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EMT223 Flashcards

1
Q

How is shock best defined?

A

Inadequate tissue perfusion

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2
Q

In relation to cardiovascular physiology, what does heart rate multiplied by stroke volume equal?

A

Cardiac output

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3
Q

What is the Fick principle used to estimate?

A

Perfusion to an organ or the body

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4
Q

What are the smooth, low-friction cells that line the peripheral vascular vessels called?

A

Endothelium

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5
Q

How is the tone of the arterial system best reflected?

A

Pulse pressure

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6
Q

Medics are evaluating a 78 year-old male with a 4-day history of fever and chills. Pt is hypotensive, tachycardic and flushed. He’s had no vomiting, diarrhea, or blood loss, but is obviously in state of shock. What has his possible sepsis produced?

A

Relative hypovolemia

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7
Q

As the body compensates for shock with peripheral vasoconstriction, oxygen delivery to the capillaries decreases. What does this cause?

A

Anaerobic metabolism to replace aerobic metabolism

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8
Q

When “leaky capillary” syndrome occurs, what happens to the capillaries?

A

Permit protein-containing fluids to leak into the interstitial space

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9
Q

Paramedics are treating a pt in decompensated shock. On physical exam, paramedics discover that the pt has hypotension, tachycardia, tachypnea and crackles. What type of shock should be suspected?

A

Cardiogenic

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10
Q

What is a severe allergic reaction caused by histamine release from exposure to an antigen called?

A

Anaphylactic shock

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11
Q

Paramedics are treating a pt who presents with signs of shock. No trauma is noted and the only pertinent history is a leg fracture 6 weeks earlier. What type of shock should paramedics suspect?

A

Obstructive shock

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12
Q

What action occurs to compensate for stage 1 shock?

A

Vasoconstriction

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13
Q

During stage 2 shock, the onset of arterial hypotension and opening of AV shunts will cause what response?

A

Stagnation of blood flow in the capillaries

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14
Q

A 42 year-old woman is the unrestrained driver of a car that crashed head-on into a tree at approx. 45 mph. Both femurs are obviously fractured and she has an unstable pelvis. She is unresponsive, tachycardic, tachypneic, and hypotensive. Based on her vital signs, the woman in this shock scenario is expected to be in what stage of shock?

A

Stage 3

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15
Q

What is a likely cellular response to stage 3 shock?

A

Disseminated intravascular coagulation

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16
Q

Peritonitis and endocrine disorders might produce what type of shock?

A

Hypovolemic shock

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17
Q

What is a clinical sign of irreversible shock?

A

Frank hypotension

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18
Q

What is the management and treatment of a patient in any stage of shock directed at?

A

Management of oxygenation and perfusion of organs

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19
Q

What is hypovolemic shock of any cause first treated with?

A

Crystalloid fluid volume replacement

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20
Q

What is an IV solution with an osmotic pressure greater than that of the body’s cells called?

A

Hypertonic solution

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21
Q

Public education concerning injury prevention would be classified as what phase of trauma care?

A

Pre-incident

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22
Q

What is the most critical factor in the survival of any severely injured patient?

A

Time from incident to definitive care

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23
Q

The “golden hour” describes which aspect of trauma care?

A

First hour after severe injury

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24
Q

Late trauma deaths most often result from which condition?

A

Sepsis

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25
Q

What is the leading cause of death in children under 4 years of age for injuries sustained?

A

Motor vehicle crashes

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26
Q

National standards concerning the use of ground ambulance transportation define the “reasonable amount of time” that it takes severe trauma patients to reach definitive care after their injuries as being within ___ min.

A

60

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27
Q

The “golden hour” begins at which time?

A

At the time of injury

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28
Q

The statement that an object in motion or at rest remains in that state until acted upon by an outside force reflects which act?

A

Newton’s First Law of Motion

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29
Q

The statement that energy cannot be created or destroyed, it can only change form, best reflects which act?

A

Conservation of Energy Law

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30
Q

The statement that force equals mass multiplied by acceleration or deceleration most closely reflects which act?

A

Newton’s Second Law of Motion

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31
Q

When calculating kinetic energy, what is the most important variable relating to total kinetic energy?

A

Velocity

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32
Q

What is the definition of kinematics?

A

The process of predicting injury patterns

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33
Q

Which of the following is true regarding rear-end collisions?

A

The difference between the speeds of the vehicles involved produces the damage

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34
Q

The “up and over” pathways of motion is most frequently associated with patients injured in what type of MVC?

A

Frontal impact

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35
Q

What types of injuries are seen in rollover collisions?

A

Unpredictable and difficult to categorize

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36
Q

Ejections from vehicles normally possess which characteristic?

A

Creates a six-fold increase for the risk of death

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37
Q

Paramedics respond to the scene of an explosion at a chemical plant. A 39 year-old male was in a closed space when the explosion occurred. During a rapid head-to-toe focused exam, you notice blood coming from the pt’s right ear and the patient is complaining of difficulty in hearing. The injury is the result of the ___ blast injury.

A

Primary

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38
Q

What is the definition of cavitation?

A

A force that pushes body tissue away from the path of a projectile

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39
Q

Of the following tissues, which is least likely to incur permanent cavitation from a bullet passing through it? Liver, spleen, muscle, or urinary bladder

A

Urinary bladder

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40
Q

Paramedic documentation of entrance and exit wounds from gunshot include what?

A

Description of the wounds

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41
Q

The outermost layer of the epidermis, composed of about 20 layers of dead skin cells, is the stratum ___.

A

Corneum

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42
Q

What is the role of thrombin in clot formation?

A

Convert fibrinogen into fibrin threads to help form a blood clot

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43
Q

After an injury, how is blood flow to the injured area affected?

A

Increases to meet the increased metabolic demands of injured tissue

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44
Q

What is one difference between a hematoma and a contusion?

A

A hematoma is a more severe injury and may result in greater blood loss than a contusion

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45
Q

How is compartment syndrome best defined?

A

Tissue pressure rising above perfusion pressure, resulting in ischemia to the muscle

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46
Q

What is a typical finding in a patient with compartment syndrome?

A

Pain seemingly out of proportion to the injury

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47
Q

What are black, “tarry” stools called?

A

Melena

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48
Q

Serious internal hemorrhage generally occurs in the chest cavity, abdominal cavity, pelvic cavity and what other area?

A

Retroperitoneal cavity

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49
Q

A 3 y/o child has bruise to his right eye. Daycare provider is worried he might have been abused. She states that, although the child “bonked” his right eye on a chair 2 days earlier, he did not have a bruise yesterday, and his father was unable to provide a suitable explanation of the current presentation. Which statement is true regarding this child’s contusion and subsequent bruising?

A

Bruising may be delayed by as much as 48 hours after an injury

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50
Q

Which treatment should not be used for severe hyperkalemia secondary to crush injuries?

A

Potassium chloride

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51
Q

Should it become necessary to augment bleeding control by using a blood pressure cuff as a tourniquet, what should inflation of the cuff be aimed at?

A

Never exceed a pressure greater than 50 mm Hg

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52
Q

Without proper care and follow-up, trauma pts with open wounds may contract a serious infection. What is a potentially fatal bacterial infection of the CNS called?

A

Tetanus

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53
Q

When dressing and bandaging a penetrating chest or abdominal wound, what type of dressing should be applied first at the wound site?

A

Sterile occlusive dressing

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54
Q

Pt has suffered a complete amputation. During treatment, medics have decided to apply pressure point control. How should paramedics proceed?

A

Pressure-point control is not recommended

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55
Q

What is true regarding chemical burns?

A

The chemical changes in the skin produce more damage than the heat

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56
Q

Which statement describes Jackson’s Thermal Wound Theory?

A

Zones of burn-injury patterns

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57
Q

What is expected to occur to cells in the Zone of Stasis?

A

Die within 24-48 hours without proper care

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58
Q

What is one example of a systemic response to burn trauma?

A

Increased vascular resistance except in the hyperemic zone

59
Q

Burn area is red and wet, painful with intact sensation, blisters are beginning to form. What burn classification is this?

A

Second-degree, superficial partial-thickness burn

60
Q

A burn is white and leathery in appearance, no painful sensation. Which burn classification?

A

Third-degree burn

61
Q

To most accurately calculate the total body surface area burned, the paramedic should use which method?

A

The Lund and Browder chart

62
Q

A pt has burns to her entire left arm, the left half of her anterior torso and one half of her head and neck. Using the rule of nines, the % burned is ___.

A

22.5

63
Q

Is a 57 year-old female with 15% second- and third-degree burns to hands and arms considered a major burn patient?

A

Yes

64
Q

The rule of nines is most accurate in which faction?

A

Children over age ten and adults

65
Q

When should the Lund and Browder chart be used for measuring burn injuries?

A

The patient is an infant

66
Q

How much fluid should be infused in the first 8 hours of a burn injury?

A

50%

67
Q

A pt has sustained circumferential burns to the chest. On arrival at the hospital, he is difficult to ventilate. What treatment is likely to improve his ventilation?

A

Escharotomy through the burned tissue

68
Q

What medication may be helpful when treating a pt with CO poisoning?

A

Sodium thiosulfate

69
Q

Because of the structure and function of the upper airway, which is typically true of thermal burn injuries of the upper airway?

A

Do not typically lead to burn injuries of the lower airway

70
Q

Which is true of hydrofluoric acid exposure?

A

It may cause serious systemic damage even if external signs and symptoms of exposure are mild

71
Q

What is the major cause of maxillofacial injury?

A

Motor vehicle crashes

72
Q

What is true of soft tissue injuries to the face?

A

They commonly bleed heavily but are seldom life threatening

73
Q

Following a car crash involving blunt force trauma to the face, a pt complains that her “teeth don’t feel right” when she closes her mouth. What should the medic suspect?

A

Mandible fracture

74
Q

What is the most commonly fractured facial bone?

A

Nasal bones

75
Q

What is a sign of a blowout fracture of the eye?

A

Enophthalmos (recessed globe)

76
Q

What is true regarding injuries to the tympanic membrane?

A

They usually heal well on their own

77
Q

For the purposes of evaluation, the neck has been divided into 3 zones. What does zone 1 represent?

A

Base of the neck

78
Q

What is true of esophageal perforation?

A

Patients with esophageal injuries should be transported in semi-Fowler’s position

79
Q

What is the most common type of skull fracture?

A

Linear

80
Q

After a fall, the pt has a large hematoma on the back of her head and states that she does not remember the fall or how she got near the edge of the bleachers. What is that symptom characteristic of?

A

Retrograde amnesia

81
Q

Which is the most severe form of brain injury?

A

Diffuse axonal injury

82
Q

As a pt’s brain swells, how does the body respond to a drop in the effective perfusion pressure of the brain (CPP)?

A

Increasing the mean arterial pressure

83
Q

A pt with an elevated blood pressure, reactive pupils and the ability to localize painful stimuli is likely to have intracranial pressure on what neurological location?

A

Cerebral cortex

84
Q

What drug may be administered to decrease cerebral edema?

A

Mannitol

85
Q

Called for a “man down,” you smell alcohol on his breath. One of the pt’s friends informs you that the pt has been falling down a lot over the last month but hasn’t had any serious injuries. Given this history, what is the pt most likely suffering from?

A

Subdural hematoma

86
Q

What is the most common cause of spinal cord trauma?

A

Motor vehicle crashes

87
Q

A pt was involved in an MVC while traveling 65 mph. Pt complains only of point tenderness in her neck. What do pts with this type of mechanism of injury and presentation require?

A

Always require immobilization

88
Q

What is one example of a negative mechanism of injury?

A

Tripping over a curb and twisting an ankle

89
Q

A pt with a distracting injury is considered to be ___.

A

Unreliable

90
Q

What is the part of the vertebrae that is palpated during assessment of the spinal vertebrae?

A

Posterior spinous process

91
Q

A spinal injury that causes compression along the length of the spinal column is known as ___.

A

Axial loading

92
Q

Injury mechanisms such as hangings typically cause a ___ type of spinal cord injury.

A

Distraction

93
Q

What is the most commonly injured area of the spinal cord?

A

C5 to C7

94
Q

A pt involved in an MVC who was unrestrained and sustained significant lateral impact, and now has numbness and tingling below the umbilicus that progresses to below the nipple line, is due to what occurrence?

A

Spinal cord damage has progressed with secondary injury

95
Q

Babinski’s sign would have no clinical relevance in what age group?

A

A pt who is 1 year-old

96
Q

When applying manual in-line stabilization to the head, what should the paramedic do?

A

Apply just enough tension to relieve the weight of the head from the cervical spine

97
Q

To achieve neutral alignment when immobilizing children, which method should be used?

A

Pad under the child’s torso to accommodate the larger occiput

98
Q

Pt fell from a 30-foot scaffolding. Bystanders report he struck the scaffolding as he fell. Your exam reveals complete bilateral paralysis below the umbilicus, bradycardia, priapism, and loss of bladder control. What should you suspect?

A

Complete cord transection

99
Q

What characterizes central cord syndrome?

A

Paralysis of the arms

100
Q

How does methylprednisone work in spinal cord injuries?

A

Reduces edema and inflammation

101
Q

After a clavicle fracture, what vessel can be injured?

A

Subclavian vein

102
Q

A 17 year-old male is complaining of left-sided chest pain after being tackled in a football game. Exam reveals pain and crepitus around the 10th and 11th ribs on the left side. Which is an underlying injury that may be present?

A

Injury to the spleen

103
Q

A pt was unrestrained in an MVC, and is now complaining to left-sided chest pain and diff. breathing. Initial assessment reveals pain and crepitance around ribs 3 through 8 with diminished breath sounds on the left side. This pt has what type of injury of the thoracic wall?

A

Flail segment

104
Q

What is the definitive treatment for a flail segment?

A

Intubation with positive pressure ventilation

105
Q

What signs/symptoms would be associated with a closed (simple) pneumo?

A

Diminished breath sounds on the affected side

106
Q

What is correct about an open pneumo?

A

The wound must be larger than the normal pathway for air to be able to enter the wound

107
Q

What does the treatment of an open pneumo consist of?

A

An occlusive dressing that is taped on 3 sides

108
Q

What will cause decreased cardiac output in a pt with a tension pneumo?

A

Pressure on the vena cava

109
Q

What is a sign of a tension pneumo?

A

Absent lung sounds

110
Q

What is the correct placement for a needle thoracostomy?

A

The second intercostal space, over the third rib, midclavicular line

111
Q

What is a sign or symptom commonly associated with hemothorax?

A

Shock

112
Q

What is the term describing muffled heart sounds, JVD, and narrowing pulse pressure?

A

Beck’s triad

113
Q

An 18 y/o male complains of severe chest pain after being trapped under a pallet of lumber that fell on him. The pt is exhibiting signs and symptoms of shock and congestive heart failure. The pt has no previous med history. What is the most likely cause of the presentation described?

A

Myocardial rupture

114
Q

What physical findings would indicate the need for intubation and positive pressure ventilation in a pt with a flail chest segment?

A

ETCO2 is 55 mm Hg

115
Q

A pt involved in an MVC is complaining of neck pain and diff breathing. Medics notice a large hematoma rapidly developing just to the right of the trachea. What is the most likely cause?

A

Laceration of the great vessels of the neck

116
Q

What is your next action after defibrillation?

A

Epi 1 mg, 1:10,000

117
Q

What vessels cannot constrict if lacerated?

A

Capillaries

118
Q

What type of shock is a tension pneumo?

A

Obstructive

119
Q

What is a drop in blood pressure on inspiration indicative of?

A

Pulsus paradoxus

120
Q

How might you see pulsus paradoxus?

A

JVD shrinking on inspiration

121
Q

Burns are classified how?

A

Degrees (1st, 2nd, 3rd)

122
Q

What are we looking for when palpating the abdomen?

A

Rigidity (to indicate bleeding)

123
Q

What is the most common group for foreign body obstructions of the airway?

A

Peds

124
Q

What is the cranial nerve for the tongue?

A

XII

125
Q

How much blood might accumulate in the pericardial sac during tamponade?

A

60-100 mL

126
Q

What is the progression of treatment for bleeding control?

A

Direct pressure -> tourniquet

127
Q

MVC’s can result in what type of brain injury?

A

Coup-contrecoup injury (sudden deceleration injury)

128
Q

What is a soft-tissue, closed injury called?

A

Contusion

129
Q

What do ascending tracts do?

A

Bring signals from the body to the brain

130
Q

How do we open the airway in a pt with suspected spinal injury?

A

Jaw thrust, holding head

131
Q

A chemical splash injury will affect what part of the eye first?

A

Conjunctiva (due to rubbing of the eyes)

132
Q

What organ is the most likely organ to be injured in abdominal trauma?

A

Liver

133
Q

Blisters are a telltale sign of what type of burn?

A

Second degree

134
Q

What cells are most vulnerable to radiation?

A

Reproductive cells (sperm)

135
Q

What type of radiation is most likely to cause damage?

A

Alpha

136
Q

What % of inspired room air is O2?

A

21%

137
Q

What is the outermost layer of the skin?

A

Epidermis

138
Q

What is the most obvious sign of fractures in the field?

A

Deformity/angulation

139
Q

What is one important question regarding history to ask a trauma pt?

A

Is the pt on blood thinners

140
Q

What is the most common source of spinal cord injuries?

A

Motor vehicle crashes

141
Q

In an electrical burn, what are you least concerned for?

A

Small burns to skin

142
Q

What is the progression of injury for a burn?

A

Burn -> fluid loss -> hypovolemia -> hyperkalemia

143
Q

What is one condition of long term radiation exposure?

A

Cancer

EMT223 (1 decks)

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