Exam 1 Review Flashcards
Function of NREMT
Asses competence of prospective EMTs through a valid testing process widely accepted across the country and agreed upon. Allows for easier reciprocity.
Who regulates standards under which EMT provide care?
State EMS office or agency (SNHD)
What did Nevada Highway Traffic Safety Administration establish?
National standards of EMS education.
Fell under organization due to original focus on traffic safety and trauma (The White Paper).
Medical Director
Ultimately determines what meds AEMT can give. Reason why national registry defers to local protocols.
What determines medication administration?
Area of work (rural vs. city)
Risk/benefit
Medical Director
Local protocols
What is negligence?
Failure to provide the same care that someone with similar training would provide.
What is proximate cause?
Must be proven if someone is being sued for negligence. Direct relationship between pt’s injury and AEMT’s actions.
What is your Legal Duty to Act?
You have a legal duty to provide medical care whether you are a witness of responding to the call.
Standard of Care
The manner in which you are require to act or behave as an AEMT
Good Samaritan Laws
Designed to protect people who try to help in emergency situation. Can protect from liability if determined that you provided good faith care.
What kinds of injuries and/illnesses require transport to a specialty facility?
Trauma Burn Stroke Cardiac Pediatric
What do you do if you get stuck with a sharp?
Inform partner to take over. Notify supervisor. Finish the call.
What do you do if you are transporting a patient to the hospital with minor injuries when you see a major car accident with potentially multiple patients?
Call dispatch and inform them of the MVA. Continue transporting to the hospital.
When do you change a portable O2 tank?
500 psi
DNR Requirements
Pt must be deemed mentally competent at the time of signing DNR.
Must be signed by physician
Notes diagnosis/terminal condition
Must have physical copy of DNR for EMS to honor wishes
What happens to a lung with COPD?
Alveoli lose elasticity and shape making it hard to exhale.
Air gets trapped in lungs.
Bronchial tubes become inflamed and narrowed.
Thick mucus forms causing chronic cough.
What happens to a COPD patient with PNA?
Pt unable to exhale and cough becomes ineffective. Cannot expel infectious sludge from PNA. Very difficult to heal.
What is the classic presentation of a patient with cardiogenic shock?
Cold and wet
Two components of cardiogenic shock
Systemic hypoperfusion due to low CO (cold)
Filling pressures are elevated (wet)
Why cardiogenic shock cannot be fixed with volume administrtion or removal?
Giving volume will worsen their pulmonary congestion and edema making them wet.
Removing volume will worsen their systemic hypoperfusion making them colder.
Why cardiogenic shock cannot be fixed with volume administration or removal?
Giving volume will worsen their pulmonary congestion and edema making them wet.
Removing volume will worsen their systemic hypoperfusion making them colder.
In addition to sudden severe pain in the abdomen, what are other s/s of a ruptured AAA?
Hypotension
Pallor
Diminish pulses in lower extremities
Additivity drug interaction
Commination of two or more chemical is the sum of the expected individual’s response. 1+1=2
Antagonism drug interaction
Exposure to one chemical results in a reduction in the effect of the other chemical. 1+1=0.5
Potentiation
Exposure to one chemical results in the other chemical producing an effect greater than if given alone. 1+0=2
Synergism
Exposure to one chemical causes a dramatic increase in the effect of another chemical. 1+1=3
Chief complaint vs. primary problem
CC : why you were called to the scene
Primary problem : what is most important to the patient
What are the components of plasma?
Plasma makes up 55% of blood component
Water 91%
Proteins 7% : albumins, globulins, fibrinogen
Other solutes 2% : electrolytes, nutrients, gases, wastes, vitamin, regulatory substances
What are the component of formed elements?
Makes up 45% of centrifuged blood
RBC (millions)
Platelets (hundreds of thousands)
WBC (thousands)
Percentage of each WBC in centrifuged blood?
Neutrophils 70% Lymphocytes 20% Monocytes 5% Eosinophils 4% Basophils 1%
Blood flow through the heart
Deoxygenated blood enters superior and inferior vena cava Right atrium Tricuspid Right ventricle Pulmonic valve Pulmonary artery to right and left lung Oxygenated blood enters pulmonary veins from left and right lungs Left atrium Mitral valve Left ventricle Aortic valve Aorta to body
What are the three meningeal layers?
Dura mater: outer layer lining skull
Arachnoid mater: contains blood vessels
Pia matter: covers brain
Obstructive shock can be caused by:
Cardiac tamponade
Tension pneumothorax
Massive pulmonary embolism
BP assessment on pediatrics
BP should be checked on children older than 3
What is the best indicator of perfusion in younger children?
Skin signs
Cap refill
When does the cardiac electrical conduction slow in the heart?
AV node
Explain why pulses in LE may be diminished during a ruptured AAA.
Blood is going to flow the path of least resistance. If the rupture is on the R side, it’ll flow down LLE and vice versa.
Who’s safety comes first when responding to a behavioral emergency?
- You
- Partner
- Patient and bystanders
List hazards of a structural fire.
CO
Building integrity
Very high temperatures
Burn/heart emergency
What anatomical structure separates in the larynx and esophagus?
Hypopharynx
What anatomical structure separates the cricoid ring from the thyroid cartilage?
Cricothyroid membrane
What is the odontoid process?
Odontoid process is located posteriorly on C2. It’s a protrusion that allows C1 to sit on top of C2 causing limited ROM.
What is a growth plate?
The epiphyseal plate is hyaline cartilage plate in the metaphysis on the end of each long bone.
Orbital fx vs. LeFort fx
Orbital involves the orbit only.
LeFort fx I
Separation of hard palate from upper maxilla
LeFort fx II
Transect nasal bones, medial-anterior orbital walls, orbital floor, inferior orbital rims, posterior maxilla and pterygoid plates.
LeFort fx III
Nasofrontal suture, medial orbital wall, lateral orbital wall, zygomatic arch, and pterygoid plates.
How much volumes goes into each cuff of the Combitube>
Depends on manufacturere
Pharyngeal cuff - 100mL
Distal cuff - 15mL
How much volumes goes into each cuff of the Combitube>
Depends on manufacturer
Pharyngeal cuff - 100mL
Distal cuff - 15mL
What should you do with an LMA before insertion?
Fully deflate and lubricate
Causes of emphysema.
Smoking and genetics
What does surfactant do?
Keeps alveoli open.
What is TB?
Bacterial disease that is spread in the air.
Why do we give IV fluid in a patient in shock?
Maintain adequate perfusion
Does IV fluid increase the blood’s ability to carry oxygen?
No, increased volume of fluid does not equal more blood as you need Hgb to transport RBC.
Adequate systolic BP for proper perfusion?
90 mmHg
Inotropic effect on heart.
Strength of contraction
Chronotropic effect on heart.
HR
Dromotropic effect on heart.
Conduction velocity
What are baroreceptors?
Nerve cells that sense pressure changes located in the carotid and aorta.
Isotonic
Equal concentration of sodium inside and outside cells.
Hypotonic
Concentration of sodium inside cell is greater than outside the cell causing water to through the cell membrane causing swelling and possible lysis.
Hypertonic
Concentration of sodium outside cell is < than inside causing water to leave the cell shrinking the cell. Called plasmolysis.
Formula for calculating IV flow rate in drops/minute.
vol/time x drop factor = IV flow gtt/min
Process of injection medications through port of an IV line.
Use alcohol wipe on needleless port
Connect syringe
Clamp line proximal to injection port
Injection medication
What do you do if there is resistance when ventilating a patient with a stoma?
Suction
Define tripod position.
Leaning forward w/ arms and elbows supporting upper body on legs
Possible etiology of tripod position.
COPD, asthma exacerbation, pulmonary edema, moderate to severe respiratory distress.
Differences between suspension, emulsion, elixir, and solution.
Suspension: particles evenly distributed through shaking or stirring.
Emulsion: mixture of two liquids that are not mutually soluble
Elixir: sweetened, aromatic, hydroalcoholic liquid.
Solution: liquid mixture of one or more substances cannot be filtered.
s/s of left hemispheric stroke
Aphasia
Right sided deficits
What heart valve controls regurgitation into lungs?
Tricuspid
Pathophysiology of psychogenic shock.
Vasovagal
What is done before, during, and after medication administration?
Assess the patient.
What is the most reliable food for long term energy production?
Complex carbs
Define virulence.
Strength or ability of pathogen to produce diease.
s/s of exposure to a cholinergic agent
Salivation Lacrimation Urination Defecation GI upset Emesis Miosis
Neurotransmitters of the sympathetic and parasympathetic nervous system.
Norepinephrine, epinephrine, and acetylcholine.
RSV
Highly contagious virus passed through droplets from cough and sneeze.
Copious secretions.
What do pH chemoreceptors respond to when increasing respirations?
CO2
s/s pulmonary embolism
Sudden onset of pinpoint sharp chest pain Dyspnea Tachycardia Tachypnea Hemoptysis
s/s cardiovascular emergency
CP w/ possible radiation to jaw, arm, back N/V Dyspnea JVD Irregular heartbeat
NTG
Class: vasodilator
MOA: lower preload & afterload to decrease workload of heart. Dilation of arterioles and veins.
Indication: acute CP, HTN, heart failure, pulmonary edema
Contraindications: hypotension, hypovolemia, intracranial bleeding or head injury, pericardial tamponade. ED medication w/in 24-48 hours
Adv rxn/side effects: HA, dizziness, weakness, n/v
Drug interaction: additive effects to vasodilators
Rout: SL, IV
Dosage & Admin.: 0.4mL SL. Repeat 3-5 mins. Max dose 3. pray: 0.4mg 1-2 sprays. IV: 10-20 mcg/min every 5 min
Schedule drug class I
High abuse potential; no medical purpose
Ex: heroin, marijuana, LSD
Schedule drug class II
High abuse potential; legitimate medical purpose
Ex: Fentanyl, Ritalin, cocaine
Schedule drug class III
Less potential for abuse than class II Ex: hydrocodone, Tylenol #3, ketamine
Schedule drug class IV
Less potential for abuse than class III Ex: Diazepam, Lorazepam
Schedule drug class V
Less potential for abuse than class IV Ex: narcotic cough medications
Calculate drip rates
(vol in mL) x (drip set) / (time in minutes) = ggt/min
Calculate # of drops/min
(vol in mL) x (drip set) / (time in minutes) = ggt/min
Calculate medication concentration.
total weight of medication / total volume = weight/ mL
Calculate volume to administer.
desired dose (mg) / concentration hand (mg/mL) = volume (mL)
