B's Flashcards 2000-2500
Open the airway gently. Infants can be placed in a _____ position and children only require _____.
Neutral position; slight extension of the neck
In suctioning infants and children, use a ____ but be careful not to ____.
Rigid tip; touch the back of the airway
The gag reflex is tied to what other reflex?
The swallow reflex
What are the two essential functions that breathing accomplishes?
Brings oxygen into the body and eliminates carbon dioxide
Your body will tolerate the buildup of ____ longer than it will tolerate the lack of ____.
Carbon dioxide; Oxygen
Inhalation is a ____ process. While exhalation is a ____ process.
Active; Passive
Because it is passive, exhalation typically takes slightly ____ than inhalation.
Longer
A normal tidal volume is typically ___.
5-7 mL per kg of body weight
What parts of the respiratory system make up dead air space?
Trachea, bronchioles, and other parts of the airway
What term refers to how much air actually reaches the alveoli?
Alveolar ventilation
Alveolar ventilation depends very much on ____.
Tidal volume
Alveolar ventilation can be altered through changes in ____ and changes in ___.
Rate and volume
Exceptionally fast breathing will actually ____ minute volume and alveolar ventilation
Reduce
The movement of gases from high concentration to low concentration
Diffusion
The movement of gases between the cells and the bloodstream is called ____
cellular respiration
the respiratory system and the circulatory system working in concert are often referred to as the cardiopulmonary system, or the _________
Ventilation-perfusion match
What are 3 mechanical failures of the cardiopulmonary system that may occur?
- Mechanics of breathing disrupted.
- Gas exchange interrupted.
- Circulation issues.
What are 4 ways that the mechanics of breathing can be disrupted?
- Stabbed in chest (sucking wound).
- Loses nervous control of respiration (muscular dystrophy and multiple sclerosis).
- Painful chest wall injuries.
- Bronchoconstriction.
____ is a disease that causes low amounts of hemoglobin in the blood.
Anemia
A patient whose body pH becomes _____, sufficient hemoglobin may be present but may have difficulty in holding oxygen.
Very acidotic
What is internal respiration?
Gas exchange between the blood and the cells
In most people, the urge to breathe is caused by the buildup of ____.
Carbon dioxide
The body of a person complaining of shortness of breath will respond by engaging the ____ nervous system.
Sympathetic (fight or flight)
Define respiratory distress.
increased work of breathing; a sensation of shortness of breath
Most mechanisms of compensation, such as increased muscle tone use, come at a cost of ____.
Increased oxygen demand
Inadequate breathing is also called ___.
Respiratory failure
In inadequate breathing, either the ____ or the ____ (or both) falls outside of the normal ranges.
Rate of breathing or depth of breathing
EMT intervention when pt is breathing adequately but needs supplemental oxygen due to a medical or traumatic condition.
Oxygen by nonrebreather mask or nasal cannula
When a pt has inadequate breathing and needs assisted ventilations, which device can be used?
pocket face mask, bvm, or FROPVD
Breathing rate for artificial ventilations for somebody in respiratory arrest.
10-12 per minute for adult and 20/minute for an infant or child
Is it ok to use oxygen powered ventilation devices on infants and children?
NO
What is the patient’s respiratory condition when speaking 3-4 word sentences?
Increasing respiratory distress
What is the patient’s respiratory condition when speaking 1-2 word sentences?
Severe respiratory distress
FROPVD?
Flow-restricted Oxygen powered ventilation device
If compensatory mechanisms are working, will you see blue skin?
NO
If a patient has an obviously serious respiratory problem, ______.
Expose and visually inspect the chest
Adequate breathing - Normal rates
Adult - 12-20 per minute.
Child - 15-30 per minute.
Infant - 25-50 per minute.
What do prolonged inspirations indicate?
A possible upper airway obstruction
What do prolonged exhalations indicate?
A possible lower airway obstruction
Where do retractions in children occur?
Above the clavicles and between and below the ribs
Will a person in respiratory distress have an adequate minute volume?
YES, respiratory failure will have an inadequate minute volume
Often patients in respiratory failure will be ___ and ____.
Breathing and conscious
If a patient will allow you to intervene with a BVM, it generally means ___.
He needs it
What are the three negative side effects of positive pressure ventilation?
- Decreasing cardiac output/dropping blood pressure.
- Gastric Distention.
- Hyperventilation.
The risk from positive pressure can be minimized by using ____ to raise the chest.
Just enough volume
_____ can be minimized by using airway adjuncts when ventilation and also by establishing proper head position and airway opening techniques.
Gastric Distention; Cricoid pressure can also help with gastric distention
Too much carbon dioxide being blown off causes ____.
Vasoconstriction
To determine the signs of adequate ventilation, you should: (2 things)
- Watch the chest rise and fall with each ventilation.
2. Ensure that the rate is sufficient (Adult 10-12 Child 20 Infant Minimum of 20/minute.
What are two examples of noninvasive positive pressure ventilation (NPPV)?
CPAP and BiPAP
NPPV can be used only by patients who are still _____.
Breathing on their own
Do some pocket masks have oxygen inlets?
YES
What O2 concentration can a pocket mask connected to O2 deliver?
50 percent
What is the oxygen percentage in exhaled air?
16 percent
Does a strap on a pocket mask replace the need for proper hand position?
NO
Where should you position yourself when using a pocket mask with a person with suspected spine injury?
Position yourself directly above (at the top of) the patient’s head
Each ventilation should be delivered over ____ in adults, infants, and children and be of just enough volume to make the chest rise
1 second
Can a pocket mask deliver higher volumes of air than a BVM?
YES, if the rescuer has an adequate expiratory capacity.
What are some requirement of a BVM device?
Must be self-refilling shell that is easily cleaned and sterilized (a lot of them are disposable now)
Where on a patient’s face do you position a BVM mask if it is the large, round style mask?
Centered first on the patient’s mouth as opposed to the nose and lower chin
What type of standard fitting is used on most BVMs?
15/22 fitting
BVM systems without a O2 reservoir deliver approx. ____ percent oxygen.
50 percent
What is the bag capacity of a BVM?
1,000 to 1,600 mL of air
What is the most difficult part of delivering BVM artificial ventilations?
Obtaining an adequate mask seal so that air does not leak out around the edges of the mask
The AHA recommends that how many rescuers are used when providing BVM artificial ventilations?
TWO
Studies have shown that ____ may prevent adequate ventilations. BVM systems with ____ should be replaced
Pop off valves
How many hands should a rescuer use to squeeze the bag?
two hands
How do you find the cricoid ring?
Palpate the adam’s apple and then identify the ring just inferior
Applying cricoid pressure should be limited to ___.
Unconscious patients or those that have a severely impaired mental status
Is it ok to apply cricoid pressure if the pt is vomiting?
NO
What is the last choice of artificial ventilation?
BVM by a single rescuer
In one rescuer CPR, it is preferable to use a ___ instead of a BVM.
Pocket mask
Do you need to position the patient’s airway when providing artificial ventilations to a stoma?
NO, leave the head and neck in a neutral position
Use a _____ to establish a seal around the stoma.
Pediatric sized mask
An FROPVD has a peak flow rate of ____ percent O2 at up to ___ lpm.
100 percent; 40 LPM
When does the inspiratory relief valve operate on an FROPVD?
60 cm of water pressure
Is an FROPVD rugged?
YES
In a patient with suspected spine injury, is it ok to immobilize the head between your knees?
Yes, if no assistance is available
When do you need to be careful using an FROPVD?
When using on a patient with chest trauma be careful not to overinflate
Can you use an FROPVD on children?
Maybe, only if you have a child FROPVD unit and special training in its use by your medical director
Oxygen administration has changed in recent years mainly due to ____.
the 2010 AHA guidelines
Oxygen is a drug. All other medications are given based on ____ and ___.
Need and therapeutic benefit
Current research indicates that oxygen can actually cause harm in ____.
Reperfusion situations at the cellular level
Patients with O2 sat less than ____ should receive O2 based on severity.
94%
In a significant number of cases a ____ will be enough to raise saturation.
nasal cannula
Always remember to ____ rather than oxygenate patients in respiratory failure or arrest.
Ventilate
What pressure are most O2 bottles under when full?
2000-2200 psi
What size and larger O2 cylinders are used for fixed systems?
M and above. (M, G, H, and K)
____ cylinders are also used for O2.
Unpainted stainless steel and aluminium
What is the safe residual for and O2 cylinder?
200 psi
D cylinder capacity
350 liters
E cylinder capacity
625 liters
M cylinder capacity
3000 liters
G cylinder capacity
5300 lites
H cylinder capacity
6900 liters
Oxygen wrenches should be ____.
Nonferrous
Oxygen must not be allow to get how old?
5 years
Open an O2 valve fully and then close it ____.
A half turn
How often do O2 bottles need to be hydrostatically tested
5 years; however some can be 10 years if there is a star after the date
What is the working pressure of the O2 pressure regulator set to?
30-70 psi
On cylinders of ___ size and smaller, the regulator is secured to the cylinder valve assembly by a yoke assembly.
E size
What is the yoke pin system referred to as?
The pin-index safety system
A pressure compensated flow meter uses gravity and ___.
indicates the actual flow at all times, even though there may be a partial obstruction to gas flow.
A constant flow selector valve flowmeter can be used with what size O2 cylinder?
Any size
What will low pressure flowmeters flow?
15 or 25 lpm
What type patients will be more comfortable with humidified O2?
COPD and children
Why are humidifiers no longer used in many EMS systems?
Short transports and infection risk
Air sac collapse due to O2 toxicity is ___.
Extremely rare in the field
When does infant eye damage occur?
When premature infants are given too much O2 over a long period of time (days)
Flow rate NRB and oxygen concentration
12-15 lpm; 80-90 percent (another spot in the book says 80-100 percent)
Flow rate and oxygen concentration NC
1-6 lpm; 24-44 percent
Flow rate and oxygen concentration Partial rebreather mask
9-10 lpm; 40-60 percent
flow rate and oxygen concentration venturi mask
Varied flow rate, up to 15 lpm; 24-60 percent
Tracheostomy mask flow rate and O2 concentration
8-10 lpm; percent is recommended by home care agency
How much can a non rebreather be allowed to deflate when the patient inhales?
Cannot deflate by more than one third
What situations need higher O2 concentrations than can be provided by NC? (4 things)
Chest pain, signs of shock, hypoxia, or other more serious problems
What if a patient will not tolerate a NRB mask?
The cannula should be used only when a patient will not tolerate the mask
How much air does a patient rebreath with a partial rebreather mask?
About one third of his exhaled air
Some venturi masks have a set percentage and flow rate whereas other have an _____. These devices are most commonly used on patients with ____.
adjustable Venturi port; COPD
How much faster do children burn O2 compared to adults?
Twice the rate
What can an EMT do to further success of advanced airway insertion?
Assure a patent airway and quality ventilations prior to insertion of the advanced airway device
What are the limitations when trying to hyperoxygenate the patient?
Do not administer more than 20 breaths/minute for more than 2-3 minutes nor administer breaths forcefully
Does passing an ET tube through a person’s nose require visualization?
NO
What size syringe to use when filling the cuff of ET tube?
10cc
Two methods to assure proper tube placement
Auscultate lungs and epigastrium and End tidal CO2
How long should intubation take?
Less than 30 seconds
A patient with an ET tube offers less resistance to ventilations, so you may not need ____ to work the bag
Two hands
What is increased bagging resistance one of the first signs of?
Air escaping through a hole in the lungs and filling the space around the lungs, which is a very serious problem
What should you do with the bag when defibrillating?
Carefully remove the bag from the tube
Blind insertion devices usually do not require the head to be placed in the ____.
Sniffing position
Scene size up is ____ to the first part of the assessment process.
Not confined
Further observations of the scene are likely to reveal more important information about the ___
Mechanism of injury
What are the 5 steps of scene size up?
- Identify hazards.
- Examine for M O I and N O I.
- B S I precautions.
- Determine the number of patients.
- Radio for additional resources early.
An ambulance should ___ be parked in the danger zone.
NEVER
When there are no apparent hazards what is the danger zone?
Danger zone extends at least 50 ft in all directions from the wreckage
Danger zone when fuel has been spilled
Danger zone extends a min of 100 ft in all direction of wreckage and fuel. Park upwind. If parking uphill is not possible position the ambulance as far from the flowing fuel as possible.
Danger zone when vehicle is on fire.
100 ft in all directions
Danger zone when wire are on the ground.
Any area where the wires could pivot around the pole and make contact with people or vehicles
How hot can the catalytic converter get?
1000 degrees F
Who publishes the ERG?
USDOT, Transport Canada, and the Secretariat of communications and transport of Mexico
How far away might you be warned to park if explosives may detonate?
2000 ft
Where should you park if gases or fumes may rise?
The same level
A call that is ____ should raise your suspicions.
Too quiet
When a pt is suspected of having TB or another disease spread through the air, wear an ___ or ___.
N-95 or HEPA mask
The ____ is what causes the injury.
Mechanism of injury
What are the three collisions in an MVC?
- Vehicle to object
- Body to interior of vehicle
- Organs to interior of body
Define the law of inertia
A body at motion will remain in motion unless acted upon by an outside force
Head on collisions have great potential for injury to ___.
All parts of the body
Rear end collisions are common causes of ____.
Neck and head injuries
In what type of collision will the head remain still as the body is pushed laterally causing injuries to the neck?
Side impact collisions
What type of collision is the most serious because of the potential for multiple impacts?
Rollover collision
Rotational impact collisions can cause ____
multiple injury patterns
What are important factors to consider when somebody has fallen? (4 things)
The height they fell, the surface they fell onto, the part of the patient that hit the surface, and anything that interrupts the fall
It is likely that you will find additional injuries if you assess along the ___.
path of the energy
What is considered a severe fall by the CDC and US dept of health and human services?
Adult - greater than 20 ft.
Child - Greater than 10 ft for a child under age 15 or more than two to three times the child’s height
How are penetrating wounds classified?
By the velocity of the item that caused the injury
Penetrating trauma velocity definitions
Low - propelled by hand, injury limited to the area penetrated.
Medium - handguns and shotguns, arrow from a compound bow, ballistic knife.
High - assault rifle; cause pressure related damage also.
Signs of blunt force trauma are often ____ and ___.
Subtle and easy to overlook
Define index of suspicion
awareness that there may be injuries
As a call progresses and you get more involved in patient care, it is ____ that you will remember to call for the additional help.
Less likely
What is the portion of patient assessment during which you will focus exclusively on life threats?
Primary assessment
What are other terms for primary assessment?
Primary survey or initial assessment
What order should the ABC’s be in if the patient appears lifeless and has no pulse?
C-A-B
What are the six parts of primary assessment?
- General impression.
- Assessing mental status.
- Airway.
- Breathing.
- Circulation.
- Determining the priority of the patient for treatment and transport to the hospital
In cases where there appears to be _____ you should check for a pulse and begin CPR if necessary.
No breathing or only very occasional, ineffective breaths (agonal breathing)
What do the initial steps of the primary assessment depend on?
Your initial impression of the patient
What is the general assessment based on?
Your immediate assessment of the environment and the patient’s chief complaint and appearance
In cases of suspected trauma, you will match this information with the ____, ___, and ____.
Mechanism of injury, the patient’s complaint, and assessment findings.
What can disrupt normal adequate breathing when the chest is injured? (3 things)
rib injury, collapsed lungs, and bleeding from the major blood vessels within the mediastinum
What does Levine’s sign indicate?
Significant chest pain or discomfort
What is the reason EMS was called, in the patient’s own words?
The chief complaint
What do you do to form a general impression?
Look, listen, and smell
What is judgement based on experience in observing and treating patients?
Clinical judgement
Most EMS systems document that a person is oriented to ____.
Person, place, and time
If the level of responsiveness is lower than alert, ____.
Provide high-concentration oxygen by nonrebreather mask and consider the patient a high transport priority
What are the two purposes of performing the primary assessment?
- Identify and correct life threats with the airway, breathing and circulation
- Gather information
Four general situations that call for assistance with breathing from more severe to less severe.
- Respiratory arrest (perform rescue breathing).
- Not alert and breathing is inadequate (positive pressure).
- Patient has some level of alertness and breathing is inadequate (synchronize assisted ventilations).
- Breathing is adequate, but signs of respiratory distress or hypoxia are present (provide O2)
How long to check a carotid pulse.
No longer than 10 seconds
3 things to assess when evaluating circulation
Pulse, skin, and bleeding
Where do you check the skin if a patient is dark skinned?
Lips or nail beds, which should be pink
Do you need to check the pulse for 30 seconds during the primary assessment.
No, just long enough to determine if it is slow, fast, or normal
What are the 3 patient classifications to help determine priority?
Stable, potentially unstable, or unstable
To be stable a patient needs to have vital signs, that are _____ or ____.
In the normal range or just slightly above abnormal
Are stable vital signs necessary to classify a person as stable?
YES, but they are not the only requirement
A threat to ABC’s, either actual or imminent, rules out ____.
Stable
When a patient does not have immediate life threats, but you believe he may deteriorate, this patient classification should be ___.
Potentially unstable, you should not delay transport, but you may not use lights and sirens to get to the ER
List high priority conditions (9 things)
- Poor general impression.
- Unresponsive.
- Responsive, but not following commands.
- Difficulty breathing.
- Shock.
- Complicated childbirth.
- Chest pain consistent with cardiac problems.
- Uncontrolled breathing.
- Severe pain anywhere.
What position should you place an unresponsive medical patient?
Position patient on side
At what age should you assess cap refill for a responsive medical patient?
Infants and children under 6
What things does a responsive medical patients priority depend on?
Chief complaint, status of ABCs and other factors
An unresponsive patient is ____ a high priority for immediate transport.
Automatically
To evaluate circulation of blood, In an infant or small child with small nail beds____.
Press the back of the hand or top of the foot instead of normal nail bed cap refill check
Is capillary refill a reliable sign for circulation in adults?
NO
How is the mental status of infants typically checked?
Talking to the infant and flicking the feet
If a patient has depressed mental status and breathing (slower than ___ per minute) how do you ventilate?
8 per minute; positive pressure with 100% O2
What do you do if a patient is breathing more than 24 times a minute and is alert?
100 % O2 by NRB
The most important part of patient assessment is the ____.
Chief complaint, the reason the patient called for EMS
Why would you be unable to collect vital signs on a patient?
You are too busy treating immediate threats to life
Which part of the assessment process will vital signs be collected?
Secondary assessment
What are the two factors you should be concerned with when taking a patient’s pulse?
Rate and quality
What factors affect pulse rate? (7 things)
Age, physical condition, degree of exercise just completed, medications or other substances being taken, blood loss, stress, and body temperature.
Normal pulse rate Adult
60-100
8Normal pulse rate Adolescent 11-18
60-105
Normal pulse rate School age 6-10
70-110
Normal pulse rate Preschooler 3-5
80-120
Normal pulse rate Toddler 1-3
80-130
Normal pulse rate Infant 6mo-12mo
80-140
Normal pulse rate 0-5mo
90-140
Normal pulse rate newborn
120-160
Possible causes for a rapid, regular, and full pulse (5 things)
Exertion, fright, fever, high blood pressure, first stage blood loss
Possible causes for a rapid, regular, and thready pulse (2 things)
Shock, later stages of blood loss
Possible causes for a slow pulse (5 things)
Head injury, drugs, some poisons, some heart problems, lack of oxygen in children
A high pulse in an infant or child is not as great a concern as a low pulse. A low pulse may indicate ____.
Imminent cardiac arrest
An athlete may have a normal at-rest heart rate between ___.
40 and 50 beats per minute
In an emergency, it is not unusual for a heart rate to temporarily be between ___.
100-140
If the pulse rate is higher than __, or if consistently above ___ or below ___ consider this a sign that something may be seriously wrong with the patient and transport as soon as possible.
150; Above 120 or below 50
What two factors determine pulse quality?
rhythm and force
You should initially find a radial pulse in a patient that is ___ year of age and older.
ONE
The thumb side of the forearm is also referred to as ___.
The lateral side
Where do you look for a pulse in an infant 1 year old and less?
Brachial pulse
Can you assess carotid pulses on both sides at the same time?
NO
How many fingers should you use when trying to measure a radial pulse?
Three, first 3 fingers
How long should you count when measuring pulse or respirations?
30 seconds
What two factors are you concerned with when assessing respiration?
Rate and quality
What factors can influence breathing rate? (5 things)
Age, sex, size, physical conditioning, and emotional state
What are the four categories of respiratory quality?
Normal, shallow, labored, and noisy
What is especially serious in an unconscious patient?
Shallow breathing
Many resting people breathe more with their ____ than with their ____.
Diaphragm; chest muscles
Normal respiratory rate Adult
12-20; Above 24 and below 8 indicates SERIOUS
Normal respiratory rate Adolescent 11-18
12 to 20
Normal respiratory rate School age 6-10
15 to 30
Normal respiratory rate Preschooler 3-5
20 to 30
Normal respiratory rate Toddler 1-3
20 to 30
Normal respiratory rate Infant 6mo-12mo
20 to 30
Normal respiratory rate 0-5mo
25 to 40
Normal respiratory rate newborn
30 to 50
What is an intervention if Crowing respiratory sound are heard?
Prompt transport; this is a medical problem that cannot be treated on the scene
Give signs of labored breathing (7 things)
- Increase in the work of breathing.
- The use of accessory muscles.
- Nasal flaring.
- Retractions above the collarbones or between the ribs (especially in infants and children).
- Stridor.
- Grunting in expirations (especially in infants).
- Gasping.
What things affect regularity of an awake patients breathing? (3 things)
Speech, mood, and activity among other things
When might you see mottled skin?
Occasionally in patients with shock
What are the three best places to assess skin color?
Nail beds, inside of cheek, and inside of the lower eyelids
What are the best places to assess skin for an infant or child?
palms of the hands or soles of the feet
Who is more susceptible to mottling?
Children and elderly who are in shock
If a patient’s forehead feels cold what should you do?
Further assess by placing the back of your hand on the abdomen beneath the clothing
What is clammy?
Both cool and moist
Cool/Clammy skin can be a sign of ____.
Shock or anxiety
Cold moist skin
Body is losing heat
Cold dry skin
Exposure to cold
Goose bumps
Possible causes - Chills, communicable disease, exposure to cold, pain or fear
Is cap refill in children reliable if they have been exposed to the cold?
NO
What should you look for when assessing pupils
Size, equality, and reactivity
Under ordinary conditions, pupils are neither large nor small, but ___.
Midpoint
How should you evaluate eyes when examining in the sun?
Cover both eyes and after a few seconds uncover one eye and examine it
Causes of dilated pupils (3 things)
Fright, blood loss, drugs, prescription eye drops
Causes of constricted pupils (2 things)
Drugs, prescription eye drops
Causes of unequal pupils (5 things)
Stroke, head injury, eye injury, artificial eye, prescription eye drops
Causes of pupil lack of reactivity (2 things)
Drugs, lack of oxygen to the brain
Normal blood pressure range Adult
Systolic - Less than 120 Diastolic - Less than or equal to 80
Normal blood pressure range Infants and children
Systolic - approx. 80 + 2 x age Diastolic - 2/3 the systolic
Normal blood pressure range Adolescent 11-14
Systolic - average 114 (88-120) Diastolic - average 76
Normal blood pressure range School age 6-10
Systolic - average 105 (80-115) Diastolic - average 69
Normal blood pressure range Preschooler 3-5
Systolic - average 99 (78-104) Diastolic - average 65
Blood pressure is usually not taken on a child under ___.
3 years
In cases of blood loss or shock, a childs BP will remain within normal limits until ___.
The near the end, then fall swiftly
Define the limits for hypertension.
Sys greater than 140 or diastolic greater than 90
What is it when systolic BP is between 121-139 or diastolic between 81-89
prehypertension
Define the limits of serious low blood pressure.
When the systolic drops below 90
What’s the first step when taking a bp with a sphygmomanometer?
Put the stethoscope around your neck like a real hero
How much of the arm should the BP cuff cover?
two thirds of the upper arm
Is it ok to have clothing under a bp cuff?
NO
Where should the bp cuff be placed in reference to a patient’s elbow?
1 inch above the crease of the elbow
What are the 3 ways to take a bp?
Auscultation, palpation, or blood pressure monitor
Where should you position the diaphragm of the stethoscope?
Directly over the brachial pulse or over the medial anterior elbow (front of elbow) if no brachial pulse can be found
How fast should you allow the pressure to fall when taking a bp?
5-10 mm per second
Blood pressure is reported in even numbers. If the reading falls between two lines on the guage, use the ___.
Higher number
How long should you wait to re-inflate the cuff if you need to retake the bp?
1 minute, if you don’t wait you will get and erroneously high number
Is MAP typically used in the prehospital setting?
NO
What gives you more information about a child or infant rather than BP? (3 things)
Sick appearance, respiratory distress, or unconsciousness
What is one very important use for temperature of a patient?
Screening for influenza
How fast will an electronic thermometer usually provide a reading?
In just a few seconds
Rectal temperatures are ____.
Not usually practical or necessary in the field
Are tympanic thermometers accurate enough for EMS use?
NO
What does a person’s normal temperature depend on? (5 things)
Time of day, activity level, age, where the temperature is measured, and simple genetics
Older people tend to have ___ temperatures than younger people.
Lower
A rectal temp is often ___ than an oral temp and an axillary temp is frequently ___.
1 degree higher for rectal and 1 degree lower for axillary
In general a healthy normal person will have a temperature greater than ___ and less than ___.
96 and 100 degree F
What is the monitor called that can measure CO and O2?
CO-oximeter
A pulse ox can help you assess the effectiveness of ___. (3 things)
artificial respirations, oxygen therapy, and bronchodilator therapy
Pulse ox hypoxia ranges
91-95 percent Mild hypoxia
86-90 percent - significant or moderate hypoxia
85 percent or less - severe hypoxia
You should try to get the SpO2 up to at least ___
96 percent
Should you withhold O2 if the patient’s saturation is above 96?
No
When is the oximeter inaccurate?
in patients with shock or hypothermic
What type of pulse ox readings will somebody with CO exposure show?
Falsely high readings
Smokers may have ____ percent of their hemoglobin bound to carbon monoxide
10-15 percent
Anemia, hypovolemia, and certain types of poisoning can give ___
Falsely high O2 sat readings
People with diabetes may test their blood sugar as often as
5-6 times a day
Some glucose meters can take blood from the __ instead of the finger
forearm
Milligrams per deciliter can also be called ___
milligrams percent
A normal blood glucose level is usually at least ___ and no more than ___.
60-80; 120-140
After you prick a person’s finger, you should ___
wipe away the first drop of blood that appears
A glucometer may take up to ___ seconds to provide a reading
15-60 seconds
Some areas recommend that the blood glucose measurements be done while ___.
En route to the hospital
Often you will not be able to see the injury or how serious it is, especially if ___.
It is internal
Signs of major injury (5 things)
- Serious bleeding.
- penetrating injury to the neck, chest, or abdomen.
- Altered mental status.
- Lack of patent airway.
- Pallor, tachycardia, other signs of shock (in another spot in the book).
What is included in a secondary assessment of a trauma patient with no significant Mechanism of injury?
- History of present illness
- Physical exam
- Set of baseline vitals
- Past medical history
Frequently in health care the word illness means both ___.
nontrauma medical problems and injuries from trauma
Secondary assessment steps for trauma patient with significant MOI
- Determine chief complaint and rapidly how the patient was injured
- manual c-spine
- Consider requesting ACLS
- Perform rapid trauma assessment
- Baseline vital
- Obtain past medical history
What is a more important question if a person was shot?
How many shots did you hear?
What are three techniques of physical exam that an EMT must master?
observe, palpate, and auscultate
What 4 things do you look for when inspecting a pt?
Symmetry, color, shape, and movement
What 4 things do you look for when palpating a pt?
Abnormalities in shape, temperature, texture, and sensation
DCAP-BTLS
Deformities, contusions, abrasions, punctures and penetrations, burns, tenderness, lacerations, swelling
What are some of the most common injuries you will see?
Abrasions
Swelling is a common result of ___.
Capillaries bleeding under the skin
What is a simpler classification for DCAP-BTLS?
Wounds, tenderness, and deformities
A sign is ___ while a symptom is ____.
Objective; subjective
Which things do you base your decision to place a c-collar?
Any patient that may have injury to the spine based on mechanism of injury, history, or signs and symptoms
Do gunshot wound automatically get a c-collar?
No, only if there are signs or symptoms of neurological injury or if the patient is unconscious and cannot be fully assessed for these findings
What is an alternative if a proper size c-collar is not available?
Rolled towel around the neck and tape patient’s head to backboard
Do you perform primary assessment and treat life threats before or after applying the c-collar?
Before
Use the ____,___ and ____ to determine the need for cervical immobilization.
MOI, level of responsiveness, location of injuries
Does a proper sized c collar depend more the the width or length of the patient’s neck?
Length
The front height of the collar should fit between the point of the chin and the chest at the ___.
Suprasternal (jugular) notch
If a c collar is supporting the chin it is ___
Too short
A trauma patient with significant MOI gets a physical exam focused on the area of injury and also receives a ___.
Head to toe rapid trauma assessment
A child may sustain the same injury as an adult, but from ___.
Less force
For falls, transport to trauma center if:
Adults: fall greater than 20 ft (one story = 10 ft).
Children under 15 yo, fall greater than 10 ft or two to three times the child’s height
For high risk auto crash, transport to trauma center if:
Intrusion greater than 12 inches to occupant side or greater than 18 inches to any site.
Ejection.
Death in same vehicle.
Vehicle telemetry data consistent with high risk injury.
Motorcycle crash greater than 20 mph
When inspecting a vehicle in which an airbag has been deployed, you should look at the ___.
Steering wheel
Does determining a significant MOI when a patient has an obvious critical injury make a difference in your decision making?
NO
Many local clinics would not be able to provide additional care that is worth a delay in transport for ___.
Awake trauma patients
Even if a patient is a high priority transport, the RTA should ___.
Be performed at the scene, before loading the patient into the ambulance
A bruise behind the patient’s ear is a ____.
Battle sign; important sign of skull injury
Additional things to check when examining the head
Crepitation
Additional things to check when examining the neck
JVD and crepitation
Additional things to check when examining the chest
paradoxial motion, crepitation, breath sounds
Additional things to check when examining the abdomen
firmness, softness, distention
Additional things to check when examining the pelvis
pain, tenderness, motion
Additional things to check when examining the extremities
distal circulation, sensation, motor function
Blood in the ___ chamber is not common.
Anterior
What is a concern if an ear of nose is leaking CSF?
Try to keep the area clean so bacteria don’t get in
What is the most common unusual breath
Alcohol
The neck veins are usually ___ when the patient is sitting up.
not visible
JVD may be caused by ___ or ___.
tension pneumothorax or cardiac tamponade
Flat neck vein in a patient who is lying down may be a sign of ___
blood loss
Can you check for crepitation and paradoxial motion of the chest at the same time?
YES
What are the two things to look for with breathing when performing a rapid assessment of the chest in the trauma patient?
presence and equality
What are the two type of poop bags that may be in the abdomen?
colostomy or ileostomy
How deep should you press when palpating the abdomen?
about 1 inch with the palm side of your fingers
Does continuing to palpate the pelvis after the patient has already expressed pain necessary?
NO
If you find a deformity, diminished function, or other indication of injury to an extremity in a patient who is a high priority for transport, you will ___.
Not splint the extremity at the scene but will treat it en route
You may place a ____ on the board before you roll the patient onto it if they have a pelvic injury.
pneumatic anti-shock garment (PASG)
one method of stabilizing an injured pelvis is forming a ___.
Pelvic wrap from a folded sheet
Where should you check for distal pulses in a lower extremity?
Posterior tibial pulse just behind the medial malleolus of the ankle or the dorsalis pedis pulse at the top of the foot
Always assume that the unconscious trauma patient has a ___.
spine injury
Young children may be less frightened if you begin your assessment at the ___ and work towards the ___ instead of proceeding in the normal ____.
Toes to head rather than head to toe direction
If you are not on a transporting unit and the ambulance has not arrived, you may do the ____ at the scene
detailed physical exam
The detailed physical exam is performed most often on the trauma patient with a ____. Seldom on a ____.
Significant injury or MOI; medical patient
You should perform the detailed physical exam only ___ you have performed all critical interventions
After
Performing a detailed physical exam is always a ___ priority that addressing life threatening problems
lower
The detailed physical exam usually takes place ___.
In the ambulance, en route
JVD is always ___ in a seated patient.
Abnormal
What should you do when trying to reassess the posterior of a patient on a backboard.
Simply reassess the flanks and as much of the spinal area as you can touch without moving the patient.
Should you call the hospital before or after the detailed physical assessment?
Normally after, but depending on how far you are from the hospital and what your local protocols say, you may do this step before the detailed exam
Does a trauma patient with no significant MOI need a detailed assessment?
This kind of patient received all the assessment he needed while still at the scene. He does not generally need a detailed physical exam.
The detailed physical exam is most appropriate for the trauma patient who is ___.
unresponsive or has a significant injury or unknown MOI
What is the most important source of information about a medical patient’s condition?
What the patient can tell you
When the patient is awake and responsive, what comes first?
Obtaining patient history
What are the four parts of the secondary assessment for a medical patient? This is also the order you do them in for a responsive medical patient
- History of the present illness.
- Past medical history.
- Physical exam.
- Baseline vitals.
What is a good mnemonic for gathering the history of the present illness in a medical patient?
OPQRST, onset, provocation, quality, radiation, severity, and time
What order are the parts of a secondary assessment of a medical patient if they are unresponsive?
- Rapid physical exam head to toe.
- Obtain baseline vitals.
- Gather history of present illness (OPQRST).
- Gather past medical history from family or bystander.
What does a conversational information gathering effort get you other than info about the present illness?
It will also reduce the patient’s fear and promote cooperation
Although relatives and bystanders can be good sources of info the most important source is the ___
patient
After finding out the patient’s age, you should then get ___ and ___.
The rest of the past medical history and the name of his personal physician
When an illness or other non traumatic condition occurs, it frequently affects not just one particular organ or part of the body but a ___
system of the body
A patient with difficulty breathing you should also assess for signs of ___.
fluid build up (this may be seen in the ankles - or in the lower back of a bedridden patient
If the type of complaint is respiratory what additional history should be attained? (5 things)
Cough, Fever or chills, dyspnea on exertion, weight gain (indicates fluid), have a prescribed bronchodilator?
FAST for neurological testing
F - face, A - Arms, S - speech, T- test oxygen saturation
Most of the useful information for medical patients comes from the ___.
history
A complete set of baseline vital signs taken during the ___ is essential to the assessment of a medical patient
secondary assessment
What is on a medic alert identification device?
Star of Life, the patient’s medical problem along with a phone number (ankle wrist or neck, also look for wallet cards)
The most important time to check the pupils are when the patient’s eyes are ___
Closed
What should you use instead of the word drugs when finding out what a patient takes
medicines or medications
Where might you see a vial of life sticker?
main outside door, closest window to the main door, or the refrigerator door
There is not usually much information gained from the secondary assessment of an ____ that will change treatment in the field.
Unresponsive medical patient
The information you gather in your assessment of unresponsive medical patients will be particularly helpful to the ____
Staff in the emergency department
You will perform reassessment on every patient after you have ___.
Finished performing lifesaving interventions and often after you have done the detailed physical assessment
What should you do during a reassessment? (4 things)
- Repeat primary assessment.
- reassess vital signs.
- repeat physical exam related to the patient’s specific complaint or injuries.
- Check any interventions you have performed.
The abdomen may become distended, a sign that you are especially likely to see if you have ___.
A long transport
What determines just how often you will conduct the reassessment?
The patient’s condition as well as the length of time you spend with the patient. General rule every 15 minutes for stable and 5 minutes for unstable or potentially unstable
Whenever you believe there may have been a change in the patient’s condition, repeat at least the ___
Primary assessment
____ is the last step in your patient assessment
Reassessment
Interventions you need to check during a reassessment include ___ (4 things)
oxygen, bleeding, spine immobilization, & splints
The EMT is governed by which guidelines?
Medical, Legal, and ethical
What defines what skills and medical interventions an EMT can perform?
Legislation
What is the primary ethical consideration?
To make patient care and well-being a priority
Scope of practice refers to
What you should do
Standard of care refers to
How you should perform care
What is practiced with the aim of maintaining the standards you would wish to have provided for you or your family?
Quality improvement
Consent given by adults who are of legal age and mentally competent to make a rational decision.
Expressed consent
Presumed consent that a parent would give for a child
Implied consent
What are the 3 types of consent?
- Expressed.
- Implied.
- Consent to treat minors or incompetant patients
Expressed consent must be
Informed consent
Is informed consent a legal requirement?
YES
What is the latin term for the daycare situation?
In loco parentis
3 ways to enforce involuntary transport.
- Police.
- Mental health worker.
- Court order
What are reasons a patient may refuse care? (3 things)
- Denial or fear.
- Failure to understand the seriousness of the situation.
- Intoxication.
Can a patient refuse care if they have unstable vital signs?
No
What 4 things are needed for a patient to refuse care? Even if a patient does these 4 things an EMT may still be held liable.
- Able to consent.
- Mentally competant.
- Fully informed.
- Sign a release.
Define battery.
Causing bodily harm or restraining
Define assault.
Placing a person in fear of bodily harm.
Is an advance directive a DNR order?
Yes
Who is the person whom the signer names to make health decisions if he is unable to?
Proxy
Living wills and proxies usually pertain to situations…
In the hospital, not in the field
What 3 circumstances must be proved to determine negligance?
- EMT had a duty to the patient.
- EMT did not provide standard of care.
- There was proximate causation, which means the EMT caused physical OR pshychological harm.
Is a tort civil or criminal?
Civil
What is latin for “It speaks for itself”? Used in tort law.
Res ipsa Loquitor
Two of the most significant causes for lawsuits against EMT’s
Patient refusals and vehical accidents
Who should you contact if you have a question regarding the validity of a legal document?
Supervisor or agency attorney
Can you supply information to insurance companies?
Yes
Libel is
written
Slander is
verbal
How far should you cut from bullet or knife holes?
6 inches
What is the entryway for air, especially in an emergency?
The mouth
What are common foreign body obstructions?
Small toys, food, blood, or vomit
What can cause swelling of the tissues around the glottic opening?
Blunt force, burns, and certain infections
Is stridor an obstructed upper or lower airway?
Upper
Swelling of the upper airway is usually due to?
Infection
How far should you insert an OPA before rotating it?
Past the uvula or until you meet resistance against the soft palate
Name the 4 parts of a suction unit.
- Suction source.
- Container.
- Tubing.
- Suction tips or catheters
Can suction catheters suction vomit?
No, they will kink
3 manual techniques for clearing an airway
- Abdominal thrusts.
- Chest thrusts.
- Finger sweeps
Does the diaphragm expand or contract during inhalation?
Contracts
Of a 500 mL tidal volume, how much actually reaches the alveoli?
350 mL
What is the first step for BVM to stoma ventilations?
Clear mucus plug or secretions
Humidifier water can become a breeding ground for.
Algea, harmful bacteria, or fungal organisms
When should you adjust the flowmeter when administering O2?
Before and after placing the device on the patient
Use orange traffic cones during daylight and these at night.
Reflective triangles
Regarding scene safety, the specific actions tou should take depend on…(3 things)
Local protocols, type of danger, and help available
After BSI and scene safety what should you do?
Identify mechanism of injury or nature of illness
What does the amount of damage from a bullet depend on? (3 things)
Size, path, and if it fragmented
General impression is based on (3 things)
Environment, chief complaint, and appearance
Oxygen saturationa and mental status are
not considered vital signs
When palpating a bloop pressure, what pulse should you use?
Radial or brachial
How much higher should you inflate the blood pressure cuff after the pulse sounds disappear?
30 mmHg
If you determine a high diastolic reading, wait __
1-2 minutes and take another reading
Describe some examples of symptoms.
Pain, dizziness, and nausea
What is a surgical incision held open by a metal or plastic tube?
Tracheostomy
Repeat the primary assesment before a
detailed assessment is performed
Which approach can you use to tailor the physical exam for a specific chief complaint?
Body systems approach
Additional history to gather for allergic reactions.
Time of exposure and time of sympton onset
What is an additional history item to check when assessing abdominal or GI issues?
Fever
How many people wear medic alert tags?
Over 1 million
When should you record vital signs?
As soon as they are taken
What is a means of determining trends?
Reassessment
