EMT- Week 6- Physical Causes of Altered Mental Status

When dealing with a behavioral or psychiatric emergency or suicide,what are some of the physical causes of altered mental status and explain why?  Are patients in this state of mind allowed to refuse medical care or transport? (NO!) Also respond to 2 other students posts.

When dealing with a behavioral or psychiatric emergency or suicide, then it’s important to consider that maybe their state of being is due to a physical cause than just assuming it’s just part of their chronic condition.  Some physical causes of altered mental status include low blood sugar, lack of oxygen, stroke or inadequate blood to the brain, head trauma, mind-altering substances, excessive cold, and excessive heat. If the patient is experiencing low blood sugar, then they may experience frustration, profuse sweating, light headedness, hunger, a rapid pulse, etc. which would make anyone, even if they don’t suffer a psychological problem, to have an irritable behavior and altered mental status. A lack of oxygen may create for an altered status because the lack of O2 can cause the brain cells to start dying off which may increase the risk for confusion, restlessness, and cyanosis may come as a result. Stroke or inadequate blood to the brain may obviously cause confusion and impair a lot of the motor skills needed to sustain an alert and conscious status. Since the blood leaking in a certain part of the brain is leaking, then the muscle is dying creating that part of the brain to be destroyed and incapable of operating/sending messages to the body. Head trauma will cause personality changes such as amnesia, for example. It doesn’t just stop at the brain though, this trauma can disrupt respiratory patterns, blood pressure, and pulse, as well. An overdose or abuse of substances can result in an altered mental status due to the chemical reaction and overload of toxins within the body that puts the body in shock. Temperature control is important. If the patient is overheated then they may become deprived of H20 and suffer heat stroke resulting in confusion, fainting, respiratory distress, etc. If the patient is too cold, then the lack of heat may result in drowsiness, shivering, altered mental status, slow breathing, and slowing heart rate. Patients who are suffering an altered mental status are not able to refuse medical care or transport because they are unable to adequately think for themselves. So, EMTs are required to go under a sort of implied consent due to their inability to think rationally. 

EMT- Week 6- Drugs

Pick 2 different abused drugs and list the signs and symptoms associated with them.  What are some of the effects of the drugs to the patient?  Will all patients show the same signs and symptoms? Also respond to 2 other students posts.

When I was reading through Chapter 23 I came across Downers and Narcotics and became interested. I thought they were the same type of drug, but I read more and understood the difference. The book didn’t give enough information, in my opinion, to fully understand the chemical process of how Downers and Narcotics effect the body so I researched these drugs some more. Here’s what I found:

Downers are sedation drugs that act through inhibiting muscle, mental, and emotional action. So, it’s easy to say Downers slow down the central nervous system and brain function, but obviously it’s not that simple. This type of drug falls into two categories; tranquilizers and sedative-hypnotics. Tranquilizers depress physical and emotional stress while Sedative-Hypnotics induce sleep.

Three types of downers include opiates/opioids, sedative-hypnotics, and alcohol. Skeletal muscle relaxants, antihistamines, over-the-counter sedatives and lookalike sedatives are considered downers, as well. It is actually a pretty common type of drug and is easy to overdose on. A family friend died at 26 from overdosing on sleeping pills which is a type of downer. Rapists may use a downer called Rohypnol (flunitrazepam) or “Roofies” as an odorless, tasteless, colorless date rape drug that can easily be slipped in a drink. According to Jim Parker, author of Downers: A New Look at Depression Drugs, Downer Drugs are one of the top used and abused drugs in two countries; USA(600 million prescriptions for minor tranquilizers) and Canada mainly, but addiction still continues around the globe. While it sounds like they can be used as a simple answer to relaxation, the action of the drug can be harmful. In the process, Downers are obstructing inhibitions, dulling reflexes, and slowing coordination. Continued use of this drug can lead to permanent “dull thinking, reduce judgment, and interfere with memory, all serious liabilities on the road, at work, or other settings that call for clear thinking and fast reactions.” It’s not a day at the spa using this drug although it may sound like it on the label. In reality, the drug has side-effects relative to a Sunday morning hangover. Since the drug is centering towards the part of the brain that focuses on slowing motor skills, nearby, it is also influencing respirations which can be really scary if an overdose was to occur. Hallucinations can occur due to the production of euphoria by the downer drug, GHB (Gamma- Hyroxybutyrate) aka: Georgia Home Boy or goop. The body eventually learns to depend on the drug and may not become as effective as the primary first use so that is why people are more likely to OD on downers. Obviously, not everyone reacts the same with different drugs, but most suffer the same symptoms and effects. Here’s a link for more information on Downers:

http://www.doitnow.org/pages/137.html

Narcotics, on the other hand, relieve pain and act as a sleep inducer. They are directed towards relieving the central nervous system that are experiencing stress to induce a more relaxed, drowsy state. Oxycodone (used for chronic pain) and Heroin (used as an illegal narcotic) are the most commonly abused modern day drugs, not to mention marijuana, too. Signs and symptoms of an overdose of narcotics include a coma, super miosis (aka: pinpoint pupils/tiny pupils), and respiratory dysfunction. Symptoms include Analgesia (feeling no pain), sedation, euphoria (feeling high), respiratory depression, small pupils, nausea, vomiting, itching or flushed skin, and constipation. Do you still want to take this drug? The list keeps going…

You can classify Downers and Narcotics as Opiates. Opiates are used to treat pain by depressing different parts of the brain and nervous system. Chemically, opioids attach to proteins called opioid receptors inducing a type of relief and relaxed state. Opioid receptors are found all over the body like in the gastrointestinal track, spinal cord, etc. Once the opiates attach to the opioid receptors, then the body creates a new perception of pain which sends a message to the brain communicating that the pain is gone.

EMT- Week 5- Seizures

What are the 3 phases of a seizure and what happens during these phases?  List 3 possible causes of a seizure? Also respond to 2 other students posts.

3 Phases of a Seizure:

1.       Tonic Phase: The body stiffens for less than a minute. This rigidity restricts lung and chest expansion due to the tight hold which may eliminate breathing for that duration of time. Patients often hold the arms stiff in an uppercut position close to their chest, urinate on themselves, and/or bit their tongue due to the clenching of the jaw muscle.

2.       Clonic Phase: This is the phase where the body participates in a jerking, violent motion for about 60 to 120 seconds (possibly even five minutes). It is best to wait out the seizure and care treat the patient thereafter. Some signs include the active shaking/uncontrollable jerking, foaming/drooling mouth, and possible cyanosis. The patient is unable to swallow saliva during their seizure due to the muscle contractions and well as the tongue possibly blocking access to the trachea, so the saliva often times turns into a foam as it collects and sits in the oral cavity. Cyanosis occurs due to lack of circulation of blood flow containing oxygen to the brain.

3.       Postictal Phase: After the convulsions stop, then the patient begins the postictal phase. After all, seizures occur due to the misfiring in the brain so the patient may experience an altered, confused, drowsy, unconscious state and/or experience a headache.

Some Causes of a Seizure Include:

1.       Stroke: caused by clots and bleeding in the brain.

2.       Traumatic Brain Injury: which could result in a rupture causing internal bleeding allowing glucose to eat away at the muscle tissue and kill the brain-to-body signal

3.       Hypoglycemia: low blood sugar (below 70mg/dL). The body is suffering from limited insulin which turns glucose into energy putting the body in a state of shock (aka: insulin shock). Without enough insulin, then the body collects excessive amounts of glucose in the blood instead of turning that glucose into energy.

4.       Congenital Brain Defects: hereditary and often seen in infants and young children

5.       Metabolic: caused by irregularities in the patient’s body chemistry/unbalanced chemical composition 

EMT- Week 5- Cardiac Conditions

Pick 2 of the many "Causes of Cardiac Conditions" and explain the differences between them.  What are some of the signs and symptoms that you may see when caring for these type of patients? Also respond to 2 other students posts.

Two of the many Causes of Cardiac Conditions include Coronary Artery Disease and Aneurysm. Coronary Artery Disease (CAD) occurs when the coronary arteries are narrowed or blocked, blood flow is reduced, thereby reducing the amount of oxygen delivered to the heart. CAD can be hereditary and age can influence the risk of developing CAD. Other risk factors include: hypertension, obesity, lack of exercise, elevated blood levels of cholesterol and triglycerides, and cigarette smoking. Obviously, maintaining a heathy diet and activity level is likely to lower the chances of falling victim to this disease. Physical activity and stress can instigate this condition by increasing the heart rate as well as the demand for oxygen. Causes for this disease include fatty deposits (plaque which then somewhat solidifies due to calcium) on the inner walls of arteries which then limits the volume of the coronary arteries; compromising the ability to supply oxygen to the heart efficiently and in the correct quantity. This collection of solidified plaque/calcium build up within the narrowing diameter of the arteries (aka: thrombus) creates the perfect opportunity for blood to clot which makes the condition even worse because now the arteries aren’t able to circulate blood due to the additional blockage. A thrombus is dangerous and cause either 1) an occlusion: complete cut off of blood flow or 2) embolism: where the thrombus detaches from the residential area within that artery to travel and get stuck in a smaller artery. Without oxygen, muscle dies. So, when either of these things happen, then the oxygen supply beyond the blockage may die. Heart attacks and strokes may result from this sort of blockage that restricts O2 blood flow to the heart and/or brain. Possible signs include: stroke activity, respiratory rate/pulse rate quality, and rhythm abnormalities, cyanosis, altered state possibly, heart attack, etc.  Symptoms include: chest pain. Related conditions: include: angina pectoris (chest pain), acute myocardial infarction (heart attack), and congestive heart failure.

Another cause of cardiac conditions includes Aneurysm. Aneurysm is the inflation of the arterial walls that dilates due to weakness in that specific area. The dilation can be due to an independent variable or due to other cardiac related problems. So, if the blood flow is compromised due to a blockage, then it is lacking in oxygen and the muscle dies/weakens like I mentioned as an action of CAD which makes the wall weak. The swelling is probable to burst which allows for the release of blood (aka: internal bleeding just like my trauma case in class). As we have learned before, glucose is in blood and destroys muscle tissue when in contact with it. In addition to the destruction of the muscle, the blood flow and circulation to the heart is absent. The bigger the rupture of the artery, the bigger the problem and stronger the shock to the body/likeliness of death. Ruptures may occur in the artery of the brain (stroke, diabetic patients, altered state), the aorta (caused from possible abdominal injuries). Signs: vomiting, seizure, drooping eyelid, altered state, loss of consciousness, etc. Symptoms: headache, nausea, stiff neck, sensitivity to light, chest pain, etc.

In other words, Coronary Artery Disease has to do with the actual disease caused from continuous build-up of plaque which then calcifies forming a thrombus/blockage in the arteries or an embolism which moves to occlude the flow of blood elsewhere. This blockage restricts the amount of O2 being circulated to the heart and brain. The result of this blockage is the inflammation of the arterial walls known as Aneurysm which normally bursts resulting in internal bleeding, stroke or heart attack, and/or possible death.  

EMT- Week 5- Breathing

During the patient assessment, what are the 3 items you check for while checking for inadequate breathing?  What is the memory aid to use for assessing breathing difficulty?  Ensure you list what each letter stands for to ensure you remember the memory aid.  Also respond to 2 other students posts.

3 Items to Check for While Checking for Inadequate Breathing:

1.       Rate: Rates of breathing that are considered normal vary by age. For an adult, a normal rate is 12-20 breaths/minute. For a child, it is 15 -30 breaths/minute. For an infant it is 25-50 breaths/minute. A patient who is suffering very slow breaths and very rapid breaths isn’t allowing enough air to enter the lungs resulting in the scarce oxygen being distributed throughout the body. Agonal respirations are an example of a irregular rate of breathing/inadequate breathing that are normally very random/sporatic and commonly occur before respiratory arrest.

2.       Rhythm: Normal breathing rhythm will usually be regular. Breaths will be taken at regular intervals and will last for about the same length of time. Remember that talking and other factors can make normal breathing slightly irregular. Rhythm, although listed, isn’t always an absolute indicator of adequate or inadequate breathing because when people are aware that their breathing pattern is being examined, then they often will have slight irregularities just from being self-conscious and distracted. On the other hand, there can be circumstances when the patient has a regular pattern/rhythm, but is breathing inadequately. So, they might be exceeding the normal rate of breathing, but at a constant rhythm which doesn’t define their health properly. That’s why it is important for the EMT to consider all three items when evaluating inadequate breathing.

3.       Quality: Breath sounds, when auscultated with a stethoscope, will normally be present and equal when the lungs are compared to each other. When observing the chest cavity, both sides should move equally and adequately to indicate a proper air exchange. The depth of the respirations must be adequate. It is actually a good thing having trouble hearing breathing sounds because that could mean that they have potential adequate breathing. The depth of respirations (tidal volume) should be shallow if they have inadequate breathing. Chest expansion should be observed and noted, too. Since the muscles are somewhat deprived of oxygen if the patient is an inadequate breather, then this would effect circulation (aka: skin may appear pale or cyanotic and may even be cold/clammy). Snoring and/or gurgling are important indications of a serious airway problem and should be heard for when listening to breathing.

By using our stethoscope, we are able to answer the rate, rhythm, and quality of the patient’s breathing, and determine their breathing status. Inadequate breathing, obviously, is the type of breathing that isn’t able to support life. It’s not sufficient and if left untreated, the patient will surely die. By identifying this medical emergency, then we are able to better help the patient. 

EMT- Five Rights of Medication Administration

What are the 5 rights of medication administration?  Why is it important to follow these rights every time that you go to administer a medication to the patient?  Also respond to 2 other students posts.

Five Rights of Medication Administration:

1.       Right Patient (Does this medication belong to the patient? Is this the same patient medical direction approved a medication order for?)

2.       Right Time (Have I made the right decision to administer the medication based on what I am seeing? Is it appropriate under these circumstances to give this particular medication?)

3.       Right Medication (Did I pick up the right bottle? Am I sure this is the correct medication?)

4.       Right Dose (Have I double checked? Am I sure I am giving the correct amount?)

5.       Right Route ((oral/swallowed, sublingual/dissolved under the tongue, Inhaled, Intravenous/injected into a vein, intramuscular/injected into the muscle, Subcutaneous/injected under the skin, intraosseous/injected into the bone marrow cavity, endotracheal/sprayed directly into a tube inserted into the trachea)

It is important to follow these rights every time I go to administer a medication to the patient because it is beneficial to the patient as well as the EMT administering the medication due to legal purposes from documentation. As simple and logical as these 5 Rights appear to be, one missed right could amount to a life. I understand the responsibility of needing to cognate the information given on the medication to determine the correct patient is being given the correct drug. It is easy to assume the patient will become more critical if given the wrong drug so right number one helps prevent the occurrence from happening. Timing has been a reoccurring stress, worry, theme, and topic of discussion in EMS because it is so critical. Time is irretrievable and therefore, highly important to consider when administering medication. Maybe the patient is stable and just having trouble breathing, but you know from their past medical history and the fact that they get short of breath when doing physical activity that they have cardiac distress. Although they might be stable at that moment, you should identify and apply their need for their current heart medication, nitroglycerin, aspirin, etc. to plan ahead of time before their condition descends. Choosing the right medication sounds simple, but I can imagine how it could easily be an issue due to most prescription medications being in similar orange bottles with labels. The correct dose administration of medication is essential. Some things to consider include the patient’s height and weight. If the patient is 100 pounds and 5 ft., then the drug will be more powerful and active in their body compared to a 300 pound man who is 6ft. 2in. The pill might need to even be split in half or diluted in water in order to properly treat the patient. Determining the correct route of medication into the patient is essential. You can’t be putting a pill intraosseously. It just doesn’t work that way. You need to not only use common sense, but be smart and read the label as well as the patient’s state. Some routes are more efficient, handy at that time, or create a stronger effect if done one route compared to another. It depends on the patient’s state and how the medication is supposed to be administered.

EMT- Trauma

You arrive on scene to a roll over car accident where a passenger has been thrown from the car and the driver is trapped.  The fire department has not yet arrived on scene, but the police are on scene.  People are starting to gather around both victims.  How should you handle the scene and who is a priority to take care of first?  Also respond to 2 other students posts.

In the case of a trauma such as this one given, I would wait until the scene and call for additional resources/back up while waiting for the scene to be safe and the crowd has been managed. I would be aware of traffic, ensure the ambulance is parked in the safest location, be observant of any glass, debris, broken power lines, spilled/leaking gasoline or fluids, etc. for the sake of me and my crew’s safety. My first priority is to ensure my safety and my next priority would be the patient evicted from the vehicle. I would make sure I have the appropriate  BSI worn properly (usually a helmet and vest). Then I would do a scene size-up as I mentioned earlier which would include determining whether or not the scene is safe, determining the MOI/NOI from the dispatcher and the observations made when pulling up to the scene, determining the number of patients (in this case two) which would then call for additional resources, ALS/EMS assistance, and bring the backboard for C-spine precautions (which are very much needed in this case, obviously.) I would medically tend to the patient evicted from the car while the firefighters are assisting the other patient/driver trapped in the car. For my primary survey, I would get a general impression of the patient and determine their alertness/ responsiveness. Since they were thrown out of the car, I would assume they are probably unconscious. At the same time I would do my ABCs and begin my Head to Toe body examination. First, cutting off the patient’s clothes then begin my Trauma Examination: Rapid Trauma Exam. While doing my trauma examination then I would be looking for DCAPBTLS (Deformities, contusions/bruises, abrasions/scraped skin, penetration/punctures, burns, tenderness, lacerations/cuts, and swelling). I would feel the head, check airway and ears patency, palpate trachea, chest palpitation down the center of the chest with my hands in the shape of a knife, check sides by pushing in to see if ribs are fractured, palpate the four quadrants of the stomach checking for distension and rigidity, place pals on inner hips while using my body weight to rotate the hips (aka: “open and close the book” motion), check broken bones by palpating with alternating pressure down the arms and legs, checking pulses both palmer and radial, turn on back while stabilizing spine with EMT partner to check for any step-offs, chepidice (not sure if I spelt it right, but it’s bone on bone), and palpating/inspecting the thorax, lumbar, and buttocks areas. , etc. Since the patient is unconscious, then I’d check for any medical/sample history by checking their wallet, pockets, and/or purse or bags (essentially any available resources) to see if the patient has any allergies, essential medical history that could be valuable when treating them, etc. I’d check for vital signs and tend to any wounds or secondary injuries properly while stabilizing the patient. I would choose to load and go while reassessing my patient every five minutes. The patient should be on oxygen and cared for appropriately with whatever their condition is at that time. As for the patient who was the driver, the firefighters would hopefully be trying to get the patient from out of the car to a safer area on scene. That would allow myself, my partner, or any other back up team to medically tend to that patient. I would assist them in the same procedure (Rapid Trauma Exam most likely) like I had with the patient evicted from the vehicle. If the scene was safe enough for me to help the patient in any way I could while they were trapped in the car, then I would, but only if it was safe enough. There are several things to consider when approaching a tumbled car like leaking fluid, possible random explosion, fire, etc. that would all need to be taken into account to ensure my safety. It would be desirable that the scene is safe enough to medically service the patient and do everything I could, while ensuring the safety of myself, my crew, and others, to help the patient medically and emotionally. 

EMT- Scene Safety and Scene Size-Up

When doing a scene size up, when should you call for help and what are three possible reasons you will need additional help?  What are some ways to determine the mechanism of injury and what type of injuries will there possibly be to take care of?  Also respond to 2 other students posts

An EMT should call for help when doing a scene size up if he/she thinks they will need additional resources like an ALS unit for more serious calls or a medical emergency concerning more than one patient. MOI and NOI is the information given to the EMT concerning the patient which gives the EMT a heads up as to what they will be expecting so that they can prepare. Some ways they will prepare include determining whether or not they will need to call for additional resources/back-up or whether or not to bring a backboard for C-Spine precautions. Some possible reasons the EMT will need additional help would include a multiple casualty incident, medical and trauma calls, if the scene is unsafe due to animals, gas leakage, fire, outraged family members, and just anything that could be hazardous/unsafe to the EMS crew,  (the scene should be safe anyway, but in the case that it isn’t, then you would need to call for scene safety/police), and/or in the case the patient is stuck in machinery and you’d need another professions with expertise in that field of area to help lift, move, or detach that industrial machinery such as a firefighter. Some ways to determine the mechanism of injury (MOI) include being given the information by the dispatcher before you arrive on scene, observing/analyzing the scene while driving/pulling up in the ambulance, and just in your overall scene size up. Some types of injuries that might be there to take care of include a patient in cardiac distress complaining of chest pain (put ALS on standby), patient with their hand stuck in a machine (need for firefighters), anxiety calls, shortness of breath patients, lacerations, burns, cuts, etc. There maybe cases when the EMT may need to call for backup once actually on scene with the patient, but the point of scene size up and MOI/NOI is to prepare so that the patient is in the best care with all the correct staff and resources to help them.

EMT- Oxygen Administration

Two conditions that would require oxygen could include:

1.Cardiac Arrest:

-The patient is unconscious and is not breathing, but has a slight pulse. At this point, the body has about 5% Oxygen available which could last about 5 minutes. By the time the EMT arrives, they will need to start compressions which will circulate the oxygen in the body. While doing the compressions, the EMT should maintain correct form with knees by the patient’s side, arms/elbows straight, overlapping hands just above the nipples towards the median, and performing compressions with full recoil of about ½ the diameter of the patient’s torso. They must follow the 30/2 ratio performing 30 compressions with 2 pumps oxygen with the Bag-Valve-Mask (BVM) until the AED is available and ready for activation. Once the AED is placed properly on the patient, then it will stop the heart and any abnormal electrical activity in hopes the body will restart with a regular, stable beating rhythm. Before performing compressions and using the BVM, then the EMT should look to make sure the airway is patent. This could explain why the patient isn’t breathing. For example, maybe the patient choked and that is how they became unconscious, but not in this case. The EMT should also look at the chest and stomach for breathing, listen for breathing, and feel the patient’s pulse. Throughout the EMT’s procedure, they should be examining vital signs to see if there is any progress in the patient’s health.

2.Anxiety

-In the case of anxiety, the patient is experiencing a rapid heart rate which is resulting in limited Carbonic Acid that is supposed to be in the body. If the patient’s respiration rate is above 40/minute, then it is appropriate to use the BVM. By using the Bag-Valve-Mask (BVM), the EMT can force Oxygen and slow the breathing to a breathing pattern appropriate (12-20/minute). While using the BVM, the EMT should talk the patient through the procedure to calm the patient down and communicate that they will be forcing them to take bigger breaths by using this BVM mask and to breathe when instructed in hopes of achieving deeper breaths.

In order to provide an open airway, the EMT can use the Head-Tilt Chin Lift or the Jaw Thrust. The Head-Tilt Chin Lift can be performed on normal patients that aren’t experiencing any trauma like spinal injury, for example. However, the Jaw Thrust is designed specifically for trauma patients to ensure the correct posture of the patient without having to move the neck. 

EMT- Different Phases of Life- Compare and Contrast

It was eye opening getting a more educational, analytical perspective on the similarities and differences between the Toddler Phase (ages 12-36 months) and the Adolescence Phase (ages 13-18 years).  As an 18 year old, I could relate to the characteristics, both physiological and psychosocial. Then, reading about the Toddler Phase, I grew somewhat quite. It was humbling understanding that this age is understood by science to be known as an age of development in mental, emotional, and physical maturity, much like 12-36 month olds. Teenagers commonly develop an image with the purpose of being “popular,” “cool,” and/or different from all other stages in life. We’ve even developed a language of slang, text lingo, etc. that is visualized by society as a completely different stage in life compared to all others. What I found was, despite the obvious differences between toddlers and adolescent teens, teenagers aren’t so advanced and act/grow very much like babies. It’s a very self-consumed age for toddlers and adolescent teenagers.

Toddler and Adolescence Similarities & Differences:

*Experience Rapid Growth

-Toddlers:

-grow 4.4 pounds/year

-systems develop and advance: pulmonary (airways grow and alveoli increases), nervous system (90% development of brain/develop motor skills), musculoskeletal (muscle mass and bone density increase), immune system (becomes more resistant/stronger), teeth (have all primary teeth)

-Adolescence:

                -growth spurt lasting 2-3 years (girls done by age 16 and men by age 18)

                -reach reproductive maturity

-heart rate: 55-105/minute, respiratory rate: 12-20/minute, systolic blood pressure: 80 120mmHg

*Body Temperature

-Toddlers:

                -96.8-99.6 Degrees Fahrenheit

-Adolescence:

                -97.8-99 Degrees Fahrenheit

*Develop own Individuality:

-Toddlers:

-As Toddlers are developing their physical strength and new body form, they become more curious and want to become more adventurous. They are often times called “curtain climbers” or “rug rats” due to this curiosity that results in “occasional” mischief (aka: “terrible twos” stage).

-Adolescence:

-Teenagers develop their individuality or identity through curiosity, as well. However, their curiosity sometimes results in home conflict with parents/guardians, self-destruction, drugs, sexual curiosity/identity, etc. As they crawl closer to Early Adulthood, they desire more independence. Toddlers may find their independence through crawling away or wanting to explore the backyard, but adolescent teens strive for independence, usually from their parents.

*Increasing Cognitive Development

-Toddlers:

-Toddlers are developing their understanding of cause and effect. By 12 months, toddlers will begin to grasp what words actually “mean” by putting names with faces, for example. From 18-24 months, toddlers begin to understand cause and effect like when they are dropped off at daycare, they understand their mom is leaving and will develop separation anxiety. (Total opposite of teens who want less time with their parents, normally). 24-36 month olds begin to be more creative and by 3-4 years old, they have basic language down.

-Adolescence:

-Teens are developing their cognitive skills more and more, but in a different way that prepares them for Early Adulthood which includes college, work, responsibilities, etc. They are understanding the consequences of their actions through cause and effect which is explanatory for the obvious tension and constant disapproval between parent and teen. Teenagers are learning abundantly through their high school experience (hopefully) in preparation of flying off into a suited life stage requiring more responsibility and are applying those morals and themes learned through life actions/experience and interpreting/applying those principles as their maturity progresses. 

EMT Stress Management Discussion Question

Knowing the causes of stress will help the EMT understand how to handle the various levels of stress that they will encounter.  List 1 of the causes of stress and the ways to handle it. Also respond to 2 other students posts about other ways to handle the stressful situation that they identified.  Use your own experience in dealing with stress.

One of the causes of stress is the scarcity of time. EMTs are expected to report to the medical emergency within minutes. Upon arrival, time is sacred in using the educational knowledge and training to the best of their abilities. There isn’t any time to forget which tool to use or how to use it, ask for a break so you don’t vomit in response to the amount of blood from the patient, or try and remember where the switch is on the machine, for example. I have volunteered for the hospital for four years and participated as an intern for Marian Medical’s Physician Mentorship Program. I remember observing a gastrointestinal surgery and watching the blood squirt into the air and onto the surgeon’s mask. This was a common surgery that he had done several times before and felt prepared, but in this one instance, something went wrong. There wasn’t time to clean up or wash off, there was only time to find the source of bleeding and provide compression, etc. There are ways to prepare for the job; however, sometimes preparation is necessary even for the most common tasks which is important to remember. In times of stress, like when the patient won’t stop bleeding out, or blood comes in contact with your eye, etc., then it’s important to stay calm, assess the situation, and perform accurately and attentively.

                My personal experience in dealing with stress stems from my sister’s Severe Crohn’s Disease. I remember when my sister was in surgery (this one out of the hundreds of others she has had) and hearing the doctor tell my parents we needed to say our goodbyes because her condition was critical. It was at that moment that I understood the responsibility of stress management. I was five years old, wanting to cry, but I knew that I needed to stay calm and be supportive of my parents as it was their daughter that was dying. Selflessness, sincerity, compassion all came along with dealing with stress. I responded to that stress by referring to prayer and remembering my priority here on Earth; to serve God and others.

                Time is precious and therefore makes for stressful situations. It causes EMTs to be better at their jobs by making it a necessity to prepare for the worst and be educated. Ways to deal with stress in these timely circumstances is by preparing, as an EMT, whether it be studying an EMT text book while off-duty or waiting for a call, communicating with other EMTs concerning your emotional suffering/stress, exercising so that time won’t have to delay based off of poor physical health, and/or participating in spirituality whether it be worship, prayer, meditation, confession, etc. as a form of expression and as an outlet.  

                 

EMT Personal and Physical Characteristics Discussion Question

EMTs should possess enumerated skills due to their medical intervention and attention among society. Personal and physical traits vary significantly including being pleasant, sincere, cooperative, resourceful, a self-starter, emotionally stable, leadership, neat and clean, moral/respectful character, control of personal habits, communication/listening skills, physical strength, etc. Considering the statistics, the U.S. had around 58 documented fire/EMS suicides in 2014 (likely only a fraction of the actual count, according to the Statistician). Therefore; I conclude the most important traits as an EMT would go as followed (3 personal, 1 physical):

1.       Cognitive/Analytical/Observational Skills: ability to process information, reason, remember, and relate new information to medical knowledge to be able to perform medical duties.

-There isn’t a statistic needed to say that 100% of the job requires this skill. Upon arrival, the EMT is required to observe the surrounding environment, thus acquiring information plausible to make a personal diagnosis of the patient and prepare. Identifying and familiarizing the setting could mean for better resourcefulness, as well. This awareness is carried through to the connection with the patient. It is essential to identify and analyze the many vital signs signifying the patient’s current state of being. Once all observations and information is acquired, then comes decisiveness. “Which hospital should we bring the patient to?” For some cases, this decision could mean life or death. If the patient is in critical condition, then the EMT is required to decide, by the use of his cognitive skills, whether to bring the patient to a specialty hospital even though it could mean a longer drive or transport the patient to a general hospital that might not have the purposeful supplies needed to better care for the patient, but could save precious time, for example.

2.       Communication Skills: able to convey information to people clearly and simply, in a way that means things are understood and get done. It's about transmitting and receiving messages clearly, and being able to read your audience.

-Communication skills are essential in all aspect of life and the global workforce whether it be through verbal words, physical touch, literary communication, eye contact, etc. Communication comes in many forms. EMTs have the responsibility to acquire appropriate communication skills whether it be asking questions concerning the patient’s current state, writing down medical documentation, contacting a doctor for further guidance, making eye contact with other drivers on the road while operating the ambulance, and/or in unfortunate circumstances, informing the family that their loved one, communicated by name, that they have died. Not only does this apply during the course of action taken to medically assist patients, but in assisting the EMT themselves. Talking about emotional distress concerning EMT employment can be a stress reliever. An EMT will be better able to medically assist if they are at a healthy state themselves.

3.       Stable/Static Physical Health and Wellness: physically fit to carry out duties as an EMT involving coordination, flexibility, strength, dexterity, etc.

-It is obvious to say that an EMT is expected to be appropriately physically fit in the case needed to carry a 200 pound human, for example. However, with the physical support and teamwork of your co-workers on cite, the physical aspect of the job should be somewhat controlled, predetermined, and realistic/doable. What are commonly overlooked and taken for granted are the importance of eyesight while performing EMT duties. Color vision can be used to identify vital signs such as skin color, for example. You also need to be able to easily see the written instructions and identify machinery for use in the proper fashion. Hearing is essential while driving the ambulance, obtaining information from the patient and society, instruction, etc. Our vital signs are important in identifying other’s vital signs which makes them extremely important in being able to carry out the job.

4.       Correct balance of Teamwork/Leadership: combined action of a group of people, especially when effective and efficient. Leadership: the action of leading a group of people or an organization.

-Direction, cooperation, management, control, etc. are all part of this job. Leading in the sense of taking necessary guidance to control a scene, organize crowds are essential in emergency medical care for the well-being and safety of the patient, yourself, and the rest of society. Teamwork allows for a more efficient approach to care and establishes confidence in the patient and society who are overseeing that all medical staff on duty is using their knowledge combined to better provide for their friend or loved one suffering.