ALL NREMT SOLUTION TEST BANK Best for 2024-2025 Exam Preparation {Nationally Registered Em, Exams of Nursing

Download ALL NREMT SOLUTION TEST BANK Best for 2024-2025 Exam Preparation {Nationally Registered Em and more Exams Nursing in PDF only on Docsity! ALL NREMT SOLUTION BANK (2024) Best for 2024-2025 Exam Preparation {Nationally Registered Emergency Medical Technician (NREMT) Exams with Complete Questions and Answers} • NREMT written exam • NREMT Practice questions 1 2024 • NREMT practise test bank- multiple choice • NREMT – Everything you need to know • NREMT practice exam 2 2024 • NREMT Written EMT basic exam • NREMT Cognitive exam prep 2024 • NREMT PRACTICE EXAM QUESTIONS 2024 • NREMT paramedic exam NREMT Cognitive Exam Prep 2024 Where does the modern EMS system have its origin? The modern EMS system has its origins in funeral homes, which often operated ambulances. However, funeral home operators were often serving competing business interests and patients received little trained care until the hospital. What is considered the "birth" of EMS? In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of Modern Society" is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma. Who developed the first EMT National Standard Curriculum? Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards. What are EMT roles and responsibilities? Equipment preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy Professional development Quality improvement Illness and injury prevention Maintain certification/licensure What is the role of the medical director? The medical director is a physician responsible for providing medical oversight. The medical director oversees quality improvement. What are the two types of medical direction?Online medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols. What is an EMT's first priority? The EMT's first priority is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders. -Use soft, padded restraints. -Monitor the patient's level of consciousness, airway, and distal circulation continuously. -Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained. What is the use of force doctrine?The EMT must act reasonably to prevent harm to a patient being forcibly restrained. The use of force must be protective, not punitive. What is scope of practice? Scope of practice outlines the actions a provider is legally allowed to perform based on his or her license or certification level. Scope of practice is tied to the licensure or certification, not the individual's knowledge or experience. Each state determines the scope of practice for its EMS providers. What is standard of care? Standard of care is the degree of care a reasonable person with similar training would provide in a similar situation. Standard of care requires EMTs to competently perform the indicated assessment and treatment within their scope of practice. What are sources that help establish standard of care? National EMS Education Standards State protocols and guidelines Medical direction EMS agency's policies and procedures Reputable textbooks Care considered acceptable by similarly trained providers in the same community. What is informed consent? Informed consent is required from all patients who are alert and competent. -Patient must be informed of your carer plan and associated risks of accepting or refusing care and transport. -Patient must be informed of, and understand, all information that would impact a reasonable person's decision to accept or refuse care and transport. What is expressed consent? Expressed consent also requires that the patient be alert and competent to give expressed consent. Expressed consent can be given verbally or nonverbally. -Expressed consent is similar to informed consent, but not usually as in- depth as informed consent. -Expressed consent is often used to obtain consent for more basic assessments or procedures. What is implied consent? Implied consent allows assumption of consent for emergency care from an unresponsive or incompetent patient. -Patients might be incompetent for many reasons, such as alcohol, drugs, head injury, hypoxia, hypoglycemia, or mental incompetency. -Implied consent can be used to treat a patient who initially refused care but later loses consciousness or becomes otherwise incapacitated. What is minor consent? Minors are not competent to accept or refuse care. -Consent is required from a parent or legal guardian. Implied consent can be used when unable to reach a parent or guardian and treatment is needed. -Minor consent is not required for emancipated minors. Criteria for emancipation varies but usually includes minors who are married or pregnant, already a parent, a member of the armed forces, financially independent, or emancipated by the courts. What is involuntary consent? Involuntary consent is used for mentally incompetent adults or those in custody of law enforcement. Consent must be obtained from the entity with the appropriate legal authority. What are advance directives? Advance directives are written instructions, signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts. There are several types of advance directives. -Do Not Resuscitate (DNR): DNRs are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest. -Living will: Living wills are broader than DNRs. They address health care wishes prior to entering cardiac arrest. This may include use of advanced airways, ventilators, feeding tubes, etc. How do Good Samaritan Laws affect EMTs? Good Samaritan laws are designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed. -Each state has some form of Good Samaritan laws. Some protect health care providers, but some do not. -Some states extend their Good Samaritan law to publicly employed EMS providers but not to those in the private sector. What is assault? A person can be guilty of assault even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault. What is battery? Battery is physically touching another person without their consent. What is negligence? Negligence is the most common reason EMS providers are sued civilly. -The plaintiff has the burden of proof, not the EMT. -With negligence, the EMS provider is accused of unintentional harm to the plaintiff. What are the four components of negligence? The plaintiff must prove all four of the following: 1. Duty to act: the EMT had an obligation to respond and provide care. 2. Breach of duty: the EMT failed to assess, treat, or transport patient according to the standard of care. 3. Damage: the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation. 4. Causation: the injury to the plaintiff was, at least in part, directly due to the EMT's breech of duty. What is gross negligence? Gross negligence exceeds simple negligence. Gross negligence involves an indfference to, and violation of, a legal responsibility. Reckless patient care that is clearly dangerous to the patient is grossly negligent. Gross negligence can result in civil and/or criminal charges. What are COBRA and EMTALA? Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA) -COBRA and EMTALA include federal regulations guaranteeing public access to emergency care. -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump." What are considered obvious signs of death? The following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation On what kind of scenes must law enforcement be notified? 1. Any scene where the patient is dead on arival 2. Suicide attempts 3. Assault or sexual assault 4. Child abuse or elder abuse 5. Suspected crime scene 6. Childbirth How should EMT's operate in crime scenes? 1. Ensure scene safety 2. Provide patient care as needed 3. Avoid any unnecessary disturbance of scene 4. Remember and note the position of patient(s) 5. Remember and report everything you touched at the scene 6. Cut around (not through) holes in clothing when exposing the patient 7. Note anything or anyone suspicious on or near the scene 8. Discourage sexual assault patients from changing clothes or showering 9. Try to get a same-sex provider to assist with sexual assault patients 10. Leave once you are no longer needed at the scene What are therapeutic communications? Therapeutic communications typically refers to your interaction with the patient and ability to obtain clinical information. What are portable and mobile radios? Portable radios: hand-held transmitter/receiver with a very limited range, unless used with a repeater. Mobile radios: vehicle-mounted transmitters and receivers. These have a greater range than portable radios, but distance is still limited unless used with a repeater. What is a repeater? A type of base station that receives low-power transmissions from portable or mobile radios and rebroadcasts at higher power to improve range. What is a base station? A transmitter/receiver in a fixed location that is in contact with all other components in the radio system. Who regulates all radio operations in the US? The Federal Communications Commission (FCC) regulates all radio operations in the US and has allocated specific frequencies for EMS use only. How should you communicate with dispatch? 1. Confirm receipt of dispatch. 2. Notify dispatch when en route to the call,on scene, en route to the hospital, and at the hospital. A. Identify who you are talking to first, then who you are. B. Use "affirmative" or "negative," not "yes" or "no." C. Use "copy" to confirm receipt of a transmission. D. Always "echo" orders from medical direction to confirm accuracy. E. DO NOT use unnecessary verbiage such as "please" or "thank you." How should you communicate with medical direction? Sample format: -Unit designation, certification level, destination and estimate time of arival -Patient's age, sex, and chief complaint -Patient's level of consciousness -History of present illness or mechanism of injury -Any associated symptoms or pertinent negatives -Patient's vitals -Patient's physical exam -Patient's history, medications, allergies -Treatment provided and response to treatment -Any requests for additional interventions -Echo any orders provided by medical direction What two components must be present for transfer of care? 1. Verbal report 2. A written copy of the patient care report must also be provided What are the purposes of the patient care report? 1. Continuation of care 2. Legal document 3. Billing 4. Research and continuous quality improvement What is the minimum data set? The minimum data set identifies the information that should be included on every PCR. Times: -Dispatch time -Time en route to call -Time on scene -Patient contact time -Time en route to hospital -Arrival time at hospital -Time transfer of care was completed Patient information: -The patient's age, sex, and chief complaint -The patient's level of consciousness -Minimum of two sets of vital signs -All assessments completed on the patient -All treatments provided and response to treatment Administrative information: -The address of the call -Date of the call -Your unit designation What are normal breathing rates for adults, children and infants? Normal adult rate: 12-20 breaths per minute Normal pediatric rate: 15-30 breaths per minute Normal infant rate: 25 to 50 breaths per minute Non-labored Regular rhythm Clear and equal breath sounds bilaterally What are the three layers of heart muscle and pericardium? Endocardium: smooth, thin lining on the inside of the heart Myocardium: thick muscular wall of the heart Epicardium: outermost layer of the heart and innermost layer of the pericardium Pericardium: fibrous sac surrounding the heart What is the heart's electrical conduction system? The primary power plant, the sinoatrial (SA) node, normally generates impulses between 60 and 100 times per minute in the adult. The atrioventricular (AV) junction is the backup pacemaker and generates electrical impulses at about 40 to 60 per minute. The bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute. What is preload? Preload is the precontracting pressure based on the amount of blood coming back to the heart. Increased preload leads to increased stretching of the ventricles and increased myocardial contractility. What is afterload? Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? Plasma: the liquid component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood White blood cells: fight infection by defending against invading organisms Platelets: essential for clot formation to stop bleeding What is perfusion? Perfusion is the flow of blood throughout the body. What is the central nervous system? The central nervous system consists of the brain and spinal cord. What are the parts of the brain? Cerebrum: largest part of the brain; controls thoughts, memory and senses Cerebellum: coordinates voluntary movement, fine motor function and balance Brain stem: includes midbrain, pons and medulla; controls essential body functions such as breathing and consciousness What are the two epidermal layers? The germinal layer produces new cells and pushes them to the surface. the cells die en route to the surface. The stratum corneal layer is the top epidermal layer and consists of dead skin cells. What are normal vital signs for infants? Respirations: normal respiratory rate is about 30-60 breaths per minute for newborns and about 25-50 breaths per minute for infants. Pulse: normal pulse rate is about 140-160 beats per minute for newborns and about 100-140 beats per minute for infants. Blood pressure: a newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by one year of age. What is the physiology of newborns and infants? The typical newborn weighs about 6-8 pounds. The newborn's weight will typically double by 6 months and triple by one year. The newborn's head makes up about 25% o f the body and is a significant source of heat loss. During the first couple weeks, neonates often lose weight, and then begin to gain it back. The newborn's fontanelles (soft spots on the skull) will be fully fused by about 18 months. Depressed fontanelles may indicate hypovolemia. Infants are often nose breathers and can develop respiratory distress easily. Rapid breathing can lead to fluid loss and loss of body heat. Hyperventilation of infants presents significant risk of barotrauma. What are the reflexes that infants have? Startle reflex, grip reflex, rooting reflex, sucking reflex What are the age ranges of toddlers and preschoolers? Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old What are normal vital signs of toddlers and preschoolers? Toddlers: -Respirations: about 20-30 breaths per minute -Heart rate: 90-140 bpm -Blood pressure: 80-90 systolic Preschoolers: -Respirations: about 20-25 breaths/minute -Heart rate: 80-130 bpm -Blood pressure: about 90-110 systolic What is the physiology of toddlers and preschoolers? As the immune system develops, children at this age typically experience a number of minor colds, viruses, flu-like symptoms, respiratory infections, etc. Fine motor skills improve and the brain grows rapidly in size. Toddlers: typically walk, climb, distinguish basic shapes and colors and are potty trained. -10 seconds for children -5 seconds for infants The recovery position reduces risk of aspiration. Unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position. When is supplemental oxygen needed? The goal of supplemental oxygen is to maintain a pulse oximetry reading of at least 94%. -Supplemental oxygen is not needed if there are no signs of symptoms of respiratory distress and the pulse oximetry is at least 94%. -When oxygen is administered, it should be titrated to maintain a pulse oximeter reading of at least 94%. Indications: -Any patient in cardiac arrest -Any patient receiving artificial ventilation -Any patient with suspected hypoxia -Any patient with signs of shock -Any patient with a pulse oximetry below 94% -Any patient that may benefit from it -Any patient with an altered or decreased LOC What is notable about oxygen cylinders? A full cylinder is about 2000 psi. The cylinder should be taken out of service and refilled if below 200 psi. What are non-rebreather masks? Usually the preferred method of oxygen administration in prehospital. Referred to as "high-flow" oxygen administration. Flow rate: 10-15 L/min Oxygen delivered: up to 90% Cautions: -The reservoir must be full before applying mask to patient -Never administer less than 10 L/min -If the reservoir completely deflates during inhalation, the flow rate must be increased -Immediately remove mask if oxygen source is lost What are nasal cannulas? Referred to as "low-flow" oxygen administration Indications: -Patient will not tolerate a non-rebreather -Patient is on long-term oxygen therapy via nasal cannula and there is no indication high-flow oxygen is needed Flow rate: 1-6 L/min Oxygen delivered: 24-44% Cautions: prolonged use can dry and irritate nasal passages if oxygen is not humidified What is a simple face mask? The simple face mask is similar to a nonrebreather, but without the oxygen reservoir. These are rarely used in the pre-hospital environment. Flow rate: 6-10 L/min Oxygen delivered: 40-60% What are Venturi masks? A mask that delivers precise concentration of low-flow oxygen. Rarely used in the prehospital environment. How do you administer supplemental oxygen in patients with a tracheostomy or stoma? Patients with a tracheostomy ventilate thorugh their stoma, not the mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask or a nonrebreather mask. What are the hazards of oxygen administration? Oxygen is highly combustible Pressurized gas Oxygen toxicity: the alveoli can collapse due to a long-term exposure to high concentrations of oxygen Respiratory depression: a risk for COPD patients on the hypoxic drive Retinal damage: can occur in newborns with long-term exposure to high-concentration oxygen When is artificial ventilation indicated? Artificial ventilations are indicated for any patient with *inadequate spontaneous breathing* leading to severe respiratory distress or respiratory failure. This could be caused by: -CNS injury, disease or impairment -Foreign-body airway obstruction -Chest trauma, such as a flail chest or a sucking chest wound -Increased airway resistance due to bronchoconstriction, pulmonary edema or inflammation Consider providing artificial ventilations for any patient breathing less than 8 times per minute or for any adult patient breathing more than 24 times per minute. Any unresponsive patient receiving artificial ventilations should have an airway adjunct in place to prevent the tongue from obstructing the airway. What are the risks of artificial ventilation? Artificial ventilations are accomplished through positive pressure ventilations (PPV) whereas normal spontaneous breathing is done through negative pressure. Complications of PPV: -Increased intrathoracic pressure, which reduces circulatory efficiency -Gastric distension, which increases the risk of vomiting and can compromise ventilatory efficiency -Hyperventilation Closed-ended questions can be answered much faster and typically require only a "yes" or "no" response. Closed-ended questions may be preferred when time is critical. They can also be useful if the patient is only able to speak short sentences due to severe pain or respiratory distress. What are the standard vital signs? Respiration: rate, rhythm, quality Pulse: rate, rhythm, quality Blood Pressure Pupils: size, equality, reactivity Skin: color, temperature, condition and capillary refill Pulse oximetry What is pulse pressure? SBP - DBP Normal pulse pressure should be greater than 25% but less than 50% of systolic blood pressure. A widened pulse pressure above 50% of systolic indicates a possible head injury. A narrow pulse pressure below 25% of systolic indicated possible hypoperfusion, tension pneumothorax, or pericardial tamponade. How can you estimate blood pressure in pediatric patients? A systolic below 70 + 2(age) for ages 1 to 10 years indicates hypotension What are blood glucose levels? Normal: 80-120 mg/dL Hypoglycemia: 60 mg/dL or below (really, below 80) Hyperglycemia: over about 140 mg/dL What is the difference between pharmacokinetics and pharmacodynamics? Pharmacokinetics is the study of how drugs enter the body, and are metabolized and eliminated. Pharmacodynamics is the study of a drugs' effects on the body. What are the routes of medicine administration? Oral (PO): slow onset of action, safe but unpredictable absorption. -Aspirin, activated charcoal, oral glucose Intramuscular (IM): rapid absorption, but less reliable. -EpiPen Inhalation: rapid onset -Albuterol Sublingual: faster onset than oral -Nitroglycerin What are the six "rights" of drug administration? Right patient, right drug, right route, right dose, right time, right documentation. What information do you need to know about activated charcoal? Class: adsorbent MOA: adheres many drugs and chemical, preventing their absorption into the GI tract Indication: recently ingested poision Contraindications: decreased LOC, inability to swallow, ingestion of acids, alkalis or hydrocarbons, expired medication or lack of medical direction Dose and route: -Adult: 1 g/kg of body weight -Pediatric dose: 25-50 grams -Administered orally Side effects: Nausea, vomiting, dark and tarry stool Considerations: -Shake before administering -Use caution if you suspect patient's LOC will change -Have suction ready What information do you need to know about aspirin? Names: acetylsalicylic acid Class: anti-inflammatory, anti-platelet aggregate, antipyretic MOA: reduces inflammation, decreases platelet aggregation, reduces fever Indication: chest pain Contraindications: allergy, decreased LOC, inability to swallow, recent bleeding or active ulcer, pediatric, expired medication, lack of medication Dose and route: -324 mg orally Side effects: nausea, vomiting, stomach pain, bleeding, allergic reaction, Reye's syndrome in pediatric patients What information do you need to know about a metered dose inhaler? Names: albuterol, ipratropium bromide Class: bronchodilator MOA: relaxes bronchial smooth muscle, improving air exchange Indications: dyspnea, wheezing, asthma , reactive airway disease Contraindications: allergy, patient unable to follow commands, expired medication, medication not prescribed to patient, lack of medical direction Dose and route: one to two inhalations Side effects: tachycardia, hypertension, restlessnessm, anxiousness Decompensated shock: late or "progressive" shock. The body can no longer compensate for the hypovolemic state, and blood pressure starts to fall. -Falling BP Irreversible shock: the final stage of shock. The patient will not survive once entering irreversible shock. What are the types of shock? 1. Cardiogenic shock 2. Obstructive shock 3. Distributive shock 4. Hypovolemic shock What is cardiogenic shock? Cardiogenic shock is a pump problem. The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension. -Pulmonary edema, accumulation of fluid in the lungs. Signs and symptoms of cardiogenic shock include hypotension, probable cardiac history, chest pain, respiratory distress, pulmonary edema, and altered LOC. What is obstructive shock? This type of shock is a pump problem caused by mechanical obstruction of the heart muscle. -Cardiac tamponade: fluid accumulates within the pericardial sac and compresses the heart. Signs and symptoms inlcude JVD, narrowing pulse pressure, hypotension, -Tension pneumothorax: air enters the chest cavity due to lung injury or sucking chest wound. Accumulating pressure compresses the lungs and great vessels. Signs and symptoms include JVD, respiratory distress, diminished or absent lung sounds, difficulty ventilating, and tracheal deviation towards the *unaffected* side. What is distributive shock? Distributive shock is a pipe problem. It occurs due to widespread vasodilation, which causes blood pooling and relative hypovolemia. Anaphylactic shock: a life-threatening severe allergic reaction due to massive vasodilation, widespread vessel permeability, and bronchoconstriction. Neurogenic shock: caused by spinal cord damage, typically in the cervical region. It leads to massive, systemic vasodilation below the level of injury. Septic shock: caused by severe infection, which damages blood vessels and increases plasma loss out of the vascular space. Psychogenic shock: caused by sudden, temporary vasodilation that leads to syncope. What is hypovolemic shock? Hypovolemic shock is a fluid problem. It may be caused by hemorrhage or by dehydration or burns. What are early signs and symptoms of shock? Altered LOC Tachycardia Pale, cool skin: due to peripheral vasoconstriction Weak peripheral pulses Increased respiratory rate Thirst Delayed capillary refill What are late signs and symptoms of shock? Falling BP Irregular breathing Mottling or cyanosis Absent peripheral pulses How should shock be managed? Control bleeding, high-flow oxygen, Trendelenburg, prevent loss of body heat, rapid transport. What are potential causes of respiratory complaints? Airway obstruction Anaphylaxis Asthma Chronic obstructive pulmonary disease (COPD) Congestive heart failure Croup Cystic fibrosis Flail chest Pneumonia Pneumothorax Pulmonary edema Pulmonary embolism Respiratory syncytial virus (RSV) Hyperventilation syndrome Sucking chest wound Thoracic trauma Toxic substance exposure What is croup? Croup is inflammation of the pharynx, larynx, and trachea. It is highly infectious and usually occurs in children up to about 3 years of age. Signs and symptoms: -Croup is usually preceded by a cold and usually occurs in winter -Croup often presents with a unique "barking" sound -Croup often presents with stridor (a high-pitched sound in the upper airway) What is cystic fibrosis? Genetic disorder leading to thick mucus production and chronic lung infections. Cystic fibrosis often causes death prior to entering adulthood. Signs and symptoms include asthma-like symptoms and GI problems. Hemorrhagic strokes limit certain interventions and are often fatal. Prevention through modification of risk factors, especially hypertension, is key. What is the Cincinnati Prehospital Stroke Scale? Facial droop: ask the patient to smile Arm drift: ask the patient to close eyes and hold arms out in front Speech: ask the patient to say "the sky is blue in Cincinnati." What is a TIA? Transient ischemic attacks (TIAs) have the same presentation as CVAs. However, the signs and symptoms self- correct within about 24 hours with no permanent brain damage. They are a warning sign of an impending stroke. What are the types of seizures? Generalized seizures -Also called grand mal seizures -Patient is unresponsive and experiences full-body convulsions Absence seizures -Also called petit mal seizures -Patient does not interact with environment, but there is no convulsive activity Partial seizures -Simple partial seizure: no change in LOC, possible twitching or sensory changes but no full-body convulsions -Complex partial seizures: altered LOC, isolated twitching and sensory changes possible Status epilepticus -Prolonged seizure (about 30 minutes) or recurring seizures without the patient regaining consciousness in between -Highly dangerous, possibly leading to permanent brain damage and death What are the phases of a seizure? Not every stage is present for every type of seizure or every patient. 1. Aura phase -Warning stage -Patient may sense onset 2. Tonic phase -Muscle rigidity -Possible incontinence 3. Tonic-clonic phase -Patient experiences uncontrolled muscle contraction and relaxation -Patient may be apneic during the tonic or tonic-clonic phase. 4. Postictal phase -"Recovery" phase -Patient's LOC progressively improves over about 30 minutes What are possible causes of seizures? Congenital, traumatic, medical conditions, diabetes, epilepsy, fever, infection, medications, toxin exposure Febrile seizures are a common cause of seizures in pediatric patients. Caused by high fevers that develop rapidly, they do not typically present significant risk to the patient. The child should, however, be evaluated by a physician. Why is glucose important? Glucose is the body's primary fuel source It is the only fuel source used by the brain In addition to oxygen, the brain must have a continuous supply of glucose The use of glucose as a fuel source is an aerobic function Why are fats and proteins important? The brain cannot use these alternate fuel sources, but the rest of the body can. These energy sources are used in an anaerobic environment. Fats and proteins are far less efficient (by about 19 times) than glucose fuel source. Byproducts of anaerobic metabolism (ketones) are dangerous. What is diabetes mellitus? Diabetes is a disease caused by an inability to metabolize glucose normally. This is frequently due to a problem with insulin production. Untreated diabetics typically have elevated blood glucose levels due to a lack of insulin or ineffective insulin. -Increased urinary output and dehydration is common. What is Type I Diabetes? Also called insulin-dependent diabetes mellitus (IDDM) Type I diabetics must take supplemental insulin Type I diabetes usually develops in pediatric patients and is usually genetically caused. Untreated type I diabetics will appear with the three P's (polyuria, polydipsia, polyphagia) and very high blood glucose levels. Type I diabetics are at high risk for diabetic ketoacidosis if untreated. Type I diabetics are at high risk for insulin shock due to insulin overdose. What is Type II diabetes? Also known as non-insulin-dependent- diabetes-mellitus (NIDDM). Type II diabetics typically do not require supplemental insulin. Type II diabetes is caused by a combination of lifestyle and genetics. It can be largely controlled through diet, exercise, and oral medications. Type II is more common than Type I. What is hypoglycemia? A blood glucose level below 60 mg/dL with signs and symptoms or a blood glucose level below 50 mg/dL regardless of the presence of signs and symptoms. Occurs more often in type I diabetes than type II diabetes. Hypoglycemia can very quickly lead to altered LOC, seizures, coma and brain death. What is insulin shock? Insulin shock is a term commonly used to refer to severe hypoglycemia with signs and symptoms. Diabetics can suddenly become confused, violent, or unresponsive due to severe hypoglycemia. Commonly caused by a sudden unexpected drop in blood glucose due to: What are inhaled toxins? Examples of inhaled poisons include various chemicals, pesticides, carbon monoxide, and natural gas. Signs and symptoms: -May be rapid or delayed -Dyspnea, coughing, dizziness, headache, abnormal lung sounds Treatment: ensure scene safety, be alert for multiple victims. Administer high-flow oxygen and monitor lung sound and respiratory status. What are injected toxins? It is difficult to diminish, dilute, or inhibit the effects of injected toxins. Most injected poisonings are due to drug abuse. Onset of effects from injected drugs is typically rapid and can be long- lasting. Signs of injected stimulants (cocaine, meth): -Mood elevation, euphoria, -Restlessness, excitability -Tachycardia, rebound depression -Seizures, heart attack, stroke, death Signs of injected narcotics (morphine, heroin): -Decreased LOC, respiratory depression -Pupillary constriction What are absorbed toxins? Signs and symptoms include burns to the skin, rash or blister, itching or burning. Interventions: -Decontaminate patient appropriately before initiating care or transport -Most chemicals on the skin or eye should be irrigated with water continuously for about 20 minutes. -When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. What do you need to know about alcohol? Alcohol is the most widely abused drug in the US Most long-term alcoholics will develop hepatitis. Alcohol is a CNS depressant and a sedative hypnotic. Ingestion of alcohol increases risks of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). -Restless, irritable, agitated -Hallucinations, tremors or seizures What do you need to know about narcotics? Narcotics are widely abused. They are typically ingested or injected. Narcotics, or opioids, include morphine, codeine, heroin, oxycodone, and many more. Narcotics are CNS depressants that can cause coma and severe respiratory depression. Most ALS providers are able to administer Narcan (naloxone), which rapidly reverses the CNS effects of narcotics. What do you need to know about sedative hypnotic drugs? Sedative hypnotics are CNS depressants. Sedatives have a calming effect, and hypnotics induce sleep. Sedative hypnotics are usually taken orally but can be injected. Barbiturates such as Amytal, Seconal, and Luminal are sedative hypnotics. Benzodiazepines such as Valium, Xanax, and Rohypnol are sedative hypnotics. What do you need to know about inhalants? Abused inhalants may include acetones, glues, cleaning chemicals, paints, hydrocarbons, aerosols, and propellants. These chemicals are inhaled to achieve sedative hypnotic effects. The difference between an effective dose and a lethal dose is very narrow. Brain damage and/or cardiac arrest due to abuse is common. Prescription and over-the-counter bronchodilators are also abused. They are taken for stimulant effects or perceived advantage in competitive sports. What do you need to know about stimulants? Stimulants include caffeine, cocaine, amphetamines, methamphetamines, among others. They are taken for stimulant and euphoric effects. They can be taken by any route and are commonly injected, ingested, and inhaled. What do you need to know about marijuana?Marijuana (cannabis) is typically smoked. It is taken to induce euphoria, relaxation, drowsiness. Marijuana use does not usually create an acute medical emergency; however, marijuana users often take other illicit drugs. What do you need to know about hallucinogens? Hallucinogens alter sensory perception. Examples include LSD and PCP. What do you need to know about carbon monoxide? CO poisoning is a leading cause of death due to fires. Other common sources include home heating devices and vehicle exhaust fumes. -Nausea, vomiting, diarrhea, loss of appetite, fever. -Pain may begin as diffuse, but usually localizes to right lower quadrant. What is peritonitis? Peritonitis is caused by inflammation of the peritoneum (membrane lining the abdominal organs and cavity). Signs and symptoms: nausea, vomiting, loss of appetite, diarrhea, fever. What is cholecystitis? Cholecystitis is inflammation of the gall bladder, often due to gallstones. Most often occurs in females 30 to 50 years of age. Signs and symptoms: -Right upper quadrant pain -Increased pain at night -Increased pain after eating fatty foods -Referred pain to the shoulder is common -Nausea and vomiting What is diverticulitis? Diverticulitis develops when small pouches (diverticula) along the wall of the intestine fill with feces and become inflamed and infected. Typically affects people over age 40 and is associated with a low- fiber diet. Signs and symptoms: -Usually abdominal pain in the lower left quadrant -Fever -Weakness -Nausea and vomiting -Bleeding NOT common What is GI bleeding? Most often occurs in middle-aged patients Most often fatal in geriatric patients Upper GI bleeds: often due to ulcers Lower GI bleeds: often due to diverticulitis Signs and symptoms: -Hematemesis: vomiting blood -Hematochezia: bloody stool -Dark, tarry stool -Signs and symptoms of hypovolemic shock What is gastroenteritis? Gastroenteritis is an infection with associated diarrhea, nausea and vomiting. It is usually due to contaminated food or water and is not contagious. Prolonged vomiting and diarrhea can lead to hypovolemic shock. Gastroenteritis is a common cause of shock in children. What are esophageal varices? Esophageal varices are a weakening of the blood vessels lining the esophagus. The condition is frequently associated with alcoholism. Signs and symptoms: -Vomiting large amounts of bright red blood -History of alcohol abuse or liver disease -Signs and symptoms of hypovolemic shock What are ulcers?Ulcers are open wounds along the digestive tract, often the stomach. Signs and symptoms: -History of ulcers -Abdominal pain in the left upper quadrant -Nausea and vomiting -Often elicits and increase in pain before meals and during stress What is an abdominal aortic aneurysm? AAA is a weakening of the wall of the aorta in the abdominal region. Weakened area is prone to rupture. A ruptured AAA will likely cause rapid, fatal bleeding. Signs and symptoms: -AAA most common in geriatric males -Tearing back pain -Signs and symptoms of hypovolemic shock -Possible pulsating abdominal mass Patients with a suspected AAA should be transported to an appropriate facility without delay. What is the most common symptom of a gynecologic emergency? Gynecologic emergencies relate to female patients and their reproductive systems. Abdominal pain is the most common symptom of most gynecologic emergencies. What are specific gynecologic emergencies? 1. Sexual Assault: sexual assault patients have been victimized physically and psychologically. Management of sexual assault victims: -Request law enforcement and victim's assistance. -Do not touch the patient without consent. -Request a same-sex provider if one is not already on scene. -Encourage the patient not to change clothes, shower, etc. -Treat clothing as evidence. Do not touch unless necessary. -Touch only those things that are necessary. 2. Pelvic inflammatory disease (PID) PID is painful and requires treatment. Nonemergency transport is recommended. Signs and symptoms: -Abdominal pain -Fever -Pain during urination -Agitated delirium is characterized by violent, unpredictable behavior, and unusual strength and pain tolerance. -It is often associated with use of methamphetamine or other CNS stimulants. -Agitated delirium patients are at high risk of sudden cardiac arrest. What is the index of suspicion? Understanding the mechanism of injury helps predict injury patterns and sharpen the EMT's index of suspicion. 1. Index of suspicion is the ability to determine what types of injuries are possible or likely based on the MOI. 2. EMS providers don't diagnose; they rule in possibilities based on three key factors: MOI, anatomical findings, and physiological presentation of the patient. What are the different types of motor vehicle collisions (MVCs)? 1. Head-on -Occupants can go up and over or down and under the dash. -Head, spinal, chest, abdomen, hip, and lower extremity injuries are common. Unrestrained patients are more likely to be ejected. 2. Rear impact -Cervical spine injury due to hyperextension is common. 3. Lateral impact (T-bone) -Injuries along the side of impact are common 4. Rollover -Injury patterns are difficult to predict. There is a high risk of ejection in rollover MVCs. 5. Rotational spins -Rotational forces increase the risk of c-spine injury. What are the three collisions in every MVC? When a vehicle strikes an object, there are three important collisions: 1. First collision: the vehicle strikes an object. 2. Second collision: the passenger strikes interior of the vehicle or safety restraint system (SRS). 3. Third collision: the internal organs strike the internal structures of the body. -Coup-contracoup brain injury: brain injury on the opposite side of impact. What are significant MOIs? 1. Rollovers or ejection from the vehicle. 2. Death of another occupant in the same vehicle. 3. Pedestrians, cyclists, or motorcyclists struck by a vehicle. 4. Significant damage to the vehicle exterior (above about 18 inches). 5. Damage intruding into passenger compartment (above about 12 inches). 6. Falls greater than 10 feet by a pediatric patient, or any fall with a loss of consciousness. What are the different types of penetrating trauma? 1. Low-velocity projectiles -Examples: knife, pencil, rebar -Injury resides along the projectile's path 2. Medium velocity -Examples: handguns, some rifles -Injury pattern is less predictable due to ricochet within body and bullet fragmentation. 3. High velocity -Example: assault rifles -Injury path can be many times larger than projectile due to cavitation (formation of a space within the body along the projectile's path). What are the different types of blast injuries? 1. Primary blast injury: injuries due to the pressure wave of the blast. 2. Secondary blast injury: injuries due to flying debris. 3. Tertiary blast injury: injuries caused by being thrown against a stationary object. 4. Miscellaneous blast injuries: injuries due to burns, inhalation injury, etc. What are the indications for air medical transport? Extended extrication time No other ALS providers available Closest trauma centers unavailable Multiple patients requiring transport Traffic conditions delay ground transport Distance to trauma center greater than 20 miles What is the Glasgow Coma Scale? What are the trauma center designations? Level 1 Trauma Center: Capable of handling all types of trauma 24/7. This includes on-site trauma teams, surgical capabilities, trauma intensive care units (ICU), and rehabilitation services. Level 2 Trauma Center: Capable of stabilizing trauma patients and transferring to a level 1 trauma center. Level 3 and 4 Trauma Centers: Limited services and ability to stabilize trauma patients. What are the types of bleeding? 1. External bleeding -May be obvious only if the patient is exposed -More manageable than internal bleeding 2. Internal bleeding -Harder to identify and more difficult to manage than external bleeding -Signs and symptoms include bruising, hematoma, hematemesis, fractured bones, abdominal distension, bloody or dark stool, signs of shock. What are the various sources of bleeding? Arteries: spurting, bright red blood. Veins: steady flow of dark red blood. Capillaries: slow oozing of dark red blood. May be mixed with clearish fluid. -Rule of nines: totals 100% of body surface area 3. Burns to critical areas: the critical areas are the respiratory tract, hands, face, feet and genitalia. 4. Associated trauma or preexisting medical conditions. Associated trauma, poor health, and certain medications complicate body's ability to handle a burn injury. 5. Age of patient. Under 5 or over 55 years of age are at greater risk. What determines the severity of burn injuries? Severe Burn Injuries -Burns with respiratory compromise -Full-thickness circumferential burns -Partial-thickness burns covering more than 30% of TBSA -Burns with associated trauma, such as fractures -Full-thickness burns to the airway, hands, face, feet or genitalia -Full-thickness burns covering more than 10% of the TBSA -All moderate burn criteria for patients under 5 or over 55 years of age Moderate Burn Injuries -Full-thickness burns cover 2-10% of TBSA -Partial-thickness burns cover 15-30% of TBSA -Superficial burns covering more than 50% of TBSA Minor Burn Injuries -Full-thickness burns covering less than 2% of TBSA -Partial-thickness burns covering less than 15% of TBSA -Superficial burns covering less than 50% TBSA What are life-threatening complications of burn injuries? The life- threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise. What are thermal burns? Thermal burns are caused by heat, such as from water, steam, or fire. Management of thermal burns include: -Stop the burning process with a moist sterile burn sheet until skin is no longer hot to the touch. -Replace moist burn sheet with dry sterile burn sheets to reduce risk of hypothermia and infection. -Remove clothing that may be trapping heat. -Remove jewelry since massive swelling is likely. -Treat for shock as needed. What are special types of burns? A. Inhalation Injury -Can occur due to chemical inhalation or if patient inhales hot gases due to fire in a confined space. -Signs and symptoms include stridor, dyspnea, coughing, wheezing, facial burns, hoarse voice, airway edema, singed facial hair, or soot in mouth or nose. B. Electrical Burns -Assess scene safety first. Do not attempt to remove patient from an electrical source without proper training. -Significant unseen injury may have occurred between entrance and exit points on the body. -Electrical burn patients are at high risk of respiratory and cardiac arrest. -All electrical injury patients require transport and evaluation by a physician. C. Chemical Burns -Eyes and respiratory system are at high risk for chemical burn injury. -Assess scene safety first. Do not risk exposure without proper training and PPE. -IF safe to do so, remove contaminated jewelry and clothing, brush off and dry chemical on the skin, irrigate patient with large amounts of water, avoid contaminating unaffected areas with runoff. What are the different types of musculoskeletal injuries? Fractures -Open fracture: a fracture with an associated open soft tissue injury. -Closed fracture: a fracture where the skin is not broken. -Signs and symptoms: pain, swelling, deformity, tenderness, loss of function, possible weak or absent distal pulses and crepitus. Strain -A strain is a stretching injury to a muscle or tendon. There is usually little bleeding with a strain, so swelling and discoloration will likely be minimal. -Signs and symptoms: pain and tenderness. Sprain -A sprain is an injury to a ligament. Sprains frequently involve the shoulder, knee, or ankle joints. -Signs and symptoms: immediate pain and tenderness, delayed swelling and discoloration. Dislocation -A dislocation is the movement of a bone out of its normal position in a joint -The bone may return to its normal position or remain out of joint -Dislocations often have associated sprains and strains -Signs and symptoms: pain, deformity, loss of function, possible weak or absent distal pulses What are potential limb-threatening injuries?Any orthopedic injury resulting in loss of circulation distal to the injury is a high-priority injury. The limb is at risk until circulation is restored. Signs of orthopedic injury with loss of distal circulation: absence of distal pulses, pale distal to injury, cool distal to injury, delayed capillary refill distal to injury. What are potential life-threatening injuries? 1. Pelvic fractures -1 in 5 hip fracture patients dies within one year of the injury. -Hip fracture patients are at risk for hypovolemic shock, embolism, pneumonia and sepsis. -Most hip fractures occur in the geriatric population due to falls. -Pelvic binders are commercial splints used in some EMS systems to stabilize pelvic fractures and reduce bleeding. 2. Femur fractures What is a subdural hematoma? Bleeding above the brain (beneath the dura mater and above the arachnoid meningeal layer). Often caused by venous bleeding following a cerebral contusion. Signs and symptoms: vomiting, decreasing LOC, pupillary changes, unilateral weakness or paralysis, hypertension, changes in respirations, headache and seizures. What is a subarachnoid hemorrhage? Bleeding within the subarachnoid space. This type of injury allows blood to enter the cerebrospinal fluid (CSF). Can be due to trauma or a ruptured aneurysm. Signs often include headache and stiff neck, and neurological impairment such as decreased LOC and seizures. What is an intracerebral hemorrhage? Bleeding within the brain tissues. Patients can deterioriate rapidly. High mortality (risk of death) rate. What is herniation syndrome? The pressure within the skull is called intracranial pressure (ICP). Herniation is when the brain is compressed due to extensive ICP. Remember, the brain is in an enclosed space. There is little extra space to accommodate swelling, bleeding, etc. Severe herniation will force the brain down toward the foramen magnum. Signs of increased ICP are called *Cushing's reflex*: -Hypertension -Bradycardia -Altered respiratory pattern Mortality rates are high for ICP patients. In an attempt to temporarily reduce dangerously high ICP, higher ventilation rates may be indicated. Consult local protocol and medical direction. How can the spine be immobilized? 1. Manual immobilization -Manual c-spine precautions must be taken immediately if spinal injury is suspected. -Manual c-spine cannot be released until the patient's head is completely immobilized by other means. -A cervical collar is not a substitute for manual immobilization. 2. Spinal immobilization techniques -Long spine board: can be use for supine or standing patients, often used if rapid extrication is needed. -Half spine board: can be used for seated patients, use of these devices may require additional time to apply. What are the types of chest injuries? 1. Pneumothorax 2. Tension pneumothorax 3. Sucking chest wound 4. Hemothorax 5. Cardiac tamponade 6. Clavicle and rib fractures 7. Flail chest What is pneumothorax? Pneumothorax is the accumulation of air in the pleural space. This can compress lung space, prevent gas exchange, and lead to hypoxia. Can be due to trauma or nontraumatic injury to lung tissue. Lung sounds may be diminished or absent over injured area. What is tension pneumothorax? A tension pneumothorax causes a progressive collapsing of lung tissue. The entire lung and great vessels can be compressed to the other side of the chest. Lung sounds will be absent over the affected area. The patient will develop severe respiratory distress and eventually respiratory failure. Compression of the great vessels can restrict blood flow, leading to shock and death. Tracheal deviation toward the unaffected side is a late and ominous sign. What is a sucking chest wound? If an open chest injury penetrates the pleural space, it can draw air during inhalation. Penetrating thoracic injuries should be covered with a three- sided occlusive dressing to prevent air from entering the chest cavity. What is a hemothorax? A hemothorax is bleeding into the pleural space. Watch for signs and symptoms of shock. Surgery is frequently required to control bleeding. What is cardiac tamponade? Cardiac tamponade occurs when blood or other fluid accumulates in the pericardial sac and compresses the heart. Cardiac function can be severely compromised, leading to circulatory collapse. Beck's triad (indicative of cardiac tamponade): -JVD -Muffled heart sounds -Narrowing pulse pressure What are clavicle and rib fractures? Clavicle and rib fractures are common and should not be dismissed. Clavicle and rib fractures can be associated with pneumothorax. A fracture to one of the first several ribs indicates a serious mechanism of injury. -Procedure for removing contact lenses varies depending on the type of contacts. Removal may be more easily accomplished with a specially designed moistened suction cup. What are face injuries and their treatment? A. Loss of Tooth -Control any bleeding to reduce risk of swallowing blood and vomiting. -Rinse tooth with saline and transport in saline-soaked gauze. B. Impaled Object in the Cheek -Stabilize the object in place unless it interferes with airway management. -Remove object only if it causes an airway obstruction or interferes with ability to manage airway. C. Nosebleed D. Ear Injuries -Treat as a soft tissue injury -Assess MOI for other possible injuries What patient factors influence heat and cold emergencies? A. Age: The very young and very old will likely develop environmental emergencies more rapidly. B. General Health and Nutrition: Those in good health, adequately nourished, and hydrated are better able to maintain homeostasis. C. Environmental Conditions: Temperature, humidity, and wind can help or hurt the body's ability to protect itself from environmental emergencies. D. Medications and Alcohol: Medications and alcohol can hinder the body's ability to regulate body temperature. How does the body lose heat? 1. Conduction: direct transfer of heat through contact with a colder structure. 2. Convection: loss of heat to passing air. 3. Evaporation: loss of heat through evaporation of water from the skin. 4. Respiration: in a cold environment, exhaled air has been warmed within the body. That heat is lost on exhalation. 5. Radiation: transfer of radiant heat. What is hypothermia? Hypothermia is a systemic cold emergency. It affects the entire body, not just an isolated area. Hypothermia develops when the body's core temperature falls below that needed to maintain homeostasis. Signs and symptoms of hypothermia: -Cold skin even at their core -Pale or cyanotic skin -Shivering (note: ceases with extreme hypothermia) -Loss of coordination -Altered LOC -Bradycardia -Bradypnea -Hypotension How should hypothermia be managed? Pulse check should be extended to determine if patient is in cardiac arrest or severely bradycardic. Remove patient from cold environment. Remove wet clothing; prevent further heat loss. -Prehospital warming is often limited to passive rewarming measures only. What are local cold emergencies?Frostnip -Frostnip develops when body parts get very cold but are not yet frozen. -Signs and symptoms include pale and cold skin , and loss of sensation in affected areas. Trenchfoot: Also called immersion foot, trenchfoot can develop when the feet have prolonged exposure to cold and water. Frostbite -The most dangerous local cold emergency. -The tissue is frozen, which frequently leads to permanent damage. -Can lead to gangrene. -Signs and symptoms include hard, frozen tissue, possible blistering and mottling. How should local cold emergencies be managed? Remove patient from cold environment. Remove wet clothing. Protect affected areas from further injury. Remove any jewelry. Bandage, splint affected areas. Keep patient immobile. Do NOT rub affected areas. Do NOT apply direct heat unless authorized by medical direction. What are the types of heat emergencies? Heat Cramps -Heat cramps are a local heat emergency. -Heat cramps typically occur during prolonged exertion and are likely caused by an electrolyte imbalance and dehydration. -Management of heat cramps includes rest, dehydration, and restoration of electrolytes. Heat Exhaustion -Heat exhaustion is a systemic heat emergency and occurs frequently. -Heat exhaustion is caused by a combination of heat exposure and hypovolemia. -Signs and symptoms include: history of exertion in a warm environment, dizziness, weakness, nausea, vomiting, headache, possible cramps, thirst, tachycardia. Heat Stroke -Heat stroke is an uncommon, extremely dangerous systemic heat emergency. -The body loses the ability to regulate body heat. Body temperature rises rapidly and will lead to death if untreated. What is abruptio placenta? Abruptio placenta is the premature separation of the placenta from the uterine wall leading to bleeding. Oxygen and nutrient delivery to fetus is compromised. Maternal blood loss can be severe. The fetus will not survive a complete abruption. Classic presentation is painful vaginal bleeding in the third trimester. Assess for signs and symptoms of shock. What is ectopic pregnancy? Ectopic pregnancy occurs when the egg is implanted outside of the uterus, usually in the fallopian tube. Ectopic pregnancy can lead to rupture and severe bleeding. Classic presentation is severe abdominal pain with or without vaginal bleeding. Assess for signs and symptoms of shock. What is uterine rupture? The uterus thins as it grows, increasing the risk of rupture. Danger to mother and fetus is high. Classic presentation is abdominal pain and vaginal bleeding. What is spontaneous abortion? Spontaneous abortion (miscarriage) is delivery of the fetus before it is capable of surviving. This is prior to about the 20th to 22nd week of pregnancy. Classic presentation includes cramping, lower abdominal pain, vaginal bleeding, and passage of tissue or clots. Assess for signs and symptoms of shock. What are seizures during pregnancy? Pregnancy can increase the risk of seizures in the mother. Management of seizures during pregnancy. -Treat as regular seizures -Place patient on left side -Minimize exposure to stimulus such as lights, noise and movements What are preeclampsia and eclampsia? 1. Preeclampsia (toxemia of pregnancy) -Preeclampsia typically occurs in the third trimester. -The cause is not completely understood -Signs and symptoms include sudden weight gain, visual disturbances, sudden swelling of the face, hands, or feet, headache, and hypertension. 2. Eclampsia -Eclampsia occurs when the mother seizes following preeclampsia -Eclampsia is a life-threatening condition for mother and fetus What is pregnancy-induced hypertension (PIH)? PIH is defined is a blood pressure in a pregnant patient above 140/90 at least twice at 6 hours apart. PIH presents with the same signs and symptoms as preeclampsia. What is supine hypotensive syndrome? Supine hypotensive syndrome occurs when the fetus compresses the inferior vena cava. This can cause a severe drop in blood pressure. This syndrome typically occurs in the later stages of pregnancy when the mother is supine. Signs and symptoms include dizziness, hypotension, pale skin, and altered LOC. Management of supine hypotensive syndrome must include keeping the fetus off of the inferior vena cava. Do not place the patient in a supine position. Instead: -Place the patient in a seated position -Place patient on her left side -If patient is supine, elevate right hip or tilt backboard. What are the stages of labor and delivery? First Stage of Labor -Begins with the onset of contractions and ends with full cervical dilation. -The cervix is fully dilated at 10 cm, allowing the infant's head to enter the birth canal. -Contractions initially occur at widespread intervals and become more severe and closer together over time. -The mucus plug that seals the uterine opening passes. -The amniotic sac may rupture spontaneously. -Stage one typically lasts longer for first-time pregnancies. Second Stage of Labor -Begins with full cervical dilation and ends with delivery of the fetus. -Contractions are close together. -Mother feels intense pressure and the urge to push. Third Stage of Labor -Begins once baby is delivered and ends with delivery of the placenta. -Placenta typically delivers within 30 minutes after delivery of the baby. -There will be an increase in vaginal bleeding shortly before the placenta delivers, and the mother will feel the urge to push again. What are indicators of imminent delivery? The mother has strong, frequent contractions under 2 minutes apart with little break between contractions. The abdomen is rigid during contractions. The mother feels the urge to push. Crowning. How do you care for a newborn? Immediately upon delivery, place on clean, dry sheets or towels. Dry baby, including the head, and immediately replace wet linen with dry. Warm the baby, including the head. Placing the baby on the mother's abdomen will provide a radiant heat source. Suction the baby's mouth first, then nose. If the baby is not active and crying, attempt tactile stimulation by rubbing the baby's back or tapping the soles of the feet. Assess respirations. If the baby is not breathing adequately, begin ventilations (40-60 per minute) with an appropriately sized bag and mask for 30 seconds with high-flow oxygen. Do not overinflate the newborn's chest. V finger Transport immediately. What is breech presentation? A breech birth occurs when the baby's buttocks or legs are the first presenting part in the birth canal. Transport immediately. Breech births present significant dangers for mother and baby. If delivery occurs, there is a high risk the head will become stuck in the birth canal. If the head is trapped, use fingers to form a "V" along vaginal wall to create space allowing the baby to breathe. What is limb presentation? A limb presentation is when a single arm or leg is the first presenting part in the birth canal. Do not attempt delivery of a limb presentation in the field. Place the mother in the knee-chest position and transport immediately. What is post-partum hemmorhage? Postpartum hemorrhage is excessive bleeding following delivery. Blood loss of greater than 500 ml is considered abnormal. Management of postpartum hemorrhage includes uterine massage, breastfeeding and treating for shock. What is the significant anatomy and physiology of pediatric patients? Airway/Respiratory -Infants have proportionally larger tongues than adults -The pediatric airway is smaller -Newborns and infants are obligate nosebreathers Head -The pediatric patient's head is proportionally large and is a source of heat loss -Padding is often required behind the shoulders to maintain a neutral, in- line position -Sunken fontanelles may indicate hypovolemia in infants, whereas bulging fontanelles may indicate increased ICP -Children require greater cerebral blood flow; hypoxia develops rapidly Chest -Ribs are more pliable in pediatric patients -Smaller lungs increase risk of overinflation -Pediatric patients are often abdominal breathers Abdomen -Organs are less protected and more anterior. Cardiovascular -Bradycardia should be treated as a sign of hypoxia -Hypotension is an ominous sign Skin -Pediatric patient's skin surface is larger in comparison to body mass What is the Pediatric Assessment Triangle? Appearance -Tone, interactivity, consolability, look, speech Work of breathing Circulation to skin What is child abuse? Physical abuse is excessive or inappropriate physical force. Neglect is failure to provide adequate attention when responsible for doing so. Signs of abuse or neglect include obvious trauma, injuries in various stages of healing, unexplained injuries, injuries that do not appear to match the description of how they occurred, and signs of malnutrition. Shaken baby syndrome is a form of abuse caused by violent shaking of a pediatric patient. What are some considerations for the geriatric population? Communication -Speak clearly -Be patient Medical History -Often extensive -Hypertension, heart disease, diabetes Medications -Polypharmacy -Can sometimes be mismanaged or interact negatively MOI -Index of suspicion should be much higher -Spinal precautions may be challenging Environmental Cues What medical conditions often affect geriatric patients? Myocardial Infarctions -Often atypical presentation Congestive heart failure -Orthopnea Pneumonia Pulmonary embolism -Long sedentary periods, recent surgery Deep Vein Thrombosis Stroke GI Disorders Dementia -A slow, progressive deterioration of cognitive function What are the diamond placards? Blue diamond: provides information about health hazards. Red diamond: provides information about fire hazard. Yellow diamond: provides information about reactivity hazards. White diamond: displays symbols indicating special hazards such as radioactivity or reactivity with water. The higher the number within the blue, red or yellow diamonds, the greater the hazard is within that category. What are the "zones" of a HazMat site? Hot Zone -This is the contaminated area -Appropriate PPE is required, as determined by HazMat personnel -Regardless of patient condition, those without proper training and PPE are not permitted in the hot zone. -Patient care does not take place in the hot zone. Warm Zone -This is area between the hot and cold zones. -Appropriate PPE is required. -Only life-threatening conditions are treated in the warm zone. -Everyone must be decontaminated in the warm zone before entering the cold zone. Cold Zone -Most treatment is performed in the cold zone. -Typically, EMS providers remain in the cold zone. What is decontamination? Decontamination is essential to prevent spreading the hazardous material. Any of the following may become contaminated and require decontamination: 1. The patient's body, hair, clothes, possessions, etc. 2. Medical equipment 3. Emergency vehicle Decontamination should be performed by those properly trained and equipped to do so. What is the National Incident Command System? NIMS provides an adaptive, standardized approach to any domestic incident. What are the components of NIMS? Preparedness: This component helps agencies and responders proactively prepare for an incident. Communications and Information: This component coordinates effective communication and information sharing. Command and Management: This component provides oversight of the incident for all participating agencies. Resource Management: This component coordinates acquisition, tracking, and recovery of resources and equipment needed during an incident. Ongoing Management: This component coordinates continuous quality improvement of EMS. What are the NIMS roles and responsibilities? Command Section: This section includes the incident commander (IC), public information officer (PIO), safety officer, and liaison officer. Finance Section: This section tracks all expenditures during an incident. This section is usually needed only on large incidents. Logistics: The logistics section is responsible for most of the things that actually allow an IMS to function. This includes the necessary communications equipment, medical supplies, food, water, facilities, shelter, etc. Operations: This section is responsible for tactical operations on larger incidents. On smaller incidents, this responsibility usually rests with the IC. Planning: This section helps to develop an action plan for the incident and solve problems as they arise during the incident. What are the EMS functions of IMS? Preparedness -EMS agencies should have written disaster plans that are routinely practiced, reviewed, and improved. -EMS facilities should have adequate resources to be fully self-sufficient for at least 72 hours. -A plan should be in place to assist families of EMS responders so responders can focus on their job. Scene Size-Up -What is the incident? -What do you need to do? -What resources do you need to do it? Medical Incident Command Functions -Triage: the sorting of patients based on the severity of injury. The triage supervisor identifies the number and severity of patients. Treatment does NOT begin until all patients are triaged. -Treatment: Secondary triage should be completed within each treatment area. -Transportation -Staging -Rehabilitation: safe location for the rest and recovery of responders. -Extrication and Special Rescue What are mass casualty incidents? A mass casualty incident (MCI) is broadly defined as an incident that taxes the locally available resources or requires a multijurisdictional response. What is START Triage? Step 1 -Direct all patients capable of moving to a central location. -Those able to follow the command and move to the assigned location are collectively triaged as Minor (green tag) or "walking wounded." Step 2 -Move from patient to patient and begin triage using the RPM method. -Respirations: If not breathing, manually open the airway. If patient does not begin breathing spontaneously, triage as Expectant (black tag) and NREMT Written exam -Dense, slow-moving radiation. -Can travel only short distances. -Stopped by clothing, skin, etc. but still very dangerous if patient is contaminated internally, such as through ingestion or inhalation. Beta radiation -Slow-moving radiation. Can travel only a few feet. -Penetrates only the first few millimeters of skin. -Serious risk if patient is internally contaminated through ingestion or inhalation. Gamma radiation -Can travel long distances. Easily penetrates the body. -A significant external hazard risk to living things. Signs and symptoms of acute radiation sickness include nausea, vomiting, diarrhea, fever, headache and skin lesions. How can radiation exposure be prevented and managed? Protection from radiation: -Time: spend as little time as possible near a radiation source. -Distance: get as far away as possible from the radiation source. -Shielding: gamma radiation will require significant shielding, such as lead or concrete. Management -Remove patients from the source of radiation to a safer location not downwind. -Complete a thorough primary assessment. -Treat blast injuries, tertiary injuries, burn injuries as you normally would. OSHA What federal agency requires that the ingredients of cosmetic pepper rations are available to employees Sds Information about the ingredients in cosmetic preparations and other products are included in a Wrap presents are called Cyanoacrylates Inhibition layer The tacky surface left on the mail after I like your gel has cured Led Light emission diode Nail apex Also known as the arch the area of the nail that has all the strength Initiators Found a polymer powder when activated by a catalyst will spring into action and cause monomer molecules to permanently linked together into a long polymer chain Monomer One unit called a molecule Polymer Substance formed by combining many small molecules into very long chain like structures Polymerization Also known as curing or hardening chemical reaction that creates polymers Curette A small scoop shaped implement used for more efficient removal of debris from the nail fold eponychial them in hyponychium areas Reflexology A unique method of applying pressure with thumb and index finger to the hand and feet it has demonstrated health benefits Acetone A colorless and flammable liquid immersible with water alcohol in either and has a Swedish odor or burning taste it is used as a solvent Fine grit abrasive Abrasives 240 grit and higher designed for buffing polishing and removing very fine scratches Chemical exfoliants Products that contain chemicals that either loosen or dissolve dead cell build ups Couperose Distended capillaries caused by weakening of the capillary walls Emollients Oil or fatty ingredients that prevent moisture from leaving the skin Enzyme peels Also know as keratolytic enzymes or protein dissolving agents A type of chemical exfoliants that works by dissolving keratin proteins in the surface cells of the skin Open comedones Also known as blackheads fall Kohl's impacted with solidified sebum and dad cell build up Ostium Follicle opening Toners Lotions that help rebalance the pH and remove remnants of cleanser from the skin Brazilian bikini waxing A waxing technique that requires the removal of all the hair from the front and the back of the bikini area. depilatory Substance, usually a caustic alkali preparation, used for the temporary removal of superfluous hair by dissolving it at the skin surface level. Epilator Substance used to remove hair by pulling it out of the follicle Hirsuties Also known as hypertrichosis; growth of an unusual amount of hair on parts of the body normally bearing only downy hair, such as the faces of women or the backs of men. Sugaring Temporary hair removal method that involves the use of a thick, sugar-based paste. Photoepilation Also known as Intense Pulsed Light; permanent hair removal treatment that uses intense light to destroy the growth cells of the hair follicles. Thio neutralization Stops the action of a permanent wave solution and rebuild the hair in its new curly form Thioglycolic Most common waving solution Side bondsDisulfide, salt, and hydrogen bonds that cross-link polypeptide chains together. Polypeptide chains Long chains of amino acids joined together by peptide bonds Peptide bonds Also known as and bonds chemical bonds that join amino acids together and end in long chains to form a polypeptide chains NREMT PRACTICE QUESTIONS 1 Technical term for split ends Trichoptilosis Scientific study of hair and its diseases and care Trichology Ringworm Tinea A week physical cross-link side bond between adjacent polypeptide chains Salt bonds Long, coiled, complex polypeptides made of amino acids proteins A week physical cross-link side bond that is easily broken by water or heat Hydrogen bond The small involuntary muscle in the base of the hair follicle Arrector pili muscle athlete's foot tinea pedis The scientific study of the functions and activities performed by the body structure is called Physiology Fluid of a cell that surrounds the nucleus and is necessary for growth and reproduction Cytoplasm Which muscle are you using when you close your eyes Orbicularis oculi Which item is included in the identification section of the MSDS Restriction on product use Chemical products that destroy all bacteria fungi and viruses on surfaces are known ass Disinfectants What is safe and useful type of disinfectant commonly called quats Quarternary ammonium compounds One cell micro organisms with both plant and animal characteristics are known as Bacteria Which disease is blood-borne and can cause liver damage Hepatitis Organisms that grow feed in find shelter on or in a host organism is called Parasites Standard precautions that require the employer and employee to assume that all human blood and body fluids are potentially infectious are published by the CDC Your patient a 52 year old male complaining of dull, achy chest pains. He is alert and oriented but upon assessment, you notice his skin is pale, cool and clammy. What is your next step? Administer Supplemental oxygen Cardiac Compromise Any type of heart problem. Cardiac compromise is a blanket term used to describe any type of heart problem. As an EMT-B it allows you to identify cardiac problems without going above your scope of practice an AED is used to treat patients is Ventricular fibrillation or ventricular tachycardia the normal heart rate for a new born (0-3 months) is 140-160 the two flap valve located on the left side of the heart is the Mitral Valve also known as the Bicuspid Valve. The three flap valve is called the Tricuspid valve Name the layers of the heart form the outside in Epicardium, Myocardium, and Endocardium what complain is often used to describe chest pain resulting from a cardiac event A ton of bricks. or an elephant sitting on my chest. A sharp stabbing pain is often a Pulmonary Embolism What artery carries deoxygenated blood and which vein carried oxygenated bleed? Pulmonary artery, and Pulmonary vein which are not blood components that are responsible for clot formation Plaque you are dispatched to a residence of a 46year old female patient who is in severe abdominal pain and vomited twice before your arrival. she ate cheesecake right before. what is the cause of her pain acute gastroenteritis- may be caused by a bacterial or viral ingestion, toxic ingestion, or ingestion of lactose in a lactose intolerant patient. signs and symptoms include nausea, vomiting diarrhea, and abdominal cramping. your patient is a 32 year old male who was complaining of severe, crushing, feeling in the center of his chest and shortness of breath that began while he was mowing his lawn 45 mins prior to you arrival. he is now only responding to painful stimuli. presently his minute ventilation is still adequate, his pulse oximeter reads 95% on room air and you find his skin to be pale, cool, and diaphoretic. what would your initial action be. 12-15 L Oxygen by nonrebreather you are called to a nursing home for a patient with swelling in her legs. Upon arrival you find a 76 year old patient sitting in a wheelchair. assessment confirms pitting edema to both lower legs you are able to palpate a dorsalis pedal pulse bilaterally. her skin is pink and dry. her lungs are clear bilaterally. which conditions do you suspect chronic CHF. Edema to the legs or sacrum is often a result of right sided congestive heart failure. there may also be a jugular vein distention and ascites present as well. the most common cause of right sided heart failure is left sided heart failure. therefore, you may not s&s of left sided heart failure as a dry hacking couch or coughing up pink frothy sputum, shortness of breath orthopnea, paroxysmal nocturnal dyspnea and fatigue. you arrive on the scene of a patient who fell from a ladder. which of the following questions is NOT an important factor in care of the patient? Height of the ladder You are dispatched to the scene of a 9 year old girl who has been struck by a car. Police are unable to reach her parents. what gives you the ability to treat the girl implied consent you are dispatched to a call for a injured man. as you approach the door of the home, a man opens the door and tells you "this is none of your business" and to "get out of here". What is the correct course of action in this case? return to the ambulance drive a safe distance away and call for police to help was correct If a patient refuses treatment and an EMT treats the patient anyway, what crime can the EMT be charged with. battery This practice of protecting yourself and your patient from the transfer of bodily fluids is known as what? Body substance isolation What Law provides protection from legal action to someone who provides help to an injured person? good Samaritan law While responding, ambulances are particularly at risk of collisions in which areas? intersections you have called an air medical service to come pick up you accident victim form your scene. The helicopter contacts you when they are 5 Controller inhalers are for long term use and will not provide relief in an emergency. The controller inhalers usually contain a steroid which reduces chronic inflammation and mucus production. examples include Flovent and Advair What are hives, and what is its medical name Uticaria. (They are red or occasionally blanched, raised and are often itchy. the Release of histamine, bradykinin and other substances cause the leaking of plasma into the dermis creating hives) You will provide ventilations to a newborn if his/her pulse is less than and provide compressions to the newborn if the pulse is less than ventilations if pulse is less than 100- at a rate of 40-60/min chest compressions at a rate of 120/min if heart rate is less than 60 beats/min What happens in the lungs of the patient with asthma during an attack A trigger (e.g. allergies, exertion, viral infection) causes constriction of bronchioles in the lungs. Results in classic wheezing and difficulty breathing. asthma if not treated can cause mucous production which can make subsequent attacks worse. Define Myocardial infarction Myocardial infarction is a clinical term for heart attack- occurs when blood flow stops to part of the heart causing damage to the heart muscle. How do you care for a new born immediately after delivery Dry the babyand keep them warm. assess the baby, baby should be moving and crying (both should be vigerous) Evaluate the babys breathing, heart rate what is the proper amount of air that should be injected to the cuff of an endo tracheal tube 10cc the space between the base of the tounge and the epiglottis is called? Vallecula (Vallecula is an important landmark in intubation; it is where the blade of a laryngoscope is placed to facilitate direct visualization of the glottis) what condition is characterized my gasping, labored breathing, and strange vocalizations? agonal Breaths (agonal respirations are also commonly seen in cases of cardiac arrest, and may persist for several minutes after cessation of heartbeat) what is the maximum amount of time that may pass while attempting an intubation?30 seconds (if you are unsuccessful with your intubation, you should always cease your attempt after 30 seconds, allow for the patient to be hyperventilated and try it again) What condition is characterized by a high pitched sound resulting from turbulent air flow in the upper airway? It may be inspiratory or present on both inspiration and expiration stridor (stridor is a severe upper airway obstruction) the inability to move enough air required for adequate perfusion is known as what Respiratory Failure (Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. Respiratory failure can be indicated by observing a drop in O2 saturation and breathing rate/quality which is not a correct technique for confirming correct ET tube placement visualizing rise and fall of chest (seeing movement of the chest wall does not garuntee correct et tube placement) two large tubes that bring air to and from the lungs are knows as what? bronchi (the trachea leads to the bronchi which lead to the bronchioles) What term refers to the expansion of the stomach caused by excessive ventilation pressures which causes excess air to enter the stomach instead of the lungs Gastric Distention (gastric distention should be avoided as it often leads to vomiting and aspiration of said emesis) Which of the following is NOT a sign of adequate breathing? Breathing limited to abdominal muscles ( using abdominal muscles to breath is a sign of labored breathing NOT of adequate breathing) cyanosis can be checked by observing the patients ? Nail beds (Early signs of cyanosis often presents more clearly in the nail beds and lips) Oral and nasal airway should be used to keep the tongue from blocking the airway (when a patients is unconscious, the tongue has a tendency to fall back in the mouth and block the airway an oral or nasal airway is used to prevent this) which medication that will open bronchioles and increase effectiveness of breathing is typically used to treat a patient with shortness of breath? bronchodilators (Bronchodilators are used to dilate or widen the bronchioles allowing air to more easily flow through them. A common bronchodilator is albuterol) blue or grayish coloration of the skin caused by lack of oxygen in the blood is called> cyanosis (cyanosis occurs when the oxygen saturation of arterial blood falls below 85-90%. it is often presented in the lips and nail beds first) you are preforming rescue breaths using an Ambu bad attached to 100% O2. After several breaths you notice the patients o2 saturation has dropped significantly. what should you do next reposition the patients head (this is a sign that you are not getting effective respirations. you should reposition the patients head using the head tilt/chin lift or jaw thrust maneuver and attempt respirations again) The normal heart rate for a newborn is 140-160 The normal heart rate for a child between the ages of 1-6 100-120 The normal heart rate for a child over 6 is 80-100 The correct flow of blood through the heart and lungs is Inferior/Superior vena cavae, right atrium, right ventricle, lungs, left atrium, left ventricle, aorta What is the difference between angina pectoris and a myocardial infarction? Angina pectoris is caused by physical or emotional stress (Angina pectoris is typically caused by physical or emotional stress. symptoms usually last no more that 10 mins and are relieved by rest) your patient is an 80 year old male with shortness of breath. which of the following could your patient be suffering from? (geriatric patients do not always present the clear-cut signs and symptoms of cardiac