Major Memory System

Question 1

Major Memory System sounds associated with the number “0”.

Answer 1

1. S;
2. C (soft);
3. Z;

Note: “Z” is the first letter of “zero.”

https://www.academictips.org/memory/majorsys.html

Question 2

Major Memory System sounds associated with the number “1”.

Answer 2

1. D;
2. T;
3. Th;

Note: Remember as letters that begin with a single downstroke.

https://www.academictips.org/memory/majorsys.html

Question 3

Major Memory System sounds associated with the number “2”.

Answer 3

1. N;

Note: Remember as a letter having two downstrokes.

https://www.academictips.org/memory/majorsys.html

Question 4

Major Memory System sounds associated with the number “3”.

Answer 4

1. M;

Note: The letter “M” features three downstrokes.

https://www.academictips.org/memory/majorsys.html

Question 5

Major Memory System sounds associated with the number “4”.

Answer 5

1. R;

Note: Remember as a “4” and an “R” glued together, back-to-back.

https://www.academictips.org/memory/majorsys.html

Question 6

Major Memory System sounds associated with the number “5”.

Answer 6

1. L;

Note: Imagine offering up a high-five with the thumb extended 90-degrees outward from the other fingers, forming a capital “L”.

https://www.academictips.org/memory/majorsys.html

Question 7

Major Memory System sounds associated with the number “6”.

Answer 7

1. J;
2. Sh;
3. Ch (soft);
4. Dg;
5. G (soft);

Note: Imagine a “g” rotated 180-degrees to resembe the number “6”.

https://www.academictips.org/memory/majorsys.html

Question 8

Major Memory System sounds associated with the number “7”.

Answer 8

1. K;
2. Ch (hard);
3. C (hard);
4. G (hard);
5. Ng;

Note: Imagine the letter “K” as formed by two “7”s.

https://www.academictips.org/memory/majorsys.html

Question 9

Major Memory System sounds associated with the number “8”.

Answer 9

1. V;
2. F;

Note: Imagine a lower-case “F” written in cursive, resembling the number “8”.

https://www.academictips.org/memory/majorsys.html

Question 10

Major Memory System sounds associated with the number “9”.

Answer 10

1. P;
2. B;

Note: Imagine the letter “b” rotated 180-degrees to resemble the number “9”.

https://www.academictips.org/memory/majorsys.html

Question 11

Approximately ___% of the population has no gag reflex at baseline.

Answer 11

1. 30;

Major Memory System: Male homos (30) engage in oral sex without exhibiting a gag reflex.

Manual of Emergency Airway Management, 3rd Ed.

Question 12

Although there is no absolute cutoff for oxygen saturation or EtCO₂ that dictates intubation, a saturation that cannot be sustained above ___%, a RR > ___ or a CO₂ > ___ mm Hg has strong associations with intubation.

Answer 12

1. 80;
2. 30;
3. 100;

Major Memory System: The Messiah (30) intubates Amy Quist with a bottle of hot sauce (100) that has a burning fuse (80) protruding from the top.

Manual of Emergency Airway Management, 5th Ed.

Question 13

Difficult direct laryngoscopy occurs in approximately ___% of all adult emergency intubations, and is defined as a grade ___ or grade ___ ___ view.

Answer 13

1. 10;
2. III;
3. IV;
4. Laryngoscopic (Cormack-Lehane);

Major Memory System: Amy (III) Quist lies naked on an operating room table with her head propped up on a pair of fuzzy dice (10), ready to be intubated. Her nipples are remarkably hairy (IV).

Manual of Emergency Airway Management, 5th Ed.

Question 14

Based on large registry data of adult intubations, rescue surgical airways occur in ___-___% of all encounters.

Answer 14

1. 0.3-0.5;

Major Memory System: A sumo (0.3) wrestler knocks the Messiah out of the way to perform an emergency cricothyrotomy on Amy Quist with a weasel (0.5).

Manual of Emergency Airway Management, 5th Ed.

Question 15

The presence of stridor is generally considered to indicate the airway has been reduced to less than ___% of its normal caliber, or to a diameter of ___ mm or less.

Answer 15

1. 50;
2. 4.5 mm;

Major Memory System: Amy Quist howls (50) stridorously while getting an ariola (4.5) pierced.

Manual of Emergency Airway Management, 5th Ed.

Question 16

The only two studies to compare obese and lean patients head to head found a ___-fold increase in intubation difficulty for obese patients.

Answer 16

1. Five (15% vs. about 3% of lean patients);

Major Memory System: Amy Quist, notably obese, lies on the operating room table with a slimy black eel (5) squirming around on her enormous belly.

Manual of Emergency Airway Management, 5th Ed.

Question 17

When a LEMONS assessment fails to show a problem, difficult intubation may occur only in as few as ___% of patients.

Answer 17

1. 2;

Major Memory System: Danny Trejo (famous Mexican actor) squeezes an intact lemon into his mouth and is surprised to notice that the end looks just like an ano (2).

Manual of Emergency Airway Management, 5th Ed.

Question 18

The AutoVent 3000 2.0 operator’s manual instructs the user to “set the volume to equal ___ - ___ mL for every kg of body weight.”

Answer 18

1. 8 - 10;

Major Memory System: A hoof (8) with a daisy (10) pinched within it reaches out to adjust the AutoVent 3000 2.0.

AutoVent 2000 / 3000 Operating Manual, Version 2.0, p. 12

Question 19

The AutoVent 3000 2.0 is not recommeded for use with patients less than ___ kg.

Answer 19

1. 20;

Major Memory System: Angry Hawaiians (20) hold a street protest against the AutoVent 3000 2.0.

AutoVent 2000 / 3000 Operating Manual, Version 2.0, p. 12

Question 20

The Patient Valve Assembly of the AutoVent 3000 2.0 features a ___ micron stainless steel mesh.

Answer 20

1. 25;

Major Memory System: A woman gives herself anal (25) pleasure with the AutoVent 3000 2.0, and farts through the stainless steel filter.

AutoVent 2000 / 3000 Operating Manual, Version 2.0, p. 22

Question 21

The most common type of dementia is ___, which comprises up to ___% of cases.

Answer 21

1. Alzhiemer’s disease;
2. 70;

Major Memory System: Grandpa Martin has left a pan of eggs (70) burning on the stove.

https://en.wikipedia.org/wiki/Dementia

Question 22

Describe the “Modified Valsalva Maneuver” utilized for conversion of stable SVT to Sinus Rhythm in the REVERT trial. The trial found the Standard Valsalva Maneuver to have a conversion rate of ___%, while the Modified Valsalva Maneuver demonstrated ___% conversion.

Answer 22

1. In a semi-recumbent position, patients produce 40mmHg pressure for 15 seconds and are then repositioned supine with a passive leg raise immediately after the valsalva strain;
2. 17;
3. 43;

Major Memory System: The passive leg raise utilized during a Modified Valsalva Maneuver causes a worm (43) to be squeezed from the patient’s dick (17).

https://rebelem.com/the-revert-trial-a-modified-valsalva-maneuver-to-convert-svt/

Question 23

With regard to stable SVT, investigators found that 6 mg of adenosine converted ~___% of patients while 12 mg converted ~___% of patients without an increase in toxicity.

Answer 23

1. 60 (62.3%);
2. 90 (91.4%);

Major Memory System: Performing his best version of “Edward Beer Hands”, Don Hodges (60) drinks booze (90) from oversized Adenosine vial-shaped beer bottles until his heart stops.

https://www.jems.com/articles/print/volume-37/issue-9/patient-care/patient-cardiac-rhythm-important-ems-ade.html

Question 24

___ is the most common serious abnormal heart rhythm. Studies performed in 2014 demonstrated that it affects about ___% of the population of the developed world.

Answer 24

1. Atrial Fibrillation;
2. 2.5;

Major Memory System: Bumba performs vigorous anal (25 → 2.5) on GamGam, their hearts palpitating.

https://en.wikipedia.org/wiki/Atrial_fibrillation

Question 25

About ___% of people with Atrial Fibrillation have permanent AF, while ___% have paroxysmal AF and ___% have persistent AF.

Answer 25

1. 50;
2. 25;
3. 25;

Major Memory System: Lassie (50) swims down the Nile (25) in an O’Neill (25) wetsuit, her heart palpitating from fear of piranhas.

https://en.wikipedia.org/wiki/Atrial_fibrillation

Question 26

___ cricothyrotomy is indicated as a life-saving, last-resort procedure in children younger than ___ years who present or progress to the “can’t intubate, can’t oxygenate” scenario and whose obstruction is ___ to the glottic opening.

Answer 26

1. Needle;
2. 10;
3. Proximal (or cephalad);

Major Memory System: A record player’s needle drops on the eighties’ (10) best album, Thriller.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

Question 27

The Walls Manual of Emergency Airway Management recommends that when performing a percutaneous needle tracheostomy one should consider the trachea as a large vein, and cannulate it with the catheter-over-needle device directed caudad at a ___ degree angle.

Answer 27

1. 30;

Major Memory System: Michael Jackson hums (30) while his famous eighties album Thriller rotates under the needle of a record player.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

Question 28

When performing a percutaneous needle tracheostomy, consider the trachea as one would a large vein, and cannulate it with the catheter-over-needle device directed caudad at a ___ degree angle.

Answer 28

1. 30;

Major Memory System: Michael Jackson hums (30) while his Thriller album rotates under the needle of a record player.

The Walls Manual of Emergency Airway Management, Fifth Edition, 2018, p. 306

Question 29

ED cardioversion of stable, new-onset atrial fibrillation is appropriate in a select population, notably, when the onset is < ___ hours. The pooled literature suggests a thromboembolism rate of < ___ under these conditions.

Answer 29

1. 48;

Note: Rosen’s Emergency Medicine allows for cardioversion when onset is < 72 hours.

• https://foamcast.org/2014/09/21/episode-15-atrial-fibrillationflutter/*
  2. 0.8;

Major Memory System: A patient is cardioverted the safe way, in a Safeway (08 → 0.8).

Cohn BG, Keim SM, Yealy DM. Is Emergency Department Cardioversion of Recent-onset Atrial Fibrillation Safe and Effective? J Emerg Med. 2013;45(1):117–27.

Question 30

The adult Ambu® SPUR II resuscitator (BVM) is intended for patients with a body weight > ___ lbs, the pediatric for patients with a body weight <= ___ lbs, and the infant for patients with a body weight <= ___ lb.

Answer 30

1. 66 lbs (30 kg);
2. 66 lbs (30 kg);
3. 22 lbs (10 kg);

Major Memory System: Cheech (66) drives a choo-choo (66) train over an onion (22).

Ambu® SPUR II Instructions for Use

Question 31

The volume deliverd by a one-handed squeeze of an adult Ambu® SPUR resuscitator (BVM) is ___ mL, while the pediatric version delivers ___ mL and the infant version delivers ___ mL.

Answer 31

1. 600;
2. 450;
3. 150;

Major Memory System: Jaws (60) jumps from the sea (0; 60 + 0 = 600) and rolls (450) in towels (150).

Ambu® SPUR II Instructions for Use

Question 32

The pressure limiting valves on so-equipped Ambu® SPUR II resuscitators (BVMs) are set to open at _(pressure)_.

Answer 32

1. 40 cm H₂O;

Major Memory System: A rose (40) pokes out from the pressure limiting valve on an infant BVM.

Ambu® SPUR II Instructions for Use

Question 33

What gestational age-range can NICUs rated 1-3 each care for, respectively?

Answer 33

1. 1 = 36 weeks and up;
2. 2 = 32 weeks and up;
3. 3 = 20 weeks and up;

Major Memory System: An Amish (36) woman births a baby, spectacularly ripping her hymen (32) and anus (20).

Pierce County EMS Procedures and PCPs, Transport Policy, p. 13, June 2019​​​​

Question 34

Limit scene time for trauma patients, with goal of ≤ ___ minutes.

Answer 34

1. 15;

Major Memory System: An old-western sheriff looks at his pocketwatch and prepares to signal the start of a duel (15)… bloody trauma ensues.

Pierce County EMS Procedures and PCPs, Traumatic Emergencies, p. 4, June 2019​

Question 35

With patients < 2 years-old, utilize a BVM as needed if their respiratory rate is < ___ or > ___.

Answer 35

1. 15;
2. 60;

Major Memory System: The toddler from the Coppertone sunscreen bottle has her heiney (2) exposed by a BVM-shaped dog pulling at her swimwuit, revealing dill-pickle- (15) and-cheese (60) laden poo.

Pierce County EMS Procedures and PCPs, General Principles / Routine Care, p. 17, June 2019

Question 36

According to the application MDCalc, a patient’s Shock Index (SI) is calculated by dividing their ___ by their ___. A normal SI score ranges from ___. ___ scores generally correlate with a higher degree of shock.

Answer 36

1. Pulse rate;
2. Systolic blood pressure;
3. 0.5-0.7;
4. Higher;

Major Memory System: A Seahawk (0.7) football player burts out of a gigantic banner of an asshole (0.5), flashing The Shocker (Shock Index) hand signals.

Pierce County EMS Procedures and PCPs, General Principles / Routine Care, p. 19, Traumatic Emergencies, p. 24, 28-29, June 2019

Question 37

As a goal, a 12-lead ECG should be obtained within ___-___ minutes after arrival at the scene of a cardiac emergency.

Answer 37

1. 5-10;

Major Memory System: Imagine applying 12-lead ECGs to big breasted ladies (510: 5-10).

Pierce County EMS Procedures and PCPs, Cardiac Emergencies, p. 31, June 2019

Question 38

How should PCPs’ “5th choice” medication / route / dose be administered to pediatric patients for the treatment of seizures?

For what type of seizure is this administration variant indicated?

Answer 38

1. Diazepam: PR 0.5 mg/kg (max dose 20 mg); May repeat p̄ 5 min x 1;
2. Medical;

​Major Memory System (for PR administration of diazepam): A sheepish paramedic tugs a seizing toddler’s Hanes™ (20) aside and uses a turkey baster to squeeze bright green aioli (5) into his asshole (0.5).

Note: “__Administer rectal dose with 3 mL syringe (without needle) inserted as far as possible. May administer patient’s own Diastat when available”.

Pierce County EMS Procedures and PCPs, Medical Emergencies, p. 39, June 2019​

Question 39

When suffering from *severe* respiratory distress or respiratory failure associated with CHF, pulmonary edema, asthma or COPD, what four criteria must a patient meet in order to qualify for CPAP therapy?

Answer 39

1. Awake and able to follow directions;
2. Over 12 years old and able to fit in a CPAP mask;
3. Able to maintain an open airway without assistance;
4. Exhibit two or more of the following:

• Respiratory rate > 25 per minute;
• SPO₂ < 90% or an EtCO₂ > 50 mm Hg;
• Using accessory muscles during respirations;
• Unable to speak in full sentences;

Major Memory System: Lazy (50) hippos (90) inhale (25) oxygen while lounging in an ER Waiting Room.

Pierce County EMS Procedures and PCPs, General Principles / Routine Care, p. 17, June 2019​​​

Question 40

For strokes caused by a blocked blood vessel in the brain (ischemic, which comprise the majority of strokes), clot-busting medication (e.g., tPA) must be administered within ___ hours from _(time)_, a treatment that can be given at WA DOH Level ___ stroke centers.

Answer 40

1. 4.5;
2. The time the patient was last known well;
3. I, II and III;

Major Memory System: A female patient experiencing a severe stroke lies naked on a couch, stroking an areola (4.5).

Pierce County EMS Procedures and PCPs, Pierce County Prehospital Stroke Triage (Destination) Procedures, Appendix D-2, June 2019​​

Question 41

When administering magnesium sulfate to adult patients for the treatment of asthma / COPD, in place of the PCPs’ prescribed route / dose (Magnesium sulfate: IO / IV (15 min) 2 g in 10 mL sodium chloride 0.9%), consider mixing 2 g (0.5 g/mL end concentration, i.e., 4 mL) in 250 mL sodium chloride 0.9% and administering over 15 minutes with a 10-drop administration set (___ gtt./min).

Answer 41

1. 167;

Major Memory System: The audacity of remembering a number like this should elicit a headshake (167)!

Pierce County EMS Procedures and PCPs, Respiratory Emergencies, p. 36, June 2019​

Question 42

If a patient is breathing inadequately and signs of IICP are associated with TBI, “ventilate at ___ breaths/min for adults, ___ breaths/min for children and ___ breaths/min for infants”.

Answer 42

1. 20;
2. 25;
3. 30;

Major Memory System: A bottle of Heinz (20) ketchup is used to perform anal (25) BMV on a trauma patient whose open head injury is leaking hummus (30).

Pierce County EMS Procedures and PCPs, Traumatic Emergencies, p. 24-25, June 2019

Question 43

According to the application MDCalc, a patient’s Shock Index (SI) is calculated by dividing their ___ by their ___. A normal SI score ranges from ___. ___ scores generally correlate with a higher degree of shock.

Answer 43

1. Pulse rate;
2. Systolic blood pressure;
3. 0.5 - 0.7;
4. Higher;

Major Memory System: A frail, dehydrated man floating in a lake (57 = 0.5 - 0.7) is stuck by lightning (shocked).

Pierce County EMS Procedures and PCPs, General Principles / Routine Care, p. 19, Traumatic Emergencies, p. 24, 28-29, June 2019

Question 44

How may the amount of fluid calculated with the Parkland Formula be manipulated to quickly determine the amount indicated for delivery within the first hour?

Answer 44

1. Divide the total by 16;

Major Memory System: A charred woman wearing a red-hot watch cools her smoldering crotch with a bottle of douche (16) for an hour.

Mathematics

Question 45

According to the Traumatic Emergencies section of the PCPs, how should diazepam be administered to pediatrics for the treatment of anxyiolysis related to burn injuiries?

Answer 45

1. Diazepam: IO / IV 2-10 mg;

Note: The Medication / IV Guide, p. O-17 describes pediatric dosage and administration as follows:

• Diazepam:
  
  • IO / IV 0.2 mg/kg (max dose 2 mg); May repeat q 1-2 min (max total 10 mg);
  • PR 0.5 mg/kg (max dose 20 mg); May repeat p̄ 5 min x 1;

​Major Memory System (for PR administration of diazepam): A sheepish paramedic tugs a seizing toddler’s Hanes™ (20) aside and uses a turkey baster to squeeze bright green aioli (5) into his asshole (0.5).

Pierce County EMS Procedures and PCPs, Traumatic Emergencies, p. 28, June 2019

Question 46

RSI pre-oxygenation should be perfomed with the patient’s head raised ___ degrees when clinically feasible.

Answer 46

1. 25-30;

Major Memory System: A sedated moose (30) is observed to inhale (25) so forcefully during RSI pre-oxygenation that the entire NRB disappears inside his mouth.

Pierce County EMS Procedures and PCPs, Appendix F, June 2019​​

Question 47

How may the appropriate drip rate, using a 10-drop administration set, be quickly determined for the administration of fluid using the Parkland Formula during the first eight hours of delivery?

Answer 47

1. Divide the total by 96;

Major Memory System: Michael Jackson, hair on fire (burn injuries) and semen dripping (drip rate) from his chin, finishes a BJ (96) on Macaulay Culkin, whose ten fingers (10-drop administration set) are spread to the sky in a classic “hands up” posture.

Mathematics

Question 48

How should glucagon be administered to pediatric patients for the treatment of hypoglycemia when the patient is unable to maintain their airway and IV access cannot be established?

Answer 48

1. Glucagon:

• ≤ 20 kg: IM 0.5 mg;
• > 20 kg: IM 1 mg;

Major Memory System: A hypoglycemic child glued to a bedpost is forcefed wines (20) by Michael Jackson.

Note: Glucagon is available for administation to pediatric patients without Base Station contact only for the treatment of hypoglycemia (i.e., not for beta blocker / calcium channel blocker overdoses nor for epinephrine-refractory anaphylaxis secondary to beta blockade).

Memory Aid (for differentiation of care based on age or weight being ≤ a specified figure): A yound child jumps (JumpStart Triage) over a fire (burns > 10% TBSA). A “G” (glucagon) lies next to the fire supine, head resting on a Sepsis Scorecard (no age score if ≤ 54), with CPR compressions being performed on his chest (transport if ≤ 30 y/o). The gangster’s pants lie low on his thighs, showing evidence of a BM (sodium bicarbonate 8.4% / midazolam).

Pierce County EMS Procedures and PCPs, Medical Emergencies, p. 38-39, Medication / IV Guide, p. O-16, June 2019

Question 49

What two special considerations regarding a patient’s age should be taken into account when assessing a trauma patient for possible Step 4 classification?

Answer 49

1. Older Adults:

• Risk of injury death increases after age 55 years;
• Systolic BP < 110 may represent shock after age 65 years;
• Low impact mechanisms (e.g. ground level fall) may result in severe injury;

2. Children:
   * Should be triaged preferentially to pediatric-capable trauma centers;

Major Memory System: An elderly man is suspended precariously high above the ground atop a mighty discharge of carrot-filled green Jello™ (65) spewing from an oil well (55), his stark-white Adidas™ (110) somehow unaffected.

Pierce County EMS Procedures and PCPs, Appendix B-1, June 2019

Question 50

Nonambulatory JumpSTART triage patients who are breathing on their own should be categorized as Red if their respiratory rate is < ___, > ___, or ___.

Answer 50

1. 15;
2. 40;
3. Irregular;

Note 1: According to Pierce County EMS Procedures and PCPs, General Principles / Routine Care, p. 17, June 2019, “With patients < 2 years-old, utilize a BVM as needed if their respiratory rate is < 15 or > 60.”

Note 2: According to Pierce County EMS Procedures and PCPs, Appendix B-1, June 2019, a trauma patient merits Step 1 status if they present with a respiratory rate of < 10 or > 29 breaths/min (< 20 or ≥ 29 if an infant < 1 year) or if they require ventilatory support.

Major Memory System: A red-headed (Red) step child with arrows (40) impaled into his chest struggles mightily to breathe while a bumbling fireman stuffs a towel (15) into his mouth.

Pierce County EMS Procedures and PCPs, Appendix M-2, June 2019

Question 51

1. How should the PCPs’ “5th choice” medication / route / dose be administered to pediatric patients for the treatment of seizures?
2. For what type of seizure is this administration variant indicated?

Answer 51

1. Diazepam: PR 0.5 mg/kg (max dose 20 mg); May repeat p̄ 5 min x 1;
2. Medical (i.e., not traumatic);

​Note: “__Administer rectal dose with 3 mL syringe (without needle) inserted as far as possible. May administer patient’s own Diastat when available”.

Major Memory System: A sheepish paramedic tugs a seizing toddler’s Hanes™ (20) aside and uses a turkey baster to squeeze bright green aioli (5) into his asshole (0.5).

Pierce County EMS Procedures and PCPs, Medical Emergencies, p. 39, June 2019​