Zack EMT-B Test 6

Describe briefly what is happening when a person is in anaerobic metabolism

Lack of O2 and/or glucose leads to cellular dysfunction to cellular chaos to cellular death to tissue failure to organ failure to system failure to organism death

List 3 causes of hypovolemic shock.

BurnsVomitingDiarrheaBlood lossDKA

List 3 causes of relative volume loss (distributive) shock

AnaphylaxisSpinal cord injurySeptic shock

List 2 causes of cardiogenic shock.

Myocardial InfarctionCHFCardiac traumaInfection

List 8 signs and symptoms of a patient noted to be in hypovolemic shock.

PallorDiaphoresisTachycardiaTachypneaAltered LOCWeak peripheral pulsesDelayed capillary refillProstrationDecreased LOCHypotensionDecreased urine outputBradycardia (late sign)

List 6 interventions for a patient in shock.

Stop bleedsHigh flow O2Keep warmKeep calmTrendelenburg positionALS rendezvousRapid transportMaintain ABC�s

List the four primary categories of shock.

HypovolemicDistributiveCardiogenicObstructive

List eight types of shock.

CardiogenicAnaphylacticNeurogenicSepticHypovolemicRespiratoryMetabolicPsychogenic

List three causes of obstructive shock

Pulmonary EmbolismPericardial TamponadeTension Pneumothorax

What is the primary deficit noted with each of the primary categories of shock.

Hypovolemic - Volume deficitDistribtive - VasodilationCardiogenic - Pump failureObstructive - Decreased preload

List 5 types of fracture a patient may sustain

ComminutedCollesLinearPiralTransverseObliqueOpen

Define fracture

A break in the continuity of bone

Define dislocation

The end of a bone being displaced from its normal place in a joint

Define sprain

A tearing or stretching of a ligament or a tendon

Define strain

A stretching or tearing of a muscle

Treating a sprain can be done with the mnemonic R.I.C.E.S, what does each letter stand for?

RestIceCompressElevationSplint

List four reasons to splint a fracture.

To limit the motion of bone fragments, bone ends, or dislocated jointsTo lessen damage to muscles, nerves, or blood vesselsTo help prevent a closed injury from becoming an open injuryTo lessen the restriction of blood flow caused by bone ends or dislocations compressing blood vesselsTo reduce bleedingTo reduce painTo reduce the risk of paralysis caused by a damaged spine

List three hazards of improper splinting

Compression of nerves, tissues, and blood vesselsTransport delayReduced distal circulation from a splint that is too tightAggravation of the musculoskeletal injuryCausing or worsening tissue, nerve, vessel, or muscle damage

List five rules of splinting.

Take BSI precautions and wear appropriate PPERemove or cut away clothing to expose the injuryRemove jewelry from the injured areaAssess pulses, movement, and sensation distal to the injury before and after splintingCover open wounds with a sterile dressingPad a rigid or a semi-rigid splintSplint the area above and below the injurySplint joints above and below the injured boneSplint bones above and below the injured joint

List five types of splints.

TractionWireCardboardSAMPillowBlanketSling and swathePneumatic Anti-Schock Garments (PASG)

List four types of spinal injuries

CompressionExtensionFlexionRotationLateralDistraction

Differentiate between paraplegia and quadriplegia

Paraplegia - Loss of movement and sensation in the body from the waist down. Results from spinal cord injury at the level of the thoracic or lumbar vertebraeQuadriplegia - Loss of movement and sensation in both arms, both legs, and parts of the body below an area of injury to the spinal cord. Results from a spinal cord injury at the level of the cervical vertebrae

List six signs and symptoms of a spinal injury

Tenderness in the injured areaPain associated with movementPain independent of movement or palpation along the spinal columnPain down the lower legs or into the rib cagePain that comes and goes, usually along the spine and/or lower legsSoft-tissue injuries associated with trauma to the head and neckNumbness, weakness, or tingling in the limbsLoss of sensation or paralysis below the site of injuryLoss of sensation or paralysis in the upper or lower limbsDifficulty breathingLoss of bladder or bowel controlInability to walk, move limbs, or feel sensationDeformity or muscle spasm along the spinal column

Briefly describe how to immobilize a patient

Assess ptApply manual stabilizationFit and apply c-collarLog roll pt assess back (person at head is in control of move)Roll pt onto backboard (work in unison, minimize movement)Secure the chest and pelvis firstSecure the extremitiesSecure the head last with towel rolls and tapeReassess the pt CSM

What needs to be done prior to and after immobilization of a pt.

Check CSM

List ten signs and symptoms of a skull fracture

Bruises or cuts to the scalpDeformity to the skullDiscoloration around the eyes (raccoon eyes)Discoloration behind the ears (Battle�s sign)Loss of consciousnessConfusionConvulsionsRestlessnessIrritabilityDrowsinessBlood or clear watery fluid (cerebrospinal fluid) leaking from the ears or noseVisual disturbancesChanges in pupilsSlurred speechDifficulties with balanceStiff neckVomiting

List five type of brain injuries

ConcussionContusionSubdural hematomaEpidural hematomaIntercerebral hematoma

Define cushings triad; and why it is important to note

Slow bounding pulseHypertension with widening pulse pressuresErratic respirationsIt is a sign of severe head trauma and requires rapid transport and tertiary interventionCushing's triad is the triad of widening pulse pressure (rising systolic, declining diastolic), change in respiratory pattern (irregular respirations), and bradycardiaIt is sign of increased intracranial pressure, and it occurs as a result of the Cushing reflexCushing triad is hypertension (systolic), bradycardia and respiratory depressionWidened pulse pressure is not a separate component of the triad as it is a result of the elevated systolic blood pressure.

Differentiate between a subdural and epidural hematoma

Subdural - venous bleed, usually a longer onset;Epidural - arterial bleed, rapid onset; lucid interval (they are unconscious, regain consciousness and then deteriorate back into unconsciousness)

List treatment interventions for a head injured patient

AssessmentMaintain C-spineControl bleeding (minimal pressure if skull fracture noted)Do not attempt to stop flow of blood or CSF from the ears or nose (check bullseye test)Do not remove a penetrating object; Stabilize it in placeIf bleeding from open head wound - Apply firm pressure with a clean cloth to control blood loss over a broad areaTreat for shock if presentDress and bandage woundsTransport

List five deadly chest injuries

Tension pneumothoraxOpen pneumothoraxMassive hemothoraxCardiac tamponadeFlail chestPulmonary contusionMyocardial contusion

What ribs are most commonly fractured?

4 through 9

List five signs and symptoms of a rib fracture

Localized pain at the fracture siteSelf-splinting of the injuryPain on inspirationShallow breathingTenderness on palpationChest wall deformityCrepitusSwelling and/or bruising at fracture sitePossible subcutaneous emphysema

List four specific interventions for a pt with rib fractures

Spinal stabilization if spinal injury suspectedEstablish and maintain an open airwayGive oxygenEncourage patient to breathe deeplyDo not apply tape or straps to the ribs or chest wallAllow patient to self-splintPerform ongoing assessments

Define flail chest, and note a classic sign noted with it

Fracture of two or more ribs in two or more places. A flail chest is a life-threatening medical condition that occurs when a segment of the chest wall bones breaks under extreme stress and becomes detached from the rest of the chest wall.Paradoxical respiration

List six signs and symptoms of a tension pneumothorax

PallorDiaphoresisCyanosisTachycardiaJVDHypotensionRespiratory distressAgitationRestlessnessBulging of intercostal muscles on the affected sideDecreased or absent breath sounds on the affected sidePossible subcutaneous emphysemaTracheal deviation toward the unaffected side (late sign)

Briefly describe how to treat a pt with a tension pneumothorax

Keep on scene time to a minimumRequest an early response of ALS personnelSpinal stabilization if suspected spinal injuryEstablish and maintain an open airwayHigh flow oxygenIf an open chest wound was bandaged with an occlusive dressing, release the dressingTreat for shock if indicatedTransportReassess often

Define hemothorax and list six signs and symptoms

Accumulation of blood in the potential space due to a traumatic chest injuryDiaphoresisWeak, rapid pulseRestlessnessAgitationAnxietyCoughing up blood (hemoptysis) (may not occur)TachypneaFlat neck veins (caused by hypovolemia)HypotensionDecreased or absent breath sounds on the affected side

Define cardiac tamponade and six signs and symptoms noted

Accumulation of blood in the pericardial sacDiaphoresisNormal breath soundsNarrowing pulse pressureTrachea in the midline positionTachycardiaCyanosis of the head, neck, and upper extremitiesMuffled heart sounds (often difficult to assess in the field)Distended neck veins (may not be present in hypovolemia)

List five interventions for a pt with cardiac tamponade

Keep on scene time to a minimumRequest an early response of ALS personnelSpinal stabilization if suspected spinal injuryEstablish and maintain an open airwayHigh flow oxygenTreat for shock if indicatedTransportReassess often

Define traumatic asphyxia and five signs and symptoms noted

Severe compression of the chest causing complete disruption to the resp and circulatory systemsJVDSwelling of the tongue and lipsEyes that appear bloodshot and bulgingDeep red, purple, or blue discoloration of the head and neck (�hooding�)Low blood pressure when compression is releasedNormal-looking skin below the level of the crush injury (unless other injuries are present)

List four solid and hollow organs in the abdomen

Solid - pancreas, kidney; ovaries; spleen; liverHollow - stomach; intestines; gallbladder; bladder; ureters; appendix;

List six signs and symptoms of a pt with an abdominal injury

Patient who lies still, usually in fetal positionNauseaVomiting blood (hematemesis)Possible blood in the urine (hematuria)Possible skin wounds and penetrationsAbdominal painRigid abdominal musclesDistended abdomenRapid, shallow breathingSigns of shockProtruding organs (evisceration)

List five interventions for a pt with an abdominal injury

Keep on scene time to a minimumSpinal stabilization if indicatedEstablish and maintain an open airwayHigh flow oxygenControl any external bleedingStabilize a penetrating object in placeApply moistened sterile dressing to protruding organsTreat for shock if indicated

List 3 causes of hypovolemic shock.

BurnsVomitingDiarrheaBlood lossDKA

List 3 ways to control bleeding.

Direct pressurePressure pointsPressure dressingSplintingTourniquetPneumatic Anti-Schock Garments (PASG)

List the 3 layers of skin.

EpidermisDermisSubcutaneous tissue

List 4 functions of skin.

ProtectionSense organPigmentationHomeostasisTemperature controlFluid regulationReservoir

Differentiate between the three types of bleeding.

Capillary � slow ooze, redVenous � steady flow, dark redArterial � spurting , bright red

6) List 6 types of open wounds.

PuncturePenetrationAvulsionAbrasionAmputationIncisionLaceration

List five ways to stop external bleeding.

Direct pressurePressure pointElevationColdPressure dressingTourniquetPneumatic Anti-Schock Garments (PASG)

8) List 3 types of burns and 3 signs and symptoms of each

1st degree � red, painful, edema, small blisters, epidermisPartial thickness � red, painful, blisters, weeping, into dermis,3rd degree � white waxy , black-charred, less painful, tissue sloughing, full thickness

List 5 interventions for a patient with a burn

Remove from sourceWet dressing < 10% TBSDry dressing > 10% TBSRemove jewelryRemove non adhering clothingHigh flow O2Keep patient warmDo not break intact blisters

10) List the �rule of nines� for an adult.

Lower leg x 2 circumferential 9%Upper leg x 2 circumferential 9%Arm x 2 circumferential 9%Anterior abdomen 9%Anterior chest 9%Posterior abdomen 9%Posterior chest 9%Head circumferential 9%Perineum 1%

11) List how to determine body surface area for a child who is burned.

Lower leg x 2 circumferential 13.5%Arm x 2 circumferential 9%Anterior abdomen 9%Anterior chest 9%Posterior abdomen 9%Posterior chest 9%Head circumferential 18%Perineum 1%

Define hemothorax

Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity)A massive hemothorax is the loss of 1.5L of blood.

Define pneumothorax

A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between your lungs and chest wall, creating pressure against the lungDepending on the cause of the pneumothorax, your lung may only partially collapse, or it may collapse completely

Define tension pneumothorax

The most serious type of pneumothorax, this occurs when the pressure in the pleural space is greater than the atmospheric pressure, either because air becomes trapped in the pleural space or because the entering air is from a positive-pressure mechanical ventilatorThe force of the air can cause the affected lung to collapse completelyIt can also push the heart toward the uncollapsed lung, compressing both it and the heartTension pneumothorax comes on suddenly, progresses rapidly and is fatal if not treated quickly.

Define open pneumothorax

A pneumotharax caused by an open wound in the chest wall.

Define subdural hematoma

A subdural hematoma is a collection of blood on the surface of the brain.Subdural hematomas are usually the result of a serious head injuryWhen one occurs in this way, it is called an "acute" subdural hematomaAcute subdural hematomas are among the deadliest of all head injuriesThe bleeding fills the brain area very rapidly, compressing brain tissueThis often results in brain injury.

Define epidural hematoma

An epidural hematoma is bleeding between the inside of the skull and the outer covering of the brain (called the "dura")An extradural hemorrhage occurs when there is a rupture of a blood vessel, usually an artery, which then bleeds into the space between the "dura mater" and the skullThe affected vessels are often torn by skull fractures

Define subcutaneous emphysema

Subcutaneous emphysema occurs when air gets into tissues under the skin covering the chest wall or neck.Subcutaneous emphysema can often be seen as a smooth bulging of the skinWhen a health care provider feels (palpates) the skin, it produces an unusual crackling sensation as the gas is pushed through the tissue