegar and honey greatly improve this syrup as a medicine. hoarseness.' which was adapted so successfully at Marseilles for protection against the plague when it prevailed there in 1722. Has been known to cause death. if cut small and applied to the soles of the feet in a linen cloth. visited the worst cases with impunity. and as an antiseptic. which are applied to the wound. Garlic was employed as a specific for leprosy. In the late war it was widely employed in the control of suppuration in wounds. Garlic ---Medicinal Action and Uses---Diaphoretic. on account of its powers of promoting expectoration. being largely used for the purpose. It possesses stimulant and stomachic properties in addition to its other virtues. The raw juice is expressed. that whilst protected by the liberal use of aromatic vinegar during the plague. being of particular virtue in chronic bronchitis. and allowed to stand in a closed vessel for twelve hours. to disperse hard swellings. it has been proved that there have been no septic results. It formed the principal ingredient in the 'Four Thieves' Vinegar. This originated. sugar then being added to make it of the consistency of syrup. Where this treatment has been given. difficulty of breathing. It is said to prevent anthrax in cattle. early last century. and most other disorders of the lungs. the French priests who constantly used Garlic in all their dishes. with four thieves who confessed. A little caraway and sweet fennel seed bruised and boiled for a short time in the vinegar before it is added to the Garlic. diuretic. upon a pound of the fresh root. and the lives of thousands of men have been saved by its use. also pounded and employed as a poultice for scrofulous sores. Syrup of Garlic is an invaluable medicine for asthma. As an antiseptic. It was also believed that it had most beneficial results in cases of smallpox. cut into slices. and put on swabs of sterilized Sphagnum moss. expectorant. Many marvellous effects and healing powers have been ascribed to Garlic. boiled hot. coughs. whilst the English clergy caught the infection. renewed daily. anxiety. 34 . its use has long been recognized. diluted with water.

High doses can lead to vomiting. Not be used for long periods or when pregnant. Bruised and mixed with lard. has been considered of good effect in epilepsy. Promotes glandular function and helps prevent colds and flu. leg weakness and vertigo. A clove or two of Garlic. It is stated that some dropsies have been cured by it alone. and digestive disorders. it has been proved to relieve whooping-cough if rubbed on the chest and between the shoulder-blades. diluted with equal quantities of water. The syrup is then poured over the boiled bulbs. is a syrup of Garlic. Amongst physiological results. Grapeseed Extract 35 . The juice of Garlic. The successful treatment of tubercular consumption by Garlic has been recorded. made by boiling the bulbs till soft and adding an equal quantity of vinegar to the water in which they have been boiled. excitatory states. it is reported that Garlic makes the eye retina more sensitive and less able to bear strong light. If sniffed into the nostrils. anti-inflammatory and astringent properties when applied topically. being inhaled antiseptically.EEI Paramedic Refresher 201 0 A remedy for asthma. which have been allowed to dry meanwhile. of the raw expressed juice may be given to children in cases of coughs without inflammation. constipation. removing the water which may already have collected and preventing its future accumulation. shortness of breath. Syrup made by melting 1 1/2 OZ. or dilute spirit of wine. An infusion of the bruised bulbs. is good in rheumatism. with a spoonful of the syrup. bradycardia. Ginkgo Biloba Used for Organic Brain Syndrome. Golden Seal Antibiotic. given before and after every meal. the freshly expressed juice. Each morning a bulb or two is to be taken. and possible paralysis. of lump sugar in 1 OZ. that was formerly most popular. and milk of Garlic made by boiling the bruised bulbs in milk is used as a vermifuge. Extended use can lead to hallucinations. pounded with honey and taken two or three nights successively. it will revive a hysterical sufferer. Garlic has also been employed with advantage in dropsy. Some have had mild GI complaints. and kept in a jar. and then sugared and boiled down to a syrup.

used in mild cardiac insufficiency. Panax ginseng Protects against physical and mental stress. hypertonia. Large overdosing can bring on sleeplessness. Gotu Kola Anti-inflammatory. edema. diuretic. and cardiac problems. senile heart and chronic corpulmonale. gastric and duodenal ulcers.EEI Paramedic Refresher 201 0 Assist in circulatory dysfunction. Rare cases of stomach problems have been reported. May interact with heparin. laxative. Not to be used while breast feeding. Green Tea 36 . pregnancy and nursing mothers. Do not take in known cases of Epilepsy. HTN. renal problems. pregnancy. cirrhosis. edema and hypertonia. hypokalemia. CNS depressant. Licorice Used for upper respiratory tract infections. during pregnancy or patients that are taking HTN or CHF medications. Should not be taken by pregnant or nursing mothers or children under 12. No known problems. Saw Palmetto Helps with Urination problems in benign prostate hyperplasia. Nausea or vomiting may occur in those with a sensitive stomach. Uva Ursi Treats disorders of the urinary tract. Not to be used in chronic hepatitis. Hawthorne Increases coronary blood flow. breast-feeding. Has helped children to increase mental capacity with known mental disabilities. High doses can lead to excess sodium in the blood.

sleep disorders. No complications known. Milk Thistle Taken for toxic liver damage and supports in liver disease. John Wart Taken for anxiety. Not to be taken with other anti-depressants. insomnia. depression. post therapy of acute and contused injuries. enlarged pupils. mental strain. antispasmodic. anti-convulsant. Kava-Kava Anti-anxiety. anxiety. Siberian Ginseng Taken for fatigue and failing concentration. hypercholesterolemia. nervous stomach and headache. causes the situations it is designed to help with. atherosclerosis. sedative. Valerian Used in restlessness. diarrhea. for dyspeptic complaints. or GI disturbances. nervousness. lack of concentration.EEI Paramedic Refresher 201 0 Stomach disorders. Reduces platelet aggregation. Should not be taken in cases of depression since Kava-Kava may increase the chance of suicide. May prevent stomach cancer. hypertension. Not to be used for long periods. Has caused rare GI complaints and with long term use. Also. vomiting. Not to be used if HTN is present. Excessive use may cause nervousness. St. cardiomyopathy. nervousness. and irritability. 37 . May manifest a yellowing of the skin.

EEI Paramedic Refresher 201 0 Refresher Evaluation Form 2006 You may include this in your returned packet or mail it separately to: EEI 1750 N University Dr #227 Coral Springs. would you like to see added and/or improved? Additional Comments: 38 . FL 33071. Your return address on the envelope may be omitted Did the course content meet your expectations? Was the course beneficial to you? Please explain. if anything. What.

EEI Paramedic Refresher 201 0 EMT-B and Paramedic Refresher Worksheets 2010 NAME________________________________ EMT _______ Cert #______________ PARAMEDIC ______ Cert #__________ NATIONAL _______ Cert #___________ FULL ADDRESS____________________________________________________________________________ PHONE_________________________________ Email Address_______________________________ Be detailed and specific in your responses. 39 . Please type your answers or print them so that it can be read. Thank you. Quick answers will be returned. 1) What is BSI? 2) What articles are included in your BSI? 3) What is involved in Quality Improvement? 4) Define proper lifting techniques that should be used.

EEI Paramedic Refresher 201 0 5) What precautions are needed when carrying a patient? 6) Define some stressful situations that may produce stress on me. 8) What can we do to promote less stress and health? 9) What is CISD? 40 . 7) List some warning signs of stress.

EEI Paramedic Refresher 201 0 10) Define expressed and implied consent and what situations would this occur? 11) Define confidentiality and how we assist in this manner. 12) Under what conditions can a patient refuse care? 41 .

42 .EEI Paramedic Refresher 201 0 13) Define a DNR and what must you do to assure is proper application? 14) What are some signs of abuse and neglect? 15) How do we go about reporting the abuse or neglect? 16) Define proper suctioning techniques.

20) What methods do we have to deliver O2 and define its proper application method(s) 21) What is involved in a “Scene Size-up”? 43 . 18) Describe the use and proper application of an Oropharyngeal airway. 19) Describe the use and proper application for a Nasopharyngeal airway.EEI Paramedic Refresher 201 0 17) Define artificial ventilation techniques.

EEI Paramedic Refresher 201 0 22) What is obtained in an initial assessment? 23) What does AVPU mean? 24) In assessing breathing. what are you looking for? 25) In assessing circulation what are you observing? 44 .

EEI Paramedic Refresher 201 0 26) In assessing the skin what are you looking for? 27) List and define priority patients? 28) Define DCAP – BLS and what application is it being used in? 45 .

30) Define OPQRST. 31) What is involved in a Detailed (secondary) Exam? Be specific from head-to-toe! 46 .EEI Paramedic Refresher 201 0 29) Define SAMPLE.

EEI Paramedic Refresher 201 0 32) What is involved in the verbal report? 33) What interpersonal communication skills can be applied? 34) Write a full SOAP or Narrative report on a call you may have recently run. 47 . make a scenario up. Then justify your treatment and actions as if I was the Medical Director. If you have made no run recently.

EEI Paramedic Refresher 201 0 35) What can happen in the falsification of a report? 36) Explain how the Epi-injector pen used and for what purpose? 37) Name all forms that medications come in. 48 .

and side effects. administration. 39) What signs and symptoms are there for breathing difficulties? 49 . actions.EEI Paramedic Refresher 201 0 38) Define the terms: dose.

EEI Paramedic Refresher 201 0 40) Define how an inhaler is to be used and for what purpose? 41) What is an AED? 42) In what patients can an AED not be used? 43) What questions should be asked of a cardiac patient feeling pain or discomfort? 44) What types of AED’s are available? 50 .

51 . 47) What is Nitroglycerin and how is it used? 48) Give and describe causes of an Altered Mental Status.EEI Paramedic Refresher 201 0 45) What rhythms will the AED defibrillate in? 46) Do you have to stop CPR or the Unit to use the AED? Explain your answer.

50) What is an allergic reaction and what sign and symptoms will a patient have? 51) How may we treat the patient in question 50? 52 .EEI Paramedic Refresher 201 0 49) How do we care for a diabetic patient? Be specific.

53) What are the risk factors for suicide? 54) How can we effectively calm and assess a mentally disturbed patient? 55) Define Shock and list its signs and symptoms.EEI Paramedic Refresher 201 0 52) List and define the different areas of poisoning? Be specific. 53 .

EEI Paramedic Refresher 201 0 56) How do we care for an: Open Chest Wound? 57) Open Abdominal Wound 58) Amputation(s) 59) Bones and joints 60) Head and spine 54 .

65) What care does a newborn require? 55 .EEI Paramedic Refresher 201 0 61) What is rapid extrication? 62) Define what a normal delivery is. 63) How much bleeding may be acceptable during a normal delivery? 64) Define the APGAR score.

67) What is a Breech Birth and how can we care for it? 68) How do we care for a limb presentation? 56 .EEI Paramedic Refresher 201 0 66) How would you care for a Prolapsed Cord situation? Be specific.

EEI Paramedic Refresher 201 0 69) What is Meconium and what precautions must we take? 70) What is Croup and how do we care for it? 71) What is Epiglottis and how do we care for it? 72) What may cause seizures in children? How do we care for them? 73) What items may cause shock in a child? 57 .

78) Give the proper procedures of CPR for Adult. Child. and Infant. 58 . and Infant.EEI Paramedic Refresher 201 0 74) What types of trauma may a child experience? 75) What area is usually affected on a child experiencing trauma? 76) How can injuries be prevented? Please define these areas of research 77) Define the Rules of 9 in burn patients? Adult. Child.

59 .EEI Paramedic Refresher 201 0 79) What areas do most ambulance accidents occur in and how can we prevent them? 80) How can we educate the public? 81) What is professionalism and how can we enhance it? 82) For Florida certified personnel. You may do research on this from the Florida Bureau of EMS site at www. please tell me what Rule 64J-1 is and what does it do for EMS.com.fl-ems.

Statue 401 do for EMS? Hint: Look at FS 401. 86) Please name the Bio agents that present a problem and what symptoms they show. 85) Provide a brief history of Bio-Terrorism. Please name the statue number. please tell me what laws govern your state.EEI Paramedic Refresher 201 0 83) For Florida Paramedics: What does FL. 60 . 84) For NON-Florida certified personnel.

what should the one being abused do if they consider leaving the abuser? 93) What drug comes from Foxglove? 94) What herbal supplements affect cardiac function? 61 .EEI Paramedic Refresher 201 0 87) How can we assist in the prevention of Domestic Terrorism? 88) What may be some factors that cause Domestic Violence? 89) What factors may make it difficult for the one being abused to leave? 90) In what case of DV may counseling show most productive and why? 91) Which cases in DV have poor outcomes? 92) Briefly.

org 101) What is the purpose of NAEMT? www.itrauma. what herb should NOT be taken? 96) What herb can be taken orally and applied to the skin that promotes healing? 97) What herb acts as an antibiotic? 98) What herbs help in brain function? 99) Describe how medication errors occur: 100) What is t he purpose of FAPEP? Go to www.org 62 .org 102) What programs does the NAEMT offer? 103) What does ITLS do? www.naemt.fapep.EEI Paramedic Refresher 201 0 95) If a patient is on an anti-depressant.

C) a sudden cardiac dysrhythmia. If you are doing this on your computer. B) irregular R-R intervals and a rate less than 40 beats/min. please place an X by the answer of your choice. In the context of cardiac compromise. syncope occurs due to: A) an increase in vagal tone. B) a drop in cerebral perfusion. 63 . 2. C) wide QRS complexes with P waves buried in the T waves. Paramedic Refresher 2010 Name: Date: 1.EEI Paramedic Refresher 201 0 Multiple Choice Questions: Circle your best answer. D) an acute increase in heart rate. An accelerated idioventricular rhythm is characterized by all of the following. EXCEPT: A) QRS complexes greater than 0.12 seconds in duration. D) regular R-R intervals and a rate between 40 and 100 beats/min.

D) cancerous tumor. a 30-year-old man. You should: A) check his blood glucose level as your partner prepares to intubate. 6. Administration of up to 10 mg of naloxone has had no effect. is unconscious and unresponsive. D) a state of denial in patients with an acute MI. His is hypoventilating. B) has an average stroke volume of 40 mL. D) can easily increase stroke volume by 50%. C) a subconsciously clenched fist over the chest. Levine sign is MOST accurately defined as: A) pushing on the sternum with the fingertips. 64 . The patient. With regard to stroke volume. B) rubbing the arm to which pain is radiating. bradycardic. C) damaged cell. and hypotensive. You respond to the residence of a known heroin abuser. 4. C) administer 25 g of 50% dextrose and reassess his level of consciousness. B) transport at once and administer additional naloxone while en route. D) hyperventilate him with high-flow oxygen to minimize tissue hypoxia. C) can double stroke volume if demand is high. B) new growth.EEI Paramedic Refresher 201 0 3. the healthy heart: A) has a relatively fixed stroke volume. and your transport time to the hospital is approximately 30 minutes. A neoplasm is MOST accurately defined as a: A) normal cell. 5.

The primary treatment for hypotension secondary to anaphylaxis is: A) epinephrine. 12. Unlike hypothyroidism. B ) stridor. D) Pancreas EXCEPT: 65 . B) causes a decrease in the metabolic rate. B) is severely hypotensive. B) liver. C ) spl een. 11. D) often results in acute myxedema coma. C) isotonic crystalloid. D) a dopamine infusion. 10. Early clinical manifestations of an allergic reaction include all of the following. C) have ducts that carry their secretions into a body cavity. C) may faint upon standing. D) has intra-abdominal bleeding. B) diphenhydramine. hyperthyroidism: A) results in a decreased cardiac output. Unlike exocrine glands. A patient with a positive tilt test: A) often requires atropine. 8. The conversion of glycogen to glucose occurs in the: A ) bl ood . C ) urticaria.EEI Paramedic Refresher 201 0 7. D ) coughing. endocrine glands: A) do not affect the rate of cellular metabolism. A ) pruritis. D) produce chemicals that work faster than the nervous system. C) causes an increase in oxygen demand. B) release chemicals directly into the bloodstream. 9.

EEI Paramedic Refresher 201 0 13. and give nitroglycerin to lower her blood pressure. B) naloxone. D) calcium. C) increased pH levels. has a blood pressure of 190/100 mm Hg. most patients who are given analgesia will experience hypotension. you should: A) recognize that she probably received an overaggressive dialysis treatment. A 70-year-old female dialysis patient presents with a headache. D) monitor her cardiac rhythm. 66 . analgesia will mask the patient's pain and skew further examination. C) transport at once. a pulse rate of 90 beats/min and regular. D) respiratory acidosis. start an IV line en route. Severe salicylate toxicity produces: A) bradypnea. transport. 14. B) metabolic acidosis. B) start an IV line with normal saline and infuse 200 mL of normal saline per hour. In addition to administering supplemental oxygen. renal failure may cause analgesics to accumulate to toxic levels. C) atropine. 15. Fluid-refractory hypotension following a barbiturate overdose is treated MOST effectively with: A) dopamine. 16. It is MOST important for the paramedic to consult with medical control prior to administering analgesia to a patient with severe flank pain and suspected acute renal failure because: A) B) C) D) patients with renal failure often require high doses of analgesia. She is conscious and alert. and respirations of 14 breaths/min and regular. and start an IV line en route to the hospital.

D) resulting hypoxemia causes the body to shift to aerobic metabolism. D) erythrocyte hemolysis. D) A person with type B-positive blood receives type B-positive blood 18. B) laryngospasm occurs and temporarily protects the lower airway. Anemia would result from all of the following conditions. C) permanent laryngeal spasm occurs and requires cricothyrotomy. EXCEPT: A) acute blood loss. 19. and dies. C) A person with type A-negative blood receives type 0 blood. waxy skin.EEI Paramedic Refresher 201 0 17. 20. B) an increase in iron. In which of the following situations would a transfusion reaction MOST likely occur? A) A person with type AB blood receives type 0 blood. B) A person with type 0 blood receives type AB blood. C) chronic hemorrhage. The MOST common symptom of frostbite is: A) localized edema. B) white. D) cyanosis of the skin. 67 . C) an altered sensation. If a small amount of water is aspirated into the trachea during a submersion event: A) the victim asphyxiates. becomes profoundly acidotic.

A child's vocal cords can be difficult to visualize during intubation because: A) B) C) D) the epiglottis is floppy and U-shaped. a sniffing position is difficult to achieve. the cords themselves are more posterior. you should: 22. the area of the cricoid cartilage is narrow.EEI Paramedic Refresher 201 0 21. Following defibrillation of a 28-pound child with ventricular fibrillation. 68 .

EEI Paramedic Refresher 201 0 23. B) often become less violent with each ensuing attack. 24. B) generally desires the presence of a caregiver. the faster our bodies decline in function. C) may use intimidation and threats to maintain control. 27. D) increased drug elimination due to decreased antidiuretic hormone. Adverse drug reactions in elderly people are the result of: A) partial digestion secondary to delayed gastric emptying. When assessing and caring for a 17-year-old gang member. D) use towel rolls for lateral head stabilization. it is MOST important to remember that he or she: A) must be separated from other gang members. To ensure that an infant's head is in a neutral position during spinal immobilization. B) changes in body composition and an increase in body water. 25. C) place a towel roll behind the infant's neck. D) may have a weapon and a reputation to earn. D) demonstrate a lack of remorse following the attack. D) older adults experience decreased functions faster than younger adults. 26. which means that: A) the older we get. C) older people exhibit the cumulative results of a longer aging process. you should: A) provide slight extension of his or her head. C) typically boasts about the use of illicit drugs. B) place padding under the infant's shoulders. 69 . B) the rate at which we lose functions does not increase with age. Aging is a linear process. C) changes in drug metabolism due to diminished hepatic function. People who abuse their partner or spouse: A) were not victims of abuse as children.

C) recall that the patient will probably not be able to communicate his or her chief complaint effectively. B) have your team members remain at a distance until you can establish a rapport with the patient. 31. D) approach the patient with at least two team members to immediately allay the patient's fear or anxiety. Hypernasality would MOST likely be caused by conditions such as: A) cleft palate and enlarged adenoids. Which of the following is an example of a speech production disorder? 70 . When making initial contact with a mentally impaired patient. A) True B) False 29. Which of the following is LEAST suggestive of hearing impairment? A) An inability to speak B) Presence of hearing aids C) Poor word pronunciation D) Failure to respond to questions 32. your partner. you should: A) immediately introduce yourself. B) chronic laryngitis and cleft palate. D) enlarged polyps and laryngeal cancer.EEI Paramedic Refresher 201 0 A) When suspected abuse is detected you should report it to the authorities 28. 30. C) laryngeal polyps and acute pharyngitis. and any other EMS personnel at the scene.

B) obtain no more than 2 readings in a 30-minute period. 36. EXCEPT: A) alopecia. When landing a helicopter at night. B) leukopenia. you should: A) only document the third peak flow reading. C) place a single strobe light in the center of the landing zone. D) refrain from parking the ambulance under overhead wires. 71 . C) ask the patient to take a deep breath through the nose. C) polycythemia. 34. B) the ambulance was not traveling in the proper lane or the operator was driving with excessive speed. D) thrombocytopenia. D) have the patient blow into the device for about 1 second. D) studies found that less than 5% of ambulance operators were offered an emergency vehicle operator's course. In MOST ambulance collisions: A) the ambulance attempted to pass a vehicle on the left side but the vehicle suddenly swerved. C) the ambulance operator was under 21 years of age and the ambulance had a mechanical malfunction.EEI Paramedic Refresher 201 0 A) B) C) D) Dysarthria Hoarseness Stuttering Aphasia 33. 35. Common side effects of chemotherapy include all of the following. B) avoid shining a spotlight up at the descending aircraft. When obtaining the peak flow reading of a patient following treatment for bronchospasm. you should: A) leave your headlights on to signify your location.

Infection with the Ebola virus is characterized by: A) a progressive onset of high fever. The _______________ has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. B) internal and external hemorrhage. D) assigned the same triage category as the walking wounded and evaluated later. D) paralysis of the respiratory muscles. D) Ricin is extremely toxic by many routes of exposure.EEI Paramedic Refresher 201 0 37. 40. 41. C) labeled with a red tag and transported immediately to a pediatric trauma center. A) logistics chief B) rescue officer C) triage officer D) safety officer 39. B) taken to the treatment sector as soon as possible for immediate secondary triage. B) Ricin is highly communicable only if it is inhaled. C) Calcium chloride is the preferred antidote for ricin. Which of the following statements regarding ricin is MOST correct? A) Ricin is five times more lethal than botulinum. C) the formation of cutaneous blisters. 38. A patient would MOST likely become trapped between the driver's seat and 72 . infants or children not developed enough to walk or follow commands should be: A) quickly moved to a designated area of the triage section and monitored closely. According to the JumpSTART triage system for pediatric patients.

Prior to accepting a patient who has been decontaminated by the hazardous materials team. C) receive a verbal report about the material involved. D) quickly recognize a rapidly deteriorating situation so that the paramedic can relocate bystanders to a place of safety. such as the Jaws of Life. 73 . D) T-bone collision. B) in the cold zone. C) understand and identify potential hazards and determine whether it is safe to gain access to the patient. Triage and emergency medical treatment should be performed: A) in the hot zone. D) at least 100 feet from the incident. 44. the paramedic must: A) make contact with the receiving medical facility. 42. 43. C) in the warm zone. it is MOST important for the paramedic to be able to: A) have an advanced working knowledge of a wide variety of rescue equipment. With regard to rescue. B) rollover crash. B) be informed about the degree of decontamination. C) lateral collision. B) be trained well enough to be able to coordinate a rescue effort and function as the incident commander.EEI Paramedic Refresher 201 0 steering wheel following a: A) frontal crash. D) don the appropriate personal protective equipment.

Upon arriving at the scene. 47. 46. B) position yourself next to the front wheel so that the engine block and tire can both protect you. the MOST effective way of protecting yourself is to: A) break out one of the side windows. 74 . an elderly-sounding man. If you are under fire from a sniper who is on the roof a building. You receive a call to a residence in a rural area of your jurisdiction for a patient with an acute COPD exacerbation. Which of the following statements regarding cold water submersion is NOT correct? A) Water that is colder than 70°F will cause a marked increase in oxygen demand. The patient. you knock on the door and identify yourself. D) stay at a safe distance from the door and ask the man to walk outside. in between the tires. C) advise the patient that you got to the scene as quickly as possible. and you are using a vehicle as cover. tells you that you took too long to get to him. and lay prone across the front seat. and that he has a shotgun. C) crawl under the vehicle. You should: A) look inside a nearby window to see if he really does have a gun. B) immediately retreat to the ambulance and notify law enforcement. but avoid the area of the vehicle near the gas tank. B) The cold protective response secondary to hypothermia can protect vital organs. D) crouch down in between the wheels of the vehicle in order to make yourself as small a target as possible.EEI Paramedic Refresher 201 0 45. crawl into the vehicle.

3 mL/kg. D) the presence of law enforcement.000. After the baby delivers. she admits to being a chronic heroin abuser and states that she last "shot up" about 6 hours ago. The MOST common risk factor for the development of type 2 diabetes in people over 65 years of age is: A) poor dietary habits and a sedentary lifestyle. 1:1.3 to 1 mL/kg: 1:10.03 mg/kg. you will MOST likely need to: A) give positive-pressure ventilations. 49. 1:10. 75 .000. D) Bradycardia occurs after falling in cold water and lowers the basal metabolic rate. C) suction meconium from its airway. B) frequent infections that do not heal properly. 48. D) 0. During your assessment of a 30-year-old woman in active labor.1 to 0.000. The single MOST important process to ensure ongoing rescuer safety at a technical rescue incident is: A) the accountability system. C) hypertension of longer than 5 years duration. 50.1 mg/kg of naloxone.000. D) the presence of more than one chronic disease. C) mandated use of reflective vests. 51. D) administer free-flow oxygen by mask. B) assignment of a safety officer.01 mg/kg. B) administer 0. 1:1.01 to 0.EEI Paramedic Refresher 201 0 C) Patients submerged in cold water are often dehydrated secondary to cold diuresis. C) 0. The recommended IV dose and concentration of epinephrine for the newborn is: A) 0. B) 0.

C) should be encouraged to ambulate if possible. 54. D) peptic ulcer disease. you should: A) call the receiving trauma center and update them on the patients' conditions. C) triage assessment is brief and patient condition categories are basic. 55. 53. C) musculature. After stabilizing the patients' conditions to the best of your ability. C) request air transport immediately and determine where you will land the helicopter. EXCEPT the: A) j oi nt s. B) should experience a decreased tidal volume. During an incident involving an explosion. you determine that two critically injured patients should be transported to a trauma center by air. B) brain. The relatively high use of nonsteroidal anti-inflammatory drugs by older patients predisposes them to: A) constipation. B) contact the incident commander and request permission to utilize air transport. The goal of doing the greatest good for the greatest number of people mandates that: A) life-threatening injuries should be treated during the triage phase. Pain receptors are found in all of the following locations. D) every victim should receive a detailed physical exam during triage. D) visceral organs. B) there should be one triage officer for every 10 victims of a disaster. When a patient is receiving treatment with continuous positive airway pressure (CPAP). he or she: A) must be placed in a supine position. D) notify the transportation officer and request that he or she establish a landing zone. B) cholelithiasis. 76 . C) mesenteric ischemia.EEI Paramedic Refresher 201 0 52. 56.

C) perform synchronized cardioversion if the rate is fast. B) an EMS ambulance is housed in a fire department and is staffed by EMTBs. A third-service EMS system is one in which: A) a public agency not affiliated with the fire department provides EMS service. C) first responders from a fire department assist the ambulance on every EMS call. B) delays in ground transport due to traffic. C) the injury mechanism that was involved. C) whether the child turns away from or toward the vehicle. 77 . 59. D) the need for definitive airway management. When attempting resuscitation of a child with pulseless electrical activity (PEA). D) a privately owned ambulance service works in tandem with a public EMS system. The MOST important factor to consider when determining if transport of a trauma patient via helicopter is appropriate is: A) the patient's hemodynamic status. 60. The general area of a child's body that sustains initial trauma after being struck by an automobile depends MAINLY on: A) the child's height and the height of the bumper upon impact. 57. 58. B) the speed at which the vehicle was traveling and the child's weight. you should: A) administer epinephrine via the ET tube if possible. D) give atropine if the heart rate is less than 60 beats/min.EEI Paramedic Refresher 201 0 D) typically finds it difficult to exhale completely. B) attempt to identify an underlying cause of the arrest.

B) eustress.EEI Paramedic Refresher 201 0 61. The LEAST preferable and reliable method of selecting people to participate in a research study is: A) random sampling. You arrive at a convenience store to find a middle-aged male in cardiac arrest. This means that you should: A) contact medical control before providing advanced level care. 62. Your protocols provide for standing orders in this type of scenario. Which of the following is NOT an example of a passive injury prevention intervention? A) The manufacture of child-resistant bottles B) Providing public education on the use of AEDs C) The use of softer materials for playground surfaces D) Installing sprinkler systems in commercial buildings 78 . Negative or injurious stress is also called: A) distress. C) projected stress. D) alternative time sampling. 64. D) pronounce the patient dead if there is no response after 10 minutes. C) begin CPR and then contact medical control for further direction. B) systematic sampling. D) redirected stress. 63. C) convenience sampling. B) perform certain interventions prior to contacting medical control.

D) do not require anyone to make decisions on the patient's behalf. D) organ systems. B) talk to the patient to determine if he or she understands what is happening. C) confirm that the patient is at least 18 years of age or otherwise emancipated.400 79 . the paramedic would give a/an: A) alpha-1 agonist. D) ensure that pulse oximetry and blood glucose readings are within normal limits 66. 67. B) can only be revoked by the patient's personal physician. 69. The child's estimated weight is 35 pounds. B) organs. C) beta-1 agonist. The BEST way for a paramedic to evaluate a patient's decision-making capacity is for the paramedic to: A) determine if the patient knows what care is appropriate for the situation.EEI Paramedic Refresher 201 0 65. C) remain in effect once a patient loses decision-making capacity. B) beta-2 agonist. You have a prefilled syringe of Dso at a concentration of 25 g/50 mL How many grams of dextrose will you administer to the child? A) 12. An unconscious 4-year-old child with a blood glucose reading of 30 mg/dL requires 2 mL/kg of 50% dextrose (Dso). C) an organism. 68. Health care powers of attorney are also called "durable" powers of attorney because they: A) must be in the patient's possession at all times. D) alpha-2 agonist. Groups of cells form: A) tissues. In order to relieve the bronchospasm associated with an acute asthma attack.

75. B) indicates a significant ocular or neurologic pathology. the skin becomes: A) cool and pale. When the blood vessels supplying the skin are fully dilated. In general. 80 .800 14. D) patient's perception of his or her problem. B) chief complaint and patient history. C) family. C) results of your detailed physical exam.000 70. D) must be assessed in the context of the patient's overall presentation. B) Pericardial tamponade C) Tension pneumothorax D) Decompensating COPD 73. 71. In which of the following conditions would you be LEAST likely to encounter pulsus paradoxus? A) Moderate asthma attack. normal psychosocial factors that affect the life of a 35-year-old person include all of the following. 74. D) anxiety. EXCEPT: A) wo r k .EEI Paramedic Refresher 201 0 B) C) D) 13. B) cold and moist. Asymmetry of the pupils: A) is a normal finding in up to 40% of the population. B) st r e ss. Which of the following is NOT an example of an open-ended question? A) "How did you feel when you awoke today?" B) "Is there anything you would like to discuss?" C) "Can you describe the pain you are feeling?" D) "Does the pain radiate to your arm or jaw?" 72. C) warm and pink. You will MOST likely make your field diagnosis of a patient based on the: A) medications the patient is taking.000 16. C) is normal when a light is shined into one of the pupils.

81 . B) determine the most common and statistically probable cause for the patient's current signs and symptoms. When documenting a statement made by the patient or others at the scene. 76. C) formulate a working field diagnosis on the basis of what you discovered in the initial assessment of the patient. 78. D) place the exact statement in quotation marks in the narrative. you should next: A) consider the worst case scenario that could be causing the patient's symptoms and either rule it out or rule it in. D) are typically ignored by the patient because he or she is frightened at the time. B) include the statement in an addendum to your run report. After addressing any life threats in the order in which you find them. 77.EEI Paramedic Refresher 201 0 D) blue or mottled. D) provide symptomatic care and promptly transport the patient to an appropriate medical treatment facility. C) translate the statement into appropriate medical terminology. B) demonstrate an illegal act for which the paramedic will be held accountable. you should: A) document the exact time that the statement was made. C) are commonly made by paramedics with less than 5 years of field experience. Comments such as "I can't believe you called EMS for this!": A) show a lack of compassion and interest in providing the best possible care.

D) a body at rest will remain at rest unless acted upon by an outside force. it can only change form. B) external bleeding. C) involves a disruption of the skin and underlying tissues in a small. Which of the following situations is MOST challenging with regard to your critical thinking and decision-making skills? A) A rigid abdomen and signs of shock B) An elderly patient with prolonged asystole C) A driver who passed out and then struck a tree D) Isolated tibia/fibula fracture from minor trauma 80. A motorcycle rider struck a parked car and was catapulted over the handlebars of 82 . B) often causes damage to a large body surface area. focused area. D) plasma loss from burns. 81. The MOST common cause of exogenous hypovolemic shock is: A) dehydration. The patient care report (PCR): A) provides for a continuum of patient care upon arrival at the hospital. penetrating trauma: A) is especially common during the primary blast injury following an explosion. C) energy can neither be created nor destroyed. even from a single projectile. B) is a legal document and should provide a brief description of the patient. 82. D) is only held for a period of 24 months. The law of conservation of energy states that: A) kinetic energy can only be converted to thermal or chemical energy. after which it legally can be destroyed. 83. D) is usually more fatal because of the severe external bleeding that accompanies it. B) the force that an object can exert is the product of its mass multiplied by its acceleration.EEI Paramedic Refresher 201 0 79. C) should include the paramedic's subjective findings or personal thoughts. C) diabetic ketoacidosis. 84. Unlike blunt trauma.

The patient has superficial and partial-thickness burns to his face. and start a large-bore IV of normal saline set at a keep vein open rate. 83 . C) full-thickness flash burns occur to the body. D) microscopic vasculature damaged by the injury is digested by macrophages through a process called phagocytosis. diaphoretic. D) administer high-flow oxygen.EEI Paramedic Refresher 201 0 his bike. cover him with a blanket. B) histamine makes the capillaries more permeable. There is no gross external bleeding present. and administer fluids based on the Parkland formula. keep him warm. You should: A) conclude that he is experiencing burn shock. 86. D) flying shrapnel may cause penetrating injuries. B) the pressure wave damages air-filled cavities. start at least one large-bore IV of normal saline. thereby closing the open tissue. Your assessment reveals that he is tachypneic. start two large-bore IV lines of normal saline. cover his burns with cold moist dressings. resulting in swelling in and around the injury site. and tachycardic. and arms. C) collagen provides stability to the damaged tissue and joins wound borders. neck. During the neovascularization phase of the wound healing process: A) new blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue. B) assist his ventilations with a bag-mask device. A 33-year-old man was burned when the hot water heater he was working on exploded. What is the MOST likely cause of this patient's clinical presentation? A) Closed head injury B) Bilateral femur fractures C) Proximal upper extremity fractures D) Sympathetic nervous system failure 85. C) apply oxygen via nonrebreathing mask. and administer fluid boluses to maintain adequate perfusion. During the secondary phase of a blast injury: A) the patient is thrown against a solid object. His BP is 80/54 mm Hg and his heart rate is 120 beats/min and weak. start an IV with normal saline and give up to 4 mg of morphine for pain. 87. Your initial assessment reveals that he is restless and tachypneic.

The back seat passenger. C) increased intracranial pressure. D) can exacerbate tissue injury and should be avoided. Which of the following statements regarding a closed head injury is MOST correct? A) In a closed head injury. C) carefully assess the driver for occult injuries before removing her 84 . B) rapidly extricate the driver so you can gain quick access to the child in the back seat. The application of ice to partial-thickness burns: A) often negates the need to administer a narcotic. B) is not necessary because such burns are painless. 90. B) compression of the vena cava. The passenger side of the vehicle has sustained severe damage and is inaccessible. B) Diffuse brain injury occurs with all open head injuries. 89. The driver is conscious and alert and complains only of lower back pain. C) offers excellent pain relief and minimizes swelling. C) Closed head injuries are less common than open head injuries. a young child who was unrestrained. is bleeding from the head and appears to be unconscious. D) patient discomfort and frustration. The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is: A) pressure lesion development. What part of the eye is MOST commonly injured following a thermal burn? A) Gl o b e B) Retina C) Cor nea D) Eye l i ds 91. Upon arriving at the scene of a motor vehicle crash. You should: A) ask the driver to step out of the vehicle so you can access the back seat passenger. D) Intracranial pressure is usually minimal in a closed head injury. 92. you find the driver of the car still seated in her two-door vehicle.EEI Paramedic Refresher 201 0 88. the dura mater remains intact.

His jugular veins are distended and his breath sounds are bilaterally diminished but equal. D) covering the stab wound with an occlusive dressing. initiating transport. assisting ventilations. transporting at once. 94. starting a large-bore IV line en route. He is semiconscious with shallow breathing and weak radial pulses. A convenience store clerk was stabbed during a robbery attempt. 95. intubating the patient and ventilating at 10 to 12 breaths/min. and establishing large-bore IV lines en route. C) assisting his ventilations. During the rapid trauma assessment. B) administering oxygen via nonrebreathing mask.EEI Paramedic Refresher 201 0 from the vehicle D) apply a vest-type extrication device to the driver and quickly remove her from the car. the FIRST thing to occur is: A) decreased pulmonary function. and administering fluids to maintain a systolic BP of 100 mm Hg. and placing an occlusive dressing over the stab wound if his oxygen saturation is low. What membranous tissue functions as the point of attachment for the various abdominal organs? A) P l e u r a B) Mesentery C) Peritoneum D) Ligamentum arteriosum 85 . The MOST appropriate treatment for this patient involves: A) performing bilateral needle thoracenteses. 93. transporting at once. you find a single stab wound to his left anterior chest. D) marked decrease in venous return. and transporting him to a trauma center. As air accumulates in the pleural space. B) contralateral tracheal deviation. C) compression of the great vessels.

97. During the third collision in a motor vehicle crash: A) hollow abdominal organs rupture upon impact. C) pectoral girdle. C) synovial joints. B) fibrous joints. D) thoracic ribs. and the bones of the extremities. C) rapid deceleration propels an unrestrained person forward.EEI Paramedic Refresher 201 0 96. B) bones of the upper extremities and the structures of the torso. The appendicular skeleton is composed of the: A) bones of the spinal column. 86 . 98. D) abdominal organs shear from their points of attachment. D) cartilaginous joints. pelvic girdle. The joints that connect the ribs to the sternum are examples of: A) fused joints. cervical vertebrae. B) the person's abdomen collides with the steering wheel. scapulae. and clavicles. and the bones of the cranium.

87 . 100. B) The position of the patient at the time of the event is considered to be an internal factor.EEI Paramedic Refresher 201 0 99. D) Rapidly applied amounts of energy are better tolerated than a similar amount of energy applied over a longer period. Following a head-on collision of a motorcycle and a truck. C) wrists and forearms. C) Blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma. Which of the following general statements regarding trauma is MOST correct? A) Bullet impact is less if the energy in the bullet is applied to a small area. the motorcyclist would MOST likely experience initial injury to the: A) cervical spine. B) chest and abdomen.

EEI Paramedic Refresher 201 0
Identify the following EKG rhythms and give rate.

Ventricular Paced rhythm with an elevated ST segment Rate = 80 bpm

Ventricular Fibrillation (Fine) / Asystole

Rate = None

Atrial Flutter

Rate = 115

Sinus rhythm with multifocal PVC’s

Rate = 80 bpm

88

EEI Paramedic Refresher 201 0
Sinus rhythm Rate = 80 bpm

Sinus rhythm with a 1st degree AV block.

Rate = 60 bpm

Atrial Fibrillation

Rate = 90 bpm (Irregular)

Sinus rhythm with a PAC

Rate = 80 bpm

Accelerated Junctional rhythm

Rate = 80 bpm

Sinus rhythm with PVC’s

Rate = 80 bpm

89

EEI Paramedic Refresher 201 0

HIV / AIDS UPDATE

Emergency Educational Institute 9381 W Sample Rd Coral Springs, Fl. 33065 Todd Soard, NREMT-P, PH.D Director Joe Nelson, M.D. Medical Director

90

saliva and perspiration may have small amounts of the virus have not been found to transmit the disease. An HIV positive person can feel and look healthy for a long time after first becoming infected. Intercourse either vaginally or anal places the participants at a high risk of getting the HIV virus. can take many years to develop. Oral sex is less of a risk but if you have an open mouth sore or cut the risk increases. 91 .EEI Paramedic Refresher 201 0 HIV / AIDS HIV is short for Human Immuno-deficiency Virus. the virus kills or impairs more and more cells in the immune system and the body loses the ability to fight off common infections. TRANSMISSION In our time the first case of AIDS came about in 1981. or Acquired Immune Deficiency Syndrome. The blood source donated is screened to reduce the chances of infected blood getting. Cases have grown throughout the years and much research has been done and is in progress. Needle sticks are of much concern to EMS personnel. Once infected with HIV. this does not necessarily mean that (s)he has symptoms or feels sick. People with AIDS can die from diseases that are usually not dangerous for people with healthy immune systems. Urine. The fluid must enter through an opening of your skin to have the potential on becoming infected. However. AIDS. tears. The risk of getting HIV / AIDS is present but getting Hepatitis B is greater. Hemophiliacs are at risk due to the amount of blood by products they use and transfusions. a person is referred to as HIV positive. The spread of AIDS is channeled through unprotected sex. such as diarrhea or colds. Eventually. the sharing of needles for drug use and direct contact with body fluids of an infected person. Nursing mothers who are infected pose a risk of passing the virus on to the infant. Blood transfusions and organ transplants are at risk of being a transmitter.

By the year 2010. and Russia) with 40 percent of the world's population will add 50 to 75 million infected people to the worldwide pool of HIV disease. 2009) Worldwide: • • • • Over 22 million people have died from AIDS. India. China. and 74 percent of these infected people live in sub-Saharan Africa. five countries (Ethiopia. sexual. hugging and kissing an infected person By sharing clothes or shaking hands with an infected person By sharing toilets and bathrooms with an infected person By living with an infected person By mosquitoes. and utensils with an infected person By touching. Nigeria. Over 19 million women are living with HIV/AIDS. or other insects Who is more at risk? Adolescents and young people Girls and young women Mobile populations People who use drugs Sex workers and their clients Social. 92 . Over 42 million people are living with HIV/AIDS.com. fleas. ethnic.EEI Paramedic Refresher 201 0 How HIV is NOT Transmitted Through air or by coughing and sneezing Through food or water Through sweat and tears By sharing cups. plates. and religious minorities Street children and children who work Numbers Infected Vital Statistics (Until.

Half of all new infections in the United States occur in people 25 years of age or younger. 75 percent of the new infections in women are heterosexually transmitted. 93 .EEI Paramedic Refresher 201 0 • There are 14. 54 percent of the new infections in the United States occur among African Americans. Then if an exposure is detected a more expensive test is done on the sample. Don't let your guard down and put yourself at risk of becoming infected. It is rare but must be noted that some people that have been exposed have not tested positive until two years later. currently. The UN estimates that. If our thinking is hindered so is our guard. Protected sex should be used at all times. This goes even for those in the medical field. 70 percent of these new infections occur in men and 30 percent occur in women. • United States: • • • An estimated one million people are currently living with HIV in the United States. • • TESTING The process of looking for the antibodies that the body produces when a person becomes infected does testing. Testing goes in an order of less expensive kits first. Having one partner that we trust to be monogamous is of consideration.000 new infections every day (95 percent in developing countries).000 new infections occurring each year. Use precautions to prevent needle sticks at any cost. Employees should consider Hep. A & B vaccines to prevent these diseases. Drug use should not be a part of our lives and if we drink alcohol. HIV/AIDS is a "disease of young people" with half of the 5 million new infections each year occurring among people ages 15 to 24. A higher number of people test positive after an exposure within 6 months. By race. with approximately 40. Be careful when handling patient and the use of needles. and 64 percent of the new infections in women occur in African American women. Usually a person who has become infected will show signs in the testing procedure 2 to 3 weeks after exposure. We do not have a special protection due to the fact we are a health care provider. there are 14 million AIDS orphans and that by 2010 there will be 25 million. PREVENTION The best prevention is to abstain from sex. do so in moderation.

Cleaning with proper agents should be done all the time. If a health care provider has had a confirmed exposure to a patient with HIV they have a right to see the infected patients files ONLY after the employer has legally obtained them. Counseling starts at the initial testing all the way through follow up care. Eye protection and gowns should be worn if the situation calls for it.609 F.up. Testing is done by a testing site that falls in line with the 381. Following the guidelines set forth by your department or facility should be read and implicated on a daily basis. Education is the key to handling the disease and many people do not know how to care for themselves in this case or how to extend their life by medications and a life style of eating properly. Testing is done at these sites as well as education and follow . 94 . Early detection is always good. 3) Cancer of different types. THE LAW The Omnibus AIDS ACT was put in place here in Florida back in 1988. The testing is confidential to the fullest. 4) Fungal infections of the body in different areas. Hand washing needs to be done even if gloves were worn. Some key signs a patient who is infected may present the following: 1) Night sweats that are excessive. These are just a few of the signs and symptoms a patient may encounter but are the most prominent. It covers how HIV affects the health care worker and what education requirements health care health care providers must meet.EEI Paramedic Refresher 201 0 Another type of prevention is INFECTION CONTROL.S. CARE for those INFECTED Ones who are infected are entitled to counseling. You must have a clear " need to know" to examine these files. People though may not know they have the disease for some time so education is the key. Never forget to follow your universal precautions (BSI) and assume that any person you come in contact with may be infected. 5) Weight loss. 2) Persistent infections.

EEI Paramedic Refresher 201 0 Blood testing can be done on a patient that you have come in contact with and have had an exposure in two ways only. The person may of only acquired the disease from another partner they trusted or by a blood transfusion.pdf PATIENT CARE We in the health care field always want to treat everyone with the most respect.us/Disease_ctrl/aids/legal/hartog. may have the same blood tested if they had an exposure but only from the blood drawn for the reasons stated already. The blood from the patient was given voluntarily or the blood drawn was for some other reason during the emergency treatment. You also may decline this counseling. and donors of blood. Under some circumstances. watch whom we are near and how loud we are speaking. 95 . Confidentiality is a must. The Federal Rehabilitation Act states that AIDS is a handicap and persons with AIDS cannot be discriminated against in the workplace.doh. What ever the patient discloses to you should only be passed on to other medical personnel on a 'need to know" basis. Mandatory testing of convicted prostitutes. COUNSELING Counseling by law is to be confidential as well as all records. Non-medical persons. Do not bring up names or locations of patients you have come in contact with. This plays a part of prevention to the public in which we all serve.state. a physician may release the finding to a sexual partner. In any case if an exposure and you are infected you have the right to counseling and follow up. federal prisoners. This is done only when the patient gives the names. Special attention needs to given to them and we should not be judgmental. For more information on Florida’s view you may download a booklet at: http://www. organs. sperm. those seeking immigration status. We in the health care field should encourage those at risk of HIV / AIDS to get tested and go for counseling and receive education on the disease.fl. convicted sexual offenders. While notifying other of the patient’s condition. bone. HIV infected and AIDS patients are no exception. It will be noted on your personnel chart not the patient chart. ALL cases of 'NO FAULT" on their part. and tissue is to be done. military personnel. who may have rendered care.

other exposure to bodily fluids which make their way into the body. practice universal precautions such as BSI. sharing of drug needles. 2. How is HIV NOT transmitted? What protection is needed on our part in the prevention of HIV/AIDS? Through air or by coughing and sneezing Through food or water Through sweat and tears By sharing cups. and utensils with an infected person By touching. use caution when handling needles. 3. Inc 1. fleas. What rights do the patients of HIV have? 96 .EEI Paramedic Refresher 201 0 Worksheet for HIV Course EEI. or other insects Practice safe sex. plates. How is the HIV virus transmitted? Unprotected sex. eye protection. hand washing. and gowns if necessary. hugging and kissing an infected person By sharing clothes or shaking hands with an infected person By sharing toilets and bathrooms with an infected person By living with an infected person By mosquitoes.

• According to the CDC’s website. and more than one million of those people are living with HIV (an estimated 1. Please conduct research and quote current rates of the spread of HIV. needle sticks. 2) Persistent infections. and public education in order to limit or prevent the spread of disease. failure to utilize proper BSI precautions. What is the purpose of the CDC? To monitor and control disease outbreaks. 10. to have any blood taken from that patient tested. and to seek counseling if infected.EEI Paramedic Refresher 201 0 Patients with HIV have the right to be respected. Healthcare workers are offered counseling if exposed. and have their records remain confidential with certain limitations. How can Healthcare workers become infected? Exposure to bodily fluids. prevention. • 97 . not discriminated against. what vaccines should an employee have? Hepatitus A and B Vaccines 9. 3) Cancer of different types. What are the signs and symptoms of HIV? 1) Night sweats that are excessive.400 adults and adolescents). more than 309 million people live in the U. The HIV transmission rate . perform research.S. 7. 5. 5) Weight loss. 6.has decreased over the past two decades. 4. 4) Fungal infections of the body in different areas. To prevent other diseases. 8. What rights do medical personnel have? Medical personnel have the right to access a patients records following an exposure. What privacy is extended to the employee? Counseling and all records are to be held confidential by law.the estimated annual number of new HIV infections per 100 persons living with HIV.106.

000 persons tested positive for HIV. the transmission rate declined approximately 89% (from 44 transmissions per 100 people with HIV in 1984 to 5 transmissions per 100 people in 2006).500 of the 17.4 million tests. HIV infections among injection drug users declined by approximately 80% between 1988 and 2006.   Of these. CDC launched the Expanded Testing Initiative.000 per year in the early 1990s to an estimated 138 per year in 2004. The proportion of persons who know they are infected with HIV increased from 75% in 2003 to 79% in 2006.500 individuals had no previous diagnosis of HIV. • • • o o CDC grantees conducted nearly 1. so that their partners could be advised of their potential exposure to HIV and counseled to receive HIV testing. Yet many of these individuals were unaware of their diagnosis.000-2.000 who tested positive had a previous diagnosis of HIV recorded in surveillance records. despite there being more people every year living with HIV. Nearly 6. 17. • HIV incidence – the annual number of new HIV infections – has decreased from an estimated high of about 130. 98 . 75% were successfully linked to medical care.000 new infections a year in 1985 to about 56. 86% received their positive HIV test result. In two years. and 78% were referred to partner services. Perinatal HIV infections – those transmitted from mother to child – have decreased from 1. o Of the more than 10. 10. In October 2007.300 in 2006.EEI Paramedic Refresher 201 0 o Since the mid-1980s.000 persons newly diagnosed with HIV.

DOSAGE: 6 mg given as a rapid IV bolus over a 1-2 second period. administer a 12-mg dose over 1-2 seconds. ROUTES: IV. including blocks. Give your answer by ANY new guidelines you that are presently being used. dizziness.INC For the following drugs please list what action they have. the dose and route it may be administered and any contraindications they may have. if. ADENOSINE CLASS: Antiarrhythmic ACTIONS: slows AV conduction INDICATIONS: symptomatic PSVT CONTRAINDICATIONS: second. after 1-2 minutes. shortness of breath. PRECAUTIONS: Arrhythmias.EEI Paramedic Refresher 201 0 PARAMEDIC DRUG ADDENDUM REFRESHER 2010 EEI. PEDIATRIC DOSAGE: Safety in children has not been established. cardioversion does not occur.or third-degree heart block. headache. Use with caution in patients with asthma. and nausea. should be administered directly into a vein or into the medication administration port closest to the patient and followed by flushing of the line with IV fluid. ALBUTEROL 99 . sick-sinus syndrome. are common at the time of cardioversion. The drugs listed are those we encounter in resuscitation of the patient and everyday use. known hypersensitivity to the drug. SIDE EFFECTS: Facial flushing.

Increases PR and QT intervals Decreases Peripheral vascular resistance INDICATIONS: Life-threatening cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation. However it is seldom used in the prehospital setting ROUTES: IV. Oral PEDIATRIC DOSAGE: Not recommended ATROPINE 100 . and EKG should be monitored use caution in patients with known heart disease SIDE EFFECTS: Palpitations. Malaise – Fatigue. Nausea.EEI Paramedic Refresher 201 0 CLASS: Sympathomimetic (ß2 selective) ACTIONS: Bronchodilation INDICATIONS: Asthma reversible bronchospasm associated with COPD CONTRAINDICATIONS: Known hypersensitivity to the drug. headache. CONTRAINDICATIONS: Severe sinus node dysfunction Sinus Bradycardia Second and Third Degree Block Hemodynamically significant bradycardia PRECAUTIONS: Heart Failure SIDE EFFECTS: Hypotension. anxiety.5 ml normal saline by small volume nebulizer AMIODARONE CLASS: Aniarrhythmic (Group III) ACTIONS: Prolongs action potential and refractory period Slows the sinus rate.15 mg (0.03 ml)/kg in 2.5 ml (2. Anorexia. pulse. symptomatic tachycardia PRECAUTIONS: Blood pressure. Ventricular escape beats DOSAGE: Adults – V-Fib / V-Tach without pulses: 300 mg IV Adults – Ventricular arrhythmias with a pulse: 150 mg over 10 minutess Maintenance Infusion: As with any Aniarrhythmic a maintenance infusion is required. Pulmonary toxicity.5 ml normal saline over 5-15 minutes Rotohaler: one 200-microgram rotocap should be placed in the inhaler and breathed by the patient ROUTES: Inhalation PEDIATRIC DOSAGE: 0. and sweating DOSAGE: Metered Dose Inhaler: 1-2 sprays (90 micrograms per spray) Small-Volume Nebulizer: 0.5 mg) in 2. Tremors. dizziness.

tachycardia.). ACTIONS: Blocks acetylcholine receptors. breastfeeding. Asystole: 1 mg. SIDE EFFECTS: Palpitations and tachycardia. overdose.5 mg every 5 minutes to maximum of 0. headache. and blurred vision. INDICATIONS: Acute hyperkalemia (elevated potassium). ACTIONS: Increases cardiac contractility. calcium channel blocker (Nifedipine. PRECAUTIONS: Dose of 0. hypotension secondary to bradycardia. INDICATIONS: Hemodynamically-significant bradycardia.04 mg/kg.0 mg) BENICAR (Olmesartan) CLASS: Angiotensin II receptor antagonists ACTIONS: Block the effects of angiotensin II by antagonizing the angiotensin II type 1 receptor INDICATIONS: Hypertension CONTRAINDICATIONS: Hypersensitivity. decreases gastrointestinal secretions. acute hypocalcemia (decreased calcium). ET (ET dose is 2 . CALCIUM CHLORIDE CLASS: Electrolyte. DOSAGE: 2-4 mg/kg of a 10% solution. hypotension. etc. PEDIATRIC DOSAGE: Bradycardia: 0. dizziness. ROUTES: IV. pregnancy. Verapamil.EEI Paramedic Refresher 201 0 CLASS: Parasympatholytic (anticholinergic). dry mouth. SIDE EFFECTS: Arrhythmias (bradycardia and asystole). hypertension.2. increases heart rate. Extravasation may cause tissue necrosis. abdominal muscle spasm associated with spider bite and portuguese man-o-war stings. antidote for magnesium sulfate. may be repeated at 10-minute 101 .0 mg) Maximum total dose (child 1. Organophosphate poisoning: 2-5 mg. Netherton's syndrome DOSAGE: 20mg per day ROUTES: Oral PEDIATRIC DOSAGE: Not indicated.5 mg) (adolescent 1.0 mg) (adolescent 2. and anxiety.5 times IV dose). pupillary dilation. urinary retention (especially older males). CONTRAINDICATIONS: Patients receiving digitalis. organophosphate poisoning.04 mg/kg should not be exceeded except in cases of organophosphate poisonings. DOSAGE: Bradycardia: 0. asystole. CONTRAINDICATIONS: None when used in emergency situations. PRECAUTIONS: IV line should be flushed between calcium chloride and sodium bicarbonate administration.02 mg/kg Maximum single dose (child 0.

ROUTES: IV. hypotension. Hypotension. and dizziness. CONTRAINDICATIONS: Hypotension. SIDE EFFECTS: Local venous irritation. SIDE EFFECTS: Drowsiness. 102 .5 g/kg slow IV. IV drip. INDICATIONS: Generalized seizures. Has short duration of effect. DOSAGE: 25 grams (50 ml). conduction system disturbances. ROUTES: IV. ROUTES: IV. ACTIONS: Anticonvulsant. Must be kept refrigerated or discarded one month after removal from refrigeration. skeletal muscle relaxant. SIDE EFFECTS: Nausea. sedative. ACTIONS: Slows conduction through the AV node. premedication before cardioversion. PEDIATRIC DOSAGE: 0. wide complex tachycardia. PRECAUTIONS: A blood sample should be drawn before administering 50% dextrose. CONTRAINDICATIONS: None in the emergency setting. causes vasodilation. should be diluted 1:1 with sterile water to form a 25% solution. CARDIZEM CLASS: Calcium channel blocker. DEXTROSE 50% CLASS: Carbohydrate. This should be followed by a maintenance infusion of 5-15 mg/hour. acute anxiety states.25 mg/kg bolus (typically 20 mg) IV over 2 minutes. PEDIATRIC DOSAGE: Rarely used. skeletal muscle relaxant. DIAZEPAM ( VALIUM ) CLASS: Tranquilizer (Benzodiazepine).EEI Paramedic Refresher 201 0 intervals. decreases rate of ventricular response. Do not mix with other drugs because of possible precipitation problems. respiratory depression. ACTIONS: Elevates blood glucose level rapidly. status epilepticus. PEDIATRIC DOSAGE: 5-7 mg/kg of a 10% solution. INDICATIONS: To control rapid ventricular response associated with atrial fibrillation and flutter. apnea. INDICATIONS: Hypoglycemia. CONTRAINDICATIONS: Patients with a history of hypersensitivity to the drug. vomiting. DOSAGE: 0. PRECAUTIONS: Should not be used in patients receiving intravenous ß blockers. PRECAUTIONS: Can cause local venous irritation. hypotension. decreases myocardial oxygen demand.

1 . cardiogenic shock. ACTIONS: Blocks histamine receptors. alpitations. PEDIATRIC DOSAGE: 2-5 mg/kg. ACTIONS: Increases cardiac contractility. ROUTES: IV drip only.0. CONTRAINDICATIONS: Asthma.2 mg/kg. PEDIATRIC DOSAGE: 2-20 μg/kg/minute. CONTRAINDICATIONS: Hypovolemic shock where complete fluid resuscitation has not occurred. ROUTES: IV (care must be taken not to administer faster than 1 ml/min) IM rectal. INDICATIONS: Anaphylaxis. EPINEPHRINE 1:1000 103 . dries bronchial secretions. allergic reactions. PRECAUTIONS: Hypotension. DOPAMINE CLASS: Sympathomimetic. SIDE EFFECTS: Ventricular tachyarrhythmias.EEI Paramedic Refresher 201 0 DOSAGE: Status epilepticus: 5-10 mg IV. Method: 400 mg should be placed in 250 ml of D5W giving a concentration of 1600 μg/ml. DIPHENHYDRAMINE ( BENADRYL ) CLASS: Antihistamine. blurred vision. DOSAGE: 2-20 μg/kg/minute. Start low and increase as needed. nursing mothers. SIDE EFFECTS: Sedation. ventricular irritability. DOSAGE: 25-50 mg. hypertension. has some sedative effects. Beneficial effects lost when dose exceeds 20 μg/kg/min. causes peripheral vasoconstriction. headache. PRECAUTIONS: Should not be administered in the presence of severe tachyarrhythmias. ROUTES: Slow IV push deep IM. Acute anxiety: 2-5 mg IM or IV. Should not be administered in the presence of ventricular fibrillation. INDICATIONS: Hemodynamically significant hypotension (systolic BP of 70100 mmhg) not resulting from hypovolemia. Premedication before cardioversion: 5-15 mg IV. dystonic reactions due to henothiazines. palpitations. PEDIATRIC DOSAGE: Status epilepticus: 0.

occasionally and Epinephrine drip is required. INDICATIONS: Congestive heart failure. PEDIATRIC DOSAGE: 0. CONTRAINDICATIONS: Epinephrine 1:10. Increases cardiac contractile force. with subsequent doses. Blood pressure.000 should be used at a dose of 0.EEI Paramedic Refresher 201 0 CLASS: Sympathomimetic. ROUTES: Subcutaneous (IV and ET for pediatric cardiac arrest). ET. INDICATIONS: Cardiac arrest.1 mg/kg. pulse. Epinephrine 1:1. Increases myocardial electrical activity. anxiousness. exacerbation of COPD. dehydration.5-1. dehydration. IV drip. PRECAUTIONS: Should be protected from light.3 mg. anxiety. PRECAUTIONS: Should be protected from light. DOSAGE: cardiac arrest: 0. anaphylactic shock severe reactive airway disease. tremulousness. Can be deactivated by alkaline solutions. DOSAGE: 0. FUROSEMIDE ( LASIX ) CLASS: Potent diuretic.01 mg/kg up to 0. CONTRAINDICATIONS: Patients with underlying cardiovascular disease. 104 .000 is for intravenous or endotracheal use. PRECAUTIONS: Should be protected from light. pregnancy.3-0. SIDE EFFECTS: Palpitations and tachycardia. CONTRAINDICATIONS: Pregnancy. PEDIATRIC DOSAGE: 0. Causes bronchodilation. ACTIONS: Bronchodilation. promotes prompt diuresis. Increases blood pressure. INDICATIONS: Bronchial asthma. SIDE EFFECTS: Few in emergency usage. headache. it should not be used in patients who do not require extensive resuscitative efforts. severe anaphylaxis: 0. hypertension.5 mg (3-5 ml). vasodilation. tremor. 1:10.000 CLASS: Sympathomimetic.0 mg repeated every 3-5 minutes. and EKG must be constantly monitored. Increases systemic vascular resistance. allergic reactions. ROUTES: IV. pulmonary edema. nausea and vomiting. ACTIONS: Increases heart rate and automaticity. SIDE EFFECTS: Palpitations.01 mg/kg initially. patients with tachyarrhythmias.3-0.5 mg. ACTIONS: Inhibits reabsorption of sodium chloride.

PEDIATRIC DOSAGE: 1 mg/kg.EEI Paramedic Refresher 201 0 DOSAGE: Standard: 40-80 mg. MAGNESIUM SULFATE CLASS: Anticonvulsant/Antiarrhythmic. heart block. pulseless ventricular tachycardia. PRECAUTIONS: Dosage should not exceed 300 mg/hr. and confusion. ACLS: 1 mg/kg. DRIP: After the arrhythmia has been suppressed a 2-4 mg/minute infusion may be started to maintain adequate blood levels. ACTIONS: CNS depressant. PEDIATRIC DOSAGE: 1 mg/kg. use only bolus therapy. IV infusion. torsades de pointes (multi-axial ventricular tachycardia). ACTIONS: Suppresses ventricular ectopic activity. convulsions.75 mg/kg can be repeated at 8-10-minute intervals until the arrhythmia has been suppressed or until 3 mg/kg of the drug has been administered. Calcium Chloride should be readily available as an antidote if respiratory depression ensues. CONTRAINDICATIONS: Shock. nausea and vomiting. INDICATIONS: Malignant PVCs. Hypotension. INDICATIONS: Obstetrical eclampsia (toxemia of pregnancy). dizziness. cardiovascular severe refractory ventricular fibrillation. premedication prior to rapid sequence induction. preeclampsia/ PIH. ventricular fibrillation. anticonvulsant. widening of QRS. ventricular tachycardia. prophylaxis of arrhythmias associated with acute myocardial infarction and thrombolytic therapy. DOSAGE: Bolus: Initial bolus of 1. Monitor for CNS toxicity. Dosage should be reduced by 50% in patients older than 70 years of age or who have liver disease in cardiac arrest. PVCs in conjunction with bradycardia. ROUTES: IV bolus. reduces velocity of electrical impulse through conductive system. reduce dosage by 50% in patients older than 70 years of age. LIDOCAINE ( Both IVP and drip ) CLASS: Antiarrhythmic. CONTRAINDICATIONS: High-degree heart blocks. PRECAUTIONS: Caution should be used in patients receiving digitalis. drowsiness. increases ventricular fibrillation threshold.5 mg/kg.5 – 0. additional boluses of 0. max of 100 mg ROUTES: IV. SIDE EFFECTS: Anxiety. post-MI as prophylaxis for arrhythmias. antiarrhyhmic. Use with caution in 105 .

volume depletion undiagnosed abdominal pain. CONTRAINDICATIONS: Head injury. causes peripheral vasodilation. PEDIATRIC DOSAGE: 0. DOSAGE: IV: 2-5 mg followed by 2 mg every few minutes until the pain is relieved or until respiratory depression ensues. PRECAUTIONS: Respiratory depression (narcan should be available). INDICATIONS: Severe pain. nausea. IM.1-0. PEDIATRIC DOSAGE: Not indicated. SIDE EFFECTS: Dizziness. SIDE EFFECTS: Respiratory depression. ROUTES: IV.5 g/kg IV over 60 minutes MORPHINE CLASS: Narcotic.5 – 2. 106 . NALOXONE ( NARCAN ) CLASS: Narcotic antagonist.0 g/kg ROUTES: Slow IV bolus or infusion PEDIATRIC DOSAGE: 0. IM: 5-15 mg based on patient weight. drowsiness. DOSAGE: 1-4 g. pulmonary edema. hypotension. altered level of consciousness.2 mg/kg IV. IM. ACTIONS: CNS depressant. patients with history of hypersensitivity to the drug. MANNITOL CLASS: Osmotic diuretic ACTIONS: Decreases cellular edema Increases urinary output INDICATIONS: Acute cerebral edema Blood transfusion reactions CONTRAINDICATIONS: Pulmonary edema Patients who are dehydrated Hypersensitivity to the drug PRECAUTIONS: Rapid administration can cause circulatory overload Crystallization of the drug can occur at lower temperatures SIDE EFFECTS: Pulmonary congestion Sodium depletion Transient volume overload DOSAGE: 1. ROUTES: IV.25 – 0. decreases sensitivity to pain.EEI Paramedic Refresher 201 0 patients in renal failure.

SIDE EFFECTS: none. alcoholic coma.5 minutes. expires quickly once bottle is opened. Nubain. chest pain associated with myocardial infarction. Methadone.1 mg/kg > 5 years old: 2. 107 . Percodan. Talwin. headache. INDICATIONS: Narcotic overdoses including the following: Codeine. SIDE EFFECTS: Dizziness. no more than three sprays in a 15-minute period. Short-acting. DOSAGE: 1-2 mg. Tylox. drug must be protected from light. ACTIONS: Smooth-muscle relaxant. Vicodin. IM ET (ET dose is 2. SIDE EFFECTS: Dizziness. decreases cardiac work. spray should not be inhaled. Syncope can occur. hypotension. chest pain associated with myocardial infarction. should be augmented every 5 minutes. DOSAGE: One spray administered under the tongue. dilates coronary arteries. may be repeated in 3 . NITROGLYCERINE (Spray) CLASS: Antianginal ACTIONS: Smooth-muscle relaxant.0 mg. To rule out narcotics in coma of unknown origin. hypotension. Stadol. PRECAUTIONS: Should be administered with caution to patients dependent on narcotics as it may cause withdrawal effects. dilates coronary arteries. hypotension. INDICATIONS: Angina pectoris. Morphine. Lortabs. dilates systemic arteries. PEDIATRIC DOSAGE: Not indicated. Fentanyl. ROUTES: IV. Paregoric. CONTRAINDICATIONS: Hypotension PRECAUTIONS: Constantly monitor vital signs. Overdoses including the following: Darvon. Demerol. PRECAUTIONS: Constantly monitor blood pressure. INDICATIONS: Angina pectoris. Dilaudid. syncope. ROUTES: Sprayed under tongue on mucous membrane. decreases cardiac work.5 times IV dose). NITROGLYCERINE (Paste) CLASS: Antianginal.EEI Paramedic Refresher 201 0 ACTIONS: Reverses effects of narcotics. dilates systemic arteries. Heroin. CONTRAINDICATIONS: Patients with a history of hypersensitivity to the drug. PEDIATRIC DOSAGE: < 5 years old: 0.0-2. synthetic analgesics. CONTRAINDICATIONS: Children younger than 12 years of age.

COPD: 35%. CONTRAINDICATIONS: None. PRECAUTIONS: Use cautiously in patients with COPD. INDICATIONS: Hypoxia. humidify when providing high-flow rates. suppresses ventricular ectopic activity. ROUTES: Inhalation.EEI Paramedic Refresher 201 0 DOSAGE: 1/2 to 1 inch ROUTES: Topical PEDIATRIC DOSAGE: Not indicated OXYGEN CLASS: Gas. elevates ventricular fibrillation threshold. ACTIONS: Necessary for cellular metabolism. Overdose can cause uterine rupture Hypertension SIDE EFFECTS: Anaphylaxis Cardiac arrhythmias DOSAGE: Intravenous (IV): 10 – 20 units in 500 mL of D5W administered according to uterine response Intramuscular (IM): 3-10 units ROUTES: IV drip IM PEDIATRIC DOSAGE: Not indicated PROCAINAMIDE CLASS: Antiarrhythmic. PEDIATRIC DOSAGE: 24-100% as required. OXYTOCIN CLASS: Hormone (oxytocin) ACTIONS: Causes uterine contraction Causes lactation Slows postpartum vaginal bleeding INDICATIONS: Postpartum vaginal bleeding CONTRAINDICATIONS: Any condition other than postpartum vaginal bleeding. Other critical patients: 100%. SIDE EFFECTS: Drying of mucous membranes. DOSAGE: Cardiac arrest: 100%. ACTIONS: Slows conduction through myocardium. Cesarean section PRECAUTIONS: Essential to ensure that the placenta has delivered and that there is not another fetus before administration oxytocin. INDICATIONS: Persistent cardiac arrest due to ventricular fibrillation and 108 .

facial pallor. convulsions. chronic nephritis PRECAUTIONS: Hyponatremia. hypotension ensues. water intoxication.EEI Paramedic Refresher 201 0 refractory to Lidocaine. Can precipitate with calcium preparations. vertigo. vasoconstriction. PVCs in conjunction with bradycardia. Monitor for central nervous system toxicity. SODIUM BICARB. epilepsy. CAD. severe acidosis refractory to hyperventilation. DOSAGE: Initial: 20 mg/minute until arrhythmia abolished. IV drip. SIDE EFFECTS: Alkalosis. PEDIATRIC DOSAGE: Rarely used. PEDIATRIC DOSAGE: 1 mEq/kg initially followed by 0. bronchoconstriction. PVCs refractory to Lidocaine. ACTIONS: Combines with excessive acids to form a weak volatile acid. DOSAGE: 5 – 10 units ROUTES: IM. Can deactivate catecholamines. ROUTES: Slow IV bolus.5 mEq/kg every 10 minutes as indicated by blood gas studies. CONTRAINDICATIONS: High-degree heart blocks. migraine. asthma. DOSAGE: 1 mEq/kg initially followed by 0. water intoxication. nausea. drowsiness. increases smooth muscle activity. sweating.5 – 10 units 109 . CONTRAINDICATION: Alkalotic states. abdominal cramps.5 mEq/kg every 10 minutes. INDICATIONS: Late in the management of cardiac arrest. CLASS: Alkalinizing agent. PRECAUTIONS: Correct dosage is essential to avoid overcompensation of ph. flatus. VASOPRESSIN CLASS: Pituitary Hormone (Antidiuretic) ACTIONS: Promotes water reabsorption. ventricular tachycardia refractory to Lidocaine. CHF SIDE EFFECTS: N/V. ROUTES: IV. intestinal activity. CONTRAINDICATIONS: Vascular disease. skin blanching. tremors. if at all. Delivers large sodium load. Maintenance: 1-4 mg/minute. QRS widened by 50% of original width total of 17 mg/kg has been given. widening of QRS. increases ph. PRECAUTIONS: Dosage should not exceed 17 mg/kg. SIDE EFFECTS: Anxiety. alternative to epinephrine in adult shock refractory ventricular fibrillation. angina pectoris. SC PEDIATRIC DOSAGE: 2. tricyclic antidepressant overdose. INDICATIONS: Diabetes insipidus. headache.

A. MAOI administration SIDE EFFECTS: seizure (convulsions). and serotonin INDICATIONS: Depression. benzodiazepine withdrawal. CONTRAINDICATIONS: Heart block. orhallucinations. a repeat dose of 5 .fever. INDICATIONS: PSVT.10 mg can be administered after 15-30 minutes if PSVT does not convert. SIDE EFFECTS: Nausea. anorexia nervosa. S. ACTIONS: Slows conduction through the AV node.severe blistering.confusion. rash or itching.1-0. headaches. hypersensitivity. DOSAGE: 2. swollen glands.2 mg/kg (maximum of 2. unusual thoughts or behavior.EEI Paramedic Refresher 201 0 VERAPAMIL CLASS: Calcium channel blocker. and red skin rash. bulimia.3 mg/kg (maximum of 5. decreases rate of ventricular response. PRECAUTIONS: Should not be used in patients receiving intravenous ß blockers.5. peeling. Viagra CLASS: Phosphodiesterase Inhibitors ACTIONS: Vasodilator Agents INDICATIONS: Erectile Dysfunction CONTRAINDICATIONS: Hypersensitivity. DOSAGE: 100 – 200mg ROUTES: Oral Zocor 110 .0 mg. conduction system disturbances. Nitrate usage PRECAUTIONS: Hypotension SIDE EFFECTS: Dependency. vomiting. or general ill feeling.. and dizziness. decreases myocardial oxygen demand. altered vision. nitrate potentiation DOSAGE: 25 – 50mg ROUTES: Oral Wellbutrin CLASS: Antidepressant ACTIONS: Inhibits reuptake of dopamine. hypotension. hypotension. joint pain.D. Zyban treatments. norepinephrine. and smoking cessation CONTRAINDICATIONS: Seizure disorders. trouble concentrating.0 mg) administered slowly. maximum dose is 30 mg in 30 minutes.1-0.0 mg) administered slowly. ROUTES: IV. 1-15 years: 0. inhibits reentry during PSVT.5 . PEDIATRIC DOSAGE: 0-1 year: 0.

itching. Hallucinations. difficulty swallowing. infection at injection site SIDE EFFECTS: allergic reactions. facial wrinkles CONTRAINDICATIONS: Hypersensitivity. headache. Unpleasant Taste. pregnant or nursing SIDE EFFECTS: muscle pain. Viral Infection. Dizziness. DOSAGE: 1 – 3 mg ROUTES: Oral EXUBERA CLASS: Insulin ACTIONS: Regulation of glucose metabolism through stimulation of peripheral glucose uptake INDICATIONS: Diabetes CONTRAINDICATIONS: Hypersensitivity. Dry Mouth. and weakness DOSAGE: 1. dry mouth DOSAGE: 1 – 3 mg ROUTES: MDI / INH BOTOX CLASS: Neurotoxin ACTIONS: Muscular paralytic INDICATIONS: Cervical dystonia. shortness of breath. rash. chest pain. Rash. Infection. neck pain. liver disease. weakness with fever or flu symptoms and dark colored urine DOSAGE: 5 – 80 mg ROUTES: Oral Lunesta CLASS: Cyclopyrrolone ACTIONS: Raises GABA levels to reduce brain activity INDICATIONS: Insomnia or other sleeping difficulty CONTRAINDICATIONS: Hypersensitivity SIDE EFFECTS: Drowsiness . tenderness.EEI Paramedic Refresher 201 0 CLASS: HMG-CoA reductase inhibitors ACTIONS: Reduces LDL cholesterol INDICATIONS: CHD or high risk of CHD CONTRAINDICATIONS: Hypersensitivity. lung disease. smoking SIDE EFFECTS: Hypoglycemia. nausea.25 – 5 units ROUTES: IM / SQ 111 .

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