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Emergency Medical Transport Protocols, Exams of Nursing

The protocols and guidelines for emergency medical transport, covering a wide range of scenarios including traumatic injuries, burn injuries, pediatric patients, stroke patients, sexual assault victims, airway management, altered mental status, behavioral emergencies, dystonic reactions, burn care, electrical burns, cpr for pregnant patients, chest pain, cold-related illnesses, drowning, heat-related illnesses, obstetrical emergencies, pain management, pulmonary embolism/congestive heart failure, respiratory distress, stemi, stroke, epistaxis, and neonatal resuscitation. It provides detailed instructions and decision-making criteria for emts and paramedics to ensure appropriate and effective patient care and transport.

Typology: Exams

2023/2024

Available from 08/28/2024

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SNHD Protocols exam 2024 with verified

answers

True or false: It may be necessary for the physician providing on-line medical consultation to direct a prehospital provider in rendering care that is not explicitly stated in the protocols, including administering a patients own medicine which is not part of the approved formulary - ANSWER: True An EMT/Paramedic may only proceed in providing care not covered in the protocols once they and the Physician contact the _______________ - ANSWER: OEMSTS (Office of EMS and Trauma System) After contacting OEMSTS for providing care that may have been outside your scope of practice, that information is then recorded on what form? - ANSWER: Quality Improvement Review A patient is anyone who meets the following 3 criterias: - ANSWER: 1. A person with a CC, MOI or NOI that may be indicative of an injury/illness

  1. A person who has obvious evidence of injury/illness
  2. A person identified by a 2nd/3rd party caller as needing evaluation for potential injury/illness For patients under __ years old, refer to the Pediatric Patient Destination Protocol - ANSWER: 18 Pediatric protocols are used on children who have not yet experienced puberty. What are the signs of puberty in males and females? - ANSWER: Males: chest/underarm hair Females: breast development If there are signs of Airway obstruction, what measures should be taken? - ANSWER: Ventilation Management Protocols

What should you do if a patient is unconscious? - ANSWER: Check breathing and pulse simultaneously If there are signs of inadequate breathing, what measures should be taken? - ANSWER: Respiratory Distress protocols What should you do if you cannot adequately ventilate a patient? - ANSWER: The patient must be transported to the nearest emergency department What should you never withhold from a patient in Respiratory Distress? - ANSWER: Oxygen Contact with medical control should be established through radio. Telephone contact can only be used if the call is routed through a recorded phone line provided by the: - ANSWER: FAO (Fire Alarm Office) Patients with Traumatic Injuries shall be transported in accordance with the: - ANSWER: Trauma Field Triage Criteria Protocol Patients sustaining burn injuries shall be transported in accordance with the: - ANSWER: Burns Protocol Pediatric Patients (less than 18 years old for transport purposes only) shall be transported in accordance with the: - ANSWER: Pediatric Destination Protocol Patients with evidence of Stroke shall be transported in accordance with the: - ANSWER: Stroke (CVA) Protocol You arrive to the scene of 3 sexually assaulted individuals. Patient #1 is 12 years old, Patient #2 is 15 years old, and Patient #3 is 20 years old. Name all appropriate hospitals that patients 1, 2, and 3 may be taken to. - ANSWER: 1: Sexual assault victims less than 13 years old shall be transported to Sunrise Hospital 2: Sexual assault victims between the ages of 13 and 18 shall be transported to Sunrise Hospital, or UMC 3: Sexual assault victims 18 years and older shall be transported to UMC

Where should sexual assault patients be transported if they are more than 50 miles from the nearest protocol designated destination? - ANSWER: The nearest appropriate facility Upon arriving in the emergency department, if transfer of care has not occurred, any patients, excluding those placed on legal psychiatric hold, may be placed in the hospital waiting room if they meet what 5 criteria requirements? - ANSWER: 1. Normal Vital Signs -HR: 60- -RR: 10- -Systolic BP: 100- -Diastolic BP: 60- -Room air pulse oximetry: greater than 94% -A&Ox4 (Alert and Oriented x4)

  1. Did not receive any parenteral medications during EMS transport except for a single dose of analgesia AND/OR an anti-emetic
  2. In the judgement of the paramedic, does not require continuous cardiac monitoring (if the transferring facility decides to start monitoring the patient, it may not be discontinued by EMS personnel)
  3. Can maintain a sitting position without adverse affect on their health
  4. Is left with a verbal report to the hospital personnel What 2 drugs are you allowed to give a patient and still leave them in the waiting room before transfer of care has taken place? - ANSWER: a single dose of analgesia AND/OR an anti-emetic If a hospital declares an internal disaster, that facility is to be bypassed for all patients EXCEPT for patients who are experiencing: - ANSWER: Cardiac Arrest or the ability to adequately ventilate has not been established

(Not part of the answer but keep in mind that operational exceptions may be initiated in regard to transport to hospitals on internal disaster. e.g. 3 hospitals in proximity going on internal disaster) During a general adult trauma assessment, if their Glasgow Coma Scale score is less than 8, what should the responder do? - ANSWER: Ventilation Management; BVM is O2 saturation is less than or equal to 94% During a general adult trauma assessment, if their Glasgow Coma Scale score is greater than or equal to 8, what should the responder do? - ANSWER: Keep oxygen saturation above 94% What care should be provided to a patient with a sucking chest wound? - ANSWER: 3-sided occlusive dressing What care should be provided to a patient with an active hemorrhage? - ANSWER: Hemorrhage Control Tourniquet What care should be provided to a patient with obvious fractures? - ANSWER: Immobilize Fractures with Splints, assess distal pulses before and after applications What care can be provided at the EMT-B level to a patient with a suspected TBI (Traumatic Brain Injury)?

- ANSWER: Raise head of bed 30 degrees What care should be provided to a patient with open wounds? - ANSWER: Cover the open wound with gauze. For abdominal evisceration, cover with wet trauma dressing When transporting a trauma patient to a Trauma Center, what should be done verbally? - ANSWER: Contact the trauma center over the telemetry and inform them of your status What type of trauma patients should be evaluated with a high index of suspicion due to their tendency to decompensate quickly? - ANSWER: Geriatric patients What is an acceptable method of ventilating and managing an airway if pulse oximetry can be maintained at or greater than 90%? - ANSWER: BVM

Nuero disorders or signs of hypoperfusion/shock in the presence of abdominal pain indicate a(n) _______________ - ANSWER: Aneurysm In patients _________________ years old, consider that the cause of abdominal pain may be from a cardiac origin - ANSWER: at 35 years of age, or older What type of pain in woman of childbearing age should be considered pregnancy until proven otherwise? - ANSWER: Abdominal pain A patient had an allergic reaction and is now experiencing signs of airway involvement breathing difficulties. What care can you provide at the EMT-B level? - ANSWER: Assist the patient with their own Epinephrine Auto-Injector A patient goes into shock after having an allergic reaction. You have already assisted administering Epinephrine via Auto-Injector one minute ago. What care can be provided now at the EMT-B level? - ANSWER: Assist patient with their MDI (Metered-Dose Inhaler) True/False: You should not notify the receiving hospital that you are bringing a patient whose CC was an allergic reaction (CC = Chief Complaint) - ANSWER: False. Notify the Receiving Hospital Radio contact should always be established for calls that involve: - ANSWER: Trauma patients, code 3 patients, need for telemetry physician, time sensitive/life threatening situations and as per protocol When should you always transport to the nearest facility? - ANSWER: Airway Emergencies, where the ability to adequately ventilate is absent. This includes cardiac arrest. Where should stable patients be transported to? - ANSWER: The hospital of their choice, and if they do not have a choice, to the closest facility

What should you document prior to administering anti-emetics and/or pain management in a patient with abdominal pain? - ANSWER: Mental Status and Vital Signs What defines a Mild, Moderate, and Severe allergic reaction? - ANSWER: MILD: Involves skin rashes, itchy sensation, or hives with no respiratory involvement (remember no respiratory involvement) MODERATE: Reactions involving skin disorders and may include some respiratory involvement like wheezing, yet the patient still maintains good tidal volume air exchange (remember good tidal exchange) SEVERE: Reactions involving skin disorders, respiratory difficulty, and may include hypotension (remember respiratory difficulty and hypotension) At the EMT-B level, what should be provided to a patient with an allergic reaction after you have already assisted administering them Epinephrine Auto-Injector, and MDI? - ANSWER: Oxygen and airway support as needed What form of Epinephrine should be prioritized in being administered before or during attempts at IV/IO Epinephrine? - ANSWER: IM In an adult patient, what is the Blood Glucose Level that you should begin administering oral glucose at?

- ANSWER: less than 60mg/dl What should you always consider in patients who have an altered mental status? - ANSWER: Low Blood Glucose Levels Stroke Seizure Head injuries Cardiac causes

Environmental toxins/exposure to HAZMAT In an adult patient of suspected narcotic overdose, what is the dose of Naloxone that should be administered and what is the maximum that can be delivered? - ANSWER: 0.4 mg - 2.0 mg. You may repeat 2.0 mg if patient is slow to respond, titrate to effect, to a maximum of 10 mg. In patients with an Altered Mental Status, what physical exam should be conducted with careful attention? - ANSWER: Head exam You should administer Narcan/Glucose to patients suspected of narcotics overdose/hypoglycemia prior to performing: - ANSWER: advanced airway procedures What should you not let yourself be confused by with a patient presenting with an Altered Mental Status? - ANSWER: Alcohol. Alcohol is not commonly a cause of total unresponsiveness to pain. In patients experiencing a Behavioral Emergency, what medical causes might you consider to be the cause of the patients behavior? - ANSWER: 1. Hypoxia

  1. Intoxication/Overdose
  2. Hypoglycemia/Electrolytes
  3. Head Injury
  4. Post-ictal state What physical control measures are commonly associated with Excited Delirium Syndrome? - ANSWER: restraints, TASER, or similar device

When may you consider restraints for a patient having a behavioral emergency? - ANSWER: When they have threatened to harm themselves, you may consider use of restraints. Consider Law Enforcement escort. Consider a flight risk. No prone position. When they have threatened to harm others, 4 point restraints, hood if indicated (spitting?), NO PRONE POSITION If they are not a threat to themselves or others, simply transport them. Law Enforcement assistance should be requested on all calls involving patients who are potentially what?

- ANSWER: Potentially violent patients Under no circumstances, are patients experiencing a behavioral emergency ever to be transported in this fashion. ___________________ - ANSWER: DO NOT TRANSPORT IN THE PRONE POSITION What are EMS providers mandatory reports in regard to? - ANSWER: Suspected abuse of any vulnerable person What should you do to ensure you do not irritate a patient with a behavioral emergency? - ANSWER: Do not irritate the patient with a prolonged exam. Excited Delirium Syndrome is most common in what patients? - ANSWER: Male patients, and patients who have a history of mental illness and/or chronic drug abuse, particularly stimulants (If mental illness had a stage 4, think of this as it) What is a Dystonic Reaction? - ANSWER: Condition that causes involuntary muscle movements or spasms typically in the face, neck, and upper extremities What is the S.A.F.E.R. Model? - ANSWER: A model of crisis intervention. S: Stabilize the situation by containing and lowering the stimuli

A: Assess and acknowledge the crisis F: Facilitate the identification and activation of resources (chaplain, family, friends, or police) E: Encourage patient to use resources and take actions in his/her best interest R: Recovery or referral - leave patient in care of responsible person or profession, or transport to appropriate facility If a patient is suspected of having Excited Delirium Syndrome, what should you consider in regards to your safety? - ANSWER: Consider behavioral restraints; consider Law Enforcement Escort Do not consider the prone position True/False: You should notify the receiving hospital that you are enroute with a patient with bradycardia.

- ANSWER: True What is the heart rate should you be looking at as a sign of bradycardia? - ANSWER: Heart rate less than 60 beats per minute What is a common cause of bradycardia? - ANSWER: Hypoxemia. Be sure to oxygenate the patient and provide ventilatory support as needed What should you always protect burn patients from? - ANSWER: Hypothermia You are called to a patient who received burns from thermal exposure. How can you stop the burning process? - ANSWER: Stop burning process with saline or readily available water. Remove smoldering clothing and jewelry. DO NOT REMOVE any clothing that is STUCK onto the skin. What should you cover a burned area with? - ANSWER: Dry Sterile Dressing

True/False: The provider should strongly consider applying ice, lotion, ointment, or antiseptic to a burn, depending on the origin of the burn. - ANSWER: False How should the medical provider respond to a burn involving the eyes? - ANSWER: Continuous saline flush in the affected eyes. Flush with water or NS for 10-15 mins. What should be removed on a patient who received a burn? - ANSWER: Jewelry, constricting items, smoldering clothing, and any clothing concealing the burned area Patients who received burns should be transported to _____________ per the Burns protocol - ANSWER: UMC Trauma Center Identify the differences between 1st, 2nd, and 3rd degree burns - ANSWER: 1st Superficial: Red and painful 2nd Partial Thickness: Blistering 3rd Full Thickness: Painless/charred or leathery skin What are 5 sources of burns that can come from gas, heat, or chemicals? - ANSWER: Thermal Burns Chemical Burns Electrical Burns Radiation Burns Lightning Strike Burns What burns are especially dangerous due to potential vascular compromise secondary to soft tissue swelling? - ANSWER: Circumferential Burns

What condition are burn patients particularly prone to? - ANSWER: Hypothermia. NEVER APPLY ICE OR COOL BURNS; They must maintain a normal body temperature Patients will be transported to UMC Trauma Center if they meet any of the following 8 criterias: - ANSWER: 1. second degree burns more than 10% surface body area

  1. any 3rd degree burns
  2. burns that involve the face, hands, feet, genitalia, perineum, or major joints
  3. Electrical burns including lightning strike
  4. Chemical burns
  5. Circumferential burns
  6. Inhalation burns
  7. Burn injury with concomitant trauma What should you do before making contact with a patient who received an electrical burn? - ANSWER: Ensure that the source of the electrical burn has been disconnected/is no longer live What are contact points in regards to a burn? - ANSWER: In electrical burns, contact points are the points where the electricity first made contact with the body, and the grounding point where the electricity traveled out of the body from. What is the rule of 9's regarding the entire body?

(Name each part of the body and what number is associated with it) - ANSWER: Head: 9 Chest: 9 Abdominal: 9 Upper back: 9 Lower back: 9 EACH ARM: 9 EACH LEG: 18 Groin: 1 All equal 100 A patient presents with burns to the anterior face, the lower back, and the posterior left leg below the knee. What percentage of burns have they received to their body? - ANSWER: Anterior face = 4. Lower back = 9 Posterior Leg Below knee = 4.5 (divide 18 by 2, and then divide the answer by 2 again) =18% What does POLST mean? - ANSWER: Provider Orders for Life Saving Treatment

What does DNR mean? - ANSWER: Do Not Resuscitate What should a provider do if they do not witness a non-traumatic cardiac arrest in an adult? - ANSWER: They should perform 2 uninterrupted minutes of CCC (Continuous Chest Compressions) After providing CCC, what should a provider do to an adult having a non-traumatic cardiac arrest? - ANSWER: Insert an OPA/NPA and BVM at 8 BPM What type of CPR is recommended in pregnant patients? - ANSWER: Manual CPR, do not use LUCAS What should be done to pregnant patients who have cardiac arrest? - ANSWER: Manual displacement of the uterus to the left side True/False: Mechanical chest compression devices are recommended on all adult non-pregnant adults - ANSWER: True. They provide consistent and uninterrupted chest compressions, as well as crew safety What are your big H's and T's regarding cardiac arrests? - ANSWER: Hypovolemia: Volume infusion Hypoxia: Oxygenate and Ventilate, CPR Hydrogen Ion (acidosis): Oxygenate, CPR Hypo/Hyperkalemia: Calcium Chloride, Glucose, Sodium Bicarbonate, Albuterol Hypothermia: Warming Tension Pneumothorax: Needle decompression Tamponade, Cardiac: Volume infusion

Toxins: Agent specific antidote Thrombosis, Pulmonary: volume infusion Thrombosis, Coronary: Emergent PCI *****There are 5 H's and 5 T's each***** If at any time a spontaneous return of circulation returns in a patient that had a cardiac arrest, what should your next course of action be? - ANSWER: Target Temperature Management and Post Resuscitation Protocol True/False: If Hypoxia was the cause of a cardiac arrest in a patient, early ventilation is not recommended - ANSWER: False What is the oximetry level you should ensure the patient is above when they are experiencing chest pain? - ANSWER: 94% What is the medication give to someone experiencing chest pain, what is the dose, and what is the route? - ANSWER: Aspirin, 324 mg, PO If a patient is experiencing chest pain, you may assist them with their prescribed nitroglycerin how many times? - ANSWER: Twice What are the contraindications of Nitroglycerin? - ANSWER: hypotension, bradycardia, tachycardia in the absence of heart failure, evidence of a right ventricular infarction, and use of erectile dysfunction drugs within the last 48 hours A high index of suspicion should be considered for these 3 types of patients experiencing chest pain due to their atypical pains. - ANSWER: 1. Diabetics

  1. Geriatrics
  1. Females What are the 4 types of ways a baby can present itself in a pregnancy? - ANSWER: Normal presentation Limb presentation Breech presentation Cord presentation What should you do first in a normal presentation of a pregnant woman? - ANSWER: If the amniotic sac has not already ruptures, puncture and break it. (like opening a bag of chips level of force) True/False: When the head is delivered, the next thing you should do is deliver the upper shoulder, then the lower shoulder - ANSWER: False. You should be suctioning the mouth, then the nose afterward. If meconium if present, repeat this multiple times. Afterwards, begin delivering the shoulders. True/False: You are to clamp the umbilical cord once the abdomen of the baby delivers and then cut it before the legs deliver - ANSWER: False. Clamp and cut after the baby has been fully delivered. What is the last thing you should do when you are assisting a pregnant patient deliver her baby? - ANSWER: Deliver the placenta. If the pregnant patients baby has limb presentation, how should you position the patient? - ANSWER: in the left lateral recumbent position True/False: A pregnant patient with Breech presentation should be shifted into a new position on the gurnee - ANSWER: False.

What should you do when a pregnant patients baby has breech presentation? - ANSWER: Support the body of the baby during delivery of the head How should you position a pregnant patient who has cord presentation? - ANSWER: In the trendelenburg position, and slightly on the left side After positioning a pregnant patient with cord presentation, how should you address the cord? - ANSWER: Wrap the cord and keep it moist True/False: During cord presentation in a pregnant patient, you should insert a gloved hand to lift the baby off the cord, and then obtain and document a cord pulse - ANSWER: True. What time related subjects should you be documenting in a pregnant patient? - ANSWER: Time of delivery, Frequency of contractions, Length of contractions, etc. What is a normal APGAR Score? What score requires resuscitative measures? - ANSWER: 7-10 is normal. 4-7 requires resuscitative measures. when should you record APGAR scores after a pregnancy? - ANSWER: one and five minutes after a pregnancy What does APGAR stand for? How is it scored? - ANSWER: Activity/muscle tone 0= absent, 1= arms/legs flexed, 2= active movement Pulse 0= absent, 1= below 100, 2=above 100 Grimace/reflex irritability 0=no response, 1= grimace, 2= sneeze, cough, or pulls away Appearance/skin color 0= blue-grey, pale all over 1= normal except extremities, 2= normal over entire body

Respiration 0=absent 1=slow, irregular, 2= good, crying What 5 things should you do to address a patient who has a Cold-Related Illness? - ANSWER: 1. Remove them from the environment

  1. Obtain a temperature measurement (if available)
  2. remove any wet clothing
  3. dry/warm the patient
  4. conduct passive warming measures True/False: You should rub a localized cold injury to warm it back up to the temperature of the rest of the body - ANSWER: False. True/False: With a localized cold injury, you should treat it with general wound care - ANSWER: True What can you do at the EMT-B level for a patient suffering from systematic hypothermia who is not in cardiac arrest or respiratory distress? - ANSWER: Active warming measures What are signs and symptoms of a cold related illness? - ANSWER: AMS/coma cold, clammy, shivering extremity pain bradycardia hypotension or shock

Who are the most prone to cold related emergencies? - ANSWER: Extremes of ages; I.E. children/toddlers, or geriatrics True/False: If you are unable to obtain a temperature from a patient suffering from a cold related illness, you should treat the patient based on what you suspect their temperature to be - ANSWER: True What are examples of active warming measures? - ANSWER: Hot packs that can be used on the armpit and groin, but care should be taken to not apply them directly to the skin What are the temperature ranges for Mild, Moderate, and Severe hypothermia? - ANSWER: Mild: 90- degrees Moderate: 82-90 degrees Severe: below 82 degrees What are the 4 mechanisms of Hypothermia? - ANSWER: Radiation: heat lost to nearby objects without touching them Conduction: body heat lost to other objects through direct contact Convection: body heat is lost to surrounding air, which heats up, rises, and is then replaced with cool air. Evaporation: Body heat causes perspiration, and when the skin is persperated the heat is transfered from the body to the liquid, turning it into a gas over time. What is the first thing you should check in regards to a patient who drowned? - ANSWER: Check is the airway is protected and if it is ventilated adequately

What should you do to a drown patient who is breathing on their own? What about a patient who is not? - ANSWER: Start oxygen at 15L NRB for patients who are breathing on their own. For patients who are not, use a BVM. Remember that ADEQUATE VENTILATION IS KEY. True/False: You should suction the foam at the bottom of the mouth for a patient who drowned because it could be chlorine that chemically reacted with bodily fluids - ANSWER: False, that's potentially amniotic fluid from the lungs and you are to bag it back down into their lungs. True/False: Emphasis should be placed on Continuous Chest Compressions in a drowning patient in cardiac arrest - ANSWER: False. Emphasis should be placed on Ventilation and Oxygenation, DO NOT use CCC on a drowning patient. Use traditional 30:2 CPR True/False: You should consider C-Spine on a drowning patient - ANSWER: True What other illness is often associated with drownings? - ANSWER: Cold related illnesses such as hypothermia True/False: It is at the discretion of the EMT/Paramedic's judgement if a drowning patient had sufficiently recovered enough to not go to the hospital - ANSWER: False. All drowning victims should be transported for evaluation because of the potential for worsening conditions over the next several hours What is Epistaxis? - ANSWER: bleeding from the nose How should you address a patient with Epistaxis in the nose? How should you address a patient with Epistaxis in the posterior oropharynx? - ANSWER: Both should be treated with direct pressure (pinch nose), tilt the head forward in a position of comfort If a patient with Epistaxis cannot control the bleeding after applying direct pressure, what should you do next? - ANSWER: Tell the patient to blow their nose. Suction any active bleeding. Tell the patient to spray OXY-META-ZOLINE or PHENYLE-PHRINE into their nose twice, and then apply direct pressure

True/False: It is very easy to quantify the amount of blood lose from a patient with Epistaxis, due to the blood coming straight out the nose. - ANSWER: False. A provider should also pay attention to the posterior orophraynx due to the fact that the bleeding also runs down into the throat. True/False: A good medication to administer to a patient with Epistaxis is Aspirin to help with the pain - ANSWER: False. Aspirin is a platelet inhibitor and will make the bleeding continue. Consider anti- coagulants. What is the difference between heat cramps, heat exhaustion, and heat stroke? - ANSWER: Heat cramps: Normal - Elevated body temperatures. Weakness, muscle cramping Heat Exhaustion: Elevated body temperature. Cool, moist skin. Weakness, anxious tachypnea Heat Stroke: High body temperature (greater than 104 degrees). hot, dry skin. hypotension, AMS/coma How can you address Heat cramps, heat exhaustion, and heat stroke at the EMT-B level? - ANSWER: Heat cramps: PO Fluids as tolerated. Monitor and reassess. Heat Exhaustion/Stroke: Active cooling measures True/False: Extremes of ages are more prone to heat related emergencies - ANSWER: True. Geriatrics and Children/toddlers are more susceptible What drugs might elevate a persons body temperature into suspected fever/heat related illness zones? - ANSWER: Cocaine, Amphetamines, and Salicylates At what body temperature does sweat usually disappear and stop perspirating at? - ANSWER: Sweat generally disappears as body temperature rises over 104 degrees True/False: Intense shivering doesn't occur in patients with heat related illnesses when they are actively/passively cooled because of their extreme temperatures - ANSWER: False. Intense shivering may occur

What are active cooling measures? - ANSWER: Application of cold packs or ice (not directly on the skin), and fanning either by air conditioning or fans True/False: Cold Saline is not to be administered for the treatment of hyperthermia unless directed by telemetry physician - ANSWER: True What is pre-eclampsia? - ANSWER: High blood pressure in a pregnant woman that can lead to significant health conditions What are some popular signs/symptoms of pre-eclampsia? - ANSWER: Visual changes, headache, hypertension, Right Upper Quadrant pain What blood pressure defined pre-eclampsia? - ANSWER: >140 systolics or >90 diastolic OR a relative increase of 30 systolic and 20 diastolic from when the patient was not previously pregnant You receive a patient having an obstetrical emergency. She exhibits signs and symptoms of pre- eclampsia. How should you position her on the gurnee? - ANSWER: left lateral position It is important to ask a pregnant patient having an obstetrical emergency to quantify the amount of _______ lost by what method measurement? - ANSWER: Ask her how many pads she goes through in an hour to quantify the amount of blood lost True/False: Any pregnant patient involved in a MVC should be seen by a physician for evaluation - ANSWER: True How long after child birth does postpartum/pre eclampsia commonly present? What is the maximum amount of time it can present after childbirth? - ANSWER: 48 hours, and up to 6 weeks Altered mental status may be profound in this type of poisoning/OD - ANSWER: Cyanide poisoning

What are the only pain management skills you can perform at the EMT-B level? - ANSWER: Splinting, positioning, ice True/False: You do not have to contact medical control to give your patient additional doses of pain management if they are experiencing severe pain in your judgement - ANSWER: False. What is an additional vital sign to be recorded before and after pain management? - ANSWER: pain severity on a scale of 1-10 True/False: Burn patients require more aggressive dosing of pain management - ANSWER: True After ensuring adequate airway & ventilation in a patient with PE/CHF, what should you do at the EMT-B level? - ANSWER: Keep oxygen saturation above 94% just like regular chest pain and general assessments. True/False: You should be reassessing blood pressure on patients with PE/CHF - ANSWER: True True/False: You should place the PE/CHF patient in the left lateral recumbent for additional comfort - ANSWER: False. Allow patient to maintain a position of comfort What can you do at the EMT-B level to address wheezing or bronchospasms in a patient with respiratory distress? - ANSWER: Assist the pt with their own MDI albuterol True/False: You should consider an allergic reaction in a respiratory distressed patient with stridor - ANSWER: True When should you test the blood glucose of a pregnant patient who had a seizure for the first time in her life? - ANSWER: Confirm she is between 6 and 20 weeks pregnant, otherwise consider it an obstetrical emergency How is status epilepticus defined? - ANSWER: Two or more seizures successively without an intervening lucid period

OR

a seizure lasting over 5 minutes What type of seizures are associated with only part of the body and not the entire body? - ANSWER: Focal seizures. Grand mal seizures are associated with the entire body. You should be prepared to address these issues shortly after a patient has a seizure - ANSWER: airway and ventilation management You have a patient in shock with a known adrenal insufficiency. How should you address his shock according to the shock protocol? - ANSWER: Administer his own Solu-Cortef as prescribed (hydrocortisine) True/False: Shock is often present with normal vital signs and may develop insidiously - ANSWER: True Hypotension can be defined as a systolic blood pressure below _______ - ANSWER: 90 What are examples of obstructive shock? - ANSWER: Pericardial tamponade, PE, Tension pneumothorax What are examples of distributive shock? - ANSWER: sepsis, anaphlaxis, neurogenic, toxins What are examples of cardiogenic shock? - ANSWER: Heart failure, MI, cardiomyopathy, myocardial contusion, toxins What are examples of hypovolemic shock? - ANSWER: hemorrhage, trauma, Gi bleeding, ruptures aortic aneurysm, or pregnancy related bleeding

What are some causes of adrenal insufficiency? - ANSWER: addisons disease congenital adrenal hyperplasia long term administration of steroids Where should you transport someone with inhalation burns? - ANSWER: UMC Trauma True/False: You should decide if you want to intubate patient with an inhalation injury early due to swelling over time making it harder later - ANSWER: True True/False: You should immediately notify the receiving hospital if you recognize a STEMI - ANSWER: true What can you do at the EMT-B level to address a recognized STEMI? - ANSWER: 1. Keep oxygen above 94%

  1. administer aspirin 324mg
  2. assist pt with their own nitroglycerin as prescribed up to 2 times What are two very important things to document in a patient with a suspected stroke? - ANSWER: 1. Last time known to be normal (onset)
  3. Witness with a phone number What RACE score is indicative of an LVO? (large vessel occlusion) - ANSWER: 5 or greater When should you contact the receiving hospital that you are bringing in a stroke pt? - ANSWER: after RACE score/test

What are all NIR capable centers? - ANSWER: centeniall hills spring valley valley st rose siena umc sunrise How is race scored? - ANSWER: similar to APGAR model. facial palsy 0= absent 1= mild 2= severe arm motor 0= normal/mild 1=moderate 2= severe leg motor 0=normal/mild 1=moderate 2=severe head/gaze deviation 0=absent 1=present 2= n/a aphasia 0=performs both tasks 1=performs task 1 2= performs meither tasks agnosia 0=patient recognizes arm and impairment 1=unable to recognize arm or impairment 2= unable to recognize both arms or impairment