5 Flashcards
The paramedic should palpate the infants pulse by the
Brachial, Carotid, or Radial (depending on the childs size)
The Pediatric Dose of Lidocaine
1 mg / kg
The primary concern of a patient with a prolapsed cord is
Compromised Blood Supply
The second stage of labor
Begins with full dilation of the cervix & Ends with delivery of baby
The stage whose ending is marked by the delivery of placenta is the
Third Stage
The statement that is Not True about febrile convulsions is
The patient does Not have to be transported
The time during a pregnancy most likely to have seizures due to toxemia is
In the ninth month
The upper area of the uterus
Fundus
There is an asthmatic child with moderate distress. A physician orders 0.12 mL Adrenaline 1:1000 given. The appropriate route is
SQ
Time prior to delivery of fetus
Antepartum
To Avoid Supine Hypotensive Syndrome
Lay patient on her left side
Toddler when experiencing seizures you do all of the following except
Wet sponge on forehead
Toxemia most commonly occurs, When
Third Trimester
Toxemia of Pregnancy
Magnesium Sulfate
Transport a 3rd trimester patient in what position
Left lateral recumbent 10-15 degree
Treatment for child with 104 deg. Temp
Tepid Bath
Treatment for Prolapsed Cord
Insert Sterile Glove, Lift Up
Treatment of a 5 yr. old child who is Dyspneic and Drooling are all, Except
Lay him flat
Treatment of Eclampsia
Magnesium Sulfate
Unresponsive baby with frantic mother
Never use restraints
Using Epinephrine to treat respiratory ailments
A “Failure” Suggests Bronchiolitis and “Success” Suggests Asthma
Waddells Triad includes
Left Femur, Spleen or Chest, and Right Sided Head Injury
What do you do to facilitate intubations on a pediatric
Press on the Larynx
What is the amount of fluid given to a neonate
10 - 20 cc / kg
What is the most common result of death in children over 1
Trauma (accidents)
What to be concerned about with a pregnant patient with toxemia
Elevated BP
When an arm or leg presentation occurs, you should
Transport Immediately
Uncuffed tube
Under 8 yrs. Old
When intubating a child under 8, you should use an
Uncuffed Tube
When opening the airway of an infant, do Not exaggerate the head tilt because this
May obstruct the breathing passages
When performing CPR on a infant, you should
Use fingertip compressions at a rate faster than on an adult
When rescue arrives, a woman is found to be in childbirth with a prolapsed cord. You should Not
Try to push the cord back inside
When the baby’s head is delivered, the Paramedic should support the head by
Distributing his fingers evenly around head
When to Start Compression on an Infant
Heart Rate Less 60 / min
When to Start Positive Pressure Ventilations on Infant
Heart Rate Less 100 / min
Where do apply pressure when tubing a pediatric
Larynx
Where does needle go when doing an IO
The Tibial Tuberosity
Which one of the following Normally Decreases During Pregnancy
Blood Pressure
You are called at 3am to a female with pain in her lower abdomen, bloody urine and fever for 2 days. The physical exam reveals tenderness over the bladder and otherwise normal vitals, except for a temperature of 100 degree. She also states that she “may be pregnant” Due to the Sx / sx, you should suspect
Inflammation of the Bladder
You are transporting a multigravida whose last two childbirth were C sections. She appears near full term and has contractions every 3 - 4 min. apart. She complains of a tearing pain in her lower abdomen and she begins to go into shock. This suggests
Uterine Rupture
You clamped and cut cord & it continues to bleed, what do you do
Clamp it again
You have an emergency delivery and must separate the mother and baby, you need to do what
Tie the cord 8” from infant and again a couple of inches from the first tie, and cut in between
You suspect patient is suffering from Abruption Placenta, you would
High O2, Ringers, VS
A Baker Act can be initiated by a
Police officer
A Branch of Civil Law concerning Civil Wrongs between two parties
Tort Law
A patient has apparent injuries from a bar fight. The patient is also obviously drunk. He refuses treatment and signs a release. The release is Not valid because
The patient was intoxicated
A Pt. was left unattended by the paramedics at the ER to respond to another call. The pt. was unattended for 20 minutes. The paramedics are guilty of
Abandonment
A repeater in a telemetry system is also used for
Increasing the transmission range
A signed release is meaningless unless
All of the risks and benefits of treatment are explained (informed refusal)
A telemetry system in which voice and EKG can be transmitted from the field to the hospital at the same time is called a
Multiplex system
Administrative Law
Examinations, Licenses and Maintenance or Records
After attaching the patient to an EKG monitor, you note quite a bit of 60 cycle interference. The best way to remedy is to
Disconnect any electrical appliance that may be nearby
Agency that sets standards on safety & health
OSHA
All are True of Good Samaritan Laws, Except
Designed by local EMS
All could reduce radio transmission capabilities, Except
Holding the radio horizontal
All regarding PPE, Except
Eating and food in ambulance
Ambulance crashes what is the court going to try to prove
Lack of Due Regard
Ambulance in left lane
So traffic will move right in natural fashion
American with Disabilities Act protects those with
Communicable Diseases
An ambulance crashes, what is the court going to try to prove
Due regard, Negligence
An EKG can be transmitted to a hospital / facility via
Biotelemetry
Assault
Unlawfully placing patient in fear
At a Scene were Patient’s Physician’s Advises what to do, You
Listen to Physician
At a scene where patients doctor advises what to do
If physician assumes responsibility for patient, listen to physician
At scene who oversees medical treatment
Incident Command
BAND
Group of frequencies
Battery
Unlawfully touching patient
Best treatment for someone with Post Incident Stress
Give them a Specific Task to Complete
Best way to Stop Spread of Disease
Washing Hands
Between intervening PhD and on - line medical who is in charge
On - line PhD
Biotelemetry is sent using
UHF
BSI address what
That All Body Fluids are Contaminated
Cannot transmit & receive at the same time
Simplex System
Catching a disease from dirty linens
Indirect Contamination
Changes to Higher or a Different Frequency
Repeater
Child Hurt, No parent, type of Consent
Implied
Civil Wrong is
Tort
Color of DNR
Yellow
Common Law
Society’s acceptance of customs or norms
Communication with online physician
Direct medical control
Court does Not have to Prove
Intent
Crime Scene
Police Wait
Crime Scene
Do Not Disturb Evidence
Direct Medical Control
Orders by Phone or Radio
Disability Act protects those with
Communicable Disease
DNR
Only to Suspend Life Resuscitation
Duplex system
Simultaneous transmission & Reception using 2 frequencies
Durable Power of Attorney
Another person makes health care decisions for you.
During transport you lose radio contact
Continue using Standard Protocols
ECG can be both transmitted and decoded on an
Oscilloscope
ECG can be transmitted to facility by
Biotelemetry
Empathy
Ability to view the world from another inner frame or reference point of view while remaining yourself.
Establish IV
By Medic Need
Ethics
Discipline relation to right and wrong standard for honorable behavior by a group.
Family learns you cannot defibrillate due to dead battery
Negligent
First Links Begin
When EMS is Activated
First Phase of Communication is
Notification of Dispatcher by the Public
Four needs required to prove negligence
Duty to act, Breach of Duty, Damages, Proximate Cause
Good Samaritan
Not implemented by local EMS
Good Samaritan Law Protects
Persons that assist at a scene with in training
Grieving Stages
Denial, Anger, Bargaining, Depression, Acceptance
Group of radio frequencies
Bands
Hand Wash
Prevent Infection
Have DNR Order
Comfort Measure
Having essential supplies and equipment at the scene can be insured by
Developing an inventory & replenish truck supplies after every run
High Risk for AIDS
Increased Exposure to Blood or Body Secretions (Unprotected sex)
If family member tells you they have DNR for patient but Can’t find it
Begin CPR
If paramedic charged in lawsuit, he is
Defendant
If the ambulance crashes the court will try to prove
Lack of due regard
If you cannot Defibrillate due to dead battery, and family finds out you didn’t check in the morning
Negligence
If you Can’t Defibrillate Because Battery is Dead and Family finds out
Negligence
If you get a call and your life pack didn’t work because you didn’t check it out in the morning it is
Negligence on your part
If you lose radio contact with the hospital, you should
Follow protocols (standing orders)
In a patient with a myocardial infarction, the information the doctor can obtain over the radio is
Present complaints and history
In cases of malpractice, courts compare the actions of the defendant to that of the actions of his peers would have taken, under the same circumstances, This comparison
Standard of care
In order to prove Negligence must have 4 things
Duty to act, Breach of that duty, Damages, & Proximate cause
Information most likely to Help ER doctor Diagnose AMI over radio
“Pt. PHX”, Description of Present Problem
Information to include on the patients report is
Concise report of the patients condition and interventions taken
Intent of Good Samaritan Law
Protect a person who stops at a scene from a lawsuit
Intervening Physician vs. On - line Medical Control
On - line control rules
Kid with no parent
Implied Consent
Legislative Law
City Councils, District Board, General Assembles, and Congress
Libel
Writing Malicious
Male in bar fight cannot refuse due to
ETOH
Malicious Writing
Libel (Slander Spoken)
Medical common frequencies
UHF, FM
Medical Control Provided over the Radio by Medic & Physician is
Direct Medical Control
Mini base stations for telemetry and communication
Repeaters
Moral
Social standard or customs dealing w/ what’s right or wrong
Most effective method to fight disease or infection
Washing Hands
Most important information for ER Doctor
Chief Complaint (c/c), Patient’s condition, Treatment
Multiplex
Talk & Listen send EKG
Needs to prove negligence
Duty to act, Breech of duty, Damages, Proximate cause
Not a part of Communications System
Graphic Equalizer
Not part of primary survey
Vital signs
Not part of the minimum data set in patient care report
Narrative
Not True regarding Portable Radios
Hold antenna horizontal for better reception
Offering support to distraught family member
Empathy
On-line radio contact between medic & medical control physician
Direct Medical Control
OSHA
Regulates Disease Control
OSHA mandates MSDS sheets be available on site for
any hazardous materials stored
Paramedic arrives at crime scene , What should you do
Medic should enter scene with creating the least disturbance
Paramedics that elect to help a patient and leaves without other help may be sued for
Abandonment
Patient has concerns
Tell Pt. to express concerns
Patient Refuses IV
Advise and let go
Patient refuses IV for “ Religious Reasons”
Advise Pt. and let him go
Patients family states they have a DNR, but they can’t find it, what do you do?
Begin CPR
Pediatric Patient without Supervision need ALS care
Based on Implied Consent
Physician can best prepare patient with what information
Chief Complaint and History
Problem Online Physician & Intervening Physician
Go Online Physician
Proper procedure on the radio is to
Speak clearly and keep the message brief
Providing care equal to, or that of similarly trained is
Standard of care
Purpose of Encoders and Decoders is
Transmit Tone Pulse & Receive Codes
Radio frequencies are measured in
Hertz
Recognizing comparable standards set forth by another agency
Reciprocity
Rescue Vehicles should be Parked
No closer than 100 feet
Rescuer found negligent, prove all except
Happened away from medical facility
Responsibility of the paramedic who is dispatched to the scene of a medical or trauma emergency is
The Duty to Act
Responsible for the coordination of all emergency, medical treatment activities within a city or region
EMS Agency
Retransmit frequency to higher or different frequency
Repeater
Ryan White AIDS Act
Notification of Emergency personnel of exposure to disease
Secondary Assessment includes all, Except
Determining life threatening injuries
Set Standards on Safety & Health
OSHA
Simplex
Talk or listen one frequency
Simultaneous Transmission Using Two Frequencies is
Duplex
Size up begins
When call is received
Slander
Verbally Lying
Standing Orders
IV, EKG, Medcon
Telemetry Frequencies
450 - 470 MHz
The 401 Emergency Medical Service Act - Providing legislature governing all Prehospital emergency medical services is known as
401
The agency responsible for licensing and policing radio frequencies
The FCC
The ambulance crashes, what will the court try to prove
Lack of Due Regard
The best description of a crisis intervention technique is that it is
Suitable for application in many situations faced by the medic
The best protection a paramedic has against legal involvement
Proper Training
The branch of civil law concerning wrongs between two parties
Tort Law
The final element that must be present for negligence to occur is
Proximal Damage
The Good Samaritan Law offers some protection to the paramedic
While off duty
The issue “Not” required for successful legal act of negligence to occur is
Intent
The less a paramedic uses a skill, the
Review of it should be more frequent
The organization that establishes the qualifications for emergency medical service personnel on a national basis is the
National Registry EMT’s
The paramedic communicates all information to the doctor, except
The patients name
The paramedic should assume that a patient wishes to be treated even though the patient is not conscious or has an altered mental status
Implied Consent
The patient in the greatest chance of false imprisonment is the
Psychiatric Patient
The permission to provide care obtained from the patient after the nature and risk of care are explained to the patient is
Informed Consent
The phase of communication is
Notification of dispatcher by the public
The physician can best prepare for a patient with a MI with what info
Chief Complaint, Past History
The physician can best prepare for a patient with MI by what info
Complaint & History of Present Issue
The Physician with the Most Scene Authority is
The Online Physician
The rules, protocols, ideals, etc. by which paramedics function
Ethics
The system used to ensure that needed resources are available in neighboring areas in a time of mass casualties is called
Mutual Aid
To ensure safety as a paramedic / ambulance driver should
Abide by All traffic laws / regulations
To make changes to report
Draw single line through error and make notation at end of report
To use the Baker Act, you must first inform
Law enforcement
True of Good Samaritan Law, Except
Designed by Local EMS
Two types of frequencies used for medical communications are
UHF ( 450-470 MHz ) & VHF ( 150-170 MHz )
Type of consent, kid without parent
Implied
Unable to defibrillate. Because you failed to replace the battery
Negligence
Vital Signs
Part of second assessment
We are informed to start IV’s under
Doctors written or verbal orders
What are rules, standards and code that govern a group or organization
Ethics
What color should the 1896 DNR be
Yellow
When a disagreement occurs between medic and an intervening doctor in charge
On Line Doctor
When a disagreement occurs between the medic and an intervening doctor, Who is in charge
On Line Doctor
When a paramedic is confronted with a patient who has a serious medical emergency and refuses to allow the paramedics to treat him, the paramedic should first
Try to explain to the patient the seriousness of his condition
When a person goes through Critical Incident Stress
Give Specific Task to Complete
When a problem occurs between the on line medic, and an intervening patients doctor on the scene. Who is in charge
On line doctor (unless patients doctor accompanies the patient to the hospital)
When a problem occurs between the online physician and an intervening physician on the scene what do you do
Go with medical direction (on line physician)
When confronted with a true emergency with a minor without parents and / or legal guardians present & cannot be contacted, you should
Consider consent for care to be implied and begin care
When does scene size up start
Upon dispatch
When person goes through critical incident stress
Give specific task to complete
When speaking to deaf persons
Look directly at them and speak slowly
When surveying the scene, initially you do not have to report the
Life threatening injuries
When the paramedic is on scene, what’s the law that requires them to provide care
Duty to act
Which except is true about radio communication
Explain in detail
Which is Not true in regards to Portable Radios
Hold horizontal for better reception
Which of the following patients would not receive care under “implied consent” is
The severe asthmatic that refuses treatment. (Other choices: 14 year old male Aox3 who refuses, combative heads trauma, & cardiac patient whose friend says the patient has a DNR)
Who were Ethical Standards Developed for
The Patient
Writing something Derogatory
Libel
You are to only give meds. Per whose orders
Written Protocols, and Direct Online Direction
You begin the assessment of the call
As soon as you receive the dispatch
You cannot discriminate against an AIDS patient because of the
Americans with Disabilities Act
You suspect child abuse
Write down on report & report to proper authorities, Let social worker & hospital know
2 medics 1st on scene at an MCI find a 23 yr. old in Cardiac Arrest, back up is 20 minutes away. What do you do
Continue Triage
5000 lbs. Load HAZMAT
Red placard
6 injured in MVA. HWY Patrol Secured Scene, you should
Begin Triage
60 yr. Old male twisted ankle HR 54, BP 140/80, stable, what is TX?
Splint & transport
A 16 yr. old fell while playing basketball and has injured his right ankle. His skin is warm & dry, BP 110/80, P 50. The appropriate action would be all, Except
Giving 0.5 mg / kg Atropine
A 23 yr. old male with Sharp Chest Pain of Short Duration and Increasing Shortness of Breath is Suspected to Have
Spontaneous Pneumothorax
A 35 yr. old patient has a Sudden, Sharp, Severe Headache and Becomes Unconscious and Unresponsive. She is suspected to have
Subarachnoid Hemorrhage
A Car Accident Victim that has Pain and Deformity to Both Thighs May Suffer from
Hemorrhagic or Hypovolemic Shock
A Drug used to Decrease Intracranial Pressure is
Mannitol
A False Statement Referring to Burns is that
There is insignificant damage to underlying tissue
A finding that receives attention during the primary survey is an
Exsanguinations Hemorrhage
A Fracture in which a Break is Straight Across the Bone Shaft is Called a
Transverse Fracture
A Fractured Elbow Should be Immobilized
In Position Found
A one man carry, which is Not used a great deal because the patients entire weight is on the rescuer is the
Fireman’s Carry
A Patient Found Unconscious at the Scene of a Fire Should Be Suspected to have
Carbon Monoxide Poisoning
A Patient has a P 40, BP 200/20. This Patient Most Likely has
ICP
A Patient has fallen from a 15’ Roof. When Assessed, the Patient has Dyspnea, Flat Neck veins, and his Chest Dull to Percussion. This is Most Likely to Be
Hemothorax
A Patient has Spinal Injury and Intercoastal Retractions. The Site of the Injury is in
C Spine ( C3 and C4)
A patient in a motorcycle accident. He has lacerations to his head that is actively bleeding. His VS are BP 80/40, P 110, Treat him by giving
Lactated Ringers Wide Open
A Patient in an MVA has a Head Injury, BP 80/60, P 132, and is Suspected to be in
Hypovolemic Shock
A Patient is AOX3, has a 3” Scalp Wound, BP 80/50, P 120, The Best IV Choice Would be
Lactated Ringers (or NS) Wide Open
A Patient is Conscious, we Should Apply Traction (when indicated)
Until the Patient Feels Relief
A Patient with a Fractured Clavicle Typically Sits or Stands with
The injured Shoulder Forward
A Patient with a Head Injury Suddenly has a Left Pupil that is Fixed and Dilated which now Reacts Slowly to Light. This is Considered
Neurological Crisis
A Patient with a Long Bone Fracture may Suffer from a
Fat Embolism
A Patient with a Twisted Angle Leg, Vitals Low BP, High Pulse, Cool & Clammy
Hypovolemia
A Patient with ICP you would Expect
Increased BP & Decreased Pulse
A Sign that it is Not Associated with an Aortic Aneurism is
Groin Pain
A Situation that is Indicated for the use of MAST Suit is a
Ruptured, Abdominal Aortic Aneurysm
A Trauma Victim Who is Immediately Unconscious then Decreasing LOC Most Likely
Epidural Hematoma
A Two Rescuer Carry that can be Used to Move a Patient Through Narrow Spaces is the
Extremities Carry
A Victim is found in the Wreckage of a Burning Building. The Mechanism of Injury Indicated Possible Spinal Injury. The Paramedic is Alone with No Equipment and there is Sever Danger of the Fire Spreading and the Building Collapsing. You Should Remove the Victim by the
Clothes Drag
Abdominal Bleed Takes
2 - 3 hrs. to occur (others say can take up to several hrs)
Abdominal Muscle Flexion on Palpation
Guarding
Abdominal Rigidity Can Take Up to
2 - 4 hrs to show
Abduction
Away from Body
Adult Burn Patient with Burns to Anterior Chest and Abdomen and Anterior Upper Extremities, using Rule of Nines, What is the Burn Score
27
Adult with Twisted Ankle, BP Good, P 66, Stable
Splint & Transport
After C Spine, how to Open Airway
Jaw Thrust
After Stabilizing the Car, We Next Complete
The Patient Assessment
All are Ignition Sources at a Hydrocarbon Spill, Except
Sealed Flashlight
All are Part of the GLASGOW Scale , Except
Pupil Response (eye opening, movement,)
All are True in Burn Patients, Except
Electrical Burns Don’t Effect Soft Tissue
All of the following Should Cause a Bulging Fontanel except a
Linear Skull Fracture
Amount of Ringers if you Lost 400 ml of Blood
1200 cc ( 3X the amount lost)
An ambulance is called to a house fire. Upon entering the burning house, a paramedic finds an unconscious woman. He decides to move her from the house using the fireman’s drag. The first step would be to
Tie the patient’s hands together
An athlete has fallen and injured his ankle, His BP 120/80, P 50, Skin warm & dry. Treatment is to
Splint the Ankle and Transport
An injury with Torn Ligament, Usually from motion forced beyond the normal range of the joints is called a
Sprain
An Opening Produced by Force that Pushes Body Tissue Laterally Away From Projectile
Cavitation
As we approach motor vehicle accidents, we need to
Insure scene safety first
Avulsions
Rip between Subcutaneous and Muscle Tissue
Babinski Reflex
Toes Go Up
Babinski’s sign
Toe faced outward
Battle’s sign
Basilar skull fracture
Best access to a patient
Door
Best Splint for Fractured Foot
Pillow
Blood loss replacement
3 X amount of loss
Burn patient concern with loss of
Plasma
Bus loads of kids, bus crashes into hazmat truck, what to do first
Scene survey
Car accident trauma to chest, Angulated leg
Hypovolemia
Cardiac Tamponade causes the following, Except
Flat Neck Veins. Other choices: (Normal pulse pressure, Decreased BP, and Muffle Heart Sounds)
Cavitation
Object penetration
Central Cord Syndrome
Spinal Cord Injury Sx / Sx Paralysis of the arms (usually extension)
Checking for Paralysis
Ask patient to wiggle toes
Clear fluids from nose
Basilar Skull Fracture
Complication of Elbow or Knee Fracture
Loss of Distal Circulation
Compound Fracture
Sterile Dress & Splint
Conservation of Energy Law
Energy cannot be created or destroyed only change form
Countercoup
Injury occurring at a site opposite the side of impact
Cribbing is used to
Stabilize the vehicle
Decerebrate Posturing
Damage in Brainstem (Decorticate Above)
Decerebrate Posturing
Extended extremities
Decontaminate patients
In the warm zone
Decontaminated patients have
Little or no threat to paramedics
Decorticate
Flexed Arms, Clenched Fist, Legs Extended
Decorticate Posturing occurs by
Lesion in the brain stem at or above upper brain stem
Define Guarding
Voluntary or in-voluntary contractions of the abdominal muscles in response to severe abdominal pain
Definition of mutual aid
Help is available when needed, agreements can be between neighboring departments, municipalities, systems & even states
Decerebrate Posturing
Extended Extremities
Disconjugated Gaze
Patient eye’s don’t move together
Dislocation of a joint
Subluxation
Do Not Stop Bleeding from Ears and Nose in Head Injury
Bleeding Relieves Pressure
Drowning victim you suspect they will be
Hypoxic & Acidotic
Ecchymosis over the Mastoid Bone (process) is known as
Battle Signs
Electrical Burn Path
Check for Entrance and Exit wounds
Electrical burns
Cause damage superficial and deep
Electrical Burns
Effect Soft Tissue
Explosive atmosphere, which is Not an Ignition source
Sealed Flashlight
Extrication is the
Removal of entrapments from victims, enabling a safe, controlled rescue.
Eye injury
Cover both eyes loosely
Eyes do not move simultaneously in the same direction
Dysconjugate Gaze
Firefighter down in fire
Clothes drag to bring him out
First person treated in MCI
Thirsty, Anxious, Agitated, Crying
First thing that happens in a blast injury
Compression of air filled organs
Flail chest
Free movement of segment, causing paradoxical chest wall motion
Fluid replacement of the Hypovolemic patient is
2000 cc to 3000 cc NS (or LR)
Football Player Guard Abdomen
Transport
Fracture on one side of Long bone
Greenstick
Fractured cheek bone - Patient is seeing double, What do you suspect
Acute Glaucoma, Retinal Detachment, Orbital Fracture
Front windshield glass is made of
Laminated Safety Glass
Frontal MVA with down and under, which is most common fracture
Ankle
Gaining Access to Rear Tempered Window of Car
Spring Loaded Center Punch To Corner Of The Window
Glasgow Coma Scale (GCS)
Eye opening, Verbal response, Motor response
Guy Crushed in Trench, Purple, Swollen head
Traumatic Asphyxia
Half Life
Time required for half of a radioactive substance to lose activity (radioactive decay)
HAZMAT call
1st thing you do, scene size up
Head Injury
Hyperventilate 20 - 40 times /min
Head Injury
Pinpoint Pupil / Dilated Pupil
Head Injury
Unlikely to get shock from head injury alone
Head injury with left pupil fixed & dilated, the right is slow to respond to light
Neuro Crisis
Head Trauma with signs of Shock
Shock is not due to head trauma. Look elsewhere
Highest level of protection of HAZMAT suits
Level A
How do you determine the route of passage for electrical burns
Entry and exit wounds
How much fluid do you give a patient that lost 750 cc of blood
.75 x 3 2500 cc
How to break a car window
Spring loaded center punch in lower corner
Hypovolemia Not Sx /Sx
Cyanosis / Diaphoresis (A)
Hypovolemic Shock Prehospital Fluid
2000 - 3000 ml
IC
Head of MCI
Immobilize shoulder injury with
Sling and Swath
In a Cricothyrotomy, the landmark used to determine the proper insertion Location
The Depression just Inferior to the Adam’s Apple
In a fire coral injury you
Remove Nematocysts
In a Fracture you should access pulse
Distal
In a MCI who is the most critical
The patient with breathing problems ( ABC’s )
In a multiple casualty vehicle, the patient with the lowest priority (this scenario) is the
Patient with paralysis from the waist down.
In spinal cord injury patients presents with vitals of
Low BP, Low HR
In the Hypovolemic patient, how much fluid replacement do you give
3 x blood lost,
Increased ICP
Decreased Pulse, Increased BP & Low LOC
Index of suspicion in trauma patient relates to the MOI to the presumption of
The Severity of the Injury
Initial emergency evaluation directs toward all of the following, Except
Significant Internal Hemorrhage
Injuries Associated with Large Body Surface Area due to Deceleration & Compression
Multi System Trauma
Injury to the Opposite Side if Impact is
Countercoup
It contraindicated in elbow fractures to
Attempt One time to straighten the elbow
It is not appropriate for a rape victim to
Clean her perineum with sterile saline
Jaw thrust
C -Spine in trauma patient
JVD with Clear Lungs, Narrow Pulse Pressure
Cardiac Tamponade
Kid in Pool Unresponsive, holding C - Spine after
Jaw Thrust
Know Projection vs. Trajectory vs. Cavitation
(Pg. 860 - 861)
Lactated ringers
Replacement of plasma (Hypovolemia)
Large Surface Area Trauma
Blunt Trauma
Largest # of preventable injuries to person over 75 are
Falls
Last person treated in MCI
Spinal Injury
Legs and Arms Extended
Decerebrate Posturing
Let CSF Leak out
Possibly Relieve an Increasing ICP
Loss of Body Fluid High Blood Volume with Burn
Shift Fluid Interstitial
Maximum amount of (Crystalloid) given to Adult Trauma patient
2000 - 3000 ml
MCI - Most critical patient
Patient walking around aimlessly repeating things over and over again has AMS
MCI - R>30, Cap refill > 2 seconds, AMS - unresponsive / responds top painful for verbal stimuli / Alert but disoriented are all for
Critical, immediate patients
MCI first priority
Thirsty & Anxious
MCI last to go
Spinal injury
MCI, do what
Prioritize Casualties
Most common type of rural MVA
Frontal
Most critical concern to a patient with chest trauma
Hypoxia
Most critical patient in a multi casualty incident
Patient asking for water, Breathing deep, Pulse 114 thready
Most critical patient pt at MCI
Amnesia, Crying, Altered LOC
Most desirable Fluid Replacement for Hemorrhagic Shock
Ringers
Most fatalities among rescuers occur in
Confined spaces
Multi system trauma & compression injuries
Blunt Trauma
Multiple Vehicle MVA, FHP secured scene, first thing to do
Begin Triage
Muscle to Bone
Tendon
MVA C - Spine
Modified Jaw Thrust
MVA patient with dec. Lung Sounds on Left Side, Bruising, and Pain Left Axillary Region. All Except
Needle Decompression Right Side
MVA patient with HR 120, BP 40/Palp. Patient has?
Hypovolemic Shock
MVA, air bag did not deploy, what do you do first
Disconnect both battery cables
MVA, fractured cheek bone, patient seeing double
Orbital Fracture
Newton’s 1st Law
Object at motion / rest will remain, until outside force act upon it
Newton’s 2nd Law
Force equals Mass X Acceleration or Deceleration
Not Common Trauma to Hollow Organs in Abdomen
Gastroenteritis
Of the following chemicals, the ones that would cause the most burns are
Oven cleaners and Drano ( Alkaline)
One eye ruptured socket fractured, Treatment
Cover both eyes, Bandage loosely
One of the indications for the MAST Suit is
A Pelvis Fracture
Open wound which goes through skin and separated fascia
Avulsion
Palpating abdomen
Palpate quadrant that hurts last
Paradoxical Respirations are a result of a
Flail Chest
Paralysis below umbilical
T 10
Paralyzed from the Nipple Down
T - 4
Paramedic affected by MCI
Assign a different task
Partial dislocation of a joint remains in place but is deformed
Subluxation
Patient Exposed to Mass amount of Radiation, Patient taken away
Minimum to no risk to Paramedic
Patient exposed to radiation, fully Decon’s in Warm Zone. Do they pose a threat to the medics now treating / transporting them
Little to No treat
Patient fell from a 3’ floor, Right Lung Sounds Absent, Legs Fractured. After Opening Airway, you
C-Spine, BVM O2, Decompress Right Side, PASG to Splint Legs, Transport with 2 Large Bore IV’s LR
Patient fell through a glass door and has a piece of glass stuck in the neck - What do you do?
C - Spine, Airway, Occlusive dressing, Stabilize the glass, Transport.
Patient in MVA frontal impact suffering down / under injury, you would suspect
Femur Fracture
Patient in MVA one pupil dilated other sluggish
Neuro Crisis
Patient in MVA with air hunger, confusion, JVD, inc. pulse, decrease BP, most likely suffering from
Pericardial Tamponade
Patient involved in MVA, down & under injuries, which bone most likely to fx
Femur
Patient is Exposed to Radiation, Fully Decon’d in Warm Zone, do they Pose a Threat to Medics now treating / transporting them
Little to No Threat
Patient loses 750 cc, how much blood do you give them
2250cc
Patient presents with Distant Heart Sounds, JVD, SOB
Pericardial Tamponade
Patient taking Coumadin, (trauma) which would you expect
Decrease in clotting factors
Patient that has Cervical Fracture
Quadriplegic
Patient Unconscious Not Responding to Verbal, Painful Stimuli or Eye Movement, What is the GCS
3 Points
Patient with 3rd degree burns over 20% BSA, Concern is for
Hypovolemia
Patient with a break in the midshaft bone has a diagonal break
An Oblique Break
Patient with apparent flail chest, You should
Assist ventilations with BVM
Patient with blood loss 750 ml
2250 ml replacement
Patient with Intracranial Pressure, first treatment should be
Hyperventilation
Patient with one eye injured
Cover both loosely
Patients eyes do Not move together
Dysconjugate gaze
Patients who are decontaminated in the warm zone
Have little or no threat to the paramedic
Pelvic Fracture
Stabilize & Transport with 2 IV’s
Penetrating Wound to Abdomen
Cover with Wet Sterile Occlusive dressing
Place for Decompression
2nd or 3rd Intercoastal, Midclavicular
Position patient with Abdominal pain in
Lateral Recumbent
Primary blast injury causes
Compression of hollow organs & eardrum troubles
Primary concern for burn patient
Hypovolemia Shock NO Septic
Primary concerns with Near Drowning
Hypoxia, Acidosis, (must transport 24 hour PE)
Proper procedure for disabling a vehicle battery is to
Disconnect ( Not cut ) the Negative Cable
Question about 4 car MVA 6 patients. Secured scene what should medic do
Begin Triage
Radioactive Particles that Decrease in Activity and Strength by Degradation Exemplify
Half Life
Red
Dangerous placard 5000 lbs. (hazmat)
Responded to MVA & notice deformity to steering wheel, what do you suspect
Severe chest trauma
Responsibility for Paramedic at MCI
Prioritize Casualties
Rigid Abdomen (how long does it take) Internal Hemorrhage in the
a.) Abdominal Cavity (how long does it take)
Rip from Sub - Q and muscle tissue
Avulsion
Rule of 9. Patient with (Adult) chest (18), Abdomen (Part of Chest) and Anterior of both Upper Extremities (4.5 Each)
18% + 4.5% + 4.5% 27% (Exact)
Rule of thumb for HAZMAT
To keep a safe distance
Scenario; MVC patient with diminished lung sound on left side and no sounds on right side
Immediate Decompression
Severed C - 4 causes
Respiratory Paralysis
Severing the Spinal Cord at C - 4 causes
Total paralysis, and unable to breathe on own
Short lower extremity
Fractured hip
Sling and Swathe most useful for what injury
Shoulder
Soft Tissue Injury Involving SQ & Fascia & Tends to have A Lot of Blood Loss
Avulsion
Some SX / SX of Shock
Dizziness, Thirst, Cool skin, Agitation
Splinting a compound fracture
Dress wound prior to splinting
Sprain
Torn ligament
START
60 sec. Assessment that focuses on the patient’s ability to Walk, Resp., Pulse / Perfusion, Neurological Status (Walking Wounded - Delayed, Breathing Absent - Dead / Dying, Rate less than 10 or more than 30 p / m - Critical, No Pulse Dead / Dying Carotid Pulse and a absent Radial Pulse - Critical
START System
Respiratory, Neurological, Circulation
Strain
Muscles over stretching
Talking or Asking about pain
OPQRST
Technical Rescue
Decide upon arrival
Tendons Connect
Muscles to Bone
The best tool for exposing a car door lock is an
Air chisel
The best way to break a windshield is a
Fire Axe
The device especially useful for removing patients from heights or over rough terrain or rubble is the
Stokes Basket
The first step in extrication is
Gaining access to the patient
The first step in immobilizing a patient on a short spine board is to
Maintain manual stabilization of patients C spine
The first thing that happens in a blast injury is
Compression of air filled organs (Hollow organs i.e.Stomach, Liver)
The first thing to do when called to MVA is to
Triage the patients and find the extent of the injuries
The key to effective management in a disaster situation is the
Communications system
The mechanism of injury can tell the medic about the patients condition. If the steering column is collapsed, the patient is most likely to have a
Flail Segment
The most common organ injured in blunt trauma to the RUQ is the
Liver
The most important thing about an angulated fracture is that it may
Cause the pinching or cutting of nerves & blood vessels
The most major complication of a joint injury is
Blood Vessel Damage. (Not nerve damage if both answers appear)
The order in which a primary survey is conducted to search for immediate life threatening emergencies is to check
A - B - C’s ( Breathing - Pulse - Bleeding )
The order of access routes during a motor vehicle accident is
Door - Window Body
The process that sorts patients is called
Triage
The safest way to enter a car wreck is
The door
The shortening of an extremity (leg) could be caused by an injury to the
Hip
The system used to ensure that needed resources are available in neighboring area in a time of mass casualties is called
Mutual Aid
The technique that should be used with a Spine Board in Narrow Places as an Alternative to the Four Man Log Roll is
The Four Man Straddle Slide
The tool Not used to pull or roll a dashboard is
A Pry Bar
The Triage Officer is Responsible for all, Except
Run Rescue Tools
To Open Airway of Trauma Patient
Modified Jaw Thrust
Tourniquet restricts
Venous flow
Trauma patient fell from roof has JVD, no lung sounds on right side
Assist ventilations, Decompress, Immobilize, Transport, 2 large bore IV’s
Trauma patient what drip
2 large bore IV’s - L Ringers
Trauma patient with tension Pneumothorax
BVM, Decompress, IV enroute
Trauma victim who immediately, unconscious that has decreasing LOC
Epidural Hematoma
Trauma victims of a plane crash are: 1) Arterial Hemorrhage, 2) Suspected femur fracture, 3) Conscious victim with head injury, 4) Partially obstructed airway
The order of treatment 4 - 1 - 3 2
Traumatic Asphyxia is caused by a
Crush injury to the chest or abdomen
Traumatic chest injury that allows air to enter
Sucking chest wound
Treatment of a patient who presents with open fracture
Dress wound first then bandage
Triage Most Important
Secure Chest Wound
Triage nurse responsible for
Sorting patient in ER
Truck transporting mixed goods, has
Dangerous placard
Two Medics at a MCI. Back up will be there in 20 minutes away (metro area), What do the medics do
Continue Triage
Umbilicus Down
T - 10 and Nipple, Line T - 4
Unconscious patient with head injury, eyes don’t move in Unison, this is called
Disconjugated Gaze
Unequal Pupils suggest
CNS Injury (Neurological Crisis)
Unlikely to develop shock from
Head Injury alone
Upon arrival of a disaster scene, the patient which should receive the lowest priority (of the following) is
3rd degree burns over 80 % of the body (Pt. will die soon anyway), (Mid sternal chest pain, 2nd degree burn over 20 - 30 %, Penetrating Chest Wound
Used to open airway of trauma patient.
Modified Jaw Thrust
Usual MAST deflation sequence is
Abdomen, Right Leg, Left Leg, (Inflation is Left Leg, Right Leg, Abdomen)
What do you Not do when Triaging
Primary & Secondary Surveys
What Fluid Loss from Body during Burn
Plasma
What is Not a normal emotion for a patient at a MCI
Paranoia
What is the key to effective management in a disaster situation
Coordination of all activities
What is your primary concerns for burn patients
Hypovolemic shock, Not Septic
