1 EMT-Basic Respiratory Emergencies | Congestive Heart Failure

Medical Scenarios
■■ Respiratory Emergencies

Congestive Heart Failure

Scenario: You are called to a local homeless shelter for a man with trouble breathing. You arrive to find a 56-year-
old man sitting in a tripod position at a picnic table in moderate respiratory distress. He is speaking in 4–5 word
phrases. He states he cannot catch his breath. He tells you he is supposed to be taking medications, but he cannot
afford them.

Prearrival Questions
1. What are some of the signs and symptoms of respiratory distress?
2. How does the lack of insurance lead to worsening of a person’s illness?

Scene safe Yes

Body substance isolation Gloves, eyewear, mask
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—advanced life support (ALS)
C-spine stabilization No
General impression 56-year-old man sitting at a table, in obvious
respiratory distress

Assessment Questions
3. What are some of the chronic respiratory illnesses for which people are on medication?
4. Which respiratory medication would you be able to help administer if the patient had it available?
5. What are the abnormal breath sounds?
6. What illnesses or conditions are associated with these abnormal breath sounds?

Level of consciousness Responsive

Chief complaint Cannot breathe
Airway Open; noisy breathing heard
Breathing 28 breaths/min
Symmetrical rise and fall of the chest
Circulation Carotid and radial pulses
Skin color, temperature, and condition Pale, with cyanosis around the earlobes; cool
Control of major bleeding None
Transport decision ALS transport
Initial interventions Oxygen via nonrebreathing mask at 15 L/min
Baseline vital signs Blood pressure—168/114 mm Hg
Pulse—124 beats/min
Respirations—26 breaths/min
SaO2—88%

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2 EMT-Basic Respiratory Emergencies | Congestive Heart Failure

SAMPLE history S—Lungs: Expiratory wheezes throughout all lung

fields; rales in the bases up to midsection; slight
jugular venous distention (JVD); pedal edema
A—Cipro, cardiac dye
M—Prescribed Lasix, Lanoxin, potassium
P—Irregular heartbeat; water in the lungs
L—Lunch
E—Sitting on a chair
OPQRST O—60 minutes
P—Lying down makes breathing worse
Q—Slight chest pain is sharp and stabbing
R—None
S—3 on pain; 9 on difficulty breathing
T—He has been sick for 3 days

Management Questions
7. Based on your assessment findings, what do you think is going on with your patient?
8. Why is it important to allow a patient in respiratory distress to maintain a position of comfort?

Treatment Oxygen via nonrebreathing mask at 10–15 L/m

Loosen restrictive clothing and work toward immedi-
ate transport.
Response to treatment Patient seems to be getting very tired and is using
accessory muscles.
Ongoing assessment Repeat vital signs:
Blood pressure—170/110 mm Hg
Pulse—120 beats/min
Respirations—30 breaths/min
ALS arrives and assumes charge of your patient. You
are directed to prepare to give positive pressure ven-
tilation with 100% oxygen.

Conclusion: Your patient is suffering from an acute exacerbation of congestive heart failure. Because of the
increased work of breathing and the delay in seeking care, your patient nearly went into respiratory failure. Your
quick actions and those of the paramedics allow the patient to avoid intubation, and the emergency department is
able to improve the situation with medication.

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3 EMT-Basic Respiratory Emergencies | Foreign Body Airway Obstruction

■■ Respiratory Emergencies

Foreign Body Airway Obstruction

Scenario: You are called to a local apartment building for an unknown medical situation. You arrive to find a
66-year-old woman lying on the living room floor. She appears unconscious, is starting to exhibit cyanosis around
the lips and ears, and is making no respiratory effort. A telephone is off the receiver next to her.

Prearrival Questions
1. What are your concerns for body substance isolation?
2. What are your treatment priorities at this time?
3. What are some potential causes for the woman’s condition?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 66-year-old woman in respiratory arrest

Assessment Questions
4. How can you gather information regarding past medical history and allergies on this patient?
5. How important are environmental clues in helping you determine what happened to the patient?

Level of consciousness Unresponsive to verbal and painful stimuli

Chief complaint Unknown
Airway Obstructed
Breathing No air exchange
Circulation Carotid pulse absent
Skin color, temperature, and condition Pale and cyanotic
Control of major bleeding None
Transport decision Stay on scene to attempt to remove object while
awaiting ALS transport
Initial interventions Lie the patient flat and immediately begin cardiopul-
monary resuscitation (CPR)
Baseline vital signs Blood pressure—Not obtained
Pulse—0 beats/min
Respirations—0 breaths/min
SAMPLE history S—Pale and cyanotic; obvious obstructed airway
A—Unknown
M—Unknown
P—Unknown
L—Half-eaten plate of chicken wings is on the table
beside her, with five empty beer bottles on the
floor
E—Lying on the floor

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4 EMT-Basic Respiratory Emergencies | Foreign Body Airway Obstruction

OPQRST O—8 minutes prior to your arrival

P—Not applicable
Q—Blocked airway
R—Not applicable
S—Blocked airway; no air movement possible
T—Not applicable

Management Questions
6. Describe the proper technique for removing a foreign body airway obstruction.
7. How long should treatment efforts continue?

Treatment Follow initial treatment plan.

Response to treatment After 2 minutes of performing CPR, you are able to
visualize a piece of chicken in the woman’s mouth
and are able to remove it. She gasps for air and
begins to breathe on her own. You are able to feel a
faint carotid pulse. At this time she remains uncon-
scious.
Ongoing assessment Place the patient in the recovery position and cover
with a blanket. Continually monitor airway, breath-
ing, and vital signs while awaiting ALS arrival.
Provide oxygen, rescue breaths, and chest compres-
sions if needed.

Conclusion: Your quick thinking and proper performance of CPR with your partner led to a successful removal
of the piece of chicken that was lodged in the patient’s airway. It is important to keep current with changes in ba-
sic life support (BLS) techniques and procedures. The patient was taken to the hospital, where she was admitted
overnight for observation and discharged the next day without further event.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

5 EMT-Basic Respiratory Emergencies | Pneumonia

■■ Respiratory Emergencies

Pneumonia
Scenario: You are called to a local residence for a man who is ill. You arrive to find a 56-year-old man lying in a
recliner. Family states he has been sick with flulike symptoms for a few days. He started having difficulty breath-
ing around 8 pm last evening and is now complaining of a fever.

Prearrival Questions
1. What are considerations for body substance isolation?
2. What are possible causes for the patient’s illness?

Scene safe Yes

Body substance isolation Gloves, eyewear, mask
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 56-year-old man lying in a chair

Assessment Questions
3. What are possible causes of shortness of breath?
4. With what conditions or illnesses might you hear rales?

Level of consciousness Responsive

Chief complaint General illness with dyspnea
Airway Open
Breathing Slightly rapid; mild intercostal retractions; rales at
right base
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pale, warm, and dry
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—148/68 mm Hg
Pulse—108 beats/min
Respirations—26 breaths/min
SaO2—92% on room air; increases to 96% with oxy-
gen at 15 L/min
SAMPLE history S—Pale and hot to the touch; he states he cannot
take a deep breath without pain in his right side
A—No known allergies (NKA)
M—Cefzil for 3 days; patient states that he is compli-
ant with medication
P—Flulike illness for 3 days
L—Has not eaten in 2 days
E—Semisitting in chair, watching TV

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6 EMT-Basic Respiratory Emergencies | Pneumonia

OPQRST O—Approximately 12 hours ago at 8 pm last night

P—Pain to right side upon inspiration
Q—Dull, achy pain
R—No radiation
S—3 on a scale of 1–10, with 10 being the worst
T—12 hours ago

Management Question
5. What are your treatment priorities at this time?

Treatment Oxygen via nonrebreathing mask at 10–15 L/min.

Continue to reassess SaO2 and make sure the patient
is in a comfortable position on the stretcher. Monitor
airway and work of breathing and report all signs
and symptoms to the paramedics.
Response to treatment The patient has no major difficulties while awaiting
ALS transport.
Ongoing assessment The patient states that he has some relief of his dif-
ficulty breathing with the oxygen.

Conclusion: The paramedics arrive and you hand off your report. They continue oxygen therapy with the
nonrebreathing mask, initiate an IV in the left antecubital space, begin fluid replacement with normal saline, and
place the patient on the cardiac monitor. He is diagnosed with right lower lobe pneumonia at the emergency de-
partment and is admitted to the hospital to receive intravenous antibiotics.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

7 EMT-Basic Respiratory Emergencies | Neuromuscular Disease

■■ Respiratory Emergencies

Neuromuscular Disease
Scenario: You are called to a local residence for a man in respiratory distress. You arrive to find a 38-year-old man
lying in bed. Family members state he has been having difficulty walking for a day or two. When he awoke this
morning (5 hours ago), he could not use his legs and began experiencing difficulty breathing. About 30 minutes
ago, he began complaining of not being able to “take in air.” When you arrived, he began gasping for air.

Prearrival Question
1. What are your considerations for body substance isolation?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 38-year-old man lying in bed in severe respiratory
distress

Assessment Questions
2. What further information would you like to know?
3. What are potential causes for the patient’s condition?

Level of consciousness Responsive to person, place, time, and event

Chief complaint Difficulty breathing and difficulty moving
Airway Open
Breathing Increased work of breathing evidenced by severe
intercostal retractions, shallow respirations, and dif-
ficulty speaking
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pink, warm, and moist
Control of major bleeding None
Transport decision High priority; ALS contacted
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min; pre-
pare for assisted ventilations with a bag-mask device
Baseline vital signs Blood pressure—168/80 mm Hg
Pulse—96 beats/min
Respirations—24 breaths/min, shallow; air movement
is heard in the upper lung fields only
SaO2—94% on room air
SAMPLE history S—No motor function in lower extremities; increased
work of breathing
A—NKA
M—None
P—None
L—Full meal 8 hours ago
E—Lying in bed

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8 EMT-Basic Respiratory Emergencies | Neuromuscular Disease

OPQRST O—Fatigue last few weeks

P—Nothing
Q—Severe respiratory distress
R—Not applicable
S—Not applicable
T—Not applicable

Management Questions
4. At this time, what is your treatment priority?
5. What are your options for maintaining airway patency?

Treatment Continue with oxygen therapy. Monitor airway and

work of breathing and be ready to take over respira-
tions.
Response to treatment The patient continues to struggle to breathe despite
high-flow oxygen therapy.
Ongoing assessment Just prior to ALS arrival, the patient begs you to
help him breathe. You begin to assist ventilations via
bag-mask device with 100% oxygen at a rate of 12
breaths/min using a nasopharyngeal airway.

Conclusion: The paramedics arrive and continue to provide artificial ventilations. They elect not to intubate the
patient because of the short transport time to the hospital. At the emergency department, the patient is promptly
intubated. He undergoes a series of tests and is diagnosed with a neuromuscular disease. He is expected to make a
full recovery following a prolonged hospital stay.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

9 EMT-Basic Cardiovascular Emergencies | Chest Pain With Tachycardia

■■ Cardiovascular Emergencies

Chest Pain With Tachycardia

Scenario: You are called to the local jail for a man with chest pain. You arrive to find a 26-year-old man sitting in a
processing room complaining of severe pain in his chest and back. He was arrested about 15 minutes ago after a
six-block foot pursuit.

Prearrival Questions
1. Are you able to rule out a cardiac cause for the chest pain based on your dispatch information?
2. Is heart disease a concern for people in their 20s?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Possibly cardiac
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 26-year-old man, handcuffed, sitting in a chair

Assessment Questions
3. Other than cardiac causes, what other conditions or illnesses can result in chest pain?
4. What assessment questions will be helpful in determining the cause of chest pain?

Level of consciousness Responsive

Chief complaint Chest and back pain
Airway Open/patent
Breathing 30 breaths/min
Symmetrical rise and fall of the chest
Circulation Rapid distal pulses
Skin color, temperature, and condition Pale, warm, and diaphoretic
Control of major bleeding None
Transport decision ALS transport
Initial interventions Oxygen via nonrebreathing mask at 15 L/min
Baseline vital signs Blood pressure—130/74 mm Hg
Pulse—178 beats/min
Respirations—30 breaths/min; breath sounds clear
and equal bilaterally
SaO2—96% on room air
SAMPLE history S—Chest pain, nausea, can’t catch breath
A—NKA
M—None
P—Wolff-Parkinson-White syndrome
L—Beer and nuts, 30 minutes prior
E—Involved in a verbal domestic dispute and ran
from police

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10 EMT-Basic Cardiovascular Emergencies | Chest Pain With Tachycardia

OPQRST O—15 minutes ago

P—None
Q—Stabbing pain
R—Between shoulders
S—Rated 4 on a scale of 1–10 with 10 being the worst
T—15 minutes

Management Question
5. What are your treatment priorities at this time?

Treatment Oxygen at 15 L/min.

Loosen restrictive clothing and maintain body tem-
perature.
Response to treatment Patient begins to feel better with oxygen; however,
his heart rate does not decrease.
Ongoing assessment Repeat vital signs:
Blood pressure—128/70 mm Hg
Pulse—164 beats/min
Respirations—24 breaths/min
SaO2—98%
His skin condition begins to return to normal after
receiving oxygen for 5 minutes.

Conclusion: The patient is loaded onto the stretcher in a position of comfort. He tells you en route that he has
an electrical conduction defect and is prone to tachycardia after extreme exertion. Paramedics meet you about 5
minutes into the ride. They assess the patient and start an IV and place him on a cardiac monitor. You notify the
receiving hospital and finish the transport without incident.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

11 EMT-Basic Cardiovascular Emergencies | Angina Pectoris

■■ Cardiovascular Emergencies

Angina Pectoris
Scenario: You are called to the local bank for a man with chest pain. You arrive to find a 76-year-old man sitting in
the lobby complaining of severe pain in his chest. A bank employee reports that the pain started right after he was
talking with a loan officer.

Prearrival Questions
1. Explain the difference between stable and unstable angina.
2. What are the risk factors for a heart attack?

Scene safe Yes

Body substance isolation Gloves
Nature of illness Possibly cardiac
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 76-year-old man in a chair

Assessment Question
3. What additional signs and symptoms can be seen in a patient with chest pain?

Level of consciousness Responsive

Chief complaint Chest pain
Airway Open/patent
Breathing 20 breaths/min
Symmetrical rise and fall of the chest
Circulation Carotid and radial pulses strong and equal
Skin color, temperature, and condition Warm, clammy, and slightly pale
Control of major bleeding None
Transport decision Load and go
Initial interventions O2 via nonrebreathing mask at 15 L/min
Baseline vital signs Blood pressure—168/94 mm Hg
Pulse—75 beats/min
Respirations—20 breaths/min
SaO2—92% on room air
SAMPLE history S—Chest pain, nausea
A—Penicillin
M—Lasix, Captopril, Slow-K Combivent
P—Hypertension, emphysema
L— Eggs, bacon, toast, and coffee 2 hours ago
E—Applying for a loan
OPQRST O—15 minutes ago
P—None
Q—Stabbing pain
R—Between shoulders
S—Rated 8 on a scale of 1–10 with 10 being the worst
T—15 minutes

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12 EMT-Basic Cardiovascular Emergencies | Angina Pectoris

Management Questions
4. What are the side effects associated with the use of nitroglycerin?
5. What is the “sense of impending doom”?

Treatment Initial oxygenation at 15 L/min.

Loosen restrictive clothing and maintain body tem-
perature.
Response to treatment Patient states no relief with oxygen.
Pain has not decreased.
Ongoing assessment Repeat vital signs:
Blood pressure—178/96 mm Hg
Pulse—72 beats/min
Respirations—20 breaths/min
SaO2—98% on 100% oxygen via nonrebreathing
mask
Just prior to the arrival of ALS transport, the patient
states that he feels like he is going to die.

Conclusion: The patient is loaded onto the stretcher in a position of comfort. The paramedics arrive 3 minutes
later, initiate an IV, and administer 324 mg of baby aspirin and sublingual nitroglycerin. The paramedics notify
the hospital of the patient’s condition and transport without further incident. The diagnosis of acute myocardial
infarction is confirmed in the emergency department, and the patient is taken to the cardiac catheterization lab for
further treatment.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

13 EMT-Basic Cardiovascular Emergencies | Chest Pain

■■ Cardiovascular Emergencies

Chest Pain
Scenario: You are called to a wedding boutique for a woman with chest discomfort. You arrive to find a 50-year-
old woman sitting on a sofa complaining of slight discomfort in her chest. She tells you that she had spent the
morning looking at wedding dresses with her daughter.

Prearrival Question
1. How do women present differently from men with symptoms of a heart attack?

Scene safe Yes

Body substance isolation Gloves
Nature of illness Possibly cardiac
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 50-year-old woman sitting on a sofa

Assessment Question
2. What medications would a patient with a history of chest pain be taking?

Level of consciousness Responsive

Chief complaint Slight chest discomfort
Airway Open/patent
Breathing 22 breaths/min
Symmetrical rise and fall of the chest
Circulation Carotid and radial pulses
Skin color, temperature, and condition Pale and clammy
Control of major bleeding None
Transport decision Load and go
Initial interventions Oxygen via nonrebreathing mask at 15 L/min
Baseline vital signs Blood pressure—150/74 mm Hg
Pulse—82 beats/min
Respirations—22 breaths/min; bilateral breath sounds
clear and equal
SaO2—95% on room air
SAMPLE history S—Slight discomfort, general malaise
A—Demerol
M—Hormone therapy
P—None
L—Coffee and pastry 4 hours ago
E—Looking at wedding dresses with her daughter
OPQRST O—90 minutes
P—None
Q—Slight pressure
R—None
S—Rated 3 on a scale of 1–10 with 10 being the worst
T—90 minutes

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14 EMT-Basic Cardiovascular Emergencies | Chest Pain

Additional present history Her daughter tells you the patient has been having
trouble with her stamina for a couple of months. She
can no longer walk long distances without becoming
very tired. She has refused to see the doctor and
told her family she was out of shape.

Management Question
3. What should you ask a patient prior to assisting the patient to self-administer nitroglycerin?

Treatment Initial oxygenation at 15 L/min.

Loosen restrictive clothing and maintain body tem-
perature.
Due to vague symptoms, you check the blood glu-
cose level and find that it is 110 mg/dL.
Response to treatment No significant relief with oxygen; she is starting to
become restless.
Ongoing assessment Repeat vital signs:
Blood pressure—142/50 mm Hg
Pulse—86 beats/min
Respirations—22 breaths/min
SaO2—98% on 15 L/min via nonrebreathing mask

Conclusion: The patient is loaded onto the stretcher in a semisitting position. ALS arrives at the scene. She tells
the paramedics that her mother and father have a history of heart disease. They assess the patient, start an IV, and
place her on a cardiac monitor. The paramedic administers aspirin and nitroglycerin to the patient and notifies the
hospital that the patient may be having a heart attack based on assessment of the 12-lead ECG. You continue to
reassess vital signs every 5 minutes and arrive at the hospital without further event.

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15 EMT-Basic Cardiovascular Emergencies | Cardiac Arrest

■■ Cardiovascular Emergencies

Cardiac Arrest
Scenario: You are called to a car dealership for an unknown medical situation. You arrive to find a 65-year-old man
lying in the parking lot, with bystander CPR in progress. The salesman states that the man was getting ready to
test drive a Porsche when he clutched his chest and collapsed.

Prearrival Questions
1. According to the most recent American Heart Association guidelines, what is the correct compression-to-
ventilation ratio for CPR?
2. How often should the person performing chest compressions be relieved?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Possibly cardiac
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 65-year-old man lying in the parking lot, with by-
stander CPR in progress

Assessment Questions
3. What are your immediate priorities?
4. What rhythms are the automated external defibrillators (AEDs) programmed to shock?
5. Which airway adjuncts can be used to help maintain a patent airway?
6. Describe the proper technique for performing mouth-to-mask ventilation.

Level of consciousness Unresponsive

Chief complaint Unknown
Airway Open/patent
Breathing None
Circulation No carotid pulse
Skin color, temperature, and condition Pale, warm, and cyanotic
Control of major bleeding None
Transport decision Load and go
Initial interventions CPR, followed by attachment of AED
Baseline vital signs Blood pressure—0/0 mm Hg
Pulse—0 beats/min
Respirations—0 breaths/min
SAMPLE history S—Unknown
A—Unknown
M—Unknown
P—Unknown
L—Unknown
E—Shopping for a car

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16 EMT-Basic Cardiovascular Emergencies | Cardiac Arrest

OPQRST O—Minutes prior to your arrival

P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—Unknown

Management Questions
7. What is the rate for rescue breathing for an apneic patient?
8. How many cycles of 30:2 are to be performed prior to reassessing the patient?
9. Which equipment would you prepare to assist the paramedic with endotracheal intubation?
10. Describe the differences between a Combitube and a King LT.

Treatment CPR at 30:2, with AED shocking if indicated. Control

airway with bag-mask ventilation connected to oxy-
gen, using an oropharyngeal airway.
Response to treatment After the AED delivers two shocks, you give 2 minutes
of CPR and detect a faint carotid pulse.
Ongoing assessment AED/CPR and ALS assist in getting a pulse back.
Vital signs:
Blood pressure—88/50 mm Hg
Pulse—60 beats/min
Respirations—10 breaths/min (assisted ventilations)
At this time the patient remains unconscious. Con-
tinue to monitor patient’s vital signs and assist other
providers with postresuscitative care en route to the
emergency department.

Conclusion: The patient is placed on the stretcher, and assisted ventilation via bag-mask device is continued.
The paramedics arrive and secure an airway using an endotracheal tube, start an IV, and administer medication to
prevent the patient from going back into cardiac arrest. You arrive at the hospital without further complications.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

17 EMT-Basic Neurologic Emergencies | Stroke

■■ Neurologic Emergencies

Stroke
Scenario: You are called to an assisted-living facility for a man having difficulty speaking. His daughter came to
visit and noticed that her father’s face was “droopy” on the right side and that his speech was garbled. She called
9-1-1 ten minutes after her arrival.

Prearrival Questions
1. What is the proper term for difficulty speaking?
2. What are possible causes for the patient’s difficulty speaking?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 62-year-old man; unknown problem

Assessment Questions
3. What are the three components of the Cincinnati Stroke Scale?
4. Why is this patient at risk for having difficulty maintaining his airway?

Level of consciousness Responsive, but speech is slurred

Chief complaint Difficulty speaking
Airway Open
Breathing 20 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Warm, dry, and pink
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—240/120 mm Hg
Pulse—62 beats/min
Respirations—20 breaths/min
SaO2—95% on room air
SAMPLE history S—Difficulty speaking; right-sided facial droop
A—Penicillin
M—Coumadin, Lopressor
P—High blood pressure
L—Breakfast, 2 hours ago
E—Unknown
OPQRST O—Unknown
P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—Unknown

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18 EMT-Basic Neurologic Emergencies | Stroke

Additional information You note as you perform your exam that the patient
also has right-sided weakness. The blood glucose
level is 91 mg/dL.

Management Question
5. How should you position the patient on the stretcher?

Treatment Provide oxygen therapy.

Position the patient in a semi-Fowler’s or Fowler’s
position for airway protection.
Suction the airway as needed.
Maintain warmth and reassess vital signs.
Transport with head inclined 30 degrees.
Response to treatment The patient’s condition remains unchanged while
you await ALS arrival.
Ongoing assessment Blood pressure—234/122 mm Hg
Pulse—65 beats/min
Respirations—20 breaths/min
SaO2—99% on nonrebreathing mask at 15 L/min

Conclusion: The patent is transported to the area hospital that provides specialized care for stroke patients. A
computed tomographic (CT) scan shows evidence of an ischemic stroke. Because the time of onset of symptoms
is not known, the patient is not a candidate for thrombolytic therapy. He is admitted to the hospital’s stroke unit,
where he will stay until he is stable enough to be transferred to a rehabilitation facility.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

19 EMT-Basic Neurologic Emergencies | Transient Ischemic Attack

■■ Neurologic Emergencies

Transient Ischemic Attack

Scenario: You are dispatched to a family reunion at a state park for a possible stroke. Upon arrival you find a
50-year-old woman insisting that she is fine and is not going anywhere.

Prearrival Questions
1. How should you approach a patient who denies having any problem?
2. What are the legal consequences, if any, of forcing a patient to go to the hospital?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 50-year-old woman; unknown problem

Assessment Questions
3. What is the difference between a stroke and a transient ischemic attack (TIA)?
4. What are the risk factors for a stroke or TIA?

Level of consciousness Responsive to verbal stimuli

Chief complaint None per the patient. However, family members
state that she has been complaining throughout the
morning of a headache and feeling dizzy. Just prior
to calling 9-1-1, the patient dropped her fork on the
ground and was unable to move her left side for ap-
proximately 5 minutes.
Airway Open
Breathing 18 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Warm, dry, and pink
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nasal cannula at 4 L/min
Baseline vital signs Blood pressure—190/96 mm Hg
Pulse—80 beats/min
Respirations—18 breaths/min
SaO2—97% on room air
SAMPLE history S—Dizziness, headache, unable to move left side
A—NKA
M—Cardizem, Coumadin
P—Irregular heart rhythm
L—Just finished lunch at time of incident
E—Visiting with family when headache and dizziness
began

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20 EMT-Basic Neurologic Emergencies | Transient Ischemic Attack

OPQRST O—Approximately 9 minutes

P—Nothing makes the symptoms worse or better
Q—Describes her headache as a dull, aching pain
R—None
S—Headache is a 5 on a scale of 1–10 with 10 being
the worst
T—9 minutes

Management Question
5. What are your treatment priorities at this time?

Treatment Provide oxygen, maintain warmth, and reassess vital

signs.
Response to treatment The patient states that her headache and dizziness
have improved, though still present, with oxygen
therapy.
Ongoing assessment Blood pressure—182/90 mm Hg
Pulse—84 beats/min
Respirations—18 breaths/min
SaO2—98% on nasal cannula at 4 L/min

Conclusion: The patient is transported without event to the emergency department, where she is diagnosed
with having a TIA. She is admitted to the hospital for further observation and a neurology consult.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

21 EMT-Basic Neurologic Emergencies | Grand Mal Seizure

■■ Neurologic Emergencies

Grand Mal Seizure

Scenario: You are called to a department store for a patient who has “passed out.” Upon arrival, you are told by
store security that a young man was walking through the store when he apparently passed out and started seizing.

Prearrival Questions
1. What is epilepsy?
2. What are potential causes of seizures?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 27-year-old man actively seizing

Assessment Questions
3. How can you obtain information regarding the patient’s past medical history?
4. What is a management priority at this point?
5. What are potential complications associated with seizures?

Level of consciousness Unresponsive

Chief complaint Active tonic/clonic episode
Airway Open
Breathing 8 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pale, warm, and moist
Control of major bleeding None
Transport decision High priority
Initial interventions Make sure the patient is not around objects that can
cause injury.
Oxygen via nonrebreathing mask at 10–15 L/min.
Baseline vital signs Blood pressure—Unobtainable
Pulse—100 beats/min
Respirations—8 breaths/min
SaO2—89% on room air
Blood glucose level—82 mg/dL
SAMPLE history S—Witnesses state the patient fell to the ground and
began seizing; he is incontinent
A—Unknown
M—Unknown (medical alert bracelet states “epileptic”)
P—Epilepsy
L—Unknown
E—Walking through the store when he fell and began
to seize

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

22 EMT-Basic Neurologic Emergencies | Grand Mal Seizure

OPQRST O—Approximately 10 minutes

P—Undetermined
Q—Not applicable
R—Not applicable
S—Not applicable
T—Undetermined

Management Question
6. What are your treatment priorities?

Treatment Oxygen via nonrebreathing mask.

Maintain warmth, reassess vital signs, and remove all
objects from around the patient. Allow him to finish
the seizure prior to initiating any invasive treat-
ments. Be prepared for patient vomiting.
Response to treatment The patient stops seizing after 2 minutes. You immo-
bilize the patient’s spine and assist the ALS provid-
ers with transport.
Ongoing assessment Blood pressure—110/66 mm Hg
Pulse—87 beats/min
Respirations—18 breaths/min
SaO2—97% on a nonrebreathing mask at 15 L/min

Conclusion: ALS arrives to assist you with transport. During the transport the patient regains full conscious-
ness. He tells you that he stopped taking his medication because he does not like the side effects. You take this
time to educate your patient about the importance of continuing medication and the dangers of sudden with-
drawal. You encourage your patient to consult with his physician prior to stopping his medications in the future.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

23 EMT-Basic Neurologic Emergencies | Syncopal Episode

■■ Neurologic Emergencies

Syncopal Episode
Scenario: You are called to a local residence for a person who has passed out. Upon arrival you find an elderly
woman passed out between the wall and the toilet. Her husband tells you he heard a thud and found her like this.

Prearrival Question
1. What are some of the potential causes of syncopal episodes in the elderly?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 78-year-old woman on the floor

Assessment Questions
2. What information would you like to obtain from the husband?
3. When is a patient considered hypotensive?

Level of consciousness Unresponsive

Chief complaint Unknown at this time
Airway Open
Breathing 10 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulse strong and equal
Skin color, temperature, and condition Pale, cool, and clammy
Control of major bleeding Laceration to the forehead; minimal bleeding noted
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—100/80 mm Hg
Pulse—60 beats/min
Respirations—10 breaths/min
SaO2—94% on room air
SAMPLE history S—Small laceration to head; no other signs exhibited
A—None
M—Aspirin, Lopressor
P—High blood pressure
L—Just finished lunch
E—Having a bowel movement
OPQRST O—Approximately 7 minutes prior to your arrival
P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—Unknown

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

24 EMT-Basic Neurologic Emergencies | Syncopal Episode

Management Questions
4. Where should you move the patient and into which position?
5. How does the shock position help raise the blood pressure?

Treatment Provide oxygen.

Place the patient in the shock position.
Maintain warmth.
Reassess vital signs and monitor the airway and
breathing.
Response to treatment Level of consciousness improves after the patient is
placed in the shock position.
Ongoing assessment Blood pressure—146/84 mm Hg
Pulse—62 beats/min
Respirations—16 breaths/min
SaO2—100% on 15 L/min via nonrebreathing mask

Conclusion: After regaining consciousness, the patient tells you that she was recently started on Lopressor for
newly diagnosed hypertension and has been experiencing constipation as a side effect. ALS arrives on scene, starts
an IV, applies the cardiac monitor, and transports without further incident. At the emergency department the
physician explains that constipation is a common side effect of many blood pressure medications and provides her
with information on how to minimize the problem.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

25 EMT-Basic Gastrointestinal Emergencies | Upper Gastrointestinal Tract Bleeding

■■ Gastrointestinal Emergencies

Upper Gastrointestinal Tract Bleeding

Scenario: You are called to the local Moose Lodge for a man vomiting blood. Upon arrival you find an anxious
man who is perched over the toilet in the men’s room. You notice that the toilet bowl is filled with vomit that
looks like coffee grounds.

Prearrival Questions
1. What are potential concerns for body substance isolation while caring for this patient?
2. What does coffee ground emesis indicate?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 57-year-old man kneeling on the floor in front of the
toilet

Assessment Questions
3. What are some causes for vomiting blood?
4. What other signs and symptoms might be present with this complaint?

Level of consciousness Responsive, will answer questions

Chief complaint Vomiting blood
Airway Open
Breathing 14 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pale, cool, and diaphoretic
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—100/88 mm Hg
Pulse—110 beats/min
Respirations—14 breaths/min
SaO2—98% on room air
SAMPLE history S—Vomiting, with some pain in the epigastric area
A—Sulfa
M—Pepcid
P—Gastroesophageal reflux disease (GERD), peptic
ulcers
L—Beer and peanuts
E—Sitting at the bar watching the football game with
his friends

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

26 EMT-Basic Gastrointestinal Emergencies | Upper Gastrointestinal Tract Bleeding

OPQRST O—Approximately 30 minutes prior to arrival

P—Nothing makes the pain worse or better
Q—Mild pain and discomfort in the epigastric area
R—Both upper quadrants of the abdomen
S—4 on a scale of 1–10 with 10 being the worst
T—30 minutes

Management Question
5. What can you do to make the patient more comfortable?

Treatment Provide oxygen.

Maintain warmth.
Reassess vital signs.
Response to treatment Level of consciousness does not change.
ALS meets you on the scene and starts an IV. You
assist ALS with vital sign trending en route to the
hospital.
Ongoing assessment Blood pressure—100/88 mm Hg
Pulse—110 beats/min
Respirations—14 breaths/min
SaO2—99% on 15 L/min via nonrebreathing mask

Conclusion: While en route to the hospital, the patient vomits two additional times. The patient admits to you
and the paramedic that he has been under significant stress lately because of a bitter divorce and custody battle.
After undergoing blood work and radiographs in the emergency department, he is diagnosed with a bleeding
ulcer and is admitted for definitive treatment.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

27 EMT-Basic Gastrointestinal Emergencies | Lower Gastrointestinal Tract Bleeding

■■ Gastrointestinal Emergencies

Lower Gastrointestinal Tract Bleeding

Scenario: You are called to a local assisted-living facility for a woman with abdominal pain. Upon arrival you find
an elderly woman lying in a fetal position on the couch.

Prearrival Question
1. What are common causes of lower gastrointestinal (GI) tract bleeding?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 73-year-old woman lying on the couch in distress

Assessment Questions
2. What are important pertinent negatives to ask a patient experiencing abdominal pain?
3. What is melena?
4. What is hematochezia?

Level of consciousness Responsive, will answer questions

Chief complaint Severe abdominal pain
Airway Open
Breathing 18 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pink, warm, and dry
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—128/66 mm Hg
Pulse—114 beats/min
Respirations—18 breaths/min
SaO2—93% on room air
SAMPLE history S—Severe abdominal pain in the left lower quadrant;
general weakness; light-headedness; black, tarry
stools
A—Cipro, Novocain
M—Aleve
P—Arthritis
L—Chicken soup last evening for dinner approximate-
ly 12 hours ago
E—Feeling bad for a few days, with increasing ab-
dominal pain

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

28 EMT-Basic Gastrointestinal Emergencies | Lower Gastrointestinal Tract Bleeding

OPQRST O—2 days ago with increasing severity

P—Movement makes the pain worse
Q—Dull, achy, cramping pain
R—None
S—8 on a scale of 1–10 with 10 being the worst
T—2 days ago

Management Questions
5. Why is it important not to allow a patient experiencing abdominal pain to have anything to eat or drink?
6. Can a person with a GI bleed go into shock?

Treatment Provide oxygen.

Allow the patient to remain in a position of comfort.
Maintain warmth, reassess vital signs, and monitor
for signs of shock.
Response to treatment The patient remains stable while awaiting ALS
transport.
Ongoing assessment Blood pressure—134/72 mm Hg
Pulse—110 beats/min
Respirations—18 breaths/min
SaO2—98% on 15 L/min via nonrebreathing mask

Conclusion: An IV is started en route and the patient is transported without event to the local emergency de-
partment, where she is admitted for further testing. A colonoscopy reveals irritation and bleeding in a portion of
the large intestine.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

29 EMT-Basic Abdominal Emergencies | Appendicitis

■■ Abdominal Emergencies

Appendicitis
Scenario: You are called to a local elementary school for a child with stomach pain. Upon arrival you find an
8-year-old boy lying on a bed in the school health clinic in the fetal position and crying.

Prearrival Questions
1. How should your approach to a pediatric patient differ from that of an adult?
2. What is a common cause of abdominal pain in children?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 8-year-old boy in obvious pain

Assessment Questions
3. Why is it important to gain the trust of a child prior to assessing him or her?
4. What are some of the things that you can do to minimize the anxiety of a pediatric patient?
5. How might you ask a child to describe his or her pain?

Level of consciousness Responsive, will answer questions

Chief complaint Severe abdominal pain
Airway Open
Breathing 20 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Warm, dry, and pink
Control of major bleeding None
Transport decision High priority
Initial interventions Assess the patient. You find the patient has rebound
tenderness in the right lower quadrant.
Baseline vital signs Blood pressure—102/60 mm Hg
Pulse—92 beats/min
Respirations—20 breaths/min
SaO2—98% on room air
SAMPLE history S—Severe abdominal pain near the right side of the
umbilicus; nausea and vomiting; temperature is
101.6°F
A—None
M—None
P—None
L—Lunch
E—Felt good all day, but pain, fever, and vomiting
have manifested in the last hour

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

30 EMT-Basic Abdominal Emergencies | Appendicitis

OPQRST O—Approximately 1 hour prior to arrival

P—Movement makes the pain worse
Q—Feels like he got “kicked in his tummy”
R—Pain radiates from the umbilicus to the right
lower quadrant
S—10 on a scale of 1–10 with 10 being the most severe
T—Approximately 1 hour

Management Questions
6. Should the child receive medication for pain? Why or why not?
7. Why might the fetal position be the most comfortable position for a patient experiencing abdominal pain?

Treatment Provide oxygen.

Allow the patient to remain in a position of comfort.
Provide reassurance.
Maintain warmth and reassess vital signs.
Response to treatment The child continues to complain of severe pain and
asks for his mommy.
Ongoing assessment Blood pressure—108/64 mm Hg
Pulse—95 beats/min
Respirations—20 breaths/min
SaO2—98% on room air

Conclusion:While awaiting the arrival of ALS transport, the school is able to contact the mother at her place of
employment. She gives consent for treatment and transport and states that she will meet you at the emergency de-
partment. An IV is started en route for fluid administration. The child is transported without incident. The child is
later diagnosed with acute appendicitis and is taken to surgery for an emergency appendectomy.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

31 EMT-Basic Abdominal Emergencies | Aneurysm

■■ Abdominal Emergencies

Aneurysm
Scenario: You are called to a law office for a man with severe abdominal pain. Upon arrival you find an obese man
sitting at his desk in obvious discomfort. He tells you that he was preparing to take depositions for a major crimi-
nal case when the pain started. You note that his desk is littered with empty coffee cups and a bottle of antacids.

Prearrival Question
1. Review the possible causes for acute abdominal pain.

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 48-year-old man in distress

Assessment Questions
2. What is the possible significance of the coffee cups and bottle of antacids?
3. What questions would you like to ask?

Level of consciousness Responsive, will answer questions

Chief complaint Severe abdominal pain radiating to the back
Airway Open
Breathing 20 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulse weak and equal
Skin color, temperature, and condition Gray and diaphoretic
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—102/50 mm Hg
Pulse—122 beats/min
Respirations—20 breaths/min
SaO2—95% on room air
SAMPLE history S—Severe abdominal pain that moves to both flanks;
shortness of breath; nausea
A—Sulfa
M—Norvasc
P—High blood pressure
L—Breakfast
E—Preparing for trial depositions
OPQRST O—Approximately 10 minutes prior to arrival
P—Nothing makes the pain better or worse
Q—Tearing pain; feels like he is “being ripped in half”
R—Both flanks
S—10 on a scale of 1–10 with 10 being the worst
T—10 minutes

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

32 EMT-Basic Abdominal Emergencies | Aneurysm

Management Questions
4. What are your treatment priorities at this time?
5. Why is it important to move the patient gently?

Treatment Provide oxygen via nonrebreathing mask at

10–15 L/min.
Maintain warmth and reassess vital signs.
Monitor for signs of shock.
Response to treatment No changes noted.
Ongoing assessment The patient continues to complain of tearing back
pain and states that he feels like he is going to die.
Upon assessment of the abdomen, you palpate a
pulsating mass in the midline.
Reassess vital signs:
Blood pressure—92/54 mm Hg
Pulse—127 beats/min
Respirations—20 breaths/min
SaO2—98% on 15 L/min via nonrebreathing mask

Conclusion: The patient is transported to the local emergency department, where it is discovered that he is
experiencing a dissecting aneurysm. A surgical consult is ordered, and the patient is brought to surgery within 30
minutes of arriving at the hospital.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

33 EMT-Basic Diabetic Emergencies | Diabetic Ketoacidosis

■■ Diabetic Emergencies

Diabetic Ketoacidosis
Scenario: You are called to a private residence for an unknown medical situation. Upon arrival you are met at the
door by the patient’s niece, who tells you that her elderly aunt has been sick with the flu for a few days. She came
to check on her aunt today when she could not get her to answer the phone. When she arrived at the house, she
was unable to arouse her aunt and called 9-1-1.

Prearrival Question
1. Discuss potential causes for the patient’s altered mental status based on the information known at this time.

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 72-year-old woman; unknown problem

Assessment Question
2. What information would you like to gather at this time?

Level of consciousness Responsive to painful stimuli only

Chief complaint Altered mental status; flulike symptoms for 3 days
Airway Open
Breathing 38 breaths/min, rapid and deep in nature
Symmetrical rise and fall of the chest
Circulation Carotid pulse strong and equal; weak radial pulses
bilaterally
Skin color, temperature, and condition Pink, warm, and dry
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—118/54 mm Hg
Pulse—120 beats/min
Respirations—38 breaths/min
SaO2—94%
SAMPLE history S—Altered mental status; rapid, deep respirations;
warm, dry skin; ill for 3 days
A—Cardiac dye
M—Docusate sodium, aspirin, levathyroxin, insulin
P—Shingles, thyroid problems, diabetes
L—Hasn’t eaten much in 3 days
E—Lying in bed, not feeling well
OPQRST O—Over the past 3 days
P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—3 days

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

34 EMT-Basic Diabetic Emergencies | Diabetic Ketoacidosis

Management Question
3. What are your treatment priorities at this time?

Treatment Provide oxygen via nonrebreathing mask at

10–15 L/min using a nasopharyngeal airway.
Maintain warmth and reassess vital signs.
Response to treatment Level of consciousness does not improve.
Ongoing assessment Blood pressure—118/54 mm Hg
Pulse—122 beats/min
Respirations—38 breaths/min
SaO2—97% on 15 L/min via nonrebreathing mask

Conclusion: ALS meets you at the scene and immediately checks the patient’s blood glucose level, which comes
back at 616 mg/dL. The paramedic immediately gains IV access and begins to administer a fluid bolus. In the
emergency department, the patient is intubated and continues to receive IV fluid and an insulin drip. She is diag-
nosed with diabetic ketoacidosis and admitted to the medical intensive care unit.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

35 EMT-Basic Diabetic Emergencies | Hypoglycemia

■■ Diabetic Emergencies

Hypoglycemia
Scenario: You are called to a residence for an unconscious subject. Upon arrival at a five-story apartment build-
ing, you notice it is dark from the outside. Law enforcement is on scene and has declared the scene safe. A young
woman is frantically waving you over. As you walk in, you see a man lying supine on the steps. He is pale and
sweaty and appears unresponsive.

Prearrival Question
1. Review the potential causes for altered mental status.

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Unknown at this time
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization Yes
General impression 25- to 30-year-old man; unknown problem

Assessment Questions
2. At this time, who is your best source of information?
3. How will your SAMPLE history help you identify potential problems?

Level of consciousness Responsive to painful stimuli

Chief complaint Unknown
Airway Open
Breathing 12 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Cool, pale, and clammy
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min
Baseline vital signs Blood pressure—118/90 mm Hg
Pulse—108 beats/min
Respirations—12 breaths/min
SaO2—97% on room air
SAMPLE history S—Equal respirations; skin is pale and cool; lungs are
clear and equal; no evidence of trauma
A—Unknown
M—Insulin
P—Diabetes (per friend)
L—Dinner, 7 hours ago
E—Friend states they had been out to dinner and
then went clubbing. She states that the patient
has been drinking heavily, and she thinks he took
extra insulin before they went out. He appeared to
be acting “drunk” all night and passed out as she
tried to help him upstairs.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

36 EMT-Basic Diabetic Emergencies | Hypoglycemia

OPQRST O—Approximately 7 minutes prior to your arrival

P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—Unknown

Management Question
4. Why shouldn’t you administer oral glucose to an unconscious patient?

Treatment Move the patient to the floor.

Maintain the airway.
Provide oxygen.
Keep the patient warm.
Monitor for signs of shock.
Response to treatment There is no change in the patient’s level of con-
sciousness as you await ALS transport.
Ongoing assessment Blood pressure—120/72 mm Hg
Pulse—110 beats/min
Respirations—12 breaths/min
SaO2—99% on 15 L/min via nonrebreathing mask

Conclusion: A blood glucose check performed by the paramedic upon arrival to the scene is 25 mg/dL. An IV
line is started and the patient is given a prefilled syringe of D50. He regains full consciousness almost immediately
and asks why you are standing over him. After explaining the situation, he becomes embarrassed and reluctantly
agrees to be transported to the hospital.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

37 EMT-Basic Poisoning | Organophosphate Poisoning

■■ Poisoning

Organophosphate Poisoning
Scenario: You are working in a rural area and are called to a local farm for a subject feeling sick. You arrive to
find an 18-year-old man lying in the back of a trailer. Coworkers tell you they have been spreading pesticides in
a field all day. The patient became warm working in the sun and removed his shirt and shoes in an effort to cool
off. After lunch he became nauseated, vomited twice, and complained of abdominal cramping. He is having some
trouble catching his breath; is drooling; has red, watery eyes; and is incontinent.

Prearrival Questions
1. What are some of your concerns regarding scene safety?
2. Is it possible that there may be more than one patient?

Scene safe Yes, with proper PPE (Personal Protective Equipment)

Body substance isolation Gloves, eyewear, gown
Nature of illness Medical
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 18-year-old man in the bed of a trailer with a sick
appearance

Assessment Questions
3. With the information that you have so far, what are some of the possibilities for his illness?
4. What are the main treatment priorities at this time?

Level of consciousness Awake and slightly confused

Chief complaint Difficulty breathing; nausea and vomiting
Airway Open; patient is excessively drooling
Breathing Rapid at a rate of 24 breaths/min
Circulation Carotid and radial pulse
Skin color, temperature, and condition Pale and warm
Control of major bleeding None
Transport decision ALS transport
Initial interventions Suction the airway when needed and place on oxy-
gen with nonrebreathing mask. Remove all clothing
and decontaminate with copious amounts of water.
Baseline vital signs Blood pressure—98/64 mm Hg
Pulse—45 beats/min
Respirations—24 breaths/min
SAMPLE history S—Difficulty breathing; nausea and vomiting; abdomi-
nal cramps; wheezes are heard bilaterally
A—None
M—None
P—None
L—Lunch
E—Spreading pesticides in the field

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

38 EMT-Basic Poisoning | Organophosphate Poisoning

OPQRST O—30 minutes prior to your arrival

P—Nothing makes his breathing worse or better
Q—Difficulty breathing
R—No radiation
S—Moderate difficulty breathing; intercostal retrac-
tions are present
T—30 minutes

Management Question
5. What are your treatment priorities at this time?

Treatment Continue oxygenating patient via nonrebreathing

mask at 10–15 L/min and suction as needed.
Response to treatment Mental status improves somewhat; however, the
patient continues to vomit.
Ongoing assessment No other problems while awaiting the arrival of ALS.
Reassess vital signs:
Blood pressure—100/72 mm Hg
Pulse—52 beats/min
Respirations—20 breaths/min
SaO2—98%

Conclusion: In this situation, responder safety is the first priority. Make sure that you have the proper level of
personal protective equipment prior to entering any scene that could be potentially unsafe. Always attempt to find
out the type of chemical to which your patient was exposed and make sure you know what to use for decontami-
nation. This patient has an exposure to organophosphates via the fertilizer. ALS medics are able to begin adminis-
tering the necessary medications needed to begin to reverse the effects of the organophosphates.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

39 EMT-Basic Obstetric and Gynecologic Emergencies | Miscarriage

■■ Obstetric and Gynecologic Emergencies

Miscarriage
You are dispatched to a church for a woman with severe cramping and moderate bleeding. You arrive to find a
29-year-old woman lying on a pew in moderate distress. She informs you that she is 3 months pregnant.

Prearrival Question
1. What are potential causes for abdominal pain for a pregnant woman?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Abdominal cramping and vaginal bleeding
Number of patients One
Additional help Dispatched ALS
C-spine stabilization No
General impression Woman with abdominal pain and bleeding

Assessment Questions
2. How can you determine estimated blood loss?
3. What information would you like pertaining to the patient’s obstetric and gynecologic history?

Level of consciousness Responsive

Chief complaint Pain and bleeding
Airway Open
Breathing Breathing about 22 times a minute
Circulation Radial pulses strong and equal bilaterally
Skin color, temperature, and condition Pink, warm, and slightly diaphoretic
Control of major bleeding None
Transport decision ALS transport
Initial interventions Start oxygen therapy via nasal cannula, 2–4 L/min
Baseline vital signs Blood pressure—110/80 mm Hg
Pulse—88 beats/min
Respirations—22 breaths/min
SaO2—97% on room air
SAMPLE history S—Severe abdominal cramping and vaginal bleeding
(dark red blood; no clots seen)
A—Penicillin
M—Prenatal vitamins
P—Miscarriage 1 year ago; she has had no additional
pregnancies
L—Breakfast 2 hours ago
E—She got up to leave church and began cramping;
she went to the bathroom and discovered she was
bleeding.
OPQRST O—Approximately 20 minutes prior to your arrival
P—Nothing makes the pain worse or better
Q—Cramping
S—5 on a scale of 1–10 with 10 being the worst
T—20 minutes

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40 EMT-Basic Obstetric and Gynecologic Emergencies | Miscarriage

Management Questions
4. What can you do to make the patient more comfortable?
5. How do you know whether the patient is going into shock?

Treatment Provide oxygen by nasal cannula if needed.

Reassess vital signs and maintain warmth.
Assess for signs of shock.
Response to treatment No change in patient condition while awaiting ALS
transport.
Ongoing assessment Blood pressure—118/72 mm Hg
Pulse—114 beats/min
Respirations—20 breaths/min
SaO2—99% on 2 L/min via nasal cannula

Conclusion: ALS arrives on scene and assists you in preparing the patient for transport. An IV is started en
route to the emergency department. Tests performed in the emergency department confirm a second miscarriage.
She is admitted and taken to the operating room for a D&C (dilation and curettage, a surgical procedure in which
the inner lining of the uterus is scraped off, removing old tissue and ensuring that all of the fetal and placental tis-
sue has been removed to prevent infection and to allow new healthy tissue to grow).

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

41 EMT-Basic Obstetric and Gynecologic Emergencies | Labor and Delivery

■■ Obstetric and Gynecologic Emergencies

Labor and Delivery

Scenario: You are dispatched to a local residence for a woman in labor. You arrive to find a 27-year-old woman
lying on her back on the floor in the bedroom. You notice that she is holding herself in the vaginal area. Her
husband states that this is her third pregnancy and that she is about 38 weeks. She has received prenatal care and
there have been no complications. She is complaining of severe pressure as if she has to have a bowel movement.
You approach the patient and take away her hands to notice a tiny head of hair at the opening of the birth canal.

Prearrival Questions
1. What equipment should you have ready to help with the delivery of the baby?
2. What factors will help you determine whether to stay on scene and deliver the baby or transport to the
hospital?

Scene safe Yes

Body substance isolation Gloves, eyewear, and gown
Nature of illness Childbirth
Number of patients One, soon to be two
Additional help Dispatched—ALS
C-spine stabilization No
General impression Woman in second stage of labor

Assessment Questions
3. What should be done once the head is delivered?
4. What is an APGAR score and how is it calculated?

Level of consciousness Responsive

Chief complaint Intense vaginal pressure; baby’s coming
Airway Open
Breathing About 28 breaths/min, panting
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Warm, sweaty, and flushed
Control of major bleeding None
Transport decision Stay for delivery
Initial interventions High-flow oxygen at 15 L/min via nonrebreathing
mask
Baseline vital signs Blood pressure—128/84 mm Hg
Pulse—110 beats/min
Respirations—28 breaths/min
SaO2—96% on room air
SAMPLE history S—Vaginal pressure, contractions, feeling the need
to push
A—Cefzil, Augmentin
M—Prenatal vitamins
P—No pertinent past medical history
L—Ate lunch about an hour ago
E—Water broke about an hour ago; contractions
became strong in the last 30 minutes

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42 EMT-Basic Obstetric and Gynecologic Emergencies | Labor and Delivery

OPQRST O—Approximately 30 minutes prior to arrival

P—Labor
Q—Labor contractions
R—Not applicable
S—Not applicable
T—Contractions are 1 to 2 minutes apart and last for
about 30 seconds.

Management Questions
5. What should your treatment be at this point?
6. Name potential complications of childbirth.

Treatment High-flow oxygen at 15 L/min via nonrebreath-

ing mask to ensure adequate oxygenation to both
mother and baby.
Reassure the parents.
Allow the father to assist in coaching.
Maintain warmth.
Monitor vital signs.
Prepare OB kit and assist with delivery.
Response to treatment As the baby’s head begins to deliver, you note that
the cord is around its neck. You gently slide two
fingers under the cord and remove it from the baby’s
neck.
Ongoing assessment Blood pressure—124/80 mm Hg
Pulse—112 beats/min
Respirations—28 breaths/min
SaO2—100% on 15 L/min via nonrebreathing mask

Conclusion: The
ALS crew arrives just as you finish delivering the baby’s head. The paramedic assists you
through the remainder of the delivery. A short 2 minutes later, you find yourself holding a brand new baby girl!
The medic clamps and cuts the umbilical cord, suctions the baby’s nose and mouth, and warms and dries her. The
baby receives Apgar scores of 8 at 1 minute and 9 at 5 minutes. The baby is wrapped in a blanket, and mother
and baby are prepared for transport.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

43 EMT-Basic Pediatric Emergencies | Asthma

■■ Pediatric Emergencies

Asthma
Scenario: You are called to an elementary school playground for a 7-year-old child having difficulty breathing.
Upon arrival you find a 7-year-old boy sitting on a bench and leaning forward in the tripod position. You observe
that he is using accessory muscles to breathe and has nasal flaring. As you approach him, you hear audible expira-
tory wheezes.

Prearrival Questions
1. What might cause difficulty breathing in a young child?
2. What is the significance of nasal flaring?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 7-year-old boy on the playground

Assessment Questions
3. Is this child in respiratory distress or respiratory failure?
4. Explain the difference between respiratory distress and respiratory failure.
5. What are some potential triggers for an asthma attack?

Level of consciousness Responsive

Chief complaint Difficulty breathing
Airway Audible expiratory wheezing heard
Breathing 48 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pale, warm, and moist
Control of major bleeding None
Transport decision Load and go
Initial interventions Oxygen via nonrebreathing mask at 15 L/min
Baseline vital signs Blood pressure—96/72 mm Hg
Pulse—152 beats/min
Respirations—48 breaths/min; shallow
SaO2—87% on room air
SAMPLE history S—Lungs: Expiratory wheezes audible and auscul-
tated in all lung fields. You notice nasal flaring and
use of accessory muscles.
A—Amoxicillin
M—Proventil inhaler
P—Asthma
L—Lunch
E—Playing on playground

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

44 EMT-Basic Pediatric Emergencies | Asthma

OPQRST O—Approximately 15 minutes prior to arrival

P—Running on playground with classmates
Q—Shallow respirations
R—None
S—Severe respiratory distress
T—Approximately 15 minutes

Management Questions
6. What are your treatment priorities at this time?
7. How does Proventil work?

Treatment Oxygen via nonrebreathing mask at 15 L/min.

Place the patient on a stretcher in a position of
comfort.
Monitor vital signs.
Monitor and maintain the airway.
Response to treatment The school nurse arrives with the child’s Proventil
inhaler. You attempt to assist him to administer the
medication; however, he is in too much distress to
use it appropriately.
Ongoing assessment Mental status unchanged.
Airway and breathing unchanged.
Blood pressure—102/76 mm Hg
Pulse—158 beats/min
Respirations—52 breaths/min
SaO2—93% on 100% oxygen via nonrebreathing
mask at 15 L/min

Conclusion: The child is placed in the ambulance immediately once the ALS unit arrives. An IV is started
and fluids are hung. A breathing treatment with Proventil is administered via a nebulizer and a mask. While the
breathing treatment is in progress, the paramedic administers Solu-Medrol, a steroid, via the IV. Upon arrival
at the emergency department, the child continues to receive breathing treatments, with moderate relief of his
distress. He is admitted to the pediatric intensive care unit for an acute exacerbation of his asthma and remains
hospitalized for 4 days.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

45 EMT-Basic Pediatric Emergencies | Croup

■■ Pediatric Emergencies

Croup
Scenario: You are called on a crisp fall evening to an apartment for a 3-year-old boy with a fever, cough, and
trouble breathing. Upon arrival, you find a young mother sitting on the couch holding the child on her lap. The
child appears to be in mild to moderate respiratory distress, with accessory muscle use and inspiratory stridor. He
has not been feeling well for 2 days and has had a low-grade fever.

Prearrival Question
1. What are potential causes of respiratory distress for children in this age group?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 3-year-old boy on the couch in mild to moderate
respiratory distress; accessory muscle use noted

Assessment Questions
2. What is stridor indicative of?
3. Why should oxygen be humidified when administered to this patient?

Level of consciousness Responsive

Chief complaint Fever, cough, and sore throat for 2 days
Airway Open
Breathing 32 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Flushed, hot, and dry
Control of major bleeding None
Transport decision Load and go
Initial interventions Oxygen via nonrebreathing mask at 15 L/min, hu-
midified if possible
Baseline vital signs Blood pressure—88/52 mm Hg
Pulse—114 beats/min
Respirations—32 breaths/min
SaO2—89% on room air
SAMPLE history S—Temperature of 101.5°F; barky cough
A—None
M—Children’s acetaminophen for fever reduction;
last dose 45 minutes prior to arrival
P—None
L—Breakfast, 6 hours ago
E—Lying around the house

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

46 EMT-Basic Pediatric Emergencies | Croup

OPQRST O—Difficulty breathing began approximately 1 hour

prior to arrival
P—Nothing makes the child’s breathing worse; he
prefers to sit upright and resists lying down
Q—Not applicable
R—Not applicable
S—Mild to moderate respiratory distress
T—Approximately 1 hour

Management Questions
4. What are your treatment priorities at this time?
5. Why would it be important not to agitate this child?

Treatment Humidified oxygen via nonrebreathing mask at

15 L/min. Place on stretcher in position of comfort,
keeping the child with the mother.
Response to treatment No change noted while awaiting ALS arrival.
Ongoing assessment Blood pressure—86/50 mm Hg
Pulse—114 beats/min
Respirations—32 breaths/min
SaO2—97% on oxygen via blow-by

Conclusion: ALS transport arrives on scene and takes the report from you. The child is loaded into the ambu-
lance, continued on oxygen therapy via blow-by, and transported to the local emergency department. A decrease
in stridor is noted secondary to cool air. After evaluation and testing, he is diagnosed with croup and admitted
overnight for observation.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

47 EMT-Basic Pediatric Emergencies | Epiglottitis

■■ Pediatric Emergencies

Epiglottitis
Scenario: You are called to a residence at 4 am for a 6-year-old child with difficulty breathing. Upon arrival you
find an ill-appearing child seated upright in a recliner. The child states that it is hard to swallow. She is leaning
forward in a tripod position and has significant drooling. The mother tells you that her daughter was fine when
the child went to bed at 9 pm last night, and that she awoke approximately 20 minutes ago complaining of not be-
ing able to breathe.

Prearrival Questions
1. What are potential causes for respiratory distress in children of this age group?
2. Based on your initial observations, is this child at risk for a potential airway obstruction?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 6-year-old girl in recliner

Assessment Questions
3. Why is the patient drooling?
4. Should you attempt to visualize the airway? Why or why not?

Level of consciousness Responsive

Chief complaint Can’t swallow
Airway Open; audible wheezing heard; significant drooling
present
Breathing 38 breaths/min
Symmetrical rise and fall of the chest
Circulation Radial pulses strong and equal
Skin color, temperature, and condition Pink, hot, and diaphoretic
Control of major bleeding None
Transport decision Load and go
Initial interventions Oxygen via nonrebreathing mask at 15 L/min, hu-
midified if possible
Baseline vital signs Blood pressure—104/62 mm Hg
Pulse—128 beats/min
Respirations—38 breaths/min
SaO2—92% on room air
SAMPLE history S—Patient has a temperature of 103.4°F, is drooling,
and has throat pain
A—Augmentin
M—Acetaminophen for pain and fever
P—None
L—Dinner last night
E—Sleeping

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48 EMT-Basic Pediatric Emergencies | Epiglottitis

OPQRST O—Approximately 20 minutes prior to your arrival

P—Sitting forward makes it easier to breathe
Q—Not applicable
R—Not applicable
S—Moderate distress
T—Approximately 20 minutes

Management Questions
5. What are your treatment priorities at this time?
6. If you do not have an oxygen humidifier available in your truck, how can you still deliver humidified oxy-
gen?

Treatment Initial oxygenation at 15 L/min.

Place the patient on a stretcher in a position of
comfort.
Do not look in the mouth for any reason.
Reassess vital signs.
Observe for increasing signs of respiratory distress.
Response to treatment Patient does not change.
Ongoing assessment Mental status does not change; airway and breathing
seem better with the oxygen.
Blood pressure—110/66 mm Hg
Pulse—128 beats/min
Respirations—38 breaths/min
SaO2—95% on 15 L/min oxygen via nonrebreathing
mask

Conclusion: ALS transport arrives and assists you with transport. The child is allowed to remain on her moth-
er’s lap in a position of comfort to keep her calm and help maintain her airway. Because of your accurate assess-
ment and prior notification of your arrival, a pediatric intensive care physician is awaiting your arrival. The child
is diagnosed with epiglottitis and admitted to the pediatric intensive care unit for further care.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

49 EMT-Basic Pediatric Emergencies | Airway Obstruction

■■ Pediatric Emergencies

Airway Obstruction
Scenario: You are called to a home for a child choking. You arrive to find a 4-year-old girl coughing weakly. She is
exhibiting stridor, pale, and has cyanotic lips and nail beds. The babysitter is frantic and tells you that the child
was fine until approximately 5 minutes ago, when she was last seen playing with her Barbie dolls in the bedroom.

Prearrival Question
1. Based on the initial observations and information, does the patient have an incomplete or complete airway
obstruction?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-spine stabilization No
General impression 4-year-old girl with difficulty breathing

Assessment Question
2. What type of assessment should you perform?

Level of consciousness Responsive but unable to speak

Chief complaint Choking
Airway Partially obstructed
Breathing Weak cough heard
Circulation Weak radial pulses
Skin color, temperature, and condition Pale and cool, with cyanotic nail beds and lips
Control of major bleeding None
Transport decision Load and go
Initial interventions Abdominal thrusts until the object comes out or the
child becomes unconscious
Baseline vital signs Blood pressure—80/48 mm Hg
Pulse—124 beats/min
Respirations—26 gasping breaths/min
SaO2—83% on room air
SAMPLE history S—Pale, cool, cyanotic; obvious obstruction
A—None
M—None
P—None
L—Lunch 2 hours ago
E—Playing with toys
OPQRST O—Approximately 5 minutes prior to your arrival
P—Not applicable
Q–Not applicable
R—Not applicable
S—Severe airway obstruction
T—Approximately 5 minutes

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50 EMT-Basic Pediatric Emergencies | Airway Obstruction

Management Question
3. When is it appropriate to reach into a choking patient’s mouth?

Treatment Continued abdominal thrusts

Response to treatment The child coughs up a toy shoe from one of her
Barbie dolls. She immediately starts to cry and asks
for her mother. You place her on the stretcher in a
position of comfort, await ALS arrival, and have the
mother contacted.
Ongoing assessment Mental status is maintained; the airway is open; and
the child’s color is pinking.
Blood pressure—82/54 mm Hg
Pulse—96 beats/min
Respirations—16 breaths/min
SaO2—98% on 5 L/min blow-by via nasal cannula

Conclusion: The child is transported without incident to the emergency department, where she is met by her
mother. She is evaluated and admitted to the pediatric floor overnight for observation.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com

51 EMT-Basic Pediatric Emergencies | Infant Resuscitation

■■ Pediatric Emergencies

Infant Resuscitation
Scenario: You are called to a home for a 4-month-old infant who is not breathing. You are met at the front door by
a hysterical grandmother holding a pale and limp baby boy in her arms. Law enforcement is en route to the scene.

Prearrival Questions
1. How might this call affect you personally?
2. What are potential causes of cardiopulmonary arrest in an infant?

Scene safe Yes

Body substance isolation Gloves, eyewear
Nature of illness Respiratory
Number of patients One
Additional help Dispatched—ALS
C-Spine stabilization No
General impression Pale and cyanotic 4-month-old boy

Assessment Questions
3. What signs and symptoms would point toward sudden infant death syndrome (SIDS)?
4. What signs and symptoms would point toward child abuse?
5. Is this considered a crime scene?

Level of consciousness Unresponsive

Chief complaint Not breathing; no heartbeat
Airway Open, with secretions coming from the mouth
Breathing None
Circulation No pulse
Skin color, temperature, and condition Pale, cyanotic, cool, and dry
Control of major bleeding None
Transport decision High priority
Initial interventions Oxygen via bag-mask device with oropharyngeal
airway; CPR
Baseline vital signs Blood pressure—0/0 mm Hg
Pulse—0 beats/min
Respirations—0 breaths/min
SaO2—No reading
SAMPLE history S—Coldlike symptoms for a few days, with large
amounts of mucus from nose
A—NKA
M—Acetaminophen for fever, saline drops for mucus
P—None
L—Dinner last night (no appetite)
E—Lying in crib
OPQRST O—Unknown
P—Not applicable
Q—Not applicable
R—Not applicable
S—Not applicable
T—Unknown

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52 EMT-Basic Pediatric Emergencies | Infant Resuscitation

Management Questions
6. Is it appropriate to terminate resuscitation efforts on scene?
7. What can you do to assist the family?

Treatment Continue CPR with ventilations until ALS arrives.

Response to treatment No change in condition.
Ongoing assessment Blood pressure—0/0 mm Hg
Pulse—0 beats/min
Respirations—0 breaths/min
SaO2—No reading

Conclusion: ALS and law enforcement arrive 2 minutes after you. The paramedic performs a rapid assessment
of the infant as he brings him to the truck. Per local protocol, resuscitation efforts must continue until arrival at
the hospital. Resuscitation is continued for a brief period at the hospital. Social services and pastoral support are
notified and are available to meet with the parents when they get to the hospital.

© 2009 Jones and Bartlett Publishers, LLC. www.jbpub.com