EMT Cheat Sheet - BLS

EMT Cheat Sheet

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

Assessment

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

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

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

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

At Patient:

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

• A: Alert patients are patients that are awake and able to communicate with you. These patients can still have severe injuries that are life threatening but due to shock or adrenaline have yet to go unconscious or have a decrease in LOC. This category is subdivided by orientation. To determine this ask the patient basic questions: Who are you? Do you know where you are? Can you tell me what happened? And also the “with it” questions, which are used to determine how the patients reasoning is affected. Those questions are usually one of the following: how many quarters are in a dollar and fifty cents (6)? What kind of Cat or Dog is Minnie Mouse (subjective answer but accept anything that isn’t dog or cat related)? Who is the president (accept a name or a insult correct to the current administration)? [the political question may not work in all situations due to not following politics or national identity of the civilian behind the character]
  • A/O x4: the patient is alert and oriented to who they are, where they are, what’s happening, when it is, and a “with it”question. This is determined by asking the patient the basic questions. 
  • A/O x3: this patient may be alert and oriented but slightly confused on one of the basic questions. This could be due to mild head injury, an unknown or untreated medical issue, lack of knowledge of the source, or light intoxication. 
  • A/O X2: this patient is moderately confused. This could be due to injury, medical emergency, age related issues (dementia or Alzheimer’s), or heavy intoxication. 
  • A/O x1: this patient is deeply confused. This could be due to severe injury, age related issues, medical emergency, or intoxication with a heavy narcotic or intoxicant. 
  • A/O x0: this patient is alert but completely confused. They are unable to answer questions. This could be due to extremely severe injury, bad head wound, severe age related issues, or medical emergency (blood sugar, dehydration, delirium, etc.) 
• Verbal: this patient only responds to verbal stimuli. If you say their name or attempt to get their attention via speaking they may turn to you and open their eyes but that’s about it. 
• Pain: if the patient doesn’t respond to verbal stimulation then a pain stimulation is needed. This comes in three waves: first attempt to use light pain (pinch earlobe or finger tip), then moderate pressure (pinch the pressure point located between shoulder and neck), and then finally the most severe stimulus is to be used. This is the eternal rub. To perform this make a fist and allow one knuckle to rise above the rest, rub that knuckle vigorously up and down the patient's sternum a couple times. This is painful and will look harsh to bystanders so use discrimination. The patient should react to one for these stimuli by either moving away from pain, groaning, or attempting to swat the source (moving hand towards provider's hand to remove stimulation). Should the patient react like this then they are reactive to pain. Should the patient wake up and verbal reassess LOC. 
• unresponsive: these patients do not respond to any stimuli. Begin immediate efforts to determine what could cause this (respiratory arrest, cardiac arrest, severe injury, blood sugar emergency, temperature emergency {hypo/hyperthermia, fever, etc.}). You may not be able to determine the cause. However immediate transport is always the best treatment as our role is not to cure but to attempt to stabilize in route to the highest level of care (hospitals). 

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

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

• For low and decreasing this may mean bleeding uncontrolled, not breathing or not breathing enough, etc. 
• low and stable may mean controlled bleed, stabilized respiratory distress (still not adequately breathing but maintaining enough oxygenation for now, etc. 
• stable/normal
• Stable but high may be due to shock (treat for shock by laying the patient down, keeping warm, ensuring adequate respirations and oxygen exchange), previously intense exercise or muscle use, fever/illness, etc. 
• high and increasing could be signs of early internal bleeding, early shock, worsening end stage sepsis or illness, etc. 

History:

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

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

S: Signs and Symptoms

A: Allergies

M: Medications

P: Past History

L: Last Intake and Output

E: Events To Present
 

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

Pain: 

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

O: Onset 

When did the pain start?

P: Provocation 

Do you know what caused the pain?
Q: Quality 

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

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

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

About how long has the pain lasted?  

Vitals: 

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

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

Hyper/Hypo glycemic shock 

Hyper >250 or Hypo <60

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

Mass-Casualty Incidents (MCI):

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

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

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

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

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

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

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

Patient Care

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

Bandaging and Splinting: 

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

Shock:

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

Cervical Spine: 

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

Medication:

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

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

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

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

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

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

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

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

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

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

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

EMS Equipment List

 

Stretcher: A wheeled device used to transport patients. This is the primary method of getting a patient from the scene to the ambulance, then from the ambulance to the ER. This should be used for PTs who are unable to walk to the ambulance or shouldn’t walk to the ambulance. They are able to be moved over most terrains other than sand/mud. The bed portion can be moved to be flat, sit the patient up, or (as pictured) keep the knees bent.

 

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StairChair: This device is a wheelchair with tank treads attached to the back that allows personnel to move patients down the stairs by rolling them up to the stairs, tilting them back onto the treads, and letting the treads ride down the front of the steps. It is used to move non-critical, Awake, patients from upstairs to the ground.

 

 

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Backboard: This is a long flat board used for critical spinal patients. If a patient has suspected spinal trauma then placing them on the backboard (and padding the areas where the body does not contact the board) is the best move. These should NOT be used on every patient. Only use this if you have to fully immobilize a patient. If they can walk or at least stand and pivot then just use the stretcher. If you arrive on scene and the patient is already walking around then just put them on the stretcher. Prolonged laying on these boards can cause pressure wounds and other damage. Consider using Scoops instead.

 

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Scoops Board: This is a backboard like device that is designed to split down the middle. It is used to simply lift a patient from the floor or difficult to reach location and carry them to the stretcher. This Board is better than a backboard because the patient can be placed on and removed from it by separating the board halves rather than rolling the patient. Use this board to move patients from difficult to reach rooms, areas where the stretcher may not reach due to terrain or access, or if the patient does not have obvious or severe spinal issues.

 

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Stokes Basket: This is a rescue device used to lift/carry patients from extreme areas to areas where the PT can be moved to the stretcher or lifted onto the helicopter for extraction. They are basically baskets with high sides, multiple attachment points, and secure points.

 

 

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KED:  The Kendricks Extrication Device is a spinal immobilization device used to remove a person with only neck or back pain (The patient can have no other injury) from a sitting position to the stretcher. This is done by first establishing C-spine hold from behind the patient, then leaning the patient forwards at the waist and sliding the device behind them, next placing the leg straps in position between both legs and securing them around the thighs, Next secure the abdominal straps, Finally place the head support between the c-collar and headpiece of KED and secure with straps. Then the patient can be lifted out by the handles on the KED and sit them on the stretcher. For comfort undo the leg straps.

 

 

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Monitor: This is a device that has many functions. For BLS personnel it can check Blood Pressure, Heart Rates, and SpO2 saturation for vitals. It can also be used as an AED device. For ALS personnel it can also provide 12-lead cardiac data, Auto-Pacing for Cardiac dysrhythmia, cardioversion, variable shocking for Cardiac episodes. This device is an expensive piece of equipment used to supplement the EMS personnel’s ability to check manual vitals, visually assess the patient, etc. 

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Code Assist Devices

 

Lucas Device: This is an auto-CPR device used to perform CPR on a person while the crew perform other tasks. It is placed on the patient after the first round of manual compressions and AED Shock.

Auto Vent: This device connects the O2 supply to the Superglotic or ET Tube in the patient. It auto regulates the flow and rate at which a breath is given to simulate breathing. This is done to assist ventilations in a patient in cardiac or respiratory arrest. First the Patient must immediately receive BVM treatment, then, once the PT has been tubed, can this device be brought out to assist. The Image below has multiple settings; however for simplicity, using “/me connect Autovent and starts ventilations at 12 breathes” is all you need. 

 

Assisted Airway Devices: -In order of least invasive to most-

 

NPA: The Nasopharyngeal airway device is a rubber tube that is inserted into the nose to provide open airway access to the semi-conscious or unconscious patient who still has a gag reflex. This is a basic device that simply keeps an open passage for air to travel freely in and out of the nose. This is NOT to be used on patients with trauma to the neck or head. Use this on patients who are unresponsive who simply need a small assist in maintaining open airflow.

 

OPA: The oropharyngeal airway device is a rigid plastic device used to keep the mouth open and tongue out of the way of unresponsive patients who simply need assistance maintaining an open airway. This is inserted into the mouth over the tongue and allows free flow of air between the outside and inside. This can accompany suctioning and the Head-tilt, Chin-Lift technique that keeps the airway open. This is a simple airway device to be used on patients who are able to breathe but need help keeping the upper airway (mouth and throat) clear. 

 

Superglotic Airway Device: On scenes where the patient is unresponsive and unable to maintain an airway of their own (respiratory or cardiac arrest) this device can be used to create a bypass path from the mouth to the epiglottis (point of separation for the “windpipe” and esophagus, which leads to the stomach). The Device we use is called the iGel. It is to be used only in cases of CPR or respiratory arrest by BLS providers and can be used by ALS providers who want to avoid intubation or can’t due to other issues. The Patient can not have a gag reflex for usage. Once inserted, breaths must be assisted or performed by the BVM. 

 

Endotracheal Tube: The ET Tube is what is used for full intubation of a patient by only ALS providers. ALS Providers use powerful paralytic medicine to stop the patient's respiratory drive to allow them to insert this device and completely take over breathing for a patient in times of emergency. On patients who require CPR due to a Cardiac Arrest or Respiratory arrest then the paralytic may not be needed. This device is inserted using a special tool, the laryngoscope that guides the tube into the trachea and beyond the vocal cords. Its final position is within the largest vessel of the lungs just prior to the split between left and right lung. Using this device, like the iGel, requires the EMS personnel to take up the BVM and provide breathes for the patient, especially if the paralytic is used.

 

 

^The ET Tube next to the Laryngoscope 

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*** For simplicity's sake, using the general names for equipment is easier for people to understand. Calling the stretcher a “Stryker” may make sense to someone who knows the brand, but someone who doesn’t know will have no clue what you are talking about.***