Emergency Medical Concepts and Procedures, Exams of Nursing

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WestCoast EMT Final Study Guide

What makes up the axial skeleton? - skull, vertebral column, thoracic cage what is the epiglottis? - a flap that flips down to cover the entry to the trachea during swallowing what is croup? - acute VIRAL inflammatory disease of larynx, primarily w/in the subglottic space -6 months to 6 years what is a pulmonary embolism? - A condition in which one or more arteries in the lungs become blocked by a blood clot. what is an aneurysm? - an excessive localized enlargement of an artery caused by a weakening of the artery wall. what is a thrombus? - stationary blood clot what is an embolism? - A piece of a blood clot that enters the bloodstream What is subcutaneous emphysema? - a characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in the soft tissue -may feel like rice crispy treats what is hemoptysis? - Coughing up blood; blood in sputum generally from the lungs. what is hematuria? - presence of blood in the urine What is hematemesis? - vomiting blood What is capnography? - A noninvasive technique to alert you to hypoventilation even when your patient's pulse ox reading are fine. Carbon dioxide is the most significant factor in monitoring ventilation. Capnography measures the CO2 in every breath to monitor air exchange in the patient's alveoli. Trendelenburg position - A position in which the patient's feet and legs are higher than the head What is CPAP? Why is it used? - continuous positive airway pressure; used to deliver pressure to the airways to keep the airway open while the individual sleeps

small-volume nebulizer - a device that uses compressed air or oxygen to nebulize a liquid medication into a mist that a patient can inhale How to care for a patient who has been sexually assaulted: - Have female be treated by female EMT

• First component is medical treatment.
• Second is psychologic care of the patient - don't cross-examine patient or attempt to obtain info
• Don't tamper any evidence. Put evidence in paper bags, not plastic. types of consent: expressed - Patient verbally or otherwise acknowledges that he/she wants you to provide care or transport. May be nonverbal. informed consent - you explained the nature of treatment being offered, along with potential risks, benefits, and alternatives to treatment, as well as consequences of refusing treatment. types of consent: implied - Legal principle that allows treatment under circumstances, such as intoxication, mentally impaired, or suffering from certain conditions such as head injury.
• applies only when a serious medical condition exists and should never be used unless there is a threat to life or limb types of consent: involuntary - Applies when a person is mentally ill, developmentally delayed, or who is in a behavioral (psychological) crisis. Someone makes the decision on their behalf (legally responsible). types of consent: minors -
  • When a parent cannot be reached to provide consent, health care providers are allowed to give emergency care to a child.
• If a minor is injured and requires medical treatment in a school or camp setting, teachers and officials may act in loco parentis, meaning in position of parent. emancipated minors: - People who, despite being under the legal age in a given state, can be legally treated as adults based on certain circumstances, such as being married, members of armed services, or if they are parents. Bradycardia - A slow heart rate. -less than 60 beats/min for adults and children (older than 10) -less than 60 beats/min for preschoolers and school-aged children (2 years to 10 years) -less than 100 for infants and toddlers (3 months to 2 years) -less than 85 for infants (up to 3 months) tachycardia -

fast heart rate -greater than 100 bpm for adults and children (older than 10) -greater than 140 bpm for preschoolers and school-aged children (2 years to 10 years) -greater than 190 bpm for infants and toddlers (3 months to 2 years) -greater than 205 bpm for infants (up to 3 months) Supraventricular Tachycardia (SVT) - Episodes of abnormally fast/racing heartbeat what is tidal volume? - the amount of air that is moved into or out of the lungs during a single breath, generally 500 mL in an adult. what is residual volume? - Gas that remains in the lungs after exhalation simply to keep the lungs open. what is minute volume? - Amount of air moved into and out of lungs per minute what is ventilation? - movement of air in and out of the lungs what is respiration? - The physiologic process of exchanging oxygen and carbon dioxide. What is a NRB and when do you use it? - Nonrebreathing mask used for patients who are breathing adequately but are suspected of having or showing signs of hypoxia. 10-15L/min flow rate provides up to 95% inspired oxygen What is a nasal cannula and when do you use it? - Delivers oxygen through two small, tubelike prongs that fit into the patient's nostrils. Used when a patient will not tolerate a NRB. Patient may find this more comfortable. 1-6L/min flow rate provides 24%-55% inspired oxygen. What is a BVM and when do you use it? - Bag valve mask used when you need to deliver high concentrations of oxygen to patients who are not ventilating adequately. Used for patients in respiratory arrest, cardiopulmonary arrest, and respiratory failure. Attach supplemental oxygen and a reservoir. 15L/min with oxygen reservoir can provide 100% nearly oxygen. What is a CPAP and when do you use it? - continuous positive airway pressure - non-invasive means of providing ventilatory support for patients experiencing respiratory distress. Use of CPAP in prehospital setting is an excellent treatment of respiratory distress associated with obstructive pulmonary disease and acute pulmonary edema. V/Q ratio -

ventilation/perfusion ratio, how much gas is being moved and how much blood is gaining access to the alveoli types of V/Q mismatches: - Ventilation compromised but perfusion continues, blood passes over some alveolar membranes without gas exchange taking place. Can lead to sever hypoxemia. Perfusion across alveolar membrane is disrupted. Alveoli filled with oxygen, but disruption in blood flow doesn't allow for exchange of gases across membrane. Results in less oxygen absorption in bloodstream and less CO2 removal, can lead to hypoxemia. hydrostatic pressure: - Fluid that pushes against the vessel walls to force fluid out of the capillary. (hydro) oncotic pressure: - The opposing force and occurs because proteins in the blood plasma cause water to be pulled into the capillary by diffusion. what is paradoxical movement? - The motion of the portion of the chest wall that is detached in a flail chest; the motion - in during inhalation, out during exhalation - is exactly the opposite of normal chest wall motion during breathing. what is a flail chest? - A condition in which three or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage. vesicant agents: - Blister agents. Primary route is the skin, but if left on skin/clothing long enough can enter the respiratory tract. types of vesicant agents: - Sulfur mustard (H) Lewisite (L) Phosgene (CX) these usually cause most damage to damp or moist areas of the body (armpits, groin, respiratory tract) span of control - Refers to keeping the supervisor/worker ratio at one supervisor for 3 to 7 workers Incident Command System (ICS) - A system implemented to manage disasters and mass-casualty incidents in which section chiefs, including finance, logistics, operations, and planning, report to the incident commander. ICS: incident commander (IC) - the person in charge of the overall incident ICS: finance -

the finance section chief is responsible for documenting all expenditures at an incident for reimbursement. ICS: logistics - the logistics section is responsible for communications equipment, facilities, food and water, fuel, lighting, and medical equipment and supples for patients and emergency responders ICS: operations - responsible for managing the tactical operations usually handled by the IC on routine EMS calls ICS: planning - solves problems as they arise during the incident.

• create the incident action plan, which is the central tool for planning during a response to a disaster emergency ICS: command staff - comprised of safety officer, public information officer, and liaison officer ICS: command staff - safety officer - monitors scene for conditions/operations that may present hazard to responders/patients ICS: command staff - public information officer - provides public/media with clear and understandable info ICS: command staff - liaison officer - relays informations and concerns among command, general staff and other agencies pneumothorax - air in the pleural cavity caused by a puncture of the lung or chest wall hemopneumothorax - The accumulation of blood and air in the pleural space in the chest. tension pneumothorax - a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels. heat stroke - a condition marked by fever and often by unconsciousness, caused by failure of the body's temperature-regulating mechanism when exposed to excessively high temperatures. heat exhaustion - condition resulting from exposure to heat and excessive loss of fluid through sweating two types of oxygen cylinders: - The most common are D (or jumbo D) and M. Other types include A, E, G, H, and K. Another naming system is: M (medical) followed by a number. D (or jumbo D) tank -

an oxygen cylinder that can be carried from your unit to the patient. M tank - remains on board your unit as a main supply tank. minimum operating PSI for an oxygen tank: - Most EMS systems consider a cylinder with less than 500 to 1000 PSI to be too low to keep in service. Learn department's policies in regards and follow them. what is chronic obstructive pulmonary disease (COPD)? - A slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction? what is the most common form of COPD? - emphysema what is emphysema? - a loss of the elastic material in the lungs that occurs when the alveolar air spaces are chronically stretched due to inflamed airways and obstruction of airflow out of the lungs. Signs and symptoms of COPD: - Patients will chronically produce sputum, have a chronic cough, and difficulty expelling air from their lungs, with long expiration phases and wheezing. Also: crackles, rhonchi, wheezes, or may have severely diminished breath sounds ischemic heart disease - a group of cardiac disabilities resulting from an insufficient supply of oxygenated blood to the heart myocardial infarction (MI) - heart attack; death of myocardial tissue (infarction) caused by ischemia (loss of blood flow) as a result of an occlusion (plugging) of a coronary artery; usually caused by atherosclerosis; symptoms include pain in the chest or upper body (shoulders, neck, and jaw), shortness of breath, diaphoresis, and nausea Angina - a condition of episodes of severe chest pain due to inadequate blood flow to the myocardium cardiogenic shock - Shock caused by inadequate function of the heart, or pump failure. Acute Myocardial Infarction (AMI) - A heart attack; death of heart muscle following obstruction of blood flow to it. Acute in this context means "new" or "happening right now." Cardiogenic Hypoperfusion - otherwise called cardiogenic shock When a child is struck by a car, the area of greatest injury depends mostly on the: - age of the child and the size of the car that struck him

radiation - Energy that is radiated or transmitted in the form of rays or waves or particles. Convection - The transfer of heat by the movement of a fluid conduction - The direct transfer of heat from one substance to another substance that it is touching. Evaporation - The change of a substance from a liquid to a gas Atherosclerosis - A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, which eventually leads to partial or complete blockage of blood flow. arteriosclerosis - a disease that causes the arteries to thicken, harden, and calcify chemoreceptors - chemical sensors in the brain and blood vessels that identify changing levels of oxygen and carbon dioxide Baroreceptors - cell that detect changes in blood pressure abrasion - Loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface. avulsion - An injury in which soft tissue is torn completely loose or is hanging as a flap. incision - A sharp, smooth cut in the skin. laceration - A deep, jagged cut in the skin. pulmonary edema - A buildup of fluid in the lungs, usually as a result of congestive heart failure. acute pulmonary edema - occurs when an excessive amount of fluid collects in the spaces between the alveoli and capillaries, disturbs normal gas exchange types of shock: - Cardiogenic Hypovolemic Neurogenic Anaphylactic Septic

psychogenic obstructive obstructive shock - caused by a mechanical obstruction which prevents an adequate volume of blood to fill the heart chambers: -cardiac tamponade -tension pneumothorax -pulmonary embolism distributive shock - when there is widespread dilation of the small arterioles, small venules, or both. four most common types of distributive shock: - septic shock, neurogenic shock, anaphylactic shock, and psychogenic shock. septic shock - result of severe infections, usually bacterial, in which toxins are generated by the bacteria or by infected body tissues; toxins damage vessel walls causing increased cellular permeability neurogenic shock - Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries. psychogenic shock - Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope). anaphlactic shock - a sudden violent allergic reaction If you can only take two pieces of equipment with you to a patients side, in addition to a jump kit, you should choose: - AED and portable suction central nervous system (CNS) - consists of the brain and spinal cord Peripheral Nervous System (PNS) - the sensory and motor neurons that connect the central nervous system (CNS) to the rest of the body. abruptio placentae - premature separation of the placenta from the uterine wall placentae previa - A condition in which the placenta develops over and covers the cervix compensated shock: - The early stage of shock, in which the body can still compensate for blood loss. decompensated shock: -

when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident Instances that cause severe allergic reactions: - injections (tetanus antitoxin, penicillin) stings (wasps, bees, hornets, ants) ingestion (fish, shellfish, nuts, eggs, medication) inhalation (dust, pollen, mold) signs and symptoms of anaphylaxis/allergic reaction: -

• Trouble breathing (throat may close up)
• Hypotension - Itching - Hives - Feeling anxious
• Burning feeling - Unusual swelling - Cardiac arrest Acute pulmonary embolism - blockage that occurs when a blood clot or other particle lodges in a pulmonary artery signs and symptoms of skull fracture: - -visible crack in the skull within a scalp laceration -raccoon eyes (ecchymosis) -battle signs (blood behind ears), CSF out of ears what 3 components make the pediatric assessment triangle? -
• work of breathing
• appearance
• circulation to skin Murphy's sign - pain with palpation of the RUQ during inspiration, indicative of cholecystitis McBurney's sign - rebound tenderness associated with appendicitis (McBurney's Point is 2/3 of the way from the umbilicus to anterior superior iliac spine) Vardenafil (Levitra, Staxyn) Tadalafil (cialis) Sildenafil (viagra) Avanafil (stendra) - all of these are used to treat erectile dysfunction return of spontaneous circulation (ROSC) - The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest. Chain of survival: -

1. Recognition and activation of emergency response system
2. immediate high quality CPR
3. rapid defibrillation
4. basic and advanced EMS
5. ALS and post-arrest care pulse oximetry -

noninvasive technique that measures the oxygen saturation (SaO2) of arterial blood sucking chest wound (open pneumothorax) - An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound. cardiac tamponade - occurs when the protective membrane around the heart (pericardium), the pericardial sac, fills with blood or fluid, perhaps from a ruptured, torn, or lacerated coronary artery or vein. Beck's triad for cardiac tamponade. -

• distended or engorged jugular veins seen on both sides of trachea
• narrowing pulse pressure (difference between systolic and diastolic)
• muffled heart sounds associated sign is decreased mental status wheezing - Difficult breathing with a high-pitched whistling or sighing sound during expiration (lungs) stridor - A high pitched sound generated from partially obstructed air flow in the upper airway (such as croup or foreign body) rhonchi - loud rumbling sounds heard on auscultation of bronchi obstructed by sputum rales (crackles) - fine crackling sounds heard on auscultation (during inhalation) when there is fluid in the alveoli why are NPAs rarely used for infants under 1 year of age? - In pediatric patients, the nasopharyngeal airway is typically used in association with possible respiratory failure. It is rarely used in infants younger than one. HIPAA - Health Insurance Portability and Accountability Act of 1996 -patient confidentiality -don't discuss findings START triage - Simple Triage and Rapid Treatment -ability to walk -respiratory status -pulse -neurologic status JumpSTART triage - system for pediatric patients younger than 8 or less than 100lbs.

-infants/children taken as soon as possible to treatment area for secondary triage -pulse (5 rescue breaths and check respirations) -respirations -hemodynamic status (distal pulse) -neurologic status Pregnancy and blood loss in trauma: - Pregnant women have an increased overall total blood volume and an approximate 20% increase in their heart rate by the third trimester of pregnancy. Therefore, a pregnant trauma patient may experience a significant amount of blood loss before you detect signs of shock. Body of woman who is in trauma often reduces blood supply to fetus so woman receives adequate amount of blood. Blood loss during delivery of a baby: - bleeding that exceeds approximately 500mL is considered excessive. Cincinnati Pre Hospital Stroke Scale: - -facial droop -arm drift -difficulty speaking Cincinnati Pre Hospital Stroke Scale: facial droop - ask patient to show teeth or smile -normal = both sides equal -abnormal = one side does not move as well Cincinnati Pre Hospital Stroke Scale: arm drift - ask patient to close eyes and hold both arms out with palms up -normal = arms move the same, or neither move -abnormal = one arms drifts down compared with other Cincinnati Pre Hospital Stroke Scale: speech - ask patient to say "the sky is blue in cincinnati" -normal = no slurring -abnormal = patient slurs, inappropriate words, unable to speak Stroke patient assessment and transport: - Stroke assessment tool should be part of your secondary assessment. Use stroke scale - if patient does not have a normal response to these evaluations, you should strongly suspect a stroke. Rapid transport to a designated stroke center is indicated. child cpr guidelines - 1 hand on chest, (rescue breathing is 1 every 3 seconds), compress 1 inch-1 1/2 inches, 5 cycles in 2 minutes. Cushing's Triad - hypertension (high BP) bradycardia (decreased HR) irregular respirations (Cheyne-strokes/Biot resp) assessing pulse in adult: - carotid artery (neck)

femoral artery (groin) radial artery (wrist on thumb side) brachial artery (inner bicep) posterior tibial artery (inner ankle) dorsalis pedis artery (top of foot) assessing pulse in infants: - brachial pulse as first choice or femoral pulse as second choice assessing pulse in children: - in children older than 1, palpate the carotid pulse generalized tonic-clonic seizure - Results from abnormal electrical discharges from large areas of the brain, usually involving both hemispheres. S/S: unconsciousness and generalized severe twitching of the body's muscles that lasts several minutes. Or, brief lapse of consciousness where patient stares Partial (focal) seizures - Begins in one part of the brain. Simple or complex. simple partial seizure - a partial seizure, starting from a focus and remaining localized, that does not produce loss of consciousness S/S: numbness, weakness, or dizziness complex partial seizure - altered mental status and does not interact normally with his/her environment. results from abnormal discharges from temporal lobe of brain. S/S: lip smacking, eye blinking, isolated convulsions or jerking of the body or one part of the body. unpleasant smells and visual hallucinations, exhibit uncontrollable fear, or exhibit repetitive physical behavior such as constant sitting and standing. hyperglycemia - excessive sugar in the blood happens gradually, warm and dry skin (intense thirst, hunger) Hypoglycemia - abnormally low level of sugar in the blood. patient will more likely have a depressed level of consciousness than patients with hyperglycemia. happens rapidly, pale cool and moist skin. Absent thirst/hunger treatment for hypoglycemia in the field: - prompt treatment with oral glucose paste or injection of glucose or glucagon by ALS Kussmaul respirations: -

deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body. Biot's respirations - varying depth and rate of breathing, followed by periods of apnea; irregular Cheyne-Stokes respiration - pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea hyperthermia: - A condition in which the body core temperature rises to 101°F (38.3°C) or more. hypothermia: - A condition in which the internal body temperature falls below 95°F (35°C), usually as a result of prolonged exposure to cool or freezing temperatures. Body restricts blood vessels in the skin; body creates heat by shivering. negative pressure breathing - During inhalation, diaphragm and intercostal muscles contract. When diaphragm contracts, it moves down slightly, enlarging thoracic cage from top to bottom. When intercostal muscles contract, they move ribs up and out. These actions combine to enlarge chest cavity. As cavity enlarges, pressure in pleural space falls and air rushes into lungs. Why are injected poisons impossible to dilute or remove from the human body? - Injected poisons cannot be diluted or removed from the body in the field because they are usually absorbed quickly into the body or cause intense local tissue destruction. High humidity and the body's ability to lose heat: - High humidity reduces heat loss through evaporation. components of Glasgow Coma Scale - eye opening, verbal response, motor response Glasgow Coma Scale (GCS): Eyes - 4 - spontaneous 3 - in response to speech 2 - in response to pain 1 - none Glasgow Coma Scale (GCS): Verbal - 5 - oriented conversation 4 - confused conversation 3 - inappropriate words 2 - incomprehensible sounds 1 - none Glasgow Coma Scale (GCS): Motor - 6 - obeys commands 5 - localizes pain 4 - withdraws to pain

3 - abnormal flexion 2 - abnormal extension 1 - none Revised Trauma Score (RTS) - A scoring system used for patients with head trauma. RTS: 4 - GCS = 13 to 15 SBP = > RR = 10 to 29 breaths RTS: 3 - GCS = 9 to 12 SBP = 76 to 89 RR = > RTS: 2 - GCS = 6 to 8 SBP = 50 to 75 RR = 6 to 9 RTS: 1 - GCS = 4 to 5 SBP = 1 to 49 RR = 1 to 5 RTS: 0 - GCS = 3 SBP = 0 RR = 0 Why are infants referred to as belly breathers? - Children do not have well-developed chest musculature, and their ribs and cartilage are softer and more pliable than an adult's. As a result, the thoracic cavity cannot optimally contribute to lung expansion. Children rely heavily on their diaphragm for breathing, which movers their abdomen in and out. Ventricular tachycardia (V-tach) - A condition in which the heartbeat is quite rapid (150-200 BPM); if rapid enough, ventricular tachycardia will not allow the heart's chambers to fill with enough blood between beats to produce blood flow sufficient to meet the body's needs. If uncorrected, will eventually lead to asystole, the absence of all heart electrical activity. May occur within minutes. Ventricular fibrillation (V-fib) - the rapid, irregular, and useless contractions of the ventricles. patient may become unconscious within seconds. defibrillate the heart is highly successful if used within first few minutes. survival diminishes 10% each minute without defibrillator.

what is ischemia? - reduced blood flow Solid organs in abdominal - Liver Spleen Kidneys Pancreas hollow organs of the abdomen - gallbladder, stomach, small intestine, large intestine and bladder Rule of Nines (adult) - 9% per arm 9% for head 18% each leg 18% anterior trunk 18% posterior trunk Rule of Nines for infants - Head (entire)- 18% Chest & Abdomen (front & back)- 18% Entire Arm- 9% Genitals- 1% Entire Leg- 13.5% rules of nines for children - Head (entire)- 12% Chest & Abdomen (front & back)- 18% Entire Arm- 9% Genitals- 1% Entire Leg- 16.5% rule of palm - a method for estimating the extent of a burn. The palm of the patient's own hand, which equals about 1 percent of the body's surface area, is compared with the patient's burn to estimate its size. 6 rights - Patient Medication Dose Route Time Documentation DDICE - Drug Dose Integrity Clarity

Expiration nitroglycerin - *Patient-assisted/EMT-administered! Action: Dilates blood vessels Indication: chest pain of cardiac origin. Contra: hypotension/ED medication within 24 hours, head injury Route: SL (under tongue) Dose: .3 to .4 mg SL; .4 mg spray aspirin (bayer) - *EMT-administered! Action: anti-inflammatory/anti-fever agent, prevents platelets from clumping Indication: mild pain, headache, muscle aches, chest pain of cardiac origin Contra: recent bleeding, hypersensitivity Route: PO (by mouth) Dose: 160 to 325 mg chewable tablets for chest pain epinephrine (epipen) - *Patient-assisted! Action: stimulates nervous system, causing bronchodilation Indications: anaphylactic reaction Contra: chest pain of cardiac origin; hypothermia, hypertension Route: IM (intra muscular) Dose: .3 mg for adults, .15 for children oral glucose (glucose) - *EMT-administered! Action: provides glucose for cell use Indications: low blood glucose (hypoglycemia) Contra: decreased LOC, nausea, vomiting Route: PO (by mouth)

Dose: 1/2 to 1 tube oxygen (no trade name) - *EMT-administered! Action: reverses hypoxia, oxygen to be absorbed by lungs Indications: hypoxia or suspected hypoxia Contra: rarely used in patients with COPD, do not use near flame Route: inhalation Dose: oxygen delivery devices to administer 28%-100% oxygen drowning: - the process of experiencing respiratory impairment from submersion or immersion in liquid. near drowning: - refers to a patient who survives at least temporarily (24 hours) after suffocation in water type 1 diabetes mellitus - diabetes in which no beta-cell production of insulin occurs and the patient is dependent on insulin for survival type 2 diabetes mellitus - Diabetes in which the body produces insulin, but not enough, or there is insulin resistance. The patient usually is not dependent on insulin for survival. diabetic ketoacidosis - acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy HHNS - a life-threatening condition resulting from high blood glucose that typically occurs in older adults, and which causes altered mental status, dehydration, and organ damage. Most common cause of airway obstruction in patients: - the tongue is the most common airway obstruction in unresponsive patients.