NREMT Cognitive Exam Prep: EMT Questions and Answers, Exams of Nursing

Download NREMT Cognitive Exam Prep: EMT Questions and Answers and more Exams Nursing in PDF only on Docsity! NREMT Cognitive Exam Prep questions and answers Where does the modern EMS system have its origin? - 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? - 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? - Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? - Emergency Medical Responder (EMR): provides basic, immediate care including bleeding control, CPR, AED and emergency childbirth. NREMT Cognitive Exam Prep questions and answers 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? - Equipment preparedness Emergency vehicle operations Establish, maintain scene safety Patient assessment and treatment Lifting and moving Strong verbal and written communication skills Patient advocacy NREMT Cognitive Exam Prep questions and answers What are the two types of PPE? - Minimum PPE: gloves and eye protection should be used during any patient contact situation. Expanded PPE: use disposable gown and mask for significant contact with any body fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA) mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis. What are emergency moves? - These are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit-forearm drag, shirt drag, and blanket drag. What is an urgent move? - Used when the patient has potentially life-threatening injuries or illness and must be moved quickly for evaluation and transport. Rapid extrication: an urgent move used for patients in a motor vehicle; it requires multiple rescuers and a long backboard. The patient is rotated onto a backboard with manual cervical spine precautions and removed from the vehicle. What are non-urgent moves? - Used when there are no hazards and no life- threatening conditions are apparent. NREMT Cognitive Exam Prep questions and answers Types of non-urgent moves include direct ground lift, extremity lift, direct carry method, and draw sheet method. What is the log roll technique? - Commonly used to place a patient on a backboard or assess the posterior. Can be done while maintaining manual cervical spine precautions. Should have at least three trained personnel. The person controlling manual cervical spine protection should direct the log roll. What are special considerations for bariatric patients? - Obese patients pose additional challenges and risks to providers during lifting and movement. Some EMS systems have special bariatric ambulances with specialized equipment, automated lifting systems, and wider stretchers capable of a greater weight capacity. What is supine hypotensive syndrome? - Patients in the later stages of pregnancy should not be placed supine due to the risk of supine hypotensive syndrome. Place the pregnant patient on her left side. If patient has potential cervical spine trauma, tilt backboard to the left about 20 degrees. NREMT Cognitive Exam Prep questions and answers When can patients be restrained? - In general, patients may be forcibly restrained if they pose a significant, immediate threat to you, your partner, or others. Restraining a patient against his will is a last resort. Anticipate and plan. Request law enforcement assistance. Contact medical direction when possible. Guidelines for restraining a patient: -Get additional help whenever possible; at least 4 people is recommended. -Use the minimum amount of force necessary to protect yourself, the patient and others. -Secure patient supine, with backboard if available. DO NOT secure the patient in a prone position. -Use soft, padded restraints. -Monitor the patient's level of consciousness, airway, and distal circulation continuously. -Thoroughly document the reason for restraining the patient, the method of restraint, the duration of restraint, and frequent reassessment of the patient while restrained. NREMT Cognitive Exam Prep questions and answers -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? - 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? - 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? - 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. NREMT Cognitive Exam Prep questions and answers -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? - 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? - 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? - Battery is physically touching another person without their consent. NREMT Cognitive Exam Prep questions and answers What is negligence? - 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? - 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? - 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. NREMT Cognitive Exam Prep questions and answers What factors determine whether a patient is competent or not? - Typically, competency requires awareness of at least four things: -Person: the patient knows his or her name. -Place: the patient knows where he or she is. -Time: the patient is aware of the date and time. -Event: the patient is aware of his or her present circumstances. 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. When can EMTs release confidential patient information? - EMTs can release confidential patient information without consent when: -The information is necessary for continuity of care -The information is necessary to facilitate billing for services -The EMT has received a valid subpoena NREMT Cognitive Exam Prep questions and answers -Reporting possible crimes, abuse, assault, neglect, certain injuries or communicable diseases What is HIPAA? - Health Insurance Portability and Accountability Act (HIPAA) -HIPAA is a federal law established in 1996 and has had a huge impact on health care. HIPAA improved privacy protection of patient health care records. -HIPAA gives patients greater control over how health care records are used and transferred. -EMS agencies are mandated to provide HIPAA training to all employees who have any contact with patients or patient records. -EMS providers must provide patients with privacy practices and obtain signature of receipt. 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." NREMT Cognitive Exam Prep questions and answers 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 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 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 NREMT Cognitive Exam Prep questions and answers 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 What two components must be present for transfer of care? - 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? - 1. Continuation of care NREMT Cognitive Exam Prep questions and answers 2. Legal document 3. Billing 4. Research and continuous quality improvement What is the minimum data set? - 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 NREMT Cognitive Exam Prep questions and answers -Minimum of two sets of vital signs -All assessments completed on the patient -All treatments provided and response to treatment Administrative information: -The address of the call -Date of the call -Your unit designation -The name or identifying number and certification level of all EMS providers on the call Narrative 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 NREMT Cognitive Exam Prep questions and answers What is exhalation? - The diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity rises and air is expelled. Exhalation is normally passive and does not require energy. Exhaled air contains 16% oxygen. What are the different types of respiration? - 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 is the primary mechanism of breathing control? - 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. NREMT Cognitive Exam Prep questions and answers What is hypoxic drive? - 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? - Respiratory rate times tidal volume. 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 the three layers of heart muscle and pericardium? - Endocardium: smooth, thin lining on the inside of the heart NREMT Cognitive Exam Prep questions and answers 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? - 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? - 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. NREMT Cognitive Exam Prep questions and answers 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? - 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. NREMT Cognitive Exam Prep questions and answers Hyperventilation of infants presents significant risk of barotrauma. What are the reflexes that infants have? - Startle reflex, grip reflex, rooting reflex, sucking reflex What are the age ranges of toddlers and preschoolers? - Toddlers: 1 to 3 years old Preschoolers: 3 to 6 years old 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 NREMT Cognitive Exam Prep questions and answers What is the physiology of toddlers and preschoolers? - As the immune system develops, children at this age typically experience a number of minor colds, viruses, flu-like symptoms, respiratory infections, etc. Fine motor skills improve and the brain grows rapidly in size. Toddlers: typically walk, climb, distinguish basic shapes and colors and are potty trained. Preschoolers: typically are physically coordinated and communicate well verbally, know their name and address and can dress themselves, can count to 10 or beyond. What developments you should know about school-age children? - Vital signs: -Respirations: about 15 to 20 breaths/minute -Heart rate: 70-110 bpm -Blood pressure: 90-120 systolic Physiology: -Permanent teeth replace baby teeth -The musculoskeletal system is growing rapidly NREMT Cognitive Exam Prep questions and answers -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? - Ventilation is the moving of air in and out of the lungs. What is hypoxia? - 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? - 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. NREMT Cognitive Exam Prep questions and answers What is notable about suction units? - Portable and fixed suction units should be able to generate a vacuum of 300 mmHg when tubing is clamped. What is proper suctioning technique? - 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? - 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%. NREMT Cognitive Exam Prep questions and answers 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? - 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? - Usually the preferred method of oxygen administration in prehospital. Referred to as "high-flow" oxygen administration. Flow rate: 10-15 L/min NREMT Cognitive Exam Prep questions and answers mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask or a nonrebreather mask. 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 Retinal damage: can occur in newborns with long-term exposure to high- concentration oxygen When is artificial ventilation indicated? - Artificial ventilations are indicated for any patient with *inadequate spontaneous breathing* leading to severe respiratory distress or respiratory failure. This could be caused by: -CNS injury, disease or impairment -Foreign-body airway obstruction -Chest trauma, such as a flail chest or a sucking chest wound -Increased airway resistance due to bronchoconstriction, pulmonary edema or inflammation NREMT Cognitive Exam Prep questions and answers Consider providing artificial ventilations for any patient breathing less than 8 times per minute or for any adult patient breathing more than 24 times per minute. Any unresponsive patient receiving artificial ventilations should have an airway adjunct in place to prevent the tongue from obstructing the airway. What are the risks of artificial ventilation? - Artificial ventilations are accomplished through positive pressure ventilations (PPV) whereas normal spontaneous breathing is done through negative pressure. Complications of PPV: -Increased intrathoracic pressure, which reduces circulatory efficiency -Gastric distension, which increases the risk of vomiting and can compromise ventilatory efficiency -Hyperventilation 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. NREMT Cognitive Exam Prep questions and answers 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) 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 NREMT Cognitive Exam Prep questions and answers Before attempting ventilations, inspect the airway for visible foreign bodies. Remove if able. 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 the standard vital signs? - Respiration: rate, rhythm, quality Pulse: rate, rhythm, quality Blood Pressure Pupils: size, equality, reactivity NREMT Cognitive Exam Prep questions and answers Skin: color, temperature, condition and capillary refill Pulse oximetry What is pulse pressure? - 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? - A systolic below 70 + 2(age) for ages 1 to 10 years indicates hypotension 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 NREMT Cognitive Exam Prep questions and answers What is the difference between pharmacokinetics and pharmacodynamics? - 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? - 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 Sublingual: faster onset than oral -Nitroglycerin NREMT Cognitive Exam Prep questions and answers Dose and route: -324 mg orally Side effects: nausea, vomiting, stomach pain, bleeding, allergic reaction, Reye's syndrome in pediatric patients What information do you need to know about a metered dose inhaler? - Names: albuterol, ipratropium bromide Class: bronchodilator MOA: relaxes bronchial smooth muscle, improving air exchange Indications: dyspnea, wheezing, asthma , reactive airway disease Contraindications: allergy, patient unable to follow commands, expired medication, medication not prescribed to patient, lack of medical direction NREMT Cognitive Exam Prep questions and answers Dose and route: one to two inhalations Side effects: tachycardia, hypertension, restlessnessm, anxiousness What information do you need to know about the EpiPen? - 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 NREMT Cognitive Exam Prep questions and answers What information do you need to know about nitroglycerin? - 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? - Class: oral hyperglycemic NREMT Cognitive Exam Prep questions and answers -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? - 1. Cardiogenic shock 2. Obstructive shock 3. Distributive shock 4. Hypovolemic shock What is cardiogenic shock? - Cardiogenic shock is a pump problem. The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension. NREMT Cognitive Exam Prep questions and answers -Pulmonary edema, accumulation of fluid in the lungs. Signs and symptoms of cardiogenic shock include hypotension, probable cardiac history, chest pain, respiratory distress, pulmonary edema, and altered LOC. What is obstructive shock? - This type of shock is a pump problem caused by mechanical obstruction of the heart muscle. -Cardiac tamponade: fluid accumulates within the pericardial sac and compresses the heart. Signs and symptoms inlcude JVD, narrowing pulse pressure, hypotension, -Tension pneumothorax: air enters the chest cavity due to lung injury or sucking chest wound. Accumulating pressure compresses the lungs and great vessels. Signs and symptoms include JVD, respiratory distress, diminished or absent lung sounds, difficulty ventilating, and tracheal deviation towards the *unaffected* side. What is distributive shock? - Distributive shock is a pipe problem. It occurs due to widespread vasodilation, which causes blood pooling and relative hypovolemia. Anaphylactic shock: a life-threatening severe allergic reaction due to massive vasodilation, widespread vessel permeability, and bronchoconstriction. NREMT Cognitive Exam Prep questions and answers Neurogenic shock: caused by spinal cord damage, typically in the cervical region. It leads to massive, systemic vasodilation below the level of injury. Septic shock: caused by severe infection, which damages blood vessels and increases plasma loss out of the vascular space. Psychogenic shock: caused by sudden, temporary vasodilation that leads to syncope. What is hypovolemic shock? - Hypovolemic shock is a fluid problem. It may be caused by hemorrhage or by dehydration or burns. What are early signs and symptoms of shock? - Altered LOC Tachycardia Pale, cool skin: due to peripheral vasoconstriction NREMT Cognitive Exam Prep questions and answers What is croup? - 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? - 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? - 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. NREMT Cognitive Exam Prep questions and answers What are cardiac emergencies? - Acute Coronary Syndrome (ACS) Angina Pectoris Acute Myocardial Infarction Congestive Heart Failure Hypertension Cardiogenic shock What is acute coronary syndrome? - Symptoms of ACS are caused by myocardial ischemia. ACS includes angina pectoris and acute myocardial infarction. What is angina pectoris? - 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. NREMT Cognitive Exam Prep questions and answers What is acute myocardial infarction? - 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? - 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. NREMT Cognitive Exam Prep questions and answers What is a TIA? - Transient ischemic attacks (TIAs) have the same presentation as CVAs. However, the signs and symptoms self-correct within about 24 hours with no permanent brain damage. They are a warning sign of an impending stroke. What are the types of seizures? - Generalized seizures -Also called grand mal seizures -Patient is unresponsive and experiences full-body convulsions Absence seizures -Also called petit mal seizures -Patient does not interact with environment, but there is no convulsive activity Partial seizures -Simple partial seizure: no change in LOC, possible twitching or sensory changes but no full-body convulsions -Complex partial seizures: altered LOC, isolated twitching and sensory changes possible NREMT Cognitive Exam Prep questions and answers Status epilepticus -Prolonged seizure (about 30 minutes) or recurring seizures without the patient regaining consciousness in between -Highly dangerous, possibly leading to permanent brain damage and death What are the phases of a seizure? - Not every stage is present for every type of seizure or every patient. 1. Aura phase -Warning stage -Patient may sense onset 2. Tonic phase -Muscle rigidity -Possible incontinence 3. Tonic-clonic phase -Patient experiences uncontrolled muscle contraction and relaxation -Patient may be apneic during the tonic or tonic-clonic phase. NREMT Cognitive Exam Prep questions and answers 4. Postictal phase -"Recovery" phase -Patient's LOC progressively improves over about 30 minutes 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. Why is glucose important? - Glucose is the body's primary fuel source It is the only fuel source used by the brain In addition to oxygen, the brain must have a continuous supply of glucose The use of glucose as a fuel source is an aerobic function Why are fats and proteins important? - The brain cannot use these alternate fuel sources, but the rest of the body can. NREMT Cognitive Exam Prep questions and answers What is insulin shock? - 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? - 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)? - Occurs more frequently with type I diabetes. With DKA, the blood glucose is frequently above 350 mg/dL. NREMT Cognitive Exam Prep questions and answers 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? - Similar to DKA, without the buildup of ketones Occurs more frequently with type II diabetes What is an allergic reaction? - An allergic reaction is an excessive immune response to an allergenic. Allergic reactions can be local or systemic. NREMT Cognitive Exam Prep questions and answers 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? - 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? - Medications Environmental triggers Foods NREMT Cognitive Exam Prep questions and answers 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 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 NREMT Cognitive Exam Prep questions and answers -Most chemicals on the skin or eye should be irrigated with water continuously for about 20 minutes. -When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. What do you need to know about alcohol? - Alcohol is the most widely abused drug in the US Most long-term alcoholics will develop hepatitis. Alcohol is a CNS depressant and a sedative hypnotic. Ingestion of alcohol increases risks of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). -Restless, irritable, agitated -Hallucinations, tremors or seizures What do you need to know about narcotics? - Narcotics are widely abused. They are typically ingested or injected. NREMT Cognitive Exam Prep questions and answers 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? - 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. NREMT Cognitive Exam Prep questions and answers 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? - 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. NREMT Cognitive Exam Prep questions and answers 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? - 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. NREMT Cognitive Exam Prep questions and answers Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What is acute abdominal pain? - Acute abdominal pain is usually due to trauma, distension, inflammation, or ischemia. 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. NREMT Cognitive Exam Prep questions and answers What is diverticulitis? - Diverticulitis develops when small pouches (diverticula) along the wall of the intestine fill with feces and become inflamed and infected. Typically affects people over age 40 and is associated with a low-fiber diet. Signs and symptoms: -Usually abdominal pain in the lower left quadrant -Fever -Weakness -Nausea and vomiting -Bleeding NOT common What is GI bleeding? - Most often occurs in middle-aged patients Most often fatal in geriatric patients Upper GI bleeds: often due to ulcers NREMT Cognitive Exam Prep questions and answers 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? - 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? - Esophageal varices are a weakening of the blood vessels lining the esophagus. NREMT Cognitive Exam Prep questions and answers 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? - 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? - AAA is a weakening of the wall of the aorta in the abdominal region. NREMT Cognitive Exam Prep questions and answers 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 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 NREMT Cognitive Exam Prep questions and answers 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 is a behavioral emergency? - A behavioral emergency is an abnormal behavior that is unacceptable to patients, family members, or society. What causes behavioral emergencies? - Causes of behavioral emergencies can be physiological or psychological. 1. Physiological causes include diabetic emergency; hypoxia; head injury; drugs, alcohol and toxins; environmental emergencies; and seizures. 2. Psychological causes include: NREMT Cognitive Exam Prep questions and answers -Anxiety: unusual level of stress about an event or problem. -Bipolar disorder: also known as manic depression; characterized by drastic mood swings. -Depression: deep sadness not associated with a specific event. -Paranoia: extreme suspicion or distrust about others. -Phobias: unusual level of fear about specific things. -Psychosis: delusional state. -Schizophrenia: a state characterized by disorganized speech and thinking. What do you need to know about suicidal patients? - Females are more likely to attempt suicide, but males are more likely to die as a result of suicide. Suicide attempts usually involve firearms, drugs, or alcohol. Most suicidal patients will give clear signals of their intent. All suicidal gestures should be taken seriously, especially when patients have a clear plan and the means to carry it out. NREMT Cognitive Exam Prep questions and answers -Rotational forces increase the risk of c-spine injury. What are the three collisions in every MVC? - 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? - 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? - 1. Low-velocity projectiles NREMT Cognitive Exam Prep questions and answers -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? - 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. NREMT Cognitive Exam Prep questions and answers What are the indications for air medical transport? - 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? - What are the trauma center designations? - 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.