NREMT Cognitive Exam Prep Questions with Answers 2024, Exams of Nursing

Download NREMT Cognitive Exam Prep Questions with Answers 2024 and more Exams Nursing in PDF only on Docsity! NREMT Cognitive Exam Prep Questions with Answers 2024 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. 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 Professional development Quality improvement Illness and injury prevention Maintain certification/licensure What is the role of the medical director? ✔ The medical director is a physician responsible for providing medical oversight. The medical director oversees quality improvement. What are the two types of medical direction? ✔ Online medical direction: direct contact between the physician and EMT via or radio. Offline medical direction: written guidelines and protocols. What is an EMT's first priority? ✔ The EMT's first priority is always his or her own safety. Scene safety is always the top priority! The EMT's safety priorities after personal safety are for his/her partner(s), patients and bystanders. What are the types of stress? ✔ Acute stress: an immediate physiological and psychological reaction to a specific event. Delayed stress: a stress reaction that develops after the stressful event. It does not interfere with the EMT's ability to perform during the stressful event. PTSD is an example of delayed stress. Cumulative stress: the result of exposure to stressful situations over a prolonged period of time. What are the stages of grief? ✔ Denial Anger Bargaining Depression Acceptance 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. What are the two types of PPE? ✔ Minimum PPE: gloves and eye protection should be used during any patient contact situation. -Expressed consent is often used to obtain consent for more basic assessments or procedures. What is implied consent? ✔ Implied consent allows assumption of consent for emergency care from an unresponsive or incompetent patient. -Patients might be incompetent for many reasons, such as alcohol, drugs, head injury, hypoxia, hypoglycemia, or mental incompetency. -Implied consent can be used to treat a patient who initially refused care but later loses consciousness or becomes otherwise incapacitated. What is minor consent? ✔ 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. -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. 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. What is abandonment? ✔ Once care is initiated, EMS providers cannot terminate care without the patient's consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care. Abandonment is the termination of care without transferring the patient to an equal or higher medical authority. Transfer of care must include a verbal report to an equal or higher medical authority. Most EMS systems allow EMTs to accept care from a paramedic or advanced EMT for transport if an advanced-level assessment or advanced care is not needed. What is false imprisonment? ✔ You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? ✔ Destination factors include: -The patient's request or medical direction -The closest appropriate facility or specialty facility -Written protocols or triage guidelines -Hospital diversion or bypass A patient's ability to pay should NOT factor into where a patient is transported. When in doubt, consult medical direction. Thoroughly document why the destination was chosen. This is especially true if you bypass a closer hospital capable of managing your patient. 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 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 -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. ✔ 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 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 -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 -5 lumbar -5 sacral -4 coccygeal What are the components of the upper airway? ✔ Components of the upper airway include: -Nose and mouth -Nasopharynx -Oropharynx -Larynx -Epiglottis What is the most common cause of upper airway obstruction? ✔ The tongue. What are the components of the lower airway? ✔ Components of the lower airway include: -Trachea -Carina -Left and right mainstem bronchi -Broncioles -Alveoli How is lung expansion achieved? ✔ During inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs. What is the diaphragm? ✔ The diaphragm is the primary muscle of respiration. It separates the thoracic cavity from the abdominal cavity. It is usually under involuntary control but can be controlled voluntarily. The esophagus and the great vessels pass through the diaphragm. The diaphragm is dome shaped until it contracts during inhalation. During inhalation, it moves down and expands the size of the thoracic cavity. What is inhalation through negative pressure breathing? ✔ The diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and air rushes in. Inhalation is an active process and requires energy. Atmospheric (inhaled) oxygen contains 21% oxygen. What is exhalation? ✔ 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. 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 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. 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 School-age children typically: -Read and write -Develop problem-solving skills -Are establishing their self-image and morals -Have a large social circle due to school -Understand the concept of death -Look up to authority figures What developments should you know about adolescents? ✔ Vitals: -Respirations: 12-20 breaths/minute -Heart rate: 60-100 beats/minute -Blood pressure: ~100-120 systolic Physiology -Significant growth occurs over about a 3-year period -Eating disorders are more common in this age group -Puberty Adolescents often: -Exhibit argumentative behavior, and are hypercritical and egocentric -Do not anticipate the consequences of their actions -Are subject to a great deal of peer pressure, and are at higher risk for depression and suicide -Are preoccupied with body image and physical appearance -Become sexually active What are the stages of adulthood? ✔ Early adulthood: 20-40 years of age Middle adulthood: 40-60 years of age Late adulthood: over 60 years of age What are developments you should know about adulthood? ✔ Vitals: -Respirations: 12-20 breaths/minute -Heart rate: 60-100 beats/minute -Blood pressurer: about 110/70 to 130/90 Characteristics: -Accidental trauma is a leading cause of death in the young adult age group -Mild physical decline typically develops in the middle adult age group -Women typically experience menopause during middle adulthood -Continued physical and mental decline is common in late adulthood -Older adults frequently have extensive medical histories and are on multiple medications What is ventilation? ✔ 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. 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%. 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 Oxygen delivered: up to 90% Cautions: -The reservoir must be full before applying mask to patient -Never administer less than 10 L/min -If the reservoir completely deflates during inhalation, the flow rate must be increased -Immediately remove mask if oxygen source is lost What are nasal cannulas? ✔ 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% Contraindications: -Apneic patients or patients unable to follow verbal commands. -Chest trauma, suspected pneumothorax, or patients with a tracheostomy. -Vomiting or suspected GI bleeding. -Hypotension What is notable about the pediatric airway? ✔ The pediatric airway is more easily obstructed (smaller nose and mouth; larger tongue). The pediatric head is larger in proportion to the body. Padding should be placed behind the shoulders in a supine patient to maintain alignment of the airway. Signs of respiratory failure in pediatric patients: -Bradycardia and poor muscle tone -Altered LOC -Head bobbing and grunting on exhalation -Seesaw breathing How is a foreign body airway obstruction managed in conscious patients? ✔ 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. 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 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 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 What are the six "rights" of drug administration? ✔ Right patient, right drug, right route, right dose, right time, right documentation. What information do you need to know about activated charcoal? ✔ Class: adsorbent MOA: adheres many drugs and chemical, preventing their absorption into the GI tract Indication: recently ingested poision Contraindications: decreased LOC, inability to swallow, ingestion of acids, alkalis or hydrocarbons, expired medication or lack of medical direction Dose and route: -Adult: 1 g/kg of body weight -Pediatric dose: 25-50 grams -Administered orally Side effects: Nausea, vomiting, dark and tarry stool Considerations: -Shake before administering -Use caution if you suspect patient's LOC will change -Have suction ready What information do you need to know about aspirin? ✔ Names: acetylsalicylic acid Class: anti-inflammatory, anti-platelet aggregate, antipyretic MOA: reduces inflammation, decreases platelet aggregation, reduces fever Indication: chest pain Contraindications: allergy, decreased LOC, inability to swallow, recent bleeding or active ulcer, pediatric, expired medication, lack of medication Dose and route: -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 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. -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. 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 Weak peripheral pulses Increased respiratory rate Thirst Delayed capillary refill What are late signs and symptoms of shock? ✔ Falling BP Irregular breathing Mottling or cyanosis Absent peripheral pulses How should shock be managed? ✔ Control bleeding, high-flow oxygen, Trendelenburg, prevent loss of body heat, rapid transport. 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 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. 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. 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 3. Tonic-clonic phase -Patient experiences uncontrolled muscle contraction and relaxation -Patient may be apneic during the tonic or tonic-clonic phase. 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. These energy sources are used in an anaerobic environment. Fats and proteins are far less efficient (by about 19 times) than glucose fuel source. Byproducts of anaerobic metabolism (ketones) are dangerous. What is diabetes mellitus? ✔ Diabetes is a disease caused by an inability to metabolize glucose normally. This is frequently due to a problem with insulin production. Untreated diabetics typically have elevated blood glucose levels due to a lack of insulin or ineffective insulin. -Increased urinary output and dehydration is common. What is Type I Diabetes? ✔ Also called insulin-dependent diabetes mellitus (IDDM) Type I diabetics must take supplemental insulin Type I diabetes usually develops in pediatric patients and is usually genetically caused. Untreated type I diabetics will appear with the three P's (polyuria, polydipsia, polyphagia) and very high blood glucose levels. Type I diabetics are at high risk for diabetic ketoacidosis if untreated. Type I diabetics are at high risk for insulin shock due to insulin overdose. What is Type II diabetes? ✔ Also known as non-insulin-dependent-diabetes-mellitus (NIDDM). Type II diabetics typically do not require supplemental insulin. Type II diabetes is caused by a combination of lifestyle and genetics. It can be largely controlled through diet, exercise, and oral medications. Type II is more common than Type I. What is hypoglycemia? ✔ A blood glucose level below 60 mg/dL with signs and symptoms or a blood glucose level below 50 mg/dL regardless of the presence of signs and symptoms. Occurs more often in type I diabetes than type II diabetes. Hypoglycemia can very quickly lead to altered LOC, seizures, coma and brain death. What is insulin shock? ✔ 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. 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. 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 Insect bites and stings Latex What are the routes of exposure to drugs and toxins? ✔ Ingestion, inhalation, injection and absorption 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 What do you need to know about stimulants? ✔ Stimulants include caffeine, cocaine, amphetamines, methamphetamines, among others. They are taken for stimulant and euphoric effects. They can be taken by any route and are commonly injected, ingested, and inhaled. What do you need to know about marijuana? ✔ Marijuana (cannabis) is typically smoked. It is taken to induce euphoria, relaxation, drowsiness. Marijuana use does not usually create an acute medical emergency; however, marijuana users often take other illicit drugs. What do you need to know about hallucinogens? ✔ Hallucinogens alter sensory perception. Examples include LSD and PCP. What do you need to know about carbon monoxide? ✔ CO poisoning is a leading cause of death due to fires. Other common sources include home heating devices and vehicle exhaust fumes. CO inhibits the body's ability to transport and use oxygen. The danger of CO poisoning is greatest when exposed in a confined space. CO is a silent killer. It is tasteless, colorless, odorless, and completely nonirritating when inhaled. Victims are usually unaware they are being exposed and eventually lose consciousness. What do you need to know about acids and alkalis? ✔ Both are considered caustic substances. Many household products are acids or alkalis. Acids have a very low pH and burn on contact. Pain is usually immediate. Alkalis have a very high pH and tend to burn deeper than acids. Pain may be delayed. Most caustic ingestion patients are children. Common household caustics include liquid drain openers, bathroom cleaning supplies, ammonia and bleach. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What do you need to know about hydrocarbons? ✔ Hydrocarbons are petroleum-based. Hydrocarbons are found in gasoline, paints, solvents, sunscreen, baby oil, makeup remover, kerosene, lighter fluid, and more. Hydrocarbons can be ingested, inhaled, and absorbed. Most hydrocarbon ingestion patients are children. Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. What is acute abdominal pain? ✔ 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. Referred pain: causes pain in an area of the body other than the source. What are potential causes of acute abdominal pain? ✔ Appendicitis Peritonitis Cholecystitis Diverticulitis GI bleeding Gastroenteritis Esophageal varices Ulcers Abdominal Aortic Aneurysm (AAA) What is appendicitis? ✔ Caused by inflammation of the appendix. Can lead to life-threatening infection and septic shock. Signs and symptoms: -Nausea, vomiting, diarrhea, loss of appetite, fever. -Pain may begin as diffuse, but usually localizes to right lower quadrant. What is peritonitis? ✔ Peritonitis is caused by inflammation of the peritoneum (membrane lining the abdominal organs and cavity). Signs and symptoms: nausea, vomiting, loss of appetite, diarrhea, fever. What is cholecystitis? ✔ Cholecystitis is inflammation of the gall bladder, often due to gallstones. Most often occurs in females 30 to 50 years of age. Signs and symptoms: -Right upper quadrant pain -Increased pain at night -Increased pain after eating fatty foods -Referred pain to the shoulder is common -Nausea and vomiting 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 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 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: -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. Risk factors for suicide: -History of mental illness, previous suicide attempts, or child abuse -Recent diagnosis of serious illness -Recent loss of job, family member, or partner -Divorced or widowed 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 is the index of suspicion? ✔ Understanding the mechanism of injury helps predict injury patterns and sharpen the EMT's index of suspicion. 1. Index of suspicion is the ability to determine what types of injuries are possible or likely based on the MOI. 2. EMS providers don't diagnose; they rule in possibilities based on three key factors: MOI, anatomical findings, and physiological presentation of the patient. What are the different types of motor vehicle collisions (MVCs)? ✔ 1. Head-on -Occupants can go up and over or down and under the dash. -Head, spinal, chest, abdomen, hip, and lower extremity injuries are common. Unrestrained patients are more likely to be ejected. 2. Rear impact -Cervical spine injury due to hyperextension is common. 3. Lateral impact (T-bone) -Injuries along the side of impact are common 4. Rollover -Injury patterns are difficult to predict. There is a high risk of ejection in rollover MVCs. 5. Rotational spins -Rotational forces increase the risk of c-spine injury. What are the three collisions in every MVC? ✔ 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 -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. 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. -Full thickness (third degree burn): injury completely through dermal layer. Dry, leathery skin; no pain. 2. Amount of body surface area burned -Rule of nines: totals 100% of body surface area 3. Burns to critical areas: the critical areas are the respiratory tract, hands, face, feet and genitalia. 4. Associated trauma or preexisting medical conditions. Associated trauma, poor health, and certain medications complicate body's ability to handle a burn injury. 5. Age of patient. Under 5 or over 55 years of age are at greater risk. What determines the severity of burn injuries? ✔ Severe Burn Injuries -Burns with respiratory compromise -Full-thickness circumferential burns -Partial-thickness burns covering more than 30% of TBSA -Burns with associated trauma, such as fractures -Full-thickness burns to the airway, hands, face, feet or genitalia -Full-thickness burns covering more than 10% of the TBSA -All moderate burn criteria for patients under 5 or over 55 years of age Moderate Burn Injuries -Full-thickness burns cover 2-10% of TBSA -Partial-thickness burns cover 15-30% of TBSA -Superficial burns covering more than 50% of TBSA Minor Burn Injuries -Full-thickness burns covering less than 2% of TBSA -Partial-thickness burns covering less than 15% of TBSA -Superficial burns covering less than 50% TBSA What are life-threatening complications of burn injuries? ✔ The life-threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise. What are thermal burns? ✔ Thermal burns are caused by heat, such as from water, steam, or fire. Management of thermal burns include: -Stop the burning process with a moist sterile burn sheet until skin is no longer hot to the touch. -Replace moist burn sheet with dry sterile burn sheets to reduce risk of hypothermia and infection. -Remove clothing that may be trapping heat. -Remove jewelry since massive swelling is likely. -Treat for shock as needed. What are special types of burns? ✔ A. Inhalation Injury -Can occur due to chemical inhalation or if patient inhales hot gases due to fire in a confined space. -Signs and symptoms include stridor, dyspnea, coughing, wheezing, facial burns, hoarse voice, airway edema, singed facial hair, or soot in mouth or nose. B. Electrical Burns -Assess scene safety first. Do not attempt to remove patient from an electrical source without proper training. -Significant unseen injury may have occurred between entrance and exit points on the body. -Electrical burn patients are at high risk of respiratory and cardiac arrest. -All electrical injury patients require transport and evaluation by a physician. C. Chemical Burns -Eyes and respiratory system are at high risk for chemical burn injury. -Assess scene safety first. Do not risk exposure without proper training and PPE. -IF safe to do so, remove contaminated jewelry and clothing, brush off and dry chemical on the skin, irrigate patient with large amounts of water, avoid contaminating unaffected areas with runoff. What are the different types of musculoskeletal injuries? ✔ Fractures -Open fracture: a fracture with an associated open soft tissue injury. -Closed fracture: a fracture where the skin is not broken. -Signs and symptoms: pain, swelling, deformity, tenderness, loss of function, possible weak or absent distal pulses and crepitus. Strain -A strain is a stretching injury to a muscle or tendon. There is usually little bleeding with a strain, so swelling and discoloration will likely be minimal. -Signs and symptoms: pain and tenderness. Sprain -A sprain is an injury to a ligament. Sprains frequently involve the shoulder, knee, or ankle joints. -Signs and symptoms: immediate pain and tenderness, delayed swelling and discoloration. Dislocation -A dislocation is the movement of a bone out of its normal position in a joint -The bone may return to its normal position or remain out of joint -Dislocations often have associated sprains and strains -Signs and symptoms: pain, deformity, loss of function, possible weak or absent distal pulses What are potential limb-threatening injuries? ✔ Any orthopedic injury resulting in loss of circulation distal to the injury is a high- priority injury. The limb is at risk until circulation is restored. Signs of orthopedic injury with loss of distal circulation: absence of distal pulses, pale distal to injury, cool distal to injury, delayed capillary refill distal to injury. What are potential life-threatening injuries? ✔ 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 is correct splinting? ✔ Correct splinting decreases pain and reduces risk of further injury. Rules of splinting: 1. Assess distal pulse, motor, and sensation (PMS) before and after splinting. 2. Immobilize above and below injury. 3. Attempt to realign deformed injuries with absent distal pulses. 4. Do NOT delay transport of a high-priority patient for a non-ife-threatening injury. What are scalp injuries? ✔ 1. Scalp injuries can be open or closed. 2. The scalp is highly vascular and bleeds heavily when lacerated. What are skull fractures? ✔ 1. Skull fractures indicate the potential for injury to the brain. ✔ 1. Manual immobilization -Manual c-spine precautions must be taken immediately if spinal injury is suspected. -Manual c-spine cannot be released until the patient's head is completely immobilized by other means. -A cervical collar is not a substitute for manual immobilization. 2. Spinal immobilization techniques -Long spine board: can be use for supine or standing patients, often used if rapid extrication is needed. -Half spine board: can be used for seated patients, use of these devices may require additional time to apply. What are the types of chest injuries? ✔ 1. Pneumothorax 2. Tension pneumothorax 3. Sucking chest wound 4. Hemothorax 5. Cardiac tamponade 6. Clavicle and rib fractures 7. Flail chest What is pneumothorax? ✔ Pneumothorax is the accumulation of air in the pleural space. This can compress lung space, prevent gas exchange, and lead to hypoxia. Can be due to trauma or nontraumatic injury to lung tissue. Lung sounds may be diminished or absent over injured area. What is tension pneumothorax? ✔ A tension pneumothorax causes a progressive collapsing of lung tissue. The entire lung and great vessels can be compressed to the other side of the chest. Lung sounds will be absent over the affected area. The patient will develop severe respiratory distress and eventually respiratory failure. Compression of the great vessels can restrict blood flow, leading to shock and death. Tracheal deviation toward the unaffected side is a late and ominous sign. What is a sucking chest wound? ✔ If an open chest injury penetrates the pleural space, it can draw air during inhalation. Penetrating thoracic injuries should be covered with a three-sided occlusive dressing to prevent air from entering the chest cavity. What is a hemothorax? ✔ A hemothorax is bleeding into the pleural space. Watch for signs and symptoms of shock. Surgery is frequently required to control bleeding. What is cardiac tamponade? ✔ Cardiac tamponade occurs when blood or other fluid accumulates in the pericardial sac and compresses the heart. Cardiac function can be severely compromised, leading to circulatory collapse. Beck's triad (indicative of cardiac tamponade): -JVD -Muffled heart sounds -Narrowing pulse pressure 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 is flail chest? ✔ Occurs when a portion of the thorax becomes separated from the rest of the thorax. Caused by the fracture of at least two consecutive ribs in two or more places. It can also occur if the sternum becomes separated from the rib cage. The patient may exhibit paradoxical motion of the separated portion of the chest wall. Paradoxical motion occurs when a portion of the chest wall appears to move in the opposite direction of the rest oft he thoracic cage. Why are abdominal injuries so serious? ✔ Solid organs bleed when injured. The primary risk to the patient is hemorrhagic shock. Solid organs include the spleen, liver, kidneys and pancreas. Hollow organs can spill their contents when injured. The primary risk to the patient is infection. Hollow organs include the stomach, intestines, and urinary bladder. Signs and symptoms of abdominal injury include pain or tenderness; distension; bruising; guarding; Kehr's sing; referred pain in the shoulder caused by blood in the peritoneal cavity; and signs and symptoms of shock. What is the most important intervention for a flail chest with respiratory compromise? ✔ Positive pressure ventilation and oxygen. What type of dressing should be applied to a sucking chest wound? ✔ A there-sided occlusive dressing. What is Cushing's response and what does it indicate? ✔ Hypertension, bradycardia, altered respiratory pattern. Indicates possible closed head injury with increased ICP. What is Beck's triad and what does it indicate? ✔ JVD, muffled heart tones, narrowing pulse pressure. Indicates possible pericardial tamponade. 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. -Heat cramps typically occur during prolonged exertion and are likely caused by an electrolyte imbalance and dehydration. -Management of heat cramps includes rest, dehydration, and restoration of electrolytes. Heat Exhaustion -Heat exhaustion is a systemic heat emergency and occurs frequently. -Heat exhaustion is caused by a combination of heat exposure and hypovolemia. -Signs and symptoms include: history of exertion in a warm environment, dizziness, weakness, nausea, vomiting, headache, possible cramps, thirst, tachycardia. Heat Stroke -Heat stroke is an uncommon, extremely dangerous systemic heat emergency. -The body loses the ability to regulate body heat. Body temperature rises rapidly and will lead to death if untreated. -Heatstroke can develop due to exertion, or from passive exposure to a hot environment. -Signs and symptoms are similar to those of heat exhaustion and include: altered LOC, dry skin, seizures. 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 long is a full-term pregnancy? ✔ A full-term pregnancy lasts about 9 months or 40 weeks. What changes take place during pregnancy? ✔ A. Reproductive Changes -The uterus requires a much larger blood supply during pregnancy. -The enlarging uterus displaces other internal structures. B. Respiratory Changes -Respiratory rate increases slightly, but oxygen demand increases significantly. -In third trimester, the diaphragm frequently is compressed by the enlarging uterus. -The pregnant patient is at risk for developing hypoxia rapidly. C. Cardiovascular Changes -Cardiac workload increases, resulting in faster resting heart rate. -Blood volume increases, but plasma increase is greater. This leads to relative anemia. -Signs and symptoms of shock are masked during pregnancy. -Postural hypotension is common, increasing the risk of syncope. D. Gastrointestinal and Urinary Changes -The pregnant patient typically has undigested food in the stomach. -Pregnancy increases the risk of nausea and vomiting. -Pregnancy increases urinary frequency, and the pregnant patient is at risk of bladder injury due to displacement. E. Musculoskeletal Changes -The woman's center of gravity changes, increasing the risk of a fall injury. What are the different types of obstetrical emergencies? ✔ A. Hemorrhage B. Placenta previa C. Abruptio placenta D. Ectopic pregnancy E. Uterine rupture F. Spontaneous abortion G. Seizures H. Preeclampsia and eclampsia I. Pregnancy-induced hypertension (PIH) J. Supine hypotensive syndrome What is hemorrhage in an obstetric patient? ✔ Hemorrhagic shock can develop quickly in the pregnant patient. Signs and symptoms may not be evident until the pregnant patient is in severe shock. Bleeding can occur with little or no external blood loss. Bleeding may be painful or painless. Several conditions can lead to severe bleeding, including placenta previa, abruptio placenta, ectopic pregnancy, uterine rupture, and spontaneous abortion. What is placenta previa? ✔ Placenta previa is a common cause of bleeding in the third trimester. Placenta previa occurs when the placenta attaches to the uterus over the cervical opening. As the cervix dilates, the placenta is torn and bleeds. Classic presentation is painless vaginal bleeding in the third trimester. Assess for signs and symptoms of shock. What is abruptio placenta? ✔ Abruptio placenta is the premature separation of the placenta from the uterine wall leading to bleeding. Oxygen and nutrient delivery to fetus is compromised. Maternal blood loss can be severe. The fetus will not survive a complete abruption. Classic presentation is painful vaginal bleeding in the third trimester. Assess for signs and symptoms of shock. What is ectopic pregnancy? ✔ Ectopic pregnancy occurs when the egg is implanted outside of the uterus, usually in the fallopian tube. Ectopic pregnancy can lead to rupture and severe bleeding. Classic presentation is severe abdominal pain with or without vaginal bleeding. Assess for signs and symptoms of shock. What is uterine rupture? ✔ The uterus thins as it grows, increasing the risk of rupture. Danger to mother and fetus is high. Classic presentation is abdominal pain and vaginal bleeding. What is spontaneous abortion? ✔ Spontaneous abortion (miscarriage) is delivery of the fetus before it is capable of surviving. This is prior to about the 20th to 22nd week of pregnancy. Classic presentation includes cramping, lower abdominal pain, vaginal bleeding, and passage of tissue or clots. Assess for signs and symptoms of shock. What are seizures during pregnancy? ✔ Pregnancy can increase the risk of seizures in the mother. Management of seizures during pregnancy. -Treat as regular seizures -Place patient on left side -Minimize exposure to stimulus such as lights, noise and movements What are preeclampsia and eclampsia? ✔ 1. Preeclampsia (toxemia of pregnancy) -Preeclampsia typically occurs in the third trimester. -The cause is not completely understood -Signs and symptoms include sudden weight gain, visual disturbances, sudden swelling of the face, hands, or feet, headache, and hypertension. 2. Eclampsia -Eclampsia occurs when the mother seizes following preeclampsia -Eclampsia is a life-threatening condition for mother and fetus What is pregnancy-induced hypertension (PIH)? ✔ PIH is defined is a blood pressure in a pregnant patient above 140/90 at least twice at 6 hours apart. PIH presents with the same signs and symptoms as preeclampsia. What is supine hypotensive syndrome? Activity (extremity movement) -0: limp -1: limited active movement -2: actively moving Respirations -0: not breathing -1: slow or irregular breathing -2: adequate breathing What are potential delivery complications? ✔ A. Meconium B. Multiple Births C. Prolapsed cord D. Breech presentation E. Limb presentation F. Postpartum hemorrhage What is meconium? ✔ Meconium is the presence of fetal stool in the amniotic fluid. This turns the amniotic fluid yellow, green, or brownish. The risk of infection and pneumonia increases if the baby inhales meconium. If meconium is present, suction the mouth and nose promptly when the head clears the birth canal. Once the baby delivers, immediately suction the mouth and nose prior to stimulating the baby to breathe. What are multiple births? ✔ Multiple births can have their own placenta, or share a placenta. Be prepared for multiple births any time it has not been ruled out by the ultrasound. Request additional units. Prepare additional supplies. If second baby does not deliver within about 10 minutes after first, transport immediately. What is a prolapsed cord? ✔ A prolapsed cord occurs when the cord is the presenting part in the birth canal. A prolapsed cord can become compressed and cut off oxygen to the baby. Instruct the mother not to push. This will increase pressure on the cord. Place mother in knee-chest position. Carefully push the presenting part of the baby away from the cord. V finger Transport immediately. What is breech presentation? ✔ A breech birth occurs when the baby's buttocks or legs are the first presenting part in the birth canal. Transport immediately. Breech births present significant dangers for mother and baby. If delivery occurs, there is a high risk the head will become stuck in the birth canal. If the head is trapped, use fingers to form a "V" along vaginal wall to create space allowing the baby to breathe. What is limb presentation? ✔ A limb presentation is when a single arm or leg is the first presenting part in the birth canal. Do not attempt delivery of a limb presentation in the field. Place the mother in the knee-chest position and transport immediately. What is post-partum hemmorhage? ✔ Postpartum hemorrhage is excessive bleeding following delivery. Blood loss of greater than 500 ml is considered abnormal. Management of postpartum hemorrhage includes uterine massage, breastfeeding and treating for shock. What is the significant anatomy and physiology of pediatric patients? ✔ Airway/Respiratory -Infants have proportionally larger tongues than adults -The pediatric airway is smaller -Newborns and infants are obligate nosebreathers Head -The pediatric patient's head is proportionally large and is a source of heat loss -Padding is often required behind the shoulders to maintain a neutral, in-line position -Sunken fontanelles may indicate hypovolemia in infants, whereas bulging fontanelles may indicate increased ICP -Children require greater cerebral blood flow; hypoxia develops rapidly Chest -Ribs are more pliable in pediatric patients -Smaller lungs increase risk of overinflation -Pediatric patients are often abdominal breathers Abdomen -Organs are less protected and more anterior. Cardiovascular -Bradycardia should be treated as a sign of hypoxia -Hypotension is an ominous sign Skin -Pediatric patient's skin surface is larger in comparison to body mass What is the Pediatric Assessment Triangle? ✔ Appearance -Tone, interactivity, consolability, look, speech Work of breathing Circulation to skin What is child abuse? ✔ Physical abuse is excessive or inappropriate physical force. Neglect is failure to provide adequate attention when responsible for doing so. Signs of abuse or neglect include obvious trauma, injuries in various stages of healing, unexplained injuries, injuries that do not appear to match the description of how they occurred, and signs of malnutrition. Shaken baby syndrome is a form of abuse caused by violent shaking of a pediatric patient. 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 medical conditions often affect geriatric patients? ✔ Myocardial Infarctions -Often atypical presentation Congestive heart failure -Orthopnea 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 "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 is decontamination? ✔ Decontamination is essential to prevent spreading the hazardous material. Any of the following may become contaminated and require decontamination: 1. The patient's body, hair, clothes, possessions, etc. 2. Medical equipment 3. Emergency vehicle Decontamination should be performed by those properly trained and equipped to do so. What is the National Incident Command System? ✔ NIMS provides an adaptive, standardized approach to any domestic incident. 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 NIMS roles and responsibilities? ✔ Command Section: This section includes the incident commander (IC), public information officer (PIO), safety officer, and liaison officer. Finance Section: This section tracks all expenditures during an incident. This section is usually needed only on large incidents. Logistics: The logistics section is responsible for most of the things that actually allow an IMS to function. This includes the necessary communications equipment, medical supplies, food, water, facilities, shelter, etc. Operations: This section is responsible for tactical operations on larger incidents. On smaller incidents, this responsibility usually rests with the IC. Planning: This section helps to develop an action plan for the incident and solve problems as they arise during the incident. 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 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 is START Triage? ✔ Step 1 -Direct all patients capable of moving to a central location. -Those able to follow the command and move to the assigned location are collectively triaged as Minor (green tag) or "walking wounded." Step 2 -Move from patient to patient and begin triage using the RPM method. -Respirations: If not breathing, manually open the airway. If patient does not begin breathing spontaneously, triage as Expectant (black tag) and move to the next patient. If the patient begins to breathe, triage as Immediate (red tag), place in recovery position, and move to next patient. If the patient is breathing spontaneously above 30 breaths/minute or below 10 breaths/minute, triage as Immediate and move to the next patient. If the patient is spontaneously breathing 10 to 30 times per minute, move immediately to the next triage step with that patient. -Perfusion: assess radial pulse to determine perfusion status. If the radial pulse is absent, triage as immediate and move to the next patient. If the radial pulse is present, move immediately to the next triage step with that patient. -Mental status: If the patient is unable to follow simple commands, triage as immediate and move to the next patient. If the patient can follow simple commands, triage as Delayed (yellow tag) and move to the next patient. What are explosives? ✔ Explosives are the most commonly used WMD. Explosive weapons can cause significant blunt and penetrating trauma as well as burns and crushing injuries. -Primary, secondary, tertiary blast injuries What are chemical agents? ✔ 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