High Yield NREMT Flashcards
Appendix is in the
Right Lower Quadrant
Transverse/horizontal
top/bottom
Relationship b/t SVR and BP and constriction
constriction ↑ SVR ↑ BP
Pulsus paradoxus
A drop in systolic BP of 10 mmHg or more on inhaling
Kussmaul Respirations
deep and labored breathing pattern often associated with severe metabolic acidosis, DKA and kidney failure
most common cause of cardiogenic shock
AMI
Differentiate sprain and strain
A sprain is the stretching or tearing of ligaments.
A strain is a stretching or tearing of muscles or tendons
Preload
Preload = The force exerted on the ventricle walls at the end of diastole
Right ventricular failure
what happens
S/S
Right ventricular failure
• Blood backs up into the venous system that feeds into the right heart
• S/s: JVD, pedal edema
Types of bleeding:
Capillary
oozing, dark red
Normal HR for toddler (1-3 yo)
Toddler HR
80-130 bpm
Infants BVM volume
150-240 mL
Nuchal cord vs prolapsed cord
in the nuchal cord, the umbilical cord has wrapped itself around the newborn’s head and in prolapsed cord, the umbilical cord precedes the baby in the birth canal
Type of shock with:
- hypotension
- cool, clammy skin
- rapid, weak pulse
- tachypnea
hypovolemic
Simple face mask
Flow rate
FdO2
best used when x
Simple face mask (NRB without O₂ reservoir)
Flow rate: 6-10 LPM
FdO2: 40-60 %
Implied consent vs expressed consent
Implied = assumption of care; unresponsive or incompetent patient
Expressed = if you say yes to A it means you’re saying yes to B and C and D within reason
Differentiate between DKA and HHS
DKA is absolute insulin deficiency and is usually seen in type I diabetics and develops over hours to 1-2 days.
HHS is relative insulin deficiency and is usually seen in type II diabetics and develops over days to weeks.
How to measure an NPA?
tip of the nose to the earlobe
differentiate between placenta previa and abrupto placenta
placenta previa occurs when the placenta attaches to the uterus over the cervical opening and results in painless vaginal bleeding.
Abrupto placenta occurs when the placenta prematurely separates from the uterine wall and results in painful vaginal bleeding.
Pink puffers
smoking
lower airway disease
wheezing
Emphysema
Normal RR for infancy (birth to 1 year)
first born
first few minutes
by one year
Infant RR
40-60 at first
30-40 after first few minutes
20-30 by 1 year
Orthopnea
inability to breathe unless in an upright position
Normal RR for toddler (1-3 yo)
Toddler RR
20-30
Burn type for blisters and wet
2ⁿᵈ degree
Types of bleeding:
Venous
Steady flow, dark red
How to measure an OPA?
corner of the mouth to the earlobe
corner of the mouth to angle of jaw
Dehydration and burns are examples of ____ ____ shock
Dehydration and burns = non-hemorrhagic hypovolemic shock
ADULT BVM volume
1200-1600 mL
Hot zone
contamination zone; limited # of rescuers; PPE; bystanders never allowed
Normal RR for adulthood
Adulthood RR
16-20 (12-20 normal)
BP and CO equations
BP = SVR x CO CO = HR X SV
Cardiac Tamponade s/s
JVD, narrow pulse pressure, hypotension
Becks Triad
Tension pneumothorax—tracheal deviation towards
Tension pneumothorax—tracheal deviation towards unaffected side
blue bloaters
Chronic bronchitis
Respiratory distress vs. respiratory failure
respiratory distress = abnormal respiratory rate/effort
respiratory failure = clinical state of inadequate oxygenation, ventilation, or both
Carina
where the trachea branches into left and right mainstem bronchi
NRB
Flow rate
FdO2
best used when
NRB
Flow rate : 10-15% (high flow)
FdO2 can be 100%
best used when: breathing w/o aid but hypoxic
Use this type of move when the Scene is dangerous and pt needs to be moved in order to provide care
Give examples if applicable
Emergency moves includes: armpit-forearm drag shirt drag blanket drag
Hypotension calculation
systolic BP <70+2(age)
Liver quadrant
RUQ
Common injuries for the Down-and-under pathway
injuries to knees, femurs, hips, acetabulum, and spine
Left ventricular failure
what happens
S/S
Left ventricular failure:
• Blood backs into the heart
• S/s: pulmonary edema, pulmonary veins fill due to back pressure, pressure ↑ in the pulmonary capillaries, water leaks from pulmonary capillaries into the alveoli
• Left HF frequently leads to Right HF
Normal BP for preschool age (3-5 yo)
Preschool BP
80-110 mmHg
Normal RR for Adolescence (13-18 yo)
Adolescence (13-18) RR
12-20
Gallbladder quadrant
RUQ
SV vs. SVR
SVR = total resistance of arterioles to flow of blood SV = amount of blood pumped by the heart each cycle
Normal RR for preschool age (3-5 yo)
Preschool RR
20-30
Subcutaneous emphysema
air flowing upward and being trapped under the skin; cracking sensation upon palpation of the patient’s neck
Normal BP for toddler (1-3 yo)
Toddler BP
70-110 mmHg
Normal BP for school age (6-12 yo)
School age 6-12 BP
80-120 mmHg
Normal HR for Adolescence (13-18 yo)
Adolescence (13-18) HR
55-105 bpm
Common injuries for the Up-and-over pathway
injuries to abdomen, chest, face, head, and neck
Steps of secondary assessment for a:
Responsive medical pt, no AMS
Responsive medical pt, no AMS
(1) history, (2) modified secondary, (3) baseline vitals
differentiate between frank and complete/incomplete breech presentations
frank = legs extended incomplete/complete = legs are flexed
Right-sided heart failure causes blood to back up into the body, causing pitting edema throughout the body
Cor Pulmonale
Atelectasis
condition in which the lungs have collapsed or are airless
Residual tank pressure
200-300 psi
Types of bleeding:
Arterial
spurting, bright red
Type of shock that is hypotension, bradycardia, warm dry skin
neurogenic
Rule of nines- peds head chest front chest back arm leg genital
Rule of nines- peds head = 18 chest front = 18 chest back = 18 arm = 9 leg=14 genital=1
BVM
Flow rate
FdO2
best used when
BVM Flow rate: 15 LPM FdO2: 21% w/o O₂ attached; 90-95% with O₂ best used when: pt need help ventilating 600 mL delivery for 1 sec ventilation
PE, tension pneumo, or cardiac tamponade = ____ shock
obstructive
Normal HR for infancy (birth to 1 year)
first born
settling
Infant HR
HR = 100-160 (first 30 mins)
After = 120 bpm
Normal BP for Adolescence (13-18 yo)
Adolescence (13-18) BP
100-120 mmHg
Venturi mask
Flow rate
FdO2
best used when
Venturi mask
Flow rate: ≤15 LPM
FdO2: 24-60%
Venturi masks are especially helpful for COPD patients
At what age group does temp usually stay 98.6
school age children (6-12) and on
Explain the process of inhalation active or passive process what happens to the diaphragm intercostal muscles thoracic cavity (contracts/expands) pressure in chest cavity
Inhalation Active process Diaphragm contracts intercostal muscles contract thoracic cavity expands negative pressure
Normal Temp for toddler (1-3 yo)
Toddler Temp
96.8-99.6
hypovolemic shock BP Skin Pulse quality Breathing rate LOC
hypovolemic shock BP: hypotension Skin: cool, clammy Pulse quality: rapid, weak Breathing rate: tachypnea LOC: AMS
Beck’s Triad consists of what 3 signs?
Muffled heart tones, hypotension and jugular vein distension
PEDS BVM volume
500-700 mL
Hollow organs do what when injured and they include what? (6)
Hollow organs:
Leak
Include:
Stomach, intestines, gallbladder, urinary bladder, ureters, uterus
Rule of nines- adult head chest front chest back arm leg genital
adult head = 9 chest front = 18 chest back = 18 arm = 9 leg = 9 genital = 1
Steps of secondary assessment for a:
Trauma pt no sig MOI no AMS
Trauma pt no sig MOI no AMS
(1) modified secondary, (2) baseline vitals, (3) history
Normal temp for infancy (birth to 1 year)
Infant Temp
98-100
Distributive shock includes 3 types of shock:
distributive shock: neurogenic, septic, anaphylactic
deficiency in insulin; urine contains glucose
diabetes mellitus
Explain the process of exhalation active or passive process what happens to the diaphragm intercostal muscles thoracic cavity (contracts/expands) pressure in chest cavity
Exhalation
passive process
Diaphragm and intercostal muscles relax
Creates a positive pressure in the thoracic cavity
air flows out until pressure is equalized
Deficiency in vasopressin; excessive thirst, large amounts of extremely dilute urine
diabetes insipidus
Type of diabetes where the body cells are resistant to insulin
type ii diabetes
Cold zone
Safe zone Normal triage, stabilization, and treatment performed; SHED PPE before entering
Normal HR for school age (6-12 yo)
School age 6-12 HR
70-110 bpm
Normal HR for preschool age (3-5 yo)
Preschool HR
80-120 bpm
Warm zone
control zone = prevents spread of contamination; PPE; lifesaving emergency care is performed
type of diabetes where the body lacks insulin
type 1 diabetes
Nasal cannula
Flow rate
FdO2
best used when
Nasal cannula
Flow rate-: 6 LPM
FdO2: 20-40%
best used when: pt not able to tolerate face mask
Commotio cordis
an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (
Frontal/coronal plane
anterior/posterior
Normal BP for adulthood
Adulthood BP
120/80 mmHg
Solid organs do what when injured and they include what? (4)
Solid organs BLEED when injured Include: KLOPS Kidneys liver (ovaries) pancreas Spleen
Steps of secondary assessment for a:
Trauma pt / Medical pt + AMS
Trauma pt / Medical pt + AMS
(1) rapid secondary, (2) baseline vitals, (3) history
Estimating BP: Normal systolic
Adult male:
Adult female:
Child
Estimating BP: Normal systolic
Adult male:100+age (≤140)
Adult female: 90+age (≤130)
Child: 80+2 (age) [only for children 1-10]
Midline/medial/sagittal
left/right
Cheyne-Stokes
progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in apnea
Stomach quadrant
LUQ
Spleen
LUQ
shock that is from widespread vasodilation
distributive shock
type of shock that is hypotension, tachycardia, weak thready pulse, cool, moist, pale skin
cardiogenic
Cardiogenic shock BP Skin Pulse quality Breathing rate LOC
Cardiogenic shock
BP: hypotension
Skin: cool/clammy
Pulse quality: weak, irregular, tachycardia
Breathing rate: tachypnea, shallow, dyspnea
LOC: restless and anxiety
Afterload
Afterload is the resistance the heart must overcome during ventricular contraction.
Use this type of move when the PT has potentially life-threat injuries/illness and must be moved quickly for evaluation and transport
Give examples if applicable
Urgent moves
Cushing reflex
BP
HR
Breathing
↑Systolic BP↓HR, irregular breathing
Right-sided vs. left-sided Heart failure
Right sided = dependent edema, JVD, enlarged liver; COR PULMONALE
Left side = crackles, dyspnea, hypoxia, fluid in lungs (pulmonary edema)
Estimating normal diastolic pressure:
Adult
Children
Estimating normal diastolic pressure:
Adult: 60-85 mmHg
Children: 1-10 yrs
80 + 2(age) /0.66 systolic
Recovery position is recommended for patients who are (conscious/unconscious) and (breathing spontaneously / not breathing spontaneously)
Recovery position = unconscious + breathing spontaneously
Normal RR for school age (6-12 yo)
School age 6-12 RR
20-30
Differentiate between the different types of blast injuries
primary blast injury is due from the sudden change in environmental pressure
secondary blast injury is from being struck by a flying object
in the tertiary blast injury, it results from the victim being thrown through the air and striking the ground or other objects
fluid accumulates w/in the pericardial sac, compressing the heart
Cardiac Tamponade
Normal BP for infancy (birth to 1 year)
at birth
at 1 year
Infant BP systolic
70 @ birth
90 @ 1 yr
type of shock that is hypotension, tachycardia, tachypnea, pink, warm flushed skin
septic shock
Normal HR for adulthood
Adulthood HR
60-100 (NEMSES says 70)
Type of shock Due to inadequate amount of fluid or volume in the circulatory system
Hypovolemic shock
Type of shock where the Heart lacks enough power to maintain an adequate cardiac output
cardiogenic shock
Cor Pulmonale
Right-sided heart failure causes blood to back up into the body, causing pitting edema throughout the body
Hypoglycemia HR and BP
Hypoglycemia
HR = tachycardic
BP = hypertensive
Hyperglycemia HR and BP
Hyperglycemia
HR = tachycardic
BP = hypotensive
How long will a patient go without breathing before it is likely that irreversible brain damage has set in?
6-10 minutes
Appendix
RLQ
Anterior circulation stroke
blockage of cerebral artery that perfuses the cerebrum and cerebral cortex
posterior circulation stroke
blockage of cerebral artery that perfuses the brainstem and cerebellum
RUQ pain and jaundice
hepatitis
LUQ pain, N/V, abdominal distention
pancreatitis
cholecystitis
inflammation of the gallbladder
RUQ pain which increases at night, referred shoulder pain
cholecystitis
RLQ pain, N/V, decreased appetite
appendicitis
calculate cardiac output
stroke volume x heart rate
normal stroke volume =
SV = 70 mL
Calculate BP
BP = CO x SVR
SV vs. SVR
SV = stroke volume and is the volume of blood ejected with each ventricular contraction (normal = 70)
SVR = systemic vascular resistance and is the resistance of blood to flow throughout the body (increases with constriction)
Pulmonary artery
The artery carrying blood from the right ventricle of the heart to the lungs for oxygenation. Note: This is the only artery in the body that carries deoxygenated blood.
Pulmonary vein
A vein carrying oxygenated blood from the lungs to the left atrium of the heart. Note: This is the only vein in the body that carries oxygenated blood.
Vasoconstriction effect on SVR and BP
Vasoconstriction ↑ SVR and ↑ BP
Pharmacodynamics
biological effects (therapeutic or adverse) of drug administration
parenteral drugs are those that are
injected or inhaled
enteral drugs are those that are
ingested
tidal volume
normal volume of gas inhaled during one respiration cycle (~500 mL)
inspiratory reserve volume
volume of air inhaled greater than the tidal volume during forced deep inhalation (<3000 mL)
Vital capacity
the maximum volume of air exhaled during forceful exhalation
Minute volume define and equation
Minute volume = volume of gas expelled from the lungs in one minute
= respiratory rate x tidal volume
normal tidal volume
500 mL
Total lung capacity define and equation
normal amount
the total volume that the lungs can contain
Total lung capacity: vital capacity + residual volume
Usually ∼ 6000 mL for adults
what 2 oxygen tanks do emts use the most? and what are their volumes?
D tank @ 350 (M15) factor 0.16
E tank @ 650 (M24) factor 0.28
which node is the heart’s natural pacemaker
SA node
Cystitis vs cholecystitis
cystitis is inflammation of the bladder whereas cholecystitis is inflammation of the gallbladder
Chemoreceptors vs. baroreceptors
chemoreceptors respond to pH ∆ and monitor levels of CO₂ in the blood whereas baroreceptors respond to pressure changes (blood pressure)
Hypothermia levels
mild = >93.2 moderate = 86-93.2 sever = <86
temp cut off for heat stroke
> 104F + AMS
Differentiate the different types of headaches in the 3 types of brain bleeds
epidural headache = sudden, severe, intense
Subdural = progressive and worsening over time
Subarachnoid = thunderclap severe headache, abrupt onset, may be worse @ the back of the head
subdural hematoms occur between
subdural = dura mater and arachnoid layer
epidural hematomas occur between
skull and dura mater
RUQ main organs (2) and diseases (3)
RUQ
liver, gallbladder
hepatitis, cholecystitis, peptic ulcer
RLQ main organs (2) and diseases (1)
RLQ
appendix, ascending colon
appendicitis
LUQ main organs (3) and diseases (1)
LUQ
stomach, spleen, pancreas
intestinal malrotation
LLQ main organs (3) and diseases (5)
LLQ
descending colon, sigmoid colon, female stuff, ileum
ABD pain, peritonitis in LLQ = colitis diverticulitis ureteral colic ovarian cysts or PID
Difference between alpha and beta adrenergic medications
alpha drugs mostly cause vasoconstriction
beta 2 drugs relax bronchi smooth muscle
Components of the LAPSS screening
Age > 45 years
No history of seizure disorder
New onset (past 24 hrs) of neurologic symptoms
Patient was ambulatory at baseline (prior to event)
Serum glucose level 60-400
Examination of the LAPSS screening
Facial smile or grimace
Grip
Arm weakness
Disturbances in O2 diffusion, carrying, offloading, or use is ____ shock
metabolism/respiratory shock
because inadequate breathing for long periods causes abnormal cellular metabolism, resulting in the buildup of metabolic products.
Normal minute volume for adult at rest
6000 mL
Differentiate between epidural and subdural bleeds
Epidural is low-velocity impact/deceleration injury bleeds; almost always is associated w/ a skull fracture, commonly in the temporal region
Subdural bleeds are low-pressure venous bleeding; common association is cerebral contusion
Visceral vs. parietal pleura
visceral = innermost layer which contacts the lung Parietal = outermost layer; contacts the thoracic wall
the scope of practice which determines what an EMT can and cannot do is determined by the
state legislature
Arteriosclerosis vs atherosclerosis
Arteriosclerosis is the stiffening or hardening of the artery walls.
Atherosclerosis is the narrowing of the artery because of plaque build-up. Atherosclerosis is a specific type of arteriosclerosis.
when you see “urticaria” think
allergic reaction
rales vs. rhonchi
rales = crackles = fluid in lungs; bubbling/popping sound, pneumonia, copd, lung infections
rhonchi = rattling = chronic lung problems (chronic smokers)
Diverticulitis
definition
who’s at risk
S/s
Small pouches (diverticular) along the wall of the intestine fill w/ feces and become inflamed & infected
People > 40 w/ low fiber diet
S/S: LLQ pain
Distributive shock includes
neurogenic, septic, and anaphylactic
In proving negligence, what is “causation”
“proximate cause” The injury to the plaintiff was, at least in part, directly due to the EMT’s breech of duty.
arterial, venous, capillary
epidural bleeding is____
subdural bleeding is ____
epidural bleeding is arterial
subdural bleeding is venous
Differentiate primary, secondary, and tertiary blast injuries
Primary blast injury is due to the sudden change in environmental pressure.
Secondary injury is due to being struck by a flying object.
Tertiary injury is due to the victim being thrown through the air and striking the ground or other objects.
ligaments connect _____
while tendons connect ____
sprains happen in ____
Strains happen in ____
Ligaments = bone::bone
Tendons: muscle::bone
sprain = ligaments strain = muscle + tendon
hyphema
Blood in the anterior chamber of the eye
The umbilical cord is made up of
__ artery/arteries
__vein/veins
2 arteries
1 vein
pale skin, dilated pupils, narrow pulse pressure, tachynpea = ___ shock
hypovolemic shock
Class II hemorrhage Blood loss % BP HR RR Urine output CNS status capillary refill
Class II Hemorrhage Blood loss: 15-30% BP: orthostatic hypotension HR: 100-120 RR: 20-30 Urine output: 20-30cc/h CNS status: agitated Capillary refill: slight delay / cool
Class I hemorrhage Blood loss % BP HR RR Urine output CNS status capillary refill
Class I hemorrhage Blood loss: <15% BP: normal HR: <100 RR: normal Urine output: >30cc/h CNS status: normal Capillary refill: normal
Class III Hemorrhage Blood loss % BP HR RR Urine output CNS status capillary refill
Class III Hemorrhage Blood loss: 30-40% BP: marked decrease HR: >120 RR: 30-40 Urine output: 5-15cc/h CNS status: confused Capillary refill: significant delay/cool
Class IV Hemorrhage Blood loss % BP HR RR Urine output CNS status capillary refill
Class IV Hemorrhage Blood loss: >40% BP: profound decrease HR: >140 RR: >35 Urine output: <5cc/h CNS status: obtunded Capillary refill: significant delay/cold
gland that is both exocrine and endocrine
pancreas
Differentiate b/t type 1 and type 2 respiratory failure
type 1 = blood O₂ less than 60
type 2 = blood CO₂ greater than 50
