Emergency Medical Procedures and Protocols, Exams of Medicine

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NC 2024,2025 EMT STATE EXAM

"5 Rights" of medication administration. - right patient, right medication, right route, right dose, and right time. #1 Way of getting bloodborne disease is? - By sexual intercourse #1 Way of preventing transmission of diseases is by? - Handwashing 2nd stage of labor - The hallmark finding in the second stage of labor is the complete delivery of the baby. 3rd stage of labor - The third stage occurs when the placenta delivers. 4 STEPS IN Determination of Negligence - 1. Duty to Act

2. Failure to Act (Breach of Duty)
3. Damages, Harm, or Injury
4. Proximate Cause (Causation): Reasonable Cause-and-Effect relationship between Breach of Duty and the Damages suffered by patient. 5 Sections of Spinal Column. (from top to bottom)? - 1. Cervical (7 vertebrae)-neck
5. Thoracic (12 vertebrae)-
6. Lumbar (5 vertebrae)
7. Sacrum (5 vertebrae)
8. Coccyx (4 vertebrae) 5 Stages of Death and Dying? - 1. Denial
9. Anger
10. Bargaining
11. Depression
12. Acceptance A 71-year-old female has fallen and complains of left hip pain. On examination you note her left foot is rotated laterally. This finding most likely indicates a - femur fracture A oxygen tank which holds 350 liters - D Cylinder (portable) A virulent disease that can remain communicable in dried blood days and even weeks after it was spilled - Hepatitis C AAA (Abdominal Aortic Aneurysm) - 1. Rare (hard to detect)
13. Occurs Slowly
14. If it tears or ruptures, massive hemorhhage may occur
15. Radiating pain to back
16. Requires PROMPT Transport

6. unequal pulses lower extremities
7. history of hypertension Abdominal Pain Assessment - Check area with most pain last. Abdominal Pain Transport - 1. Usually in lateral recumbent position (one side) with knees bent Abduction - Away from midline Abruptio placenta - placenta separates prematurely Activated Charcoal - Absorbs poisons-Binds with them; may cause black stools Can cause vomiting Types; SuperChar, InstaChar, Actidose, LiquiChar Dosage: 12.5 gm charcoal in liquid; 1 gm per kg Adult (25-50gm) Pedi (12.5-25 gm) Activated Charcoal (Ingestion) - 1. Be sure not acid or alkali
8. Can Swallow
9. Awake
10. Medical control order Adduction - Toward midline Adrenal glands location? - On superior portion of upper quadrant AED " no pulse or response"? - Always do CAB's then use AED AED "no shock advised" what to do? - Do CPR for 2 mins with AED and reanalyze. AED "semiautomatic"? - Means operator has to push down to shock after "shock advised" prompt AED pads placement with medication patch? - Do not place on top of medication patch or directly over defibrillator or pacemaker. Air embolism & decompression sickness difference? - Air embolism occurs immediately on return to surface, whereas decompression sickness will not occur until several hours Alcoholism - 1. Central nervous system depressant, complicates assessment
11. Delirum Tremens (withdrawl))-24/48 hours without alcohol. Will hallucinate, shake, seizure, possible death

Allergic Reaction/Anaphylasix Treatment - 1. oxygen

2. Transport
3. If auto injector (help administer) Altered mental status in hyperglycemia is caused by - dehydration of the brain cells. Alveoli Defined, location and Importance? - Located at end of the airway, are millions of thin-walled, balloon-like sacs that serve as the functional site for the exchange of oxygen and carbon dioxide. Always give HIGH FLOW oxygen to what patients? - COPD, Infants and child Ambulance Operations/Rescue Awareness-CAR BATTERY - Always disconnect NEGATIVE LINE FIRST; Then positive. NEVER CUT Ambulance Operations/Rescue Awareness-Distance to park Ambulance from burning vehicle? - No close than 100 feet & UPHILL AND UPWIND Ambulance Operations/Rescue Awareness-GAINING ACCESS ORDER - 1. Door
4. Window
5. Body Always this order Ambulance Operations/Rescue Awareness-MAIN Priority - Always SAFETY first Ambulance Operations/Rescue Awareness-Other Windows Entrance-TEMPERED GLASS - Use Center punch in corner Ambulance Operations/Rescue Awareness-What is CRIBBING? - Used to stabilize vehicles (wood blocks) Ambulance Operations/Rescue Awareness-When does assessment BEGIN? - At Dispatch Ambulance Operations/Rescue Awareness-WINDSHIELD; LAMINATED SAFETY GLASSES Entrance - Use A fire ax Amenorrhea - Without period. Sign of pregnancy Amniotic sac - Where the fetus develops. "bag of waters" Contains about 500 to 1000 mL of amniotic fluid, help insulate and protect the fetus. Anisocoria - Unequal pupils Another name for "Implied Consent"? - Emergency Doctrine

APGAR SCORE - Appearance: 0=blue/pale; 1=blue & pink; 2=no cyanosis-all pink Pulse Rate: 0=Absent; 1=<100; 2=> Reflex: 0=no response to stimuli; 1=grimace; 2=cry or pull away Activity: 0=None; 1=some flexion,2=flexed arms/legs resisting extension Respiratory: 0=Absent; 1=weak, irregular; 2=strong, lusty cry Appendicitis - RLQ pain Constipation N + V no appetite Slight fever unless ruptured Frequent cause of Acute Abdomen Rebound Tenderness (women who are pregnant may not exhibit rebound tenderness) Artificial Ventilation: Adult, Infant and child - 1.Ventilate 6 secs for adult

2. Ventilate 3.5 secs for infant and child 3 Ventilation rate for Respiratory arrest 10-12 per min and watch for chest rise and fall (adult and pedi) Artificial Ventilation: Gastric Distention - It interferes with ventilation. Put on side and apply gentle pressure on diaphragm Artificial Ventilation: ORDER OF PREFERENCE - 1. Mouth to mask (w/ oxygen attached)-most preferred
3. 2 person BVM
4. Flow restricted
5. Oxygen powered ventilation device
6. 1-person BVM (least preferred) Artificial Ventilation: What to do if no chest rise or fall? - Always reposition the airway Assessment of Trauma patient (Infant or child) - 1. Falls > 10 feet
7. Bicycle collision 3.Vehicle in medium speed collision Asthma Signs; Treatment - Wheezing, expiratory first Ataxia - Lack of muscle coordination Ataxic Respirations - irregular, ineffective respirations that may or may not have an identifiable pattern.

Atelectasis - Collapsed Alveoli Aura - Sensation primo to seizure Battle's sign - Discoloration behind the ears. The Battle's sign is one that develops late, hours to days after an injury Biot's Respiration - an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea. Bites: Coral Snake - Neuro-toxic Symptoms may not show for 24 hours Most die from respiratory paralysis Bites: Marine Animal Remedy - 1. Salt Water

2. Meat tenderizer
3. Vinegar 4 Dont rub Stings Bites: Pit Viper - 1. Necrotoxic-severe swelling & tissue damage Contraindications
4. No tourniquets; no ice; dont elevate
5. Immobilize Black Tag (MCI) - Not expected to live or dead Bladder location - The bladder is found on the midline between the lower two quadrants. Blood Components - 1 unit=1 pint=500 mL's 12 units in adults or 6 liters Blood Loss (after delivery) - Less than 500 mL's is normal after deliver Bloody show - May indicate 1st stage of labor Brain is divided into how many parts? And what are they? - 1. 3 parts
6. Brain Stem, Cerebellum, and Cerebrum (largest part) Brain Stem - Controls breathing, BP, Swallowing, and pupil constriction Breathing: Respiraton >24 or < * 8 - Use NRM @ 15LPM or BVM Burns: Partial - 2nd degree=pain, redness blisters Burns: Superficial - 1st=red, pain, no blisters

Burns: Treatment - 1. Stop burning

2. Remove clothing and jewerly
3. Prevent further contamination
4. Dont break blisters
5. No ointment & no cold packs
6. Mod to severe: use sterile dry dressing, keep patient warm
7. Chemical (acid or akali)-flush
8. Dry (lime)-brush off powder-no water Burns=Full - 3rd degree=no pain, dry, white, yellow, black, leathery, bone, muscle BVM - 1. Volume 1600 mL's
9. Less than mouth to mask (mouth to mask gives better volume)
10. May need adjunct (OPA/NPA)
11. Self-refilling; no pop off valve (recommended for pediatric)
12. Over 1-2 secs;
13. Leave dentures in unless they are loose BVM flow rate and oxygen delivery - 15L /min and nearly 100% Capillary bleed - oozing and dark red Cardia Tamponade - 1. Mostly from penetrating chest trauma
14. Occurs when the pericardial sac fills with blood or fluid. From a ruptured, torn, or lacerated coronary artery or vein.
15. Heart becomes less able to fill and thus cannot pump adequate.
16. Beck's Triad occurs (distended or engorged JV seen on both sides of trachea, narrowing pulse pressure, muffled heart sounds Carina location?= - Point at which the trachea bifurcates (divides) into left and right main-stem bronchi Cephalgia - Headache Cerebellum - Controls muscle and body coordination & complex tasks that involve many muscles, such as walking & writing (located just behind the brain stem) Cerebral injuries (Helmet) - Only remove if unable to assess or maintain airway. Cant C-spine with helmet in place Cerebrovascular Accident (CVA) or Stroke - Interruption of blood flow to the brain resulting in loss of brain function. End result is Ischemia or lack of oxygen to the brain. Cerebrum - Divided into 2 hemispheres. Each hemisphere controls activities on the opposite side of the body. Front part controls emotion and thought

Middle part touch and movement Back part sight Certification - Process by which individual, institution, or program is evaluated and recognized as meeting certain predetermined standards. Chair Carry (Lifting and Moving) - 1. No spinal injury

2. Test Chair Chemoreptors monitor what? - The levels of oxygen, carbon dioxide, hydrogen ions, and the pH of the cerebrospinal fluid and provide feedback to the respiratory centers to MODIFY the rate and depth of breathing based on needs Cheyne-Stokes Respirations - Shows irregular respirations followed by a period of apnea CHF-Pulmonary Edema - Left side heart failure Respiratory distress: Rales/Crackles Children rely heavily on what for breathing? - Diaphram (moving abdomen in and out). Referred to as "belly breathers" Cholecystits (Gall Bladder) - RUQ pain, yellow or green bile vomit Target Audience=Female, multipara (multiple births), forty, after a fatty meal Chronic Bronchitis Signs & defined - Blue bloater, cough, mucus, overweight patient Defined: ongoing irritation of the trachea and bronchi. Excess mucous is constantly produced. Cincinatti Stroke Score - 1. Test (Facial Droop)-Ask patient to smile- Both sides of face must move equally well.
3. Test (Arm Drift)-Ask patient to close eyes and raise arms-Both arms must move at same time
4. Test (Speech)-Ask patient to say "The sky is blue"Patient must use correct words and no slurring CISD is? - Critical Incident Stress Debriefing CISM (Critical Incident Stress Management is DEFINED AS? - Process developed to address acute stress situations and potential decrease the likelihood that PTSD will develop after and incident CISM is? - Critical Incident Stress Managment Classes of hemorrhage - A Class III hemorrhage is said to occur when the patient has lost 30-40% of their circulating blood volume. This is a significant bleed due to the fact

that the body's compensatory mechanisms are maximized, and any additional blood loss will now create significant disturbances in hemodynamic stability. In Class I and II hemorrhage, blood pressure remains acceptable, in Class IV hemorrhage the blood pressure drops dangerously low. Classic Symptoms of Uncontrolled diabetes are (3 P's)" - Polyuria: frequent urination Polydispia: Frequent drinking to satisfy continuous thirst Polyphagia: Excessive eating due to "cellular hunger" Clothes or blanket drag (Lifting and Moving) - 1. One rescuer

2. Dragged head first
3. Possible spinal injury and risk of danger to patient and/or rescuer.
4. Head first and low to ground Communication "Reflection" - Reflection is a technique where you paraphrase the patient's words to encourage more information and to build trust Complications of fractures and dislocations - Always splint joint injure in position found, even if no pulse Conditions that MIMIC STROKE? - 1. Hypoglycemia
5. Postictal state (period following a seizure that last between 5 and 30 minutes.
6. Subdural or epidural bleeding (collection of blood near skull that presses on brain) COPD Defined - Slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction. COPD Patients - 1. Have difficulty elemination carbon dioxide thru exhalation
7. Body uses "back up system" or hypoxic drive.
8. It is believed that high flow O2 can have a negative impact on this patient.
9. However, one must give O2 to all patients who need it Coronal - Front and back CQI - Circular System of continuous internal and external reviews and audits of all aspects of an ems system Cricoid Cartilage importance? - 1.Location to use the Sellick Maneuver to help maintain a proper airway
10. Lies inferiorly to the thyroid cartilage
11. Forms the lowest portion of the larynx.
12. Only lower airway structure that forms a complete ring. Crime Scene Situations - 1.Emergency care is priority
13. Preserve evidence if possible

D Tank (PSI): - 2000 psi Decerebrate? - Extended arms (WORSE) & legs with pronation of arms Decompression sickness - Too rapid ascent from a dive, too long of a dive at too deep of depth. Hyperbaric chamber is equipment in treatment of decompression sickness and air embolism Decorticate? - Flexed arms and extended legs Deep Rapid Breathing symptom of DKA is: - Kussmaul Respirations Define Ascites: - Fluid in abdominal cavity Diabetic Ketoacidosis (DKA) - Prolonged hyperglycemia with extremely high glucose levels. When fat is used as source of immediate energy, chemicals called ketones and fatty acids are formed as waste products and hard for body to excrete. As it builds up the body becomes extremely acidic causing this condition. Diabetic Ketoacidosis (DKA) sypmtoms - weakness, nausea, vomiting, abd pain, weak & rapid pulse, and deep rapid breathing. Patients may have an altered mental status and "SWEET'' BREATH caused by keytones Diamond carry - 1. requires 4 rescuers

2. One Emt at head end of the device, one at the foot end, and one at each side of the patients torso. Difference between Cheyne Stokes, Kussmaul's, and Biot's Respirations? - Kussmaul respirations, or hyperpnea, are deep, rapid respirations and indicate the body is trying to compensate for severe metabolic acidosis (blow off the excess carbon dioxide in the system) or after strenuous exercise. They have an increased rate, very large tidal volumn (deep breath) and no expiratory pause. In other words there is no stopping between inhaling and exhaling. Typically seen in diabetics who are in ketoacidosis. Cheyne-Stokes respirations are a phase, or cyclic, type of breathing in response to hypercapnia (carbon-dioxide buildup) in the system. The cycle starts with a smooth increase, or crescendo effect, in the rate and depth of respirations followed by a gradual smooth decrease, or decrescendo effect, in the rate and depth of respirations ending in a short period of apnea that can last from 15 to 60 seconds. Then the cycle repeats itself. Cheyne Stokes respirations result from any condition that slows the blood flow to the brain stem because it slows impulses sending information to the respiratory center of the brain stem. An injury or compromise of the brain above the brain stem will also contribute to the development of Cheyne-Stokes respirations.

Biots' Breathing is irregular respirations with irregular periods of apnea. There is no cyclic nature to them as in Cheyne-Stokes breathing. Breaths are generally of equal depth (also distingishing them from Cheyne-Stokes). Think of them as Cheyne-Stokes cycle gone chaotic. Distended neck veins causes - Tension pneumo, cardiac tamponade , right heart failure Distress - Bad stress Distributive shock - Septic, Neurogenic, anaphylactic, and psychogenic Widespread dilation of arterioles resulting in blood pools in the vascular beds and tissue perfusion decreases Diving Accidents - Barotrauma to middle ear or chest (pneumothorax); decompression sickness (bends) Air embolus-on left side with feet elevated Most diving injuries occur on ascending Position on left side to stay off off vena cava DNR or Advanced Directive - 1. Must be original form

2. Any questions to validity of DNR, MUST start resuscitation and contact medical control Dorsal "Dorsal Fin" - Spinal side of body DRIVING SAFETY - 1. Obey ALL traffic laws
3. Always look LEFT first at intersections
4. Drive in LEFT LANE so others can pull right Dsyconjugate gaze - Unequal eye movement Dura - Leathery covering over the brain, next to skull Durable Power of Attorney - Legal document where a person designates another to make health care decisions Duty to Act (OFF duty) - In most cases if you are OFF DUTY and come upon a crash, you are not legally obligated to stop and assist patients. Embolus emboli - Clot or particle that travels in the blood stream Emergences medical services Act - Defines scope and role of prehospital providers Emesis - Vomit

Emphysema Signs & defined - Barrel chest, pursed lips, expiration is active (damaged aveoli), pink puffer Defined: Type of COPD, It is a loss of the elastic material around the air spaces that results of chronic stretching of the alveoli when inflamed airways obstruct easy expulsion of gases. Usually from smoking. Walls of the aveoli eventually fall apart leaving large holes. EMS Communication: Base Station - 1. Needs to be Highest point or High tower

2. Principal transmitter and receiver. EMS Communication: FCC (Federal Communications Commission) - Has jurisdiction over interstate and international telephone, telegraph, and satellite communications-all which may involve EMS activity. EMS Communication: FCC Licensing - 1. Licensing base stations and assigns appropriate radio call signs for those stations.
3. Issued for 5 years, must be renewed. EMS Communication: FCC Monitoring - Includes making spot field checks to help ensure compliance. EMS Communication: Hertz - Radio Frequency (1 cycle per second) EMS Communication: Mega hertz - MHZ, 1 million cycles per second EMS Communication: Mobile radio - Installed on a vehicle and operates at a lower power than base station. EMS Communication: Portable radio - More limited than mobile or base radios. Usually used at MCI scenes EMS Communication: Repeater - 1. Boosts transmission range for long periods.
4. Receives message and signals from one frequency then automatically retransmits them on a second frequency. EMS Communication: Trunking - Many frequencies are assigned to a group EMS Communication: UHF - 300 to 3,000 MHZ EMS Communication: VHF - 30 to 300 MHZ Epiglottis= - 1. Thin, leaf-shaped valve which protects opening of the trachea
5. Prevents food and liquid from entering the larynx during swallowing.
6. Folds over the glottis to prevent aspiration of contents into the trachea Epinephrine (Auto Injector) - 1. Adrenalin

2. Medical director approval to use patient's own
3. Adult dose (.3mg) Pedi dose: (.15mg)
4. Admin lateral part of thigh; injection; biohazard
5. Dialates bronchioles, constricts blood vessels
6. May increase HR, chest pain, headache Ethics: - Philosophy of right and wrong, of moral duties, Etopic Pregnancy - Pregnancy that develops outside of the uterus. History of PID increases the chance of this. Eupnea - normal, good, unlabored ventilation, sometimes known as quiet breathing or resting heart rate. Eustress - Good Stress Evisceration treatment (Abs); exposed organs - Use most sterile saline keep warm occlusive dressing DO NOT REPLACE Exacerbate - Increase in symptoms or severity of disease Expressed Consent - Verbal or acknowledges he or she wants you to provide care. Includes NONVERBAL AS WELL External Bleeding (Serious) Adult, Child, Infant? - Adult=1000mL's Child=500 mL's Infant=100 mL's Fight or Flight Response - The physiologic response involves the interaction of the endocrine and nervous systems. Fireman Carry - Not used much because all of patients weight on rescuer. Fireman's Drag (Lifting and Moving) - 1. One rescuer
7. No spinal injury
8. Tie hands together FIRST STAGE OF LABOR - The first stage occurs from onset of true labor contractions till dilation and effacement of the uterus. Flail chest - 1. 2 or more ribs broken in 2 or more places (segment of chest wall detached from rest of thoracic cage)
9. Paradoxical movement
10. Splint-use hand or large dressing (Place on exhalation only)

4. Treatment is positive pressure ventilation Flow Restricted Oxygen Powered Breathing Device (FROPVD) Usage and patient? - 1. For adults only
5. up to 40 l/m Foreign Body Airway Obstruction "Conscious Choking" Adults, Child, and Infant - Adult & Child=Abdominal Thrusts Infant=5 back blows followed by 5 chest thrusts Frosbite - Only thaw if no chance of refreezing; warm water less than 110 degrees, no alcohol or nicotine, no massaging of frozen parts GCS (Best Motor Response) - Obeys Commands- Localizes Pain- Withdraws Pain- Abnormal Flexion- Abnormal Extension- None- GCS (Eye Opening) Ratings - Spontaneous- Verbal response- Response to pain- None- GCS (Verbal Response) Ratings - Oriented Conversation- Confused Conversation- Inappropriate Words- Incomprehensible sounds- None- GCS Scores Total Ratings: - 13-15: mild dysfunction; 15 is considered a person with no neurologic disabilities General Adaptation Syndrome (stress) - 1. Alarm Response
6. Reaction and Resistance
7. Recovery or exhaustion Geriatrics (over 65) - 1. Osteoporosis, especially in women
8. Difficulty of frequency of urination
9. Lower total body water
10. Brain Deterioration (Alzheimer's)
11. Be patient with assessment

Geriatrics (over 65): IMPORTANT characteristics - 1. Decreased thirst, vision, hearing, temperature regulation, lower tidal volume (lower lung capacity), decreased pain response Glascow Comas Scale (GCS) Components; - Eye opening, Verbal Response Motor Response Gonorrhea - Women may not have symptoms-men have burning sensation on urination and discharge. Most common cause of PID Green Tag (MCI) - Minimal INjury (walking wounded) Gynecology (Fertilization) - In tube and then travels and implants in endometrium Hard or Rigid (Yankauer) Tonsil Tip - Dont touch back of airway especially in Pediatrics. Causes gag and lower heart rate. Haz Mat (HOT zone) - Area immediately surrounding the release, MOST contaminated area Haz Mat (Warm Zone) - Where personnel and equipment transition into and out of the hot zone. Decontamination area is set up here. HazMat (Cold Zone) - Safe area where personnel do not need to wear special equipment. Personnel staging, command post, EMS providers, and the area for medical monitoring, support, and/or treatment are all located here. Heat Exhaustion VS. Heat Stroke - Heat Exhaustion=Will continue to sweat when dried off Heat Stoke=Will stop sweating when dried off (Medical Emergency)-Temp 105-106. Unable to regulate heat, brain problem not fluid loss Hematuria - Blood in urine Hemoptysis - Coughing up blood Hemorrhagic Stroke - Accounts for about 10% to 20% of all strokes

2. People experiencing stress or exertion are top candidates.
3. Highest risk are people with HBP or long-term elevated pressure.
4. Cerebral hemorrhages are often fatal. Hemothorax - Shock; none or decreased lung sounds

Hepatitis - Fever, RUQ pain, N+V, no appetite, Jaundice, Dark collared urine, clay colored stools Inflammation of liver Hepatitis A - Transmitted thru fecal-oral contamination Vaccine is available. Approx. 2% of patients die. Hepatitis B - Bloodborne thru blood, sex, salivia, urine, breast milk.vaccination very important; needle stick (acute and onsite) Far more contagious than HIV Vaccine is available. Hepatitis C - Transmitted thru blood (sexual contact) No vaccine available. Cirrhosis of liver develops in 50% of patients HHNC (Hypermolar Hyperglycemic Nonketoic Coma - 1. More often seen in Type 2 diabetes patients.

2. Onset is usually slower and occurs over a longer period of time than DKA.
3. Sweet smell not present, because body is producing some insulin
4. Body does not burn fat for energy;thus keytones are not produced.
5. Body tries to rid itself of excess sugar in urine, causing dehydration Hollow organs - stomach, bowel, bladders Homeostasis - Equal balance. Equilibrium How does "SPINAL SHOCK" differ from other shocks? - So unlike other forms of hypoperfusion, spinal shock typically does not have a tachycardic pulse rate. It will have a BRADYCARDIC pulse instead. How many bones of Spinal Column? - 33 bones How many muscles of musculoskeletal system? - more than 600? How should a unresponsive patient with no suspected spinal injury should be placed? - Into the recovery position by rolling patient onto his or her side without twisting the body. How to insert and NPA in adult and Infant? - ... How to insert and OPA in Adult and Infant? - ... Hyperglycemia (Diabetic Coma) Characteristics-pg. 625 - Kussmaul respirations, dehydration (dry, warm, "tenting skin, sunken eyes), sweet or fruity breath, rapid/weak (thready) pulse, normal or slightly low bgl, varying degrees of responsiveness, weakness, nauses/vomiting 3 P's

Hyperglycemia cause by? - Without insulin, glucose remains in the blood and the levels become extremely high. When BGL reaches 200 mg/dl or more Hyperglycemia Meds - 1. Diabinase, Orinase, Micronase (Oral)

2. Insulin (injection) Hyperglycemia Occurs? - 1. Too much sugar (glucose), not enough insulin
3. Naseau/vominting, acetone on breath, warm, dry skin, signs of dehydration, fever, gradual onset. COMA TAKES DAYS TO DEVELOP Hyperventilation=? - rapid and shallow; usually from a emotional aspect Hypoglycemia (Insulin Shock) Characteristics-pg. 625 - Normal, shallow, or rapid respirations, pale, moist (clammy) skin, diaphoresis (sweating), dizziness, headache, rapid pulse, normal to low blood pressure, Altered Mental Status (aggressive, confused, lethargic, or unusual behavior), Anxious or combative, Hunger, Seizure, fainting, or coma, WEakness on one side of body (MAY MIMIC a STROKE), Rapid changes in mental status Hypoglycemia Meds - 1. Oral Glucose (medical director order)
4. Glucose (Trade names): Glutose, Insta-glucose
5. AMS with know diabetes Contrandications-Unresponsive & cant swallow
6. Put gel between CHEEK & GUM-PUT ON TONGUE BLADE Hypoglycemia Occurs? - 1. Taking too much insulin, not enough glucose
7. Taken a regular dose of insulin but not eating enough food
8. Unusual amount of activity or vigorous exercise and used all glucose
9. May occcur after patients vomits a meal after taking insulin
10. SUDDEN ONSET
11. Cold, clammy, headache, weakness/dizzy, BIZARRE behavior Hypoperfusion - Shock symptoms Hypoxia - Decreased oxygen in blood ICP (intracranial Pressure) Signs/symptoms - decreased pulse (Bradycardia), increased B/P (Hypertension), irregular respirations. ICP Defined - Accumulations of blood within the skull or swelling of the brain. IF Airbag does not employ - 1. Avoid working in front of it
12. Do not try to disable it

If you are responsible for establishing the landing zone for the helicopter, what is the minimum size of the LZ you should prepare assuming the rescue efforts are occurring at night? - The minimum size of the landing zone at night is 100' by 100'. During daylight, the minimum LZ zone is 60' by 60'. In either situation the LZ should be square, with a marker indicating the direction of wind travel Immersion Foot also called? - Trench foot. Occurs after prolonged exposure to cold water. Implied Consent - When a person is unconscious or incapable of making a rational decision, the LAW ASSUMES the patient would have wanted consent to treatment. Inadequate Breathing Traits - 1. Breath sounds diminished or absent;irregular rhythem; abnormal rate; asymmetry

2. use of accessory muscles; increased effort; inadequate tidal volume (shallow); retractions
3. Skin pale or cyanotic; cold and clammy; agonal respirations, nasal flaring (mostly in peds) Inadequate Ventilation Signs - 1. No chest rise or fall
4. Rate too fast or too slow
5. Heart rate does not return to normal with ventilation Incident command does what at MCI's? - control, direct, and coordinate the scene and resources Sr. Officer must start triage 1st Incident Commander (MCI) role? - Overall direction and supervision Informed Consent - When an EMT explains the treatment plan, risks involved, benefits, and alternatives to treatment & the PATIENT HAS GIVEN CONSENT Ischemia - Lack of oxygen in tissue/cells Ischemic Stroke - 1. Most common (about 80%) of all strokes
6. Blood flow is cut to part of brain by a blockage (clot)-from a thrombosis or embolism. Atherosclerosis is often the culprit. Kidney location? - Upper and lower quadrant: retro peritoneal Kidney Stone - Right or Left Flank pain Hematuria One side May be lower ab pain or in groin area Disturia (painful urination)

Large and small intestine locations? - Each quadrant Larynx - Typically considered the dividing line between the upper and lower airway. Lateral - Farther from midline Left Hemisphere affects of stoke: Signs and Symptoms? - 1. May have speech disorder (aphasia)-inability to produce or understand speech

2. Left hemisphere affects right side of body (opposite)
3. May cause paralysis of right side of body Left side of Lungs lobes? - 2 Libel - Form of Defamation by WRITING Licensure - Process by which competent authority, grants permission to practice a job, trade, or profession. Lifting and Moving: Body mechanics - 1. Use legs (squat); not back
4. Weight close to body; not extended
5. Dont twist; keep back locked into normal curvature
6. Dont bend at waist
7. Push rather than pull
8. Lift stretcher with palms up Lifting and Moving: Moving Patient - 1. Move patient in direction of long axis (NEVER around corners) Lifting and Moving: Moving Patient (RAPID EXTRICATION) - 1. Always Manual immobilize
9. Use C-collar and move along LONG axis
10. Dont use vest type device Ligaments connect.... - Bone to Bone loading supervisor (MCI) role? - charge of communicating with hospitals and managing transport of injured patients. Lower Gi Bleed - Bright red or wine colored stool (hematachezia) Lung Sounds Crackles & Rales usually from? - CHF, pulmonary edema, left side heart failure Lung Sounds Rhonci usually from? - chronic bronchitis, pneumonia

Lung Sounds Wheezing usually from? - Bronchitis, Asthma, Anaphalaxis, Allergic reaction, emphysema, partial airway; TB Lungs are surrounded by a serous membrane called? - Pleura or visceral pleura (thin, slippery outer membrane) Major burns - 1. 3 degree-10% of body

2. 2 degree-30%
3. Respiratory, face/neck, genitalia, feet, circumference burns of chest or extremities
4. Moderate burns in elderly over 55 or less than 5 year old
5. possible fracture MASS Casualty (Organ Donor Patients)? - 1. Lower priority in these situations Mass Casualty Incident/Hazardous Materials=MUTUAL AID? - Agreement among departments to assist Mass Casualty Incident=Most important aspect is? - Pre-planning and communication MDI (Prescribed Inhaler) Administration & Side effects - 1. Use with respiratory distress- seek medical direction
6. Be sure patient takes a deep breath while depressing inhaled; hold breath for long as possible. Side Effects=rapid heart rate (tachycardia), anxiety, tremors
7. Transport in sitting position if possible Medial - Closer to midline Medical Record - 1. Legal Document.
8. Must be complete & legible
9. Accuracy can be best defense or worst enemy.
10. Do not change, mark thru mistake with 1 line. Initial and date and enter new information
11. Addendum to add at a later date (dont fill in blanks) Melena - Black stools Menigitis - fever, stiff neck, neuro symptoms, headache, backache; bulging fontanels in infant. Nochal Rigidity=Cant touch chin to chest (sign of meningitis) MI & Angina: Transport - Position in comfort, oxygen (if needed). Aspirin if needed MI and Angina: S & S - chest pain, SOB, N & V, Dizzy, pale, diaphretic Midsagittal - Equal left and right halves

Minimum Data Set on Report - 1. Times

2. Cheif Complaint
3. LOC
4. Vitals
5. Skin Minimum safe residual pressure in oxygen tank is? - The minimum safe residual pressure in an oxygen tank is 200 psi. Minute Volume defined as? - Amount of air in or out in 1 minute; MV=TV X RR Most important part of neuro exam is? - LOC Most often injured spinal regions are? - cervical and lumbar Mouth to mask - 1. 15 l/m
6. If patient still cyanotic of hypoxic, connect O2, REPOSITION, check seal MRSA (Methicillin-resistant Staphylococcus aureus) - Causes infections and resistant to most antibiotics. Transmitted mostly thru hand to hand contact. Multigravada - previous pregnancies Nasal cannula oxygen concentration - 24% to 44% Nasal cannula oxygen flow rate - 1 to 6L/min Nasopharynx roles? - 1. Keeps contaminates such as dust and other particles out of respiratory tract.
7. Warms and humidifies air as it enters the body. Near Drowing - Do ABC's on this patient
8. Consider C-Spine
9. Hypoxia, hypothermia
10. If possible, minimize hypoxia by rescue breathing in water. Necrosis - Death of tissue Negligence - Failure to provide same care that a person with similar training would provide in same or similar situation Neonatal Frequent needs: - Dry, warmth, position, suction, stimulate. Oxygen Neonatal infrequent needs: - Chest compressions and medications

Neonatal moderate needs: - Establish effective ventilation. BVM or endotracheal intubation. Neonatal resuscitation: assess and support - Temperature: warm and dry Airway: position and suction Breathing: stimulate to cry Circulation: HR and color Neonatology (Airway) - Suction prior to delivery; mouth first Neonatology (Umbilical cord) - 1. 2 arteries and 1 vein

2. Reclamp proximal Neurogenic shock - Damage to spinal cord, all vessels below the spinal injure dilate widely, causing blood to pool. Nitro. Contraindication - systolic <100 Head injury. Dont use Give sublingual (Nitro-bid, Nitrostat) tablet or spray Normal BGL - 80 and 120 mg/dL NRB Flow rate - 12 to 15L/min NRB oxygen delivered - 90% to 100% NRM Bag requirements - Should not collapse on inhalation; reservoir bag must be full before applying on patient Obese patients should be positioned how? - Same as other patients, but pay attention to ensure their dignity is maintained. Obstructive shock - Cardiac tamponade and tension pneomothorax Results when conditions that cause mechanical obstruction of the cardiac muscle impact the pump function Opiate overdose - 1. Small Pupils
3. Decreased LOC
4. Track marks
5. Resp Depression
6. People often forget to breathe Order of assessing a patient after scene size up: - 1. Initial assessment
7. Focused Assessment
8. Complete assessment

4. Ongoing Assessment Order of Safety Protocol - 1. Yourself
5. Partner
6. Crew
7. Patient Organ that produces insulin? - Pancreas Organophosphate poisoning - 1. Migrants, farmers, workers, etc
8. SLUDGE (Salivation, Lacrimation, urination, Diarrhea, GI Symptoms, Emesis 3 Pupils Consticted
9. Dont get cross-contaminated (PPE) Organs in Upper Left Quadrant of Abs - The stomach and spleen are typically found in the upper left quadrant. Organs in Upper Right Quadrant of Abs - The liver is found primarily within the boundaries of the upper right quadrant. Oropharynx is? - Throat Orthopnea - Difficulty breathing in flat positions OSHA mandates what? - Workplace safety and bloodborne pathogen procedures Oxygen (Flowmeter) defined? - ... Oxygen (Humidifier) defined? - ... Oxygen (Regulator) defined? - ... Oxygen Cylinder: E tank? - 625 Oxygen Cylinder: G Tank? - 5,300 Oxygen Cylinder: H Tank? - 6,900 Oxygen Cylinder: M Tank? - 3000 Pancreatitis - LUQ & RUQ Caused by obstructing gall stone, alcohol abuse, and others Paraplegia - paralysis of lower extremeties Paresthsia - Numbness. Can be anywhere even the face

Parietal Pleura is where? - Lines the inside of the thoracic cavity. Patient "OPA"= - Insert 90 degrees or use tongue depressor Patient with nausea and vomiting should be positioned how? - in position of comfort, but be sure you are positioned appropriately to manage and maintain a patent airway Patients in shock position should be packaged and moved how? - In a Trendelenburg's position or supine with their legs elevated 6'' to 12''. Patients who are not treated in MCI are? - Cardiac arrest patients Brain tissue exposed Patients with AMS (Altered Mental Status) - 1. Must have BGL checked to accurately determine cause. Patients with chest pain or who are having difficulty breathing should sit in what position? - A position of comfort, as long as they are not HYPOTENSIVE. Patients with suspected spinal injuries must be immobilized how? - In a supine position on a long backboard or scoop stretcher pedal pulse - on top of foot Pelvic Assessment - Downward and inward pressure on Iliac crests and syphysis Pelvic Inflammatory Disease (PID) - infection of upper organs of female reproduction Generalized lower abdominal pain. Foul smelling discharge Increase pain with intercourse, fever Causes ectopic pregnancy Perfusion Triangle - The heart (the pump) The pipes (blood vessels or arteries) The contents of container (blood) When a person is in shock one or more of these will not work properly Perioneum - lining of abdominal cavity PERL: dilated signs - Cerebral hypoxia, cocaine, Epi, amphetamine PERL: small eye signs - Narcotic, organophosphate PERL: Unequal eyes - Brain injury, can be normal

Pertussis signs - "Whooping Cough". Usually seen in pediatric patients Pharynx composed of? - Composed of the nasopharynx and oropharynx Physiology of Breathing - Air enters the body through the oral and nasal cavities and travels into the larynogopharynx. It passes through the vocal cords, into the glottis, and down the trachea, where it is distributed into the mainstem bronchi into the bronchioles of the lungs. Eventually the air reaches the alveolar sacs, where oxygen is diffused across the alveolar membrane into the pulmonary capillaries. At the same time carbon dioxide is diffused across this membrane and is exhaled from the body. The oxygen in the pulmonary capillaries is transported back to the hear, where it is distributed to the rest of the body. Pink Tag (MCI) - Contaminated Placenta previa - placenta develops over and covers the cervix Pneumonia signs - SOB, fever, not sudden onset; chest pain Pocket mask oxygen % and delivery - 21% room air; delivery of air over 2 secs Poisonings: Acid and Alkali - 1. No vomitng and no charcoal

2. heavier than water and is worse popliteal pulse - behind knee Posterior hip dislocation signs? - With a posterior hip dislocation the leg is commonly rotated inward, the hip is flexed, and the knee is bent Postictal - Period of regaining consciousness after a seizure. Preeclampsia - Pregnancy induced hypertension. Develops after 30th week Preeclampsia and eclampsia - Preeclampsia is before seizure and eclampsia occurs after seizure Pregnancy Complications (breech) - When buttocks are delivered 1st Make airway for baby (use sterile glove-V shaped with fingers Pregnancy Complications (Limb) - Go to hospital ASAP-Dont try to deliver Pregnancy Complications (Nuchol cord) - Around the neck...check as soon as head is delivered, slip around neck or may have to clamp cord and cut

Pregnancy Complications (Post partum hemorrhage) - Over 500mL's in 24hour; Must massage uterus around the neck Pregnancy Complications (Prolapsed cord) - 1. Mother position with knees to chest

2. Push head back (unless delivering)
3. Prevent pressure on the cord; do not push cord back Pregnancy Complications (Twins) - Still in labor after 1st delivery with twins Pregnancy Emergencies (1st trimester) - Ectopic pregnancy Unilateral lower abd pain, vag bleeding or spotting; may have syncope and then generalized abd pain Pregnancy Emergencies (3rd Trimester) - Abruptio placenta and placenta previa Pregnancy Emergencies (Early) - Abortion (loss of pregnancy before 20 weeks Vaginal bleeding Lower abd pain, cramps Pregnant patients should be positioned and transported how? - On their left sides Pregnant Transport Rule - 1. MUST PLACE ON LEFTSIDE NO MATTER WHAT Prescribed Inhaler - MDI. Side effects is tachycardia and palpitations Prescribed inhaler GENERIC types? - albuterol, isoetharine, metaproteranol Prescribed inhaler TRADE types? - Proventil, Ventolin, Bronkosol, Bronkometer, Alupent Primagravida - 1st preganancy Primary blast stage - also known as the pressure wave), damages hollow, gas containing organs of the body such as the lungs, GI system, inner ears, and sinuses. Priority 2 Patient traits (MCI) are? - Urgent but not immediate life threatning Priority 3 Patient traits (MCI) are? - Walking wounded Priority One Patient Traits (MCI) are? - 1. Airway, breathing, external bleeding. Pulmonary Embolus Signs - Shock and respiratory distress, sudden onset, chest pain. After childbirth or surgery Pulse Pressure is? - Difference between systolic and diastolic pressure