Emergency Medical Procedures and Assessments, Exams of Advanced Education

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NYS EMT-B STATE EXAM WRITTEN

An EMS Provider responds to a call and finds an 8- yr old female with no pulse or respirations. The patient has a history of terminal brain cancer. The family states the last time she as seen alive was 5 mins prior to EMS being called. They also state patient has a DNR oder. In NYS, EMS personnel may accept which of the following DNR instruments as valid? Verbal request from family A. Written non-hospital B. DNR or MOLST form C. Written healthcare proxy D. Written living will - Written out-of-hospital DNR OR MOLST FORM Implied Consent exists when a patient is suffering from a life-threatening injury or illness and is: a. Under police custody b. A threat to himself and others c. Under age of 18 d. Unconscious - D. unconscious The opposite of distal is a. Superior b. Medial c. Lateral d. Proximal - D. Proximal The chamber of the heart that is most muscular and that pumps the most blood into the aorta is the a. Right atrium b. Left ventricle c. Right ventricle d. Left atrium - B. LEFT VENTRICLE In correct sequence (VERTEBRAE SECTIONS) and number in each section - cervical (7), thoracic (5), lumbar (12), sacral (5), and coccygeal (4) The purpose of the first set of vital signs is to: - A. establish a baseline for additional evaluations PCR has how many spots for writing vital signs? - 3 spots When you take the pulse of a patient, you are really a. Counting pressure waves of blood that the heart sends through an artery

b. Feeling the swelling of the vein as each wave of blood passes back to the heart c. Noting the heartbeats in the column of blood in a large vein d. Feeling the vibrations of the heart muscles as they push the blood through - A. counting the pressure waves of blood that the heart sends through an artery In people whose skin is darkly pigmented, cyanosis is BEST seen by observing a. Mucosal membranes b. Earlobes c. Scalp d. Face - A. mucosal membranes You are treating an alert 35-year old trauma patient. You palpate a strong radial pulse of

100. Your partner has taken the patient's blood pressure and advised you that it is 68/32. You should: a. Suspect the accuracy of the pressure reading and reevaluate it b. Accept the reading as accurate c. Ask you partner to retake BP reading again in 15 min d. Treat patient for hypertension immediately - A. suspect the accuracy of the pressure reading and reevaluate it yourself A correct statement about diastolic blood pressure is that it is the pressure a. Exists when heart left ventricle is refilling b. Due to the contraction of the ventricles of the heart c. Caused by contraction of the atria of heart d. Caused by relaxation of the walls of the major arteries - d. Caused by relaxation of the walls of the major arteries All of the following are symptoms EXCEPT? a. Headache b. Weak pulse c. Chest pain d. Nausea - B. weak pulse sign vs symptom - a sign is a physical manifestation (objective)- something you can measure symptom is what the patient tells you about the disease (subjective) For a patient with a suspected lumbar spinal injury, the BEST device for moving the patient as a single unit over uneven terrain is the: A. wheeled stretcher B. long spine board C. flexible stretcher D. short spine board - B. long spine board Which of the following is the best indicator of the quality of ventilations

A. chest expansion B. pupil size C. blood pressure D. skin color - A. CHEST EXPANSION What is the best measure of respiration? - skin color ventilation vs respiration - ventilation- the simple movement of air into and out of the lungs respiration- the exchange of gases between the lungs, the blood, and the tissues of the body Unless additional suctioning time is necessary to clear the airway, an adult patient should be suctioned for NO LONGER THAN A. 5 sec B. 10 sec C. 15 sec D. 20 sec - 15 seconds During single-rescuer CPR, which of the following ventilation devices would be MOST effective for ventilating a patient A. NRB B. Pocket mask w/ oxygen C. Flow-restricted, oxygen-powered ventilation device (FROPVD) D. BVM w/o oxygen - B. Pocket mask with Oxygen because you can maintain a better seal While performing ventilations on an infant or child in respiratory arrest, you should ventilate every A. 5-6 seconds B. 3-5 seconds C. 1-2 seconds - B. 3-5 seconds The oropharyngeal airway will help keep the tongue away from the a. Posterior pharyngeal wall b. Nasal passage c. Epiglottis d. Posterior larynx - a. Posterior pharyngeal wall You are called to the home of a patient who is on physician prescribed low- concentration oxygen and who is NOT in acute respiratory distress. Which type of oxygen delivery device should you use during transport? A. NRB B. Flow-restricted, oxygen-powered ventilation device (FROPVD) C. BVM w/ supplemental oxygen

D. Nasal cannula - D. Nasal cannula Used specifically for someone not in respiratory distress and prescribed O2 from doctor An EMS provider is treating a patient who has a head injury resulting from a blow by a baseball bat. What other problem are likely to be present? A. Hypothermia B. Hypertensive shock due to blood loss C. Spinal injuries D. Lung collapse - C. Spinal injuries biggest risk for someone with a massive injury is? - Airway problem In a HEALTHY person, respiration is controlled by level A. carbon dioxide B. blood sugar C. oxygen D. carbon monoxide - A. carbon dioxide

• normal stimulus to breathe: HIGH CO In patients with COPD respiration is controlled by? - Low O2 levels called hypoxic breathing In conducting the Primary Assessment of a conscious patient, the EMS provider must attend to the patient's emergency needs in the order of: A. Respiration, Pulse, Bleeding B. Pulse, Bleeding, Respiration C. Pulse, Respiration, Bleeding - A. Respiration, Pulse, Bleeding A patient with acute respiratory distress requiring oxygen therapy is LEAST likely to exhibit: A. a slow pulse rate B. anxiety C. nasal flaring D. intercostal muscle retractions - A. slow pulse rate After you have determined that the scene is safe, the FIRST step in caring for a patient is to: A. check for a carotid pulse B. open the airway C. determine unresponsiveness D. check for breathing - C. Determine unresponsiveness (GEN IMP, LOC, CC) During the Prim. Assessment, you are assessing a conscious trauma patient complaining loudly of pain in the leg, you should: A. begin to obtain the history

B. assess the leg immediately C. discontinue the Primary Assessment and start the Detailed Physical Examination D. continue with your Primary Assessment - D. Continue with Primary Assessment Which of the following measures is NOT part of the Primary Assessment of an accident victim? A. assessing the pulse quality B. manual stabilization of the cervical spine C. suctioning of the airway D. taking patient history - D. Taking patient history Any physical exam of a patient should begin with A inspection B manipulation C stabilization D palpation - A inspection the "A" in the mnemonic AVPU stands for for - ALERT A 65-yr old male was involve in a two motor vehicle crash. Upon examination, he complains of chest pain when breathing and tenderness of the sternum. Your INITIAL care should include: A stabilizing the sternum B positioning the patient on his side C administering high-concentration oxygen D administering the patient's prescribed nitroglycerin - C Administering high-conc oxygen When spinal injuries are suspected, the EMS provider should FIRST A hyperextend the neck to secure the airway B determine the extent of the paralysis C apply an extrication collar D apply manual stabilization and secure the airway - D apply manual stabilization and secure the airway For a trauma victim w/ a respiratory rate of 40/min, shallow and irregular, who is pale and has a history of emphysema, the MOST APPROPRIATE treatment would be to: a. use of a bvm w/ supp oxygen b. administer low-conc oxygen b/c of emphysema history c. administer supp oxygen w/ a high-conc mask d. transport the patient sitting up to ease the patient's dyspnea - A. Use of a BVM w/ supp. oxygen If the EMS provider is unable to find a patient's peripheral pulse during a Primary Assessment, next step should be to: a. turn on the AED

b. palpate the carotid pulse c. open the airway and insert an OPA d. check breathing and begin CPR - b. palpate the carotid pulse While assessing the MOI of a motor vehicle crash, an EMS provider finds that the airbag has been deployed: The EMS provider should: a. decontaminate the patient b. remove the airbag c. disconnect the battery d. lift the airbag and check underneath for damage - d. lift the airbag and check underneath for damage If life threatening conditions are identified during the focused history and physical exam, the EMT should immediately: a. repeat the Primary Assessment b. take vital signs c. begin transportation efforts d. provide life-saving interventions - D. provide life-saving interventions Which one of the following instructions applies to the performance of mask-to-stoma ventilation on a person who has had a COMPLETE laryngectomy? a. the nose and mouth must be manually sealed off b. perform Head tilt neck lift maneuver to open the airway c. the nose must be sealed off d. neither the nose nor mouth must be sealed off - d. neither the nose nor mouth must be sealed off Treating for a complete stoma vs incomplete stoma - COMPLETE: stoma down to lungs, DONT SEAL NOSE OR MOUTH INCOMPLETE: seal mouth and nose When a patient is stable, EMS provider should repeat the ongoing assessment every - 15 minutes In performing an ongoing assessment on a 10-yr old pedestrian struck by a MV, the EMS provider's first step is to, a) recheck vital signs b) repeat the primary assessment c) check the interventions d) repeat a rapid assessment - b) repeat the primary assessment The pre-hospital care report PCR is considered to be a) part of patient's hospital chart b) matter of public record

c) inadmissible in a court of law d) research document only - A) part of patient's hospital chart Before assisting patient's in taking their own nitroglycerin, and EMS provider must check the: a. Expiration date b. Physicians name c. Color of tablet d. Prescription date - A. expiration date 40-yr old female has difficulty breathing. You determine she has an open airway nad an altered mental status. Her respirations are 8 and shallow. The MOST important step for the EMS provider to take is to a) ask family members of the patients if there's a history of COPD b) assist patient's respiratory efforts w/ high conc oxygen using a BVM c) watch patient carefully and obtain vital signs d) assess the use of accessory muscles while breathing - b) assist patient's respiratory efforts w/ high conc oxygen using a BVM You are assessing a patient who complains of difficulty breathing and of "not getting enough air" Which of the following will quickly CONFIRM that the pt is not getting sufficient oxygen? A. pink nail beds B. smell of nail polish C. use of accessory muscles while breathing - C. the use of accessory muscles while breathing While carrying concrete blocks at a construction site, a 58 yr old man suddenly develops chest pain and shortness of breath- appears frightened, vomits, and has cool clammy skins. thse are probably signs of a- hiatal hernia b- heat exhaustion c- fatigue d- heart attack - D. heart attack A building contractor, under tremendous pressure to meet a job deadline, experiences diffuse pain in his chest. The pain lasts for several minutes, then disappears w/ rest. The EMS provider should suspect a- angina pectoris b- muscular cramps c- pulmonary edema d- congestive heart failure - A. angina pectoris What acute disorder of the Cardiovascular system is caused by sudden blockage of coronary arteries a. Angina pectoris

b. Myocardial infarction c. Stroke - B. Myocardial infarction Angina vs Heart attack - angina: spastic constriction of the arteries Heart attack: sudden blockage of arteries You are treating a patient who is complaining of chest pain and difficulty breathing. You should have the patient lie: a) flat and take slow deep breaths b) in whatever position feels most comfortable c) on his/her back w/ head elevated and take fast shallow breaths d) in a coma position - b) in whatever position feels most comfortable

45. A 62-yr old male is complaining of breathing difficulty and left arm pain radiating to the right jaw. Vital signs BP 90/60, P= 120, R=24. The patient should be administed: - A. high-conc oxygen and should be placed in a position of comfort for ease of breathing Immediately after delivering an initial shock to the patient, the EMS provider should a- give 2 ventilations b- perform compressions c- check for a pulse d- check BP - B. perform compressions One reason for using the automated external defribillator is to: - detect a shockable rhythm in a patient Rhythms shockable by an AED include ventricular fibrillation and - ventricular tachycardia A nitroglycerin patch discovered on the chest of a 75yrold patient in cardiac arrest should: - be removed prior to defibrillation A diabetic emergency with a rapid onset is due to: - too much insulin (causes very low blood sugar) HYPOGLYCEMIA

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CAUSES

• takes too much insulin -reduces sugar intake by not eating overexercises/overexerts -vomits -increases the metabolic rate in conditions such as fever or shivering SIGNS -rapid onset

-drunken stupor -pale, sweaty skin, -tachycardia -rapid breathing -seizures RESULTS -starvation of brain cells -altered mental status -unconsciousness -permanent brain damage Hypoglycemia vs Hyperglycemia - Hypoglycemia (low blood sugar, high insulin)- RAPID ONSET Hyperglycemia (high blood sugar, low insulin) Which one of the following is the medical term for a low blood sugar concentration? - hypoglycemia Which of the following is a sign assoc. with a patient w/ a history of diabetes who has an altered mental status? a. Flushed face b. Slow pulse c. Drunken appearance d. Warm dry skin - C. drunken appearance A 21 yr old male is found sitting in an automobile in a parking lot. He has an altered mental status and a history of diabetes. Your attempt to question him yields little info, as his responses are inappropriate for the questions. Your treatment for this patient include: a. Suctioning patients airway b. Full immobilization of patients head neck and spine c. Administration of a glucose solution by mouth d. Open airway with OPA - C. Administration of a glucose solution by mouth

• AMS//likely hypoglycemia Sugar passess from the blood to the cells w/ the aid of a chemical susbtances known as
• insulin Which of the following are the signs of a severe allergic reaction a. Decreased BP, itching, swelling, difficulty breathing b. Pain in chest, rapid pulse, pallor, sweating c. Decreased BP strong pulse, heavy breathing - A. Decreased BP, Itching, Swelling, Difficulty breathing WUSH (Wheezing, urticaria, strider, hypotension)

Autoinjectors should be administed in the - d- lateral thigh, midway b/w the waist and the knee do after injection : Massage area, dispose in sharps container A child drank some unknown fluid. You arrive at the scene and note the following signs: Child's mouth and lips are burned, child is coughing and gagging. What should you do? a) administer syrup of ipecac b) administer activated charcoal and induce vomiting c) call the medical or poison control center for advice d) administer syrup of ipepac and activated charcoal - c- call the medical or poison control center for advice

• wouldn't use ipecac bc of corrosiveness-burned lips A 28-yr old patient presents supine on the floor, unconscious, unresponsive, and with snoring respirations at a rate of 6 per minute. Bystanders report that the patient is diabetic, taken no medications, and may have ingested heroin half an hour prior to the EMS Provider's arrival. After opening the patient's airway, the EMS provider should: - insert an airway adjunct and ventilate w/ 100% oxygen using a BVM The treatment for an unconscious patient w/ generalized hypothermia would be to: - prevent further heat loss & transport gently why gently? VFIB can happen A severe heat emergency is characterized by - hot, dry skin severe heat emergency
• heat stroke- hot, dry For a patient who has been bitten on the arm by a rattlesnake, which of the following actions should be taken while the patient is being transported to the hospital? a. Place an ice pack over site of bite b. Place site of bite below patients heart c. Apply heat d. Excercise the patients arm - B. place the site of the bite below the level of the patient's heart The appropriate action to take when you MUST apply restraints to an emotionally disturbed patient who is a danger to himself and others is to remove the straps a. When directed by physician at hospital b. When patient is rational c. When patient is in discomfort d. When patient calms down - A. when directed by a physician at the hospital

Which of the following statements regarding the basic anatomy of the developing fetus is correct? a. Umbilical cord connects the fetus directly to the uterus b. The after birth is another name for amniotic sac c. Fetus receives O2 and nutrients from the placenta d. The fetus develops inside placenta - C. the fetus receives oxygen and nutrients from the placenta If the baby's head has been delivered and the amniotic sac is still intact, the EMS provider should - puncture the sac and remove the membrane from the baby's mouth and nose Treatment for excessive vaginal bleeding following delivery is to a) massage the mother's uterus b) apply direct pressure to the vagina c) hold the mother's legs together in order to stop the bleeding d) pack the vagina with gauze pads - A. massage the mother's uterus The EMS provider has clamped and cut the umbilical cord following the delivery of a baby, then notices that the end of the cord attached to the baby is bleeding. In this situation, the MOST APPROPRIATE course of action would be to: - apply another clamp as close to the original as possible You are assisting in an emergency childbirth/ The baby's head has completely emerged and you are supporting it with one hand. At this point you should a. Gently pull on baby's head to ensure delivery b. Apply pressure to babys head to avoid explosive delivery c. Turn baby's head to one side d. Remove cord if it is wrapped around the neck - D. remove the cord if it is wrapped around the infant's neck A 25-yr old woman is in active labor. The umbilical cord is presenting through the vagina. You would: a. Gently pull on cord b. Massage uterus c. Replace cord in vagina d. Place mom supine with hips elevated, administer O2 and transport - D. place the mother in a supine position with hips elevated, administer oxygen, and transport During breach delivery, what should you do if the baby's head is not delivered after the body - with a gloved hand, establish an airway for the baby How would you describe bleeding from a vein - Dark red, flowing steadily

To control a nosebleed in a patient WITHOUT suspected spinal traujma, the EMS provider should - pinch the patient's nostrils together and sit the patient leaning forward to allow drainage All of the following cojnditions can lead to hypoperfusion (SHOCK) except: A. dilated blood vessels/pooling blood in extremities B. loss of fluid volume C. inc fluid volume D. dec cardiac output - increased fluid volume A localized soft tissue injury characterized by swelling and bruising a. Contusion b. Avulsion c. Laceration d. Abrasion - contusion Contusion Avulsion: Laceration: Abrasion: Definitions - Contusion Bruise Avulsion: flap Laceration: jagged cut Abrasion: road rash You are treating a male patient who has a penetrating chest wound and frothy bright-red blood at the mouth. About 10 minutes after sealing the chest wall, you notice the patient's breathing becoems much worse. At this point you should, a) immediately place the patient on the uninjured side b) lift one corner of the dressing c) administer positive-pressure ventilation immediately d) administer pure oxygen to aid respiration - b) lift one corner of the dressing Which of the following best describes an evisceration - bowel loops protruding through the abdomen tension pneumothorax - a type of pneumothorax in which air that enters the chest cavity is prevented from escaping mediastinum includes - heart, aorta, esophagus, trachea, thymus gland Which of the following BEST describes evisceration - Bowel loops protruding through the abdomen Treatment: Cover with moist sterile dressing keep warm

A patient was pulled from a house fire and has burns involving arms, chest and back. You should FIRST - assess for airway and respiratory distress An adult has suffered partial thickness burns over the chest, abdomen, back, buttocks, and right arm. According to rule of 9's, what percentage of body surface has been burned? - 45% Rule of 9's Chest Abdomen Back Buttocks Right arm Anterior of one arm? - Chest- 9, Abdomen- 9 back- 9 buttocks- right arm- 9 anterior of right arm: 4. Which one of the following statements regarding burns is INCORRECT? a) Full thickness burns inolving the hands, face or feet are considered critical burns b) Burns occuring in patients w/ heart conditions should be considered critical c) Electrical burns usually cause insignificant damage to the underlying soft tissues d) Chemical antidotes should never be used to neutralize burns of the eyes - C- electric burns usually cause insignificant damage to the underlying soft tissues An EMS provider is called to the scene where a victim has sustained an electrical burn. It is important for the EMS provider to: a. Immediately connect AED b. Check patient for entry and exit wounds c. Immediately pulls the patient from electrical source d. Administer oxygen to the patient via nasal cannula - B. check the patient for entry and exit wounds What should you do first for a victim who shows signs of an injured shoulder? - Manually stabilize the injury site When the bone ends of a joint are out place, the injury is called a - dislocation In the emergency care of extremity injuries, a splint should be applied because a) immobilization lessens pain and prevents further damage to tissues b) if left out of alignemnt, bone ends might grow together crookedly c) splinting will permit a limited use of the broken limb d) this will promote immediate healing - A. immobilization lessens pains and prevents further damage to tissues

When the spinal cord is severed above the fifth cervical vertebrae, paralysis is likely to occur in a. All extremities b. The upper extremities c. Lower extremities - A. all extremities Severing of spinal cord above 5th vs below 5th vertebrae - ABOVE 5TH = ALL paralyzed BELOW 5TH= LOWER paralysis In rescuing a diving accident victim from a swimming pool, the EMS provider's FIRST action is to: a. Lay victim on flat surface b. Stabilize entire spine before removing from water c. Take patient out of water and then stabilize pt - b. Stabilize/immobilize entire spine before removing from water To extricate a PT from an automobile w/ a suspected cervical spine injury, which of the following mechanical aids should be employed fIRST? a) soft cervical collar b) long backboard c) extrication collar d) short backboard - C. extrication collar The treatment for a trauma victim who has sustained a hip joint injury is to: - apply padded board splints and a long spine backboard You are assessing a 55 yr old male who has tripped and hit his head on the sidewalk. You find a large hematoma on his forehead, normal vital signs, and no other visible injuries. He complains of tingling in both hands. You should treat this patient for: a) hypoperfusion b) hyperventilation c) angina pectoris d) cervical spine injury - D. cervical spine injury Infants are obligate nose breathers until approx. 6 months of age, which means that they a) should never be given 02 by a nasal cannula b) should never be placed on their stomachs fro breathing c) may suffer respiratory distress if their noses become obstructed d) are at a high risk for dying of SIDS - C. may suffer respiratory distress if their noses become obstructed In a child, all of the following are signs of respiratory failure except? a) limp muscle tone

b) cyanosis c) slow HR d) crying - D. CRYING All of the following statements concerning SIDS are true except: a) it is preventable if parents are more attentive to their children b) if EMS provider arrives shortly after infants arrest, should administer CPR c) it is defined as the death of an infant that is sudden, unsuspected, and unexplainable d) if the infant shows very obvious signs of death, the EMS provider should hep the family deal wit htheir grief and guilt - a- it is preventable are more attentitive to their children Which of the following is a condition commonly found in children and is characterized by fever, diarrhea, vomiting and sunken eyes? a. Dehydration b. Seizures c. Hypoglycemia d. Croup - A. DEHYDRATION Sunken fontanelle vs bulging - sunken: dehydration bulging fontanelle: inter cranial pressure Which of the following is an effective method of quickly assessing the circulatory status of a pediatric trauma victim? - Squeezing patient's finger to check capilary refill THE MOST COMMON CAUSE OF SEIZURES IN CHILDREN IS a. Fever b. Airway obstruction c. Epilepsy - FEVER (febrile seizure- contracts illness/infection, fever results) rapid rise in temp Because of the relatively large size of the head, spinal immobilization for infants and children should include padding of the a) hips b) head c) neck d) shoudlers - D. shoulder If you suspect that a patient is a victim of child abuse, you should - notify your local child protective agency and complete the DSS form When treating an injured child suspected of being a victim of child abuse, your PRIMARY responsibility is to a. Asses and provide appropriate care for child b. Report to police

c. Accuse parents d. Ask child - A. assess and provide appropriate care The operator of an emergency vehicle must remember that NYS Vehicle and Traffic law grants all of the following privileges to emergency vehicles to drive light and sirens when: a. Transporting a patient in full cardiac arrest b. Transporting stable patient to emergency room c. Proceeding through red light with due caution - c. Proceeding through red light with due caution Upon arrival at a MVA, an EMS provider should immediately assess the scene for safety, determine the # of patients and the mechanism of injury, and - take body substance isolation precautions Which of the following is/are the MOST IMPT personal safety items when responding to an emergency is: - a. Seatbelt and shoulder harness In triage, which of the following injuries would be considered to have the HIGHEST priorities (red) - Severe uncontrolled bleeding, open abdominal wounds, severe head injury A single EMS provider finds a non breathing and pulseless victim of a mva lying face down in the road, and suspects the victim has a spinal injury. The EMS provider should

• turn the victim's body as a unit and begin CPR If slight gastric distention occurs in a victim as a result of positive-pressure ventilation, the FIRST action the rescuer should take is to: - ensure proper tidal volume for visible chest rise When it is necessary to perform CPR while transporting a patient on a stretcher, the EMS provider should - move the stretcher slowly so that effective CPR can continue The ratio of compressions to ventilations for one-rescuever CPR on an adult without an advanced airway is: - 30 compression to 2 ventilations To perform external cardiac compressions on a 4-yr old child, you should use the - heel of one hand When performing CPR on an infant, the MINIMUM rate of chest compressions is at least - 120 per min The preferred method of chest compressions on an infant by two healthcare providers is the - two thumb, encircling hands technique

When performing adult two-rescuever CPR, when should the rescuer palpate the carotid artery to check for the return of a spontaneous pulse? - After 5 cycles of CPR When should ventilations be deliverd during 2 rescuer infant CPR with an advanced airway in place? - Any time during the compressions cycle The method of clearing a severe airway obstruction in an unconscious adult patient is to: - administer chest compressions As you lift a patient into the rear of the ambulance, a reporter recognizes the patient as a state senator. The press demands to be told what has happened to the senator, you should - Advise the press that you are unable to comment If the patient care protocols have been revised, it's the EMS providers responsiiblity to - Attend in-service training with the agency medical director to become familiar w/ the new protocols The back surface of the body is known as the - posterior surface The overall purpose of the Primary Assessment is to - Identify and correct life- threatening problems and set prioriities Gaseous exchange in the lungs takes place in the - alveoli which of the following is the BEST definition of the term" auscultation" - listening In assessing a ped. trauma patient's capillary refill time, and abnormal finding would be a refill time of - Greater than 2 seconds All of the following are part of the respiratory system EXCEPT the: - esophagus Foreign matter is kept from entering the trachea by the - Epiglottis An accident victim exhibits noisy breathing that resembles the sound of snoring. What is the probable cause of this sound? - Partial airway obstruction by the tongue An adult patient has a foreign body obstruction and is able to forcefully cough. THE EMS provider's MOST APPROPRIATE action is to - not interfere and monitor the patient encourage them to cough The management of airway obstruction in the conscious infant includes: - back blows & chest thrusts

In caring for a non-breathing pt with a stoma or tacheotomy tube; the EMS provider must - Ventilate through the neck opening Keeping the heel of the hand lightly in contact w/ the chest during the relaxation phase of chest compression is important b/c - Correct hand position can be maintained Which of the following statements regarding nasopharyngeal airways is true - NPA's should be coated w/ water-soluble lubricant prior to insertion The use of a NPA is NOT indicated for a patient who - has cerebrospinal fluid leaking through the nose and/or ears You have inserted an OPA into the mouth of an unconscious vicitm who reacts by having a gag reflex. You should - remove the airway When using a NRB w/ an oxygen reservoir- the EMS provider should adjust the liter flow to - 15 l/min In mouth-to-mask ventilation, the stomach is likely to be distended if too great a force is used to inflate the lungs. Lung ventilation may become more difficult b/c stomach inflation....? - pushes up on the diaphragm and increases the likelihood of vomiting The oyxge concentration delivered by a NRB w/ a flow rate of 12-15 l/min is approx. - 90% Bleeding due to laceration in the neck may threaten the patient's life because - air may enter the blood vessel, making the patient prone to air embolism Compressing a pressure point on an extremity will aid in controlling bleeding - distal to injury Appropriate care for a patient w/ suspected internal bleeding should include - splinting all suspected fractures without delaying transport Which of the following groups of signs & symptoms indicates that a patient is in hypoperfusion (shock) - rapid weak pulse, perspiration, pallor, shallow breathing A characteristics of arterial bleeding is that it - flows from the wound in distinct spurts A localized soft tissue injury characterized by swelling & bruising is called a/an - contusion Which of the following factors is common to all forms of hypoperfusion (shock)? - Inadequate cell perfusion

What is the recommended procedure for the transportation of a severed limb to the hospital? - Wrap the limb in sterile gauze, seal in a plastic bag, and keep the limb cool DONT PUT ON ICE A closed bone or joint injury is BEST defined as an injury - In which there is no break in the continuity of the skin Which of the following procedures should be used to splint a hand injury? - Splint the lower arm with the hand in a position of function The correct term for an open wound that has jagged skin edges is - Laceration When checking the lower extremities of a conscious patient for paralysis, the EMS provider should FIRST - Touch the patients feet and leg and ask if he/she can feel the touch. The MOST SERIOUS problem assoc. w/ an injury to a joint is this type of injury: - is frequtnly accompanied by nerve and vascular damage To assess the circulatory status of a patient's limbs distal to an injury site, you should check? - Pulses, skin color and temperature A correct statement about skeletal muscles is that they - relax quickly and are voluntary Which of the following statements regarding management of pelvic injuries is correct? - the patient should be immobilized on a backboard You are called to a local elementary school where you find a hysterical child with a pencil impaled in the left cheek. Examination reveals that the pencil has penetrated the inner cheek wall. The treatment that would be MOST APPROPRIATE would be to: - remove the pencil and control bleeding on both sides of the cheek An elevated blood pressure w/ a decreasing pulse rate indicates - brain injury in a patient w/ head trauma Cushing's triad: INC BP, DEC HR, irregular RR When treating a patient with a brain injury, it is MOST IMPORTANT to record changes in the patient's - mental status A victim of a diving accident should be removed from the water - After he has been properly immobilized

You arrive at the scene of an automobile accident. The driver who is breathing adequately, has a laceration of the forehead with minor bleeding. He is conscious although somewhat dazed as you question him. His only complaint is that he feels numb and cannot move his legs. After assessment, your first management consideration should be to: - apply an extrication collar and immobilize the entire spinal column When a patient is being secured to a spinal immobilization device, which part should be secured FIRST - TORSO Which areas of the spine are composed of 5 vertebrae each? - Lumbar and Sacram C T L S C Your patient has an open gunshot wound to the chest that is making a gurgling noise. The patient has labored breathing and cyanosis. The FIRST priority of treatment is to: - administer oxygen and seal the chest wound Signs & symptoms of multiple broken ribs include - Unequal chest expansion, inadequate breathing effort, deformity, and pain When are you providing treatment for a patient with an abdominal injury, all of the following actions are appropriate EXCEPT - Providing a drink of water Upon arriving at the scene of an accident, you find a victim who has bowel loops protruding through an abdominal laceration. You should cover the loops - with a moist sterile dressing An EMS provider can assist a conscious patient in taking his/her prescribed nitroglycerin pill by seeing to it that the patient: - places it under his/her tongue The MOST OBVIOUS indication of a paralyzed limb in a non-traumatic brain injury patient is that the limb will: - appear loose and will lack muscle tone when it is moved by the EMS provider According to one theory, the way in which nitroglycerine relieves chest pain is by: - dilating coronary arteries While assisting at an emergency childbirth, it is important for you to remember that you should - GUIDE- not pull the baby out If a newborn does not breathe spontaneously, the EMT provider's first action should be to: - Flick the baby on the bottom of the feet gently

The FIRST objetive in the care of any burn is to - Stop the burning process For the treatment of a burn caused by a dry chemical, you should FIRST - brush the chemical off the skin You respond to a call for a possible suicide. A a 16 yr old female is locked in the basement. The patient's mother does not know if the patient has a weapon. Your first action should be to - request police assistance before entering the basement At the scene of an accident, an unconscious non-breathing male patient is found trapped ina vehicle in a sitting position. Although the victim can be reached, he cannot be immediately extricated from the vehicle. Your INITIAL action to aid the patient should be to: - Manually stabilize his head and establish an airway infant 1 rescuer CPR ratio and hand placement? - 30 compression :2 ventilation 2 fingers in center of chest infant 2 rescuer CPR ratio and hand placement? - 15 compressions: 2 ventilations 2 thumbs encircling hands in center of chest CPR WITH Advanced airway ratio - compressions at rate of 100-120/min 1 breath every 6 seconds (10 breaths/min) compression depth for adult CPR - 2-2.4 inches compression depth for children CPR - 2 inches compression depth for infant CPR - At least one third the chest depth, approximately 1 ½ in CPR witnessed collapse - If you are alone with no mobile phone, leave the victim to activate the emergency response system and get the AED before beginning CPR. Otherwise, send someone and begin CPR immediately; use the AED as soon as it is available CPR unwitnessed collapse - Give 2 minutes of CPR FIRST Leave the victim to activate the emergency response system and get the AED

Return to the child or infant and resume CPR; use the AED as soon as it is available 5 Stages of Grief: - 1. Denial

2. Anger
3. Bargaining
4. Depression
5. Acceptance Expressed Consent - - Expressed consent also requires that the patient be alert and competent to give expressed consent. Can be given verbally or nonverbally Implied Consent - - Allows assumption of consent for emergency care from an unresponsive or incompetent patient Minor Consent - - Consent is required from a parent or legal guardian. Implied consent can be used when unable to reach a parent of guardian and treatment is needed. Minor consent is not needed for emancipated minors (including minors who are married, pregnant, a parent, a member of the armed forces, financially independent or emancipated by the courts) Involuntary Consent - - used for mentally incompetent adults or those in custody of law enforcement Obvious Signs of Death: - 1. Decomposition (putrefaction)
6. Rigor Mortis
7. Dependent Lividity
8. Decapitation Negligence - - failure to provide the same care that a person with similar training would provide in the same or similar situation. ligament - Ligaments- fibrous tissues that connects bone to bone tendon - Tendons- ropelike structures that connects muscle to bone lateral - away from the midline medial - toward the midline proximal - Closer to the point of attachment distal - away from the point of attachment posterior - back

Anterior - front ventilation - Ventilation- simple movement of air between the lungs and the environment Respiration - - gas exchange of O2 and CO2, happens at the cellular level in the pulmonary capillaries (wrapped around the alveoli) newborns apneic CPR ratio - 3 compressions : 1 breath cardiac output - Stroke volume x Heart Rate