NREMT Cognitive Exam Prep: Questions and Answers, Exams of Medicine

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How does the body lose heat? - ✔️ ✔️ 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.

How can you prevent the risk of infection? - ✔️ ✔️ Immediately report exposures to the designated infection control officer. 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.

How do Good Samaritan Laws affect EMTs? - ✔️ ✔️ 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.

How do you administer supplemental oxygen in patients with a tracheostomy or stoma?

• ✔️ ✔️ Patients with a tracheostomy ventilate thorugh their stoma, not the mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask or a nonrebreather mask.

Chemical Agents Cont. - ✔️ ✔️ 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.

How can an EMT reduce liability on patient refusal? - ✔️ ✔️ 1) The EMTs best protection from liability is to provide excellent care and convince the patient to accept transport.

2. The second best way for an EMT to protect himself or herself is to ensure the patient is fully informed, contact medical direction, and document extremely well.

How can radiation exposure be prevented and managed? - ✔️ ✔️ Protection from radiation:

• Time: spend as little time as possible near a radiation source.
• Distance: get as far away as possible from the radiation source.
• Shielding: gamma radiation will require significant shielding, such as lead or concrete.

Management

• Remove patients from the source of radiation to a safer location not downwind.
• Complete a thorough primary assessment.
• Treat blast injuries, tertiary injuries, burn injuries as you normally would.

How can the spine be immobilized? - ✔️ ✔️ 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.

How can you estimate blood pressure in pediatric patients? - ✔️ ✔️ A systolic below 70

• 2(age) for ages 1 to 10 years indicates hypotension

How do you care for a newborn? - ✔️ ✔️ Immediately upon delivery, place on clean, dry sheets or towels.

Dry baby, including the head, and immediately replace wet linen with dry.

Warm the baby, including the head. Placing the baby on the mother's abdomen will provide a radiant heat source.

Suction the baby's mouth first, then nose.

If the baby is not active and crying, attempt tactile stimulation by rubbing the baby's back or tapping the soles of the feet.

Assess respirations. If the baby is not breathing adequately, begin ventilations (40- 60 per minute) with an appropriately sized bag and mask for 30 seconds with high-flow oxygen. Do not overinflate the newborn's chest.

Assess heart rate.

1. Heart rate below 60 beats per minute

• Begin chest compressions and ventilations at a 3:1 ratio
• Reassess every 30 seconds

2. Heart rate above 60 but below 100

• Provide ventilations
• Reassess every 30 seconds

3. Heart rate above 100: assess skin color.

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

How do you know you're performing correct artificial ventilations? - ✔️ ✔️ The best way to determine appropriate tidal volume is rise and fall of the chest.

• Artificial ventilations should cause gentle rise and fall.
• It should take at least one second to inflate the chest.

Correct rates of artificial ventilation for apneic patients with a pulse:

• Adults: one breath every 5-6 seconds (10-12 times per minute)
• Infants and children: one breath every 3-5 seconds (12-20 times per minute)
• Newborns: one breath every 1 to 1.5 seconds (40-60 times per minute)

How is a foreign body airway obstruction managed in conscious patients? - ✔️ ✔️ 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? - ✔️ ✔️ Initiate CPR.

Before attempting ventilations, inspect the airway for visible foreign bodies. Remove if able.

How is lung expansion achieved? - ✔️ ✔️ During inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs.

How long is a full-term pregnancy? - ✔️ ✔️ A full-term pregnancy lasts about 9 months or 40 weeks.

How long quickly does hypoxia damage the heart and brain? - ✔️ ✔️ 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.

How many bones are there in the human body? - ✔️ ✔️ There are 206 bones in the human body.

How many vertebrae are in the spinal column? - ✔️ ✔️ 33 vertebrae

• 7 cervical
• 12 thoracic
• 5 lumbar
• 5 sacral
• 4 coccygeal

How should EMT's operate in crime scenes? - ✔️ ✔️ 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

How should hypothermia be managed? - ✔️ ✔️ 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.

How should impaled objects be managed? - ✔️ ✔️ 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 local cold emergencies be managed? - ✔️ ✔️ Remove patient from cold environment. Remove wet clothing. Protect affected areas from further injury. Remove any jewelry. Bandage, splint affected areas. Keep patient immobile. Do NOT rub affected areas. Do NOT apply direct heat unless authorized by medical direction.

How should open neck injuries and bite wounds be managed? - ✔️ ✔️ 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.

• 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.

How should shock be managed? - ✔️ ✔️ Control bleeding, high-flow oxygen, Trendelenburg, prevent loss of body heat, rapid transport.

How should systemic heat emergencies be managed? - ✔️ ✔️ 1. Move patient to a cooler environment.

2. If patient is completely alert, water can be administered.
3. If heatstroke is suspected, cooling measures must be rapid and aggressive.

• Expose patient to improve dissipation of heat.
• Cool patient with water, wet towels, cold packs, etc.
• Cold packs are best applied to groin, neck, armpits.
• Rapid transport is indicated.
• Prepare for vomiting and/or seizures.

How should you communicate with dispatch? - ✔️ ✔️ 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? - ✔️ ✔️ 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

On what kind of scenes must law enforcement be notified? - ✔️ ✔️ 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

What are absorbed toxins? - ✔️ ✔️ 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 are advance directives? - ✔️ ✔️ 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.

What are blood glucose levels? - ✔️ ✔️ Normal: 80-120 mg/dL Hypoglycemia: 60 mg/dL or below (really, below 80) Hyperglycemia: over about 140 mg/dL

What are cardiac emergencies? - ✔️ ✔️ Acute Coronary Syndrome (ACS) Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure Hypertension Cardiogenic shock

What are chemical agents? - ✔️ ✔️ 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.

What are clavicle and rib fractures? - ✔️ ✔️ Clavicle and rib fractures are common and should not be dismissed.

Clavicle and rib fractures can be associated with pneumothorax.

A fracture to one of the first several ribs indicates a serious mechanism of injury.

Patient may present with subcutaneous emphysema. Subcutaneous emphysema is a "crackling" sensation upon palpation due to air escaping into the fatty tissue.

What are COBRA and EMTALA? - ✔️ ✔️ Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA)

• COBRA and EMTALA include federal regulations guaranteeing public access to emergency care.
• 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? - ✔️ ✔️ The following are typically considered obvious signs of death indicating that resuscitation should not be initiated:

• Decomposition
• Rigor mortis
• Dependent lividity
• Decapitation

What are defensive driving tactics? - ✔️ ✔️ Emergency vehicles should usually travel in the far left lane

What are developments you should know about adulthood? - ✔️ ✔️ Vitals:

• Respirations: 12-20 breaths/minute
• Heart rate: 60-100 beats/minute
• Blood pressurer: about 110/70 to 130/

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 are early signs and symptoms of shock? - ✔️ ✔️ Altered LOC

Tachycardia

Pale, cool skin: due to peripheral vasoconstriction

Weak peripheral pulses

Increased respiratory rate

Thirst

Delayed capillary refill

What are emergency moves? - ✔️ ✔️ 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 are EMT roles and responsibilities? - ✔️ ✔️ 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 are esophageal varices? - ✔️ ✔️ 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 explosives? - ✔️ ✔️ 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 eye injuries and their treatments? - ✔️ ✔️ A. Foreign Objects

• Nonpenetrating foreign objects in the sclera are often easily removed by irrigating the eye.
• Foreign objects in any other part of the eye should be removed by a physician.

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? - ✔️ ✔️ 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 are genitourinary and renal emergencies? - ✔️ ✔️ 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.

What are hazardous materials? - ✔️ ✔️ 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 hemorrhagic strokes? - ✔️ ✔️ 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 are high-risk behavioral situations? - ✔️ ✔️ 1. Suicidal patients

2. Patients with agitated delirium

• Agitated delirium is characterized by violent, unpredictable behavior, and unusual strength and pain tolerance.
• It is often associated with use of methamphetamine or other CNS stimulants.
• Agitated delirium patients are at high risk of sudden cardiac arrest.

What are indicators of imminent delivery? - ✔️ ✔️ The mother has strong, frequent contractions under 2 minutes apart with little break between contractions.

The abdomen is rigid during contractions.

The mother feels the urge to push.

Crowning.

What are ingested toxins? - ✔️ ✔️ 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.

Signs and symptoms include:

• Burning to the mouth and airway
• Stomach pain, cramps, nausea, vomiting
• Altered LOC,
• Seizures

Sedatives, narcotics and barbiturates are commonly abused drugs.

Treatment: consider activated charcoal per medical direction.

What are inhaled toxins? - ✔️ ✔️ Examples of inhaled poisons include various chemicals, pesticides, carbon monoxide, and natural gas.

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? - ✔️ ✔️ 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

What are ischemic strokes? - ✔️ ✔️ 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 late signs and symptoms of shock? - ✔️ ✔️ Falling BP

Irregular breathing

Mottling or cyanosis

Absent peripheral pulses

What are life-threatening complications of burn injuries? - ✔️ ✔️ The life-threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise.

What are local cold emergencies? - ✔️ ✔️ 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.

Frostbite

• The most dangerous local cold emergency.
• The tissue is frozen, which frequently leads to permanent damage.
• Can lead to gangrene.
• Signs and symptoms include hard, frozen tissue, possible blistering and mottling.

What are mass casualty incidents? - ✔️ ✔️ A mass casualty incident (MCI) is broadly defined as an incident that taxes the locally available resources or requires a multijurisdictional response.

What are multiple births? - ✔️ ✔️ 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 are nasal cannulas? - ✔️ ✔️ 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

What are non-rebreather masks? - ✔️ ✔️ 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 non-urgent moves? - ✔️ ✔️ Used when there are no hazards and no life- threatening conditions are apparent. Types of non-urgent moves include direct ground lift, extremity lift, direct carry method, and draw sheet method.

What are normal breathing rates for adults, children and infants? - ✔️ ✔️ 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 normal vital signs for infants? - ✔️ ✔️ 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 are normal vital signs of toddlers and preschoolers? - ✔️ ✔️ 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 are open-ended vs. closed-ended questions? - ✔️ ✔️ 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 patient refusals? - ✔️ ✔️ Competent patients may refuse treatment regardless of the severity of their condition.

• Refusals present high liability risk for EMS providers.
• Negligence or abandonment can be much easier to provide if the patient is not transport.
• Consider requesting advanced life support personnel or contacting medical direction per local protocols.
• During a refusal, the patient must be fully informed of the treatment recommended and the possible consequences of refusing treatment.
• The patient is rarely, if ever, fully informed the first time he or she conveys the intent to refuse treatment. Documentation should reflect both the initial refusal and the second refusal after being fully informed.

What are portable and mobile radios? - ✔️ ✔️ 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 are possible causes of seizures? - ✔️ ✔️ Congenital, traumatic, medical conditions, diabetes, epilepsy, fever, infection, medications, toxin exposure

Febrile seizures are a common cause of seizures in pediatric patients. Caused by high fevers that develop rapidly, they do not typically present significant risk to the patient. The child should, however, be evaluated by a physician.

What are potential causes of acute abdominal pain? - ✔️ ✔️ Appendicitis Peritonitis Cholecystitis Diverticulitis GI bleeding

Gastroenteritis Esophageal varices Ulcers Abdominal Aortic Aneurysm (AAA)

What are potential causes of respiratory complaints? - ✔️ ✔️ Airway obstruction Anaphylaxis Asthma Chronic obstructive pulmonary disease (COPD) Congestive heart failure Croup Cystic fibrosis Flail chest Pneumonia Pneumothorax Pulmonary edema Pulmonary embolism Respiratory syncytial virus (RSV) Hyperventilation syndrome Sucking chest wound Thoracic trauma Toxic substance exposure

What are potential delivery complications? - ✔️ ✔️ A. Meconium B. Multiple Births C. Prolapsed cord D. Breech presentation E. Limb presentation F. Postpartum hemorrhage

What are potential life-threatening injuries? - ✔️ ✔️ 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

• 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 are potential limb-threatening injuries? - ✔️ ✔️ 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 preeclampsia and eclampsia? - ✔️ ✔️ 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 are scalp injuries? - ✔️ ✔️ 1. Scalp injuries can be open or closed.

2. The scalp is highly vascular and bleeds heavily when lacerated.

What are seizures during pregnancy? - ✔️ ✔️ 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 significant MOIs? - ✔️ ✔️ 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 skull fractures? - ✔️ ✔️ 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.
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 some considerations for the geriatric population? - ✔️ ✔️ Communication

• Speak clearly
• Be patient

Medical History

• Often extensive
• Hypertension, heart disease, diabetes

Medications

• Polypharmacy
• Can sometimes be mismanaged or interact negatively

MOI

• Index of suspicion should be much higher
• Spinal precautions may be challenging

Environmental Cues

What are sources that help establish standard of care? - ✔️ ✔️ 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 are special considerations for bariatric patients? - ✔️ ✔️ 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 are special types of burns? - ✔️ ✔️ 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 specific gynecologic emergencies? - ✔️ ✔️ 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
• Fever, nausea and vomiting

What are strokes? - ✔️ ✔️ 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 the "zones" of a HazMat site? - ✔️ ✔️ Hot Zone

• This is the contaminated area
• Appropriate PPE is required, as determined by HazMat personnel
• Regardless of patient condition, those without proper training and PPE are not permitted in the hot zone.

• Patient care does not take place in the hot zone.

Warm Zone

• This is area between the hot and cold zones.
• Appropriate PPE is required.
• Only life-threatening conditions are treated in the warm zone.
• Everyone must be decontaminated in the warm zone before entering the cold zone.

Cold Zone

• Most treatment is performed in the cold zone.
• Typically, EMS providers remain in the cold zone.

What are the age ranges of toddlers and preschoolers? - ✔️ ✔️ Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old

What are the appropriate managements for life-threatening conditions associated with breathing? - ✔️ ✔️ Flail chest: initiate artificial ventilations

Sucking chest wound: apply an occlusive dressing

What are the components of blood? - ✔️ ✔️ 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 are the components of NIMS? - ✔️ ✔️ Preparedness: This component helps agencies and responders proactively prepare for an incident.

Communications and Information: This component coordinates effective communication and information sharing.

Command and Management: This component provides oversight of the incident for all participating agencies.

Resource Management: This component coordinates acquisition, tracking, and recovery of resources and equipment needed during an incident.

Ongoing Management: This component coordinates continuous quality improvement of EMS.

What are the components of the lower airway? - ✔️ ✔️ Components of the lower airway include:

• Trachea
• Carina
• Left and right mainstem bronchi
• Broncioles
• Alveoli

What are the components of the primary assessment? - ✔️ ✔️ 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 components of the scene size-up? - ✔️ ✔️ 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 upper airway? - ✔️ ✔️ Components of the upper airway include:

• Nose and mouth
• Nasopharynx
• Oropharynx
• Larynx
• Epiglottis

What are the compression:ventilation ratios for adults and children? - ✔️ ✔️ 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 are the diamond placards? - ✔️ ✔️ 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.

What are the different ambulance types? - ✔️ ✔️ 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 different types of abdominal pain? - ✔️ ✔️ 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 the different types of blast injuries? - ✔️ ✔️ 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 different types of motor vehicle collisions (MVCs)? - ✔️ ✔️ 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 different types of musculoskeletal injuries? - ✔️ ✔️ 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 the different types of obstetrical emergencies? - ✔️ ✔️ 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 are the different types of penetrating trauma? - ✔️ ✔️ 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 radiation? - ✔️ ✔️ 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.

Gamma radiation

• Can travel long distances. Easily penetrates the body.
• A significant external hazard risk to living things.

Signs and symptoms of acute radiation sickness include nausea, vomiting, diarrhea, fever, headache and skin lesions.

What are the different types of respiration? - ✔️ ✔️ 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.

What are the EMS functions of IMS? - ✔️ ✔️ Preparedness

• EMS agencies should have written disaster plans that are routinely practiced, reviewed, and improved.
• 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 the five factors of burn severity? - ✔️ ✔️ 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 are the four components of negligence? - ✔️ ✔️ 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 are the hazards of oxygen administration? - ✔️ ✔️ Oxygen is highly combustible Pressurized gas Oxygen toxicity: the alveoli can collapse due to a long-term exposure to high concentrations of oxygen Respiratory depression: a risk for COPD patients on the hypoxic drive