Scheda di revisione: Basic Anatomy and Emergency Procedures

📋 Course Outline

1. Body planes and directional terms
2. Anatomic positions
3. Medical abbreviations
4. Prehospital shorthand practice
5. Myocardial infarction and stroke
6. Stroke scale and assessment
7. Scene assessment and trauma survey
8. Medication review and administration rights
9. Common EMS medications
10. START triage system
11. PCR requirements and documentation

📖 1. Body planes and directional terms

🔑 Key Concepts & Definitions

• Lateral : A directional term meaning away from the body’s middle line.
• Medial : A directional term meaning toward the body’s middle line.
• Superior : A directional term meaning above another structure.
• Inferior : A directional term meaning below another structure.
• Proximal : A directional term meaning nearer the point where an appendage joins the body.

📝 Essential Points

• Left is medial to the lateral side and superior is above while inferior is below.
• Anterior refers to the front and posterior refers to the back of the body.
• Midline is the nose-to-belly-button plane that bisects the body.
• Distal means farther from the point of attachment or at the end of a limb.
• Dorsal means the back and ventral means the front.
• Supine means face up and prone means face down.

💡 Memory Hook

Medial=Middle, Lateral=Leaves, Superior=Up, Inferior=InDown, Proximal=Where it attaches, Distal=Far end.

📖 2. Anatomic positions

🔑 Key Concepts & Definitions

• Supine position : Supine position is lying face up.
• Prone position : Prone position is lying face down.
• Fowlers position : Fowlers position is sitting with the head elevated.
• Trendelenburg position : Trendelenburg position is lying so the feet are higher than the head, used for shock positioning.

📝 Essential Points

• Fowlers is described as head elevated, which changes the body from flat supine to an upright angle.
• Trendelenburg is defined as feet higher than the head in a shock position.

💡 Memory Hook

Supine=“sub” (up at the back), Prone=“pro” (face down), Fowlers=“Fowl” upright head, Trendelenburg=“Trend” feet up.

📖 3. Medical abbreviations

🔑 Key Concepts & Definitions

• BP : Vital-sign abbreviation for blood pressure, written as a systolic/diastolic measurement like 180/90.
• bpm : Heart-rate abbreviation meaning beats per minute, used to record pulse frequency.
• SOB : Symptom abbreviation for shortness of breath, a patient complaint commonly paired with breathing difficulty.
• LOC : Neurologic-status abbreviation for loss of consciousness, indicating the patient became unresponsive to awareness.

📝 Essential Points

• NRB stands for non-rebreather, and it was referenced with flow rates in lpm such as 12 lpm or 15 lpm.
• PEARL means pupils are equal, round, and reactive to light, used to document pupillary findings.
• CMS x4 means circulation, motor, and sensation are present in all four extremities.
• A+O x 3 (or x 2) indicates alert and oriented to the specified number of domains.
• NKA means no known drug allergies and WNL means vital signs are within normal limits.

💡 Memory Hook

SOB and LOC go together as “breathing trouble + altered awareness,” while NRB + lpm tells you oxygen method and flow.

📖 4. Prehospital shorthand practice

🔑 Key Concepts & Definitions

• Face movement test : A stroke screening check that compares how well both sides of the face move.
• Arm drift test : A stroke screening check that looks for unequal arm movement when arms are held out for about 10 seconds.
• Speech test phrase : A stroke screening method using a simple familiar sentence to detect slurred or wrong words.
• Seizure first aid : A set of practical steps meant to protect the patient during a convulsion and support airway safety afterward.

📝 Essential Points

• Normal face movement is equal on both sides, while one-sided reduced or absent movement is abnormal.
• Normal arm result is both arms moving equally or not at all, while unequal motion or one arm drifting down is abnormal.
• Normal speech is correct words with no slurring, while slurred/inappropriate words or mute speech is abnormal.
• Hypoglycemia is low blood sugar, often seen in diabetics on insulin, starvation, or excessive alcohol intake.
• Seizure first aid includes moving the person from danger, not restraining, not inserting anything into the mouth, and using recovery position after convulsions cease.

💡 Memory Hook

FACE-ARM-SPEECH: equal face, equal arms, clear speech to spot stroke quickly.

📖 5. Myocardial infarction and stroke

🔑 Key Concepts & Definitions

• Cardiac chest pain : A heart-related symptom where the patient’s discomfort may be treated as an acute cardiac problem under EMS medication guidelines.
• Nitroglycerin : A cardiac medication used to relieve prescribed chest pain by relaxing blood vessels and reducing the heart’s workload.
• Aspirin (chewable) : A cardiac medication given by chew for non-traumatic chest pain when the patient has no listed contraindications.

📝 Essential Points

• Nitroglycerin is indicated for chest pain when tablets are prescribed for the patient.
• Nitroglycerin is contraindicated with hypotension or systolic BP below 120 mmHg.
• Aspirin (chewable) is contraindicated if the patient cannot chew or swallow, is allergic, has a bleeding disorder or ulcer, took it in the last 24 hours, is on anticoagulation therapy, or has an aortic aneurysm.
• Aspirin dosage for chewed tablets is 160–325 mg (2–4 children’s tablets).
• Nitroglycerin actions are relaxing blood vessels and decreasing the workload of the heart, and its side effects include hypotension, headache, and pulse rate changes.

💡 Memory Hook

Nitro = “BP check first”: give only if systolic BP is not below 120 mmHg; it relaxes vessels to reduce heart workload.

📖 6. Stroke scale and assessment

📖 7. Scene assessment and trauma survey

🔑 Key Concepts & Definitions

• Scene safety : Scene safety is the first step where you ensure the area is safe before starting any patient assessment or treatment.
• Walking wounded separation : Walking wounded separation is the process of directing uninjured or less-injured people away from the immediate area to a set evaluation spot.
• START triage tag colors : START triage tag colors are the color-coded priorities used to quickly identify patients as deceased, immediate, delayed, or minor from a distance.
• RPMs triage sequence : RPMs triage sequence is the order of assessing Respirations, Perfusion, then Mental Status for rapid patient prioritization.

📝 Essential Points

• Do not spend too much time on any one patient; move quickly to the next patient during the triage process.
• Triage begins at the patient closest to you, using bystanders to control bleeding, maintain an open airway, or hold c-spine traction.
• Assess Respirations first, and if not breathing then open the airway and if still not breathing tag DECEASED (BLACK).
• If breathing: tag IMMEDIATE (RED) when respirations are >30, and if <30 then assess Perfusion.
• If radial pulse is absent or capillary refill is >2 seconds tag IMMEDIATE (RED); if radial pulse present or capillary refill <2 seconds then assess Mental Status.

💡 Memory Hook

RPM = Respirations → Pulse/Perfusion → Mental status (then match to tag colors by thresholds).

📖 8. Medication review and administration rights

📖 9. Common EMS medications

📖 10. START triage system

📖 11. PCR requirements and documentation

🔑 Key Concepts & Definitions

• PCR Patient Contact documentation : PCR Patient Contact documentation is the set of required fields completed whenever any patient contact occurs.
• PCR Cancelled Elements : PCR Cancelled Elements are the required fields completed when a run is cancelled prior to arrival on scene.
• PCR Refusal documentation : PCR Refusal documentation is the required PCR content plus use of a WREMAC approved refusal form when transport is refused.
• NYS certification number requirement : NYS certification number requirement is the need to record certification level and the six digit NYS number when crew members are NYS certified.

📝 Essential Points

• When cancelled prior to arrival on scene, required elements include dispatch information, call type, time call received and service responded, disposition and disposition code, and crew names with certification details.
• When ANY patient contact occurs, required elements include date of call, agency code, vehicle ID, dispatch information, agency name, call location and location code, call type, times, disposition and code, patient name, DOB, gender, Social Security number, presenting problem, chief complaint, subjective and objective sections, past…
• When a patient refuses transport, the PCR must include all patient-contact required elements PLUS a WREMAC approved refusal form.
• Crew member in charge of the patient goes in the first box, and the driver goes in the second box.
• If a crew member is not NYS certified, enter their name and fill the certification boxes with zeroes, and if a certification is provided enter the six digit NYS number.
• On PCR forms, write only what your agency did, use zeroes for unknown/blank boxes, and draw a horizontal line with initials across any section left blank.

💡 Memory Hook

Patient-contact rule: cancelled = fewer fields; any contact = full patient identifiers; refusal = full contact + WREMAC refusal form.

⚠️ Common Pitfalls & Confusions

1. Mixing up medial vs lateral (medial is toward the middle line; lateral is away) when describing patient sides.
2. Confusing dorsal vs ventral (dorsal=back; ventral=front) or anterior vs posterior (anterior=front; posterior=back).
3. Reversing supine vs prone (supine=face up; prone=face down) or forgetting Trendelenburg is feet higher than head.
4. Using SOB/LOC without the matched meaning (SOB=shortness of breath; LOC=loss of consciousness) and misreading what each indicates.
5. Triaging with RPMs thresholds incorrectly (e.g., using respirations >30 for Immediate vs the documented <30 path).
6. Forgetting the stroke face-arm-speech logic (equal face/arms and correct words are normal; droop/drift/slur are abnormal).
7. Applying medication contraindications incorrectly, especially nitroglycerin if systolic BP is below 120 mmHg or aspirin contraindications/chewability/bleeding/ulcer/anticoagulation/aortic aneurysm.

✅ Exam Checklist

1. Define and apply lateral, medial, superior, inferior, proximal, distal, dorsal, ventral, anterior, posterior, and the midline plane correctly.
2. State supine vs prone and describe Fowlers (head elevated) and Trendelenburg (feet higher than head, shock position).
3. Interpret key abbreviations: BP as systolic/diastolic and bpm, SOB, LOC, LPM, NRB, PEARL, CMS x4, A+O x3 (or x2).
4. Use the Face-Arm-Speech checks exactly: facial droop, arm drift for ~10 seconds, and the specified familiar phrase for speech changes.
5. Recognize hypoglycemia and seizure first aid steps: move from danger, don’t restrain, don’t insert anything into mouth, and use recovery position after convulsions cease.
6. For myocardial infarction/chest pain care: state aspirin (chewable) indications, contraindications, and dose (160–325 mg / 2–4 children’s tablets).
7. For nitroglycerin: state indication (prescribed tablets for chest pain) and contraindication (hypotension or systolic BP below 120 mmHg) plus core actions/side effects.
8. Complete the START sequence in order using RPMs and tag thresholds: not breathing→DECEASED (BLACK); respirations >30→IMMEDIATE (RED); <30→perfusion; radial absent or cap refill >2s→IMMEDIATE; then mental status criteria for IMMEDIATE vs DELAYED (YELLOW).
9. List scene/triage fundamentals: scene safety first, walking wounded separation to a set evaluation area, start where you stand, and not spending too long on one patient.
10. Apply PCR documentation rules in order: cancelled prior to arrival required elements, ANY patient contact required elements, and refusal requiring all contact elements plus a WREMAC approved refusal form.
11. Recall PCR form handling requirements: use black ink, use military time, fill circles fully, use zeroes for unknown/blank boxes, and draw a horizontal line with initials across any section left blank.
12. Identify crew documentation placement rule: crew member in charge of the patient in the first box and driver in the second box, with NYS certification details entered (zeroes if not certified).