Emergency Medical Respiratory and Cardiac Conditions, Exams of Nursing

Download Emergency Medical Respiratory and Cardiac Conditions and more Exams Nursing in PDF only on Docsity! NREMT Pocket Prep (2023 NREMT PARAMEDIC EXAM) Complete Questions with highlighted Answers What are the late signs of hemorrhagic shock? Rapid breathing, cool clammy skin, dull slightly dilated pupils Is carbon monoxide an internal factor or external factor for respiration? External Name 3 of the AHA recommended management principles for ROSC patients. Initiate Targeted Temperature Management if patient is comatose, Administer colloid/vasopressor to a goal blood pressure of <90 systolic or MAP <65mmHg, and obtain 12- lead. According to the NREMT, what is the dose of NARCAN for a patient with suspected opiod overdose? Narcan 2mg IN (1mg per nare) Name 3 WMD chemical agent exposures that a paramedic can see symptoms of on scene? Pulmonary agents, nerve agents, and vesicant agents. (Vesicant agents include mustard gas and primarily affect DNA to cause cellular damage) Why is an uncuffed ET tube appropriate for a 6 year old child? Pediatrics of this age range have a narrowing of the trachea at the level of the cricoid cartilage. Name the major signs of hypothermia. Lack of coordination, confusion and memory loss, lack of shivering, weak pulses, slowed speech, drowsiness and very low energy, and slow shallow breathing. In dislocations and fractures, splinting is normally done in the position it is found. If circulation is compromised, a paramedic may attempt to manipulate the injury one time to regain circulation. What is the one anatomical location that is the exception to this rule and therefore contraindicated in the prehospital setting? Elbow dislocations and fractures, due to the anatomical position of these injuries. Name 3 common SSRI medications. Zoloft (Sertaline), Prozac (Fluoxetine), and Paxil (Paroxetine) Define how to calculate the rate of an irregular rhythm and how and why it should be used. The range of an irregular heart rate can be determined by calculating the heart rate of the QRS complexes closest together and the QRS complexes furthest apart. The two rates can be calculated using the block or memory method. Regarding irregular heart rates, how do you perform the 6 second method? How do you perform the 10 second method? *NOTE, NREMT DOES NOT BELIEVE THIS METHOD EXISTS, BUT IT IS GOOD TO KNOW ANYWAY Viewing the rhythm strip, on a 6-second strip count the number of QRS complexes and multiply by 10. For a 10 second strip, count the number of QRS complexes and multiply by 6. Why is cystic fibrosis not considered a lower airway infection? Cystic fibrosis is caused by genetic factors, not an infection. What three factors effect stroke volume? Contractility, afterload, and preload. What is cardiac elasticity? Elasticity is the factor that defines how "springy" the cardiac muscle is. It DOES NOT affect stroke volume. Name 3 factors that contraindicate endotracheal intubation. Name 2 things that do not affect indication of intubation. Inability to open the patient's mouth, inability to view the glottic opening, and intact gag reflex. Traumatic brain injury and respiratory compromise do not contraindicate intubation. Why should patients receiving hemodialysis receive sodium bicarb and calcium chloride during cardiac arrest? Patients in cardiac arrest who have received hemodialysis should be considered to have hyperkalemia, an excessively high potassium level in their blood. What are dysrhythmia of sinus origin? An ectopic rhythm is activity that occurs from a focus that is not the sinus node. Dyshythmias of sinus origin contain the same conduction path but are irregular, too fast, or too slow. Evaluation of ST segment elevation is not indicative of a myocardial infarction if there is ________ present. Left bundle branch blocks. A left bundle branch block may impair repolarization, making it look like an ST elevation myocardial infarction (STEMI). In regards to increased ICP, what drug may be indicated when attempting to intubate? Lidocaine has been shown to control increases in intracranial pressure in closed-head injury patients that may occur during intubation. When extricating a stable patient from a vehicle seated in the drivers seat and the drivers side door is damaged too much to open, what is the safest way to extricate the patient? Open the passenger's side door and extricate the patient through the passenger's side. Interference from other electrical devices will present as what kind of artifact on the EKG? 60 cycle interference, appears as fibrillation-type waves between QRS complexes that is too rapid to be caused by a dysrhythmia. What EKG abnormalities are present with WPW syndrome? Delta waves (slurred upstroke in the QRS complex), widened QRS complex, and short PR interval (>120ms) How will hip dislocations present? Most dislocations at the hip will involve anterior rotation, and shortening of the affected leg with internal rotation. Mesentric ischemia is rare, but when it is present it is caused by what 3 things? Arterial thrombosis, arterial embolism, and vasospasm. Satolol is used for what condition, and what drug class is it considered? Class III, for wide complex tachycardia Define chronotropic rate of heartbeat Define dromotropic conductivity of heart Define inotropic The strength of the contractility Why is a patient in hypovolemic shock likely to develop increased dyspnea even after bleeding is controlled? Loss of erythrocytes decreases the bloods ability to carry oxygen, thus increasing respiratory rate. According to the AHA, what kind of electrical shock is required when a patient presents with monomorphic VTACH? Synchronized cardioversion. Defibrillation is indicated when the VTACH is polymorphic, and in cases that one is unable to distinguish the two, treat as polymorphic. What would be the proper way to administer epinephrine to the patient without IV/IO access who is intubated while en route to the hospital? Through the patient's ET tube at 2.0-2.5 times the normal dose, diluted in 5-10 mL of sterile water What is true concerning J point elevation? The J point elevation is a type of ST segment elevation seen in normal hearts. It is seen in young, healthy adults and typically returns to baseline with exercise. It can be mistaken for a pathologic ST elevation; however, the key difference is a merging of the ST elevation with the T wave during an infarction. In J point elevation the T wave is an independent, normal wave. Your patient has bradycardia with shortness of breath and diaphoresis. Which intervention is considered a class IIa intervention after the maximum dose of atropine fails to improve the patient's condition and heart rate? The prehospital treatment for symptomatic bradycardia includes O2, atropine, dopamine, or epinephrine if the patient fails to improve after all other interventions. However, transcutaneous pacing (TCP) is the only class IIa intervention for the treatment of bradycardia after atropine (3 mg max) fails to improve the patient's condition and heart rate. According to AHA guidelines, unsynchronized high-energy shocks are recommended in which circumstances? Unsynchronized high-energy shocks are recommended: For a patient with no pulse (VF/pVT) For clinical deterioration (in prearrest), such as those with severe shock or polymorphic VT, when you think a delay in converting the rhythm will result in cardiac arrest For patients who are unstable or deteriorating and synchronization cannot be immediately accomplished When you are unsure whether monomorphic or polymorphic VT is present in the unstable patient If the shock causes VF (occurring in only a very small minority of patients despite the theoretical risk), immediately attempt defibrillation According to research, approximately what percent of patients experiencing a STEMI do not receive pre-hospital ECGs because they do not present with chest pain? 25% All of the following arrhythmias cause a decrease in cardiac output except: (a) atrial fibrillation (b) multifocal atrial tachycardia (c) wandering atrial pacemaker (d) premature atrial complexes (d) premature atrial complexes Which crainal nerves play a role in the act of swallowing? X, V, and VII (X controlling the vagus nerve, V controlling sensations in your face, cheeks, as well as taste and jaw movement, and VII controling facial expressions and sense of taste) Which EKG waveform abnormality occurs when the right atrium pumps against a closed tricuspid valve sending waves of pressure through the jugular veins? Cannon A waves are waves of the pulse pressure visible in the jugular veins of a patient in Supra-Ventricular Tachycardia (SVT). They may also be seen in Ventricular Tachycardia (VTACH) with a pulse Which treatments are AHA recommendations for management of SVT in the adult patient? SVT is treated with vagal maneuvers, adenosine, β-blocker or calcium channel blocker. What are the "AHA 8 D's" of stroke care? Detection: rapid recognition of stroke signs and symptoms Dispatch: early activation and dispatch of EMS by phoning 9-1-1 Delivery: rapid EMS stroke identification, management, triage, transport, and prehospital notification Door: emergent ED/imaging suite triage and immediate assessment by the stroke team Data: rapid clinical evaluation, laboratory testing, and brain imaging Decision: establishing stroke diagnosis and determining optimal therapy selection Drug/Device: administration of fibrinolytic and/or EVT if eligible Disposition: rapid admission to the stroke unit or critical care unit, or emergent interfacility transfer for EVT What is Wolff-Parkinson-White syndrome? Congenital malformation resulting in incomplete separation of the atria from the ventricles during foetal maturation 4. Confirm placement 5. Apply suction to the tube 6. Secure the tube in place If you suspect that the ET tube has advanced too far and gone down the left bronchus, how far back should the ET tube be pulled after the cuff is deflated? 2-3 cm What is the benefit of inducing mild hypothermia to a post-arrest patient who has a return of spontaneous circulation? It reduces intracranial pressure, the cerebral metabolic rate, and the brain's demand for oxygen. What is the most common medication prescribed for epileptic seizures today? (this question was made in 2023) Common epileptic seizure medication is prescribed today mainly in the form of phenytoin. A patient is having severe chest discomfort that is not responsive to nitroglycerine. Morphine may be administered by a paramedic because (list at least two of the answers) Morphine may be used to manage ACS because it: Produces central nervous system analgesia, which reduces the adverse effects of neurohumoral activation, catecholamine release, and heightened myocardial oxygen demand Alleviates dyspnea Produces venodilation, which reduces LV preload and oxygen requirement Decreases systemic vascular resistance, which reduces LV afterload Helps redistribute blood volume in patients with acute pulmonary edema If a patient is experiencing hypocapnia, what signs and symptoms can the paramedic expect to occur? Hyperventilation causes excessive loss of exhaled carbon dioxide, which produces hypocapnia; this results in cerebral vascular constriction and reduced cerebral perfusion. If not quickly corrected and hyperventilation continues, paresthesia (tingling sensation), dizziness, and/or feelings of euphoria may be present. What is a naturally occurring steroidal hormone produced by the adrenal cortex to help regulate the sodium/potassium balance in the blood? Aldosterone What treatment is indicated for a patient presenting with atrial fibrillation lasting less than 48 hours? Synchronized cardioversion What would a paramedic expect to see in a patient with a chronic adrenal dysfunction such as Addison's disease? Darkened skin, anorexia, hypoglycemia, nausea, and vomiting. Patients who present with unusually darkened skin patches, especially in areas such as the underarms and behind the knees, anorexia, hypoglycemia, nausea, and vomiting are most likely suffering from the long-term effects of Addison's disease due to corticosteroid deficiency. Where in the body has a patient been struck if you suspect they are experiencing commotio cordis? The chest by a fast moving object (most often in sports; such as a baseball or hockey puck) What is myasthenia gravis? It is an autoimmune neuromuscular disease that affects the motor cranial nerves. It is the GRAVE MUSCLE WEAKNESS. Exacerbation and remissions are parts of the disease which tend to be progressive over time.