Patient Treatment and Transport Study Guide for the EMT Test

Musculoskeletal Management

Musculoskeletal injuries involve damage to bones, joints, or soft tissues such as muscles, tendons, and ligaments. The role of the EMT is to identify these injuries, prevent further harm, reduce pain, and support proper alignment/positioning. Management begins with assessment, looking for signs of deformity, swelling, bruising, pain, or limited movement. Always be sure to check for pulse, motor, and sensory (PMS) before and after any treatment. The goal of the EMT is to stabilize, protect, and comfort the patient. Management of these types of injuries can be provided in many ways, including immobilization, exposure, bleeding control, cold packs, and elevation.

Immobilization

Immobilizing the injury prevents further damage from occurring through gross motor movement. The most common type of immobilization for EMTs is splinting. A variety of splints may be utilized depending on what is made available to the EMT (rigid, soft, vacuum, or traction splints). Once the injury is immobilized in the position found, PMS should be assessed, and splints should be secured firmly but not tightly. PMS should be reassessed afterwards.

Bleeding Control

Any significant bleeding should be controlled by the most appropriate means, either direct pressure or tourniquet application. Once bleeding has stopped, cover wounds with sterile dressings in order to prevent infection.

Elevation

If no severe fracture with deformity is present, the injury should be elevated as much as possible to reduce swelling.

Medication and 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, meaning it can be purchased without a prescription, or prescription, 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 involve pills or liquids. Medications may also be administered through an injection either under the skin or in the muscle. Respiratory medications are often administered via 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 by injection or through an IV. Medication may also come in gels, lotions, creams, patches, and gases.

The Administration Process

Paramedics and EMTs should administer only medications within their scope of practice and which are authorized 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 /ASA, epinephrine, and activated charcoal. EMTs may also assist a patient to deliver a metered dose inhaler.

Special Considerations for Common Medications

ASA/Aspirin

Before giving medication, EMTs should check for reasons it might be unsafe for the patient. For example, with aspirin/ASA, some contraindications include a known allergy, active or suspected bleeding problems, and a history of stomach ulcers or gastrointestinal bleeding. In these cases, the findings should be reported and documented, and medication administration should follow protocols and medical direction.

Nitroglycerin

Before assisting a patient with nitroglycerin, the EMT should follow local protocols and requirements. Important safety checks include confirming that the medication belongs to the patient, checking the expiration date, and verifying that the patient’s condition meets requirements for use. Gloves should also be worn when handling the medication since it may be absorbed through the skin. The EMT should check for common safety concerns, including low systolic blood pressure, recent use of erectile dysfunction medications, head injury or increased intracranial pressure, and allergy to nitroglycerin. These findings may make nitroglycerin unsafe, so you should follow local protocols and medical directions. The maximum dose is generally 3 doses, allowing five minutes in between each.

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 to the medication. Call medical control and inform them of the mistake. Also, follow your agency’s policy to report and document the medication error.

Here are some terms to know:

• metered dose inhalers—handheld device that delivers a precise, pre-measured dose of medication in the form of an aerosol spray for the patient to inhale

• nebulizer—a device that turns liquid medication into a fine mist that the patient inhales through a mouthpiece or mask

• epinephrine—a medication and naturally occurring hormone that stimulates the body’s sympathetic response; most commonly used to treat severe allergic reactions by constricting blood vessels and relaxing airway muscles

• nitroglycerin—a medication used to relieve chest pain (angina) caused by the heart not getting enough oxygen; works by dilating the blood vessels, which reduces the hearts workload and improves blood flow to the heart muscle

• absorption—process by which a medication or substance enters the bloodstream after being taken into the body, which can occur through the skin, lungs, mouth, or digestive tract