FINAL PARAMEDIC FISDAP COMPLETE STUDY GUIDE
Final Paramedic Fisdap Study Guide
Ems Operations - Page 1
OB/Gynecology - Page 11
Pediatrics - Page
... [Show More] 20
Airway - Page 30
Medical Emergencies - Page 39
Trauma - Page
Cardiology - Page - Page 54
EMS OPERATIONS
1. Airbags Safety During Extrication (2228)
• Un-deployed airbags may deploy during extrication and cause harm to the patients and
rescuers.
• Look for airbag badging or labeling system
• A vehicles airbags system comes equipped with an energy capacitor that can store power for
up to 30 mins in some models
• Remove key from ignition
4. Criteria for Transferring Care of Patient (154)
• In your documentation of care, it is important that you were able to show in whose care you
left the patient with, otherwise you could face allegations of abandonment. some agencies
have begun to require physician or nurse signatures to verify that the patient was left with a
medical professional of a higher level of training. Another situation that may require you to
document a transfer of care is when you hand over your patient to another agency such as a
paramedic transport crew or an air medical team.
5. Decontamination of Airway Equipment
• Sanitize and disinfect everything after a call
• Any piece of equipment that is intended for single use should be discarded in an appropriate
hazardous materials bag. For any reusable piece of equipment that has had direct contact
with the patient or patients bodily fluids, use a commercial disinfecting agent for
decontamination. Bleach diluted in water (1:10) can also be used as disinfecting agent.
6. Documenting Medication Administration (471)
• Documentation is everything, if you did not document it, you didn’t do it. Always document
your actions and the patients response on the on the patient care report after administering a
medication. This includes...
- Name
- Dose
- Time
- Route
- Persons name who administered it
- Patients response to the medication, whether positive or negative
7. Indications for N95 Mask
• 95 (Heppa) Mask on you, surgical or normal mask on patient
8. Indications for Rapid Extrication (1677-1699) (2226)
• Patient can be moved from sitting in a car to laying supine on a backboard in 2 mins.
Indications listed below
- The vehicle or scene is unsafe
- The patient cannot be properly assessed before being removed from the car
- The patient needs immediate intervention that requires a supine position
- The patients condition requires immediate transport to the hospital
- The patient blocks your access to another seriously injured patient
• A team member should remain with the patient to direct the rescuers who are preforming the
disentanglement. For example, unless there is an immediate threat to fire, explosion, or other
danger, you should preform a primary assessment and perform and critical interventions
before disentanglement begins. This may include providing c-spine immobilization, opening
airway, providing O2, ventilations, or controlling significant bleeding. Once life threats have
been treated, disentanglement can begin. Sometimes a patient must be removed quickly
(Rapid extrication) because his or her general condition is deteriorating and time does not
permit meticulous splinting and dressing procedures. Quick removal may also occur if hazards
are present, such as as spilled gas or other materials that could endanger the patient or
rescue personnel. The only time the patient should be moved prior to completion of initial
care, assessment, stabilization, and treatment is when the patient’s or emergency responders
life is in immediate danger.
10. Making Decisions Regarding a Patients Request to Refuse Care (96-99)
• Patients with decision-making capacity have the right to refuse all or part of the emergency
medical care offered to them
• Refusing care - Needs to be informed consent.
• Need to use your “People skills” and just talk to the patient
· Ensure your pt is fully informed about their current situation, his or her right to
receive or refuse medical care, and the consequences of a refusal of care
· Unresponsive patients may be treated under implied consent
· Involve online medical control if pt have severe injuries but refusing care
· Document carefully and have pt sign AMA
Minors - Because minors have no legal status, they can neither refuse no consent to medical
care. In the case of children and adults who have legal guardians, consent must be obtained, if
possible, from a parent or legal guardian of the patient. If the parent or guardian is not available,
emergency treatment to sustain life may be undertaken without direct consent under the
doctrine of implied consent. You should also be aware of the legal principle known as “In loco
parentis”. This term literally means “In place of the parent”. This principle may apply in school,
day care, or summer camp situations if a parent is unavailable. The school administrator or day
care director may make treatment and transportation decisions on behalf of the minor.
A particularly difficult circumstance can arise if a parent or legal guardian refuses to grant
consent to treat a minor who clearly requires lifesaving or limb-saving treatment. Although adults
clearly have the right to refuse treatment for themselves, state laws generally do not permit a
parent or guardian to deny treatment to a minor child. In fact, the failure of a parent to allow
such treatment may constitute neglect. When confronted with such a circumstance, the
paramedic should notify law enforcement and medical control. State law may permit the state to
assume custody of the child for purpose of ensuring that necessary emergency treatment be
provided.
Emancipated Minors - are under legal age in a given state but can be treated as legal adults
because certain circumstances. By court order. Marriage, pregnancy, or active military service.
They can accept or deny care.
12. Operations within a HazMat Scene
Responding to Hazmat incidents
· Look for warning signs such as patient S/S, placards, labels, etc.
· Placards or labels may be found on building, trucks/railway cars, drums/storage
vessels
· Intentional ingestion of chemicals and activities occurring at illicit labs or potential
terrorist activities may have no obvious signs
· Some chemicals are odorized (propane, methane) where other dangerous
substances are odorless (carbon monoxide)
· If you approach a scene where more than one person has collapsed due to
respiratory distress, suspect the presence had a hazardous material
· When arriving, you should stop at a safe distance, uphill and upwind from the scene
· Items to report include:
o Exact location
o Atmosphereic conditions
o Size/shape of containers
o Chemical ID number or symbols
o # of victims with S/S
o Type and number of additional resources
18. Stress Management (42-43)
• Fight or flight mode S/S - heart palpitations, rapid breathing, chest tightness, sweating, rapid
breathing, unnecessary shouting.
1. Control breathing
2. Progressive Relaxation - tighten/relax muscle groups to initiate muscle relaxation throughout
the body. Stupid.
3. Professional Assistance - Seek therapist
• Focus on immediate situations while on duty, remind yourself “I will do my very best, but what i
can do may not be enough”
• Avoid excessive amounts of stimulants such as caffeine or alcohol, cigs, or sleeping aids after
a stressful event.
• Stages of Stress
· Acute reaction – occurs during stressful situations
· Delayed reaction – manifests after stressful situations
· Cumulative reaction – when you are exposed to prolonged/excessive stress
19. Treating a Patient with Advance Directives
An advance directive is usually a written document (but can be also an oral statement) that
expresses the wants, needs, and desires of a patient in reference to his o her future medical
care. Advance directives state what medical care the patient wants or does not want when the
patient is unable to express his or her wishes. Living wills, DNR’s, and organ donation orders
are all advance directives. DNR’s can also be called Resuscitation Directive
Living Wills and Health Care Power of Attorney are types of advance directives in which a
patient can express wishes regarding end-of-life medical care. These directives are sometimes
called health care “durable” power of attorneys because they remain in effect once a patient
loses “decision making capacity”. The person who carries the Health Care Power of Attorney is
often called the “Surrogate Decision Maker”. They are legally obligated to make decisions as the
patient would want, and has presumably discussed these decisions with the patient. It is
important to keep in mind that the “Surrogate Decision Maker” has no authority until the patient
becomes incapable of making decisions. If the “Surrogate Decision Maker” is attempting to
make decisions that conflict with a competent patients decisions, the patients decisions are
always the ones to be followed.
20. Treating a Violent Patient (99/100)
• May restrain a violent patient to protect you/crew and as well as the patient
• Under the law, you are only able to use force if the patient attacks you. You may defend
yourself.
• Contact Law Enforcement if patient becomes uncooperative and or has weapons.
• Violence can be the result of hypoxia, hypoglycemia, mental illness, brain injury, drug abuse/
OD, or alcohol use, and psych problems.
• Protocol dependent - however, some agencies let EMS personal use “Chemical Restraints”
such a benzodiazepines or antipsychotics to calm patients who are violent and need
transportation to hospital.
• If scene is not safe - contact Law enforcement and go back to ambulance like a lil bitch boy
you are
• Bullet proof vests?
• Always be aware of your surrounding
• Soft restraints while transporting if needed
•
OB/GYNECOLOGY
1. Complications Associated with Pregnancy Induced Hypotension (1931)
• When a Pregnant females uterus compresses the Inferior Vena Cava, venous blood return to
the heart is diminished or occluded.
• Occurs when the women is Supine, or sometimes when she is sitting
• Usually in the 3rd Trimester
• Can lead to fetal distress
• Generally takes 3-7 minutes of Compression before S/S occur
• Early S/S - Nausea, Dizziness, Tachycardia, Claustrophobia
• Late S/S - Diff Breathing, Syncopal Episodes, Hypovolemia from either blood loss or
dehydration.
• Treatment - Placing patient in the left lateral recumbent position - tilting backboard and
treating underlying causes (Fluids if hypovolemic) and monitoring VS such as BP/EKG
2. Complications associated with pregnancy induced hypertension (PIH): (1931)
Chronic HTN: BP that is equal to or Greater than 140/90mm Hg prior to 20th week.
(Diastolic >110mmHg = increased risk for stroke or Cardiovascular disorders)
Pregnancy Induced Hypertension: Develops after the 20th week and resolves postpartum.
(Early sign of Preeclampsia)
2. Identifying a Patient with Braxton Hicks Contractions (1930)
• Known as “False Labor”
• Intermittent Uterine Contractions that may occur every 10-20 mins
• Usually seen in the 3rd Trimester
• No way to actually tell if it is a miscarriage or another complication of pregnancy, the patient
needs to be transported.
3. Identifying and Treating a Nuchal Cord
Nuchal Cord: Umbilical cord becomes wrapped around the newborn’s neck.
Tx: 1. Slip cord over head with one gloved finger.
2. If unsuccessful or cored is wrapped multiple times - clamp and cut cord
4. Identifying and Treating a Patient with Eclampsia (1931/1932)
• Exist when patient experiences a seizure seizure as a result of the severe hypertension. A
systolic pressure exceeding 160 to 180mm Hg and diastolic pressure exceeding 105mm Hg,
in the presence of these other risk factors, may require administration of hypertensive meds.
• Risk Factors - Liver or renal failure, Cerebral Hemorrhage, Placenta Abruption, Younger than
20 or older than 35, Poor Diet, First time Pregnancy, HELLP Syndrome -
• S/S - Seizures, Loss of consciousness, Agitation, Headaches or muscles pain, RUQ pain,
Visual disturbances.
• Causes - Develops from preeclampsia, Develops after 20th week, Proteinuria, Hypertension
• TX - Anticonvulsant med - Mag Sulfate 1-4g in 50-100mL NS IVP/IVPB over 5 mins. Transport
to Hospital
5. Identifying and Treating a Patient with Postpartum Bleeding
• Early postpartum hemorrhage is bleeding within 24 hours of delivery and is the most common.
• Late postpartum hemorrhaging: 24 hr to 6 weeks after delivery
• Average Blood Loss is 150mL
>500mL during first 24hrs considered postpartum hemorrhaging.
Causes: 1. Lacerations or tears around vagina or perineum
! ! 2. Prolong labor or multiple deliveries
! ! 3. Retained products of conception
! ! 4. Uterus loses ability to contract
! ! 5. Placenta Previa
! ! 6. Full Bladder-may prevent placenta separation
Tx:! ! 1. Continue Fundal massage
! ! 2. Encourage Breast Feeding
! ! 3. Oxytocin (Pitocin): 10 Units in 1000mL NS @ rate 20-30 mL/min
! ! 4. Advise Receiving Hospital
! ! 5. Establish 2nd IV
! ! 6. Manage bleeding from external only
6. Postpartum Complications (1950-1951)
• Postpartum Hemorrhage (See above)
• Postpartum Depression - Also called the “Baby Blues” Is the most common pregnancy
complication. S/S of this disorder can appear any time during pregnancy and up to 1 year after
birth.
• Risk Factors - Adolescent mothers and those in lower income levels have an increased
chance of this condition, Previous history of depression or family history; financial or marital/
relationship issues; diabetes; a complicated pregnancy or delivery, major life-changing events,
• S/S - Depression, lack of interest to care for themselves, insomnia to sleeping all the time,
sadness and crying, lack of apatite. Sometimes strong anger to themselves and infants.
7. S/S of a Patient with a Spontaneous Abortion (1936)
• Abortion is defined as “Expulsion of the fetus from any cause before the 20th week of
gestation
• Most abortions occur during the 1st trimester, before the placenta is fully mature
• Also known as “Miscarriage”
• Abdominal cramping with vaginal bleeding 8 weeks pregnant
• Bleeding usually before pain
• Causes:
- Acute or chronic illness in the pregnant women
- Maternal exposure to toxic substances (Drugs)
- Abnormalities in the fetus
- Abnormal attachment of the placenta
Elective Abortion
• Brought on intentionally
• Women may try to export the fetus by traumatic ways or “Self-Medicate” - Making it too toxic
for the fetus
Habitual Abortion
• Defined as 3 or more consecutive pregnancies that end in abortion
• Causes: Chromosomal and Endocrine disorders, Ovarian Issues, Uterine malformations,
Cervical conditions (Incompetence), Infections, and lifestyle factors.
Threatened Abortion
• Is an abortion that is attempting to take place
• Characterized by - Vaginal Bleeding during the first half of pregnancy - usually in the 1st
Trimester
• S/S: Abdominal discomfort, or menstrual cramps
• Severe pain is rarely a presenting complaint because uterine contractions are not rhythmic.
• Threatened Abortion can progress to an Incomplete Abortion, or it may subside, allowing the
pregnancy go to term.
• TX: Bed rest, often in a hospital environment, so women's condition can be monitored.
Provide emotional support.
Imminent Abortion
• Is a Spontaneous Abortion that cannot be prevented
• S/S: Severe abdominal pain caused by strong uterine contractions, Vaginal bleeding (often
massive), as well as cervical dilation because the uterus is preparing to expel the production
of conception.
• TX: Maintain BP and prevent hypovolemia, IV, 100% O2, EKG, and Emotional support, Be
alert for S/S of shock
Incomplete Abortion
• Occurs when part of the products of conception are expelled but some remain in the uterus.
(For example, the fetus is expelled but the placenta remains, or only part of the fetus is
expelled)
• S/S: Vaginal Bleeding (slight or profuse) but will be continuous, Be alert for S/S of shock
• If products of conception are protruding from the vagina, call medical control for instructions;
gentle removal of protruding tissues may prevent or relive signs of shock.
• You will most often encounter this situation when the patient is on the toilet trying to have a
bowel movement, with the fetus in the toilet still attached to the umbilical cord hanging from
the vagina. The fetus should be gently collected, and emotional support is provided. Fundal
massage is a good idea.
Complete Abortion
• Occurs when all the products of conception have been expelled
Missed Abortion
• Fetus Dies during the first 20 weeks of gestation, but remains in utero.
• S/S: Typical history will be a cessation of vaginal bleeding followed by a gradual diminishing of
the signs of pregnancy, such as uterine and breast enlargement. Women may also report
having had a brownish vaginal discharge, and rank smell. Uterus will feel like a hard mass and
fetal heart sounds cannot be heard.
• Usually occurs before a spontaneous abortion
Septic Abortion
• Was once the leading cause of maternal death worldwide.
• Complication was puerperal fever, which was caused by a streptococcal infection of the
genital tract. - fixed by washing hands between patients.
• Occurs when the uterus becomes infected often by common vaginal bacterial flora-following
any type of abortion.
• Women will generally give a history of fever and bad-smelling vaginal discharge, usually
starting within a few hours of abortion.
• Fever and abdominal tenderness and possible septic shock
8. S/S of a Patient with Abruptio Placenta (1937-1938)
• PAINFUL - Refers to a premature separation of a normally implanted placenta from the wall of
the uterus. Commonly occurs in the 3rd trimester of pregnancy, but may occur in the 2nd as
well. Incidence is greater among multiparous women and those who have previously
experienced Abruptio Placenta. Dark Blood?
• S/S:
• Vaginal Bleeding
• Bright Red Blood, However no blood may be present, may remain concealed within the
endometrium
• Sudden Onset of Severe Abdominal Pain
• May report that she no longer feels the fetus moving inside her
• Physical Findings mays revel signs of shock, often due to volume loss
• Tender Abdomen, rigid rigid upon palpation
• Fetal heart sounds are often absent because the fetus, being partly or completely cut off from
its blood supply, is likely to die.
• Severe Hemorrhaging
• If hemorrhaging cannot be controlled after delivery, a hysterectomy may be necessary
TX/Assessment:
• Look for a positive Grey Turners Sign or Cullen Signs (Bruising on Flanks/near Umbillicus)
can help correlate the presence of internal bleeding
• Keep PT recumbent, lying on her left side
• Administer 100% O2 NRB 15LPM
• Rapid Transport to definitive Care Hospital Facility
• Large Bore IV, Infuse NS at a necessary rate to maintain BP
• Obtain EKG and Baseline Vitals
• Use Loosely placed trauma pads over vagina in effort to stop blood flow
9. S/S of a Patient with an Ovarian Cyst (1197)
• Fluid filled sacs that form in ovaries
• The cyst holds the oocytes
• Once an oocyte matures, the sac breaks open and released the oocyte, which then begins its
journey through the fallopian tube for fertilization; the sac itself desolves.
• S/S: May report dull, achy pain in the lower back and thighs, abdominal pain or pressure, N/V,
breast tenderness, abdominal bleeding and painful menstruation, and painful intercourse.
• A Ruptured Ovarian Cyst usually presents with a sudden onset of abdominal pain and can be
related to the menstrual cycle. Can lead to shock from internal bleeding and infection. S/S
include - lower abdominal pain (described as sharp), abdominal distention and tenderness,
dizziness, weakness, or possible syncopal episodes.
10. S/S of a Patient with Placenta Previa (1938)
PAINLESS - The Placenta is implanted low in the uterus and, as it grows, it partially or fully
obscures the cervical canal. This condition is the leading cause of vaginal bleeding in the 2nd
and 3rd trimesters of pregnancy, with the majority of problems occurring near term because the
cervix begins to dilate in preparation for delivery. Occurring after the 7th month (3rd Trimester)
Risk Factors:
• Maternal Age
• Multiparity
Complications:
• Disseminated Intravascular Coagulation
• Hemorrhage
• Low Fetal Birth Weight
S/S:
• Women will complain with C/C of Painless Vaginal Bleeding With Loss of Bright Red Blood
• On gentle palpation, the uterus is soft and non-tender
• Because the blood supply to fetus is not immediately jeopardized, Fetal movements and heart
sounds remain present
• May have spotting or recurrent hemorrhage
• TX: - Same as Abruptio placenta
11. S/S of a Patient with Pregnancy Induced Hypertension
Pregnancy Induced Hypertension: Develops after the 20th week and resolves
postpartum. (Early sign of Preeclampsia)
S/S: Symptoms (similar to preeclampsia)
▪ Edema
▪ Sudden weight gain
▪ Blurred vision or sensitivity to light
▪ Nausea and vomiting
▪ Persistent headaches
▪ Increased blood pressure
12. S/S of Abnormal Pregnancy
Abruptio Placenta:
Pregnancy Induced Hypertension:
Signs and symptoms of a patient with a spontaneous abortion: (aka: Miscarriage):
Placenta Previa:
Preeclampsia:
Eclampsia:
All Different types of abortions:
12. S/S of a STD
Bacterial Vaginosis - normal bacteria in vagina are replaced by overgrowth of other bacteria.
S/S: - Itching, Burning, Pain, Foul-Smelling Discharge (May lead to PID if left untreated)
Candidiasis - (aka:thrush or yeast infection) transmitted sexually
Chlamydia - Infection of the Cervix that can spread to the rectum
S/S: - Lower Abdominal/Back Pain, Nausea, Fever, Painful Intercourse, Bleeding between
periods, Rectal pain with discharge or bleeding , (May lead to PID if left untreated)
Gonorrhea - Bacteria that multiplies rapidly in the moist reproductive tract or in mouth, throat,
eyes, or anus.
S/S: - May be asymptomatic for months, but may appear in 2-10 days, Dysuria (painful
urination), Yellow or bloody vaginal discharge, Bleeding with intercourse
More Severe Infections S/S: Cramping, Abdominal Pain, N/V, Bleeding btw periods, Anal
Discharge with painful BM.
Human Papilloma Virus (HPV)- Genital Warts
S/S: May be asymptomatic
Growth to the genital area
May be passed to fetus and be fatal
Syphilis- STD infection divided into 3 stages
Stage 1 or Primary: Marked by a single sore, painless, small, and firm
goes away in 3-6 weeks
Stage 2 or Secondary: Marked by mucus membrane lesions or skin rash.
Fever, Swollen Lymph Nodes, Sore Throat
Headaches Muscle Aches Fatigue
Hair Loss Weight Loss
Stage 3 or Late: No signs or symptoms, but attacks internally to
Brain Heart Blood Vessels
Nerves Liver Joints/Bones
S/S: Numbness/Paralysis Dementia
Gradual Blindness Difficulty with Muscle Movements
Death (may cause stillborn)
Trichomoniasis- caused by a single cell parasite transmitted sexually
S/S: May appear in 5-28 days
Frothy/Foul smelling yellow-green vaginal discharge
Vaginal Itching Lower Abdominal Pain
Dysuria Pain with intercourse
Toxoplasmosis- infection caused by a parasite from handling or eating contaminated
food; or exposure from handling cat liter.
S/S: May be asymptomatic
13. S/S of an Ectopic Pregnancy (1937)
• Life Threatening condition. A fertilized ovum becomes implanted somewhere other than the
uterus, 97% of the time in one of the fallopian tubes. Fetus will not develop to term. All the
normal S/S or pregnancy are usually present. All females of child-bearing age with severe,
lower abdominal pain should be considered as experiencing an ectopic pregnancy.
• With a tubal pregnancy, the fertilized oocyte implants in the fallopian tube, then begins to grow
and produce hormones in the same way a normal implanted oocyte does. The fallopian tube
can only stretch so far until the embryo gets too big and runs out of growing room. When this
occurs, the tube is likely to rupture, causing massive intra-abdominal hemorrhage and shock.
As the Pregnancy progresses, the embryo will abort or the tube will rupture.
• Causes/Risk Factors:
- Pelvic Inflammatory Disease most common
- Pelvic Surgeries
-Smoking
- IUD’s - (Do not cause ectopic pregnancy but, by blocking uterine pregnancy, may cause
fertilization to occur higher up)
- Fibroids
- Tumors
- Cysts in the tubes
- Fallopian Endometriosis
- Hormonal Imbalance
• Classic Triad -
1. Amenorrhea (Abnormal absence or Menstration)
2. Vaginal Bleeding
3. Abdominal Pain.
• History of Ectopic Pregnancy, IUD use, and PID also raise the index of suspicion.
• Women will complain of Abdominal Pain
• Severe lower abdominal pain, localized to one side of the abdomen. Early stages will be
described as crampy and irregular.
• May be in Hypovolemic Shock
• Severe abdominal pain to one side
• Diffuse pain may be caused by Hemoperitoneum (Blood in the Abdominal Cavity)
• Vaginal Bleeding [Show Less]