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EMT > NREMT Part III > Flashcards

NREMT Part III Flashcards

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1
Q

Signs

A

findings you can objectivly:
- See
- hear
- feel
- smell
- Exmpl: vomiting, deformity, wheezing

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2
Q

Symptoms

A

Subjective feelings the patient must tell you about
empl: Nausea, pain, dyspnea

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3
Q

OTC

A

Over The Counter Medications

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4
Q

when to reassess stable patient

A

Every 15 mins

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5
Q

When to reassess unstable patient

A

Every 5 mins

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6
Q

Six standard vital signs

A
  1. RR
  2. Pulse
  3. BP
  4. Pupils
  5. Skin temp
  6. Pulse ox
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7
Q

Tachypnea

and tachypnic rate for adult

A

Rapid breathing
Over 20 breaths a min

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8
Q

Bradypnea

And bradypnic rate for adult

A

Slow breathing
Under 12 breaths a min

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9
Q

Normal Respiratory Rhythm

A

Regular rhythm and adequate chest rise and fall

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10
Q

Shallow Respiratory Rhythm

A

Minimal chest rise and fall

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11
Q

Labored Respiratory Rhythm

A

Increased work of breathing

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12
Q

Irregular Respiratory Rhythm

A

Abnormal breathing pattern

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13
Q

Best place to hear lung sounds

A

pts back

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14
Q

Wheezing

A

High-pitched whistleing sound
- usually on expiration

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15
Q

Crackles/Rales

A

Wet, crackling sound
- usually on inspiration and expiration

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16
Q

Rhonchi

A

Low-pitched congested sounds
- usually due to mucus
- usually on expiration

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17
Q

Three fields to auscultate lungs

A
  1. Upper lungs (apices): below clavicals @ midclavicular line
  2. Middle lung field: middle chest @ midclavicular posterior
  3. Lower lungs (base): lower portion of thorax @ miclavicular or midaxillary
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18
Q

At what Systolic BP is it unlikely you can palpate a pulse

A

60 mmHg

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19
Q

3 componants to documenting a pulse

A
  1. Rate
  2. Rhythm
  3. Quality
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20
Q

Quality of pulse descriptors

A
  1. strong
  2. weak
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21
Q

Rhythm of pulse descriptors

A
  1. regular
  2. irregular
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22
Q

What is BP measured in?

A

Millimeteres of mercury (mmHg)

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23
Q

what is pulse pressure

A

Difference between systolic and diastolic

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24
Q

‘normal’ pulse pressure

A

Difference that is >25% but <50% of systolic

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25
Q

Wide pulse pressure

and indicates what

A
  • Greater than 50% of systolic
  • indicates increased ICP
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26
Q

Narrow pulse pressure

and indicates what

A
  • <25%
  • Indicates possible obstructive shock
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27
Q

Hypertension stages (BP Values)

A

Stage 1: 130/80 - 139/89
Stage 2: systolic > 140 OR diastolic >90
Hypertension crisis: Systolic >180 OR diastolic >120

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28
Q

Hypotension in child (1 - 10 Y.O)

A

Systolic below
70 + 2(age)
Exmpl: 5 y.o. with systolic BP of 80

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29
Q

orthostatic hypotension considerations

A
  • have pt stand for 1 min then repeat BP
  • do not assess if pt is already dizzy, weak, hypotensive while supine
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30
Q

orthostatic hypotension findings

A
  • Drop is SBP >20
  • Drop is DBP >10
  • sharp rise in pt pulse rate
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31
Q

Mydriasis

A

Dialated pupils

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32
Q

Miosis

A

Constricted pupils

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33
Q

‘Normal’ pupil size

A

midsize:
2 - 5 mm in light

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34
Q

Anisocoria

A

pupils are different in size or shape

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35
Q

Body temp (Adult average & range)

A

Average: 98.6 F (37C)
Range: 97 F (36.1C) - 99 F (37.2C)

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36
Q

What age group has a lower body temp

A

Elderly

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37
Q

Where to palpate for relative skin temp

A

upper back or neck
(Not forehead)

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38
Q

What age group is cap refill a reliable sign of poor perfusion

A

Under 6 years

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39
Q

SaO2 and SpO2 difference

A

SaO2: O2 saturation of arterial blood
SpO2: O2 saturation detected by pulse oximeter

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40
Q

Pulse Oximetry limitations

A
  • not only tool for respiratory efficiency
  • cannot measure amount of hemoglobin (only saturation of hemoglobin that is present)
  • Inaccurate readings due too :hypovolemia, hypothermia, anemia, nail polish, carbon monoxide, tabacco use
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41
Q

NIBP

A

Non-invasive Blood Pressure monitoring

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42
Q

What scope is capnography/capnometry in?

A

AEMT or Paramedic

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43
Q

Capnography

A

End-tidal CO2 (ETCO2)
- measurement of carbon dioxide in pts exhaled breath

Some systems allow EMT to assist set up ( LIKE COLORADO :) )

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44
Q

Capnography vs. Capnometry

A

Capnography: Co2 waveform and numerical value
Capnometry: numerical value only

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45
Q

5 components of Patient Assessment for EMT

A
  1. Scene Saftey
  2. Primary assessment
  3. Patient History
  4. Secondary Assessment
  5. Reassessment
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46
Q

Scene Size up componants

A
  1. Scene saftey
  2. BSI/PPE
  3. MOI or NOI
  4. # of patients
  5. additional resources
  6. consider spinal precautions
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47
Q

When should you carry a portable, compact, flashlight

A

all times

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48
Q
A
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49
Q

Primary Assessment

A
  1. begins when you reach the pt
  2. Identify and manage life threats
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50
Q

Primary Assessment componants

A
  1. General impression
  2. LOC
  3. ABC or CAB (AVPU)
  4. Rapid scan as needed
  5. transport priority
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51
Q

ABC vs. CAB

A
  • Airway, Breathing, Circulation
  • Circulation, Airway, Breathing
52
Q

When do you use CAB instead of ABC

A
  • unconscious pts
  • obvious life threatening bleeding
53
Q

How long do you check for a pulse in an unresponsive pt?

A

5 - 10 seconds

54
Q

What type of PPV do pts with inadequate breathing always get

A

BVM

55
Q

Rapid scan

A

head-to-toe assessment used to identify remaining life threatening conditions not already managed

56
Q

Rapid scan componants

A
  • should not take longer than 90 seconds
  • utilize inspection, palpation, auscultation as needed
  • includes assessment of posterior
  • do NOT be distracted/focus on non-life threatening conditions
57
Q

high transport priority pts (unstable pt)

A
  • decreased LOC
  • signs of shock
  • serious medical condition
  • severe pain
58
Q

stable pt

A
  • no obvious life-threatening condition
59
Q

Secondary assessment

A
  • should not delay transport for high priority pt
  • identify remaining s/s, conditions, injuries
  • all potentially life-threatening conditions should have already been found or managed
  • can be a detailed head-to-toe assessment or focused exam
60
Q

detailed head-to-toe indicated for

A
  • unresponsive
  • multisytem trauma
61
Q

Focused secondary survey

A
  • focuses only on areas/systems considered relevant to pt complaint
62
Q

Focused secondary survey indication

A
  • alert pt
  • isolated complaint
63
Q

Secondary assessment componants

A
  • detailed or focused secondary survey
  • baseline vitals
64
Q

Reassessment

A

used to continuously monitor pt condition for deterioration or improvement

65
Q

Reassessment componants

A
  • begin by reassessing primary assessment for changes
  • reassess pt CC
  • Reassess interventions you performed
  • continues until pt care is transferred or you discover something that requires attention
66
Q

pt history componants

A

SAMPLE

67
Q

what is the terminal (final) structure in the lower airway

A

Alveoli

68
Q

What is spontaneous breathing driven by

A

Negative pressure

69
Q

What is the active part of ventilation

A

Inhalation

70
Q

What is the passive part of ventilation

A

Exhalation

71
Q

Two primary methods brain uses to control O2 delivery

A
  1. Rate of ventilation
  2. Tidal volume
72
Q

Hypoxic drive

A
  • monitors O2 levels in plasma
73
Q

Hypoxia

A

Inadequate delivery of O2 to the tissues of the body

74
Q

S/S of mild (early) hypoxia

A
  • resltess, anxiety, irritable
  • Dyspnea
  • Tachycardia, tachypnea
  • SpO2 90% - 94%
75
Q

S/S of severe (late) hypoxia

A
  • Altered or decreased LOC
  • Severe dyspnea
  • Cyanosis
  • Bradycardia (especially peds)
  • SpO2 below 90%
76
Q

Oxygenation

A

Delivery of O2 to the blood
- ventilation must be adequate for oxygenation to occur

77
Q

NC, NRB, CPAP require what from pt

A

spontaneous ventilation

78
Q

Respirations

A

Exchange of O2 and carbon dioxide

79
Q

Assessment of breathing includes

A
  • look
  • listen
  • feel
80
Q

Adequate breathing componants

A

Adequate RR and tidal volume

81
Q

Inadequate breathing componants

A
  • Abnormal RR
  • shallow chest rise
  • accessory muscle
  • abnormal/diminished/absent lung sounds
  • paradoxical motion
  • dyspnea
  • Cyanosis
  • Low Spo2
  • Agonal breaths
  • Apnea
82
Q

Order of assessment and management of airway

A
  1. open airway
  2. suction
  3. secure
83
Q

Aspiration

A

Entry of matter into the lungs
- can cause aspiration pneumonia
- 1 in 5 pt with aspiration pneumonia will die

84
Q

Suction units require

A
  • disposable canister
  • generate vacuum of 300 mmHg when tubing clamped
85
Q

Yankauer

A

Rigid suction catheter
- known as “tonsil tip”
- for oral airway

86
Q

French catheter

A

Flexible
- several sizes
- for nose, stoma, inside advanced airway

87
Q

Suctioning increases risk of

A
  • hypoxia
  • delays time
88
Q

Suction times

A

adult: 15 seconds
Children: 10 seconds
Infants: 5 seconds

89
Q

How to measure french catheter

A

from corner of mouth to earlobe

90
Q

how to measure OPA

A

Corner of mouth to earlobe

91
Q

OPA contraindications

A
  • Gag reflex
  • Responsive to pain
92
Q

NPA contraindications

A
  • pt awake and protecting own airway
  • severe head injury
  • severe facial trauma
  • do not force when you meet resistance
93
Q

How to measure NPA

A

Tip of nose to earlobe

94
Q

NPA insertion considerations

A
  • water-soluble lubricant ONLY
  • insert with bevel toward septum
  • rotate as necessary
  • remove if pt begins to gag
95
Q

What supraglottic airway is not currently part of NREMT

(yes its part of CO EMT scope)

A

i-gel

96
Q

Indications for supplimental O2

A
  • cardiac or respiratory arrest
  • BVM
  • dyspnea, cyanosis
  • signs of shock
  • Spo2 less than 95%
  • altered or decreased LOC
97
Q

AHA guidelines for administering O2 with suspected acute coronary syndrome or stroke

A

NOT recieve O2 UNLESS:
- SpO2 of 94 or less
- complain of dyspnea
- signs of shock
- signs of heart failure

98
Q

Oxygen cylinders look like?

A
  • seamless
  • aluminum
  • green
  • various sizes
99
Q

Amount of O2 in a tank is measured by

A

pounds per square inch (psi)

100
Q

Full O2 tank is ____ psi

A

2,000 psi

101
Q

When do you replace or refill O2 tank

A

200 psi
(Known as the safe residual pressure)

102
Q

Regulators

A

Flow meters
- reduce pressure coming from tank
- measured in liters per minute (L/min or lpm)

103
Q

NRB

A
  • typicall set to 10 lpm (as needed to keep reservoir filled)
  • pt recieves 90% O2
104
Q

NRB cautions

A
  • reservoir full before applying mask
  • never under less than 10 lpm
  • if reservoir deflates during inhale = increase flow rate
  • Remove mask if O2 source is lost
105
Q

NC

A

Nasal Cannula
- referred to as ‘low-flow’ O2
- flow rate 1 to 6 lpm
- pt recieves 24% - 45% depending on lpm

106
Q

Venturi mask

A
  • deliver specific concentrations of low flow O2
  • Not commonly used in EMS
107
Q

HFNO

A

High Flow Nasal Oxygen
- emergency therapy that delivers CPAP-like support
- 40 - 70 lpm
- not well tolerated

108
Q

Hazards of O2 administration

A
  • combustable
  • highly pressurized tanks
  • long term exposure to high concentration can cause retinal damage in infants
109
Q

PPV

A

Positive pressure ventilations
also called: assisted ventilation or artificial ventilation

110
Q

PPV devices

A
  • Pocket mask
  • BVM
111
Q

PPV indications

A
  • inadequate spontaneous breathing
  • RR <10 or >30
  • Apnea
  • Agonal
  • respiratory distress/failure
112
Q

PPV complications

A
  • hyperventilation
  • gastric distention
  • aspiration
  • intrathoracid pressure = decrease coronary perfusion
113
Q

Pocket mask O2 % deliver

A

16%
(think: amount of O2 in rescuers exhale)

114
Q

Sizes and volumes of BVM devices

A

Infant: 150 - 280 mL
Child: 500 - 700 mL
Adult: 1,000 - 1,600 mL

115
Q

Best way to assess adequate ventilation for PPV

A
  • Gently chest rise and fall
116
Q

Rates for ventilation for apneic pts with a pulse

A
  • Adults - 1 breath every 6 sec
  • Infants/children - 1 breath every 2-3 sec
  • Newborns - 40-60 per min
117
Q

rates for ventilation in cardiac arrest

Fancy tip

A
  • Adults - 1-2 rescuer 30 compressions 2 breaths
  • Children - 1 rescuer 30 compressions 2 breaths
  • Children - 2 rescuer 15 compressions 2 breaths
  • Newborns - 3 compressions 1 breath

Fancy tip: No need to pause compressions for ventilation once an advanced airway has been placed

118
Q

CPAP

Contraindications

A
  • Hypotension
  • Can’t protect their own airway
  • vomitting
  • Not breathing spontaneously
  • Can’t follow commands
  • Upper GI bleeds
119
Q

BiPAP

Define

A
  • Bilevel Positive airway pressure
  • 1 level of pressure for the patients inhalation and 1 level of pressure for the exhilation
120
Q

FROPVD

A
  • Automatic and manual settings
  • Press button to initiate ventilation until chest rises
  • In a spontaneously breathing patient relief valve open automatically
121
Q

Pediatric considerations

Airway and ventilation

A
  • Bradycardia is hypoxia until proven otherwise
  • Hypoxia develops rapidly
  • Less oxygen reserves
  • Higher metabolic rates
  • Sniffing position for PPV
122
Q

Signs for respiratory fialure in pediatric pts

A
  • Bradycardia
  • Poor muscle tone
  • Decreased LOC
  • Headbobbing
  • Grunting on exhilation
  • Seesaw breathing
123
Q

Tracheostomy

A

Surgical opening at the beginning of the trachea for artificial access to the airway

124
Q

Trach tube/stoma considerations

A
  • Stoma = infant or ped mask for BVM
  • Trach tube = remove mask connect bvm directly to trach tube
  • Have suction ready for both - Use a french catheter
125
Q

FBAO

Whats it mean?

A

Foreign body airway obstruction

Good job! so smart

126
Q

FBAO indications

A
  • Inability to cough, speak, or breath
  • Clutching throat
  • Inability to ventilate pt despite repositioning airway
127
Q

Managing FBAO

A
  • Conscious = Abdominal thrusts unitl obstruction is releived or patient loses consciousness
  • Conscious infant = 5 back slaps, 5 chest thrusts until obstruction is releived or pt loses consciousness
  • Unconscious patient = Chest compressions, ventilations, inspect airway, remove if visible

EMT (42 decks)

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