What is the most commonly injured joint in the body?
Ankle
When suctioning a patient, you should only insert the catheter to what point?
Never past the base of the tongue
What is the NFPA 704 system stand for & what does it mean?
The National Fire Protection Association. Identifies potential danger with the use of background colors & numbers ranging form 0 to 4. The BLUE DIAMOND is a gauge of health hazard; the RED, fire hazard; and the YELLOW, reactivity hazard. The WHITE diamond
6 P's of musculoskeletal assessment
pulselessness, pain, pressure, paralysis, paresthesia, pallor
Minor MS injuries
Minor sprains, fractures or dislocations of digits
Moderate MS injuries
Open fractures of digits, nondisplaced long-bone fractures, nondisplaced pelvic bone fractures, major sprains of a major joint
Serious MS injuries
Displaced long-bone fractures, multiple hand & foot fractures, open long-bone fractures, displaced pelvic fractures, dislocations of major joints, multiple digit amputations, laceration of major nerves or blood vessels
Severe, life-threatening MS injuries (survival is probable)
Multiple closed fractures, limb amputations, fractures of both long bones of the legs (bilateral femur)
Critical MS injuries (survival is uncertain)
Multiple open fractures of the limbs, suspected pelvic fractures w hemodynamic instability
AIRWAY:
A patient who isn't breathing for 3 mins is
a. not likely to have brain damage
b. very likely
a. not likely; damage can occur as soon as 4 mins w/ brain death occurring @ 4-6 mins
AIRWAY:
When you do CPR, the patient gets how much oxygen?
a. 0.21
b. 0.16
c. 0.4
d. 0
b. 0.16
The initial CPR has caused some gastric distention and you are worried about possible aspiration. What is the best method to protect the patient's airway?
Cricoid pressure/sellick maneuver
O2 tank @ 1500 psi & pt needs 16L/min. How long will it last?
(1500-200)*16/15=13.86 mins
RESPIRATORY
You are dispatched to a residence for a man experiencing shortness of breath. Upon arrival you are directed to a bedroom where you find an older man sitting on the end of the bed. From across the room you notice that the patient is leaning for
1. Absent or decreased lung sounds on 1 side
2. Spontaneous pneumothorax
Name 2 processes of COPD and explain
COPD is composed of three separate disease processes: emphysema, bronchitis, and asthma. Emphysema and bronchitis are the processes of concern here, discussed in this chapter. The underlying cause of both emphysema and chronic bronchitis is inhalation of
I see increased CO2 in pt w COPD- does this change the assessment?
Patients with COPD routinely have high CO2 levels in their blood stream. For this reason, the body gets used to the high CO2 levels and uses other means such as hypoxic drive to control respirations.
As you enter the mayor's office you see an older man sitting in a chair. He is pale, sweaty, and appears to be short of breath. You introduce yourself and the patient responds, "I feel like I'm going to die." He tells you he has a "stabbing" pain in his c
1. AMI (acute myocardial infarction)
2. angina pectoris
A severe blockage of a coronary artery that depletes the heart's ability to pump is called:
Cardiac arrest
AMIs (heart attacks) do not always lead to sudden death. The patient can also have cardiogenic shock and:
congestive heart failure (CHF)
Explain the differences in pain between an AMI and angina pectoris.
AMI pain is not caused by exertion and it does not resolve in a few minutes. Pain of AMI is not relieved after administering nitroglycerin.
What are signs and symptoms of congestive heart failure (CHF) and the treatment?
Congestive heart failure is a chronic disease of the heart muscle. As the muscle gets older and damaged from lack of oxygen the muscle loses strength. As the heart muscle pump is weakened, blood backs up. In right-sided CHF blood backs up from the right a
PHARM
What are the different routes for administering medications and how do they differ?
The primary difference is in absorption time. For immediate absorption the following routes are used: intravenous (IV), intraosseous (IO), and rectal (PR). For rapid to immediate absorption, the inhalation route is used. The moderate routes include the in
6 RIGHTS of med admin?
1. Right patient
2. Right med
3. Right expiration date
4. Right route
5. Right time
6. Right documentation
NEURO
The chief complaint heard in cases of hemorrhagic stroke, "This is the worst headache of my life!" is caused by:
Irritation of brain tissue
All patients who have altered mental status, including possible stroke patients, should have what assessment performed?
AVPU & Glasgow coma scale
What physical tests would you include in your assessment of an older woman patient in this scenario?
Facial droop, Speech, arm drift: Cincinnati stroke scale
Stroke patients who have trouble understanding speech but can speak clearly are experiencing what condition?
Receptive aphasia
What common medical emergencies can mimic stroke?
Insulin shock and seizures. Hypoglycemia and the postictal state of seizures can appear very similar to strokes. In some patients, you may note one-sided weakness or hemiparesis.
TIPS AEIOU
CAUSES OF AMS
Trauma
Infection
Psychogenic causes
Seizure, syncope
Alcohol
Electrolytes
Insulin
Opiates
Uremia (kidney failure)
Glasgow coma scale specifics?
4: EYE opening
Alert- 4
Verbal- 3
Pain- 2
Unresponsive- 1
5: VERBAL response
Oriented convo- 5
Confused convo- 4
Inappropriate words- 3
Incomprehensible sounds- 2
None- 1
6: MOTOR response
Obeys commands- 6
Localizes pain- 5
Withdraws to pain- 4
Abnormal
CONDITION & LOCALIZATION OF PAIN
1. Appendicitis
2. Cholescystitis (inflammation of gallbladder)
3. Ulcer
4. Diverticulitis
5. Abdominal aortic aneurysm (ruptured or dissecting)
6. Cystitis (inflammation of the bladder)
7. Kidney infection
8. Kidney stone
CONDITION & LOCALIZATION OF PAIN
1. RLQ (direct), around navel (referred); rebounding pain
2. RUQ (direct); right shoulder (referred)
3. Upper mid abdomen or upper part of back
4. LLQ
5. Low part of back & lower quadrants
6. Lower midabdomen (retropubic)
Your patient with an acute abdomen repeatedly asks you for a drink of water. What do you do?
Any time a patient has the possibility of going to surgery, he or she should not be allowed any food or drink; however, simply telling the patient 'no' without offering an explanation can make you seem insensitive to his or her needs. Always explain what
Why is it important to prevent the patient with an acute abdomen from receiving any pain medications in the field?
There are a wide variety of causes for sudden, severe abdominal pain. If the pain is masked through the administration of analgesics, the physician may have difficulty in pinpointing the exact cause of the patient's pain. If the patient has taken any pain
ENDOCRINE/HEMATOLOGIC
What questions should be asked of the patient with diabetes when completing the SAMPLE history?
The questions should include whether the patient takes insulin and, if so, whether it has been taken, how long ago it was taken, and whether the patient has eaten and how long ago. This information will usually give the EMT clues to whether the patient ma
What are the medical complications of diabetes?
Diabetes affects all parts of the body, especially the kidneys, arteries, nerves, and eyes. Diabetes can lead to stroke and heart attacks. People with diabetes also do not heal well due to vascular problems and have ulcers of the feet and toes. Some perso
Signs, symptoms & treatment o f Hyperglycemia?
Hyperglycemia is typically characterized by excessive urination and resulting thirst, in conjunction with the deterioration of body tissues.
Hyperglycemia is usually associated with dehydration and ketoacidosis and can result in marked rapid (often deep)
Signs, symptoms & treatment o f Hypoglycemia?
Symptoms of hypoglycemia classically include confusion; rapid respirations; pale, moist skin; diaphoresis; dizziness; fainting; and even coma and seizures. This condition is rapidly reversible with the administration of glucose or sugar. Without treatment
There are 2 types of hemoglobin. Which is normal? Which is responsible for sickle cell crisis?
Hemoglobin A is considered normal hemoglobin; hemoglobin S is considered an abnormal type of hemoglobin and is responsible for sickle cell crisis.
What delayed reaction can occur as the result of an acetaminophen overdose?
Liver failure
What is the usual adult dose of activated charcoal?: What is the usual pediatric dose of activated charcoal?
25-50 g adult
12.5-25 g ped
You are called to a scene of attempted suicide. What problems do you foresee regarding information from the dispatch?
Oftentimes, reports of suicide come from a "third-party" caller. This means that information originates from a person who is not on the scene of the emergency. Suicidal patients will sometimes call friends or family to inform them of their intentions or a
Can a patient who intentionally overdosed refuse medical care?
Any patient who threatens suicide cannot be released from care, regardless of mental status. You may be required to use restraints if the patient will not cooperate. This is another reason it is extremely important to have law enforcement on scene. Office
How should you handle the emotional aspects of a suicidal patient?
It is important to listen to the patient's concerns, but you must understand your role as an EMT. You are not a licensed counselor or psychologist. It is beyond your scope of practice to provide your opinion regarding mental health issues. Your purpose is
Legal consent for treating this patient is granted by
implied consent.
If patient's ventilations are not adequate, provide assistance with 100% oxygen using Bag-Valve Mask (BVM)
A. If patient's age is > 12 yo, provide 1 breath every ___seconds
B. If patient's age is < 12 yo, provide 1 breath every ____ seconds
A. 5
B. 3
Respiratory distress is present if the patient has
retractions, nasal flaring, wheezing, stridor, or difficulty speaking.
Unless in respiratory distress, avoid administration of high flow oxygen to patients presenting with the following conditions:
STEMI/Angina
CVA/stroke
Post arrest
False SPO2 readings may occur in the following patients:
Hypothermic
hypoperfusion (shock )
CO poisoning
hemoglobin abnormality
anemia
vasoconstriction.
A.Hyperventilate the head injured patient only if signs/symptoms of herniation are present:
B.If hyperventilating the patient, use the following rates
A. posturing
loss of pupillary light response
dilation of one or both pupils
vomiting
hypertension
bradycardia
irregular respirations
B.Adult 20 breaths per minute
Child 30 breaths per minute
Infant 35 breaths per minute
Complete Spinal Immobilization (C-spine and back maintaining neutral alignment and padding when appropriate) should occur if patient presents with any blunt traumatic mechanism which could cause cervical spine injury and meets ANY of the following criteri
History of Loss of Consciousness (LOC) or unconscious?
Disoriented or altered level of consciousness?
Suspected use of drugs or alcohol?
Midline cervical tenderness or pain?
Focal neurologic deficit?
Has a painful distracting injury that could mask cervic
TRAUMA DECISION TREE
Category Alpha patients include... (6)
Glasgow Coma Scale 13 or less
Adult Systolic BP less than 90
Peds Systolic BP less than 60
Respiratory rate in patients older than 1 year is less than 10 or greater than 29
Respiratory rate in patients aged 1 year or younger is less than 20 or greater tha
TRAUMA DECISION TREE
Category Bravo patients include...(8)
2+ proximal long bone fractures
Amputation proximal to wrist or ankle
Chest wall instability/deformity
Crushed, degloved, mangled or pulseless extremity
Open or depressed skull fracture
Penetrating injuries to head, neck, torso or extremities proximal to
TRAUMA DECISION TREE
Category Charlie patients include...
High risk auto crash
Falls
Exposure to blast/explosion
TRAUMA DECISION TREE
Category Delta patients include...(6)
-Older adults. Risk of injury/death increases after 55. Systolic BP less than 110 may indicate shock after age 65. Low impact falls may result in severe injury.
-Children
-Burns (without trauma, triage to Burn Center. With trauma, triage to Trauma Center.
What qualifies as a High Risk Auto Crash? (7)
Intrusion (incl. roof) greater than 12 in occupant site; greater than 18 in any site
Ejection (partial or complete) from vehicle
Death in same passenger compartment
Vehicle telemetry data consistent w high risk of injury
Rollover w/o restraint
Auto v. ped
What qualifies as a significant fall? (Adult & peds)
Adult: 20+ ft (2 stories)
Peds: 10+ ft/3x height of pt
What factors should you take into account when evaluating a patient who has fallen from a significant height?
The height of the fall
The surface struck
The part of the body that hit first
Should you ask about a trauma patient's medical history?
Yes- Sometimes traumatic events are preceded by a medical condition. If you cannot find an obvious reason why the incident occurred, suspect an underlying medical condition
A. A patient who has sustained a significant mechanism of injury (MOI) and is considered to be in serious or critical condition should receive a _________________.
B. Any patient who has sustained a nonsignificant mechanism of injury (MOI) should receive
A. rapid full-body scan or rapid head-to-toe examination.
B. assessment focused on the chief complaint.
A. Bleeding from the nose, ears, and/or mouth may result from a
B.Other causes may include
A.skull fracture
B.high blood pressure and sinus infection
A. If bleeding is present at the nose and a skull fracture IS suspected,__________________ .
B1. If bleeding from the nose is present and a skull fracture is NOT suspected, __________.
B2. If the patient is awake and has a patent airway, ______________.
A. place a gauze pad loosely under the nose
B1. pinch both nostrils together for 15 minutes.
B2. place a gauze pad inside the upper lip against the gum.
Signs of serious internal bleeding include the following:
- Vomiting blood (hematemesis)
- Black tarry stools (melena)
- Coughing up blood (hemoptysis)
- Distended abdomen
- Broken ribs
Rule of nines
The primary objectives in burn care by EMS providers (4)
to stop the burning process, establish IV access, avoid hypothermia, and transport patients quickly and safely to a burn center.
signs of respiratory failure
symptomatic airway obstruction, shock, altered mental status, hypoxemia while receiving supplemental oxygen, or dyspnea, etc.
Indications for Referral to a Burn Center
1. All 3rd degree burns
2. 2nd degree burns greater than 10% of the total body surface area
3. Burns of the face, hands, feet, major joints, genitalia, or perineum
4. Electrical burns, incl. lightning or contact w hi-voltage (greater than 120 volts)
5. Su
Chemical burns should be
A. transported to the closest hospital for decontamination PRIOR to referral to a burn center
B. referral to the nearest appropriate trauma center, for initial care
C. transported to a pediatric burn center
D. considered for trans
A
PATIENTS PRESENTING WITH ALTERED MENTAL STATUS OR NAUSEA WITH VOMITING, SEIZURES, LOSS OF CONSCIOUSNESS, OR MARKED DYSPNEA IN THE FACE OF SUSPECTED CARBON MONOXIDE OR TOXIC INHALATION WITH OR WITHOUT MINOR BURNS SHOULD BE
A. transported to the closest hos
D
PATIENTS WITH BURNS AND TRAUMA SHOULD BE
A. transported to the closest hospital for decontamination PRIOR to referral to a burn center
B. referral to the nearest appropriate trauma center, for initial care
C. transported to a pediatric burn center
D. cons
B
CHILDREN WHO MEET BURN INCLUSIVE CRITERIA WHO HAVE NOT REACHED THEIR 15TH BIRTHDAY
A. transported to the closest hospital for decontamination PRIOR to referral to a burn center
B. referral to the nearest appropriate trauma center, for initial care
C. tran
C
PATIENTS IN CLOSED SPACE INCIDENTS ARE MORE LIKELY TO MANIFEST THESE SYMPTOMS
ALTERED MENTAL STATUS OR NAUSEA WITH VOMITING, SEIZURES, LOSS OF CONSCIOUSNESS, OR MARKED DYSPNEA IN THE FACE OF SUSPECTED CARBON MONOXIDE OR TOXIC INHALATION WITH OR WITHOUT MINOR BURNS
A burn patient is thirsty. Can he have some water?
DO NOT GIVE ANYTHING BY MOUTH.
Ice packs are useful for burns up to ____% of total BSA (body surface area).
5
What is the rule of palms?
Palm=1% BSA
A pregnant patient with a history of blood pressure problems should be transported in which body position
in Fowler's position
Apgar
appearance, pulse, grimace, activity, and respirations
A.Normal respiratory rates for infants are
B. The normal heart rate range for infants is:
A.30 to 60 breaths/min
B. 100-160 bpm
What makes infants so good at compensating for blood loss?
By increasing their heart rates. An infant's heart rate can become as high as 200 beats or more per minute if the body needs to compensate for injury or illness. They also compensate for decreased perfusion by the constriction of blood vessels.
If a baby dies suddenly (dependent rigidity, cyanosis) & then you arrive on scene, should you still do CPR?
Yes for the emotional well being of the family
The ambulance is a specialty van and has a forward-control intergraded cab. Which type of ambulance is this?
III
Can you use just lights, or just sirens?
No, both must be used at once
What toxicity level is used to describe a substance that will cause death with minimal exposure?
Level 4
Most serious injuries and deaths from hazardous materials result from:
Airway & breathing problems
One of the roles of the EMT at the scene of a hazardous materials spill is to assist
in keeping bystanders back
The safe area that should be set up when there is an unknown agent should be:
Upwind & 100 ft
You and your partner respond to a local elementary school where an 9-year-old girl had a single, brief seizure. Her mother arrives at the same time you do and reports that she has seizures often, and is under medical treatment. What should you do?
Ensure a patent airway and request medical direction regarding transport