Tonys Review Flashcards
Lidocaine 2gm / 500ml run at 2mg / min =
30gtts
Lidocaine Drip =
4mg / min
Lidocaine Drip =
2gm in a 500 bag D5W at 30gtts
2gm into 500ml with concentration of 4mg/min?
60gtts
IV set at 20gtts/min using microdrip; how many ml’s?
10ml
Dr. orders 1000mg of a drug. The Drug comes packaged .5gm/ml. How many ml’s do you give?
200ml
Dr. orders 200mg of a drug. The Drug comes packaged 25mg/ml. How many ml’s?
8ml
Epinephrine does what?
Vasoconstriction and Bronchodilation
Epinephrine stimulates heart in?
Asystole
Epinephrine causes what?
Increased BP, Palpitation, Tachycardia
In regards to Epi, what is the correct dose? 1:1000 IV, 1:1000 SQ, IM, 1:10,000 IM, 1:10,000 SQ
1:1000 I.V.
Burns shift what?
Plasma to interstitial space
An 80kg . Patient who needs Lidocaine (scenario calls for Lido as TX of choice not Cardioversion due to description they give of the patient)
100mg Lido Bolus (best answer)
sign of Irreversible Shock?
Bradycardia
(Irreversible shock is a condition in which the shock can no longer respond to any treatment as a result of massive cell damage*)
Administration of IV Hypertonic solution on a hydrated patient will?
Draw water from the cells to the vascular space
Anaphylactic & Septic shock, Low BP due to?
Vasodilation
Beta question =
Increased heart rate
did not refer to beta 1or2, just beta
When beta-receptors are stimulated, the Heart Rate does what?
Increases
Cells of the heart that conduct electrical activity causing Depolarization and Contraction? (characteristic)
Automaticity
Chief Intracellular Cation =
Potassium
Chief Extracellular Cation =
Sodium
Hint: dont get EXTRA = salty) ;
Definition of shock?
Lack of Tissue Perfusion or Inadequate Tissue Perfusion
One of the FIRST Sign’s of Shock?
Restlessness, Elevated Heart Rate
Irreversible Shock =
Low Heart Rate,
slower than normal) (death is inevitable
Late Sign of Irreversible Shock?
Bradycardia
Which is a sign of UNCOMPENSTAED Shock?
Decrease BP
Earliest Detectable Sign of Shock is?
Tachycardia
Compensated Shock causes what?
Increased blood & Decreased Peripheral Perfusion
1st Tachycardia, Increased Pulse, cool, clammy, anxious
Decompensated shock causes what?
Falling BP, Thirst, Decreased LOC
1st Hypotension, un-palpable pulse, respirations slows, & Lethargic
Pt. with valid DNR order, what treatment can you still offer as a medic?
Pt. Comfort Measures/Supportive Care
(O2, & Pain control)
(DNR is a form of refusal)
You find clear FLUID coming out of the patient Ears, you should suspect?
Basilar Skull Fracture
You see Fluid running out of the patient’s nose and ears, what do you do?
Halo Test
Parasympathetic nervous system?
Decreases HR
A Chemical Mediator for the Parasympathetic Nervous system is?
Acetylcholine
SLUDGE
What is the neurotransmitter for the Parasympathetic Nervous system =
Acetylcholine
Increase PaCO2 Regulates/Controls what?
Respiration
partial pressure of CO2 in the blood
Intent is NOT required to PROVE?
Negligence
Malicious Writing in a report?
Libel
Slander = verbal version of libel
Elements of Negligence are? )
Duty to Act, Failure to act, Breach of duty
Cause harm, damages
Adenosine slows conduction where?
The Sinus (SA) & the AV Node
Sympathetic stimulation causes what?
Vasoconstriction & Increase HR
Emergency Medical Service Act?
Chapter 401
provides legislation governing all pre hospital EMS
In an ambulance crash, the court will try to prove?
Lack of due regard
for the ambulance driver
What’s due regard?
Driving with care for others
Put 1gm in 250cc of D5W, how much do you give?
4mg/ml (1gm=1,000mg/250 = 4mg/ml)
you have a 15gtts/ml drip set, you must infuse medication for ONE HOUR, & you are running it at 45gtts/min. How many ml/cc?
180cc (45x60=2700/15 = 180)
Patient in an MVA has a head injury, Pt. BP 80/60, Pulse 132, you suspect?
Hypovolemia Shock
Who were Ethical Standards Developed for =
The Patient
The best protection a paramedic has against legal involvement =
Proper Training
Info transmitted over the radio, everything EXCEPT?
Name & Insurance
The paramedic communicates all of the information to the doctor EXCEPT?
Pt. Name & Insurance Policy
Cushing’s Triad?
Widening pulse pressure, hypertension, bradycardia, irregular resp.
pH over 7.45?
Alkalosis
below 7.35 = Acidosis
Movement of fluid from LOW to HIGH across plasma membrane?
Osmosis
Drug & Dose for Pt. after RSC (rapid sequence circulation)?
Dopamine @ 5mcg/kg/min
Child with no parents, what type of consent?
Implied consent
You get on scene & the patient rolls up sleeves, what type of consent?
Implied Consent
Which is not an indication of an infiltrated IV Site?
Air in tubing
The Number 1 buffer system is?
Bicarbonate
What electrolyte is the PRIMARY Buffer?
Bicarbonate
You don’t have to investigate further?
Pertinent Negative
2nd dose of albuterol for adult patient?
- 5mg
2. 5mg/3mls
Patient weight is 86lbs, how many Kg?
39kg
Patient tells you he doesn’t want to be treated with Glasgow of 15 & you give him a shot, it is?
Battery
Battery is?
Unlawfully touching patient (Assault = Threat)
Abandonment means?
Not turning over care to an appropriate professional
If paramedic charged in lawsuit, he is the?
Defendant
3 Stages of Stress?
Alarm, Resistance, Exhaustion (ARE)
Which drugs go down the Tube?
Lido, Epi, Atropine, Narcan (remember LEAN)
What kind/type of drug is Cocaine?
Schedule II
schedule I –addictive but NO medical use: heroin, LSD, or crack cocaine
What does HR do late in decompensating shock?
Less then normal, There will be a narrowing of the pulse pressures
Racemic EPI, Tx to relief?
Croup
racemic EPI is EPI made for a nebulizer
Smooth muscle relaxant used for patient’s with bronchial asthma?
Aminophyline 5-6mg/kg
AKA theophylline, is a bronchodilator
3 systems that regulate acid-base balance?
Buffer, respiratory, & renal systems.
(buffer systems functioning in blood plasma include plasma proteins, phosphate, and bicarbonate and carbonic acid buffers)
Increase in acid due to metabolism, vomiting, diarrhea, diabetes or meds?
Metabolic Acidosis
Parenteral route of med administration?
SQ, IM, IV, IO, ET
Parenteral: administered or occurring elsewhere in the body than the mouth and alimentary canal
ABDUCTION?
Away from the body
ADDUCTION?
Towards the body
remember ADD to me
In an ambulance crash the court will try to prove?
Lack of due regard – for the ambulance driver
Administration of a Hypertonic solution to a hydrated PT will draw water from?
The PT’s cells into the vascular space.
Atropine does what?
Blocks Vagus Nerve (parasympathetic)
55 yr old Pt. with P 50, P Wave for every QRS, P – R Interval of 0.16, Cold & Clammy with BP 70/50 with Sinus Bradycardia. The Pt. should be given?
.5mg Atropine
What must occur to Maintain Relative Homeostasis?
Input MUST equal Output (equilibrium, balance)
Pt. doesn’t speak English?
Try to talk to both pt. & person doing the interpreting
Anytime you are dispatched to a call you have a duty to what?
Duty to act
it’s prescribed by the law as what we must do and how we must do it
Name a controlled substance that does not produce constricted pupils?
Valium
Is a benzodiazepan
Blood Components?
1unit = 1pint = 500ml
12units in adults or 6 liters
Act creating the Food & Drug administration (FDA)?
Controlled Substance Act 1970
Pounds to kg? 1kg =
2.2lbs
After C-Spine, how do you open the Airway?
Jaw Thrust
Hypercarbia =
Increased Co2 in the blood
Hypoxemia =
Decreased O2 in the Blood
Patient in car accident, not breathing with head injury. What is the risk of intubation?
Increased ICP
Pediatric with SPo2 78%, breathing 40bpm, you should do what?
Assist Ventilation
When intubating you hear absent lung sounds on the LEFT due to?
Right Mainstem Bronchus insertion
What is correct about Nasogastric tube on intubation?
Creates a Bad Face Seal or gets in the way of intubating
Complications of nasal gastric tube?
It makes intubations more difficult
Suctioning the back of a child’s mouth can cause all of the following EXCEPT?
Dehydration or bradycardia
Patient with air in the stomach, what do you do?
NG Tube
Attempted to intubate 4 Times without success what do you do?
Try another Advance Airway (use other method)
I-gel, LMA or Dual lumen etc…
Which Blade would you use to intubate an ADULT Pt.?
A curve blade (Macintosh) in the vallecula or a straight blade (miller) lifting the epiglottis
A Substance from High to Low concentration?
Diffusion
Minute Volume =
Tidal Vol X Resp. Rate
amount. of air in or out in one minute
(tidal volume = amount. of air breathed in or out in one breath)
In a normal person, what is the body’s primary respiratory drive?
Increase in Pco2
How to Measure Pediatric ET =
Size of Smallest Finger
How do you Measure Pediatric ET tube?
Broselow Tape
(Size 6 cuffed, size 6 uncuffed, size of index finger) were the other answers given
What separates the upper and lower airway?
Epiglottis (vocal cords)
A local alcoholic on a cold night is found to be inarousable, in V-FIB, & is Apneic. TX should include?
Airway, Defibrillate 3 times, CPR, Transport
Patient Choking, has PARTIAL Obstruction, you?
Encourage him to keep Coughing
What is a good indication for nasal intubation?
Gag Reflex intact
What do you check immediately after intubation?
Auscultation of the Epigastric & Breath Sounds
When doing a HALO Test, what are you looking for?
CSF (cerebral spinal fluid)
You should palpate the Abdomen quadrant?
Area with pain/injury LAST
Palpate abdominal quadrants in what order?
UL, UR, LR, LL
Kussmaul Respirations?
Rapid Deep Gasping Breathing – Associated with DKA/Hyperglycemia
Let CSF (cerebral spinal fluid) leak out, why?
To Relieve Increasing Pressure of the brain (ICP)
Mrs. J is in DKA. Her breathing pattern is Bradypena & Tachypnea. What is this respiratory pattern Called?
Kussmaul
Increased then Decreased Respiration followed by Apnea (a temporary suspension of breathing)?
Cheyne-Stokes
S/S of Hyperglycemia?
Deep, Rapid, Gasping respirations associated with Ketoacidosis
Harsh, high pitch sound heard on inspiration that indicate partial airway obstruction?
Stridor
You Expect to see Flat Neck Veins in Pt’s with?
Hypovolemia
Most important information for ER Doctor?
Chief Complaint (c/c), Patient’s condition, Treatment
Medical Pt., the first thing you ask or evaluate?
Chief Complaint
Which Vertebrae is responsible for loss of sensation of the Lower & Upper Extremities?
(Look it up) Thoracic? T4 or T6
*this answer is questionable
To make changes in the PCR (patient care report) you would?
Draw a single line & initial, make a notation at the end of the report
The Difference between Systolic & Diastolic is?
Pulse Pressure
The Systolic Portion of the blood pressure is the?
Pressure of blood against the Atrial Wall
During the heartbeat (pressure is arteries during ventricular contraction)
Orthostatic BP =
Supine, Sitting, Standing @ 2min intervals
JVD best checked?
Semi-fowlers
JVD is best observed at a?
45 degree angle
What is a contraindication for an NPO?
Basilar Skull Facture, look for battle signs or raccoon eyes
Rales are?
Fluid in alveoli
small airways or crackels
A high-pitched whistling is what type of sound?
Wheezing
Decorticate posturing?
Flexion of the arms, extension of legs, & clenched fist
head injury
Trauma Pt. with Arms & Legs FULLY extended?
Decerebrate Posturing (head injury/worse one)
Patient with chest pains, you ask?
O,P,Q,R,S,T
Amount of blood pumped by the heart in one (1) min, is called?
Cardiac Output
Rales usually heard in? Lower airway –
Fluid in the Aveoli
Man was cleaning the bathroom with bleach and fainted, a co-worker pulled him out and upon arrivial you notice the man has RALES. What is his condition?
Pulmonary Edema
Cardiac Tamponade causes the following, Except
A. Flat Neck Veins
B. normal pulse pressure C. decrease BP
D. muffle heart sounds
Except = Flat Neck Veins
How do you check for stable pelvis?
Downward & Inward pressure on iliac crests
What to check for in Extremities?
PMS-D (pulse, motor, sensory, deformities)
A repeater does what?
Boosts transmission range
Most common frequency in EMS?
VHF & UHF (VeryHF/UltraHF)
Types of radio systems?
Simplex (1freq-only talk to listen,
Duplex (2freq-talk & listen),
Mutiplex (2freq-talk, listen, & send ECG)
A group of frequencies close together?
Band
A Scuba Diver has Tingling in the HAND and FEET with Frothy Red Sputum. The patient should be Transported in?
Trendelenberg on his Left Side
All of the following are true regarding electrical burns EXCEPT:
There is more external than internal damage
(There is an entrance & exit wound, it may cause V-FIB, Path of electricity may follow nerve pathways)
[were the other answers given]
Air Embolism =
Diver with joint pain, Tingling in the legs, Abdominal Pain
Which is part of the 6 P’s?
PULSES
(pain, pallor, paralysis, paresthesia, pressure) the other five P’s
Abdomen Covering or Lining of the stomach?
Peritoneum
Lining of the LUNGS?
Visceral Pleura
A Pt. with abdomen pain is found in what position?
Fetal
Cerebellum controls what?
Motor control, Balance, Coordination
makes body move smoothly
Cerebrum controls what?
Thought, Personality, Analysis, Learning, Memory, & Speech
(T-Palms)
Child gets his hand stuck on Dry Ice for more than 5 minutes, what do you do?
Immerse in warm water (105degree’s) sterile dressing - don’t let refreeze
Concussion means?
A brief period of Unconsciousness, Followed by a complete return of function
Countracoup means?
Injury occurring on the opposite side of impact of the brain
Coup – injury to brain on side of impact
Eyes don’t move in Unison (together)?
Dysconjugate Gaze
head trauma
Disconjugated Gaze TX?
Cover both eyes loosely
Pt. Severed the Spinal Cord at C3–C4 that causes?
Total Paralysis & Pt. can’t Breathe on their own
Spleen is Located where?
LUQ left upper quadrant – (Liver = RUQ)
Appendix RLQ
Spontaneous Pneumothorax-Signs/Symptoms =
Short duration of sudden pain, SOB, Knife like pain
Tendons connect to what?
Muscles To Bone
ligaments - bone to bone
Difference between Sprain & Strain?
Sprain is injury to Ligaments, Strain is injury to muscles and or tendons
A False statement referring to burns is that?
There is insignificant damage to underlying tissue
A Pt. in a motorcycle accident has lacerations to his head that is actively bleeding. His Vital Sign’s are BP 80/4 Pulse 110, Treat him by giving what?
Lactated Ringers Wide Open (ringers lactate)
Muti trauma Pt., what do you treat first?
Hypoxia
To Open the Airway of a Trauma Patient you would use a?
Modified Jaw Thrust
Trauma patient fell from the roof with positive JVD, NO Lung Sounds on Right Side, TX would be?
Assist Ventilations, Decompress, Immobilize, Transport, 2 large bore IV’s
All are TRUE in Burn Patients, EXCEPT?
Electrical Burns Don’t Effect Soft Tissue
Cavitation is?
Object Penetration / Pressure waves from bullet / opening produced by force that pushes body tissues laterally away
A Clear Fluid coming from the nose and mouth, you expect?
Basilar Skull Fracture
Most Critical concern to a patient with chest trauma?
Hypoxia
Poor Bag compliance seen in what Pts.?
Sucking Chest Wounds, Tension pneumo thorax
Patient that has Cervical Fracture =
Quadriplegic
Placement for Decompression is?
Between 2nd & 3rd Intercostal Space (Midclavicular) or Between 5th & 6th intercostal space – (Mid-Axillary)
Decompress prior to ET, IV, & TRANSPORt)
Traumatic Asphyxia occurs from what type of injury?
Crush
injury to the chest or abdomen
Flail Chest is when?
2 or more ribs FX in 2 or more places
Complications of fractures & dislocations
Nerve & Vascular damage (vascular is the worst complication)
Most commonly fractured bone in the body?
Clavicle
Number of LITERS of Blood Loss in Abdominal Distension?
1.5 to 2 Liters
Anterior dislocation of a shoulder or fracture clavicle, Pt. presents how?
Leaning Forward with Affected shoulder & arm held close to chest
Always splint bones?
Above & Below joint injuries (If it’s a joint? Above/Below fractured bone)
(check PMS Before & After)
Treatment of a patient who presents with an OPEN Fracture?
Dress Wound first then Bandage/Splint
Patient with 3rd degree burns over 20% BSA, Concern is for?
Hypovolemia
You have a patient with head trauma & signs of Shock =
Look elsewhere; Shock is not due to head trauma (rare to see)
Your index of suspicious is based on mechanism of injury in regards to what?
Extent of patients injuries
Major Complication of thrombolytic therapy is?
BLEEDING OUT
Exclusion Criteria from thrombolytic therapy, all EXCEPT?
Hip Surgery 2 Years Ago
Blood Loss Replacement?
3 times the volume lost (20ml/kg) (exp. Pt. loss 750ml X 3 = 2,250)
Trauma Bolus?
20ml/kg (Adult)
Best Fluid for replacement?
BPlasma, packed cells, or wholeblood
The Pt. with Increased ICP Varies from the expected in that?
Pulse Decreases & BP increases
Signs of Increased ICP?
Hypertension, bradycardia, widening pulse pressures (Pt. with icp should be hyperventilated. lowers ICP by induction of cerebral vasoconstriction with a subsequent decrease in cerebral blood volume. May also lower systemic BP)
(do not hyperventilate or use high flow o2 with stroke PT.)
Drug used to decrease ICP
Mannitol
In a MVA there is a MULTITRAUMA patient, what is the FIRST thing to Control?
HEMORRHAGE
Other choices: airway, circulation,
Burn patient with Anterior Chest(9), Abdomen(9), & BOTH Arms(18)? 36%. If its says one arm then it’s
27%
Adult burn Pt. with burns to anterior chest (9), Abdomen(9), & Anterior upper extremities (4.5each). Using rule of 9’s what is the burn score?
27%
What is your primary concern for burn patients?
Hypovolemic Shock
NOT Septic Shock
Occipital part of the brain Controls what?
Vision
Flat Neck Veins are common to all of the following EXCEPT?
Cardiac Temponade
other choices; Dehydration, Hypovolemia, Hemothorax
Cardiac Tamponade is?
Narrowing pulse pressures
pulsus paradoxus, JVD, muffle heart sounds, beck’s triad, Pt. need a pericardial synthesis**
Patient has Scalp wound, BP 80/50, Pulse 120, the best IV CHOICE is?
Lactated Ringers
(Wide Open)
Patient in a MVA says he has radiating pain on LEFT Shoulder, you suspect?
Spleen Injury
Patient has Stroke like signs & symptoms, but then they RESOLVE & become better. This is what?
TIA
Which soft tissue injury causes the most bleeding?
Avulsion
An avulsion is a soft tissue injury involving?
The SQ & Facia with lots of blood loss
rip between subcutaneous & muscle tissue
Multiple attempts using ET Tube with ICP, CAUSE’s more?
ICP, Bradycardia, & other Dysrhythmias
Patient fell from 3rd floor, Pt. lying down, (R) lung sound absent, & FX leg. After airway TX?
BVM with O2, Decompress (R) Side, PASG, IV in route
A Pt. in a trauma accident that gets hit in the abdomen, may mimic peritonitis because?
Stomach acids can spill into abdomen cavity
A question about Synch. Cardioversion?
Cardioversion is carried out only for pt.’s whose cardiac
output is severely impaired.
(wrong choice’s: hemodynamically unstable, & V-FIB)
Trauma Pt. hit steering wheel, absent lung sounds on the left side, do not?
Decompress on the right side
Ascites is?
the build up of fluid in the space between the lining of the abdomen and abdominal organs
(the peritoneal cavity & Bulges in the flanks)
Penetrating trauma to abdomen, 40% blood loss from this organ?
Liver
Rule of 9’s, what percentage is the child head?
18%
arms: 9% each, 18% front, 18% back, 1% genitals, 14% each Leg
C1 – C4 injury, problems with?
Respiration
c1=atlas, c2=axis
Man Complains of SOB, CHEST PAIN after working out?
Spontaneous Pneumothorax
Patient with twisted leg, with low BP, high Pulse, cool & clammy skin?
Hypovolemia
Paralyzed from nipple line down?
T-4
Umbilicus down?
T-10
Tension Pneumothorax is known as what shock?
Obstructive Shock (S/S; JVD, tracheal deviation away from injured side; shock, asymmetrical chest rise)
Blood in the eye?
Hyphemia
Bleed under the dura is described as?
Subdural
What part of the brain regulates BP, Resp, and Heart Rate?
Medulla Oblongata
Damages to tissues due to high speed bullet is known as what?
Cavitation
Babinski Reflex/Sign?
Toes go up / Toe Faced outward
regarding infants feet when they are stimulated
First thing that happens in a blast injury?
Compression of air filled organs
secondary – struck by flying debris, Tertiary – pts. Propelled through space/impact other objects
Fracture on one side of Long-Bone?
Greenstick
Most common type of rural MVA?
Frontal
head on collision) (cause of two lane roads
Most common cause of death at a Fire Scene?
Carbon Monoxide (headache,confusion,cherry red lips)
Patient in MVA frontal impact suffering down / under injury, you would suspect?
Femur Fracture (down under the dashboard)
Patient fell through a glass door & has a piece of glass stuck in the neck, what do you do?
C-Spine, Airway, Occlusive dressing, Stabilize the glass, Transport
Which would you treat Last? A. Spinal B. Arterial Hemorrhaging C. Airway Obstruction D, Sucking Chest Wound
A. Spinal
Type of fractures?
Transverse (across) Spiral, Greenstick (kids, incomplete) Oblique (diagonal with sharp points) Compound (open) Comminuted (bone fragments)
La Forte Fracture:
FX within the face
F1 = Maxilla
F2 = Nose
F3 = Orbits
Bradycardia With PVC’s, What MED?
Give Atropine (not lidocaine)
What is a wide Etopic Beat?
PVC
A 22 yr. old woman complains of severe pain in RLQ, She has not eaten in 12 days & is constipated, & No chance of being pregnant. She most likely has?
Appendicitis
A 23 yr. old Gym rat has Explosive headache, this indicates?
Subarachnoid Aneurysm
When you Approach radiation the 3 Principles of Safety are?
Time, Distance, Shielding
alpha – weak 6inches / beta – weak 1-2ft / gamma –Bad
A patient complains of Dyspnea, he is CYANOTIC, has RALES, Reg. Pulse 140, BP 150/120, with Pink
Frothy Sputum. Pt. has?
Pulmonary Edema
A patient has a history of SOB, Orthopnea, and Coughing up pink tinged mucus. The patient most likely
has?
Left Sided Heart Failure or Acute Pulmonary Edema (instead of using CHF*)
Pulmonary Edema?
Left Heart Failure
Lady sitting upright with pink frothy sputum indicative of?
Left Heart Failure
Best position for Pt. with Orthopnea?
Sitting Position (orthopnea: SOB laying down)
A patient is found on the floor in a pool of vomit, shaking, CONFUSED and frightened
of SPIDERS on the wall (there are no spiders!). Patient has stopped drinking for 2 Days and is experiencing what?
Withdraws (DT’s)
A patient is Unconscious, Incontinent, and having Generalized Muscle Relaxation and Contraindications, what type of Seizure?
Grand Mal Seizure
A prolong P-R Interval is indicative of a?
First Degree Heart Block
First Degree block is indicated on ECG tracing when the P-R interval is greater than?
.20 sec
P-R Interval begins and ends?
Begins @ the P wave & ends @ the Beginning of the QRS
P waves get wider & wider till QRS drops, is set to be?
Mobitz I Wenkebach (going, going – gone*)
QRS interval?
0.08 - 0.12
A man repeatedly dove today & made a fast ascent from the last dive. He is complaing of Joint pains, Tingling legs, & Adominal pain. The Pt. has?
Decompression Sickness (bends)
Septic, anaphylactic, neurogenic shock, the Low BP is due to what?
Vasodilation
A Victim is found with Bright Red, frothy blood bubbling from the mouth which each exhalation.
This is an Indication of what?
Lung Damage (hemoptysis)
Pt. with Abdomen Pain, position of comfort?
On their sides with knee’s bent (fetal position)
Or in Lateral Recumbent
Acetylcholine / Oxytocin are Secreted by?
The Pituitary Gland
Adrenal Glands Secrets / Releases what?
Epinephrine & Norepinephrine
Angina caused by physical (exercise) or emotional stress is called?
Stable Angina
not unstable angina
During Cardiac Arrest, Build up of Pyruvic & Lactic Acid causes?
Metabolic Acidosis
Primary concern with treating a near drowning victim?
Hypoxia / Acidosis
both metabolic/resp
Eclampsia is?
A Seizures
related to pregnant women
What do you do BEFORE Admin. D50?
Check Sugar
glucose check
When a patient is vomiting GREEN like substance, this is a sign of what?
Rupture of the Gallbladder (cholecystitis – RUQ pain, could be yellow or green bile vomit)
Antepartum =
Prior to the delivery of the fetus
A female Pt. with ABD pain to her LLQ with vaginal bleeding & a missed menstrual cycle
approximately 7-10 days ago, what type of pregnancy?
Ruptured Ectopic Pregnancy
A 22yr. old female with LLQ Pain. She is 2 weeks late for her period. Pt. is shocky. She is diagnosed as?
Ectopic Pregnancy
A Child that has a headache, STIFF NECK, Vomiting, high fever, lethargic, & pale has?
Meningitis
Pt. mother is Pregnant with 2nd child; pt. mother has had 2 Miscarries before, with ONE Live Birth? Gravid 4, Para 1, Abortions 2 (twins, count as one birth)
Gravid 4, Para 1, Abortions 2
twins, count as one birth
Transporting a pregnant patient in the 3rd trimester, how do you transport?
Left Lateral Recumbent supine 10 – 15 degree’s
Woman in third trimester, minimal bleeding, ridged uterus & pain?
Abruptio Placenta
pregnancy complication in which the placenta detaches from the uterus
Abdominal pain and dark bleeding is characterized by?
Abruptio Placenta
S/S of Pregnancy?
lower BP, increase HR, & Plasma increase
After you have clamped and cut the cord, blood keeps oozing out, what do you do?
Clamp proximal to the previous clamp (
Pregnant female in childbirth with prolapse cord, what to do?
Sterile Gloved hand in canal, Hold baby face away from cord and Transport
(do not push the cord back inside the canal) (transport mother = in knee chest)
What do you do if you see a Nuchal Cord?
Insert gloved hand, move baby’s head away From the cord, & transport immediately
If baby delivers with amniotic sac not ruptured, what to do?
Poke with glove finger & pull away from baby face
Baby delivers in a “bag of water” what do you do?
Puncture the bag with your finger & uncover The baby’s face
Patient has been decontaminated from Radiation, come to you, what is he considered?
Low Threat
DKA or Diabetic ketoacidosis Pt. present with?
Warm & Dry Skin (dehydration/fever)
The Upper Area of the Uterus is?
The Fundus (which is a muscular structure located behind the cervix)
Top Priority of Heat Stroke Pt.?
Rapid Cooling, IV, & Transport (temp is 105-106)
Heat Stroke signs/symptoms?
Hot & Dry Skin, Syncope, Weak Pulse, Hypotension
Heat Exhaustion is?
Profuse Sweating, weak/pale, Tachy
sodium and water loss
Heat Cramps is?
ABD & Leg cramps
cool down, give fluids
Which one is NOT a SIGN of a Stroke?
Hypotension
correct choice given; headache, aphasia, facial drooping
How long does death generally occur after an MI?
1-3 hours after MI or (1-3hrs Check) OR Most deaths involving MI occur within? 2-3 hours
In MI, which part of the heart is affected?
Left Atrium (other choices = Right Atrium, Left Ventricle, Right Ventricle -wrong)
Blue or Purple Lesions on AIDS Pt. face, neck, mouth is?
Kaposi’s Sarcoma
Neurotic VS Psychotic Pts, psychotic pt are not in touch with?
Reality
When talking to Psych. Pt.? contact**)
Take away from situation & let them speak
(remove spouse from scene)
(calm approach, good eye contact)
PPE is the same as? BSI is used because of assumption that all blood & other body fluids are infection (ppe and bsi are not the same)
PPE is the same as? BSI is used because of assumption that all blood & other body fluids are infection (ppe and bsi are not the same)
What happens in the 3rd Trimester?
Decreased BP
What trimester does toxemia usually occur in pregnancy?
3rd Trimester
Rapid Cooling for Heat Stroke patient is to prevent what?
Irreversible Brain Damage
Cardiac Output is the amount of?
Blood pumped by the heart in one min
Total amount of blood ejected in each contraction of the ventricle?
AKA stroke vol 80-100mls (Adult male)
Patient with chest pain, P-72 and 10MIN later pulse decreases to 38. If stroke volume DOSEN’T CHANGE…?
Cardiac Output DECREASES
What is TRUE about HIV patient?
They Appear NORMAL (you couldn’t tell)
Fibrinolytic Therapy time frame is?
3 Hours
Causes of AMS?
Hypoperfusion, hypoglycemia, hyperglycemia, heat stroke (AEIOU-TIPS)
Guy went on Vacation and went diving, how do you transport pt.?
Left Lateral
Absent P wave in LEAD II means?
The SA Node is not the Pacemaker
Normal Pacemaker of the heart?
SA Node
What does the QRS mean on an ECG?
Ventricular Depolarization
When dealing with a patient exhibiting a hostile, aggressive behavior, appropriate action would be to?
Contact the police dept. & remove bystanders from the scene
Behavior emergency Pt., you should?
Try to orient the Pt.
How to restrain a behavioral emergency Pt.?
One arm above his head, One arm by his side,
Patient lying prone with feet tied at the end of the stretcher
Hypogylcemia Pt. resembles what?
Behavioral problems
A Pt. complains of SOB. On assessment he has pursed lips & barrel chest, which indicates?
Emphysema
(pink puffers)
(Chronic Bronchitis is called - “blue bloaters”*)
Patient with Barrel Chest and is pink has?
Emphysema
Female Pt., puffing & with pink skin?
Emphysema
A guy in an MVA, Pt. has subcutaneous emphysema on the right neck side, Dyspnea, Absent lung sounds on the right side & diminish lung sounds on the left side?
Tension Pneumothorax
Pt. is a Chronic Smoker with Barrel Chest; what condition would you expect him to have?
Emphysema
ST Elevation in Leads II, III, AVF?
Inferior Wall MI
- Leads V1-V4?
Anteroseptal MI
- Leads V3-V6?
Anterolateral MI
ST elevation on V1-V6, l, AVF?
Anterior Wall MI
ST elevation on V2, V3, V4, V5?
Anterior Lateral Wall MI
Lead Placement of V4 electrode?
Midclavicular
P Wave =
QRS Wave =
T-Wave =
P Wave = Atrial Depolarization
QRS Wave = Ventricular Depolarization, T-Wave = Repolarization of the Ventricles
Enlarged Liver, distended neck veins & edema are Sign’s of?
Heart Failure (RIGHT)
Pain in the chest “tearing & shearing” pain towards the neck, with no pedal pulses?
Dissecting Aortic Aneurysm
Man complaining of tearing pain in the back & in between SHOULDERS with no pedal pulses?
Aortic Aneurysm
Causes of pinpoint pupils?
Narcotics
The Drug of choice for Cardiogenic shock is?
Dopamine
pump problem, MI
Pt. presents with whistling sound during exhalation is consider being?
Asthmatic Bronchiolitis
When blood leaves the Lungs, where does it go FIRST?
Left Atrium
O2 rich blood leaves the pulmonary veins & goes to the?
Left Atrium
Where do you put pressure for the Sellick maneuver?
Cricoid Cartilage
Sign of a Pt. with a progressive disease that affects the nervous system?
Mental Status
All are S/S of Kidney Stones EXCEPT? severe flank pain pale Frequent Urination lower abd pain
Frequent Urination
Patient with ringing in the EAR & is SICK?
ASA Overdose
Patient coping with stress, common reaction?
Stress, Fear, Anxiety Anger
2nd Phase of child birth is when?
Full Dilation of cervix until child is delivered
3rd phase is when the baby is fully out
Blood Clot in the legs will lodge where?
In the Lungs
35yr. old female has sudden, sharp, severe headache & becomes unconscious & unresponsive.
She is suspected to have?
Subarachnoid Hemorrhage
What is the BEST Method to use on LSD Pt.?
Talk down method
Which of the following bites is most neurotoxins?
Coral Snake
Red to Yellow - kills a fellow / Red to Black - is a friend of jacks
Patient with chest pain & back pain, with no pulses in extremities?
Dissecting Aorta
What are some of the signs/symptoms expected to be seen in a pt. who has been giving Narcan?
Combative & Aggressive Behavior
Definition of Status Epilecticus?
Seizure without gaining consciousness in between 2 or more
Episodes
(prolonged seizure) (remember - no break between Seizures, Don’t Intubate*)
Petit mal seizures?
A type of seizure that involves brief, sudden lapses in attention.
Also in children
(many a day / may or may not lose consciousness)
Guy playing baseball then DROPS, Swollen tongue & Lips?
Anaphylaxis
Guy with Fever, SOB, productive cough, no edema?
Pneumonia
Bilateral, Dilated Pupils indicate?
Cerebral Hypoxia
What causes unequal pupils?
CNS Injury (neurological crisis)
Best way to evaluate a behavioral emergency patient?
Away from crisis & cause
Maternal blood volume increases how much?
40%
A Pt. has one pupil that is dilated & non-reactive, while the other is slow to respond. This is a form of a?
Neurological Crisis
WPW (Wolff-Parkinson-White) Syndrome ( Meds you cant give like Cardizem, why?
Because it will bypass the AV Node & the rapid Firing of the atrium will get to the ventricles & eventually will go into V-Fib
(WPW:extra electrical pathway in the heart causes a rapid heartbeat.
Why would you SYNC a Pt. in SVT?
Because he is Hemodynamically Unstable
Which is consider a peripheral vein?
The arms, hands, legs and feet
Not the veins in the chest or abdomen
R on T Causes what?
V-FIB
What do we NOT want to give a stroke Pt?
Fluid Bolus (*remember by doing so, you will increase BP causing ICP = No Bueno!*)
What does glucagon do?
Stimulates the liver to change glycogen into sugar and secrete it into the blood stream for energy.
Which is not a vector of hepatitis ? blood Saliva semen feces
Saliva
blood & semen = HEP B
A Fecal or Orally Transmitted Disease is?
Hepatitis A
(viral) is fecal
How does an elderly Pt. mask an MI?
They have a decreased sensation to pain
Proper meds for CHF?
02 (CPAP), Morphine sulfate, lasix and Nitro
Common finding w/ Cystitis (inflammation of bladder) is?
Urinary tract infection
What kind of diabetes do you develop during Pregnancy?
Gestational
must be on insulin
9 month pregnant patient w/ seizures?
Valium 2.5mg - 10mg (Slow IVP) or 5-10mg
Valium = Ped:
Adult:
Ped: 0.2mg/kg
Adult: 5-10mg
10 QRS complexes in a 6 sec strip would most likely indicate?
A Ventricular Rate
Prolong P-R Interval?
1st Degree Block
Normal Rhythm with no Pulses, what med do you give?
Epi
Strip shown, the above strip represents? Sinus Bradycardia
NSR, Junctional Rhythm, 1st Degree heart Block – were the other answers
Strip shown, the above strip represents? Sinus Bradycardia
NSR, Junctional Rhythm, 1st Degree heart Block – were the other answers
V-Tach shown how?
Wide, Bizarre QRS
Most common route of poisoning?
Ingestion
Tricyclic antidepressants?
Mellaril, Trofranil, Elavil, Amytriptyline
TX-sodium bicarb
Intrinsic Rate of the SA Node?
60-100 BPM
Intrinsic Rate of the AV Node?
40 – 60 BPM
Intrinsic rate of the Ventricles?
20-40 BPM
purkinje fibers
Tourniquet does what?
Restrict Venous Blood Flow BUT Allows Arterial Blood Flow
34 yr. old male appears Jaundiced with Sclera, No appetite, Lost 10 lbs. in 3 weeks, Nauseated, Generally Fatigued, Low fever, & Sudden distaste to cigarettes?
Viral Hepatits
51 yr old. Farmer has cramps & diarrhea, this indicates?
Organophosphate Poisoning
The Pharmacological TX of Anaphylactic Shock?
Epinephrine & Benadryl
Endocrine system acts by?
Releasing hormones into the bloodstream
Chicken Pox (Varicella), Measles, & Mumps are spread by?
Airborne Droplets (virus)
Delirium Tremors can occur?
48 -72 hours after cessation of alcohol (ETOH)
Patient says “I hear bells in my head”?
Aspirin OD
22 y/o female, RLQ pain, radiating to right shoulder, no menses with spotting?
Ectopic pregnancy
Define Cor Pulmonale?
Right sided heart failure secondary to chronic lung disease
Acute Myocardial Infarction, what is the Treatment?
Morphine MONA – (O2,ASA,nitro,Morphine*)
What are signs & symptoms of respiratory distress?
Nasal Flaring
Most common error with AED use is?
Dead Batteries
A situation that is indicated for the use of MAST Suit is a?
Ruptured, Abdominal Aortic Aneurysm, A pelvis fracture
inflate – left leg, right leg, ABD
Which of these can lead to permanent Brain Damage if not corrected?
HYPOglycemia
constricted pupils are most indicative of?
Heroin Overdose (dilated pupils may indicate amphetamine overdose)
Addison Disease
Adrenal gland failure
adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone
UPPER GI hemorrhage?
Black tarry stool, vomiting blood or coffee ground
Lower GI Bleed?
Bright red or wine color stool
Adult GCS scenario = 13 (lowest 3 – highest 15)
Adult GCS scenario = 13 (lowest 3 – highest 15)
What is correct about Nasogastric tube on intubation?
Bad Face Seal or gets in the way of intubating
Complications of nasal gastric tube?
It makes intubations more difficult
Suctioning the back of a child’s mouth can cause all of the following EXCEPT?
Dehydration
suction can stimulate the vagal nerve causing slower than normal heart rate
Inter-facility transport Pt. receiving a blood transfusion & not feeling well?
Stop Transfusion
NPA is used when?
Used on pt. with a intact gag reflex
When Suctioning the Tracheotomy?
3 – 5 inches
During Intubation you could stimulate the Vagus Nerve, what happens?
Bradycardia
Aphasia is inability to?
Produce or Understand Speech
Catecholamine’s causes?
increase Heart Rate, & Increase vasoconstriction
Catecholamines are hormones produced by the adrenal glands
Increase in acid due to metabolism or vomiting, diarrhea, diabetes or meds?
Metabolic Acidosis
External Jugular vein is NOT a?
Central Line
Movement of fluid or molecules through a cell membrane against the concentration?
Active Transport
Lowest APGAR Score?
0
highest 10
When do you check (APGAR)?
1 & 5min after birth
Which is part of APGAR?
Which is part of APGAR? Appearance
pulse, grimace, activity, respiration
A baby is born, delivery finds it’s Body is Pink, Extremities are blue, Pulse120, Crying lustily while jerking arms legs. The APGAR score is?
9
SIDS?
Below the age of 1 but most occur between 4-6 months, may have vomit or fluids from mouth/nose (unexpected death which is unexplained even after autopsy)
Place infants on back or side to sleep
When you get OLD, you get Thirsty because?
Decrease in Bone Mass, skin turgor, & decrease in thermoregulation
Which is NOT a characteristic problem in the OLD People?
Increased Thirst
Neonate Pt. how much fluid replacement?
10ml/kg
Pediatric assessment?
Toe to Head
Laryngotracheobronchitis AKA Croup presents with?
Stridor
All happens during the AGING Process EXCEPT?
Increase Thirst
Rapport with geriatric Pt.?
Be professional, open stance, caring
be patient
How would you approach a geriatric patient differently than a non-geriatric patient?
More formally With an open stance
The #1 cause of trauma in elderly injuries?
The #1 cause of trauma in elderly injuries? Falls
In bathrooms/stairs
Elderly Pt. output more than input causing?
Electrolyte Imbalance
Child Abuse, what do you do?
Take child to hospital & document, report to authorities
Old man urinates MORE than he puts in, due to what?
Dehydration/Electrolyte Imbalance
Guy on Vent, how do you treat?
Remove from vent, suction trachea, o2 BVM
Child with SOB, mother being hysterical & not letting you treat child, what would you do?
Try & talk to calm her down
Most common seizures in children under the age of 6?
Febrile
rapid increase of temp.
Where do you apply pressure when tubing a pediatric?
Larynx
Landmark for IO in a 10kg infant?
2-3 inches (fingers) below the Tibial Tuberosity in medial aspect
Diabetic Pt. with headache, Most important question to ask?
How long has he had the head ache
Newborn treatment?
Dry, Warm, Suction, Stimulate
Do What Seems Sensible
Umbilical Cord has?
2 Arteries, 1 Vein, Supplies to the fundus
In a Criothyrotomy, the landmark used to determine the proper insertion location is?
The Depression just INFERIOR to the Adam’s Apple
Pt. who are decontaminated in the warm zone, have how much threat to paramedics?
Little or no threat to medic
Part of the Scene Size Up includes?
Number of Pt. on scene
MCI, first crew on scene come upon Pt. in cardiac arrest?
continue triage to triage pt.s
What do you check in the triage system?
Breathing, Circulation, & LOC
(32 can do)
(breathing under 30, cap refil less than 2 seconds, follows direction. if pt passes these test triage yellow. if not triage red)
When triaging at MCI, the Highest Priority when treating?
Sucking Chest Wound
When prioritizing patients at an MCI, which one is LEAST important? AMS Airway compromise arm & leg numbness sucking chest wound
arm & leg numbness
Last person treated in MCI
Spinal Injury
The Incident Commander is in Charge of?
MCI
Arrive on scene of an MCI where do you PARK yourself?
Staging area
wait for assignment
Upon Arrival of a disaster scene, the patient who should receive the lowest priority
(of the following) is?
A.Mid sternal chest pain
B.2nd degree burn 20-30%
C.penetrating chest wound
D.3rd degree burns over 80% of the body
D.3rd degree burns over 80% of the body
pt. will die soon anyway
In S.T.A.R.T system a patient breathing at 40bpm is consider a?
Critical Pt.
red
At a crime scene, you have a Pt. that is viable, what do you do?
Treat the Patient, & cooperate with law
enforcement
(“DO NOT DISTURB THE SCENE”)
Landing Zone for helicopter is?
100ft x 100ft
All are Ignition Sources at a Hydrocarbon Spill, Except
Sealed Flashlight
The Front windshield glass is made of
Laminated Safety Glass (use fire ax)
In a MVA scene, what should you do first?
Stabilize scene, then car, then patient
Always put Safety First
Assessment begins at?
Dispatch
Pt. in MVA, while trying to gain access, what should you try first?
Door, Window, Body
try before you pry
Arrive to an MVA, how should you disable the car battery?
Disconnect the BLACK (negative) First
don’t cut cables
Arrive on scene and see a Burning Vehicle, park where?
100ft away uphill & upwind from hazmat scene
At intersections, before proceeding you must?
Look Left first
obey all traffic laws
What lane should you drive on your way to a call, why?
Left lane, so others can pull right
An ambulance is called to a house fire. Upon entering the burning house, a paramedic finds an unconscious woman. He decides to mover her from the house using a fireman’s drag. The First step would be to?
Tie the patient’s hands together
Definition of Multi System Trauma?
Pt. considered to have more than one injury
Highest Level of protection of HAZMAT suits?
Highest Level is A
(then B,C,D)
(hot – scene; warm – decon; cold zones – treatment/transport)
Most fatalities among rescuers occur in?
Confined Spaces
The most major complication of a joint injury is?
Blood Vessel Damage (not nerve damage)
The tool not to use to pull or roll a dashboard is?
A Pry Bar
H’s
Hypovolemia Hypothermia
Hypoxia
Hydrogen Ion (acidosis) Hyper/Hypo kalemia
T’s
Thromboemboli (pulmonary & coronary) Trauma
Tension pneumothorax
Tamponade, Cardiac
Toxins (overdose)
STAGES OF LABOR
- Contractions & Dilationofthecervix
- Baby enters birthcanal until birth
- Birth to Delivery of the Placenta
Transection above T1
Quadriplegia (tetraplegia) no use of upper/lower ext
Transection below T1
Paraplegia, use of upper ext, but no use of lower ext
Adult respirations and pulse
12-20
60-100
Child respirations and pulse
18-30
65-110
Infant/Newborn respirations and pulse
40-60
140-160