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EMT Exam 3 Flashcards

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1
Q

Perfusion

A

The supply of oxygen to and removal of wastes from the body’s cells and tissues as a result of the flow of blood through the capillaries

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2
Q

Hypoperfusion

A

The body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients

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3
Q

Shock

A

The body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients, which is a life-threatening condition

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4
Q

What is shock a state of

A

Hypoperfusion

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5
Q

True or false: respiration and perfusion is the same

A

True

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6
Q

What can be the cause of shock/hypoperfusion

A

The malfunctioning of:
- The heart (pump)
- The vessels (pipes)
- Blood (fluid)

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7
Q

Types of shock

A
  • Hypovolemic
  • Cardiogenic
  • Neurogenic
  • Anaphylactic
  • Septic
  • Obstructive
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8
Q

Hypovolemic Shock

A
  • One of the 6 types of shock
  • “Fluid” problem
  • Results from a decreased volume of circulating blood and plasma
  • Often called hemorrhagic shock if caused by uncontrolled bleeding (internal or external)
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9
Q

Cardiogenic Shock

A
  • One of the 6 types of shock
  • Results from inadequate perfusion to heart, decreasing strength of contractions
  • Heart’s electrical system may malfunction, causing heartbeat that is too slow, too fast, or irregular
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10
Q

Who do you often see cardiogenic shock in

A

MI patients

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11
Q

Neurogenic Shock

A
  • One of the 6 types of shock
  • “Pipe” problem
  • Results from inability to control dilation of blood vessels because of nerve paralysis from spinal cord injuries
  • No blood loss, but vessels dilated so much that blood volume can’t fill them
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12
Q

Anaphylactic Shock

A
  • One of the 6 types of shock
  • “Pipe” problem
  • Results from histamine release by severe allergic reaction
  • No blood loss, but vessles dilated so much that blood volume can’t fill them
  • Bronchioles constrict, reducing the amount of air entering lungs
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13
Q

What can hypovolemic shock be caused by

A

Can be caused by burns or crush injuries

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14
Q

Septic Shock

A
  • One of the 6 types of shock
  • “Pipe” problem
  • Results from systemic infection
  • Immune and inflammatory response in addition to actual infection release a multitude of toxins, proteins, hormones, etc; these cause vasodilation and impaired ability for cells to absorb oxygen
  • Requires aggressive fluid and antibiotic treatments
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15
Q

Obstructive Shock

A
  • One of the 6 types of shock
  • Blood flow is blocked
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16
Q

Severity of Shock

A
  • Compensated: Body shunts blood where needed
  • Decompensated: Blood pressure falls as body can’t handle loos of volume
  • Irreversible: Cell damage occurring; causes rapid death
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17
Q

What can obstructive shock be caused by

A

Caused by conditions such as pulmonary embolism, cardiac tamponade (trauma to chest causing bleeding), tension pneumothorax (collapsed lung leads to build up leading to pushed organs)

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18
Q

Signs and symptoms of shock

A
  • AMS
  • Pale, cool, clammy skin
  • N/V
  • Vital signs changes
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19
Q

Infants/children have efficient compensating mechanisms that maintain their blood pressure until

A

Half of their volume is depleted (children are good at compensating); potential for shock must be recognized and treated before tell-tale signs appear

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20
Q

Care for shock

A
  • Aggressive airway maintenance (administer high-concentration oxygen)
  • Keep the patient warm with blankets and move to ambulance
  • Place supine
  • Rapid transport to trauma center within “golden hour”
  • Attempt to stop cause of shock
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21
Q

Deadly triad of trauma

A
  • Acidosis
  • Hypothermia
  • Coagulopathy
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22
Q

Types of bleeding

A
  • Hemorrhage is severe bleeding; major cause of shock in trauma
  • External
  • Internal
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23
Q

External bleeding- arteries

A
  • Spurting blood
  • Pulsating flow
  • Bright red color
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24
Q

External bleeding- veins

A
  • Steady, slow flow
  • Dark red color
  • Use occlusive dressing because prevents air from getting in (and therefore embolism)
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25
Q

External bleeding- capillaries

A
  • Slow, even flow
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26
Q

External bleeding

A
  • Occurs outside of body after force penetrates skin and lacerates or destroys underlying blood vessels
  • Typically visible on surface of the skin
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27
Q

What is how much a person bleeds determined ny

A
  • Size and severity of wound
  • Size and pressure of ruptured vessel
  • Individual’s ability to clot
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28
Q

How fast can someone who is bleeding from an artery die

A

They can die in 3 minutes

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29
Q

What is the most frequent cause of preventable death from injury

A

Serious bleeding from an extremity

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30
Q

Methods of controlling external bleeding

A
  • Direct pressure
  • Hemostatic agents
  • Wound packing
  • Tourniquet use on extremities
  • Specialized compression devices for junctional bleeding
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31
Q

How to apply direct pressure to bleeding

A
  • Apply firm pressure to would with gloved hand and/or gauze
  • Hold pressure until bleeding is controlled
  • If necessary, add dressing when lower ones are saturated
  • Never remove bandages
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32
Q

Hemostatic agents

A
  • Dressing containing substance that absorbs and traps RBCs
  • Can be wadded up and inserted into wound
  • May be a power poured directly into the wound
  • Manual pressure is always necessary
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33
Q

How to do a wound packing

A
  • Open clothing around the wound
  • Locate the source of the most active bleeding
  • Pack hemostatic dressing or gauze roll tightly into wound and directly onto the source of bleeding
  • Compress firmly
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34
Q

What to do if wound packing is reassessed and it fails

A

Pack a second gauze on top of the first and reapply pressure

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35
Q

Tourniquet

A
  • Use if bleeding is uncontrollable via direct pressure
  • If applied correctly, a tourniquet stops arterial blood flow into the extremity and from the wound
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36
Q

Where do you place tourniquets

A

Above the bleeding site

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37
Q

What to do if bleeding is not controlled by applying initial tourniquet

A

Apply a second one jut about the first

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38
Q

Other ways to stop bleeding

A
  • Splinting: Helps realign bones; decrease bleeding
  • Cold application
  • Elevation
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39
Q

Bleeding from ears

A
  • Usually from head injury
  • From increased intracranial pressure not direct trauma
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40
Q

What to do with a nosebleed patient

A
  • Have patient sit and lean forward
  • Apply direct pressure to fleshy portion of nostrils
  • Keep patient calm and quiet
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41
Q

Epistaxis

A

Nosebleed

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42
Q

Internal bleeding

A
  • Damage to internal organs and large blood vessels can result in loss of a large quantity of blood in short time
  • Blood loss commonly cannot be seen
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43
Q

Signs of internal bleeding

A
  • Injuries to surface of body
  • Bruising, swelling, or pain over vital organs
  • Painful, swollen, or deformed extremities
  • Bleeding from mouth, rectum, or vagina
  • Tender, rigid, or distended abdomen
  • Vomiting coffee-round or bright-red material
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44
Q

Blood loss of single rib fracture

A

125 mL

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45
Q

Blood loss of radius or ulna fracture

A

250-500 ml

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46
Q

Blood loss of humerus fracture

A

750 ml

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47
Q

Blood loss of tibia or fibula fracture

A

500-1000 ml

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48
Q

Blood loss of femur fracture

A

1000-2000

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49
Q

Blood loss of pelvis fracture

A

Massive

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50
Q

Blunt force trauma

A

Leading cause of internal bleeding; can be caused by falls, MVCs, automobile-pedestrians collisions, blast injuries

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51
Q

Common penetrating traumas

A
  • GSWs
  • Stab wounds
  • Impaled objects
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52
Q

What do soft tissues include

A
  • Skin
  • Fatty tissues
  • Muscles
  • Blood vessels
  • Fibrous tissues
  • Membranes
  • Glands
  • Nerves
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53
Q

Functions of skin

A
  • Protection
  • Water balance
  • Temp regulation
  • Excretion
  • Shock absorption
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54
Q

True or false: soft tissue injuries often appear worse than they are

A

True; after cleaning up blood looks much better

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55
Q

Types of closed wounds

A
  • Contusion
  • Hematoma
  • Closed crush injury
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56
Q

Contusion

A
  • Type of closed wound
  • A bruise
  • Pain, swelling, discoloration at site
  • May be immediate or delayed
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57
Q

Hematoma

A
  • Type of closed wound
  • Similar to contusion but with more tissue damage and involves larger blood vessels
  • “Pocket” of blood
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58
Q

Closed crush injury

A
  • Type of closed wound
  • Excessive force transmitted from the body’s exterior to it’s internal structures
  • Often crushes or ruptures internal organs
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59
Q

Assessment for closed wounds

A
  • Bruising may be internal injury or bleeding
  • Consider MOI
  • Crush injuries are difficult to identify
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60
Q

Treatment for closed wounds

A
  • Manage ABC’s
  • Always manage shock
  • Splint extremities that are painful, swollen, or deformed
  • Stay alert for vomiting
  • Continuously monitor
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61
Q

Types of open wounds

A
  • Abrasion
  • Laceration
  • Puncture
  • Avulsion (peeled skin)
  • Amputation
  • Crush injury
  • Blast injury
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62
Q

General treatment strategy for open wounds

A
  • Expose wound
  • Clean surface of wound
  • Control bleeding
  • Provide care for shock
  • Prevent further contamination
  • Bandage dressing in place after bleeding is controlled
  • Keep patient still
  • Reassure patient
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63
Q

Dressing

A

Any material applied to wound to control bleeding and preventing contamination (eg MIDDLE of bandage)

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64
Q

Bandage

A

Any material used to hold dressing in place (adhesive part of bandage)

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65
Q

How to care for abrasions and lacerations

A
  • Reduce wound contamination
  • Hold direct pressure
  • Always check pulse, motor, and sensory function distal to injury to assure function
  • Never open edges of laceration to see inside or further clean wound
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66
Q

Penetrating and puncture wounds

A

An open wound that tears through the skin and destroys underlying tissues

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67
Q

Concerns for puncture wounds

A
  • Objects may be embedded deeper than they appear
  • Check for exit wounds; may require immediate care
  • Bullets can fracture bones as they enter
  • Stab wounds are considered serious if in a vital area of body
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68
Q

Treatment for puncture wounds

A
  • Search for exit wound
  • Assess need for shock care
  • Follow spinal immobilization protocols
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69
Q

Avulsion

A

Flaps of skin or tissue are torn loose or pulled completely off

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70
Q

Degloving

A

The skin is removed like a glove

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71
Q

Treatment for avulsions

A
  • Clean the wound surface
  • Fold the skin back, if possible; will help the flap continue to profuse and not die
  • Control bleeding and dress with bulky dressings
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72
Q

What are skin tears considered

A

Avulsions

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73
Q

Amputation

A

The traumatic severing of a body part, usually an extremity

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74
Q

Treatment of amputations

A
  • Control bleeding (apply pressure dressing over stump/apply tourniquet)
  • DON’T COMPLETE AMPUTATION
  • Wrap amputated part in sterile wet dressing and place in plastic bag; put bag in pan with water and cold packs
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75
Q

Open crush injury

A
  • Crush injuries can also be open if bones are fractured as a result of the heavy force and those bone ends break the skin
  • Treat any open injuries with basic strategies and expect massive internal injuries
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76
Q

Blast injury

A

Several waves:
- Pressure wave/primary injuries
- Blast wave (things flying at you)/secondary injury
- Patient displacement/tertiary injury
- Hazmat or structural collapse/quaternary injury
- May have a combination of all open and closed injuries

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77
Q

What is at risk during blast injuries

A

Hollow organs

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78
Q

Evisceration

A

Abdominal organs protruding through an open wound

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79
Q

How to treat evisceration

A
  • Don’t touch or try to replace the exposed organ
  • Cover exposed organs and wound with a sterile WET dressing, moistened with sterile water/saline, and secure in place
  • Flex the patient’s hips and knees if uninjured to relieve pressure
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80
Q

Treatment for impaled objects

A
  • Don’t remove object; may cause severe bleeding
  • Expose wound area
  • Control profuse bleeding by direct pressure
  • Apply several layers of bulky dressing to “splint” object in place
  • Treat for shock
  • Provide rapid transport
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81
Q

Impaled object in cheek

A
  • Take care that object does not enter oral cavity, causing airway obstruction
  • If cheek wall is perforated, profuse bleeding into mouth and throat can cause N/V
  • External wound care will not stop flow of blood into the mouth
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82
Q

Treatment for impaled object in cheek

A
  • Examine wound site, both inside and outside mouth
  • If you find the perforation and can see both ends, remove the object (only if its impaling only the cheek)
  • If object is impaled into another structure, stabilize in place
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83
Q

Treatment for impaled object in eye

A
  • Stabilize the object in place
  • Cover the other eye
  • Secure both in place
  • Reassure patient
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84
Q

Treatment for genital injuries

A
  • Control bleeding
  • Preserve avulsed parts
  • Consider if injury suggest a more serious injury
  • Maintain patient’s dignity
  • Dress and bandage wound
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85
Q

Burns

A
  • May involve more than just skin-level structures
  • If respiratory structures are affected, swelling (of airway) may occur, causing life-threatening obstruction
  • Don’t let burn distract from spinal damage or fractures
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86
Q

Assessment of burns

A
  • Agent and source
  • Depth
  • Severity
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87
Q

Depth of burns: 1st degree

A
  • AKA superficial burn
  • Involves only epidermis
  • Reddening with minor swelling
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88
Q

Depth of burns: 2nd degree

A
  • AKA partial thickness burn
  • Epidermis burned through, dermis damaged
  • Deep, intense pain
  • Blisters and mottling
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89
Q

Depth of burns: 3rd degree

A
  • AKA full thickness burn
  • All layers of skin burned
  • Blackened areas surrounded by dry and white patches
  • Often doesn’t feel pain because lack of functioning nerves
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90
Q

How to measure the percent of skin burned

A
  • Rule of 9’s
  • Palmar method (hand is 1% of skin)
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91
Q

True or false: a minor burn area in a young adult can be fatal to a geriatric adult

A

True

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92
Q

True or false: infants and children have a much greater relationship of body surface area to total body size, resulting in greater body fluid and heat loss from burned skin

A

True

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93
Q

What are thermal burns caused by

A

Flame, radiation, excessive heat from fire, steam, hot liquids, and hot objects

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94
Q

How to treat (and not treat) thermal burns

A
  • Use dry, sterile dressings
  • Never apply ointments, sprays, or butters
  • Don’t break blisters (the blister keeps fluid away from healing skin)
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95
Q

What are chemical burns caused by

A

Various acids, bases, and caustic substances

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96
Q

Treatment for chemical burns

A
  • Wash with lots of flowing water
  • If dry chemical, brush away, then flush with water
  • Remove contaminated clothing
  • Apply sterile dressings
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97
Q

Electrical Injuries

A

Severe damage through body by disrupting nerve pathways

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98
Q

What can be caused by electrical injuries

A
  • Entry and exit burns
  • Respiratory/cardiac arrest
  • Bones may fracture from violent muscle contractions
  • Cardiac rhythm changes (be ready to defibrillate)
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99
Q

How to treat electrical injuries

A
  • Cool burning areas and apply sterile dressings
  • Treat for shock and provide oxygen
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100
Q

Blunt Trauma

A

A mechanism of chest injury; can fracture ribs, sternum, and costal (rib) cartilages

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101
Q

Compression

A

A mechanism of chest injury; occurs when severe blunt trauma causes the chest to rapidly compress

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102
Q

Penetrating Objects

A

A mechanism of chest injuries; bullets, knives, pieces of metal or glass, steel rods, pipes, etc; can damage internal organs and impair respiration

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103
Q

Flail Chest

A
  • A fracture or two or more consecutive ribs in two or more places
  • Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration
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104
Q

Assessment for flail chest

A
  • MOI
  • Difficulty breathing/hypoxia
  • Chest wall muscle contraction/paradoxical movement
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105
Q

Treatment for flail chest

A
  • Administer oxygen
  • Use bulky dressing to stabilize flail segment
  • Monitor patient for respiratory rate and depth; assist ventilations if too shallow
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106
Q

Open chest injuries

A
  • Difficult to tell what is injured from entrance wound
  • Assume all wounds are life-threatening
  • Open wounds allow air into chest which sets pressure imbalance and causes lung to collapse
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107
Q

Assessment for open chest wound

A
  • Sucking chest wound
  • Direct entrance wound to chest
  • May or may not be sucking sound
  • May be gasping for air
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108
Q

Treatment for open chest wounds

A
  • Maintain open airway
  • Seal wound
  • OCCLUSIVE DRESSING
  • Administer oxygen
  • Treat for shock
  • Immediate transport
  • Consider ALS
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109
Q

In how many places do you tape an occlusive wound for a one sided open chest wound

A

Three; allows air to escape but still keeps air out (flutter valve)

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110
Q

What to do if there is an entrance and exit open chest wound

A

Tape occlusive dressing on four sides to the back exit wound, tape on three sides to chest open wound

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111
Q

Pneumothorax

A

Air in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse

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112
Q

Tension pneumothorax

A

Pneumothorax causes the heart to be pushed to one side; causes drop in blood pressure and tracheal deviation

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113
Q

Hemothorax

A

Blood in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse

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114
Q

Hemopneumothorax

A

Blood and air in pleural cavity of lung which causes excessive pressure on lungs; can cause lung to collapse

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115
Q

Traumatic Asphyxia

A
  • Sudden compression of chest
  • Sternum and ribs exert pressure on hearts and lungs
  • Blood forced out of right atrium and up into jugular veins
  • Causes ruptured blood vessels and extensive neck/facial bruising
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116
Q

What can cause traumatic asphyxia

A

People get stuck between heavy objects/machinery

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117
Q

Cardiac Tamponade

A
  • Direct injury to heart causing blood to flow into the pericardial sac around the heart
  • Pericardium is a tough sac that rarely leaks
  • Increased pressure on heart so chambers cannot fill causing blood to back up into veins
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118
Q

What causes cardiac tamponade

A

Usually a result of penetrating trauma

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119
Q

Beck’s Traid for cardiac tamponade

A
  • JVD
  • Muffled heart sounds
  • Narrowing pulse pressure
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120
Q

What is the largest blood vessel in the body

A

The aorta

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121
Q

What can be caused by damage from the aorta

A

High-pressure bleeding that is often fatal

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122
Q

Types of trauma to the aorta

A
  • Penetrating trauma can cause direct damage
  • Blunt trauma can sever or tear the aorta
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123
Q

Signs and symptoms of aortic injury

A
  • Patient complains of pain in chest, abdomen, or back
  • Signs of shock
  • Differences in blood pressure between right and left arms
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124
Q

Commotio Cordis

A
  • Trauma to chest when heart is vulnerable
  • Causes ventricular fibrillation
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125
Q

Treatment for commotio cordis

A

CPR, defibrillation

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126
Q

Abdominal injuries

A
  • Can be open or closed
  • Internal bleeding if organs or blood vessels are lacerated or ruptured
  • Serious, painful reactions if hollow organs rupture
  • Evisceration may occur
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127
Q

Assessment for abdominal injuries

A
  • Pain
  • Nausea
  • Weakness
  • Thirst
  • Indications of blunt trauma to chest, abdomen, or pelvis
  • Coughing up or vomiting blood
  • Rigid and/or distended abdomen
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128
Q

Treatment for abdominal injuries

A
  • Carefully monitor airway in presence of vomiting
  • Position of comfort
  • Place patient on back with knees flexed
  • Treat for shock
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129
Q

Treatment for evisceration

A
  • Don’t touch or replace organs
  • Apply sterile dressing moistened with sterile saline over wound site
  • For large evisceration, maintain warmth by placing laters of bulky dressing over occlusive dressing
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130
Q

How many ribs are in the thoracic cavity

A

12 pairs

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131
Q

How many ribs are floating in the thoracic cavity

A

2 pairs; they are not attached to the sternum or anterior ribs

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132
Q

Striated Muscle

A

AKA voluntary muscle

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133
Q

Smooth Muscle

A

AKA Involuntary muscle

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134
Q

Bones physiology

A

Framework

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135
Q

Joints physiology

A

Bending

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136
Q

Muscles physiology

A

Movement

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137
Q

Cartilage physiology

A

Flexibility

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138
Q

Ligaments physiology

A

Connect bone to bone

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139
Q

Tendons physiology

A

Connects muscles to bone

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140
Q

What are bones made of

A

Formed of dense connective tissue

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141
Q

Why are bones susceptible to bleeding on injury

A

They are vascular

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142
Q

Self-healing nature of bone

A
  • Break causes soft tissue swelling and a blood blot in the fracture area
  • Interruption of blood supply causes the bone section to die
  • Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone
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143
Q

Mechanisms of musculoskeletal injruy

A
  • Direct force
  • Indirect force
  • Twisting (rotational) force
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144
Q

Fracture

A

Any break in a bone (open or closed); can be comminuted, greenstick, angulated

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145
Q

Comminuted Fracture

A

Broken in several places

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146
Q

Greenstick Fracture

A

Incomplete break

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147
Q

Angulated Fracture

A

Bent at an angle

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148
Q

Dislocation

A

“Coming apart” of a joint

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149
Q

Sprain

A

Stretching and tearing of ligaments

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150
Q

Strain

A

Overstretching of muscle

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151
Q

Splinting of fractured extremity

A

Splinting of an extremity with a suspected fracture helps prevent blood loss from bone tissues

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152
Q

Assessment for musculoskeletal injuries

A
  • Treat life-threatening conditions
  • Be alert for injuries besides grotesque wound
  • Pain and tenderness
  • Deformity and angulation
  • Grating (crepitus)
  • Swelling
  • Brusing
  • Exposed bone ends
  • Nerve/blood vessel compromise (decreased CMS)
  • Compartment syndrome
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153
Q

Compartment Syndrome

A

Painful conditions that occurs when pressure within the muscles builds to dangerous levels; this pressure can decrease blood flow

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154
Q

Six P’s of musculoskeletal assessment

A
  • Pain or tenderness
  • Pallor (pale skin)
  • Parasthesia (pins and needles)
  • Pulses diminished or absent
  • Paralysis
  • Pressure
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155
Q

Advantages of splinting

A
  • Minimizes movement of disrupted joints and broken bone ends
  • Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)
  • Decreases pain
  • Minimizes blood loss
  • Can prevent a closed fracture from becoming an open fracture
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156
Q

Principles of splinting

A
  • Expose injury site
  • Assess distal CSM
  • Align long-bone injuries to anatomical position
  • Don’t push protruding bones back into place
  • Immobilize both injury site and adjacent joints/bones
  • Apply splint before moving patient to stretcher
  • Pad voids (prevents hunchback)
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157
Q

Realigning deformed extremity

A
  • Assists in restoring effective circulation to extremity and to fit it to splint
  • If not realigned, splint may be ineffective, causing increased pain and possible further injury
  • ONE TRY TO REALIGN, then just splint
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158
Q

Hazards of splinting

A
  • “Splinting patient to death”- splinting patient before life-threatening conditions are addressed
  • Not ensuring ABC’s
  • Too tight- compresses soft tissues
  • Too loose- allows too much movement
  • Splinting in deformed position
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159
Q

Assessment for shoulder girdle injuries

A
  • Pain in shoulder
  • Dropped shoulder
  • Severe blow to back over scapula
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160
Q

Treatment for shoulder girdle injuries/Humerus, Elbow, Radius

A
  • Assess distal CSM
  • Use sling and swathe
  • Don’t attempt to straighten or reduce
  • Reassess distal CSM
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161
Q

Assessment for pelvic injuries

A
  • Pain in pelvis, hips or groin
  • Pain when pressure applied
  • Can’t life legs
  • Lateral rotation of foot
  • Unexplained pressure in bladder
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162
Q

Treatment for pelvic injuries

A
  • Minimize movement
  • Check distal CSM
  • Anatomical position
  • Stabilize lower limbs
  • Treat for shock
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163
Q

Assessment for hip dislocation/fracture

A
  • Anterior hip dislocation
  • Posterior hip dislocation (rotation of leg and foot; shortening)
  • Pain and unable to stand
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164
Q

Treatment for hip dislocation or fracture

A
  • Assess distal CSM
  • Move patient onto spine board
  • Immobilize limb with pillows and blankets
  • Secure patient to spine board
  • Reassess distal CSM
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165
Q

Assessment for femoral shaft fracture

A
  • Intense pain
  • Possibly open fracture
  • Injured limb may be shortened
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166
Q

Treatment for shaft fracture

A
  • Control bleeding
  • Assess distal CSM
  • Apply traction splint
  • Reassess distal CSM
  • Treat for shock
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167
Q

Assessment for knee injury

A
  • Pain and tenderness
  • Swelling
  • Deformity with swelling
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168
Q

Treatment for knee injury

A
  • Assess distal CSM
  • Immobilize in current position
  • Reassess distal CSM
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169
Q

Assessment for Tib/Fib injury

A
  • Pain and tenderness
  • Swelling
  • Possible deformity
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170
Q

Treatment for Tib/Fib Injury

A
  • Air inflated splint
  • Two-splint method
  • Single splint with ankle hitch
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171
Q

Treatment for ankle/foot injury

A
  • Assess distal CSM
  • Stabilize limb
  • Lift limb
  • Place cravats under ankle
  • Lower limb into pillow
  • Tie pillow around ankle
  • Apply ice pack as needed
172
Q

Disability

A

Condition interfering with the ability to engage in ADLs

173
Q

Terminal Illness

A
  • May depend on tech to sustain life or relieve pain
  • Advance directives
  • Special emoitonal needs
174
Q

Obesity

A
  • Increases risk of multiple diseases
  • Special measures to care for obese patient
  • Allow patient to assume comfortable position for breathing
  • Have enough assistance when lifting/moving patient
175
Q

Serious health problems related to homeless and poverty

A
  • Mental health issues
  • Malnutrition
  • Substance abuse problems
  • HIV/AIDS
  • Tuberculosis
  • Pneumonia
176
Q

How many children does autism effect

A

1 in 91 children

177
Q

What does autism effect

A

Ability to communicate; may need to modify assessment techniques and treatment protocols

178
Q

ABCS of dealing with autistic patients

A
  • Awareness
  • Basic
  • Calm
  • Safe
179
Q

(A)wareness of ABCS of dealing with autistic patients

A
  • EMT must adapt
  • Disruption of routine not well tolerated by patient
  • May have meltdown
180
Q

(B)asic of ABCS of dealing with autistic patients

A
  • Keep instructions simple
  • Keep questions short and close-ended
  • Keep equipment at a minimum as to not overstimulate patient
  • Defer interventions that are not precautions vs necessary
181
Q

(C)alm of ABCS of dealing with autistic patients

A
  • Calm creates calm
  • Start with one-to-one contact
  • Clear, controlled voice
  • Empathy and compassion
  • Take extra time to follow patient’s timeline unless emergency
182
Q

(S)afe of ABCS of dealing with autistic patients

A
  • Begin treatment where patient is found
  • Remove things that may aggravate child
  • Do toe-to-head survey, one step at a time
  • Consider taking breaks during exam
  • Let patient tell you when they are ready for next step
183
Q

Congenital Disease

A
  • Type of disease
  • Birth defect
  • Congenital heart disease, cleft palate, congenital deafness
184
Q

Acquired Disease

A
  • Type of disease
  • COPD, AIDS, traumatic spinal cord injury, deafness
185
Q

Respiratory Devices

A
  • CPAP
  • Tracheostomy tubes
  • Home ventilators
186
Q

EMT Assessment and Transport for home CPAP device

A
  • The problems are not usually related to the machine
  • If patient wishes to bring it to hospital, alert ER staff of use in radio report
187
Q

Tracheostomy Tubes

A

Respiratory device; surgical opening through neck into trachea in which breathing tube is placed

188
Q

What fits on the end of a tracheostomy tube

A

BVM

189
Q

Assessment for tracheostomy tube

A
  • If tube is clogged with mucus, clear using whistle tip catheter
  • Patient may buck during suction (gag and lurch forward)
  • May need to ventilate with BVM
190
Q

Transport for tracheostomy tube

A
  • During transport, elevate patient’s head to allow drainage
191
Q

EMT Assessment and transport for home ventilators

A
  • Make sure vent tube has no mucus
  • Assure that BVM is attached to oxygen
  • Secure ventilator if transporting
192
Q

Cardiac Devices

A
  • Implanted pacemaker
  • Automatic implanted cardiac defibrillator (AICD)
  • Left ventricular assist device (LVAD)
193
Q

AICD

A
  • Detects life-threatening cardiac rhythms
  • Delivers shock to correct dysrhythmia
  • Shock is very painful to patient but can’t be felt by caregivers
194
Q

Where is the AICD implanted

A

Upper left chest or upper left abdominal quadrant

195
Q

Assessment for AICD

A
  • Treat as high-risk cardiac patient
  • If cardiac arrest, use CPR and AED
196
Q

Left Ventricular Assist Device

A

Surgically implanted pump used for end-stage heart failure pump; helps heart pump blood effectively through continuous flow of blood SO NO PULSE

197
Q

Assessment for LVAD

A
  • Battery failure: plug into AC source
  • Pump failure: use hand or foot pump
  • Battery should be secured as not to pull tubing
198
Q

Gastrourinary Devices

A
  • Feeding tubes
  • Urinary catheters
  • Ostomy bag
199
Q

Assessment and Transport for feeding tube

A
  • Secure tubes to patient with tape before transport
  • Keep nutrients higher than tube
  • Put protective cap in place to prevent leakage
200
Q

Assessment and transport for urinary catheters

A
  • During transport, keep catheter bag lower than patient but not on floor
  • Empty bag if one-third to one-half full
201
Q

What to document during assessment/transport of urinary catheter patients

A

Urine discoloration, odor, amount emptied

202
Q

Ostomy Bags

A

Connected to site of colostomy or ileostomy to collect feces

203
Q

Are ostomy bags visible through clothing

A

No

204
Q

Common problems with ostomy bags

A
  • Infection at stoma site
  • Blockage
  • Dislodgement
205
Q

Hemodialysis

A
  • Usually at dialysis center
  • Performed by attaching patient to dialyzer
  • Large needles and tubing removes and returns blood to filter
206
Q

Complication with hemodialysis

A
  • Bleeding from A-V fistula
  • Infection
207
Q

Peritoneal Dialysis

A
  • Permanent catheter implanted through abdominal wall into peritoneal cavity
  • Dialysis solution runs into abdominal cavity and its absorbed by intestines
208
Q

Complications from peritoneal dialysis

A
  • Dislodging of catheter
  • Infection (peritonitis)
209
Q

Assessment for dialysis

A
  • Don’t take blood pressure on any arm with shunt, fistula, or graft
  • Rupture of shunt, fistula, or graft causes fast, significant blood loss
  • Direct pressure to control bleeding
210
Q

Central IV Catheters

A
  • Surgically inserted for long-term delivery of meds or fluids
  • May have infection
211
Q

Vulnerable Population

A
  • Patients dependent on others
  • More vulnerable to physical/sexual abuse, exploitation, neglect
212
Q

What to look for when dealing with vulnerable population

A
  • Stories that are inconsistent with injuries
  • Multiple injuries in various stages of healing
  • Repeated injuries
  • Caregiver’s indifference to patient
213
Q

What to do when dealing with vulnerable populations

A
  • Don’t make accusations
  • Do best to get patient out of environment
  • Report suspicions according to requirements of jurisdiction
214
Q

Central nervous system parts

A
  • Brain
  • Spinal Cord
215
Q

Peripheral nervous system

A
  • Vertebral nerves
  • Cranial nerves
  • Body’s motor and sensory nerves
216
Q

How many facial bones are there

A

14

217
Q

Injuries to scalp

A

Lots of blood vessels; profuse bleeding

218
Q

Skull injuries

A
  • Open head injury
  • Closed head injury (SKULL is in tact)
218
Q

True or false: until proven otherwise, breakages are considered open

A

True

219
Q

Traumatic Brain Injuries (TBI)

A
  • Concussion
  • Contusion (coup, contrecoup)
220
Q

Subdural Hematoma

A

Hematoma between dura mater and brain

221
Q

Epidural Hematoma

A

Hematoma between skull and dura mater

222
Q

Intracerebral Hematoma

A
  • Hematoma in the brain
  • Patient experiences severe headache
223
Q

Intracranial Pressure

A

As pressure inside the skull increases the brain is compressed against the skull and this pressure reduces perfusion to vial brain structures

224
Q

Is ICP a closed or open head injury

A

Closed

225
Q

Cushing’s Triad

A
  • For ICP
  • Increase in blood pressure
  • Decrease in pulse
  • Irregular breathing rate
226
Q

Ataxic Respirations (slide 14 of brain)

A
227
Q

Central Neurogenic Hyperventilation

A
228
Q

Cheynes-Stokes Breathing

A

Fast shallow breathing followed by slow heavier breathing

229
Q

Racoon Eyes

A
230
Q

Battle Signs

A
231
Q

Signs and symptoms of brain injuries

A
  • AMS
  • Laceration, contusion, hematoma to head
  • Depressions or deformities in the skill
  • Battle signs/raccoon eyes
  • One eye appears sunken
  • Bleeding/clear fluid from ears or nose
  • Change from irritable to irrational behavior
  • Hypertension, bradycardia, and irregular respirations
232
Q

What to do with cranial injuries with impaled objects

A

Stabilize object in place

233
Q

What is the primary concern for injuries to the face and jaw

A

Airway; when possible, position to allow for drainage

234
Q

Signs and symptoms for nontraumatic brain injuries

A

Signs are the same as for traumatic injury, except no evidence of trauma and no MOI

235
Q

What is Glasgow Coma Scale Used (GCS) for

A

May use GCS in addition to AVPU for ongoing neurological assessment

236
Q

Considerations for use of GCS

A
  • Eye opening
  • Verbal response
  • Motor response
237
Q

Should you spend extra time at the scene calculating GCS?

A

No

238
Q

KNOW GCS CHART

A
239
Q

Is the pressure in the large vein in neck higher or lower than atmosphere

A

Lower

240
Q

Why do wounds to the neck create potential for serious bleeding

A

Large, major vessels close to surface

241
Q

What is there a great possibility of with wounds to the neck besides bleeding

A

Air embolus being sucked through

242
Q

Treatment for neck injury

A
  • Stop bleeding (direct pressure)
  • Prevent air embolism with 4- side taped occlusive dressing
243
Q

Treatment for open neck wound

A
  • Ensure open airway
  • Placed glove hand over wound
  • Apply occlusive dressing
  • Apply pressure
  • Bandage dressing in place
  • Immobilize spine if MOI suggest c-spine injury
244
Q

Neurogenic shock

A

Form of shock resulting from nerve paralysis; causes uncontrolled dilation of blood vessels

245
Q

Assessment for spinal injuries

A
  • Paralysis of extremities
  • Pain with or without movement
  • Tenderness anywhere along spine
  • Impaired breathing
  • Deformity
  • Priapism
  • Loss of bowel or bladder control
246
Q

Treatment for spinal injury

A
  • Provide manual in-line stabilization
  • Assess ABC’s
  • Rapidly assess for sensory and motor function (mark with pen)
  • Apply appropriate c-spine
  • Reassess sensory and motor function
247
Q

How many spinal cord injuries to males account for

A

80%

248
Q

How many people are living with SCI in the US

A

200,000

249
Q

How many new SCI cases a year

A

12,000 to 20,000 (15 to 40 new cases per million people a year)

250
Q

True or false: C-spine collar used in conjunction with long backboard

A

True

251
Q

Stabilizing a seated patient: low priority

A

Use a short board or vest-immobilization device

252
Q

Stabilizing a seated patient: high priority

A

Maintain manual stabilization while moving patient

253
Q

Applying a long backboard

A
  • Log roll patient
  • Pad voids between board and head/torso
  • Secure head last
  • If pregnant, tilt board to left after immobilizing
254
Q

When to leave helmet in place

A
  • Fits snugly, allowing no movement
  • Absolutely no impending airway or breathing issues
  • Removal would cause further injury
  • Proper spinal immobilization can be done with helmet in place
255
Q

When to remove helmet

A
  • Interferes with access to manage airway
  • Improperly fitted
  • Interferes with immobilization
  • Cardiac arrest
256
Q

Multiple trauma patient

A

More than one serious injury

257
Q

Multisystem trauma patient

A

Patient with one or more injuries serious enough to affect more than one body system

258
Q

Determining patient severity

A
  • Physiologic criteria = function
  • Anatomic criteria = structure/location
  • MOI (unreliable by itself)
259
Q

Physiologic Criteria for determining patient severity

A
  • AMS (GCS<14): head injury
  • Hypotension (systolic <90mmHg): shock, internal bleeding
  • Abnormally slow respiratory rate: head injury, later stages of shock
  • Abnormally high respiratory rate: shock
260
Q

Anatomic Criteria for determining patient severity

A
  • Injury to specific body part/area requiring immediate surgical intervention
  • Injuries to head and chest
  • Multiple musculoskeletal injuries
  • Amputations
  • Severely mangled extremities
  • Pelvic injuries
261
Q

MOI for determining patient severity

A
  • In absence of anatomic or physiological signs, MOI is considered if severe
  • Fall
  • High risk auto crash
  • Automobile-pedestrian crash
  • Motorcycle crash
262
Q

How to prepare for multisystem trauma patients

A

Determine crew roles

263
Q

Treating multisystem trauma

A
  • Follow priorities determined by primary assessment
  • Attend to life threats
  • Reassess what to treat on scene and what needs definitive care
  • Call hospital so they can prepare
  • POSTPONE VITALS; SURGERY IMPORTANT
264
Q

Trauma scoring

A
  • Numerical rating system for trauma
  • Assigns number to certain patient characteristics to create a score
  • Objectively describes severity
  • Helps determine transport to trauma vs local hospital
  • Helps trauma centers
265
Q

Revised Trauma Score (RTS)

A
  • Components are GCS, systolic blood pressure, respiratory rate
  • Follow local protocol for use of scoring system
  • Don’t let it interfere with patient care/transport
266
Q

How the body loses heat

A
  • Conduction
  • Convection
  • Radiation
  • Evaporation
  • Respiration
267
Q

Generalized hypothermia

A

The body is unable to maintain proper core temperature

268
Q

Predisposing factors of hypothermia

A
  • Injury
  • Chronic illness
  • Geriatric/pediatric
269
Q

Why are geriatrics at risk for hypothermia

A

Older citizens live in unheated rooms; the environment, slowing body systems, and lack of activity can lead to hypothermia

270
Q

Why are pediatrics at risk for hypothermia

A

They have larger skin surface areas in relation to their total body mass, little body fat, and smaller muscle mass which makes them unable to shiver

271
Q

Assessment for hypothermia

A
  • Shivering, in early stages
  • Numbness
  • Stiff/rigid posture
  • Drowsiness
  • Rapid breathing/pulse
  • Loss of motor coordination
  • Joint/muscle stiffness
  • Unconsciousness
  • Cool abdominal skin temperature
272
Q

Passive vs active rewarming

A
  • Passive: Cover patient, remove wet clothing
  • Active: Apply external heat source
273
Q

True or false: The more severe the hypothermia, the less aggressive rewarming

A

TRUE

274
Q

When is a patient considered to have extreme hypothermira

A
  • Patient is unconscious, with no discernible vital signs
  • Heart rate can slow to 10 bpm
  • Very cold
275
Q

What are the most commonly affected areas for localized cold injuries

A
  • Ears
  • Nose
  • Face
  • Feet
276
Q

What happens with localized cold injuries

A
  • Blood flow limited by constriction of blood vessels
  • Tissues freeze, may form ice crystals
277
Q

What to do with patient in early/superficial phase of cold injury (frostnip)

A

Remove from cold and cover

278
Q

What to do with patient in late/deep phase of cold injury (frostbite)

A

Cover and immobilize gently (immobilize because affected areas can snap off)

279
Q

Dos for frostbite

A
  • Transport, keeping patient warm
  • Perform ongoing assessment
280
Q

Do not do for frostbite

A
  • Rub affect areas
  • Break blisters
  • Expose affected area to dry heat
  • Immerse affected area in snow or hot water
  • Allow affected part to thaw if it may refreeze before transport is complete
281
Q

How is hyperthermia caused

A

When heat that isn’t needed for temperature maintenance and isn’t lost creates hyperthermia

282
Q

True or false: unchecked hyperthermia can lead to death

A

True

283
Q

Predisposing factors of hyperthermia

A
  • Peds/geri
  • Chronic illness
  • Obesity
  • Exercise for health individuals
284
Q

Signs and symptoms for heat exhaustion

A
  • Muscular cramps
  • Weakness or exhaustion
  • Rapid, shallow breathing
  • Weak pulse
  • Heavy perspiration
  • Loss of consciousness
285
Q

Treatment for heat exhaustion

A
  • Remove from hot environment
  • Administer oxygen
  • Loosen/remove clothing
  • Position supine
  • Small sips of water
  • Transport
286
Q

Signs and symptoms of heat stroke

A
  • Rapid, shallow breathing
  • Full, rapid pulse
  • Generalized weakness
  • Little or no perspiration
  • AMS
  • Dilated pupils
  • Seizures
287
Q

Treatment for heat stroke

A
  • Remove from hot environment
  • Remove clothing
  • Apply cool packs to neck, groin, and armpits
  • Administer oxygen
  • Transport immediately
288
Q

PA state protocols for heat cramps

A

Moist, pale, normal to cool skin

289
Q

PA state protocols for heat exhaustion

A

Moist, pale, normal to cool skin (do passive cooling)

290
Q

PA state protocols for heat stroke

A

Hot, dry, or possibly moist skin (active cooling)

291
Q

Heat cramps (according to pa state protocols)

A

Painful muscle spasms of the skeletal muscles that occur following heavy work or strenuous exercise in hot environments; thought to be caused by rapid changes in extracellular fluid osmolarity resulting from fluid and sodium loss

292
Q

Signs and symptoms of heat cramps (pa state protocols)

A
  • Alert
  • Muscle cramps (normally in most recently exercised muscle)
  • Hot, diaphoretic skin
  • Tachycardia
  • Normotensive
293
Q

Heat exhaustion (according to PA state protocols)

A

Patient presents with dizziness, nausea, headache, tachycardia, and possibly syncope. Usually from exposure to high ambient temperatures accompanied by
dehydration due to poor fluid intake. Temperature is less than
103° F. Rapid recovery generally follows saline administration.

294
Q

When should patient be treated as if they have heat stroke (according to pa state protocols)

A
  • Exposure to hot environment
  • Hot skin
  • AMS
    (all three)
295
Q

Treatment for drowning

A
  • Begin rescue breathing without delay
  • ABC vs CAB
  • May encounter airway resistance
  • Don’t delay transport
296
Q

Arterial gas embolism

A
  • Common in scuba diving accidents
  • Gas bubbles in bloodstream (diver holding breath)
  • May be due to inadequate training, equipment failure, underwater emergency, or trying to conserve air
297
Q

Decompression sickness

A
  • Common in scuba diving accidents
  • Diver surfacing too quickly from deep, prolonged dive
  • Takes 1-48 hours to appear
298
Q

Water Rescue

A
  • Reach: Hold object for patient to grab
  • Throw: Throw object that will float
  • Row: Row boat to patient
  • Go: Swim to patient (last resort)
299
Q

Ice Rescue

A
  • Throw flotation device to patient
  • Toss rope with loop
  • Push out flat bottomed aluminum boat
  • Lay ladder flat on ice to distribute weight of rescuer
  • Treat patient for hypothermia
  • Always transport
300
Q

Differences at higher altitudes

A
  • Less air to breathe
  • Decreased air pressure
301
Q

True or false: Normal, healthy people who have adjusted to high altitudes have a lower oxygen saturation than do those at sea level because there is less oxygen to breathe

A

True

302
Q

Acute Mountain Sickness

A
  • Type of high-altitude sickness
  • Less serious case of a person experiencing problems adjusting to thinner air
  • In mild cases, all that may be needed to overcome acute mountain sickness is rest and rehydration at altitude
  • In more severe cases, supplemental oxygen and immediate descent should lead to improvement
303
Q

High-altitude cerebral edema (HACE)

A
  • The worst form of acute mountain sickness
304
Q

Signs and symptoms for HACE

A
  • Headache that gets worse
  • Loss of coordination
  • Severe fatigue
  • Seizure
  • AMS
  • LOC
305
Q

Patient care for HACE

A
  • Arrange for immediate descent (always first)
  • Oxygen
  • Provide supportive treatment
306
Q

Which is more serious: HAPE or HACE

A

HACE

307
Q

Signs and symptoms of High Altitude Pulmonary Edema (HAPE)

A
  • Shortness of breath
  • Dry cough that progresses to coughing up blood
  • Tachypnea and tachycardia
  • Mild fever up to 100.4 DF
  • Ox sat lower
  • Respiratory failure and arrest
308
Q

Patient care for HAPE

A
  • Arrange for immediate descent
  • Administer high-concentration oxygen
  • Minimize physical activity
  • Provide supportive treatment
309
Q

True or false: insect stings and bites are rarely dangerous

A

True

310
Q

What can be a concern with spider/insect bites/stings

A

Anaphylactic shock

311
Q

True or false: you must remove stingers quickly

A

True

312
Q

Snakebites

A
  • Requires special care but are not usually life-threatening
  • Death is not sudden unless anaphylactic shock develops
  • Stay calm, keep patient calm and at rest
313
Q

True or false: you should not suck on bites

A

True

314
Q

How can marine life poisoning happen

A
  • Eating improperly prepared seafood or poisonous organisms
  • Stings and punctures
315
Q

What can activate toxins on skin, increasing pain related to marine life poisoning

A

Fresh water

316
Q

How to treat marine life poisoning

A

Use salt water to rinse affected area (vinegar also works)

317
Q

Poisonous vs venomous

A

Poisonous: You ingest something
Venomous: Something bites/stings you

318
Q

What is menstruation stimulated by

A

Estrogen and progestrone

319
Q

What happens during menstruation

A
  • Ovaries release ovum
  • Uterus walls thicken
  • Fallopian tubes moves eggs (peristalsis)
  • Uterus walls expel; bleeding 3-5 days
320
Q

What happens during fertilization

A
  • Sperm reaches ovum
  • Ovum becomes embryo
  • Embryo implants in uterus
  • Fetal stage begins
321
Q

Supine hypotensive syndrome

A
  • Placenta, infant, and amniotic fluid totals 20-24 lbs; when mother is supine, that mass compresses inferior vena cava
  • Cardiac output decreases
  • Dizziness and drop in blood pressure
322
Q

Physiological changes to respiratory system during pregnancy

A
  • Maternal oxygen demand increases
  • Changing diaphragm shape
323
Q

Physiological changes to cardiovascular system during pregnancy

A
  • Cardiac output increases
  • Maternal blood volume increases
  • HR, BP changes (faster pulse)
324
Q

Physiological changes to GI system during pregnancy

A
  • Morning sickness
  • Slowed peristalsis
325
Q

Physiological changes to urinary system during pregnancy

A
  • Changes in urinary frequency
326
Q

Physiological changes to musculoskeletal system during pregnancy

A
  • Shuffled gait
  • Center of gravity changes
327
Q

GPA Shorthand

A

Obstetric history

328
Q

History to ask for OB emergency

A
  • When is your EDD (Expected Due Date)
  • How far along are you? (Weeks)
  • How many are you expecting?
  • Contractions, Period and Frequency
  • Water broken or any vaginal discharge?
  • Have you been receiving pre-natal care?
  • If so, when was the last time?
  • Are you a “high risk” pregnancy, what for?
  • OB History (GPA)
  • Any complications or issues with previous pregnancies/deliveries?
  • Have you had now, or in any previous pregnancy had Gestational DM, Pre-Eclampisa,
    Eclampsia, c-section
  • Social Hx (Smoker, drinker, Drugs
329
Q

When does the first stage of childbirth start/end

A
  • Begins: Regular contractions
  • Ends: When the cervix is fully dilated
330
Q

Braxton-Hicks Contractions

A

Irregular, not sustained, and not indicative of impending delivery

331
Q

Lightening in childbirth

A

Fetus’s movement from high in the abdomen down toward birth canal

332
Q

Breach

A

Baby’s rear end comes out first during child birth (usually head first)

333
Q

When does the second stage of childbirth begin/end

A
  • Begins: When the cervix is fully dilated
  • Ends: When the baby is born
334
Q

Second stage of childbirth

A
  • Full dilated of cervix
  • Contractions increasingly frequent
  • Labor pain is severe
  • Mother feels urge to push or move bowels
  • EMT will have to decide whether to transport the patient, or keep her where she is and prepare to assist with delivery
335
Q

When does the third stage of pregnancy begin/end

A
  • Begins: After the baby is born
  • Ends: After the placenta is delivered
336
Q

Imminent Delivery

A
  • Control scene
  • Proper PPE
  • Place mother on bed, floor, or ambulance stretcher
  • Remove clothing obstructing vagina
  • Position assistant and OB kit
337
Q

Off-Duty Delivery Supplies

A
  • Clean sheets and towels
  • Heavy, flat twine or new shoelaces
  • Towel or plastic bag for placenta
  • Clean, unused rubber gloves and eye protection
338
Q

How to deal with fluid in newborns airways

A

Suctioning mouth right after its born

339
Q

Neonate

A

Birth to one month old

340
Q

APGAR Score

A
  • Activity (muscle tone), Pulse, Grimace, Appearance (skin color), Respiration
  • 0-10 points, 10 is best
  • Should be done at 1 and 5 minute
  • By 5 minute mark, should be 7-10
341
Q

Severely depressed AGPAR score

A

0-3

342
Q

Moderately depressed AGPAR Score

A

4-6

343
Q

Excellent condition AGPAR score

A

7-10

344
Q

How to keep new born warm

A
  • Heat retention is high priority
  • Dry baby
  • Discard wet blankets
  • Wrap baby in dry blanket
  • Cover head
345
Q

Basic neonatal resucitation

A
  • Drying, warming, positioning, suction, tactile, simulation
  • Oxygen
  • Bag-Mask
  • Chest compressions
346
Q

Advanced neonatal resucitation

A
  • Intubation
  • Medications
347
Q

Placenta previa

A

Placenta is in way of baby coming out; tell mother to stop pushing; c-section needed

348
Q

Neonatal resuscitation rules

A
  • Pulse greater than 100: Reassess and warm (this is normal)
  • Pulse lower than 100 but greater than 60: Ventilate 40-60
  • Pulse lower than 60: Ventilate and chest compressions 3:1
349
Q

How to control vaginal bleeding

A
  • Pad vagina (not pack)
  • Vaginal massage (painful)
350
Q

What does placenta delivery start with

A

Labor pains

351
Q

How long does it take for placenta to come out

A

30 minutes or longer

352
Q

When to begin transport after birth

A

10 minute after birth (do not wait to deliver placenta)

353
Q

Providing comfort to mother after childbirth

A
  • Take vitals signs frequently
  • Acts of kindness
  • Wipe face and hands with damp washcloth
  • Replace blood-soaked sheets and blankets
354
Q

What to do when delivery baby i breeched position

A
  • Try to tell mother to not push
  • If not, insert fingers near baby’s mouth to protect airway
355
Q

Limb presentation during childbirth

A

Limb comes out first

356
Q

What to do during limb presentation birth

A

Put mother in head down position, give oxygen, tell mother not to push, rapid transportation

357
Q

Prolapsed Umbilical Cord

A

Cord sticks out before baby

358
Q

What to do during prolapsed umbilical cord

A

Push fingers into vagina, lift upwards to relive pressure, rapid transport

359
Q

What to do for multiple birth

A
  • Have appropriate resources (multiple ambulances)
  • Clamp or tie cord of first baby
  • Assist with second delivery
  • Still only one placenta and cord per birth
  • Keep babies and mother warm
360
Q

What to do for premature birth

A
  • Keep baby warm
  • Keep airway clear
  • Provide ventilations and chest compressions
  • Watch umbilical cord for bleeding
  • Oxygen (blow by)
  • Call ahead to emergency department
361
Q

Meconium

A
  • Newborn’s first bowel movement
  • Don’t stimulate infant before suctioning
  • Suction MOUTH FIRST, then nose
  • Maintain open airway
  • Provide ventilations and/or chest compressions
362
Q

Emergencies in pregnancy

A
  • Excessive prebirth bleeding
  • Ectopic pregnancy (embryo in fallopian tube)
  • Pre-eclampsia and eclampsia (sign is seizure)
  • Miscarriage and abortion
  • Trauma in pregnancy
  • Still births
  • Accidental death of pregnant woman
363
Q

Signs of excessive prebirth bleeding

A
  • Main sign is usually profuse bleeding
  • Abdominal pain may or may not be felt
364
Q

What to do for excessive prebirth bleeding

A
  • Assess for signs of shock
  • High-concentration oxygen and transport
  • Pace sanitary napkin over vagina
365
Q

Sign of ectopic pregnancy

A
  • Pain on one side of mother
366
Q

Pre-eclampsia and eclampsia signs and symptoms

A
  • Elevated blood pressure
  • Excessive weight gain
  • Excessive swelling to face, ankles, hands, and feet
  • AMS or headache
  • Eclampsia is most severe form, when seizures occur
367
Q

Miscarriage signs snd symptoms

A
  • Cramping, abdominal pains
  • Bleeding: moderate to severe
  • Discharge of tissue and blood from vagina
368
Q

Trauma in pregnancy

A
  • Pulse 10-15 beats faster than non-pregnant women
  • Blood loss may be 30% to 35% before symptoms appear
  • Ask patient is she received blows to abdomen
369
Q

What to do for stillbirth

A
  • Do not resuscitate if it is obvious that the baby died some time before birth
  • Resuscitate if baby is born in cardiac/respiratory arrest
  • Prepare to provide life support
  • Age of viability
370
Q

What to do during accidental death of pregnant woman

A
  • Chance to save unborn baby
  • Being CPR on mother immediately
  • Continue CPR until emergency c-section can be performed or until we are relieved
371
Q

What to do for vaginal bleeding

A
  • Treat as potential life threat
  • Check for associated abdominal pain
  • Monitor for hypovolemic shock
372
Q

What to do for trauma to external genitalia

A
  • Observe MOI
  • Look for signs of severe blood loss and shock
  • Consider additional internal injuries
373
Q

What to do in cases of sexual assault

A
  • Treat immediate life threats
  • Do not disturb potential evidence
  • Examine genitals only if severe bleeding is present
  • Discourage bathing, voiding, or cleansing
  • Fulfill mandated reporting
374
Q

The Bradley Method

A
  • An alternate birthing method
  • All natural, no epidural
375
Q

Hypnobirth

A
  • An alternate birthing method
  • Relaxed state
376
Q

Lamaze

A
  • An alternate birthing method
  • Breathing exercises
377
Q

Home Birth

A
  • An alternate birthing method
  • Not recommended for high risk
378
Q

Water Delivery

A
  • An alternate birthing method
  • Not recommended for high risk
379
Q

Name of normal headfirst birth

A

Cephalic

380
Q

What is the average weight of an infant at birth

A

6.6-7.7lbs or 3.0-3.5 kg

381
Q

Weight gain of average infant

A

Weight doubles by six months and triples by twelve months

382
Q

What percent of an infant’s total body weight is made up by their head

A

25%

383
Q

Airway/breathing for infants

A
  • Airway is narrow, short, and easily obstructed
  • Nose and diaphragm are used for breathing vs adults who mainly use their nose/mouth
384
Q

How are antibodies passed to infants

A

They are passed from the mother to the child during pregnancy and also passed through breastfeeding

385
Q

Moro reflex (startle)

A
  • An infant reflex
  • Throws arms out, spreads fingers, and then grabs with fingers and arms
386
Q

Palmar Reflex

A
  • An infant reflex
  • Grasps objects placed in palm
387
Q

Rooting Reflex

A
  • An infant reflex, usually indicating hunger
  • Turns head to the side when cheek is touched
388
Q

Sucking Reflex

A
  • An infant reflex
  • Sucks when lips are stroked
389
Q

Sleep patterns for infants

A
  • Initially sleeps 16-8 hours throughout the day and night
  • Soon changes to 4-6 hours during the day and 9-10 hours at night
  • By 2-4 months, will sleep through the night
390
Q

Fontanelles

A

“Soft spot” of newborn’s skull

391
Q

When do fontanelles close

A
  • Posterior fontanelle closes in 2-3 months
  • Anterior fontanelle closes in 9-18 months
392
Q

What do sunken fontanelles indicate

A

Dehydration

393
Q

What do bulging fontanelles indictae

A

Without crying, they indicate increased pressure inside the skull

394
Q

Psychosocial aspects of infancy

A
  • Bonding: The sense that needs will be met
  • Desire for an orderly predictable environment
  • Scaffolding: Learning by building on what is already known
  • Temperament: Reaction to environment
395
Q

Body temperature range for toddler phase

A

98.6-99.6 deg F or 36-37.5 deg C

396
Q

About how weight does a toddler gain per year

A

4.4 lb or 2.0 kg

397
Q

True or false: body systems improve in efficiency during the toddler phase

A

True

398
Q

Pulmonary system during toddler phase

A
  • Terminal airways branch and grow
  • Alveoli increase in number
399
Q

Nervous system during toddler phase

A
  • Brain is 90% of adult brain weight
  • Fine-motor skills develop
400
Q

Musculoskeletal system during toddler phase

A
  • Muscle mass and bone density increase
401
Q

Immune system during toddler phase

A
  • More susceptible to illness
  • Immunity develops through exposure and vaccination
402
Q

When do all primary teeth come in by

A

36 months

403
Q

When is toilet training physically possible vs psychologically possible

A
  • Physically: 12-15 months
  • Psychologically: 18-30 months
404
Q

Psychosocial aspects of toddler phase

A
  • Begins to understand that words have meaning
  • Begins to understand cause and effect
  • Develops separation anxiety
  • Begins to develop “magic thinking” and engages in play-acting
  • Masters language basics that are refined through childhood
405
Q

What are considered preschool years

A

3-5 years old

406
Q

Physiologic aspect of preschool years

A

Body systems continue to develop

407
Q

Psychosocial aspects of preschool years

A
  • Interactive and social skills develop
  • Peer groups provide information about other families and the outside world
  • Peer interaction offers opportunity for learning, making comparisons and being part of a group
408
Q

What is considered school age

A

6-12 years old

409
Q

About how weight is gained each year during the school age phase

A

6.6 lbs or 3.0 kg

410
Q

Much much do school age children grow a year

A

2.4 inches or 6 cm

411
Q

Teeth during school age years

A

Primary teeth will be shed and replaced with permanent teeth

412
Q

Psychosocial aspects of school age years

A
  • Parents spend less time with child and provide general supervision
  • Decision-making skills develop
  • Self-esteem develop and is affected by popularity, support, etc
  • Moral development begins based on rewards and punishments for behaviors
  • Moral reasoning appears and control of behavior shifts to internal sources
413
Q

What are considered adolescence years

A

13-18 years

414
Q

Physiological aspects of adolescence

A
  • A rapid 2-3 year growth spurt begins with growth of feet and hands, then arms and legs
  • Sexual maturity is reached and secondary sexual development occurs
415
Q

Psychosocial aspects of adolescence

A
  • Strives for independence and individual identity
  • Interest in sex develops
  • Body image becomes a concern
  • May be prone to self-destructive behaviors
  • Personal code of ethics develops
416
Q

What is considered early adulthood

A

19-40 years old

417
Q

Physiological aspects of early adulthood

A
  • Lifelong habits and formed
  • Peak physical condition occurs between 19 and 26 years of age
418
Q

Psychosocial aspects of early adulthood

A
  • Job and family stress levels are high
  • Marriage, childbirth, and child rearing often occur
  • Accidents are the leading cause of death
419
Q

What is considered middle adulthood

A

41-60 years old

420
Q

Physiological aspects of middle adulthood

A
  • No significant changes occur in vital signs
  • Vision correction may be needed
  • Cancer, high cholesterol, and heart disease often develop
  • Weight control becomes more difficult
  • Menopause may begin for women
421
Q

Psychosocial aspects of middle adulthood

A
  • Task orientation increases
  • Problems are viewed as challenges rather than threats
  • Empty-nest syndrome can occur
  • Is concerned about both adult children and elderly parents
422
Q

What is considered late adulthood

A

61+ years

423
Q

Physiological aspects of late adulthood

A
  • Vital signs depend on health and physical condition
  • Cardiovascular system is less efficient and blood volume decreases
  • Respiratory system deteriorates and increases the likelihood of respiratory disorders
  • Endocrine changes decrease metabolism
  • Sleep-wake cycle is disrupted
  • Other body systems deteriorate
424
Q

Psychosocial aspects of late adulthood

A
  • Face challenges regarding living environment, self-worth, financial burden, and death
  • Motivation, personal interests, and activity level can enhance late adulthood
425
Q
A

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