First Responder

What is legally permitted to be done by some or all individuals trained or licensed at a particular level such as EMR, EMT or Paramedic. The scope of practice does not define what must be done for a given patient or in a particular situation

allows you to be judged based on what is expected of someone with your training and experience working under similar conditions. If the care you provide is not up to the expected standard, you may be held liable for your actions

• Any alert, responsive, and competent person may refuse care.
• shaking head or pulling away may show refusal

Only a parent or guardian may refuse care for the child

• Your level of training
• Why you think care may be necessary
• What care you plan to provide
• Any consequences related to refusing care
• *must receive consent

• unresponsive, confused or severely ill and cannot get expressed consent you may legally provide care under implied consent
• Parents or guardians not on scene= implied consent

• Duty to Act- The EMR had a legal duty to provide care
• Breach of Duty- Care for the patient was NOT provided to an acceptable standard of care
• Damages- The patient was injured in some way as a result of improper care
• Causation- A direct link can be established between the damages and the breach of duty on the part of the EMR

Once you begin to help someone who is sick or injured you have established a legal duty to act and must continue to provide care until you transfer patient care to someone of equal or higher training. If you leave the scene earlier you may be guilty of abandoning the patient and may be subject to legal action

patients refridgerator

Excess carbon dioxide in the blood

Clinical Death

• over 4-6 mins oxygen depletes, cells begin to die
• this is the most critical time to adminster cpr
• if cells dont receive oxygen w/in 10 mins cells die
• organ 1st affected is the brain
• Biological death occurs 6-10mins; occurs when too many brain cells die
• Clinical death can be reversed Biological death cannot

• size in chest cavity increases, pressure decreases
• as volume up, pressure down

diaphragm relaxes; reduces volume; pressure builds in lungs until greater than atmosphere, then exhale

• Look-for adequate tidal volume; rise and fall of chest; air moving in and out
• Listen- for air entering and leaving nose and mouth
• Feel- for air moving into and out of mouth and nose
• Observe- skin color cyanotic or blue and responsiveness- "responsive patient almost always a breathing patient"

• Abesnt or shallow rise and fall of chest
• No air heard or felt
• Noisy breathing or gasping sounds
• Breathing which is too rapid or too slow or irregular
• Use of accessory muscles in chest
• Nostrils flare when breathing * esp children
• Skin is pale or cyanotic
• Sitting or leaning forward in a tripod position in effort to make breathing easier

• atmosphere 21% oxygen
• air exhaled 16% oxygen; more than enough to biologically keep alive

• Adult- 12 to 20 or every 3-5 seconds
• Child- 15 to 30 or every 2-4 seconds
• Infant- 25 to 50 or every 1-2 seconds

• 1. Head tilt, chin lift maneuver
• used on ill or injured patients w/out suspected spinal injury
• 2. Jaw thrust maneuver
• recommended where possiblility exists for neck and spinal injury *Do Not Tilt or Rotate Head*

• Look, Listen, Feel, Observe
• -take no more than 10 seconds to determine if patient is breathing adequately. Deliver each breath over one second
• -If initially successful continue, one breath every 5-6 seconds for an adult, 3-5 seconds for child and infant
• -best signs-obvious chest rise and fall
• -if inadequate change position

• mouth and nose smaller, easier obstruction
• tongue takes up more space in mouth and throat
• trach is smaller and softer=*easy to become obstructed by tilting to far
• no chest muscles more diaphragm
• chest cavity and lung volumes are smaller, gastric distention occurs more commonly
• provide rescue breathes 2 mins then alert ems
• gentle but adequate breaths; onlt until chest rises

• head =neutral position
• stoma =free and clear of obstructions

• obstruction by the tongue
• obstruction by epiglottis
• obstruction by foreign objects

• tissue damage
• allergic reactions
• infections

• 1.Noisy breathing
• Snoring-caused by tongue back of throat
• gurgling-usually caused by fluids or blood in the airway or by a foriegn object in trachea
• crowing-usually caused by spasm of larynx
• wheezing-usually due to swelling or spasms of lower airway caused by asthma but doesnt always mean airway problem; not always airway obstruction, more common during exhalation
• stridor-high pitched inhale swollen tissue in larynx
• 2. Breathing present but skin is pale or blue

• If forceful= enough air exchange and may dislodge/ don not interfere
• Poor exchange= begin as complete obstruction
• Clearing complete obstruction w/ responsive patient
• abdominal thrust most effective for clearing airway of adult or child choking, infant different
• Give 5 abdominal thrust in rapid succession

• Combination thrusts and back slaps
• keep infant head lower than trunk
• rapidly deliver 5 back blows between shoulder blades if this doesn't dislodge
• turn onto back and deliver 5 chest thrusts w/ tips of fingers along midline of breastbone
• continue till this works or till infant loses responsiveness
• if unresponsive begin CPR