Download Emergency Medical Care: Protocols and Procedures and more Exams Nursing in PDF only on Docsity! NREMT COGNITIVE EXAM PREP 300 QUESTIONS AND WELL ELABORATED ANSWERS TOP RATED VERSION FOR 2024- 2025 ALREADY A GRADED WITH EXPERT FEEDBACK|NEW AND REVISED!(ACTUAL EXAM) Where does the modern EMS system have its origin? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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. What are the types of stress? - ANSWER>> >>Acute stress: an immediate physiological and psychological reaction to a specific event. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT's ability to perform during the stressful event. PTSD is an example of delayed stress. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time. What are the stages of grief? - ANSWER>> >>Denial Anger Bargaining Depression Acceptance How can you prevent the risk of infection? - ANSWER>> >>Immediately report exposures to the designated infection control officer. Handwashing is the single most important way to prevent the spread of infection. Hand sanitizers can be effective, but soap and water is preferred when available. What are the two types of PPE? - ANSWER>> >>Minimum PPE: gloves and eye protection should be used during any patient contact situation. Expanded PPE: use disposable gown and mask for significant contact with any body fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA) mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis. What are emergency moves? - ANSWER>> >>These are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit- forearm drag, shirt drag, and blanket drag. What is an urgent move? - ANSWER>> >>Used when the patient has potentially life-threatening injuries or illness and must be moved quickly for evaluation and transport. How do Good Samaritan Laws affect EMTs? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Battery is physically touching another person without their consent. What is negligence? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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 is abandonment? - ANSWER>> >>Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed. What is false imprisonment? - ANSWER>> >>You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? - ANSWER>> >>Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported. When in doubt, consult medical direction. Thoroughly document why the destination was chosen. This is especially true if you bypass a closer hospital capable of managing your patient. What are patient refusals? - ANSWER>> >>Competent patients may refuse treatment regardless of the severity of their condition. -Refusals present high liability risk for EMS providers. -Negligence or abandonment can be much easier to provide if the patient is not transport. -Consider requesting advanced life support personnel or contacting medical direction per local protocols. -During a refusal, the patient must be fully informed of the treatment recommended and the possible consequences of refusing treatment. -The patient is rarely, if ever, fully informed the first time he or she conveys the intent to refuse treatment. Documentation should reflect both the initial refusal and the second refusal after being fully informed. What factors determine whether a patient is competent or not? - ANSWER>> >>Typically, competency requires awareness of at least four things: -Person: the patient knows his or her name. -Place: the patient knows where he or she is. -Time: the patient is aware of the date and time. -Event: the patient is aware of his or her present circumstances. How can an EMT reduce liability on patient refusal? - ANSWER>> >>1) The EMTs best protection from liability is to provide excellent care and convince the patient to accept transport. 2) The second best way for an EMT to protect himself or herself is to ensure the patient is fully informed, contact medical direction, and document extremely well. When can EMTs release confidential patient information? - ANSWER>> >>EMTs can release confidential patient information without consent when: -The information is necessary for continuity of care -The information is necessary to facilitate billing for services -The EMT has received a valid subpoena -Reporting possible crimes, abuse, assault, neglect, certain injuries or communicable diseases What is HIPAA? - ANSWER>> >>Health Insurance Portability and Accountability Act (HIPAA) -HIPAA is a federal law established in 1996 and has had a huge impact on health care. HIPAA improved privacy protection of patient health care records. -HIPAA gives patients greater control over how health care records are used and transferred. -EMS agencies are mandated to provide HIPAA training to all employees who have any contact with patients or patient records. -EMS providers must provide patients with privacy practices and obtain signature of receipt. What are COBRA and EMTALA? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Therapeutic communications typically refers to your interaction with the patient and ability to obtain clinical information. What are portable and mobile radios? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>A transmitter/receiver in a fixed location that is in contact with all other components in the radio system. What is inhalation through negative pressure breathing? - ANSWER>> >>The diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and air rushes in. Inhalation is an active process and requires energy. Atmospheric (inhaled) oxygen contains 21% oxygen. What is exhalation? - ANSWER>> >>The diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity rises and air is expelled. Exhalation is normally passive and does not require energy. Exhaled air contains 16% oxygen. What are the different types of respiration? - ANSWER>> >>External respiration: the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. Internal respiration: gas exchanged between the body's cells and the systemic capillaries. Cellular respiration: also known as aerobic metabolism, uses oxygen to break down glucose to create energy. What is the primary mechanism of breathing control? - ANSWER>> >>Carbon dioxide drive is the primary mechanism of breathing control for most people. The brain stem monitors carbon dioxide levels in the blood and CSF. High carbon dioxide levels will stimulate an increase in respiratory rate and tidal volume. What is hypoxic drive? - ANSWER>> >>Hypoxic drive is a backup system to the carbon dioxide drive. Specialized sensors in the brain, aorta and carotid arteries monitor oxygen levels. Low oxygen levels will stimulate breathing. The hypoxic drive is less effective than carbon dioxide drive. What is the minute volume? - ANSWER>> >>Respiratory rate times tidal volume. What are normal breathing rates for adults, children and infants? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? - ANSWER>> >>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? - ANSWER>> >>Perfusion is the flow of blood throughout the body. What is the central nervous system? - ANSWER>> >>The central nervous system consists of the brain and spinal cord. What are the parts of the brain? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Startle reflex, grip reflex, rooting reflex, sucking reflex What are the age ranges of toddlers and preschoolers? - ANSWER>> >>Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old What are normal vital signs of toddlers and preschoolers? - ANSWER>> >>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? - ANSWER>> >>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. Preschoolers: typically are physically coordinated and communicate well verbally, know their name and address and can dress themselves, can count to 10 or beyond. What developments you should know about school-age children? - ANSWER>> >>Vital signs: -Respirations: about 15 to 20 breaths/minute -Heart rate: 70-110 bpm -Blood pressure: 90-120 systolic 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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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 How do you know you're performing correct artificial ventilations? - ANSWER>> >>The best way to determine appropriate tidal volume is rise and fall of the chest. -Artificial ventilations should cause gentle rise and fall. -It should take at least one second to inflate the chest. Correct rates of artificial ventilation for apneic patients with a pulse: -Adults: one breath every 5-6 seconds (10-12 times per minute) -Infants and children: one breath every 3-5 seconds (12-20 times per minute) -Newborns: one breath every 1 to 1.5 seconds (40-60 times per minute) What are the compression:ventilation ratios for adults and children? - ANSWER>> >>30 compressions: 2 breaths -Always for adults -Always for single-rescuer CPR on any patient 15 compressions: 2 breaths -Two-rescuer CPR on children and infants 3 compressions: 1 breath -Newborns For patients in cardiac arrest with an advanced airway, provide one breath every 6 to 8 seconds What is CPAP? - ANSWER>> >>Continuous positive airway pressure (CPAP) is used to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress. Often used for patients with sleep apnea, has proven very effective for patients with COPD or pulmonary edema. Can help the patient avoid more invasive treatment such as intubation. Indications: -Conscious patients in moderate to severe respiratory distress. -Tachypnic patients with reduced respiratory efficiency. -Pulse oximetry is below 90%. Contraindications: -Apneic patients or patients unable to follow verbal commands. -Chest trauma, suspected pneumothorax, or patients with a tracheostomy. -Vomiting or suspected GI bleeding. -Hypotension What is notable about the pediatric airway? - ANSWER>> >>The pediatric airway is more easily obstructed (smaller nose and mouth; larger tongue). The pediatric head is larger in proportion to the body. Padding should be placed behind the shoulders in a supine patient to maintain alignment of the airway. Signs of respiratory failure in pediatric patients: -Bradycardia and poor muscle tone -Altered LOC -Head bobbing and grunting on exhalation -Seesaw breathing How is a foreign body airway obstruction managed in conscious patients? - ANSWER>> >>Adults and children: administer conscious abdominal thrusts until the obstruction is relieved or until the patient loses consciousness. Infants: Administer a series of five back blows and five chest thrusts until the obstruction is relieved or until the patient loses consciousness. How is a foreign body airway obstruction managed in unconscious patients? - ANSWER>> >>Initiate CPR. Before attempting ventilations, inspect the airway for visible foreign bodies. Remove if able. What are open-ended vs. closed-ended questions? - ANSWER>> >>Open-ended questions require the patient to respond with more than just "yes" or "no." These questions require a descriptive response. When you want the patient to describe things in his or her own words, open-ended questions are preferred. Open-ended questions take longer to ANSWER>> but provide more information from the patient's perspective. Closed-ended questions can be ANSWER>> ed 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? - ANSWER>> >>Respiration: rate, rhythm, quality Pulse: rate, rhythm, quality Blood Pressure Pupils: size, equality, reactivity Skin: color, temperature, condition and capillary refill Pulse oximetry MOA: peripheral vasoconstriction, increased heart rate, bronchodilation Indication: anaphylaxis (wheezing, swollen upper airway, hives) Contraindications: expired medication, lack of medical direction Dose and route: 0.3 mg adult, 0.15 mg pediatric administered IM Side effects: tachycardia, hypertension, restlessness, anxiousness What information do you need to know about nitroglycerin? - ANSWER>> >>Class: antianginal, vasodilator MOA: vasodilation, decreased myocardial oxygen demand, increased myocardial oxygen supply Indications: chest pain, suspected angina or MI Contraindications: expired, not prescribed to patient, hypotension, recent use of Viagra, Cialis, Levitra or another ED medication, head injury, lack of medical direction Dose and route: 0.4 mg sublingual Side effects: tachycardia, hypotension, headache, burning under tongue, nausea, vomiting What information do you need to know about oral glucose? - ANSWER>> >>Class: oral hyperglycemic MOA: increases blood glucose levels Indication: hypoglycemia Contraindications: -Decreased LOC -Inability to swallow -Expired medication -Lack of medical direction Dose and route: one tube administered orally Side effects: nausea and vomiting What are the components of the scene size-up? - ANSWER>> >>1. Scene safety 2. Standard precautions (PPE) 3. Number of patients/additional resources 4. Mechanism of injury/nature of illness What are the components of the primary assessment? - ANSWER>> >>1. Manual cervical spine stabilization 2. General impression 3. Level of consciousness (AVPU and orientation; person, place, time and event) 4. Airway, Breathing, Circulation 5. Transport priority What are the appropriate managements for life-threatening conditions associated with breathing? - ANSWER>> >>Flail chest: initiate artificial ventilations Sucking chest wound: apply an occlusive dressing What are the stages of shock? - ANSWER>> >>Compensated shock: the early stage of shock. The body is still able to compensate for the hypovolemic state through defense mechanisms, such as increased heart rate and peripheral vasoconstriction. -Tachycardia -Peripheral vasoconstriction -Increased respirations 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? - ANSWER>> >>1. Cardiogenic shock 2. Obstructive shock 3. Distributive shock 4. Hypovolemic shock What is cardiogenic shock? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Falling BP Irregular breathing Mottling or cyanosis Absent peripheral pulses How should shock be managed? - ANSWER>> >>Control bleeding, high-flow oxygen, Trendelenburg, prevent loss of body heat, rapid transport. What are potential causes of respiratory complaints? - ANSWER>> >>Airway obstruction Anaphylaxis Asthma Chronic obstructive pulmonary disease (COPD) Congestive heart failure Croup What is a TIA? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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: -Taking a regular insulin dose but not eating -Extreme physical activity without adjusting insulin level or food intake -Insulin overdose What is hyperglycemia? - ANSWER>> >>A sustained blood glucose over 120 mg/dL Hyperglycemia typically develops slowly and requires a slower recovery process. Hyperglycemic patients can experience seizures, coma, and permanent injury; however, they do not typically develop signs and symptoms rapidly as do hypoglycemic patients. What is diabetic ketoacidosis (DKA)? - ANSWER>> >>Occurs more frequently with type I diabetes. With DKA, the blood glucose is frequently above 350 mg/dL. Brain cells are able to utilize glucose, but the rest of the body's cells are starving and begin using alternate fuel sources, which leads to the production of ketones and acidosis. Signs and symptoms of DKA: -High blood glucose, typically above 350 mg/dL -Kussmaul respirations: deep, rapid breaths -Polydipsia, polyuria, polyphagia -Fruity odor on breath -Tachycardia -Coma What is hyperglycemic hyperosmolar nonketotic syndrome? - ANSWER>> >>Similar to DKA, without the buildup of ketones Occurs more frequently with type II diabetes What is an allergic reaction? - ANSWER>> >>An allergic reaction is an excessive immune response to an allergenic. Allergic reactions can be local or systemic. Sensitization: patients can develop sensitivity to a substance that did not previously cause a reaction. Following sensitization, the severity of reactions can get progressively worse each time. What is anaphylaxis? - ANSWER>> >>Anaphylaxis is a severe, life-threatening form of allergic reaction. Anaphylaxis is always systemic and impairs the airway, respiratory, and cardiovascular systems. Anaphylaxis causes upper and lower airway swelling, bronchoconstriction, vasodilation, hypotension, capillary permeability and increased mucus production. Signs and symptoms: -Skin: flushed, hives, swelling -Respiratory: wheezing, upper airway swollen -Cardiovascular: hypotension What causes anaphylaxis? - ANSWER>> >>Medications Environmental triggers Foods Insect bites and stings Latex What are the routes of exposure to drugs and toxins? - ANSWER>> >>Ingestion, inhalation, injection and absorption 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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Hallucinogens alter sensory perception. Examples include LSD and PCP. What do you need to know about carbon monoxide? - ANSWER>> >>CO poisoning is a leading cause of death due to fires. Other common sources include home heating devices and vehicle exhaust fumes. CO inhibits the body's ability to transport and use oxygen. The danger of CO poisoning is greatest when exposed in a confined space. CO is a silent killer. It is tasteless, colorless, odorless, and completely nonirritating when inhaled. Victims are usually unaware they are being exposed and eventually lose consciousness. What do you need to know about acids and alkalis? - ANSWER>> >>Both are considered caustic substances. Many household products are acids or alkalis. Acids have a very low pH and burn on contact. Pain is usually immediate. Alkalis have a very high pH and tend to burn deeper than acids. Pain may be delayed. Most caustic ingestion patients are children. Common household caustics include liquid drain openers, bathroom cleaning supplies, ammonia and bleach. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What do you need to know about hydrocarbons? - ANSWER>> >>Hydrocarbons are petroleum-based. Hydrocarbons are found in gasoline, paints, solvents, sunscreen, baby oil, makeup remover, kerosene, lighter fluid, and more. Hydrocarbons can be ingested, inhaled, and absorbed. Most hydrocarbon ingestion patients are children. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What is acute abdominal pain? - ANSWER>> >>Acute abdominal pain is usually due to trauma, distension, inflammation, or ischemia. What are the different types of abdominal pain? - ANSWER>> >>Note that the level of pain does not necessarily indicate the illness's severity. Patients can have a life-threatening abdominal emergency without severe pain. Visceral pain -Dull, diffuse pain that is difficult to localize -Frequently associated with nausea and vomiting -Often not severe, but may indicate actual organ injury Parietal pain -Severe, localized pain. Usually sharp and constant. -The pain will often cause the patient to curl up with knees to chest. -The patient is often very still and breathing shallowly to diminish pain. Referred pain: causes pain in an area of the body other than the source. What are potential causes of acute abdominal pain? - ANSWER>> >>Appendicitis Peritonitis Cholecystitis Diverticulitis GI bleeding Gastroenteritis Esophageal varices Ulcers Abdominal Aortic Aneurysm (AAA) What is appendicitis? - ANSWER>> >>Caused by inflammation of the appendix. Can lead to life-threatening infection and septic shock. Signs and symptoms: -Nausea, vomiting, diarrhea, loss of appetite, fever. -Pain may begin as diffuse, but usually localizes to right lower quadrant. What is peritonitis? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Gastroenteritis is an infection with associated diarrhea, nausea and vomiting. It is usually due to contaminated food or water and is not contagious. -Bipolar disorder: also known as manic depression; characterized by drastic mood swings. -Depression: deep sadness not associated with a specific event. -Paranoia: extreme suspicion or distrust about others. -Phobias: unusual level of fear about specific things. -Psychosis: delusional state. -Schizophrenia: a state characterized by disorganized speech and thinking. What do you need to know about suicidal patients? - ANSWER>> >>Females are more likely to attempt suicide, but males are more likely to die as a result of suicide. Suicide attempts usually involve firearms, drugs, or alcohol. Most suicidal patients will give clear signals of their intent. All suicidal gestures should be taken seriously, especially when patients have a clear plan and the means to carry it out. Risk factors for suicide: -History of mental illness, previous suicide attempts, or child abuse -Recent diagnosis of serious illness -Recent loss of job, family member, or partner -Divorced or widowed What are high-risk behavioral situations? - ANSWER>> >>1. Suicidal patients 2. Patients with agitated delirium -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? - ANSWER>> >>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)? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >> What are the trauma center designations? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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. Note that bone fractures can lead to significant arterial and venous bleeding. A liter of blood can be lost from a single femur fracture. What are the three types of soft tissue injuries? - ANSWER>> >>1. Open injuries -Abrasion: a scrap to the skin due to surface friction -Laceration: a jagged cut -Penetrating wound: puncture wound -Incision: a sharp, clean cut -Avulsion: injury caused by a flap of skin being torn partially or completely loose -Crush injury: may be open or closed -Amputation: when part of the body is severed completely from the rest Management of open soft tissue injuries is the same as for external bleeding. 2. Closed injuries -Contusion -Hematoma: a collection of blood beneath the skin -Crush injury: may be open or closed Management of closed soft tissue injuries involves RICES: rest, ice, compression, elevation, splinting. 3. Burn injuries 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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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 -A single femur fracture can cause hypovolemic shock. -Femur fracture patients are at an increased risk of embolism. -Fractures to multiple smaller long bones can combine to cause hypovolemic shock. 3. Amputations -Control bleeding. -Wrap amputated part in a sterile dressing and place in plastic bag and keep cool. -Do not delay transport of a high-priority patient for an amputated part. What is correct splinting? - ANSWER>> >>Correct splinting decreases pain and reduces risk of further injury. Rules of splinting: 1. Assess distal pulse, motor, and sensation (PMS) before and after splinting. 2. Immobilize above and below injury. 3. Attempt to realign deformed injuries with absent distal pulses. 4. Do NOT delay transport of a high-priority patient for a non-ife-threatening injury. What are scalp injuries? - ANSWER>> >>1. Scalp injuries can be open or closed. 2. The scalp is highly vascular and bleeds heavily when lacerated. What are skull fractures? - ANSWER>> >>1. Skull fractures indicate the potential for injury to the brain. 2. Linear fracture: most skull fractures are linear fractures and do not present with deformity or depression. 3. Depressed fracture: depressed skull fractures may be noticeable upon palpation. There is an increased risk of brain injury due to bone being displaced into brain tissue. 4. Basal skull fracture: these fractures occur at the base of the skull. Cerebrospinal fluid may leak from nose or ears. Signs include Battle's sign (bruising behind the ears) and raccoon eyes (bruising under the eyes). What are the types of brain injuries? - ANSWER>> >>1. Concussion 2. Cerebral contusion 3. Epidural hematoma 4. Subdural hematoma 5. Subarachnoid hemorrhage 6. Intracerebra hemorrhage 7. Herniation syndrome What is a concussion? - ANSWER>> >>A concussion causes brain function to be disrupted in some manner. Signs and symptoms typically occur rapidly and gradually improve. Signs and symptoms may include altered LOC that gradually improves, brief loss of consciousness, nausea, vomiting, irritability, repetitive questioning, vision problems, and amnesia. What is a cerebral contusion? - ANSWER>> >>Cerebral contusion is often accompanied by edema and/or concussion injury. Signs and symptoms of cerebral contusion may include signs of concussion and at least one of the following: decreasing mental status, unresponsive, pupillary changes, changes in vital signs, or obvious behavioral abnormalities. What is an epidural hematoma? - ANSWER>> >>Bleeding beneath the skull but above the dura mater. Typically includes significant arterial bleeding. Extremely dangerous due to increase in intracranial pressure. Often accompanied by a temporal skull fracture. Signs and symptoms: -Patient experiences a brief loss of consciousness, wakes up, then LOC deteriorates. -Worsening LOC, headache, seizures, vomiting, posturing, hypertension, bradycardia, changes in respirations, pupillar changes. What is a subdural hematoma? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Bleeding within the brain tissues. Patients can deterioriate rapidly. High mortality (risk of death) rate. What is herniation syndrome? - ANSWER>> >>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. What is Beck's triad and what does it indicate? - ANSWER>> >>JVD, muffled heart tones, narrowing pulse pressure. Indicates possible pericardial tamponade. What are eye injuries and their treatments? - ANSWER>> >>A. Foreign Objects -Nonpenetrating foreign objects in the sclera are often easily removed by irrigating the eye. -Foreign objects in any other part of the eye should be removed by a physician. B. Corneal Abrasion -Direct trauma and foreign objects can cause a corneal abrasion. -The cornea is the transparent covering over the iris and pupil. -Symptoms include pain, tearing, and the sensation of something in the eye. C. Orbital Fracture -Orbital fractures indicate a significant MOI. -Consider possibility of associated spinal trauma. -Symptoms include visual disturbances, double vision, deformity around the orbit, loss of sensation around the orbit, and the inability to move the eye in an upward gaze. -Suspected orbital fractures required physician evlaluation. D. Chemical Burns -Chemicals in the eye require immediate and continuous irrigation. -Avoid irrigating chemicals from one eye into the other. E. Impaled Objects -Do not removed impaled objects from the eye. -Stabilize object in place. -Keep both eyes closed to prevent passive movement of impaled object. F. Contact Lenses -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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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. -Heatstroke can develop due to exertion, or from passive exposure to a hot environment. -Signs and symptoms are similar to those of heat exhaustion and include: altered LOC, dry skin, seizures. How should systemic heat emergencies be managed? - ANSWER>> >>1. Move patient to a cooler environment. 2. If patient is completely alert, water can be administered. 3. If heatstroke is suspected, cooling measures must be rapid and aggressive. -Expose patient to improve dissipation of heat. -Cool patient with water, wet towels, cold packs, etc. -Cold packs are best applied to groin, neck, armpits. -Rapid transport is indicated. -Prepare for vomiting and/or seizures. How long is a full-term pregnancy? - ANSWER>> >>A full-term pregnancy lasts about 9 months or 40 weeks. What is supine hypotensive syndrome? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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. Assess heart rate. 1. Heart rate below 60 beats per minute -Begin chest compressions and ventilations at a 3:1 ratio -Reassess every 30 seconds 2. Heart rate above 60 but below 100 -Provide ventilations -Reassess every 30 seconds 3. Heart rate above 100: assess skin color. Assess skin color. If central cyanosis is present, provide blow-by oxygen at about 4-6 Lm/in with oxygen tubing near the baby's face until color improves. APGAR Score What is the APGAR score? - ANSWER>> >>Attempt to obtain APGAR score at 1 minute and 5 minutes after delivery of the baby. Appearance -0: cyanotic all over -1: core pink, hands and feet cyanotic -2: pink all over Pulse -0: no pulse -1: heart rate under 100 -2: heart rate over 100 Grimace (stimulation reflex) -0: no response to stimulation -1: minimal (facial grimace) response to stimulation -2: responds vigorously, such as crying Activity (extremity movement) -0: limp -1: limited active movement -2: actively moving Respirations -0: not breathing -1: slow or irregular breathing -2: adequate breathing What are potential delivery complications? - ANSWER>> >>A. Meconium B. Multiple Births C. Prolapsed cord D. Breech presentation E. Limb presentation F. Postpartum hemorrhage What is meconium? - ANSWER>> >>Meconium is the presence of fetal stool in the amniotic fluid. This turns the amniotic fluid yellow, green, or brownish. The risk of infection and pneumonia increases if the baby inhales meconium. If meconium is present, suction the mouth and nose promptly when the head clears the birth canal. Once the baby delivers, immediately suction the mouth and nose prior to stimulating the baby to breathe. What are multiple births? - ANSWER>> >>Multiple births can have their own placenta, or share a placenta. Be prepared for multiple births any time it has not been ruled out by the ultrasound. Request additional units. Prepare additional supplies. If second baby does not deliver within about 10 minutes after first, transport immediately. What is a prolapsed cord? - ANSWER>> >>A prolapsed cord occurs when the cord is the presenting part in the birth canal. A prolapsed cord can become compressed and cut off oxygen to the baby. Instruct the mother not to push. This will increase pressure on the cord. Place mother in knee-chest position. Carefully push the presenting part of the baby away from the cord. V finger Transport immediately. What is breech presentation? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>Postpartum hemorrhage is excessive bleeding following delivery. Blood loss of greater than 500 ml is considered abnormal. What are the different ambulance types? - ANSWER>> >>Type I ambulance: truck chassis with modern ambulance body Type II: standard van design Type III: specialty van design with a square patient compartment mounted on the chassis What are the phases of an ambulance call? - ANSWER>> >>Preparation Phase -Inspect the ambulance everyday and after each shift change Dispatch -Nature of the call, location and number of patients En Route -Notify dispatch you're responding -All emergency vehicle operators must drive with due regard for the safety of others Arrival at Scene/Patient Contact -Notify dispatch you are on scene -Ambulance in a safe position/as a barrier Patient Transfer to Ambulance Transport to Receiving Facility -Notify dispatch where you are taking patient -Notify receiving hospital Arrival at Hospital/Transfer of Care -Notify dispatch you've arrived -Provide verbal report to appropriate personnel -Provide written copy of PCR -Obtain transfer of care signature Postrun Phase/Return to Service What are defensive driving tactics? - ANSWER>> >>Emergency vehicles should usually travel in the far left lane What vehicle safety systems should you be aware of? - ANSWER>> >>Shock-Absorbing Bumpers -Most vehicles today are equipped with shock-absorbing bumpers (front and rear). They can become compressed during an accident and spontaneously release, injuring anyone standing in front of them. -Approach vehicles from the side, not the front. Simple access: gaining access to the patient without any tools or need to break the glass. Complex access: requires the use of special tools and training. What are hazardous materials? - ANSWER>> >>Hazardous materials are solids, liquids or gases that pose a threat to people, property or the environment. Risks of exposure depend on the dose, concentration, route of exposure, and duration of contact. The EMT's primary responsibilities at a hazardous materials incident are personal safety, notification of appropriate authorities, and the safety of the patient and public. What are the diamond placards? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>NIMS provides an adaptive, standardized approach to any domestic incident. What are the components of NIMS? - ANSWER>> >>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? - ANSWER>> >>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? - ANSWER>> >>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