nremt_exam_20230205144429 Flashcards
National Highway Traffic Safety Administration (NHTSA)
The lead agency for coordinating and promoting evidence-based emergency medical services (EMS) and the 911 system.
Public Safety Answering Point (PSAP)
The designated call-receiving site that directs high-priority calls to the apporpriate emergency services.
Hand-Off Procedure
- S = Situation (Overview of Present Issue)* B = Background (Patient History)* A = Assessment (Pertinent Findings)* R = Recommendations (Actions Needed)
CBNRE Agents| Terrorism
- C = Chemical* B = Biological* N = Nuclear* R = Radiological* E = Explosive## FootnoteThe CNBRE agents are technologic hazardous agents (i.e. “weapons of mass destruction”) that are intended to cause widespread harm and/or fear amongst a population.
TRACEM-P Harms| Exposure
- T = Thermal* R = Radiological* A = Asphyxiation* C = Chemical* E = Etiological* M = Mechanical* P = Psychological## FootnoteThe TRACEM-P harms are types of hazards that EMS personnel may be exposed to (during terrorist incidents).
SLUDGEM| Nerve Agents
- S = Salivation (Stimulation of Salivary Glands)* L = Lacrimation (Stimulation of Lacrimal Glands)* U = Urination (Relaxation of Internal Sphincter of Urethra)* D = Defacation (Relaxation of Anal Sphincter)* G = Gastrointestinal Upset (Changes to GI Muscle Tone)* E = Emesis (GI System Effects)* M = Miosis (Contraction of Pupil)## FootnoteSLUDGEM is a mnemonic that refers to the common signs/symptoms of nerve agent poisioning.
Maximum Visibility of Emergency Vehicles| Night Operations
- On: Red Warning Lights* Off: Headlights* Off: Fog Lights* Operating: Traffic Directional Boards
NFPA 704 Placard| HAZMAT
- Blue = Health Hazard* Red = Fire Hazard* Yellow = Reactivity* White = Specific Hazard## FootnoteNFPA = National Fire Protection Assocation
Triage| Mass Casualty Incidents (MCI)
- Priority 1 (Red): Treatable Life-Threatening Illnesses/Injuries* Priority 2 (Yellow): Serious, Non-Fatal lllnesses/Injuries* Priority 3 (Green): “Walking Wounded”* Priority 4/0 (Black): Dead or Fatally Injured
Priority 1 (Red)| Triage
- Airway/Breathing Difficulties* Uncontrolled/Severe Bleeding* Decreased/Altered Mental Status* Severe Medical Problems* Shock (Hypoperfusion)* Severe Burns## FootnotePriority 1 = In Critical Condition
Priority 2 (Yellow)| Triage
- Burns w/o Airway Difficulties* Major/Multiple Bone or Joint Injuries* Back Injuries w/ or w/o Spinal Cord Damage## FootnotePriority 2 = In Need of Ambulance Support
Priority 3| Triage
Patients with minor musculoskeletal injuries or minor soft-tissue injuries.## FootnotePriority 3 = Likely NOT in Need of Ambulance Support
Priority 4/0| Triage
- Exposed Brain Matter* Cardiac Arrest (for >20 Minutes)* Decapitation* Severed Trunk* Incineration## FootnotePriority 4/0 = Too Late to Save
START| Triage
- R = Respiration* P = Pulse* M = Mental Status
Privileges of Ambulatory Driving| Vehicle Operations
- Able to park the ambulance anywhere (if no harm is done to property/people).* Able to proceed past red stop signals, flashing red stop signals, and stop signs.* Able to exceed the posted speed limit (if people/property are not endangered).* Able to pass other vehicles in no-passing zones after properly signaling.* Able to disregard regulations for direction of travel and turning in certain directions.
DCAP–BTLS
- D = Deformities* C = Contusions* A = Abrasions* P = Penetrations/Punctures* B = Burns* T = Tenderness* L = Lacerations* S = Swelling
Past Medical History (PMH)| Secondary Assessment
- S = Signs/Symptoms* A = Allergies* M = Medications* P = Pertinent Past History* L = Last Oral Intake* E = Events Leading to Illness
History of Present Illness (HPI)| Secondary Assessment
- O = Onset* P = Pain/Palliation* Q = Quality* R = Radiation* S = Severity* T = Time* AS = Associated Signs* PN = Pertinent Negatives
Beck’s Triad| Cardiac Tamponade
- Hypotension (Narrowing Pulse Pressure)* Muffled Heart Sounds* Jugular Vein Distention (JVD)## FootnoteBeck’s Triad represents the three hallmark signs/symptoms of cardiac tamponade.
Cushing’s Triad| Intracranial Pressure (ICP)
- Hypertension (Widening Pulse Pressure)* Bradycardia* Irregular Respirations## FootnoteCushing’s Triad represents three hallmark signs/symptoms of increased intracranial pressure.
Ryan White CARE Act
The law that established a procedure by which emergency response personnel can seek to find out if they have been exposed to potentially life-threatening disease while providing patient care.
Stress Reactions
- Acute Stress Reaction (Soon After Incident)* Delayed Stress Reaction (Long After Incident)* Cumulative Stress Reaction (Years of Low-Level Stressors)
Situations Requiring Emergency Moves
- The scene is hazardous.* Care of life-threatening conditions requires patient re-positioning.* It is necessary to reach other patients.## FootnoteEmergency moves should be performed only when absolutely necessary.
Urgent Move
- The patient’s condition is deteriorating.* The required treatment can be performed only if the patient is moved.
Requirements of Refusal of Care
- Legally Able to Consent* Mentally Competent/Oriented* Fully Informed of Risks* Signed Release Form
Requirements of Negligence
- The EMT had a duty to act.* There was a breach of duty.* There was proximate causation.## FootnoteBreach of Duty: The EMT failed to act OR failed to provide care at the standard expected.
Types of Shock
- Cardiogenic: The heart fails in its ability to pump blood.* Hypovolemic: Loss of blood volume via severe bleeding or dehydration.* Distributive: Loss of blood vessel tone (leading to hypotension).* Obstructive: Blood is physically prevented from flowing.## FootnoteDistributive shock encompasses neurogenic shock, anaphylactic shock, and septic shock.
Compensated Shock
- Slight Mental Status Changes (e.g. Anxiety; Feelings of Impending Doom)* Increased Heart Rate (Tachycardia)* Increased Respiratory Rate (Tachypnea)* Delayed Capillary Refill Time* Diaphoresis (i.e. Pale, Cool, Moist Skin)## FootnoteCompenstated shock occurs when the body is able to sustain normal physiological function despite hypoperfusion.
Causes of Obstructive Shock
- Tension Pneumothorax* Cardiac Tamponade* Pulmonary Embolism
Decompensated Shock| Hypotensive Shock
- Decreased Blood Pressure (Hypotension)* Altered Mental Status## FootnoteDecompensated shock occurs when the physiological compensatory mechanissm failed in their effort to sustain perfusion.
Irreversible Shock
The state in which inadequately perfused organ systems begin to die, which is commonly followed by patient death.
Infant Physiologic Reflexes| Life Span Development
- Moro Reflex: The infant throws out arms, spreads fingers, and grabs with fingers/arms when startled.* Palmar Reflex: Infant grasps when object is placed in palm.* Rooting Reflex: Infant turns head toward the side touched, when cheek is touched while hungry.* Sucking Reflex: Infants starts sucking when lips are stroked.
Pediatric Repiratory Anatomy Considerations| Airway Assessment
- The mouth and nose are smaller (i.e. more easily obstructed).* The tongue take up proportionally more space within the oral cavity.* The trachea is softer (i.e. more flexible) and narrower (i.e. more easily obstructed).* The chest wall is softer (i.e. less rigid).
Compsensation for Hypoxia| Respiratory Assessment
- Shortness of Breath* Increased Respiratory Rate (Tachypnea)* Increased Heart Rate (Tachycardia)* Use of Accessory Muscles
Stages of Respiratory Compensation
- Respiratory Distress: Body’s compensating mechanisms are meeting increased metabolic demand (and characterized by increased work of breathing).* Respiratory Failure: Body’s compensating mechanisms fail to meet elevated metabolic needs (and characterized by severe hypoxia and hypercapnia).* Respiratory Arrest: The complete stoppage of breathing.## FootnoteRepiratory failure is indicative of inadequate breathing.
Respiratory Failure
- No/Poor Movement of Air* Diminished/Absent Breath Sounds* Rapid/Slow/Irregular Ventilation Rate* Inability to Speak* Unusual Breathing Noises (Wheezing, Crowing, Stridor, Snoring, Gurgling, Gasping)
Oxygen Therapy Devices
- Nonrebreather Mask: O2 @ 12–15 LPM* Bag-Valve Mask: O2 @ 12–15 LPM* Nasal Cannula: O2 @ 2–6 LPM* Tracheostomy Mask: O2 @ 8–10 LPM
Pulse| Vital Signs
- Adult/Adolescents: 60–100 BPM* Preschooler/School-Age: 70–110 BPM* Toddler: 90–130 BPM* Infant/Newborn: 110–160 BPM
Brachial Pulse vs. Radial Pulse
- Measure the brachial pulse for infants of 1 year old or younger.* Measure the radial pulse for patients of 1 year old or older.## FootnoteThe carotid pulse should be measured if the radial pulse nor brachial pulse can be measured/accessed.
Respiration| Vital Signs
- Adult/Adolescents: 12–20 BPM* Preschooler/School-Age: 20–32 BPM* Toddler: 24–40 BPM* Infant/Newborn: 30–60 BPM
Respiratory Sounds| Vital Signs
- Snoring: Patient’s airway is blocked/obstructed.* Wheezing: Medical condition involving bronchocontriction.* Gurgling: Fluids are present in the airway.* Crowing: Medical condition that cannot be treated on-scene.
Skin Abnormalities| Vital Signs
- Pale: Poor Circulation (due to Blood Loss, Hypotension, Shock, or Distress)* Cyanotic: Hypoxia (due to Inadeuate Breathing or Heart Dysfunction)* Flushed: Heat Exposure* Jaundiced: Liver Abnormalities* Mottled: Shock
Pupil Abnormalities| Vital Signs
- Dilated: Drug Usage; Blood Loss* Constricted: Narcotics Consumption* Unequal: Stroke; Head Injury; Eye Injury* Unreactive: Drug Usage; Brain Hypoxia
Blood Pressure| Vital Signs
- Adult: Systolic ≤ 120 mmHg* Adolescent Systolic @ 110–120 mmHg* Infant: Systolic @ 90 mmHg* Birth: Systolic @ 50–70 mmHg
Common Medications| Secondary Assessment
- Hypertension: Captopril, Lisinopril, HZTC* Diabetes (Insulin): Humalog, Humalin, Lantus, Metformin* Mental Disorders: Xanax, Celexa, Lexapro, Paxil, Seroquel
Verbal Report| Communications
- Patient’s Chief Complaint* History of Present Illness/Injury* Treatment Administered En Route + Patient Response* Vital Signs taken *En Route** Assessment Findings (+ Pertinent Negatives)
Elements of Prehospital Care Report| Documentation
- General Impression of Patient* Narrative Summary of Events throughout the Call* Patient History; Assessment Findings; Treatments Administered* Transport Information
Six Rights of Medication Administration| Pharmacology
- Right Patient* Right Medication* Right Route* Right Dose* Right Time* Right Documentation
Routes of Administration| Pharmacology
- PO = Oral* SL = Sublingual* INH = Inhalation* IN = Intranasal* IM = Intramuscular* SubQ = Subcutaneous* IO = Intraosseous* ET = Endotracheal* IV = Intravenous
Administerable/Assistable Medications
- Oxygen* Aspirin* Nitroglycerin* Naloxone (Narcan)* Activated Charcoal* Oral Glucose* Albuterol/Inhaler* Epinephrine Pen
Pediatric Inadequate Breathing| Respiratory Emergencies
- Nasal Flaring* Retractions* Grunting* Seesaw Breathing
Pathophysiological Indications of C-PAP| Respiratory Emergencies
- Congestive Heart Failure (CHF)* Pulmonary Edema* Drowning* Asthma* Chronic Obstructive Pulmonary Disease (COPD)* Respiratory Failure
Sign/Symptom Indications of C-PAP| Respiratory Emergencies
- Pulse Oximetry < 90%* Respiratory Rate > 25 BPM* Use of Accessory Muscles during Breathing## FootnoteAt least two of these conditions must be experienced for C-PAP to be indicated.
Contraindications of C-PAP
- Severely Altered Mental Status* Inability to Protect Airway* Inability to Follow Commands* Inability to Sit Up* Lack of Normal/Spontaneous Respirations* Hypotension (< 90 mmHg)* Inability to Maintain Mask Seal* Nausea/Vomiting* Chest Trauma (Tension Pneumothorax)* Shock* Upper Gastrointestinal Bleeding (or Gastric Surgery)
Side Effects of C-PAP
- Hypotension* Pneumothorax* Increased Risk of Aspiration* Drying of Corneas
Dosage of C-PAP
- 5–10 cm H2O## FootnoteThe dosage of C-PAP should be gradually increased from 5 cm H2O to 10 cm H2O.
Lung Auscultation Abnormalities
- Wheezing: Narrowed Air Passageways in Lungs (e.g. Asthma; Emphysema; COPD)* Crackles/Rales: Fluid in the Alveoli* Rhonchi/Snoring: Secretions in Larger Airways (e.g. Pneumonial Bronchitis)* Stridor: Partial Obstruction of Trachea/Larynx
Asthma
Congestive Heart Failure (CHF)
An inability to pump blood out of the heart that results in increased pressure within the pulmonary capillaries (and the lungs)## FootnoteCHF results in pulmonary edema.
Pulmonary Edema (PE)
Signs/Symptoms of CHF/PE| Congestive Heart Failure + Pulmonary Edema
- Respiratory Distress (Dyspnea)* Anxiety* Pale + Diaphoretic Skin* Tachycardia* Hypertension* Hypoxia* Crackles/Wheezes* Pink/White Sputnum* Pulmonary Edema
Signs/Symptoms of Pneumonia
- Coughing (w/ Green Mucus)* Shortness of Breath* Fever + Chills* Sharp/Pleuritic Chest Pain* Headaches* Confusion* Fatigue* Pale + Diaphoretic Skin## FootnotePneumonia is an infection of one or both lungs caused by bacteria/viruses/fungi.
Signs/Symptoms of Spontaenous Pneumothorax
- Sharp/Pleuritic Chest Pain* Decreased/Absent Breath Sounds on Injured Lung* Shortness of Breath (Dyspnea)* Hypoxia + Cyanosis* Tachycardia* (Jugular Vein Distension)* (Hypotension)
Spontaneous Pneumothorax
A collapse of the lung without injury or any other obvious cause.## FootnoteIndividuals who are thin, tall, or smoke are at highest risk of experiencing a spontaneous pneumothorax.
Signs/Symptoms Pulmonary Embolism
- Sharp/Pleuritic Chest Pain* Shortness of Breath (Dyspnea)* Hypoxia + Cyanosis* Tachycardia * Tachypnia* Anxiety* Cough (w/ Bloody Sputnum)## FootnotePulmonary embolism is the blockage of blood supply to the lungs that often results from Deep Vein Thrombosis (DVT)
Epiglottitis
- Sore Throat* Difficulty/Painful Swallowing (Drooling)* Muffled Voice* Sick Appearance* Fever* Tripod Position* Stridor## FootnoteEpiglottitis is the obstruction of the glottic opening due to infection (and subsequent inflammation/swelling) of the epiglottis.
Croup
- Loud Seal-Bark Cough* Hypoxia* Altered Mental Status* Fever* Dyspnea/Stridor (w/ Relief when Upright)* Restlessness## FootnoteCroup is a viral illness that results in inflammation of the larynx, trachea, and bronchi (and the constriction of the lung airways).
Bronchiolitis
- Cold-Like Symptoms (Runny Nose; Fever; General Illness)* Hypoxia* Dypnea## FootnoteBronchiolitis is a viral illness (often caused by RSV) that results in the inflammation/constriction of small airways.
Cystic Fibrosis
- Coughing (w/ Blood and Mucus)* Fatigue* Pneumonia (i.e. Fever, Coughing, Dypnea, Green Sputnum, Loss of Appetite)* Abdominal Pain + Distention* Nausea* Weight loss## FootnoteCystic Fibrosis is a genetic disease that causes thick, sticky mucus to accumulate in the lungs and digestive system.
Cardiac Implants
- Cardiac Pacemaker: An implanted pacemaker that enables the heart beat in a normal, coordinated fashion (when the body’s natural pacemaker fails).* Implanted Defibrillator: A miniature defibrillator surgically implanted in the chest/abdomen that detects lethal cardiac rhythms and shocks the patient.* Ventricular Assist Device: A mechanical device that pumps blood for the heart when one or both ventricles are weak/incompetent.
Causes of Altered Mental Status
- S = Sugar, Stroke, Seizure* N = Narcotics* O = Oxygen* T = Temperature, Toxins, Trauma
