NREMT Cognitive Exam Prep Questions With Complete Answers.., Exams of Nursing

Download NREMT Cognitive Exam Prep Questions With Complete Answers.. and more Exams Nursing in PDF only on Docsity! NREMT Cognitive Exam Prep Questions With Complete Answers. Where does the modern EMS system have its origin? Answer- 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? Answer- 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? Answer- Early in the 1970s, the US Department of Transportation developed the first EMT National Standard Curriculum. What are the levels of EMS training? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- Denial Anger Bargaining Depression Acceptance How can you prevent the risk of infection? Answer- 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? Answer- Minimum PPE: gloves and eye protection should be used during any patient contact situation. Expanded PPE: use disposable gown and mask for significant contact with any body fluid--for example, during childbirth. Use a high-efficiency particulate air (HEPA) mask o N-95 respirator for suspected airborne disease exposure, such as tuberculosis. What are emergency moves? Answer- These are used when the scene is dangerous and the patient must be moved before providing patient care. Types of emergency moves include the armpit-forearm drag, shirt drag, and blanket drag. What is involuntary consent? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- Battery is physically touching another person without their consent. What is negligence? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- You may be guilty of false imprisonment if you transport a competent patient without consent. What factors influence hospital determination? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- Health Insurance Portability and Accountability Act (HIPAA) -HIPAA is a federal law established in 1996 and has had a huge impact on health care. HIPAA improved privacy protection of patient health care records. -HIPAA gives patients greater control over how health care records are used and transferred. -EMS agencies are mandated to provide HIPAA training to all employees who have any contact with patients or patient records. -EMS providers must provide patients with privacy practices and obtain signature of receipt. What are COBRA and EMTALA? Answer- Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA) -COBRA and EMTALA include federal regulations guaranteeing public access to emergency care. -COBRA and EMTALA are also intended to stop the inappropriate transfe of patients, known as a patient "dump." What are considered obvious signs of death? Answer- The following are typically considered obvious signs of death indicating that resuscitation should not be initiated: -Decomposition -Rigor mortis -Dependent lividity -Decapitation On what kind of scenes must law enforcement be notified? Answer- 1. Any scene where the patient is dead on arival 2. Suicide attempts 3. Assault or sexual assault 4. Child abuse or elder abuse 5. Suspected crime scene 6. Childbirth How should EMT's operate in crime scenes? Answer- 1. Ensure scene safety 2. Provide patient care as needed 3. Avoid any unnecessary disturbance of scene 4. Remember and note the position of patient(s) 5. Remember and report everything you touched at the scene 6. Cut around (not through) holes in clothing when exposing the patient -Nasopharynx -Oropharynx -Larynx -Epiglottis What is the most common cause of upper airway obstruction? Answer- The tongue. What are the components of the lower airway? Answer- Components of the lower airway include: -Trachea -Carina -Left and right mainstem bronchi -Broncioles -Alveoli How is lung expansion achieved? Answer- During inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs. What is the diaphragm? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- Respiratory rate times tidal volume. What are normal breathing rates for adults, children and infants? Answer- 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? Answer- 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? Answer- The primary power plant, the sinoatrial (SA) node, normally generates impulses between 60 and 100 times per minute in the adult. The atrioventricular (AV) junction is the backup pacemaker and generates electrical impulses at about 40 to 60 per minute. The bundle of His is the final pacemaker for the heart. It generates impulses only at about 20 to 40 per minute. What is preload? Answer- Preload is the precontracting pressure based on the amount of blood coming back to the heart. Increased preload leads to increased stretching of the ventricles and increased myocardial contractility. What is afterload? Answer- Afterload is the resistance the heartm ust overcome during ventricular contraction. Increased afterload leads to decreased cardiac output. What are the components of blood? Answer- Plasma: the liquid component of blood, made mostly of water Red blood cells: the oxygen-carrying component of blood White blood cells: fight infection by defending against invading organisms Platelets: essential for clot formation to stop bleeding What is perfusion? Answer- Perfusion is the flow of blood throughout the body. What is the central nervous system? Answer- The central nervous system consists of the brain and spinal cord. What are the parts of the brain? Answer- Cerebrum: largest part of the brain; controls thoughts, memory and senses Cerebellum: coordinates voluntary movement, fine motor function and balance Brain stem: includes midbrain, pons and medulla; controls essential body functions such as breathing and consciousness What are the two epidermal layers? Answer- The germinal layer produces new cells and pushes them to the surface. the cells die en route to the surface. The stratum corneal layer is the top epidermal layer and consists of dead skin cells. What are normal vital signs for infants? Answer- Respirations: normal respiratory rate is about 30-60 breaths per minute for newborns and about 25-50 breaths per minute for infants. Pulse: normal pulse rate is about 140-160 beats per minute for newborns and about 100-140 beats per minute for infants. Blood pressure: a newborn's blood pressure is about 70 systolic and will increase to about 90 systolic by one year of age. What is the physiology of newborns and infants? Answer- The typical newborn weighs about 6-8 pounds. The newborn's weight will typically double by 6 months and triple by one year. The newborn's head makes up about 25% o f the body and is a significant source of heat loss. During the first couple weeks, neonates often lose weight, and then begin to gain it back. The newborn's fontanelles (soft spots on the skull) will be fully fused by about 18 months. Depressed fontanelles may indicate hypovolemia. Infants are often nose breathers and can develop respiratory distress easily. Rapid breathing can lead to fluid loss and loss of body heat. Hyperventilation of infants presents significant risk of barotrauma. 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? Answer- 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? Answer- 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? Answer- 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? Answer- Referred to as "low-flow" oxygen administration Indications: -Patient will not tolerate a non-rebreather -Patient is on long-term oxygen therapy via nasal cannula and there is no indication high-flow oxygen is needed Flow rate: 1-6 L/min Oxygen delivered: 24-44% Cautions: prolonged use can dry and irritate nasal passages if oxygen is not humidified What is a simple face mask? Answer- The simple face mask is similar to a nonrebreather, but without the oxygen reservoir. These are rarely used in the pre-hospital environment. Flow rate: 6-10 L/min Oxygen delivered: 40-60% What are Venturi masks? Answer- A mask that delivers precise concentration of low-flow oxygen. Rarely used in the prehospital environment. How do you administer supplemental oxygen in patients with a tracheostomy or stoma? Answer- Patients with a tracheostomy ventilate thorugh their stoma, not the mouth or nose. Supplemental oxygen should be applied over the stoma using a tracheostomy mask or a nonrebreather mask. What are the hazards of oxygen administration? Answer- Oxygen is highly combustible Pressurized gas Oxygen toxicity: the alveoli can collapse due to a long-term exposure to high concentrations of oxygen Respiratory depression: a risk for COPD patients on the hypoxic drive Retinal damage: can occur in newborns with long-term exposure to high- concentration oxygen When is artificial ventilation indicated? Answer- Artificial ventilations are indicated for any patient with *inadequate spontaneous breathing* leading to severe respiratory distress or respiratory failure. This could be caused by: -CNS injury, disease or impairment -Foreign-body airway obstruction -Chest trauma, such as a flail chest or a sucking chest wound -Increased airway resistance due to bronchoconstriction, pulmonary edema or inflammation Consider providing artificial ventilations for any patient breathing less than 8 times per minute or for any adult patient breathing more than 24 times per minute. Any unresponsive patient receiving artificial ventilations should have an airway adjunct in place to prevent the tongue from obstructing the airway. What are the risks of artificial ventilation? Answer- Artificial ventilations are accomplished through positive pressure ventilations (PPV) whereas normal spontaneous breathing is done through negative pressure. Complications of PPV: -Increased intrathoracic pressure, which reduces circulatory efficiency -Gastric distension, which increases the risk of vomiting and can compromise ventilatory efficiency -Hyperventilation How do you know you're performing correct artificial ventilations? Answer- The best way to determine appropriate tidal volume is rise and fall of the chest. -Artificial ventilations should cause gentle rise and fall. -It should take at least one second to inflate the chest. Correct rates of artificial ventilation for apneic patients with a pulse: -Adults: one breath every 5-6 seconds (10-12 times per minute) -Infants and children: one breath every 3-5 seconds (12-20 times per minute) -Newborns: one breath every 1 to 1.5 seconds (40-60 times per minute) What are the compression:ventilation ratios for adults and children? Answer- 30 compressions: 2 breaths -Always for adults -Always for single-rescuer CPR on any patient 15 compressions: 2 breaths -Two-rescuer CPR on children and infants 3 compressions: 1 breath -Newborns For patients in cardiac arrest with an advanced airway, provide one breath every 6 to 8 seconds What is CPAP? Answer- Continuous positive airway pressure (CPAP) is used to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress. Often used for patients with sleep apnea, has proven very effective for patients with COPD or pulmonary edema. Can help the patient avoid more invasive treatment such as intubation. Indications: -Conscious patients in moderate to severe respiratory distress. -Tachypnic patients with reduced respiratory efficiency. -Pulse oximetry is below 90%. 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? Answer- The pediatric airway is more easily obstructed (smaller nose and mouth; larger tongue). The pediatric head is -Have suction ready What information do you need to know about aspirin? Answer- 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? Answer- Names: albuterol, ipratropium bromide Class: bronchodilator MOA: relaxes bronchial smooth muscle, improving air exchange Indications: dyspnea, wheezing, asthma , reactive airway disease Contraindications: allergy, patient unable to follow commands, expired medication, medication not prescribed to patient, lack of medical direction Dose and route: one to two inhalations Side effects: tachycardia, hypertension, restlessnessm, anxiousness What information do you need to know about the EpiPen? Answer- Names: epinephrine Class: sympathomimetic, bronchodilator MOA: peripheral vasoconstriction, increased heart rate, bronchodilation Indication: anaphylaxis (wheezing, swollen upper airway, hives) Contraindications: expired medication, lack of medical direction Dose and route: 0.3 mg adult, 0.15 mg pediatric administered IM Side effects: tachycardia, hypertension, restlessness, anxiousness What information do you need to know about nitroglycerin? Answer- Class: antianginal, vasodilator MOA: vasodilation, decreased myocardial oxygen demand, increased myocardial oxygen supply Indications: chest pain, suspected angina or MI Contraindications: expired, not prescribed to patient, hypotension, recent use of Viagra, Cialis, Levitra or another ED medication, head injury, lack of medical direction Dose and route: 0.4 mg sublingual Side effects: tachycardia, hypotension, headache, burning under tongue, nausea, vomiting What information do you need to know about oral glucose? Answer- Class: oral hyperglycemic MOA: increases blood glucose levels Indication: hypoglycemia Contraindications: -Decreased LOC -Inability to swallow -Expired medication -Lack of medical direction Dose and route: one tube administered orally Side effects: nausea and vomiting What are the components of the scene size-up? Answer- 1. Scene safety 2. Standard precautions (PPE) 3. Number of patients/additional resources 4. Mechanism of injury/nature of illness What are the components of the primary assessment? Answer- 1. Manual cervical spine stabilization 2. General impression 3. Level of consciousness (AVPU and orientation; person, place, time and event) 4. Airway, Breathing, Circulation 5. Transport priority What are the appropriate managements for life-threatening conditions associated with breathing? Answer- Flail chest: initiate artificial ventilations Sucking chest wound: apply an occlusive dressing What are the stages of shock? Answer- Compensated shock: the early stage of shock. The body is still able to compensate for the hypovolemic state through defense mechanisms, such as increased heart rate and peripheral vasoconstriction. -Tachycardia -Peripheral vasoconstriction -Increased respirations Decompensated shock: late or "progressive" shock. The body can no longer compensate for the hypovolemic state, and blood pressure starts to fall. -Falling BP Irreversible shock: the final stage of shock. The patient will not survive once entering irreversible shock. What are the types of shock? Answer- 1. Cardiogenic shock 2. Obstructive shock 3. Distributive shock 4. Hypovolemic shock What is cardiogenic shock? Answer- 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? Answer- 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? Answer- 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. Geriatric patients, women, and diabetic patients may have atypical MI presentations. Complications of MI include cardiac dysrhythmias, sudden cardiac arrest, congestive heart failure, and cardiogenic shock. What is congestive heart failure? Answer- CHF occurs when the ventricles are unable to keep up with the flow of blood coming to them. Right ventricular failure: if the right ventricle pumps inefficiently, blood backs up into the venous system that feeds into the right heart. Signs include JVD, pedal edema. Left ventricular failure: if the left ventricle pumps inefficiently, blood backs up into the lungs. Signs include pulmonary edema. Signs and symptoms: dyspnea, chest pain, pulmonary edema, JVD, pedal edema, orthopnea What is hypertension? Answer- Systolic greater than 140 and/or diastolic greater than 90 Signs and symptoms: headache, tinnitus, nausea, dizziness, nosebleed. What are strokes? Answer- Death to brain tissue due to an interruption in blood flow. Also called cerebrovascular accident or "brain attack." Modern treatment can dramatically reduce the amount of damage and resulting disability if received in time. Signs and symptoms: severe headache, slurred speech, facial droop or drooling, unilateral numbness or weakness or paralysis, altered LOC, vision problems What are ischemic strokes? Answer- Blood flow to the brain is compromised due to a blockage. Ischemic strokes are often due to atherosclerosis. Overwhelming majority of strokes are ischemic in nature. What are hemorrhagic strokes? Answer- Caused by bleeding within the brain. The bleeding robs the brain of oxygen delivery, and can apply pressure to surrounding brain tissue, further compromising oxygenation. Hemorrhagic strokes limit certain interventions and are often fatal. Prevention through modification of risk factors, especially hypertension, is key. What is the Cincinnati Prehospital Stroke Scale? Answer- Facial droop: ask the patient to smile Arm drift: ask the patient to close eyes and hold arms out in front Speech: ask the patient to say "the sky is blue in Cincinnati." What is a TIA? Answer- Transient ischemic attacks (TIAs) have the same presentation as CVAs. However, the signs and symptoms self-correct within about 24 hours with no permanent brain damage. They are a warning sign of an impending stroke. What are the types of seizures? Answer- Generalized seizures -Also called grand mal seizures -Patient is unresponsive and experiences full-body convulsions Absence seizures -Also called petit mal seizures -Patient does not interact with environment, but there is no convulsive activity Partial seizures -Simple partial seizure: no change in LOC, possible twitching or sensory changes but no full-body convulsions -Complex partial seizures: altered LOC, isolated twitching and sensory changes possible Status epilepticus -Prolonged seizure (about 30 minutes) or recurring seizures without the patient regaining consciousness in between -Highly dangerous, possibly leading to permanent brain damage and death What are the phases of a seizure? Answer- Not every stage is present for every type of seizure or every patient. 1. Aura phase -Warning stage -Patient may sense onset 2. Tonic phase -Muscle rigidity -Possible incontinence 3. Tonic-clonic phase -Patient experiences uncontrolled muscle contraction and relaxation -Patient may be apneic during the tonic or tonic-clonic phase. 4. Postictal phase -"Recovery" phase -Patient's LOC progressively improves over about 30 minutes What are possible causes of seizures? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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: Signs of injected narcotics (morphine, heroin): -Decreased LOC, respiratory depression -Pupillary constriction What are absorbed toxins? Answer- Signs and symptoms include burns to the skin, rash or blister, itching or burning. Interventions: -Decontaminate patient appropriately before initiating care or transport -Most chemicals on the skin or eye should be irrigated with water continuously for about 20 minutes. -When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. What do you need to know about alcohol? Answer- Alcohol is the most widely abused drug in the US Most long-term alcoholics will develop hepatitis. Alcohol is a CNS depressant and a sedative hypnotic. Ingestion of alcohol increases risks of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). -Restless, irritable, agitated -Hallucinations, tremors or seizures What do you need to know about narcotics? Answer- Narcotics are widely abused. They are typically ingested or injected. Narcotics, or opioids, include morphine, codeine, heroin, oxycodone, and many more. Narcotics are CNS depressants that can cause coma and severe respiratory depression. Most ALS providers are able to administer Narcan (naloxone), which rapidly reverses the CNS effects of narcotics. What do you need to know about sedative hypnotic drugs? Answer- Sedative hypnotics are CNS depressants. Sedatives have a calming effect, and hypnotics induce sleep. Sedative hypnotics are usually taken orally but can be injected. Barbiturates such as Amytal, Seconal, and Luminal are sedative hypnotics. Benzodiazepines such as Valium, Xanax, and Rohypnol are sedative hypnotics. What do you need to know about inhalants? Answer- Abused inhalants may include acetones, glues, cleaning chemicals, paints, hydrocarbons, aerosols, and propellants. These chemicals are inhaled to achieve sedative hypnotic effects. The difference between an effective dose and a lethal dose is very narrow. Brain damage and/or cardiac arrest due to abuse is common. Prescription and over-the-counter bronchodilators are also abused. They are taken for stimulant effects or perceived advantage in competitive sports. What do you need to know about stimulants? Answer- 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? Answer- 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? Answer- Hallucinogens alter sensory perception. Examples include LSD and PCP. What do you need to know about carbon monoxide? Answer- 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? Answer- 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? Answer- 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? Answer- Acute abdominal pain is usually due to trauma, distension, inflammation, or ischemia. What are the different types of abdominal pain? Answer- 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? Answer- Appendicitis Peritonitis Cholecystitis Diverticulitis GI bleeding Gastroenteritis Esophageal varices Abdominal pain is the most common symptom of most gynecologic emergencies. What are specific gynecologic emergencies? Answer- 1. Sexual Assault: sexual assault patients have been victimized physically and psychologically. Management of sexual assault victims: -Request law enforcement and victim's assistance. -Do not touch the patient without consent. -Request a same-sex provider if one is not already on scene. -Encourage the patient not to change clothes, shower, etc. -Treat clothing as evidence. Do not touch unless necessary. -Touch only those things that are necessary. 2. Pelvic inflammatory disease (PID) PID is painful and requires treatment. Nonemergency transport is recommended. Signs and symptoms: -Abdominal pain -Fever -Pain during urination -Often, increased pain while walking 3. Vaginal bleeding. This condition has many potential causes, including spontaneous abortion, PID, and sexually transmitted diseases. 4. Signs and symptoms of gynecologic problems: -Abdominal pain -Vaginal bleeding or discharge -Signs and symptoms of shock -Fever, nausea and vomiting What are genitourinary and renal emergencies? Answer- A. Urinary Tract Infection (UTI) Signs and symptoms: -Abdominal pain -Hematuria: blood in urine -Painful or frequent urination -Fever, nausea, and vomiting B. Kidney Stones Kidney stones are crystals formed in the kidneys that can cause an obstruction in the urinary tract, causing severe pain. Males are much more likely to develop kidney stones. Signs and symptoms: -Severe abdominal pain, groin pain -Painful urination, fever, nausea, and vomiting C. Kidney failure Kidney failure is when the kidneys are no longer able to function sufficiently. Water and toxins accumulate and dialysis may be needed. Dialysis artificially removes excess fluid and waste products from the blood. What is a behavioral emergency? Answer- A behavioral emergency is an abnormal behavior that is unacceptable to patients, family members, or society. What causes behavioral emergencies? Answer- 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? Answer- 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? Answer- 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? Answer- 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)? Answer- 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? Answer- 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? Answer- 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? Answer- 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). -Rabies is an acute, deadly viral infection of the CNS. If the animal responsible for the bite is not tested for rabies, the patient typically must receive a series of painful injections. -All bites that break the skin should be evaluated by a physician for infection and hte need for a tetanus shot. What are the five factors of burn severity? Answer- 1. Depth of burn -Superficial (first degree burn): epidermal damage only. Painful, red, no blisters. -Partial thickness (second degree burn): epidermal and partial dermal injury. Painful, blisters present. -Full thickness (third degree burn): injury completely through dermal layer. Dry, leathery skin; no pain. 2. Amount of body surface area burned -Rule of nines: totals 100% of body surface area 3. Burns to critical areas: the critical areas are the respiratory tract, hands, face, feet and genitalia. 4. Associated trauma or preexisting medical conditions. Associated trauma, poor health, and certain medications complicate body's ability to handle a burn injury. 5. Age of patient. Under 5 or over 55 years of age are at greater risk. What determines the severity of burn injuries? Answer- 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? Answer- The life- threatening complications related to burn injury are sepsis, hypothermia, hypovolemic shock, and airway compromise. What are thermal burns? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 1. Scalp injuries can be open or closed. 2. The scalp is highly vascular and bleeds heavily when lacerated. What are skull fractures? Answer- 1. Skull fractures indicate the potential for injury to the brain. 2. Linear fracture: most skull fractures are linear fractures and do not present with deformity or depression. 3. Depressed fracture: depressed skull fractures may be noticeable upon palpation. There is an increased risk of brain injury due to bone being displaced into brain tissue. 4. Basal skull fracture: these fractures occur at the base of the skull. Cerebrospinal fluid may leak from nose or ears. Signs include Battle's sign (bruising behind the ears) and raccoon eyes (bruising under the eyes). 5. Cardiac tamponade 6. Clavicle and rib fractures 7. Flail chest What is pneumothorax? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- Positive pressure ventilation and oxygen. What type of dressing should be applied to a sucking chest wound? Answer- A there-sided occlusive dressing. What is Cushing's response and what does it indicate? Answer- Hypertension, bradycardia, altered respiratory pattern. Indicates possible closed head injury with increased ICP. What is Beck's triad and what does it indicate? Answer- JVD, muffled heart tones, narrowing pulse pressure. Indicates possible pericardial tamponade. What are eye injuries and their treatments? Answer- A. Foreign Objects -Nonpenetrating foreign objects in the sclera are often easily removed by irrigating the eye. -Foreign objects in any other part of the eye should be removed by a physician. B. Corneal Abrasion -Direct trauma and foreign objects can cause a corneal abrasion. -The cornea is the transparent covering over the iris and pupil. -Symptoms include pain, tearing, and the sensation of something in the eye. C. Orbital Fracture -Orbital fractures indicate a significant MOI. -Consider possibility of associated spinal trauma. -Symptoms include visual disturbances, double vision, deformity around the orbit, loss of sensation around the orbit, and the inability to move the eye in an upward gaze. -Suspected orbital fractures required physician evlaluation. D. Chemical Burns -Chemicals in the eye require immediate and continuous irrigation. -Avoid irrigating chemicals from one eye into the other. E. Impaled Objects -Do not removed impaled objects from the eye. -Stabilize object in place. -Keep both eyes closed to prevent passive movement of impaled object. F. Contact Lenses -Procedure for removing contact lenses varies depending on the type of contacts. Removal may be more easily accomplished with a specially designed moistened suction cup. What are face injuries and their treatment? Answer- A. Loss of Tooth -Control any bleeding to reduce risk of swallowing blood and vomiting. -Rinse tooth with saline and transport in saline-soaked gauze. B. Impaled Object in the Cheek -Stabilize the object in place unless it interferes with airway management. -Remove object only if it causes an airway obstruction or interferes with ability to manage airway. C. Nosebleed D. Ear Injuries -Treat as a soft tissue injury -Assess MOI for other possible injuries What patient factors influence heat and cold emergencies? Answer- A. Age: The very young and very old will likely develop environmental emergencies more rapidly. B. General Health and Nutrition: Those in good health, adequately nourished, and hydrated are better able to maintain homeostasis. C. Environmental Conditions: Temperature, humidity, and wind can help or hurt the body's ability to protect itself from environmental emergencies. D. Medications and Alcohol: Medications and alcohol can hinder the body's ability to regulate body temperature. How does the body lose heat? Answer- 1. Conduction: direct transfer of heat through contact with a colder structure. 2. Convection: loss of heat to passing air. 3. Evaporation: loss of heat through evaporation of water from the skin. -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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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? Answer- 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)? Answer- 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? Answer- Supine hypotensive syndrome occurs when the fetus compresses the inferior vena cava. This can cause a severe drop in blood pressure. This syndrome typically occurs in the later stages of pregnancy when the mother is supine. Signs and symptoms include dizziness, hypotension, pale skin, and altered LOC. Management of supine hypotensive syndrome must include keeping the fetus off of the inferior vena cava. Do not place the patient in a supine position. Instead: -Place the patient in a seated position -Place patient on her left side -If patient is supine, elevate right hip or tilt backboard. What are the stages of labor and delivery? Answer- First Stage of Labor -Begins with the onset of contractions and ends with full cervical dilation. -The cervix is fully dilated at 10 cm, allowing the infant's head to enter the birth canal. -Contractions initially occur at widespread intervals and become more severe and closer together over time. -The mucus plug that seals the uterine opening passes. -The amniotic sac may rupture spontaneously. -Stage one typically lasts longer for first-time pregnancies. Second Stage of Labor -Begins with full cervical dilation and ends with delivery of the fetus. -Contractions are close together. -Mother feels intense pressure and the urge to push. Third Stage of Labor -Begins once baby is delivered and ends with delivery of the placenta. -Placenta typically delivers within 30 minutes after delivery of the baby. -There will be an increase in vaginal bleeding shortly before the placenta delivers, and the mother will feel the urge to push again. What are indicators of imminent delivery? Answer- The mother has strong, frequent contractions under 2 minutes apart with little break between contractions. The abdomen is rigid during contractions. The mother feels the urge to push. Crowning. How do you care for a newborn? Answer- Immediately upon delivery, place on clean, dry sheets or towels. Dry baby, including the head, and immediately replace wet linen with dry. Warm the baby, including the head. Placing the baby on the mother's abdomen will provide a radiant heat source. Suction the baby's mouth first, then nose. If the baby is not active and crying, attempt tactile stimulation by rubbing the baby's back or tapping the soles of the feet. Assess respirations. If the baby is not breathing adequately, begin ventilations (40- 60 per minute) with an appropriately sized bag and mask for 30 seconds with high- flow oxygen. Do not overinflate the newborn's chest. Assess heart rate. 1. Heart rate below 60 beats per minute -Begin chest compressions and ventilations at a 3:1 ratio -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? Answer- Appearance -Tone, interactivity, consolability, look, speech Work of breathing Circulation to skin What is child abuse? Answer- 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? Answer- 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? Answer- Myocardial Infarctions -Often atypical presentation Congestive heart failure -Orthopnea Pneumonia Pulmonary embolism -Long sedentary periods, recent surgery Deep Vein Thrombosis Stroke GI Disorders Dementia -A slow, progressive deterioration of cognitive function Delirium -A sudden change in cognitive function or mental status, can be treated and reversed. Depression -Geriatric females have higher rates of depression; geriatric males have higher suicide rates. -Geriatric suicide attempts are more successful. Trauma Osteoporosis What are the different ambulance types? Answer- Type I ambulance: truck chassis with modern ambulance body Type II: standard van design Type III: specialty van design with a square patient compartment mounted on the chassis What are the phases of an ambulance call? Answer- Preparation Phase -Inspect the ambulance everyday and after each shift change Dispatch -Nature of the call, location and number of patients En Route -Notify dispatch you're responding -All emergency vehicle operators must drive with due regard for the safety of others Arrival at Scene/Patient Contact -Notify dispatch you are on scene -Ambulance in a safe position/as a barrier Patient Transfer to Ambulance Transport to Receiving Facility -Notify dispatch where you are taking patient -Notify receiving hospital Arrival at Hospital/Transfer of Care -Notify dispatch you've arrived -Provide verbal report to appropriate personnel -Provide written copy of PCR -Obtain transfer of care signature Postrun Phase/Return to Service What are defensive driving tactics? Answer- Emergency vehicles should usually travel in the far left lane What vehicle safety systems should you be aware of? Answer- Shock-Absorbing Bumpers -Most vehicles today are equipped with shock-absorbing bumpers (front and rear). They can become compressed during an accident and spontaneously release, injuring anyone standing in front of them. -Approach vehicles from the side, not the front. Simple access: gaining access to the patient without any tools or need to break the glass. Complex access: requires the use of special tools and training. What are hazardous materials? Answer- Hazardous materials are solids, liquids or gases that pose a threat to people, property or the environment. Risks of exposure depend on the dose, concentration, route of exposure, and duration of contact. The EMT's primary responsibilities at a hazardous materials incident are personal safety, notification of appropriate authorities, and the safety of the patient and public. What is START Triage? Answer- 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? Answer- 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? Answer- Nerve agents -Nerve agents are a significant threat due to the relative ease with which they can be acquired and used. -Nerve agents cause excessive parasympathetic nervous system stimulation. -Specific nerve agents include Tabun, Sarin, Soman, and VX. -Signs and symptoms of nerve agent exposure: salivation, lacrimation, urination, defecation, gastric upset, emesis, miosis. -Management: aggressive airway management including suction, specific medications. Vesicants -Vesicants cause pain, burns and blisters to exposed skin, eyes and respiratory tract. -Vesicants are also known as blistering agents. -Depending on the vesicant agent, the onset of signs and symptoms could be delayed several hours. -Affected areas should be irrigated with copious amounts of water as soon as possible. Cyanide -Cyanide interferes with the body's ability to deliver oxygen to the cells, leading to severe hypoxia and death. -Signs and symptoms include dizziness, weakness, anxiety, nausea, tachypnea, seizures, and respiratory arrest. -Management: administer high-flow oxygen, support positive-pressure ventilation as needed, antidotes. Chemical Agents Cont. Answer- Pulmonary Agents -Pulmonary agents cause lung injury -Signs and symptoms include dyspnea, cough, wheezing, runny nose and sore throat. -Management: manage the airway, administer oxygen and support ventilations as needed. Biological Agents -Biological agents are used to cause disease. -Even small quantities of certain biological agents can cause disease in a large number of people. -Signs and symptoms include fever, weakness, respiratory distress, and flulike symptoms. -Management is based on providing supportive care for the patient's symptoms. Nuclear and radiological weapons -Nuclear weapons can cause death as a result of the blast, the radiation, or thermal burns. -Nuclear radiation is dangerous because it can kill living organisms in the body or cause them to mutate. These mutations can lead to birth defects, cancer, and other problems. What are the different types of radiation? Answer- Alpha radiation: -Dense, slow-moving radiation. -Can travel only short distances. -Stopped by clothing, skin, etc. but still very dangerous if patient is contaminated internally, such as through ingestion or inhalation. Beta radiation -Slow-moving radiation. Can travel only a few feet. -Penetrates only the first few millimeters of skin. -Serious risk if patient is internally contaminated through ingestion or inhalation. Gamma radiation -Can travel long distances. Easily penetrates the body. -A significant external hazard risk to living things. Signs and symptoms of acute radiation sickness include nausea, vomiting, diarrhea, fever, headache and skin lesions. How can radiation exposure be prevented and managed? Answer- Protection from radiation: -Time: spend as little time as possible near a radiation source. -Distance: get as far away as possible from the radiation source. -Shielding: gamma radiation will require significant shielding, such as lead or concrete. Management -Remove patients from the source of radiation to a safer location not downwind. -Complete a thorough primary assessment. -Treat blast injuries, tertiary injuries, burn injuries as you normally would.