Your patient responds to your voice with incomprehensible murmurers. Using the AVPU scale, he is classifed as responsive to:
Verbal stimuli
Do vitals signs have to be taken on-scene in every situation?
No. Vitals should be taken enroute for patients idenitified as high priority for immediate transport for definitive care .
What does SAMPLE stand for?
Signs and symptoms, allergies, medications, past medical history, last meal, events lead to current state.
What forms of abuse are EMS providers mandated to report?
Child, Spouse, and Elder Abuse must be reported on the PCR/E-PCR and verbally at transfer of care. Child abuse must also be reported according to NYS Bureau of EMS Policy #02-01.
Does a PCR/E-PCR have to be completed when no patient contact is made?
Yes, even for stand-bys, calls where no patients are located, cancellations, and events.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act of 1996.
When reporting responsiveness, EMS providers should use _______________ to avoid less clear descriptors.
AVPU
For a hypoglycemic patient, when is it appropriate to give oral glucose, juice, or non-diet soda?
If the patient is alert enough to sit unsupported, follow commands, and drink without assistance.
When is aspirin contraindicted for an MI patient?
Recent GI bleed and known allergy.
According to NYS BLS protocol, the administration of nitroglycerin for chest pain is indicated if the adult patient's BP is than _____mmHg.
120
According to NYS BLS protocol, a maximum of ____ total doses of nitroglycerin can be given without medical direction to adult chest pain patients.
3
When is it appropriate to actively rewarm frostbite in the field?
The patient does not need to walk further and there will be a transport greater than 30 minutes,
For a genrealized hypothermia patient, pulse checks should last at least _____ before CPR is started.
30-45 seconds
If severe hypothermia is present, can defibrillation be performed?
Give a mximum of three shocks, but withhold drugs.
Your patient acutely developed a high grade fever, has a muffled voice, stridor, and drooling. You should suspect:
Epiglottitis (bacterial)
Your patient has been ill for the last few days with coldlike symptoms, a barky cough, and a low grade fever. He woke at 3:00am with severe symptoms. You suspect:
Croup (viral)
Ideally, a BVM used for emergency situations should:
Be self-inflating, have no a pop-off valve, and have an anatomically shaped, clear mask.
List signs of respiratory failure in children:
increased respiratory eefort with retractions, breathing less than 10 per minute, head bobbing, grunting, accessory muscle use, absent or shallow chest wall movement, limp muscle tone, altered mental status, slow or absent heart rate, poor skin perfusion,
Sings of impending cardiac arrest in a pediatric patient are:
Altered mental status, bradycardia, and cyanosis.
For a heat exhaustion patient, when is it appropriate to give fluids orally?
Consious and not nauseated, and able to drink without assistance.
What position should a nauseated patient be transported in?
left lateral recumbent.
If your choking patient becomes unconsious, you should:
Begin CPR
Your pediatric patient choked on a small toy peice. He is conscious, but has labored breathing and stridor. You should:
Monitor closely and transport in the position of comfort with blowby oxygen administration as tolerated.
For a patient who has ingested a poison, you should contact:
Medical Direction (Poison Control can not give treatment orders to EMS providers.)
Before an advanced airway is placed, during CPR the adult patient should be ventilated every ____-____ seconds to a rate of _____-_____ breaths per minute.
5-6 seconds (10-12 bpm)
After an advanced airway is placed, the adult patient should be ventilated every ____-____ seconds to a rate of _____ - _____ breaths per minute.
6-8 seconds (8-10 bpm)
During rescue breathing, each breath should be given over:
1 second.
The primary advantage of a nasopharyngeal airway is:
that it can be used in a patient who has an intact gag reflex.
BVM's must have a volume of at least _____mL for newborns and infants.
500 (Child BVM)
For infants and children, ventilations should be delviered every ____-____ seconds once an advanced airway is in place.
6-8 (8-10 breaths per minute)
When an advanced airway is in place you should not pause compressions for ventilations.
True or False
True
Which should occur first:
Turn on the AED or Attach the AED patches
Turn on the AED
For EMT's, a maximum of ___ defibrillations should occur before beginning transport.
3
You are at a local elementary school at an event, off duty, when a child collapses in sudden cardiac arrest. An AED is available, but it does not have pediatric patches, you should:
Ensure quality CPR and use the adult patches to assess for a shockable rhythm.
The time goal for recognition of stroke symptoms until time of arrival at a stroke center is ____ hours.
2
Skin exposed to chemicals should be flushed for at least ____ minutes.
20
Burn patients with burns less than _____ % can be treated with moistened dressings for comfort.
10% (NYS protocol)
An open fracture is
any open wound near a suspected bone injury.
When can a limb be manually aligned using traction prior to splinting?
severe long bone deformity, distal extremity cyanosis, loss of distal pulses. Dislocations should only be repositioned if distal cyanosis and loss of distal pulses occurs.
When is extremity traction contraindicated?
Injury close to the knee, hip, or pelvis, partial amputation or avulsion with bone separation, and injury to the lower leg or ankle.
Trauma Field Traige decisions are based first on:
Vital signs and presenting injuries.
Adult trauma patients with a respiratory rates less than ____ or greater than ____ should be transported to the trauma center.
10 or 29
Chemical burns to the eyes must be irrigated for a minimum of _____ minutes.
20
For eyes injuries you should bandage
(the injured eye/both eyes)
Both eyes to reduce sympathetic eye movement.
Your patient is on a NRB at 12 lpm. The reservoir fully collapses with each breath the patient takes. You should:
Increase the flow to 15 lpm.
You can assume the patient is hypoperfusing with a BP less than 90mmHG if what clinical signs are present:
loss of peripheral pulses and altered mental status
According to NYS protocol, PASG is indicated when:
The systolic BP is less than 50 mmHg, or the patient has an unstable pelvis with a BP less 90 mmHg.
PASG is contraindicated if the patient has:
pulmonary edema, penetrating chest trauma,unilaterally decreased breath sounds,has cardiac related problems, or is a pediatric patient.
When can PASG be deflated?
PASG cannot be deflated in the field without medical direction.
Ventilations should be provided if an infants heart rate is less than ______bpm.
100
CPR should be started if an infants heart rate is less than _____bpm.
60
If a newborn infant's respiratory rate is depressed and central cyanosis is present you should:
Position and stimulate the baby, suction the mouth and nose as needed, and begin ventilations if there is no clinical improvement.
When is it appropriate to insert sterile gloved hand/fingers into the vagina during childbirth?
Breech birth that is not progressing and prolapsed umbilical cord.
Medical direction must be contacted before an EMT can administer nebulized albuterol to a patient with a medical history of:
angina, MI, dysrhythmias, or CHF.
Nebulized albuterol is administered with an O2 flow rate of:
4-6 LPM.
Your patient has a GCS of 14. He is refusing to go to the hospital despite being told that he may have serious internal injuries due to the mechanism of injury he sustained. You should:
Request police and contact medical direction. GCS must be 15 to be considered mentally competent to refuse care.
Your patient has hemophilia fell from a ladder. On your arrival his wife is preparing to administer an infusion of his prescribing clotting factor concentrate. You should:
Allow her to proceed, and contact medical control if transport may be delayed.
Hyperventilation causes a _____ in CO2 levels whcih in turn causes the blood vessels of the brain to _______________.
decrease, constrict
Moderate hyperventilation has what effect on brain swelling?
Decreases swelling due to the primary injury.
Excessive hyperventilation can lead to cerebral _________________.
Cerebral hypoxemia due to excessive cerebral vasoconstriction.
A single episode of ______________________ or ________________________ significantly increases moratility due to head trauma.
hypoxia, hypotension
Cushing's triad indicates
increased intracranial pressure
Cushing's triad consists of:
Increased systolic BP, decreased heart rate, and abnormal respirations.
Colormetric CO2 detectors turn ________ when CO2 is exhaled, confirming the ET tube is in the trachea.
Yellow
During CPR, your patinet has an ETCO2 of 8. You should:
Assure high quality CPR is being performed.
During CPR, your patient's ETCO2 rapidly changes from 12 to 20mmHg. You should:
Assess for return of spontaneous circulation. (ROSC)
Pediatric AED patches are designed for use on children ________ years of age.
1-8
For patient's with potential tuberculosis, the most appropriate BSI includes:
Gloves and a #M sub-micron molded surgical mask
Potential infectious disease exposures must be reported to you agencies:
Infection Control Officer.
According to NYS policy, who can consent to or refuse medical care for themself:
Any person who is 18 years of age, or is pregnant or the parent of a child, or who has married
What is the Abandoned Infant Protection Act
It grants immunity to anyone abandoning an infant (5 days old or less) at a safe place. This can be done anonymously, and requires that someone is immediately notified of where the baby was left.
How long does an EMS provider have to submit written documentation of suspected child abuse or neglect?
48 hours
(The verbal report to the NYS Child Abuse and Maltreatment Register should be made immediately after transferring care to the ED.)
Airborn disease protection requires the use of:
#M sub-micron molded surgical mask (Ex N95), and plaing a surgical mask on the patient unless the patient is on O2 via mask
Droplet protection requires:
disposable gown, gloves, googles and mask when within 6.5 feet of the patient.
Common droplet spead infections disease
Measles, mumps, chicken pox, meningitis, tuberculosis, pneumonia, common cold, influenza
The antidote for nerve agents is:
Atropine first, then prallidozime (2-PAM), this is the Mark I Kit
What PPE is required for nerve agents:
SCBA, goggles, gloves made of viton, nitrile, or neoprene, and protective coveralls or aprons.
What does SLUDGEM stand for
Salivation, lacrimation, urination, defecation, GI upset, emesis, miosis/muscle (twitching, spasm, "bag of worms")
If severe signs and symptoms of nerve agent exposure are presnt, how many Mark I Kits should be administered?
3 in rapid succession
As children grow older their heart rate becomes ___________ and there BP __________.
HR slower, BP increases