EMT Test 1 - Test 1 Flashcards
What are protocols?
The policies and procedures for all components of the EMS system. Also called orders or standing orders.
What is a order in relation to a EMT?
Preauthorized treatment procedures; a type of treatment protocol. See also offline medical direction, protocols.
What are directives?
These are documents designed to control certain future health care decisions of the future patient in question. The person must also have a terminal illness, permanent unconsciousness(vegetative state). If a person has hope of recovery, the living will generally doesn’t apply. State laws vary on this matter. Living wills and durable power of attorney are two common forms of directives. They can be in the form of a DNR do not resuscitate order and or include specifics on medical treatment. For example no CPR or no blood transfusions.
What BSI do you use in all scenarios?
Types of BSI (body substance isolation) used by EMTs are Hospital gowns Medical gloves Shoe Covers Surgical mask or N95 Respirator Safety Glasses
How does your body use glucose on a cellular level?
Mitochondria converts glucose and other nutrients into adenosine triphosphate (ATP)
(
(ATP) is fuel for cell functions
Without ATP many of the cell’s specialized structures cannot function
What proves negligence legally?
Duty to act/ or the standard of care exits
There has been failure to conform to the duty or standard of care
A link exists showing the failure cause injury to the complaining party
There has been an actual loss or injury. Damages whether physical or psychological; which can be measured in actual damages
What is the Ryan white care act?
Comprehensive AIDS emergency act. Mandates that all patients must be treated equally despite the disease they may have. Also mandates that EMS personnel can find out whether they were exposed to life threatening diseases while providing care.
What does OSHA
OSHA = Occupational Safety and Health Act
Established in 1970
What does CDC stand for
Center For Disease Control
When are you legally obligated to take care of a patient?
When you have a duty to act.
What is implied consent?
Implied consent is a legally recognized doctrine that allows provider to consider an unconscious or incoherent patient as having consented to treatment if a reasonable patient in the same circumstance would be presumed to give consent
What express consent?
Consent directly given by voice or in writing.
What is informed consent?
Permission granted in knowledge of the possible consequences, typically that which is given by a patient to a doctor for a treatment with full knowledge of the possible risks and benefits.
What is Scope Of Practice?
The actions and care that are legally allowed to be provided by a EMT.
What is Standard Of Care in regards to a EMT?
Emergency care that would be expected to given to a patient by any trained EMT under similar circumstances.
How do you maintain patient confidentiality?
By following HIPPA guidelines. Only sharing patient information with pertinent healthcare provides in direct care for the patient.
What is abandonment?
Failure to act on your duty as a EMT
What is used for HIPPA?
To maintain privacy of a patient’s health records.
What type of calls are EMTs required to report?
Different forms of physical abuse. Elder abuse Pediatric abuse Domestic abuse Anything involving in a crime
What is minute volume?
It is tidal volume over a minute. (Tidal volume = amount of air breathed in one breath)
Lateral
Toward the outside
Medial
Toward the midline
Proximal
Closer to the torso
Distal
Further away from the torso
Superior
Toward the top ( or lower portion )
Inferior
Toward the bottom ( or upper portion )
How do you calculate cardiac output?
Cardiac output is the volume of blood pumped by the heart per minute (mL blood/min) Cardiac output is a function of heart rate and stroke volume. The heart rate is simply the number of heart beats per minute. The stroke volume is the volume of blood, in milliliter a (mL), pumped out the heart with each beat. Stroke volume X heart rate = Cardiac Output. The average is 5.6 L/min for a male and 4.9 for a female L/min
What is the Cranium?
The skull
What is the mandible?
The jaw bone
What is the Scapula?
The shoulder blade
What is the clavicle?
The collar bone
What is the sternum?
The flat bone between the ribs
What is the vertebrae?
The spine
What is the ribs?
The cage that protects the organs in the chest.
What is the humerus?
The bone in the upper half of the arm
What is the radius?
One of the two bones in the forearm ( on inside of arm mostly )
What is the Ulna?
One of the two bones in the forearm ( closer to outside of arm )
What is the carpals
The bones in the wrist
What is the metacarpals?
The bones in the palm
What is the phalanges
The bones in the fingers and toes
What is the sacrum?
The bone near the end of the spine
What is the coccyx?
The tail bone
What is the femur?
The larger leg bone above the knee
What is the patella?
The knee cap
What is the tibia?
The thick bone in the lower leg
What is the talus?
The ankle bone
What is the tarsals?
The bones in the back of the foot
What is the metatarsals
The bones in the front of the foot
What is a bilateral fracture?
Two fractures directly across from each other. For example. Bilateral femur bone fracture.
What makes up the basic anatomy of the lungs?
Trachea - windpipe
Esophagus - splits away from the Trachea and connects to stomach - can cause aspiration into lungs during vomitus
Right Bronchus - pathway air pipe connecting to right lung
Left Bronchus - pathway air pipe connecting to left lung from trachea
Bronchial Tree ( trachealbronchial tree - the passageway from the mouth to he interior of the lungs)
Diaphragm - muscle under the lungs - helps in breathing air into lung because breathing requires muscular effort.)
Alveoli - air filled sacs in the lungs - where gas exchange occurs
Right Lung - upper,middle,and lower lobes of right lung
Left Lung - upper and lower lobes of left lung ( only two to make room for heart)
What is the order of the spinal column?
CTLSC
Cervical Thoracic Lumbar Sacrum Coccyx
Where are the ribs attached in respect to the spinal column?
The ribs are attached at the thoracic region of the spinal column.
There are twelve vertebrae that make up the thoracic spine
Which can be referred to as T-1 to T-12
What bones make up the shoulder girdle?
CS - acronym for bones in shoulder girdle
The Clavicle and Scapula
What bones make up the pelvic girdle?
IIP - acronym for bones that make up the pelvic girdle
ilium, ischium, and the pubis
What bones make up the upper extremities?
HRUMP - acronym for bones in upper extremities
Humerus, radius, ulna, metacarpals, and the phalanges
What are the types of muscles?
Smooth muscle - controlled by autonomic nervous system; may be generally inactive and then respond to neural activity and hormones.
Cardiac muscle - found in the heart, acts like a rhythmic smooth muscle, modulated by neural activity and hormones.
Skeletal Muscle - moves us around and is responsible for most of our behavior, most attached to bones at each end via tendons.
What are the types of patient positioning?
Supine Prone Fowlers -Full Fowlers -Semi Fowlers Trandelenberg - rare- dangerous in field (patient is propped up in risky way could lead to fall) Reverse Trandelberg- rare Shock Lateral AKA - Recovery Right lateral recumbent - recovery position Left lateral recumbent - recovery position
What is the medical terminology for the forehead?
Frontal bone
What is the medical terminology for behind the ear?
Temple bone
What is the medical terminology for the top of the skull that wraps around the head
Parietal bone
What is the medical terminology for the back of the skull?
Occipital bone
What is the thinnest bone in the skull? (significant damage can happen).
The temporal bone
What artery is behind the temporal bone?
Middle menial artery ( type of head injury noticeable in field)
What is the medical terminology for cheek bone
Zygomatic bone
What is the medical terminology for upper jaw
Maxilla
What is the medical terminology for the lower jaw
Mandible - ( patient with broken mandible can’t speak/ teeth are not lining up/ they don’t want to bite down/ patient does not want to move jaw.
Anatomically where is the trachea ?
The trachea is at the midline
Posterior to the trachea is the?
Esophagus
Where are the carotid arteries located?
They are veins on the outside of the neck you can see them.
What is JVD?
Jugular Vein Distention
What is the medical terminology for Adam’s apple?
Thyroid cartilage
Paramedics put a needle like a fish hook into this membrane ( makes a popping noise, and goes right to the airway ) . What is this membrane called?
Cricothyroid membrane
Name the organs in the RUQ (right upper quadrant)?
Liver Gall Bladder Stomach Portion of small intestine Portion of colon
Name the organs in the LUQ (Left Upper Quadrant)?
Spleen Stomach Portion of small intestine Portion of colon (Transverse colon/Descending colon)
Name the organs in the LLQ (Left Lower quadrant)?
Portion of small intestine
Large intestine
Colon
Left ovary and Fallopian tube (in women only) important in the detection of of ectopic pregnancy, considered a life threatening scenario female can burst Fallopian tube and bleed to death.
Name the organs in the RLQ (Right Lower quadrant)?
Portion of small intestine Portion of large intestine The colon Appendix Right ovary and Fallopian tube (ectopic pregnancy danger)
What is bifurcation associated with the aorta?
This means the aorta splits
If you have something on both sides of your body (arms,legs etc) what is this called?
Bilateral
Your trachea splits into what?
Right and left lung
Potentially how many pints of blood can you loose from a broken femur?
2-3 liters of blood
What are the basic anatomical veins in the heart
Superior Vena Cava
Inferior Vena Cava
Pulmonary artery
Aorta
Do you have to use a advanced airway with a BVM?
No. Although, a EMT should use one because it helps evaluate ALOC.
What is the preferred way to ventilate the patient if not the BVM
Mouth to Mask would be the preferred method of ventilation. ( need to double check this answer )
When is it likely a EMT would use the Jaw Thrust maneuver?
It would be used in trauma patients
When does the diaphragm work as a involuntary muscle?
The diaphragm is driven by carbon dioxide sensors in the body. These Co2 levels send a message directly to the brain to force the body to breathe again. Also, when sleeping the diaphragm is again involuntary. ( you can hold your breath/ this makes the diaphragm voluntary due to it having its own set of nerves we can control)
What is the bodies normal stimulus to breathe?
Co2 sensors In our bodies send messages to our body forcing us to breathe and intake air to oxygenate blood for survival
What are the structures of the upper airway?
Everything above the vocal chords/trachea. Nose, mouth
What are the structures of the lower airway?
Everything below the vocal chords.
Is inhalation a active or inactive process
Active ( requires effort)
Is exhalation a active or passive process?
Passive. Exhalation happens without effort (no work) although in some depending on patient can be a active process.
What is ventilation in regards to what is physiologically happening in the body?
It is the movement of gases, oxygen and Co2
What is respiration?
Moving gases between cells and blood.
Often called the “bellows”system.
We
Describe inhalation.
Diaphragm descends, intercostal muscles contract, chest cavity expands and atmospheric pressure in chest decreases. Resulting in air in the lungs
Describe Exhalation.
This is the air leaving the lungs.
As everything relaxes air is pushed out in a passive process
Describe how a person breathes in relation to chemo receptors.
We breathe by changes in chemo receptors
Central - sense Co2 ( in brain ) senses high levels of carbon monoxide.
Peripheral - senses O2
What is oxygenation
Think of the respiratory tree. Brings air (oxygen) deep into the lungs at the tips of the tree are Alveoli. These look like clumps of grapes like round balls. Aveolus the singular form of Alveoli, have a thin membrane which has many small blood vessels over and around each one. Here, the air we breathe passes into the bloodstream as oxygen. At the same time Co2 is released from the bloodstream to the Alveoli.
What is accessory muscle use?
Accessory muscle of respiration, any muscles of the neck, back, and abdomen that may assist the diaphragm and the internal and external intercostal muscles in respiration, especially in some breathing disorders (CPOD- trapped air in lungs causing person to feel lung fullness and in effect make them labor harder to breathe.
What can cause unequal chest rise
Broken ribs Blunt force trauma Broken clavicle Pierced/ punctured lungs Collapsed lung(s)
What is Agonal Respirations?
Is an abnormal breathing pattern characterized by gasping, labored breathing, accompanied by strange vocalizations and myoclonus. Possible causes include ischemia, extreme hypoxia or even anoxia.
What do you do when ventilating the airway and you are having trouble getting air into the lungs?
Stop ventilation, check the airway for any obstructions that you can see with the naked eye. Things like vomitus, food ( hotdogs), or toys may be blocking trachea. Clear obstruction with rapid suction or other methods and continue to ventilate if no other obstructions exist.
How long should you ventilate/ how long should you deliver ventilation?
You should deliver ventilations 1 second every 5-6 seconds as per AHA Guidelines.
What are the basic respiratory rates for adults, children, and infants.
Adults 12-20
Children 15-30
Infants 25-50
What is abdominal distention?
Occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing a outward expansion beyond the normal girth of the stomach and waist. Typically a symptom of a underlying disease or dysfunction in the body, rather than a illness in its own right.
How do you decide the proper OPA or NPA for a patient.
OPA - measured from corner of mouth to ear lobe.
NPA - measured from nose to ear lobe
What is a EMT looking for when evaluating a patient breathing?
Breathing rate and pattern can be a good clue to diagnosing a patient’s trauma/ medical emergency. Also, assessing the skin can be a indicator of problems.
Observe for cyanosis!
Is the patient cyanotic (blueish-lack of oxygenated blood)
Jaundice?
Paleness?
is the patient Hypoxic from reduced oxygen environment?
Where do you find the different pulses In the body?
Carotid - side of neck
Radial - The wrist
Femoral - near the groin
Dorsal pedis -on top of the foot (distal pulses)
Brachial - at the inside of the elbow or under the shoulder
Posterior Tibialis - Medical, near achilies tendon.
(Also there is) Anterior tibial Apical pulse Ulnar pulse Popliteal pulse Posterior pulse
How do you check a patient’s pupils?
You check for PERL - pupils are equal and reactive to light. Are the pupils uneven?
What does Systolic stand for?
The top reading when measuring blood pressure . Systolic/ Diastolic. The energy exuded during contraction of the heart.
What is Diastolic?
The bottom reading when measuring blood pressure . Systolic/ Diastolic. The energy exuded during resting of the heart.
What does SAMPLE stand for?
Signs/Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events Leading Up To Illness/Injury
What can cause cyanosis?
Central Cyanosis - ( requires urgent assessment, especially in infants and young children, who require urgent admission)caused by diseases of the heart , lungs, or abnormal haemoglobin.
Cyanosis can be seen in the tongue and lips due to desaturation of central arterial blood resulting from cardiac or respiratory disorders associated with the shunting of deoxygenated venous blood into the systematic circulation
Peripheral Cyanosis - caused by decreased local circulation and increased extraction of oxygen in the peripheral tissues. Signs are bluish purple discoloration of the affected areas ( usually cold ). Usually most intense In nail beds and may resolve with gentle warming of the extremity
What is the first thing you should do at a accident?
Scene size up, scene safety, BSI, prioritize patients,if more then one patient is on scene call for backup. Work on most seriously injured/ill patients first.
What is general impression?
Manage immediate life threats.
Check for airway obstructions, open airways.
Look for abnormalities in breathing (paradoxical motion)
Control problems such as bleeding open wounds (direct pressure on open wounds)
find out patients Chief Complaint C/C
Is the patient trauma or medical?
C-spine for trauma patients with high index of suspicion.
Mental status
AVPU - ALERT VERBAL PAINFUL UNRESPONSIVE
you can do this through Trapezius Pinch (pinch between neck and shoulder)
Also sternal rub, armpit pinch, supra orbital pressure
Check peripheral stimuli ( Nail bed Pressure)
Check ABCs -
Airway -
Breathing -
Circulation -
Check skin - pale or mottled (onset of shock)
Cyanotic: late sign of shock
Red: anaphylactic or vasogenic shock, poisoning, overdose or other medical condition.
Yellow- Jaundice, liver problems
Cool and Clamy - shock
Establish Priorities - is the patient in a stable or unstable condition.
Unstable - significant MOI, altered mental status, Hugh index of suspicion. (Car crash, car striking pedestrian, Fall over 15 feet, trauma resulting in ALOC, penetrating injuries to head, neck, chest, abdomen, Explosions and collisions, seatbelt injuries.
Stable: no significant MOI, alert and oriented, lo index of suspicion.
Unstable patient is “Load and Go” reassess vitals every 5 minutes
Stable patient is “ Sit and Play “ reassess every 15 minutes.
What is a rapid assessment called
Load and Go
What is a detailed assessment called?
Stay and Play
What constitutes a specific MOI?
The MOI is the basis for your index of suspicion.
MOI - Mechanism Of Injury
Did a bowling ball from the back seat break the window in a car accident or did the patient break the window with their head. Important in your “General Impression” evaluation.
What is OPQRT?
Onset, Provoking,/Palliating, Quality, Region/Radiation, Severity, Time
How do you asses LOC on a child?
Ask the parents if available if the child is acting normal or abnormal since they know his usual demeanor and attitude.
Also you can find out what is going on and see if the child is focused on the questions asked.
What is AVPU?
Alert - can talk to you normally
Verbal - responds to verbal stimulus, attempts to respond when you talk to him or her.
Painful - responds to painful stimulus
- Central stimuli - nail bed pressure, pinch the thumb-index finger web, pinch the finger, toe, hand, or foot.
Unresponsive - non-purposeful movements
Flex ion posturing: aka decorticate posturing, patient arches back and extends arms inwards. Upper brainstorm compressions.
Extension posturing: aka decerebrate posturing. Patient arches back and extends arms straight and parallel to the body. Lower brain stem compression.
Altered mental status: Non alert, but not completely unresponsive either responds to either. Responds to either verbal or painful stimuli.
open and protect the airway and administer oxygen to unresponsive or altered status patients.
When would you perform a detailed assessment?
Usually in route to the hospital. Or in regards to non-critical patients
If a patient is in cardiac arrest, and another EMT or person is grabbing the AED what would you be doing?
Chest compressions
How do you palpate the abdomen?
This would consist of visual examination of the abdomen, skin, abnormalities, abdominal masses, and the movement of the abdominal wall with respiration. Abnormalities detected on inspection provide clues to intra-abdominal pathology; see are further investigated with auscultation (listening to internal sounds) and Palpation. Palpate the abdomen (using hands) for crepitus of the abdominal wall (rice crispy sound), for any abdominal tenderness! Or for abdominal masses. The liver and kidneys may be palpable in normal individuals, but any other masses are abnormal.
Position the patient supine on an examine table/bed. The head and knees should be supported with pillows to relax the abdominal wall. Patients arms should be at their sides and not folded behind head, as this tenses the abdominal wall. Good lighting is essential, and is helpful to have tangential lighting available for this can create subtle shadows of abdominal wall. Check the contour of the abdomen for Distention and note whether generalized or localized to a portion of the abdomen. Similarly the flanks should be checked for any bulging. Check for skin discoloration. Bluish coloration of the umbilicus (Cullen’s sign) or flanks (Grey Turner’s sign). The skin should be inspected for striae, or “stretch marks,” and surgical scars. Check for engorged veins in the abdominal wall and the direction of blood flow in these veins. Above the umbilicus blood flow is usually upward, and below downward. Obstruction of the vena cava will cause reversal of flow to the lower abdomen. Note any spider angiomas of the skin wall. Inspect for masses (commonly hernias), also neoplasms, infections, hematomas. Once a mass is located it should be described in relation to the quadrants. The relationship of intra-abdominal organs to these quadrants should be considered in attempting to determine the cause of the mass. The mass should be examined for movement with respiration or for pulsation with each heart beat. Also, the mass should be observed for peristalsis, as it may well represent dilated bowel. Lastly, the abdominal wall should be observed for motion with respiration. Normally the abdominal wall moves posteriorly in a symmetrical fashion with inspiration. With peritonitis, there may be localized or generalized rigidly of the wall so that motion is absent.
( Ausculation with stethoscope for presence of bowel sounds)
Palpate/percussion - generally examine with fingertips, this will demonstrate. Crepitus or crunching feeling, a sign of gas or fluid within the subcutaneous tissues. It will demonstrate irregularities of the abdominal wall (lipomas and hernias) and give some idea if the tenderness. Ask patient to point to area of greatest pain if and when possible.
Deep palpate on of the abdomen is performed by placing the flat of hand on the abdominal wall and applying firm, and steady pressure. While the lower hand is used to feel. One should start deep palpation in the quadrant directly opposite any area of pain and carefully examine each quadrant. At each costal margin it is helpful to have a patient inspire deeply to aid in palpation of liver, gallbladder, and spleen.
When running calls on the freeway be aware of what?
Other cars on the road.
In trauma patients what is the first thing you assess and how ?
You would do a jaw thrust, and assess breathing of patient.
What are the different ways of illiciting pain? What is appropriate and inappropriate?
…
When performing auscultation on the lungs what are you listening for?
EMTs are listening for Equal and present lung sounds. In case of a lung puncture, lung collapse (blunt force trauma) , and aspiration are a few.
If looking into a patient’s ear what are you looking for?
You are looking for fluid (CSF-cerebral spinal fluid) and blood.
Why is it important to know the MOI ( mechanism Of Injury)
To determine what caused the injury EMTs look at the accident scene for signs of things that could have injured or caused the injuries to the patient. For example, a bowling ball in the back seat broke the car front window in a accident or the patients head broke window. This is important for the initial general impression and to help determine cause and importance of patient transport. Either “load and go,” or “ stay and play.
Why do EMTs do rapid transport?
EMTs do rapid transport in the case of critical trauma patients where detailed assessments are unnecessary and not in the interest of saving a patient’s life. Asses patient every 5 minutes when trauma patient for signs of recovering or getting worse.
How do you asses a spinal injury in a potential trauma patient?
CSM (circulation,sensation,motor)
These are very important and key to assessing a patient with a spinal injury.
Look for changes of CSM in extremities ( also involuntary CSMs)
Look for bruising
Point specific pain
Incontinence ( loss of bladder control - most common)
Priapism (nerve controlled erection)
Describe what a normal abdomen feels like.
…
What is perfusion
Perfusion is the filling of vessels and capillaries with blood or other fluid under pressure.
What is ventilation?
Ventilation is the act or process of inhaling or exhaling.
What is diffusion?
Diffusion is the gas exchange between the air-filled alveoli and the pulmonary capillary bed.
What is the best way a EMT can protect his/herself from liability?
EMTs protect themselves (risk management) from liability by helping the patient safety and outcome through proper application of appropriate standards of care (effective protocols) and good clinical judgement (effective training) by competent clinicians, using safe equipment ( effective fleet and equipment maintenance). In other words, risk management is intended to minimize the hazards associated with unpredictability.
