EMT223 Flashcards
How is shock best defined?
Inadequate tissue perfusion
In relation to cardiovascular physiology, what does heart rate multiplied by stroke volume equal?
Cardiac output
What is the Fick principle used to estimate?
Perfusion to an organ or the body
What are the smooth, low-friction cells that line the peripheral vascular vessels called?
Endothelium
How is the tone of the arterial system best reflected?
Pulse pressure
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?
Relative hypovolemia
As the body compensates for shock with peripheral vasoconstriction, oxygen delivery to the capillaries decreases. What does this cause?
Anaerobic metabolism to replace aerobic metabolism
When “leaky capillary” syndrome occurs, what happens to the capillaries?
Permit protein-containing fluids to leak into the interstitial space
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?
Cardiogenic
What is a severe allergic reaction caused by histamine release from exposure to an antigen called?
Anaphylactic shock
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?
Obstructive shock
What action occurs to compensate for stage 1 shock?
Vasoconstriction
During stage 2 shock, the onset of arterial hypotension and opening of AV shunts will cause what response?
Stagnation of blood flow in the capillaries
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?
Stage 3
What is a likely cellular response to stage 3 shock?
Disseminated intravascular coagulation
Peritonitis and endocrine disorders might produce what type of shock?
Hypovolemic shock
What is a clinical sign of irreversible shock?
Frank hypotension
What is the management and treatment of a patient in any stage of shock directed at?
Management of oxygenation and perfusion of organs
What is hypovolemic shock of any cause first treated with?
Crystalloid fluid volume replacement
What is an IV solution with an osmotic pressure greater than that of the body’s cells called?
Hypertonic solution
Public education concerning injury prevention would be classified as what phase of trauma care?
Pre-incident
What is the most critical factor in the survival of any severely injured patient?
Time from incident to definitive care
The “golden hour” describes which aspect of trauma care?
First hour after severe injury
Late trauma deaths most often result from which condition?
Sepsis
What is the leading cause of death in children under 4 years of age for injuries sustained?
Motor vehicle crashes
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.
60
The “golden hour” begins at which time?
At the time of injury
The statement that an object in motion or at rest remains in that state until acted upon by an outside force reflects which act?
Newton’s First Law of Motion
The statement that energy cannot be created or destroyed, it can only change form, best reflects which act?
Conservation of Energy Law
The statement that force equals mass multiplied by acceleration or deceleration most closely reflects which act?
Newton’s Second Law of Motion
When calculating kinetic energy, what is the most important variable relating to total kinetic energy?
Velocity
What is the definition of kinematics?
The process of predicting injury patterns
Which of the following is true regarding rear-end collisions?
The difference between the speeds of the vehicles involved produces the damage
The “up and over” pathways of motion is most frequently associated with patients injured in what type of MVC?
Frontal impact
What types of injuries are seen in rollover collisions?
Unpredictable and difficult to categorize
Ejections from vehicles normally possess which characteristic?
Creates a six-fold increase for the risk of death
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.
Primary
What is the definition of cavitation?
A force that pushes body tissue away from the path of a projectile
Of the following tissues, which is least likely to incur permanent cavitation from a bullet passing through it? Liver, spleen, muscle, or urinary bladder
Urinary bladder
Paramedic documentation of entrance and exit wounds from gunshot include what?
Description of the wounds
The outermost layer of the epidermis, composed of about 20 layers of dead skin cells, is the stratum ___.
Corneum
What is the role of thrombin in clot formation?
Convert fibrinogen into fibrin threads to help form a blood clot
After an injury, how is blood flow to the injured area affected?
Increases to meet the increased metabolic demands of injured tissue
What is one difference between a hematoma and a contusion?
A hematoma is a more severe injury and may result in greater blood loss than a contusion
How is compartment syndrome best defined?
Tissue pressure rising above perfusion pressure, resulting in ischemia to the muscle
What is a typical finding in a patient with compartment syndrome?
Pain seemingly out of proportion to the injury
What are black, “tarry” stools called?
Melena
Serious internal hemorrhage generally occurs in the chest cavity, abdominal cavity, pelvic cavity and what other area?
Retroperitoneal cavity
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?
Bruising may be delayed by as much as 48 hours after an injury
Which treatment should not be used for severe hyperkalemia secondary to crush injuries?
Potassium chloride
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?
Never exceed a pressure greater than 50 mm Hg
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?
Tetanus
When dressing and bandaging a penetrating chest or abdominal wound, what type of dressing should be applied first at the wound site?
Sterile occlusive dressing
Pt has suffered a complete amputation. During treatment, medics have decided to apply pressure point control. How should paramedics proceed?
Pressure-point control is not recommended
What is true regarding chemical burns?
The chemical changes in the skin produce more damage than the heat
Which statement describes Jackson’s Thermal Wound Theory?
Zones of burn-injury patterns
What is expected to occur to cells in the Zone of Stasis?
Die within 24-48 hours without proper care
What is one example of a systemic response to burn trauma?
Increased vascular resistance except in the hyperemic zone
Burn area is red and wet, painful with intact sensation, blisters are beginning to form. What burn classification is this?
Second-degree, superficial partial-thickness burn
A burn is white and leathery in appearance, no painful sensation. Which burn classification?
Third-degree burn
To most accurately calculate the total body surface area burned, the paramedic should use which method?
The Lund and Browder chart
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 ___.
22.5
Is a 57 year-old female with 15% second- and third-degree burns to hands and arms considered a major burn patient?
Yes
The rule of nines is most accurate in which faction?
Children over age ten and adults
When should the Lund and Browder chart be used for measuring burn injuries?
The patient is an infant
How much fluid should be infused in the first 8 hours of a burn injury?
50%
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?
Escharotomy through the burned tissue
What medication may be helpful when treating a pt with CO poisoning?
Sodium thiosulfate
Because of the structure and function of the upper airway, which is typically true of thermal burn injuries of the upper airway?
Do not typically lead to burn injuries of the lower airway
Which is true of hydrofluoric acid exposure?
It may cause serious systemic damage even if external signs and symptoms of exposure are mild
What is the major cause of maxillofacial injury?
Motor vehicle crashes
What is true of soft tissue injuries to the face?
They commonly bleed heavily but are seldom life threatening
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?
Mandible fracture
What is the most commonly fractured facial bone?
Nasal bones
What is a sign of a blowout fracture of the eye?
Enophthalmos (recessed globe)
What is true regarding injuries to the tympanic membrane?
They usually heal well on their own
For the purposes of evaluation, the neck has been divided into 3 zones. What does zone 1 represent?
Base of the neck
What is true of esophageal perforation?
Patients with esophageal injuries should be transported in semi-Fowler’s position
What is the most common type of skull fracture?
Linear
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?
Retrograde amnesia
Which is the most severe form of brain injury?
Diffuse axonal injury
As a pt’s brain swells, how does the body respond to a drop in the effective perfusion pressure of the brain (CPP)?
Increasing the mean arterial pressure
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?
Cerebral cortex
What drug may be administered to decrease cerebral edema?
Mannitol
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?
Subdural hematoma
What is the most common cause of spinal cord trauma?
Motor vehicle crashes
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?
Always require immobilization
What is one example of a negative mechanism of injury?
Tripping over a curb and twisting an ankle
A pt with a distracting injury is considered to be ___.
Unreliable
What is the part of the vertebrae that is palpated during assessment of the spinal vertebrae?
Posterior spinous process
A spinal injury that causes compression along the length of the spinal column is known as ___.
Axial loading
Injury mechanisms such as hangings typically cause a ___ type of spinal cord injury.
Distraction
What is the most commonly injured area of the spinal cord?
C5 to C7
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?
Spinal cord damage has progressed with secondary injury
Babinski’s sign would have no clinical relevance in what age group?
A pt who is 1 year-old
When applying manual in-line stabilization to the head, what should the paramedic do?
Apply just enough tension to relieve the weight of the head from the cervical spine
To achieve neutral alignment when immobilizing children, which method should be used?
Pad under the child’s torso to accommodate the larger occiput
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?
Complete cord transection
What characterizes central cord syndrome?
Paralysis of the arms
How does methylprednisone work in spinal cord injuries?
Reduces edema and inflammation
After a clavicle fracture, what vessel can be injured?
Subclavian vein
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?
Injury to the spleen
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?
Flail segment
What is the definitive treatment for a flail segment?
Intubation with positive pressure ventilation
What signs/symptoms would be associated with a closed (simple) pneumo?
Diminished breath sounds on the affected side
What is correct about an open pneumo?
The wound must be larger than the normal pathway for air to be able to enter the wound
What does the treatment of an open pneumo consist of?
An occlusive dressing that is taped on 3 sides
What will cause decreased cardiac output in a pt with a tension pneumo?
Pressure on the vena cava
What is a sign of a tension pneumo?
Absent lung sounds
What is the correct placement for a needle thoracostomy?
The second intercostal space, over the third rib, midclavicular line
What is a sign or symptom commonly associated with hemothorax?
Shock
What is the term describing muffled heart sounds, JVD, and narrowing pulse pressure?
Beck’s triad
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?
Myocardial rupture
What physical findings would indicate the need for intubation and positive pressure ventilation in a pt with a flail chest segment?
ETCO2 is 55 mm Hg
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?
Laceration of the great vessels of the neck
What is your next action after defibrillation?
Epi 1 mg, 1:10,000
What vessels cannot constrict if lacerated?
Capillaries
What type of shock is a tension pneumo?
Obstructive
What is a drop in blood pressure on inspiration indicative of?
Pulsus paradoxus
How might you see pulsus paradoxus?
JVD shrinking on inspiration
Burns are classified how?
Degrees (1st, 2nd, 3rd)
What are we looking for when palpating the abdomen?
Rigidity (to indicate bleeding)
What is the most common group for foreign body obstructions of the airway?
Peds
What is the cranial nerve for the tongue?
XII
How much blood might accumulate in the pericardial sac during tamponade?
60-100 mL
What is the progression of treatment for bleeding control?
Direct pressure -> tourniquet
MVC’s can result in what type of brain injury?
Coup-contrecoup injury (sudden deceleration injury)
What is a soft-tissue, closed injury called?
Contusion
What do ascending tracts do?
Bring signals from the body to the brain
How do we open the airway in a pt with suspected spinal injury?
Jaw thrust, holding head
A chemical splash injury will affect what part of the eye first?
Conjunctiva (due to rubbing of the eyes)
What organ is the most likely organ to be injured in abdominal trauma?
Liver
Blisters are a telltale sign of what type of burn?
Second degree
What cells are most vulnerable to radiation?
Reproductive cells (sperm)
What type of radiation is most likely to cause damage?
Alpha
What % of inspired room air is O2?
21%
What is the outermost layer of the skin?
Epidermis
What is the most obvious sign of fractures in the field?
Deformity/angulation
What is one important question regarding history to ask a trauma pt?
Is the pt on blood thinners
What is the most common source of spinal cord injuries?
Motor vehicle crashes
In an electrical burn, what are you least concerned for?
Small burns to skin
What is the progression of injury for a burn?
Burn -> fluid loss -> hypovolemia -> hyperkalemia
What is one condition of long term radiation exposure?
Cancer
