Medical and Obstetrics/​Gynecology Study Guide for the EMT Test

Pharmacology

Pharmacology refers to ingredients, preparation, and actions of various medications in the body. Understanding the basics, such as how medications are administered, is a top priority for paramedics and EMTs.

How Medicines Work

Medications are used to reduce pain and treat and prevent illness and infection. The specifics of how a medication works varies, based on the drug. In general, a medication binds with receptor cells in different parts of the body to cause a certain effect, such as increased heart rate or to block an effect, such as pain. The dose of a medication is how much is given and the therapeutic effect is the desired action the medication has on the body. Medications also often have unwanted effects, referred to as side effects.

Medication Names

Medications may be referred to by their generic name or brand name. When documenting a generic name, the medication does not have to be capitalized. The brand name (or trade name) is the name the manufacturer gave to the medication and should be capitalized. For example, ibuprofen is the generic name, and Advil® is the brand name of the same drug. Medication is also classified as either over the counter, which means it can be purchased without a prescription, or prescription medication, which requires a doctor’s order.

Administration Routes

Medications may be administered using different routes. Oral administration is one of the most common routes and may include pills or liquids. Medications may also be administered through an injection either under the skin or in the muscle. Respiratory medications are often administered through inhalation. Additional routes of administration include sublingual, which is under the tongue, rectal, and transcutaneous (or transdermal), which is through the skin.

Medication Forms

Medication comes in different forms. In some cases, the same medication may be available in different forms. Common forms of medication include liquid, tablets, and capsules. Medications also come in the form of a solution, which can be administered through an injection or through an IV. Medication may also come in gels, lotions, creams, patches, and gases.

The Administration Process

Paramedics and EMTs should only administer medication that is in their scope of practice and allowed by their medical control. When administering medications, it’s essential to follow a specific process to avoid mistakes. This is referred to as the Six Rights of Medication Administration: making sure you have the right patient, right medication, right dose, right route, right time, and right documentation. Failure to verify one of these factors can result in a medication error and have potentially life-threatening consequences.

Medication Administration by an EMT

Medications administered by EMTs and paramedics typically include oxygen, which is administered as a gas, oral glucose, aspirin, as well as epinephrine and activated charcoal. EMTs may also assist a patient to deliver a metered dose inhaler.

Errors in Medication

There are different types of medication errors, including giving the wrong dose or administering the medication through an incorrect route. There are also two classifications of errors: administration errors and knowledge-based errors. Administration errors may include giving a medication that is not in your scope of practice. Knowledge-based errors may involve giving the wrong medication for the patient’s condition. If an error does occur, it’s essential to be truthful about the situation. Provide any medical care the patient may need to prevent adverse reactions from the medication. Call medical control and inform them of the mistake. Also, follow your agency’s policy to report and document the medication error.

Terms/Concepts to Know: metered dose inhalers, nebulizer, epinephrine, nitroglycerin, absorption

Toxicology

Toxicology involves studying toxic substances. EMTs and paramedics may encounter patients who have been exposed to, or ingested, a poison.

Identifying the Patient

Recognizing the fact the patient has either been exposed to a toxin or has been poisoned is the first step in treating the problem. Since people who have been poisoned may develop symptoms that also occur in various medical illnesses, it’s essential to assess the patient thoroughly.

Type of Poisons

Poisons and toxins can enter the body in different ways. There are many types of poisons and toxins, including gases, liquids, and solids. Poisons can also enter the body in other ways. For example, poison can be ingested, absorbed, injected, and inhaled. The most frequent route of poisoning is through ingestion.

Assessing the Patient

Assess the scene for safety and make sure toxic substances do not present any danger to you or other personnel. Poisonings can cause life-threatening situations, so your primary assessment should focus on the airway, breathing, and circulation. Taking a history is vital to determine when the poisoning occurred and to rule out other problems. A secondary assessment should include vital signs and a rapid exam to check for non-life-threatening signs of poisoning. Depending on the type of poison, a patient’s condition can change quickly. Reassessment should be ongoing.

Emergency Care in Case of Poisoning

Emergency care for poisoning should focus on providing support until the patient gets to the hospital. Antidotes and additional treatment will probably need to be administered in a hospital setting. Emergency care should include airway support and close monitoring.

Specific Poisons

Although they are not thought of as poisons, alcohol and drugs can act as poisons to the body, leading to adverse effects. Opioids and synthetic street drugs can decrease the respiratory system function and lead to respiratory and cardiac arrest. Inhaled chemicals, used to get “high,” such as those contained in paint thinners and cleaning products, are also considered poisonous and can cause cardiac complications.

Food Poisoning

Food poisoning is a common condition you may encounter on the job. Symptoms may include vomiting, stomach cramps, diarrhea, and fever. There are numerous types of bacteria that can cause food poisoning, including Staphylococcus, Escherichia coli, and Salmonella. Symptoms may start anywhere from 2 to 12 hours after eating the contaminated food.

Plant Poisoning

Plant poisoning can occur, especially in children. Many types of household plants are poisonous if they are eaten, and young children often put things in their mouths. Plant poisoning can cause a variety of symptoms, from a skin rash to life-threatening respiratory and circulatory conditions. If possible, try to determine what type of plant the patient may have ingested in order to inform the hospital staff.

Terms/Concepts to Know: Safety Data Sheet, antidote, hematemesis, toxin, poison

Psychiatric Emergencies

Psychiatric emergencies can include life-threatening situations, including suicide attempts. Extreme emotional and behavioral crises can also develop, requiring medical assistance.

Mental Illness vs. Emotional Crisis

A mental illness is a condition that affects a person’s thinking, behavior, and mood. Examples of mental illnesses include bipolar disorder and depression. An emotional crisis can involve an intense emotional reaction. The individual may or may not have an underlying mental illness. Both conditions may interfere with a person’s ability to function normally.

Behavioral Crisis

A behavioral crisis involves a person’s reaction to a situation or event. The reaction is so intense that it affects the person’s ability to function normally. A person having a behavioral crisis may exhibit aggression and agitation and may be uncooperative. In some situations, behavior can become bizarre and they may be a threat to themselves or others.

Pathophysiology

Two classifications may be used to describe behavioral crisis or psychiatric emergencies: organic and functional. Organic psychiatric conditions have a physical cause. They occur due to a disturbance of brain tissue. A functional disorder occurs when there is a disturbance in the person’s functioning, but a physical cause cannot be found.

Safe Approach

People who are experiencing a psychiatric emergency can be unpredictable. Using an approach that helps the patient feel safe and not threatened is vital. Start by identifying yourself and being direct. Use clear language and keep a safe distance. Be honest and reassuring to create a calm atmosphere. Do not argue with the patient or do anything that will escalate the situation.

Patient Assessment

When doing your scene size-up on a psychiatric emergency, determine if you need law enforcement backup. During your primary assessment, explain everything you are going to do to avoid agitating the patient. It may not be possible to get an accurate history. If family members are present, they may be able to help. Complete a secondary assessment by closely observing the patient. Reassessment should include monitoring the patient for a change in status, such as increased agitation.

Acute Psychosis

Acute psychosis is characterized by delusional behavior. A person who has acute psychosis is out of touch with reality. They may see or hear things that are not real. There are different causes of acute psychosis, including drug use, mental illness, such as schizophrenia, and extreme stress.

Excited Delirium

Excited delirium is characterized by impaired cognitive function. Some people may have hallucinations and be disoriented. Since the patient may experience hallucinations, they may become paranoid, which can create a potentially unsafe situation. Physical symptoms may include sweating, increased heart rate, and dilated pupils.

Restraint

There may be some situations in which a patient is a danger to themselves or others that necessitate the use of restraints. Restraints should only be used if there is a potential for injury to EMS, the patient, or bystanders. The restraint protocol varies among EMS agencies. Be sure to keep your safety in mind when using restraints and always follow your agency’s protocols.

Potential Violence

Occasionally, an EMT will encounter a violent patient. To assess the risk of danger, try to determine if the patient has a history of violence. Assess his/her body language, looking for signs of physical tension and aggression. Consider the type of speech or language the person is using, such as shouting. Also, be aware of your surroundings and determine if there is anything near the patient that could be used as a weapon. Always use extreme caution if you think there is potential for violence and get law enforcement involved, if needed.

Suicide

Suicide is a possibility when an EMT encounters a person who is having an emotional crisis. If the patient threatens suicide, take it seriously. Signs a person may be suicidal include being tearful and expressing signs of hopelessness. A flat affect and an inability to make eye contact are also signs the person is experiencing despair. Approach the patient in a calm manner and call law enforcement for backup.

PTSD

Post-traumatic stress disorder (PTSD) can develop after experiencing an extremely stressful situation or event, such as a car accident, assault, or natural disaster. People with PTSD may be unpredictable and can become angry quickly. Signs of PTSD include anxiety, fear, and an exaggerated startle response. When dealing with a patient with PTSD, always explain everything you are going to do in advance. Do not touch the patient without asking and maintain a calm and reassuring manner.

Legal Issues

When a patient is mentally incompetent, there are some legal considerations. Patients who are mentally unstable cannot give consent for medical care. If a patient is not mentally competent, law enforcement may place the person in protective custody, which allows you to provide treatment. In situations where mental competency is a consideration, always have law enforcement involved.

Terms/Concepts to Know: acute psychosis, schizophrenia, organic brain syndrome, excited delirium, post-traumatic stress disorder (PTSD)