EMT Final Exam Questions with Correctly Solved Answers, Exams of Medicine

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EMT Final Exam Questions with Correctly Solved Answers

1. Compare and contrast the scopes of practice for each of the nationally recognized EMS

certification levels: Emergency medical responder provides im- mediate lifesaving care while waiting for EMTs or higher level. Emergency medical technician provides basic care and transportation. Similar to EMR but has the addition of advanced oxygen therapy and ventilation equipment, pulse oximetry, use of automatic blood pressure equipment, and limited medication administration. Advanced emergency medical technician: Same as EMT with the addition of ad- vanced airway devices, monitoring blood glucose levels, initiation of intravenous and intraosseous infusion, and the administration of certain medications. Paramedic: Same as AEMT with the addition of more advanced assessment and patient management skills. Perform field impression, advanced assessment, and provide invasive and drug interventions. Their care is designed to reduce disability and death.

2. Discuss the roles and responsibilities of the EMT and how the EMT can best meet these

expectations.: Roles and responsibilities include personal safety and safety of others, patient assessment and emergency medical care, safe lifting and moving, patient transport and transfer, record keeping and data collection, and patient advocacy. After personal safety it is best to lean to what's best for the patient.

3. Identify the stages of grief experienced by patients and their families, and explain principles for

interacting with these individuals in situations involving death and dying.: Denial: "not me" refuse to accept the possibility of death Anger: "why me" Bargaining: "okay, but first let me..." hoping to postpone death for a short time Depression:

2 / 71 "okay, but I haven't..." patient becomes silent and sad about leaving those he loves behind and things left undone Acceptance: "okay, I am not afraid." Family usually requires more support. Show respect, talk to him as if he is fully alert, allow families to stay with resuscitation efforts, never give up on a patient, communicate what has happened and give straight forward answers, do not guess or make assumptions, allow family to express themselves, listen empathetically, do not give false assurances, say :we are doing everything we can for you, we need you to help us by not giving up", use gentle tone, arrange and improve body appearance for patients to hold after death, encourage them to talk to the unresponsive patient.

4. Compare and contrast the characteristics of acute, delayed, and cumulative stress reactions:

Acute: results from high stress situation. Occur immediately after the incident. Delayed: PTSD is a delayed stress reaction, occurs from exposure to high stress situation where signs are evident days, months, or years after. Cumulative: results from constant exposure to stressful situations that build up over time. Common cause of burnout which is a state of exhaustion and Irrability.

5. Discuss the components of a comprehensive system of critical incident stress management:

Critical incident stress debriefing CISD: means to relive stress. held within 24-72 hours of a critical incident. Mental health professionals help EMS personal through seven phases. Review the facts, share feelings, identify signs and symptoms they are experiencing, sort through feelings, receive suggestions, develop a plan for returning to the job, and obtain follow up assistance. Defusing: version of CISD held up to 8 hours after incident. Attended by those involved and lasts only 30-40 minutes. Allows personnel to vent and get information they may need.

6. Describe ways EMTs can protect themselves from exposure to diseases caused by pathogens, as

well as from accidental and work-related injuries: - Standard precautions, hand washing (single

3 / 71 most important way to prevent spread), eye protection, gloves, gowns (use in any situation that requires significant contact with blood or body fluids, such as during childbirth), masks (can put a surgical mask on a patient with an airborne disease) (need HEPA or N95 for tuberculosis patients). Cleaning, disinfecting, sterilization, and immunizations can protect from diseases.

7. Define key terms introduced in this chapter: tort: wrongful act, injury, or dam- age.

negligence: is a tort in which there is no intent to do harm but there was a breach in the duty to act. Proximate cause: must be determined that the injuries suffered were the result of the EMTs negligence. Intentional tort: knowingly committed harm or wrongdoing towards the patient.

8. Differentiate between the concepts of scope of practice and standard of care: Scope of

practice: actions and care legally allowed to perform. Standard of care: care that is expected to be provided. Did the EMT provide the right assessment and emergency care? Did the EMT perform the assessment and care properly?

9. Be able to recognize situations in which an EMT would have a duty to

act: While you are on duty you are obligated to care for a patient who requires and consents to it. If you stop to help while off duty you assume responsibility.

10. Discuss the actions an EMT should take when a patient refuses care: - Complete a thorough

physical assessment. Try again to persuade the patient to accept treatment or transport to a hospital. Make sure the patient has the capacity to understand and make a rational decision. Consult medical direction as needed. If patient still refuses clearly document what was told to the patient, his response, and have him sign a refusal form. Before leaving the scene encourage the patient to seek help if symptoms develop. If unsure patient can make a rational decision contact medical

4 / 71 direction.

11. List and describe the purpose and typical contents of each section in a PCR.: The main

purpose of the PCR is for continued patient care, documentation for legal action, and a record for your accountability. Minimum data set: includes patient information and administrative data. Purpose is to lead to higher level of care and permits comparison and analysis of data which may speed the implementation of new and better methods. Administrative information: aka Run Data includes the time incident was reported, time the unit was notified, time of arrival at the patient, time left the scene, time unit arrived at destination, time of transfer of care, Ems unit number and the run or call number, names of crew and level of cert., address to which unit was dispatched. Patient demographics: patients name, age, sex, race, birth date, home address, insurance, location where patient was found, and any care given before arrival. Vital signs: two sets of vital signs usually, patients position at the time vitals were taken and what time. Patient Narrative: Sets the tone for the entire course of care. Includes chief complaint (should be in patients on words), patients' history or description of the MOI. Treatment: chronological order of all treatments, what time administered, and re- sponse.

12. Be able to recognize examples of each type of information common to the narrative portion of a

PCR: Chief complaint: should be in own words of patient in quotations. Objective information: measurable or verifiable in some way. Reference to patients pulse or a statement that the patient has discoloration. A sign is an objective observation. Subjective information: based on individuals' perception or interpretation. EX: "I feel lightheaded" or "patient seems to be in pain". Subjective information should relate to medical circumstances and not include diagnosis. Subjective information is a symptom. Pertinent negatives: signs or symptoms that might be expected based on the chief complaint,

5 / 71 but the patient denies having.

13. Accurately and completely record pertinent patient and EMS call informa- tion using the SOAP,

CHART, and CHEATED methods.: SOAP: S: subjective: refers to information the patient must tell you such as symptoms. O: objective refers to information identified in the physical examination such as a sign. A: assessment refers to field assessment and the general idea you form about patient's condition based on information collected such as scene size up and chief complaint. P: paln: plan of action. CHART: C: chief complaint H: history A: assessment Rx: treatment provided T: transport: any change in patients condition and type of transport CHEATED: C: chief complaint H: history E: physical exam info A: assessment: field impression T: treatment E: evaluation D: disposition: transfer of care

14. Describe the responsibilities of the Federal Communications Commission-

: FCC licenses station operations, assigns radio call signs, approves equipment for use, establishes limitations for transmitter power output, assigns radio frequencies, and monitors field operations. They also set regulations to limit interference with emergency radio broadcasts and to bar the use of obscenity and profanity in broadcasts.

15. Describe the standard rules and expectations for using a transmitter/re- ceiver during radio

communications: Listen before transmitting, wait 1 second before speaking, speak 2-3 inches from microphone, address the unit being called by its name and number and identify your unit by name, keep transmitions brief, pause for a few seconds to allow other communication, use plain English, when transmitting a number say number than individual numbers, give only objective information, when receiving orders use echo method and repeat word for word, write down important information, do not cuss, use we rather than I, use affirmative rather than yes, when finished say over.

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16. Discuss how to provide a concise radio report to medical direction or the receiving facility, and

when to update that report while still enroute: Unit identification and level of service, patients age and sex, chief complaint, history, mental status, vital signs, pertinent findings, care given, patients response to care, patients current condition, and ETA. SBAR Situation, Background, Assessment, Recommendation. SBAR lessens the chance for miscommunication when seeking medical direction.

17. Define key terms introduced in this chapter: Lordosis: stomach is too anterior, and the

buttocks are too posterior causing stress on the lumbar region. kyphosis: shoulders are rolled forward which fatigues lower back and increases pressure on entire spine. emergency move: immediate danger to patient or rescuer such as a fire urgent move: immediate threat to life and patient must be moved quickly and transported for care. nonurgent move: no immediate threat to life exists.

18. Discuss teamwork and communication considerations for lifting and mov- ing patients: Ideally

partners lifting and moving a patient should have adequate and equal strength and height. Know physical abilities and limitations. Determine weight of patient and weight limitations of equipment. Call for help whenever necessary, use even number of rescuers to maintain balance, two rescuers should carry heavy loads for 1 minute or less. Use equipment with wheels whenever possible, keep the weight close to body, keep back locked, lift then turn as a unit.

19. Discuss the advantages, disadvantages, and steps for each of the recom- mended lifting and

moving techniques: Power lift: offers best defense against injury and protects the patient with safe and stable move. Good for rescuers with weak knees or thighs. Keep back locked and avoid bending at the waist. Squat lift: helpful if you have one weak leg or ankle, or if both knees are legs are strong. Weaker

7 / 71 leg slightly forward and squat down and lift with power grip. Emergency moves: Armpit forearm drag you know it. shirt drag shouldn't be used if only wearing a t-shirt, pulling should engage the armpits not the neck. blanket drag: roll patient on to blanket and wrap around then pull. Urgent moves: Rapid extrication: used in abnormality of ABCs, in line stabilization, apply collar, free legs, slide patient onto backboard. Self-extrication: need to get to another patient, tell them to keep head in neutral position and apply a collar then tell them to exit. Nonurgent moves: Direct ground lift: not recommended for heavier patient. Extremity lift: to move from ground to device. direct carry: transferring to supine from bed to device. drawsheet method: bed to stretcher.

20. Differentiate between the processes of aerobic and anaerobic cellular me- tabolism, and outline

the consequences of cellular sodium/potassium pump failure: Aerobic metabolism: breakdown of molecules such as glucose that produce energy within the cells in the presence of oxygen. Anaerobic metabolism: breakdown of molecules in the cells without the presence of oxygen. Failure of the sodium potassium pump results in buildup of sodium inside the cell attracting water eventually the cell swells and ruptures and dies.

21. Explain the concept of perfusion, including components necessary to maintain perfusion:

perfusion: delivery of oxygen, glucose, and other substances to the cells and the elimination of waste from the cells. Components needed are ventilation charteristics, blood volume, pump function, SVR, blood pressure.

22. Explain how changes in compliance of the lungs and chest wall and changes in airway resistance

affect ventilation.: Decrease in compliance would make it harder to ventilate a patient and more difficult for the patient to move air in and out. Airway resistance makes it harder for airflow to move through the airway. Poor

8 / 71 compliance and higher airway resistance leads to less air for the alveoli resulting in less oxygen in the blood resulting in cellular hypoxia.

23. Describe and differentiate between tidal volume, alveolar ventilation, and minute ventilation.:

Tidal volume: volume of air breathed in with each breath. Alveolar ventilation: amount of air moved in and out of the alveoli in one minute. Minute ventilation: amount of air moved in and out of the lungs in one minute.

24. Identify and discuss the numeric age range, key physiological and psy- chosocial

developments, and normal vital signs for neonates and infants: - neonate: birth to 1-month Vitals: 40-60 breaths per minute, tidal volume 6-8 mL. 100-205 bpm. SBP 67-84 DBP 35- infant: 1 month to 1 year Vitals: 30-53 breaths per minute. tidal volume 10-15 mL, 100- bpm. SBP 72-104 DBP 37-

25.. Describe the physiological changes that occur immediately after birth.: - Within the first 30

minutes the heart rate decreases to 100-160 then settles around 120 bpm.

26. Identify and discuss the numeric age range, key physiological and psy- chosocial developments,

and normal vital signs for school-age children: 6-11 Vitals: 18-25 breaths per minute, 75-118 bpm, SBP 97- Bones increase in density and grow larger experiencing discomfort, able to read and write, some struggle with nocturnal enuresis or bed wetting after age of 10. Develop relationships outside of home. Develop own self-concept. Understand rules.

27. Identify and discuss the numeric age range, key physiological and psy- chosocial developments,

and normal vital signs for adolescence.: 12-18 Vitals: 60-100 bpm, 12-20 breaths per minute, SBP 110-131. Experience puberty. Think they are invincible and become more argumentative. Desire to be treated as adults and want privacy.

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28. Define key terms introduced in this chapter.: visceral pleura: innermost cov- ering of the lung.

parietal pleura: thicker more elastic layer that adheres to the inner portion of the chest wall. pleural space: between the two layers that creates negative pressure. chemoreceptors: continuously monitor levels of oxygen, carbon dioxide, and pH hy- drogen concentration in the blood and stimulate an increase or decrease in impulses from the respiratory rhythm centers to control the rate and depth of ventilation.

29. Recognize the progressive assessment findings of mild, moderate, and severe hypoxia in

pediatrics and adults.: mild to moderate: tachypnea, dyspnea, pale cool clammy skin (early), tachycardia, elevation in blood pressure, restlessness and agitation, disorientation and confusion, and headache severe hypoxia: tachypnea, dyspnea, cyanosis, tachycardia that may lead to dys- rhythmias and eventually bradycardia, severe confusion, loss of coordination, sleepy appearance, head bobbing, slow reaction time, altered mental status, seizure. Bradycardia in children is a severe sign.

30. Discuss the function and performance of fixed and portable suction de- vices.: fixed: powerful

enough to provide airflow of above 40 lpm and create a vacuum of more than 300 mmHg on the gauge when the tubing is clamped. Should be adjustable to reduced vacuum for infants and children. portable: 80 to 120 mmHg is necessary for adequate suction and 300 mmHg when clamped. Must be fully charged. Must have wide bore, thick wall, nonkining tubing that fits rigid or soft catheters, unbreakable collection bottle, enough vacuum pressure and flow to suction substances. Hand powered devices can be more effective for heavy substances.

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31. Explain the difference between rigid and soft suction catheters, how to use both, and special

considerations when suctioning patients: Rigid: hard catheter used to suction the mouth of an unresponsive patient. Only insert as far as you can see. Measured from angle of jaw to corner of the mouth. Soft: flexible tubing used for suctioning the nose or when the rigid can't be used. Length is determined from the tip of the patients nose to the tip of his ear. To use: adult 100-120 mmHg child 80-100 mmHg. Apply suction only on the way out of the airway. Move tip from side to side. Suction for no more than 15 seconds and only 5 seconds for children. Special considerations: Log roll if can't be suctioned, if needs ventilation, suction 15 sec, provide PPV w O2 for 2 minutes, then suction, repeat process. Residual volume is the air remaining in the lungs after a maximal exhalation. Monitor heart rate and remove suction and administer O2. Look for bradycardia and tachycardia. If occurs stop suction provide PPV Ventilate for 5 minutes before suctioning in artificial ventilation patient.

32. Define key terms introduced in this chapter: conjunctiva: mucous mem- branes that line

the eyelid. jaundice: yellow color indicates liver disease. mottling: blotchy pattern similar to cyanosis orthostatic vital signs: done by placing patient in supine position and measuring blood pressure and heart rate the standing the patient up and after 2 minutes reassessing. If heart rate increases more than 10 bpm and SBP decreases 10 or more, it is a positive test. aka tilt test indicating blood or volume loss. pulse oximetry: method of measuring oxygen saturation levels in the blood. pulsus paradoxus: decrease in strength of the pulse during inhalation and can indicate cardiac or

11 / 71 respiratory injury or blood loss.

33. Discuss normal and abnormal findings when assessing a patient's breath- ing, how to determine

oxygen needs, and indications of respiratory distress or failure.: Normal: 12-20 breaths per minute, chest motion of 1 inch, tidal and minute ventilations should be adequate. less than 10 or greater than 26 is a concern, if over 40 needs assistance Sounds audible without stethoscope: snoring: tongue partially blocking upper airway at level of the pharynx. Gurgling: fluid in the upper airway. Stridor or crowing partial obstruction at the level of the larynx. Sounds audible with a stethoscope: wheezing: constriction and inflammation of bronchioles. Crackels: fluid surrounding the and filling the alveoli. Rhonchi: mucus blocking larger bronchioles.

34. Differentiate between normal and abnormal respiratory rates for each age bracket: adult: 12-

adolescent: 12- 20 school age: 18- 25 preschooler: 20- 28 toddler: 22- 37 infant: 30- 53 neonate: 40- 60 remember elderly patients have decreased tidal volume so their resting rate is typically 20 per minute.

35. Describe normal and abnormal findings in the assessment of skin color, temperature, condition,

capillary refill, and color of the mucous membranes.- : Skin should be pink. Paleness could be blood loss, cyanosis is poor perfusion, flushing is heating exposure, jaundice is live disease, mottling is blotchy pattern. Normal skin feels warm to the touch. If it's hot indicating fever or exposure to heat, cool is a sign of shock, exposure to cold or

12 / 71 inadequate circulation. Cold indicates extreme cold exposure. Normal skin is dry. Wet or moist may indicate shock or many other illnesses. Capillary refill time is normal at 2 seconds for infants, children, and make adults. # seconds for females and 4 seconds for elderly.

36. Explain factors that can cause abnormalities to skin color, temperature, condition, capillary refill,

and mucous membrane color.: Cold environment, preexisting conditions of poor circulation, and certain medication can be an affect. Wet or moist skin can indicate shock, heat emergency, or diabetic emergency. Abnormally dry skin can indicate spinal injury, dehydration, heat stroke, or poising.

37. When assessing the pupils, recognize normal findings versus abnormal findings, and associate

these with potential underlying causes: Size: Dilated may be from drugs such as LSD, amphetamines, or cocaine, or cardiac arrest. Pupils that are constricted can indicate central nervous system disorder or narcotics, glaucoma meds or bright environment. Equality: Unequal size may indicate stroke, head injury, artificial eye, disease of the eye, certain eye drops, injury to the eye or nerve. Some ppl has unequal and are fine if they both react to light. Reactivity: constrict when light is shined and dilate when shaded. Both have same response even when light is only shined in one eye. Pupils that remain the same indicate cranial nerve damage. Sluggish pupils indicate hypoxia, drug overdose, or inadequate perfusion. Cardiac arrest, head injury, hypoxia can cause pupils to become fixed.

38. In relation to blood pressure measurement, explain systolic and diastolic blood pressure, pulse

pressure, and causes of abnormal findings: Systolic BP: amount of pressure exerted on the walls of the arteries from the pump of the left ventricle. Diastolic BP: amount of pressure on the artery walls while the ventricle is at rest. Pulse pressure:

13 / 71 difference between SBP and DBP Indicator of shock or hypoperfusion. Head injury may have a widened pulse pressure where the SBP rises but DBP remains. Shock, cardiac tamponade, tension pneumothorax causes a narrow pulse pressure. Basically, when there is pressure on the heart resulting in less blood being ejected and the SBP falls while DBP rises because of vasoconstriction.

39. Define key terms introduced in this chapter: Nature of illness: gather informa- tion to narrow

down the nature of the complaint. Index of suspicion: degree of anticipation that the patient has been injured. mechanism of injury: how the patient was injured

40. Explain the purposes and goals of performing a scene size-up on every EMS call.: Identify

hazards and ensure personal and crew safety. Identify what let to you being called to the scene. Determine any factors that require additional assistance.

41. Discuss measures necessary to protect the patient, protect bystanders, control the scene, and

maintain situation awareness: Move patient to back of ambulance, or move to a safer area, provide blanket if cold, place on a backboard, ask bystanders to hold up sheets for privacy. Remove bystanders if it is not safe. Control the scene by providing light, moving Funiture, moving the patient, maintain escape route, pay attention to bystanders, be calm and compassionate.

42. Identify factors involved in determining the number of patients.: Additional Ems, law

enforcement, fire department, hazardous materials, special rescue teams, specialized search and extrication teams, power company.

43. Define key terms introduced in this chapter.: paradoxical movement: seg- ments of the

14 / 71 chest that are moving inward during inspiration and outward during exhalation, opposite to the direction of the rest of the chest. Priapism: persistent erection of the penis and is a sign of possible spinal cord injury. brain herniation: swelling or bleeding to or around the brain creating excessive pressure within the skull and causes the brain stem to be compressed.

44. Explain the importance of developing a systematic patient assessment routine and list the

four main phases of the patient assessment process.- : Systematic approach ensures that every patient is assessed consistently and appropriately. It helps to not get distracted or tunnel visioned. Scene Size up Primary Assessment Secondary Assessment Reassessment

45. Review the steps of the scene size-up phase of the patient assessment process: Take

standard precautions Evaluate scene hazards and ensure scene safety Determine the MOI or NOI Establish the number of patients Ascertain the need for additional help

46. State the main purpose of the primary assessment and list the components of the primary

assessment phase.: Main purpose: identify and manage immedi- ately life threatening conditions to the airway, breathing, oxygenation, or circulation. Form a general impression Assess level of consciousness Assess the airway Assess breathing Assess oxygenation

15 / 71 Assess circulation Establish patient priorities

47. Discuss ways to determine if a patient is injured or ill and how to obtain the chief complaint:

Through your general impression of the patient and the environment. Consider MOI or NOI. Obtain chief complaint from the patient or family members or bystanders. Or you can obtain it through your observations.

48. Differentiate between patients who do and do not need spinal motion restriction techniques

and discuss proper patient positioning for assess- ment.: Think of MOI that could cause spinal injury. A person who is laying at the bottom of steps could have a spinal injury. Provide manual in line SMR and bring patients head into neutral inline position. Or you can have the patient self-restrict if possible. Provide SMR before log rolling. If patient is prone, they need to be log rolled to supine to assess. If there is an open wound to posterior thorax cover before logrolling.

49. Using the AVPU method, describe how to assess and document the level of responsiveness.:

AVPU: alert, verbal stimuli, painful stimuli, unresponsive If patient responds or opens eyes to verbal stimuli, he is responsive to Verbal stimuli. Determine whether he will obey commands. If patient obeys commands, he has a higher level of responsiveness. Trapezius pinch, supraorbital pressure (pressure under upper ridge of eye), sternal rub, earlobe pinch, armpit pinch are methods of applying central painful stimuli. Nail bed pressure, pinch to the web between the thumb and index finger, pinch to the finger or toe are peripheral painful

16 / 71 stimuli. Look for facial grimace or body movement. Look for purposeful or non-purposeful movements. Purposeful is documented as withdraws from pain. Non purposeful movements can be flexion where the patient arches the back and flexes the arms inward and extension where the patient arches but extends arms out. They are signs of head injury. Always be sure to assess central painful stimulus which is transmitted to the brain. Documenting level of responsiveness: Document exact response. A patient with the ability to grasp hand has a higher level of response than a flexion postured patient. Be specific in how the patient responds. Should take only a few seconds to assess to establish a baseline of mental status.

50. Determine airway status in responsive versus unresponsive patients and identify methods for

establishing and maintaining an open airway for each.: If the person is talking or crying without difficulty the airway is patent. If not and has stridor, dyspnea, or troubled speaking if could be blocked.

17 / 71 If the patient is unresponsive their tongue is probably blocking the airway. Open airway with chin lift head tilt, jaw thrust, suction or finger sweeps, airway adjuncts to maintain airway, manual thrust to the abdomen, position in lateral if no spinal injury. Snoring: tongue or epiglottis is blocking the airway. Open airway using maneuver and maybe an adjunct to maintain. Gurgling: liquid is in the airway. Open and suction. Crowing and stridor: high-pitched sounds associated with swelling or muscle spasms from infections, allergic reactions, or burns. Do not place an adjunct device.

51. Describe how to assess the rate and quality of breathing, and based upon findings, identify how

to manage the ventilatory insufficiency.: Looking, listening, and feeling. Poor movement of the chest wall indicates inadequate tidal volume. Too fast or slow respiratory rate. Look for retractions, use of neck muscles, abdominal use, tracheal tugging, SpO reading, asymmetrical movement, and listen and feel for escape of air. If the patient is apneic or inadequately breathing begin PPV with oxygen.

52. Define key terms introduced in this chapter: medication: drug or substance that is used as a

remedy for illness. drug: chemical substance used to treat or prevent a disease or condition. pharmacology: study of drugs Metered dose inhaler MDI: contains a beta 2 agonist that causes bronchodilation. Small volume nebulizer SVN: beta2 agonist delivered through a fine vapor of the medication and oxygen or air. route: how medication is given or taken sublingual:

18 / 71 placed under tongue. oral: swallowed. inhalation: inhaled. intramuscular injection: injected into a muscle mass. intranasal: sprayed into nostril. subcutaneous: injected under the skin into the subcutaneous layer. indications: use of a drug for treating a specific condition Contraindication: drug should not be administered because of potential harm that can be caused dose: how much of a drug is given administration: refers to route and form of drug is given action: the effect the drug has side effects: actions that are not desired from the drug

53. List the medications in the EMT's scope of practice that are carried on the ambulance: Oxygen,

oral glucose, activated charcoal, aspirin, Inhaled bronchodila- tor, nitroglycerin, epinephrine, naloxone hydrochloride.

54. List the medications in the EMT's scope of practice that the EMT is permit- ted to assist the

patient to administer: Oxygen, oral glucose, activated charcoal, aspirin, Inhaled bronchodilator, nitroglycerin, epinephrine, naloxone hydrochloride.

55. Explain the roles of off-line and on-line medical direction with regard to medication

administration: Every medication the emt administers or assists with requires an off or online order. Online order is from medical direction over the radio. Offline is through protocols or standing orders.

56. List in order the key steps of medication administration for each of the medications used by the

EMT, based on the medication packaging or form: - obtain order from medical direction, select

19 / 71 proper medication, verify the patient's prescription, check the expiration date, check for discoloration, verify the proper form, route, and dose, use the five rights as a final check (right patient, right medication, right route, right dose, right date), document the administration and the patient's response.

57. Describe the reassessment of a patient after the EMT has administered or assisted the patient

in: look for change in condition, repeat vital signs assess for changes in the patient's condition, document improvement or deterioration, be prepared to re administer Narcan if no response to initial dose or not enough.

58. Discuss the physiology of adequate perfusion and the pathophysiology of hypoperfusion

(shock), including the consequences of cellular hypoxia and death.: Shock aka hypoperfusion: is the inadequate perfusion of cells, tissues, and organs with oxygen and other nutrients resulting in cell, tissue, and organ dysfunction. Adequate perfusion: delivery of oxygen, glucose, and other substances to the cells and the elimination of waste products from the cells. Consequences of Cellular hypoxia and death: lower production of ATP and creation of lactic acid. Less ATP results in sodium/potassium pump failure. Cells eventually die from sodium build up in the cell. Acid collected in the blood causes failure of enzyme system and the release of lysozymes that auto digest the cell resulting in cell death and organ death.

59. Describe the features, functions, advantages, disadvantages, uses, and precautions related to

automated external defibrillators (AEDs).: Uses: Perform CPR first until AED is available Advantages: speed of delivery the first shock, hands free defibrillation and more effective, more efficient monitoring.

20 / 71 Functions: delivers electric shock o convert a fibrillating heart to an organized rhythm with a pulse. Semi-automated AED: operator must press button to deliver the shock. Fully automated AED: AED is automatic and does everything except attach device and turn on the device. Disadvantages: Uses: when the heart is in ventricular fibrillation or ventricular tachycardia as well as pulseless, apneic, and unresponsive. Precautions: Don't touch the patient when AED is analyzing, any patient less than 1 year of age should receive controlled energy, 1-8 should be reduced if possible.

60. Given a series of cardiac arrest scenarios involving infants, children, and adults, discuss

appropriate assessment and resuscitative techniques.: Infants: Check for breathing and brachial pulse for less than 10 seconds. Start CPR with 30 compressions and 2 ventilations. 15 /2 for 2 emts. 100 compressions per minute no more than 120. Depth is 1/3 of chest. Apply AED as soon as available. If heart rate is above 60 begin PPV at 12-20 per minute. If below 60 after ventilations and oxygen start CPR. Children: Same as for infants. Adults: same as for children but 30/2 is used with one or two emts. Depth of compressions should be 2 inches. If someone witnessed cardiac arrest apply AED first. Continue chest compressions

21 / 71 while attaching pads then stop and begin analysis. If no shock is advised resume CPR. If Shock is delivered begin CPR for 2 minutes.

61. Identify assessment and management techniques of a post-cardiac-arrest patient with return of

spontaneous circulation.: Identify return of spontaneous circulation ROSC: pulse is felt, patient regains spontaneous breathing, patient begins to move. If breathing is inadequate continue PPV. Provide oxygen at a reduced flow needed to achieve a SpO of 94%. Do not hyperventilate.

62. Define key terms introduced in this chapter: hypoxemia: decreased oxygen in the blood

hypercarbia: increased carbon dioxide in the blood hypoxia: cells are not getting adequate supply of oxygen. acute severe asthma: prolonged life-threatening attack that produces inadequate breathing and severe signs and symptoms. pulsus parodoxus: drop in SBP of 10 mmHg on inhaling. spontaneous pneumothorax: sudden rupture of the visceral lining of the lung not caused by trauma that causes the lung to partially collapse.

63. Define and differentiate between respiratory distress, respiratory failure, and respiratory arrest.:

Respiratory distress: a patient who has difficulty breathing but has adequate tidal volume and respiratory rate. Assessment: adequate tidal volume and respiratory rate that produces an adequate minute ventilation. In an infant or child: retractions, tachycardia, nasal flaring, frequent coughing, anxiety, and increased use of accessory muscles. Respiratory failure: when the tidal volume or respiratory rate is inadequate and can no longer

22 / 71 provide adequate oxygenation of the cells. Assessment: Inadequate tidal volume or inadequate respiratory rate or both In an infant or child: Altered mental status, bradycardia, hypotension (low blood pressure), head bobbing, seesaw breathing, and irregular breathing. Respiratory arrest: complete cessation of breathing effort or agonal breathing Assessment: not tidal volume and no respiratory rate, may have agonal respirations in which there is sudden gasping with ling period of apnea.

64. Discuss the pathophysiology, symptomatology, and management goals of a patient suffering

from an obstructive pulmonary disease.: COPD symptoms: cough, tachypnea, increase in sputum, dyspnea with prolonged expiratory, tripod posture, diffuse wheezing, decreased breath sounds, barrel chest, purse lip breathing. Pathophysiology: In emphysema the walls of the alveoli are destroyed resulting in reduced gas exchange leading to hypoxia and carbon dioxide retention. In chronic bronchitis inflamed bronchioles and mucous restrict airflow to the alveoli causing distress and hypoxia Management: Provide PPV if needed, oxygen, and maintain airway.

65. Discuss the pathophysiology, symptomatology, and management goals of a patient suffering from

cardiogenic and noncardiogenic pulmonary edema: - Cardiogenic Pulmonary edema: rales (crackles), lower extremity edema, dyspnea, tachypnea, tripod posture, hypotension, tachycardia, and potential wheezing. Pathophysiology: occurs when excessive fluid collects in the spaces between the alveoli and the capillaries disrupting gas exchange

23 / 71 Managment: upright position and provide PPV and O2.

66. Discuss the pathophysiology, symptomatology, and management goals of a patient suffering

from epiglottitis, pertussis, cystic fibrosis, poisonous inhalations, and viral respiratory infections.: Epiglottitis: epiglottis becomes swollen and inflamed leading to partial obstruction of the airway. Symptoms: dys- pnea, high fever, sore throat, inability to swallow with drooling, stridor, tripod, and upper respiratory tract infection. Pertussis: aka whooping cough starts as infection then is a rapid cough that disrupts breathing. Symptoms: fever, infection, weakness, severe coughing, and dyspnea. Cystic fibrosis: an abnormal gene causes excess mucous in the respiratory tree. Symptoms: history of disease, thick mucus, clubbing of the digits, dehydration, and weakness. Poisonous inhalations: inhaled dangerous vapors. Symptoms: precense of chemi- cals, stridor, oral burns, seizures, headache, and vomiting. Viral respiratory infections: infections from virus that cause airway obstruction. Symptoms: nasal congestion, scratchy throat, fever, malaise, and tachypnea. Care: PPV and O2. Humidified oxygen helps with cystic fibrosis.

67. Describe special considerations in the assessment and management of pediatric and geriatric

patients with respiratory emergencies: Pediatric: Re- tractions aren't as serious in children because the relay more on the diaphragm and abdominal muscles. Head bobbing, grunting, and seesaw breathing indicates respiratory failure. Have parent hold O2 mask near face if they do not tolerate it. Remove from patient and begin PPV if breathing becomes inadequate. Infants and children require a mask for MDI and SVN. If the airway is partially blocked apply 15 lpm of O2 or blow by O2 and transport.

24 / 71 Geriatric: May not develop a fever or have typical response to hypoxia. Retractions are a serious sign. PPV and O2 for care. For O2 use nasal cannula.

68. Discuss proper assessment and clinical decision making skills regarding treatment plans for

patients when using an assessment-based approach to respiratory distress: Assessment: Form a general impression. Look for tripod position, agitated face, speech, altered mental status, use of intercostal muscles, cyanosis, diaphoresis, nasal flaring, pursed lips, and assess ABCs. Transport asap. Take history, physical exam, and vitals otw to the hospital. If patient is responsive take history with OPQRST. PPV and O2 if breathing is inadequate. O2 if breathing is adequate. Consider ALS backup.

69. Describe the relationships among chest pain or discomfort, heart disease, and cardiac arrest:

Chest Pain as a Warning Sign: Chest pain is often an early warning sign of heart disease. It can indicate that the heart muscle is not receiving enough oxygen due to reduced blood flow, potentially leading to more severe cardiac events. Heart Disease Progression: Heart disease, particularly conditions like CAD, can progress over time. If left untreated, it may lead to complications such as heart attacks, which can further damage the heart muscle. Cardiac Arrest as a Complication: In some cases, cardiac arrest may be a compli- cation of heart disease. A severe heart attack, for example, can disrupt the heart's electrical system and lead to life-threatening arrhythmias, resulting in cardiac arrest.

70. Explain the pathophysiology, symptomatology, and prehospital manage- ment for myocardial

ischemia.: myocardial ischemia: is when there is an inad- equate delivery of oxygen to the heart muscle. angina pectoris is a symptom of inadequate oxygen to the heart muscle. It is caused by blockage of the coronary arteries which causes ischemia that results in tissue hypoxia.

25 / 71 Symptoms: chest discomfort, tightness, aching, crushing in the chest. Pain radiates to shoulders, arms, neck, jaw, or back. Cool clammy skin, anxiety, dyspnea, sweat- ing. Care: PPV and O2 via cannula if needed. Have them rest and if prescribed and SBP is above 90 administer nitroglycerin tablets. If suspected coronary artery occlusion administer aspirin if allowed. If classic angina not relived after rest and 3 nitroglycerin over a 10-minute period suspect acute coronary syndrome. Unstable angina comes with pain that occurs at rest and continues without relief. If it lasts longer than 20 minutes suspect acute coronary syndrome.

71. Discuss the current understanding and guidelines for oxygen administra- tion in a patient with an

acute coronary syndrome: Administer oxygen IF the patient is dyspneic, hypoxemic, has obvious signs of heart failure, has a SpO of less than 94, or the SpO is unknown. Initiate oxygen via nasal cannula at 2 lpm to maintain a 94% SpO if these signs exist. Only maintain at 94 %. Anything more can cause damage.

72. Explain the pathophysiology, symptomatology, and prehospital manage- ment for cardiogenic

shock and hypertensive emergencies: Cardiogenic shock: can happen when the heart no longer can eject blood the heart fails aka heart failure. Cardiogenic shock can result from either ventricle failure. Leading to less oxygen to the cells. Symptoms of cardiogenic shock include dyspnea, tachycardia, orthopnea, waking at night, upright position with arms and legs hanging, edema to the hands and feet, jugular vein distention JVD, and distended abdomen. Care is the same for any cardiogenic emergency. Hypertensive: results from sympathetic nervous system discharge and the release of epinephrine and norepinephrine. Pain causes the discharge and in turn raises the blood pressure. Focus on treating the underlying cause such as ACS or heart failure. Evaluate current blood pressure and compare to normal BP. If elevated possible sign of a heart condition.

73. Explain the indications, contraindications, forms, dosage, administration, actions, side effects,