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PAAM Final Flashcards

1
Q

What is always your number one priority on any call:
When is scene safety assessed:
When would you use NOI versus MOI?
Do you have a legal obligation to enter a unsafe scene:

A

= yourself
= when you first get the call
= After you make your GI of the PT
= NO

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2
Q

What is known as “action circle” at the scene of an accident?
What is the safe (minimum) radius of the action circle?
What is the purpose of the “Circle Survey”?

A

= circular area extends out from accident vehicles & 50ft (min) radius
= 50ft
= Survey all 360 degrees of accident

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3
Q

Dangers of performing rescue in confined space?
Dangers of performing a rescue in a farm silo?
Order which you should conduct a water rescue?

A

= Gases & Collapsing
= Sinking, only up & down
= Reach (with long pole), Throw (flotation device), Row (boat), Go (water entry)

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4
Q

Distance to park w/ 1 of cars on fire at road incident?
Position of vehicle approaching potential hazard?
Book most used to identify hazard materials:
Must be worn working scene of vehicle accident:

A

= 100ft or>
= Uphill & Upwind
= Emergency Response Guidebook
= Reflective vest

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5
Q

What info do you obtain w/ general impression?
What is the purpose of the primary assessment?

A

= Immediate life/death signs/hemorrhaging, PT info
= Fix any life threatening problems

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6
Q

Assessed during PT assessment?
Something wrong in primary assessment, what are you to do?
Type of hemorrhage cause interruption of ABCs:

A

= 1. SS/sizeing, M/NOI, 2. PT assess, 3. LOC, 4A, 5B, 6C
= Stay & Play

= squirting/arterial

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7
Q

Assessed during “A” phase of primary assessment?
Assessed during “B” phase of primary assessment?
Assessed during “C” phase of primary assessment?

A

= Airways all possible & best airways
= Breathing; quality, rate, rhythm, symmetry,
= Circulation; CTC, quality, rate, rhythm, regularity, strength

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8
Q

How do you use the AVPU scale?
GCS- E points:
M points:

S Points:

A

= Alert, Verbal, Pain, Unresponsive
= 4 Alert, 3 Verbal, 2 Pain, 1 Unresponsive
= 5 Oriented, 4 Confused, 3 inappropriate words, 2 sounds, 1 no audiation
= 6 Obeys comands, 5 localizes to pain, 4 withdraws w/ pain, 3 flextion, 2 extension, 1 no response

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9
Q

Systolic BP estimates for following pulse sites- Radial
Femoral:
Carotid:

A

= 80
= 70
= 60

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10
Q

How long to conduct a primary assessment?

A

= 60secs

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11
Q

Goal of therapeutic communication?

What is therapeutic communication?

A

= PTs feel heard & understood; can help reduce anxiety, build trust, & improve quality of care provided.
= Specific techniques & strategies to establish a positive rapport, convey empathy, & effectively gather info from PTs.

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12
Q

Active communication consists of what 4 things?
What actions can you take for a good 1st impression?

A

= sender, a message, a receiver, and feedback
= Introduction, Open stance, eye contact, ect

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13
Q

PT distance in intimate zone?
You assess for what in what zone?
PT distance in person space?
where most our PT assessment occurs
Distance for social space?
Distance for public space?

A

= 0-1.5 feet
= Internal signs in intimate zone
= 1.5-4ft
= Personal zone
= 4-12ft
= 12ft or more

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14
Q

3 different relative Lvls mean to a PT:
1. Remaining at eye level:
2. Standing above/over PT:
3. Dropping below eye level indicates:

A

= eye contact Lvl
= equality
= authority & can be intimidating
= Willing for PT have some control (w/ elderly&PEDI)

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15
Q

Eye contact 50/70 rule- 50%:
70%:
helps interaction by making it by creating a :

A

= maintain eye contact 50% of the time= speaking
= Maintain eye contact 70% of the time= listening.
= comfortable & engaging w/o making other uneasy

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16
Q

Be familiar with the parts of active listening:

A

Silence, Reflection, Facilitation, Empathy, Clarification, Confrontation, Interpretation, Asking about feelings, Explanation, Summarization,

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17
Q

SAMPLE history:

OPQRST-ASPN:

AEIOU-TIPS:

DCAP-BLS-TIC:

A

= Sign/Symptoms, Allergies, Meds, Past med/ Hx, Last oral intake, Events leading up
= Onset, Provocation/Palliation, Quality, Radiating, Severity, Timing - Associated Sign/Symptoms & Pertinent Negatives
= Alcohol, Epilepsy, Insulin (hypo/hyperglycemia), Overdose, Uremia (kidney failure), Trauma, Infection, Psychosis, Stroke
= Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, Crepitus

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18
Q

Goal of the secondary assessment?

4 techniques when assessing PT in 2nd assessment?

A

=more through exam objective & measurable (quantifiable) info is taken from PT’s health condition: vitals, SAMPLE, ect
= 1st. Visual, 2nd. Palpation, 3rd. Percussion, 4th. Auscultation

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19
Q

2nd. Palpation inspection:

A

= Fingers for sensations EX pulse, Ball of hand(calluses) for vibrations (tactile fremitus- vibration in back when talking)

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20
Q

3rd. Percussioning:

A

= striking surface of body; Direct EX sinus taping listening for hypo-rresonant dull sound means filled sinuses, Indirect= tap on top of own fingers (percussing for pneumo) Blunt percussion= hitting hard EX kidneys hitting & listening for pain response

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21
Q

Erb’s point @:
&means:

A

= 3rd ICS L-sternal border.
= heart murmurs can be heard more distinctly.

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22
Q

4th. Auscultation:

A

= Diaphragm hyper-sounds lungs bell= (held at stem), BP & heart sound

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23
Q

Percussion sounds:

Tympany sound:

Hyperresonance sound:

Resonance sound:

Dull sound:

Flat sound:

A

= tone’s resonance/lack of indicates if region is filled w/ air, air under pressure, fluid, or normal tissue
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach “teeter-totter”
= “Booming” ,loud intensity, Low pitched, long duration, located in Hyperinflated-Lung “Hums of mongolian”
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung “Ringing tornado”
= “thud” , Medium intensity, medium pitched, medium duration, in solid organs “Dumb down-syndrome”
= “Extremely dull” , Soft intensity, High pitched, short duration, in muscle & atelectasis “fly flying by”

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24
Q

dysarthria:
dysphonia:
aphasia:
expressive aphasia:
Receptive aphasia:
PT w/ aphasia be mistaken for:

A

= defective speech caused by motor deficits
= voice changes caused by vocal cord prob/s
= defective language from brain damage
= words will be garbled
= words will be clear but unrelated to your questions.
= a psych disorder b/c such difficulty speaking

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25
Q

(ODERS) Fruity breath:
Urine or ammonia:
Bitter almonds:
General bad breath:
Fishy vaginal/penis odor:
Fecal breath:

A

= DKA
= UTI
= cyanide poisoning
= hygiene and/or infection
= infection and/or Ghonearrhea
= GI obstruction

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26
Q

Pulse Deficit:
Pulse Deficit indicates:
Pulsus Alternans:
Pulsus Alternans indicates:

A

= difference in HR w/ auscultation & PR w/ palpation.
= not all heartbeats make palpable pulse, often A-Fib
= Alternation of strong & weak pulses, typically
=L-ventricle dysfunc/or H-failure & often chronic condition of the heart.

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27
Q

Cardiac Output formula:
HR:
SV:
Formula for BP:
Calculate a PT’s MAP:

A

= CO=HR×SV
= Heart Rate (beats per minute)
= Stroke Volume (amount of blood pumped per beat)
= BP= SVR x (SV x HR)
= DBP+ ⅓(SBP-DBP)

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28
Q

(Korotkoff sounds & in order) 1st sound:
2nd sound:
3rd sound:
4th sound:
5th sound:
Mnemonic:

A

= snapping
= swooshing
= tapping
= thumping (muffling)
= silence
= “Sounds Silly That They Sing”

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29
Q

(skin signs) 1. Pallor:
2.Cyanosis:
3. Jaundice:
4. Erythema:
5. Petechiae:
6. Purpura:
7. Mottling:
8. Ecchymosis:
9. Vesicle:
10. Cyst:
11. Bulla:
12. Telangiectasia:
13. Excoriation:
14. Scale:
15. Lichenification:
16. Atropy:

A
  1. =Abnorm/ pale; hypoxia by shock or hypothermia.
  2. = Blue: hypoxia
  3. = yellow: liver failure
  4. = Red: carbon monoxide
  5. = small flat purple spots by cap/blood/;many etiologies
  6. = purple spots by minor cap/ bleeding
  7. = purplish patches; poor circu/oxygen/seen near-death
  8. = Bruising
  9. = elevated area <1cm w/ serous fluid
  10. = elevated palpable area w/ liquid or viscous matter
  11. = “bulb” Vesicle diameter >1cm
  12. = Red/blue threads “spider”
  13. = linear epidermis loss leaving dermis exposed
  14. = excessive exfoliation white-silver-tan
  15. = thickening/hardening epidermis w/ emphasize lines
  16. = thin “clear” epidermis
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30
Q

Skin turgor test:
Norm/ skin tugor:
Decreased skin mobility suggests:
“Tenting” Poor turgor:

A

= pulling skin fold over bony area then releasing it
= immediately returns to its original state.
= edema or scleroderma, a progressive skin disease.
= results from dehydration

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31
Q

(Abnormal Nails) Clubbing:

Paronychia:

Onycholysis:

Terry’s nails:

Transverse/Beau’s lines:

Psoriasis:

A

= “finger clubs” distal phalanx of fingers rounded/ bulbous & Proximal nail feels spongy; from chronic hypoxia in COPD & lung cancer.
= inflamed nail; can be acute trauma or chronic & Cuticle isn’t visible
= Separation of nail from nail bed; can be from fungal infections, psoriasis, or trauma.
= white w/ narrow pink band @ tip; can indicate liver disease, diabetes, or heart failure
= horizontal grooves; nail growth disruption from illness, trauma, or nutritional deficiencies
= small pits; can be an early sign of psoriasis

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32
Q

Medical word for unequal pupils >1mm:
Unequal pupils alert you to:
Medical word used for pinpoint pupils:
Medical word used for dilated pupils:
Name of eye chart used to test visual acuity:
Bitemporal hemianopsia:
Left/Right Homonymous Hemianopsia:
Homonymous Quadrantic Defect:
Medical word for ecchymosis around eyes& sign of:

A

= anisocoria
= Brain trauma!!!
= Miosis
= Mydriasis
= Snell chart
= loss of vision in the outside half of each eye
= loss of vision in right or left half of both eyes
= loss of vision in the same quadrant of both eyes
= Periorbital ecchymosis & basilar skull fracture

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33
Q

3 parts of the ear:
What part contains the three ossicles:

A

= Outer, middle, Inner
= Middle ear

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34
Q

Outer Ear consists:

A

= Auricle, External Acoustic Meatus “Ear canal”, & Tympanic membrane “eardrum”

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35
Q

Inner ear contains:
Names of 3 ossicles:

A

= Vestibule, Semicircular canals, Cochlea, Labyrinth
= “Hammer” malleus, “Stirup” incus, “Anvil” stapes

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36
Q

“Hammer” of ear:

A

= Malleus “both have M”

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37
Q

“Stirup” of ear:

A

= Incus

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38
Q

“Anvil” of ear:

A

= Stapes

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39
Q

Medical word for ecchymosis behind ears & a sign of: What can be assessed using an otoscope:

A

= Retroauricular- ecchymosis
= Typmanic membrane for Otitis media

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40
Q

Name/meaning for increased JVD during inhalation:

A

Kussmaul’s sign & Hemothorax

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41
Q

Pressure in the jugular veins approximate:
Elevated jugular venous pressure can indicate:

A

= central venous pressure (CVP)indicator of body’s overall blood volume & venous return
= L-side ventricle failure or fluid overload.

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42
Q

PT w/ subcutaneous emphysema:

A

= Air leaking from respiratory into tissues of neck ;indicating a serious neck/chest injury.

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43
Q

Presence of Carotid bruit:
What is a carotid bruit:

A

= usually means= atherosclerosis
= sound of turbulent blood flow around partial vessel obstruction

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44
Q

3 phases when assessing PT’s chest- Phase 1:

Phase 2:

Phase 3:

A

= Inspection: shape, symmetry, & abnormal m-nts or signs.
Palpation: Feel for tenderness, vibrations, & abnormalities.
Percussion: Tap to assess the underlying lung tissue & identify areas of abnormal density

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45
Q

adventitious lung sounds:

A

= crackles/rales, wheezes, rhonchi, stridor, & pleural rubs

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46
Q

What is considered normal heart sounds?

A

= S1/S2 “lub dub”

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47
Q

S1 Sounds auscultate @:
S2 Sounds (aortic) auscultate @:
S2 Sounds (Pulmonic) auscultate @:

A

= 5th ICS at Left Sternal border “TRI BI”
= 2nd ICS at Right Sternal border “aoRtic Right”
= 2nd ICS at Left Sternal “puLmonic L”

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48
Q

Aortic Valve auscultate @:
Pulmonic Valve auscultate @:
Erb’s Point auscultate @:
Tricuspid Valve auscultate @:
Mitral Valve (Apex) auscultate @:

A

= 2nd ICS, Right Sternal border.
= 2nd ICS, Left Sternal border
= 3rd ICS Left sternal border.
= 4th ICS Left Sternal border
= 5th ICS, Left Midclavicular line

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49
Q

What makes the heart sounds?

What heart valves are open during diastole?
What heart valves are open during systole?

A

= Bi/Tricuspid valves closing S1 & pulmonic/aortic valves closing S2
= Bi&Tricuspid
= Pulmonic & Auratic

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50
Q

What is a scaphoid abdomen & its significance?

Obvious pulsating mass indicates what in abdomen?
Accumulation of fluid across PT’s abdomen is?

A

= Abdomen appears sunken; can indicate malnutrition or diaphragmatic hernia.
= Indicates an abdominal aortic aneurysm. AAA
= Ascites

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51
Q

Cullen’s Sign:
Grey Turner’s sign:

A

= Bruising @ umbilicus; intra-abdominal bleeding
= Shoulder referred pain from abdomen

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52
Q

PT vomiting up bright red blood is called?
PT coughing up blood from respiratory system is?
PT passing bright red blood in stool is? Hematochezia
PT passing very dark, sticky, foul Smelling stool is?

A

= Hematemesis: upper GI bleed “em flem”
= Hypotyposis “hy-pot cough”:resp/ bleed
= Hematochezia; Lower GI bleed “crap w/ blood”
= Melena; Upper GI bleed

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53
Q

What is Kehr’s sign/meaning:
PT w/ Murphy’s sign means?

Where/what is McBurney’s Point?

A

= Referred shoulder pain from spleen or liver
= Suspected gall bladder infection→ cupping under rib w/ breath causes pain
= LRQ pain w/ rebound tenderness ⅔ of way from umbilicus to illicac; pos/ appendicitis

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54
Q

(Pitting edema)- +1 grade:
+2 grade:
+3 grade:
+4grade:

A

= 1-2 mm (0.04-0.08 inches)
= 3-4 mm (0.12-0.16 inches)
= 5-6 mm (0.20-0.24 inches)
= 7-8 mm (0.28-0.31 inches)

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55
Q

(0, +1, +2, or +3 pulses)- 0 pulse grade:
+1 pulse grade:
+2 pulse grade:
+3 pulse grade:

A

= Absent, no detectable pulse
= Weak; thready, barely detectable,
= Normal; easily felt but not bounding.,
= Strong; full & easily palpable.

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56
Q

What is Lordosis?
What is Scoliosis?
What is Kyphosis?

A

= Swayback “Lord the way swayback”
= Lateral curve “S curve”
= Humpback

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57
Q

CN 1:

A

= Olfactory → smell “1 nose”

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58
Q

CN 2:

A

= Optic → vision (sensing light) “2 eyes”

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59
Q

CN 3:

A

= Oculomotor: pupil m-vt (controls pupils sizes) “3 words cocaine constricts pupils”

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60
Q

CN 4:

A

= Trochlear: eye motor function (look up & down) “it go up, down, up, down”

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61
Q

CN 5:

A

= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) “5 fingers to the face/chew”

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62
Q

CN 6:

A

= abducens= Lateral Eye m-vt “6 letters (TO SIDE)”

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63
Q

CN 7:

A

= facial: controls facial expressions, taste @ front 2/3s of tongue, & some F.s of salivary & lacrimal glands “L I C K M A D”

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64
Q

CN 8:

A

= vestibulocochlear= sense hearing, balance, equilibrium

65
Q

CN 9:

A

= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. “9 lime”

66
Q

CN 10:

A

= vagus “wondering” parasympathetic F.s: HR, digestion, & RR & also provides sensory info from throat & voice box.

67
Q

CN 11:

A

= Accessory = traps Muscles motor

68
Q

CN 12:

A

= Hypoglossal = motor tongue control out “12 & 21 baskin robin flavors”

69
Q

Cranial nerves carrying parasympathetic nerve fibers?

A

CN: 3,7,9,10

70
Q

Ocular Muscles do what & Innervated by 3CNs:
Remember by:

A

= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6

71
Q

Contractile cell RP:
Contractile cell AP:
Autorhythmic cell RP:
Autorhythmic cell AP:
Neuron cell RP:
Neuron cell AP:

A

= -90mV
= -85mV
= -60mV
= -40mV
= -70mV
= -55mV

72
Q

Ion that depolarizes Contractile cell :
Ion that repolarizes Contractile cell :
Ion that depolarizes Autorhythmic cell :
Ion that repolarizes Autorhythmic cell :
Ion that depolarizes Neuron cell :
Ion that repolarizes Neuron cell :

A

= Sodium
= Potassium
= Calcium
= Potassium
= Sodium
= Potassium

73
Q

(Pacemaker spots in heart w/ firing rates) SA
AV rate:
Purjunkie rate:

A

= 60-100
= 40-60
= 15-40

74
Q

Electrical stimulus travel from SA node to L-atrium via:

A

= Backman’s Bundle

75
Q

(Einthoven’s Triangle) Negative Lead 1@:
Positive Lead 1 @
Negative Lead 2 @
Positive Lead 2 @
Negative Lead 3 @
Positive Lead 3@
Remember by:

A

= RA
= LA
= RA
= LL
= LA
= LL
= neg-pos RA to arm to LL

76
Q

(Einthoven’s Triangle 12/15lead) V1=
V2 lead @=
V4 lead @=
V3 lead @=
V5 lead @=
V6 lead @=
V4R lead @=
V5/8 lead @=
V6/9 lead @=
Numbers:

A

= (anterior)4th ICS(between 4&5th~1inch R sternum)
= (anterior) 4th ICS ~1inch L of the Sternum
= (anterior) 5th ICS Midclavicular (left breast)
= (anterior) ½ way in between V2&4
= (anterior) 5th ICS Anterior Axillary
= (anterior) 5th ICS Mid Axillary
= (anterior) 5th ICS Midclavicular
= (posterior) 5th ICS Mid-Scapular
= (posterior) ½ way in-between Scapula & Spine
= 4 & 5 ICS and 1/2 inbetweens

77
Q

What is the normal speed of ECG paper?

A

25mm per sec

78
Q

Positive electrode = what flex on ekg:
Positive charges look at what side of heart:

A

= + flex on ekg: LL & lead 2 positive
=+ charges look at inferior side of heart

79
Q

Positive electrode makes wave:
Negative electrode makes wave:

A

= makes inverted wave “U”
= makes wave positive “/"

80
Q

!!!Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:

A

=neutral/ground “ground grass”
= Negative “feeling blue”
= Positive

81
Q

!!!Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:

A

= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)

82
Q

(Einthoven’s triangle) BiPolar Limb Leads:

A

= 2 electrodes, + & -, “+looks to -”,

83
Q

Unipolar Limb Leads:
aVR:
aVL:
aVF:

A

= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)

84
Q

(EKG) Horizontal Boxes: Each small box ?secs:
5 small boxes equal:
Each large box is ?secs:

A

= 0.04 sec
= 1 large box
= 0.20 sec

85
Q

Vertical Boxes Each small box is:
Each small box also equals:
5 small boxes equal:
Each large box is:
2 large boxes equal: 1 mV

A

= 0.1mV
= 1 mm
= 1 large box
= 0.5 mV
= 1 mV

86
Q

ECG Heart waves – P wave:
QRS complex:
T wave:

A

= Atrial depolarization
= Ventricular depolarization
= Repolarization of ventricles

87
Q

P Wave- Morphology:

Interval P Wave Duration:
PRI wave duration:

Amplitude in the limb leads:
Amplitude in the precordial leads:

A

= Smooth hump, Upright in limb lead:1-3, Biphasic(2 waved) in V1, should have same morphology
= <0.12secs
= 0.12-0.20secs 3-5 small boxes >5 boxes (Atrium depolarizing)=
= < 2.5 mm in the limb leads
= < 1.5 mm in the precordial leads

88
Q

QRS Complex- Morphology- Q Wave is:
R Wave is:
S wave is:
Interval Duration:

A

= 1st negative deflection after the P wave
= 1st positive flection after the P wave
= any negative deflection after the R wave
= 0.04 – 0.12 sec/ 1-3 small boxes

89
Q

T Wave- Morphology:

Interval Duration:
Amplitude in limb leads:
Amplitude in precordial leads:

A

= Upright in all leads except aVR & V1, Normally downslope>upslope
= Variable (QT Calculation)
= < 5 mm/ 5 small boxes in the limb leads
= < 10 mm in the precordial leads

90
Q

Oxyhemoglobin is:
Carbaminohemoglobin:
Methemoglobin:

Deoxyhemoglobin:
Carboxyhemoglobin:
Sulfhemoglobin:
Glycated Hemoglobin (HbA1c):

A

= oxygen carrying Hemoglobin
= carbon dioxide on hemoglobin amino-acid
= Hemoglobin not picking up ( w/ iron in ferric (Fe3+) vs oxy)
= Hemoglobin not bound to oxygen.
= Hemoglobin bound to carbon monoxide (CO).
= Hemoglobin irreversibly bound to sulfur.
= Hemoglobin bound to glucose for measuring long-term BGL control

91
Q

Cranial nerves name mnemonic:
Cranial nerve names:

A

= “Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, Such Heaven!
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear (or Auditory)
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal

92
Q

Tracheal Stenosis:

A

=narrowing of trachea from injury/ scarring often caused by Cricothyrotomy

93
Q

“Coffee grounds” in mouth suggests:
Pink sputum indicates:
Green/Yellow phlegm suggests:

A

= upper gastrointestinal (GI) bleed.
= acute pulmonary edema
= a respiratory infection

94
Q

Heart sounds)Ejection Click:
Opening Snap:
Pericardial Friction Rub:
Murmur:

A

=a stiff or stuck valve.
= stenotic bi/tricuspid valve’s leaflets recoiling abruptly after diastole.
=inflammation causing visceral & parietal surfaces to rub w/ each heartbeat.
= Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.

95
Q

Heart sounds)Ejection Click:
Opening Snap:
Pericardial Friction Rub:
Murmur:

A

=a stiff or stuck valve.
= stenotic bi/tricuspid valve’s leaflets recoiling abruptly after diastole.
=inflammation causing visceral & parietal surfaces to rub w/ each heartbeat.
= Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.

96
Q

Can loose testie from torsion in how many hours:

A

6 hours

97
Q

ABDMN consistent pain for how many hours is a surgical emergency:

A

=6 hours

98
Q

1957, Dr. J. Frank Pantridge & his colleague Dr. John Geddes made:

A

= modern concept of cardiopulmonary resuscitation (CPR) for the early treatment of cardiac arrest.

99
Q

The 3 types of ECG leads are:

A

bipolar, augmented “unipolar”, and precordial.

100
Q

(Bipolar leads) impulse moving toward + electrode creates:
Impulse moving toward -electrode causes:

A

= + deflection (upward) on the ECG paper or monitor.

= a - (downward) deflection on ECG paper/monitor.

101
Q

Artifacts on ECG produce:

Common causes of artifacts include:

A

=deflections by factors other than heart’s electrical activity
= Muscle tremor/Shivers, PT m-vt, Loose electrodes, 60-hertz interference, Machine malfunction

102
Q

Chronically ill=
frail=
feeble=
robust=
vigorous=

A

= Can’t do basic human necessities
= sick soreness
= lack of strength
= energetic
= VERY energetic

103
Q

(eye H-test) Direct response:
Indirect (consensual):
accommodation:
H test actual name:

A

= observe same pupil
= observe opposite pupil
= crossing eyes when going to nose
= Ocular eye motor movement test

104
Q

Bristol stool chart & types:

A

= type 4 healthy, type1 hard deer pebbles, type 8 liquid

105
Q

Aaron’s signs:
Rovsing’s sign:
Psoas sign:

A

= Epigastric pain during palpation to McBurney’s point
= RLQ pain w/ palpation to LLQ
= RLQ pain when PT tries to raise R-leg against resistance

106
Q

Priapism penis causes:

A

= sickle cell anemia, meds, spinal damage

107
Q

Cranial nerve types mnemonic:
Nerve types:

A

= “Some Say Marry Money, But My Bitch Says Big Boobs Matter Most.”
= 1. Olfactory - Sensory
2. Optic - Sensory
3. Oculomotor - Motor
4. Trochlear - Motor
5. Trigeminal - Both
6. Abducens - Motor
7. Facial - Both
8. Vestibulocochlear (or Auditory) - Sensory
9. Glossopharyngeal - Both
10. Vagus - Both
11. Spinal Accessory - Motor
12. Hypoglossal - Motor

108
Q

Cranial nerve location mnemonic:
Nerve locations:

A

= “Sexy EMTs Play Erotic Jokes, Exciting Their Erotic Lover’s Asshole Stimulating Them.”
= Sniffer- smells (Olfactory)
= Eyes - Eyesight (Optic)
= Pupils - Pupils & eye movement (Oculomotor)
= Eyes = eyes movement (Trochlear)
= Jaw -mastication (Trigeminal: sense face & motor jaw)
= Eyes - Eye movement (Abducens)
= Taster - Taste & facial expression (Facial)
= Ears - Ears hearing & balance (Vestibulocochlear)
= Licker- tongue taste & swallow (Glossopharyngeal)
= ABDMN- Autonomic control thorax & ABDMN (Vagus)
= Shoulders -shrug & neck m-nt (Spinal Accessory)
= Tongue - Tongue movement (Hypoglossal)

109
Q

Endotracheal intubation indications:

A

= breathing fail/arrest, cardiac arrest, airway closing/needs to be protected

110
Q

Endotracheal intubation indications:

A

= breathing fail/arrest, cardiac arrest, airway closing/needs to be protected

111
Q

Surgical cric indication:

A

= severe facial trauma & other airways not patent

112
Q

Trachea bifurcates @?

A

Carina

113
Q

where does the gases exhange in the lungs

A

Aveoli

114
Q

Identify the differences between the visceral and parietal pleura

A

V=has no nerves P= has nerves

115
Q

How does the airway of an adult differ from that of a pediatric patient?

A

Pediatric airway = funnel & floppy

116
Q

What is the difference between ventilation and respiration?

A

Vent= mechanical Respi= gas exchange

117
Q

Difference w/ cellular (internal) & (external) pulmonic respiration:

A

Internal = cells external= lungs

118
Q

calculate alveolar volume:
minute volume:
Alveolar minute volume:

A

AV= TIDAL-DEAD
MINUTE = RR X TIDAL VOL
AVMV= AV x RR

119
Q

What signals us to breathe→ Central chemoreceptors:
Increase in arterial CO2:
Hypercarbic & hypoxic drives & dif/s:

A

= pH receptors
= hypercarbic drive
=too much CO2 so initiates from high PACO2 &hypoxic= not enough oxy so initiates from low PAO2

120
Q

How does CO2 get transported throughout our body:

A

Bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%

121
Q

What reflex stops us from over ventilating ourselves:
What receptors are involved?
What is a V/Q mismatch?

A

= Hering-Breuer
= Stretch receptors
= Ventilation Perfusion mismatch

122
Q

DISS fitting on an oxygen therapy regulator:
What PIN system does an oxygen tank/therapy regular use:

A

= Diameter Index Sizing System
= 2:5

123
Q

(Supplemental oxygen devices & FiO2%) Nasal cannula:
NRB:
BVM:
Pocket-mask

A

= (lpm x 4) + 20 ,ex 1lpm=24%
= 80% 15LPM
= (90-95)per book 100% LPM
= 16%

124
Q

What makes an OPA a better airway adjunct over an NPA?

A

Aspiration, displaces tongue, & can suction

125
Q

4 ways that you can ventilate a PT & which is best & worst:

A

mouth to pocket mask(best), 2 person BVM, demand valve/FROPVD, 1 person BVM (worst)

126
Q

Suction times for the different age groups:
Suction time limits for suctioning an ET or Trach tube:

A

= 5,10,15secs
= 5-10secs

127
Q

What is “LEMONS?”

A

= Looks, Exam 3-3-2, Mallampati, obstruction, neck mobility, saturation

128
Q

3-3-2 Rule=

A

= 3 fingers (Mouth opening): PT should be able to open their mouth wide enough to fit three fingers vertically.
= 3 fingers (Chin to hyoid): distance from the chin to the hyoid bone should be at least the width of three fingers.
= 2 fingers (Hyoid to thyroid notch): distance from hyoid bone to the thyroid notch should be at least the width of two fingers.

129
Q

Mallampati Scores: Class 1
Class 2
Class 3
Class 4

A

Class I: Everything in the back of the mouth is easily seen.
Class II: Most structures are seen, but the back pillars are not.
Class III: Only the uvula and soft palate are seen.
Class IV: Only the roof of the mouth (hard palate) is seen.

130
Q

CPAP and how does it help a patient with either CHF or asthma/COPD?

A

= Continuous Positive Air Pressure → forces PT’s lungs take in more air

131
Q

Cormack/LeHane Classification system: Grade 1:
Grade 2:
Grade 3:
Grade 4:

A

= entire glottic opening & vocal cords may be seen
=epiglottis & post/ glottic opening pos/ seen w/ partial vocal cord view
= only epiglottis & (sometimes) posterior cartilages seen
= neither epiglottis nor glottis seenw/ a partial view of vocal cords

132
Q

Parts of the ET tube:
How should a stylet be used?
What is the distal lateral hole called?
o When is a good time to use a bougie?
§ What is the distal curved tip of a bougie called?

A

= cuff, piolet, balloon,
= in ETT for structure strength to prevent flimsyness
= Murphy’s eye
= Need to feel cartilage rings, Cric/, Trach intubat/, Pedi oral intubat/
= Coude tip

133
Q

estimate ET tube size for a PEDI PT: Pedi (uncuffed) ETT form:
Pedi (cuffed) ETT form:

A

= (age/4) +4 or (age +16)/4
= (age/4) +3.5

134
Q

estimate weight of a PEDI PT:

A

(age+4)x2=Kg<Old> (age X 3) +7=Kg <New></New></Old>

135
Q

equipment used to help successful placement of a nasal ET tube?

A

BAAM Beck Airway Airflow Monitor→ high pitch on inhale

136
Q

Measuring NG tube:
Measuring OG tube:

A

= tip of nose, around ear, & down to xiphoid process (make a “?”)
= corner of mouth, around ear, & down to xiphoid process (make a “?”)

137
Q

(BURP for neck pressure) B:
U:
R:
P:

A

= Backward: pressure posteriorly (toward back) on thyroid cartilage
= Upward: pressure superiorly (toward head) on thyroid cartilage
= Rightward: pressure laterally (toward R-side) on thyroid cartilage
= Pressure: keep BUR pressure to improve view of vocal cords

138
Q

Laryngeal Airways sit @:
Dif airways: 1.
2.
3.
4.
5.

lumens=

A

= supra glottic airways (above glottis)
1. LMA:commonly OR setting,
2. LMA Supreme: updated LMA design w/o need for fingers in mouth
3. LMA Fastrach(saxophone) designed to aid blind endotrac/ intubat/
4. CookGas air-Q(tongue w/ tube) pedi/ sizes & shape allows intubat/ w/ ETT introducer & w/ direct tube placement.
5. I-Gel= most common, has a built-in bite block & passageway allows insertion of a gastric tube to decompress the stomach
= “pigtails” PT vent & provider vent

139
Q

Delayed Sequence intubation(DSI):

Rapid Sequence Intubation (RSI):

Sedation-Facilitated Intubation (SFI):
Medication-Assisted Intubation (MAI):

A

= use of sedative w/o paralytic allows better mask-seal & preoxygenation during intubation
= use of potent induction med followed by a rapid neuromuscular blocker (NMBA) to sedate & paralysis for “quicker” intubation
= med/ admin, but no paralytics are administered.
= RSI & SFI

140
Q

type of cric/ for PEDIs years ?&<:

A

= needle cric/ for 8yrs old & younger

141
Q

PEEP and how much do we usually use?

A

= Positive expiratory end pressure 5cmH2o

142
Q

different ways monitor a PT’s ETCO2?

A

Colorimetric, capnometry, capnography

143
Q

purpose of a chest drainage system?
Water is required to maintain a patent one-way valve?
Most common complications of a chest tube?

A

= Restore and keep negative gas pressure
= Distal tube in 2cm of water
= Tubes disconnecting or kinking & air leaks

144
Q

What does Boyle’s Law state?

When/how does Boyle’s law apply in EMS?
What does Henry’s Law state?

When/how does Henry’s law apply in EMS?

A

= Vol/ of gas is inversely proportional to pressure of it (more pressure less volume)
= BVM Ventilations to PT
= amount of a dissolved gas in given amount of fluid is directly proportional to amount of pressure on top of that gas
=supplemental oxygen therapy

145
Q

What does Charles’s Law state?

When/how does Charle’s law apply in EMS?

What is Gay-Lussac’s Law?
When/how does it apply in EMS?

A

=At a constant temp/, the volume of a gas is directly proportional to gas temp
= Ensuring oxy/ cylinders & other gas containers are stored at appropriate temp/s to maintain consistent gas delivery.
=As you heat gas, the pressure is going to go up.
=Gas Storage: gas containers stored @ stable temp/s to avoid pressure changes & PT Care: Recognize PT hyper/hypothermic conditions might altered resp/circulatory from changes in gas pressures w/in body

146
Q

What is Dalton’s Law?

When/how does it apply in EMS?

A

=Total pressure of a mixture of gases = the sum of the partial pressure of the individual gases.
=Resp/ Gas Exchange: how partial pressures of oxygen & CO2 affect diffusion across the alveolar-capillary membrane.
& Hyperbaric Oxygen Therapy: Utilizing increased partial pressure of oxy/ to treat conditions like carbon monoxide poisoning by displacing CO from hemoglobin.

147
Q

shock index:
quick & easy way to assess shock index:

A

= ratio of HR-SBP. #s over 0.9 suggest impending hypotension.
= if HR>SBP, shock index must be over 1 & should anticipate peri-intubation hypotension.

148
Q

Needle Cricothyrotomy:
Open Cricothyrotomy:

A

= 14-gauge needle into trachea @crico-thyroid membrane
= ETT/shiley tube into trachea through incision @ crico-thyroid

149
Q

transtracheal jet ventilation/ insufflation:
Barotrauma:

A

= vent/ing through 14-gauge needle from needle cricothyrotomy
= damage to lungs by changes/increasing pressure. (can also occur from over ventilation)

150
Q

lowest residual tank pressure:
D cylinder form:
E cylinder form:
M cylinder form:

A

= 200 PSI
= (tank PSI x 0.16) / LPM
= (tank PSI x 0.28) / LPM
= (tank PSI x 1.56) / LPM

151
Q

Bone usually fractured in basilar skull fracture:

A

= Cribriform plate

152
Q

Retroglottic airway devices: 1.
2.
3.

A

= King LT: large silicone cuff; disperses pressure over mucosal surface
=King LT-D: disposable 1-lumen latex-free retro glottic airway
=King LTS-D: 1-lumen retro airway w/ channel for placing gastric tube

153
Q

(atelectasis) alveolar collapse can occur:
surfactant:
Parenchyma:

A

= surfactant is insufficient or if the alveoli are not inflated
= Alveoli “lube” to create surface tension in pleurals
= Core structure of lung

154
Q

PaO2) & normal range

A

= partial pressure of oxygen dissolved in plasma & 80–100% (mmHg)

155
Q

pre-Botzinger complex:
VRG ventral respiratory group:
DRG dorsal respiratory group:
Pontine resp group=

A

= “Sa node” of the RR
= transmits signals via phrenic nerve & intercostal nerves
= keeps in check w/ VRG “Backhand man”
= smooths out transition of inhalation & exhalation

156
Q

Angionecrosis Edema:
Trimsmis:
Mentim:

A

= angioedemna
= Locked jaw
= tip of chin

157
Q

Needle cric/ Potential Complications:

A

= Barotrauma, Pneumothorax, Hypercarbia

158
Q

Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:

A

= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )

159
Q

(Paralysis w/ RSI Induction med pushes) Etomidate
Midazolam 0.1-0.3 mg/kg IV/IO
Ketamine 1-2 mg/kg IV/IO
Propofol 1-2 mg//kg IV/IO
(Push paralytic med RIGHT after med induction): Succinylcholine
Rocuronium

A

= 0.2-0.4 mg/kg IV/IO
= 0.1-0.3 mg/kg IV/IO
= 1-2 mg/kg IV/IO
= 1-2 mg//kg IV/IO
= 1-1.5 mg/kg IV/IO
= 0.6-1.2 mg/kg IV/IO (If succinylcholine is contraindicated)

Exams (10 decks)

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