EMT Final NREMT Study Guide: Essential Concepts and Conditions, Exams of Health sciences

Download EMT Final NREMT Study Guide: Essential Concepts and Conditions and more Exams Health sciences in PDF only on Docsity! EMT FINAL, NREMT STUDY Anaphylaxsis (anaphylactic shock) – Severe allerigic reaction characterized by airway swelling and dilation of blood vessels all over the body, which may significantly lower blood pressure. Pneumothorax – A partial or complete accumulation of air in the pleural space. Most often caused by trauma, if medically it is 'spontaneous' Pleuritic chest pain – A sharp stabbing pain on one side that is worse during inspiration and expiration or with certain movement of the chest wall. Pleural effusion – The collection on fluid outside of the lung on one or both sides of the chest. It compresses the lung or lungs causing dyspnea Embolus – anything in the circulatory system that moves from its point of origin to a distant site and lodges there, obscuring subsequent blood flow in that area. Pulmonary Embolism – A blood clot formed in a vein, usually in legs or pelvis, that breaks off and circulated through the venous system. Common in long term bed rest and damage to the lining of vessels. symtoms: dyspnea, tachypenea, tachycardia, hypoxia, cyanosis, acute chest pain, hemoptysis hemoptysis – coughing up blood Vesicular breath sounds – Normal breath sounds Adventitious breath sounds – decreased, absent or abnormal breath sounds Wheezing – Indicates constriction or inflammation in the bronchus Usually heard on exhalation as a high-pitched whistling sound -asthma or COPD, CHF, pul. edema, pneumonia Crackles (Rales) – Sounds of air trying to pass fluid in the alveoli. Heard on inspiration. High pitched = 'Fine _____' Low pitched ' Coarse _______' -CHF, Pneumonia Rhonchi – Low pitched rattling sounds caused by secretions of mucus in the larger airway. -COPD, Pneumonia, Bronchitis Stridor – High-pitched sound heard on inspiration as air tries to pass through and obstruction in the upper airway. Indicated a partial obstruction of the trachea, foreign body obstruction -Croup, Epiglottitis hypoperfusion – shock Adequate Breathing – 12-20 breaths per minute How to asses respirations – BERT: Breathing, Effort to breath, Rate and Rhythm, Tidal volume Abnormal Breathing Rates – Less than 12 or greater than 20. Prof. notes less than 12 but greater than 30 Ataxic Respirations – irregular or unidentifiable pattern. May follow serious head injury. Kussmaul Respirations – Rapid and Deep respirations. Sometimes seen in diabetes with increased blood sugar Orophyngeal Airway OPA – Airway indications: Unresponsive without a gag reflex. contraindications: Any patient with intact gag reflex Nasopharyngeal Airway NPA – Airway indications: If patient has gag reflex, semi or unconcious, or can't handle OPA contraindications: excessive skull fracture or blood in nose, history of fractured nasal bone. -uses water soluble lubricant Signs of Skull fracure - -Cerenbrospinal Fluid -Raccoon eyes -Battle Signs Blood Pressure Ranges - Newborn: 50-70 Infant: 80-100 Child: 80-100 Adult: 90-140 Hypotension: Males: less than 90 Females: less than 80 Children: less than 70 Respiration Rates - Newborn: 30-60 Infants: 25-50 Children: 15-30 Adults: 12-20 Pulse Rates - Neonate: 120-140 Infant 0-5 months: 90-140 Infant 6-12 months: 80-140 Toddler: 80-130 Preschool: 80-120 School Age: 70-110 Adolescent: 60-105 Adult: 60-100 Croup - Inflammation of the pharynx, larynx, and trachea children 6 months to 3 years -stridor sound Pertussis or Whooping cough - Airborne infection: bacterial Children under 6 years Angina Pectoris - chest pain due to lac of oxygen getting to the heart through the coronary arteries. Goes away with rest in approx. 30 minutes Acute Myocardial Infarction - Pain mean cell death -requires thrombolytic clot buster within first few hours to prevent damage. -not always due to exertion -lasts 30 minutes to hours cons: CHF, Cardiogenic Shock, Sudden Death Hypertensive Emergency - 180+ mmHg -sudden severe headache, altered mental status, pulmonary edema - if untreated it can lead to stroke or dissecting aortic aneurysm tension headaches - due to muscular contraction in head and neck described as a squeezing dull ache Migraine Headaches - Thought to be caused by changes in vessel size to brain -throbbing pulsing pounding -vomiting and nausea proceeded by visual changes - can last hours or days sinus headaches - Sinus congestion, pressure by accumulated fluid Serious signs of Headaches - -Sudden Onset -AMS -Weak immune system -Neurological deficits -Neck Stiffness or pain (meningitis) -Fever -Changes in vision -One-sided paralysis/ weakness Ischemic stroke - -resultant of thrombosis or embolus. -80% if strokes Hemorrhagic Stroke - Cerebral Hemorrhages often fatal - 3 hours after onset of symptoms to help -13% of strokes Transient Ischemic Attack TIA - When the body breaks down embolism or thrombosis -symtoms gone in 24 hours -1/3 of TIA will have a stroke later Signs and Symptoms of Stroke - -Facial Droop -One-side weakeness or paralysis -Lack of muscle coordination -sudden loss of vision - difficulty swallowing - AMS -Speech disorders, slurred (disarthia) -Sudden severe headaches -confusion -dizziness -combative -restless -tongue deviation -coma - incontinence Generalized seizures - Fullbody tonic-clonic seizures - muscle rigidity before seizure Status epilepticus - seizure to postictal to seizure repeating with no recovery -can last 30 minutes or longer Causes of seizures: - Due to: Congenital (born with), Structural (tumor), Metabolic (blood sugar), febrile (child sudden inc. in temp) , epileptic Syncope - fainting AEIOU-TIPS - Alcohol, epilepsy, insulin, overdose, underdose - Trauma, Infection, psychological, stroke Cincinnati Pre-hospital Stroke Scale - FAST: -Facial droop, Arm Drift, Speech, Time Glascow Coma Scale or GCS - Eye opening ( best is 4), Best verbal ( best is 5), Best Motor Response ( best is 6) Type 1 Diabetes - Autoimmune disorder, body makes anti-bodies against pancreatic beta cells symptoms onset: polyeuria (pee), polydipsea (frequent drinking water), polyphasia (freq. eating), weightloss, and fatigue Diabetic Keto Acidosis or DKA - Occurs with fat metabolism in diabetes patients, can result in death -400ml/dL is close to DKA, 80-120ml/dL is normal Type 2 diabetes - body's resistance to insulin Hyper vs. Hypo glycemia - skin tone: hyper- hot/dry hypo- pale/cool, rapid weak pulse 3 signs of anaphylaxsis - Urticardia or Hives, Angioedema, Wheezing Perfusion Triangle - Heart - pump Vessels - container Blood- fluid - distended jugular veins, cyanosis, eyes bleed CPR - 2'' depress, 100bpm, 30:2 ratio Child CPR - 1 rescuer: 30:2 2 rescuer: 15:2 Advanced Airway - intubated: 1 breath per 6-8 seconds Hyperthermia - 101 degrees F or higher Heat Cramps - Muscle Spasms that occur after exercises -leg/abdomin Heat exhustion - loss of water/ electrolytes (hypervolemia) -cool/wet skin Heat Stroke - hot/dry skin, 106 degrees F or more Air Embolisms or The Bends - too rapid ascent from a dive or too long of a dive. decompression sickness Birth Canal - Vagina and Cervix Umbilical cord - 2 arteries and one vein -vein is oxygenated, arteries deoxygenated Amniotic Sac - to insulate and protect the fetus. -500 to 1000ml of fluid Term Gestation - 39 to 40 weeks and 6 days Pregnancy changes - 2nd trimester pushes on diaphram effecting respirations 3rd trimester: increase in vomiting due to fetus pressing on stomach. Increase in demands on heart to support fetus Gestational Diabetes - Diabetes during pregnancy, usually resolves after pregnancy Pre-eclampsia - Pregnancy induced hypertensionn developed after the 20th week of gestation -persistent/severe headache, visual abnormalities, swelling hands/feet, and anxiety Ectopic Pregnancy - embryo develops outside of the uterus -most often in fallopian tubes - 1/300 pregnanacies Spontaneous Abortion - Miscarriage Abruptio Placenta - Placenta separtes abruptly from the wall of uterus. Usually in a trauma Placenta Previa - Placenta blocks cervix Abortion - Induced or Spontaneous, before 20 weeks. May be serious complications due to bleeding and infection, treat for shock abruptly Stages of Labor - 1st stage: onset of contractions and ends when fully dialated. 2nd stage: Fetus to birth canal 3rd stage: birth to delivery of placenta Perineum - space beteen vagina and anus Imminent birth - -how long/ expected due date -First child? -Contractions how long and far apart -Spotting/bleeding -Water broken -Need to push? -Previous C-sections? problems? -Multi-delivery? nuchal cord - Umbilical cord wrapped around baby's neck. -1 or 2 fingers to loop it off. -if not clamp 2 inches apart and cut Clamps ( Umbilical Cord cutting) - 6'' from baby to mom, 2'' distal to another clamp, cut in between APGAR definitintion - appearance, pulse, grimmace or irritability, activity or muscle tone, respirations APGAR Score @ 1 min and 5 min - 1. Appearance: - 2 entirely pink - 1 body pink/hand blue - 0 entire blue 2.Pulse -2 100+ -1 less than 100 -0 Pulseless 3. Grimmace -2 Cries and tries to get away -1 Weak Cry -0 no reaction 4. Activity -2 resist to straighten knees -1 weak attempt -0 Limp 5. Respirations -2 Rapid -1 Slow -0 None best score 10, lowest 0 Breech Delivery - buttocks first -insert 2 fingers to prevent walls of vagina from compressing fetus' airway Limb presentation - Cannot deliver, immediate transport. -cover limb with sterile towel, warm Prolapsed cord - umbilical cord comes out before fetus. Keep fetus' head away from cord Spina bifida - Portion of spinal cord or meninges exposed outside of vertebra Premature - 36 weeks or earlier -or less than 5 lbs Post Term - 42 or more weeks or over 10lbs Patient weight - 250lbs + team lifts 350lbs = bariatric techiniques Emergency moves - immediate danger to you or patient -clothes drag, blanket drag, arm drag, arm to arm drag -one person: grasp under arms, lower down to supine Urgent moves - Altered mental status, inadequate ventilation, in shock -rapid extrication. NO KED Non-Urgent moves - Also known as Standard Moves Relatively Stable patient and scene -direct ground lift, extremity lift Transfer Moves - Direct carry, draw sheet method Patient positioning - -Chest pain : Semi-fowler -Dyspnea: Fowler -W/o: deceased Control zones - HazMat - Hot zone: Hazardous material Warm zone: decontamination center Cold zone: Incident commander, command post Negligence qaulifiers - -Duty to Act -Breech of duty -Due cause harm/injury -Causation Hypoxic Drive - the drive to breath caused by lack of oxygen instead of the need to rid body of carbon dioxide Renal System - Kidneys, Ureter, and bladder - to filter/ and maintain pH balance Liver - Produces bile, and filters toxins from the blood bile breaks down Fats Max suction time - Adults: 10-15 seconds Peds: 5-10 seconds infants: 5 seconds % oxygen in atmosphere - 21% Bag-Valve mask - 15 liters per minute 90-100% Oxygen PSI on a full tank of Oxygen - 2000psi Respiratory conditions from minor to worse - Respiratory Distress, Respiratory Failure, Respiratory Arrest Lung sounds (Auscultation) - Chronic obstructive pulmonary disease or COPD - Chronic Bronchitis, emphysema Chronic Bronchitis - enflamed bronchioles, excessive mucus production. - wet sounds, productive cough Emphasima (chronic) - dry lungs -damage to walls of alveoli, gas exchange suffers -lungs don't expand or contract well -chronic Carbon dioxide retension -wheezing and unilateral lung sounds -albuterol through a MDI Coronary Artery disease - caused by plaque buildup in the walls of the arteries that supply blood to the heart and other parts of the body. Aortic dissection - Aneurysm - tearing from the inside out due to hypertension. Described as a tearing sensation in the back. Cerebrovascular attack or Stroke frequencies - Ischemic (clot) 80%, Hemorrhagic (aneurysm) 20% During an active seizure... - ...Clear area, put patient on their side, protect their head, NPA Sickle Cell Anemia - congestion of blood, die sooner, odd shape, doesn't bind with oxygen well Anaphylactic Shock - Causes vasodilation, bronco constriction EPI Pen - indications: Anaphylactic shock, signs/symptoms of severe allergic reactions -Vasoconstriction, broncho dilation -Intramuscular dose: .3mg Adults, .15mg Peds side effects: tachycardia, tremors, increased Heart Rate. Nausea Patient Appears unresponsive. What do you do? - Level of responsiveness -if unresponsive use CAB -Carotid: 5-10 seconds - Open airway -Breathing..?... BVM -1 breath every 5-6 seconds, 3-5 for peds AED - AED stops V. Tach and V. Fib Endotracheal tube (advanced airway) - compressions at 100 per minute, 1 vent every 6- 8 seconds If an airway is completely obstructed, what do you do? - Abdominal thrusts until patient unresponsive than begin CPR, check airway, 2 breaths, rinse and repeat starting at CPR. Depth for infant compressions - 1.5 inches melena - dark tary stool Hemoptesis - coughing blood hematomesis - vomiting blood, indicating upper GI bleed Treatment of Decompensated shock - Oxygen, keep warm, and supine Tourniquet application - 2-3 inches proximal to injury, not over joint -record time Abdominal evisceration - Place, don't replace. -use sterile moist dressing, dry dressing, than occlusive dressing Critical burn areas - Chest, Face, groin, hands/feet Dealing with liquid chemicals - Remove clothes and irregate eyes- rinse for 20 minutes Dealing with dry chemicals - Dry, brush, irregate Injury to the Face (concerns/ expectations) - Primary concern is the airway -combative behavior -decreased sensory function -unequal pupils epidural hematoma - above duramater, fast bleed Signs of intracranial pressure - Sluggish pupils, posturing -decorticate: flexion -deceribate: extension cerebral contusion - tissue damage Concussion damage - no tissue damage how do you control a bleed on the skull? - Using gentle pressure Stable patient extrication - KED/ short backboard When should you remove a helmet? - Leave it on unless it interferes with breathing/airway Branch Director. Command is: - the act of directing, ordering, or controlling by virtue of explicit statutory, regulatory, or delegated authority. You are implementing tactical activities to achieve the incident objectives. What is the correct title of the ICS organizational element to which you are assigned? - Operations Section Chief Which ICS function records time accounting and procures needed items? - Finance and Administration The Incident Command System (ICS) is: - A standardized approach to incident management that is applicable for use in all hazards. The ability to communicate within ICS is absolutely critical. To ensure efficient, clear communication, ICS requires the use of: - Common Terminology and Clear Text You are working in a complex incident. There are multiple Incident Commanders representing multiple jurisdictions working together to establish incident objectives. What type of ICS structure is being used? - Unified Command At the incident scene, who handles media inquires? - Public Information Officer The major activities of the Planning Section include: - Preparing and documenting Incident Action Plans. Which incident facility is the location where personnel and equipment are kept while waiting for tactical assignments? - Staging area (on a map, the staging area appears as a circle with an S in it) Which Section Chief is responsible for ensuring that assigned incident personnel are fed and have communications, medical support, and transportation as needed to meet the operational objectives? - Logistics Section Chief Which of the following organizational entities within the Operations Section may be used to divide an incident geographically? - Division Who has overall responsibility for managing the on-scene incident? - Incident Commander The Operations Section Chief: - Directs tactical actions to achieve the incident objectives. The Liaison Officer: - Serves as the primary contact for other agencies assisting at an incident. In ICS, the members of the Command Staff assume the title of: - Officer If the Incident Commander designates personnel to provide public information, safety, and liaison services, the personnel are collectively referred to as the: - Command Staff You are a Group Supervisor working in a Branch within the Operations Section. Who is your immediate supervisor? - Branch Director Joint Information Center (JIC) - May be established to coordinate all incident-related public information activities. Serves as the central point of contact for all news media. When possible, public information officials from all participating agencies should co-locate at the JIC. Implied Consent or emergency doctrine - when a person is unconscious or otherwise incapable of making a rational informed decision Expressed consent - the type of consent given when the patient verabally or otherwise acknowledges that he or she wants you to provide care or transport Involuntary consent - assisting patient that are mentally ill, developmentally delayed, or in behavioral crisis. similar to case involving minors in loco parentis - teachers or school officials may act in leu of parent or legal guardian and can give consent to treatment Advance directive - written document that specifies medical treatment for a competent person should they become unable to make decisions Definitive signs of death - -Obvious mortal damage -Dependent lividity -Rigor mortis (2-12 hours) -Putrification (decomp @ 40-96 hours) Scope of practice - commonly defined by state law, and outline the care your are legally able to provide for the patient Negligence - Failure to provide the same car a person with similar training would provide in the same or similar situation -Duty, Breach of duty, damages, causation res ipsa loquitor - An EMT can be held liable if it can be shown that an injury occurred and that it was in conrol of the EMT negligence per se - when the conduct of the person being sued is alleged to have occurred in clear violation of statute. ex if you exceed your scope of practice Kidnapping - If a person is transported against their will False imprisonment - unauthorized confinement of an individual that lasts for an appreciable amount of time. defamation - the communication of false information that damages the reputation of a person Libel - defamation in writing Slander - Defamation that is spoken Good Samaritan Laws - 1. Acted in good faith rendering care 2. Rendered care without expectation of compensation 3. You acted in your scope of training 4. you did not act in a grossly negligent manner Statute of Limitations - time in which a case must be commenced Contributory negligence - legal defense raised when the conduct of plantiff may have contributed to his or her injuries or damages Skin turgor - sign of dehydration in pediatrics Child Abuse - improper or excessive action that injures or otherwise harms a child or infant. Abdominal Aortic Aneurysm - Abdominal pain radiating through to the back with occasional flank pain Kyphosis - forward curling of the spine Osteoporosis - decrease in bone mass decubitis ulcers - ulcers caused by a person sittin in the same position or lying in the same position for a long time