NREMT Cognitive Exam Prep: Emergency Medical Technician (EMT) Guidelines and Procedures, Exams of Nursing

Download NREMT Cognitive Exam Prep: Emergency Medical Technician (EMT) Guidelines and Procedures and more Exams Nursing in PDF only on Docsity! NREMT Cognitive Exam Prep NREMT Cognitive Exam Prep Containing 309 Questions with Verified Solutions 2024-2025. (Dark Back Ground for better Visibility and eye Care) Where does the modern EMS system have its origin? - Answer: The modern EMS system has its origins in funeral homes, which often operated ambulances. However, funeral home operators were often serving competing business interests and patients received little trained care until the hospital. 1 NREMT Cognitive Exam Prep What is considered the "birth" of EMS? - Answer: In 1966, a paper titled "Accidental Death and Disability: The Neglected Disease of Modern Society" is published by the National Academy of Sciences. This paper is widely known in the EMS profession as the White Paper. The White Paper is widely considered the birth of modern EMS. It spotlighted inadequacies of prehospital care in the United States, particularly related to trauma. Who developed the first EMT National Standard Curriculum? - Answer: Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? - Answer: Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. Emergency Medical Technician (EMT): includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications. Advanced Emergency Medical Technician (AEMT): includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications. 2 NREMT Cognitive Exam Prep Handwashing is the single most important way to prevent the spread of infection. Hand sanitizers can be effective, but soap and water is preferred when available. What are the two types of PPE? - Answer: Minimum PPE: gloves and eye protection should be used during any patient contact situation. Expanded PPE: use disposable gown and mask for significant contact with any body fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA) mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis. What are emergency moves? - Answer: These are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit-forearm drag, shirt drag, and blanket drag. What is an urgent move? - Answer: Used when the patient has potentially life- threatening injuries or illness and must be moved quickly for evaluation and transport. Rapid extrication: an urgent move used for patients in a motor vehicle; it requires multiple rescuers and a long backboard. The patient is rotated onto a backboard with manual cervical spine precautions and removed from the vehicle. What are non-urgent moves? - Answer: Used when there are no hazards and no life-threatening conditions are apparent. 5 NREMT Cognitive Exam Prep Types of non-urgent moves include direct ground lift, extremity lift, direct carry method, and draw sheet method. What is the log roll technique? - Answer: Commonly used to place a patient on a backboard or assess the posterior. Can be done while maintaining manual cervical spine precautions. Should have at least three trained personnel. The person controlling manual cervical spine protection should direct the log roll. What are special considerations for bariatric patients? - Answer: Obese patients pose additional challenges and risks to providers during lifting and movement. Some EMS systems have special bariatric ambulances with specialized equipment, automated lifting systems, and wider stretchers capable of a greater weight capacity. What is supine hypotensive syndrome? - Answer: Patients in the later stages of pregnancy should not be placed supine due to the risk of supine hypotensive syndrome. Place the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt backboard to the left about 20 degrees. When can patients be restrained? - Answer: In general, patients may be forcibly restrained if they pose a significant, immediate threat to you, your partner, or others. Restraining a patient against his will is a last resort. 6 NREMT Cognitive Exam Prep Anticipate and plan. Request law enforcement assistance. Contact medical direction when possible. Guidelines for restraining a patient: -Get additional help whenever possible; at least 4 people is recommended. -Use the minimum amount of force necessary to protect yourself, the patient and others. -Secure patient supine, with backboard if available. DO NOT secure the patient in a prone position. -Use soft, padded restraints. -Monitor the patient's level of consciousness, airway, and distal circulation continuously. -Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained. What is the use of force doctrine? - Answer: The EMT must act reasonably to prevent harm to a patient being forcibly restrained. The use of force must be protective, not punitive. What is scope of practice? - Answer: Scope of practice outlines the actions a provider is legally allowed to perform based on his or her license or certification level. Scope of practice is tied to the licensure or certification, not the individual's knowledge or experience. Each state determines the scope of practice for its EMS providers. 7 NREMT Cognitive Exam Prep What are advance directives? - Answer: Advance directives are written instructions, signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts. There are several types of advance directives. -Do Not Resuscitate (DNR): DNRs are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest. -Living will: Living wills are broader than DNRs. They address health care wishes prior to entering cardiac arrest. This may include use of advanced airways, ventilators, feeding tubes, etc. How do Good Samaritan Laws affect EMTs? - Answer: Good Samaritan laws are designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed. -Each state has some form of Good Samaritan laws. Some protect health care providers, but some do not. -Some states extend their Good Samaritan law to publicly employed EMS providers but not to those in the private sector. What is assault? - Answer: A person can be guilty of assault even if another person only perceived that they intended to inflict harm. Physical contact is not required to be guilty of assault. What is battery? - Answer: Battery is physically touching another person without their consent. 10 NREMT Cognitive Exam Prep What is negligence? - Answer: Negligence is the most common reason EMS providers are sued civilly. -The plaintiff has the burden of proof, not the EMT. -With negligence, the EMS provider is accused of unintentional harm to the plaintiff. What are the four components of negligence? - Answer: The plaintiff must prove all four of the following: 1. Duty to act: the EMT had an obligation to respond and provide care. 2. Breach of duty: the EMT failed to assess, treat, or transport patient according to the standard of care. 3. Damage: the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation. 4. Causation: the injury to the plaintiff was, at least in part, directly due to the EMT's breech of duty. What is gross negligence? - Answer: Gross negligence exceeds simple negligence. Gross negligence involves an indfference to, and violation of, a legal responsibility. Reckless patient care that is clearly dangerous to the patient is grossly negligent. Gross negligence can result in civil and/or criminal charges. What is abandonment? - Answer: Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS 11 NREMT Cognitive Exam Prep agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed. What is false imprisonment? - Answer: You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? - Answer: Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported. When in doubt, consult medical direction. Thoroughly document why the destination was chosen. This is especially true if you bypass a closer hospital capable of managing your patient. 12 NREMT Cognitive Exam Prep -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump." What are considered obvious signs of death? - Answer: The following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation On what kind of scenes must law enforcement be notified? - Answer: 1. Any scene where the patient is dead on arival 2. Suicide attempts 3. Assault or sexual assault 4. Child abuse or elder abuse 5. Suspected crime scene 6. Childbirth How should EMT's operate in crime scenes? - Answer: 1. Ensure scene safety 2. Provide patient care as needed 3. Avoid any unnecessary disturbance of scene 4. Remember and note the position of patient(s) 5. Remember and report everything you touched at the scene 6. Cut around (not through) holes in clothing when exposing the patient 15 NREMT Cognitive Exam Prep 7. Note anything or anyone suspicious on or near the scene 8. Discourage sexual assault patients from changing clothes or showering 9. Try to get a same-sex provider to assist with sexual assault patients 10. Leave once you are no longer needed at the scene What are therapeutic communications? - Answer: Therapeutic communications typically refers to your interaction with the patient and ability to obtain clinical information. What are portable and mobile radios? - Answer: Portable radios: hand-held transmitter/receiver with a very limited range, unless used with a repeater. Mobile radios: vehicle-mounted transmitters and receivers. These have a greater range than portable radios, but distance is still limited unless used with a repeater. What is a repeater? - Answer: A type of base station that receives low-power transmissions from portable or mobile radios and rebroadcasts at higher power to improve range. What is a base station? - Answer: A transmitter/receiver in a fixed location that is in contact with all other components in the radio system. Who regulates all radio operations in the US? - Answer: The Federal Communications Commission (FCC) regulates all radio operations in the US and has allocated specific frequencies for EMS use only. 16 NREMT Cognitive Exam Prep How should you communicate with dispatch? - Answer: 1. Confirm receipt of dispatch. 2. Notify dispatch when en route to the call,on scene, en route to the hospital, and at the hospital. A. Identify who you are talking to first, then who you are. B. Use "affirmative" or "negative," not "yes" or "no." C. Use "copy" to confirm receipt of a transmission. D. Always "echo" orders from medical direction to confirm accuracy. E. DO NOT use unnecessary verbiage such as "please" or "thank you." How should you communicate with medical direction? - Answer: Sample format: -Unit designation, certification level, destination and estimate time of arival -Patient's age, sex, and chief complaint -Patient's level of consciousness -History of present illness or mechanism of injury -Any associated symptoms or pertinent negatives -Patient's vitals -Patient's physical exam -Patient's history, medications, allergies -Treatment provided and response to treatment -Any requests for additional interventions -Echo any orders provided by medical direction 17 NREMT Cognitive Exam Prep -Nose and mouth -Nasopharynx -Oropharynx -Larynx -Epiglottis What is the most common cause of upper airway obstruction? - Answer: The tongue. What are the components of the lower airway? - Answer: Components of the lower airway include: -Trachea -Carina -Left and right mainstem bronchi -Broncioles -Alveoli How is lung expansion achieved? - Answer: During inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs. What is the diaphragm? - Answer: The diaphragm is the primary muscle of respiration. It separates the thoracic cavity from the abdominal cavity. It is usually under involuntary control but can be controlled voluntarily. The esophagus and the great vessels pass through the diaphragm. 20 NREMT Cognitive Exam Prep The diaphragm is dome shaped until it contracts during inhalation. During inhalation, it moves down and expands the size of the thoracic cavity. What is inhalation through negative pressure breathing? - Answer: The diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and air rushes in. Inhalation is an active process and requires energy. Atmospheric (inhaled) oxygen contains 21% oxygen. What is exhalation? - Answer: The diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity rises and air is expelled. Exhalation is normally passive and does not require energy. Exhaled air contains 16% oxygen. What are the different types of respiration? - Answer: External respiration: the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries. Internal respiration: gas exchanged between the body's cells and the systemic capillaries. Cellular respiration: also known as aerobic metabolism, uses oxygen to break down glucose to create energy. 21 NREMT Cognitive Exam Prep What is the primary mechanism of breathing control? - Answer: Carbon dioxide drive is the primary mechanism of breathing control for most people. The brain stem monitors carbon dioxide levels in the blood and CSF. High carbon dioxide levels will stimulate an increase in respiratory rate and tidal volume. What is hypoxic drive? - Answer: Hypoxic drive is a backup system to the carbon dioxide drive. Specialized sensors in the brain, aorta and carotid arteries monitor oxygen levels. Low oxygen levels will stimulate breathing. The hypoxic drive is less effective than carbon dioxide drive. What is the minute volume? - Answer: Respiratory rate times tidal volume. What are normal breathing rates for adults, children and infants? - Answer: Normal adult rate: 12-20 breaths per minute Normal pediatric rate: 15-30 breaths per minute Normal infant rate: 25 to 50 breaths per minute Non-labored Regular rhythm Clear and equal breath sounds bilaterally What are the three layers of heart muscle and pericardium? - Answer: Endocardium: smooth, thin lining on the inside of the heart 22 NREMT Cognitive Exam Prep What are normal vital signs for infants? - Answer: Respirations: normal respiratory rate is about 30-60 breaths per minute for newborns and about 25-50 breaths per minute for infants. Pulse: normal pulse rate is about 140-160 beats per minute for newborns and about 100-140 beats per minute for infants. Blood pressure: a newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by one year of age. What is the physiology of newborns and infants? - Answer: The typical newborn weighs about 6-8 pounds. The newborn's weight will typically double by 6 months and triple by one year. The newborn's head makes up about 25% o f the body and is a significant source of heat loss. During the first couple weeks, neonates often lose weight, and then begin to gain it back. The newborn's fontanelles (soft spots on the skull) will be fully fused by about 18 months. Depressed fontanelles may indicate hypovolemia. Infants are often nose breathers and can develop respiratory distress easily. 25 NREMT Cognitive Exam Prep Rapid breathing can lead to fluid loss and loss of body heat. Hyperventilation of infants presents significant risk of barotrauma. What are the reflexes that infants have? - Answer: Startle reflex, grip reflex, rooting reflex, sucking reflex What are the age ranges of toddlers and preschoolers? - Answer: Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old What are normal vital signs of toddlers and preschoolers? - Answer: Toddlers: -Respirations: about 20-30 breaths per minute -Heart rate: 90-140 bpm -Blood pressure: 80-90 systolic Preschoolers: -Respirations: about 20-25 breaths/minute -Heart rate: 80-130 bpm -Blood pressure: about 90-110 systolic What is the physiology of toddlers and preschoolers? - Answer: As the immune system develops, children at this age typically experience a number of minor colds, viruses, flu-like symptoms, respiratory infections, etc. Fine motor skills improve and the brain grows rapidly in size. 26 NREMT Cognitive Exam Prep Toddlers: typically walk, climb, distinguish basic shapes and colors and are potty trained. Preschoolers: typically are physically coordinated and communicate well verbally, know their name and address and can dress themselves, can count to 10 or beyond. What developments you should know about school-age children? - Answer: Vital signs: -Respirations: about 15 to 20 breaths/minute -Heart rate: 70-110 bpm -Blood pressure: 90-120 systolic Physiology: -Permanent teeth replace baby teeth -The musculoskeletal system is growing rapidly School-age children typically: -Read and write -Develop problem-solving skills -Are establishing their self-image and morals -Have a large social circle due to school -Understand the concept of death -Look up to authority figures 27 NREMT Cognitive Exam Prep What is proper suctioning technique? - Answer: Suction time cannot exceed: -15 seconds for adults -10 seconds for children -5 seconds for infants The recovery position reduces risk of aspiration. Unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position. When is supplemental oxygen needed? - Answer: The goal of supplemental oxygen is to maintain a pulse oximetry reading of at least 94%. -Supplemental oxygen is not needed if there are no signs of symptoms of respiratory distress and the pulse oximetry is at least 94%. -When oxygen is administered, it should be titrated to maintain a pulse oximeter reading of at least 94%. Indications: -Any patient in cardiac arrest -Any patient receiving artificial ventilation -Any patient with suspected hypoxia -Any patient with signs of shock -Any patient with a pulse oximetry below 94% -Any patient that may benefit from it -Any patient with an altered or decreased LOC 30 NREMT Cognitive Exam Prep What is notable about oxygen cylinders? - Answer: A full cylinder is about 2000 psi. The cylinder should be taken out of service and refilled if below 200 psi. What are non-rebreather masks? - Answer: Usually the preferred method of oxygen administration in prehospital. Referred to as "high-flow" oxygen administration. Flow rate: 10-15 L/min Oxygen delivered: up to 90% Cautions: -The reservoir must be full before applying mask to patient -Never administer less than 10 L/min -If the reservoir completely deflates during inhalation, the flow rate must be increased -Immediately remove mask if oxygen source is lost What are nasal cannulas? - Answer: Referred to as "low-flow" oxygen administration Indications: 31 NREMT Cognitive Exam Prep -Patient will not tolerate a non-rebreather -Patient is on long-term oxygen therapy via nasal cannula and there is no indication high-flow oxygen is needed Flow rate: 1-6 L/min Oxygen delivered: 24-44% Cautions: prolonged use can dry and irritate nasal passages if oxygen is not humidified What is a simple face mask? - Answer: The simple face mask is similar to a nonrebreather, but without the oxygen reservoir. These are rarely used in the pre-hospital environment. Flow rate: 6-10 L/min Oxygen delivered: 40-60% What are Venturi masks? - Answer: A mask that delivers precise concentration of low-flow oxygen. Rarely used in the prehospital environment. 32 NREMT Cognitive Exam Prep What are the compression:ventilation ratios for adults and children? - Answer: 30 compressions: 2 breaths -Always for adults -Always for single-rescuer CPR on any patient 15 compressions: 2 breaths -Two-rescuer CPR on children and infants 3 compressions: 1 breath -Newborns For patients in cardiac arrest with an advanced airway, provide one breath every 6 to 8 seconds What is CPAP? - Answer: Continuous positive airway pressure (CPAP) is used to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress. Often used for patients with sleep apnea, has proven very effective for patients with COPD or pulmonary edema. Can help the patient avoid more invasive treatment such as intubation. Indications: -Conscious patients in moderate to severe respiratory distress. -Tachypnic patients with reduced respiratory efficiency. -Pulse oximetry is below 90%. 35 NREMT Cognitive Exam Prep Contraindications: -Apneic patients or patients unable to follow verbal commands. -Chest trauma, suspected pneumothorax, or patients with a tracheostomy. -Vomiting or suspected GI bleeding. -Hypotension What is notable about the pediatric airway? - Answer: The pediatric airway is more easily obstructed (smaller nose and mouth; larger tongue). The pediatric head is larger in proportion to the body. Padding should be placed behind the shoulders in a supine patient to maintain alignment of the airway. Signs of respiratory failure in pediatric patients: -Bradycardia and poor muscle tone -Altered LOC -Head bobbing and grunting on exhalation -Seesaw breathing How is a foreign body airway obstruction managed in conscious patients? - Answer: Adults and children: administer conscious abdominal thrusts until the obstruction is relieved or until the patient loses consciousness. Infants: Administer a series of five back blows and five chest thrusts until the obstruction is relieved or until the patient loses consciousness. 36 NREMT Cognitive Exam Prep How is a foreign body airway obstruction managed in unconscious patients? - Answer: Initiate CPR. Before attempting ventilations, inspect the airway for visible foreign bodies. Remove if able. What are open-ended vs. closed-ended questions? - Answer: Open-ended questions require the patient to respond with more than just "yes" or "no." These questions require a descriptive response. When you want the patient to describe things in his or her own words, open-ended questions are preferred. Open-ended questions take longer to answer but provide more information from the patient's perspective. Closed-ended questions can be answered much faster and typically require only a "yes" or "no" response. Closed-ended questions may be preferred when time is critical. They can also be useful if the patient is only able to speak short sentences due to severe pain or respiratory distress. What are the standard vital signs? - Answer: Respiration: rate, rhythm, quality Pulse: rate, rhythm, quality Blood Pressure Pupils: size, equality, reactivity Skin: color, temperature, condition and capillary refill Pulse oximetry 37 NREMT Cognitive Exam Prep Dose and route: -Adult: 1 g/kg of body weight -Pediatric dose: 25-50 grams -Administered orally Side effects: Nausea, vomiting, dark and tarry stool Considerations: -Shake before administering -Use caution if you suspect patient's LOC will change -Have suction ready What information do you need to know about aspirin? - Answer: Names: acetylsalicylic acid Class: anti-inflammatory, anti-platelet aggregate, antipyretic MOA: reduces inflammation, decreases platelet aggregation, reduces fever Indication: chest pain Contraindications: allergy, decreased LOC, inability to swallow, recent bleeding or active ulcer, pediatric, expired medication, lack of medication Dose and route: 40 NREMT Cognitive Exam Prep -324 mg orally Side effects: nausea, vomiting, stomach pain, bleeding, allergic reaction, Reye's syndrome in pediatric patients What information do you need to know about a metered dose inhaler? - Answer: Names: albuterol, ipratropium bromide Class: bronchodilator MOA: relaxes bronchial smooth muscle, improving air exchange Indications: dyspnea, wheezing, asthma , reactive airway disease Contraindications: allergy, patient unable to follow commands, expired medication, medication not prescribed to patient, lack of medical direction Dose and route: one to two inhalations Side effects: tachycardia, hypertension, restlessnessm, anxiousness What information do you need to know about the EpiPen? - Answer: Names: epinephrine Class: sympathomimetic, bronchodilator 41 NREMT Cognitive Exam Prep MOA: peripheral vasoconstriction, increased heart rate, bronchodilation Indication: anaphylaxis (wheezing, swollen upper airway, hives) Contraindications: expired medication, lack of medical direction Dose and route: 0.3 mg adult, 0.15 mg pediatric administered IM Side effects: tachycardia, hypertension, restlessness, anxiousness What information do you need to know about nitroglycerin? - Answer: Class: antianginal, vasodilator MOA: vasodilation, decreased myocardial oxygen demand, increased myocardial oxygen supply Indications: chest pain, suspected angina or MI Contraindications: expired, not prescribed to patient, hypotension, recent use of Viagra, Cialis, Levitra or another ED medication, head injury, lack of medical direction Dose and route: 0.4 mg sublingual 42 NREMT Cognitive Exam Prep Irreversible shock: the final stage of shock. The patient will not survive once entering irreversible shock. What are the types of shock? - Answer: 1. Cardiogenic shock 2. Obstructive shock 3. Distributive shock 4. Hypovolemic shock What is cardiogenic shock? - Answer: Cardiogenic shock is a pump problem. The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension. -Pulmonary edema, accumulation of fluid in the lungs. Signs and symptoms of cardiogenic shock include hypotension, probable cardiac history, chest pain, respiratory distress, pulmonary edema, and altered LOC. What is obstructive shock? - Answer: This type of shock is a pump problem caused by mechanical obstruction of the heart muscle. -Cardiac tamponade: fluid accumulates within the pericardial sac and compresses the heart. Signs and symptoms inlcude JVD, narrowing pulse pressure, hypotension, -Tension pneumothorax: air enters the chest cavity due to lung injury or sucking chest wound. Accumulating pressure compresses the lungs and great vessels. Signs and symptoms include JVD, respiratory distress, diminished or absent lung 45 NREMT Cognitive Exam Prep sounds, difficulty ventilating, and tracheal deviation towards the *unaffected* side. What is distributive shock? - Answer: Distributive shock is a pipe problem. It occurs due to widespread vasodilation, which causes blood pooling and relative hypovolemia. Anaphylactic shock: a life-threatening severe allergic reaction due to massive vasodilation, widespread vessel permeability, and bronchoconstriction. Neurogenic shock: caused by spinal cord damage, typically in the cervical region. It leads to massive, systemic vasodilation below the level of injury. Septic shock: caused by severe infection, which damages blood vessels and increases plasma loss out of the vascular space. Psychogenic shock: caused by sudden, temporary vasodilation that leads to syncope. What is hypovolemic shock? - Answer: Hypovolemic shock is a fluid problem. It may be caused by hemorrhage or by dehydration or burns. What are early signs and symptoms of shock? - Answer: Altered LOC Tachycardia 46 NREMT Cognitive Exam Prep Pale, cool skin: due to peripheral vasoconstriction Weak peripheral pulses Increased respiratory rate Thirst Delayed capillary refill What are late signs and symptoms of shock? - Answer: Falling BP Irregular breathing Mottling or cyanosis Absent peripheral pulses How should shock be managed? - Answer: Control bleeding, high-flow oxygen, Trendelenburg, prevent loss of body heat, rapid transport. What are potential causes of respiratory complaints? - Answer: Airway obstruction Anaphylaxis 47 NREMT Cognitive Exam Prep What is angina pectoris? - Answer: Angina is transient chest pain caused by a lack of oxygen to the heart muscle. The heart's oxygen demand temporarily exceeds its supply. -Angina is usually caused by atherosclerosis in the coronary arteries. -Angina usually occurs during physical activity or stress and resolves with rest, oxygen, or nitroglycerin. Angina does not usually last longer than 10 minutes. Angina does not cause permanent cardiac damage. What is acute myocardial infarction? - Answer: MI is death to an area of the myocardial muscle due to lack of oxygenated blood flow through the coronary arteries. Dead myocardial muscle cells become scar tissue and cannot contribute to cardiac contraction. Time to restoration of blood flow through coronary arteries is critical to minimizing cardiac damage. Signs and symptoms: chest pain or pressure, nausea, weakness or fatigue, dyspnea, diaphoresis, abnormal vital signs, sudden cardiac arrest. Geriatric patients, women, and diabetic patients may have atypical MI presentations. Complications of MI include cardiac dysrhythmias, sudden cardiac arrest, congestive heart failure, and cardiogenic shock. What is congestive heart failure? - Answer: CHF occurs when the ventricles are unable to keep up with the flow of blood coming to them. 50 NREMT Cognitive Exam Prep Right ventricular failure: if the right ventricle pumps inefficiently, blood backs up into the venous system that feeds into the right heart. Signs include JVD, pedal edema. Left ventricular failure: if the left ventricle pumps inefficiently, blood backs up into the lungs. Signs include pulmonary edema. Signs and symptoms: dyspnea, chest pain, pulmonary edema, JVD, pedal edema, orthopnea What is hypertension? - Answer: Systolic greater than 140 and/or diastolic greater than 90 Signs and symptoms: headache, tinnitus, nausea, dizziness, nosebleed. What are strokes? - Answer: Death to brain tissue due to an interruption in blood flow. Also called cerebrovascular accident or "brain attack." Modern treatment can dramatically reduce the amount of damage and resulting disability if received in time. Signs and symptoms: severe headache, slurred speech, facial droop or drooling, unilateral numbness or weakness or paralysis, altered LOC, vision problems 51 NREMT Cognitive Exam Prep What are ischemic strokes? - Answer: Blood flow to the brain is compromised due to a blockage. Ischemic strokes are often due to atherosclerosis. Overwhelming majority of strokes are ischemic in nature. What are hemorrhagic strokes? - Answer: Caused by bleeding within the brain. The bleeding robs the brain of oxygen delivery, and can apply pressure to surrounding brain tissue, further compromising oxygenation. Hemorrhagic strokes limit certain interventions and are often fatal. Prevention through modification of risk factors, especially hypertension, is key. What is the Cincinnati Prehospital Stroke Scale? - Answer: Facial droop: ask the patient to smile Arm drift: ask the patient to close eyes and hold arms out in front Speech: ask the patient to say "the sky is blue in Cincinnati." What is a TIA? - Answer: Transient ischemic attacks (TIAs) have the same presentation as CVAs. However, the signs and symptoms self-correct within about 24 hours with no permanent brain damage. They are a warning sign of an impending stroke. What are the types of seizures? - Answer: Generalized seizures -Also called grand mal seizures -Patient is unresponsive and experiences full-body convulsions 52 NREMT Cognitive Exam Prep Fats and proteins are far less efficient (by about 19 times) than glucose fuel source. Byproducts of anaerobic metabolism (ketones) are dangerous. What is diabetes mellitus? - Answer: Diabetes is a disease caused by an inability to metabolize glucose normally. This is frequently due to a problem with insulin production. Untreated diabetics typically have elevated blood glucose levels due to a lack of insulin or ineffective insulin. -Increased urinary output and dehydration is common. What is Type I Diabetes? - Answer: Also called insulin-dependent diabetes mellitus (IDDM) Type I diabetics must take supplemental insulin Type I diabetes usually develops in pediatric patients and is usually genetically caused. Untreated type I diabetics will appear with the three P's (polyuria, polydipsia, polyphagia) and very high blood glucose levels. Type I diabetics are at high risk for diabetic ketoacidosis if untreated. Type I diabetics are at high risk for insulin shock due to insulin overdose. What is Type II diabetes? - Answer: Also known as non-insulin-dependent- diabetes-mellitus (NIDDM). 55 NREMT Cognitive Exam Prep Type II diabetics typically do not require supplemental insulin. Type II diabetes is caused by a combination of lifestyle and genetics. It can be largely controlled through diet, exercise, and oral medications. Type II is more common than Type I. What is hypoglycemia? - Answer: A blood glucose level below 60 mg/dL with signs and symptoms or a blood glucose level below 50 mg/dL regardless of the presence of signs and symptoms. Occurs more often in type I diabetes than type II diabetes. Hypoglycemia can very quickly lead to altered LOC, seizures, coma and brain death. What is insulin shock? - Answer: Insulin shock is a term commonly used to refer to severe hypoglycemia with signs and symptoms. Diabetics can suddenly become confused, violent, or unresponsive due to severe hypoglycemia. Commonly caused by a sudden unexpected drop in blood glucose due to: -Taking a regular insulin dose but not eating -Extreme physical activity without adjusting insulin level or food intake -Insulin overdose What is hyperglycemia? - Answer: A sustained blood glucose over 120 mg/dL Hyperglycemia typically develops slowly and requires a slower recovery process. 56 NREMT Cognitive Exam Prep Hyperglycemic patients can experience seizures, coma, and permanent injury; however, they do not typically develop signs and symptoms rapidly as do hypoglycemic patients. What is diabetic ketoacidosis (DKA)? - Answer: Occurs more frequently with type I diabetes. With DKA, the blood glucose is frequently above 350 mg/dL. Brain cells are able to utilize glucose, but the rest of the body's cells are starving and begin using alternate fuel sources, which leads to the production of ketones and acidosis. Signs and symptoms of DKA: -High blood glucose, typically above 350 mg/dL -Kussmaul respirations: deep, rapid breaths -Polydipsia, polyuria, polyphagia -Fruity odor on breath -Tachycardia -Coma What is hyperglycemic hyperosmolar nonketotic syndrome? - Answer: Similar to DKA, without the buildup of ketones Occurs more frequently with type II diabetes What is an allergic reaction? - Answer: An allergic reaction is an excessive immune response to an allergenic. 57 NREMT Cognitive Exam Prep Signs and symptoms: -May be rapid or delayed -Dyspnea, coughing, dizziness, headache, abnormal lung sounds Treatment: ensure scene safety, be alert for multiple victims. Administer high-flow oxygen and monitor lung sound and respiratory status. What are injected toxins? - Answer: It is difficult to diminish, dilute, or inhibit the effects of injected toxins. Most injected poisonings are due to drug abuse. Onset of effects from injected drugs is typically rapid and can be long-lasting. Signs of injected stimulants (cocaine, meth): -Mood elevation, euphoria, -Restlessness, excitability -Tachycardia, rebound depression -Seizures, heart attack, stroke, death Signs of injected narcotics (morphine, heroin): -Decreased LOC, respiratory depression -Pupillary constriction 60 NREMT Cognitive Exam Prep What are absorbed toxins? - Answer: Signs and symptoms include burns to the skin, rash or blister, itching or burning. Interventions: -Decontaminate patient appropriately before initiating care or transport -Most chemicals on the skin or eye should be irrigated with water continuously for about 20 minutes. -When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. What do you need to know about alcohol? - Answer: Alcohol is the most widely abused drug in the US Most long-term alcoholics will develop hepatitis. Alcohol is a CNS depressant and a sedative hypnotic. Ingestion of alcohol increases risks of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). -Restless, irritable, agitated -Hallucinations, tremors or seizures What do you need to know about narcotics? - Answer: Narcotics are widely abused. They are typically ingested or injected. 61 NREMT Cognitive Exam Prep Narcotics, or opioids, include morphine, codeine, heroin, oxycodone, and many more. Narcotics are CNS depressants that can cause coma and severe respiratory depression. Most ALS providers are able to administer Narcan (naloxone), which rapidly reverses the CNS effects of narcotics. What do you need to know about sedative hypnotic drugs? - Answer: Sedative hypnotics are CNS depressants. Sedatives have a calming effect, and hypnotics induce sleep. Sedative hypnotics are usually taken orally but can be injected. Barbiturates such as Amytal, Seconal, and Luminal are sedative hypnotics. Benzodiazepines such as Valium, Xanax, and Rohypnol are sedative hypnotics. What do you need to know about inhalants? - Answer: Abused inhalants may include acetones, glues, cleaning chemicals, paints, hydrocarbons, aerosols, and propellants. These chemicals are inhaled to achieve sedative hypnotic effects. 62 NREMT Cognitive Exam Prep Most caustic ingestion patients are children. Common household caustics include liquid drain openers, bathroom cleaning supplies, ammonia and bleach. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What do you need to know about hydrocarbons? - Answer: Hydrocarbons are petroleum-based. Hydrocarbons are found in gasoline, paints, solvents, sunscreen, baby oil, makeup remover, kerosene, lighter fluid, and more. Hydrocarbons can be ingested, inhaled, and absorbed. Most hydrocarbon ingestion patients are children. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What is acute abdominal pain? - Answer: Acute abdominal pain is usually due to trauma, distension, inflammation, or ischemia. 65 NREMT Cognitive Exam Prep What are the different types of abdominal pain? - Answer: Note that the level of pain does not necessarily indicate the illness's severity. Patients can have a life- threatening abdominal emergency without severe pain. Visceral pain -Dull, diffuse pain that is difficult to localize -Frequently associated with nausea and vomiting -Often not severe, but may indicate actual organ injury Parietal pain -Severe, localized pain. Usually sharp and constant. -The pain will often cause the patient to curl up with knees to chest. -The patient is often very still and breathing shallowly to diminish pain. Referred pain: causes pain in an area of the body other than the source. What are potential causes of acute abdominal pain? - Answer: Appendicitis Peritonitis Cholecystitis Diverticulitis GI bleeding Gastroenteritis Esophageal varices Ulcers Abdominal Aortic Aneurysm (AAA) 66 NREMT Cognitive Exam Prep What is appendicitis? - Answer: Caused by inflammation of the appendix. Can lead to life-threatening infection and septic shock. Signs and symptoms: -Nausea, vomiting, diarrhea, loss of appetite, fever. -Pain may begin as diffuse, but usually localizes to right lower quadrant. What is peritonitis? - Answer: Peritonitis is caused by inflammation of the peritoneum (membrane lining the abdominal organs and cavity). Signs and symptoms: nausea, vomiting, loss of appetite, diarrhea, fever. What is cholecystitis? - Answer: Cholecystitis is inflammation of the gall bladder, often due to gallstones. Most often occurs in females 30 to 50 years of age. Signs and symptoms: -Right upper quadrant pain -Increased pain at night -Increased pain after eating fatty foods -Referred pain to the shoulder is common -Nausea and vomiting 67 NREMT Cognitive Exam Prep Signs and symptoms: -History of ulcers -Abdominal pain in the left upper quadrant -Nausea and vomiting -Often elicits and increase in pain before meals and during stress What is an abdominal aortic aneurysm? - Answer: AAA is a weakening of the wall of the aorta in the abdominal region. Weakened area is prone to rupture. A ruptured AAA will likely cause rapid, fatal bleeding. Signs and symptoms: -AAA most common in geriatric males -Tearing back pain -Signs and symptoms of hypovolemic shock -Possible pulsating abdominal mass Patients with a suspected AAA should be transported to an appropriate facility without delay. What is the most common symptom of a gynecologic emergency? - Answer: Gynecologic emergencies relate to female patients and their reproductive systems. 70 NREMT Cognitive Exam Prep Abdominal pain is the most common symptom of most gynecologic emergencies. What are specific gynecologic emergencies? - Answer: 1. Sexual Assault: sexual assault patients have been victimized physically and psychologically. Management of sexual assault victims: -Request law enforcement and victim's assistance. -Do not touch the patient without consent. -Request a same-sex provider if one is not already on scene. -Encourage the patient not to change clothes, shower, etc. -Treat clothing as evidence. Do not touch unless necessary. -Touch only those things that are necessary. 2. Pelvic inflammatory disease (PID) PID is painful and requires treatment. Nonemergency transport is recommended. Signs and symptoms: -Abdominal pain -Fever -Pain during urination -Often, increased pain while walking 3. Vaginal bleeding. This condition has many potential causes, including spontaneous abortion, PID, and sexually transmitted diseases. 4. Signs and symptoms of gynecologic problems: -Abdominal pain 71 NREMT Cognitive Exam Prep -Vaginal bleeding or discharge -Signs and symptoms of shock -Fever, nausea and vomiting What are genitourinary and renal emergencies? - Answer: A. Urinary Tract Infection (UTI) Signs and symptoms: -Abdominal pain -Hematuria: blood in urine -Painful or frequent urination -Fever, nausea, and vomiting B. Kidney Stones Kidney stones are crystals formed in the kidneys that can cause an obstruction in the urinary tract, causing severe pain. Males are much more likely to develop kidney stones. Signs and symptoms: -Severe abdominal pain, groin pain -Painful urination, fever, nausea, and vomiting C. Kidney failure Kidney failure is when the kidneys are no longer able to function sufficiently. Water and toxins accumulate and dialysis may be needed. Dialysis artificially removes excess fluid and waste products from the blood. 72 NREMT Cognitive Exam Prep What are the different types of motor vehicle collisions (MVCs)? - Answer: 1. Head-on -Occupants can go up and over or down and under the dash. -Head, spinal, chest, abdomen, hip, and lower extremity injuries are common. Unrestrained patients are more likely to be ejected. 2. Rear impact -Cervical spine injury due to hyperextension is common. 3. Lateral impact (T-bone) -Injuries along the side of impact are common 4. Rollover -Injury patterns are difficult to predict. There is a high risk of ejection in rollover MVCs. 5. Rotational spins -Rotational forces increase the risk of c-spine injury. What are the three collisions in every MVC? - Answer: When a vehicle strikes an object, there are three important collisions: 1. First collision: the vehicle strikes an object. 2. Second collision: the passenger strikes interior of the vehicle or safety restraint system (SRS). 3. Third collision: the internal organs strike the internal structures of the body. 75 NREMT Cognitive Exam Prep -Coup-contracoup brain injury: brain injury on the opposite side of impact. What are significant MOIs? - Answer: 1. Rollovers or ejection from the vehicle. 2. Death of another occupant in the same vehicle. 3. Pedestrians, cyclists, or motorcyclists struck by a vehicle. 4. Significant damage to the vehicle exterior (above about 18 inches). 5. Damage intruding into passenger compartment (above about 12 inches). 6. Falls greater than 10 feet by a pediatric patient, or any fall with a loss of consciousness. What are the different types of penetrating trauma? - Answer: 1. Low-velocity projectiles -Examples: knife, pencil, rebar -Injury resides along the projectile's path 2. Medium velocity -Examples: handguns, some rifles -Injury pattern is less predictable due to ricochet within body and bullet fragmentation. 3. High velocity -Example: assault rifles -Injury path can be many times larger than projectile due to cavitation (formation of a space within the body along the projectile's path). 76 NREMT Cognitive Exam Prep What are the different types of blast injuries? - Answer: 1. Primary blast injury: injuries due to the pressure wave of the blast. 2. Secondary blast injury: injuries due to flying debris. 3. Tertiary blast injury: injuries caused by being thrown against a stationary object. 4. Miscellaneous blast injuries: injuries due to burns, inhalation injury, etc. What are the indications for air medical transport? - Answer: Extended extrication time No other ALS providers available Closest trauma centers unavailable Multiple patients requiring transport Traffic conditions delay ground transport Distance to trauma center greater than 20 miles What is the Glasgow Coma Scale? - Answer: What are the trauma center designations? - Answer: Level 1 Trauma Center: Capable of handling all types of trauma 24/7. This includes on-site trauma teams, surgical capabilities, trauma intensive care units (ICU), and rehabilitation services. Level 2 Trauma Center: Capable of stabilizing trauma patients and transferring to a level 1 trauma center. Level 3 and 4 Trauma Centers: Limited services and ability to stabilize trauma patients. 77 NREMT Cognitive Exam Prep What is evisceration? - Answer: Open abdominal injury with external organs (usually intestine) protruding. Management of evisceration: -Cover with moist sterile dressing. -Cover moist dressing with occlusive dressing. -Flex legs if possible to reduce abdominal contraction. -Treat for shock. -This is a high-priority transport. How should impaled objects be managed? - Answer: Impaled objects should be stabilized in place. There are only two indications for removing an impaled object: -The object creates an airway obstruction or inability to manage the airway, such as an impaled object in the cheek. -The object is in the chest and prevents CPR for a patient in cardiac arrest. How should open neck injuries and bite wounds be managed? - Answer: Open neck injuries should be covered with an occlusive dressing to prevent air embolism. All bite wounds that break the skin pose a high risk of infection. Small animal bites may lead to rabies. 80 NREMT Cognitive Exam Prep -Rabies is an acute, deadly viral infection of the CNS. If the animal responsible for the bite is not tested for rabies, the patient typically must receive a series of painful injections. -All bites that break the skin should be evaluated by a physician for infection and hte need for a tetanus shot. What are the five factors of burn severity? - Answer: 1. Depth of burn -Superficial (first degree burn): epidermal damage only. Painful, red, no blisters. -Partial thickness (second degree burn): epidermal and partial dermal injury. Painful, blisters present. -Full thickness (third degree burn): injury completely through dermal layer. Dry, leathery skin; no pain. 2. Amount of body surface area burned -Rule of nines: totals 100% of body surface area 3. Burns to critical areas: the critical areas are the respiratory tract, hands, face, feet and genitalia. 4. Associated trauma or preexisting medical conditions. Associated trauma, poor health, and certain medications complicate body's ability to handle a burn injury. 5. Age of patient. Under 5 or over 55 years of age are at greater risk. What determines the severity of burn injuries? - Answer: Severe Burn Injuries 81 NREMT Cognitive Exam Prep -Burns with respiratory compromise -Full-thickness circumferential burns -Partial-thickness burns covering more than 30% of TBSA -Burns with associated trauma, such as fractures -Full-thickness burns to the airway, hands, face, feet or genitalia -Full-thickness burns covering more than 10% of the TBSA -All moderate burn criteria for patients under 5 or over 55 years of age Moderate Burn Injuries -Full-thickness burns cover 2-10% of TBSA -Partial-thickness burns cover 15-30% of TBSA -Superficial burns covering more than 50% of TBSA Minor Burn Injuries -Full-thickness burns covering less than 2% of TBSA -Partial-thickness burns covering less than 15% of TBSA -Superficial burns covering less than 50% TBSA What are life-threatening complications of burn injuries? - Answer: The life- threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise. What are thermal burns? - Answer: Thermal burns are caused by heat, such as from water, steam, or fire. 82 NREMT Cognitive Exam Prep -Dislocations often have associated sprains and strains -Signs and symptoms: pain, deformity, loss of function, possible weak or absent distal pulses What are potential limb-threatening injuries? - Answer: Any orthopedic injury resulting in loss of circulation distal to the injury is a high-priority injury. The limb is at risk until circulation is restored. Signs of orthopedic injury with loss of distal circulation: absence of distal pulses, pale distal to injury, cool distal to injury, delayed capillary refill distal to injury. What are potential life-threatening injuries? - Answer: 1. Pelvic fractures -1 in 5 hip fracture patients dies within one year of the injury. -Hip fracture patients are at risk for hypovolemic shock, embolism, pneumonia and sepsis. -Most hip fractures occur in the geriatric population due to falls. -Pelvic binders are commercial splints used in some EMS systems to stabilize pelvic fractures and reduce bleeding. 2. Femur fractures -A single femur fracture can cause hypovolemic shock. -Femur fracture patients are at an increased risk of embolism. -Fractures to multiple smaller long bones can combine to cause hypovolemic shock. 3. Amputations 85 NREMT Cognitive Exam Prep -Control bleeding. -Wrap amputated part in a sterile dressing and place in plastic bag and keep cool. -Do not delay transport of a high-priority patient for an amputated part. What is correct splinting? - Answer: Correct splinting decreases pain and reduces risk of further injury. Rules of splinting: 1. Assess distal pulse, motor, and sensation (PMS) before and after splinting. 2. Immobilize above and below injury. 3. Attempt to realign deformed injuries with absent distal pulses. 4. Do NOT delay transport of a high-priority patient for a non-ife-threatening injury. What are scalp injuries? - Answer: 1. Scalp injuries can be open or closed. 2. The scalp is highly vascular and bleeds heavily when lacerated. What are skull fractures? - Answer: 1. Skull fractures indicate the potential for injury to the brain. 2. Linear fracture: most skull fractures are linear fractures and do not present with deformity or depression. 3. Depressed fracture: depressed skull fractures may be noticeable upon palpation. There is an increased risk of brain injury due to bone being displaced into brain tissue. 86 NREMT Cognitive Exam Prep 4. Basal skull fracture: these fractures occur at the base of the skull. Cerebrospinal fluid may leak from nose or ears. Signs include Battle's sign (bruising behind the ears) and raccoon eyes (bruising under the eyes). What are the types of brain injuries? - Answer: 1. Concussion 2. Cerebral contusion 3. Epidural hematoma 4. Subdural hematoma 5. Subarachnoid hemorrhage 6. Intracerebra hemorrhage 7. Herniation syndrome What is a concussion? - Answer: A concussion causes brain function to be disrupted in some manner. Signs and symptoms typically occur rapidly and gradually improve. Signs and symptoms may include altered LOC that gradually improves, brief loss of consciousness, nausea, vomiting, irritability, repetitive questioning, vision problems, and amnesia. What is a cerebral contusion? - Answer: Cerebral contusion is often accompanied by edema and/or concussion injury. 87 NREMT Cognitive Exam Prep Remember, the brain is in an enclosed space. There is little extra space to accommodate swelling, bleeding, etc. Severe herniation will force the brain down toward the foramen magnum. Signs of increased ICP are called *Cushing's reflex*: -Hypertension -Bradycardia -Altered respiratory pattern Mortality rates are high for ICP patients. In an attempt to temporarily reduce dangerously high ICP, higher ventilation rates may be indicated. Consult local protocol and medical direction. How can the spine be immobilized? - Answer: 1. Manual immobilization -Manual c-spine precautions must be taken immediately if spinal injury is suspected. -Manual c-spine cannot be released until the patient's head is completely immobilized by other means. -A cervical collar is not a substitute for manual immobilization. 2. Spinal immobilization techniques -Long spine board: can be use for supine or standing patients, often used if rapid extrication is needed. 90 NREMT Cognitive Exam Prep -Half spine board: can be used for seated patients, use of these devices may require additional time to apply. What are the types of chest injuries? - Answer: 1. Pneumothorax 2. Tension pneumothorax 3. Sucking chest wound 4. Hemothorax 5. Cardiac tamponade 6. Clavicle and rib fractures 7. Flail chest What is pneumothorax? - Answer: Pneumothorax is the accumulation of air in the pleural space. This can compress lung space, prevent gas exchange, and lead to hypoxia. Can be due to trauma or nontraumatic injury to lung tissue. Lung sounds may be diminished or absent over injured area. What is tension pneumothorax? - Answer: A tension pneumothorax causes a progressive collapsing of lung tissue. The entire lung and great vessels can be compressed to the other side of the chest. Lung sounds will be absent over the affected area. 91 NREMT Cognitive Exam Prep The patient will develop severe respiratory distress and eventually respiratory failure. Compression of the great vessels can restrict blood flow, leading to shock and death. Tracheal deviation toward the unaffected side is a late and ominous sign. What is a sucking chest wound? - Answer: If an open chest injury penetrates the pleural space, it can draw air during inhalation. Penetrating thoracic injuries should be covered with a three-sided occlusive dressing to prevent air from entering the chest cavity. What is a hemothorax? - Answer: A hemothorax is bleeding into the pleural space. Watch for signs and symptoms of shock. Surgery is frequently required to control bleeding. What is cardiac tamponade? - Answer: Cardiac tamponade occurs when blood or other fluid accumulates in the pericardial sac and compresses the heart. Cardiac function can be severely compromised, leading to circulatory collapse. Beck's triad (indicative of cardiac tamponade): -JVD -Muffled heart sounds -Narrowing pulse pressure 92 NREMT Cognitive Exam Prep B. Corneal Abrasion -Direct trauma and foreign objects can cause a corneal abrasion. -The cornea is the transparent covering over the iris and pupil. -Symptoms include pain, tearing, and the sensation of something in the eye. C. Orbital Fracture -Orbital fractures indicate a significant MOI. -Consider possibility of associated spinal trauma. -Symptoms include visual disturbances, double vision, deformity around the orbit, loss of sensation around the orbit, and the inability to move the eye in an upward gaze. -Suspected orbital fractures required physician evlaluation. D. Chemical Burns -Chemicals in the eye require immediate and continuous irrigation. -Avoid irrigating chemicals from one eye into the other. E. Impaled Objects -Do not removed impaled objects from the eye. -Stabilize object in place. -Keep both eyes closed to prevent passive movement of impaled object. F. Contact Lenses 95 NREMT Cognitive Exam Prep -Procedure for removing contact lenses varies depending on the type of contacts. Removal may be more easily accomplished with a specially designed moistened suction cup. What are face injuries and their treatment? - Answer: A. Loss of Tooth -Control any bleeding to reduce risk of swallowing blood and vomiting. -Rinse tooth with saline and transport in saline-soaked gauze. B. Impaled Object in the Cheek -Stabilize the object in place unless it interferes with airway management. -Remove object only if it causes an airway obstruction or interferes with ability to manage airway. C. Nosebleed D. Ear Injuries -Treat as a soft tissue injury -Assess MOI for other possible injuries What patient factors influence heat and cold emergencies? - Answer: A. Age: The very young and very old will likely develop environmental emergencies more rapidly. B. General Health and Nutrition: Those in good health, adequately nourished, and hydrated are better able to maintain homeostasis. 96 NREMT Cognitive Exam Prep C. Environmental Conditions: Temperature, humidity, and wind can help or hurt the body's ability to protect itself from environmental emergencies. D. Medications and Alcohol: Medications and alcohol can hinder the body's ability to regulate body temperature. How does the body lose heat? - Answer: 1. Conduction: direct transfer of heat through contact with a colder structure. 2. Convection: loss of heat to passing air. 3. Evaporation: loss of heat through evaporation of water from the skin. 4. Respiration: in a cold environment, exhaled air has been warmed within the body. That heat is lost on exhalation. 5. Radiation: transfer of radiant heat. What is hypothermia? - Answer: Hypothermia is a systemic cold emergency. It affects the entire body, not just an isolated area. Hypothermia develops when the body's core temperature falls below that needed to maintain homeostasis. Signs and symptoms of hypothermia: -Cold skin even at their core -Pale or cyanotic skin -Shivering (note: ceases with extreme hypothermia) 97