EMC 113 - Pharmacology and Shock/Trauma Management for the EMT-Intermediate

Competency Areas	Hours
Pharmacology
Diabetic Emergencies And D₅₀Administration	Class	2
Intravenous Infusion Therapy	D. Lab	1
Intravenous Infusion Therapy	P. Lab/O.B.I.	0
Intraosseous Infusion Therapy
IV/IO Infusion Therapy (Lab)	Credit	3
Shock/Trauma
Shock Management
Shock Management/Patient Assessment Lab
Didactic Review And Practical Skills Lab

Prerequisite:	EMC 100, EMC 103, EMC 105, EMC 108
Corequisite:	EMC 110

Course Guide

			Hours
Competency		After completing this section, the student will:	Class	D.Lab	P.Lab/
Competency		After completing this section, the student will:	Class	D.Lab	O.B.I.
		PHARMACOLOGY	4	2	0
X6-1.1*		Review the specific anatomy and physiology pertinent
		to pharmacology.
X6-1.2		Discuss the standardization of drugs.
X6-1.3		Differentiate among the chemical, generic (non-proprietary),
		and trade (proprietary) names of a drug.
X6-1.4		Describe how drugs are classified.
X6-1.5		List the authoritative sources for drug information.
X6-1.6		Discuss special consideration in drug treatment with regard
		to pregnant, pediatric, and geriatric patients.
X6-1.7		Discuss the EMT-Intermediates responsibilities and scope
		of management pertinent to the administration of medications.
X6-1.8		List and describe general properties of drugs.
X6-1.9		List and differentiate routes of drug administration.
X6-1.10		Describe mechanisms of drug action.
X6-1.11		Describe pharmacokinetics, pharmacodynamics, theories
		of drug action, drug-response relationship, factors
		altering drug responses, predictable drug responses,
		iatrogenic drug responses, and unpredictable adverse
		predictable drug responses,
X6-1.12		Discuss considerations for storing drugs.
X6-1.13		List the components of a drug profile.
X6-1.14		List and describe drugs which the EMT-Intermediate may
		administer in a pharmacological management plan
		according to protocol.
X6-1.15		Review the specific anatomy and physiology pertinent
		to medication administration.
X6-1.16		Review mathematical principles.
X6-1.17		Review mathematical equivalents.
X6-1.18		Differentiate temperature readings between the Centigrade
		and Fahrenheit scales.
X6-1.19		Calculate Intravenous infusion rates for adults, infants,
		and children.
X6-1.20		Discuss legal aspects affecting medication administration.
X6-1.21		Discuss the “six rights” of drug administration and correlate
		these with the principles of medication administration.
X6-1.22		Discuss medical asepsis and the differences between clean
		and sterile techniques
X6-1.23		Describe the use of antiseptics and disinfectants.
X6-1.24		Describe the use of universal precautions and body substance
		isolation (BSI) procedures when administering a medication.
X6-1.25		Describe the indications, equipment needed, techniques
		utilized, precautions, and general principles of administering
		medications by the inhalation route.
X6-1.26		Differentiate among the different dosage forms of oral
		medications.
X6-1.27		Describe the equipment needed and general principles of
		administering oral medications.
X6-1.28		Differentiate among the different parenteral routes of
		medication administration.
X6-1.29		Describe the equipment needed, techniques utilized,
		complications, and general principles for the preparation
		and administration of parenteral medications.
X6-1.30		Differentiate among the different percutaneous routes
		of medication administration.
X6-1.31		Demonstrate preparation and administration of parenteral
		medications.
		DIABETIC EMERGENCIES AND D50 ADMINISTRATION	4	0	0
X6-2.1		Discuss the function of insulin and it's relationship to glucose metabolism
X6-2.2		Describe the pathophysiology of diabetes mellitus
X6-2.3		List five signs of diabetic ketoacidosis
X6-2.4		Identify the signs and symptoms of hypoglycemia
X6-2.5		Describe the care given to patients with hypoglycemia
X6-2.6		Determine if D/50/W is indicated in a given patient scenario with several signs and symptoms identified
X6-2.7		List the complications or side effects associated with the administration of D/50/W
		INTRAVENOUS INFUSION THERAPY	4	0	0
X6-3.1		Discuss fluid replacement, the types of fluid that are available,
		the benefits and detrimental effects of each.
X6-3.2		Discuss how fluid replacement is monitored and controlled.
X6-3.3		Discuss the routes of fluid replacement and the advantages
		and disadvantages of each.
X6-3.4		Describe the indications, equipment needed, techniques.
		utilized, precautions, and general principles
		of peripheral venous cannulation.
X6-3.5		Describe the purpose, equipment needed, techniques
		utilized, complications, and general principles for obtaining
		a blood sample.
X6-3.6		Describe disposal of contaminated items and sharps.
X6-3.7		Define the term “intravenous cannulation”
X6-3.8		Recall the indications and contraindications for IV cannulation
X6-3.9		Identify the equipment and supplies needed to perform an IV cannulation
X6-3.10		Select preferred solutions for use in the management of both medical and trauma patients
X6-3.11		Select the appropriate administration to be used for various medical and trauma patients
X6-3.12		Describe the methods used to determine the proper IV flow rate
X6-3.13		State the proper ratio of fluid replacement to blood loss in hypovolemic patients
X6-3.14		List and discuss the advantages, disadvantages and complications associated with use of peripheral veins
X6-3.15		Identify the veins commonly used for IV sites
X6-3.16		Recall the steps top be followed to establish a peripheral IV
X6-3.17		Determine problems associated with an IV that is not functioning properly to determine the cause and correct the problem
X6-3.18		Discuss complications associated with IV therapy
		INTRAOSSEOUS INFUSION THERAPY	4	0	0
X6-4.1		Describe the indications, equipment needed, techniques utilized, precautions, and general principles of intraosseous needle placement and infusion.
X6-4.2		Identify the five conditions that must exist prior to considering intraosseous needle place
X6-4.3		From a list of l0 patient situations, determine those in which an intraosseous infusion is indicated
X6-4.4		Identify on a diagram the proper location for needle placement
X6-4.5		Identify on a diagram the pertinent anatomical landmark (s ) referenced in performing intraosseous needle placement including the tibial tuberosity, the epiphyseal plate and the medial malleolus
X6-4.6		Identify on a diagram the internal anatomy of a bone to include:
		the periosteum,
		the yellow marrow cavity,
		the red marrow cavities, and
		the emissary veins
X6-4.7		From a list of equipment, select the appropriate devices and supplies for performing an intraosseous infusion
X6-4.8		From a list of drugs and fluids, identify those which should not be infused or should be infused with caution via the intraosseous route
X6-4.9		Identify four potential complications of intraosseous infusion therapy
X6-4.10		Identify three relative or absolute contraindications to intraosseous infusion therapy
X6-4.11		List, in proper sequence, the steps in performing an intraosseous infusion
X6-4.12		Affirm the rationale for placement of an intraosseous needle in an infant or toddler
X6-4.13		Describe which laboratory samples are drawn in the field when the IV is started and their usefulness.
		IV/IO INFUSION THERAPY (Lab)	0	8	0
X6-5.1		Demonstrate cannulation of peripheral veins.
X6-5.2		Demonstrate the proper technique to insert an intravenous catheter.
X6-5.3		Demonstrate the steps involved in establishing and discontinuing an IV
X6-5.4		Demonstrate intraosseous needle placement and infusion.
X6-5.5		Demonstrate how to locate the primary and three alternate sites for establishing an I.O. infusion
X6-5.6		Demonstrate preparing the patient and necessary equipment for an I.O. infusion
X6-5.7		Using an I.O. mannequin demonstrate correct placement of an I.O. infusion and infuse 5cc of fluid
X6-5.8		Demonstrate at least two methods of rapid infusion of fluids through an intraosseous site
X6-5.9		Demonstrate how to properly troubleshoot a malfunctioning I.O. infusion
X6-5.10		Demonstrate the steps in properly discontinuing an I.O. infusion
X6-5.11		Perfect disposal of contaminated items and sharps.
		SHOCK/TRAUMA	8	0	0
X6-6.1		Describe the problems that occur with decreased perfusion.
X6-6.2		Define shock based on aerobic and anaerobic metabolism
X6-6.3		Discuss the prevention of anaerobic metabolism.
X6-6.4		Discuss red blood cell oxygenation in the lungs based on alveolar O2 levels and transportation across the alveolar capillary wall.
X6-6.5		Discuss tissue oxygenation based on tissue perfusion and release of oxygen.
X6-6.6		Discuss the role played by respiration, inadequate ventilation in the management of shock.
X6-6.7		Describe perfusion and the mechanisms of improvement of cardiac output based on the strength and rate of contractions.
X6-6.8		Discuss the fluid component of the cardiovascular system and the relationship between the volume of the fluid and the size of the container.
X6-6.9		Discuss the systemic vascular resistance, the relationship of diastolic pressure to the SVR and the effect of diastolic pressure on coronary circulation.
X6-6.10		Discuss the container size in its relationship to the fluid volume and the effect on blood returning to the heart.
X6-6.11		Discuss body fluids based on total body water, intracellular fluid, and extracellular fluid.
X6-6.12		Identify the significant anions and cations in the body.
X6-6.13		Describe the role of protein.
X6-6.14		Discuss osmosis. Define semi-permeable membranes, and discuss their function.
X6-6.15		Define isotonic fluids, hypotonic fluids, and hypertonic fluids.
X6-6.16		Define and discuss diffusion.
X6-6.17		Define active transport.
X6-6.18		Describe the mechanisms of concentration of electrolytes.
X6-6.19		Define acid-base balance.
X6-6.20		Discuss acid-base balance based on hydrogen concentration, pH, and buffer systems.
X6-6.21		Define and discuss the following:
		- Respiratory acidosis
		- Respiratory alkalosis
		- Metabolic acidosis
		- Metabolic alkalosis.
X6-6.22		Describe the mechanism of the body response to perfusion change.
X6-6.23		Identify the role of the baroreceptor.
X6-6.24		Describe how the actions of the baroreceptor affect blood pressure and perfusion.
X6-6.25		Describe compensated shock.
X6-6.26		Describe uncompensated shock, both cardiac and peripheral effects.
X6-6.27		Describe the information provided by the following in physical examination: pulse, blood pressure, diastolic pressure, systolic pressure, skin color, appearance, temperature, and respiration.
X6-6.28		Define the following terms that refer to cardiac physiology:
		- Stroke volume
		- Starling’s Law
		- Preload
		- Afterload
		- Cardiac output
		- Blood pressure
X6-6.29		Discuss the assessment of the patient’s perfusion status, based on physical observations within the initial assessment, including pulse, skin, temperature, and capillary refill time.
X6-6.30		List three signs associated with a skull fracture
X6-6.31		Discuss the relationship of the neurological exam to assessment of hypoperfusion and oxygenation.
X6-6.32		Describe Cheyne-Stokes respirations
X6-6.33		Describe the Cushing reflex
X6-6.34		Describe decorticate and decerebrate posturing
X6-6.35		Describe a flail chest
X6-6.36		List three signs of a pneumothorax
X6-6.37		List two early and three late signs or symptoms of a tension pneumothorax
X6-6.38		Describe the position for a pregnant trauma patient to be placed to optimize the venous return to her heart
X6-6.39		Discuss the benefits and complications of hemorrhage control by the following means:
		- Direct pressure
		- Tourniquets
		- Hemostats
X6-6.40		Describe the anatomy of the skin, bones, vessels, and subcutaneous tissue as it relates to hemorrhage control.

		SHOCK MANAGEMENT/PATIENT ASSESSMENT LAB	0	8	0
X6-7.1		Discuss management of a patient in shock, to include:
		red cell oxygenation,
		tissue ischemic sensitivity,
		IV fluids, and the
		pneumatic anti-shock garment
X6-7.2		Describe the beneficial and detrimental effects of the pneumatic antishock garment.
X6-7.3		Describe the indications and contraindications for the pneumatic antishock garment.
X6-7.4		Discuss fluid replacement, the types of fluid that are available, the benefits and detrimental effects of each.
X6-7.5		Discuss how fluid replacement is monitored and controlled.
X6-7.6		Discuss the routes of fluid replacement and the advantages and disadvantages of each.
X6-7.7		Demonstrate in order of priority the steps of shock resuscitation.
X6-7.8		Demonstrate the use of the pneumatic antishock garment (PASG).
X6-7.9		Describe how a patient is packaged and stabilized for transportation to the hospital, including airway ventilation, IV fluids, pneumatic anti-shock garment, fracture stabilization, bandaging.
X6-7.10		Identify the need for intervention and transport of the patient
		patient with compensated shock.
X6-7.11		Discuss the treatment plan and management of
		compensated shock.
DIDACTIC REVIEW AND PRACTICAL SKILLS LAB			2	2	0
	Demonstrate competency of module components
FINAL EXAM FOR MEDICAL EMERGENCIES FOR THE EMT-INTERMEDIATE