NREMT questions Flashcards
When is nitroglycerin contraindicted and how many doses can a payient have?
Contradicted in patients with a systolic blood pressure below 100 mmHg, patients with head injury, patients who had taken erectile dysfunction medications and patients who taken the max dosage of 3
What 2 types of radiation are rays
Gamma radiation
X ray radiation
Hypothermia early signs and treatment
Early signs: confusion, shivering, tachypnea
Treatment: placing patient in dry environment and covering them in dry blankets. Warm fluids can also be given
Best way to lift patient lying on stretcher
- Bend at the knees
- Keep back in locked position
- Keep patient’s weight as close to the body as possible
- lifting with palms upwards
- Keep legs shoulder width apart
What antidote kits are used for nerve agents
Mark 1
Duodote
What antidote kits are used for nerve agents
Mark 1
Duodote
What antidote kits are used after exposure to cyanide
Pasadena and Cyanokit
What is Narcan used for?
Over the counter opiod overdose treatment
Signs and symptoms of shoulder dislocation
- Severe pain
- Flattened shoulder
- Guarding of affected limb by holding it towards the torso
- Numbness of the hand due to nerve damage
- Impaired range of motion
What is COPD characterized by? What is the signs and symptoms? What is the most common cause
- Characterized by degree of irreversible airway obstruction (emphysema), presence of significant inflammation (chronic bronchitis)
- Dyspnea, poor exercise tolerance, chronic coughing with and without sputum production, wheezing and respiratory failure
- Smoking is the most common cause of COPD
Special reporting situation
Definition: Special situation reports are used to document events that should be reported to local authorities or to amplify and supplement a primary report.
Examples: Mass casualty incidents, gunshot wounds, animal bites, specific infectious diseases, suspected physical and sexual abuse
How to treat a chest pain patient
- Place in position of comfort (Fowler or Semi-fowler position)
- Administer oxygen to keep SpO2 at 95-99%
- High priority patients require immediate transport
Standard of care
Acceptable practice of care for a given situation if someone of equal training was to face the same situation
Scope of practice
Defines what is legally permitted for some or all licensed individuals at that level
Duty to act
Responsibility to provide patient care
What is compensated shock and its signs and symptoms
Earlier stage of shock
Signs and symptoms: restlessness, anxiety, altered mental status, shortness of breath; cool,clammy, skin; narrowing pulse pressure; pallor/cyanosis; nausea and vomiting; rapid breathing
What are snoring respirations an indicator of?
A partially obstructed airway
What should be placed in red biohazard containers
Any medical waste, including contaminated disposable equipment or clothing, should be placed in a red biohazard bag and disposed of at the hospital.
How much blood can a patient lose from a
- Individual rib fracture
- Tibial fracture
- Femur fracture
- Pelvic fracture
- 100-200 mL
- 300-500 mL of blood
- 800 - 1000 mL
- 2000 mL
If the fractures are open, the figures are doubled
What is the proper way to do CPR
- The heel of one hand placed on the lower half of the sternum, with the other hand placed on the top
- Chest compressions should be done in cycles of 30
- Compressions should be at a depth of 2 to 2.4 inches
- rate of 100 to 120 per min
If an AMI is left untreated, what timeframe do 90% of myocardial cells die
Within 4 to 6 hours
What is the flow rate and maximum oxygen concentration that can be delivered via nasal cannula and nonrebreather
- The flow rate range of the nasal cannula is 1-6 liters per minute and delivers oxygen concentration between 24% and 44%
- The flow rate of the non-rebreather mask can supplement oxygen at 15 liters per minute and deliver oxygen up to 95%
Febrile seizure
Common in children between six months and six years of age
Characterized by generalized tonic-clonic seizure, do not last more than 15 minutes and have a short or absent postictal state, occur in children who experience a sudden spike in body temperature
Interventions: Assessment of ABCs, cooling measures, and rapid transport
What is Epilepsy? And what are its signs and symptoms
brain condition that causes recurring seizures.
Diagnosed if you’ve had at least two unprovoked seizures at least 24 hours apart
Symptoms
Temporary confusion.
A staring spell.
Stiff muscles.
Uncontrollable jerking movements of extremities
Loss of consciousness.
Psychological symptoms such as fear, anxiety, or deja vu.
Risk factors that increase likelihood of heat-related illnesses
fatigue, dehydration, viral infection, obesity, lack of sleep, poor physical fitness, use of drugs such as cocaine and amphetamines, athletes in good condition
Locations of 10 electrodes placed on the patient
V1 4th intercostal space to the right of the sternum
V2 4th intercostal space to the left of the sternum
V3 Midway between V2 and V4
V4 5th intercostal space at the midclavicular line
V5 Anterior axillary line at the same level as V4
V6 Midaxillary line at the same level as V4 and V5
RL Anywhere above the right ankle and below the torso
RA Anywhere between the right shoulder and the wrist
LL Anywhere above the left ankle and below the torso
LA Anywhere between the left shoulder and the wrist
What specific aspects of advanced life support do AEMTs have training in?
Intravenous therapy, and administrations of certain emergency medications
What is cardiogenic shock? Early signs? Signs and symptoms?
When heart lacks enough power to force the appropriate volume of blood throughout the body
Early signs: restlessness, anxiety, hypoperfusion
SIgns and symptoms: Dyspnea; cool,clammy skin; weak, thread pulse; tachycardia; rapid, shallow breathing; nausea/vomiting; hypertension
Emphysema
Type of COPD where the alveoli sacs are weakened and rupture due to smoking and limit the amount of oxygen that enters the blood stream causing mainly shortness of breath
- Adventitious breath sounds may be heard of lung auscultation
- Dyspnea, chronic coughing, chronic sputum, and long expiration phases are possible in patients with COPD
Definition of ischemia
Absence of oxygen delivery to body tissue, that is a result of partial or complete blockage of blood flow
What should be suspected in patients with significant mechanisms of injury such as motor vehicle crashes, falls of greater than 20 ft for adults, 10 ft for children, blunt trauma, diving accidents, et cetera
Head and spinal injuries
Head and spinal injuries signs and symptoms
altered level of consciousness, seizures, nausea, vomiting, decreased movement and numbness of extremities, unequal pupils, blood ore cerebrospinal fluid leaking from ears
Paraparesis
a partial paralysis or weakness in both lower extremities that can affect motor or sensory function.
Superficial (first-degree) burn
Involves only epidermis
Patient presents with erythema and pain at site without blistering
Superficial partial-thickness and deep partial thickness burns (second degree burns)
Two types of second degree burns
Superficial partial thickness: Involves epidermis and dermis resulting in thin-walled, fluid filled burns that appear pink, moist, soft and tender
Deep partial-thickness burns: Extend into reticular dermis, skin color is mixture of red and blanched white, capillary refill is slow
Full thickness burns
Burns are dry, dark brown, charred, and feel hard to the touch
If nerve endings are destroyed, sensation may be lacking
Pathologic conditions commonly found in asthma
Combination of bronchospasm, bronchial edema, and excessive mucus production.
How does abdominal distention happen
Can occur during assisted ventilation if airway is inappropriately positioned or if the patient is hyperventilate
Can be fixed by repositioning the head and watching for rise or fall of chest wall
How long should CPR be conducted between automated external defibrillator (AED) assessments of a patient’s cardiac rhythm?
2 minutes since the AED assesses patient rhythm every two minutes (five cycles) of CPR
What is the cause of angina pectoris
Lack of adequate oxygenation to the heart
What is an appropriate method to alleviate gastric distention in a patient when repositioning the head or ALS is not there to perform nasogastric decompression?
Roll patient to one side and apply pressure to the upper abdomen
What gases are released as a result of chemical suicide (mixing common household substances in an enclosed space)
Hydrogen sulfide and Hydrogen cyanide
Rule of 9s for children
18% for the head
18% for the chest
18% for the back
9% for each arm
13.5% for each leg
1% for genitalia
Characteristics of severe pediatric burn injuries
- partial-thickness burn > 10%
= any full-thickness burn - circumferential burns
- electrical, chemical, or inhalation injury
- burns of critical areas such as face, hands ,feet or joints
Compression to ventilation ratio for one person CPR on a pediatric patient
Compression to ventilation ratio for two-person CPR for infant patients
- 30:2
- 15:2
What position should patients in shock be put in? Pregnant? Chest pain or respiratory distress
- Supine
- Transported on their left side
- Fowler or semi-fowler
What is the Rule of Nines for adults
For an adult, the entire head is equal to 9% of the body’s surface area.
The front and back of each arm and hand equal 9% of the body’s surface area.
The anterior torso is equal to 18% (chest equals 9% and the abdomen equals 9%) of the body’s surface area.
The posterior torso is equal to 18% of the body surface area.
The front and back of each leg equal 18% of the body’s surface area.
The genitalia equal 1% of the body’s surface area.
What are the results of hypoventilation
Hypoxia, minute volume reduction, and hypercarbia (high carbon dioxide)
What is the narrowest portion of a child’s upper airway
In children younger than eight years old, the narrowest part of the airway is the cricoid ring.
What are the target SpO2 levels of ACS, a stroke and post-cardiac-arrest care
ACS: 90%
stroke: 95% to 98%
post–cardiac-arrest care: 92% to 98%
Give descriptions of Type I, Type II, and Type III ambulances
A Type I ambulance is a conventional truck-cab chassis separated from the patient compartment.
A Type II ambulance is a standard van chassis that is all one piece.
A Type III ambulance is a van chassis separated from the patient compartment.
How often should vital signs be assessed for a patient who requires airway management?
Every 5 min
What are common causes of seizures in adults
Epilepsy, tumors, infections, a head injury or scar tissue from a previous head injury, stroke, hypoxia, hypoglycemia, poisoning, drug overdose or withdrawal, or fever.
What happens after the baby’s head is delivered and what should be done
After the baby’s head is delivered, it will rotate to one side on its own. At the next contraction, the upper shoulder should be visible. Guide the head down slightly by applying gentle downward traction to help the upper shoulder deliver. Support the head and upper body as the shoulders deliver. Upward guidance of the head may be required to help deliver the lower shoulder.
What should you do to slow the bleeding after the placenta has been delivered
Massage the uterus
What is the most appropriate treatment for a patient with respiratory failure?
Assisted ventilation
What is obstructive shock and what could be the main reasons for it?
Obstructive shock is the mechanical obstruction of the cardiac muscle, causing a decrease in output.
Three common reasons for obstructive shock are tension pneumothorax, cardiac tamponade, and pulmonary embolism.
What is neurogenic shock and its causes
Neurogenic shock occurs when the nervous system that controls cardiac contraction/relaxation is damaged.
Commonly due to damage to the upper cervical levels of the spine
What happens in a tension pneumothorax
Air buildup in the pleural space applies pressure to organs in the mediastinum (i.e., heart and great vessels).
What happens in cardiac tamponade?
The pericardium fills with blood and prevents ventricles from filling
Signs and symptoms: Beck’s Triad (JVD, narrow pulse pressures, muffled heart tones)
What are altitude sicknesses
AMS
HACE
HAPE
Why are pelvic fractures life-threatening and how would you manage it.
Life-threatening due to a significant amount of blood loss
It can be managed by
- Stabilizing the pelvis with a pelvic binder (if protocols allow) or
- Tying a sheet around the pelvis
- Securing a long device such as a scoop stretcher or long spine board to prevent further injury during transport
- treating for shock,
- rapidly transporting to a trauma center
What do the two subcategories of hallucinogens, classic hallucinogens and dissociative drugs do?
What drugs are part of those subcategories?
Classic hallucinogens typically produce visual and auditory hallucinations and may result in an altered sense of time and heightened sensory experiences.
Classic hallucinogens: include LSD, psilocybin (mushrooms), peyote, and DMT.
Dissociative drugs produce feelings of detachment, such as derealization (the feeling that one is detached from reality or that things are not real) and depersonalization (the feeling of being detached from one’s physical body).
Dissociative drugs: PCP and ketamine
What patients do not require spinal motion restriction
- a normal level of consciousness (Glasgow Coma Score 15)
- no spine tenderness or anatomic abnormality
- no neurologic findings or complaints
- no distracting injury
- no intoxication
What are the three components of Cushing’s Trial
Changes in respiration
Bradycardia
Widening pulse pressure
What is Gastrointestinal (GI) bleeding and what are its signs and symptoms
Can occur in the upper GI tract (from the esophagus to the upper small intestine) or the lower GI tract (from the upper small intestine to the anus).
Signs and symptoms: Vomiting bright red blood or coffee-ground material, and Melena (dark tarry stool)
What is appendicitis and its signs and symptoms?
Inflammation of the appendix
Signs and symptoms: Right lower quadrant pain and rebound tenderness are common. Nausea and vomiting are likely
What position should patients who are hypotensive or have shock be placed in?
Supine position
What are sympathomimetic drugs and what are some examples?
Sympathomimetics are central nervous system stimulants that mimic the effects of the sympathetic (fight or flight) nervous system.
Examples include cocaine, MDMA (ecstasy), methamphetamine, and caffeine.
Parasympathetic nervous system
is part of the autonomic nervous system and generally slows the body down (“rest and digest”).
If stimulated, the parasympathetic nervous system will cause bradycardia and a decreased force of heart contraction.
What is a thromboembolism
a portion of a blood clot that breaks from its original position and occludes a smaller vein or artery.
What is pancreatitis? Causes? Signs and symptoms?
Definition: the swelling (inflammation) of the pancreas.
Causes: An obstructing gallstone, alcohol abuse, and other diseases
Signs and symptoms:
1. abdominal pain that worsens after eating
2. severe pain in the upper right or left abdominal quadrant that radiates to the back
3. nausea and vomiting
4. abdominal tenderness
What treatments should be indicated for adults with pulmonary edema
Nitroglycerin and CPAP
Carbon monoxide poisoning
- Carbon monoxide is a colorless, odorless, tasteless and highly poisonous gas
- Leading cause of accidental poisoning death in the US
- Happens during cold months where heaters may be on
- Presents with flu like signs and symptoms: restlessness, irritability, anxiety that can progress to altered mental status; a weak, thready pulse; cyanosis; dyspnea in conscious patients; and an inability to speak in complete sentences.
What does amniotic fluid with a greenish color indicate?
Presence of meconium (fetal stool) may happen after water is broken
What are common causes of seizures?
epilepsy, tumors, infections, a head injury or scar tissue from a previous head injury, stroke, hypoxia, hypoglycemia, poisoning, drug overdose or withdrawal, or fever.
What is aspirin? What is it used for? What are the contraindications?
- Aspirin acts as an antipyretic (fever reducer), analgesic (pain reducer), anti-inflammatory agent (inflammation reducer), and platelet-aggregation inhibitor (prevents clots from forming or growing in size).
- Used after AMI to prevent future AMIs
- Contraindications to aspirin include allergy to aspirin (absolute), preexisting liver damage (absolute), bleeding disorders (relative), and asthma (relative).
What are the components of APGAR score
appearance, pulse, grimace, activity, and respiration
In what situation can the AED cannot properly analyze a patient’s cardiac rhythm?
It cannot while a vehicle is in motion
What is diabetic ketoacidosis and its signs and symptoms?
Definition: a serious and potentially life-threatening complication of diabetes that occurs when the body doesn’t have enough insulin to allow blood sugar into cells for energy
Signs and symptoms:
- blood glucose levels above 400 mg/dL
- rapid, deep respirations (Kussmaul respirations)
- fruity breath odor
- intense thirst
- warm, dry skin
- abdominal pain
What treatment is indicated for nontraumatic vaginal bleeding
Place a sanitary pad to absorb the blood
What does an opioid overdose present with?
sedation/unconsciousness, bradypnea, cyanosis, and pinpoint pupils.
Spina bifida
birth condition caused by the incomplete closure of the spinal column during fetal development, exposing part of the spinal cord.
Often, patients with spina bifida have partial or full paralysis, incontinence, and an extreme allergy to latex products.
Range of respiration for
Infant (0 to 12 months)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School-aged (6 to 11 years)
Adolescent (12 to 15 years)
Ages >15 years
Infant (0 to 12 months): 30 to 60 breaths per minute
Toddler (1 to 3 years): 22 to 37 breaths per minute
Preschooler (3 to 5 years): 20 to 28 breaths per minute
School-aged (6 to 11 years): 18 to 25 breaths per minute
Adolescent (12 to 15 years): 12 to 20 breaths per minute
Ages >15 years: 12 to 20 breaths per minute
What is croup?
An infection of the upper airway, which becomes narrow, making it harder to breathe
Signs and symptoms: presents with loud, barking cough, and stridor.
It is seen in children ages 2-6 and follows an upper respiratory tract infection
Crush syndrome
Can develop when an area of the body is trapped for longer than four hours and arterial blood flow is compromised
Primary blast injuries
Occur due to the pressure wave caused by the explosion. Common injuries are ruptured tympanic membrane, lung injury, and injury to hollow organs.
Secondary blast injuries
result from being struck by the flying debris scattered from the explosion as projectiles.
Tertiary blast injuries
result from the patient’s body being displaced against stationary objects, such as trees, buildings, or the ground
Quaternary blast injuries
are any other injury that occurs secondary to a blast injury.
What are three serious consequences of an AMI
Sudden death
Cardiogenic shock
Congestive heart failure
How are penetrating injuries treated?
By applying an occlusive dressing to ensure air does not enter
What are the four factors that must be proven to determine negligence
Duty
Breach of duty
Damages
Causation
What is chronic bronchitis and its signs and symptoms
Chronic bronchitis: Long term inflammation of the bronchial tubes
Chronic sputum-producing cough
Wheezing
Cyanosis
Tachypnea
Emphysema signs and symptoms
Emphysema: Alveolar damage
Barrel chest
Pursed lip breathing
Dyspnea
Cyanosis
Wheezing/decreased breath sounds
Mostly seen in older patients
Flushed skin on the nose and mouth
Wheezing
A high-pitched whistling or purring sound that occurs when air moves through narrowed airways in the lungs, usually heard upon exhalation
Occurs in asthma and bronchiolitis because of swelling of bronchioles and bronchospasms
Preclampsia
Serious pregnancy condition that occurs after 20th week of pregnancy.
Characterized by hypertension, protein in urine and severe swelling in hands and feet, and headaches
Left-sided heart failure and signs and symptoms
Lungs become congested in fluid because the left side of the heart fails to pump blood effectively
Signs and symptoms: wet lung sounds, pink frothy sputum, and severe dyspnea
Eclampsia
a life-threatening pregnancy-related emergency that occurs when a pregnant person with preeclampsia develops seizures or coma:
JumpSTART triage system
The JumpSTART triage system was designed specifically for pediatric patients involved in a mass-casualty incident.
The first step is to check the child for breathing. If not breathing, check a pulse; if a child has no pulse, tag them as expectant. If they have a pulse, open the airway. If the patient remains apneic, provide five rescue breaths.
The second step is to assess the rate of respiration. If the patient is breathing less than 15 breaths/min or more than 45 breaths/min, tag the patient as a priority. If the patient is breathing between 15-45 breaths/min, move to step 3.
The third step is to check neurological status. Depending on the results, a modified AVPU is assessed, and then the patient is tagged as a priority or delayed priority.
BVMs are never advised
Right-sided heart failure
Blood backs up in vena cava, resulting in pedal edema or JVD
What does putting a patient in recovery position do?
It will keep their airway clear and open, and ensures any obstruction will not cause them to choke
What is a common chest pain description associated with AMI
Crushing, squeezing chest pain unrelieved by nitroglycerin
What are the organizational sections of the Incident Command Center and what does it ensure
Operations
Planning
Logistics
Finance
Ensures responder and public safety, achieves incident management goals, and efficiently uses resources.
Ventricular tachycardia and signs and symptoms
A rapid heart arrhythmia in which the electrical impulse begins in the ventricle (instead of the atria). This may result in inadequate blood flow and eventually deteriorate into cardiac arrest.
Signs and symptoms: Lightheaded, chest pain, palpitations
Palpitation
a skipped, extra or irregular heartbeat
occurs when an electrical signal fires from the wrong place at the wrong time, causing the heart to beat out of rhythm.
Advance directive orders
Written document detailing, the accepted medical treatment for a competent patient, should they be unable to make their own decisions
What are the conditions that must be met for a DNR to be valid
- Must contain the signature of the patient or the legal guardian
- the signature of a physician or a licensed health care provider
- a clear and concise statement of the patient’s medical problem(s),
Chyne-Stokes respirations
Characterized by pattern of breathing that involves gradual increase in depth, followed by gradual decrease, then a temporary stop in breathing (apnea), cycle repeats
Often seen in patients with heart failure, stroke, and traumatic brain injuries
What are the signs of the Cushing triad
Hypertension, bradycardia, and irregular respirations
Biot’s Respiration (ataxic breathing)
Irregular breathing pattern characterized by groups of quick shallow breaths, followed by irregular periods of apnea. Does not follow a cycle
Often caused by strokes, trauma, opioid use, or increased intracranial pressure
Kussmaul’s respirations
Characterized by deep, rapid respirations commoinly seen in patients with metabolic acidosis
Metabolic acidosis
Life-threatening condition that occurs when there is too much acid in the body’s blood.
Happens when the body produces too much acid or cannot get rid of enough
Agonal respirations
Occasional gasping breaths that occur when the respiratory center in the brain continues sending signals to the respiratory muscles
What is the effect of vagus nerve stimulation in infants and small children
Aggressive suctioning can stimulate it and cause bradycardia
Syncope
Temporary fainting episode
Supine hypotensive syndrome
A condition in pregnant women in which there is compression of the inferior vena cava by the pregnant uterus when the patient lies supine.
This ultimately results in hypotension as the amount of blood being returned to the heart is reduced
Supraventricular tachycardia
Heart dysrhythmia with rate above 150 bpm
How deep should you insert the suction device when suctioning the tracheostomy tube
No more than 1 to 2 inches deep
What is the most dependable indicator of shock that an EMT can assess?
Mean Arterial Pressure as it is = (heart rate x stroke volume) x systemic vascular resistance
Grunting
uh sound heart during ventilation.
Indicates inadequate oxygenation, such as in pneumonia
Pneumonia
an infection that inflames the air sacs in one or both lungs.
Signs and symptoms:
Cough with phlegm or pus
Fever
Difficulty breathing
Chest pain
Chills
Productive cough
Rhonchi
Caused by bacteria, viruses or fungi
Stridor
an abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway
Indicates significant upper airway obstruction and is prominent during inspiration phase
Often heard in
croup
epiglottis
foreign airway aspirations
Rhonchi
loud, low-pitched, continuous lung sounds that can sound like snoring or gurgling
Caused by constricted or rough airflow in the airways. Sounds occurs during expiration or both inspiration and expiration
How do you measure the rigid-tip suction catheter
From the corner of the mouth to the earlobe or angle of the jaw
What is the primary function of plasma
Transports carbon dioxide
Aortic aneurysm
A life-threatening condition that occurs when the layers of the aorta, the body’s main artery, separate
Includes very sudden chest pain
Most often described as stabbing, or tearing.
What are methods of transmission that diseases can spread
Contact (direct or indirect)
Aerosolized (in droplets)
Foodborne
Vector-borne (through insects and parasitic worms)
Capillary refill
Evaluated to assess for circulation or perfusion in pediatric patient
A decreased capillary refill can indicate shock in a pediatric patient
Diverticulitis
inflammation of irregular bulging pouches in the wall of the large intestine.
Signs and symptoms: Lower, left-sided abdominal pain, fever and malaise
What is the cushion of safety
This is referred to as safe distance between emergency vehicle and vehicle driving in front of it.
Defined as driving 4 to 5 seconds behind vehicle traveling at the same speed.
Decompensated shock and signs and symptoms
a late phase of shock that occurs when the body’s compensatory mechanisms can’t maintain adequate blood flow to vital organs and the brain.
Also occurs when blood volume is decreased by more than 30%
Signs and symptoms
- systolic blood pressure below 90 mmHg
- declining mental status
- labored or irregular bleeding
- ashen, mottled, cyanotic skin
- thready or absent peripheral pulses
- dull eyes; dilated pupils
- poor urinary output
How are severe adult burns classified?
- Full-thickness burns involving the hands, feet, face, genitalia, airway, or circumferential burns
- Full-thickness burns covering more than 5% of total body surface area (TBSA) in any patient
- Partial-thickness burns covering more than 20% TBSA (aged 10-50) and 10% TBSA (aged <10 and >50)
Burns with concomitant traumatic injuries - Burns to patients younger than 5 or older than 50 years who would otherwise be classified as moderate
How are moderate burns of adults classified
- Full-thickness burns involving 2%-10% TBSA (excluding hand, feet, face, genitalia, and upper airway)
- Partial-thickness burns covering 15-30% TBSA
- Superficial burns covering more than 50% TBSA
Minor burns
- Full-thickness burns covering <2% TBSA
- Partial-thickness burns covering <15% TBSA
- Superficial burns covering <50% TBSA
Cardiac tamponade
When fluid or blood builds up in the heart’s outer covering, the pericardium and compresses the heart
Signs and symptoms Beck’s Triad: JVD, muffled heart sounds, and narrowing pulse pressure
Distributive shock
This happens when there is widespread dilation of the small arterioles, small venules, or both, resulting in circulating blood volume in an expanded vascular bed and decreased tissue perfusion
Septic shock, neurogenic shock, and anaphylactic shock are types of distributive shock
What does parasympathetic nervous system do
Slows heart and respiratory rate, cause vasoconstriction and dilates blood vessels in the digestive system
Hypoxia and early, late signs
Low levels of oxygen in your body tissues
Early signs of hypoxia are: anxiety, tachycardia, and irritability
Late signs of hypoxia are: changes in mental status, a weak, thready pulse and cyanosis
Tension pneumothorax
LIfe threatening condition where air builds up in the pleural space between the lungs and chest wall, increasing pressure on the chest and compressing the heart.
Occurs with blunt force trauma to the chest
SIgns and symptoms: Characterized the most by decreased or dimished lung signs on affected side
Other signs and symptoms: Difficulty breathing, tachycardia, diminished or absent lung sounds on the affected side, and possible signs of shock
Flail chest
Occurs when two or more ribs are fractured in two or more places
- Characterized by paradoxical motion (abnormal movement of flail segment of chest during breathing, moving in the opposite direction of the chest wall during inspiration and expiration)
- Can also lead to respiratory failure due to inability to breath properly
Hemophilia
Blood disorder that decreases ability of clotting factors after an injury
Cause people to bleed for longer after injuries, bruise easily
What is the effect of sickle cell disease
The blood disorder that causes red blood cells to distort into a sickle shape can cause them to clot and obstruct blood flow, causing ischemic injury
This is termed a vasoocclusive crisis
CHF exacerbation
a temporary worsening of symptoms of heart failure
Tuberculosis (TB)
an infectious disease that most often affects the lungs and is caused by bacteria.
Spread through the air when infected people cough or sneeze
What are commonly prescribed asthma medications
- Albuterol
- Atrovent
- Budesonide
- beclomethasone
- fluticasone
- ipratropium
- levalbuterol
- montelukast
- salmeterol
What is acute coronary syndrome and the conditions associated with it?
Term used to describe group of symptoms caused by myocardial ischemia (decrease in blood flow to the heart)
Conditions associated with it
- Stable angina
- Unstable angina
- AMI
Pericardial effusion
Collection of fluid between pericardial sac and myocardium that can lead to cardiac tamponade
What are vesicant agents and three types
Cause blister that appear like burns on victim’s skin or respiratory tract
- Sulfur mustard
- Lewisite
- Phosgene
What are the four types of skull fractures
Linear, Depressed, Open, Basilar
Linear skull fractures are non-displaced fractures. They are the most common type of skull fracture.
Depressed skull fractures involve the bones of the skull being pushed into the brain.
An open skull fracture is a skull fracture that occurs when a fractured bone emerges through the skin.
A basilar skull fracture involves a break in at least one of the bones at the base of the skull.
What is considered the primary pacemaker of the heart
SA node in the upper part of the right atrium
What is the process of impulses in the pacemakers of the heart that triggers the hearts contractions
- Normal impulses begin in sinus node in the uper part of right atrium
- The electrical impulses from the SA node travels to the AV node between atria and the ventricles
- From AV node the electrical impulse travels through both ventricles via Bundle of HI
- Then travels through right and left bundle branches and Purkinje fibers before causing the muscle cells of ventricles to contract
What is internal respiration?
the exchange of oxygen and carbon dioxide between the cells of the body an systemic circulation
Systemic circulation
a pathway in the human body that carries oxygenated blood from the heart to the body’s tissues and organs, and then returns deoxygenated blood to the heart
What is the first sign of heatstroke and its signs and symptoms
First sign is confusion
Can quickly lead to unresponsiveness, bradycardia, hypotension and increased respiratory rate
What are the three causes of obstructive shock
Cardiac tamponade, tension pneumothorax and pulmonary embolism
Placenta previa
Pregnancy complication where the placenta covers the cervix
Characterized by painless moderate to severe bleeding
Abruptio placentae
When the placenta separates from the uterus wall and causes painful moderate to severe bleeding
What are all the endocrine glands that release hormones directly into the blood stream
- Adrenal
- Ovaries
- Pancreas
- Parathyroid
- Pituitary
- Testes
- Thyroid
Atherosclerosis
Disorder in which calcium and a fatty material called cholesterol build up and form a plaque inside the walls of blood vessels, obstructing flow and interfering with their ability to dilate or contract.
Arteriosclerosis
describes the hardening of the arteries and can reduce perfusion of the tissues.
Thromboembolism
is a blood clot that floats through blood vessels until it reaches an area too narrow for it to pass, causing it to stop and block the blood flow at that point.
What does a sudden rush of clear fluid from a pregnant women’s vagina indicate
The rupture of the amniotic sac (water breaking)
What is the maximum amount of time a patient should be suctioned
10 seconds
What is the proper way and location for performing abdominal thrusts on a child?
- Kneeling behind the child, wrap your arms around the child’s body.
- Make a fist and place your thumb just above the umbilicus, well below the lower tip of the sternum.
- The opposite hand is placed over the fist, and thrusts are performed in an inward and upward direction.
What is hepatitis A, B, and C and what are the differences
They are viral liver infections that can cause inflammation of the liver
Hepatitis A is highly infectious disease that can spread through food, drinks, and sex practices. It is an acute disease that can get better without treatment and there is a vaccine to prevent it.
Hepatitis B: Exposure to infected blood, semen, or other body fluids, even in microscopic amounts. It can also be passed from mother to baby during childbirth. Hepatitis B can cause a chronic infection that can lead to chronic liver disease. There is a vaccine to prevent it, but treatment may need to be taken for the rest of a person’s life
Hepatitis C: spread through exposure to infected blood, even in microscopic amounts. This can happen through sharing needles or other items used to inject drugs, or getting a tattoo or body piercing with an infected needle. Can cause chronic infection leading to liver damage. It is also curable with antiviral treatments.
What interventions should be considered for patients with ischemic-type chest discomfort?
- If oxygen saturation is below 90%, start oxygen at 4 L/min and titrate
- Give aspirin 162 to 325 mg
- Administer nitroglycerin
Common causes of altered mental status
AEIOU-TIPS
AEIOU-TIPS
A: Alcohol
E: epilepsy, endocrine disorders, electrolyte imbalance
I: insulin (i.e., hypoglycemia)
O: opiates and other drugs
U: uremia (kidney failure)
T: trauma (particularly head trauma), temperature (hypothermia/hyperthermia)
I: infection
P: poisoning, psychogenic causes
S: shock, stroke, seizure, syncope, space-occupying lesions, subarachnoid hemorrhage
What is hemodialysis and its complications
Treatment that filters a person’s blood when their kidneys are no longer able to do so.
Complications:
Hypotension
Electrolyte imbalance,
muscle cramps
Altered mental status,
Infection
Bleeding from the access site
What are the signs of a lacerated liver
Abdominal pain with referred pain to the right shoulder, right side pain, distended abdomen
What is Cholecystitis? Signs and symptoms?
Inflammation of gallbladder
Signs and symptoms
upper-right-quadrant abdominal pain (especially after eating fatty foods)
referred pain to the right shoulder
nausea
vomiting
fever
jaundice
loose, light-colored bowel movements
What are the signs of respiratory distress or failure?
Common signs and symptoms of respiratory distress include agitation, anxiety, or restlessness; stridor; wheezing; retractions; tachypnea; mild tachycardia; nasal flaring; seesaw breathing; or head bobbing.
Treatment: Assisted ventilation
What are common erectile dysfunction medications?
Viagra/sildenafil
Cialis/tadalafil
Levitra/vardenafil
What is a costovertebral angle?
the area between the ribs and the spine
What is passive rewarming and when should it be used
Passive rewarming is an appropriate first step when dealing with a patient who has mild hypothermia, like the patient in this scenario.
Passive rewarming includes placing the patient in a warm environment (e.g., the patient compartment with the heat on); removing wet clothing; applying heat packs/hot water bottles to the groin, axillary, and cervical regions; placing dry blankets over and under the patient; and giving warm, humidified oxygen.
What is active rewarming and when should it be used?
Active rewarming is used for patients with severe hypothermia and is performed by ALS providers with constant temperature monitoring.
What is the Glasgow Coma Scale (GCS) and the parameters it measures
The GCS is an evaluation tool used to assess a patient’s level of consciousness
Parameters
Eye-opening scoring
Verbal response scoring
Motor response scoring
What are indications for CPAP
- an alert patient displaying moderate to severe respiratory distress from underlying pathology such as COPD, pulmonary edema or pneumonia
- respiratory distress after a submersion incident
- pulse oximetry below 90% despite supplemental oxygen
- rapid breathing that affects minute volume
What is the RICE mnemonic and its components
rest, ice, compression, elevation
four steps you can take at home to treat minor soft tissue injuries:
What are considered presumptive signs of death?
- Profound cyanosis
- Unresponsive to painful stimuli
- Absence of chest rise and fall
How long do you spend checking a patient’s pulse
10 seconds
What two fundamental categories are seizures classified into?
A generalized (tonic-clonic) seizure
A partial (focal) seizure
generalized (tonic-clonic) seizure
Results from abnormal electrical discharges from large areas in the brain, usually involving both hemispheres.
Signs and symptoms: unconsciousness and severe, generalized twitching of the muscles that lasts several minutes or longer.
partial (focal) seizure
Begins in one part of the brain. Partial seizures are classified as simple or complex.
In a simple partial seizure, there is no change in the level of consciousness.
Signs and symptoms: weakness, dizziness, numbness, visual changes, and unusual smells or tastes.
A complex partial seizure will exhibit changes in mental status and unusual interaction with the patient and their environment. It results from abnormal discharges from the brain’s temporal lobe.
Signs and symptoms: eye blinking, lip-smacking, and isolated jerking and twitching movements in one part of the body.
What is the GEMS diamond acronym and what makes up the diamond?
The GEMS diamond was created to help EMTs remember what is different about older patients.
G: Geriatric patients
E: Environmental conditions
M: Medical assessment
S: Social assessment
What is the medical term for hives
The medical term for hives is urticaria, defined as small areas of generalized itching and burning that appear as multiple raised areas on the skin.
Urticaria
Defined as small areas of generalized itching and burning that appear as multiple raised areas on the skin.
When a person is stung by a bee, histamines are released into the body. When released, histamines leak tiny blood vessels under the skin, resulting in hives. Urticaria can develop near the site of the sting or centrally on the body. If the patient is allergic to the bee sting, anaphylaxis may occur.
Anarthria
A severe form of motor speech disorder that occurs when a person cannot coordinate the muscles used for speaking.
Hematuria
Blood in the urine
What is the recommended time frame from the time the patient received the trauma to the time of reimplantation for an avulsed tooth
20-60 minutes after the injury has occurred
What is the medical term for someone who was born with unequal pupils?
Anisocoria
What are considered intrinsic factors that cause challenges with maintaining an open airway?
Allergic reactions
Airway obstruction from tounge
Swollen tissue from infection
Cataracts
Defined as the clouding of the lenses of the eye, which develops slowly over time. Cataracts typically affect adults over the age of 50, but they have been known to affect younger adults and children.
Glaucoma
Disease of the eye that damages the optic nerve. It generally happens when fluid builds up in the front part of the eye, which increases the pressure in the eye and damages the optic nerve.
Astigmatism
Where the lens inside the eye or the front surface of the eye is curved differently in one direction than the other. Patients who have astigmatism often complain of distorted or blurred vision.
What symptoms would you expect to find in a newborn with fetal alcohol syndrome?
Prematurity, low birth weight, and severe respiratory depression
What are the two main types of traumatic brain injury?
A primary brain injury is an injury to the brain and its structures associated with the brain that is a result of an impact to the head.
A secondary brain injury refers to the processes that increase the severity of the primary injury and negatively impact the outcome. The two most common causes of secondary injury are hypotension and hypoxia.
What causes migraines?
Changes in blood vessel size at the base of the brain
What kind of organs are most susceptible to damage from pressure changes?
Organs that are hollow and contain air such as the lungs, middle ear, and GI tract
What guidelines does the National Highway Traffic Safety Administration (NHTSA) provide for emergency medical services (EMS)?
Guidelines for EMS educational standards
What are three examples of an advance directive
Do not resuscitate
Living will
Durable power of attorney
Ischemic stroke
Occurs when the blood flow through the cerebral arteries is blocked.
Accounts for 80% of all strokes and is the most common.
Blood clots inside a vessel in the brain block blood flow to a particular part of the brain, resulting in an ischemic stroke.
Hemorrhagic stroke
Occurs when a blood vessel ruptures and causes increased pressure in the brain from the accumulated blood. When the blood vessels rupture, the accumulated blood forms a blood clot, which compresses the brain tissue next to it.
When the tissue is compressed, oxygenated blood cannot enter the area, and the brain’s cells start dying. Cerebral hemorrhages are often fatal to the patient.
How do you select the proper size of an oropharyngeal airway?
Measure from the patient’s earlobe or angle of the jaw to the corner of their mouth.
What does a patient have when they have suffered a traumatic head injury and can remember everything except for the events leading up the the injury?
Retrograde amnesia
Transient ischemic attack (TIA)
a brain disorder where cells stop functioning temporarily due to ischemia, or insufficient oxygen. The symptoms of a TIA usually resolve within 24 hours and are not typically caused by a blow to the head.
What does blue gel under the defib pads indicate
The device has already delivered at least one shock
What is the STOP mnemonic for? What four events make up the mnemonic STOP?
Working as an EMT, you must continue CPR once you start until one of four events occurs.
- Starts
- Transferred
- Out of strength
- Physician
Almost one-third of people who are killed immediately in a vehicle accident die from what type of chest injury?
Traumatic rupture of aorta
When palpating the abdomen, where do you expect the patient to have the most pain if he is experiencing pancreatitis?
The upper right and left quadrants due to the pancreas
What drug is commonly known as liquid ecstasy?
Gamma-hydroxybutyric acid (GHB)
Sedative and has anesthetic effects like alcohol and causes drowsiness, euphoria, and relaxation and reduces people’s inhibitions.
What is rigor mortis?
The stiffening of the body’s muscles after death
Occurs between 2 and 12 hours after death.
How would you treat the patient’s epistaxis (nosebleed)?
Have the patient lean forward while sitting
Apply direct pressure, pinching the fleshy part of the nostrils together
Apply an ice pack to the nose
Peritonitis
Inflammation of the peritoneum. When foreign material such as pus, blood, pancreatic juice, or bile enters the abdominal space, the peritoneum becomes irritated and inflamed.
Signs and symptoms: Abdominal distention, nausea, vomiting, and a loss of appetite.
What is the normal blood glucose levels?
80-120 mg/dl
What is the normal blood glucose levels?
80-120 mg/dl
What are 3 reasons to use endotracheal intubation?
Protects airway from aspiration
Provides route for medication
Makes ventilation for patient easier
What are Type 1 diabetes mellitus and its signs and symptoms?
an autoimmune disorder in which antibodies are created against pancreatic beta cells. Insulin is subsequently inadequate or absent in these patients.
Signs and symptoms: polyuria (increased urination), polydipsia (increased fluid intake due to thirst), polyphagia (increased food intake due to hunger), fatigue, and weight loss.
What are all supraglottic airway devices that are available for EMS use?
i-Gel, King LT, CobraPLA, and laryngeal mask airway (LMA)
What are signs of increased intracranial pressure?
- headache
- altered mental status (lethargy, obtundation, nonreactive pupils)
- bradycardia,
- nausea, vomiting,
- changes in respiration (Cheyne-Stokes, ataxic rhythms).
What are nerve agents that cause the immediate onset of symptoms after exposure?
Tabun, Sarin, and VX
What is the maximum tidal volume of a reservoir bag on an adult bag-valve mask? pediatric? infant?
In a reservoir bag, the total volume is typically 1600 mL for an adult Bag-Valve Mask (BVM), 500 mL for a pediatric bag, and 240 mL for an infant bag.
What is the cricoid cartilage and where is it located anatomically
It is a firm ring located inferior to (below) the thyroid cartilage at the lowest portion of the larynx.
What are the potential signs of airway obstruction?
Potential signs of airway obstruction in an unconscious adult patient include noisy breathing (e.g., snoring, bubbling, gurgling, crowing, or stridor), extremely shallow breathing, and apnea.
What are some examples of opioids
Heroin, fentanyl, and oxycodone
What is a contraindication to CPAP
Apnea is a contraindication to CPAP administration, as the patient must be breathing and able to support their airway for it to be effective.
What are some common SSRIs used as antidepressants
fluoxetine (Prozac)
paroxetine (Paxil)
citalopram (Celexa)
sertraline (Zoloft)
What are the primary differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
In HHS blood glucose levels are higher, and ketones are typically absent.
More common in individuals with type II diabetes
DKA: Blood glucose levels are lower, and ketones are typically present. More common in individuals with type I diabetes
What are the primary differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)
In HHS blood glucose levels are higher, and ketones are typically absent.
More common in individuals with type II diabetes
DKA: Blood glucose levels are lower, and ketones are typically present. More common in individuals with type I diabetes
Hyperosmolar Hypoglycemic State (HHS)
Hyperosmolar hyperglycemic state (HHS) is a life-threatening complication of diabetes — mainly Type 2 diabetes. HHS happens when your blood glucose (sugar) levels are too high for a long period, leading to severe dehydration and confusion.
