Préhos

Question 1

Nommer ce qui est inclus dans le BLS

Answer 1

BLS describes the provision of emergency care without the use of advanced therapeutic interventions. Skills include airway management (oral and nasal airways, bag-mask ventilation), cardiopulmonary resuscitation (CPR), hemorrhage control, fracture and spine immobilization, and childbirth assistance. Defibrillation with an automated external defibrillator (AED) is often included by many BLS systems

Question 2

Décrire les gestes de ALS

Answer 2

Provider skills include advanced airway interventions, intravenous line placement, medication administration, cardiac monitoring and manual defibrillation, and certain invasive procedures

Question 3

Décrire les différents niveaux de formation de EMS et leurs tâches autorisées

Answer 3

Question 4

Décrire la chaîne de survie en arrêt cardiaque

Answer 4

Reconnaissance rapide de l’ACR

Appel rapide 911

Initier RCR

Défibrillation rapide

Soins avancés rapides

Hôpital/réadaptation rapide

Question 5

Nommer des éléments de contrôle direct et indirect du directeur médical

Answer 5

Indirect: Patient care guidelines and protocol development for EMTs and EMDs, formation des EMT, continuing medical education, medical-legal policies, and quality and performance improvement processes are important elements

Direct: This may be in the form of radio or telephone communications or by direct scene observation and may be considered centralized or decentralized. In a centralized system, a selected hospital is designated the lead facility (base station hospital, resource hospital, or sponsor hospital) and is responsible for providing all direct medical control orders and notification regardless of the receiving facility. In a decentralized system, each hospital functions as a base station, providing direction to EMTs transporting patients to its facility.

Question 6

Nommer les requis pour un transfert inter-hospitalier

Answer 6

Complete certification (risks and benefits) of transfer

Informed consent obtained from the patient or family

Appropriate transportation (equipment and personnel) arranged

Treatment and stabilization performed

Acceptance from receiving facility ensured

Appropriate patient care data sent (fax or with patient)

Question 7

Nommer les 4 lois des gaz et leur implication en transport aérien

Answer 7

Loi Boyle: le volume d’un gaz est inversement proportionnel à sa pression. (barotrauma, PTX, air a/n matériel de transports, ballonnets)

Loi Charles: Lorsque le volume d’une unité de gaz augmente, la température diminue

Loi Dalton: La pression totale d’un gaz est la somme des pressions partielles de chacun des gaz.

Loi Henry: La qte de gaz dissoute dans un liquide est proportionnelle à la pression de ce gaz au dessus du liquide. (accidents de décompression)

Question 8

Nommer les désavantages rotor / fixed

Answer 8

Rotor: noise, vibration, thermal variances, and other stressors on patients and crew exaggerated by rotor-wing flight. Weather considerations may at times significantly limit the availability of helicopter transport. In smaller helicopters, cramped spaces and weight limitations may limit the number of patients, transport personnel, or equipment that can be carried.

Fixed: Fixed-wing operations are limited, however, to areas that have airports with runways of appropriate length and airports with refueling facilities. During fixed-wing transports, patient transfers require multiple vehicles for each leg of the transport (ie, hospital to ground ambulance to airplane

Question 9

Nommer des règles de sécurité associées aux zones d’atterrissages

Answer 9

Vehicles and personnel should be kept at least 100 ft from the landing zone.

Spectators should be kept at least 200 ft from the landing zone.

No smoking or running is permitted within 50 ft of the helicopter.

All items (eg, intravenous lines, poles) should be kept below shoulder height.

The flight crew opens and closes aircraft doors.

The flight crew directs and supervises the loading and unloading of the patient and equipment.

Ground personnel should use eye and ear protection.

Approach the helicopter only when signaled to do so by the pilot or an onboard crew member.

Approach and depart the helicopter only forward of the rear cabin door and in a crouched position with your head down.

Never approach or depart from the rear of the helicopter.

Stay clear of the tail rotor; it is virtually invisible and extremely dangerous.

If the aircraft is parked on a slope, approach and depart on the downhill side (greatest clearance under the blades).

Keep the landing zone clear of (or hold on to) all loose articles (eg, hats, scarves, sheets, pillows).

Protect patient from the dust and debris.

Follow the flight crew’s instructions at all times.

In disaster situations and mass casualty incidents, victims, witnesses, and spectators may become hysterical or exhibit signs of an acute situational reaction. These individuals must be kept clear of the landing zone and helicopter at all times. Injured victims who exhibit this behavior should not be triaged for helicopter transport, or they should be transported only with adequate physical or chemical restraints in use.

If you do not know, ask.

Question 10

Nommer les éléments de sécurité requis sur les zones d’aterrissages

Answer 10

Landing Area

Landing zone should be as close as possible to the scene or hospital entrance but not so close that it may interfere with ground operations or patient care.

Landing zone should be at least 100 × 100 ft.

Landing zone should be as flat and level as possible.

Landing zone must be clear of debris.

Hazards and Obstructions

Identify all potential hazards that may be on the ground or near the approach/departure path of landing zone.

Landing zone should be clear of wires, poles, trees, buildings, vehicles, and spectators.

Road cones, ropes, tape, and barricades are not recommended for use near landing zone.

Perimeter of landing zone should be at least 50 ft away from potential obstructions and hazards.

Landing zone should be located upwind from any hazardous material incident.

Approach and Departure Path

Path should point into the wind and be free of obstruction to an altitude of 500 ft above the surface.

Path should not pass over command posts, treatment areas, or operationally congested areas on the ground.

Day Operations

Use radio communications and hand signals.

Stand with your back to the wind.

Night Operations

Use radio communications and lighting to designate landing zone.

Spotlights should be directed at the top of possible hazards, not toward the approaching or departing aircraft.

Position a portable light, vehicle headlights, emergency vehicle flashing lights, flare, or chemical stick at each corner, with a fifth light upwind.

Nonessential lights should be turned off.

Light Sources

Lights must be clear of landing zone.

If portable, lights must be well secured.

Never point lights toward an approaching or departing helicopter.

Wind Indicator

Indicator may be a wind sock, flag, flare, or smoke.

Indicator must be clear of landing zone.

If portable, indicator must be well secured.

Question 11

Situations nécessitant un transport aérien

Answer 11

Distance to the closest appropriate facility is too great for safe and timely transport by ground ambulance.

Patient’s clinical condition requires that the time spent in transport be as short as possible.

Patient’s condition is time critical, requiring specific or timely treatment not available at the referring hospital.

Potential for transport delay associated with ground transport is likely to worsen the patient’s clinical condition.

Patient requires critical care life support during transport that was not available from the local ground ambulance service.

Patient is located in an area inaccessible to regular ground traffic, impeding ambulance egress or access.

Local ground units are not available for long-distance transport.

Use of local ground transport services would leave the local area without adequate EMS coverage.

For interfacility medical transport, the requesting physician based on his/her best medical judgment and information available at that time of transport determined the need for AMT.

For scene medical transport, the requesting authorized out-of-hospital provider based on applicable policy, his/her best medical judgment and information available at that time of transport determined the need for AMT.

Question 12

Nommer les 3 composantes nécessaires lors d’une demande importante de service (surge capacity)

Answer 12

3 S

Staff

Stuff

Structure

3T : treatement, triage, transport

3D: decant, deflect, defer

Question 13

préciser le vocabulaire relié au désastre

Answer 13

Désastre: événement besoins nécessaires surpassent les ressources disponibles.

Interne vs externe: événement se produisant à l’intérieur de l’hôpital versus extérieur. Certains peuvent être mixtes. (Ex tremblement de terre)

Nomenclature PICE, potential injury-creating event

Question 14

Donner des exemples de désastres paralytiques destructifs et non destructifs

Answer 14

Destructive

Bomb explosion

Earthquake

Fire

Civil unrest

Nondestructive

Snowstorm

Employee strike

Power failure

Water supply cutoff

Question 15

Décrire le triage START

Answer 15

Question 16

Décrire le incident command system

Answer 16

At the most basic level, there are five functional elements in the organizational structure: incident command, operations, planning, logistics, and finance. The principles of an incident command system can also be applied to the hospital setting through implementation of a Hospital Incident Command System

Incident commander: The incident commander has overall management responsibility for the incident.

Operations section: The operations section has a chief who is responsible for the management of all incident tactical activities.The operations section also manages the resources assigned to staging areas. It is under the operations section that all medical triage and care is provided.

Planning: The planning section collects, evaluates, and disseminates information about incident operations and the status of resources. This section also develops incident action plans and conducts planning meetings.

Logistic: The logistics section’s chief is responsible for providing facilities, services, and material in support of the incident. This includes procuring equipment and supplies, providing food and medical support, and meeting transportation needs

Finance: The finance section is responsible for maintaining records on personnel and equipment, providing payments to vendors for supplies and use of equipment, and determining the cost of various alternatives for strategic planning

Question 18

Décrire les 4 phases du emergency management plan

Answer 18

Comprehensive emergency management consists of four phases: mitigation, preparedness, response, and recovery. Mitigation involves taking actions to reduce the impact of identified hazards. Enhancing the seismic structural design of hospitals is one strategy to mitigate the impact of large earthquakes on the health care system. Training, drills, and cataloging of resources are examples of preparedness activities. Responseincludes assessment of the situation and coordination of resources. Finally, recoveryconsists of a return to normal operations and debriefing to critique the response and to provide long-term psychological support to the victims and rescuers.

Question 19

Décrire les composantes requises au plan de réponse en cas de désastre

Answer 19

Groupe de planification interdépartemental

Planification des ressources

Structure de commande claire

Médias

Communication

Personnel

Prise en charge des patients

Exercices - pratiques

Question 20

Pourquoi les enfants sont-ils plus à risque lors des expositions CBRNE

Answer 20

Children are particularly vulnerable to these weapons.1 They breathe at a faster rate than adults do, increasing their relative exposure to aerosolized agents.2 Some chemicals, such as sarin, are heavier than air, so they tend to accumulate at the level where children are more likely to inhale them. Children have a greater surface area–to–volume ratio and their skin is thinner. This makes them more susceptible to agents that act on or through the skin. They have smaller fluid reserves and higher metabolic rates. Therefore, they are more vulnerable to dehydration from vomiting and diarrhea and suffer increased toxicity from a given exposure, such as to radioactive iodine (131I).

Question 21

Nommer des agents de destruction de masse

Answer 21

Chemical

Nerve agents

Sarin

Soman

Tabun

VX

Mustard agent

Biologic

Anthrax

Plague

Smallpox

Botulism

Viral hemorrhagic fever

Tularemia

Radiologic

Simple device

Dispersal device

Question 22

Nommer des caractéristiques dans la survenue d’une attaque par agent de destruction de masse

Answer 22

Fear of unknown or unfamiliar

Lack of training for hospital personnel

Lack of equipment, including personal protective equipment (PPE) and diagnostic aids

Potential for mass casualties

Psychological casualties

Crime scene requiring evidence collection and interaction with law enforcement

Potential for ongoing morbidity and mortality (dynamic situation)

Question 23

3 types d’exposition à la radiation

Answer 23

Radiation simple, contamination interne et contamination externe.

Question 24

Nommer des signes suggérant la présence d’un agent biologique

Answer 24

Syndromes

Pulmonary symptoms, pneumonia

Rashes

Sepsis syndrome

Influenza symptoms

Epidemiology

Multiple, simultaneous events

Dead animals

Large numbers of patients with high toxicity and death rate

Question 25

Recommandations pour prévenir la transmission des agents infection intra-hospitaliers

Answer 25

Isolate patient in single room with adjoining anteroom.

Have handwashing facilities and personal protective equipment (PPE) available in anteroom.

Use negative air pressure if possible.

Use strict barrier precautions: PPE, gowns, gloves, high-efficiency particulate air (HEPA) filter respirators, shoe covers, protective eyewear.

Alert hospital departments that generate aerosols: Laboratory (centrifuges), pathology (autopsies)

Question 26

Nommer les 6 agents biologiques de catégorie A (major threat)

Answer 26

six Category A (high threat) agents (anthrax [Bacillus anthracis],botulism [Clostridium botulinum toxin], plague [Yersina pestis], smallpox [variola major], tularemia [Francisella tularensis], and viral hemorrhagic fevers [filoviruses (eg, Ebola, Marbug)] and arenaviruses [eg, Lassa, Machupo]

Question 27

présentation clinique anthrax

Answer 27

Bacillus anthracis, gram positif formant spores. Inoculation via inhalation, ingestion ou contamination cutanée. Habituellement a/n chèvres, veaux et chevaux

Forme respiratoire: 50-90% mortalité. Influenza-like, choc septique avec médiastinite hémorragique/adn hilaires, épanchement pleuraux hémorragiques

Forme cutanée: mortalité 20% sans et 1% avec traitement. Papule-vésicule-adn-oedème- escarre noir, puis auto-résolu versus dissémination et mort. Antibio pour prévenir dissémination

Forme GI ou oropharyngée: dlr gorge, adn, dlr abdo, no/vo, lymphadénite mésentérique, abdomen aigu. Mortalité 50%

Traitement: CF tableau. Prophylaxie post exposition, même traitement pour 60 jours ou ad 3 doses de vaccin

Question 28

Nommer les 3 formes de peste et leurs particularités

Answer 28

yersinia pestis, bacille gram neg. PAs de spore, réservoir a/n rongeurs et chats. Transmission via morsure ou inhalation

Forme pneumonique: inhalation - influenza like, puis pneumonie sévère, fulminante, hémoptysie, choc. Coagulopathie avec nécrose doigts/orteils/ nez. (enzyme produite lorsque temp sous 37). Transmission humain-humain possible

Forme bubonique: inoculation via morsure, puis localisation a/n ganglions avec oedème et nécrose. Formation de bubo (pas transmission humain-humain), parfois ulcération et vésicule. Disparition avec antibio.

Forme septicémique: dissémination via bubonique ou spontanée. Pas transmision humain-humain. Choc/CIVD

Question 29

Variole

Answer 29

4 formes: variole majeure et mineure (90%), 10% forme hémorragique et maligne (plate)

Inoculation via inhalation, réplication a/n ganglions, dissémination rate/moelle osseuse/foie, virémie 10jr + tard avec fièvre et sx pharyngé + peau. Rash maculopapulaire qui devient vésiculaire et pustulaire. Apparition lésions a/n visage/bras et progresse. Lésions cutanées toutes au même stade

It relies on three major and five minor criteria. The major criteria are a febrile prodrome, classic smallpox lesions, and lesions in the same stage of development. The minor criteria are centrifugal distribution of pustules; first lesions on the oral mucosa, face, or forearms; toxic appearance; slow evolution of lesions; and pustules on the palms and soles

Si exposition: vaccin + IVIg, pas de tx si maladie clinique

Question 30

Planification en cas d’attaque avec agents chimiques

Answer 30

Community-based hospital planning

Personnel trained in recognition, mass casualty triage, and treatment

Decontamination facility with protocols (eg, runoff water, warm water)

Personal protective equipment (PPE) readily accessible and compliant with regulations

Rapid access to antidotes, cyanide kits, and anticonvulsants

Hospital incident management system in place

Knowledge of how to access experts quickly

Question 31

Nommer les 4 types d’agents chimiques

Answer 31

Nerve agent

Agents vésicants

Agents asphyxiants

Cyanides

Question 32

Nerve agents

Answer 32

organophosphates, bloquent l’Achcholinestérase. Sx cholinergiques muscariniques (larmes, vo, bronchorrhée…) + nicotiniques (fasciculations, paralysie). Convusions/coma.

Vapor Exposure (Sarin)

Mild: Rhinorrhea and miosis

Moderate: Mild symptoms plus increased secretions, wheezing or dyspnea, muscle weakness or fasciculations, or gastrointestinal effects

Severe: Apnea, seizures, loss of consciousness, flaccid paralysis, or major involvement of two organ systems

Liquid Exposure (VX)

Mild: Localized sweating and fasciculations where a drop touches the skin; no miosis; may be delayed for 18 hours

Moderate: Gastrointestinal effects; miosis uncommon; may be delayed for 18 hours

Severe: Apnea, seizures, loss of consciousness, flaccid paralysis, or major involvement of two organ systems; occurs in less than 30 minutes at or above median lethal dose (LD50)

Traitement

Vapor

Mild: Observe for 1 hour, then release; no treatment

Moderate: One or two Mark I kits IM; or atropine, 2 to 4 mg IV, may repeat every 5 to 10 minutes as needed; and 2-PAM, 1 g IV during 30 minutes, may repeat every hour as needed

Severe: Three Mark I kits IM and one diazepam autoinjector IM; or atropine, 6 mg IV, may repeat 2-mg boluses IV every 5 to 10 minutes; and 2-PAM, 1 g IV during 30 minutes, repeat every hour for total of 3 g; and midazolam or diazepam, 5 mg IV, or midazolam 10 mg IM, may repeat as needed

Liquid

Mild: One Mark I kit IM; or atropine, 2 mg IV; and 2-PAM, 1 g IV during 30 minutes

Moderate: Same as for vapor

Severe: Same as for vapor

Pediatric Doses

Atropine, 0.02 mg/kg IV

2-PAM, 20 to 40 mg/kg IV during 20 to 30 minutes

Midazolam, 0.15 mg/kg IV; or diazepam, 0.2 to 0.3 mg/kg IV

Question 33

Agents vésicants

Answer 33

Gaz moutarde. Toxique en forme liquide + gazeuse. Cause lésions cutanées (type brûlure 2e degré avec vapeur et 3e degré avec liquide) + toxicité systémique. (induit aplasie médullaire)

Sx respiratoires léger ad intubation avec nécrose des bronchioles. Tx support

Pas d’antidote. Décontamination importante

Question 34

Cyanide

Agents asphyxiants

Answer 34

hydrogen cyanide or cyanogen chloride

Low-dose exposures result in tachypnea, headache, dizziness, vomiting, and anxiety. Symptoms subside when the patient is removed from the source. At higher doses, the symptoms progress to seizures, respiratory arrest, and asystole within minutes of exposure.

Cyanokit pour traitement

Agents asphyxiants: phosgene et chlorine, tx support

Question 35

Nommer les 3 types de ballistique

Answer 35

.

Internal ballistics, which pertains to the projectile while in the firearm

2.

External ballistics, or the path of the projectile from when it leaves the firearm until it reaches the target

3.

Terminal (or wound) ballistics

Question 36

Nommer la formule de l’énergie cinétique

Answer 36

KE= 1/2 (mv²)

Question 37

Décrire la différence entre la cavité temporaire et permanence

Answer 37

The temporary cavity results from a shock wave generated as the bullet enters the tissue, which results in a brief distortion or stretching of the tissue.7,10 This tissue distortion lasts for a brief amount of time, 5 to 10 milliseconds from its generation until its collapse, and leaves behind the permanently crushed tissue and permanent cavity.7,9,10 The effect of the temporary cavity depends on the elasticity of the tissue traversed: solid organs such as the liver, bone, or kidneys do not tolerate this temporary deformation as well as more elastic tissue (eg, lungs, skeletal muscle, skin), and therefore sustain more damage

Question 38

Décrire les composantes d’une cartouche d’arme à feu

Answer 38

Question 39

Décrire de facon générale l’aspect des plaies selon la porte de l’arme à feu

Answer 39

Question 40

Nommer 5 indications de prophylaxie antibio avec les plaies d’arme à feu

Answer 40

Indications for prophylactic antibiotics are grossly contaminated wounds, abdominal wounds with hollow viscus injury, intraarticular injuries, intracranial injuries, and high-energy gunshot injuries

Question 41

Nommer des patterns de blessures induites par trauma blunt

Answer 41

Slap marks with digits delineated

Looped or flat contusions from belts or cords

Circular contusions from fingertip pressure

Parallel contusions with central clearing from linear objects

Contusions from shoe heels and soles

Semicircular contusions and abrasions from bite marks

Question 42

Nommer 5 caractéristiques de plaies auto-infligées

Answer 42

Multiple superficial incisions located on the anterior trunk, arms, and face

Multiple superficial stab wounds located on the anterior trunk, arms, and face

Parallel incisions, in close proximity to each other, on the nondominant side of the body

Sparing of sensitive body areas

Linear or curved incisions toward the hand inflicting the wound

Intact clothing covering the wound

Evidence of prior wounds in repeat offenders

Question 43

Qu’est-ce que la loi humanitaire internationale? ou loi de guerre

Answer 43

IHL gives special protections to people not taking part in conflict—civilians and soldiers rendered incapable of fighting due to injury, illness, surrender, or having been taken prisoner. It mandates that these noncombatants be treated humanely and be given food, water, shelter, and medical care. IHL not only ensures noncombatants the right to humanitarian assistance, but also grants humanitarian aid workers the right to offer that assistance

Question 44

Nommer les 4 principes humanitaires

Answer 44

Humanité: Human suffering must be addressed wherever it is found. The purpose of humanitarian action is to protect life and health and ensure respect for human beings.

Neutrality: Humanitarian actors must not take sides in hostilities or engage in controversies of a political, racial, religious or ideologic nature.

Impartiality: Humanitarian action must be carried out on the basis of need alone, giving priority to the most urgent cases of distress and making no distinctions on the basis of nationality, race, gender, religious belief, class or political opinions.

Independence: Humanitarian action must be autonomous from the political, economic, military or other objectives that any actor may hold with regard to areas where humanitarian action is being implemented.

Question 45

Nommer les éléments d’une unité aux nations unies

Answer 45

Question 46

Décrire les différentes zones en combat

Answer 46

Zone rouge - under fire - menace directe: garrot seulement

Tactical field care - zone jaune - menace indirecte: tx hémorragie avec pansements/ hémostatiques topiques, décompression à l’aiguille, airway BLS, CPR, accès IO ou IV

Zone verte- combat casualty evacuation care - evacuation: evacuation et traitements définitifs, ALS