NREMT Exam Medical/OB Module
Assessment is the foundation of emergency care. Without proper assessment and discovery, all other knowledge and skills you acquire are useless. If we can’t find the problem, we can’t solve it. If we don’t know what to look for, we’ll never have the opportunity to save a life. Whether you’re a grizzled veteran, or just starting your journey in this exciting field, true, lifelong masters of emergency medicine, first become masters of Assessment.
BASIC LIFE SUPPORT
Basic life support is arguably the most important set of skills you need to have mastered as an EMT or Paramedic. The advanced skills involved in your expertise mean nothing if we can’t perform good quality CPR. Only two things have ever been proven time and again to make any real difference in survival when it comes to patients in cardiac arrest; good quality chest compressions and early defibrillation. In this module we will review the ins and outs of high-quality BLS and highlight the importance of mastery of these basic skills.
Stroke is one of the leading causes of death and disability in the United States. The same risk factors for coronary artery disease, such as high blood pressure, high cholesterol and diabetes are risk factors for strokes as well. In these emergencies, time is the most important factor. The sooner these patients seek care and treatment is undertaken, the greater chance of survival. Because of this, the first responder who can identify signs and symptoms of stroke quickly and confidently can affect huge change in survival rates. Differentiating stroke from other neurological conditions is also critical since stroke is not the only disease process that may manifest with neurological symptoms.
EYE, EARS, NOSE AND THROAT
Most conditions of the eyes, ears, nose and throat probably aren’t what you would define as a medical emergency. After all, responding to an earache or blurred vision doesn’t really capture the drama and intensity we often seek in this field. But consider that these injuries and illness greatly affect our patients quality of life. Navigating the world without our senses can be terrifying and debilitating. Any type of issue that affects quality of life in this way is always considered a high priority. The responsibility of a medical provider like you is not just to save lives, but improve them. It’s sometimes a much heavier burden to provide encouragement, comfort, and true care to a patient whose concerns aren’t about dying, but living a life that’s changed forever.
ABDOMINAL / GI
Your abdominal cavity carries 9 organs, dozens of tissues and various protective linings. Trauma or disease involving this vital area is always a concern, and with so many possibilities, providers can have difficulty finding where the source of the problem lies. Pain in the stomach could be any number of organs, tissues,, or referred pain from somewhere else. Without a deep understanding of each abdominal organ and how trauma or disease can affect it, we don’t have a hope of finding the root of our patients’ problems. In this module we will give you the tools to properly assess the abdomen and understand the underlying pathology of different abdominal and GI diseases so that you are able to identify the patient’s problem and treat it in a timely fashion.
Our body has many mechanisms by which it prevents disease and infection. From the protective layer of our skin to the immune cells that travel our blood stream, our bodies are designed to protect the equilibrium within us that allows us to function and thrive. Sometimes however, our bodies defenses are bypassed or overwhelmed and organisms foreign to us attempt to grow and reproduce at our expense. Infections are the invasion of our body by disease causing agents. These agents cause illness secondary to their destructive nature as well as our bodies’ response to their presence. When these infections can be transmitted to others, we call this infectious disease.
The musculoskeletal system is made up of bones, joints, cartilage, tendons, ligaments and muscles. When this system suffers trauma, it can be pretty obvious that injury has occurred. However, there are other conditions and diseases that affect this system that are non- traumatic. Diseases like arthritis, muscle strains and even infections of the bones and muscles fall into this category. Assessing the musculoskeletal system is the same whether trauma is present or not. In most cases management will be supportive since most of these conditions are not life threatening in the acute setting. Without identification though, some of these processes can become more emergent which is where the first responder plays an important role.
Any substance that can harm the body is considered to be a poison. Poisonings, both unintentional and intention account for nearly a million EMS calls a year. As you have probably learned already, any chemical, drug, or product, if used incorrectly or given in large enough amounts can be toxic to the body. Toxicology is the study of these toxic effects and the poisons that cause them. As first responders you will come in contact with toxicological emergencies every day. Whether it’s a chemical exposure to the skin, a patient who has taken too much of their medication, or an alcoholic or drug addict suffering from an overdose, the first responder must know how to quickly identify poisonings and toxic exposures, and treat and stabilize the patient in order to prevent decompensation and death.
Emergency providers often think of blood through one lens; if it’s outside the body, that’s bad. With just a little study, we quickly see that the reason the blood is so important is its function. It’s responsible for not just sustaining life in the tissues of our body, but also to fight infection, and dispose of waste. With important functions, we get dangerous dysfunction, so understanding how the blood works, and what can go wrong with it is critical for EMS providers to understand. The study of the blood and the many functions it plays is called hematology.
Our body is constantly invaded by harmful organisms and substances intent on doing serious damage. Physical barriers like our skin, our mucus and the acid in our stomach exist to prevent exposure from dangerous pathogens. But this defense isn’t always enough. When invaders DO breach the walls, we counterattack by activating the immune and inflammatory responses. These responses, though helpful, can create complications for the body if left unchecked. In this module we will briefly review the responses themselves and then talk about specific conditions affecting them.
The kidneys and the rest of the genitourinary system play the important role of keeping toxins and by-products of metabolism from building up in our bodies and causing harm. These structures are extremely resilient, but too much stress or injury can lead to dysfunction. Though the first responder takes on a more supportive role in dealing with these patients, without identification of the underlying issue and guidance to correct treatments, patients can suffer tremendously from both increased morbidity and mortality and decrease in quality of life.
The endocrine system is a complex system made up of glands and hormones that play vital roles in proper functioning of the body and have effects on all of the other body systems. Understanding how the endocrine organs work and the effect their hormones have, allows the first responder to include these possible diagnoses into their differential. Without doing so, these disorders can go unrecognized and undiagnosed, leading to severe and sometimes deadly complications. Remember, the diagnosis never considered can never be diagnosed. By taking the time to gain the knowledge presented in this lecture, you can trust that you will not miss some key endocrine emergencies that commonly present in the prehospital setting.
When it comes to acid base balance and ph of the body, everything is about homeostasis. In order for vital functions of the body to take place, the body tissues must be in a specific range of ph. If they aren’t, things begin to break down. In this module we are going to take a topic that some find very frustrating to learn and make it straightforward and easy to understand. If you can remember that the body is always trying to get back to homeostasis, the rest falls into place nicely.
As you learn how chemical and electrical signals in our body help shape our behavior, you’ll quickly see that when something is wrong with these mechanisms, your patient’s behavior will be affected, against his or her will. Just like any illness, mental health patients don’t choose to be sick, they don’t control their symptoms, and they aren’t happy with their prognosis. We often respond when these people are feeling at their worst. When we approach these patients in an educated and compassionate way, we can help them live a happy and healthy life. In this module we will cover some common psychiatric disorders and psychiatric emergencies that the first responder should be able to identify.
Gynecological emergencies can lead to poor outcomes and be life threatening if left untreated. Unfortunately, many of these conditions can also present with non specific symptoms such as abdominal pain. Being able to differentiate between benign complaints and more serious symptoms can be a challenge for the EMT or Paramedic who first encounters the patient. Having an understanding of what types of life threatening gynecological emergencies might exist in our female patients helps us to better assess these patients for underlying conditions that may have initially gone unnoticed or undiagnosed. Here we will discuss some of the more common conditions that can occur and examine what types of clinical clues can help us diagnose them. Even if an exact diagnosis cannot be reached in the field, understanding that these disease processes exist may make a significant impact in managing patients efficiently and effectively from the start.
OB GYN 1
The management of an obstetrical patient presents a unique challenge to the first responder. We find ourselves taking care of two patients instead of just one. This can be anxiety provoking since even experienced emergency personnel are not regularly assessing and managing pregnant women. Usually pregnancies progress without issue or difficulty, however when things do go wrong or when the mother is injured or ill, the first responder must know how to manage both the patient and the fetus. In this module we will cover how to do just that.
OB GYN 2
Here we will focus on the different complications that can arise both in pregnancy as well as during labor and delivery. Obstetrical patients can be an intimidating patient population for the first responder because we are not only caring for the patient but their fetus as well. Generally, treating the mother is the best way to treat the fetus and we will discuss the best way to manage these patients. Complications can arise during pregnancy, during labor, during delivery and postpartum. We will discuss the most common and life threatening conditions with the goal of giving you the tools to approach these patients with confidence.