Exam 2 Flashcards
WhichofthefollowingisNOTapartofthescenesize-up?
A.Determiningthemechanismofinjury
B. Determiningthenumberof
patients
C. Establishinganairway
D.Takingbodysubstanceisolationprecautions
C
Scene size up should take place
At beginning and throughout the entire call
Most important part of patient assessment
Chief complaint
Vitals are taken when
After primary assessment, more thorough in secondary
Blood pressure 1 year to puberty
80 + 2 x age
When the artery expands, blood moves through arteries in waves
Pulse
Concerned with what during the pulse
Rate and quality and rhythm
During emergency, it’s not abnormal for pulse rates to temp be between
100-140
Find __ pulse in patients one and up
Radial
Infant 1 or younger what kind of pulse
Brachial pulse
What are the elements of scene size up
BSI Scene safety Moi Noi Additional resources Number of patients C spine
Whentherearenoapparenthazards,thedangerzoneatthe
sceneofavehiclecollisionshouldextendatleast:
50 feet in all directions
Whenfuelhasbeenspilledatamotor-vehiclecollision,the
dangerzoneshouldbeextendedatleast:
100 ft in all directions
When a veichle is on fire
At least 100 ft in all directions
Check __ when hazardous materials involved
Emergency response guidebook
When wires are down…
1 full span of wires away from poles
Age 65 is considered
Geriatric
Biggest threat of violence is
Domestic violence
BSI stands for
Body substance isolation
Forces that may have caused injury
Mechanism of injury
Always assess from
Head to toe
If a patient is critical or unresponsive in a roll over collisions
Put c collar on outside
A fall or an adult is
More than 20 feet or 3x height
A fall for Children under 15
More than 10 feet or 3x child’s height
Injury causes by an object that passes through the skin of other body tissues
Penetrating trauma
In penetrating trauma, the injury is classified by
The velocity of the item that caused the injury
Low velocity injuries are
Knife, bat, stick
Pressure related damage
Cavitation
Damage directly from a projectile
Medium/high velocity injuries (guns)
Injury caused by a blow that strikes the body but penetrate skin or other tissues
Blunt force trauma
Signs are often subtle and can be overlooked in a
Blunt force trauma
Ineverymotorvehicleaccidentthereareactuallyhowmanycollisions? A. Two B. Three C. Four D. Five
B
Duringscenesize-upatamultiple-vehiclecrash,itisimportant
todeterminethenumberof
patientsbecause:
A.additionalEMSresources
mayhavetobecallediftherearemorepatientsthanthe
firstcrewonthescenecan
handle.
B.runreportsarerequiredforeachpatient
C. Als must be called if there aremorethantwopatients.
D. themediamustbegiven
accurateinformation.
A
Responsible for overall coordination of activities
Incident commander
If hazardous material is known, seek advice from
CHEMTREC through commander
Park __ from wreckage if hazardous materials
Upwind
During a shooting, while police clear the scene you should
Stage somewhere
When breathing, you take in __ but __ is dead space
500, 150
existsaroundthewreckageof
everyvehiclecollision,within
whichspecialsafetyprecautionsmustbetaken.
Danger zone
5.Duringscenesize-uptheEMTmustmaintainahigh___________________
___________________ ___________________ basedonthemechanismof
injury.
Index of suspicion
7.Withamedicalpatient,
findingoutwhatisormaybewrongwiththepatientis
calledidentifyingthe___________________
NOI
In a head on collision, type of injuries can be
Head to toe
In rear end collision, injury can be
Head, neck, chest
In side impact collision, injury can be
Head, neck, chest, abdomen, pelvis, thighs
Theportionoftheassessmentthatisdesignedtoidentifyandtreatimmediately
lifethreateningconditionsis
calledthe:
Primary assessment
Actions taken to correct or manage a patients problems are
Interventions
When an EMT feels that a patient doesn’t Look right, this is
Clinical judgment
Inanypatientwithsuspectedspinalinjury,anEMTshould
apply
manualstabilization:
Right on first contact with patient
Ifapatientisnotalertandisbreathingless
than8breathsaminute,theEMTshould:
A. beginmouth-to-mouthventilations.
B. givehigh-concentrationoxygenviaanonrebreathermask.
C. ventilatewithapositive
pressuredeviceand100
percent oxygen
C
Poor circulation in skin is
Clammy
Assessment more reliable for children than taking the BP
Capillary refill (no more than 2 seconds)
Respiratory problem =
High priority
When checking mental status use
AVPU
Reason EMS was called is the
Chief complaint
ABCS stand for
Airway, breathing, circulation
If patient appears lifeless, no pulse than what is the order of ABC
CAB
If CPR and bleeding control aren’t required, then
Administer oxygen
Always suction before
Ventilation
Steps of primary assessment
Forming gene to impression
Assess mental status (AVPU) and stabilize head or neck
assess ABCs
Determine patient priority
Assess the ____ in breathing
Rate quality depth
What determines mental status for A and O
Person place time
Breathing in what percent of oxygen
21
The pediatric triangle includes
Appearance, circulation, breathing
Gets a feel about patients condition from environment observations and first look at patients, identities critical patients
The look test
What is the sign for chest pain
Levine sign
What kind of approach is best when treating patients
Systematic
With circulation, assess the
Skin, pulse, bleeding
When should you initiate priority transport
Life threat problems can’t be controlled and declined responsiveness
To check the mental status for an infant
Shout and flick feet
If there is trauma in the airway vs medical
Jaw thrust, head tilt chin lift
For breathing, if in respiratory arrest
Rescue breaths
If depressed mental status and inadequate breathing
Give positive pressure ventilations with 100% O2
If a patient if in cardiac arrest
CPR
TheratingontheAVPUscalethatindicatesthemostseriousmentalstatusis
___________________ .
U
Ifapatientisalertandhisbreathingrateismorethan24breathsperminute,
provide100percentoxygenby___________________ ___________________ .
Nonrebreather mask
Inchildandinfanttraumapatients,theairwayisopenedbymovingtheheadshoto
a___________________ .
Neutral
Ifapatientisnotalertandherbreathingrateisslowerthan8breathsperminute,
provide___________________ -___________________ ____________
High pressure ventilations
Signs that can indicate shock
Anxiety, pale, clammy, high heart rate, low blood pressure
How to treat shock
Supine, warmth, give oxyegn
An EMT should be most concerned with a pulse rate maintained above: A. 60 beats per minute. B. 80 beats per minute. C. 100 beats per minute. D. 120 beats per minute.
D
In case of shock or later stages of blood loss, an E M T would
expect the pulse to be:
Rapid and thready
If an E M T has trouble finding the radial pulse on a conscious patient, he should first: A. try the other side of the same wrist. B. press more gently. C. use the thumb to palpate the pulse. D. try the wrist on the other arm.
D
A person is considered febrile if he has a temperature greater than
101.3
If pulse is above __ or above. __ or below __
150, 120, 50
Excessive pressure on the carotid can
Slow heart
If pulse isn’t normal, take the pulse for
60 seconds
In cases of children and infants, an EMT can expect to find the highest normal respiration rates in a(n): A. adolescent. B. preschooler. C. 9-month-old infant. D. newborn.
D
If you can’t find a pulse and patient is talking to you…
Ventricular assist device
Propels blood continuously and not in waves, no change in pressure
Ventricular assist device
When checking pupils look for
Size equality and reactivity
With head injuries, pupils are
Unequal
When deflating the cuff of a sphygmomanometer, the “systolic”
blood pressure is the:
1st sound
Normal pulse oxygen
94-99
Respiration concerned with
Rate and quality
Adults respiratory rate
12-20
Slight movement of chest or abdomen
Shallow
Crowing breathing means
Prompt transport
If snoring….
Open airway
For unstable patients, EMT should take vitals
Every 5 mins
Normal blood glucose level
70-100 mg/dL
Constricted blood vessels results in what color skin
Pale
Pale skin indicates
Blood loss, shock, bad circulation
Flushed skin indicates
Heat, excited
To determine temperature
Feel the patients forehead with back of hand
If the patient is cold on the skin, place had in the
Abdomen
Cap refill in patients
Under 6
Force of blood against Walls of vessels
BP
The __ contracts and forces blood out
Left ventricle
Pressure when heart contracts and forces blood into arteries
Systolic
An E M T should be concerned with an adult patient with a respiratory rate above
___________________ breaths per minute or below ___________________ breaths per
minute.
24, 10
Goose pimples” or “goose bumps” are associated with exposure to
___________________ , ___________________ , or ___________________ .
Cold, pain, fear
Taking blood pressure by use of the fingertips is known as ___________________ .
Palpitation
A person with a pulse oximetry level less than is considered to
be in severe hypoxia.
85
Capnography measures
End total carbon dioxide
Normal or abnormal character of breathing
Respiratory quality
Dilated pupils with
Blood loss
101 degrees patient inside
Infection
93 degrees patient in cool environment
Hypothermia
Remaining in arteries when left ventricle relaxes and refills
Diastolic
At birth the blood pressure is
50-70
121-139 or 81-89 blood pressure is
Pre hypertension
BP of 140 or greater and 90 or greater is
Hypertension
Measure blood pressure three ways
Auscultation, palpating, blood pressure monitor
In palpating for BP you only get
Systolic number
If the cuff is too small for BP,
The BP is higher
Listen and inflate BP cuff until gauge reads
30 mmHg higher than the point where pulse disappeared
What sound is dull, systolic or diastolic
Diastolic
Release valve on BP at what rate
5-10 mm per sec
Difficult to obtain bp on children younger than
3
The temperature should be greater than
96.8
Older people have __ temps than young people
Lower
Mild hypoxia o2 reading
91-95
Significant hypoxia o2 reading
86-90
Severe hypoxia treatment
non rebreather mask at 15 lpm
What binds with hemoglobin in the blood
CO
Smokers will have __ of hemoglobin bound to CO
10-15%
To measure capnography the two methods are
Patient breathing spontaneously has special nasal cannula, in vented patient a plastic collar fits between bag valve and mask
Pediatric patient can be delayed how many seconds for pulse oxygen
90
Which of the following would be included in the secondary assessment of a patient? A. Determine responsiveness. B. Assess history of present illness. C. Determine chief complaint. D. Assess the airway.
B
The patient’s statement, “I feel like I just can’t get enough air
when I breathe” best relates to what letter of the S A M P L E
mnemonic?
A. S
B. L
C. M
D. P
S
the sound or feel of broken bones rubbing.
Crepitation
You are using the mnemonic S A M P L E to obtain the patient history. What question would be included in the “P” part of the history?
______
______
A. Are you allergic to any medications? B. What sequence of events led to today’s problem? C. When did you last eat or drink? D. Have you had surgery recently?
D
Begin the assessment of infants and small children at the:
A. head. B. fingertips. C. toes. D. abdomen.
C
Difficulty breathing while lying down is called:
Orthopnea
Shock may be indicated by: A. wheezing. B. high oxygen saturation. C. hypertension. D. narrowing pulse pressure.
D
When obtaining the patient’s history related to the nervous
system, you should determine the patient’s:
A. normal state of mental functioning.
B. peripheral sensation and movement.
C. extremity strength.
D. blood glucose level.
A
By obtaining the patient’s blood glucose level, you are
assessing the:
Endocrine system
An analytical process that can help the E M T think through a
problem in an organized and efficient manner is:
Critical thinking
After assessing a patient, the E M T should develop a list of
potential diagnoses. This list is called the:
Differential diagnosis
Your previous patient had difficulty breathing because of pulmonary edema related to heart failure, so when you encounter another patient with difficulty breathing, you assume
the patient has pulmonary edema. This is an example of:
Availability
When you assess areas of the patient’s body, you will evaluate them in three main
ways: ___________________ , ___________________ , and ___________________ .
Observation, inspection, auscultation
Try to ask what kind of questions
Open ended
When gathering a respiratory history, ask if the patient has ___________________
___________________ ___________________ , or trouble breathing after exercise.
Dyspnea on exertion
You can check for stroke using the ___________
CPSS or Fast
If an E M T assumes that one thing causes another in a patient’s condition, when, in
fact, the two issues are unrelated, this may be due to ___________________
___________________ .
Illusionary correlation
As an E M T, you should learn to love ___________________ because you will frequently go out into unknown situations armed with limited education and experience.
Ambiguity
Patients history has two components
HPI, PMH
Memory aid used to develop info pertaining to chief complaint and history of present illness
OPQRST
OPQRST
onset Provocation Quality Region or radiation Severity Time
What were you doing when pain began
O
Does anything trigger the pain
Provocation
Can you describe the pain or problem
Quality
Where’s the pain, does it spread
Region radiation
How bad is the pain or problem on a scale of 1-10
Severity
Has anything changed since the pain started
Time
Memory aid to learn about medical history
SAMPLE
Sample
Signs and symptoms Allergies Medications Pertinent medical history Last oral intake Events Leading up to injury or illness
3 techniques for physical exam
Observe, palpate, auscultation
the body system exam, focused into the
Secondary assessment
If it hurts a patient to take a deep breath the body system most effected is
Musculoskeletal
Jugular vein distinction is an indicator of
Heart failure
To examine the nervous system, see if the patient is walking to examine __. Be sure to __ all extremities
Gait, squeeze
Most common emergency with a diabetic in what system
Endocrine
In the GI system, ___ the abdominal quadrants
Palpate
Common body system assessment for the immune system
Anaphylaxis (gives and wheezing)
What body system exam is performed as a trauma exam
Musculoskeletal
Cincinnati stroke scale measures
Face dropping, palms up and closed eyes, grip strength, speech
Need __ stroke symptom to be considered to be having a stroke
1
Insulin gets the
Glucose in the cell
FAST stands for
Face dropping, arm weakness, speech, time
Heart of the pattern recognition, when you encounter patient with a certain group of signs/symptoms that resemble condition
Representativeness
Urge to think of things because more readily available, how common a condition is
Availability
Be skeptical about instances that appear to be a cause
Illusionary correlation
EMT considers a condition to be likely and later thinking is anchored to hypothesis
Anchoring and adjustment
Looking for a cause of problems
Search satisfying
3 categories of patients
Medical, trauma, unknown
Components of secondary assessment
Physical examination
Patient history
Vital signs
Something you can see
Sign
Something a patient tells you
Symptom
For a medical patient secondary assessment, if they are response…
Patient history
Brief physical exam from chief compliant
Vitals
For a medical patient secondary assessment if they are unresponsive…
Rapid Physical exam
Baseline vitals
The rapid physical exam should take about
60-90 seconds
Aftertherapidtraumaassessment,themorethorough
assessmentthatanEMTperformsisthe:
A. focusedphysicalexam.
B. primaryassessment.
C. detailedphysicalexam.
D. scenesurvey.
C
Thedecisiontodoarapidtraumaassessmentisbasedon:
A.informationobtainedfromtheSAMPLEhistory
B. thenumberofpatients.
C. mechanismorinjury.
D. vitalsignsbeingoutsidenormallimits.
C
Thephysicalexaminationoftheresponsivemedicalpatientisa:
A. detailedhead-to-toeexam.
B. specializedexamthatisfocusedontheABCs.
C. rapidphysicalexamination.
D. focusedexamcenteredontheareaofcomplaint
D
Flatneckveinsinapatientwhoislyingflat
indicate:
Blood loss
Paradoxicalmotionismostcommonlyassociatedwith:
Chest injury
Theassessmentprocedureusuallyperformed
onseriouslyinjuredorillpatientsenroutetothehospitalisthe:
Detailed physical exam
Most important time to check patients pupils is when the eyes are
Closed
HistorytakingisMOSTextensiveforwhichtypeofpatient?
Responsive medical patient
Beforeapplyingacervicalcollar,youmust:
Care for all life threats
Bruising
Contusion
Thefirststepofthefocusedhistoryandphysicalexamforatraumapatientwitha
minorinjuryistoreconsiderthe___________________ ___________________
MOI
TheacronymEMTscanusetorememberthetypesofinjuriestolookforis
DCAP -BTLS
goodtimetoslideinabackboardunderthepatientiswhenyouareassessingthe
___________________ ___________________ .
Posterior body
MOI for adult: intrusion is __ on occupant side or __ to any site
> 12 or >18
MOI for adults: motorcycle crash greater than
20 mph
If there is any medical change, reassess the
ABCs
For a trauma patient with low priority….
Determine chief complaint Patient history (nature of force, strength) Physical exam (observation, palpitation, auscultation) DCAP BTLS
Observe abnormalities in
Symmetry, color, shape, movement
Palpate for abnormalities
Shape, temp, texture, sensation
Trauma patient with high priority…
C spine
ALS
rapid trauma assessment at scene
It is normal for veins to __ when laying down
Budge
Movement of chest in opposite direction or the rest of chest
Paradoxical motion
Look for breath sounds in the
Midclavicular and axillary lines
A pulsating mass in the abdomen means
Enlarged aorta
Erection of penis from injury of spinal cord
Priapism
In a pediatric exam, don’t apply pressure to the
Fontanelles (sunken is dehydrated, bulging is head trauma )
Larger pediatric heads increase the chance of
Spinal cord injury
What pediatric organs more suspected for trauma in abdomen
Spleen or liver
Thephysicalexamforaresponsivemedical
patientwillincludea
rapidassessmentoftheentirebody.
True or false
False
Thephysicalexamofanunresponsivemedical
patientwillbesimilartothehead-to toephysicalexamforatraumapatient.
______
True
TheonlythingthatshouldpreventanEMTfromperformingthe reassessmentofapatientis: A. policeorders. B. life-savinginterventions. C. delayedtransport. D. initialvitalsignsthatarenormal.
B
Reassessmentisameansofdetermining:
Trending
Duringthereassessment,attempttolookatapatientasifyouhadneverseenthepatientbeforewhenchecking:
Interventions
Justhowoftentoconductthereassessmentis
determinedby
the:
Patients condition
Anappropriatepainfulstimulustousewhen
checkingthe mentalstatusofanunresponsivechildorinfant
is:
Flicking feet
Duringthe___________________ ,youwillrepeat
keyelementsofassessmentproceduresyou
havealreadyperformed.
Reassessment
Changessuchaslossofconsciousness,anxiety,orsweatingmayindicateachange
in___________________ .
Circulation
Steps of reassessment
Primary assessment
Vitals
Repeat pertinent parts of secondary exam
Check interventions
2 way radios at a fixed site
Base station
Mobile radios have a
10-15 mile range
Devices used when transmissions must be carried over long distances
Repeaters
Transmits through air not wires
Cell phones
Sending and receiving data wirelessly (ECG, vitals)
Telemetry
Radio communication is regulated by the
FCC
The federal agency that assigns and licenses radio frequencies used by E M S units is the:
FCC
The federal agency that assigns and licenses radio frequencies
used by E M S units is the:
FCC
Speak with lips on radio
2-3 inches from mic
All of the following patient data should be included in a radio medical report EXCEPT: A. name and address. B. age and sex. C. mental status. D. chief complaint.
A
The part of the patient’s history that an E M T must report in the patient’s own words is the: A. chief complaint (C C). B. past medical history (P M H). C. estimated time of arrival (E T A). D. history of present illness (H P I).
A
Discussions between an E M T and a patient are known as:
Interpersonal communication
The two-way radio at a hospital or dispatch center is known as a: A. mobile radio. B. repeater. C. digital radio. D. base station.
D
A prehospital care report can become all of the following EXCEPT:
A. evidence in a legal case.
B. part of the hospital’s permanent records.
C. data in a research project.
D. private property controlled by the patient.
D
A system in which calls are routinely reviewed for conformity to
current medical and organizational standards is called:
QI
The federal agency that has developed a list of minimum elements to be included in all prehospital care reports is the:
NHTSA
An E M T would record the time in which an emergency unit left on a call in the: A. patient data section. B. narrative section. C. check boxes section. D. run data section.
D
All of the following are included in the patient data section of a prehospital care report EXCEPT: A. charges to the patient. B. patient’s name and address. C. patient’s weight. D. patient’s date of birth.
A
All the following can be found in a well-written narrative EXCEPT: A. pertinent negatives. B. radio codes. C. specialized medical terminology. D. standardized abbreviations.
B
Actions performed on a patient that are wrong and improper
are known as:
Errors of commissions
Incorrect information in a prehospital care report should be: A. erased. B. crossed out completely. C. corrected in different-colored ink. D. left unchanged.
C
Elements in a verbal report
Chief complaint
History not given previously
Treatment given
Additional vitals en route taken
Learned by experience
Therapeutic communication
Abbreviated containing minimum data
Drop transfer report
Observable, measurable, verifiable are….
Objective
Subject to interpretation or opinion
Subjective
Physical exam doesn’t take place before transport unless
Transport is delayed
The three key links in E M S radio communications are the dispatchers, ___________________
___________________ , and the hospitals.
Mobile units
The one item that should never be found in the 12 parts of a radio medical report is
the patient’s ___________________ .
Name
statements reflect an individual’s point of view.
Subjective
The failure to document errors of omission and commission is an example of
Falsification
In a multiple-casualty incident (M C I), patient information is often passed through the
system in the form of ___________________ ___________________ .
Triage tags
The “three R s” of E M S communication are
Radio, report, record
Two sections of PCR
Run data and patient information
Questions to ask about breathing in ABCs
Is it adequate
Do they need oxygen
In an MOI, assess
Rapid trauma assessment
In an NOI, assess
Focused assessment
Vitals
Sample
Opqrst
