Pocket Prep 1

Question 1

define the following:

• epiglottis
• cricoid cartilage
• vallecula
• carina

Answer 1

The epiglottis is a flap-like structure that closes off the trachea during swallowing.

The cricoid cartilage forms the lower portion of the larynx; indicates the end of the upper airway and beginning of lower airway.

The vallecula is the depression just behind the tongue; it forms a depression where the rings of the trachea begin.

The carina is the location of the bronchiole bifurcation.

Question 2

guidelines for approaching a helicopter or any another aircraft w a patient (5)

Answer 2

Ensure that all patient care equipment is properly secured.

With the exception of rear-loading aircraft, always approach the helicopter in a crouched position from the front and after the pilot has signaled it is clear to do so.

This approach should be between the ten o’clock and two o’clock positions.

Do not duck under the body, the tail boom or rear sections of the helicopter, as the pilot is unable to see in these areas.

If flight crew is present, always follow their instructions.

Question 3

larynx

Answer 3

structure formed by independent cartilaginous structures, the epiglottis, the glottis, and the vocal cords (superior aspect), the thyroid cartilage (middle structure), and the cricoid cartilage (inferior aspect), which lies opposite the 6th cervical vertebra

The cricoid cartilage of the larynx marks the end of the upper respiratory tract.

Question 4

early signs of hypoxia vs late

Answer 4

Restlessness, irritability, apprehension, tachycardia, and anxiety are early signs of hypoxia. Late signs of hypoxia include altered mental status, a weak/thready pulse, and cyanosis.

use a NRB on patients that are suspected of or showing signs of hypoxia

Question 5

Penetrating injuries to the neck can result in …. (4)

Answer 5

Cervical spine tenderness, subcutaneous emphysema, tracheal deviation, and laryngeal fracture

Question 6

subcutaneous emphysema

Answer 6

presence of air in the soft tissues of the neck; this commonly occurs due to blunt trauma

noted w a characteristic crackling sensation upon palpation of the neck

Question 7

air embolism

Answer 7

An air embolism is when air exists within the vascular system. If a vein is punctured within the neck, air may be sucked through to the heart.

If enough air is present in the right atrium and right ventricle, cardiac arrest may occur.

Question 8

traction splints contraindication

Answer 8

Traction splints are contraindicated in injuries involving the upper extremities, the pelvis, knee, lower leg, foot or ankle as well as injuries close to the knee or partial amputations or avulsions with bone separation.

Question 9

substance abuse during pregnancy can lead to … (4)

Answer 9

prematurity, low birth weight, and severe respiratory depression

specifically for alcohol, fetal alcohol syndrome

Question 10

guidelines for dealing w patient w acute psychosis (6)

Answer 10

In cases of acute psychosis, it is important to remain calm and speak to the patient in a respectful, direct, and straightforward manner.

Maintain an emotional distance.

Explain procedures.

Involve people that the patient trusts.

Do not agree or disagree with the patient’s delusions.

Do not patronize, argue with the patient, or challenge the validity of his/her perception.

Question 11

Risk factors that increase the likelihood of heat-related illnesses

Answer 11

preceding viral infection, dehydration, fatigue, obesity, lack of sleep, and poor physical fitness

Illicit drugs such as cocaine and amphetamines (Ecstasy), also put users at risk.

Question 12

another name for the following:

• opiate / opiods
• anticholinergics
• sedative-hypnotics

Answer 12

Opiate / opioid = narcotics

Anticholinergic = antihistamines

sedative-hypnotic = Benzodiazepines

Question 13

What is the order of treatment for a patient in a high MOI car accident that presents with a profusely bleeding head injury and claims he cannot move anything below his neck?

Answer 13

Inline stabilization
Bleeding control
Continuation of rapid assessment
ABC management
Cervical collar application

Question 14

High priority patients (not in a MCI scenario)

Answer 14

High-priority patients are those that require a rapid transport.

Examples include patients who are unresponsive, are responsive but unable to follow commands, yield a poor general impression, have difficulty breathing, have uncontrolled bleeding, have severe chest pain, have severe pain in any area of the body, have pale skin/signs of poor perfusion, or pregnant patients with a likely complicated childbirth.

Question 15

triads to know

Answer 15

Cushing: high systolic / mean arterial blood pressure (aka hypertension); Bradycardia; irregular respiration
– signifies increased ICP

Beck: jugular vein distension + narrowing pulse pressures + muffled heart sounds
– signifies obstructive shock, cardiac tamponade

Question 16

guidelines when transporting a patient with family members (either a parent or child) present (4)

Answer 16

While family-centered care is desirable, it must be done without placing the patient, family, child or provider at increased risk.

When the patient is a child, when possible, arrange for alternative care and/or transportation so that attention can be focused on the patient. Appropriate child restraints should be used when possible, although ambulances are often ill-equipped to safely secure pediatric patients.

If the child is not the patient, consider utilizing accompanying law enforcement or another emergency vehicle.

If separating the child and parent is problematic, follow proper procedures and protocols, and secure both patients in appropriate restraint systems and position.

Question 17

asthma
+ common triggers (4)
+ signs / symptoms

Answer 17

condition in which bronchioles are inflamed, swollen, and producing excessive mucus

common triggers: upper respiratory infections, exercise, exposure to cold air or smoke, and emotional stress

Wheezing, dyspnea, cyanosis, and respiratory arrest may occur.

Question 18

Signs of internal bleeding within the gastrointestinal tract

vs. urinary tract

Answer 18

bloody vomit, known as hematemesis, (either bright red or having a coffee ground appearance), bright red blood in the stool (hematochezia) or dark and tarry stools, known as melena

bloody urine (hematuria)

Question 19

neurogenic shock symptoms vs cardiogenic

Answer 19

Neurogenic shock can be identified by the absence of sweating under the site of injury.

Vs. Cardiogenic shock commonly presents with chest pain, weak pulse, hypotension, cyanosis, rales, pulmonary edema, and cool, clammy skin.

Question 20

passive rewarming

• what is it
• how to achieve it (5)
• what not to do (2)

Answer 20

appropriate first step when dealing with a patient who has mild hypothermia

warm environment + removing of wet clothing + applying heat packs/hot water bottles to the groin, axillary, and cervical regions + placing dry blankets over and under the patient + supplying humidified oxygen

patient should not be walking, nor should any heat packs / water bottles be placed directly on the skin

Question 21

neurogenic shock symptoms vs hypovolemic

Answer 21

both are marked by hypotension

but neuro is also marked by bradycardia

and hypo is marked by tachycardia + cool / clammy skin

Question 22

define the following:

• tolerance
• addiction
• overdose
• substance abuse

Answer 22

A tolerance is a need for increasing amounts of a drug to obtain the same effect.

Addiction is the overwhelming obsession to continue the use of a substance.

An overdose is the excessive quantity of a drug that can have toxic or lethal consequences.

Substance abuse is the misuse of any substance to produce the desired effect.

Question 23

pupils change w what drugs

Answer 23

Pinpoint pupils are commonly seen in opiate / opioids

whereas dilated pupils are often seen in sympathomimetic / anticholinergic / hallucinogens / marijuana

Question 24

how to treat vaginal bleeding that is traumatic vs non traumatic

Answer 24

If external injuries are present, treat the bleeding with local pressure and a diaper-type bandage to hold dressings in place.

If the bleeding is non-traumatic, place a sanitary pad to absorb the blood.

If any foreign bodies are present, stabilize them with bandages. It is inappropriate to pack or place dressings inside the vagina.

Question 25

what type of edema can left ventricular heart failure vs right

Answer 25

left causes pulmonary edema

vs right causes peripheral

Question 26

power lift stance

Answer 26

lock back in a slight curve with legs apart

ensure balance of weight btwn the arms (if not, adjust legs)

lift with your legs, not your back

Question 27

Significant MOI in the setting of a motor vehicle is defined as… (4)

Answer 27

death of another occupant of the vehicle

severe deformity/damage of the vehicle or intrusion into the vehicle

crashes in which rotation (rollover and spins) is involved

ejection of an occupant from the vehicle

Question 28

primary assessment takes precedence over …

Answer 28

Assessment of the individual (ie obtaining a set of vitals) takes precedent over all non-life threatening injuries or non-emergency moves (incl rapid transportation).

Question 29

heimlich maneuver

• what is it / how does it work
• actual technique

Answer 29

recommended for removing severe airway obstructions in responsive adults and children older than one year of age
– This technique creates an artificial cough by causing a sudden increase in intrathoracic pressure.

Abdominal thrusts should be performed with the rescuer standing behind the patient and wrapping his/her arms around the patient’s body. Place a fist just above the umbilicus and well below the xiphoid process. Place the other hand over the fist. Thrusts are performed in an upward direction. If the patient becomes unresponsive, chest compressions, as in CPR, are performed in lieu of abdominal thrusts.

Question 30

General guidelines for safe lifting of a patient (8)

Answer 30

keeping the legs shoulder-width apart

keeping the back in a straight, locked-in position

keeping the patient’s weight as close to one’s body as possible

bending at the knees, not the waist, when lifting

avoidance of lifting and reaching simultaneously

avoidance of twisting of one’s body while lifting

lifting with the palms facing upward

constant communication with other partners or team members

Question 31

define the following:

• dyspnea
• atelectasis
• hypoxia
• aspiration

Answer 31

Dyspnea is shortness of breath or difficulty breathing.

Atelectasis is the collapse of alveoli.

Hypoxia is low oxygenation throughout the body.

Aspiration is the introduction of vomitus or other foreign material into the lungs.

Question 32

how far should AEDs be placed away from a pacemaker

Answer 32

at least one inch away (2.5 cm)

Question 33

What should be done when a competent, alert adult patient is refusing treatment / transportation?

Answer 33

recall that the patient has a right to self-determination and to make decisions about his care.

risk, benefits, and alternatives to the treatment and its refusal must be explained to the patient prior to accepting a refusal

Any refusal of treatment/transport should be documented and signed by the patient, with a witness

Question 34

narrowest portion of the airway

• children
• adults

Answer 34

In children younger than eight years old, the narrowest part of the airway is the cricoid ring.

in adults, it is the glottis

Question 35

When should you use humidified oxygen?

+ how does it work

Answer 35

Humidified oxygen is generally used for extended transport or for specific conditions, such as croup.

An oxygen humidifier consists of a small, single-patient-use bottle of water through which tubing for oxygen flows before it reaches the patient.

Question 36

What should be done after a previously pulseless, apneic patient is observed to have ROSC?

Answer 36

ROSC is defined as the return of spontaneous circulation (pulse) in a patient recovering from cardiac arrest. ABCs should be followed, with airway and breathing assessment after ROSC is achieved.

If the patient is not breathing adequately, assisted ventilation should be provided. If the patient is breathing adequately, high-flow oxygen via a nonrebreather mask should be provided.

Question 37

how far should a catheter be inserted

Answer 37

A rigid catheter should be inserted to the depth measured. The catheter is measured prior to use on the patient from the corner of the mouth to the tip of the earlobe in a conscious or semiconscious patient. Catheter insertion in this setting may induce vomiting.

Question 38

anaphylactic shock causes

Answer 38

injections (e.g., tetanus antitoxin, penicillin), stings from insects, ingestion of foods, and inhalation of particles (e.g., dust, pollen, mold)

Question 39

heat exhaustion causes

+ assoc condition

Answer 39

most common heat emergency

It is caused by heat exposure, stress, and fatigue.

Hypovolemia is common, due to the loss of water and electrolytes via sweating.

Question 40

Patients who are involved in a fire …

Answer 40

Patients who are involved in a fire are likely to inhale smoke and experience respiratory distress or arrest; smoke inhalation is the most frequent cause of death in patients who are involved in a fire.

Question 41

what patient should an AED be used on

Answer 41

An automated external defibrillator (AED) is indicated in a patient who is pulseless and unresponsive. An AED should not be used on a patient who is responsive or has a palpable pulse.

Question 42

Cardiac tamponade

• what is it
• common causes
• common signs

Answer 42

result of blood or fluid filling the pericardial sac

commonly occurs due to a ruptured, torn, or lacerated coronary artery or vein, but may occur due to autoimmune disorders or cancer

indicated by beck’s triad (jvd + muffled heart sounds + narrowing pulse pressure)

Question 43

how to treat epistaxis

Answer 43

Epistaxis = bloody nose

Can occur for patients of all ages; treatment begins by placing the patient in a upright, seated position with the light pinching of the nose and slight forward leaning for 10 minutes.

Blood from a nosebleed may be swallowed, so it is appropriate to monitor for nausea and vomiting. This can be prevented by avoiding leaning the head back or having the patient lay supine.

Question 44

MCI

• what is it
• what should be done and in what order

Answer 44

A mass-casualty incident (MCI) is a situation that involves, or could potentially involve, three or more patients.

1) request additional resources, establish incident command, and begin primary triage procedures (aka tagging patients based on priority of care) then secondary triage (sorting patients into categories for movement / transport)
2) information relayed to director about convey info about # of patients total, # in each category, recommendations for extrication / movement of patients, resources needed to complete triage and begin movement of patients

3) Once law enforcement has declared a scene safe, it is acceptable to enter the scene and begin assessment/treatment.
- - If new potential danger arises, immediately leave the scene and contact appropriate authorities.

Question 45

Causes of altered mental statuses

AEIOU-TIPS mnemonic
E3 T2 P2 S6

Answer 45

Alcohol

Epilepsy, endocrine disorders, electrolyte imbalance

Insulin (i.e., hypoglycemia)

Opiates and other drugs

Uremia (kidney failure)

Trauma (particularly head trauma), temperature (hypothermia/hyperthermia)

Infection

Poisoning, psychogenic causes

Shock, stroke, seizure, syncope, space-occupying lesions, subarachnoid hemorrhage

Question 46

Head tilt / chin lift technique

Answer 46

The head-tilt/chin-lift maneuver is completed by placing the patient in a supine position and the rescuer beside the patient’s head.

The heel of one hand is placed on the patient’s forehead and firm backward pressure is applied to tilt the patient’s head back. The fingertips of the alternate hand are placed under the lower jaw, near the bony part of the chin; the chin is then lifted upward. The forehead is held to maintain the backward tilt.

Question 47

Jaw thrust technique

Answer 47

If spinal trauma is suspected, the jaw-thrust maneuver is performed. Inline stabilization of the cervical spine is used to ensure no further damage occurs until a C-collar can be applied.

The rescuer kneels above the patient’s head with fingers behind the angles of the lower jaw. The jaw is then moved upward with the index and middle fingers while the thumbs are used to help position the lower jaw.

Question 48

other issues assoc w burns

+ specifically due to airway swelling

Answer 48

All burns increase the potential risk of infection, hypothermia, hypovolemia, and shock.

A burn to the airway could potentially lead to an airway obstruction due to swelling of mucosa in the airway; obstruction will compromise breathing.

Question 49

circumferential burns

• of airway
• of extremities

Answer 49

Circumferential burns of the chest can compromise breathing, as well.

Circumferential burns of an extremity can lead to compartment syndrome (painful condition that occurs when pressure within the muscles builds to dangerous levels as a result of fluid accumulation, thus disrupting blood flow to muscle and nerve cells)

Question 50

When do you use various techniques of opening the airway?

Answer 50

The jaw-thrust maneuver is used to open the airway of a traumatic patient. The head-tilt/chin-lift maneuver is reserved for non-traumatic patients or patients in which opening the airway with the jaw-thrust maneuver has failed; a patent airway takes precedence over a further injury.

Question 51

guidelines for treating a poisoned patient

• what does contact w poison look like
• dry chemical
• liquid chemical
• other concerns

Answer 51

Contact with a poison may cause chemical burns, rash, itching, irritation, or erythema.

If the chemical is dry, brush off the remaining chemical, flush with water for 15-20 minutes, then wash with soap and water. Cases of liquid exposure should be flushed for 15 to 20 minutes.

Emergency management of contact poisoning includes avoiding self-contamination by EMS personnel and removal of the irritating or corrosive substance from the patient. Ensure communication with hazardous materials teams, and be sure to decontaminate yourself after treatment of the patient.

Question 52

early v late signs of respiratory distress

Answer 52

Early signs of respiratory distress in an adult patient may include the tripod position, tachypnea, and retractions.

As respiratory distress continues and the patient becomes tired from the effort of breathing, hypoxia, bradypnea, bradycardia, and altered level of consciousness may occur.

In severe respiratory distress, wheezing may be audible.

Question 53

cardiac compromise symptoms

Answer 53

Chest pain/discomfort that is commonly described as pressure or heaviness, with nausea and vomiting, dyspnea, and sweating

any patient exhibiting these symptoms should be assumed to be having an acute myocardial infarction (AMI)

Question 54

RUQ pain that radiates to the right shoulder indicates …

vs. left

Answer 54

right = lacerated liver
left = lacerated spleen

Question 55

What artery should you palpate based on age of the patient?

Answer 55

Brachial if patient is less than one year of age (ie infants)

Carotid for any patient older than one year of age.

never radial