2,000 terms

EMT

EMT--Basic Review for NREMT CBT Practice Examinations
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Snoring respirations are most rapidly managed by

A. suctioning the oropharynx
B. initiating assisted ventilations
C. correctly positioning the head
D. inserting an oropharnygeal airway
correctly positioning the head
Which of the following patients would be most in need of a rapid trauma assessment?

A. an awake and alert 19-year-old man with a small caliber gunshot wound to the abdomen
B. A conscious 25-year-old woman who fell 12' from a roof and landed on her side
C. A 43-year-old woman with a unilaterally swollen, painful deformity of the femur
D. a 60-year old man who fell from a standing position and has an abrasion on his check
an awake and alert 19-year-old man with a small caliber gunshot wound to the abdomen
Which of the following bones is affected with a swollen, painful deformity to the lateral bone of the left forearm?

A. Ulna
B. Radius
C. Clavicle
D. Humerus
Radius
During your assessment of a 34-year old man with a gunshot wound to the chest, you note that his skin is pale. This finding is most likely caused by

A. a critically low blood pressure
B. increased blood flow to the skin
C. decreased blood flow to the skin
D. peripheral dilation of the vasculature
decreased blood flow to the skin
An 80-year old woman has pain in the right upper quadrant of her abdomen and a yellowish tinge to her skin. You should suspect dysfunction of the

A. liver
B. spleen
C. pancreas
D. gallbladder
liver
Which of the following situations is an example of abandonment?

A. An EMT--Paramedic givers a verbal report to any emergency nurse.
B. An EMT--Intermediate assumes patient care from an EMT-Basic
C. An EMT--Basic transfers care of a patient to patient to an EMT-Paramedic
D. A first responder assumes patient care from an EMT-Intermediate
A first responder assumes patient care from an EMT-Intermediate
Which artery should you palpate when assessing for a pulse in an unresponsive 6-month old patient?

A. Radial
B. Carotid
C. Femoral
D. Brachial
Brachial
During the initial assessment of a trauma patient, you note massive facial injuries, weak radial pulses, and clammy skin. What should be your most immediate concern?

A. Potential obstruction of the airway
B. Internal bleeding and severe shock
C. Applying 100% supplemental oxygen
D. Providing rapid transport to a trauma center
Potential obstruction of the airway
You are called to treat a male patient who overdosed on heroin and is unconscious with shallow breathing and cyanosis to the face. The patient suddenly begins to vomit. What should you do first?

A. Suction the oropharynx
B. Turn the patient onto his side.
C. Insert an oropharyngeal airway.
D. Assist ventilations with 100% oxygen.
Turn the patient onto his side.
The scene size up includes all of the following components, EXCEPT

A. determining scene safety
B. applying personal protective gear
C. assessing the need for assistance
D. evaluating the mechanism of injury
applying personal protective gear
In which of the following patients would an oropharyngeal airway be indicated?

A. Any patient suspected of having hypoxia
B. A semiconscious patient with an intact gag reflex
C. A semiconscious patient who took an overdose of propoxyphene
D. An unconscious patient with fluid drainage from the ears
An unconscious patient with fluid drainage from the ears
Upon arriving at the scene of a multiple vehicle crash, you can see that at least two patients have been ejected from their vehicles. What should you do next?

A. Begin triage
B. Treat the most critical patient first
C. Gather all of the patients together
D. Call for at least one more ambulance
Call for at least one more ambulance
A 75 year old man has generalized weakness and chest pain. He has a bottle of prescribed nitroglycerin and he states that he has not taken any of his medication. After initiating oxygen therapy, you should next

A. apply the AED and prepare the patient for immediate transport
B. perform a detailed physical examination to located any other problems.
C. contact medical control for permission to assist the patient with his nitroglycerin.
D. complete a focused physical examination, including obtaining baseline vital signs.
complete a focused physical examination, including obtaining baseline vital signs.
Which of the following organs is not part of the endocrine system?

A. Thyroid
B. Pituitary
C. Pancreas
D. Gallbladder
Gallbladder
Which of the following injuries or conditions should be managed first?

A. Fluid drainage from both ears
B. Bleeding within the oral cavity
C. A large open abdominal wound
D. Bilateral fractures of the femurs
Bleeding within the oral cavity
You arrive at a residence where you find a man lying unconscious in his front yard. There were no witnesses to the event that caused the unconsciousness. In assessing this man, you must assume that he

A. has sustained an injury
B. is having a heart attack
C. is having a diabetic reaction
D. is having a heat-related emergency
has sustained an injury
When is the best time to perform a detailed physical examination?

A. While enroute to the hospital
B. After all life threats have been ruled out
C. Immediately after taking baseline vital signs
D. Following the initial assessment of a trauma patient.
While enroute to the hospital
Which of the following conditions would most likely cause flushed skin?

A. Shock
B. Hypoxia
C. Exposure to heat
D. Low blood pressure
Exposure to heat
During the rapid trauma assessment of a patient with multiple injuries, you expose the chest and find an open wound with blood bubbling from it. What should you do next?

A. Apply 100% supplemental oxygen.
B. Provide rapid transport to the hospital
C. Prevent air from entering the wound.
D. Place a porous dressing over the wound.
Prevent air from entering the wound.
You are called to a local park for a 7-year old boy with respiratory distress. During your assessment, you find that the patient is wheezing and has wide-spread hives and facial edema. What should you suspect has occurred?

A. Heat emergency
B. allergic reaction
C. Acute asthma attack
D. Exposure to a poisonous plant
allergic reaction
A common side effect of nitroglycerin is

A. nausea
B. headache
C. hypertension
D. chest discomfort
headache
As you assess a 56-year old man, you note that he is pulseless and apneic. As your partner gets the AED from the ambulance, you should

A. obtain a medical history from the wife.
B. place the patient in the recovery position
C. perform CPR until the AED is ready to use
D. conduct a detailed examination of the patient.
perform CPR until the AED is ready to use
Prescribed inhalers, such as albuterol (Ventolin), relieve respiratory distress by

A. constricting the bronchioles in the lungs.
B. contracting the smaller airways in the lungs.
C. relaxing the smooth muscle of the bronchioles.
D. dilating the large mainstem bronchi of the airway.
relaxing the smooth muscle of the bronchioles.
In a patient with cardiac compromise, you would be LEAST likely to encounter

A. anxiety
B. dyspnea
C. headache
D. chest pain
headache
When monitoring a patient with a head injury, the most reliable indicator of his or her condition is the

A. pupillary reaction
B. level of consciousness
C. systolic blood pressure
D. rate and depth of breathing
level of consciousness
A 56-year-old man with a history of cardiac problems reports pain in the upper midabdominal area. This region of the abdomen is called the

A. peritoneum
B. epigastrium
C. mediastinum
D. retroperitoneum
epigastrium
Which of the following mechanisms cause respiratory and circulatory collapse during anaphylactic shock?

A. Bronchodilation and vasodilation
B. Bronchodilation and vasoconstriction
C. Bronchoconstriction and vasodilation
D. Bronchoconstriction and vasoconstriction
Bronchoconstriction and vasodilation
In the patient with diabetes, hypoglycemia typically presents with

A. dry skin and a slow onset
B. dry skin and a rapid onset
C. clammy skin and a slow onset
D. clammy skin and a rapid onset
clammy skin and a rapid onset
Which of the following signs would LEAST suggest a diabetic emergency?

A. Bradycardia
B. Tachycardia
C. Combativeness
D. Fruity breath odor
Bradycardia
Which of the following patients would be at most risk for suicide?

A. A woman who quit her job for one that pays more
B. A man who is in the midst of losing a significant relationship
C. A man who is planning a family trip, but gets called away to work
D. An EMT who saved a drowning child and receives a lot of media attention
A man who is in the midst of losing a significant relationship
A middle-aged woman has acute shortness of breath and respirations of 30 breath/min. How should you first manage this patient?

A. Assess respiratory quality
B. Begin assisting ventilations.
C. Apply supplemental oxygen
D. Perform a detailed examination
Assess respiratory quality
To obtain the most reliable assessment of a patient's tidal volume, you should

A. assess for retractions
B. listen for airway noises
C. count the respiratory rate
D. look at the rise of the chest
look at the rise of the chest
As you are performing CPR on an elderly man, his wife presents you with a "do not resuscitate" order. Your most appropriate course of action is to

A. ignore the document and continue the CPR
B. comply with the document and stop CPR
C. continue CPR until medical control is notified
D. withhold CPR until medical control validates the order
continue CPR until medical control is notified
A 5 year old boy complains of pain to the right lower quadrant of his abdomen. Correct assessment of this child's abdomen includes

A. avoiding palpation of the abdomen
B. palpating the left upper quadrant first
C. auscultating bowel sounds for 2 minutes
D. palpating the right lower quadrant first
palpating the left upper quadrant first
In most states; the EMT-Basic is required to report which of the following occurrences?

A. Animal bite
B. drug overdose
C. Injury to a minor
D. Motor vehicle crash
Animal bite
A set of regulations and ethical considerations that define the extent or limits of an EMT-Basic's job is called

A. a duty to act
B. confidentiality
C. scope of practice
D. the Medical Practices Act (??? can't read this for sure)
scope of practice
A 9-year-old girl was struck by a car while she was crossing the street and is displaying signs of shock. During your assessment, you note a large contusion over the left upper quadrant of her abdomen. Which of the following organs has most likely been injured?

A. Liver
B. Kidney
C. Spleen
D. Pancreas
Spleen
The automated external defibrillator (AED) should NOT be used in patients who

A. are between 1 and 8 years of age
B. experienced a witnessed cardiac arrest
C. are apneic and have a weak carotid pulse
D. have a nitroglycerin patch applied to the skin
are apneic and have a weak carotid pulse
As you step out of the ambulance at the scene of a nighttime motor vehicle crash on the highway, your immediate concern should be

A. oncoming traffic
B. whether the car will catch on fire
C. placing safety flares by the ambulance
D. quick assessment of the patients in the car
oncoming traffic
Which of the following actions should be carried out during the initial assessment of an unconscious patient?

A. Assessing the skin
B. Palpating the cranium
C. Auscultating the lungs
D. Obtaining a blood pressure
Assessing the skin
You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. The man's wife states that he had cardiac by-pass surgery approximately 6 months earlier. There are no signs of trauma. Your first action in the management of this patient should be to

A. attach an AED and analyze the cardiac rhythm.
B. check the effectiveness of the CPR in progress.
C. insert an oropharyngeal airway and continue CPR
D. stop CPR so you can assess pulse and breathing
stop CPR so you can assess pulse and breathing
You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. The man's wife states that he had cardiac by-pass surgery approximately 6 months earlier. There are no signs of trauma. Cardiac arrest in the adult population is most often the result of

A. an acute stroke
B. respiratory failure
C. cardiac arrhythmias
D. myocardial infarction
cardiac arrhythmias
You arrive at the scene shortly after a 55-year-old man collapsed. Two bystanders are performing CPR. The man's wife states that he had cardiac by-pass surgery approximately 6 months earlier. There are no signs of trauma. After you attach the AED and analyze this patient's heart rhythm, the machine states, "shock advised." What cardiac rhythm is the patient most likely in?

A. Asystole
B. Ventricular fibrillation
C. Ventricular tachycardia
D. Pulseless electrical activity
Ventricular fibrillation
Immediately upon delivery of a newborn's head, you should first

A. dry the face
B. cover the eyes
C. suction the nose
D. suction the mouth
suction the mouth
You assess a newborn with cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do next?

A. Resuction the mouth.
B. Briskly dry off the infant.
C. Begin chest compressions
D. Begin artificial ventilations
Begin artificial ventilations
An EMT-B's failure to obtain consent to treat a patient could result in allegations of

A. battery
B. negligence
C. abandonment
D. breach of duty
battery
Which of the following describe the MOST appropriate method of performing chest compressions on an adult patient in cardiac arrest?

A. Compress the chest to a depth of 1 1/2" to 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions.
B. Allow full recoil of the chest after each compression, compress the chest to a depth of 2", deliver compressions at a rate of at least 80/min
C. Do not interrupt chest compressions for any reason, compress the chest to a depth of 1 1/2" to 2", allow partial recoil of the chest after each compression
D. Minimize interruptions in chest compressions, provide 70% compression time and 30% relaxation time, deliver compressions at a rate of 100/min
Compress the chest to a depth of 1 1/2" to 2", allow full recoil of the chest after each compression, minimize interruptions in chest compressions
Prevention of cardiac arrest in infants and small children should focus primarily on

A. keeping the child warm
B. avoiding upsetting the child
C. providing immediate transport
D. providing airway management
providing airway management
You are managing a conscious patient who you believe is having an acute ischemic stroke. After administering oxygen, your next priority should include:

A. providing prompt transport for possible fibrinolytic therapy.
B. determining whether the patient has prescribed nitroglycerin
C. closely monitoring the blood pressure
D. completing a detailed physical examination before providing transport.
providing prompt transport for possible fibrinolytic therapy.
Which of the following patients with diabetes should receive oral glucose?

A. A confused patient who has cool, clammy skin
B. A confused patient who has suspected
C. A semiconscious patient with pale skin
D. An unconscious patient who took too much insulin
A confused patient who has cool, clammy skin
During a bar fight, a 22-year old man was stabbed in the chest with a large knife. The patient is pulseless and apneic, and the knife is impaled in the center of his chest. management should include

A. stabilizing the knife, starting CPR, and providing rapid transport
B. stabilizing the knife, applying an occlusive dressing and providing rapid transport
C. removing the knife, starting CPR, and providing rapid transport
D. removing the knife, applying an occlusive dressing, and providing rapid transport.
removing the knife, starting CPR, and providing rapid transport
in which of the following patients would nitroglycerin be contraindicated?

A. 41-year-old male with crushing chest pressure, a blood pressure of 160/90 mm Hg, and severe
nausea
B. 53-year old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Cialis
C. 58-year old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol
D. 66-year-old female with chest pressure of 6 hours' durationi, lightheadedness, and a blood pressure of 110/58 mm Hg
53-year old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Cialis
Firefighters have rescued a man from his burning house. he is conscious and in considerable respiratory distress. He has a brassy cough and singed nasal hairs. The most immediate threat to this patient's life is

A. hypothermia
B. severe burns
C. sever infection
D. closure of the airway
closure of the airway
You respond to a call for a shooting at a local bar. You arrive at the scene and find a young man sitting against the wall, screaming in pain, with bright red blood spurting from a wound near his groin. What should you do first?

A. Ensure an open airway
B. administer 100% oxygen
C. Apply pressure to the wound
D. Transport the patient at once.
Apply pressure to the wound
Patients with closed head injuries often have pupillary changes and

A. paralysis
B. paresthesia
C. hypertension
D. tachycardia
hypertension
When assessing a patient with a reduction in tidal volume, you would expect the respirations to be

A. deep
B. labored
C. shallow
D. dyspneic
shallow
Prior to applying a nonrebreathing mask on a patient with difficult breathing you should

A. set the flow rate to no more than 10 L/min.
B. prefill the reservoir bag to ensure delivery of 100% oxygen
C. insert a nasopharyngeal airway to maintain airway patency.
D. perform a complete physical examination to determine the degree of hypoxia.
prefill the reservoir bag to ensure delivery of 100% oxygen
A 60-year-old woman is experiencing severe respiratory distress. When you ask her a question, she can only say two words at a time. You should manage this patient by

A. inserting a nasopharyngeal airway
B. providing positive pressure ventilations.
C. applying a nasal cannula set at 2 to 6 L/min.
D. applying a nonrebreathing mask set at 15 L/min.
providing positive pressure ventilations.
The most effective method for determining whether you are providing adequate artificial ventilation is

A. assessing the chest for adequate rise
B. assessing the pulse for a improving heart rate
C. checking the pupils for increased reactivity
D. checking the skin for improvement of cyanosis
assessing the chest for adequate rise
You are administering oxygen to a woman with asthma who took two puffs of her prescribed inhaler without relief prior to your arrival. Your next action should be to

A. contact medical control for further advice
B. administer one more puff from the inhaler
C. provide immediate transport to the hospital
D. confirm that her inhaler is prescribed to her
contact medical control for further advice
Unconsciousness, shallow breathing, and constricted pupils are most indicative of what type of drug overdose?

A. Narcotic
B. Marijuana
C. Barbiturate
D. Amphetamine
Narcotic
When dealing with an emotionally disturbed patient, you should be concerned with

A. providing safe transport
B. whether the patient could harm you
C. obtaining a complete medical history
D. gathering all of the patient's medications
whether the patient could harm you
During your initial assessment of an unconscious adult patient, you find the patient is apneic. You should next

A. assess for a carotid pulse
B. begin chest compressions
C. deliver two rescue breaths
d. place an oropharyngeal airway
deliver two rescue breaths
A 6 year old male, who weighs 40 pounds, ingested a bottle of aspirin approximately 20 minutes ago. Medical control orders you to administer activated charcoal in a dose of 1 g/kg. How much activated charcoal will you administer?

A. 12 g
B. 14 g
C. 18 g
D. 24 g
18 g
Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. You should manage this situation initially by

A. clamping and cutting the umbilical cord
B. gently pulling on the cord to facilitate removal
C. trying to remove the cord from around the neck.
D. keeping the cord moist and providing rapid transport
trying to remove the cord from around the neck.
You arrive at the scene shortly after a 3-year old female experienced a seizure. The child, who is being held by her mother, is conscious and crying. The mother tells you that her daughter has been ill recently and has a temperature of 102.5 degrees F. What is the MOST appropriate treatment for this child?

A. Oxygen via pediatric nonrebreathing mask, place the child in a tub of cold water to lower her body temperature, and transport
B. Oxygen via the blow-by technique, remove clothing and cool the child with towels soaked in tepid water, and transport.
C. Oxygen via pediatric nonrebreathing mask, avoid any measures to lower the child's body temperature, and transport at once.
D. Oxygen via the blow-by technique, transport at once and request a paramedic rendezvous so that an anticonvulsant drug can be given
Oxygen via the blow-by technique, remove clothing and cool the child with towels soaked in tepid water, and transport.
You receive a call to a local daycare center for a 3-year old boy who is not breathing. When you arrive and assess the child, you find him to be in cardiopulmonary arrest. You initiate CPR and request a back-up ambulance. As you are performing one-rescuer CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for this child is

A. 3:1
B. 5:1
C. 15:2
D. 30:2
30:2
You receive a call to a local daycare center for a 3-year old boy who is not breathing. When you arrive and assess the child, you find him to be in cardiopulmonary arrest. You initiate CPR and request a back-up ambulance. After attaching the AED, you push the analyze button and receive a "shock advised" message. After delivering the shock, you should

A. assess for a carotid pulse
B. immediately perform CPR
C. reanalyze the cardiac rhythm
D. open the airway and ventilate
immediately perform CPR
You receive a call to a local daycare center for a 3-year old boy who is not breathing. When you arrive and assess the child, you find him to be in cardiopulmonary arrest. You initiate CPR and request a back-up ambulance. A paramedic unit arrives at the scene to provide assistance. After one of the paramedics intubates the child, you should deliver ventilations at a rate of

A. 6 to 8 breaths/min
B. 8 to 10 breaths/min
C. 10 to 12 breaths/min
D. 12 to 20 breaths/min.
8 to 10 breaths/min
You receive a call to a local daycare center for a 3-year old boy who is not breathing. When you arrive and assess the child, you find him to be in cardiopulmonary arrest. You initiate CPR and request a back-up ambulance. In infants and children, the most detrimental effect of gastric distention is

A. increased ease of ventilations
B. decreased ventilatory volume
C. acute rupture of the diaphragm
D. less effective chest compressions
decreased ventilatory volume
Which of the following parameters would be most reliable as an indicator of perfusion in a 1 year old child?

A. Heart rate
B. capillary refill
C. Blood pressure
D. Respiratory rae
capillary refill
While managing a patient with acute shortness of breath, you prepare and apply a nonrebreathing mask set at 12 L/min. The patient pulls the mask away from his face, stating that it is smothering him. You should next

A. increase the oxygen flow and reapply the mask
B. securely tape the oxygen mask to the patient's face
C. reassure the patient and apply a nasal cannula instead
D. inform the patient that refusing oxygen might result in his death
reassure the patient and apply a nasal cannula instead
Signs of inadequate breathing in an unconscious patient include

A. a fast heart rate
B. warm, moist skin
C. equal breath sounds
D. a rapid respiratory rate
a rapid respiratory rate
Initial attempts at providing artificial ventilation should be accomplished using

A. the one-person bag valve mask technique
B. the two-person bag valve mask technique
C. a pocket mask with supplemental oxygen
D. a flow-restricted oxygen-powered ventilation device
a pocket mask with supplemental oxygen
The most effective means of preventing the spread of disease is

A. effective handwashing
B. up-to-date immunizations
C. wearing gloves with all patients
D. wearing a mask with all patients
effective handwashing
You have completed your prehospital care report and left a copy at the hospital when you realize that you forgot to document a pertinent finding on the front of the report. Your most appropriate action would be to

A. attach an addendum to the original run report.
B. write the information on the original run report.
C. complete a new run report and add the information.
D. take no action and report the event to your supervisor
attach an addendum to the original run report
An awake and alert 92-year-old woman with chest pain is refusing EMS treatment and transport to the hospital. Her family insists that you transport her. This situation is most appropriately managed by

A. transporting the patient as the family wishes.
B. advising the patient of the risks of refusing care
C. obtaining a signed refusal from a family member
D. transporting the patient as you explain your actions.
advising the patient of the risks of refusing care
At the scene of a mass-casualty incident, you notice a bystander who is clearly emotionally upset. An appropriate action to take would be to

A. tell the bystander to leave the scene at once.
B. have the bystander assist you with patient care
C. notify the police and have the bystander removed
D. assign the bystander a simple, non-patient-care task
assign the bystander a simple, non-patient-care task
Which of the following situations would necessitate treatment using implied consent?

A. A 16 year old pregnant girl with an isolated extremity injury
B. An 18-year old man who is now alert after receiving oral glucose
C. A 25 year old man who is restless and has severe chest pain and diaphoresis
D. A 65-eyar old man who is semiconscious and suspected of having a severe stroke
A 65-eyar old man who is semiconscious and suspected of having a severe stroke
Which of the following patients would MOST likely present with atypical signs and symptoms of acute myocardial infarction?

A. 72-year old female with diabetes and hypertension
B. 64-year old male with renal disease and depression
C. 59 year old male with alcoholism and angina pectoris
D. 55-year old female with COPD and frequent infections
72-year old female with diabetes and hypertension
While assessing a patient with chest pain, you note that the patient's pulse is irregular. This most likely indicates

A. acute myocardial infarction or angina pectoris
B. a dysfunction in the left side of the patient's heart
C. high blood pressure that is increasing cardiac workload
D. abnormalities in the heart's electrical conduction system
abnormalities in the heart's electrical conduction system
While a man was using a chainsaw to trim branches from a tree, it slipped and caused a large laceration to his left forearm. Bright red blood is spurting from the wound. The patient is conscious, alert, and talking. You should first

A. copen the patient's airway
B. control the active bleeding
C. apply supplemental oxygen
D. thoroughly cleanse the wound
control the active bleeding
After an initial attempt to ventilate a patient fails, you reposition the patient's head and reattempt ventilation without success. You should next

A. assess for a carotid pulse and initiate CPR if necessary
B. use a flow-restricted oxygen-powered ventilation device
C. initiate airway obstruction removal techniques and provide transport
D. continue to reposition the patient's head at the scene until you are able to secure a patent airway
initiate airway obstruction removal techniques and provide transport
A 40-year old patient sustained full=thickness burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult Rule of Nines, what percentage of the patient's body surface area has been burned?

A. 18%
B. 27%
C. 36%
D. 45%
27%
When assessing a patient with a complaint of chest pain, which of the following questions would you ask to assess the R in OPQRST?

A. Did the pain begin suddenly or gradually
B. What were you doing when the began?
C. Is there anything that makes the pain worse?
D. Is the pain in one place or does it move around?
Is the pain in one place or does it move around?
Which of the following describes the most correct method for inserting a nasopharyngeal airway

A. Insert the device with the bevel facing the septum
B. Insert the device with the bevel facing the lateral aspect of the nose.
C. Rotate the device as you insert it into the right nostril
D. Apply firm, gentle pressure if you meet resistance during insertion.
Insert the device with the bevel facing the septum
Which vital sign is the best indicator of cardiac output during the initial assessment?

A. Pulse rate and quality
B. Systolic blood pressure
C. Quality of the respirations
D. Condition and color of the skin
Pulse rate and quality
After assisting a patient with her epinephrine auto-injector, you should dispose of the device by

A. giving it to the patient to have it refilled
B. placing the device in a red biohazard bag.
C. placing the device in a puncture proof container
D. replacing the cover and putting it in a trash can
placing the device in a puncture proof container
Which of the following assessment findings would most suggest a systemic reaction following ingestion of a poison?

A. Nausea and vomiting
B. Burns around the mouth
C. Tachycardia and hypotension
D. Difficulty swallowing and burning in the mouth
Tachycardia and hypotension
You are at the scene where a man panicked while swimming in a small lake. As you attempt to rescue this patient, you should first

A. throw a rope to the patient
B. row a small raft to the patient
C. swim to the patient to rescue him
D. attempt to grab the patient with a stick
throw a rope to the patient
After removing a patient from the water, your assessment reveals that the patient is breathing inadequately and is continuously regurgitating large quantities of water. You should manage this patient by

A. alternating suctioining with artificial ventilations
B. performing abdominal thrusts to remove the water.
C. placing the patient on the side and press in on the abdomen.
D. initiating artificial ventilations after the patient stops regurgitating
alternating suctioining with artificial ventilations
Your first action in managing a patient with an altered mental status should be to

A. give the patient oral glucose
B. administer 100% supplemental oxygen
C. make sure that the patient is breathing adequately
D. try to determine the cause of the altered mental status
make sure that the patient is breathing adequately
Management of a patient with severe abdominal pain includes

A. administering 100% oxygen
B. auscultating for bowel sounds
C. giving the patient sips of water
D. placing the patient in a supine position
administering 100% oxygen
Immediately following a generalized motor seizure, most patients are

A. apneic
B. confused
C. hyperactive
D. awake and alert
confused
As you are providing initial ventilations to a patient with apnea using a bag-valve-mask device, you note minimal rise of the chest. You should next

A. initiate the mouth-to mask technique
B. increase the volume of the ventilations
C. switch to a smaller mask for the BVM device
D. ensure that a reservoir is attached to the BVM device
increase the volume of the ventilations
As you begin your assessment of an unresponsive man who fell approximately 20' from a roof, you should first

A. gently shake the patient to confirm unresponsiveness
B. gently tilt the patient's head back to assess for breathing
C. assess the rate, depth, and regularity of the patient's breathing
D. manually stabilize the patient's head and perform a jaw-thrust maneuver
manually stabilize the patient's head and perform a jaw-thrust maneuver
A 56-year old man has labored, shallow breathing at a rate of 28 breaths/min. He is conscious, but extremely restless. Airway management should consist of

a. a nasal cannula
b. a simple face mask
c. a nonrebreathing mask
d. positive pressure ventilation
positive pressure ventilation
Indications that artificial ventilations in an apneic adult are ineffective include

A. a normal heart rate
B. improvement of skin color
C. asymmetrical rise of the chest
D. ventilations given at 12 breaths/min
asymmetrical rise of the chest
The AED analyzes your pulseless and apneic patient's cardiac rhythm and advises that a shock is indicated. You should

A. deliver the shock and resume CPR
B. ensure that nobody is touching the patient
C. perform CPR for 2 minutes and then deliver the shock
D. push the analyze button to confirm that the shock is indicated
ensure that nobody is touching the patient
The most appropriate management of a patient who has sustained widespread full-thickness burns following an explosion should consist of applying

A. oxygen; dry, sterile dressings; warmth; and providing rapid transport
B. oxygen; dry; sterile dressings; burn ointment; and providing rapid transport
C. oxygen; moist; sterile dressings; warmth; and providing rapid transport
D. oxygen; moist; sterile dressings; burn ointment; and providing rapid transport
oxygen; dry, sterile dressings; warmth; and providing rapid transport
To ensure delivery of the highest concentration of oxygen to your patient using a nonrebreathing mask, you should

A. set the flow rate to at least 12 L/min
B. securely fasten the mask to the patient's face
C. make sure that the reservoir bag is pre inflated
D. cover the one-way valves on the oxygen mask
make sure that the reservoir bag is pre inflated
You arrive at the scene where a 49 year old woman is found semiconscious on the floor of her living room. The patient's husband tells you that they were watching TV when this condition suddenly developed. No trauma was involved. The patient moans occasionally and has slight cyanosis to her lips.

After performing a head tilt-chin lift maneuver on this patient, you should next

A. assess her respirations
B. determine the need for oxygen
C. insert an oropharyngeal airway
D. insert a nasopharyngeal airway
insert a nasopharyngeal airway
You arrive at the scene where a 49 year old woman is found semiconscious on the floor of her living room. The patient's husband tells you that they were watching TV when this condition suddenly developed. No trauma was involved. The patient moans occasionally and has slight cyanosis to her lips.

The patient's respirations are at a rate of 26 breaths/min and shallow. The most appropriate management includes

A. a nasal cannula set at 1 to 6 L/min
B. assisted ventilations with 100% oxygen
C. a simple face mask set at 10 to 12 L/min
D. A nonrebreathing mask set at 15 L/min
assisted ventilations with 100% oxygen
You arrive at the scene where a 49 year old woman is found semiconscious on the floor of her living room. The patient's husband tells you that they were watching TV when this condition suddenly developed. No trauma was involved. The patient moans occasionally and has slight cyanosis to her lips.

Shallow respirations will result in

A. decreased tidal volume
B. increased tidal volume
C. increased oxygen intake
D. increased carbon dioxide removal
decreased tidal volume
You arrive at the scene where a 49 year old woman is found semiconscious on the floor of her living room. The patient's husband tells you that they were watching TV when this condition suddenly developed. No trauma was involved. The patient moans occasionally and has slight cyanosis to her lips.

Skin will become cyanotic with

A. an increase in the amount of venous oxygen
B. an increase in the amount of arterial oxygen
C. a decrease in the amount of arterial oxygen
D. a decrease in circulating red blood cells
a decrease in the amount of arterial oxygen
You are dispatched to the scene of a motorcycle crash in which two patients were injured. Upon arrival, you find that one patient, a 19-year-old woman, is conscious and alert and is being tended to by a police officer for minor scrapes and cuts. The second patient is a 20-year-old man who is found facedown approximately 25' from the motorcycle. he states that he cannot feel or move his legs. Neither patient was wearing a helmet.

After taking body substance isolation precautions, you begin your initial assessment of the man. Your first action should be to

A. apply an extrication collar
B. stabilize his head manually
C. evaluate the patency of his airway
D. roll him to a supine position
stabilize his head manually
You are dispatched to the scene of a motorcycle crash in which two patients were injured. Upon arrival, you find that one patient, a 19-year-old woman, is conscious and alert and is being tended to by a police officer for minor scrapes and cuts. The second patient is a 20-year-old man who is found facedown approximately 25' from the motorcycle. he states that he cannot feel or move his legs. Neither patient was wearing a helmet.

You have given high concentration oxygen to the man and completed the remainder of your initial assessment. What should you do next?

A. Obtain baseline vital signs
B. Perform a rapid trauma assessment
C. Conduct a detailed physical examination
D. Immobilize the patient with a vest-style device
Perform a rapid trauma assessment
You are dispatched to the scene of a motorcycle crash in which two patients were injured. Upon arrival, you find that one patient, a 19-year-old woman, is conscious and alert and is being tended to by a police officer for minor scrapes and cuts. The second patient is a 20-year-old man who is found facedown approximately 25' from the motorcycle. he states that he cannot feel or move his legs. Neither patient was wearing a helmet.

As you are loading the man into the ambulance, the police officer advises you that the woman is refusing EMS treatment and transport. You should next

A. ask the police officer to obtain a signed refusal from the patient as you proceed to the hospital
B. ask the police officer to administer a breathalyzer test to determine if the patient has been drinking alcohol
C. advise the patient that she should be transported to the hospital because of the seriousness of the crash
D. obtain a signed refusal from the patient and ask the police officer to transport her to the hospital
advise the patient that she should be transported to the hospital because of the seriousness of the crash
You are dispatched to the scene of a motorcycle crash in which two patients were injured. Upon arrival, you find that one patient, a 19-year-old woman, is conscious and alert and is being tended to by a police officer for minor scrapes and cuts. The second patient is a 20-year-old man who is found facedown approximately 25' from the motorcycle. he states that he cannot feel or move his legs. Neither patient was wearing a helmet.

While en route to the hospital with the male patient, you begin a detailed physical exam. During the exam, you note that the patient's respiratory rate has increased. You should

A. immediately notify the receiving facility
B. count the number of respirations per minute
C. assess his oxygen saturation with a pulse oximeter
D. repeat the initial assessment and treat as needed
repeat the initial assessment and treat as needed
You are dispatched to the scene of a motorcycle crash in which two patients were injured. Upon arrival, you find that one patient, a 19-year-old woman, is conscious and alert and is being tended to by a police officer for minor scrapes and cuts. The second patient is a 20-year-old man who is found facedown approximately 25' from the motorcycle. he states that he cannot feel or move his legs. Neither patient was wearing a helmet.

the most reliable indicator of injury to the spinal vertebrae is

A. lack of pain at the site of the injury.
B. palpable pain at the site of the injury.
C. decreased movement on one side of the body
D. decreased grip strength in the upper extremities
palpable pain at the site of the injury.
you receive a call for a 3 year old girl with respiratory distress. When you enter her residence, you see the mother holding the little girl, who does not acknowledge your presence. This finding indicates that the child

a. has hypoxia
B. probably is sleeping
C. is afraid of your presence
d. is reacting normally for her age.
has hypoxia
Following an apparent febrile seizure, a 4 year old boy is alert and crying. His skin is warm and moist. The most appropriate management of this child includes

A. rapidly cooling the child in cold water
B. allowing the parents to transport the child
C. offering oxygen and providing transport
D. keeping the child warm and providing transport
offering oxygen and providing transport
you should suspect potential abuse of a 4 year old child when you encounter

A. bruises to the anterior tibial area
B. curious siblings who are watching you
C. purple and yellow bruises to the thighs
D. clinging to the parent during your assessment
purple and yellow bruises to the thighs
A 30 year old woman has sever lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect

A. a normal pregnancy
B. an ectopic pregnancy
C. a spontaneous abortion
D. a ruptured ovarian cyst
an ectopic pregnancy
Management of an 18-year old woman with severe vaginal bleeding includes all of the following, EXCEPT

A. high concentrations of oxygen
B. elevation of the lower extremities
C. placing sterile dressings into the vagina
D. covering the vagina with a trauma dressing
placing sterile dressings into the vagina
A sudden onset of respiratory distress in a 5 year old child with no fever most likely is the result of

A. infection of the lower airways
B. inflammation of the upper airway
C. a progressive upper airway infection
D. obstruction of the airway by a foreign body
obstruction of the airway by a foreign body
the most important initial steps of assessing and managing a newborn include

A. suctioning the airway and obtaining a heart rate
B. clearing the airway and keeping the infant warm
C. keeping the infant warm and counting respirations
D. drying and warming the infant and obtaining an APGAR score
clearing the airway and keeping the infant warm
Which position is most appropriate for a mother in labor with a prolapsed umbilical cord?

A. Left lateral recumbent
B. Left side with legs elevated
C. Supine with hips elevated
D. Supine with legs elevated
Supine with hips elevated
When is it most appropriate to clamp and cut the umbilical cord?

A. As soon as the cord stops pulsating
B. After the placenta has completely delivered
C. Before the newborn has taken its first breath
D. Immediately following delivery of the newborn
As soon as the cord stops pulsating
Which of the following statements best describes a mass-casualaty incident?

A. More than 5 patients are involved
B. At least half of the patients
C. The number of patients overwhelms your resources
D. More than three vehicles are involved
The number of patients overwhelms your resources
In addition to ensuring your own safety, your primary responsibility when functioning at the scene of a violent crime is to

A. preserve any potential evidence
B. appropriately manage the patient
C. notify medical control prior to initiating care
D. obtain police permission before providing patient care
appropriately manage the patient
the initial treatment of choice for ventricular fibrillation of short duration, such as a witnessed cardiac arrest is

A. 100% oxygen delivery
B. prompt defibrillation
C. CPR for 2 minutes
D. cardiac drug therapy
prompt defibrillation
While managing a patient in cardiac arrest, you turn the AED on and attach the pads to the patient. When you push the analyze button, the machine signals "low battery" and then ceases to function. The patient subsequently dies. Which of the following statements regarding this case is most correct?

A. You and your partner may be held liable for negligence.
B. The crew that preceded you may be held liable for negligence.
C. The manufacturer of the AED may be held liable for negligence.
D. Most errors associated with the AED involve equipment failure.
You and your partner may be held liable for negligence.
Following delivery of a newborn, you note that the mother has a moderate amount of vaginal bleeding. The mother is conscious and alert and her vital signs are stable. The most appropriate management of the mother includes

A. massaging the uterus if signs of shock develop
B. administering oxygen and massaging the uterus
C. placing a sanitary pad in the vagina and administering oxygen
D. treating her for shock and providing immediate transport
administering oxygen and massaging the uterus
You are responding to a call for a 2 year old child who fell from a second story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child's

A. head
B. chest
C. abdomen
D. lower extremities
head
At the peak of the inspiratory phase, the alveoli in the lungs contain

A. high quantities of carbon dioxide
B. minimal levels of oxygen and carbon dioxide
C. equal levels of oxygen and carbon dioxide
D. more oxygen than carbon dioxide
more oxygen than carbon dioxide
Pulmonary surfactant serves which of the following functions?

A. It carries fresh oxygen from the lungs to the left side of the heart
B. it dilates the bronchioles in the lungs and enhances the flow of air
C. It lubricates the alveolar walls and allows them to expand and recoil
D. It facilitates the transport of oxygen-poor blood from the right ventricle to the lungs.
It facilitates the transport of oxygen-poor blood from the right ventricle to the lungs.
You receive a call to a restaurant where a 34 year old man is experiencing shortness of breath. When you arrive you immediately note that the man has urticaria on his face and arms. He is in obvious respiratory distress, but is awake and alert.

Suspecting an allergic reaction, your first action should be to

A. ask the patient if he has an epinephrine auto-injector
B. remove the patient's shirt to inspect his chest for urticaria
C. obtain a set of baseline vital signs and a SAMPLE history
D. place a nonrebreathing mask set at 15 L/min on the patient.
place a nonrebreathing mask set at 15 L/min on the patient.
You receive a call to a restaurant where a 34 year old man is experiencing shortness of breath. When you arrive you immediately note that the man has urticaria on his face and arms. He is in obvious respiratory distress, but is awake and alert.

Epinephrine possesses which of the following effects when it is used to treat anaphylaxis?

A. As a vasodilator, it increases the blood pressure.
B. As a vasoconstrictor, it lowers the blood pressure
C. As a bronchodilator, it facilitates adequate breathing
D. As a bronchoconstrictor, it inhibits the release of chemicals that cause the reaction.
As a bronchodilator, it facilitates adequate breathing
You receive a call to a restaurant where a 34 year old man is experiencing shortness of breath. When you arrive you immediately note that the man has urticaria on his face and arms. He is in obvious respiratory distress, but is awake and alert.

the patient tells you that he does not have his own epinephrine; however, his wife is allergic to bees and has a prescribed epinephrine auto-injector. you should next.

A. provide transport and consider an ALS rendezvous
B. assist the patient with the wires prescribed epinephrine
C. obtain consent from medical control to give the wife's epinephrine to the patient
D. assist the patient with one half the usual dose of the wife's epinephrine.
provide transport and consider an ALS rendezvous
An elderly man is found unconscious in his kitchen. The patient's wife tells you that her husband has diabetes and that he took his insulin, but did not eat anything. You should suspect

A. ketoacidosis
B. diabetic coma
C. hypoglycemia
D. hyperglycemia
hypoglycemia
Which of the following statements regarding the function of insulin is most correct?

A. it stimulates the liver to produce glycogen
B. it promotes the entry of glucose from the cell into the bloodstream
C. It facilitates the uptake of glucose from the bloodstream into the cell.
D. it causes the pancreas to produce glucose based on the body's demand
It facilitates the uptake of glucose from the bloodstream into the cell.
Which of the following natures of illness is most consistent with a patient with low blood glucose level who is acting bizarre and breathing shallowly?

A. Cardiac compromise
B. Altered mental status
C. Behavioral emergency
D. respiratory emergency
Altered mental status
A 42- year old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him lying approximately 50' from the car. After manually stabilizing his head, your next action should be to

A. assess the quality of his breathing
B. grasp the angles of the jaw and lift
C. administer high-concentration oxygen
D. determine the patient's level of consciousness
grasp the angles of the jaw and lift
Which of the following actions is most important when immobilizing a patient with a suspected spinal injury?

A. Immobilize the patient using a vest-style device
B. Secure the patient's head prior to immobilizing the torso.
C. Select and apply the appropriate size of extrication collar.
D. Assess for range of motion by asking the patient to move the head
Select and apply the appropriate size of extrication collar.
During a soccer game, an 18 year old woman injured her knee. You note that the knee is in the flexed position and is obviously deformed. Your first action should be to

A. assess her distal circulation
B. straighten the knee to facilitate immobilization
C. manually stabilize the leg above and below the knee
D. immobilize the knee in the position in which it was found
manually stabilize the leg above and below the knee
You have applied a pressure bandage and additional dressings to a large laceration with severe arterial bleeding. The bandages are quickly blood-soaked. You should next

A. elevate the extremity and apply a proximal arterial tourniquet
B. apply pressure to the pulse point that is most distal to the injury
C. place additional dressings on the wound until the bleeding stops
D. remove the bandages and apply pressure at the site of the bleeding
remove the bandages and apply pressure at the site of the bleeding
Which of the following assessment findings would LEAST suggest cardiac compromise?

A. Tachycardia
B. An irregular pulse
C. Palpable pain to the chest
D. nausea and epigastric pain
Palpable pain to the chest
Management of an unconscious, breathing patient with a significant cardiac history would include all of the following, EXCEPT

A. analyzing the rhythm with an AED
B. providing ventilatory support as needed
C. requesting the presence of an ALS ambulance
D. obtaining a SAMPLE history from the patient's spouse
analyzing the rhythm with an AED
The wall that separates the left and right sides of the heart is the

A. carina
B. septum
C. pericardium
D. mediastinum
septum
Prior to administering nitroglycerin to a patient with chest pain, you must

A. complete a detailed physical examination of the patient
B. contact medical control and obtain proper authorization
C. make sure that the systolic blood pressure is at least 120 mm Hg
D. make sure that the nitroglycerin is prescribed to the patient or a family member
contact medical control and obtain proper authorization
After the delivery of the defibrillation with the AED, the patient has a return of a pulse. You should next

A. provide rapid transport to the hospital
B. reanalyze the rhythm for confirmation
C. assess the airway and ventilatory status
D. remove the AED and apply 100% oxygen
assess the airway and ventilatory status
Which of the following actions would most likely cause a sudden drop in a patient's blood glucose level?

A. Mild exertion after eating a meal
B. Eating a meal after taking insulin
C. Taking too much prescribed insulin
D. Forgetting to take prescribed insulin
Taking too much prescribed insulin
Prior to your arrival at the scene, a near-drowning victim was removed from the water. You should manage the patient's airway appropriately while considering the possibility of

A. spinal injury
B. hyperthermia
C. internal bleeding
D. airway obstruction
spinal injury
A soft-tissue injury that results in a flap of torn skin is referred to as

A. an incision
B. an avulsion
C. an abrasion
D. a laceration
an avulsion
Following blunt injury to the anterior trunk, a patient is coughing up bright red blood. You should be most suspicious of

A. intra-abdominal bleeding
B. gastrointestinal bleeding
C. bleeding within the lungs
D. severe myocardial damage
bleeding within the lungs
The effectiveness of chest compressions are most effectively assessed by

A. listening for a heartbeat with each compression
B. carefully measuring the depth of each compression
C. palpating for a carotid pulse with each compression
D. measuring the systolic blood pressure during compressions
palpating for a carotid pulse with each compression
The position of comfort for a patient with nontraumatic chest pain most commonly is

A. semisitting
B. lateral recumbent
C. on the side with the head elevated
D. supine with the legs elevate slightly
semisitting
Which of the following structures is the primary pacemaker, which sets the normal rate for the heart?

A. Bundle of His
B. Purkinje fibers
C. Sinoatrial node
D. Atrioventricular node
Sinoatrial node
The middle, muscular layer of the heart is called the

A. epicardium
B. pericardium
C. myocardium
D. endocardium
myocardium
Minute Volume=
Respiratory Rate x Tidal Volume
The safest ambulance driver is one who

A. is physically fit
B. has a positive attitude
C. drives with due regard
D. drives with lights and siren
drives with due regard
You are called to treat a 25-year-old man who is alert and having difficulty breathing. After making contact with your patient, he extends his arm out to allow you to take his blood pressure. This is an example of

A. actual consent
B. informed consent
C. implied consent
D. formal consent
actual consent
You are providing care to a male patient at the scene of a shooting. the police are at the scene collecting evidence Your actions should include

A. limiting your care to the initial assessment.
B. beginning care when the police authorize you to
C. beginning immediate care as you would with any other patient
D. providing care to the patient while manipulating the scene minimally.
providing care to the patient while manipulating the scene minimally.
Which of the following statements regarding the use of an escort vehicle when en route to an emergency call is true?

A. an escort vehicle will allow you to arrive at the scene quicker.
B. To avoid getting separated from the escort vehicle, you should closely follow it.
C. An escort vehicle should be used only if you are unfamiliar with the patients location.
D. With an escort vehicle, the risk of an accident at an intersection is reduced significantly.
An escort vehicle should be used only if you are unfamiliar with the patients location.
You arrive at the scene of a fall where you encounter a male patient who fell approximately 30' and landed on his head. He is unconscious with an open head injury and exposed brain matter. Upon identifying this patient as an organ-donor, you should

A. request authorization from medical control not to initiate care.
B. manage the patient aggressively and provide rapid transport
C. recognize that the patient's injuries disqualify him as an organ donor.
D. provide supportive care only because the patient likely will not survive.
manage the patient aggressively and provide rapid transport
You are giving a presentation to a group of laypeople on the importance of calling EMS immediately for cardiac arrest patients. What point should you emphasize the most?

A. Laypeople are incapable of providing adequate CPR
B. Rapid transport significantly reduces patient mortality
C. CPR and defibrillation are key factors in patient survival
D. Cardiac drug therapy is the most important EMS treatment
CPR and defibrillation are key factors in patient survival
As an EMT-Basic, your primary responsibility is to

A. provide competent patient care
B. ensure the safety of your partner
C. keep yourself as safe as possible
D. transport all patients to the hospital
keep yourself as safe as possible
You arrive at the scene of a traffic accident in which multiple vehicles are involved. You see at least two patients who appear to be unconscious. Your first action should be to

A. begin triaging the patients
B. begin immediate patient care
C. notify medical control for advice
D. request an additional ambulance
request an additional ambulance
When providing care to multiple patients at the scene of a mass-casualty incident, your goal should remain focused on

A. transporting patients to the hospital
B. immobilizing all patients at the scene
C. initiating CPR for those in cardiac arrest
D. keeping all bystanders at a safe distance
transporting patients to the hospital
Immediately upon leaving the scene with a patient, you should

A. contact medical control
B. notify the receiving facility
C. advise dispatch of your status
D. can't read the answer
advise dispatch of your status
When you arrive at a mass-casualty incident at which other ambulances already have arrived, you should first

A. repeat the triage process
B. report to the incident commander
C. initiate care for the most critically injured patients
D. obtain information from the fire service commander
report to the incident commander
During the triage process, which of the following injuries or conditions would classify a patient as a high priority?

A. Pulselessness and apnea
B. Unilateral femur fracture and tachycardia
C. Partial-thickness burns with no respiratory difficulty
D. A large avulsion to the arm and an altered mental status
A large avulsion to the arm and an altered mental status
The role of triage officer at a mass-casualty incident should be assumed by the

A. most knowledgeable EMS provider
B. EMS provider with the most years of experience.
C. first EMS provider who is willing to perform the task
D. EMS medical director via telephone communication
most knowledgeable EMS provider
The information that would be of LEAST pertinence when educating the public on injury prevention is

A. how to provide rescue breathing.
B. the proper usage of child safety seats.
C. building a childproof fence around a pool.
D. teaching children to wear bicycle helmets.
how to provide rescue breathing.
You are called to a residence for a woman in cardiac arrest. As you are initiating CPR, the patient's husband presents you with an unsigned document that states "do not resuscitate". Your most appropriate action in this case should be to

A. stop all resuscitative efforts in accordance with the document.
B. stop CPR until the document can be validated by a physician
C. continue CPR until you have contacted medical control for guidance
D. contact medical control prior to beginning any resuscitation measures.
continue CPR until you have contacted medical control for guidance
According to the United States Department of Transportations EMT-Basic National Standard Curriculum, minimum staffing for a basic life support ambulance includes

A. an EMT-Basic who functions as the driver
B. at least one EMT-Basic in the patient compartment
C. at least two EMT-Basics in the patient compartment
D. a minimum of two EMT-Basics in the ambulance
at least one EMT-Basic in the patient compartment
The ultimate goal of any EMS quality improvement program should be to

A. deliver a consistently high standard of care to all patients who are encountered
B. make sure that all personnel receive an adequate number of continuing education credits.
C. provide EMS protocols to all EMTs and hold them accountable when protocols are not adhered to.
D. provide recognition to all EMT's who have demonstrated consistency in providing competent patient care
deliver a consistently high standard of care to all patients who are encountered
You are caring for a 6-year old child with a swollen, painful deformity to the left forearm. As you communicate with the parents of this child, you should

A. ask them repeatedly how the child was injured
B. use appropriate medical terminology at all times.
C. make sure that they remain aware of what you are doing.
D. tell them that the child will be transported to the hospital
make sure that they remain aware of what you are doing.
Following a call in which a 6-week old infant in cardiac arrest did not survive, your partner is exhibiting significant anxiety and irritability. How can you most effectively help her?

A. Allow her to voice her feelings to you.
B. Tell her that she needs psychiatric help.
C. Tell her to go home and get 12 hours of sleep
D. Report her behavior to the medical director
Allow her to voice her feelings to you.
When is it most appropriate to complete your prehospital care report for a critically ill patient?

A. During the initial assessment phase
B. During the ongoing assessment phase
C. As soon as all patient care activities are completed
D. After the ambulance has been restocked at the station
As soon as all patient care activities are completed
Which of the following scene size-up findings is LEAST suggestive of an unsafe environment?

A. A large man standing in his yard awaiting your arrival
B. Liquid draining from a car that struck a telephone pole
C. screaming and yelling coming from inside a residence.
D. The sound of breaking glass as you approach a residence
A large man standing in his yard awaiting your arrival
Proper body mechanics when lifting and moving a patient include

A. maintaining a slight curvature of your back
B. using the muscles of your lower back to lift
C. keeping the weight as close to you as possible
D. twisting at the waist when moving a patient around a corner
keeping the weight as close to you as possible
The immobilization device most appropriate to use for a patient with multiple injuries and unstable vital signs is a

A. scoop immobilization device
B. vest-style immobilization device
C. short spine board immobilization device
D. long spine board immobilization device
long spine board immobilization device
Medical control has ordered you to administer one tube of oral glucose to your patient suspected of having hypoglycemia. Immediately after receiving this order, you should

A. document the order on the prehospital care report
B. administer the medication and reassess the patient
C. ask medical control to repeat the order word for word
D. repeat the order back to medical control word for word
repeat the order back to medical control word for word
While caring for a critically injured patient, you remove blood-soaked clothing in order to manage injuries. You should dispose of the clothing by

A. leaving it at the scene
B. leaving it at the hospital
C. placing it in a biohazard bag
D. placing it in the ambulance trash can
placing it in a biohazard bag
Which of the following statements regarding the head tilt-chin lift maneuver is MOST correct?
A. It can only be used in conjunction with an oropharyngeal airway
B. It can only be used temporarily and must be replaced by an airway adjunct
C. It should be used on all unresponsive patients that you encounter.
D. It is the technique of choice for patients with potential spinal injury.
It can only be used temporarily and must be replaced by an airway adjunct
In which of the following situations should the jaw-thrust maneuver be used?
A. In any patient who is in cardiac arrest.
B. In a patient with apnea with no signs of trauma.
C. In a patient who is in need of frequent suctioning.
D. When the mechanism of injury is unclear.
When the mechanism of injury is unclear.
An elderly man is found lying unresponsive next to his bed. The patients's wife did not witness the event that caused the unconsciousness. You should first
A. assess the patient's respirations.
B. apply 100% supplemental oxygen.
C. tilt the head back and lift up the chin.
D. grasp the angles of the lower jaw and lift
grasp the angles of the lower jaw and lift
A patient has severe facial injuries, inadequate breathing, and copious secretions coming from the mouth. How should this situation be managed?
A. Alternate suctioning for 15 seconds and ventilations for 2 minutes.
B. Provide artificial ventilations and suction for 30 seconds as needed.
C. Turn the patient to the side and provide oral suctioning continuously.
D. Insert an oropharyngeal airway and suction until the secretions clear.
Alternate suctioning for 15 seconds and ventilations for 2 minutes.
When ventilating an apneic adult patient with a bag-valve mask device, you must make sure that
A. an airway adjunct has been inserted.
B. you are positioned alongside the patient.
C. ventilations occur at a rate of 20 breaths/min.
D. the pop-off valve on the BVM device remains open.
an airway adjunct has been inserted.
Which of the following processes occurs during inhalation?
A. The intercostal muscles and diaphragm both contract.
B. The intercostal muscles relax and the diaphragm descends.
C. The diaphragm contracts and the intercostal muscles relax.
D. The diaphragm descends and the intercostal muscles relax.
The intercostal muscles and diaphragm both contract.
Which of the following processes occurs during cellular/capillary gas exchange?
A. The cells give up oxygen to the capillaries.
B. The cells receive carbon dioxide from the capillaries.
C. The capillaries give up oxygen to the cells.
D. The capillaries give up carbon dioxide to the cells.
The capillaries give up oxygen to the cells.
What is the preferred method for initially providing artificial ventilations to a patient with apnea?
A. Flow-restricted, oxygen-powered ventilation device
B. Mouth-to mask technique with supplemental oxygen
C. One-person bag-valve-mask technique with 100% oxygen
D. Two-person bag-valve-mask technique with 100% oxygen.
Mouth-to mask technique with supplemental oxygen
A reduced tidal volume would most likely occur from
A. flaring of the nostrils.
B. accessory muscle use.
C. unequal chest expansion.
D. increased minute volume.
unequal chest expansion.
Which of the following patients is exhibiting signs of inadequate breathing?
A. A 41-year-old woman with shallow respirations of 20 breaths/min.
B. A 60-year-old woman with bilaterally equal breath sounds.
C. A 30-year old man with respirations of 18 breaths/min and equal breath sounds.
D. A 50-year-old man with respirations of 12 breaths/min and pink, dry skin.
A 41-year-old woman with shallow respirations of 20 breaths/min.
Snoring respirations in an unresponsive patient most likely are the result of
A. foreign body airway obstruction.
B. upper airway obstruction by the tongue.
C. collapse of the trachea during breathing.
D. swelling of the larynx and surrounding structures.
upper airway obstruction by the tongue.
In an unresponsive patient who has not sustained trauma, how are respirations of 16 breaths/min with good chest expansion most appropriately managed?
A. Suctioning as needed and artificial ventilations.
B. The jaw-thrust maneuver and frequent suctioning.
C. An airway adjunct and oxygen via non-rebreathing mask.
D. An airway adjunct and ventilations with a BVM device.
An airway adjunct and oxygen via non-rebreathing mask
Initial management of an unconscious adult patient who fell 15' from a tree includes
A. performing a jaw-thrust.
B. performing a head tilt-chin lift maneuver.
C. providing oxygen or artificial ventilations.
D. assessing the rate and quality of breathing.
performing a jaw-thrust
What should your first action be when treating a 40-year old man with rapid respirations?
A. Apply 100% supplemental oxygen.
B. insert an airway adjunct as needed.
C. Assess the regularity and quality of breathing.
D. Initiate artificial ventilations with a pocket mask.
Assess the regularity and quality of breathing
In what position would you expect a patient with severe dyspnea to be in?
A. Prone
B. Supine
C. Fowler's
D. Lateral recumbent
Fowler's
Which of the following listings of techniques and devices represents the correct order of preference for providing artificial ventilation?
A. Pocket mask, one-person BVM, two-person BVM, flow-restricted oxygen-powered ventilation device.
B. Pocket mask, two-person BVM, flow-restricted oxygen-powered ventilation device, one-person BVM
C. One-person BVM, pocket mask, two=person BVM, flow-restricted oxygen-powered ventilation device
D. Two-person BVM, one-person BVM, flow-restricted oxygen-powered ventilation device, pocket mask
Pocket mask, two-person BVM, flow-restricted oxygen-powered ventilation device, one-person BVM
Tidal volume is best defined as the
A. volume of air inhaled in a single breath.
B. volume of air that remains in the upper airway.
C. total volume of air that the lungs are capable of holding.
D. volume of air moved in and out of the lungs each minute.
volume of air inhaled in a single breath
You would most likely encounter agonal respirations in which of the following patients?
A. A hypoxic patient who is in the early phase of compensation
B. A severely hypoxic patient who is in the later stages of compensation.
C. A patient who is in the midst of complete respiratory failure.
D. A semiconscious patient whose tongue in occluding the airway.
A patient who is in the midst of complete respiratory failure
A young woman who has overdosed on a strong narcotic dry is unconscious with slow, shallow breathing. As you attempt to insert an oropharyngeal airway, the patient begins to gag. You should next
A. remove the oropharyngeal airway and be prepared to suction the mouth.
B. remove the oropharyngeal airway and insert a nasopharyngeal airway.
C. suction the patient's oropharynx as you insert a nasopharyngeal airway.
D. make sure you are using the most appropriate size of oropharyngeal airway.
remove the oropharyngeal airway and be prepared to suction the mouth
As you are ventilating an apneic patient using the one-person bag-valve-mask technique, you note minimal rise of the chest each time you squeeze the bag. You should
A. ensure that the reservoir is attached to the bag-valve-mask device.
B. squeeze the bag harder to ensure delivery of adequate tidal volume.
C. suction the patient's mouth for 15 seconds and reattempt ventilations.
D. evaluate the mask-to-face seal and the position of the patient's head.
evaluate the mask-to-face seal and the position of the patient's head
After an adult cardiac arrest patient has been intubated by a paramedic, you are providing ventilations as your partner performs chest compressions. When ventilating the patient, you should
A. deliver 2 breaths during a brief pause in chest compressions.
B. deliver each breath over 1 second at a rate of 8 to 10 breaths/min
C. hyperventilate the patient to maximize carbon dioxide elimination.
D. deliver each breath over 2 seconds at a rate of 12 to 15 breaths/min.
deliver each breath over 1 second at a rate of 8 to 10 breaths/min
When ventilating a patient with apnea with a pocket mask device, each breath should be delivered over
A. 1 second
B. 2 seconds
C. 3 seconds
D. 4 seconds
1 second
A 60-year old woman presents with acute respiratory distress. She is alert and oriented, but restless. Her respiratory rate is 26 breaths/min with adequate chest expansion and clear breath sounds. What is the most appropriate method of airway management for this patient?
A. Supplemental oxygen with a non-rebreathing mask
B. A nasopharyngeal airway and assisted ventilations
C. A nasopharyngeal airway and supplemental oxygen
D. A nasal cannula with the flowmeter set at 4 to 6 L/min
Supplemental oxygen with a non-rebreathing mask
A semiconscious young man has shallow, gurgling respirations at a rate of 10 breaths/min. Initial management should include
A. suctioning the oropharynx
B. inserting a nasopharyngeal airway
C. initiating positive pressure ventilations.
D. applying 100% oxygen with a nonrebreathing mask.
suctioning the oropharynx
Which of the following airway sounds would most likely indicate a lower airway obstruction?
A. Stridor
B. Crowing
C. Gurgling
D. Wheezing
Wheezing
Which of the following assessment findings would most likely indicate cardiac compromise?
A. Tachypnea
B. Tachycardia
C. Irregular pulse
D. Sudden fainting
Irregular pulse
A 50-year old man presents with "crushing" chest pain of sudden onset. He is diaphoretic and nauseated. You should
A. obtain baseline vital signs
B. apply supplemental oxygen
C. ask him if he takes nitroglycerin
D. perform a focused physical exam
apply supplemental oxygen
As you are assessing an elderly man who is complaining of chest pain, the patient suddenly loses consciousness. Your first step should be to

A. attach the AED
B. open the airway
C. assess for a pulse
D. assess for breathing
open the airway
Freshly oxygenated blood returns to the heart via which of the following blood vessels?

A. Aorta
B. Vena cava
C. Pulmonary vein
D. Pulmonary artery
Pulmonary vein
Which of the following statements regarding the automated external defibrillator is true?

A. It should be applied to patients at risk for cardiac arrest
B. It will analyze a patient's rhythm while CPR is in progress
C. It should not be used in patients with an implanted pacemaker
D. It can safely be used in children between 1 and 8 years of age.
It can safely be used in children between 1 and 8 years of age.
Nitroglycerin possesses which of the following effects when administered to patients with suspected cardiac chest pain?

A. Vasodilation and increased myocardial oxygen supply
B. Vasodilation and decreased myocardial oxygen supply
C. Vasoconstriction and increased cardiac workload
D. Vasoconstriction and increased cardiac oxygen demand
Vasodilation and increased myocardial oxygen supply
You arrive at the scene of a 56 year old man who is not breathing. Your initial assessment reveals that the patient is pulseless and apneic. The patient's wife tells you that her husband suddenly grabbed his chest and then passed out. As your partner confirms cardiac arrest and begins one-rescuer CPR, you should

A. notify medical control
B. insert an airway adjunct
C. prepare the AED for use
D. obtain a SAMPLE history
prepare the AED for use
You arrive at the scene of a 56 year old man who is not breathing. Your initial assessment reveals that the patient is pulseless and apneic. The patient's wife tells you that her husband suddenly grabbed his chest and then passed out. When performing two-rescuer CPR on this patient, you should

A. slowly compress the chest to a depth of about 1" to 1 1/2".
B. not attempt to synchronize compressions with ventilations.
C. have your partner pause after 30 compressions as you give two breaths.
D. continue ventilations as the AED analyzes the patient's cardiac rhythm.
have your partner pause after 30 compressions as you give two breaths.
You arrive at the scene of a 56 year old man who is not breathing. Your initial assessment reveals that the patient is pulseless and apneic. The patient's wife tells you that her husband suddenly grabbed his chest and then passed out. After successfully resuscitating the patient, you provide immediate transport. While en route to the hospital, the patient goes back into cardiac arrest. Your next step should be

A. tell your partner to stop the ambulance.
B. Begin CPR and proceed to the hospital
C. contact medical control for further advice.
D. analyze the patient's rhythm with the AED.
tell your partner to stop the ambulance
A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband's nitroglycerin tablets without relief. What is your most appropriate course of action?

A. Attach the AED, administer 100% oxygen, and contact medical control for advice.
B. Apply supplemental oxygen and transport the patient to the hospital without delay.
C. Call medical control and request permission to assist the patient with one more nitroglycerin tablet.
D. Obtain the patients's blood pressure and administer one more nitroglycerin tablet if her blood pressure is greater than 100 mm Hg systolic.
Apply supplemental oxygen and transport the patient to the hospital without delay
Cardiac arrest in the adult population most often is the result of

A. myocardial infarction
B. respiratory failure
C. a cardiac arrhythmia
D. accidental electrocution
a cardiac arrhythmia
The chest pain associated with cardiac compromise often is described as

A. sharp
B. stabbing
C. pressure
D. cramping
pressure
As you are attempting to resuscitate an adult man with cardiac arrest, you receive a "o shock advised" message from the AED. What should you do next?

A. continue CPR
B. Check for a pulse
C. Assess for breathing
D. Reanalyze the rhythm
Check for a pulse
The myocardium receives its blood supply from the coronary arteries that branch directly from the

A. aorta
B. vena cava
C. left atrium
D. right ventricle
aorta
The EMT-B should consider performing 2 minutes of CPR prior to attaching the AED to adult victims of cardiac arrest when

A. the arrest is caused by a traumatic injury
B. the patient's cardiac arrest was witnessed
C. the call-to-arrival time is more than 5 minutes.
D. the patient has known coronary artery disease
the call-to-arrival time is more than 5 minutes
Which of the following are side effects of nitroglycerin?

A. Nausea
B. Anxiety
C. Headache
D. Hypertension
Headache
Which of the following patients would be the best candidate for the administration of nitroglycerin?

A. A woman who has taken 3 doses of prescribed nitroglycerin without relief of chest pain
B. A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 102/76 mm Hg
C. A man with chest pain, a bottle of expired nitroglycerin, and a blood pressure of 110/80 mm Hg
D. An elderly man with crushing chest pain and a blood pressure of 90/60 mm Hg
A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 102/76 mm Hg
Which of the following chambers of the heart has the thickest walls?

A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle
Left ventricle
in addition to oxygen therapy; the most effective way to minimize the detrimental effects associated with cardiac compromise is to

A. give the patient up to 4 doses of nitroglycerin
B. reassure the patient and provide prompt transport
C. transport the patient rapidly, using lights and siren
D. request ALS support for all patients who have chest pain.
reassure the patient and provide prompt transport
Which of the following questions would be most appropriate to ask when assessing a patient with chest pain?

A. What does the pain feel like?
B. Does the pain radiate to your arm?
C. Would you describe the pain as sharp?
D. Is the pain worse when you take a deep breath?
What does the pain feel like?
Which of the following statements regarding one-rescuer CPR is correct?

A. you should assess the patient for a pulse after 3 cycles of CPR.
B. A compression to ventilation ratio of 15:2 should be delivered
C. Ventilations should be delivered over a period of 1 to 2 seconds
D. The chest should be allowed to fully recoil after each compression.
The chest should be allowed to fully recoil after each compression
You are caring for a 66-year-old woman with sever pressure in her chest. As you initiate oxygen therapy, your partner should

A. notify medical control
B. obtain a SAMPLE history
C. measure the blood pressure
D. gather the patient's medications.
measure the blood pressure
When managing a patient with chest pain, you should first

A. administer high-concentration oxygen
B. place the patient in a position of comfort
C. request an ALS ambulance to respond to the scene.
D. measure the blood pressure and administer nitroglycerin
place the patient in a position of comfort
What is the most detrimental effect that tachycardia can have on a patient experiencing cardiac compromise?

A. increased blood pressure
B. increased oxygen demand
C. increased stress and anxiety
D. decreased cardiac functioning
increased oxygen demand
After applying the AED to a 56-year old female in cardiac arrest, you analyze her cardiac rhythm and receive a "shock advised" message. First responders, who arrived at the scene before you, tell you that the patient was without CPR for about 10 minutes. You should

A. perform 2 minutes of CPR and then defibrillate
B. detach the AED and prepare for immediate transport
C. deliver the shock as indicated followed immediately by CPR.
D. notify medical control and request permission to cease resuscitation.
deliver the shock as indicated followed immediately by CPR
During transport of a patient with a head injury, what assessment factor will provide you with the most information regarding the patient's condition?
A. Pupil size
B. Heart size
C. Mental status
D. Blood pressure
Mental status
A young man fell and landed on his outstretched hand, resulting in pain and deformity to the left midshaft forearm. Distal circulation should be assessed at which of the following pulse locations?

A. Radial
B. Brachial
C. Pedal
D. Popliteal
Radial
You are called to a local nightclub for an injured patient. Upon arrival, you see a young man who is lying on the ground screaming in pain, bright red blood is spurting from an apparent stab wound to his groin area. Your first action should be to

A. control the bleeding
B. apply 100% oxygen
C. ensure an open airway
D. elevate the patient's legs
control the bleeding
During a soccer game, a 20 year old man collided shoulder to shoulder with another player. He has pain and a noticeable anterior bulge to the left shoulder. What is the most effective method of immobilizing this injury?

A. An air-inflatable splint with the left arm immobilized in the flexed position
B. A long board splint with the left arm immobilized in the extended position
C. A sling to support the left arm and swathes to secure the arm to the body
D. A sling to support the left arm and swathes to maintain downward traction
A sling to support the left arm and swathes to secure the arm to the body
Which of the following mechanisms of injury would necessitate performing a rapid trauma assessment?

A. A 5'8" tall adult who fell 12' from a roof and landed on his side
B. A stable patient involved in a car crash, whose passenger was killed
C. Amputation of three toes from the patient's left foot with controlled bleeding
D. An impaled object in the patient's lower extremity with minimal venous bleeding
A stable patient involved in a car crash, whose passenger was killed
You are assessing a 33 year old male's Glasgow Coma Scale (GCS) score. The patient opens his eyes in response to pain, is speaking with incomprehensible words, and withdraws from pain by flexing his upper extremities. What is his GCS score?

A. 6
B. 7
C. 8
D. 9
7
The police summon you to a residence for a domestic dispute. When you arrive, you are advised by a police officer that a man, who is now in custody, shot his wife. When you enter the residence, you see a woman lying supine. She is conscious, but very restless, and is in obvious respiratory distress.

After ensuring a patent airway, your next course of action should be to

A. apply 100% oxygen
B. assess respiratory quality
C. compare carotid and radial pulses
D. check the condition of the patient's skin
assess respiratory quality
The police summon you to a residence for a domestic dispute. When you arrive, you are advised by a police officer that a man, who is now in custody, shot his wife. When you enter the residence, you see a woman lying supine. She is conscious, but very restless, and is in obvious respiratory distress.

During which part of your assessment would you be most likely to discover a small caliber gunshot wound, with minimal bleeding, to the back?

A. General impression
B. Initial assessment
C. Rapid trauma assessment
D. Detailed physical examination
Rapid trauma assessment
The police summon you to a residence for a domestic dispute. When you arrive, you are advised by a police officer that a man, who is now in custody, shot his wife. When you enter the residence, you see a woman lying supine. She is conscious, but very restless, and is in obvious respiratory distress.

Upon discovering an open chest wound, your first action should be to

A. prevent air from entering the open wound
B. begin assisted ventilation and prepare for transport
C. immediately reassess the patient's ventilatory status
D. cover the wound with a trauma dressing and reassess the patient's ventilatory status
prevent air from entering the open wound
When applying a vest-style spinal immobilization device to a patient with traumatic neck pain, you should
A. immobilize the head prior to securing the torso straps.
B. secure the torso section prior to immobilizing the head.
C. ask the patient to fully exhale as you secure the torso.
D. gently flex the head forward as you position the device.
secure the torso section prior to immobilizing the head.
Which of the following findings would indicate that a patient is in decompensated shock?
A. Diaphoresis and pallor
B. Falling blood pressure
C. Restlessness and anxiety
D. Heart rate greater than 130 beats/min
Falling blood pressure
General care for an amputated body part includes
A. Immersing the amputated part in cold water to prevent further damage
B. thoroughly cleaning the amputated part and wrapping it in a sterile dressing.
C. wrapping the amputated part in a moist, sterile dressing and placing it on ice.
D. wrapping the amputated part in a moist, sterile dressing and keeping it warm.
wrapping the amputated part in a moist, sterile dressing and placing it on ice.
You are called to a local knife-throwing contest, where a 42-year old man has a large dagger impaled in the middle of his chest. Your assessment reveals that he is pulseless and apneic. How should you manage this patient and his injury?
A. Carefully remove the knife, control the bleeding, and begin CPR
B. Carefully remove the knife, control the bleeding, and attach an AED to the patient.
C. Secure the knife in place with a bulky dressing and transport immediately
D. Make sure that the knife is secured, initiate CPR and transport immediately
Carefully remove the knife, control the bleeding, and begin CPR
Rapid extrication of a patient from an automobile is most appropriately performed by
A. applying an extrication collar and removing the patient from the car using the direct carry method
B. applying an extrication collar, sliding a long spine board under the patient's buttocks, and removing the patient from the car.
C. applying a vest-style extrication device and sliding the patient out of the car onto a long spine board for full immobilization.
D. maintaining support of the head, grasping the patient by the clothing, and rapidly removing the patient from the car.
applying an extrication collar, sliding a long spine board under the patient's buttocks, and removing the patient from the car.
During your rapid trauma assessment of a critically-injured patient, you should assess the chest for
A. symmetry and pain
B. rigidity and guarding
C. crepitus and distention
D. distention and guarding
symmetry and pain
Following penetrating trauma to the abdomen, a 50 year old woman has a large laceration with a loop of protruding bowel. How should you manage this injury?
A. Carefully replace the bowel and apply an occlusive dressing.
B. Carefully replace the bowel and cover the wound with a moist, sterile dressing.
C. Apply a dry, sterile dressing covered by an occlusive dressing.
D. Apply a moist, sterile dressing, covered by a dry, sterile dressing.
Apply a moist, sterile dressing, covered by a dry, sterile dressing
During the initial assessment of an unconscious trauma patient, you find that the patient is breathing inadequately, has a weak radial pulse, and is bleeding from a lower extremity wound. You should direct your partner to
A. radio for an ALS ambulance to respond to the scene.
B. apply direct pressure to the bleeding as you assist ventilations.
C. initiate positive pressure ventilations as you control the bleeding.
D. prepare the long spine board and straps for rapid immobilization.
initiate positive pressure ventilations as you control the bleeding.
While removing a hot radiator cap, a young man sustained partial-thickness burns to the anterior chest and both anterior arms. Based on the Rule of Nines, what percentage of his body surface area (BSA) has been burned?
A. 18%
B. 27%
C. 36%
D. 45%
18%
An elderly woman who was removed from her burning house by firefighters has sustained full-thickness burns to approximately 50% of her body. Appropriate management for this patient should consist of
A. applying moist, sterile dressings to the burned areas and preventing hypothermia.
B. cooling the burns with sterile saline and covering them with dry, sterile burn pads.
C. covering the burns with dry, sterile dressings and preventing further loss of body heat.
D. peeling burned clothing from the skin and removing all rings, necklaces, and bracelets
covering the burns with dry, sterile dressings and preventing further loss of body heat.
Initial care of a large avulsion includes
A. cleaning the wound.
B. controlling any bleeding
C. assessing distal circulation
D. immobilizing the injured area.
controlling any bleeding
A 19 year old man was struck in the side of the head with a steel pipe during a gang altercation. Blood-tinged fluid is draining from the ears and bruising appears behind the ears. The most appropriate management for this patient includes
A. elevating the lower extremities and providing immediate transport
B. applying 100% oxygen and packing the ear with sterile gauze pads
C. controlling the drainage from the ear and applying spinal immobilization
D. applying spinal immobilization and oxygen while monitoring the patient for vomiting
applying spinal immobilization and oxygen while monitoring the patient for vomiting
Basic shock management consists of
A. applying and inflating the PASG, applying oxygen, and providing warmth.
B. elevating the lower extremities, applying and inflating the PASG, and applying oxygen
C. applying oxygen, elevating the upper body, and providing warmth
D. applying oxygen, elevating the lower extremities, and providing warmth
applying oxygen, elevating the lower extremities, and providing warmth
Damaged small blood vessels beneath the skin following blunt trauma manifests as
A. mottling
B. cyanosis
C. hematoma
D. ecchymosis
ecchymosis
When assessing a patient with a gunshot wound, you should routinely
A. apply ice directly to the wound
B. determine why the patient was shot
C. look for the presence of an exit wound
D. evaluate the pulses proximal to the wound
look for the presence of an exit wound
Which of the following signs would you expect to see in the early stages of shock
A. Hypotension
B. Restlessness
C. Thready pulses
D. Unconsciousness
Restlessness
Seizures in children most often are the result of

A. a life-threatening infection
B. a temperature greater than 102 degree F
C. an abrupt rise in body temperature
D. an inflammatory process in the brain.
an abrupt rise in body temperature
After clearing the airway of a newborn who is not in distress, it is most important for you to

A. apply free-flow oxygen
B. clamp and cut the chord
C. keep the newborn warm.
D. obtain an APGAR score.
keep the newborn warm.
You are caring for a 6-year-old child with a possible fractured left arm and have reason to believe that the child was abused. How should you manage this situation?

A. inform the parents of your suspicions
B. Call the police so the parents can be arrested.
C. Advise the parents that the child needs to be transported
D. Transport the child to the hospital regardless of the parents wishes
Advise the parents that the child needs to be transported
At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is lying on the couch in obvious pain.

The woman states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be most appropriate to ask at this point?

A. has your bag of waters broken yet?
B. have you had regular prenatal care?
C. At how many weeks gestation are you?
D. how many other children do you have?
At how many weeks gestation are you?
At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is trying on the couch in obvious pain.

Which of the following statements regarding crowning is true?

A. Crowning represents the end of the second stage of labor.
B. Crowning always occurs immediately after the amniotic sac has ruptured.
C. It is safe to transport the patient during crowning if the hospital is close.
D. Gentle pressure should be applied to the baby's head during crowning.
Gentle pressure should be applied to the baby's head during crowning.
At 0345, you receive a call for a woman in labor. upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby "now". This man escorts you into the living room where a 25-year old woman is trying on the couch in obvious pain.

After determining that delivery is not imminent, you begin transport. While en route, the mother tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What is your most appropriate first action?

A. Allow the head to deliver and check for the location of the cord.
B. Advise your partner to stop the ambulance and assist with the delivery.
C. Tell the mother to take short, quick breaths until you arrive at the hospital.
D. Prepare the mother for an emergency delivery and open the obstetrics kit.
Advise your partner to stop the ambulance and assist with the delivery.
Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

A. Begin positive pressure ventilations.
B. provide blow-by oxygen with oxygen tubing
C. assess the newborn's skin condition and color.
D. start chest compressions and contact medical control
Begin positive pressure ventilations.
Your assessment of a mother in active labor reveals that a limb is protruding from the vagina. Management of this condition should include

A. positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport
B. positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport.
C. applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord.
D. giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur.
positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport.
When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your most appropriate initial action should be to

A. ask the patient to sign a release form.
B. ask a female EMT-B to attempt to assess the patient.
C. explain to the patient that she must be examined.
D. transport the patient without performing an assessment.
ask a female EMT-B to attempt to assess the patient.
Which of the following techniques represents the most appropriate method of opening the airway of an infant with no suspected neck injury?

A. Lift up the chin and hyperextend the neck.
B. Tilt the head back without hyperextending the neck
C. Gently lift the chin while maintaining slight flexion of the neck.
D. Perform the technique as you would for an older child or adult.
Tilt the head back without hyperextending the neck
A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect

A. croup
B. epiglottitis
C. lower respiratory infection
D. foreign body airway obstruction
foreign body airway obstruction
Which of the following findings would indicate an altered mental status in a small child?

A. Recognition of the parents
B. Fright at the EMT-B's presence
C. Lack of attention to the EMT-B's presence
D. Consistent eye contact with the EMT-B
Lack of attention to the EMT-B's presence
Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year old child with possible shock?

A. Distal capillary refill
B. Systolic blood pressure
C. Skin color and temperature
D. Presence of peripheral pulses
Systolic blood pressure
Care for an alert 4-year old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color includes

A. back blows, abdominal thrusts, transport
B. oxygen, avoiding agitation, transport
C. assisting ventilations, back blows, transport
D. chest thrusts, finger sweeps, transport
oxygen, avoiding agitation, transport
You are called to a residence for a "sick" 5-year-old child. When you arrive and begin your assessment, you note that the child is unconscious with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Management of this child should consist of

A. 100% oxygen via a nonrebreathing mask and rapid transport.
B. positive pressure ventilations with a BVM device and rapid transport.
C. chest compressions, artificial ventilations, and rapid transport
D. back blows and chest thrusts while attempting artificial ventilations
chest compressions, artificial ventilations, and rapid transport
Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. Management should include

a. oxygen, uterine massage, and transport.
B. oxygen, placement on the left side, and transport
C. oxygen, treatment for shock, and uterus massage during transport
D. oxygen, internal vaginal pads, and treatment of shock during transport.
oxygen, treatment for shock, and uterus massage during transport
While performing a visual inspection of a 30-year-old woman in active labor, you can see the umbilical cord at the vaginal opening. After providing high concentration oxygen, you should next
A. massage the uterus to facilitate delivery of the fetus.
B. relieve pressure from the cord with your gloved fingers.
C. place the mother on her left side and provide rapid transport
D. elevate the mother's lower extremities and provide immediate transport.
relieve pressure from the cord with your gloved fingers.
A 34-year old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her

A. on her left side.
B. in the prone position
C. in the supine position
D. in a semi-sitting position
on her left side.
A 7-year old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for

A. vomiting
B. seizures
C. combativeness
D. respiratory distress
seizures
Which of the following is the most common cause of shock (hypoperfusion) in infants and children?

A. infection
B. Cardiac failure
C. Accidental poisoning
D. sever allergic reaction
infection
Which of the following signs or symptoms is more common in Children than adults following head trauma?

A. Nausea and vomiting
B. Altered mental status
C. Tachycardia and diaphoresis
D. Changes in pupillary reaction
Nausea and vomiting
A 4-year old fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and bleeding from her mouth. After performing a jaw-thrust maneuver with simultaneous stabilization of her head, you should

A. suction the oropharynx
B. insert a nasopharyngeal airway
C. initiate positive pressure ventilations
D. CANT READ it
suction the oropharynx
Which of the following statements regarding 2-rescuer child CPR is correct?

A. The chest should not be allowed to fully recoil in between compressions as this may impede venous return.
B. Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest.
C. The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered.
D. A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations
Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest.
General guidelines when assessing a 2-year old child with abdominal pain and adequate perfusion include

A. examining the child in the parent's arms.
B. palpating the painful area of the abdomen first.
C. placing the child supine and palpating the abdomen
D. separating the child from the parent to ensure a reliable examination
examining the child in the parent's arms.
You are managing a 10-month old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first?

A. lower the extremities and reassess the child
B. Begin positive pressure ventilations and reassess the child
C. Place a nasopharyngeal airway and increase the oxygen flow.
D. Listen to the lungs with a stethoscope for abnormal breath sounds.
lower the extremities and reassess the child
Your patient responds to your voice with incomprehensible murmurers. Using the AVPU scale, he is classifed as responsive to:
Verbal stimuli
Do vitals signs have to be taken on-scene in every situation?
No. Vitals should be taken enroute for patients idenitified as high priority for immediate transport for definitive care .
What does SAMPLE stand for?
Signs and symptoms, allergies, medications, past medical history, last meal, events lead to current state.
What forms of abuse are EMS providers mandated to report?
Child, Spouse, and Elder Abuse must be reported on the PCR/E-PCR and verbally at transfer of care. Child abuse must also be reported according to NYS Bureau of EMS Policy #02-01.
Does a PCR/E-PCR have to be completed when no patient contact is made?
Yes, even for stand-bys, calls where no patients are located, cancellations, and events.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act of 1996.
When reporting responsiveness, EMS providers should use _______________ to avoid less clear descriptors.
AVPU
For a hypoglycemic patient, when is it appropriate to give oral glucose, juice, or non-diet soda?
If the patient is alert enough to sit unsupported, follow commands, and drink without assistance.
When is aspirin contraindicted for an MI patient?
Recent GI bleed and known allergy.
According to NYS BLS protocol, the administration of nitroglycerin for chest pain is indicated if the adult patient's BP is than _____mmHg.
120
According to NYS BLS protocol, a maximum of ____ total doses of nitroglycerin can be given without medical direction to adult chest pain patients.
3
When is it appropriate to actively rewarm frostbite in the field?
The patient does not need to walk further and there will be a transport greater than 30 minutes,
For a genrealized hypothermia patient, pulse checks should last at least _____ before CPR is started.
30-45 seconds
If severe hypothermia is present, can defibrillation be performed?
Give a mximum of three shocks, but withhold drugs.
Your patient acutely developed a high grade fever, has a muffled voice, stridor, and drooling. You should suspect:
Epiglottitis (bacterial)
Your patient has been ill for the last few days with coldlike symptoms, a barky cough, and a low grade fever. He woke at 3:00am with severe symptoms. You suspect:
Croup (viral)
Ideally, a BVM used for emergency situations should:
Be self-inflating, have no a pop-off valve, and have an anatomically shaped, clear mask.
List signs of respiratory failure in children:
increased respiratory eefort with retractions, breathing less than 10 per minute, head bobbing, grunting, accessory muscle use, absent or shallow chest wall movement, limp muscle tone, altered mental status, slow or absent heart rate, poor skin perfusion, and altered mental status.
Sings of impending cardiac arrest in a pediatric patient are:
Altered mental status, bradycardia, and cyanosis.
For a heat exhaustion patient, when is it appropriate to give fluids orally?
Consious and not nauseated, and able to drink without assistance.
What position should a nauseated patient be transported in?
left lateral recumbent.
If your choking patient becomes unconsious, you should:
Begin CPR
Your pediatric patient choked on a small toy peice. He is conscious, but has labored breathing and stridor. You should:
Monitor closely and transport in the position of comfort with blowby oxygen administration as tolerated.
For a patient who has ingested a poison, you should contact:
Medical Direction (Poison Control can not give treatment orders to EMS providers.)
Before an advanced airway is placed, during CPR the adult patient should be ventilated every ____-____ seconds to a rate of _____-_____ breaths per minute.
5-6 seconds (10-12 bpm)
After an advanced airway is placed, the adult patient should be ventilated every ____-____ seconds to a rate of _____ - _____ breaths per minute.
6-8 seconds (8-10 bpm)
During rescue breathing, each breath should be given over:
1 second.
The primary advantage of a nasopharyngeal airway is:
that it can be used in a patient who has an intact gag reflex.
BVM's must have a volume of at least _____mL for newborns and infants.
500 (Child BVM)
For infants and children, ventilations should be delviered every ____-____ seconds once an advanced airway is in place.
6-8 (8-10 breaths per minute)
When an advanced airway is in place you should not pause compressions for ventilations.
True or False
True
Which should occur first:
Turn on the AED or Attach the AED patches
Turn on the AED
For EMT's, a maximum of ___ defibrillations should occur before beginning transport.
3
You are at a local elementary school at an event, off duty, when a child collapses in sudden cardiac arrest. An AED is available, but it does not have pediatric patches, you should:
Ensure quality CPR and use the adult patches to assess for a shockable rhythm.
The time goal for recognition of stroke symptoms until time of arrival at a stroke center is ____ hours.
2
Skin exposed to chemicals should be flushed for at least ____ minutes.
20
Burn patients with burns less than _____ % can be treated with moistened dressings for comfort.
10% (NYS protocol)
An open fracture is
any open wound near a suspected bone injury.
When can a limb be manually aligned using traction prior to splinting?
severe long bone deformity, distal extremity cyanosis, loss of distal pulses. Dislocations should only be repositioned if distal cyanosis and loss of distal pulses occurs.
When is extremity traction contraindicated?
Injury close to the knee, hip, or pelvis, partial amputation or avulsion with bone separation, and injury to the lower leg or ankle.
Trauma Field Traige decisions are based first on:
Vital signs and presenting injuries.
Adult trauma patients with a respiratory rates less than ____ or greater than ____ should be transported to the trauma center.
10 or 29
Chemical burns to the eyes must be irrigated for a minimum of _____ minutes.
20
For eyes injuries you should bandage
(the injured eye/both eyes)
Both eyes to reduce sympathetic eye movement.
Your patient is on a NRB at 12 lpm. The reservoir fully collapses with each breath the patient takes. You should:
Increase the flow to 15 lpm.
You can assume the patient is hypoperfusing with a BP less than 90mmHG if what clinical signs are present:
loss of peripheral pulses and altered mental status
According to NYS protocol, PASG is indicated when:
The systolic BP is less than 50 mmHg, or the patient has an unstable pelvis with a BP less 90 mmHg.
PASG is contraindicated if the patient has:
pulmonary edema, penetrating chest trauma,unilaterally decreased breath sounds,has cardiac related problems, or is a pediatric patient.
When can PASG be deflated?
PASG cannot be deflated in the field without medical direction.
Ventilations should be provided if an infants heart rate is less than ______bpm.
100
CPR should be started if an infants heart rate is less than _____bpm.
60
If a newborn infant's respiratory rate is depressed and central cyanosis is present you should:
Position and stimulate the baby, suction the mouth and nose as needed, and begin ventilations if there is no clinical improvement.
When is it appropriate to insert sterile gloved hand/fingers into the vagina during childbirth?
Breech birth that is not progressing and prolapsed umbilical cord.
Medical direction must be contacted before an EMT can administer nebulized albuterol to a patient with a medical history of:
angina, MI, dysrhythmias, or CHF.
Nebulized albuterol is administered with an O2 flow rate of:
4-6 LPM.
Your patient has a GCS of 14. He is refusing to go to the hospital despite being told that he may have serious internal injuries due to the mechanism of injury he sustained. You should:
Request police and contact medical direction. GCS must be 15 to be considered mentally competent to refuse care.
Your patient has hemophilia fell from a ladder. On your arrival his wife is preparing to administer an infusion of his prescribing clotting factor concentrate. You should:
Allow her to proceed, and contact medical control if transport may be delayed.
Hyperventilation causes a _____ in CO2 levels whcih in turn causes the blood vessels of the brain to _______________.
decrease, constrict
Moderate hyperventilation has what effect on brain swelling?
Decreases swelling due to the primary injury.
Excessive hyperventilation can lead to cerebral _________________.
Cerebral hypoxemia due to excessive cerebral vasoconstriction.
A single episode of ______________________ or ________________________ significantly increases moratility due to head trauma.
hypoxia, hypotension
Cushing's triad indicates
increased intracranial pressure
Cushing's triad consists of:
Increased systolic BP, decreased heart rate, and abnormal respirations.
Colormetric CO2 detectors turn ________ when CO2 is exhaled, confirming the ET tube is in the trachea.
Yellow
During CPR, your patinet has an ETCO2 of 8. You should:
Assure high quality CPR is being performed.
During CPR, your patient's ETCO2 rapidly changes from 12 to 20mmHg. You should:
Assess for return of spontaneous circulation. (ROSC)
Pediatric AED patches are designed for use on children ________ years of age.
1-8
For patient's with potential tuberculosis, the most appropriate BSI includes:
Gloves and a #M sub-micron molded surgical mask
Potential infectious disease exposures must be reported to you agencies:
Infection Control Officer.
According to NYS policy, who can consent to or refuse medical care for themself:
Any person who is 18 years of age, or is pregnant or the parent of a child, or who has married
What is the Abandoned Infant Protection Act
It grants immunity to anyone abandoning an infant (5 days old or less) at a safe place. This can be done anonymously, and requires that someone is immediately notified of where the baby was left.
How long does an EMS provider have to submit written documentation of suspected child abuse or neglect?
48 hours
(The verbal report to the NYS Child Abuse and Maltreatment Register should be made immediately after transferring care to the ED.)
Airborn disease protection requires the use of:
#M sub-micron molded surgical mask (Ex N95), and plaing a surgical mask on the patient unless the patient is on O2 via mask
Droplet protection requires:
disposable gown, gloves, googles and mask when within 6.5 feet of the patient.
Common droplet spead infections disease
Measles, mumps, chicken pox, meningitis, tuberculosis, pneumonia, common cold, influenza
The antidote for nerve agents is:
Atropine first, then prallidozime (2-PAM), this is the Mark I Kit
What PPE is required for nerve agents:
SCBA, goggles, gloves made of viton, nitrile, or neoprene, and protective coveralls or aprons.
What does SLUDGEM stand for
Salivation, lacrimation, urination, defecation, GI upset, emesis, miosis/muscle (twitching, spasm, "bag of worms")
If severe signs and symptoms of nerve agent exposure are presnt, how many Mark I Kits should be administered?
3 in rapid succession
As children grow older their heart rate becomes ___________ and there BP __________.
HR slower, BP increases
Five emotional stages
1. Denial ("Not me")
2. Anger ("Why me")
3. Bargaining ("Okay, but first let me....")
4. Depression ("Okay, but I haven't....")
5. Acceptance ("Okay, I am not afraid")
How to help reduce the emotional of Dying patients and family
Do everything to maintain the patient's dignity
Show the greatest possible respect for the patient
Communicate
Allow family members to express themselves
Listen empathetically
Do NOT give false assurance-allow for some hope but be honest
Use a gentle tone of voice with the patient and family
Take appropriate steps if the family wants to touch or hold the body after death
Do what you can to comfort the family
What is stress?
Any change to the body's internal balance
What is an acute stress reaction?
A result from exposure to a high-stress situation. Signs includes nausea, elevated heart rate, sweating, tremors, loss of appetite or excessive eating, trouble concentrating, and inability to sleep
What is a delayed stress reaction?
A reaction that might take days, months, or years before the patient begins to experience the signs and symptoms of stress. Typically produces nightmare, irritability, insomnia, inability to think clearly or concentrate, flashbacks, increased interpersonal conflicts and a decreased ability to relate to others
What is Cumulative Stress reaction?
The result of constant exposure to stressful situations that build overtime.
What is burnout?
A state of exhaustion and irritability
What are the warning signs of stress?
Irritability with coworkers, family, and friends
Inability to concentrate
Difficulty sleeping and nightmares
Anxiety
Indecisiveness
Guilt
Loss of appetite
Loss of sexual desire or interest
Isolation
Loss of interest at work
What are the four ways to deal with stress?
1. Take a look at your diet.
2. Exercise more often
3. Learn to relax
4. Avoid self-medication
Common situations that cause your family and friends to stress
Lack of understanding
Fear of separation or of being ignored
Worry about on-call situations
Inability to plan
Frustrated desire to share
How to make changes in your work environment
Develop a "buddy" system with a coworker
Encourage and support your coworkers
Periodically take a break and get some exercise
Request work shifts that allow you more time to relax
Request a rotation of duty assignment
What is Critical Incident Stress Debriefing (CISD)?
A event held 24-72 hours after a critical incident where a team of peer consolers and mental health professionals help emergency personnel work through the 7 stages
What are Bacteria?
microscopic single-celled organisms that have the capability of reproducing on their own without a host. Typically respond to antibiotics
What is a virus?
smaller than bacteria, cannot reproduce on their own
Infectious Diseases, Transmission, and Personal Protective Measures
Standard Precaution
Protecting yourself from disease transmission through exposure to blood or other body fluids
Personal protective equipment (PPE)
The equipment used for Standard Precautions: eye protection, Protective gloves, Gowns and Masks
What is cleaning?
The process of washing a soiled object with soap and water
What is Disinfecting?
Using a hospital-grade disinfectant or germicide to kill microorganisms on an object
What is Sterilization?
Using chemical or physical substance (autoclave) to kill all microorganisms on the surface of an object
Hepatitis B
Affects the liver, can last for months, can be contracted through blood and body fluids. A major source of the virus is the chronic carrier, usually no signs or symptoms and is often unaware of being ill. Signs and symptoms: fatigue, nausea and loss of appetite, abdominal pain, headache, fever, yellowish color of skin and whites of eyes, dark.
Hepatitis C
Requires introduction through the skin by needlestick. 80% of patients have no symptoms; those with symptoms typically present with: jaundice, fatigue, abdominal pain, nausea, dark urine, loss of appetite
Tuberculosis (TB)
Can be infected by droplets from the cough of a patient and from the patient's infected sputum. Sign and symptoms: fever, cough (often coughing up blood), night sweats, weight loss
Severe Acute Respiratory Syndrome (SARS)
Transmitted by close person-to-person contact by respiratory droplets produced by the infected person who coughs or sneezes. Signs or symptoms include: a high fever greater than 100, headache and body ache, general felling of discomfort, respiratory symptoms, diarrhea, dry cough
West Nile Virus
Transmitted through the bite of an infected mosquito. Severe signs and symptoms; high fever, headache and stiff neck, confusion and disorientation to coma, seizures, muscle weakness, numbness, paralysis, vision loss. Mild signs and symptoms: fever, headache and body ache, nausea and vomiting, skin rash to chest, stomach, and back, soreness to neck from swollen lymph gland
afterload
The force or resistance against which the heart pumps.
anaphylactic shock
Severe shock caused by an allergic reaction.
anaphylaxis
An unusual or exaggerated allergic reaction to foreign protein or other substances.
aneurysm
A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall.
automatic nervous system
The part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion, and sweating.
cardiogenic shock
Shock caused by inadequate function of the heart, or pump failure.
compensated shock
The early stage of shock, in which the body can still compensate for blood loss.
cyanosis
Bluish color of the skin resulting from poor oxygenation of the circulating blood.
decompensated shock
The late stage of shock when blood pressure is falling.
dehydration
Loss of water from the tissues of the body.
distributive shock
A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.
edema
The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area.
homeostasis
A balance of all systems of the body.
hypothermia
A condition in which the internal body temperature falls below 95^oF (35^oC), usually as a result of prolonged exposure to cool or freezing temperatures.
hypovolemic shock
Shock caused by fluid or blood loss.
irreversible shock
The final stage of shock, resulting in death.
myocardial contractility
The ability of the heart muscle to contract.
neuogenic shock
CIrculatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.
obstructive shock
Shock that occurs when there is a block of blood flow in the heart or great vessels, causing an insufficient supply to the body's tissues.
perfusion
Circulation of blood within an organ or tissue in adequate amounts to meet the cell's current needs.
preload
The precontraction pressure in the heart as the volume of blood builds up.
psychogenic shock
Shock caused by a sudden, temporary reduction in blood supply to the brain that causes fainting (syncope).
sensitization
Developing sensitivity to a substance that initially caused no allergic reaction.
septic shock
Shock caused by severe infection, usually a bacterial infection.
shock
A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypofusion.
sphincters
Circular muscles that encircle an, by contracting, constrict a duct, tube, or opening.
syncope
Fainting.
skull
cervical vertebrae (7)
clavicle
scapula
ribs (12)
humerus
illiac crest
sacrum (5)
ischium
coccyx (4)
femur
patella
fibula
tibia
pubis
head of femur
illium
lumbar vertebrae (5)
floating rib
thoracic vertebrae (12)
xiphoid
body of sternum
manubrium
phalanges
metacarpals
carpals (8)
radius
ulna
metatarsals
tarsals
calcaneus
What two types of rhythms can you defibrillate?
V-Fib and V-Tach.
Initial sign of shock is:
Tachycardia and diaphoretic.
Adequate ventilation is best determined by:
Chest rising and falling.
Sample history is an acronym - what does the S stand for?
Signs/symptoms.
When a patient becomes conscious and had an oral airway inserted, you:
Take it out.
Capillary refill should take no longer than ___ in an infant.
2 seconds.
DCAP-BTLS - D stands for?
Deformities.
What is the maximum does for nitro?
0.4 mg, up to 3, one every 5 minutes.
The acronym LOC means:
Level of Consciousness.
A marked drop in blood pressure is considered life threatening for a child. True or false?
True.
There are many ways to activate EMS. True or false.
True.
Systolic blood pressure is defined as:
Pressure in the arteries when the heart contracts.
Diastolic blood pressure is defined as:
Pressure in the arteries when the heart relaxes.
Babies are obligate nose breathers. True or false?
True.
When a neonate is born, you suction where?
Mouth than nose.
A NRB mask is delivered at ___ rate and ___ percentage oxygen.
15 L, 90%.
After you defibrillate your patient, your next action is:
Do 5 more CPR cycles.
Cells give up ___ and capillaries pick up ___.
CO2, O2.
The baby is born in what stage of delivery?
2nd stage, "pushing".
Dyspnea is:
Shortness of breath.
What form of medication is activated charcoal?
Suspension.
Oral glucose is what form of medication?
Oral, gel.
Epi pen is what form of medication?
Solution, liquid, intravenous, intramuscular, subcutaneous.
Late sign of shock is:
Blood pressure drop = hypoperfusion.
What is QI?
Quality improvement.
Flow restricted oxygen powered ventilation device?
100% O2, 40 L/M, 12+ 5-7 seconds.
What is the anatomical position?
Facing forward, palms facing forward, supine.
The anatomical position for the top of the head is?
Superior.
Normal anatomical position is with the palms facing:
Forward.
Crepitus:
Grinding sensation caused by broken bone ends rubbing together.
A wound that is sucking in air, what style of dressing do you use?
Occlusive dressing.
Off-line medical direction, you:
Follow standing orders.
Open fracture:
Compound fracture, fracture and wound open.
Rales:
Rattling sound when breathing, lower/moist.
Stridor:
Grating sound when breathing, upper/high pitch.
Meconium can create what problem in a neonate?
Block airway.
Prolapsed cord?
Umbilical cord comes out before uterus. Push baby's head back and elevate patient.
Normal respiratory rate for an adult is:
12-20 breaths per minute.
Skeletal muscles provide:
Shape, support, and protection.
When treating a patient with anaphylaxis, epi's action is to:
Bring down swelling in order to maintain the airway.
Your patient has an impaled object, you can do what for this?
Stabilize, remove if in cheek.
The baby's head is what percent of burns?
18%
The rule of mines is used to assess:
% of body burned.
After you administer your patient's inhaler, you expect to see what action?
Tachycardia.
Suction an adult patient no longer than:
15 seconds.
Triage has how many categories?
5
A side effect of epi is?
Tachycardia.
A patient has a stab wound to the neck, you expect to find the following?
Veins distended and increased pulse pressure.
The epi auto injector you hold in place for how many seconds?
10 seconds.
Oral glucose is administered?
Orally.
DNR means?
Do Not Resuscitate.
The bodies greatest abundance of tissue is:
Connective tissue.
The first process of the assessment is to evaluate:
Scene size-up.
Side of effects of albuterol are:
Altered mental status.
Signs and symptoms of heat exhaustion are:
Nausea and cramps.
You have an unconscious and unresponsive patient. You treat this patient under:
Informed consent.
You verbally explain to your patient that you're going to force them to get on the backboard and be transported to the nearest ER after a significant trauma incident. You have ___ the patient.
Assaulted.
If you suspect spinal trauma, you must do what until the patient is completely immobilized and secured to a backboard?
Stabilize the head.
Medical direction can be obtained by?
Medical control.
You arrive on the scene for a patient you were dispatched to for dyspnea. Upon entering the scene, you realize this is a scene of domestic violence. Your next step is to:
Call the police and let them determine safety.
Febrile seizures occur from?
Fever in infants or small children.
If you do not have a distal pulse in an injured extremity, you should:
Re-align.
Exhalation is considered the ___ process of breathing.
Relaxation.
During exhalation the diaphragm and intercostal muscles relax. True or false?
True.
Epigastric pain can be a sign of cardiac compromise? True or false?
True.
A tourniquet is used to restrict blood flow to an extremity? True or false?
True.
The ring shaped cartilage below the larynx is the:
Cricoid.
Heat exhaustion is defined as:
Heat-related illness, lack of water and salt/fluids due to sweating.
Common form of shock in children is:
Hypovolemic.
Blood pressure is defined as pressure against the walls of the arteries when the heart is contracting. True or false?
True.
When you suction a neonate you suction the mouth first? True or false?
True.
The highest level of AVPU is:
Awake and alert.
Veins carry blood back to the heart. True or false?
True.
Arteries carry blood to the body after receiving oxygen from the lungs? True or false?
True.
The largest chamber of the heart is the:
Left ventricle.
The base of the heart is the:
Apex.
Bilateral femur fractures are:
Both femurs broken.
The best way to determine if breathing is adequate is to:
Look for chest rise and fall.
When bleeding is uncontrolled, the best way and most common way to control it is to:
Apply pressure and elevate.
A CISD should be performed:
After a major incident within 24-72 hours.
Gravida refers to:
Number of times pregnant.
Oral glucose is administered:
Orally, side of cheek, dissolved.
When you have a sucking chest wound you need to use what style of dressing?
Occlusion tape, tape all 3 sides.
How often can you administer nitro tablets?
One every 5 minutes.
Your peripheral nervous system includes?
Ganglia, outside of spine and brain.
How many pair of ribs does the body have, excluding floating ribs?
10.
After stabilizing a patient on a spine board you should always reassess?
PMS (pulse-motor-sensory).
Restlessness is a sign of:
Dyspnea.
White blood cells are:
Fight infection.
Red blood cells are:
Carry oxygen and remove waste.
SAMPLE
Signs/Symptoms, Allergies, Medications, Pertinent Past History, Last Oral Intake, Events Leading To Injury Or Illness.
OPQRST
Onset, Provocation, Quality, Region/Radiation, Severity, Timing.
DCAPBTLS
Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling.
ABCBSS
Airway, Breathing, Circulation, Bleeding, Spine, Shock.
PPE
Personal Protective Equipment.
CISD/CISM
Critical Incident Stress Debriefing/Critical Incident Stress Management.
MOI/NOI
Method of Injury/Nature of Illness.
FROPVD/BVM
Flow Restricted Oxygen Powered Ventilation Device/Bag Valve Mask.
LOC/SOB/NRB
Level of Consciousness/Shortness of Breath/Non ReBreather.
AEIOU TIPS
Alcohol, Endocrine, Infection, Overdose, Uremia, Trauma, Insulin, Poisoning, Stroke.
Relative Fi02 Mouth to Mask
17%
Relative fi02 Mouth to Mask with oxygen supplement
50%
Relative Fi02 Bag valve with oxygen supplement
80%
Relative fi02 demand valve
100%
Relative fi02 ET tube
<90%
Relative fi02 Nasal cannula
30-44%
Relative fi02 Simple face mask
40-60%
Relative fi02 venturi mask
24% most likely
Relative fi02 partial rebreather
35-60%
Relative fi02 total non rebreather
90%
Mild shock
rapid thread pulse, rapid shallow breathing, pale skin, cool clammy, sweaty skin, weakness, dizziness, confusion, decrease in mental status
Moderate shock
Anxiety, agitation, Nausea, Thirst
Late shock
Vomiting, glassy eyes, decrease in mental status(further), Drop in blood pressure, Altered respirations, cyanosis, dilated pupils, coma
Status Asthmaticus
anxiety, wheezing, tachypnea, tachycardia, dyspnea, possible chest tightness(usually no pain), accessory muscle use, prolonged expiratory phase -forcing each breath out, "pursed lip breathing", coughing, does not respond to usual treatment
Acute Asthma attack
anxiety, wheezing, tachypnea, tachycardia, dyspnea, possible chest tightness(usually no pain), accessory muscle use, prolonged expiratory phase -forcing each breath out, "pursed lip breathing", coughing,
COPD
anxiety, may "tripod, dsypena, has trouble getting air in, accessory muscle use, pursed lip breathing, prolonged expiratory phase, abnormal breath sounds (wheezes, or rhonci), cyanosis or ruddiness, barrel chest
Pulmonary Edema
typically starts as mild or pronounced agitation, tachycardia, pale, cool, clammy skin, persistent cough usually non productive, crackles (in the lung base), severe dyspnea especially when lying down, eventually develop cyanosis, productive cough and possibly foam appearing at the mouth (pink, frothy)
Pulmonary Embolus
sudden onset of dramatic agitation, Aphrension, sudden dramatic hyperventilation, sudden and dramatic dyspnea with congestion and shortness of breath, pleuretic chest pain (stabbing) especially on inhalation, tachypnea, tachycardia, hemoptysis, cyanosis, possibly abnormal breath sounds, calf or leg pain
Pneumonia
history of respiratory infection, fever, productive cough (possibly rust colored or greenish mucus) possibly some wheezing, chest discomfort of chest pain
FLU
sudden onset of fever and chills (out of nowhere 102-104), sever headache (photophobia), severe muscle aches and pain (legs and back mostly) cough (with substernal burning), worst symptoms last for 3-7 days but feel dragged down for weeks
Hyperventilation syndrome
usually severe agitiation, anxiety or fright, hyperventilation, progressive signs and symptoms of alkalosis, (light headedness dizziness, numbness, feeling of tightness, muscle twitching, carpal-pedal spasms, tetany, seizures, loss of consciousness
Epiglottis
fever, sore throat (difficulty swallowing, drooling) dyspnea, accessory muscle use, coughing
pleurisy
pleuritic chest pain, cough, history of respiratory infection
Adult Respiratory Distress Syndrome
Dyspnea and tachycardia,crackles
Angina Pectoris
Brought on by exercise, stress or eating to much, Feels like pressure or chest tightness, usually substernal or epigastric, sudden onset (usually 3-5 minutes) not past 10
Myocardial infarction
brought on by exercise, activity or stress (but sometimes nothing), feels like pressure or chest tightness , a weight on the chest, usually feels substernal or epigastric (usually on the left), usually lasts 30 minutes or longer, nausea, diaphoresis, dyspnea or orthopnea, irregular pulse, sudeen onset of weakness or lightheadedness, Denial
Left-Sided CHF
slow onset, often over several days- may not be noticed till acute
Dyspnea, Shortness of Breath (SOB), productive cough
Orthopnea difficulty breathing when lying straight (supine)
Sitting up- often found propped p on pillows- may have spent the last evening in a chair
Pulmonary edema- from excessive pulmonary capillary pressure and increased respiratory effort= greater inspiratory vacuum
Right sided CHF
Dependent Edema (pedal edema)
Jugular Vein Distention (JVD)
Liver engorgement (ascites)
Hypertensive Crisis
Hypertension with Angina, Pulmonary Edema, Pregnancy or signs of cerebral edema (such as usually severe headache blurred vision/visual disturbances, nausea and vomiting, altered mental status, focal neurological sign or deficits, paresthesias, dizziness, vertigo or tinnitus
Hypertensive Emergency
Pulse that is strong bounding
Tinnitus
headache
nosebleed
nausea/vomiting
Dissecting Aortic Aneuryism
P-Lifting heavy weights straining
Q-tearing knife like
R- pain on anterior chest but boring through the back
S very severe, and hits maximum at onset
T Sudden onset
CVA
altered level of cosiousness
hemiparesis, hemiplegia
ataxia, asymmetry of face
unequal pupils, dysarthria
aphasia, dysphagia
incontinence, sudden blurred vision
intense vertigo, hypertension
Bell's Palsy
One sided facial droop
Alert and Oriented
No other neurological deficiets
Grand Mal Seizure
They may have an "aura"
Tonic-Clonic phase
Loss of consciousness
clenched teeth, biting the cheek or tongue, incontinence
post-itcal phase
Absence Seizure
staring into space
little to no body movement (beyond an eye flutter exc)
1-3 seconds "lapses in awareness" but no falling down usually
Focal Motor Seizure
Starts in a group of muscles a "focus"
May progress to include the whole entire arm
May progress to a Grand Mal Seizure
Complex Partial Seizure
attacks of confusion,& loss of awareness with semi purposeful movements, often refusion
Gastric ulcer
persistent pain in the upper abdomen, often described as burning
pain is somewhat or completely relieved by eating bland foods
often have hematernesis or melana
Abdominal Aortic Aneurysm
P-Lifting heavy weights straining
Q-tearing knife like
R- pain on Abdomen but boring through the back
S very severe, and hits maximum at onset
T Sudden onset
Appendicitis
Fever
Anorexia
Nausea/or vomiting
sharp right lower quadrant pain, guarding rebound tenderness
increases over several hours
Esophageal Varices
Massive hematemesis
dramatic hemoptysis- bright red blood
life threatening hypovolemic
Gallbladder inflammation/ cholecystitis
history of recent ingestion of a meal with a lot of fat
gradual onset of sharp pain in right upper quadrant, possibly the right shoulder area after fatty meal
Kidney stone
tremendous pain in the lower quadrants, radiating in pulse-like waves from the rear flank, downward toward the pubic symphysis worsens as the stone is pushed along
anxiety, restlessness
nausea and or vomiting
hematuria
bowel obstruction
crampy pain in the abdomen, usually diffuse
often has abdominal distention
anorexia, nausea and or vomiting
fever
Chronic liver disease
jaundice, ascities, pedal edema, muscle atrophy, decreased clotting, petechiae, varicose veins
pacreatitis
sudden severe LUQ epigastric pain -steady boring through to the back
usually with a history of chronic alcohol abuse
may have abdominal tenderness and or distention
nausea/vomiting
may develop shock
Irritable Bowel syndrome
Abdominal pain, abdominal cramping, gas, bloating, diarrhea or constipation. The pain is described as "worse than childbirth" "a sudden knife like pain that can double you over" can bring you to your knees
Diverticlitis
Abdominal pain (usually LLQ)
Fever
Vomiting
Constipation
GERD
Presents as heartburn
Type 1 diabetes
The patient needs to inject insulin several times per day
an auto immune disease where the body produces antibodies that attack and destroy the pancreatic islet cells
these produce no insulin
Type 2 diabetes
pateints control their disease through diet and exercise and weight loss (they are usually obese or through oral medications that increase the pancreas production of insulin
Diabetic Coma
Gradual onset- often over several days
flushed- dry warm skin (mild fever)
intense thirst dry mouth (if he complains at all)
rapid weak pulse (tachycardia)
hypotension
kussmaul respirations
decreased level of consciousness
nausea, vomiting, abdominal pain, and possibly anorexia
blurred vision
Insulin shock
Rapid onset (often too sudden to react)
headache
pale, cool, wet skin (often soaking wet)
tachycardia pulse may be strong/bounding
weakness, dizziness
agitated restless, uncooperative abnormal behavior, syncope, ALOC
Anaphylaxis
tachypnea, tachycardia, hypotension
red or pale, itchy
dyspnea, wheezing, stridor from bronchospasm
respiratory distress (wheezes)
sigs of hypovolemic with normal skins
Hymenoptera
pain, located swelling, redness
"bully's eye" mark
itching
watch for airway swelling
Asprin Overdose
mild overdose-tinnitus
Larger overdoes it produces gastrointestinal pain & cramping ad hyperventilation to blow of the acidosis
Tylenol overdose
Acute- Few if ay symptoms (possibly a good night's sleep)
Later phase (after a few days maybe a week) general malaise, anorexia possibly cyanosis, followed by acute liver failure
Tricylic Antidepressants
Decreased LOC
Seizures
Cardiac Dysrhythmia
Beta blockers
Cardiac dysthymias
hypotension, bradycardia, cardiac arrest
Narcotics/opiates
decreased LOC
respiratory depression/ hypoventilation
pinpoint pupils
hypotension
Nausea/vomiting
Depressants
decreased LOC
respiratory depression/hypoventilation
loss of muscle coordination
slurred speech
nystagmus (especially alchohol)
bradycardia/hypotension
Stimulants
increased LOC
Tachycardia/HTN
rapid speech
dilated pupils or normal
seizures, muscle twitching, tremors
Chest pain
Hallucinogens
Altered LOC,
tachycardia/ HTN
Visual halluctinations
Seizures
Nystagumus -especially with PCP
hot flashes
Hydrocarbons
Altered LOC
coughing choking
Toxic inhalations
dyspnea, tachypnea
nausea/vomiting
aloc
airway irritation, wheezes or crackles
sore throat, cough
Smoke inhalation
Dyspnea, tachypnea
cough
abnormal breath sounds- stridor, wheezes crackles
watery, irritated eyes
singed facial hairs, eyebrows, nasal hairs
Carbon Monoxide Inhalation
headache- rapid onset out of nowhere
ALOC, confusion, coma
nausea/vomiting
dyspnea, tachypnea, tachycardia
flushed skin
dizziness
Cyanide Gas Inhalation
sudden onset-within minutes of inhalations, within 30 minutes of ingestion
the patient becomes rapidly uncounscious, often falling
respirations are rapid and convulsions at first then slow and gasping
hypotension, seizures, incontinence, cardiovascular collapse
Chlorine Gas Inhalations
instant onset of burning in lungs and mouth
dyspnea, tachypnea
sever cough
abnormal breath sounds, stridor wheezes
watery, irritated eyes
Phosgene Gas inhalation
An extremely corrosive gas from burning plastics. Does tremendous tissue damage/total destruction of lung tissue and eyeballs on contact
Ammonia Inhalation
A corrosive or irritating gas (used in manufacturing ) and some refrigerator units, tanker trucks on the freeway or railcars.
organophosphate poisoning
Constricted Pupils, Diarrhea, urination, Muscle weakness, Bradycardia, Bronchospasm, Bronchorrhea, Emesis, Lacrimation, Sweating, Salivation, Seizures, GI cramping
Pelvic Inflammatory Disease
Tremendous pain in the lower quadrants
often has a fever
anxiety, restlessness
Nausea/vomiting
abnormal vaginal discharge
Ectopic Pregnancy
abrupt onset of sever, stabbing pain in lower quadrants
abdominal distention, guarding, rigidity
may or may not know she is pregnant
signs/symptoms of shocks
nausea/vomiting
vaginal bleeding may occur
Abrasion
Small amounts of blood loss, with a large amounts of tissue damage
Puncture
Usually very little external blood loss, but there may be significant internal bleeding
Avulsion
A torn loose or torn off piece of flesh (partial or complete avulsion) Often with considerable blood loss Although the vessels pinch off quickly
Incision
A smooth edged cut, typically done with a sharp blade, often they bleed a lot
laceration
A jagged-edged cut, typically done with a somewhat duller blade or piece of metal, ripping the skin rather than cutting it, often they bleed alot
Evisceration
a type of laceration where internal body parts are exposed on the surface of the body(like intestines)
Fractured larynx/ trachea
Obvious signs of injury, edema, hoarseness, stridor, subcutaneous emphysema
1st degree burn
Thermal damage to the first layer of skin only (epidermis), lower layers heated and react by turning red and becoming tender and uncomfortable to touch
2nd degree burn
thermal damage to the first & second layers of the skin (epidermis and dermis) Blisters will appear, and may break making the skin appear moist. Can be red or white color depending on the thermal agent. (hot water may make them appear pale)
3rd degree burn
thermal damage to all three layers of the skin, also cooks blood vessels, so it appears to be dry and leathery- color depends on agent
Minor Burns
No critical areas burned
No respiratory involvement
2nd degree burns to less than 15% of BSA or
3rd degree burns to less than 2% of BSA
Moderate Burns
No Critical areas burned
No Respiratory involvement
2nd degree burns to 15%-25% of BSA
3rd degree burns to 2%-10% of BSA
Severe Burns
Respiratory involvement or inhalation injury
Involvement of "Critical Areas"
2nd degree burns to greater than 25% of BSA
3rd degree burns to greater than 10% of BSA
Airway Burns
burns around face, mouth
Singed facial hair- eyebrows, eyelashes, nasal hair
productive cough-sooty sputum
hoarseness when they try to talk
dyspnea
Dysphagia
history of a burn in an enclosed area
Electrical Burns
frequently associated with significantly greater internal injuries than would be suspected from the appearance of entrance and exit wounds. May cause arrest through ventricular fibrillation activity
Concussion
usually with a transient decrease in level of consciousness followed by complete, and prompt recovery Often the patient will complain of a headache, some light-headedness, dizziness, "grogginess" and some nausea. Patient recovery is measured in minutes and hours
Cerebral contusion
All those present for a concussion except they are more sever here, and tend to last longer. Usually there are also some of the sign/symptoms of increased intracranial pressure. Patient recovery is measured in hours or more likely days. There may be permanent disability.
Epidural hematoma
All the signs of a concussion
ALOC with a lucid interval
S/s may be delayed 1-4 hours
S/s of ICP
Subdural hematoma
All the signs of a concussion
S/s may be delayed up to 2-4 Weeks
Signs of ICP
Intra-cerebral hemorrhage
Sudden onset of an extremely severe headache (sometimes described as the worst headache they have ever felt) then rapid losss of consciousness without regaining it- suddenly falling out of their chair
s/s of ICP
ICP
-increasing systolic blood pressure
-Widened pulse pressure
-Brady cardia (Baroreceptor reflex)
-Altered, abnormal Respiratory patterns
-Deteriorating level of consciousness
-Nausea/Vomiting
-Severe, Persistent Headache
-Pulpillary changes, unequal or dilated
-Seizures
-Brainstem posturing in severe cases
Cervical spine trauma
-pain especially upon palpation
-swelling deformity at injury site
-neck muscle spasm and stiffness
-neurological deficits
respiratory compromise
neurogenic shock
loss of bowel control
priapism
Rib fracture
sharp stabbing pleuritic CP, made worse by inspiration
may have an abrasion or contusion (seatbelt)
patient will attempt the splint his own arm
may be hypoventilating due to pain
Flail chest
dyspnea, tachypnea
Floating chest wall segment
cyanosis
subcutaneous emphysema
Pneumothorax
dyspnea, tachypnea
diminished breath sound on one side
sharp stabbing chest pain
Tension Pneumothorax
progressive dyspnea, tachypnea
absent lung sounds on the affected side
JVD
narrow pulse pressure
unequal chest expansion seen on deviation
tracheal deviation
Pericardial tamponade
distended neck veins
dyspnea
narrow pulse pressure
muffled heart sounds
myocardial contusion
CP
bruising over sternum
dyspnea, tachypnea
irregular pulse, dysrthymia
signs of shock
commotion cordis
Sudden death directly following blunt force trauma
Pulmonary contusion
CP
bruising over sternum
Progressive dyspnea
decreased breath sounds on one side
hemoptysis
irregular pulse-dysrthymia
tracheobronchial rupture/laceration
severe respiratory distress
stridor, hoarsness (if able to talk)
subcutaneous crackling sensations to touch
decreased or unequal breath sounds
hemotypsis
tachycardia, hyptension
cyanosis
hemothorax
signs of severe shock
respiratory distress
decreased or absent breath sounds on one side
Blunt abdominal trauma
pain and tenderness often diffuse, sometimes local "point" tenderness
abdominal "guarding" abdominal rigidity
abdominal distention
signs of surface wounds abrasions, discoloration, bruising
nausea and or vomiting
s/s of shock
Sprain
May have "heard" the injury
Pain and tenderness often significant enough to prevent walking
swelling often significant especially of the ankle
discoloration often delayed sometimes by 24 hours
strains
may have "heard" the injury
Pain and tenderness can be significant but usually "discomfort" is more likely- extreme point tenderness
Dislocation
Usually dramatic deformity
Pain usually extreme
swelling occurs but takes time, and may be masked by the deformity
discoloration occurs but may take time possibly many hours
Inability to move
Fracture
Deformity often present, but not always
pain and tenderness usually significant pain
swelling edema occurs but takes time
discoloration occurs but takes time
Usually can be moved, it isn't moved because it hurts to much to do so
Crepitus
Patient heard it break
Frostbite
pale, waxy appearing cold skin
usually painless(clubbing= using their hand as a club beating it against their thigh)
very delayed or more likely, no capillary refill
usually also hypothermic
Heat Syncope
Very similar to Heat Exhaustion but body temperature, Water & salt balance are all normal
Heat Exhaustion
Fatigue, malaise, drowsiness, headache, confusion, weakness,dizziness, syncope, rapid thread pulse, hypotension, pale,soaked skin, usually cool, thirst, muscle cramps, abdominal cramps, nausea/vomiting/possibly diarrhea
Heat Cramps
Muscle cramps of legs and muscles being used the most, and sometimes in the abdomen, history of prolonged heavy exertion in high heat, nausea, body temperature normal
Heat Stroke
Hot dry skin. All other s/s are exterional
Exertional heat stroke
Hot,wet, pale skin, ALOC-bizarre behavior, tachycardia/hypotension, seizure, dilated pupils
Air embolism
Dizziness, confusion, headache, dyspnea, chest discomfort or chest pain, neuro deficits which can mimic CVA( unequal pupils, ataxia, dysarthria, unconsciousness, seizures or Cardiopulmonary arrest
Barotrauma
tinnitus or ruptured eardrum, small amounts of blood leaking from the ear,nosebleed, can be coughing up small amounts of blood
Decompression Sickness
Join pain- May be "bent" over, "Diver's itch" Paresthesias, Headache, general fatigue, malaise, dyspnea, dysarthria, ataxia, nausea, Vomiting, vertigo (dizziness)
Acute Mountain Sickness (AMS)
Headache, Dyspnea, Nausea, Vomiting, Anorexia, Insomnia
High Altitude Pulmonary Edema
Delayed onset of symptoms-usually developing on 2nd or 3rd night after working strenuously for 1-2 days, Dyspnea and SOB (after significant rest), Crackles, fatigue, tachypnea, tachycardia at rest, hypotension
HACE
Delayed onset of symptoms(likely 1-3 days after arrival), ataxia is primary identifier, sever lack of energy, impaired mental function, confusion or hallucinations, focal neurologic deficits
Black Widow Bite
Usually no reaction, little or no redness or pain, symptoms delayed 1/2 to 2 hours, systemic muscle pain, extreme abdominal pain, muscle cramping, chest tightness, dyspnea, abdominal rigidity, may develop hypertensive crisis, seizures
Brown Recluse Bite
Minimal pain initially, symptoms usually delayed 2-8 hours, fever/chills, nausea/vomiting joint pain, local tissue necrosis
Scorpion Sting
little or no redness, no discoloration, instant onset of fairly sever pain, muscle cramps, paresthesias, muscle twitching, possible seizures, excessive salivation, nausea/vomiting, hypertensive crisis is possible as is circulatory collapse
Jellyfish sting
Instant burning pain at site, shock is possible, but rare
Stingray sting
instant burning pain at site, muscle spasm and pain, can cause partial paralysis, shock is possible
Rattlesnake bite
puncture wounds (1-4), progressive rapid swelling in the area, pain in the area, weakness, diaphoresis, metallic or rubbery taste in mouth, discoloration below the surface due to bleeding
Rabies
Incubation period is 9 days to under 1 year (2 weeks to 4 months is normal), Although the "furious dog" type is most common a large percentage of animals present with the "paralytic or "dumb dog" type that is they are not snarling or attacking, but are lazy and lethargic
Stages of Dyspnea
1) Respiratory Distress
2) Respiratory Failure
3) Respiratory Arrest
Tidal Volume (TV)
Volume of air moving in and out of lungs during each breath cycle; ~ 500 mL
Minute Volume (MV)
Amount of air moving in and out of lungs each minute (~8,000 mL); TV x RR = MV
Respiratory Rate (RR)
Number of breaths per minute; Adults = 12-20, Infants = 15-30
Respiratory Distress
Normal MV, increased RR (give supplemental O2)
Respiratory Failure
Low MV, shallow/slow breathing (give ventilations)
Respiratory Arrest
No MV; give ventilations
Inadequate Breathing
Poor MV, insufficient to support life
Toxin
A harmful substance that comes from living things
Poison
A harmful substance that comes from nonliving things
Pneumothorax
Air in the chest cavity
Hypoxia
Low O2 levels
Hypercapnia
High CO2 levels
Red Blood Cells (RBC)
Aerebocyte; contain hemoglobin; exchange O2 and CO2
White Blood Cells (WBC)
Leukocyte; fight infection
Osmosis
Movement of a solvent (ex H2O) from a low to high concentration of solute (across a membrane)
Hypovolemia
Loss of bodily fluids (ex H2O)
Anemia
Low amount of RBC
Stretch Receptors
Structures within blood vessel that monitor pressure
Sepsis
Infection
Edema
Swelling; increased fluid in an area
Hypertension
High blood pressure
Hypotension
Low blood pressure
Beta Blocker
Medication that lowers pulse rate
3 Ways to Control High BP
1) Diuretic
2) Ace-Inhibitor
3) Beta Blocker
Diuretic
Medication that causes urination to remove excess water
Ace-Inhibitor
Medication that dilates the blood vessels
Stroke Volume
Amount of blood pumped per contraction (~70 mL)
Preload
Amount of blood returning to the heart
Contractility
How hard the heart squeezes
Afterload
Pressure in the blood vessels (SVR)
Nitroglycerin
An ace-inhibitor given during a heart attach; decreases afterload
Sublingual
Under the tongue
Cardiac Output (CO)
Amount of blood pumped in 1 minute (~5 L)
Exsanguination
Sudden death due to blood loss
Commotio Cordis
When the heart stops due to a sudden blow to the chest
Contusion
Bruising
Pedal Edema
Swelling in feet
Pulmonary Edema
Swelling in the lungs
Intracerebral Hematoma
Bleeding in the brain
Pia Mater
Innermost layer of the meninges
Arachnoid
Middle layer of meninges
Dura Mater
Outer layer of meninges
Frank Bleeding
Bright red blood in vomit and/or stool
Coffee Grounds
Partially digested blood
Melena
Black tarry stool (from partially digested blood)
Hypersensitivity (Anaphylaxis)
Allergic reaction, the result of an exaggerated immune response
What does "ABC" stand for when you're doing the patient assessment?
Airway, Breathing, and Circulation
What do you call the area directly posterior to the nasal cavity?
The nasopharynx
What do you call the area directly posterior to the oral cavity?
The oropharynx
What do you call the area that is composed of the nasopharynx and oropharynx?
The pharynx
What is the u-shaped bone on the anterior aspect of the cervical region situated directly superior to the larynx?
The hyoid bone
What important organ protects the trachea and has many components, including the thyroid cartilage and cricoid cartilage?
The larynx
What ring of cartilage is found just inferior to the thryoid cartilage?
The cricoid cartilage
What ring of cartilage is found just superior to the cricoid cartilage?
The thyroid cartilage
What are the organelles found in cells in the trachea and lungs that help propel mucus and dirt out of the body?
Cilia
What are the two large branches that originate at the trachea and bring air into the right and left lungs?
Bronchi
What are the smaller branches that originate at the bronchi and bring air to alveoli in the lungs?
Bronchioles
What do you call the sacs at the end of the bronchioles that are encircled by capillaries and are integral in oxygen/carbon dioxide exchange?
Alveoli
Which lung is larger?
The right lung -- it has three lobes instead of two
What do you call the cavity between the lungs?
The mediastinum.
What is the muscle inferior to the lungs that's the major muscle responsible for inspiration?
The diaphragm
What do you call the site at which the trachea branches into the bronchi?
The carina
Which one of these processes is active: inhalation, or exhalation?
Inhalation -- it requires energy in the form of muscle contractions.
Define "respiratory distress."
Respiratory distress is characterized by a sensation of shortness of breath, and physically presents as labored breathing. It's basically having to put forth effort to keep breathing adequate.
Define "respiratory failure."
The reduction of breathing to the point where oxygen intake is not sufficient to support life.
Define "respiratory arrest."
When breathing completely stops.
What should one be looking for when judging whether a patient's breathing is adequate or inadequate?
Adequate expansion on both sides of the chest
What should one be listening for when judging whether a patient's breathing is adequate or inadequate?
For air leaving the chest (bad sign!) or leaving the mouth and nose (good sign!)
What should one be feeling for when judging whether a patient's breathing is adequate or inadequate?
For air leaving the chest (bad sign!) or leaving the mouth and nose (good sign!)
What are adequate breathing rates for children, adults, and infants?
Adults: 12-20 breaths/minute\nChildren: 15-30 breaths/minute\nInfants: 25-50 breaths/minute
Define "hypoxia."
Inadequate oxygen being delivered to cells
What are 8 symptoms of mild to moderate hypoxia?
1) Tachypnea (fast breathing)\n2) Dyspnea (poor breathing)\n3) Tachycardia (fast heart rate)\n4) Pale, cool skin\n5) Restlessness\n6) Disorientation\n7) Headache\n8) Hypertension
What are some symptoms of severe hypoxia?
1) Tachycardia progressing to bradycardia (heart rate drops = trouble!)\n2) Dyspnea (poor breathing)\n3) Pale, cool skin\n4) Drowsiness\n5) Altered mental status\n6) Accessory muscle use
Define the EMT's primary goal in one sentence.
To immediately find and correct life-threatening problems pertaining to airway, breathing, and circulation (ABC).
Name some events that might trigger respiratory arrest.
1) Heart attack\n2) Stroke\n3) Airway obstruction\n4) Drowning\n5) Electrocution\n6) Drug overdose\n7) Poisoning\n8) Brain injury\n9) Severe chest injury\n10) Suffocation\n11) Prolonged respiratory failure
Define "minute volume."
The amount of air breathed in during each respiration multiplied by the number of breaths per minute.
How would you intervene if you found a patient that was breathing adequately but required supplemental oxygen due to a medical or traumatic condition?
Give supplemental oxygen via nonrebreather mask or nasal cannula
How would you intervene if you found a patient that was breathing inadequately?
Give assisted ventilations with a pocket face mask, bag-valve mask, or FROPVD. Do NOT use FROPVD on children or infants.
How would you intervene if you found a patient that was in respiratory arrest?
Give artificual ventilations with a pocket face mask, a bag-valve mask, FROPVD, or ATV at 10-12/minute for adults, 20/minute for a child.
When giving artificial ventilations to an adult, how many ventilations should you give per minute?
10-12 ventilations per minute
When giving artificial ventilations to a child, how many ventilations should you give per minute?
20 ventilations per minute
If a patient is speaking in full sentences and is alert and calm, is that patient breathing adequately or inadequately?
Adequately. If they are complaining of shortness of breath, though, provide them with a nonrebreather mask or a nasal cannula.
If a patient is visibly short of breath and is speaking in 3-4 word sentences with anxiety increasing, is that patient breathing adequately or inadequately?
That patient is on the cusp. A nonrebreather mask might be a good idea.
If patient is speaking only 1-2 word sentences, is very sweaty, and is exhibiting severe anxiety, is that patient breathing adequately or inadequately?
Patient is breathing inadequately and needs assisted ventilations. Provide them with a pocket face mask (PFM), bag-valve mask (BVM), or flow-restricted oxygen-powered ventilation device (FROPVD). Assist ventilations before they stop altogether!
Define the anatomic "dead space" of the respiratory system.
Areas of the lungs outside the alveoli where gas exchange with the blood does not take place.
Why is it important to keep in mind the anatomic "dead space?"
Because even when the depth and rate of breathing changes, the amount of dead space does not. So when breaths become more shallow, a greater proportion of each breath is wasted in the dead space.
During a normal breath, what percentage of each inhalation rests in the anatomic dead space of the respiratory system?
About 30%.
What are the four principal procedures to treat life-threatening respiratory problems?
1) Opening and maintaining the airway\n\n2) Providing artificial ventilation to the nonbreathing patient and the patient with inadequate breathing\n\n3) Providing supplemental oxygen to the breathing patient\n\n4) Suctioning as needed
Define "airway."
The passageway by which air enters or leaves the body. The structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi, and lungs.
What takes precedence: the spine, or airway and breathing?
Airway and breathing. If you find a non-breathing patient and suspect injury, you will probably have to provide manual stabilization and treat the breathing problem before you have time to put on a cervical collar.
What three indications do you have of a spinal injury, even with an unconscious patient?
1) Mechanism of injury - falls, car crashes, etc.\n\n2) Location of injury - above the shoulders\n\n3) Family or bystanders
Define "patent airway."
An airway that is open and clear and will remain open and clear, without interference to the passage of air into and out of the body.
What are four steps of positioning a prone patient for basic life support when you are the only rescuer present?
1) Straighten patient's legs, position the closest arm above the patient's head.\n\n2) Grasp under the distant armpit\n\n3) Cradling head and neck, move patient as a unit onto his side\n\n4) Move patient onto back and reposition the extended arm
Most airway problems are caused by the ______.
Tongue
The risk of airway obstruction by the tongue is even greater when the patient is __________.
Unconscious
What two methods are used to clear the tongue out of the airway and open the airway wide?
1) Head-tilt/Chin-lift maneuver\n\n2) Jaw-thrust maneuver (preferable when spine injury is suspected)
What are the four steps of performing the head-tilt/chin-lift maneuver?
1) Place one hand on the forehead and the fingertips of the other hand under the bony area at the center of the patient's lower jaw.\n\n2) Tilt the head by applying gentle pressure to the patient's forehead\n\n3) Use your fingertips to lift the chin and to support the lower jaw. Move the jaw forward to a point where the lower teeth are almost touching the upper teeth.\n\n4) Do not allow patient's mouth to be closed.
What maneuver would you use to open the airway of an unconscious patient with suspected spine injuries?
The jaw-thrust maneuver
How do you perform the jaw-thrust maneuver?
1) Keep head, neck, and spine aligned, moving patient as a unit until he is supine.\n\n2) Kneel at top of head.\n\n3) Reach forward and place one hand on each side of the patient's lower jaw, at the angles of the jaw below the ears. \n\n4) Stabilize head with forearms\n\n5) Using index fingers, push jaw forward (patient's forward, not your forward :)\n\n6) Retract lower lip with thumb if necessary\n\n7) Do not tilt or rotate head
Define "ventilation."
The breathing in of air or oxygen or providing breaths artificially
Define "artificial ventilation."
Forcing air or oxygen into the lungs when a patient has stopped breathing or has inadequate breathing. Also called positive pressure ventilation.
What are the four major techniques available to an EMT for providing artificial ventilation, in order of preference?
1) Mouth to mask (preferably with oxygen at 15 liters/minute)\n\n2) Two-rescuer bag-valve mask (BVM)(preferably with oxygen at 15 liters/minute)\n\n3) Flow-restricted oxygen-powered ventilation device\n\n4) One-rescuer bag-valve mask (preferably with oxygen at 15 liters/minute)
What are the signs of adequate artificial ventilation?
1) Chest rise\n\n2) Heart rate returning to normal\n\n3) Rate of ventilations is sufficient and not excessive
What are signs of inadequate artificial ventilation?
1) Chest doesn't rise and fall\n\n2) Patient's heart rate does not return to normal\n\n3) Rate of ventilation is inadequate or excessive.
What guidelines must you follow when preparing to attempt ventilation on a conscious patient with rapid ventilations?
1) Assess adequacy of respirations\n\n2) Explain procedure to the patient\n\n3) Place mask over mouth and nose\n\n4) After sealing the mask, squeeze the bag with the patient's inhalation. Watch as the patient's chest begins to rise and deliver the ventilation with the start of patient's own inhalation. Over the next several breaths, adjust the rate so you are ventilating fewer times, but deeper.
What guidelines must you follow when preparing to attempt ventilation on a conscious patient with slow ventilations?
1) Carefully assess adequacy of respirations\n\n2) Explain procedure to the patient\n\n3) Place mask on face\n\n4) After sealing mask, squeeze the bag with every inhalation. If the rate is very slow, add ventilations in between the patient's own to obtain a rate of approx. 12/minute.
Define "pocket face mask."
A device, usually with a one-way valve, to aid in artificial ventilation. A rescuer breathes through the valve when the mask is placed over the patient's face. It can be used with supplemental oxygen when fitted with an oxygen inlet.
Why is it important to use a clear face mask?
So you can observe the patient's mouth and nose for vomiting or secretions that need to be suctioned.
What steps must you follow in order to provide mouth-to-mask ventilation?
1) Position yourself at the patient's head and open the airway. It may be necessary to clear the airway of obstructions. If necessary, insert oropharyngeal airway to help keep airway open.\n\n2) Connect oxygen to the inlet on the mask and run at 15 liters/minute. If oxygen isn't available, go ahead without it.\n\n3) Position mask on the patient's face so that the apex is over the bridge of the nose and the base is between the lower lip and the chin. Center port over mouth.\n\n4) Hold mask in place\n\n5) Exhale into mask -- deliver breath over one second and watch for chest rise.\n\n6) Remove mouth from port and wait for passive exhalation.
What important things must you remember when using a face mask on a patient with a spinal injury?
Do NOT tilt the head backward!
Define "bag-valve mask."
A handheld device with a face mask and a self-refilling bag that can be squeezed to provide artificial ventilations to a patient. It can deliver air from the atmosphere or oxygen from a supplemental oxygen supply system.
What steps must you follow in order to use a bag-valve mask on a patient without suspected spine injury?
1) Kneeling above patient's head, open airway and insert properly sized oral or nasal airway if no gag reflex is present.\n\n2) Position thumbs over top of mask, index fingers at the bottom.\n\n3) Place mask over patient's face. Position mask over nose and lower to the chin.\n\n4) Use your middle, ring, and little fingers to bring jaw up to mask\n\n5) Connect bag to mask and have assistant squeeze bag until chest rises.\n\n6) If no rise, reevaluate head position and mask seal. \n\n7) If unable to ventilate, use another method.
What additional step must one take when applying a bag-valve mask with two rescuers?
Make sure an assistant stabilizes and immobilizes the head and neck.
The use of a BVM is often reffered to as ______ the patient.
Bagging
Do bag-valve-mask units come in multiple sizes?
Yes, sizes for adults, children, and infants.
A BVM bag will hold between _____ and _____ mL of air.
1000 and 1600
What is the most difficult part of using a BVM?
Obtaining an adequate seal around the edges of the mask.
The AHA recommends that BVM artificial ventilation is performed by ___ rescuers.
Two
Define "stoma."
A permanent surgical opening in the neck through which the patient breathes.
What steps would you follow to provide artificial ventilations to a patient with a stoma?
1) Clear any mucus plugs or secretions from the stoma\n\n2) Leave the head and neck in a neutral position, as it is unnecessary to position the airway prior to ventilations in a stoma breather.\n\n3) Use a pediatric-sized mask to establish a seal around the stoma\n\n4) Ventilate at the appropriate rate for the patient's age.\n\n5) If unable to artificially ventilate through the stoma, consider sealing the stoma and attempting to ventilate through the mouth and nose. This will not work if the trachea has been disconnected from the mouth and nose.
What can you do to avoid gastric distension?
Make sure that the chest is rising when ventilating artificially. This shows that air is entering the lungs, not the stomach. Be especially careful when using a FROPVD.
What is the peak flow rate of most FROPVDs?
100 percent oxygen at up to 40 liters/minute
At what pressure level will the inspiratory pressure release valve on a FROPVD open?
60 cm of water pressure
When using a FROPVD and the chest doesn't rise, what should you do?
1) Reposition head\n\n2) Check seal\n\n3) Check for obstructions\n\n4) Consider alternative methods of ventilation
Define "automatic transport ventilator."
A device that provides positive pressure ventilations. It includes settings designed to adjust ventilation rate and volume, is portable, and is easily carried on an ambulance.
Define "oropharyngeal airway."
A curved device inserted through the patient's mouth into the pharynx to help maintain an oral airway.
Define "nasopharyngeal airway."
A flexible breathing tube inserted through the patient's nose into the pharynx to help maintain an open airway.
Define "airway adjunct."
A device that helps maintain an open airway.
What are the two most common airway adjuncts?
Oropharyngeal and nasopharyngeal airways.
What 9 general rules apply to the use of airway adjuncts?
1) Use an airway on all unconscious patients that don't exhibit a gag reflex.\n\n2) Some patients that can't tolerate an oropharyngeal airway can tolerate a nasopharyngeal airway.\n\n3) Open the airway manually before using an adjunct device.\n\n4) When inserting the airway, take care not to push tongue into pharynx.\n\n5) Do not continue inserting airway if patient begins to gag.\n\n6) When an airway adjunct is in place, you MUST MAINTAIN the head-tilt/chin-lift, or jaw-thrust maneuver and monitor the airway.\n\n7) When an airway adjunct is in place, you must remain ready to suction.\n\n8) If the patient regains consciousness or develops a gag reflex, remove airway and prepare to suction immediately.\n\n9) Use infection control practices!
How do you determine the best size of oropharyngeal airway for a patient?
Choose an airway that extends from the corner of the patient's mouth to the tip of the earlobe.
What steps do you follow to insert an oropharyngeal airway?
1) Place patient on his back. Keep spinal injuries in mind.\n\n2) Perform a crossed-finger technique -- cross thumb and forefinger and push jaws open at teeth at corner of mouth.\n\n3) Position airway so tip is pointing toward roof of mouth.\n\n4) Insert airway and slide it along roof of mouth past the uvula or until you meet resistance at soft palate. Don't push tongue into pharynx. Use tongue depressor if necessary. (carefully insert the airway pointing DOWN and using a tongue depressor for children/infants)\n\n5) Gently rotate airway 180 degrees. (unless already pointing down)\n\n6) Position patient -- use maximum head tilt if no spinal injury, otherwise maintain straight and immobilized spine.\n\n7) Check to see that flange of airway is against patient's lips.\n\n8) Place mask over adjunct.\n\n9) Provide ventilations and monitor patient closely. When removing device, there is no need to rotate it.
Which nasopharyngeal airway do you use in the field?
The soft flexible one, not the rigid clear plastic one.
What advantage does a nasopharyngeal airway have over an oropharyngeal airway?
It's less likely to initiate the gag reflex.
How does one determine the correct sizing for a nasopharyngeal airway?
Measure the nasopharyngeal airway from the nostril to the earlobe.
What steps must you follow when inserting a nasopharyngeal airway?
1) Measure airway from patient's nostril to earlobe.\n\n2) Lubricate the tube with water-based lubricant.\n\n3) Gently push tip of nose upward. Keep patient's head in neutral position. Try right nostril first, and make sure that the bevel points towards the septum.\n\n4) Insert airway until flange rests against nostril. If you meet resistance, try the other nostril. DO NOT FORCE IT.
When must you NOT use a nasopharyngeal airway?
Do not use a nasopharyngeal airway in the case of a severe head injury, ESPECIALLY when you can see clear cerebrospinal fluid coming from nose or ears.
Define "suctioning."
Use of a vacuum device to remove blood, vomitus, and other secretions or foreign materials from the airway.
What are the four components of any suctioning device?
A suction source, a collection container, tubing, and suction tips or catheters
What are the two most basic classifications of suctioning units?
Mounted suction systems and portable suction units.
Before operating a suction unit, you must have:
Tubing, suction tips, suction catheters, a collection container, and a container of clean water
What is the most popular type of suction tip?
The rigid pharyngeal tip, also known as the Yankauer, tonsil sucker, or tonsil tip.
Why must you be careful when suctioning the pharynx?
Because you might trigger additional vomiting, and you might trigger the vagus nerve in the back nof the pharynx, thus slowing the heart rate.
What are the primary rules of suctioning?
1) always use infection control measures. Gloves required, eye and face protection recommended.\n\n2) Try to limit suctioning to 15 seconds or less at a time. However, you must also continue suctioning until a patient stops vomiting. \n\n3) Place the tip where you want to begin suctioning and suction as you pull the tip out.
If no spine injury is suspected, what position should the patient's head be in during suctioning?
On its side.
Why must you avoid prolonged suctioning?
Excessive suctioning will cause hypoxia and death.
If using a flexible suction catheter, how do you measure the proper length?
Measure from patient's earlobe to corner of patient's mouth.
What percent oxygen does the atmosphere provide?
21%
What conditions will require oxygen?
Respiratory arrest, cardiac arrest, heart attack, stroke, shock, blood loss, lung diseases, broken bones, head injuries, drug overdose, severe chest injuries, and more.
Define "hypoxia."
An insufficiency of oxygen in the body's tissues.
Most oxygen delivery systems include what three key components?
Oxygen cylinder, pressure regulator, and delivery device (nonrebreather mask or cannula)
A full oxygen cylinder should read a pressure of ___ psi.
2000-2200
What are the five common oxygen cylinder sizes, and what are their oxygen capacities?
D cylinder: 350 liters\nE cylinder: 625 liters\nM cylinder: 3000 liters\nG cylinder: 5300 liters\nH cylinder: 6900 liters
What three sizes of oxygen cylinders would you find used in fixed systems on an ambulance?
M, G, H
What colors on an oxygen cylinder let you know that it does indeed contain oxygen?
Green, white, stainless steel.
What is the safe residual pressure reading on an oxygen cylinder?
200 psi. Below this level, oxygen delivery systems cannot operate properly.
What safety rules must you follow when using oxygen cylinders?
1) always use gauges, regulators, and tubing intended to be used with oxygen.\n\n2) Always use nonferrous metal oxygen wrenches. These are non-spark wrenches.\n\n3) Always ensure that valve seat inserts and gaskets are in good condition. Be sure to replace disposable gaskets with every use.\n\n4) Always use medical-grade oxygen labeled "OXYGEN USP" that is less than 5 years old.\n\n5) always open oxygen valve fully then turn back a half turn to prevent others from mistakenly trying to force it open,\n\n6) always have reserve oxygen stored in a cool, dry place, securely fastened,\n\n7) Never drop a tank, always have it secured.\n\n8) never leave a tank standing upright.\n\n9) No smoking!\n\n10) no open flames!\n\n11) keep grease/oil/petroleum products away from tanks\n\n12) do not move tanks by dragging or rolling
How do you calculate the flow time of an oxygen tank?
Subtract the safe residual from the current pressure. Multiply the difference by the appropriate tank constant. Divide that by 10
What are the cylinder constants?
D=0.16\nE=0.28\nM=1.56\nG=2.41\nH=3.14\nK=3.14
Define "pressure regulator."
A device connected to an oxygen cylinder to reduce cylinder pressure to a safe amount for delivery of oxygen to a patient.
How do pressure regulators attach to oxygen cylinders size E or smaller?
Using a yoke assembly with pins and holes.
How do pressure regulators attach to oxygen cylinders size M and larger?
Using a threaded outlet.
What should you do before attaching a pressure regulator to the valve on an oxygen cylinder?
Crack the valve for a moment to clear any dirt.
Define "flowmeter."
A valise that indicates the flow of oxygen in liters per minute.
What are the three major types of flowmeter?
Bourdon gauge (durable and useable in most situations), pressure-compensated flowmeter (accurate but delicate and must be upright), constant flow selector valve
What is the main drawback of using a Bourdon gauge flowmeter?
Any blockages or kinks will result in a higher than actual reading.
What extremely rugged flowmeter is gaining in popularity?
Constant flow selector.
Define "humidifier."
A device connected to the flowmeter to add moisture to the dry oxygen coming from an oxygen cylinder.
Why use a humidifier when administering oxygen?
Inhaling humidified oxygen is more comfortable for patients, especially for children and patients with COPD.
Why aren't humidifiers used widely on ambulances?
Because they're an infection risk and generally unnecessary for short trips.
What are the nonmedical hazards of using oxygen?
1) Pressurized tanks can become explosives or missiles when damaged. They can be deadly.\n\n2) Oxygen supports combustion and makes fires burn more rapidly.\n\n3) Under pressure, oxygen and oil don't mix. When combined, they can essentially explode. DO NOT USE petroleum-based lubricants or adhesives (tape) around oxygen.
What are the medical hazards of oxygen?
1) Oxygen toxicity or air sac collapse (extremely rare in the field)\n\n2) Infant eye damage\n\n3) Respiratory depression or respiratory arrest.
What are the steps to preparing an oxygen delivery system?
1) Select desired cylinder, check for label "Oxygen U.S.P."\n\n2) Place the cylinder in upright position and stand to one side.\n\n3) Remove plastic wrapper or cap protecting the cylinder outlet.\n\n4) Keep the plastic washer (some setups)\n\n5) Crack the main valve for one second.\n\n6) Select the correct pressure regulator and flowmeter. \n\n7) Place the cylinder valve gasket on the regulator oxygen port. \n\n8) Make sure that the pressure regulator is closed. \n\n9) Tighten t-screw on pin yoke, or tighten threaded outlet with nonferrous wrench.\n\n10) Attach tubing and delivery device
What are the steps to administering oxygen?
1) Explain to the patient the need for oxygen.\n\n2) Open the main valve, adjust flowmeter.\n\n3) Place an oxygen delivery device on the patient. \n\n4) Adjust flowmeter\n\n5) Secure cylinder during transfer
What are the steps to discontinuing oxygen?
1) Remove the delivery device\n\n2) Close the main valve
Define "nonrebreather mask."
A face mask and reservoir bag device that delivers high concentrations of oxygen. The patient's exhaled air escapes through a valve and is not rebreathed.
What's the best device for delivering high concentrations of oxygen to a breathing patient?
Nonrebreather mask
What are the appropriate flow rates for the various oxygen delivery devices?
1) Nonrebreather mask: 12-15 LPM\n\n2) Nasal cannula: 1-6 LPM\n\n3) Venturi mask: Varied, up to 15 LPM
What are the oxygen concentrations for the various oxygen delivery devices?
1) Nonrebreather mask: 80-90%\n\n2) Nasal cannula: 24-44%\n\n3) Venturi mask: 24-60%
How do you inflate a rebreather bag?
After hooking up to oxygen and starting flow at 12-15 LPM, cover the exhaust port or the connection between the mask and reservoir
What types of patients will need more oxygen than a nasal cannula can provide?
Patients with chest pain, shock, hypoxia, or other more serious problems (really any patient with inadequate breathing)
What special considerations must be taken into account when administering oxygen and clearing the airway?
1) Facial injuries: massive bleeding may require an airway adjunct and plenty of suctioning\n\n2) Obstructions: sometimes obstructions are so large that they must be cleared using manual techniques such as abdominal thrusts, chest thrusts, or finger sweeps.\n\n3) Dental appliances: Leave dentures and partials in place in possible since they give form to the face, but remove if they endanger the airway.
How much should you tighten the regulator onto the oxygen cylinder?
Only hand-tight, in case of any malfunctions of the air cylinder, or in case the cylinder runs out and you need to quickly disconnect it.
How can you remember what percentage of oxygen is being administered by a nasal cannula?
At 1 LPM, a nonrebreather mask will deliver 24% oxygen. For every additional LPM,add 4% oxygen, up to 6 LPM (for a maximum of 44% oxygen)
What do you do when you hear gurgling?
Suction! Fast!
What's an NPA?
Nasopharyngeal airway.
define bronchoconstriction.\n\nwhen is this common?\nIs this in the upper or lower airway?
the contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resistance to air flow. \nCommon in diseases like asthma. \nIn the lower airway.
What can happen to a patient when he loses muscle tone in his airway? What can cause this?
(possibly due to altered mental status and neurological disorders)\n\nTongue relaxes and falls back, which causes the epiglottis to fall back and cover the entrance of the trachea. Obstructs the airway.
Two questions you must consider when assessing a patient's airway:
Is the airway open?\n\nWill the airway stay open?
Define stridor.
high-pitched sound generated from partially obstructed air flow in the upper airway.\n\ncan be present on inhalation or exhalation.
What are signs - especially in children - of inadequate breathing?
retractions (pulling in of the muscles) above clavicles and between and below the ribs. \nnasal flaring
A partially obstructed airway can cause what sounds?
Stridor - severely restricted in upper airway. nearly complete obstruction\nHoarseness - narrowing of upper airway. voice changes are useful in reassessment of airway issue.\nSnoring - decrease in mental status can cause diminished airway muscle tone, so soft tissue of upper airway impedes airflow. airway needs assistance to stay open.\ngurgling - fluid obstructing. immediate suctioning.
what is the most common impediment to an open airway?
lack of airway muscle tone.
while opening the airway, what equipment must you ready for immediate use?
suction unit to clear the airway if necessary.
When can you not use an OPA?
OPA can only be used when gag reflex not present. Gag reflex may reappear as a patient regains consciousness. But patient may be able to tolerate NPA instead.
Rules to inserting OPA. \n\n(used when airway is opened, this helps maintain airway)
Have suction ready.\nWear gloves, mask and goggles.\nOpen airway manually first. \nDon't push tongue into pharynx.\nMaintain head-tilt or jaw-thrust when adjunct in place. \nRemove immediately if regains consciousness or gag reflex.
What to do in reduced LOC but intact gag reflex?\nwhen else would you use this?
Use NPA instead of OPA. \nOr use when teeth clenched, or oral injuries.
When do you NOT use NPA?
If CSF coming from EARS or nose. indicates skull fracture. really don't use when head injury suspected.
to be effective, suction devices must furnish an air intake....
air take > 30 L/min at open end of collection tube\n(must generate vacuum of >300 mmHg when tube is clamped).
What are suction catheters used for?\n\nDescribe measurements.
Not large enough for vomitus or thick secretions. Used when rigid tip cannot be used. It can be passed through OPA, NPA, or endotracheal tube. \n(bulb suction can also be used to suction nasal passages).\n\nlarger the number, larger the catheter. "14 french" is larger than "8 french"
special considerations in airway management?
1. facial injuries. frequent suctioning may be required for all the bleeding. consider airway adjunct or endotracheal tube. \n2. obstruction. suctioning will probably not work for larger things. use abdominal thrusts, chest thrusts or finger sweep. \n3. dental appliances - leave denture in place unless it endangers airway.
Blunt trauma
Can fracture ribs, sternum, and costal (rib) cartilages
Lungs, airway and great vessels of the heart
Blunt trauma, compression, and penetrating trauma are mechanisms that can injure the chest. Chest injuries are classified as either
open or closed
closed chest injury
the chest wall remains intact. , the skin is not broken
open chest injury
the chest wall has been penetrated
Penetrating objects
Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects. Can damage internal organs and impair respiration
Flail chest
is a fracture of two or more consecutive ribs in two or more places. This injury can create an unstable chest wall and can lead to inadequate breathing. Injuries commonly cause damage to heart, lungs, and great vessels that are not readily detectable. A flail chest occurs from blunt trauma with a resulting fracture to two or more consecutive ribs. Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration.
Assessment: Flail Chest
Mechanism of injury
Difficulty breathing/hypoxia
Chest wall muscle contraction
Mechanism of injury causing blunt trauma to the chest wall is capable of creating a flail segment in the chest. The patient will have difficulty breathing, which over time will cause hypoxia. The chest wall muscles will initially tighten to splint the area but will eventually cause fatigue and make the flail segment more visible. A visible segment is a late sign.
Treatment: Flail Chest
Primary assessment for life threats
Administer oxygen
Use bulky dressing to stabilize flail segment
Monitor patient for respiratory rate and depth
Assist ventilations if too shallow
Open Chest Injuries
Difficult to tell what is injured from entrance wound
Assume all wounds are life-threatening
Open wounds allow air into chest
Sets imbalance in pressure
Causes lung to collapse
Assessment: Open Chest Wound
"Sucking chest wound"
Direct entrance wound to chest
May or may not be a sucking sound
May be gasping for air
Treatment: Open Chest Wounds
Maintain open airway
Seal wound
Occlusive dressing
Administer oxygen
Treat for shock
Immediate transport
Consider ALS
An open chest wound is a true emergency that requires rapid initial care and immediate transport.
Care for an open chest wound involves sealing the wound to prevent air from entering the chest cavity. Care also may include application of a dressing that will allow air to escape the chest cavity while preventing air from entering.
An open chest wound is a true emergency that requires rapid initial care and immediate transport.
Traumatic Asphyxia
Sudden compression of chest forcing blood out of organs and rupturing blood vessels
Neck and face are a darker color than rest of the body
May cause bulging eyes, distended neck veins, broken blood vessels in face
Cardiac Tamponade
Direct injury to heart causing blood to flow into the pericardial sac around the heart
Pericardium is a tough sac that rarely leaks
Increased pressure on heart so chambers cannot fill
Blood backs up into veins
Usually a result of penetrating trauma
Distended neck veins
Shock and narrowed pulse pressure
Aortic Injury
Aorta is the largest blood vessel in the body
Penetrating trauma can cause direct damage
Blunt trauma can sever or tear the aorta
Damage can cause high-pressure bleeding; often fatal
Patient complains of pain in chest, abdomen, or back
Signs of shock
Differences in blood pressure between right and left arms
Commotio Cordis
Uncommon condition
Trauma to chest when heart is vulnerable
Ventricular fibrillation (VF)
Treat like VF patient: CPR, defibrillation
An example of such a condition a young athlete who tries to catch a baseball, but misses. The ball strikes the patient in the center of the chest and the patient collapses in cardiac arrest.
What is commotio cordis? How is it different from other traumatic injuries to the chest?
Abdominal Injuries
Can be open or closed
Internal bleeding can be severe if organs or blood vessels are lacerated or ruptured
Serious, painful reactions if hollow organs rupture
Evisceration may occur
...
Blunt or penetrating trauma can damage the abdomen. The level of damage typically depends upon the organ system injured beneath the skin. An abdominal injury can be either open or closed. In a closed injury, the abdominal wall remains intact. Structures such as the liver, spleen, and diaphragm are particularly vulnerable to blunt abdominal trauma.
Assessment: Abdominal Injuries
Pain, initially mild but rapidly becoming intolerable as bleeding worsens
Nausea
Weakness
Thirst
...
Because of the vulnerability of large vascular organs, internal bleeding should be assumed in most abdominal trauma. EMTs must watch carefully for shock and must initiate rapid transport to an appropriate facility.
Assessment: Abdominal Injuries
Indications of blunt trauma to chest, abdomen, or pelvis
Coughing up or vomiting blood
Rigid and/or distended abdomen
Feel an abdomen. Have students work in pairs and palpate their partner's abdomen. Feeling a normal abdomen will help them differentiate abnormal changes.
Treatment: Abdominal Injuries
Carefully monitor airway in presence of vomiting
Place patient on back with knees flexed to reduce tension on abdominal muscles
Administer oxygen
Treat for shock
Treatment: Abdominal Injuries
If allowed, utilize pneumatic anti-shock garments (PASG)
Nothing to patient by mouth
Continuously monitor vital signs
Treatment: Evisceration
Do not touch or replace eviscerated organs
Apply sterile dressing moistened with sterile saline over wound site
For large evisceration, maintain warmth by placing layers of bulky dressing over occlusive dressing
Some EMS systems may recommend that you apply an occlusive dressing as well. It may be necessary to remoisten the dressings with additional saline in order to ensure that the eviscerated organ or organs do not dry out.
...
Define evisceration. Discuss the steps for appropriate treatment.
...
Treatment: Impaled Object
Do not remove
Stabilize with bulky dressings bandaged in place
Leave patient's legs in position found to avoid muscular movement that may move impaled object
...
An open chest or abdominal wound is considered to be one that penetrates not only the skin but the chest and abdominal wall to expose internal organs.
...
Open chest and abdominal wounds are life threatening.
...
A patient who collapses in cardiac arrest after a force to the center of the chest should receive CPR.
...
If a patient develops signs of tension pneumothorax, arrange immediately for ALS intercept.
...
Blunt trauma, penetrating trauma, and compression are mechanisms that can injure the chest and abdomen.
Open or closed pertains to the integrity of the chest or abdominal wall after injury.
Seal open chest wounds to prevent air from entering the chest cavity.
...
Closed chest and abdominal wounds bear a high risk for underlying organ system damage and internal bleeding. Use mechanism of injury and patient assessment to recognize the signs and symptoms of shock.
...
EMTs should learn signs and symptoms, and treatment procedures for specific chest and abdominal injuries.
...
Is the patient's breathing adequate, inadequate, or absent?
Is the patient displaying signs of shock?
Is there an open wound in the chest that needs to be sealed?
...
Is the patient displaying signs of a tension pneumothorax?
Is there an open wound in the abdomen that needs to be dressed and covered?
...
You are caring for a patient who was shot in the chest with a nail gun. You applied an occlusive dressing around the wound. The patient is suddenly deteriorating. He is having extreme difficulty breathing and his color has worsened.
...
Breath sounds have become almost totally absent on the side with the impaled nail. What complication might you suspect is causing his worsening condition? How could this be corrected?
About the head tilt chin lift maneuver
Can only be used temporarily and must be replaced by an airway adjunct.
When should you used the Jaw-thrust maneuver?
When the mechanism of injury is unclear (Possible spinal, or head trauma)
Elderly man found lying unresponsive, no witness of event. What should you do first?
Open the air way by Grasp the angle of the lower jaw and lift (only if needed)
Patient with severe facial injuries, inadequate breathing, and bleed from mouth. What should you do?
Alternate suctioning (10 sec), on side, ventilate with high flow oxygen
What occurs during cellular/capillary gas exchange?
Capillaries give up oxygen to cells.
Reduced tidal volume would most likely occur from
Unequal chest expansion
first step for managing an unconscious adult for fell 15 ft
Open the airway by using the Jaw thrust Maneuver.
The first action for treating a 40 year old with rapid respiration's.
Assess the regularity and quality of breathing (Rate, Rhythm, and Quality)
For what condition should you put a patient in Fowlers?
For dyspnea, chest pain, CVA with hemiplegia (one-sided
paralysis) or any suspected CVA
What is Tidal Volume?
Volume of air inhaled in a single breath
A patient who OD on a narcotic is unconscious with slow, shallow breathing. When inserting an oropharyngeal airway, the patient gag's. What should you do first?
Remove Oropharyngeal airway and be ready to suction the mouth
When using a BVM to ventilating a patent with Apnea you see very little rise in the chest. What actions should you take first?
Check the mask seal, and preposition head
40 year old patient with respiratory distress and a rate of 26 breaths/min and no other issues found. What is the best method to manage this airway?
Supply high flow oxygen with oxygen mask,(No need for BVM),
A semicoscious young man with shallow, gurgling respirations at a rate of 10 breaths/min. What action should you make first?
Clear the airway by suctioning,
What sound indicates a likely lower airway obstruction?
Wheezing (Anatomical obstruction of birinci)
What assessment findings would likely indicate cardiac problem? (such as CAD, Pulmonary Edema, excreta)
Irregular Pulse
And adult patient has "crushing" chest pain lasting longer then 30 minutes. Skin signs are pale and clammy. What should you do first?
Give High flow oxygen (Initiate oxygen therapy)
Adult patient compaining of chest pain suddenly loses consciousness. What should you do first?
Attach AED
What blood vessels take freshly oxygenated blood to the heart.
Pulmonary vein.
Dos a AED recognize and defibrillate patients in Asystole?
Yes
Dos a AED recognize and defibrillate patients not in Asystole?
No, but can still send a deadly shock to anyone in contact to a Asystole patient being defibilllated.
A confirmed cardiac arrest patient is receiving one person CPR from your partner. What should you do first?
Open airway
What are the depth sizes of chest compression for an adult, child and infant?
Adult - 2' inches minimum
child - 2' inches max
Infant -1 1/2' inches, or 1/3rd
If a patent goes in to cardiac arrest while in rout to the hospital what should you do?
Tell your partner to stop the ambulance.
Elderly patient complaining of chest pain tells you she had taken two of her husbands Nitro. pills before you arrived and has not relived the pain. What should you do?
Give oxygen therapy and transport ASAP in position of comfort
Cardiac arrest in adult most often happens due to
A cardiac arrhythmia
Chest pain associated with cardiac compromise often is described as
Pressure
An AED gives a "No shock advised" for a patient. what should you do first?
Check pulse
The Myocardium receives blood from the
Coronary arteries
Coronary arteries branch from the
Aorta
other then giving oxygen, what is the best way to reduce the effects of cardiac related problems?
Keep them calm and get them to a hospital
What should you ask first for a patient with chest pain?
What dos the pain feel like?
when managing a patient with chest pain
Place in position of comfort, give oxygen, and ask what the pain feels like
Worst effect of tachycardia for a patient?
Increase oxygen demand (Need for oxygen)
What factor provide the most information about the condition of a patient with a head injury?
Mental Status
In any incident involving excessive bleeding
always control bleeding
When ensuring a patients airway is clear what should you do next?
assess respiratory quality
At what point in an assessment would you check the back of the patient?
During the rapid trauma assessment
What should you do when you discover a patient with an open chest wound?
Cover the would (sucking chest would = Valvoline patch with tape, moist dressing = everything else)
s/s of a patient in decompensated shock?
Falling blood pressure
What should you do with an amputed body part?
Wrapping it in moist dressing and place it on ice
What should you do with a man who has an impaled object in chest is pulseless and apneic?
Removed impaled object, control bleeding and start CPR
Rapid extraction of a patient from an automobile accident is done by.
apply neck brace, slide a long backboard undre the patients butt, and removing them from the car.
A large laceration to the abdomen with protruding bowls should be managed how?
Apply moist, sterile dressing covered by a dry sterile dressing
Man burns the Anterior of both his arm as well as the anterior of his chest. What percent of his body is burned? (rule of nine)
18%
(anterior chest = 9, anterior of arm = 4.5 (2) = 9
patient who was just removed from a house fire sustaining full thick burns to 50% of her body. What do you do?
Cover burns with dry sterile dressing and prevent hypothermia (less blood/fluid = less warmth)
FIrst respons to treat a large avulsion
Control any bleeding and bandage.
Head trauma patient has fluid mixed with blood draining from his ears and has bruising behind the ears. What do you do first?
Apply Spinal Immobilization and give high flow oxygen.
Basic Shock Management consists of
Applying oxygen, elevating lower extremities, and providing warmth
When assessing a patent with a gun shot wound you should
Look for an exit wound
Early signs of shock?
Restlessness
When caring for a patient with an emotional/behavioral crisis, your first concern is
Your partners and your own safety
S/S of a diabetic coma?
Worm,dry skin and slow onset. Hyperglycemia
Assesing a patient suffering from an OD, what should you ascertain (find out) first?
What drug was it?
Patient that is acting confused and laking incoherently, nature of the illness is most consistent with
Altered mental Status
How to assess severe lower abdominal pain?
Ask where the pain is and palpate that area last. This is to help verify the actual vicinity of the pain.
Rattle snake bite treatment
High flow oxygen, lower the effected part, and immobilize the it.
Patient with with a history of epilepsy who is at the very
...
For what conditions should up place a patient in Supine?
For C-spine trauma without shock, pelvic fracture, flail chest
For what conditions should up place a patient in shock position?
For patient in shock'without' spinal trauma
For what conditions should up place a patient in Left lateral ?
For unconscious (non-traumatic), altered level of
consciousness
For what conditions should up place a patient in Left lateral Trendelenburg?
For Pregnency complications or diving emergenices
For what conditions should up place a patient in Trendelenburg?
For spinal trauma 'with' shock
What is Homeosatasis
Activity in the body to needed to maintain balance between all body systems.
What are Aerobic metabilism
They are carbonic acid, weak, easily broken down to
COz and HzO
Anaerobic metabolism
lactic acid, strong, difficult for body to
excrete
What is the NERVOUS SYSTEM?
cerebrum - center of intellect, learning, personality
cerebellum - balance, equilibrium, coordination
Brainstem - controls vital functions
Autonomic nerves - control involuntary (automatic) functions
Where is the Location of heart?
2nd intercostal space at right sternal border to
5th intercostal space at Ieft midclavicular line
What is the sac around the heart?
Pericardium, protects and pressurizes the heart.
What is in the lower airway?
Pharynx-- contains vocal cords, location of gag reflex
Larynx - voice box
What are the Categories of shock, and what do they do?
Hypovolemic - inadequate blood volume '
. Cardiogenic - pump failure
. Obstructive - physical obstruction to blood flow
. Distributive - widespread reduction in vessel tone (PVR)
What are the common causes of the categories of shock?
Hypovolemia- trauma, hemorrhage, burns, dehydration, diarrhea
Cardiogenic- myocardial infarction, dysrhythmia
Obstructive- tension pneumothorax, cardiac tamponade,
pulmonary embolus, dissecting aortic aneurysm
Distributive- spinal cord trauma, sepsis = widespread infection,
anaphylaxis, drugs/overdose (especially barbiturates)
what is D5w?
D5W- 5% dextrose (sugar) in water. TKO IV, with a minidrip
tubing
Bradycardia
heart rate less than 60/min.
Tachycardia
heart rate greater than 100/min
Hypertension
any blood pressure greater than 140/90
Hypotension
too low for needs of body
Pre-Hypertension
120/80 BP
Obvious signs of death
Decapitation, Evisceration of heart, lung, brain, incineration, Decomposition, Levidity and rigor mortis
What is the maximum amount of time CPR should be interupted?
No more then 10 seconds, except for intubation (30 sec.) or transportation problems.
What are the S/S of stroke?
BP above 140/90, altered LOC, hemiparesis - one-sided tingling, hemiparalysis or numbness/one-side paralysis, headache, blurred vision, incontinence, aphasia - inability to speak. Transport in Flowers or Reverse Trendelenburg.
What Types of SEIZURES(Epilepsy) are there and what do they do?
May experience an "aura" before seizure.
Grand-mal - full body generalized tonic-clonic muscle contractions with loss of consciousness.
Post-ictal - period of ALOC following seizure
Febrile seizure - only happens to kids and by fever
Hypoxic seizure - lack of oxygen to the brain (loss of consciousness)
What is Status Epilepticus
May be life threatening) Seizure more then 10 minutes long, repetitive without periods of consciousness, more then 3 per hour. This may lead to - Hypoxia, trauma, hyperthermia, hypoglycemia, aspiration, dehydration.
TIA
(Transient ischemic Attack)- temporary inadequate perfusion to brain resulting in neurological deficit(Weakness, paralysis, speech disorder, etc.) minutes or hours. Has S&S of stroke.
Syncope
fainting due to lack of brain perfusion
What are the S/S of Pesticides
An Organophosphate poisoning that results in Bradycardia, Hypotension, flushed skin, muscle weakness, constricted pupils, drooling or increased salivation, abdominal cramping/diarrhea.
What are the S/S of Ingested Caustic Substances?
They are Caustic: substance that burns tissue, may be acid or base.
Give sips of water or milk, maintain airway, fowler's position, rapid transport (We dont administer lpecac, or activated charcoal)
What can cause chest pain?
Mvocardial - angina, Ml, pericarditis (CAD = coronary artery
disease, plaque build-up, hardening of arteries)
Vascular - dissecting aneurysm
Pulmonary - pulmonary embolus, pneumonia
pneumothorax, pleurisy (pain with breaths)
Gastro- intestinal - gastritis, esophagitis
What is Anqina' pectoris and what are the S/S
Decreased blood supply to heart muscle causing temporary ischemia and is easy to provoke. Pain generally lasts up to 30 min.
Same s/s as M.l
Dissecting Aortic Aneurysm
severe tearing knifelike pain, radiatinq from
chest throuah to back, unequal pulses/BP (putsating abdominal mass)
Chevne-Stok
increasing and decreasing respiratory rate
and tidal volume with periods of apnea. sign of injury to
head/brain
Ataxic
An irregular , unpredictable respiratory rate and tidal volume.
What is GOPD
(Chronic Obstructive Pulmonary Disease)
What are the S/S of Emphysema
Pursed lip breathing, prolonged expiratory phase,
barrel chest, sitting in 'tripod' position. Patients are often thin and
Smokes,
CHF
(Congestive Heart Failure/Pulmonary Edema)-
(left-sided heart failure) from chronic heart disease or M.!.
SOB, Pale, cool, diaphoretic, Hypertension, Neck vein distention, Jugular Vein Distention, Pedal edema,Productive sputum (foaming from mouth)
Transport in Fowler's with legs down, over edge of gurney,
dependent and high oxygen
Pulmonary Embolus
Pulmonarv Embolus- (P.E.), pleuritic chest pain, hemoptysis, rales, prolonged bed rest, recent fractures, surgery, pregnancy.
hemoptysis
Coughing up blood
Abdominal Aneurvsm
tear between layers of the aorta creating a balloon effect, often
fatal, bleeding (may feel pulsating mass in abdomen)
Esophageal Vaices
enlarged vessels in the esophagus, may rupture and cause serious bleeding. (caused by liver disease,in alcoholics).
Hematemesis
vomiting bright red blood
Melena
black, tarry stool. lndicates gastro-intestinal
bleeding.
Ulcer
The erosion of stomach or intestinal lining causing pain
and/or bleeding
What dos Bright red Emesis mean?
indicated recent upper gastrointestinal bleeding, often acute ulcer or rupture of esophageal varices.
S/S for non-traumatic abdominal emergency and treatment
Abdominal pain, Nausea/vomiting (N&V), Signs/symptoms of shock. No oral fluids, Position of comfort (knees drawn up to chest), Monitor vitals, and Treat for shock, 'p r n' as needed. Code 3 if vitals are odd or vomiting blood.
S/S of qastrointestinal bleeding
:Epigastric or lower abdominal pain, "Heartburn", Nausea/vomiting blood, or bloody diarrhea, Signs of shock, Melena, = possible internal bleeding.
Treat by Left lateral or shock position. No oral fluids, oxygen, Transport Code 3 continue assessment in route
Bowel obstruction
constipation, history of recent abd. surgery,cramp pain, or abd. distention.
Appendicitis
fever, anorexia (loss of appetite), right lower quadrant
pain
Cholecystitis
gallbladder drsease/fatty food,riqht upper quadrant pain. (fat, forty, farty, female)
Kidney stones
severe cramp pain radiating to groin, with restlessness, N&V
PID
(Pelvic lnflammatorv Disease) right or left lower quadrant pain,
abnormal vaginal discharge, fever, N&V.
Ectopic Pregnancy
(tubal pregnancy) right or left lower abdominal pain, shock, vaginal bleeding (code 3 transport!) Egg growing in fallopian tube will rupture and cause bleeding
How do you sssess the abdomen?
Using all fingers of one hand to palpate gentily, then harder
S/S and treatment for Heat exhaustion
Heat exhaustion - dehydration with loss of salts. They will be warm, moist, flushed skin. Headache, nausea, weakness, dizziness, syncope. Treat by giving oral fluids, and remove from heat, loosen clothes
S/S and treatment for Heat stroke
failure of body's cooling mechanisms. Will be hot dry flushed, ALOC, Hypotension, tachycardia, seizure . Do not give oral fluids. immediate cooling, Oxygen, shock, position, rapid transpoi rt.
S/S and treatment for Frostbite
body tissue injury due to cold. Appear white, may or have no pain. Remove from cold, do not massage or allow patient to use the part.
Hvpothermia
Hvpothermia - general lowering of body temperature. Apathv, shivering, delayed capillary refill, altered LOC, Bradycardia, Hypotension, dilated pupils. Remove wet clothing, cover patient with blankets, Warm ambulance, Handle patient gently, oxygen.
S/S and treatment for Carbon Monoxide (GO) inhalation
Headache, confusion, N&V, dyspnea, tachypnea,
tachycardia, flushed skin, unconsciousness.
-Remove Pt. from exposure if possible, oxygen
S/S for Smoke inhalation:
Dyspnea, tachypnea, cough, stridor, wheeze or rales, watery eyes,
singed nasal hairs, strider.
When arriving to a call involving violence (any danger)
Take your time, consider s-econdary danger, exprosion/shooting
Prejudge for danger, gang cross outs, Assess police presence (If police are present always talk to them first when arriving on scene)
If there is a Police presence at the scene
do not follow police into dangerous , you can wait until they secure area and call you in.(always wait till they say its clear)
What organs are in the Upper Left Quadrant
Stumach, Spleen
What organs are in the Upper Right Quadrant
Liver, Gallbladder
What organs are in the Lower Left Quadrant
...
What organs are in the Lower Right Quadrant
Appendix
What organs are Hollow?
Gallbladder, Intestine, Appendix, Stumach
What organs are Solid?
Liver, Spleen, Pancreas, Kidneys
Signs and treatment of a Flailed Chest
loose chest segment, 'paradoxical,chest movement stabilize segment with dressing, hand.
AED Weight Limit
AED minimum weight for children, must be 80 lbs. (55k9) Although new AED's may' be used for children if allowed for that particular model of AED.
When should you remove an Impaled objects?
Only removed if you have to for CPR / Airway management (Knife in back MUST be removed to do CPR, can,t just
turn on their side for CPR)
When dealing with major burn victims what should you do to treat them?
For significant burns: 70% or so don't use wet dressings (too much moisture can lead to hypothermia) Cool burn with water, then
apply a DRY dressing. Expect respiratory problems.
When preforming Spinal immobilization which section do you secure to the backboard first?
secure torso on backboard before securing, the head to the backboard
When should the Trauma assessment be done?
should be done before and after any treatment, not
wait until transport.
When dealing with Suicide patient how do you restrain them?
Do Not initially restrain them to prevent violence, this may only cause violence. If restrained do not use any material that can harm their wrists or have them in the prone position.
What is CPR with 'Signs of recovery"?
When checking pulse and breathing, Signs of recovery
means they are not in cardiac arrest
How long should a 2 person CPR Switch take?
it should take 5 seconds or less to switch
What is the most serious sign in Shock?
Its is NOT tachycardia (that is the 'first' sign) most serious is low BP
What is the important factor for EMT safety regarding
communicable diseases
immunizations are VERY important factor for EMT safety regarding
communicable diseases, (gloves are NOT the 'most' important factor.)
Long term complications of Diabetes?
Can contribute to leg ulcers, vision problems, damage to organs, and amputations.
When dealing with a bee stings what is top priority?
Removal of stinger is NOT first priority in bee sting if not breathing, BVM /Oxygen FIRST, finding out and dealing with what caused problem NOT first priority.
When should you restrain a patient and how?
only used if patient is violent or a danger to themselves or others. lf police use their restraints, they must remain available to
remove them immediately if needed. EMS should use soft and/or padded restraints, not plastic hand ties,Never restrain hands and feet behind the back. Check restrained patients every 15 minutes for pulse, capillary refill, PMS. Never use the 'sandwich' technique to restrain. Can attach restraints to gurney but must use frame, not movable side rails.
When should you remove a helmet from a patient?
only remove if necessary (if loose or unstable) or for airway
control.
When should you hyperventilate a patient with a head injury
only if signs of cerebral herniation are present;
BP rises, pulse slows, Cheney-stokes breathing, posturing, blown pupil
Shunt
surgical procedure for dialysis patients (patients with kidney failure),
brings an artery closer for access during dialysis. Do not take blood
pressure on the arm with a shunt. (also known as a 'fistula')
What is the Malleolus
ankle bone (posterior to medial malleolus is site of posterior
tibial pedal pulse)
Sprain
injury to tendon, muscle, or ligaments
What are DT's?
Delirium Tremors - potentially life threatening reaction to alcohol
withdrawal
What is Botulism?
constipation, dysphagia (difficulty swallowing), loss of head
control
What to worry about Electrical injury
the most serious injury may be expected at the 'exit' wound site.
Also suspect internal damage, irregular pulse. (use moist dressing)
When should you do before and after splinting a fracture?
Check for PMS
Patent with an imapaled object in the back
if CPR is needed remove. lf patient is breathing, left lateral
position and rapid transport, 'don't' remove
First actions taken for a Drowning victim?
consider C-spine first, 'then' airway, CPR, etc.
If Delivery complications occure
Put the mother in left lateral trendelenburg position or supine
with hips raised and transport code 3.
When transporting a pregnant woman c-spine on backboard
Place in Trendelenburg position. If in discomfort place towels under the left side of the backboard to help relieve pressure.(Supine hypotensive syndrome)
After giving birth and having with excessive bleeding what should you do?
Also know as postpartum hemorrhage = greater than 5OOcc. Only after delivery of placenta externally massage of funda and allow breast feeding. If the bleeding continues transport code 3.
S/S of a Tension pneumothorax
absent lung/breath sounds on affected side, tracheal
deviation, JVD, increasing respiratory difficulty.
Triaqe tag colors
black= dead/morgue
red= immediate
yellow=delayed
green= minor
Common organ trauma problems
left upper quadrant (contains stomach and spleen) Spleen often damaged in trauma causing internal bleeding/shock.
When Triage in a multiple patient disaster you should only
1. stop bleeding.
2. if Pt. in full arrest, open airway only, (no CPR if resources limited)
S/S of a Cardiac tamponade
Hear only muffled heart sounds, with a 'narrowing' pulse pressures
What to report
Must' report all suspected gun shot wounds to police. Not
required by law to report stab wound or drug use (but may do so if part of your protocol to notify police)
what are the Four elements of 'Negligence'?
Duty to act, failed to act or acted improperly, resulted in 'damage', EMT was the cause of the damage.
What is PIH?
lfgg_nrrcy.lnduced Hypertension same as toxemia, eclampsia. Results in edema, weight gain, may result in life threatening seizures.
What is Supine hypotensive syndrome?
especially in pregnancy; pressure on vessels (vena cava) causing low BP, shock. Put patient in left lateral position.
What is a Stoma?
(laryngectomies) - surgical hole in anterior neck, in trachea. Must
ventilate/_suction through stoma using small mask, BVM, if soB.
When transporting a patient with a feeding tube you may
Clamp the tube to prevent vomiting.
When transporting a patient with a colostomy bag
Always keep bad below waist level.
Hemopneumothorax
blood and air in thoracic cavity
what is Hyperventilation syndrome and what dos it do?
(too much tidal volume) causes changes in blood chemistry causing chest pain, dizziness, carpal (hand) spasms, or pedal (foot) spasm / cramps. Pt. has sufficient 02 but is blowing off excessive C02. EMT cannot 'diagnose' hyperventilation. Treat like SOB, give 02, and transport. (Never allow re breathing into bag)
When you happen uppon Evidence at a crime scene
whenever possible don't disturb evidence, report any
changes made to scene. Unless you like going to court then you can touch whatever you like.
What is the Responsibility for patient care?
goes to highest medical authority on scene (Doctors/nurses must have proper l.D.) (contact base hospital doctor if a dispute happens) Always be there until all the paperwork is done and the patient has been transfer to the care of the hospital (otherwise that abandonment)
Dependent edema
swelling of 'dependent' parts: parts lower than rest of body; feet, hands if hanging down, the back if bedridden (sacral edema)
Hemiplegia
one-sided paralysis
When a patent is "Posturing"
sign of intracranial pressure:
What are the Three stages of labor?
dilation, expulsion, placental
What is Serious blood loss in child?
Anything greater than 250 milliliters/cc
How should you park at a scene?
Park ahead of accident, same side of road, when possible
When Driving on bridges/overpasses
they tend to freeze sooner in cold weather so use caution, and slow down
Pediatric meningitis
photophobia (light sensitivity) nucchal rigidity (stiff neck)
Hip dislocation
foot facing out, knee bent inward, no movement, and longer then the other.
Hip fracture
leg shortened, externally rotated, swelling,
Epiglotitis
in child, drooling, fever, stridor, tripod position, inability to swallow, history of recent illness, (put nothing in mouth, transport immediately and quietly, 02 it tolerated, do not intervene if not necessary- crying may cause further obstruction of airway)
When exposed to anything lnfectious
notify receiving hospital, notify your supervisor, determine if followup care is needed, fully document the exposure and the steps taken
Cholecystitis
gallbladder disease. RUQ pain with 'referred' pain to right shoulder
Where are the Kidneys?
lie in the 'retroperitoneal' space, between peritoneum and the back muscles
When Realigning fractures
Must be pulseless, transport time over one hour, or if it is necessary to apply splint
When to preform Newborn CPR
If not breathing or with a pulse less than 80/mm.
You find a diabetic patient that unconscious and the last time she took her insulin shot is unknow
Transport and give high flow oxygen by BVM
When dealing with a sexual assault victim who will not allow you to examine her what should your first action be?
Request a female EMT to preform the assessment (if one is not on hand you can request one)
What is a sign that indicate ALOC in a small child?
Lack of attention to the EMT presence.
What is Key for cardiac Arrest Patients?
Timely defibillation is the key factor in the their servival
When transporting from a multi-casualty scene
Inform dispatch of your status
When arriving at a multi casualty scene which other ambulance have arrived you should
report to the incident commander
when performing CPR and presented with a document of DNR for the patient you should
Continue until you have contacted and confirmed with medical control that you can stop.
When with a Partner suffering from stress due to the death of a child
allow them to open up to you and express how they feel
The goal of EMS Quality improvement program is to
Deliver a consistently high standered of care to all patients who are encountered
Long spine board immobilization device
For patient with multiple injuries and unstable vital signs
Patient with pain in the upper quadrent of her abdomen and a yellowish tinge to her skin. This is caused by which organ?
Liver
Most states require refresher training for EMT-B's every:
2-3 years
An EMT at a basic level is operating as a designated agent of the:
Medical Director
What is not a role or responsibility for an EMT?
Providing medical direction
The first concern of an EMT-B must be:
Personal safety
A policy set by an EMS Medical Director that allows EMT-B's to administer glucose to patients in certain circumstances without speaking to the physician in an example of a:
Standing order
An order from an EMS system's on-duty physician given by radio or phone is an example of:
On-line medical direction
The level of EMS training in which the emphasis is on activating the EMS system and controlling immediate life-threatening emergencies is:
First responder
A good personal trait for an EMT is:
Nonjudgmental
Lists of steps, such as assessment and interventions, to be taken in different situations by EMS personnel are known as:
Protocols
What is a way for an EMT to have a role in the QI process?
Continue her education
Organisms that cause infection, such as viruses and bacteria, are:
Pathogens
Equipment and procedures that protect you from the blood and body fluids of the patient are referred to as:
Body substance isolation precautions
Gloves, masks, and gowns are examples of:
PPE
The positive form of stress that helps people work under pressure and respond effectively is:
Eustress
A single incident that produces multiple patients is an:
MCI
The goal of the CISD is to:
Assist emergency care workers in dealing with stress
An initial component of the CISD, which may be held before the formal debriefing, is called a:
Defusing session
The stage of grieving in which a patient seeks to postpone death, even for a short time, is:
Bargaining
It is important that the EMT-B follow the same path in and out of a crime scene in order to:
Prevent disturbing the crime scene
The agency that has issued strict guidelines detailing precautions against exposure to bloodborne pathogens is the:
OSHA
What material is not recommended for gloves to be used when there is potential for contact with blood and other body fluids?
Cotton
Personal protective equipment does not include:
Cotton scrub pants
In cases where TB is suspected, use a:
HEPA respirator
A situation that would usually call for the use of a gown as protection would be one involving:
Childbirth
An infection that causes an inflammation of the liver is:
Hepatitis
The 3 R's of reacting to danger are:
Retreat, radio, reevaluate
Hep B, TB, and AIDS are the communicable diseases of greatest concern because they are:
All spread through the air
The test that can detect exposure to TB is the:
PPD test
Under the Ryan White CARE Act, the officials in every emergency response organization who gather facts about possible emergency responder exposure to infectious diseases are the:
Designated officers
Vehicles, structures, and storage containers holding hazardous materials should be identified with:
Placards
An ambulance crew's participation in a contructive mutual critique after each call is part of the process known as:
Quality improvement
Mentally competent adults of legal age who accept care from an EMS crew are said to give:
Expressed consent
EMS personnel can treat unconscious patients because the law holds that rational patients would consent to treatment if they were conscious; this principle is known as:
Implied consent
Minors who are married or of a certain age and who are legally able to give consent for medical care are known as:
Emancipated
When a patient refuses care, he or she must sign a:
Release form
Refusal to go to the hospital may be a form of __________, or unwillingness to acces the idea of illness.
Denial
If an EMT-B forces a competent patient to go to the hospital against his or her will, the EMT-B may be charged with:
Assault
A legal document, usually signed by the patient and his physician, which states that the patient has a terminal illness and does not wish to prolong life through resuscitative efforts, is called a:
DNR order
A person whom the signer of a document names to make health care decisions in case the signer is unable to make such decisions for himself or herself is called a:
Proxy
Legislative means intended to provide legal protection for citizens and some health care personnel who administer emergency care are known as:
Good Samaritan laws
An EMT-B's obligation in certain situations to provide care to a patient is referred to as a:
Duty to act
If a jury finds that an EMT-B had a duty to a patient, that he failed to carry out that duty properly, and that his action caused harm to the patient, the EMT-B would be guilty of:
Negligence
A loss that requires reimbursement is called a:
Compensable
A DNR order is one example of a:
Advance directive
The principle that information about a patients history, condition, or treatment must not be shared with unauthorized parties is called:
Confidentiality
If you discover that a critically injured patient is an organ donor, as an EMT-B you should:
Notify the nurse/physician at the hospital
Once police have made the scene safe, the priority of the EMT-B at a crime scene is to:
Provide patient care
Leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training is known as:
Abandonment
The extent and limits of the job that an EMT-B does are referred to as:
Scope of practice
Simply stated, liability means:
Legal responisbility
The study of functions of the body is called:
Physiology
The structure of the body is referred to as its:
Anatomy
The anatomical position is best described as a person:
Standing, facing forward, palms facing forward
An imaginary line down the center of the body that passes between the eyes and extends down past the umbilicus is the:
Midline
The term that refers to a position closer to the midline is:
Medial
Another word for anterior is:
Ventral
The preferred position for any unconscious nontrauma patient is:
Recovery
The Fowler's position is usually achieved by raising the head end of the stretcher so that the body is at a:
45-60 degree angle
This division of the spinal collumn is subject to injury because it is not supported by another part of the skeleton:
Lumbar
The pelvis is commonly referred to as the:
Hip
The scapula and acromion are parts of the:
Shoulder
Inferiorly, the knee connects with the:
Tibia and fibula
The body contains how many different types of muscle:
3
After inhaled air goes through the larynx the next part of the respiratory system the air passes as it moves to the lungs is the:
Trachea
The chamber that pumps oxygen-rich blood out of the heart for distribution to the rest of the body is the:
Left ventricle
The largest artery in the body is the:
Aorta
The pulse checked during infant CPR is the:
Brachial
The blood vessels where gases, nutrients, and waste products are exchanged between the body's cells and the bloodstream are the:
Capillaries
The component of the blood that has a primary function of carrying oxygen to tissue is:
Red blood cells
The pressure created in the arteries when blood is forced out of the heart is referred to as:
Systolic
The adequate supply of oxygen and nutrients to the organs and tissues of the body is called:
Perfusion
The CNS is made up of the brain and the:
Spinal cord
The skin layer rich with blood vessels, nerves, and specialized structures such as sweat glands and sebaceous glands is the:
Dermis
The endocrine system produces chemicals called:
Hormones
Body functions such as digestion and heart rate are controlled by the:
Autonomic nervous system
When you are lifting a heavy object, most of the work should be done by the muscles of your:
Legs
What is a reason that an urgent move should be used:
Immediate treatment for a breathing emergency can be performed
The preferred device for carrying a conscious medical patient down a flight of stairs is the:
Stair chair
One technique that can greatly reduce risk of back injuries when lifting and moving patients is:
Keeping the lifted weight in close to your body
What is not a condition that permits the use of an emergency move?
A stable patient's position is hampering a police investigation
When an abbreviated assessment on a patient trapped in wreckage reveals that the patient must be moved quickly, you would order a:
Urgent move
The technique used when quickly removing a patients from a vehicle is called:
Rapid extraction
Unresponsive patients without suspected spinal injuries should be placed in the:
Recovery position
The method that should be used when moving a patient onto a long spine board is the:
Log roll
The method commonly used to transfer a patient from a bed at home to a stretcher is the:
Draw sheet method
The first step of emergency care in the patient with inadequate breathing is:
Opening and maintaining the patient's airway
The reduction of breathing to the point where oxygen intake is not sufficient to support life is called:
Respiratory failure
Signs of inadequate breathing include:
wheezing, crowing, gurgling noises; cyanosis of the lips, earlobes, or nail beds; being unable to speak in full sentences
During your assessment of a 54 year old male patient, you find that he is not breathing; your next step would be to:
Begin providing artificial respirations to the patient
Your 24 year old female patient has fallen from the roof of her house and is unconscious; the bets method of opening her airway is the:
Jaw-thrust maneuver
What method for providing ventilatory assistance is considered most effective?
2 person BVM technique with high flow supplemental oxygen
Signs of inadequate artificial ventilation of an adult patient include:
Failure of the patients skin color to improve
If oxygen is connected to a pocket face mask the setting on the oxygen tank regulator should be set to:
15 lpm
What device on a BVM may prevent adequate ventilation?
A pop off valve
The most difficult part of delivering BVM artificial ventialtions is:
Obtaining an adequate mask seal
Oropharyngeal airways can be used on unconscious patients, except those who:
Have a gag reflex
If you do not have the proper size oropharyngeal airway to fit your patient:
Do not use one
The nasopharyngeal airway is popular because it:
Often does not stimulate a gag reflex
What is true when suctioning a patient's airway?
You may hyperventilate a patient before and after suctioning
The most popular type of suction tip used in the prehospital setting is:
Rigid pharyngeal tip (Yankauer)
Patient conditions that may require supplemental oxygen include:
Shock, head injury, and broken bones
A nasal cannula should be used to deliver oxygen to a patient who:
Will not tolerate a nonrebreather mask
Safety is of prime importance when working with oxygen; what is therefore true?
Always store reserve oxygen tanks in a cool and ventilated space
Oxygen cylinder sizes vary, but all are considered "full" when pressure is equal to:
2,000 psi
An insufficiency in the supply of oxygen to the body's tissues is called:
Hypoxia
The artificial ventilation technique whose use in children is contraindicated unless the provider has has special training is:
Flow resticted, oxygen powered ventilation device
Nasopharyngeal airways must be lubricated to ease insertion; you should use:
Any water based lubricant
One method of determining which size oropharyngeal airway to use is by:
Measuring from the corner of the patients mouth to the tip of the earlobe on the same side
Suctioning should not be done for longer than:
15 seconds
When a nasal cannula is used, the flow rate should be set for no more than:
4 to 6 lpm
What is not a part of the scene size-up?
Establishing an airway
Body substance isolation precautions may include:
Gloves, eyewear, mask
The scene size-up should take place:
At the beginning and throughout the entire call
When there are no apparent hazards, the danger zone at the scene of a vehicle collision should extend at least:
50 feet in all directions
When fuel has been spilled at a motor vehicle collision, the danger zone should be extended at least:
100 feet in all directions
If you observe potential signs of violence at a scene, your first action generally should be to:
Retreat to a position of safety
In every motor vehicle accident there are generally how many collisions:
3
A fall should be considered severe whenever patients have fallen:
3 times their height
During scene size up at a multiple vehicle crash, it is important to determine the number of patients because:
Additional EMS resources may have to be called if there are more patients than the first crew on the scene can handle
What may be useful in determining the nature of illness/mechanism of injury?
Patient, family, and bystanders
The portion of the assessment that is designed to identify and treat immediately life-threatening conditions is called the:
Initial assessment
Actions taken to correct a patient's problems are called:
Interventions
When an EMT-B feels that a patient just "doesn't look right" this is called:
Clinical judgement
What is not an example of an intervention?
Checking a carotid pulse
In any patient with a suspected spinal injury, an EMT-B should apply manual stabilization:
On first contact with the patient
Using the AVPU scale, a patient who will respond only to a brisk rubbing of the sternum would recieve a rating of:
Painful
If a patient is not alert and is breathing less than 8 breaths per minute, the EMT-B should:
Ventialte with a positive pressure device and 100% oxygen
In light-skinned people, poor circulation is indicated if the skin at the wrist is pale and:
Clammy
The assessment sign that is generally more reliable in children than adults is:
Capillary refill
The mental status of unresponsive infants is typically checked by flicking the feet and:
Talking to the infant
What is not a vital sign?
Mental status
You should obtain the first vital signs:
During the focused hisory and physical exam
The vital sign that is least useful in adults is:
Capillary refill
The patient that you would expect to have the slowest at rest pulse rate is a:
Athlete
An EMT-B should be most concerned with a pulse rate maintained above:
120 beats per minute
In case of shock or later stages of blood loss, an EMT-B would expect the pulse to be:
Rapid and thready
The first pulse taken by an EMT-B on patients one year and older is the:
Radial pulse
If an EMT-B has trouble finding the radial pulse on a conscious patient, he should first:
Try the wrist on the other arm
A rapid pulse, or any pulse over 100 beats per minute, is called:
Tachycardia
The act of breathing out is called:
Exhalation
In cases of children and infants, an EMT-B can expect to find the highest normal respiration rates in a:
Newborn
What are signs of labored breathing:
Nasal flaring, retractions, and grunting
The respiratory sound that points toward medical problems such as asthma is:
Wheezing
The respiratory sound that indicates a patient might need suctioning is:
Gurgling
The skin color that indicates poor circulation is:
Pale
The skin color that indicates inadequate breathing or heart function is:
Cyanotic
For skin to be called clammy it must be:
Cool and moist
When checking pupils, an EMT-B should look for:
Size, equality, and reactivity
In cases of stroke or head injury, the pupils are likely to be:
Unequal
A normal systolic BP for a 40 year old female would be:
130
When deflating the BP cuff, the systolic BP is the:
First sound
High blood pressure is associated with fright, exertionm and emotional distress, but not:
Blood loss
On unstable patients, vital signs are taken every:
5 minutes
In distinguishing signs from symptoms, an example of a symptom would be:
Chest pain
The L in SAMPLE stand for:
Last oral intake