Upgrade to remove ads
Only $35.99/year

PARAMEDIC FINAL

Terms in this set (155)

A protocol that is a written document signed by the EMS system's medical director that outlines specific directions, permissions, and sometimes prohibitions regarding patient care that is rendered prior to contacting medical control.
Standing order
If a paramedic transports a patient without the patient's consent or uses restraints in a wrongful manner
False Imprisonment
A treatment plan developed for a specific illness or injury.
Protocol
If you must deviate from your protocols because of unusual circumstances, you should FIRST:
Notify Medical Control
HIPPA mandates that:
Patient information shall not be shared with entities or persons not involved in the care of the patient.
HIPPA Defined:
a. The first standards established to protect the confidentiality of a patient's health information.
b. Medical information can be disclosed only if it is necessary for a patient's treatment or for payment.
c. Special situations such as dog bites, gunshot wounds, and abuse require the release of patient information without the patient's consent.
According to HIPAA, it is acceptable and permissible for hospitals to:
share information with the EMS providers about patient outcome for purposes of quality assurance and education.
Wheezing that is resolved with administration of bronchodilator medication was probably caused by?
constriction of smooth muscles
Wheezing is resolved with medications that?
Relax the smooth muscle of the bronchiole
Difficulty with exhalation is MOST characteristic of:
obstructive lung disease
COPD: Emphysema:
Characterized by distention of the alveoli and destructive changes in the lungs.
COPD: Chronic Bronchitis:
Defined as sputum production most days of month for 3 or more months out of year for more than 2 years. Will rarely have normal oxygen saturation; (maybe less than 90%). May have another condition, including respiratory conditions
A 66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient's wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient's respiratory distress?
Recent antitussive use
A 76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to?
place her in a position that facilitates breathing.
Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT:
a decreased expiratory phase
Chronic obstructive pulmonary disease (COPD) is characterized by:
changes in pulmonary structure and function that are progressive and irreversible
The hypoxic drive is a phenomenon in which
bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance
Pulmonary Embolism Characteristics
Sudden dyspnea & cyanosis, and perhaps, a sharp pain in the chest. A hallmark of pulmonary embolism is that the cyanosis does not resolve with oxygen therapy.
You are dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient's clinical presentation, you should be MOST suspicious for:
acute pulmonary embolism
One of the hallmarks of a pulmonary embolism is:
cyanosis that does not resolve with oxygen therapy.
Paradoxial Respiratory Movement is
the inward movement of a segment of the chest during inhalation and a outward movement of the chest during exhalation, opposite normal chest movement and a indication of flail chest.
Paradoxical respiratory movement is characterized by:
the epigastrium and thorax moving in opposite directions
Cor pulmonale is defined as:
right heart failure secondary to chronic lung disease
Right Side Heart Failure Characteristics: .
(pg. 1020)-Distention with external jugular veins, Serum forced out producing edema (feet and/or lower back), right upper quadrant swelling (hepatomegaly, eg. Liver), abdominal distention, (eg, Ascites),end enspiratory crackles, a progressive increase in dyspnea over several days, greater than usual fluid intake, and improper use of diuretics
An elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a "water pill" and Vasotec for high blood pressure. You should:
suspect acute right heart failure and administer oxygen.
Hepatomegaly and jugular venous distention are MOST suggestive of:
right heart failure
The movement of a solute from an area of higher concentration to an area of lower concentration is called:
diffusion
Osmosis occurs when:
water moves from an area of lower solute concentration to an area of higher solute concentration.
What is filtration? .
Filtration is a process within the body, similar to osmosis that is used to redistribute water and other particles. High pressure to low pressure
Any cell that ingests microorganisms or other cells is called a:
phagocyte
Phagocytosis is the process by which:
monocytes digest microbes
Group of cells make up _______________?
Tissues
Which of the following structures comprise different types of tissues that work together to perform a particular function?
Organs
The middle muscular layer of the heart is called the:
myocardium
Which layer of the heart would be penetrated during an emergent medical procedure in order to remove fluid?
Pericardium
The thick fibrous membrane that surrounds the heart is called the:
pericardium
The most inferior portion of the heart is called the:
apex
3 layers of the Heart wall
inner-indocardium
mid-myocardium
out-pericardium
The __________ represents the end of ventricular depolarization and the beginning of repolarization.
J point
The Q-T interval would MOST likely be prolonged in patients:
Who are hypocalcemia
The atrioventricular valves of the heart include the:
tricuspid and mitral
What prevents the backflow of blood during ventricular contraction?
Atrioventricular valve
Cardiac output is dependent upon:
stroke volume and heart rate.
know about cardiac out put:
the amount of blood pumped out by either ventricle, normal 5-6 L/M
Changes in cardiac contractility may be induced by medications that have a positive or negative ___ effect.
Inotropic
The Mitral Valve is:
(left) is located on the higher-pressure side of the heart.
Atrial Kick is most accurately defined as:
20% of ventricular filling caused by atrial contraction.
A wide QRS complex that is preceded by a normal P wave indicates:
an abnormality in ventricular conduction.
The inferior wall of the left ventricle is supplied by the:
right coronary artery
The right atrium, right ventricles, and part of the left ventricle are supplied by:
the Right coronary artery
If the R-R interval spans more than ____ large boxes on the ECG graph paper, the rate is less than 60 beats/min.
5
Unlike the parasympathetic nervous system, the sympathetic nervous system:
provides a mechanism for the body to adapt to changing demands.
Under normal conditions, the strength of the cardiac contraction is regulated by:
The nervous system
The circumflex branch of the left coronary artery supplies the _________ wall of the left ventricle.
Lateral
The Left main coronary artery branches into:
The circumflex and the left anterior descending arteries
The left main coronary artery subdivides into the:
Left anterior descending and circumflex arteries
In contrast to arteries, veins:
are more likely to distend when exposed to backpressure.
How many large boxes on the ECG graph paper represent 6-seconds:
30
Chronotropic effect :
Influences heart rate. For example, a drug with a positive chronotropic effect would speed up the heart rate
Administering a drug that possesses a positive chronotropic effect will have direct effect on:
The heart rate
A medication that possesses a negative chronotropic effect will:
Cause a decrease in the heart rate
In contrast to the right side of the heart, the left side of the heart:
Drives blood out of the heart against the relatively high resistance of the systemic circulation
Once an advanced airway device has been inserted into a cardiac arrest patient:
ventilations are delivered at a rate of 8 to 10 breaths/min.
The appropriate dosing regimen for epinephrine in cardiac arrest is:
1 mg of a 1:10,000 solution every 3 to 5 minutes.
You have restored spontaneous circulation in a 54-year-old man who was in ventricular fibrillation. During the arrest interval, you delivered 2 shocks, 1 mg of epinephrine, and 300 mg of amiodarone. The patient's blood pressure is 96/60 mm Hg and the cardiac monitor displays a sinus rhythm at a rate of 70 beats/min with frequent premature ventricular complexes. Appropriate post-resuscitation care for this patient :
an infusion of amiodarone.
In addition to IV fluids, treatment for a patient in neurogenic shock may include:
amiodarone
What is the approximate maximum dose of lidocaine for a 200-pound patient?
275 mg
Following return of spontaneous circulation, you are ordered to begin a lidocaine infusion at 3 mg/min on your 50-year-old patient. You add 2 g of lidocaine to a 500 mL bag of normal saline and are using a microdrip administration set. At how many drops per minute (gtts/min) will you set the IV flow rate?
45
Electrical capture during transcutaneous pacing is characterized by:
A pacemaker spike followed by a wide QRS complex
The recommended first-line treatment for third-degree heart block associated with bradycardia is:
transcutaneous pacing.
Which of the following factors would present the GREATEST difficulty when distinguishing supraventricular tachycardia from ventricular tachycardia?
Aberrant conduction
Atherosclerosis is a process in which:
plaque infiltrates the arterial wall, decreasing its elasticity and narrowing its lumen.
You have just administered 0.4 mg of sublingual nitroglycerin to a 60-year-old woman with severe chest pain. The patient is receiving high-flow oxygen and has an IV line of normal saline in place. After 5 minutes, the patient states that the pain has not subsided. You should:
Reassess her BP
A 25-year-old woman presents with acute abdominal pain and vaginal bleeding. She tells you that she has soaked eight high-absorbency tampons in the past 2 hours. Approximately how much blood has she lost externally?
160 mL
You are dispatched to a residence for a 34-year-old woman who is "sick." Upon your arrival, the patient greets you at the door. She states that she recently had her menstrual period, which was accompanied by more pain than usual. Her vital signs are stable, she is conscious and alert, and denies vaginal bleeding or fever. This patient MOST likely has?
a ruptured ovarian cyst
The Candida albicansfungus is the causative agent in:
vaginal yeast infections
In contrast to endometritis, endometriosis?
may present without abdominal pain
Which of the following would you MOST likely observe in a newborn with hemolytic disease?
Jaundice
An immature egg is called an:
oocyte
The uterine fundus is measure:
vertically from the top of the pubic bone to the top of the fundus.
A spontaneous abortion:
occurs naturally and may or may not have an identifiable cause.
.
If a woman is gravida 3 and para 2:
she has delivered two babies, but was pregnant 3 times
A woman has been pregnant three times, has had two spontaneous abortions, and has carried one baby to term. You should document her obstetric history as:
G3A2P1
During the second stage of labor:
contractions become more intense and more frequent.
You are dispatched to the parking lot of a shopping mall for a pregnant woman with severe vomiting. When you arrive and assess the patient, she tells you that she is 26 weeks pregnant and that this is her first child. She further tells you that her normal morning sickness nausea became worse 3 days ago and that she has vomited numerous times since then; she also noticed small amounts of blood in her vomitus. Her blood pressure is 94/60 mm Hg, pulse rate is 124 beats/min and weak, and respirations are 22 breaths/min and regular. After loading the woman in the ambulance and placing her on her left side, you should: suspect hyperemesis gravidarum, administer high-flow oxygen, start a large-bore IV and give a 250-mL normal saline bolus, assess her blood sugar and cardiac rhythm, consider administering diphenhydramine if protocols allow, and transport promptly.
suspect hyperemesis gravidarum, administer high-flow oxygen, start a large-bore IV and give a 250-mL normal saline bolus, assess her blood sugar and cardiac rhythm, consider administering diphenhydramine if protocols allow, and transport promptly.
A woman is in the second stage of labor when:
she feels a strong urge to move her bowels.
Women who experience hyperemesis gravidarum:
have persistent nausea and vomiting throughout pregnancy that often causes dehydration and malnutrition.
In pregnancy, magnesium sulfate is used principally for?
eclamptic seizures
What is the corpus luteum?
Remnants of the follicle after the egg has been released
What is the primary source of heat production for the newborn?
Nonshivering thermogenesis.
What would be the correct fluid bolus amount for a neonate weighing 6.6 lb?
66 Ml (10ml/kg)
Average gestation of newborn;
A newborn born between ___ and ___ weeks of gestation is described as term. 38, 42
Unlike the prenatal period, the gestational period:
is 38 weeks in duration
If hypovolemia is suspected or confirmed, you should administer ____ mL of normal saline to a 6-pound newborn over a period of ____.
27, 5 to 10 minutes
A 7pound newborn is dehydrated. How much fluid do you need to give:
7* 2.2 = 32 ml
Infants and children in shock:
Compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.
Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?
QRS complex width
Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by:
an unvarying pulse rate.
Retractions of the sternum or ribs during inhalation:
are especially common in infants and small children.
A 6 year old child has burns to his head, face, neck and anterior chest. What % his body surface area has been burned?
21%
When assessing a hemodynamically stable child, the toe-to-head approach is generally indicated for children who are:
1 to 3 years of age.
Medications used to prevent an asthma attack include:
inhaled steroids.
A child who is experiencing a moderate asthma attack would MOST likely present with:
wheezing during inspiration and expiration.
Initial treatment of Croup:
Swelling can occur rapidly and obstruct the airway, therefore... Avoid manipulating the airway unless absolutely necessary. Ventilations is usually possible with careful bag-mask technique
You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mother's lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should:
allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital.
.
Which of the following statements regarding croup is correct?
Croup is a viral upper airway infection that may cause stridor
You should be MOST suspicious for child abuse when caring for an injured 4-year-old child if:
there was an unusual delay in calling 9-1-1.
Which of the following injury patterns is MOST suggestive of child abuse?
Bruises on the abdomen
Which of the following behaviors or actions should make you the MOST suspicious that a caregiver has abused his or her child?
Offering unsolicited explanations for abnormal physical exam findings
EMS providers can be MOST effective in helping reduce the incidence of suicide, domestic violence, and child abuse by?
noting risk factors at the scene and reporting data
A child in anaphylactic shock:
May require a low dose of a epinephrine infusion
A typical finding for a foreign body aspiration is:
an afebrile child with a sudden onset of coughing or gagging while playing.
A foreign-body airway obstruction should be suspected in a child who presents with:
acute respiratory distress without fever.
Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm?
Ipratropium, 0.5 mg nebulized
Initial drug for bradycardia in child is?
Epinephrine is indicated during newborn resuscitation if: the heart rate remains below 60 beats/min after 30 seconds of effective ventilation and an additional 30 seconds of chest compressions
When evaluating a child's oxygen saturation level with a pulse oximeter:
it should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment.
A child's vocal cords can be difficult to visualize during intubation because:
Epiglottis is floppy and U shaped
First-degree heart block in children:
is typically asymptomatic and does not require special treatment
When an infant or child is in respiratory failure:
he or she can no longer compensate, which causes hypoxia and hypercarbia.
A sick or injured child's general appearance is MOST reflective of:
his or her central nervous system function
Distributive shock in children is MOST often the result of:
sepsis
Early distributive shock in children is characterized by:
warm, flushed skin
The pediatric assessment triangle was designed to:
help EMS providers form a hands-off general impression of an ill child.
In contrast to a child with pulmonary edema secondary to congestive heart failure, the respirations of a hypercarbic child without pulmonary edema would MOST likely be:
tachypneic and without retractions
Triage and emergency medical treatment should be performed:
in the cold zone.
What level of personal protective equipment is typically worn by the hazardous materials decontamination team in the warm zone?
Level B
When a base substance is placed on a burn caused by an acid:
Heat is generated as a by-product of the reaction
Signs and symptoms of nerve agent exposure include all of the following, EXCEPT:
tachycardia
The seizures associated with nerve agent exposure:
will continue until a MARK 1 antidote is administered
You are dispatched to a residence for a 50-year-old woman with respiratory distress. While you are assessing the patient, she tells you that she began experiencing flulike symptoms 4 days ago, shortly after delivering mail on the rural mail route for which she is responsible. Due to her illness, she has been unable to return to work. Her blood pressure is 90/50 mm Hg, pulse rate is 120 beats/min, and respirations are 26 breaths/min and labored. Auscultation of her breath sounds reveals the presence of coarse crackles. This patient has MOST likely been exposed to:
anthrax
Anthrax is a bacterium that:
lies dormant in a space and is released when exposed to the optimal temp and moisture
Although __________ anthrax is the most deadly, __________ anthrax is the only form that is communicable.
pulmonary, cutaneous
What type of injuries will MOST likely occur if a passenger is wearing his or her lap belt above the pelvic bone during a frontal impact?
Abdominal and lumbar spine
You receive a call to a residence for a patient who is "sick." Upon arriving at the scene, you find the patient, a 39-year-old woman, lying on the couch with a wet washcloth on her forehead. She is conscious and alert, and tells you that she has had several episodes of diarrhea and noticed bright red blood in her stool. Her pulse rate is rapid and weak, her skin is cool and clammy, and her blood pressure is 98/58 mm Hg. Her medical history is significant for hemophilia, for which she is receiving factor VIII therapy. As you pull out a nonrebreathing mask, she tells you that her husband will be home in a few hours and that he will take her to the hospital. You should:
advise her that her condition dictates immediate transport to the hospital and that delaying transport could result in death.
A young woman attempted to commit suicide by cutting her wrist. Bright red blood is spurting from the injury site. Despite direct pressure and a pressure dressing, the wound continues to bleed heavily. You should:
apply a tourniquet between her elbow and wrist.
According to the rule of nines, an adult man with partial- and full-thickness burns to his head, face, and anterior chest has burns to ____% of his total body surface area.
18
The MOST important prehospital treatment intervention for a patient with carbon monoxide poisoning is:
High flow oxygen
The LEAST common sign or symptom of carbon monoxide toxicity is:
Cherry red skin color
_______________ binds to red blood cells and prevents them from transporting oxygen to all parts of the body.
Carbon monoxide
The application of ice to partial-thickness burns:
Can exacerbate tissue injury and should be avoided
Patients suspected of having burns to the upper airway will benefit MOST from:
cool, humidified oxygen.
If a knife is impaled in the neck:
a cricothyrotomy may be required to establish a patent airway.
Proper treatment for an open wound to the neck includes:
Sealing it with an occlusive dressing
Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of:
parasympathetic nervous system stimulation due to excessive pressure on the carotid artery
A complete spinal cord injury to the upper cervical spine:
will result in permanent loss of all cord-mediated functions below the level of the injury.
At what age do the sutures of the skull solidify and the fontanelles close?
18 months
Hyperacute pain to touch is called:
Hyperesthesia
Which of the following organs/structures lie(s) in the retroperitoneal space of the abdomen?
Kidneys
The MOST important aspect in the care of a woman with severe vaginal bleeding is:
treating for shock and transporting rapidly.
You are dispatched to a grocery store for a woman with severe abdominal pain. When you arrive, you find the patient lying on her side in the manager's office. She is confused, diaphoretic, and appears to be bleeding from her vagina. Her blood pressure is low, and her pulse and respiratory rates are elevated. You should?
apply high-flow oxygen, visually inspect her vagina and cover it with sterile dressings, keep her warm, begin transport, establish at least one large-bore IV en route, and administer enough crystalloid fluid to maintain radial pulses
You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient's chances of survival?
Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed in route
What is an indirect injury:
Occurs when force is applied to one region of the body but causes an injury in another region of the body.
Secondary brain injury can occur
anywhere from a few minutes to several days following the initial injury.
A patient with a GCS score of 8 or less:
may require definitive airway control.
A common cause of intrarenal acute renal failure is:
type 1 diabetes
Students also viewed