EMR Written Exam Flashcards
What are levels of EMR responders
1) EMR
2) EMT
3) AEMT
4) Paramedic
Role of EMR is to …
♣ EMR’s should be professional, calm, good communication, controls fears, works within their scope of knowledge, seek additional help
Most common Blood Bourne Pathogens
Bacteria and viruses
What are examples of PPE’s you should always wear
Gloves, mask, gown if possible
DNR =
Do not resuscitate
When would you DNR
mortal wounds, rigor mortis, tissue decay, situation endangering to EMR’s life
Stages of Grief are DABDA, which =
Denial, anger, bargaining, depression, acceptance
When you arrive on any emergency scene, what should you do first
1) Is the scene safe?
2) Check for responsiveness / consciousness (LOC)
IF UNCONSCIOUS:
- PPE
- ABC’s
- Start CPR
- Call 911
- Manage scene
IF CONSCIOUS:
- Introduce yourself
- State training
- Ask if you can help (consent)
- Explain what you will do
- Communicate, manage scene
T or F: If patient is conscious, you must obtain consent to help?
True
When is implied consent ok?
If they are unconscious or can’t talk
Is HIPPA important as an EMT?
When is it not necessary?
Yes, of course.
If passing info on to other EMT’s, calling 911, etc.
Supine vs. prone
Supine is face up
Prone is face down
Fowlers Position is
Sitting up
Cephalic vs. caudal
Cephalic is superior, and caudal is inferior
What is Right Lateral Recumbent (RLR)
Laying on right side
Proper ways to lift or move a patient safely would be …
- Lift with legs and buttocks
- Maintain good posture, keep weight close to body, push rather than pull
- Clothes or blanket drag, shoulder or ankle drag, firefighters drag or carry, walking assist or two person seat carry,
T or F: you should always operate within your knowledge and skill base
True
It’s ok if you don’t know
Should you move someone?
When would you?
Never move anyone, unless you need to for their safety.
LOC =
Level of consciousness
MOI =
mode of injury
ABC’s =
Airway, Breathing, Circulation
Remember steps when you arrive on scene what to do:
- Scene safety
- Mechanism of injury (MOI) / nature of illness
- Number of patients involved
- Resources needed
When would you call 911?
If you don’t know / not sure.
But if they are unconscious, breathing issues, chest pain, no pulse, seizures, major injury, severe bleeding, open fracture
What is AVPU:
- A: Alert (they are alert and good)
- V: Verbal (they are verbalizing, but not making sense)
- P: Painful (just responds to / groans in pain)
- U: Unresponsive (not responsive)
What are steps to determine if they are breathing
LOOK, LISTEN, FEEL
Areas to check pulse:
radial artery (most unintrusive) brachial artery carotid artery femoral artery posterior tibial artery
For CPR, if there is not a head injury, how do you position their head for CPR. How do you with a suspected head/spinal injury?
No injury: tilt head and chin lift
Injury: jaw thrust
Normal respiratory rates for adults, children, and infants:
o Adults: 12-20 breaths per min
o Children: 15-30 breaths per min
o Infants: 25-50 p/m
Abnormal respiratory rates for adults, children, and infants:
o Adults is less than 8 or more than 20
o Children is less than 10 or more than 30
o Infants is less than 20 or more than 60
How many compressions and ventilations for adult and child and infant with ONE PERSON
30 compressions, 2 ventilations
How many compressions and ventilations for adult and child and infant with TWO PEOPLE
30 compressions, 2 ventilations for adults
15 compressions, 2 ventilations for children and infants
What are the signs of shock
Irritible, Losing responsiveness, heart rate goes up or down, confused/dizzie, pale, weakened pulse
How can you control shock:
Control bleeding, give extra oxygen, lay patient flat, don’t let them get cooled/overheated, comfort/distract/calm patient
Lack of oxygen is called:
Hypoxia
Oxygenation is:
Level of oxygen in bloodstream
NORMAL RESPIRATORY RATE: If person is breathing, the breaths for normal respiratory rate is what for adults, children, and infants:
- Adults … Need 8-10 breaths per minute. They should be doing about 1 ventilation about every 5-6 seconds
- Child … Need 12-20 breaths / pm. They should be doing about 1 Ventilation about every 3 seconds
- New born … Need 30-60 breaths / per / minute. They should be doing about 1 ventilation every 1-2 seconds
1 killer in the U.S. is:
Cardiovascular disease
Coronary Heart Disease is:
Is when plaque buildup occurs in arteries
Signs and Symptoms of Heart Attack
- Persistent chest discomfort or pain
- Pain that comes and goes
- Difficulty breathing
Cardiac Chain of Survival is:
- Early recognition and early EMS system
- Early CPR
- Early defibrillation
- Early advanced medical care
Explain one person CPR on an adult vs. child vs. infant
Adult & Children: two hands, center of chest, 2 inches deep compressions, 30 compressions to 2 ventilations
Infant: 2-3 fingers middle of chest below nipple line, 1.5inches deep, 30 compressions to 2 ventilations
Explain 2 person CPR on an adult vs. child vs. infant
Same things. But, with child and infant, now do 15 compressions, 2 ventilations. And switch off by calling “change” every 2 minutes.
If there is a suspected spinal injury, do you still do CPR
Yes, absolutely. Better they live and possibly mess up their spine a bit more.
Just use Jaw Thrust when moving them.
When do you do rescue breathing versus CPR
If person has pulse but not breathing, do rescue breathing of ventilations (adult every 5-6 seconds, child every 3 seconds, infant every 1-2 seconds). If no breathing and no pulse, do CPR with compressions and ventilations.
With a suctioning device, it should measure how long
From ear to side of the lip
Proceedure for using a suctioning device to remove object from throat
First, make sure device works
Second, measure from ear to side of mouth
third, place person slightly on their side
Fourth, look and clear mouth of anything, then put suction in mouth and suction
Fifth, sweep with index or little finger
Swipe no longer than 15 seconds for adult, 10 for child, and 5 for infant
Review “Oxygen Delivery” proceedure in the steps PDF
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Steps for what to do with an excessive bleeding incident
1) Go through primary assessment
2) Introduce yourself, ask permission, communicate
3) Get gauze, apply pressure, use bandage
4) Get pulse before and after you bandage (ask if too tight). Especially check for pulse beyond injury.
5) Call 911 if necessary
6) Control shock
7) Keep applying gauze, don’t take stuff off
Where to place a turnicate, and where not to
Place turnicate slightly above where injury happened.
Don’t place it below or over a joint
If you come across person lying with epi pen, what do you do
Is scene safe? Primary Assessment. Call for help.
Clear clothing around thigh if possible, check to make sure it is their epi pen. Remove cap. Place on thigh. inject epi pen into thigh for 10 seconds. Keep monitoring. Wait for help.
Review hand positions, depth of compressions, ventilations for adults, children, infants - one person vs. 2
Two hands on adult and child. 30 compressions, 2 ventilations. 2 inches deep
2-3 fingers on infant, 30 compressions and 2 ventilations. 1.5 inches deep.
IF 2 PERSON RESCUE:
Child and Infant get 15 compressions and 2 breaths, switch “change” every 2 minutes
When is it ok to stop CPR
- AED arrives
- EMS arrives
- Too exhausted
- Situation becomes unsafe
- Dead
- Life
Tachy =
Brady =
Too fast
Slow
Process for using a mask
Position mask, seal mask, blow into mask
T or F: With a BVM, one person does compressions, the other person does bag?
False. One person does compressions and presses bag / ventilations. The other seals mask.
Chocking infant vs. adult
Infant: face down, 5 back blows, turn over and do 5 chest compressions (3 fingers, 1.5 inches deep).
Adult: One arm in front, bend over, 5 back blows, 5 abdominal thrusts, repeat until dislodged or CPR needed.
Do you need to count out loud doing CPR?
Yes
START DOING FLASHCARDS FOR DAY 2 NOTES
ok
How far should you reach for equiptment
20 inches
What lift for person with spinal injury (and how many people at least do you need):
If you have a hurt leg, what lift should you use?
Log roll (at least 4 people)
Squat lift
What is the body’s most effective natural defense against infection
What is best way to prevent spread of disease
intact skin
wash hands
Explain HA.IN.ES position
Put farthest arm up, other arm bent across chest, furthest leg bent - roll head then body over
What is in blood that helps stop bleeding / causes clotting
platlets
With a squat lift, explain what you do
Lead with weaker foot forward. Bend down. Move upper body before hips. Lead with head.
In an AED, after shock is delivered, what do you do next?
Keep doing CPR
Steps for using a ventilation mask
1) Position mask
2) Seal Mask
3) Open Airway
4) Blow into mask
When giving chest compressions, obviously don’t use fist or arms on an adult, but what about fingers?
Dont let fingers touch when doing compressions on an adult. Use palm, not fingers.
When fire trucks and ambulances arive on scene, remember this:
Fire truck blocks intersection/traffic/lanes at an angle. Ambulance parks in shadow of fire truck. Set up flares 10-15 feet around. Create radius 50 feet around scene for safety.
When using an oropharyngeal airway tool, what are steps to determine if and how to use it?
1) Are they unresponsive (FIRST)
2) Evidence of airway obstruction
3) Is there a gag reflex
4) Measure from corner of mouth to ear.
What is choking and blocking when it comes to cars with patients in them at scene
Choking: put blocks of wood in front / behind tires
Blocking: Fire engine blocks off traffic.
If an adult patient shows signs of heart attack, give them what medication
asprin
An oxygen cylinder holds about how many psi?
2000 lbs/psi is full, about 200 lbs/psi is its getting low.
So if it is at 1200 lbs/psi, you are good.
State ages of kid in these stages:
1) Infant
2) Toddler
3) Preschooler
4) School age child
1) 0-1
2) 1-3
3) 3-6
4) 6-12
In older aged persons, what signs would you noticed as they age:
- Their heart muscle would thicken
- Decreased lung elasticity
- Slower movement through digestive system
- They can still learn
There are different phases of EMS response. List them
- Preparation for an emergency call. (PREPARE KIT)
- Dispatch.
- En-route to the scene.
- Arrival at the scene and patient contact.
- Transferring the patient to the ambulance.
- En-route to the receiving facility.
- Arrival at the receiving facility.
- Clear medical facility.
- Available for next emergency call.
T or F: symptoms of multiple sclerosis appear and disappear over a period of years
True
What delivers more oxygen, a nasal cannula or a non-rebreather mask?
The non-rebreather mask (or BVM) delivers much more … about 90% oxygenated air.
How do you tell if Oxygen is flowing in oxygen tank
You should hear audible hissing. Remember that pressure gauge of 200-1200 lbs/psi tells you how much is in, and the flowmeter should stay constant if oxygen is flowing. The o-ring gasket seals the regulator to the tank (and never carry it by the regulator)
If you come across a hazmat scene, what do you do?
Go to uphill or upwind area, don’t be the hero. Call for help. Stay in cold zone.
If a child has a high high fever (103+), what do you do, and in what order?
1) Call 911
2) try to cool down
3) Calm and assure
Remove blankets and cool them down. Get a sponge and get them wet or wet towel. Do NOT put them in an ice bath or alcohol
In a HAZMAT situation, explain these types of decontamination:
- dilution
- gross
- absorption
- neutralization
- Dilution: Dilute liquid
- Gross: Enters the zone
- Absorption: Soak up or hold contaminents
- Neutralization: Chemically altering a substance to render it harmless
How long does it take for the placenta to be delivered after the baby?
30 mins
Explain each:
- Primary Assessment
- Secondary Assessment
- SAMPLE
- OPQRST
- DCAP BTLS (DOTS)
Primary: Is scene safe, MOI, Check for other patients, Other Resources. Introduce yourself …
Secondary: Head, shoulders, abdomen, extremities
SAMPLE
For MCI incidents, what do colors mean:
- Red
- Yellow
- Green
- White
- Black
Red: critical Yellow: Injured but can wait Green: Can walk White: Hold ... minor injuries Black: Dead
T or F: If woman is in labor, you can calm her and help her by telling her to focus on some object in room as she had contractions
True
What should you report to hospital and what don’t you need to report to hospital (of these 2 options) when reporting incident to hospital:
- Personal characteristics of person (age, height, color)
- SAMPLE
You WOULD report personal characteristics
You would NOT report SAMPLE info.
Would checking vital signs be a good indication of determining LOC
Not really
If you come to a car in an accident, what order do you check the ignition, park, brake?
Put in Park, E-brake on, Ignition off
Hypoglycemic =
Low blood sugar levels
If patient is hypoglycemic and unconscious, would you give them juice or glucose pills?
No. Give those to conscious patients. In unconscious patients - call 911
Vasogenic shock is what?
Neurological / spinal cord shock
Accronym for assessing whether stroke has occured?
FAST F-face A-arms S-speech T-time
If person is drowning, should you go after them?
When can you?
No
With help, life jacket, or shallow water up to chest
If you approach a fire and firefighters are there, would you seek to have firefighters tell you how you can help, or keep people from approaching the fire?
Help firefighters - you are an EMR
Signs of a heat stroke:
- Flushed dry skin
- Temp above 104
- Not sweating’
- Shallow breathing
- ## Low blood pressure
Define:
- Avulsion
- Amputation
- Laceration
- Impalement
Avulsion: skin or tissue being torn away
A drowning victim who is passive is _______
floating face up or face down
Depressant drugs do what to you?
Stimulants do what to you?
Designer Drugs do what to you?
Depress, slow/lethargic, relax
Excite, speed up, energy
Mood swings and hallucinations
Phases of a seizure are what? Explain each
Aura Phase: strange sound … sense something unusual
Tonic Phase: unconsciousness and muscle rigidity
Clonic Phase: seizure occurs
Post-ictal phase: deep sleep
How can poisens get into you. Different types?
Absorbed (poisen ivy)
Injected (snake bite)
Ingested (contaminated water)
Inhaled (Chloroform)
If you are doing triage, and you find someone with a suspected spinal injury, would you mark them red or yellow
Yellow. The red is for someone needing immediate care who can’t breathe or is unconscious.
Remember, someone with a genital injury … it is extremely painful
true
Do you rub effected area of a frostbite?
No
For HAZMAT situations, explain what happens in hot, warm, and cold zones
Hot: rescue, treatment of life threatening conditons, and initial decontamination
Warm; Complete decontamination, life saving care, and immobilization.
Cold: Bystanders and other activities
What is Traumatic Asphyxia
Injury from some strong crushing mechanism / pinned by heavy object.
First thing to do with a snake bite is …
Wash the wound
Do you elevate the leg (if bitten there) for a snake bite?
No
Should you place wet clothes (from a sexual assult) in a closed plastic bag or open paper bag
Open paper bag. The closed plastic bag causes DNA to detiorate.
What do you do with evidence in a sexual assult
Place each item in dry paper bag individually
Signs of excited delirium syndrome
high body temps
increased body strength
insensitivity to pain
What is a transient ischemic attack
A mini stroke (smaller / shorter stroke)
If someone has tooth knocked out, what do you do?
Call for help. Hold tooth by crown, not root. Place tooth in MILK after running it through water.
If eye is impaled, do you put styrofoam cup over it?
No
What is it called when you move a fractured bone and hear a grating sound
Crepitus
What is a cravat
folded triangular bandage used to hold splints in place.
What do you apply on a jellyfish sting
vinegar
What is a binder used for with an injury
wrap around abdomen for a wound
Most important thing for a patient to do with a heat cramp
REST
If a fracture occurs on a right rib, which way would the patient lean?
To the right
If blood is gushing, would you put PPE of gloves or mask on first
mask
After other medical help arrives, who prepares patient for transport?
The EMT
Which can apply an IV? An EMT or AEMT
AEMT
T or F: Firefighters and police are the only EMS service providers?
False. They are EMT’s, but it is a multi-tiered nationwide system of police, fireman, private companies, etc.
Would a paramedic act as an EMR?
no
If person just lost a loved one and they say “he wanted to hang on till Jake graduated H.S.” … what stage of grief are they in?
Bargaining
Which one is transmission by direct contact, which is indirect, which is droplet transmission
- Blood splashing in eyes
- Touching body fluids
- Touching soiled dressing of infected patient
- Inhaling particles from sneeze
- Direct
- Direct
- Indirect
- Droplet
What type of infection are each of these:
- Hepatitis
- Measles
- Mumps
- Chiicken Pox
- Flu
- Malaria
- Tuberculosis
- Tetnus
- Anthrax
- Virus
- Virus
- Virus
- Virus
- Virus
- Protozoan
- Bacteria
- Bacteria
- Bacteria
Rabies is a vector borne trasmission, which means
Given/passed to you by someone/something that carries the disease.
MCI =
Multiple casualty incident
Explain difference between a debriefing vs. a defusing after an event
Debreif is a formal one with trained professional
Defusing is right after to assess situation
How long should you vigorously wash your hands for
15 seconds
If you touch someone without consent, is it battery or assault?
Battery
If you stop care of a patient you were helping before EMS arrives, you are guilty of what?
Abandonment
Which situations require mandatory reporting?
Abuse and violence (and tuberculosis / aids)
T or F: HIPPA does not apply to family members
False
True or False: HIPPA does not apply to public health organizations and donor procurment organizations
True
If a person refuses care, do you have to honor it?
Yes. You may recommend they get care, but if the refuse care, you honor it. Document it!
Does a mentally incompetent person fall under the rule of implied consent?
Yes
Which body system regulates blood sugar levels
endocrine
A patient will die within how many minutes if they are not breathing and don’t get oxygen to the brain?
4-6 minutes
Blood being pumped to the body comes from what cavity of the heart?
Left Ventricle
If you are not breathing, what part is not working:
- brainstem
- spinal cord
- cerebellum
- cerebrum
Brainstem is responsible for breathing function
The bodys largest organ is the ______
skin
Kidneys are which direction in relation to the lungs?
Inferior
T or F: when moving someone into HAINES position, move their head first, then roll their back
False. Move their Head and neck and back at same time
Who would you help / treat first. A patient lying unconscious, or a violent person thrashing about
The violent person needs to be restrained first for everyone’s safety.
When restraining a patient onto a flat board, you need at least how many people?
5
What type of stretcher moves really really heavy patients
Bariatric
How many people do you need to do these lifts:
- Walking assist
- Pack strap
- Direct Ground Lift
- Extremity Lift
- 1
- 1
- 6
- 3
If someone is unconscious, put them in what position?
If they are struggling breathing, what position?
If they have abdominal pain, what position?
If you have to leave them?
- supine
- Fowlers
- On side
- Haines
T or F: when determining what other help you’ll need, do you factor in how many bystanders there are?
NO
You can suspect a head/neck injury if the person who fell, fell higher than what height?
Higher than how tall they are.
Remember with a seat belt, if lap part is too low it can hurt hip area in a crash. If it is too high, it can cause damage in abdomen area.
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In a blast, there is a primary phase and secondary phase of the blast. What happens in each, and what can get hurt on a victim’s body in each?
Primary: initial blast that sends out waves. What gets hurt is anything with air inside (lungs, organs, head, ears, etc.)
Secondary: when blasts shoots objects out, so muscle and bone and skin gets hurt.
If you fall off a house or ladder, do you speed up as you fall?
Yes. So injury becomes worse the higher up you are.
Remember with water rescues the saying. Which thing do you do first, then next, etc?
Throw, Go, Row, Reach
Reach, Throw, Row, then Go
If there is a downed wire, how far out do you set up the safe zone?
Example: wire is 15 ft, how big should safe zone be?
2x
30 ft
You should look, listen, and feel NO longer than _____ seconds
10
When doing head tilt / chin lift, how far back do you go with an:
- infant
- child
- adolescent
- adult
Infant: neutral position
Child: just past neutral
Adolescent and Adult: past neutral (more than child)
First thing to watch for if someone is going into shock?
Irritibility
If a patient is unstable, how often should you check them?
If a patient is stable, how often should you check them?
5 min
15 min
Accronym for the Glasgow Coma Scale?
EVM
Eyes opening, Verbal response, motor response
How old to use Pediatric Glasgow scale?
Under 5
If taking blood pressure by palpation, you get first reading, and then inflate up how much past that?
20 mmHg (we learned, 30, Red cross does 20)
If you have a trauma patient/situation, when would you get their patient history? Before, during, or after the physical exam?
After
T or F: if doing a thorough physical exam, maintain patients privacy and do it away from bystanders?
True
According to Red Cross, normal respiratory rates for an infant is what range:
25-50
The formula for average blood pressure of a child is what?
Child of age 5 is what?
90 + (2x their age)
100
How often would you measure pulse oximetry for a stable patient?
Every 15 mins
If speaking on emergency radio, it is ok to use “yes” and “no”
Use “affirmative” or “negative”
Speak into radio, and do NOT use please and thank you
Difference between mobile and portable radios
Mobile go in cars
Portable is hand held to walk around with
Is the “run report” used in a situation more important for legal documentation, or providing good care?
Providing good care (although it is a legal document as well)
Where do you put SAMPLE info on the run report?
Where are vital signs recorded?
The EMS section is called _______
Patient info is inputed into what section?
The patient narrative section (not the patient data section)
The check boxes section
The run data
Patient data
T or F: documentation is as important as the care provided?
True
Which part of the PCR is the section most often falsified?
Vital signs
Which organ controls the rate and depth of breathing based on oxygen and CO2 levels in the body?
Brain
If you blow too much air into lungs during ventilation, will the stomach become distended?
yes
Do you use a finger sweep on a conscious patient?
no. Only use finger sweeps on unconscious patients.
If you come across small child who is struggling breathing, what can you almost always assume
They swallowed some food or toy that is blocking air way (no cardiac or not often pulmonary)
When listening to breaths from the front side, which intercostal space would you place stethescope on?
2nd
Explain these sounds:
Rhonchi:
Wheezing:
Rales:
Stridor:
Rhonchi: snoring
Wheezing: high pitched
Rales: popping
Stridor: high pitched
What is Sellicks manuever
Placing pressure on adam’s apple / throat / espophogous to prevent regurgitation
Do you use Selliks manuever on a responsive or unresponsive patient?
unresponsive (so no gag reflex)
After a patient with asthma uses their inhaler, they should hold their breath how long?
10 seconds
If a patient is pregnant and choking, what is different about doing back blows / thrusts
Normally you do abdominal thrusts. With pregnant women, you do chest thrusts.
A oral pharyngeal airway causes one to gag. Does a nasal pharyngeal make someone gag?
No
When would you not use a Nasal pharyngeal airway
With major injury or trauma to the head.
You would give emergency oxygen to a child with which respiratory rate:
- 16 b/p/m
- 22 b/p/m
- 29 b/p/m
- 37 b/p/m
For a child, it is anything less than 15 or greater than 30.
So 37
Oxygen cylinders must have at least how much flow / O2 in them?
200 psi … or 15 minutes worth of O2
You have a nasal cannula, resuscitation mask, non-rebreather mask, and BVM mask. Which ones are/can be used for unconsious patients to get O2, and which ones do patients have to be conscious
Unconscious: BVM, and resuscitation mask
Conscious: Nasal cannula, non-rebreather mask.
What is the most common abnormal cardiac rhythm?
A fib
Does the SA node or the AV node conduct the electrical pulse in the heart?
SA node
T or F: an older adult having a heart attack won’t feel chest pain?
True
If you find a medication patch on a chest when doing an AED, what should you do?
Remove patch with gloved hands
With a diabetic who is unconscious, do you give fruit juice or glucose tablets?
No, only do those with conscious diabetic patients.
T or F: an embolism is most common cause of stroke
True
T or F: asprin reduces platelts’ ability to form clots
True. It thins the blood
Normal Blood Glucose Levels (BGL) are what?
90-130 mg/dL
BGL’s (blood glucose levels) need to be below _____ for it to be considered hypoglycemic
70 mg/dL
If someone has food poisening, do they get a fever?
yes
Activated charcoal (in a poisen situation) needs to be administered in what time frame
60 mins (within)
Remember:
- A paramedic would NOT act as an EMR
- Do NOT use finger sweeps on a conscious chocking patient
- A Pneumatic tool is used to free someone stuck
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You arrive to a scene and an adult is conscious but struggling breathing. Which device should you not use?
Nasal cannula
After doing secondary assessment and determining patients complaints, what do you do next in your assessment?
SAMPLE
Deep partial thickness burns can be identified by
Abscense of hair
