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EMS1055 FINAL EXAM STUDY GUIDE
How to Read Blood pressure - Answers - Apply a sphygmometer, pump to around 240mmhg listen to the beginning and end of beats for the systolic and diastolic pressures Carotid Pulse - Answers - 60mmHg SBP Femoral Pulse - Answers - 70mmHg SBP Radial Pulse - Answers - 80mmHg SBP Pedal Pulse - Answers - 90 - 100mmHg SBP Anaphylactic Shock - Answers - Type of shock due to an allergic reactions. S/S: Anxiety, Altered LOC, thirst, decreased urine output, runny nose, lightheadedness, diarrhea, vomiting, crampy abdominal pain, cough, pain with swallowing, headache, pruritus, Skin: urticaria, flushing, Delayed capillary refill, Tachypnea, Dilated pupils, Decreasing SBP, wheezes, stridor. Treatment: High flow Oxygen, Trendelenburg position, keep warm, load and go transport, assist with Epi Pen Cardiogenic Shock - Answers - Type of shock due to complications with the heart and or circulatory system. S/S: Anxiety, Altered LOC, thirst, decreased urine output, Skin: Pale, cool, and diaphoretic, Delayed capillary refill, Tachypnea, sustained tachycardia, Dilated pupils, Decreasing SBP. Treatment: High flow Oxygen, Trendelenburg position or position of comfort, keep warm, load and go transport to a cardiac facility Hypovolemic Shock - Answers - Type of shock that is due to fluid loss in the body, blood or dehydration. S/S: Anxiety, Altered LOC, thirst, decreased urine output, Skin: Pale, cool, and diaphoretic, Delayed capillary refill, Tachypnea, sustained tachycardia, Dilated pupils, Decreasing SBP, Fontanelle: sunken, Mucus membranes: Dry. Treatment: High flow Oxygen, Trendelenburg position, keep warm, load and go transport Hypoglycemic Shock - Answers - Type of shock that isn't true shock, can happen more often with diabetics. S/S: Anxiety, Altered LOC, thirst, decreased urine output, Skin: Pale, cool, and diaphoretic, Delayed capillary refill, Tachypnea, sustained tachycardia, Dilated pupils, Decreasing SBP. Treatment: oral glucose or sugar and juice if patient can swallow, if not immediate transport, Paramedic: IV glucose Neurogenic Shock - Answers - Type of shock that begins with injury to the brain or spinal chord. S/S: Anxiety, Altered LOC, thirst, decreased urine output, Skin: warm and dry, autonomic dysreflexia, temperature dysregulation (Poikilothermic), Hypotension, bradycardia. Treatment: High flow Oxygen, Trendelenburg position, keep warm, load and go transport, protect from further spinal cord damage (c-collar if necessary)
Septic Shock - Answers - If this shock is not treated, patient can go into multi organ failure. Originates from an infection within the body. S/S: Anxiety, Altered LOC, thirst, decreased dark urine output, Skin: Pale, cool, and diaphoretic, Delayed capillary refill, Tachypnea, sustained tachycardia, Dilated pupils, Decreasing SBP, Febrile. Treatment: High flow Oxygen, Trendelenburg position, keep warm, load and go transport Beck's Triad - Answers - Hypotension with narrow pulse pressure, neck veins distended, heart sounds muffled. This triad means you have a cardiac tamponade. Basilar Skull Fracture - Answers - Signs and symptoms of this condition: blood or fluid leaking from ears or nose, bruising around the eyes, hearing problems, loss of sense of smell, vision changes, weakness in the face from nerve damage, fatigue, dizziness OPA (Oropharyngeal Airway) - Answers - used in patients with no gag reflex, measured from the corner of the mouth to the curve of the jaw bone, insert by pointing the to the top of the head then rotating 180 degrees until in position NPA (Nasopharyngeal Airway) - Answers - patients with an gag reflex, measured from the tip of the earlobe to the corner of the nostril, use the right nostril to insert using a twisting motion, do not use on patients with suspected head injury Bag Valve Mask - Answers - Can be used with a mask or attached to a kind airway tube, requires 10-15 L of oxygen, used for patients who cannot breath sufficiently on their own Non-rebreather Mask (NRBM) - Answers - Used in major trauma, respiratory failure, and unstable patients, requires 10-15 L of Oxygen, used for patients who can breathe sufficiently but need oxygen Nasal Cannula - Answers - can be used for patients who have a low SpO2 however high enough to be stable, low flow oxygen normally given around 2-4 L of oxygen How to open an airway - Answers - If the patient cannot move air in and out of their lungs they do not have an airway, if not use a Head tilt-chin lift, jaw thrust maneuver, clear any possible obstructions How to use Suction - Answers - Do not use it for more than 15 seconds, after a patient vomits, needs their airway cleared or has a blockage in their mouth. Do not used a finger swoop AVPU - Answers - Alert, patient tracks you with their eyes, is awake and actively speaking, Voice, patient responds to your voice, Pain, patient responds with a pain stimulus such as a sternal rub with eye opening or sounds, Unconscious, patient has no response to either voice or pain
tenderness, guarding, pelvic tenderness or bony crepitation, Cullen's sign, Grey- Turner's sign, seat belt sign, hot abdomen, rigidity of the abdomen Bandage - Answers - use Gauze, compression, triangular, or tube by each case, figure 8 bandaging most popular Hip Dislocation Posterior knee with be facing inwards, anterior knee will be facing outwards - Answers - Fractures that result in serious hemorrhage - Answers - (long bones) Femur fractures, pelvic fractures Triage tagging - Answers - Black tag, patient is dead or cannot be saved, green tag walking wounded, yellow tag cannot walk but not critical, red tag is critical cases that are load and go/trauma alert Cardiac Arrest Causes - Answers - Cocaine overdose, hemorrhagic shock, tension pneumothorax, pericardial tamponade, myocardial contusion, AMI Chemical Burns Treatment - Answers - safely remove them from the source, cool skin, clean water or saline for 1-2 minutes, clean, dry sheets or dressings, maintain body temperature, prevent hypothermia Rule of 9's - Answers - Patient's palm is 1%, chest, abdomen, front leg, back leg, whole arm , whole head, shoulder blades, and back are all 9% CO (carbon monoxide poisoning) Signs and Symptoms - Answers - S/S: headache, throbbing, SOB, altered central nervous system function with disturbed judgement, irritability, dizziness, decreased vision, confusion, collapse, fainting with exertion, convulsions, unconsciousness, apnea Inhalations Burns - Answers - signs: facial and scalp burns, sooty sputum, singed nasal hair, eyebrows, soot, swelling, redness, hoarse voice, persistent cough, wheezing or crackles Respiratory distress in pediatrics - Answers - abnormal breath sounds, noisy breathing, snoring, crowing, grunting, or wheezing, abnormal positioning, retractions (tensing of muscle), flaring (nostrils), diaphoretic, cyanotic, tensed stomach muscles Injury Patterns of pediatrics - Answers - head injuries common (problems with balance and head size), falls, MVCs, auto-pedestrian or bicycle crashes, burns, drownings, and child abuse Trauma in OB Patients - Answers - high flow oxygen rapidly administered, fetal hypoxia occurs before maternal hypoxia, fluid administration must me prompt (load and go), frequently reassess, do not put them in a supine position: results in acute maternal
hypotension and fetal bradycardia, relatively minor abdominal trauma can cause fetal death, most common cause of fetal death is maternal death Results of trauma in OB patient - Answers - Head injury: fetal distress or fetal death, Uncontrolled hemorrhage: placental abruption and uterine rupture, assess pelvis: pre- term labor Indications Of Nitroglycerin - Answers - dyspnea, pressure on chest, suspected AMI or angina Contraindications of Nitroglycerin - Answers - has taken a phosphodiesterase (Viagra) or SBP under 100 OB History - Answers - How far along are you? How many times have you been pregnant? How many children do you have? Have you ever had an abortion or miscarriage? AMI - Answers - Levin's Sign, substernal chest pain (pressure and radiates to the neck/jaw and/or left arm, SOB, nausea/vomiting Tachycardia, tachypnea Apply Oxygen, no high flow unless SPO2 is <94%, Nitroglycerin (in patients SBP is higher than 100 and hasn't taken phosphodiaesterases AMI (History IDDM) - Answers - Nausea and Vomitting, no feeling of pain (neuropathy) Tachycardia, tachypnea Apply Oxygen, no high flow unless SPO2 is <94%, Nitroglycerin (in patients SBP is higher than 100 and hasn't taken phosphodiaesterases Unstable Angina - Answers - Levine's Sign, substernal chest pain (pressure and radiates to the neck/jaw and/or left arm, SOB, nausea/vomiting Tachycardia, tachypnea Nitroglycerin and rest do not help, transport as an AMI patient Stable Angina - Answers - Levin's Sign, substernal chest pain (pressure and radiates to the neck/jaw and/or left arm, SOB, nausea/vomiting Tachycardia, tachypnea Nitroglycerin and rest, Transport as an AMI patient CVA - Answers - Facial drooping, arm weakness, speech difficulty, headache, tinnitus, dysphagia (difficulty swallowing), dysphasia (difficulty with speech), Diplopia (double vision), Photophobia Confusion, Dysdiadochokinesia, pronator drift, Pupils (bilateral Dilated), Positive FAST exam FAST exam and detailed neuro assessment, Stroke alert and transport immediately in a 30 degree Semi-fowlers Hyperglycemia - Answers - Weight Loss. Hunger (polyphagia), Thirst (polydipsia), Frequent urination (polyuria), Hyperventilation, Nausea BGL <7.0 mmol/l (126mg/dL) [Fasting] BGL <11.0 mmol/L (200 mg/dL) [2 hours after a meal], Acetone Breath, Skin pale, cool, and diaphoretic, altered mentation If patient can swallow: oral glucose or juice with added sugar (MUST EAT AFTERWARDS), Can not swallow: Immediate transport, (will need IV glucose)
Uterine Rupture - Answers - excessive vaginal bleeding, sudden pain between contractions, abdominal pain or soreness abnormal heart rate, low blood pressure, signs of shock, limbs, fingers, ect. are visible through the skin transport emergently Epidural Bleed - Answers - Arterial bleed in the brain, altered levels of consciousness, initial loss of consciousness then a lucid interval follows, photophobia, high BP, nausea, vomiting, tinnitus, changes pupils, transport and go, slight hyperventilation Subdural Bleed - Answers - venous brain bleed, onset can take hours up to days, changes of level of consciousness, alcoholics and elderly high risk, slower onset but more deadly Subarachnoid Bleed - Answers - Blood in the subarachnoid space, intravascular fluid, thunderclap headache, Berry aneurysm, altered level of consciousness, blood squeezes the brain, could have symptoms of a CVA Severe HTN - Answers - heart risk disease doubles with each increment 20/10 mmHg, most patients have no specific symptoms so are diagnosed at a time of a physical exam, could result in heart failure, accelerates atherosclerosis/coronary artery disease, increased myocardial oxygen demand on coronary arteries, results in angina, retinal dysfunction, visual impairment, blindness, occipital headaches, cerebral hemorrhage or infarction, altered consciousness, Very High blood pressure : 180/120 is severe, supportive care and immediate transport HHS (Hyperosmolar Hyperglycemic State) - Answers - complication with diabetes which results in high blood sugar, most common in type II diabetics, dehydration, weakness, leg cramps, vision problems, and severely altered LOC, blood glucose higher than 600 mg/dL, no fruity smell in the breath, shallow breathing Acute Pancreatitis - Answers - inflammation of the pancreas, most commonly caused by gallstones stuck in bile ducts or pancreatic duct, severe upper abdominal pain that radiates to the back, N/V, fever, tachycardia, Cullen's sign or grey's turners sign in severe cases, stool may be yellow/pale, less dense, and or have an oily greasy texture, medical emergency, transport immediately Appendicitis - Answers - pain begins in the right umbilicus and moves into the RLQ severely, rupture can occur 24-72 hours after onset of symptoms, positive rebound tenderness, pain can be dull or sharp, exacerbated by jarring movements, N/V, loss of appetite, fever, chills, transport immediately APGAR Score - Answers - Activity (0- 2 points, 1 point being arms and legs flexed), Pulse (0-2, 1= 100 bpm, 2= over 100 bpm, Grimace: reflex irritability (0=flaccid, 1= some flexion of extremities, 2= active, motion, cough, sneeze), Appearance (0-2 blue to pink), respiration (vigorous cry =2), assessed every 5 minutes after birth until in excellent condition (7-10 points)
TB (Tuberculosis) - Answers - risk of active disease in HIV infection with latent TB is 7- 10%, INH prophylaxis, caused my mycobacterium, airborne, highly contagious, most people are asymptomatic, productive cough, night sweats, poor appetite, weakness, fever, weight loss, chest pain, supportive car, most important to protect yourself (N mask) Influenza - Answers - fever, cough, malaise, sore throat, myalgia, chills, eye pain, sudden onset, cough has high productive value, croup, bronchiolitis, asthma exacerbation, otitis media, sinusitis, headache, runny or stuffy nose, weakness, vomiting, achy joints, FDA approved drugs: Tamiflu, zanamivir, peramivir, baloxavir, vaccine to prevent Heat stroke - Answers - flushed, hot, DRY skin, lethargy, dialted pupils, unconscious seizures, core body temp can reach 106 degrees, muscle cramps, experience a form of shock due to water and salt loss, brain and CNS damage, dehydration, treat with removing patient from environment, clothing, applying cool packs to their groin, neck and armpits, administer oxygen and transport Heat Exhaustion - Answers - profuse sweating, lightheadedness, dizziness, muscle cramps, rapid and shallow breathing, weak pulse, treatment to move patient to a cool environment, lay supine, give small sips of fluid, apply moist towels over cramped muscles, monitor and transport Epiglottis - Answers - can cause airway obstruction, stridor lung sounds, high-pitch cough, hurts to swallow, treat with humidified oxygen and transport Croup - Answers - seal bark cough, drooling, most common in children between 6 months and 3 years, swelling of the pharynx, larynx, and trachea, stridor, upper airway obstruction, responds well to humidified oxygen and 90 degree fowlers position Shock in Pediatrics - Answers - first sign of shock is delayed capillary refill, altered mental status, pale, cool and clammy skin, absences of tears when crying, falling BP, rapid, weak, or thready pulse, ensure an open airway, provide high-flow oxygen, supine position, keep patient warm, immediate transport Pulmonary Edema - Answers - fluid buildup in alveolar, dyspnea, most common cause is left sided Heart failure, can present with pink frothy sputum, lung sounds show rales, place in high fowlers position, high flow oxygen, exertion with worsen the condition, transport Cocaine Use - Answers - increased risk of strokes, reduced attention, insatiable hunger, insomnia/hypersomnia, lethargy, sore throat, hoarse voice, hemoptysis, bronchospasm, dyspnea, infiltrates, eosinophilia, chest pain, asthma, fever, rhinorrhea, increased risk of infarction, pruritus skin
