NREMT Cognitive Exam Prep Questions: A Comprehensive Guide for EMT Candidates, Exams of Nursing

Download NREMT Cognitive Exam Prep Questions: A Comprehensive Guide for EMT Candidates and more Exams Nursing in PDF only on Docsity! NREMT Cognitive Exam Prep Questions All Answered Correctly. 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. 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. Paramedic: includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions. This is the highest level of prehospital care outlined in the National EMS Education Standards. What are EMT roles and responsibilities? - Answer Equipment preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy Professional development Quality improvement Illness and injury prevention Maintain certification/licensure What is the role of the medical director? - Answer The medical director is a physician responsible for providing medical oversight. The medical director oversees quality improvement. What are the two types of medical direction? - Answer Online medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols. What is an EMT's first priority? - Answer The EMT's first priority is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders. What are the types of stress? - Answer Acute stress: an immediate physiological and psychological reaction to a specific event. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT's ability to perform during the stressful event. PTSD is an example of delayed stress. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time. What are the stages of grief? - Answer Denial 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. What is standard of care? - Answer Standard of care is the degree of care a reasonable person with similar training would provide in a similar situation. Standard of care requires EMTs to competently perform the indicated assessment and treatment within their scope of practice. What are sources that help establish standard of care? - Answer National EMS Education Standards State protocols and guidelines Medical direction EMS agency's policies and procedures Reputable textbooks Care considered acceptable by similarly trained providers in the same community. What is informed consent? - Answer Informed consent is required from all patients who are alert and competent. -Patient must be informed of your carer plan and associated risks of accepting or refusing care and transport. -Patient must be informed of, and understand, all information that would impact a reasonable person's decision to accept or refuse care and transport. What is expressed consent? - Answer Expressed consent also requires that the patient be alert and competent to give expressed consent. Expressed consent can be given verbally or nonverbally. -Expressed consent is similar to informed consent, but not usually as in-depth as informed consent. -Expressed consent is often used to obtain consent for more basic assessments or procedures. What is implied consent? - Answer Implied consent allows assumption of consent for emergency care from an unresponsive or incompetent patient. -Patients might be incompetent for many reasons, such as alcohol, drugs, head injury, hypoxia, hypoglycemia, or mental incompetency. -Implied consent can be used to treat a patient who initially refused care but later loses consciousness or becomes otherwise incapacitated. What is minor consent? - Answer Minors are not competent to accept or refuse care. -Consent is required from a parent or legal guardian. Implied consent can be used when unable to reach a parent or guardian and treatment is needed. -Minor consent is not required for emancipated minors. Criteria for emancipation varies but usually includes minors who are married or pregnant, already a parent, a member of the armed forces, financially independent, or emancipated by the courts. What is involuntary consent? - Answer Involuntary consent is used for mentally incompetent adults or those in custody of law enforcement. Consent must be obtained from the entity with the appropriate legal authority. 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. 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 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. 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 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. 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 What two components must be present for transfer of care? - Answer 1. Verbal report 2. A written copy of the patient care report must also be provided What are the purposes of the patient care report? - Answer 1. Continuation of care 2. Legal document 3. Billing 4. Research and continuous quality improvement What is the minimum data set? - Answer The minimum data set identifies the information that should be included on every PCR. Times: -Dispatch time -Time en route to call -Time on scene -Patient contact time -Time en route to hospital -Arrival time at hospital -Time transfer of care was completed Patient information: -The patient's age, sex, and chief complaint -The patient's level of consciousness -Minimum of two sets of vital signs -All assessments completed on the patient -All treatments provided and response to treatment Administrative information: 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 Myocardium: thick muscular wall of the heart Epicardium: outermost layer of the heart and innermost layer of the pericardium Pericardium: fibrous sac surrounding the heart What is the heart's electrical conduction system? - Answer The primary power plant, the sinoatrial (SA) node, normally generates impulses between 60 and 100 times per minute in the adult. The atrioventricular (AV) junction is the backup pacemaker and generates electrical impulses at about 40 to 60 per minute. The bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute. What is preload? - Answer Preload is the precontracting pressure based on the amount of blood coming back to the heart. Increased preload leads to increased stretching of the ventricles and increased myocardial contractility. What is afterload? - Answer Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? - Answer Plasma: the liquid component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood White blood cells: fight infection by defending against invading organisms Platelets: essential for clot formation to stop bleeding What is perfusion? - Answer Perfusion is the flow of blood throughout the body. What is the central nervous system? - Answer The central nervous system consists of the brain and spinal cord. What are the parts of the brain? - Answer Cerebrum: largest part of the brain; controls thoughts, memory and senses Cerebellum: coordinates voluntary movement, fine motor function and balance Brain stem: includes midbrain, pons and medulla; controls essential body functions such as breathing and consciousness What are the two epidermal layers? - Answer The germinal layer produces new cells and pushes them to the surface. the cells die en route to the surface. The stratum corneal layer is the top epidermal layer and consists of dead skin cells. 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. Rapid breathing can lead to fluid loss and loss of body heat. -Become sexually active What are the stages of adulthood? - Answer Early adulthood: 20-40 years of age Middle adulthood: 40-60 years of age Late adulthood: over 60 years of age What are developments you should know about adulthood? - Answer Vitals: -Respirations: 12-20 breaths/minute -Heart rate: 60-100 beats/minute -Blood pressurer: about 110/70 to 130/90 Characteristics: -Accidental trauma is a leading cause of death in the young adult age group -Mild physical decline typically develops in the middle adult age group -Women typically experience menopause during middle adulthood -Continued physical and mental decline is common in late adulthood -Older adults frequently have extensive medical histories and are on multiple medications What is ventilation? - Answer Ventilation is the moving of air in and out of the lungs. What is hypoxia? - Answer Inadequate delivery of oxygen to the cells. Early indications of hypoxia: restlessness, anxiety, irritability, dyspnea, tachycardia. Late indications of hypoxia: altered or decreased level of consciousness. How long quickly does hypoxia damage the heart and brain? - Answer The heart and brain become irritable due to lack of oxygen almost immediately. Brain damage begins within about 4 minutes. Permanent brain damage is likely within 6 minutes. Irrecoverable injury is likely within 10 minutes. What is notable about suction units? - Answer Portable and fixed suction units should be able to generate a vacuum of 300 mmHg when tubing is clamped. 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 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: -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 -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%. 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. 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 What is pulse pressure? - Answer SBP - DBP Normal pulse pressure should be greater than 25% but less than 50% of systolic blood pressure. A widened pulse pressure above 50% of systolic indicates a possible head injury. A narrow pulse pressure below 25% of systolic indicated possible hypoperfusion, tension pneumothorax, or pericardial tamponade. How can you estimate blood pressure in pediatric patients? - Answer A systolic below 70 + 2(age) for ages 1 to 10 years indicates hypotension What are blood glucose levels? - Answer Normal: 80-120 mg/dL Hypoglycemia: 60 mg/dL or below (really, below 80) Hyperglycemia: over about 140 mg/dL What is the difference between pharmacokinetics and pharmacodynamics? - Answer Pharmacokinetics is the study of how drugs enter the body, and are metabolized and eliminated. Pharmacodynamics is the study of a drugs' effects on the body. What are the routes of medicine administration? - Answer Oral (PO): slow onset of action, safe but unpredictable absorption. -Aspirin, activated charcoal, oral glucose Intramuscular (IM): rapid absorption, but less reliable. -EpiPen Inhalation: rapid onset -Albuterol What information do you need to know about the EpiPen? - Answer Names: epinephrine Class: sympathomimetic, bronchodilator 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 Side effects: tachycardia, hypotension, headache, burning under tongue, nausea, vomiting What information do you need to know about oral glucose? - Answer Class: oral hyperglycemic MOA: increases blood glucose levels Indication: hypoglycemia Contraindications: -Decreased LOC -Inability to swallow -Expired medication -Lack of medical direction Dose and route: one tube administered orally Side effects: nausea and vomiting What are the components of the scene size-up? - Answer 1. Scene safety 2. Standard precautions (PPE) 3. Number of patients/additional resources 4. Mechanism of injury/nature of illness What are the components of the primary assessment? - Answer 1. Manual cervical spine stabilization 2. General impression 3. Level of consciousness (AVPU and orientation; person, place, time and event) 4. Airway, Breathing, Circulation 5. Transport priority What are the appropriate managements for life-threatening conditions associated with breathing? - Answer Flail chest: initiate artificial ventilations Sucking chest wound: apply an occlusive dressing What are the stages of shock? - Answer Compensated shock: the early stage of shock. The body is still able to compensate for the hypovolemic state through defense mechanisms, such as increased heart rate and peripheral vasoconstriction. -Tachycardia -Peripheral vasoconstriction -Increased respirations Decompensated shock: late or "progressive" shock. The body can no longer compensate for the hypovolemic state, and blood pressure starts to fall. -Falling BP 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. Pneumothorax Pulmonary edema Pulmonary embolism Respiratory syncytial virus (RSV) Hyperventilation syndrome Sucking chest wound Thoracic trauma Toxic substance exposure What is croup? - Answer Croup is inflammation of the pharynx, larynx, and trachea. It is highly infectious and usually occurs in children up to about 3 years of age. Signs and symptoms: -Croup is usually preceded by a cold and usually occurs in winter -Croup often presents with a unique "barking" sound -Croup often presents with stridor (a high-pitched sound in the upper airway) What is cystic fibrosis? - Answer Genetic disorder leading to thick mucus production and chronic lung infections. Cystic fibrosis often causes death prior to entering adulthood. Signs and symptoms include asthma-like symptoms and GI problems. What is RSV? - Answer Respiratory syncytial virus is a respiratory infection very common in infants and children. It is extremely contagious. The virus can survive on surfaces, clothing, etc. Signs and symptoms include cold-like symptoms, poor fluid intake, and signs of dehydration. What are cardiac emergencies? - Answer Acute Coronary Syndrome (ACS) Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure Hypertension Cardiogenic shock What is acute coronary syndrome? - Answer Symptoms of ACS are caused by myocardial ischemia. ACS includes angina pectoris and acute myocardial infarction. 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. 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 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 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). 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. 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. Allergic reactions can be local or systemic. Sensitization: patients can develop sensitivity to a substance that did not previously cause a reaction. Following sensitization, the severity of reactions can get progressively worse each time. What is anaphylaxis? - Answer Anaphylaxis is a severe, life-threatening form of allergic reaction. Anaphylaxis is always systemic and impairs the airway, respiratory, and cardiovascular systems. Anaphylaxis causes upper and lower airway swelling, bronchoconstriction, vasodilation, hypotension, capillary permeability and increased mucus production. Signs and symptoms: -Skin: flushed, hives, swelling -Respiratory: wheezing, upper airway swollen -Cardiovascular: hypotension What causes anaphylaxis? - Answer Medications Environmental triggers Foods Insect bites and stings Latex What are the routes of exposure to drugs and toxins? - Answer Ingestion, inhalation, injection and absorption What are ingested toxins? - Answer *Ingestion is the most common route of exposure.* Ingestion of poisons by children is usually accidental, but most incidences involving adults are intentional. Common accidental overdose medications include cardiac medications, psychiatric medications, and acetaminophen. What do you need to know about narcotics? - Answer Narcotics are widely abused. They are typically ingested or injected. 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. The difference between an effective dose and a lethal dose is very narrow. Brain damage and/or cardiac arrest due to abuse is common. Prescription and over-the-counter bronchodilators are also abused. They are taken for stimulant effects or perceived advantage in competitive sports. What do you need to know about stimulants? - Answer Stimulants include caffeine, cocaine, amphetamines, methamphetamines, among others. They are taken for stimulant and euphoric effects. They can be taken by any route and are commonly injected, ingested, and inhaled. What do you need to know about marijuana? - Answer Marijuana (cannabis) is typically smoked. It is taken to induce euphoria, relaxation, drowsiness. Marijuana use does not usually create an acute medical emergency; however, marijuana users often take other illicit drugs. What do you need to know about hallucinogens? - Answer Hallucinogens alter sensory perception. Examples include LSD and PCP. What do you need to know about carbon monoxide? - Answer CO poisoning is a leading cause of death due to fires. Other common sources include home heating devices and vehicle exhaust fumes. CO inhibits the body's ability to transport and use oxygen. The danger of CO poisoning is greatest when exposed in a confined space. CO is a silent killer. It is tasteless, colorless, odorless, and completely nonirritating when inhaled. Victims are usually unaware they are being exposed and eventually lose consciousness. What do you need to know about acids and alkalis? - Answer Both are considered caustic substances. Many household products are acids or alkalis. Acids have a very low pH and burn on contact. Pain is usually immediate. Alkalis have a very high pH and tend to burn deeper than acids. Pain may be delayed. 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. -Weakness -Nausea and vomiting -Bleeding NOT common What is GI bleeding? - Answer Most often occurs in middle-aged patients Most often fatal in geriatric patients Upper GI bleeds: often due to ulcers Lower GI bleeds: often due to diverticulitis Signs and symptoms: -Hematemesis: vomiting blood -Hematochezia: bloody stool -Dark, tarry stool -Signs and symptoms of hypovolemic shock What is gastroenteritis? - Answer Gastroenteritis is an infection with associated diarrhea, nausea and vomiting. It is usually due to contaminated food or water and is not contagious. Prolonged vomiting and diarrhea can lead to hypovolemic shock. Gastroenteritis is a common cause of shock in children. What are esophageal varices? - Answer Esophageal varices are a weakening of the blood vessels lining the esophagus. The condition is frequently associated with alcoholism. Signs and symptoms: -Vomiting large amounts of bright red blood -History of alcohol abuse or liver disease -Signs and symptoms of hypovolemic shock What are ulcers? - Answer Ulcers are open wounds along the digestive tract, often the stomach. 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. 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 -Vaginal bleeding or discharge -Signs and symptoms of shock What is the index of suspicion? - Answer Understanding the mechanism of injury helps predict injury patterns and sharpen the EMT's index of suspicion. 1. Index of suspicion is the ability to determine what types of injuries are possible or likely based on the MOI. 2. EMS providers don't diagnose; they rule in possibilities based on three key factors: MOI, anatomical findings, and physiological presentation of the patient. 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. -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). 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. What are the types of bleeding? - Answer 1. External bleeding -May be obvious only if the patient is exposed -More manageable than internal bleeding 2. Internal bleeding -Harder to identify and more difficult to manage than external bleeding -Signs and symptoms include bruising, hematoma, hematemesis, fractured bones, abdominal distension, bloody or dark stool, signs of shock. What are the various sources of bleeding? - Answer Arteries: spurting, bright red blood. Veins: steady flow of dark red blood. Capillaries: slow oozing of dark red blood. May be mixed with clearish fluid. 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 -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. Management of thermal burns include: -Stop the burning process with a moist sterile burn sheet until skin is no longer hot to the touch. -Replace moist burn sheet with dry sterile burn sheets to reduce risk of hypothermia and infection. -Remove clothing that may be trapping heat. -Remove jewelry since massive swelling is likely. -Treat for shock as needed. What are special types of burns? - Answer A. Inhalation Injury -Can occur due to chemical inhalation or if patient inhales hot gases due to fire in a confined space. -Signs and symptoms include stridor, dyspnea, coughing, wheezing, facial burns, hoarse voice, airway edema, singed facial hair, or soot in mouth or nose. B. Electrical Burns -Assess scene safety first. Do not attempt to remove patient from an electrical source without proper training. -Significant unseen injury may have occurred between entrance and exit points on the body. -Electrical burn patients are at high risk of respiratory and cardiac arrest. -All electrical injury patients require transport and evaluation by a physician. C. Chemical Burns -Eyes and respiratory system are at high risk for chemical burn injury. -Assess scene safety first. Do not risk exposure without proper training and PPE. -IF safe to do so, remove contaminated jewelry and clothing, brush off and dry chemical on the skin, irrigate patient with large amounts of water, avoid contaminating unaffected areas with runoff. What are the different types of musculoskeletal injuries? - Answer Fractures -Open fracture: a fracture with an associated open soft tissue injury. -Closed fracture: a fracture where the skin is not broken. -Signs and symptoms: pain, swelling, deformity, tenderness, loss of function, possible weak or absent distal pulses and crepitus. Strain -A strain is a stretching injury to a muscle or tendon. There is usually little bleeding with a strain, so swelling and discoloration will likely be minimal. -Signs and symptoms: pain and tenderness. Sprain -A sprain is an injury to a ligament. Sprains frequently involve the shoulder, knee, or ankle joints. -Signs and symptoms: immediate pain and tenderness, delayed swelling and discoloration. Dislocation -A dislocation is the movement of a bone out of its normal position in a joint -The bone may return to its normal position or remain out of joint -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. What is an epidural hematoma? - Answer Bleeding beneath the skull but above the dura mater. Typically includes significant arterial bleeding. Extremely dangerous due to increase in intracranial pressure. Often accompanied by a temporal skull fracture. Signs and symptoms: -Patient experiences a brief loss of consciousness, wakes up, then LOC deteriorates. -Worsening LOC, headache, seizures, vomiting, posturing, hypertension, bradycardia, changes in respirations, pupillar changes. What is a subdural hematoma? - Answer Bleeding above the brain (beneath the dura mater and above the arachnoid meningeal layer). Often caused by venous bleeding following a cerebral contusion. Signs and symptoms: vomiting, decreasing LOC, pupillary changes, unilateral weakness or paralysis, hypertension, changes in respirations, headache and seizures. What is a subarachnoid hemorrhage? - Answer Bleeding within the subarachnoid space. This type of injury allows blood to enter the cerebrospinal fluid (CSF). Can be due to trauma or a ruptured aneurysm. Signs often include headache and stiff neck, and neurological impairment such as decreased LOC and seizures. What is an intracerebral hemorrhage? - Answer Bleeding within the brain tissues. Patients can deterioriate rapidly. High mortality (risk of death) rate. What is herniation syndrome? - Answer The pressure within the skull is called intracranial pressure (ICP). Herniation is when the brain is compressed due to extensive ICP. 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. -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. 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. 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 -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. 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) -Loss of coordination -Altered LOC -Bradycardia -Bradypnea -Hypotension How should hypothermia be managed? - Answer Pulse check should be extended to determine if patient is in cardiac arrest or severely bradycardic. Remove patient from cold environment. Remove wet clothing; prevent further heat loss. -Prehospital warming is often limited to passive rewarming measures only. What are local cold emergencies? - Answer Frostnip -Frostnip develops when body parts get very cold but are not yet frozen. -Signs and symptoms include pale and cold skin , and loss of sensation in affected areas. Trenchfoot: Also called immersion foot, trenchfoot can develop when the feet have prolonged exposure to cold and water. -Blood volume increases, but plasma increase is greater. This leads to relative anemia. -Signs and symptoms of shock are masked during pregnancy. -Postural hypotension is common, increasing the risk of syncope. D. Gastrointestinal and Urinary Changes -The pregnant patient typically has undigested food in the stomach. -Pregnancy increases the risk of nausea and vomiting. -Pregnancy increases urinary frequency, and the pregnant patient is at risk of bladder injury due to displacement. E. Musculoskeletal Changes -The woman's center of gravity changes, increasing the risk of a fall injury. What are the different types of obstetrical emergencies? - Answer A. Hemorrhage B. Placenta previa C. Abruptio placenta D. Ectopic pregnancy E. Uterine rupture F. Spontaneous abortion G. Seizures H. Preeclampsia and eclampsia I. Pregnancy-induced hypertension (PIH) J. Supine hypotensive syndrome What is hemorrhage in an obstetric patient? - Answer Hemorrhagic shock can develop quickly in the pregnant patient. Signs and symptoms may not be evident until the pregnant patient is in severe shock. Bleeding can occur with little or no external blood loss. Bleeding may be painful or painless. Several conditions can lead to severe bleeding, including placenta previa, abruptio placenta, ectopic pregnancy, uterine rupture, and spontaneous abortion. What is placenta previa? - Answer Placenta previa is a common cause of bleeding in the third trimester. Placenta previa occurs when the placenta attaches to the uterus over the cervical opening. As the cervix dilates, the placenta is torn and bleeds. Classic presentation is painless vaginal bleeding in the third trimester. Assess for signs and symptoms of shock. What is abruptio placenta? - Answer Abruptio placenta is the premature separation of the placenta from the uterine wall leading to bleeding. Oxygen and nutrient delivery to fetus is compromised. Maternal blood loss can be severe. The fetus will not survive a complete abruption. Classic presentation is painful vaginal bleeding in the third trimester. Assess for signs and symptoms of shock. What is ectopic pregnancy? - Answer Ectopic pregnancy occurs when the egg is implanted outside of the uterus, usually in the fallopian tube. Ectopic pregnancy can lead to rupture and severe bleeding. Classic presentation is severe abdominal pain with or without vaginal bleeding. Assess for signs and symptoms of shock. What is uterine rupture? - Answer The uterus thins as it grows, increasing the risk of rupture. Danger to mother and fetus is high. Classic presentation is abdominal pain and vaginal bleeding. What is spontaneous abortion? - Answer Spontaneous abortion (miscarriage) is delivery of the fetus before it is capable of surviving. This is prior to about the 20th to 22nd week of pregnancy. Classic presentation includes cramping, lower abdominal pain, vaginal bleeding, and passage of tissue or clots. Assess for signs and symptoms of shock. What are seizures during pregnancy? - Answer Pregnancy can increase the risk of seizures in the mother. Management of seizures during pregnancy. -Treat as regular seizures -Place patient on left side -Minimize exposure to stimulus such as lights, noise and movements What are preeclampsia and eclampsia? - Answer 1. Preeclampsia (toxemia of pregnancy) -Preeclampsia typically occurs in the third trimester. -The cause is not completely understood -Signs and symptoms include sudden weight gain, visual disturbances, sudden swelling of the face, hands, or feet, headache, and hypertension. 2. Eclampsia -Eclampsia occurs when the mother seizes following preeclampsia -Eclampsia is a life-threatening condition for mother and fetus What is pregnancy-induced hypertension (PIH)? - Answer PIH is defined is a blood pressure in a pregnant patient above 140/90 at least twice at 6 hours apart. PIH presents with the same signs and symptoms as preeclampsia. What is supine hypotensive syndrome? - Answer Supine hypotensive syndrome occurs when the fetus compresses the inferior vena cava. This can cause a severe drop in blood pressure. This syndrome typically occurs in the later stages of pregnancy when the mother is supine. Signs and symptoms include dizziness, hypotension, pale skin, and altered LOC. Management of supine hypotensive syndrome must include keeping the fetus off of the inferior vena cava. Assess skin color. If central cyanosis is present, provide blow-by oxygen at about 4-6 Lm/in with oxygen tubing near the baby's face until color improves. APGAR Score What is the APGAR score? - Answer Attempt to obtain APGAR score at 1 minute and 5 minutes after delivery of the baby. Appearance -0: cyanotic all over -1: core pink, hands and feet cyanotic -2: pink all over Pulse -0: no pulse -1: heart rate under 100 -2: heart rate over 100 Grimace (stimulation reflex) -0: no response to stimulation -1: minimal (facial grimace) response to stimulation -2: responds vigorously, such as crying Activity (extremity movement) -0: limp -1: limited active movement -2: actively moving Respirations -0: not breathing -1: slow or irregular breathing -2: adequate breathing What are potential delivery complications? - Answer A. Meconium B. Multiple Births C. Prolapsed cord D. Breech presentation E. Limb presentation F. Postpartum hemorrhage What is meconium? - Answer Meconium is the presence of fetal stool in the amniotic fluid. This turns the amniotic fluid yellow, green, or brownish. The risk of infection and pneumonia increases if the baby inhales meconium. If meconium is present, suction the mouth and nose promptly when the head clears the birth canal. Once the baby delivers, immediately suction the mouth and nose prior to stimulating the baby to breathe. What are multiple births? - Answer Multiple births can have their own placenta, or share a placenta. Be prepared for multiple births any time it has not been ruled out by the ultrasound. Request additional units. Prepare additional supplies. If second baby does not deliver within about 10 minutes after first, transport immediately. What is a prolapsed cord? - Answer A prolapsed cord occurs when the cord is the presenting part in the birth canal. A prolapsed cord can become compressed and cut off oxygen to the baby. Instruct the mother not to push. This will increase pressure on the cord. Place mother in knee-chest position. Carefully push the presenting part of the baby away from the cord. V finger Transport immediately. What is breech presentation? - Answer A breech birth occurs when the baby's buttocks or legs are the first presenting part in the birth canal. Transport immediately. Breech births present significant dangers for mother and baby. If delivery occurs, there is a high risk the head will become stuck in the birth canal. If the head is trapped, use fingers to form a "V" along vaginal wall to create space allowing the baby to breathe. What is limb presentation? - Answer A limb presentation is when a single arm or leg is the first presenting part in the birth canal. Do not attempt delivery of a limb presentation in the field. Place the mother in the knee-chest position and transport immediately. What is post-partum hemmorhage? - Answer Postpartum hemorrhage is excessive bleeding following delivery. Blood loss of greater than 500 ml is considered abnormal. Management of postpartum hemorrhage includes uterine massage, breastfeeding and treating for shock. What is the significant anatomy and physiology of pediatric patients? - Answer Airway/Respiratory -Infants have proportionally larger tongues than adults -The pediatric airway is smaller -Newborns and infants are obligate nosebreathers Head -The pediatric patient's head is proportionally large and is a source of heat loss -Padding is often required behind the shoulders to maintain a neutral, in-line position -Sunken fontanelles may indicate hypovolemia in infants, whereas bulging fontanelles may indicate increased ICP Pneumonia Pulmonary embolism -Long sedentary periods, recent surgery Deep Vein Thrombosis Stroke GI Disorders Dementia -A slow, progressive deterioration of cognitive function Delirium -A sudden change in cognitive function or mental status, can be treated and reversed. Depression -Geriatric females have higher rates of depression; geriatric males have higher suicide rates. -Geriatric suicide attempts are more successful. Trauma Osteoporosis What are the different ambulance types? - Answer Type I ambulance: truck chassis with modern ambulance body Type II: standard van design Type III: specialty van design with a square patient compartment mounted on the chassis What are the phases of an ambulance call? - Answer Preparation Phase -Inspect the ambulance everyday and after each shift change Dispatch -Nature of the call, location and number of patients En Route -Notify dispatch you're responding -All emergency vehicle operators must drive with due regard for the safety of others Arrival at Scene/Patient Contact -Notify dispatch you are on scene -Ambulance in a safe position/as a barrier Patient Transfer to Ambulance Transport to Receiving Facility -Notify dispatch where you are taking patient -Notify receiving hospital Arrival at Hospital/Transfer of Care -Notify dispatch you've arrived -Provide verbal report to appropriate personnel -Provide written copy of PCR -Obtain transfer of care signature Postrun Phase/Return to Service What are defensive driving tactics? - Answer Emergency vehicles should usually travel in the far left lane What vehicle safety systems should you be aware of? - Answer Shock-Absorbing Bumpers -Most vehicles today are equipped with shock-absorbing bumpers (front and rear). They can become compressed during an accident and spontaneously release, injuring anyone standing in front of them. -Approach vehicles from the side, not the front. Simple access: gaining access to the patient without any tools or need to break the glass. Complex access: requires the use of special tools and training. What are hazardous materials? - Answer Hazardous materials are solids, liquids or gases that pose a threat to people, property or the environment. Risks of exposure depend on the dose, concentration, route of exposure, and duration of contact. The EMT's primary responsibilities at a hazardous materials incident are personal safety, notification of appropriate authorities, and the safety of the patient and public. What are the diamond placards? - Answer Blue diamond: provides information about health hazards. Red diamond: provides information about fire hazard. Yellow diamond: provides information about reactivity hazards. White diamond: displays symbols indicating special hazards such as radioactivity or reactivity with water. The higher the number within the blue, red or yellow diamonds, the greater the hazard is within that category. -EMS facilities should have adequate resources to be fully self-sufficient for at least 72 hours. -A plan should be in place to assist families of EMS responders so responders can focus on their job. Scene Size-Up -What is the incident? -What do you need to do? -What resources do you need to do it? Medical Incident Command Functions -Triage: the sorting of patients based on the severity of injury. The triage supervisor identifies the number and severity of patients. Treatment does NOT begin until all patients are triaged. -Treatment: Secondary triage should be completed within each treatment area. -Transportation -Staging -Rehabilitation: safe location for the rest and recovery of responders. -Extrication and Special Rescue What are mass casualty incidents? - Answer A mass casualty incident (MCI) is broadly defined as an incident that taxes the locally available resources or requires a multijurisdictional response. What is START Triage? - Answer Step 1 -Direct all patients capable of moving to a central location. -Those able to follow the command and move to the assigned location are collectively triaged as Minor (green tag) or "walking wounded." Step 2 -Move from patient to patient and begin triage using the RPM method. -Respirations: If not breathing, manually open the airway. If patient does not begin breathing spontaneously, triage as Expectant (black tag) and move to the next patient. If the patient begins to breathe, triage as Immediate (red tag), place in recovery position, and move to next patient. If the patient is breathing spontaneously above 30 breaths/minute or below 10 breaths/minute, triage as Immediate and move to the next patient. If the patient is spontaneously breathing 10 to 30 times per minute, move immediately to the next triage step with that patient. -Perfusion: assess radial pulse to determine perfusion status. If the radial pulse is absent, triage as immediate and move to the next patient. If the radial pulse is present, move immediately to the next triage step with that patient. -Mental status: If the patient is unable to follow simple commands, triage as immediate and move to the next patient. If the patient can follow simple commands, triage as Delayed (yellow tag) and move to the next patient. What are explosives? - Answer Explosives are the most commonly used WMD. Explosive weapons can cause significant blunt and penetrating trauma as well as burns and crushing injuries. -Primary, secondary, tertiary blast injuries What are chemical agents? - Answer Nerve agents -Nerve agents are a significant threat due to the relative ease with which they can be acquired and used. -Nerve agents cause excessive parasympathetic nervous system stimulation. -Specific nerve agents include Tabun, Sarin, Soman, and VX. -Signs and symptoms of nerve agent exposure: salivation, lacrimation, urination, defecation, gastric upset, emesis, miosis. -Management: aggressive airway management including suction, specific medications. Vesicants -Vesicants cause pain, burns and blisters to exposed skin, eyes and respiratory tract. -Vesicants are also known as blistering agents. -Depending on the vesicant agent, the onset of signs and symptoms could be delayed several hours. -Affected areas should be irrigated with copious amounts of water as soon as possible. Cyanide -Cyanide interferes with the body's ability to deliver oxygen to the cells, leading to severe hypoxia and death. -Signs and symptoms include dizziness, weakness, anxiety, nausea, tachypnea, seizures, and respiratory arrest. -Management: administer high-flow oxygen, support positive-pressure ventilation as needed, antidotes. Chemical Agents Cont. - Answer Pulmonary Agents -Pulmonary agents cause lung injury -Signs and symptoms include dyspnea, cough, wheezing, runny nose and sore throat. -Management: manage the airway, administer oxygen and support ventilations as needed. Biological Agents -Biological agents are used to cause disease. -Even small quantities of certain biological agents can cause disease in a large number of people. -Signs and symptoms include fever, weakness, respiratory distress, and flulike symptoms. -Management is based on providing supportive care for the patient's symptoms. Nuclear and radiological weapons -Nuclear weapons can cause death as a result of the blast, the radiation, or thermal burns. -Nuclear radiation is dangerous because it can kill living organisms in the body or cause them to mutate. These mutations can lead to birth defects, cancer, and other problems. What are the different types of radiation? - Answer Alpha radiation: -Dense, slow-moving radiation. -Can travel only short distances. -Stopped by clothing, skin, etc. but still very dangerous if patient is contaminated internally, such as through ingestion or inhalation. Beta radiation -Slow-moving radiation. Can travel only a few feet. -Penetrates only the first few millimeters of skin. -Serious risk if patient is internally contaminated through ingestion or inhalation.