NREMT COGNITIVE EXAM (After you pass your class and forget everything) Questions with Answ, Exams of Nursing

Download NREMT COGNITIVE EXAM (After you pass your class and forget everything) Questions with Answ and more Exams Nursing in PDF only on Docsity! NREMT COGNITIVE EXAM (After you pass your class and forget everything) Questions with Answers 2024 In trauma a low pulse pressure suggests? ✔ Significant blood loss Blood pressure has a direct effect on? ✔ The perfusion of the bodys tissues Cells that die during a stroke are called? ✔ Infarcted cells You are called to a home where a 91 year old man has had a syncopal episode and is vomiting. The caregiver who called 911 stated that the patient's bowel movements have been bright red since yesterday. The patient has not complained of any pain, but is nauseated. What is most likely wrong with this man and which choice includes appropriate treatment steps? Choices: A. He has an upper GI bleed and should be transported sitting up with high flow O2 administered via a non rebreather mask at 15 LPM. B. He has had a TIA and should be given high flow oxygen via NRB and transported on his effected side to the nearest hospital. C. He has pancreatitis and should be given high flow O2 via NRB at 15 LPM. Rapid transport in a left lateral recumbent position while keeping him warm will help avoid shock. D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while t ✔ D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while treating for shock Rationale: The bright red blood in the bowel movements is indicative of a lower GI bleed. Answer 1,2, and 3 all utilize an NRB to deliver high flow O2. Given that the patient is vomiting and nauseated, it would be advisable to use a nasal cannula, rather than an NRB, to help avoid potential airway compromise if the patient continues to vomit. If a patient was feeling nauseated this would likely be a_______________response. If a person was tachycardic it would likely be a___________________ response. ✔ Parasympathetic/Sympathetic You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate? Choices: A. An embolism B. Collapse of the vena cava C. Left ventricular failure D. Right ventricular failure ✔ C. Left ventricle failure Rationale: These are signs and symptoms of a possible failure of the left ventricle. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs. A child between 3-5 would have normal vitals if they were? Choices: A. 35 breaths a minute, pulse of 88, and Systolic BP of 100 B. 24 breaths a minute, pulse of 76, and Systolic BP of 98 C. 20 breaths a minute, pulse of 100, and Systolic BP of 110 D. 20 breaths a minute, pulse of 120, and Systolic BP of 120 ✔ 20 breaths a minute, pulse of 100, and Systolic BP of 110 Rationale: A child between 3 and 5 (preschool-age) should have respirations between 20-30, a pulse of 80-120, and a systolic BP of 80 - 110. (Toddler 12 to 36 months) The pediatric assessment triangle is composed of three elements: Choices: A. Muscle Tone, Respiratory depth and rate, Perfusion B. Circulation, Appearance, Work of Breathing C. Level of Consciousness, Quality of Respirations, General Appearance D. Blood pressure, Pulse rate, Respiratory Rate B. Check for responsiveness, Assess for breathing, Check carotid pulse , put your gloves on C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check D. Turn on power to AED, open the patient's airway, insert an adjunct and then analyze the rhythm ✔ C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check Rationale: Your gloves should be on! According to the NREMT skill sheet one cycle of CPR should be performed prior to attaching AED. Inserting an adjunct is not listed on this NREMT Skill Sheet. Signs and symptoms of Cushing's phenomenon include all of the following except: Choices: A. Hypertension B. Biot respirations C. Tachycardia D. Central neurogenic hyperventilation ✔ C. Tachycardia Rationale: Signs and symptoms of Cushing's phenomenon include: hypertension, bradycardia, irregular respirations, central neurogenic hyperventilation, and Biot respirations. Cushing's triad signs and symptoms are caused by a significant head trauma, also referred to as herniation syndrome. The intracranial pressure increases forcing the brain stem and the midbrain through the foramen magnum. This can be a fatal injury if it is allowed to continue, and can be treated by hyperventilating the patient via positive-pressure ventilations if local protocols allow. What is Cushing's triad? ✔ Includes hypertension, bradycardia and apnea. ... As intracranial pressure continues to increase, the patient's heart rate will increase, breathing will became shallow, periods of apnea will occur, and blood pressure will begin to fall. A man has both legs burned on the front and back, along with the fronts of both arms. Approximately what percentage of his body was burned? Choices: A. 36 percent B. 50 percent C. 45 percent D. 54 percent ✔ C. 45 percent Rationale: Each leg is 18% and the front of each arm counts as 4.5 for a total of 45%. Rapid breathing is first seen in what stage of shock? Choices: A. Decompensated shock B. Compensated shock C. Irreversible ✔ B. Compensated Shock Rationale: A person may breath rapidly in compensated and decompensated shock, but it is FIRST seen in compensated shock. Which list includes only the "Five Rights" of medication administration? Choices: A. Medication, dose, time, route, and documentation. B. Patient, medication, dose, route, and time. C.Patient, medication, indication, dose, and time. D. Medication, dose, generic name, route, and documentation ✔ B. Patient, medication, dose, route, and time Rationale: The "Five Rights" of medication administration are: patient, medication, dose, route, and time. There is also generally an accepted "Sixth Right" which is 'Right Documentation,' or 'Write it Down,' however the NEMSES doesn't reference that "right." Cellular respiration and cellular metabolism are best described as: Choices: A. The exchange of respiratory gases between the systemic capillaries and the surrounding tissue beds B. The exchange of respiratory gases between the alveoli and the pulmonary capillary bed C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by-products D. The use of oxygen to create hemoglobin in the blood stream ✔ C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by products Rationale: Cellular respiration and cellular metabolism is the use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by- products. All of the following are contraindications of oral glucose except: A. Vomiting B. Decreased level of consciousness C. Nausea D. Hypoglycemia ✔ D. Hypoglycemia Rationale: Nausea, vomiting, and decreased levels of consciousness are contraindicated for the use of oral glucose. Hypoglycemia, or low blood sugar, is an indication for the use of oral glucose. Upon making patient contact, you notice a large quantity of prescription bottles on the nightstand next to their bed. Which of the letters in the SAMPLE mnemonic is related to the observation? Choices: A. L B. P C. E D. A ✔ B. P (Past medical history) Rationale: This observation is going to tell you that the patient has some significant PAST medical history. It is associated with the P in the mnemonic. A 73 year old female was in her backyard gardening when she collapsed to the ground. Her husband told 911 that "she is breathing very fast and will not talk to me." You arrive to find the woman lying on her side in the grass. She is breathing at 7 breaths per minute and her pulse is irregular and very thready. Her lungs also present with crackles upon auscultation As you are taking a blood pressure (88/66) the husband tells you that the woman has been having jaw pain and some weakness for approximately 3 days. What is the most likely cause of this woman's condition and how would you treat her? Choices: A. Hypoperfusion B. Cardiac arrest, Treat for shock, and rapid transport C. Cardiogenic shock, Assist ventilations, and transport D.Septic shock, Transport in a position of comfort with high flow O2 via NRB ✔ C. Cardiogenic Shock, Assist ventilations, and transport Rationale: This woman is likely experiencing pump failure and she is hypoperfusing. Her poor respiration rate necessitates assisted ventilations. Transporting in the Fowler's 1. Diaphragm/Intercostal muscles relax which creates a POSITIVE pressure in the thoracic cavity which results in air being pushed out Is exhalation an active or a passive process? ✔ Passive. Rationale: Unlike inhalation, there normally is no muscle contraction to exhale air. What drive is responsible for breathing control? What is the backup system? ✔ Carbon Dioxide Drive is our body's primary mechanism for breathing control. Increased CO2 levels will stimulate the body to increase the respiratory rate. As a backup, the Hypoxic Drive will stimulate breathing when O2 levels are sensed. What is the role of surfactant within the lungs? ✔ Think of surfactant as a lubricant in your lungs. Surfactant reduces surface tension inside of the alveoli. By doing this, gas exchange can take place because the presence of surfactant in the alveoli keeps them open. What is the normal rate of breathing in adults? ✔ 12 to 20 breaths per minute What is the normal rate of breathing in children? ✔ 15 to 30 breaths per minute What is the normal rate of breathing in infants? ✔ 25 to 50 breaths per minute What are four causes of an airway obstruction? ✔ 1) The tongue (most common) 2) Edema (swelling) 3) Fluid (vomitus, blood, mucous) 4) Foreign bodies (anything put into the mouth) What does a pulse oximeter measure? ✔ The pulse rate and the oxygen saturation of hemoglobin within arterial blood. What are 3 possible causes of getting an incorrect pulse oximeter reading? ✔ Nail polish Cold extremeties Carbon monoxide poisioning Tachypnea ✔ Rapid breathing Bradypnea ✔ Slow breathing Wheezing ✔ high-pitched whistling sound of air moving through narrowed airways Rales ✔ "wet" or "crackling" sounds Stridor ✔ High pitched sound from an airway obstruction Hypoxia ✔ Inadequate oxygen delivery to the cells Visceral pleura ✔ Membrane that covers the outside of each lung Parietal pleura ✔ Membrane that lines the inside surface of the chest cavity Describe two methods for opening the airway of an unconscious patient. When would you use one over the other? ✔ Head tilt chin lift (best choice/preferred method). Tilt the forehead back while lifting the chin. Jaw thrust maneuver (use for suspected cervical spine injury/trauma patient) Physically push the angle of the lower jaw (mandible) up. How do you correctly size an OPA and NPA prior to use? ✔ OPA - measure from the corner of the mouth to the earlobe NPA - measure from the tip of the nose to the earlobe What are the steps to suctioning an adult patient? ✔ - Prepare equipment - Test equipment - Insert suction catheter into oropharynx only as far as you can see - Apply suction while withdrawing the catheter - Suction for no more than 10-15 seconds - Rinse the suction catheter after use Match the following oxygen cylinder sizes with their capacity: D, E, M. 1) 350-Liter 2) 625-Liter 3) 3,000-Liter ✔ Amount of oxygen when full D= 350 Liters E= 625 Liters M= 3,000 Liters What is the purpose of a regulator on an oxygen bottle? ✔ The pressure regulator on an oxygen bottle is responsible for taking the high pressure within the bottle down to a more manageable and controllable pressure. For example, for use with a nasal cannula. When a patient has COPD and is having trouble breathing, what is going on in their body? ✔ When they take a breath, air is "trapped", preventing the patient from completely exhaling. What is COPD? ✔ COPD is a chronic inflammatory lung disease that causes obstructed airflow due to collapsed alveoli, mucous, or narrowed passages within the lungs Chronic bronchitis and emphysema are two chronic conditions that contribute to COPD. What is the difference between the two? ✔ Chronic bronchitis - inflammation of the lining of the bronchial tubes. The body responds by decreasing ventilation and increasing cardiac output. The patient is commonly known as a "blue bloater" due to cyanosis and edema. Emphysema - most often the cause of cigarette smoking, the alveoli at the end of the bronchioles are damaged. This results in less area for gas exchange to occur, which the body responds to by increasing ventilation and decreasing cardiac output. These patients are commonly referred to as "pink puffers". Blue bloater vs. Pink puffer ✔ Chronic bronchitis is blue bloater because they have insufficent oxygenation that leads to hypoxemia and causes them to be cyanotic Emphysema patients take in suffienent o2 but they are retaining C02 so they are pink, and they are using accessory muscles to breath which causes barrel chest or "puffer" look Pneumonia is an infection within the lungs. What causes shortness of breath in a patient with pneumonia and how is it different than emphysema? ✔ Pneumonia is most often caused by a bacterial or viral infection within the lungs. This produces an inflammatory response that causes fluid buildup in the alveoli, and prevents oxygen from efficiently diffusing to the blood. With emphysema, the alveoli are collapsed and damaged. This is a chronic condition while pneumonia can occur rapidly, but both have very similar signs and symptoms. ✔ Cyanosis is the bluish or purple coloration of the skin or mucous membranes. Cyanosis occurs when the blood in the body does not carry enough oxygen. This lack of oxygen in the blood can be due to an airway obstruction, lung disease, or hypoventilation/apnea. Explain what pulse oximetry is? ✔ Measures the amount of oxygen that is bound to hemoglobin in the blood, also known as the oxygen saturation. How do bronchodilators help respiratory patients? Give an example of one you would use in the field. ✔ Dilate the bronchi and bronchioles which decreases resistance in the lower airway and increases airflow to the lungs. Albuterol What is the correct sequence of assessment for an unconscious/unresponsive patient and why? ✔ C-A-B. Circulation, Airway, Breathing. Circulation is emphasized as the first thing to assess because it poses the greatest life- threat. The goal is early intervention with compressions and defibrillation (if indicated). In a conscious patient, we still use the traditional method of assessment, A-B-C. What is the correct compression/ventilation ratio for 1-rescuer and 2-rescuer CPR with no advanced airway in place? ✔ 1-rescuer is 30:2 - 2-rescuer is 30:2 In a children and infant, the 2-rescuer ratio is 15:2, but otherwise stays the same. What is the proper compression rate during CPR? ✔ 100-120 bpm What is the proper depth of compressions in adults? ✔ At least 2 inches What is the proper depth of compressions in children? ✔ At least 1/3 the depth of the chest. About 2 inches. What is the proper depth of compressions in infants? ✔ At least 1/3 the depth of the chest. About 1.5 inches. Why is allowing the chest to recoil during CPR critical to survival? ✔ During recoil, the heart is filled with blood before being compressed and circulated to the body/brain. Without proper recoil, the heart doesn't fill and the brain isn't properly perfused. What is the maximum amount of time that chest compressions should be interrupted during CPR? ✔ 10 seconds With an advanced airway in place, what is the proper ventilation ratio during CPR? ✔ 1 breath every 6 seconds. 10 breaths per minute. When first coming across an adult patient in cardiac arrest, when should the first defibrillation be delivered? ✔ Perform CPR until the pads are attached then perform defibrillate immediately. Which two heart rhythms are considered "shockable" rhythms? ✔ - Ventricular fibrillation - Pulseless ventricular tachycardia Bystanders performed 5 minutes of CPR before you arrived. You took over compressions and defibrillation victim. What would be your next action to take? ✔ Perform 2 minutes of CPR and then a rhythm check Use the following terms, describe the flow of blood through the body: Atrium, ventricle, arteries, veins, aorta, pulmonary artery, pulmonary veins, capillaries, vena cava, arterioles. ✔ 1.Unoxygenated blood (this is the blood that has been "used up" by your body and needs to be resupplied with oxygen) enters the heart through the SUPERIOR AND INFERIOR VENA CAVA 2. Blood enters into the RIGHT ATRUM 3. Then it squeezed through the TRICUSPID VALVE 4. Blood then enters into the RIGHT VENTRICLE 5. Then it squeezed into the PULMONANIC VALVE 6. Blood is then shot up through the PULMONARY ARTERY and then enters the LUNGS for some oxygen Since the goal of the right side is to get blood to the lungs always remember that the pulmonic valve and the pulmonary artery will be on the right side since it is associated with the lungs 7. Blood enters from the lungs through the PULMONARY VEIN 8. Blood then enters the LEFT ATRIUM 9. Down the BISCUPID VALVE (also called MITRAL VALVE) 10. Then blood is squeezed into the LEFT VENTRICLE 11. After leaving the left ventricle blood is squeezed up the AORTIC VALVE 12. Lastly up through the AORTA where blood is pumped throughout the body 13. Arteries branch off into 14. arterioles 15. capillaries 16. veins What is the difference between systolic and diastolic blood pressure? ✔ Systolic blood pressure - the pressure in the blood vessels while the heart is contracting. Represented as the top number of a blood pressure (i.e. 120/80 mmHg). Diastolic blood pressure - the pressure in the blood vessels while the heart is at rest. Represented as the bottom number of a blood pressure reading (i.e. 120/80 mmHg) What are two important roles of red blood cells? ✔ - Transport oxygen to the cells - Transport carbon dioxide to the lungs What are 7 signs of cardiac compromise? ✔ 1) Abnormal blood pressure 2) Pain, pressure or discomfort in the chest or abdomen 3) Shortness of breath 4) Palpitations 5) Anxiety and/or irritability 6) Abnormal pulse 7) Sudden onset of nausea/vomiting Auscultation of the lungs reveal crackles and the patient is having difficulty breathing. Which side of the heart do you believe to be affected and why? ✔ Shortness of breath with crackles in the lungs is indicative of left-sided heart failure. The failure of the left ventricle to effectively pump blood to the body causes the blood to back up, or be congested, in the lungs. Right sided heart failure causes blood to back up into the body, causing pitting edema through the body. Whats the cause and what is another name for this condition? ✔ Cor pulmonale. The usual cause is pulmonary disease, such as pulmonary hypertension or pulmonary stenosis (obstruction within the pulmonary artery). 6. Left-lateral recumbent ✔ 1) Lying flat on the back 2) Lying flat on the stomach 3) Lying supine with the legs elevated 4) Sitting or standing, leaning forward with hands on knees or another surface 5) Sitting upright at 90 degrees, with legs extended 6) Lying flat on the left-side of the body THIS SLIDE IS BACKWARDS FLIP IT OVER!!! 1) Femur 2) Fibula 3) Tibia 4) Humerus 5) Patella 6) Mandible 7) Cranium 8) Ulna 9) Radius 10) Phalanx ✔ Name the major bones of the body found on this image ;) What is the largest organ in the body and what are its three major layers? ✔ Skin Epidermis Dermis Subcutaneous What two parts make up the nervous system? ✔ Central nervous system/Peripheral Nervous System What does the central nervous system consist of? ✔ brain and spinal cord What does the peripheral nervous system consist of? ✔ Motor and sensory functions What are the three main types of joints in the body and provide examples of each. ✔ Ball and socket - femur and the pelvis Hinged - ulna and the humerus Pivotal - atlas (C1) and the axis (C2) THIS CARD IS REVERSED FLIP TO STUDY!!! 1) Mandible 2) Maxilla 3) Nasal bone 4) Frontal bone 5) Temporal bone 6:) Parietal bone 7) Zygomatic bone 8) Sphenoid bone ✔ Label the major bones of the skull in the numbered diagram Describe the ten major systems of the human body: Cardiovascular, Digestive, Endocrine, Integumentary, Respiratory, Reproductive, Skeletal, Nervous, Renal, and Lymphatic ✔ 1) Cardiovascular: Delivers oxygen and nutrients to the major organs and cells of the body while also removing waste via the heart (pump), arteries, and veins. 2) Digestive: This is also known as the excretory system and its major role is eliminating waste from the body. The digestive system also is what provides us the ability to take in and process nutrients 3) Endocrine: Through the use of hormones, the endocrine system allows the body to communicate with itself. Think of hormones as chemical messengers. 4) Integumentary: Protection of the internal organs and thermoregulation from the environment. 5) Respiratory: Responsible for bringing oxygen and air into the body so that it can be transported throughout the body. 6) Reproductive: This is comprised of the major sex organs that aid in the production of offspring 7) Skeletal: Provides support, protection, and facilitates movement through the use of bones and muscle 8) Nervous: Sends and receives sensory information through neural pathways between the brain, spinal cord and muscle. 9) Renal: Responsible for eliminating waste, regulating blood pH and blood volume, and controlling electrolyte levels. 10) Lymphatic: This is the body's defense system against disease THIS CARD IS REVERSED PLEASE FLIP TO STUDY: ✔ Label each quadrant and list two organs that are contained with each. The spinal column is comprised of how many total vertebrae? How many of each type are there? ✔ The spinal column is composed of 33 vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused vertebrae in the sacrum, and 3-5 fused vertebrae in the coccyx. Define the different types of pain: Visceral, somatic, referred ✔ Visceral Pain - This is the type of pain that stems from the stretching of structures, ischemia(inadequate blood supply to organs), and/ or inflammation affecting the internal organs. Somatic Pain - This type of pain refers to the pain that is caused by damage or injury to the integumentary or skeletal systems, ie skin, bone, nails, muscle, or connective tissue. Referred Pain: Pain that is felt in one part of the body, but is actually coming from a different source. What is a hormone? ✔ Hormones are chemical substances found in the body that control certain functions of the bodies organs and tissues. Hormones play a major role in helping the body maintain homeostasis. What is the difference between type "1" and type "2" diabetes? ✔ Diabetes is a condition where the body is unable to produce the hormone insulin, or the body is unable to respond to it. Type 1 - The body makes little or no insulin. Often diagnosed at an early age. Type 2 - The body still produces insulin, but the body is unable to respond to it properly because of insulin resistance. Often diagnosed after the age of 40. Define the following terms associated with diabetes: Polyuria Polydispia Polyphagia ✔ Polyuria - Frequent urination Polydipsia - Frequent thirst or frequent drinking Polyphagia - Frequent eating What is the normal range for a capillary blood glucose reading in an adult patient? ✔ 80 - 120 mg/dl (can be slightly higher or lower based on whether the patient has just eaten or been fasting) Diabetes inspidus differs from diabetes mellitus in what way? ✔ In diabetes insipidus there is a missing hormone that controls the reabsorption of urinary fluid. These patients end up having excessive urination, more than diabetes mellitus patients. When should you withhold administration of oral glucose in the hypoglycemic patient? ✔ When they have a change in their level of consciousness. The last thing you want to have happen is aspiration of the medication. Ensure your patient has a patent airway and can swallow without difficulty prior to administering the medication. What is diabetic ketoacidosis? ✔ 1. E 2. B,D 3. C,G 4. A,F What is Septic Shock and how do people get it? ✔ Septic shock is a type of distributive shock. People develop septic shock when they have an infection that gets into the bloodstream and spreads throughout the body. When the immune system becomes overwhelmed from the infection, the body produces substances the cause vasodilation (widening of blood vessels) and decreased cardiac output. What does nitroglycerin do to help treat cardiogenic shock? ✔ Nitro relaxes smooth muscle and dilates coronary arteries so that more oxygen rich blood flow can get to the heart What is toxicology? ✔ Toxicology is the study of the adverse affects that chemicals or poisons have on the body. It includes the symptoms, mechanisms of action, detection, and treatment of poisons that are found in nature or synthetically made in the form of drugs. What is pharmacokinetics and what are the 4 processes involved? ✔ Pharmacokinetics refers to what happens to a substance from the time it enters the body, to the time it exits the body. The 4 processes of pharmacokinetics are absorption, distribution, metabolism, and clearance of a substance. How does Carbon Monoxide poisoning affect the body? ✔ Carbon monoxide is a gas that enters the body via inhalation. CO has a higher affinity to hemoglobin than oxygen, meaning it binds to the red blood cells better than oxygen does. For this reason, CO saturates the red blood cells and prevents oxygen from getting transported to the cells. This eventually leads to hypoxia, as the cells of the body become deprived of the necessary oxygen levels. How do you treat CO poisoning? ✔ Treatment of CO poisoning in the field requires removing the patient from the toxic environment and supplying a high concentration of oxygen in an attempt to displace the CO molecules from the hemoglobin. What should you do if you get a call for a child who ingested a toxic substance you have never heard of? ✔ In any situation where someone has ingested a toxic substance you don't know of, you should call the Poison Control Center at 1-800-222-1222. The Poison Control Center is a medical facility that provides immediate treatment advice via the telephone and can give you specific information about how to treat your patient based on the substance they ingested. What is toxidrome? List all 5 toxidromes ✔ A toxidrome is a set of signs and symptoms or characteristic effects that are associated with a certain category of substance or poison. - Cholinergic toxidrome - Anticholinergic toxidrome - Sympathomimetic toxidrome - Narcotic toxidrome - Sedative/Hypnotic toxidrome You find a patient who is unresponsive, has a very slow and shallow respiratory rate, and pinpoint pupils. What toxidrome fits the patients presentation? How would you treat this patient? ✔ Based on the patient's presentation, he has likely taken some form of drug from the narcotic toxidrome, which depresses the central nervous system. Treatment of this patient would require aggressive airway management and ventilations as well as a dose of Naloxone to counteract the opiate. What does SLUDGE stand for and what are the symptoms associated with? ✔ SLUDGE is an acronym for the signs and symptoms that someone would present with if they have organophosphate poisoning, which is a cholinergic toxidrome. S- Salivation L- Lacrimation (tears) U- Urination D- Defecation G- Gastrointestinal upset (diarrhea) E- Emesis (vomiting) How do the drugs in the sympathomimetirc toxidrome affect the body and what the signs and symptoms of this toxidrome? ✔ Sympathomimetic drugs produce physiological effects that mimic the sympathetic nervous system. This is the same system that is responsible for the fight or flight response. Drugs in this toxidrome are methamphetamines, amphetamines, and over the counter drugs that contain epinephrine. Signs and symptoms associated with these drugs include hypertension, tachycardia, dilated pupils, agitation, and seizures. What are the 4 routes of absorption and give an example of each one? ✔ Ingestion- Swallowing medications Injection- Snake bite Inhalation- CO poisoning Absorption- Pesticides What is the difference between a local reaction to a bee sting and a systemic reaction? ✔ A local reaction will typically present with pain, redness, and swelling around the site. A systemic reaction can result in anaphylaxis and can affect the entire body, causing dyspnea, wheezing, hypotension, and eventually shock. You are called to the scene of a 30 year old male who has overdosed on an unknown medication. You arrive to find the man laying unconscious on his bed with an empty bottle of pills next to him. How would you be able to estimate how many pills the patient may have ingested? ✔ To figure a rough estimate of how many pills someone has taken, look at the pill bottle fill date and the number of pills originally in the bottle. This information should be labeled clearly on the bottle. If the fill date was very recent and the bottle is empty, you can assume the patient took most, if not all of those pills at once. If the fill date was a long time ago, they may not have taken as many. What people in society are at the greatest risk for being victims of abuse or neglect? ✔ People who are at greatest risk of abuse or neglect are those that are dependent on others for their basic needs. This includes children, dependent elderly and adults with cognitive or emotional impairments. What is neglect and what are the 5 types of neglect? ✔ Neglect is a form of mistreatment in which a person responsible for the well-being of another, fails to provide care for that person, resulting in harm. The 5 types of neglect are: - Physical neglect - Emotional neglect Abandonment - Financial neglect - Self neglect What socioeconomic factors play a role in the likelihood of abuse within a family? ✔ Financial struggles Divorce Single parenthood Substance abuse What does bariatric mean and what are 4 complications when treating bariatric patients? ✔ Treatment and management of people with obesity. 1) Airway management(patients have larger tounges and minimal neck mobility which makes opening the airway/inserting an airway difficult) 2) Difficult to ventilate when lying supine because of the accessive weight on their chest 3) Transporation 4) Equipment failure (blood pressure cuffs or standard stretchers) What are 3 reasons why some people have tracheostomy tubes and how do they function? ✔ Some patients require tracheostomy tubes if they need long-term ventilatory support or if they require airway protection due to various medical conditions. Some of these reasons can be due to: What is the difference between a mobile and portable radio? Hint: Do not think cell phones/ Think mobile like a car ✔ A portable radio is handheld with limited range. A mobile radio is usually vehicle mounted and has a much larger range. What is a repeater used for? ✔ It increases the range of both portable and mobile radios. It takes low voltage transmission and broadcasts them at a higher power. Is a cellular phone a simplex or duplex radio system? ✔ Duplex. The cellular phone can receive and transmit at the same time, using two separate channels. What are 3 advantages of a Mobile Data Computer? ✔ 1) Reduce the amount of radio traffic 2) Displays address and call information 3) Allows for off-air communication between other units and dispatchers. When speaking on the radio, how should you begin your transmission? ✔ Who you're talking to, and then who you are. For example: "Main street command from medic one". What information is typically provided from dispatch when responding on an emergency call? ✔ Address. Nature of the emergency. The triaged priority of the call (code 1 or code 3). Symptoms relayed from the caller. Hazards. Need for police or staging. For effective and accurate information what should be done after you receive orders over the phone or the radio? ✔ Acknowledge and summarize the information. This ensures that what they said was conveyed accurately. Are protocols considered "Off-line" or "On-line" medical control? What is the difference between the two? ✔ Protocols are off-line medical control. They are a set of standing orders that a medical doctor has approved. On-line medical direction would be direct orders received by radio or telephone from a medical doctor. What is a scope of practice? ✔ It is an outline of the actions and procedures a provider is legally allowed to perform. Although there is a national curriculum, each state defines their own scope of practice. What is assault and give an example how it would relate to you as an EMT? ✔ 1) The threat of bodily harm to someone else that causes fear - you threaten to hit your partner if they don't stop talking What is battery and give an example of how it would relate to you as EMT? ✔ Physical harm caused to someone else - you physically hit your partner after they kept criticising you What is abandonment and give an example of how it relates to you as an EMT? ✔ Discontinuing care without assuring that someone of equal or higher expertise/certification is taking over - you take your patient to the hospital and leave them in the waiting room without transferring care to a nurse What is negligence and give an example of how it relates to you as an EMT? ✔ The EMT had a duty to act. They breached that duty. Harm was caused to the patient as a result of breaching their duty. - you were supposed to replace the oxygen tank when it was empty, but you forgot and went to lunch instead. On your next call, the patient needed oxygen and went unconscious because it wasn't available. What is defamation and give an example of how it relates to you as an EMT? ✔ Written or spoken false communication that damages someone's reputation - you post an untrue story on the office bulletin board about a co-worker not being able to perform their job What is libel and give an example of how it relates to you as an EMT? ✔ WRITTEN defamation - you write something defamatory on social media What is slander and give an example of how it relates to you as an EMT? ✔ SPOKEN defamation - you tell your partner that your boss never went to paramedic school, which isn't true. What is an emancipated minor? Can they give consent? ✔ Emancipated minors have been legally freed from their parent's/guardian's care and control before they reach the age of majority (usually 18 years of age). They assume full responsibility for their own care and can consent to treatment. What is the difference between expressed and implied consent? ✔ Expressed consent is when a person gives spoken or written permission to someone else to render care (i.e. a patient is having chest pain, calls 911, and asks for an ambulance to come help her). Implied consent is not expressly granted, but occurs based on the circumstances (an unconscious victim at the scene of a motor vehicle collision). You are treating a patient with a large laceration on the leg. Bleeding is uncontrolled but they tell you they dont want your help. Are you able to help them? Why? If they go unconscious from their injury, can you help them? Why? ✔ - No. If the patient is competent and correctly oriented, they are legally able to refuse care. - Yes. Based on implied consent, you can assume that a competent person would want care to prevent them from further injury. What is an advanced directive? ✔ Advanced directives, such as, living wills, Do Not Resuscitate (DNR) forms, or POLST forms, are written instructions outlining the patient's wishes regarding resuscitation and medical care in case they were incapacitated. What goes into determining whether or not a person is competent to make their own medical decisions? ✔ If the person conscious, alert, and oriented to who they are (person), whey they are (place), the date and time (time), and their current circumstances (event). Other factors include being of legal age, communication barriers, and drug or alcohol impairment. You are treating a 39 year old male who was involved in a motor vehicle accident. His car suffered significant damage and he was able to self-extricate. He complains of a headache, is slurring his words, and appears to be intoxicated, but he does not consent to treatment and asks that you leave. He is conscious and alert, and oriented to person, place, time, and event. Can this patient give consent for refusal? ✔ No. Although he is conscious, alert, and correctly oriented, he is unable to consent to a refusal because of his intoxication and/or possible head injury. What is HIPPA and how does it affect healthcare providers? ✔ Health Insurance Portability and Accountability Act. It's a federal law that was established to protect the privacy of patient health care records. It dictates how their information can be exchanged and who has access to it. What are 3 instances where you are allowed to release confidential patient information? ✔ - For the purpose of patient billing - For continuity of care (i.e. giving information to a nurse at the hospital) - To report a crime of abuse, neglect, assault, etc. What considerations should be taken when establishing a landing zone? ✔ - The size should be 100 feet by 100 feet, on firm, level ground. - Loose debris should be moved or weighted down. - Tree, power lines, or other overhead obstructions should be avoided and if necessary, need to be communicated to the pilot. - Radio communication should be maintained between the pilot and someone on the ground. Only emergency traffic should be communicated during landing and takeoff. - At night, light the four corners of the landing zone, but ensure that the lights to not shine directly into the sky. What do the four sections of the NFPA placard represent? ✔ Blue - Health hazard Red - Fire hazard Yellow - Reactivity L- Last oral intake E- Events preceding What is OPQRST and when is it used? ✔ OPQRST is also a mnemonic for remembering what questions to ask. It is typically used to gain information about a persons pain, such as chest pain. O- Onset (gradual or rapid) P- Provocation (Does anything make it feel better or worse?) Q- Quality (What does the pain feel like?) R- Radiate (Does the pain move anywhere?) S- Severity (Pain scale 1-10) T- Time (How long ago did the pain start?) What are two techniques for obtaining sensitive information from a patient? ✔ Ask the patient questions in privacy away from other family members or bystanders. If you need to, ask people to leave the room or bring the patient into the ambulance where they will feel more comfortable talking. Ensure the patient that you are a medical professional and the information they give you will be kept confidential. Explain to the patient that accurate information is important for proper treatment. How do you obtain a history from a pediatric patient? ✔ It is always important to try and include the child in the history taking process to build trust, but understand that the most reliable information will likely come from a parent or caregiver. Gather information about the child's behavior as well as family history and look for signs of abuse. What are some ways to communicate and obtain history from a deaf patient? ✔ If the patient is hard of hearing, you can allow them to wear your stethoscope and speak into it to amplify your voice. Many people who are deaf are very good at reading lips, so be sure to communicate face-to-face and speak slowly. You may also communicate by writing questions on paper. Be sure to let the receiving facility know the patient is deaf so they can have a sign language translator available. What are some complications you might encounter while trying to obtain a history from geriatric patients? ✔ In many cases, obtaining history form geriatric patients may be difficult because their symptoms are non-specific or they have multiple unrelated symptoms. They may have complicated histories due to co-morbidities and obtaining a history may take a long time, which can be a real challenge with short transports. What is the purpose of the primary assessment? ✔ The purpose of the primary assessment is to identify and manage any life- threatening issues to a patient's airway, breathing or circulation, within the first 60-90 seconds. Identification of these issues in a timely manner is crucial for the outcome of the patient. What is a general impression and when do you form it? ✔ The general impression is your basic opinion of how the patient is doing based on their chief complaint and how they are presenting. The general impression is typically formed as soon as you see the patient, and is often referred to as the "view from the front door." With your general impression, you should be able to determine if the patient is sick or not sick. What is one way to assess a patients level of consciousness? ✔ A common method for assessing level of consciousness is the use of the AVPU scale where: -A stands for alert, meaning the patient is aware of his or her surroundings and responds to you appropriately -V stands for verbal, meaning the patient does not appear alert but responds to verbal stimulation -P stands for pain, meaning the patient only responds to painful stimulation such as a sternal rub -U stands for unresponsive, meaning the patient does not respond to any of the previous stimuli. What is the difference between opening the airway of an unresponsive medical patient as opposed to an unresponsive trauma patient? ✔ When opening the airway of an unresponsive medical patient, use the head-tilt, chin- lift maneuver. For an unresponsive trauma patient, you want to use the jaw-thrust maneuver, which allows you to open the patient's airway without bending their neck so that you can maintain C-spine immobilization in case the patient has a spinal cord or neck injury. How can accessing a childs airway lead to obstruction? ✔ Children have very small, non-rigid airway structures compared to adults. Improper positioning while assessing the airway can cause the trachea to collapse or become occluded during position changes. If repositioning the airway does not work, what other options are there to maintain the airway? ✔ Use of a nasopharyngeal adjunct (NPA) or oropharyngeal adjunct (OPA) should be used. The OPA is inserted into the oropharynx and prevents the tongue from occluding the airway. The NPA is inserted into the nasopharynx and is beneficial for when the OPA is not tolerated due to the patient's gag reflex. Name 5 anatomical differences that pediatric patients have as opposed to adults? ✔ 1) Head is larger in proportion to their body 2) Airway structures are generally smaller 3) Bones are softer and more pliable 4) Respiratory rates are much faster than adults 5) Their tongue is proportionately large What is a fontanelle and how do you assess it? ✔ The fontanelle is the "soft spot" found in patients from birth to 18 months of age. When assessing, look for a flat surface when the child is not crying. It is normal for the fontanelle to bulge when the patient is crying and upset. If you find that the fontanelle is sunken, it can be an indication that the patient is dehydrated. If you have a trauma patient with a bulging fontanelle, this can be an indication of increased intracranial pressure. THIS CARD IS REVERSED FLIP IT OVER TO STUDY!! 1) Perimetrium: thin layer of epithelial cells than surround/envelop the uterus 2) Myometrium: this is the smooth muscle layer of the uterus 3) Endometrium: lining of the uterus 4) Fundus of Uterus: the top portion of the uterus 5) Ovary: produces the ova 6) Cervix: the narrow passage forming the lower end of the uterus 7) Vagina: also known as the birth canal, provides lubrication and sensation 8) Uterus: a hollow muscular organ that houses the development of offspring ✔ Label the following diagram and explain the significance/role of each structure: What components make up the Pediatric Assessment Triangle? ✔ 1) Apperance 2) Work of breathing 3) Circulation. The PAT is a rapid assessment tool based on your general impression of the patient when you first walk in the room. It shouldn't take more than a few seconds and is used to determine a critical patient. What additional questions should be asked of a pregnant patient? ✔ - Are you pregnant and if so, what's the due date? - Have you been receiving prenatal care? - Are you expecting multiple births (i.e. twins)? - Has this been a normal pregnancy up until this point? - Have you been told that this was going to be a complicated birth? - Do you have any previous children and how were they delivered (i.e. vaginal, cesarean)? - Do you have any abdominal pain or vaginal bleeding? - Are you having contractions? How long do they last? What is the time in between contractions? Describe the 3 stages of labor: ✔ First Stage: This stage begins when the mother starts having contractions and ends when the cervix is completely dilated Second Stage: Starts when the child enters the birth canal and ends when they are born is called when the mother has a seizure and this is a true emergency. The fear is that blood flow will be reduced to the placenta and cause harm to the fetus. What is Nuchal Cord and why is it an emergency? ✔ Nuchal cord occurs when the umbilical cord has wrapped itself around the newborn's head. Most often, it can be slipped over the head and if needed, can be clamped and cut in place. The fear is that the cord can become compressed, cutting off the blood supply to the newborn. What is the normal blood loss during childbirth? ✔ 300-500 mL What is a Prolapsed Cord and why is it an emergency? ✔ A prolapsed cord is when the umbilical cord proceeds the fetus into the birth canal. The fear is that the cord can become compressed between the infant's head and the birth canal, reducing blood flow to the baby. Define: Placenta Previa ✔ The placenta attaches to the uterus close to or over the cervical opening Define: Abruptio Placenta ✔ The placenta separates from the uterine wall Define: Uterine Rupture ✔ A tear in the wall of the uterus Define: Ectopic Pregnancy ✔ The egg is implanted outside of the uterus, most often in the fallopian tube What are the 3 types of breech presentations and how do they differ? ✔ The three types are Frank, Incomplete, and Complete. Frank breech: A presentation where the legs are extended upwards towards the face and the buttocks are presenting. Incomplete breech: One or both legs are flexed and often presents with a foot. Complete breech: Has both legs flexed and the buttocks presenting. How do you manage a breech birth in the prehospital setting? ✔ 1) If birth is imminent prepare the mother by assisting her into an appropriate position for delivery and draped. 2) Administer Oxygen as needed and place an IV if it is in your scope. 3) Allow the delivery of the legs and support with your palm and arm until the umbilicus is visible. 4) Then attempt to extract 4-6 inches of umbilical cord to keep it from pulling as the infant is delivered. 5) When the arms come into view gently guide downward to deliver the posterior shoulder and 6) Then upward to deliver the anterior shoulder. 5)The head should then deliver, if it does not do so easily and rapidly make a v with the index and middle finger and place on either side of the nose to enable the infant to breathe and rapidly transport. 5) A second rescuer can attempt to apply suprapubic pressure to deliver the head. What is shoulder dystocia and how do you recognize it? ✔ A shoulder dystocia is when the fetal shoulder is wedged against the mothers pubic symphysis. This allows the head to deliver but not the shoulders and can be recognized when the head continues to advance slightly with pushing, but then retracts again at the end and no advancement is made overall. This is also called the turtle sign. What is another term for the turtle sign/what does it mean? ✔ Shoulder dystocia: When the fetal shoulder is wedged against the mothers pubic symphysis. What is the pubic symphysis? ✔ Pubic symphysis. The pubic symphysis is a secondary cartilaginous joint (a joint made of hyaline cartilage and fibrocartilage) located between the left and right pubic bones near the midline of the body. How do you manage a shoulder dystocia in the field? ✔ You can attempt to deliver the shoulder by positioning the mother on her left side with her knees to her chest. Then try to guide the infants head downward to try to let the anterior shoulder deliver. Then attempt to rotate the shoulders at an angle to allow the posterior shoulder to deliver. What is a shoulder presentation and how do you manage it in the field? ✔ A shoulder presentation means that the shoulder is overlying the opening and a hand or arm may be presenting. This cannot be delivered in the field and requires a cesarean section. Place the mother in left lateral recumbency if tolerated, administer Oxygen as needed and place an IV. Monitor airway, breathing, and circulation and transport rapidly. What is a cord presentation and how do you manage it in the field? ✔ Cord presentation means that a part of the umbilical cord has prolapsed and is being compressed against the presenting part of the fetus. You can manage this by applying pressure to the presenting part and attempting to push it back into the vagina thereby relieving pressure on the cord. You must then keep your hand there to keep pressure off the cord and rapidly transport. You can also place the mother in Trendelenburg or knee to chest position to further attempt to relived pressure on the cord. Administer Oxygen to the mother and place moist sterile dressings on the cord. What is a cephalopelvic disproportion and how is it managed in the field? ✔ Cephalopelvic disproportion means that the head is too large to fit through the pelvis or the pelvis is unusually small. This is characterized by frequent strong contractions without movement of the fetus as the head is unable to fit through the pelvis. This is managed by administering oxygen as needed, placing an IV, fluid resuscitation as needed, and rapid transport. What is the most common type of breech? ✔ Frank breech is the most common type of breech, followed by incomplete breech, and then complete breech. What does occiput posterior presentation mean? ✔ Occiput posterior presentation means that the baby is facing up with delivery instead of sideways or down. How is the occiput posterior managed in the field? ✔ This position can often result in difficult labor and delivery and may require a cesarean section. This is managed by administering oxygen as needed, placing an IV for possible fluid resuscitation, and rapid transport What are some of the signs that a patient is respiratory distress? ✔ A patient in respiratory distress may have a respiratory rate that is too fast (>24 breaths/min) or too slow (< 8 breaths/min). A patient in respiratory distress may also exhibit an increased work of breathing by use of accessory muscles, abnormal breath sounds such as wheezes or rales, pale or blue skin (cyanosis), or an altered level of consciousness. Where do palpate a pulse on a conscious adult or child? An unconscious patient? An infant? ✔ To assess a conscious patient's pulse, palpate the radial artery just proximal to the wrist. If a patient is unconscious, palpate the carotid artery on either side of the trachea. For infants, the best place to palpate the pulse is the brachial artery in the medial aspect of the bicep. What is the goal of performing a reassessment? ✔ The goal of the reassessment is to monitor the overall condition of the patient and the effectiveness of any interventions you have done, as well as identify any trends in the patient's vital signs. What does performing a reassessment consist of? When should a reassessment be performed? ✔ Reassessment consists of repeating the primary assessment by evaluating the airway, breathing, and circulation. It also consists of ensuring that you have addressed the patients chief complaint, as well as rechecking vital signs and addressing small wounds. The reassessment should be performed any time a patient's condition changes. How often should vital signs be rechecked? ✔ 5 mins unstable 10-15 mins stable If a patient is stable, vital signs should be checked every 15 minutes. If the patient is unstable, or in critical condition, vital signs should be checked every 5 minutes because there is a greater chance their condition could deteriorate. Give a few examples of a "mechanism of injury" and why it is important in EMS? ✔ Fall off of a ladder, gunshot wound, head-on motor vehicle collision, baseball bat hitting the head are all examples of a mechanism of injury. MOI is used to describe how an injury occurred and help determine how serious the injuries are. For example, an MOI where someone is injured during a 10 mph head-on crash is much less life-threatening than someone that was injured during a high-speed vehicle rollover. What factors would raise your index of suspicion for traumatic injuries? ✔ - Children - Elderly - Alcohol or drug use - Language or cultural barrier Name 5 types of motor vehicle collisions? ✔ Head-on Rear impact Rollover Rotational Lateral impact What is kinetic energy? Using the formula for kinetic energy...Explain how a car traveling TWICE as fast as another car will have 4 TIMES the amount of energy during an impact. ✔ Kinetic energy is the amount of energy an object has while in motion. It is represented by the formula: KE = 1/2 Mass x (Velocity x Velocity). Due to velocity being squared, the amount of energy increases rapidly when the speed increases. What is the difference between kinetic energy and potential energy? ✔ Kinetic energy is the energy an object has in motion (i.e. A bullet flying through the air). Potential energy is the energy stored within an object (i.e. A car stopped at the top of a hill). Why are there less injuries sustained from motor vehicle collisions today than 40 years ago? ✔ Due to improvement in automobile technology and design, a car manufactured today is designed to absorb energy and protect the occupants. Cars are equipped with safety restraint systems. Due to legislation and public education, seatbelt use has drastically increased. What are 3 types of blast injuries and how do they cause injuries? ✔ Primary blast injury - this is the initial explosion and the blast waves that hit the person Secondary blast injury - these types of injuries are caused by flying objects or shrapnel hitting the person Tertiary blast injury - the injuries sustained when a person is thrown and hits another object, such as a building or the ground. What 3 components of the Glascow Coma Scale? Write out the entire scale ✔ Eye opening. Verbal response. Motor response. Eyes 4 - Spontaneous 3 - To Speech 2 - To pain 1 - None Verbal 5 - Alert and oriented 4 - Confused 3 - Inappropriate words 2 - Incomprehensible words 1 - None Motor 6 - Obeys commands 5 - Localizes pain 4 - Withdraws from pain 3 - Abnormal flexion 2 - Abnormal extension 1 - None What is the difference between a penetrating injury and a blunt injury? ✔ A penetrating injury breaks the surface of the skin (bullet or knife). A blunt injury results from an object hitting the body (baseball bat) What is cavitation? ✔ Cavitation is the void space left behind by a bullet traveling through the body. Due to the shock waves of the bullet, the space created can be larger than the object itself. What is the difference between a sprain and strain injury? ✔ A sprain is the stretching or tearing of ligaments. A strain is a stretching or tearing of muscles or tendons. Often you will hear, "I sprained my ankle" or "I strained my hamstring" THIS SLIDE IS REVERSED PLEASE FLIP TO STUDY!! Open... The bone has broken the surface of the skin. Likewise, a closed fracture is when there is no broken skin. ✔ Is the following fracture considered open or closed? Which of the following types of bone fractures is the most common in children? A) Transverse B) Linear C) Oblique, nondisplaced D) Obique displaced E) Spinal F) Greenstick G) Comminuted ✔ Greenstick. Part of the bone is bent and the other part is broken is more common in pediatrcs due to stronger periostenum(dense, fiborous membrane that covers the bone) is stronger, thicker, and more flexible in children than in adults. What is a linear skull fracture? ✔ A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone. What are the 6 P's of the musculoskeletal trauma? ✔ The first priority is to look for signs of hypothermia and treat that first. Remove any wet clothing or jewelry that is remaining on the patient. Wrap the frostbitten area with a sterile dressing. Be sure not to attempt to pop any blisters, massage the affected area or try to rewarm the affected area in the field. Rewarming of the area is best done in the hospital. What causes a bee sting to have such a high rate of mortality? ✔ Many people are allergic to bee stings. It is not the poison that causes so much harm, but rather the body's reaction to it. People with severe allergies to bees can go into anaphylaxis, which is a life-threatening emergency that can cause the tongue to swell up, dyspnea, and loss of consciousness. What is barotrauma and what are the two mechanisms by which it can cause injury? ✔ Barotrauma is any Injury that results from pressure imbalances within gas-filled spaces in the body. It is a common injury in scuba divers. The two mechanisms are compression injuries, in which gas-fill spaces of the body undergo immense pressure during descent, and expansion injuries, in which gas-filled spaces expand too rapidly during ascent. What is perfusion? What is the result of hypoperfusion? ✔ Perfusion is the circulation of blood throughout a tissue or organ in an amount that meets the requirements for the tissues demand for oxygen, nutrients and waste removal. Hypoperfusion occurs when a tissues oxygen demand is not met. Persistent hypoperfusion results in shock and eventually cell death and organ dysfunction if not treated. How can you identify arterial bleeding from venous bleeding? ✔ Arterial bleeding is the most serious type of bleed because of the high pressure and the potential to lose a lot of blood in a short amount of time. It is characterized as bright red "spurting" blood and may be difficult to control. Venous blood is a darker red color than arterial blood and is characterized by a more steady flow or gushing. It does not spurt like arterial bleeds and is easier to control. How does the human body try to control bleeding on its own? ✔ When bleeding occurs the body naturally tries to stop the bleeding by coagulation, or forming blood clots. Platelets aggregate at the injury site and plug the hole, preventing blood from leaking out. Clotting factors activate a reaction that triggers the formation of fibrin strands, making the clot stronger. What is hemmoragic shock? ✔ Hemorrhagic shock is a condition of reduced tissue perfusion due to excessive blood loss that results in inadequate delivery of oxygen to the cells of the body. What are 3 levels of shock? Describe each one ✔ Compensated shock: The body can still compensate for blood loss and is able to maintain blood pressure and brain perfusion by means of vasoconstriction and tachycardia. Decompensated shock: The late stage of shock when the body is no longer able to maintain blood pressure and perfusion to vital organs decreases. Irreversible shock: The final stage of shock in which the body does not respond to treatment and recovery is impossible due to extensive cell death. Why is bleeding more significant in children? ✔ Children do not conserve fluids well so they have a lower tolerance for blood loss. Children also have a large surface area to weigh ratio so they get cold easier which leads to coagulation problems and hypothermia in shock. Children have longer compensatory functions but an abrupt decrease in function if the problem is not managed soon enough. What are some special considerations for bleeding in geratric patients? ✔ Many geriatric patients take medications that affect their body's ability to coagulate and compensate for blood loss such as blood thinners, beta blockers, calcium channel blockers and antiarrhythmics. Geriatrics also tend to have other health conditions that are exacerbated by severe blood loss. What are the steps for managing external hemmorage? ✔ Apply direct pressure over the wound with a dry, sterile dressing. Hold the pressure dressing in place and wrap it with gauze. Its ok to add more dressings if necessary but do not remove the original one as it will break any blood clots that had formed. If the bleeding is on an extremity and direct pressure is not stopping the bleeding, apply a tourniquet 2-3 inches proximal to the injury and turn it until the bleeding stops. Be sure to mark the time the tourniquet was applied. How does body temperature affect bleeding management? ✔ Hypotension and hypovolemia due to severe bleeding interrupts the body's ability to thermoregulate, which can cause hypothermia. Hypothermia in a bleeding patient can lead to problems with coagulation and acidosis. What is the main function of blood and what are the four components that make up blood? ✔ The main function of blood is to act as a transport system for dissolved gases, hormones, enzymes, waste products and nutrients. The four components of blood are: Red blood cells (erythrocytes) White blood cells (leukocytes) Platelets Plasma THIS SLIDE IS REVERSED PLEASE FLIP TO STUDY!! Number 1 is correct. You want to place the tourniquet two inches proximal to the wound to effectively cut off blood supply to stop the bleeding. Tourniquets are used to occlude an artery to prevent blood from reaching the wound and to treat arterial bleeds. Number 2 is not effective because the tourniquet is placed below the location of the arterial bleed. Number 3 could cause further tissue damage and does not occlude the vessel proximal to the wound. ✔ Where should you place the torniquet based on the picture which one is correct? When is the use of a torniquet indicated? ✔ A tourniquet is indicated if bleeding is not controlled by direct pressure either with holding direct pressure or using a pressure dressing. What are the steps to appliying a torniquet? ✔ 1. Select a site that is roughly 2 inches proximal to the wound. 2. Place a commercially available tourniquet or roughly 4 inch wide flat material over the artery to be compressed. 3. If fashioning a tourniquet place a pad or rolled up gauze over the artery to be compressed. 4. Then wrap the material around the extremity and pad twice and tie a half knot over the pad. 5. Place a windlass on the half knot and tie a square knot. (a stick, pen, or another similar type of object can be used) 6. Tighten the windlass of the commercial or fashioned tourniquet by twisting until the bleeding stops and then secure the windlass in position. 7. Note the time of the tourniquet application and secure it to the patient. (this can be a piece of tape or written on the patient in permanent marker) THIS CARD IS REVERSED PLEASE FLIP TO STUDY!!! The bleeding here looks well controlled and does not need a pressure dressing or tourniquet. The patient does have some bruising around the skin tear and would likely benefit from a dressing placed for comfort and to prevent infection. In this case a non- adherent dressing would be appropriate to minimize discomfort and further damage when the dressing is removed. ✔ Does this wound need to have bleeding controlled and if not how would you treat this wound? How would you apply a pressure dressing to the neck, groin or axilla? ✔ You can apply pressure to these areas using wound packing. There are commercial wound packing materials available but rolls of gauze can be used to pack a wound to apply pressure to the bleeding area. After the wound is packed you apply a dressing to the outside to hold the packing in place. What is the axilla? ✔ the space below the shoulder through which vessels and nerves enter and leave the upper arm; a person's armpit. Rationale: When chemoreceptors detect an increased level of CO2 in the blood, they send signals that eventually will speed the rate of breathing in an effort to blow off excess CO2. When there is excess CO2, the blood pH is lower, or more acidic. You shouldn't suction the airway of an adult patient for more than 15 seconds and should ensure that you only suction while removing the catheter due to the risk of causing? ✔ Hypoxia: Rationale: Suctioning removes fluid and other occlusive matter from the airway, but it also removes oxygen. Adults should not be suctioned for more than 15 seconds. The smaller airway of children and infants should be suctioned even less. When performing adult CPR, how far should you compress the chest? ✔ At least two inches, not more than 2.4 inches. . What is the compression rate for adult CPR? ✔ 100 to 120 per minute You have been dispatched for "chest pain" at a local park. Your patient is a 52-year-old male who was playing in his recreational basketball league when he experienced sudden-onset, crushing chest pain. Your patient laid down on the court after becoming dizzy and vomiting. Vitals: P 81, BP 140/70, SpO2 99%, RR 18. The patient denies all other complaints other than chest pain. The patient also denies use of ED drugs. Which of the following is not indicated for this patient? ✔ High flow oxygen Rationale: The patient is having chest pain and denies ED drug use - ASA, NTG, and cardiac monitoring are all indicated for this patient. The patient is not having difficulty breathing and his SpO2 is at 99% - oxygen is not indicated, especially high-flow oxygen. While performing chest compressions, where do you want to ensure your hands are located? ✔ The lower half of the breastbone Rationale: Correct hand placement for chest compressions is the center of the chest over the lower half of the breastbone. With any type of CPR, which of the following stays the same for all victims? ✔ Compression rate ALWAYS STAYS THE SAME! Between 100 and 120 compressions per minute Rationale: Everything else changes What is the mediastinum? ✔ Space that seperates the lungs What is not located in the mediastinum? ✔ The lungs Rationale: The lungs are located in the pleural cavities and the mediastinum is what separates these cavities. You are assessing your patient who is complaining of abdominal pain, nausea, and vomiting. You take the patient's blood pressure while he is supine and then take it again when he sits up. You are looking to see if his systolic blood pressure drops by 10 mmHg or his pulse rate drops by 20 bpm when he changes position, which may indicate hypovolemia. This test is commonly referred to as? ✔ A positive tilt test Rationale: A positive tilt test is one in which a patient's blood pressure drops more than 10 mmHg and the heart rate drops more than 20 bpm when moving from a supine to upright position. A positive tilt test indicates hypovolemia. Your diabetic patient is experiencing symptoms of hypoglycemia. You test her blood sugar with a glucometer and determine that her blood sugar level is 63 mg/dL. She is conscious and alert. The proper treatment is: ✔ Administer oral fluids with sugar or oral glucose Rationale: If the hypoglycemic patient is conscious and alert, you should administer oral fluids with sugar or oral glucose. Rapid transport would be proper for a patient who is not conscious or alert. Administering insulin would further lower her blood sugar and is out of your scope. A blood sugar level under 70 mg/dL requires treatment. The fetus umbilical cord is made up of how many arteries and how many veins? ✔ 2 arteries and 1 vein During the first 8 weeks of pregnancy, a fertilized egg is medically referred to as a: ✔ Embryo You are called to a 36-year-old female who is having labor pains. She appears to be in active labor and as you inspect the vagina, she begins to bleed excessively prior to crowning. You should immediately? ✔ Treat with high-flow O2 and rapid transportation. Place a sanitary napkin over the vaginal opening. Rationale: The woman should be transported immediately with high-flow O2, because excessive pre-birth bleeding is a symptom of placenta previa or abruptio placentae. Both are conditions that are life-threatening to both mother and fetus. When giving chest compressions to a newborn, the proper hand position is? ✔ Hands around the body, thumbs pressing just below the nipple line Rationale: The proper hand position when giving chest compressions to a newborn is placing both thumbs just below the nipple line with your hands wrapped around the body. Excessive pain during menstruation is known as? ✔ Dysmenorrhea Dys(bad) men/o(menstruation,) Fertilization of the egg most often happens in which female organ? ✔ Fallopian tube Rationale: Fertilization most often occurs in the distal third of the fallopian tube and then the egg usually implants in the uterine wall. You are called to the home of a 20-year-old pregnant female who is 37-weeks pregnant. Upon arrival, she tells you that she had a sudden visual obstruction while going up the steps to her apartment. She described it as "seeing wiggly lines off to the side" in her peripheral vision followed immediately by a migraine which has lasted for over 2 hours. She is mentally competent and has no other complaints besides the migraine at this time. Vitals: BP 142/92, HR 90, RR 18, SpO2 98%, and her skin is slightly warm and diaphoretic. What is the most likely cause of this patient's condition and what is the best course of action? ✔ Preeclampsia, recommend rapid transport Rationale: The patient's blood pressure, skin condition, vision disturbances, and headache should all alert you to preeclampsia. Rapid recognition and transport are the best course of action. Signs and symptoms of preeclampsia: ✔ Swelling Rapid weight gain Abdominal pain Severe headaches(migrane like headache) Urinary retention Vision changes Dizziness Vomitting/Nausea C. Removing charred clothing that is stuck to the burn D. Applying ice to the burn ✔ A. Removing jewelry and smoldering clothing Rationale: Assume that the burn will cause intense swelling, which is why it's important to immediately remove any clothing or jewelry that could constrict circulation. Never apply ice and never scrape skin or clothing from a burn. The type of injury that involves a blunt blow to the chest causing cardiac arrest is termed? ✔ Commotio Cordis What is Commo Cordis? ✔ (Latin, "agitation of the heart") is an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region), at a critical time during the cycle of a heart beat causing cardiac arrest. On a hot day, what method of heat exchange is accomplished when the human body sweats? ✔ Evaporation Rationale: Evaporation of sweat (from a liquid to a vapor), is an important method the body performs to automatically regulate temperature. Agnosia is a cognitive disturbance. It is: ✔ Failure to recognize objects or stimuli despite intact sensory function. You are dispatched to a 9-year-old female not acting right. Her mom states that she has been sick for a few days and has been very sleepy for the past 12 hours. Vitals - BP: 82/62, P: 98, R: 10, SpO2: 86%. What is your first intervention? ✔ Ventilate with a bag-valve-mask Rationale: There is a lot of information missing from this question and you just have to go with what you're given and make the best choice. As you assess this patient, seeing respirations at 10 should alert you that she's unable to adequately breathe for herself. Both a non-rebreather and nasal cannula are not appropriate with respirations so low. You can't transport this patient without first intervening. An airbag that has not deployed after the vehicle has crashed is called a(n): ✔ Loaded airbag You are en route to a motorcycle vs. truck at a dangerous, high-speed intersection. Dispatch information indicates that all patients are "up and walking around, but the motorcyclist is becoming increasing belligerent and short of breath." As you initiate care of the motorcyclist, what should be your first priority? A. Perform a neurological assessment B. Maintain a patent airway C. Splinting a broken arm D. Controlling light venous bleeding ✔ A. Maintaining a patent airway Rationale: Maintaining an open and patent airway should be your number one priority in management of any trauma patient. You arrive on scene to find an elderly male, who after your assessment, appears to be having an extrapyramidal reaction. His eyes are fixed to the right, and moans when you ask him a question. His arms, legs, hands, and feet, are fixed inward. What is his GCS score? ✔ GCS Score of 6 Rationale: Eyes: 1. Verbal: 2. Motor: 3. Total = 6 The ascending aorta arises from the left ventricle and consists of two branches, the right and left _____ ? ✔ Descending aortas APGAR scores can range from: ✔ 0 to 10 Jugular vein distention (JVD) if present, would be best seen with the patient placed in which position? ✔ Semi-Fowlers After directing the walking wounded to a safe location, what should you do next when utilizing the JumpSTART triage system? ✔ Immediately begin triage The deterioration of mental capacities like memory, concentration, and judgement describes which of the following terms? ✔ Dementia Your patient tells you that he has been taking medication for a medical condition for some time. He tells you that his doctor prescribed an additional medication for him to take. He tells you that it seems that after taking this new medication, the effects of his normal medication seem to increase or be enhanced. This is an example of: ✔ Potentation Which of the following is not a type of connective tissue? A. Blood B. Nerve C. Cartiledge D. Bone ✔ B. Nerve Rationale: Bone, blood, and cartilage are all forms of connective tissue. Nervous tissue is a different type of tissue. DNA is to the nucleus as RNA is to the ____________. ✔ Nucleolus DNA is located inside the nucleus. RNA is located inside the nucleolus. You are treating an unconscious 24-year-old male who was struck by a baseball bat. As you take c-spine precautions, he regains consciousness and states that he'll be fine and doesn't want any help. He is alert and oriented appropriately. After explaining the risks of refusing care, how should you proceed? ✔ Do everything you can to encourage treatment, and then allow the patient to sign a 'patient refusal' You are obtaining medical history from an 82-year-old male patient at a care home. Care home staff called 911 after the patient reported having difficulty breathing and his oxygen saturations were dropping despite being on home oxygen. The patient tells you he has atrial fibrillation and COPD. He could have any of the following respiratory diseases except for? A. CHF B. Emphysema C. Bronchitis D. Asthma ✔ Congestive Heart Failure Rationale: COPD is a term that encompasses asthma, bronchitis, and emphysema. When cutting the battery cables of a vehicle, which cable should be cut first? ✔ Negative battery cable Rationale: The negative battery cable, often black in color, should be cut first. This will create a break in the electrical circuit of the vehicle. Be sure not to touch any metal component of the vehicle while doing this! Which of the following body senses can detect radiation? None Touch Sight The spinal cord leaves the brain through a hole in the base of the skull called the? ✔ Foramen Magnum What are the phrenic nerves? ✔ 2 nerves (left and right) that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. Major function: Carries impulses from the diaphragm to the brain What type of radiation is least damaging to the human body? ✔ Beta radiation alpha radiation ✔ Alpha radiation is a heavy, very short-range particle and is actually an ejected helium nucleus. Some characteristics of alpha radiation are: Most alpha radiation is not able to penetrate human skin. beta radiation ✔ Beta radiation is a light, short-range particle and is actually an ejected electron. May travel several feet in air and is moderately penetrating. Can penetrate human skin to the "germinal layer," where new skin cells are produced. If high levels of beta-emitting contaminants are allowed to remain on the skin for a prolonged period of time, they may cause skin injury. gamma radiation/X radiation ✔ Highly penetrating electromagnetic radiation Gamma radiation or x rays are able to travel many feet in air and many inches in human tissue. They readily penetrate most materials and are sometimes called "penetrating" radiation. Think "X-ray machine" The phrenic nerves control the diaphragm. An injury above what vertebrae will cause a patient to stop breathing? ✔ C2 Rationale: The phrenic nerves are located between C2 and C5 on the spinal cord. If damage occurs above C2, those nerves can no longer send impulses to control the diaphragm and breathing. This means the patient will become apneic unless they receive positive pressure ventilation. Select the correct travel of an ovum from release to implantation: A. Ovary ---> fallopian tube ---> uterus ---> endometrium B Endometrium ---> uterus ---> ovary ---> Fallopian tube C. Uterus ---> endometrium ---> Fallopian tube ---> ovary D. Fallopian tube ---> ovary ---> endometrium ---> uterus ✔ A. Ovary ---> fallopian tube ---> uterus ---> endometrium Rationale: An ovum is the singular form of ova, or eggs. Eggs are stored in the ovaries. Once fertilized, the egg travels through the corresponding Fallopian tube into the uterus and implants into the endometrium. endometrium ✔ inner lining of uterus wall, where embryo implants An 8-year-old boy has fallen off his bike and appears to have a broken arm. You have tried to contact the parents, but they cannot be reached. Your next step would be to? A. Assume that the parents would have given consent for treatment B. Ask the police for permission to treat the patient C. Transport the patient, but ensure that police accompany you in the ambulance D. Contact Medical Control and ask if it is okay to transport the patient ✔ A. Assume that the parents would have given consent for treatment Rationale: When you are unable to contact the parents of a minor regarding treatment, the patient falls under implied consent. Implied consent means that it is implied that the parents would want the patient treated and transport to the hospital. You should always make every effort to contact the parents/guardian, but you should never withhold treatment. Signs of cardiac tamponade include: ✔ JVD Hypotension Muffled heart sounds What happens in the second stage of labor? ✔ The second stage of labor occurs from full dilation of the cervix to delivery of the infant. A complete breech presentation is when the baby is in which position? A. The buttocks present first, with the baby having its knees and hips flexed B. The shoulders present first with arms extended and legs hyperflexed C. The buttocks present first with the legs flexed and the arms extended D. The shoulders present first with the legs flexed and the knees extended ✔ A. The buttocks present first, with the baby having its knees and hips flexed You are called to the scene of a stabbing. Your patient has been stabbed on their right side, directly below the 12th rib. The penetrating injury has occurred in the? ✔ Right Upper Quadrant Rationale: The trauma has occurred to the abdomen above the level of the umbilicus. This indicates that the right upper quadrant (RUQ) has been injured. Right Upper Quadrant (Abdomen) ✔ Right portion of the liver(rids the body of toxins) Gallbladder (stores bile produced by liver) Right kidney (filters blood) Small section of the stomach (aids in digestion) Part of the colon (eliminates waste products) Duodenum(first section of the small intestine) Left Upper Quadrant (Abdomen) ✔ Stomach Spleen Left lobe of liver Body of pancreas Left kidney/Adrenal gland Colon Right Lower Quadrant (Abdomen) ✔ Cecum(beginning of the large intestine) Appendix(sits in between small and large intestine) Ascending colon(carries feces from the cecum to the transverse colon) Right ovary and fallopian tube Right ureter(males) Left Lower Quadrant (Abdomen) ✔ Descending colon(part of the large intestine from the splenic flexure to the begining of the sigmoid colon/resp. for storing the remains of digested food that will be emptied into the rectum) Sigmoid colon: Part of the largest intestine that is closest to the rectum and anus. Left ovary and fallopian tube Left ureter (propels urine from the kidneys to the bladder in males) You are dispatched to a 56-year-old male with chest pain. He tells you that he's taken 2 nitroglycerin tablets, but hasn't felt any relief from his pain. Vitals: BP - 86/52, P - 62, R- 20, SpO2 - 95%, Skin - pale, cool, diaphoretic. How should you proceed? A. Transfer the patient to the gurney and transport rapidly D. Lay the patient flat, and pour copious amounts of water in the affected eye ✔ A. Elevate the patient's head, and pour continuous amounts of NS in the affected eye Rationale: You should elevate the head to ensure you do not contaminate the uninjured eye and then flush the injured eye with copious amounts of normal saline. You are called to a restaurant where you find an unconscious 65-year-old male. Bystanders say the patient appeared to be choking, then slumped over in his chair. You attempt ventilations and reposition the airway with no success. Your next action would be to? A. Initiate CPR B. Apply defibrillation pads and defibrillate at 200 joules C. Perform blind finger sweep D. Perform abdominal thrusts ✔ D. Initiate CPR Rationale: CPR should be initiated if initial attempts to establish airway are unsuccessful on unconscious, choking patients. You are called for a 29-year-old male that was struck by lightning. The patient is unconscious, but breathing. You move the patient to a safer location, administer oxygen, and attach an EKG monitor at your partner's request. Your next course of action is to? A. Look for entrance and exit wounds B. Look for entrance wounds and signs of internal bleeding C. Elevate the patient's head to a 45-degree angle D. Apply moist sterile dressings ✔ A. Look for entrance and exit wounds Rationale: With lightning or electrocution injuries you should inspect and manage entrance and exit wounds. You should be applying dry sterile dressings, and immobilizing the patient flat for possible c-spine injuries. Labored breathing is indicative of respiratory distress. Signs of distress include? A. Muscle retractions above the clavicle B. Movement of the abdomen C. Audible chest breath sounds from both sides of the lungs D. Regular rise and fall of both sides of the chest ✔ A. Muscle retractions above the clavicle(collarbone) Rationale: When a patient is in respiratory distress, they will automatically recruit additional muscles to help with inspiration. Watch for recruitment of neck, abdomen, and rib muscles during inspiration as signs of respiratory distress. Your patient is a 41-year-old female who has just been pulled from a burning building. Her respirations are 25-per-minute and very shallow. The best management for this patient is? A. 100% supplemental oxygen with assisted positive pressure ventilation B. 100% supplemental oxygen via a non-rebreather mask C. 100% supplemental oxygen via a nasal cannula D. Blow-by 100% supplemental oxygen allowing the patient to hold the mask ✔ A. 100% supplemental oxygen with assisted positive pressure ventilations Rationale: Shallow breaths of 25-per-minute are inadequate to sufficiently ventilate the patient. The patient's breathing should be assisted with ventilation and supplemental oxygen. Passive ventilation is inadequate due to the patient's decreased tidal volume. What is positive pressure ventilation? ✔ forcing air or oxygen into the lungs You are transporting a 29-year-old woman in her 37th week of pregnancy. You have her lie lateral recumbent on her left side to avoid supine hypotensive syndrome. This is to avoid pinching off which blood vessel? A. Inferior Vena Cava B. Portal Artery C. Superior Vena Cava D. Abdominal Aortic Artery ✔ Inferior Vena Cava Rationale: Based upon the anatomical placement of the fetus in the lower abdomen, the inferior vena cava will be affected. The increased weight of the fetus on the inferior vena cava will reduce the amount of blood reaching the heart, decreasing preload and cardiac output and hemodynamic stability. Your patient cut his leg with a circular saw. After twenty minutes, bleeding is controlled, but you believe the patient lost at least one liter of blood. The best position for this patient is? A. Supine B. Trendelenburg position C. On a backboard in full-spinal immobilization D. Fowler's position ✔ A. Supine Rationale: Patient should be laid supine. Would not need a backboard because it is only a laceration on the leg. You respond to a drowning victim who is face down in waist-deep, still water. The first thing you should do is: A. Apply the head-splint technique B. Remove the patient from the water C. Ensure airway and breathing D. Roll the patient over ✔ A. Apply the head-splint technique Rationale: You should do all of these things, but the first thing to do is apply the head splint. You can then roll the patient over and ensure breathing. The last thing you would do in calm, shallow waters, is remove the patient from the water. What is the head-splint technique? ✔ Water rescue technique for shallow waters: FACE UP- 1. Approach the victim slowly and from the head, as you get close to the victim submerge so the water is at your neck. 2. Grasp the victim's arms midway between the shoulders and the elbows. 3. Gently place the victim's arms along side of their head, and squeeze the arms against the head, this immobilizes the head and neck. 4. Position yourself along the victim's side, continue to squeeze the arms together to secure and maintain alignment of the head and spine. Rationale: These types of questions are difficult. Read the question carefully and remember that it is asking for you to find the answer that contains an anatomically incorrect answer. The trachea is much more flexible in children than in adults. You are assessing a 56-year-old male patient who is acting "weird" according to his friends. They were out mountain biking together when he quickly became altered. His friends deny any traumatic injury. Your patient is unable to provide any information to your assessment. Which of these vitals signs should be acquired last (due to least importance)? A. Temperature B. Pulse oximetry C. Stroke screen D. CBG ✔ A. Temperature What are biots respirations? ✔ Caused by damage to the pons of the brain stem. Common in a trauma situation, i.e. MVA Uniformly deep gasps, apnea, then more gasps What are agonal respirations? ✔ Abnormal pattern of breathing and brainstem reflex commonly seen in sudden cardiac arrest or stroke. Characterized by slow, very shallow, gasping labored breathing What are Cheyne-Stokes respirations? ✔ Abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea. Seen in heart failure or stroke What are Kussmaul respirations? ✔ A deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. Commonly described as a loud sighing kind of breathing What is preload? ✔ volume of blood in ventricles at end of diastole What is diastole? ✔ the phase of the heartbeat when the heart muscle relaxes and allows the chambers to fill with blood. What is hemodynamic stability? ✔ If a patient has stable hemodynamics, it means that the force at which the heart pumps blood is stable. What is a pericardial effusion? ✔ accumulation of fluid in the pericardial cavity (between the two layers) What is the pericardial sac(pericardium)? ✔ Pericardium is a double-walled sac containing the heart and the roots of the great vessels. The pericardial sac has two layers, a serous layer and a fibrous layer. It encloses the pericardial cavity which contains pericardial fluid. What is occiput posterior position? ✔ When the back of the babys head is against the mothers back parapleglia ✔ Paralyzed from the waist down Quadplegic ✔ Paralyzed in all four legs and torso Autonomic Dysrelexia ✔ DFangerous syndrome that results from some form of stimulation below the level of paralysis which causes uncontrolled hypertension. What is Semi-Fowler's position? ✔ position in which a patient, typically in a hospital or nursing home in positioned on their back with the head and trunk raised to between 15 to 45 degrees, although 30 degrees is the most frequently used bed angle.