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West Coast EMT Block 3 Study Guide, Exams of Medicine

University of Massachusetts - BostonMedicine

West Coast EMT Block 3 Study Guide

Typology: Exams

2023/2024

Available from 02/17/2024

DrShirleyAurora
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West Coast EMT Block 3 Study Guide
Medical Assessment Steps -
1) Scene Size up: PENMAN
2) Primary Survey/Resuscitation: General impression, Consciousness (AVPU), Chief complaint, ABC
management
3) History Taking: OPQRST/SAMPLE
4) Secondary Assessment: Cardiovascular, Pulmonary, Neurological, Musculoskeletal, Integumentary,
GI/GU, Reproductive, Psychological, Social
5) Vital Signs: BP, pulse, respiratory rate and quality, field impression of patient,
interventions/treatment
6) Reassessment: Verbal reports/Radio reports
O2 administration cheat sheet -
1) Nasal Cannula: Normal/Regular breathing (1-6 liters/min)
- Pattern and rate
2) Non-Rebreathable: Normal/Regular breathing (10-15 liters/min, high flow)
- Pattern and rate but borderline (10-20 RR)
3) Bag-valve mask: Abnormal/Irregular/Apneic/Absent (15-20 liters/min)
- Assist ventilations, artificial ventilations, > 8 or < 28 breaths/min
What part of the brain controls basic bodily functions like blood pressure, breathing, heart rate,
swallowing, etc)? -
Brain Stem
Where does the spinal cord exit the brain? -
Foramen magnum
TIA (transient ischemic attack) -
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West Coast EMT Block 3 Study Guide

Medical Assessment Steps -

  1. Scene Size up: PENMAN
  2. Primary Survey/Resuscitation: General impression, Consciousness (AVPU), Chief complaint, ABC management
  3. History Taking: OPQRST/SAMPLE
  4. Secondary Assessment: Cardiovascular, Pulmonary, Neurological, Musculoskeletal, Integumentary, GI/GU, Reproductive, Psychological, Social
  5. Vital Signs: BP, pulse, respiratory rate and quality, field impression of patient, interventions/treatment
  6. Reassessment: Verbal reports/Radio reports O2 administration cheat sheet -
  7. Nasal Cannula: Normal/Regular breathing (1-6 liters/min)
  • Pattern and rate
  1. Non-Rebreathable: Normal/Regular breathing (10-15 liters/min, high flow)
  • Pattern and rate but borderline (10-20 RR)
  1. Bag-valve mask: Abnormal/Irregular/Apneic/Absent (15-20 liters/min)
  • Assist ventilations, artificial ventilations, > 8 or < 28 breaths/min What part of the brain controls basic bodily functions like blood pressure, breathing, heart rate, swallowing, etc)? - Brain Stem Where does the spinal cord exit the brain? - Foramen magnum TIA (transient ischemic attack) -
  • A transient ischemic attack which are stroke-like symptoms that resolve on their own in less than 24 hours.
  • These symptoms occur when blood flow to the brain is obstructed either through atherosclerosis (build-up of calcium and cholesterol in blood vessels) or blood clotting (embolus) Ischemic Stroke - The most common type of strokes caused by a
  • blockage of blood flow to a particular part of the brain usually by a blood clot inside a blood vessel. Two types of blood clot that may cause the blockage are:
  • thrombosis (blood clot formed at the site of blockage) embolus (blood clot formed elsewhere and travels to the site of blockage)
  • atherosclerosis (calcium and cholesterol build up in the blood vessels). Hemorrhagic Stroke -
  • Occurs as a result of bleeding inside the brain.
  • In this stroke the blood vessels ruptures and the accumulated blood then forms a clot which compresses the brain tissue.
  • The compression prevents oxygenated blood blood from getting into the area and the brain cells begin to die. Often fatal.
  • Commonly occurs in people experiencing stress or exertion, high blood pressure or long term untreated elevated blood pressure. Signs and Symptoms of a stroke -
  • Facial drooping
  • Sudden weakness or numbness in the face, are, leg, or one side of the body
  • Lack of muscle coordination or no balance
  • Sudden vision impairment
  • Difficulty swallowing and tongue deviation
  • Speech disorders (Aphasia)
  • Dysarthria (slurred speech)

normal: both arms move equally or not at all abnormal: one arm drifts compared to the other

  • Speech normal: patient uses correct words with no slurring abnormal: slurred or inappropriate words or mute How do we transport a stable stroke patient with a paralyzed extremity? - If the extremities are paralyzed, they will require protection from injury because the patient may not feel their extremities or move them out of harm's way as they are being moved. Continuously talk to them even if unable to talk or communicate; reassure the patient and provide emotional support throughout the call. Liver - Assists in digestion by secreting bile, which aids in the digestion of fats. Liver also filters toxic substances produced by digestion. Kidneys - Kidneys play a role in the regulation of acid-base balance and blood pressure. Kidneys also rid the body of toxic wastes and control the body's balance of fluid and electrolytes. Spleen - Assists in the filtration of blood cells and serves as a blood reservoir and produces antibodies. Pancreas - Secretes juices containing enzymes that help break down starches. fats. and proteins. Also produces bicarbonate and insulin. Gallbladder - A hollow pouch located beneath the liver that acts as a reservoir for bile.

Stomach - Gastric juices break down food to a form that can be used by the body. large intestine (colon) - The food that is not broken down as nutrients travel to the colon or large intestines as waste products. Water is absorbed and stool is formed that then passes through the rectum to the anus. Small intestine - Three sections: duodenum, jejunum, ileum.

  • Duodenum: digestive juices from the pancreas and liver mix together.
  • Jejunum: absorption of digestive products
  • Ileum: Absorbs nutrients that were absorbed earlier; absorbs bile acids so they can be returned to the liver for future use and vitamin B12 for making nerve cells and red blood cells. Urinary bladder - Hollow, muscular sac that holds and stores urine Know what the parietal and visceral peritoneum are -
    • The parietal peritoneum lines the walls of the abdominal cavity
  • The visceral peritoneum covers the organs themselves. Peptic Ulcer Disease - Signs and symptoms include burning gnawing pain in the stomach that subsides after eating and reemerges 2 to 3 hours after. Nausea, vomiting, belching, and heartburn. Sometimes vomiting blood or black stool containing Renal Failure - Nausea, headaches, cramps, and edema (swelling) in the extremities. Seizures may also occur Strangulated Hernia -

Polyphagia (excess hunger) If a patient is coming at you with a baseball bat & is screaming at you what should you do? - Leave the scene and wait for the police to arrive. When getting a SAMPLE history of a diabetic patient "the MOST important" question to ask? - If they've had any recent illnesses or stress How can you tell the difference between hyperglycemia and hypoglycemia in an unresponsive patient? - Check for skin signs, breath odor, and vomiting. Hyperglycemia will cause warm and dry skin Hypoglycemia will cause cool and moist skin Contraindications for oral glucose - Altered mental status Unconsciousness. Know the definition of an allergen - Substance that causes an allergic reaction. What will have the slowest onset time in an allergic reaction: injected, ingested, inhaled, touch. Why? - Ingested Know what a wheal is and what urticaria is: -

  • Wheal: Raised swollen well-defined area on the skin.
  • Urticaria: Hives, small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin. How long does a stinger continue to inject venom -

Up to 20 minutes What is the most rapidly fatal symptom of anaphylaxis? - Airway swelling and obstruction that stops breathing. What does epinephrine do? What are the common side effects? -

  • Epinephrine has properties that cause the blood vessels to constrict, which reverses vasodilation and hypotension; this elevates diastolic blood pressure and improves coronary blood flow.
  • Side effects include tachycardia. sweating, pale skin, dizziness, headache, and palpitations. Know the indications for using epinephrine, how to administer it (and what to do with the needle/epipen after injection), the dose, side effects, etc -
  • Indications include a severe allergic reaction causing airway, breathing, or circulatory compromise or an anaphylactic reaction.
  • Adult dose is 0.3 mg and children is 0.15 mg.
  • Side effects include high blood pressure, increased pulse rate, dysrhythmias, pallor, chest pain, headache, nausea, and vomiting. What does activated charcoal do? -
  • It is an adsorbent that binds poisons to its surface, thus reducing the amount that gets absorbed into the bloodstream.
  • Prevents drug absorptions and is used to reverse overdose or ingestion of harmful toxins. What is excited delirium? What would make it worse/better? -
  • Excited delirium: Also known as agitated delirium is a condition of cognitive impairment and is characterized by disorientation, hallucination, delusions as well as restless and irregular physical activity.
  • Symptoms may include hyperactive irrational behavior with possible vivid hallucinations; hypertension, tachycardia, diaphoresis, and dilated pupils
  • Uncontrolled or poorly controlled patient agitation and physical violence can place the patient at risk for sudden cardiopulmonary arrest
  • Any female who has reached menarche is capable of becoming pregnant will continue to experience the cycle of ovulation and menstruation until they reach menopause, which marks the end of menstrual activity What do ovaries do? - The primary female reproductive organ produces an ovum or egg. Pelvic Inflammatory Disease -
    • An infection of the upper female reproductive organs, specifically the uterus, ovaries, and fallopian tubes.
  • Can expand to fallopian tubes resulting in scarring which leads to an increased risk of life-threatening ectopic pregnancy or sterility
  • Signs and symptoms include lower abdominal pain, abnormal and often foul-smelling vaginal discharge, and increased pain during sexual intercourse, fever, general malaise, and nausea and vomiting. Ectopic pregnancy - Ectopic pregnancy is a pregnancy that develops outside the uterus Bacterial Vaginosis: -
    • Most common vaginal infection in women age 15 to 44.
  • Normal bacteria in the vagina are replaced by an overgrowth of other bacterial forms.
  • Characterized by itching, burning, or pain and foul-smelling discharge Gonorrhea -
    • Caused by a bacterium called Neisseria gonorrhoeae that can grow and multiply rapidly in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes and in the urethra in the men and women.
  • Signs and symptoms include painful urination, with associated burning or itching; yellowing or bloody vaginal discharge, usually with a foul odor and blood associated with vaginal sexual intercourse
  • Throat infection present with mild symptoms consisting of painful or difficult swallowing, sore throat, swollen lymph glands, and fever; headache and nasal congestion may also be present. If a female with vaginal trauma loses consciousness, what should we suspect? - A sign of shock until proven otherwise What should be our main focus when caring for a woman experiencing a gynecologic emergency? - Maintaining privacy Know abruptio placenta, placenta previa. -
    • Abruptio placenta: The placenta separates prematurely from the wall of the uterus
  • Placenta previa: The placenta develops over and covers the cervix What is vs what isn't considered an obstetrical emergency - Non Emergency:
  • High hormone level
  • Increased respiratory rate
  • Increase in blood volume and high heart rate
  • Increased vomiting and weight gain Emergency:
  • Hypertension
  • Seizures
  • Internal hemorrhage from the vagina before labor begins and extensive bleeding
  • Hypotension (Transport patient on their left side)
  • Miscarriage
  • Abruptio placentae and placenta previa
  • Maintain this position and transport rabidly to the ED. What is spina bifida - A developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body. Know the indications of fetal demise and what to do if delivering an obviously deceased newborn. -
    • Demise caused by an infection will have an extremely foul odor
  • The decomposing fetus may have skin blisters, skin sloughing, dark discoloration, and the head will be soft and grossly deformed.
  • Do not attempt to resuscitate an obviously deceased fetus Know an infant's vital signs. - HR: 100 to 160 beats/min RR: 30 to 60 breaths/min BP 1 month to 3 months - 73 to 94 mmHg BP 3 months to 6 months - 78 to 103 mmHg BP 6 months to 1 year - 82 to 105 mmHg Know how an infant/small child's airway differs from that of an adult? -
    • Pediatrics have a smaller airway in diameter and short in length
  • Lungs are smaller and the heart is positioned higher in the chest
  • A larger, rounder occiput or back of the head
  • A proportionately larger tongue relative to the size of the mouth
  • A floppy U-shaped epiglottis larger than in adults When should the fontanelles fuse together? - 18 months for the anterior suture 6 months for the posterior suture

Know the characteristics in a 9 month old & 13 month old. -

  • 9 month olds can grab to pull themselves up; "oral stage" uses mouth to explore their world
  • 13 months toddler in age; knows their name and typically can walk; separation anxiety; they can actively explore the environment around them What age does separation anxiety peak? - 6 to 12 months What is the common cause of shock in infants/children? -
  • Traumatic injury
  • Dehydration
  • Sever infection
  • Neurologic injury
  • Allergic reaction
  • Disease of the heart
  • Collapsed lung
  • Cardiac tamponade or pericarditis S&S of dehydration in infants/children - Increased pulse, slowed level of activity, decreased urine output, cold and clammy skin, sunken eyes, sunken anterior fontanelle, altered level of consciousness Asthma - Condition in which smaller air passages become inflamed, swell, and produce excessive mucus which leads to difficulty breathing. Pneumonia - A general term for any infection of the lungs. Often a secondary infection occurring after pre- existing infections like cold.

Partial Airway obstruction - Decreased or absent breath sounds and stridor and cyanosis

  • If patient consciousness and coughing forcefully encourage them to cough to clear the airway.
  • If the material is not fully removed but the patient is able to breathe adequately on their own, do not intervene
  • Provide oxygen. Severe Airway obstruction - Ineffective cough (no sound), inability to speak or cry, increasing respiratory difficulty, cyanosis, and loss of consciousness.
  • In a conscious infant perform five back blows followed by five chest thrusts
  • In conscious children older than 1 year perform abdominal thrusts
  • Chest compressions to relieve severe airway obstruction in unconscious patients. What is the most common cause of cardiac arrest in infants/children? - Respiratory problems Why does cardiac function decline in late adulthood? -
    • Overtime the heart enlarges with age due to chronically increased afterload imposed by stiffened blood vessels.
  • Cardiac output declines as a result of decreasing stroke volume. Why are head injuries a particular concern in patients who take blood thinning medications? -
    • These medications reduce the blood's ability to clot, lowering your risk of stroke. Your body creates clots to stop you from bleeding.
  • If you fall or bump your head while taking a blood thinner, you may have internal bleeding - even if there's no external sign you've been hurt What to do if you can't find a DNR or if it's not valid? - Continue to resuscitate the patient until a valid DNR is found

Why do victims of abuse make false statements or lie about their injuries? -

  • They are often traumatized by the situation and are afraid the abuser will hurt them further if they report.
  • Afraid of retribution S&S of pulmonary embolism, esp. risk factors - Pulmonary embolism: Sudden blockage of artery by a venous clot.
  • Signs and Symptoms: Shortness of breath (Dyspnea), chest pain, cough, syncope, anxiety, apprehension, fever, hemoptysis (coughing blood), leg pain, redness, unilateral swelling in the leg.
  • Risk Factors: Living in nursing homes or recent hospitalization, trauma, cancer, history of blood clot, or heart failure. How to reduce patient anxiety when transporting an elderly patient? - Provide emotional support; listen to your pt; respond to your pt; provide reassurance Why do elderly patients understate or minimize their symptoms? - Fear of hospitalization or death Symptoms are not as severe What do anti-hypertensive medications (such as beta blockers) do? Why would the patient not have tachycardia? -
  • Used to treat hypertension
  • It slows down the heart rate and reduces the force at which blood is pumped around your body
  • Beta blockers attach themselves to the receptor sites for epinephrine and norepinephrine, preventing the hormones from binding and speeding up heart rate.
  • This forces the body to slow down the movement of blood, vasodilate, and lowers blood pressure. How to care for a tracheostomy? -
  • Because these tubes are foreign to the respiratory tract, the body reacts by building up secretions in or around the tube. The tubes are prone to obstruction by mucus plugs or foreign bodies.