CPR Final
CPR Infant:
- Flick the bottom of the foot to check for response - If alone administer a couple minutes of CPR and then call 911 - Tilt the baby's head to a more neutral position rather than up like an adult - When giving a rescue breath create a seal with your mouth over both the nose and mouth and deliver 2 rescue breaths - Begin CPR after rescue breaths - For compressions use two fingers and 30 quick compressions that are about 1.5 inches deep
Eye:
- Fold a cravat and place the center right over the eyes - Put the criss cross low on the back of the head and then comes back and ties off right over the bridge of the nose and a square knot
What are the signs, symptoms for respiratory distress
- Hard to breath (their breath is shallow, deep, labored, force of breath, they will be gasping - Wheezing sounds, as well as a crackle - breathing is either slow or rapid - hypoxia (restless, irritable, increased heart rate and respiratory rate, pale blue skin and moist, angina, and nausea
List the steps for treating a knocked-out tooth.
- Have victim sit with head tilted forward - Rinse wound with saline solution or tap water - Do not try to put tooth back in the socket - Control bleeding by having victim bite down for 20 to 30 minutes on gauze pad or cotton ball placed over tooth socket - Save tooth - may be re implanted if victim sees dentist - touch only tooth's crown - rinse if dirty - place in container of milk or clean water if no milk is available - Do not clean or scrub tooth - Get victim and tooth to dentist
Unconscious Choking Infant:
- If the chest doesn't rise with rescue breaths the airway could be blocked, raise the head and give another rescue breath if it still doesn't rise assume airway is blocked - Remove the barrier and give 30 chest compressions -Open mouth and if you see an object remove it with your fingers - If you can't retrieve it or see it give two rescue breaths and continue this process until you can see an object, or the chest rises with rescue breaths - If air goes in check for 10 seconds for breaths
Radial Heart rate:
- Put your index finger and middle finger on the inside of the wrist right below your thumb look for the spot between the bone and tendon that will be the radial artery - Once you find the pulse count the beats for 30 seconds and then multiple by 2 to get the heart rate -If the beats are irregular count for the entire minute
List the steps for treating a wound with an imbedded object or facture (open or closed).
- Removing an object could cause more injury and bleeding - Leave it in place and dress wound around or over it - Control bleeding by applying direct pressure at sides of object surrounding the object - Monitor vitals and treat for shock
Infant/Child Unconscious Assessment:
- Same as adult with some slight adjustments - Do not tilt the head as far back for opening the airway, tilt the head back so that the airway is slightly past neutral, tilting it back too far can close off a child's airway - When you check an infant for responsiveness shout, tap the underside of the foot, and tap again - If there is no response simultaneously check for breathing and a pulse, tilt the head so that it is at a neutral position - When checking an infant's pulse maintain an open airway, locate the brachial pulse on the inside of the upper arm, check for breathing and a pulse for at least 5 but no more than 10 seconds
What are the signs and symptoms of cardiac distress (not cardiac arrest)?
-Angina - Discomfort, pressure, pain, tightness or heaviness in the chest, neck, jaw, shoulder, back or arms that lasts for more than 3 minutes or goes away and comes back - Restlessness and irrability - Increased respiratory rate - Increased heart rate - Skin changes (cyanosis, pale, cool or flushed) - Change in consciousness due to hypoxia in brain - Nausea due to hypoxia of brain
What four components are necessary for an infection to occur?
-Pathogen -Quantity -Entry site -direct -indirect - droplet - vector-borne -Susceptibility - innate immunity - adaptive immunity
What is the standard treatment for cardiac distress?
- Activate EMS system/summon AMP - Rest - Loosen clothing and comfort victim -Continue to monitor - Give 2 baby aspirin or 1 adult aspirin (if available and allowed, and if victim does not have allergies, stomach ulcers, taking blood thinners or told not to take aspirin)
List the signs/symptoms of the first stage of shock?
- Axiety, restlessness, fear - Increased breathing and heart rate
Blood Pressure (with stethoscope):
- Before you start make sure you have hand hygiene, privacy to the patient and tell them what you are going to be doing -Ask if they are in pain, rate on a scale of 0-10, ask for quality and location of pain (if applicable) - Take their temperature with one of the following methods (oral, axillary, tympanic, temporal, and rectal), (axillary and temporal the readings are going to be 1 degree lower than oral temperature), (tympanic and rectal the readings are going to be 1 degree higher than oral temperature) - For taking oral temperature have the patient lift up the tongue put the thermometer underneath and put tongue over the probe and hold it until it beeps (normal is 97-99 degrees F) -Then take the oxygen saturation, put device on the nailbed of the finger and the lights will read the oxygen saturation (normal is 95-100%) - Count the heart rate and respirations, count heart rate by either using the radial, brachial, and carotid artery, use two fingers and put it in the groove, count heart rate for 30 seconds if regular and then multiple by 2, if heart rate is irregular count for 1 minute (normal adult heart rate is 60-100 bpm), check for respirations by counting the number of times the chest rises and falls - get the blood pressure, make sure you have the right cuff size, palpate the brachial artery, ask the patient which arm to take it in because you do not want to take it in an arm with blood clots, AV shunts, etc. , have the patient extend their arm out and palpate the brachial artery, place the cuff so that the arrow on the cuff is placed is 1-2 inches above where you felt the brachial artery, two fingers should be able to be placed under the cuff to ensure correct fit, put the stethoscope over the brachial artery, blow the cuff up to about 180-200 mmHg, let needle drop about 2-3 mmHg slowly, listen for the first sound which will be the top number of the blood pressure (systolic), then listen for whenever it stops (diastolic) - when you are done let the patient know the results and hand hygiene
CPR Adult:
- Check the scene and ensure it is safe - Tap the person on the shoulder and as if they are ok and make sure they need help - Either call or ask a bystander to call 911 and have another person go and get an AED - Make sure the person is lying on their back and tilt the head back and lift the chin to open the airway - Place one hand on top of the other in the middle of the chest and push hard and fast at least 2 inches deep - Practice cycles of 30 chest compressions with 2 ventilations, keep an even pace pausing the compressions for less than 10 seconds to provide 2 ventilations - Deliver rescue breaths with the head tilted back and chin lifted pinch the nose and make a seal over the mouth and breath in the mouth until the chest rises - Deliver two rescue breaths and then continue compressions - Keep this process going until the person exhibits signs of life or EMS has arrived
List the signs/symptoms of musculoskeletal injuries.
- DOTS - Bruising or discoloration - Snapping or Grating (Crepitus) sounds - Inability to move/ Numbness/ Tingling - Mechanism of injury
What are the 3 categories of precautions for using an AED safely?
- Don't interfere with the analysis and the shock delivery - Very important to not touch the victim - Electrical shock can ignite substances - Unlikely but do not use alcohol swabs to dry the chest - Use the right pads - Adult pads cannot be used on an infant - Pediatric pads cannot be used on an adult not enough shock
Conscious Choking Adult/Child:
- If the person is forcefully coughing, they are getting air and encourage them to keep coughing - If they can no longer cough or breath have someone call 911 and get consent - 5 back blows and 5 abdominal thrusts - For back blows place one arm across chest and bend person forward at waist so that airways parallel to the ground and with the heel of the hand give 5 back blows in-between the shoulder blades -If that does not clear it give 5 abdominal thrusts, find the naval with two fingers and then make a fist and place thumb side above the naval then grab the fist with your other hand and give 5 quick upper thrusts - Continue this until the person can cough, breath, or speak - If they become unconscious try to help protect the head as they fall to the ground -May need to kneel behind the children to give thrusts and back blows but do not use as much force
Scalp:
- Make a small fold on the long end of the triangular and put it near the eyebrows and have the patient hold it in place and turn them around and behind the head and take the ends and crisscross them low on the head and turn them back around and then tie it in the front of the head right by the eyebrows - Turn them around and hold the forehead so it doesn't slip and pull the point and then tuck into the criss crossed ends
AED Adult:
- Make sure the scene is safe and that the person needs help, have someone call 911 - Check for a pulse and listen for breath by lifting chin up - Turn AED on and follow the audio instructions - Open persons shirt and wipe it dry attach the AED pads one the victim's top left chest and lower right side then plug in the connector - Tell everyone to stand clear and make sure no one is touching the person - Let the AED analyze the heart rhythm and then once the AED says to deliver a shock make sure no one is touching the victim and say stand clear and press the shock button - After the shock begin CPR and continue it
Physical Exam Conscious:
- Make sure the scene is safe and that you are wearing glove, do a head to toe exam - If it is a life-threatening situation that is when you call or get someone to call EMS and bring an AED bag - Introduce yourself to the patient and communicate with them who you are and what you are going to be doing -Ask them if they know what happened, their pain levels, while asking these questions notice their level of movement. Such as if they are nodding or if they are able to move their fingers and toes. - Look for early signs of shock (nervous, rapid heart rate or breathing, anxiousness, sweaty, fearful, clammy skin) - Ask if they can wiggle their toes and fingers - Look at the pupils (if they are dilated or not), look at the breathing and if the patient is still responsive and alert - If at any point the responsive patient goes unresponsive call 911 immediately and activate EMS
List the steps for applying a closed overlapping roller bandage to the forearm.
- Make sure your hands are gloved and use a gauze pad applying direct pressure over the wound for five or more minutes in order to get the bleeding to stop - Once bleeding has stopped keep the gauze in place because it is part of the clot, take off any jewelry or watches because the arm will swell - Using a roller bandage to hold the gauze in place you are going to anchor at the narrowest part of the limb by putting the edge of the bandage towards the wound coming underneath the wrist crossing over the anchor left out and then fold it back into the path and then next time you wrap around it is anchored - Then you are going to do overlapping spirals until it is nice, flat, and neat. Wrap until you have covered the gauze pad by at least 1 inch and tie off over the wound site to apply additional direct pressure - To tie off you need two ends so roll out to a length that would be long enough and go back the way you came and with the two ends and you can make a tie over the wound
List the signs/symptoms of the second stage of shock?
- Mental status continues to deteriorate - Breathing becomes rapid and shallow, and heartbeat is rapid - Skin becomes pale and ashen and cool - Nausea and thirst occur - BP drops - Pupil changes
Conscious Choking Infant:
- Obtain consent from a guardian if present - Do not use as much force - Place infant of forearm and with the infant facing down support the jaw with your fingers - For chest thrusts carefully flip the infant over so that the infant is facing up on the other forearm, put two to three below the nipple line and toward the head give the 5 thrusts about 1.5 inches deep - Make sure infant is supported and head is below chest - Continue until infant can cough, cry, or becomes conscious
1. When would you suspect that a head, neck or back injury has occurred?
- Obvious HNB injury (can see a clear injury to those areas) - Victim presenting signs/ symptoms of HNB injury - DOTS - Pain in HNB - Paralysis of impaired speech - Timgling, weakness - Loss of balance/coordination - Not fully alert or appears intoxicated - Blood/fluid from ears/nose - Seizures - Headache - Nausea/vomiting/incontinence - Combative/aggressive behavior - Impaired breathing without clear cause - Impaired vision or unequal pupil size - Any forceful injury - Collision between car, cycle and pedestrian - Fall from greater than standing height - Any fall for elderly or frail
Pain Assessment:
- Onset - ask the patient what they were doing when the pain started and did the pain happen suddenly or had it been coming on for awhile - Provocation or Palliation - ask the patient what makes the pain worse and what makes it better - Quality - ask the patient to describe the pain to you - Region or Radiation - ask the patient where the pain is located and if it is spreading to or extending to another area - Severity - Ask the patient to rate the pain they are having right now on a scale of 0-10 with 0 being no pain at all and 10 being the worst possible pain imaginable - Timing - Ask the patient what they were doing when the pain started and if the pain is always there or does it come and go. Ask if there is anything different about the pain than when it started and if the pain has ever happened before.
List the steps for treating a suckling chest wound.
- Open wound in chest caused by penetrating injury - Wound lets air move in and out of chest during breathing - Can be life threatening -Summon AMC - Position of comfort - Flutter bandage for suckling chest wound - Emergency Oxygen if available - Treat for shock
Chest:
- Put the point of the triangle bandage over the shoulder and have them hold it there with the good arm and have them turn around and with the wrap a little folded up to come up to the mid chest and tie it off - It is important to tie up right under the point straight down because if you have enough tail you can use the tail to tie off the top of the shoulder if not enough just add another cravat
SAMPLE History:
- Signs or symptoms - ask questions that is going to get the patient to describe in their own words their experiences (traumatic injury or illness) -Allergies - Ask if they have any allergies or medications and write down anything that they have - Medications - write down any prescription medication that the patient has used or is using on a regular daily basis - Past pertinent medical history - Get a complete medical history breakdown of the patient including family member medical history - Last Oral Intake - what was the last thing they had to eat or drink and is it playing a role in the thing they are experiencing today that made them call 911 -Events leading - the events leading up to and preceding the reason they called 911 for, what happened that lead them to call 911, what were the trigger points
List the steps for treating a nose bleed.
- Sit and tilt head forward - Pinch nostrils together for ten minutes - If victim is gasping or choking on blood, call 911 - Place cold compress on bridge of nose - After 10 minutes release pressure slowly, Pinch nostrils closed for 10 more minutes if bleeding continues
Adult Unconscious Assessment:
- Size up the scene and form an initial impression looking for severe life-threatening bleeding - Check for responsiveness for a patient that appears unresponsive by using a shout tap shout sequence -Summon more advanced personal if not already done - If patient is face down, roll the patient onto their back while supporting the head, neck, and back - Open the patients airway and check for breathing and a definite pulse for at least 5, but no more than 10 seconds - Use the head-tilt/chin-lift maneuver to open the airway from the side, from above the patient's head use the jaw-thrust maneuver -feel for carotid pulse by placing two fingers in the groove of the neck closest to you -Provide care based on the conditions found - If the patient is unconscious with no normal breathing or no pulse immediately begin CPR, starting with chest compressions
List the steps for treating an open abdominal wound.
- Summon AMC - Do not touch organs - Cover - Moist dressing - Occlusive plastic dressing - Towel or blanket for warmth - Treat for shock
Shoulder:
- Take the point of the triangle and put it all the way up at the ear so that you have enough triangle to fold over and have them hold the triangle by the ear - Take a cravat and you go from the neck and under the armpit, its got to be snug from the neck to the armpit - Take the point and tuck it under that securing cravat, on the arm you fold it up so its just enough so its above the elbow and then you criss cross under the arm and tie off on the outside
Sling and Binder:
- Tie a knot at the point of the cravat and with the open cravat put it over the hurt injured shoulder over the injured arm and have them hold their arm across their body holding it with the other hand and wrap it over the good shoulder - Tie it off on one side of the neck not on the back of the neck and cover the hand in the sling - The binder is going to go around the body under the armpit where you will tie it off which will keep the arm nice and secure
List the steps for using a tourniquet.
- Use if they have lost a lot of blood and you do not think you can control the bleeding - Works anywhere on the limb can't be used on torso or on the neck - Can use a kit or use a firm piece of fabric or belt (with the fabric you can make a knot and put a rod in the know and turn it to tighten it) you know it is tight enough when the bright bleeding stops - Record time and do not loosen or remove it
AED Child:
- Use pediatric pads if you have them - If it is a small child put the pad on the child's chest and back
AED Infant:
- Use pediatric pads if you have them - Put the pad on the child's chest and back
CPR Child:
- When giving CPR to a child you want to tilt the chin a little less up than the adult - If alone administer a couple minutes of CPR and then call 911 - Begin CPR after rescue breaths
Ear:
- With a cravat put the center over his ear and wrap around the other side of the head at the temple you criss cross the ends and come around the forhead and back of head to tie back over the hurt ear
List the steps for applying a figure 8 roller bandage to the hand/wrist.
- With a gloved hand place a piece of gauze so that it fits over the wound and apply direct pressure until the bleeding stops and make sure the jewelry - Anchor at the wrist, put anchor out and wrap around and anchor back into the path of the roller - Do loops at the wrist and loops of the palm crossing on the side of the hand and going around the wrist continue this rotation until there are enough wraps to cover the bandage completely and it is nice, neat, and flat. - Tie off on top of the wound because there is no fracture, roll out until you have enough and roll back down the way you came and with the two ends tie it off and then tuck the rest into the hand and have them hold it in a fist to apply even more pressure
What information do you need to give the dispatcher when you call 9-1-1?
- Your name and phone number you are using - The location and number of victims
What are the signs and symptoms for respiratory arrest?
- if the breathing has stopped and soon after that the heart will stop
What flow rate should you choose for delivering supplemental oxygen with a nasal cannula?
1 to 6 Lpm
For most emergency care, a child is a victim aged
1-12 years
Chest compressions for an adult should be performed at a rate of about
100 compressions per minute
What is a normal breathing rate for an adult?
12-20 breaths per minute
A normal adult blood pressure is
120/80
What is a normal resting heart rate for an adult?
60-100 beats per minute
If you are alone, you will have to decide whether to call or care first. In which of the following situations should you care first?
A child found unconscious
An irregular tear like wound is called
A laceration
What is a paramedic?
An EMS professional with advanced training
A wound that is superficial and mostly epidermis is called
An abrasion
A complete separation of a body part is called
An amputation
You arrive at the scene of an emergency and complete your primary assessment of the patient. You notice what looks like a bone protruding from an open and bleeding wound on the patient's lower let. Which of the following should you do?
Apply direct pressure around the wound without pushing on the fracture site
To treat mild internal bleeding (bruises) you
Apply ice or cold pack
When used with emergency oxygen, which of the following breathing devices is appropriate for non-breathing victims?
BVM
When placing a blood pressure cuff on a patient's arm, ensure that the bladder of the cuff is centered over which artery?
Brachial
A fracture in which the bone is crushed into multiple pieces is a
Comminuted
As you perform a physical exam, you may use the mnemonic DOTS to help you remember what you are trying to find. DOTS stands for
Deformity, open injury, tenderness and swelling
If there is a fracture to the forearm, which two joints should you immobilize when splinting?
Elbow and wrist
You are providing care to a patient and your assessment reveals that the patient is unstable. As a general rule, you should repeat ongoing assessment at which frequency?
Every 5 minutes
Compression only CPR is just as effective as traditional CPR with rescue breaths
False
A chemical burn to the eye should be cared for by
Flushing the eye with running water until advanced medical personnel arrives
A patient has a suckling chest wound. Which type of dressing should you apply?
Flutter Bandage
Which of the following is the purpose of a secondary assessment?
Further assess signs and symptoms of an injury
Which of the following is not part of the standard care for shock?
Give 10 ounces of fluid every 10 minutes
Shock is another term for
Hypoperfusion (decreased circulation of oxygenated blood)
Why would you choose to put the AED pads in the alternate chest/back position?
If there is an internal pacemaker/ defibrillator place the AED pads at least one or more inches away - If you are using the AED on a child and pediatric pads are not available put the adult pads on the front and back of the child's chest
When using an AED, it is important to prevent anyone from touching the victim because
Touching the victim could interfere with the analysis and they could be injured by the shock
Which of the following statements is true about defibrillation?
It is intended to briefly disrupt abnormal electrical activity
When caring for a victim with a nose bleed, the standard care is to pinch the nose and have the victim
Lean slightly forward
When using an AED, a child is classified as a victim
Less than 8 years or 55 pounds
You need to stabilize a patient's head and neck. The patient's head is turned sharply to the right. Which of the following should you do?
Maintain the head in the position found
Besides calling for advanced medical care, the most important treatment for head, neck and back injuries is
Minimizing movement
To treat severe internal bleeding you should
Monitor vital signs while waiting for advanced medical care
Which of the following airway adjuncts can be used on a responsive victim?
Nasal Airway
The pads of an AED for an adult should be placed-
On the upper right side of the victim's chest and the lower left side
Good Samaritan laws generally protect people from legal liability when providing care in an emergency-
Only if they act in good faith within the scope of their training
You should remove the helmet from a motorcycle victim
Only if you are unable to perform CPR with the helmet on
Which of the following is a primary goal of first aid?
Preventing the victim's condition from getting worse
It is alright to elevate an extremity with a skeletal injury, after you have
Properly immobilize the injury with a splint
It is important to document an exposure to a communicable disease in order to
Receive appropriate follow-up care
In which situation can you stop CPR without being negligent?
Someone else trained in CPR offers to take over.
When splinting an injured body part, you should
Splint the injured part in the position found
A stretching or tearing a ligament or other tissue at a joint is called a
Sprain
As an EMR, you are expected to provide care based on specific criteria. E.g., CPR is performed as cycles of 30 compressions to 2 breaths. This criteria is called-
Standard of care
Which of the following refers to the idea that all body fluids, secretions and excretions should be treated as potentially infective?
Standard/Universal precautions
You are a member of your company's emergency response team. You arrive on the scene and find another co-worker, who is not a professional rescuer, performing CPR. What should you do?
Take over care and reassess the victim
You see a car has crashed into a utility pole. There is an electrical wire on top of the car. There are 2 responsive victims in the car. What should you do?
Tell the victims to stay in the car.
Hypovolemic shock is the result of
There is not enough blood volume
A full-thickness burn that has firm light colored tissue and charring is a
Third degree burn
To treat external bleeding, you should first
Use direct pressure
An abnormal heart rhythm characterized by totally disorganized electrical activity that results in the inability of the heart to pump blood is
Ventricular fibrillation
What is the meaning of the "S" in the SAMPLE history format?
What can you observe about the victim? How does the victim say he or she feels?
After you have cleared the clothing from the patient's chest, you should-
Wipe the victim's chest dry
How do package an amputated body part?
Wrap the body part in a clean dressing, place it in a plastic bag and place the bag on top of some ice
AED electrodes
both monitor the heart's electrical activity and deliver an electric shock to the heart.
A woman in late stages of pregnancy with an airway obstruction should be given
chest thrust rather than abdominal thrusts to expel an obstructing object.
If a victim is unresponsive, you may assume that they want you to provide first aid. This is known as?
implied consent.
When caring for a victim with a lost or broken tooth, the best way to preserve the viability of the tooth is by putting the tooth
in milk
In an infant, the correct hand position for chest compressions is on the breastbone
just below the nipple line.
