NREMT Exam

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Which of the following is considered a tertiary blast injury?

injuries due to being hurled into a stationary object or by the blast onto environmental surfaces or other debris, causing fractures, traumatic amputations, and close/open brain injury -blast injuries may occur in mines, shipyards, chemical plants, on the battlefield, and through terrorist activities.

Avulsion

injury that separates various layers of soft tissue, typically between the subcutaneous layer and fascia; separation may be complete or having remaining issue hanging as a flap

Renal calculi

kidney stones. If a stone blocks a ureter, pressure will build up behind the stone and the kidney will swell.

Dissecting Aortic Aneurysm

Disparity of Bp between the upper extremities

Complilcations from improper compressions

Frac. ribs or sternum and a lacerated liver

Hematoma

Blood that has collected w/in damaged tissue or in a body cavity

Appendicitis

Inflammation of the appendix, R lower quad pain and rebound tenderness are common -Nausea and vomiting are likely

Male with blunt force chest injury that has S/S of shock

Supine position with cervical spine immobilization

Bleeding Ulcer

-Abdominal pain, clammy feeling, tachycardia, hypotension & hematemisis -an ulcer that is deep enough to affect the capillaries

Which of the following is the most common cause of brain injury?

-Motor vehicle crashes Brain injuries can be caused by penetrating objects (e.g., bullet, knife) or as a result of external forces exerted on the skull. The most common cause of brain injuries in the US, motor vehicle collisions, account for approximately 50% of all TBIs. "Coup" (pronounced "koo") contusions occur at the area of direct impact to the skull and occur because of the creation of negative pressure when the skull, distorted at the site of impact, returns to its normal shape. "Contrecoup" (pronounced, "kontra-koo") contusions are similar to coup contusions but are located opposite the site of direct impact. Cavitation in the brain, from negative pressure due to translational acceleration impacts from inertial loading, may cause contrecoup contusions as the skull and dura matter start to accelerate before the brain on initial impact. Alternate reasons for brain injury include other traumatic causes (e.g., blast injuries), blood clots or hemorrhages.

How long should one suction for?

-Suction during w/drawl for no more than 15 seconds -suctioning removeds o2 and can result in hpoxia. it is important to insert the catheter no further than can be visualized and to suction during w/drawl for no more than 15 seconds for adults 10 seconds for cildren and 5 seconds for infants -suctioning unit should have at least 300 mmhg of vacuum pressure

Patients for whom immoblization with a backboard is appropriate include

-blunt trauma and ALOC -spinal pain/ tenderness -neurologic complain ( numbness or motor weakness) -anatomic deformity of spine -high-energy mechansim of injury and drug/ OH intox, inability to commun., distracting injury patients with penetrating trauma to the head, neck or torso and no evidence of spinal injury SHOULD NOT be immoblizied on the backboard

erythrocytes (red blood cells)

-carbon monoxoide has a higher affinity for RBC than oxygen in normal circumstances

How long after birth should a newborn infant start to breath spontaneously?

-fifteen to thirty seconds -An infant should begin breathing spontaneously w/in 15 to 30 seconds after birth. If respirations are not observed (or crying is not heard) gently tap or flick teh soles of the newborn's feet or rub the back to stimulate breathing

Which of the following may indicate that a pt's tidal volume is inadequate

-inadequate chest rise/fall during breathing -tidal volume: defined as the amt of air that moves in or out of the lungs during one breath. An inadequate rise/fall of the chest during breathing would suggest a decrease in the volume of air being inhaled/exhaled

Chemical that overstimulates the parasympathetic nervous system (organophosphate poisoning)

-increase salivation, bronchorrhea, bronchospasm, sweating, abd pain, diarrhea, miosis, muscle paralysis, and brady -pt dies from asystole

in infants and children, what does drawing in of the intercostal or substernal muscles during inspiriation commonly indicate?

-increased work of breathing -in children, increased work of breathing may present as grunting/ wheezing, accessory muscle use, retractions (drawing in of the intercostal or substernal muscles during inspriation), head bobbing, nasal flaring, tachypnea, or the tripod position, ensure a patent airway and supplemental oxygen or assisted ventilation, as indicated, in these patients. this breathing is not adequate but is not shallow either -Apnea: absence of spontaneous breathing

Mechanism of injury: Quaternary type

-independent of primary or secondary or tertiary blast injury and result in burns, crush injuries with thabdomyolsis and compartment syndrome, respiratory tract injury from inhaled toxicants, asthma, angina, or MI triggered by the event

How should you treate amputated hand?

-warp the hand in a sterile dressing, then place in a dry plastic bag, keeping it cool -Amputated parts should be placed in a dry/ moist (depending on local protocol) sterile dressing, placed in a dry plastic bag and kept in a cool contained. It is not appropiate to soak an amputated part in water or allow it to freeze

How long can the brain be deprived of oxygen before developing irreversible brain damage?

4-6 minutes

When providing assisted ventilations via a bag-valve mask, what is the approximate tidal volume given that will cause a noticeable rise of an adult patient's chest?

600ml -An adult bag-valve mask has a volume capacity of between 1,200 and 1,600 mL. When providing assisted ventilations via a bag-valve mask, one should aim to squeeze the bag to cause a noticeable rise of the patient's chest. The approximate volume that causes this is about 600 mL (approximately six to seven mL/kg) provided over one second. This amount of tidal volume helps reduce the risk of gastric distension.

At what level must a pt's systolic bp be in order to find a palpable radial pulse?

90mmHg if palpable femoral then at least 80 mmHg then if palpable carotid then at least 70 mmHg for systolic

Which of the following patients should be placed on high-flow oxygen via a nonrebreather mask?

A 65-year-old man with a respiratory rate of 18 breaths per minute, exhibiting restlessness and tachycardia Restlessness, irritability, apprehension, tachycardia, and anxiety are early signs of hypoxia. Late signs of hypoxia include altered mental status, a weak/thready pulse, and cyanosis. A nonrebreather mask should be used in patients with adequate breathing but who are suspected of or showing signs of hypoxia. A patient in severe respiratory distress/failure requires assisted ventilation such as with a bag-valve mask. Signs of respiratory distress include tachypnea/bradypnea, irregular rhythm, diminished or noisy breath sounds, reduced air flow, unequal/inadequate chest expansion, use of accessory muscles, shallow depth, retractions, or skin that is pale, cyanotic, cool, or moist. A 40-year-old man with a respiratory rate of 36 is in respiratory distress and requires assisted ventilation. A 50-year-old man with bradypnea is not adequately ventilating and needs assistance with a BVM. 8bpm and cyanosis

Basilar skull fracture

A basilar skull fracture is associated with high-energy trauma and occurs following diffuse impact to the head. Signs and symptoms include cerebrospinal fluid (CSF) draining from the ears, "raccoon eyes" or a Battle sign (ecchymosis behind one ear over the mastoid process). Patients with leaking CSF are at risk for bacterial meningitis. These symptoms may not occur until 24 hours after the inciden

Aneurysm

A bluging of the endothelium through a weakened area in the wall of a blood vessel, resulting in an abnormal widening or balloning of an artery (more common) or vein

Platysma

A broad sheet of muscle fibers extending from the collarbone to the angle of the jaw

Morality

A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

Concussion

A concussion is a mild traumatic brain injury, leading to impairment of brain function without overt hemorrhage or gross lesion, and results in a GCS score of 14 or 15. Signs and symptoms include confusion and alterations in consciousness. The patient may refer to the incident in terms of having had their "bell rung" or "seeing stars." The presence of vomiting, headache, loss of consciousness, focal neurologic deficit, or a dangerous mechanism of injury indicate increased risk for serious injury.

Epilepsy

A congenital seizure disorder, first seizure can occur at any time throughout life

Which of the following physical findings would be most indicative of a pt with suspected pleural effusion?

A decrease in breath sounds -Plueral effusion: is the collection of fluid around the lung (s). Common causes include irriation, infection, congestive heart failure, and cancer. The fluid can build up over days or weeks. The fluid can compress the lungs, causing dyspnea. Breath sounds may be decreased over the affected region. pts. often feel better if they are sitting upright. The fluid should be removed in a hospital setting. Oxygen should be provided during rapid transport. -Crackles are wet, crackling breath sounds, heard on inhalation and exhalation. They are suggestive of fluid w/in the lungs

What is the definition of ischemia?

A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow -absence of oxygen to body tissue; this lack of oxygen is commonly the result of a partial or complete blockage of blood flow. Permanent injury is possible depending on the length of ischemia

Preferred method for defib of an infant (age 1-12 months)

A manual defib but if unavailable an Aed with pediatric dose attenuator if that also unavail then an adult-sized AED may be used. For peds under 8 years old, an AED equipped with a ped dose attenuator is preffered then adult

Hemiparesis

A patient who has experienced a stroke or is in the postictal state may present with hemiparesis, a weakness on one side of the body.

Urticaria

A round rash, red welts ont he skin that itch intensely, sometimes with dangerous swelling, caused by an allergic reaction, typically to specific foods

urticaria

A skin rash triggered by a reaction to food, medicine, or other irritants.

Which of the following best describes the epiglottis?

A thin, leaf-shaped valve that allows air to pass into the trachea but prevents food and liquid from entering The trachea is the main trunk for air passing to and from the lungs. The glottis is the space in between the vocal cords that is the narrowest portion of the adult's airway. The larynx is where the upper airway ends and the lower airway begins. It is a complex structure formed by many independent cartilaginous structures that all work together.

Which of the following is not commonly seein in new-onset type 1 diabetes mellitus? A. Polypharmacy B. Polyuria C. Polydipsia D. Polyphagia

A. Type 1 diabetes mellitus is an autoimmue disorder where antibodies are created against pancreatic beta cells. Insulin is subsequently inadeq. or absent. Symptoms: Polyuria (increased urination), Polydipsia (increased fluid intake due to thirst), polyphagia (increased food intake due to hunger), fatigue and weight loss. External insulin use (injectable insulin) is required for survival in patients who have autoimmune diabetes mellitus Polypharmacy is the use of multiple medications by a patient

Postictial State

ALOC following seizure, commonly around 5-30 minutes; charc by lethargy, drowsiness, confusion, nausea, HPTN, headache, signs of disorient -most sz affected pt will be in postictal state upon EMS arrival... ensure a patent airway via pt positioning, clearing of secretions, and precention of aspirations is vital to obtaining the best pt outcome!

You are on scene with a choking adult male who is unable to speak or cough. When performing the Heimlich maneuver, where should you deliver the inward and upward thrusts?

Above the umbilicus and below the xiphoid process

Which of the following has the least level of suspicion for a fracture?

Absent peripheral pulses -Weak or absent peripheral pulses indicate decreased perfusion to the affected area; this may be due to a cardiovascular condition or shock, and not necessarily due to a fracture. -Crepitus (a grating or grinding sensation), false motion (free movement in a limb where no joint exists) and defromity (shortened, rotated or angulated where no joint exists) are all commonly seen in fractures

an adult male has a partially obstructed airway. bystanders state he is choking on pizza. the pt is slightly cyanotic aroudn the mouth, nose and nailbeds. Decreased breath sounds and stridor are noted. He is still managing to move air and cough. The obstruction is not visualized. Which of the following is the most appropriate next step>

Administer high-flow oxygen and rapidly transport -wheezing, stridor and coughing ar commonly heard in pts with a mild/partial airway obstructor. A partial airway obstruction pt should be monitored for adequate oxygenation and progression of the obstruction. Pts. with a partial airway obstruction and poor air exchange may present wiht an ineffective cough, stridor, increase difficulty breathing and cyanosis. if the obstruction is visible, use a gloved index finger to sweep it forward and remove it from the mouth. suction may be used to assist w/ this procedure as well as to maintain a clear airway. if obstruction is not visible and air exchange is adequate, administer oxygen and rapdily transport -A pt. with poor air exchange should be treated as if he or she has a severe airway obstruction. severe airway obstruction pts. will be unable to breathe, talk or cough; cyanosis and extreme difficulty breathing are common. opening the airway and performing abdominal thrusts are appropiate for a severe airway obstruction. Do not attempt to remove a foreign body if it is unable to be visualized

Ventilation Rate

Adult= 1 breath ever 5-6 seconds Child= 1 breath every 3-5 seconds (12-20 bpm) CPR should be initiated on a child without a palpable pulse or pulse less than 60 bpm

Adventitious breath sounds

Adventitious breath sounds are abnormal sounds such as crackles or rales, wheezes or rhonchi, pleural rubs or stridor.

Complication specific to burns of the airway and most other external burns?

Airway obstruction, all burns increase the potential risk of infection, hypothermia, hypovolemia, and shock -A burn to the airway could potentially lead to an airway obstruction due to swelling of mucosa in the airway; obsturciton will compromise breathing -Circumferential burns of the chest can compromise breathing, as well and can lead to compartment syndrome

Arteriovenous shunts

Allow a bypass of blood to flow past a capillary bed, should a backup of cells exist prior to the capillary -noted that blood cells flowing through the arteriovenous shunt do not offload their oxygen, and may require several passes throughout these shunts in order to reach the true capillaries

Ulnar artery

Along with radial artery is located in the distal forearm and the wrist and suppllies blood to the hand

Where do o2 and co2 exchange take place in the repsiratory system?

Alveoli The respiratory system is divided into two zones: the conduction zone (transport of gases to/from the atm) and the respiratory zone -inspired air passes through the trachea, which divides at the carina into two mainstem bronchi, then 23 bifurcations of bronchioles, leading to the termainl bronchioles (all apart of the conduction zone), then the respiratory bronchioles and alveoli (resp. zone), where gas exchange occurs -Co2 in the blood passes into the lungs through the alveoli; o2 in the lungs passes through the alveoli into the blood

Aortic Dissection

An aortic dissection is a medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears. It's most common in men in their 60s and 70s. Symptoms include sudden, severe chest or upper back pain that radiates to the neck or down the back, loss of consciousness, and shortness of breath. Treatment may include surgery and medication, such as beta blockers.

Angina Pectoris

Angina (angina pectoris), a component of acute coronary syndrome (ACS), has a wide range of clinical expressions. The symptoms are substernal chest pressure or tightening, frequently with radiating pain to the arms, shoulders, or jaw. The symptoms may also be associated with shortness of breath, nausea, or diaphoresis. Symptoms stem from inadequate oxygen delivery to myocardial tissue. There are no definitive diagnostic tools that capture all patients with angina pectoris. Use of terms like "stable" and "unstable" relate to change in frequency of symptoms or precipitating activity.

Angina Pectoris and an AMI are indistinguishable in the prehospital setting

Angina Pectoris, temporary chest pain associated with acute coronary syndrome, and an acute myocardial infarction (AMI), presents w/ similar s/s in the prehospital setting -Both have ches pain/ discomfort that is typically described as feeling of pressure or heaviness, that can radiate to the jaw, arms, epigastirum, or back; shortness of breath, sweating, and nausea Pain with angina pectoris typically resolves w/in 3-8 minutes while pain with AMI may last several hours Pain from both may or may not be resolved with rest &/or nitro -AMI is a more serious condition, it should be assumed in all nontraumatic pts with chest pain/discomfort until ruled out by a physician Not all myocardial infarctions present with electrocardiogram changes. Physicians evaluation and blood analysis is required to definitely diagnose an AMI

Which of the following is responsible for carrying oxygenated blood away from the heart?

Aorta -oxy blood is pumped from the left ventricle of the heart to the body via the aorta -deoxy blood flows back from teh body to the heart via the superior and inferior vena cavae then flows through the right atria, to the right ventricle, and then to the lungs via the pulmonary artery -oxy blood returns from the lungs to the left atria via pulmonary vein

Pulmonary Embolism

Arises from a thrombi that orginate in the deep venous system of the lower extremities ( a DVT) and travel to the lung, where large thrombi can lodge at the bifurcation of the main pulmonary artery or the lobar branches and cause significatn, life threatening hemodynamic compromise Classic presentation includes abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia

Ataxic Respirations

Ataxic respirations are those without an identifiable pattern.

Where should automated external defibrillator (AED) pads be placed on a patient with a pacemaker?

Automated implanted cardioverter-defibrillators (AICDs) or pacemakers are used in patients who are at high risk for cardiac dysrhythmias/arrest. The devices will be easy to recognize as they create a hard lump just beneath the skin, typically on the upper left side of the chest just below the clavicle. AED pads should never be placed over such devices, as the shock from the AED will not likely be effective and the implant may be damaged; AED pads should be placed at least one inch (2.5 cm) away from the device. If the device shocks the patient during resuscitation, CPR should be continued for another 30-60 seconds before delivering a shock via an AED.

Occlusion

Blockage, as in a tubular structure like a blood vessel -complete occlusion occurs in a blood vessel, perfusion may be restricted, causing ischemia, which can lead to infarction

28-year-old pt who has sustained a closed head injury and has a GCS of 7. which of the following findings would indicate an increased intracranial pressure?

Bradycardia -ICP (intracranial pressure) is increased by the accumulation of blood w/in the skull or swelling of the brain. As ICP increases, blood pressure must also rise, otherwise cerebral ischemia wil result. Prompt regonition of ICP is critical. -irregular breathing (cheyne-strokes), bradycardia, widened pulse pressure, headache, nausea, vomiting, alt. mental status, sluggish or absent pupillary response, and decebrate posturing are all indications of possible ICP -the traid of increase systolic blood pressure, bradycardia, and irregular respirations is called Cushing's triad and signified increased ICP

Ecchymosis

Buildup of blood in the dermis that causes a characteristic blue or black discoloration -contusion, or bruise is an injury that occurs w/in the dermis when the epidermis remains intact

Burning Chest Pain

Burning chest pain (heartburn) is commonly due to gastroesophageal reflux disease (GERD).

Heart Burn

Burning chest pain (heartburn) is commonly due to gastroesophageal reflux disease (GERD).

Full thickness burn

Burns extend through all skin layers and may involve the subcutaneous tissue, muscle, bone, or internal organs -skin is dry and leathery and may appear white, dark, brown, or even charred -Some can be hard to touch; if nerve endings are destroyed, the severely burned section may not have sensation, while the surrounding area is extremely painful

Which of the following should not be treated with a manually triggered ventillation device?

COPD, pts with suspected cervical spine or suspected chest injury -manually triggered ventillation device is also known as a flow-restricted, oxygen-powered ventillation device, is used for providing artifical ventilations Major adv. of this device is the ability of a single rescuer to use both hands to maintain a mask to face seal - may be considered for the management of pts. who do not have an adv. airway in place and whom a mask is being used for ventilation during CPR Rescuers should avoid using the automatic mode of the o2-powered flow- limited resuscitator bc it applies continuous PEEP that is likely to impede cardiac output during chest compressions -device is associated with high gastric distention and possible damage to structures w/in chest cavity -Additional training is required for use of this device with infants and children

Chronic renal failure

Can occur due to long-standing diabetes and hypertension -irreversible progresses over months and years kidney begins atrophy and function diminishes symptoms if untreated: alt mental, malaise, lethargy, nausea, headaches, cramps and peripheral edema

Which of the following directly regulates the blood flow through the capillary beds?

Capillary Sphincter, circular muscular walls that constrict and dilate to regulate the blood flow through capillary beds -controlled by the autonomic nervous system, which also regulates involuntary functions such as sweating and digestion respond to outside stimuli: temp, need for o2, need for water removal overall regulation of blood flow through cap beds is determined by CELLULAR NEED

What is the name of the cartilaginous ridge where the trachea divides into the right and left main-stem bronchus?

Carina The trachea divides into the two main bronchi at the anatomical point known as the carina. It is the ring of cartilage just superior to the bifurcation of the bronchi into the right and left lungs. Cricoid cartilage is a firm ridge forming the lower part of the larynx. It is the only complete ring of cartilage around the trachea and is a landmark for cricothyrotomy, the surgical rescue technique of choice for a failed airway in adults. The pharynx is the area between the mouth and the epiglottis, in which the trachea and esophagus separate. The epiglottis is a thin, leaf-like structure that folds over the glottis to prevent food and liquid from entering the trachea.

Which of the following arteries are considered to have central pulses?

Carotid and femoral arteries -central pulses are those pulses that emanate from larger arteries that are easiest to palpate.

Tension pneumothorax

Caused by damage to the lung tissue. The damage allows air normally held within the lung to escape into the chest cavity. The lung subsequently collapses and air can begin to apply pressure to the structures in the mediastinum (e.g., heart, great vessels). The patient will present with a trachea that deviates toward the unaffected side, along with tachycardia, tachypnea, dyspnea, anxiety, and decreased breath sounds. The onset of a tension pneumothorax is slower than that of a spontaneous pneumothorax.

Sympathomimetics (e.g., cocaine, MDMA, PCP, amphetamine/methamphetamine)

Central nervous system stimulants that mimic the sympathetic nervous system (fight-or-flight). Common signs and symptoms of use include tachycardia, hypertension, and dilated pupils.

Central pontine demyelination

Central pontine myelinolysis (CPM) is a neurological disorder caused by severe damage of the myelin sheath of nerve cells in the area of the brainstem termed the pons, predominately of iatrogenic, treatment-induced cause.

Aspirin Injestion Route

Chew the tablet before swallowing -Antipyretic (fever reducer), analgesic (pain reducer), anti-inflammatory (inflammation reducer), and platelet aggregation inhibitor, prevents clots from forming or growing in size -often used after an acute myocardial infarction or in cardiac pts. to prevent future AMI May cause: bleeding, stomach ulcers Contraindications: swallow, allergy to aspiring, preexisting liver damage, bleeding disorders, asthma NOT GIVEN for pain caused by trauma or fevers in children

Renal Calculi (Kidney Stones)

Complain of vague flank pain that can radiate to the groin, and hematuria (blood in urine)

Diabetic Ketoacidosis

Condition found in pts with type 1 diabetese mellitus -excessive hyperglycemia (greater than 400 mg/dl), kussmaul respirations, abd pain, body aches, nausea, vomiting, and alt mental status are common -infection or illness may cause a relative lack of insulin within the body, which in turn can predispose a pt

CHF

Congestive heart failure is when the ventricular heart muscle is permanently damaged and can no longer keep up with the return flow of blood from the atria. It can occur after a myocardial infarction, heart valve damage, or long-standing hypertension. When the ventricular muscle can no longer contract effectively, the body attempts to maintain cardiac output by increasing heart rate and/or enlarging the left ventricle. Eventually, these adaptations no longer maintain cardiac output, and congestive heart failure develops. Pulmonary and peripheral edema are common symptoms.

Which of the following is a system of internal and external reviews and audits of all aspects of an EMS system?

Continuous quality improvement Continuous quality improvement is a system of internal and external reviews and audits of all aspects of an EMS system. Periodic run review meetings are held with those involved in patient care to review reports and discuss areas of care that may need changing or improvement.

Assuming the assessment for a pulse and breathing are done simultaneously, what is the maximum time these assessments should take?

Correct answer: 10 seconds After a patient is deemed unresponsive, one should assess for a pulse and breathing. These assessments can be done simultaneously and should take no longer than 10 seconds in total. A pulse assessment should occur at the carotid. If no pulse is palpable, CPR should be initiated, beginning with chest compressions.

A three-year-old was playing in the kitchen and dumped a pan of boiling water on his body, suffering partial-thickness burns to a portion of his lower body, sparing the feet and genitals. At what percentage of total body surface area would this patient's burns be considered severe?

Correct answer: 10% Organization of burn care should begin at the site of injury and continue through prehospital care and transportation to the closest burn center, or to the closest ED with advanced life support capability, followed by transfer to a burn center when appropriate. Children are not "little adults," and what might be considered a moderate burn injury in an adult would be considered severe in a child, requiring inpatient hospital treatment and management. Infants and young children have a relatively greater surface area per unit of body weight, with disproportionately thin skin. Therefore, severe damage can be caused by shorter contact periods with lower temperatures, and burns in children that initially appear to be partial-thickness in depth may actually become full-thickness third-degree burns. After securing the airway, measures include immediate IV access and administration of fluid. Delay in fluid resuscitation (Ringer's lactate) may result in acute renal failure and increased mortality. Transfer to a certified burn center and inpatient care should be provided for the following pediatric burn injury characteristics: Any partial-thickness burn >10% total burn surface area (TBSA) Any full-thickness burn Circumferential burns Electrical, chemical, or inhalation injury Burns of critical areas, such as face, hands, feet, perineum, or joints Rule of 9's for Children: 18% for head, 18% for chest, 18% for back, 9% for each arm, 13.5% for each leg, and 1% for genitalia.

ALS and EMS providers are preparing to hyperventilate a patient who has a suspected brainstem herniation. As waveform capnography becomes available, what should be the target end-tidal carbon dioxide level during hyperventilation?

Correct answer: 30-35 mmHg Hyperventilation is a controversial treatment sometimes used in patients who have a brainstem herniation. It should only be performed if allowed by local protocols. Additionally, waveform capnography should be available to ensure that end-tidal carbon dioxide (ETCO2) levels are between 30 and 35 mmHg while hyperventilating.

Which of the following is the normal respiratory rate range for an infant patient at rest?

Correct answer: 30-60 breaths per minute Range of Respiration by Age: Ages 0 to 12 months: 30 to 60 breaths per minute Ages 1 to 3 years: 24 to 40 breaths per minute Ages 4 to 5 years: 22 to 34 breaths per minute Ages 6 to 12 years: 18 to 30 breaths per minute Ages 13 to 18 years: 12 to 16 breaths per minute Ages 18 and up: 12 to 20 breaths per minute

A seven-day-old newborn has cyanosis on his face and chest and a palpable pulse of 90 beats per minute. Which of the following is an appropriate respiratory rate for this child?

Correct answer: 36 breaths per minute An appropriate respiratory rate for an infant (under one year of age) is 30-60 breaths per minute. As the patient continues to age, the respiratory rate will decline. As with all patients, if a patient does not have adequate respirations, assisted ventilations should be provided. An increased work of breathing in infants may include grunting/wheezing, accessory muscle use, retractions, head bobbing, nasal flaring, and tachypnea. Normal respiratory ranges for other children is listed below: Toddler (one to three years old): 24 to 40 breaths per minute Preschool-age (four to five years old): 22 to 34 breaths per minute School-age (six to twelve years old): 18 to 30 breaths per minute Adolescent (thirteen to eighteen years old): 12 to 16 breaths per minute

What is the maximum oxygen concentration that can be delivered via a nasal cannula?

Correct answer: 44% A nasal cannula will commonly deliver between 24% and 44% oxygen and has a flow rate range of one to six liters per minute. A nasal cannula should be reserved for those patients who are unable to tolerate a nonrebreather mask. A nonrebreather mask with a reservoir with supplemental oxygen at fifteen liters per minute can deliver oxygen up to 95%.

If a patient has a stroke volume of 75 mL per beat and a heart rate of 75 beats per minute, what is his or her cardiac output?

Correct answer: 5.6 L/min Cardiac output is the estimation of the amount of blood pumped by the heart in one minute. It is found by multiplying stroke volume (in mL per beat) and heart rate (in beats per minute). Stroke volume is the amount of blood ejected from the heart in one minute. The average stroke volume for an adult is 70 to 80 mL per beat. The average heart rate for an adult is 60 to 100 beats per minute. For this patient: 75 mL per beat x 75 beats per minute = 5,625 mL per minute.

An adult patient has sustained a likely closed femur fracture. Swelling, deformity and diminished pulses are noted. The patient is beginning to show early signs of hypovolemic shock but has no obvious external blood loss. How much blood can be lost due to internal bleeding secondary to a closed femoral shaft fracture?

Correct answer: 500 to 1,000 mL Hemodynamic instability is a primary concern in prehospital care, and can be a result of fracture-related blood loss. An individual rib fracture can produce a loss of 100 to 200 mL of blood, and tibial fractures may result in 300 to 500 mL of blood loss. Femur fractures easily lose 800 to 1,000 mL, and pelvic fractures can produce significant blood loss greater than 2,000 mL.

In which of the following scenarios is a high-efficiency particle absorbing (HEPA) respirator to be used?

Correct answer: A 46-year-old patient with a nonproductive cough and tuberculosis High-efficiency particle absorbing (HEPA) respirators should be worn during any aerosol-generating procedures, such as suctioning of airway secretions, performing CPR, or assisting with endotracheal intubation. HEPA respirators are also used when in the presence of conditions spread via droplet transmission (e.g., tuberculosis). A HEPA respirator is not required for a bloodborne pathogen (e.g., HIV/AIDS); standard precautions are adequate, with a face shield for use if blood splattering is possible. Standard precautions with eye protection are appropriate for potential bodily fluid contact.

An elderly male is pulseless, apneic, and exhibiting dependent lividity. Which of the following best describes dependent lividity?

Correct answer: A discoloration of the skin at the lowest point of the body Dependent lividity is when blood settles at the lowest point of the body; this causes a discoloration of the skin at that point. This is a definitive sign of death. Rigor mortis is the stiffening of the body muscles caused by chemical changes within the muscle tissue. This is also a definitive sign of death. Putrefaction is the decomposition of body tissues, which can occur between 40 and 96 hours after death. Cyanosis is the blueing of skin, lips, mucous membranes, or nail beds. This is a sign of low levels of oxygen in the blood. If severe enough, cyanosis can also be a sign of death.

What is the definition of ischemia?

Correct answer: A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow Ischemia is the absence of oxygen to body tissue; this lack of oxygen is commonly the result of a partial or complete blockage of blood flow. Permanent injury is possible, but not always definite, in cases of ischemia; permanent injury is dependent upon the length of time ischemia is occurring. The death of body tissue is called infarction; this is commonly caused by an interruption of blood supply to the tissue. Perfusion is the flow of blood through body tissues and vessels. An occlusion is a blockage, as in a tubular structure like a blood vessel. If a complete occlusion occurs in a blood vessel, perfusion may be restricted, causing ischemia, which can lead to infarction.

Which of the following is an example of a likely special reporting situation?

Correct answer: A mass-casualty incident Special reporting situations may include mass-casualty incidents, gunshot wounds, animal bites, specific infectious disease, or suspected physical/sexual abuse. Local laws/protocols dictate which incidents require special reporting. A patient reluctant to receive treatment and the witnessing of a crime while off duty do not constitute special reporting situations. An error in documentation should be corrected with a single line through the error with dates and initials of the author, and correction of information.

During the initial assessment of a semiconscious patient's airway, snoring respirations are heard. What are these respirations an indication of?

Correct answer: A partially obstructed airway Snoring is an indication that the upper airway is partially obstructed. Fluid or secretion in the upper airway will manifest as gurgling, which requires suctioning. If the bronchi are constricted, wheezing will be heard. This commonly occurs in asthmatic and chronic obstructive pulmonary disease patients. Crackles (formerly rales) are the sounds of air trying to pass through fluid in the alveoli. Crackles are a result of congestive heart failure or pulmonary edema.

Sterilization is defined as which of the following?

Correct answer: A process that removes all microbial contamination Sterilization is a process that eliminates, removes, kills, or deactivates all forms of life and other biological agents. Disinfection eliminates nearly all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial spores) on inanimate objects. Decontamination reduces the level of microbial contamination so that infection transmission is eliminated. Cleaning is the process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment.

Which of the following would have rights to otherwise confidential information without expressed patient consent?

Correct answer: A third-party billing representative Any communication between patient and EMS personnel is considered privileged information, even the fact that the patient is under prehospital/hospital care. Additional information that is protected under HIPAA (protected health information, or PHI) includes patient history, assessment findings, and treatment provided. This information may only be disclosed for the purposes of treatment, payment (to third-party billing personnel), operations, or when legally required (e.g., cases of suspected abuse, when subpoenaed). Otherwise, proper authorization, typically documented permission from the patient, is required to disclose confidential information. Personal electronic devices, such as cell phones, should not be used to capture information.

An adult patient has been in cardiac arrest for several minutes without response to resuscitation. Medical direction advises continuing basic life support procedures during the fifteen-minute transport to the hospital. Resuscitation is discontinued as the patient will likely die anyway, despite medical direction advisement. No do-not-resuscitate order or advance directive is present. Which of the following has occurred?

Correct answer: Abandonment Abandonment is the unilateral termination of care without the patient's consent and without making any provisions for continuing care by a medical professional who is competent to provide it. This scenario constitutes abandonment, as care was terminated.

What is/are the anatomical landmark(s) for performing abdominal thrusts in a conscious child with an airway obstruction?

Correct answer: Above the umbilicus and below the lower tip of the sternum If a child can still cough, cry, or speak, the airway is only partially blocked; therefore, keeping the child comfortable, avoiding anything that may agitate the child, and using only noninvasive treatments while transporting immediately is the best course of action. If the child has severe respiratory distress and is at risk for deteriorating in condition during transport, foreign body airway obstruction maneuvers should be considered. Never do this if the child can cough, cry, or speak! Kneeling behind the child, wrap your arms around the child's body and make a fist and place your thumb just above the umbilicus, well below the lower tip of the sternum. The opposite hand is placed over the fist, and thrusts are performed in an inward and upward direction. If the child becomes unresponsive, begin CPR with chest compressions.

What is standard of care?

Correct answer: Acceptable practice of care for a given situation Standard of care is the domain of acceptable practice, as defined by scope of practice, current evidence, industry consensus, and experts. Standard of care can vary, depending on the independent variables of each situation. Scope of practice does not define a standard of care, nor does it define what should be done in a given situation (i.e., it is not a practice guideline or protocol). It defines what is legally permitted to be done by some or all of the licensed individuals at that level, not what must be done. A duty to act is the responsibility to provide patient care. This may occur if one is charged with emergency medical response or one's service's/department's policy states that assistance must be provided in any emergency. A duty to act begins once a response has been assigned/initiated. Good Samaritan laws are based on the principle in which, when a person is helped, the provider should not be liable for errors and omissions that are made in giving good faith emergency care.

An elderly woman is in respiratory distress. Gasping for breath, the patient attempts to explain the history of her respiratory problems, beginning in her youth. What is the appropriate response?

Correct answer: Advise the patient to focus on her current complaint In the prehospital setting, history that is not associated with the chief complaint need not be discussed. In the focused assessment, information discussed and the assessment should be based on the chief complaint. In this particular scenario, excessive talking may lead to further dyspnea. Additionally, delaying assessment/treatment to await a complete history may cause further respiratory exacerbations.

Which of the following medications is for use of acute asthma exacerbation?

Correct answer: Albuterol Inhalation medications used in the acute exacerbation of asthma and chronic obstructive pulmonary disease include albuterol, ipratropium bromide, levalbuterol, and metaproterenol sulfate. These medications may also be used in the setting of bronchitis. Inhalation medications used in chronic asthma and chronic obstructive pulmonary disease include beclomethasone, cromolyn, fluticasone, montelukast, and salmeterol. Salmeterol may also be used in the setting of bronchitis.

An adult male twisted his right ankle while running on grass. On examination, the patient has good distal pulses, sensation, and movement of his right foot with a pain he rates at a four out of ten. Which of the following is a common sign or symptom of an ankle sprain?

Correct answer: All of these An ankle sprain is usually that of an inversion-type twist of the foot, followed by pain and swelling. The most commonly injured site is the lateral ankle complex. Signs and symptoms of an ankle sprain include the following: Pain/tenderness Swelling and/or bruising Cold foot or paresthesia (possible neurovascular compromise) Muscle spasm Ankle sprains are classified into the following three grades: Grade 1 injuries involve a stretch of the ligament with microscopic tearing but not macroscopic tearing. Generally, little swelling is present, with little or no functional loss and no joint instability. The patient is able to fully or partially bear weight. Grade 2 injuries stretch the ligament with partial tearing, moderate-to-severe swelling, ecchymosis, moderate functional loss, and mild-to-moderate joint instability. Patients usually have difficulty bearing weight. Grade 3 injuries involve complete rupture of the ligament, with immediate and severe swelling, ecchymosis, an inability to bear weight, and moderate-to-severe instability of the joint. Typically, patients cannot bear weight without experiencing severe pain.

A patient has been stung by a jellyfish while swimming. What symptoms may present if envenomation occurred?

Correct answer: All of these Envenomation causes painful, red lesions extending in a line from the site of the sting. Some patients may complain of headache, dizziness, muscle cramps, and fainting. Treatment of a sting from a jellyfish should begin with removing the patient from the water, followed by the scraping of remaining tentacles with the edge of a stiff object (e.g., credit card), soaking the affected area in hot water for thirty minutes, and transport.

Which of the following is a concern in a patient with a neck injury?

Correct answer: All of these Penetrating injuries to the neck can potentially injure several organ systems. Cervical spine tenderness, subcutaneous emphysema, tracheal deviation, and laryngeal fracture may be discovered with a focused examination of the neck. Wounds that extend through the platysma should not be explored manually; these injuries require evaluation by a surgeon. Subcutaneous emphysema is the presence of air in the soft tissues of the neck; this commonly occurs due to blunt trauma. Subcutaneous emphysema is noted with a characteristic crackling sensation upon palpation of the neck. An air embolism is when air exists within the vascular system. If a vein is punctured within the neck, air may be sucked through to the heart. If enough air is present in the right atrium and right ventricle, cardiac arrest may occur. If trauma to the neck occurs, a cervical spinal injury is always a possibility. Cervical spine injuries should be immobilized.

Which of the following signs are seen in patients with a foreign body airway obstruction?

Correct answer: All of these Wheezing and coughing are commonly heard in patients with a mild airway obstruction. A mild airway obstruction patient should be monitored for adequate oxygenation and progression of the obstruction. Patients with a mild airway obstruction and poor air exchange may present with an ineffective cough, stridor, increased difficulty breathing and cyanosis. A patient with poor air exchange should be treated as if he or she has a severe airway obstruction. Severe airway obstruction patients will be unable to breathe, talk, or cough; cyanosis and extreme difficulty breathing are common. Opening the airway and performing abdominal thrusts are appropriate for a severe airway obstruction. Do not attempt to remove a foreign body if it is unable to be visualized.

Which of the following conditions is not a common cause of an altered mental status?

Correct answer: Allergic reaction An altered mental status may arise from sudden illness, traumatic brain injury, seizure disorders, drug/alcohol abuse/overdose/withdrawal, diseases of the brain (e.g., Alzheimer's or meningitis), hypoglycemia, hypoxia, impaired cerebral blood flow, hyperthermia/hypothermia, or a psychiatric disorder. It is unlikely that an allergic reaction will cause an altered mental status.

Which of the following is a sign/symptom of a subdural hematoma?

Correct answer: Altered mental status A subdural hematoma is a collection of blood due to rupture of "bridging veins" between dura mater and the arachnoid membrane (surrounding the cerebral cortex). It is the most common type of traumatic intracranial hematoma, and presentation varies widely. It can occur after a fall or strong deceleration force injury, or after a seemingly insignificant head trauma in an elderly person on anticoagulation therapy. The clinical presentation depends on the location of the lesion and the rate at which it develops. Often, patients are rendered comatose at the time of the injury. A subset of patients remain conscious, while others deteriorate in a delayed fashion as the hematoma expands. Other symptoms of subdural hematoma can include headache, dizziness, nausea and vomiting, lethargy or excessive drowsiness, weakness, apathy, and seizures. Numerous disorders can cause abnormal bleeding and bruising, including platelet dysfunction, thrombocytopenia, clotting factor deficiencies, and factor inhibitors. In 85% of cases, dyspnea is due to asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or panic attack. Palpitations—sensations of a rapid or irregular heartbeat—are most often caused by cardiac arrhythmias or anxiety

Which of the following is the most likely cause of dilated pupils in an adult patient?

Correct answer: Amphetamine use Recognition of the agent behind use or an overdose is important. Signs and symptoms may help differentiate possible causes. Sympathomimetic (e.g., epinephrine, albuterol, cocaine, [meth]amphetamine) use will present with tachycardia, hypertension, hyperthermia, dilated pupils, and agitation or seizures. Opiate/opioid (e.g., morphine, codeine, oxycodone, methadone, heroin) use will typically present with hypoventilation/respiratory arrest, hypotension, pinpoint/constricted pupils, and sedation/coma. Anticholinergic (e.g., diphenhydramine, atropine, chlorpheniramine, doxylamine) use will present with tachycardia, hypertension, hyperthermia, dilated pupils, dry skin/mucous membranes, decreased bowel sounds, and sedation/coma. Sedative-hypnotic (e.g., diazepam, secobarbital, flunitrazepam, midazolam) use will present with hypoventilation, hypotension, slurred speech and sedation/coma. Sedative-hypnotics generally do not affect pupil diameter.

Which of the following is not a supraglottic airway device?

Correct answer: An endotracheal (ET) tube Should intubation with an endotracheal (within the trachea) tube fail, an EMT may be asked to prepare and assist with the use of a supraglottic airway. In some locations, protocol may allow EMTs to use supraglottic airways. Instead of being in the trachea, a supraglottic airway sits above the glottis while allowing advanced airway access. Examples of supraglottic airway devices include a King laryngotracheal airway device (single lumen), a laryngeal mask airway (LMA) device, and an i-gel airway device. Intubation, whether with an endotracheal or supraglottic airway device, is confirmed by attaching an end-tidal waveform carbon dioxide detector between the airway and the bag used to assist with ventilations. The presence of bilateral breath sounds and absence of gastric or epigastric sounds help confirm appropriate placement.

Which of the following is most likely to be seen in a patient with a core body temperature of less than 80°F (26.7°C)?

Correct answer: Apnea A patient suffering from severe hypothermia, whose core body temperature is less than 80°F (26.7°C), may show signs and symptoms of apparent death, including unresponsiveness and cessation of cardiorespiratory activity (apnea and nonpalpable pulse due to cardiac dysrhythmias). A patient with a core body temperature between 93°F (33.9°C) and 95°F (35°C) may present with shivering, rapid breathing, and constricted blood vessels and may be withdrawn. A patient with a core body temperature between 89°F (31.7°C) and 92°F (33.3°C) will likely have loss of coordination, muscle stiffness, and slowing respirations/pulse and will be confused, lethargic, and sleepy. A patient with a core body temperature between 80°F (26.7°C) and 88°F (31.1°C) will likely be unresponsive in a coma-like state, with a weak pulse and very slow respirations.

An adult patient is bleeding profusely from a puncture wound on his upper left leg near the groin. Bleeding is not well controlled with a gloved fingertip over the wound. What is the most appropriate next step?

Correct answer: Apply a pressure dressing Most cases of external bleeding can be controlled simply by applying direct, local pressure to the bleeding site. If the bleeding continues to ooze through, then a pressure dressing is the next step. If direct pressure and a pressure dressing are not immediately effective, apply a tourniquet to an extremity above the level of the bleeding. Elevation is no longer indicated because there is no evidence that it helps control bleeding and it may aggravate other injuries.

Which of the following is correct in regard to approaching a medical transport helicopter?

Correct answer: Approach after the pilot signals it is clear to do so With the exception of rear-loading aircraft, always approach the helicopter in a crouched position from the front and after the pilot has signaled it is clear to do so. This approach should be between the ten o'clock and two o'clock positions. Do not duck under the body, the tail boom or rear sections of the helicopter, as the pilot is unable to see in these areas. If flight crew is present, always follow their instructions.

An adult patient has sustained a severe upper arm laceration that is spurting bright red blood. What is the likely type of bleeding?

Correct answer: Arterial Arterial bleeding is bright red and will spurt in time with the pulse. Arterial bleeding may be more difficult to control due to cardiac pressure. Venous bleeding will present with a darker color and varies in speed, based on the size of the vein. Venous bleeding does not spurt. Capillary bleeding is also dark red and will ooze steadily, but slowly. Internal bleeding is defined as bleeding that occurs inside the body.

What is done first in a primary assessment?

Correct answer: Assess the level of consciousness After completing a scene size-up, the primary assessment is initiated. First, EMS providers should form a general impression about the patient. Next, one should assess the level of consciousness. According to the AVPU scale, a patient is considered awake and alert if his or her eyes open spontaneously and he or she is responsive to the environment. A patient is considered responsive to verbal stimuli if his or her eyes do not open spontaneously, but they open when spoken to or the patient is able to respond in some meaningful way. A patient is responsive to pain if he or she does not respond to questions, but moves or cries out in response to painful stimuli. Appropriate painful stimuli include gently but firmly pinching the earlobe, pressing on the bone above the eye, or gently but firmly pinching the muscles of the neck. If none of the above elicit a response, the patient is considered unresponsive. After the level of consciousness is assessed, airway, breathing, and circulation are assessed and life-threats are treated.

A 90-year-old female is found lying supine on the floor, appearing unconscious. Upon examination, she is unresponsive. Which of the following is the most appropriate next step?

Correct answer: Assess the patient's pulse and initiate chest compressions if indicated When approaching a patient and forming a general impression, medical professionals should take no more than 10 seconds to assess both breathing and pulse. If a patient is not responsive and not breathing, CPR should be initiated, beginning with chest compressions, and calling for an AED.

Which of the following may EMS personnel be charged with, should emergency care be given without consent?

Correct answer: Battery Battery is the unlawful touching of another person. This includes providing emergency care without consent. This crime may be criminal or civil. For criminal proceedings, proof of an intent to harm is generally necessary. Assault is the unlawful placing of a person in fear of immediate bodily harm. An example of this is the threatening of a patient with restraint in order to transport.

An 11-year-old female complains of an allergic reaction. Upon arrival, her mother presents an epinephrine auto-injector. Which of the following is the most appropriate next step?

Correct answer: Begin the primary assessment At the very least, a primary assessment must be conducted prior to performing any intervention, including the use of an epinephrine auto-injector. The general impression, formal assessment (i.e., vital signs, DCAP-BTLS) and the determination of the priority of the patient are all involved in the primary assessment. Administering treatment prior to evaluation is negligent. As above, interventions (whether by EMS personnel, patients, family members or bystanders) should be completed after a primary assessment is done. In this scenario, there is no reason to contact a prescribing provider.

A 20-year-old has a possible knee dislocation from skiing. During the physical exam, the presence and quality of the popliteal artery is assessed. What is the location of the popliteal artery?

Correct answer: Behind the knee The popliteal artery is located behind the knee on the posterior aspect of the leg. It may be lacerated or compressed due to a dislocation of the knee. The posterior tibialis artery is located in the medial aspect of the ankle. The dorsal pedis is located on the top of the foot. The femoral pulse is found along the anteromedial aspect of the thigh, located along the crease midway between the pubic bone and the anterior iliac crest. Use the tips of your 2nd, 3rd and 4th fingers. If there is a lot of subcutaneous fat, you will need to push firmly.

Which of the following is the correct placement of the V3 electrode when performing an electrocardiogram?

Correct answer: Between V2 and V4 An electrocardiogram is a form of cardiac monitoring that can be used in the prehospital setting. In order for the monitoring to be accurate, reliable and useful, the electrodes must be placed in the appropriate positions. There are four limb electrodes: white (placed on the right arm), black (placed on the left arm), green (placed on the right leg or lower right abdomen), and red (placed on the left leg or lower left abdomen). The remaining leads are listed below with their respective placement: V1: fourth intercostal space, right sternal border V2: fourth intercostal space, left sternal border V3: between V2 and V4 V4: fifth intercostal space, left midclavicular line V5: fifth intercostal space at the anterior axillary line V6: fifth intercostal space (V4, V5, and V6 are all on the same horizontal level) in the midaxillary line

An adult patient has a diabetic history. Which of the following would be a common feature found in a patient suffering from hypoglycemia?

Correct answer: Diaphoresis A normal blood glucose level is between 80 and 120 mg/dL. Hypoglycemia will commonly have a rapid onset of pale, cool, and moist skin (from sweating), a rapid, weak pulse, potential hypotension and shallow or ineffective breathing and altered mental status if the blood glucose volume is too low. Oral glucose is the primary prehospital setting treatment for suspected hypoglycemia.

Where is the tricuspid valve located?

Correct answer: Between the right atrium and the right ventricle Deoxygenated blood flows from the right atrium through the tricuspid valve to the right ventricle. The right ventricle pumps deoxygenated blood through the pulmonic valve to the lungs, to be oxygenated, via the pulmonary artery. Oxygenated blood returns to the left atrium via the pulmonary vein. Oxygenated blood flows from the left atrium to the left ventricle through the mitral valve. The left ventricle pumps oxygenated blood from the heart through the aortic valve to the body via the aorta. Deoxygenated blood returns to the right atrium via the superior and inferior vena cavae.

Which of the following is not a sign of internal bleeding into the gastrointestinal tract?

Correct answer: Bloody urine Bloody urine (hematuria) is usually indicative of injury to the urinary tract (e.g., kidney, ureter, bladder, or urethra). Signs of internal bleeding within the gastrointestinal tract include bloody vomit, known as hematemesis, (either bright red or having a coffee ground appearance), bright red blood in the stool (hematochezia) or dark and tarry stools, known as melena.

A 6-month-old infant is unresponsive. Where should a pulse be assessed to determine if CPR should be initiated?

Correct answer: Brachial artery The brachial artery is assessed in an infant (age 1-12 months) to determine pulse rate. CPR should be initiated on an infant/child without a palpable pulse or a pulse of less than 60 beats per minute. Carotid and femoral arteries are not typically palpable in a child less than one year of age. The radial artery is not used to assess the need for CPR in any age group.

You are on-scene with a 55-year-old female complaining of sudden onset shortness of breath while at rest. Following a quick examination, you determine that the patient may be experiencing non-traumatic cardiac tamponade. If so, the patient will likely exhibit all of the following signs and symptoms except:

Correct answer: Bradycardia Cardiac tamponade occurs when the pericardial sac fills with blood or fluid. This commonly occurs due to penetrating chest trauma, but may occur in blunt trauma; alternate causes include infection, autoimmune diseases, or cancer. As the fluid within the pericardial sac increases, the heart is less able to fill with blood during each relaxation phase; cardiac output decreases. Patients with cardiac tamponade present with Beck's triad: jugular vein distension, narrowing pulse pressure and muffled heart sounds. Supplemental oxygen should be given to all patients with suspected cardiac tamponade; assisted ventilations may be required. Bradycardia is not commonly seen in cardiac tamponade.

Which of the following is a late sign of respiratory distress in an adult patient?

Correct answer: Bradycardia Early signs of respiratory distress in an adult patient may include the tripod position, tachypnea, and retractions. As respiratory distress continues and the patient becomes tired from the effort of breathing, hypoxia, bradypnea, bradycardia, and altered level of consciousness may occur. In severe respiratory distress, wheezing may be audible. Vesicular breath sounds are normal breath sounds.

You encounter a 28-year-old patient who has sustained a closed head injury and has a Glasgow Coma Score of 7. Which of the following findings would indicate an increased intracranial pressure?

Correct answer: Bradycardia Intracranial pressure (ICP) is increased by the accumulation of blood within the skull or swelling of the brain. As ICP increases, blood pressure must also rise, otherwise cerebral ischemia will result. Prompt recognition of ICP is critical. Irregular breathing (e.g., Cheyne-Stokes), bradycardia, widened pulse pressure, headache, nausea, vomiting, altered mental status, sluggish or absent pupillary response, and decerebrate posturing are all indications of possible increased ICP. The triad of increased systolic blood pressure, bradycardia, and irregular respirations is called Cushing's triad and signifies increased ICP.

Which of the following is a sign of impending respiratory arrest in a pediatric patient?

Correct answer: Bradypnea Bradypnea is an ominous sign of impending respiratory arrest in a pediatric patient. Bradycardia is also seen in pediatric patients with impending cardiopulmonary arrest. Red flags are respiratory rates less than 20 breaths/min for children younger than 6 years of age, and less than 12 breaths/min for older children. Strong central pulses is a good indication that a child is not hypotensive and blood pressure is adequate. Tachycardia may be an early sign of hypoxia; it is also seen in fever, anxiety, pain, and excitement. A capillary refill of greater than two seconds is an estimation of a low end-organ perfusion; it can be affected by environmental factors.

What is the common name for a contusion?

Correct answer: Bruise A contusion is a bruise; it commonly occurs due to blunt force striking the body. Blue or black discoloration (ecchymosis) is an indication of bleeding beneath the skin. An injury that separates the various layers of soft tissue, either completely detached or as a hanging flap, is known as an avulsion. An abrasion is commonly referred to as a scrape, road rash, road burn, or rug burn. A cut may refer to a laceration (jagged cut) or an incision (sharp, smooth cut).

An adult patient was cleaning out his garage where several bags of dry lime were stored. He is now covered with lime and in pain from the chemical burns to his hands and face. Which action should be performed first?

Correct answer: Brush the remaining dry chemical from the skin and clothing Decontamination by properly trained personnel should be completed. Potency, concentration, and duration of exposure to a toxic agent are the primary determinants of the degree of tissue damage in a chemical burn. It is critical to immediately begin treatment. Management of topical chemical burns generally consists of the following steps: - Ensure protection of rescuers and health care workers from exposure. - Remove the patient from the area of exposure. - Remove all clothing and jewelry. - Brush any dry chemicals off the patient; any suitable instrument may be used (e.g., dry brush, towel). The most important component of active therapy is irrigation of all wounds and areas of exposure thoroughly with copious amounts of water. If done in the field, ensure that the patient is kept warm following irrigation, to avoid hypothermia. Oxygen therapy is appropriate in a patient involving the airway; however, placing a nonrebreather mask or nasal cannula over already-present chemicals will only serve to push more chemical into the lungs. Wrapping a chemical burn will ensure continuous contact with the chemical and cause further injury. There is no evidence that this patient has an airway involvement, but nevertheless, treatment remains the same. You must remove the remainder of the lime before initiating care to keep from causing additional burns to the patient and/or EMS personnel.

Which of the following occurs during the peripheral capillary cellular exchange?

Correct answer: Carbon dioxide from cells enters the capillaries and oxygen leaves the capillaries and enters the cells During the capillary cellular exchange, cells give up carbon dioxide and obtain oxygen from the capillaries, which in turn accept the yielded carbon dioxide. The carbon dioxide is then returned to the lungs via red blood cells in the form of bicarbonate and is dissolved in the blood. Glycogen is glucose that is stored within the liver and skeletal muscles for later use. It can be converted to glucose, which the body can use as energy. There is no direct exchange between alveoli and cells. Pulmonary respiration is the exchange of carbon dioxide and oxygen between the capillaries and the alveoli. Body cells never obtain nourishment from stored glycogen during capillary-cellular exchange. Oxygen-poor blood from the capillaries never passes into the alveoli. The capillaries and body cells never exchange hormones for communication.

A 30-year-old patient was shocked while working on a high transmission line and has suffered severe electrical burns. Which of the following is a primary concern for this patient?

Correct answer: Cardiac arrest Prehospital care of electrical injury involves three primary steps: remove the patient from contact with the source (using rubber or wood - do not touch the patient directly), assess for need for CPR (ventricular fibrillation is the most common arrhythmia), and transport. Electrical current can cross the chest and cause cardiac arrest or dysrhythmia; cardiac arrest is unlikely to develop if not seen on the initial assessment. Respiratory arrest is also a possible concern when dealing with patients shocked by electricity. Be sure to check for an entrance and exit wound when dealing with electrical burns. Internal bleeding can occur, either immediately or delayed; thrombosis is more common, and can result in organ damage. Cardiac arrhythmia is a greater concern in the prehospital setting. Electric shocks have no link to allergic reactions. Heat shock is not a type of shock.

An adult chest pain patient presents with a low blood pressure, jugular vein distension (JVD), and muffled or distant heart tones. Which of the following is most likely the cause of the patient's signs?

Correct answer: Cardiac tamponade Cardiac tamponade is the filling of blood or fluid past the pericardium (protective membrane around the heart) into the pericardial sac. This most commonly occurs due to penetrating or blunt chest trauma; subsequently, a rupture, tear or laceration may occur in a coronary artery or vein. Less common causes include cancer and autoimmune diseases (e.g., systemic lupus erythematosus). Due to the increased pressure on the heart, it is less able to fill with blood during diastole. The signs and symptoms of cardiac tamponade are referred to as Beck's triad: bilateral distended jugular veins, narrowing pulse pressure (i.e., small difference between systolic and diastolic blood pressure) and muffled heart sounds. Altered mental status is common. Oxygen is a mainstay prehospital treatment. Positive-pressure ventilations are to be given to hypoventilating or apneic patients. An acute myocardial infarction (AMI) is the death of heart muscle due to lack of blood flow or oxygen. Chest pain described as pressure or heaviness, that radiates to the jaw, neck, arms, back or abdomen; sudden weakness; irregular heartbeat; dyspnea; nausea; vomiting; and syncope are potential signs and symptoms. A pulmonary embolism is a sudden blockage of an artery within the lungs by a clot. These clots can develop in the veins of the legs or pelvis and then embolize (move) through the pulmonary artery or one of its branches. A pulmonary embolism will commonly present with dyspnea and chest pain. Top risk factors include recent hospitalization or living in a nursing home, trauma, cancer, history of blood clots or heart failure, the presence of a pacemaker or central venous catheter, paralysis of extremities, obesity, sedentary lifestyle, traveling a long distance, and recent surgery. A spontaneous pneumothorax is the buildup of air within the pleural space, inhibiting appropriate expansion of a lung during inspiration. Common presentation is of dyspnea and pleuritic chest pain (sharp, stabbing pain on one side that is worse with inspiration, expiration, or certain movements of the chest wall). This is a potentially life-threatening condition.

A 64-year-old post-myocardial-infarction patient presents with severe chest pain, respiratory distress, and pulmonary edema. He has an altered level of consciousness. His skin is cool and clammy and he is hypotensive. Which of the following is most likely the cause of his signs and symptoms?

Correct answer: Cardiogenic shock Cardiogenic shock is when the heart lacks enough power to maintain an adequate cardiac output. The most common cause of cardiogenic shock is an acute myocardial infarction (AMI); cardiogenic shock can occur immediately after an AMI or as late as 24 hours after the incident. As with most forms of shock, restlessness and anxiety are one of the first signs of cardiogenic shock. Common signs and symptoms are cool, clammy skin; weak, irregular pulse; tachycardia; tachypnea; shallow breathing; dyspnea; nausea/vomiting; and hypotension. Cardiac tamponade is the result of blood or fluid filling the pericardial sac. This most commonly occurs due to a ruptured, torn, or lacerated coronary artery or vein, but may occur due to autoimmune disorders (e.g., systemic lupus erythematosus) or cancer. Common signs include bilateral jugular vein distension, narrowing pulse pressure (little difference between systolic and diastolic blood pressure) and muffled heart sounds; the combination of these signs is called Beck's triad. Cerebrovascular accidents (CVAs), or strokes, are an interruption of blood flow to an area of the brain, causing loss of function. Facial drooping, sudden weakness/numbness unilaterally, ataxia (lack of coordination), unilateral vision changes, difficulty swallowing, altered mental status or confusion, aphasia, sudden/severe headache, dizziness, combativeness, restlessness, and tongue deviation are possible. Septic shock may also present with tachycardia and hypotension, but a fever is commonly present.

Which of the following is a classic symptom of acute coronary syndrome (ACS)?

Correct answer: Chest pain or discomfort described as pressure or heaviness Acute coronary syndrome (ACS) is a group of symptoms caused by myocardial ischemia; the most notable symptom is chest pain that is described as pressure or heaviness. It should be noted that not all patients have chest pain during ACS or an acute myocardial infarction (AMI). Additional signs and symptoms of ACS/AMI may include weakness, dyspnea, nausea/vomiting, lower jaw/arm/back/abdominal/neck pain, sweating without an obvious cause, pink frothy sputum (indicating possible pulmonary edema), an irregular cardiac rhythm, syncope and sudden death. Any patient complaining of nontraumatic chest pain should be assumed to have an AMI until it is ruled out by a physician.

Which of the following is a reason that children are more susceptible to airway obstruction than adults?

Correct answer: Children have a proportionally smaller mandible and larger tongue There are many contributing factors as to why infants and children are more susceptible to airway obstruction. Infants and small children have a proportionally larger occiput, which can cause the head to flex while the patient is supine, which may lead to an obstruction. Children have a proportionally smaller mandible and proportionally larger tongue than adults, which causes children to be more susceptible to airway obstructions.

Which of the following is true regarding suctioning children versus adults?

Correct answer: Children should be suctioned for no more than 10 seconds Suctioning time limits should be adjusted for the age of the patient. An adult should be suctioned for no more than 15 seconds. A child should be suctioned for no more than 10 seconds. An infant should be suctioned for no more than 5 seconds. A French, or whistle-tip, catheter should be used in patients with a stoma, those whose teeth are clenched, or when suctioning of the nose is required. A tonsil-tip, Yankauer tip catheter is the best option for infants and children, as the tips have a large diameter and are rigid, and therefore will not collapse. The tip of a suction catheter should be inserted only as far as can be visualized.

Which of the following is expected in a patient who has suffered a retinal detachment?

Correct answer: Complaints of flashes of light Retinal detachment is a medical emergency requiring prompt surgical intervention. In this condition, the retina is pulled away from the choroid (a thin layer of vessels that supply nutrients and oxygen to the retina). Retinal detachment is painless. Early symptoms may include sudden increase or change in floaters, flashes of light (photopsia), description of a "curtain" or "veil" falling across the visual field, and blurred vision. Permanent vision loss is possible. Cataracts are the clouding of the visual lenses. This condition causes interference with vision, decreased tear production, and difficulty distinguishing colors and seeing clearly. Macular degeneration is the most common cause of irreversible central vision loss in elderly patients. Risk factors include smoking, hypertension, obesity, sun exposure, and a diet low in omega-3 fatty acids and/or dark green leafy vegetables.

A 74-year-old female is complaining of chest pain and having trouble catching her breath. She has a cough that is producing pink, frothy sputum. Crackles are noted on auscultation of the lungs. Which of the following is most likely causing her signs and symptoms?

Correct answer: Congestive heart failure Congestive heart failure is when the ventricular heart muscle is permanently damaged and can no longer keep up with the return flow of the blood from the atria. It can occur after a myocardial infarction, heart valve damage, or long-standing hypertension. When the ventricular muscle can no longer contract effectively, the body attempts to maintain cardiac output by increasing heart rate and/or enlarging the left ventricle. Eventually, these adaptations no longer maintain cardiac output, and congestive heart failure develops. Pulmonary and peripheral edema, easier breathing while sitting up, distended neck veins, hypertension, tachycardia, tachypnea, retractions, cyanosis, diaphoresis, and crackles on auscultation are common; chest pain may or may not be present. Pink, frothy sputum may occur due to pulmonary edema. Stable angina pectoris will typically present with chest pain, dyspnea, and diaphoresis that are all relieved with rest. Emphysema, a type of chronic obstructive pulmonary disease, is a loss of elastic material within the alveolar air space. Adventitious breath sounds (e.g., crackles, rhonchi, wheezing) may be heard on lung auscultation. Dyspnea, chronic cough, chronic sputum, and long expiration phases are possible in patients with COPD. Cardiogenic shock is when the heart lacks enough power to force the appropriate volume of blood throughout the body. As with most types of shock (hypoperfusion), restlessness and anxiety are an early sign. Other signs and symptoms include dyspnea; cool, clammy skin; weak, thready pulse; tachycardia; rapid, shallow breathing; nausea/vomiting; and hypertension that can eventually become hypotension.

What is the first assessment/treatment completed in an unconscious patient showing signs and symptoms of shock?

Correct answer: Control life-threatening bleeding A patient with suspected shock should have a rapid exam to determine the level of consciousness and identification and management of life-threatening concerns. If a massive, life-threatening hemorrhage exists, this issue is treated prior to airway and breathing management. After life-threatening conditions have been treated and ABCs have been assessed and managed, further treatment, including ensuring the patient is kept warm with blankets, is appropriate. The use of external heat sources (e.g., hot water bottles, heating pads) should be avoided as their use may cause vasodilation and further decrease of blood pressure. It should be noted that different treatment is appropriate for different kinds of shock.

Which of the following blood vessels provides oxygenated blood to the heart muscle?

Correct answer: Coronary arteries The coronary arteries provide oxygenated blood to the heart; the coronary arteries are branches from the aorta. The carotid arteries supply blood to the head; they are located in the neck. The cerebral arteries provide blood to the brain and are located in the skull. The femoral arteries supply blood to the lower extremities and are located in the thigh.

Which of the following is not a cause of obstructive shock?

Correct answer: Damaged cervical spine Obstructive shock is the mechanical obstruction of the cardiac muscle, causing a decrease in cardiac output. Three common reasons for obstructive shock are tension pneumothorax, cardiac tamponade, and pulmonary embolism. Neurogenic shock occurs when the nervous system that controls cardiac contraction/relaxation is damaged. This is commonly due to damage to the upper cervical levels of the spine. Alternate causes include brain conditions, tumors, pressure on the spinal cord, and spina bifida. As the neural pathway to the heart is damaged, nerve impulses do not reach the heart, causing it to contract. Common signs and symptoms include bradycardia, hypotension, and signs of a neck injury. In a tension pneumothorax, air buildup in the pleural space applies pressure to organs in the mediastinum (e.g., heart and great vessels). If cardiac tamponade occurs, fluid or blood in the pericardial space prevents the ventricles from filling with blood. When a patient has a saddle (pulmonary) embolism, pulmonary circulation is blocked, causing a backup into the right ventricle of the heart and eventual pump failure. Patients commonly present with dyspnea; rapid, weak pulse; rapid, shallow breathing; unilateral, decreased, or absent breath sounds; hypotension; jugular vein distension; subcutaneous emphysema; cyanosis; and tracheal deviation toward the unaffected side. If cardiac tamponade is occurring, patients will commonly present with Beck's triad (jugular vein distension, narrowing pulse pressures, and muffled heart tones).

Which of the following options best explains the process of inhalation?

Correct answer: Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity, creating a negative pressure which results in air being pushed into the lungs Inhalation is an active process. When the diaphragm and intercostal muscles contract, it increases the size of the thoracic cavity, creating a negative pressure space (lower than atmospheric pressure). Exhalation is a passive process. When the diaphragm and intercostal muscles relax, it decreases the size of the thoracic cavity, which pushes air out of the lungs.

Which of the following terms best describes the period when the ventricles are relaxed and filling with blood?

Correct answer: Diastole Diastole is the relaxation period of the cardiac cycle. The ventricles are relaxed and fill with blood in preparation. Systole is the contraction period of the cardiac cycle. After the ventricles are filled with blood, they contract and force the blood to the body or the lungs from the left and right ventricles, respectively. Perfusion is the circulation of blood in an organ or tissue in an adequate amount. Systemic vascular resistance is the resistance to blood flow within all of the blood vessels except the pulmonary vessels.

An asthmatic patient is experiencing dyspnea. She says she feels better after having self-administered a nebulized albuterol inhaler prior to EMS arrival. What is the primary function of albuterol?

Correct answer: Dilating bronchioles Albuterol is a medication often used in the setting of dyspnea. Patients who have asthma, bronchitis, and chronic obstructive pulmonary disease will commonly have a beta-agonist (e.g., albuterol) prescribed as a rescue inhaler. Like most medications used for respiratory distress, albuterol works by dilating bronchioles. It does not affect swelling, myocardial oxygen demand, or moisture in the lungs. Common side effects include tachycardia, nervousness, and muscle tremors. Coughing is possible after inhalation of the medication. Some respiratory medications (e.g., beclomethasone, fluticasone, montelukast) work via an anti-inflammatory pathway, reducing swelling.

Which of the following medications blocks the effects of histamine and is taken for allergic reactions?

Correct answer: Diphenhydramine Diphenhydramine is a medication indicated for allergic reactions. It blocks the effects of histamine. It can lead to drowsiness and increased pressure of the fluid within the eye. Asthma is a relative contraindication for diphenhydramine as it can worsen lower airway constriction. Activated charcoal is a very fine powder in a premixed suspension that is used to help absorb ingested poisons. Aspirin is an antipyretic (reduces fever), analgesic (reduces pain), anti-inflammatory (reduces inflammation), and platelet aggregation inhibitor (prevents clot formation and enlargement). It is often used by patients who are at risk for coronary artery disease. Naloxone is an intramuscular or intranasal medication used to reverse the effects of opioid overdose.

A seven-year-old patient jumped from a swing and injured his left leg. There is a prominent deformity to the left leg above his ankle. Which of the following bones is/are most likely fractured?

Correct answer: Distal tibia and fibula The tibia and fibula are the bones that form the lower leg. Often both bones are fractured at the same time, even though a single deformity may be noted. Severe deformities should be corrected and a padded, rigid, long leg splint or air splint (that extends from the foot to the upper thigh) should be applied and then secured to the unaffected leg. The femur is the long bone of the upper leg, below the hip and above the knee.

What are the names of the two main layers of the skin?

Correct answer: Epidermis and dermis Human skin is composed of two main layers: the epidermis, which is superficial, and the dermis, which is the deeper layer that contains specialized skin structures. The epidermis varies in thickness, depending upon the part of the body. The dermis contains such structures as sweat glands, sebaceous glands, hair follicles, blood vessels, and specialized nerve endings. Below the skin lies the subcutaneous tissue layer (hypodermis). The germinal layer is the base part of the epidermis; it produces new cells that gradually rise to the surface. The stratum corneal layer is the dead layer of skin at the top of the epidermis.

A 45-year-old woman was having a private lesson on a beginner ski slope when she fell and hit her head. When you arrive she is conscious, smiling and making jokes. There is no blood and no sign of impact. After you assess her for about 15 minutes, she states that she doesn't need any further care and signs appropriate documentation. As she signs the form, you realize that she is a movie star, and being a fan, you engage in conversation. While you are conversing, she complains of a headache and says she's not feeling well. What is the most likely diagnosis?

Correct answer: Epidural hematoma In addition to epidural hematoma (EDH), head trauma is a major cause of subdural hematoma (SDH), subarachnoid hemorrhage (SAH), cerebral contusion, diffuse brain swelling, and fractures. Any of these injuries may coexist in a given patient following trauma, and their clinical manifestations can be difficult to distinguish. Patients with head trauma should be transported to a hospital with a dedicated trauma team, if feasible, because this is associated with significantly better outcomes. An epidural hematoma (EDH) results from a collection of blood in the potential space between the skull and the dura mater. Blunt trauma to the temporal or temporoparietal area with an associated skull fracture, with disruption of the middle meningeal artery, is the primary mechanism of injury. Classic presentation of an EDH involves significant blunt trauma, with a loss of consciousness or altered mental status, followed by a "lucid interval" of indeterminate duration; the patient then quickly declines in status, with a rapid neurologic demise. High-pressure arterial bleeding can lead to herniation of the brain within hours after injury. While the "lucid interval" is regularly taught to health care practitioners, this "classic" presentation occurs in a minority of cases (< 20%).

A 32-year-old patient appears to be intoxicated. Bystanders are unaware of any alcohol or drug use. They report that the patient seemed to be fine until he began acting drunk. Which of the following is the most likely cause?

Correct answer: Hypoglycemia Hypoglycemia, hyperglycemia (diabetic ketoacidosis, or DKA) and alcohol intoxication may all present with altered mental status. Hypoglycemia is more likely than intoxication to present with a rapid onset, as in this patient, with no history or report of alcohol use. If the fruity odor of ketones on the breath is present, suspect DKA. As bystanders did not see the patient consume any alcohol, medication, or illicit substances, poisoning and alcohol abuse are unlikely; the lack of acetone breath makes DKA less likely (and is not an answer choice, here). An allergic reaction will commonly involve hives, rash, urticaria, respiratory complaints and/or swelling; as these are not present in this scenario, an allergic reaction is not likely.

A 17-year-old male was struck on the side of the head. Police arrive on the scene and find him unconscious and call for EMS assistance. By the time they arrive, the patient has regained consciousness and states that he is fine. During their primary assessment, they notice that there is no obvious bleeding, no airway compromise, and his breathing is fine. As they proceed, he becomes obtunded and subsequently loses consciousness. What is the likely cause of his sudden decline?

Correct answer: Epidural hematoma Intracranial hemorrhage is the accumulation of blood within the skull, increasing intracranial pressure (ICP). Bleeding can occur between the skull and the dura mater (epidural), between the dura mater and the brain (subdural), within the brain tissue (intracerebral), or into the subarachnoid space, where the cerebrospinal fluid (CSF) circulates. An epidural hematoma is nearly always the result of a temporal bone fracture from a blow to the head. The middle meningeal artery will commonly bleed from this fracture and result in rapidly progressing symptoms. Patients commonly present with immediate loss of consciousness followed by a brief period of consciousness (lucid interval) and later, lapse back to unconsciousness. ICP continues to increase and the pupil on the affected side becomes fixed and dilated. Death is imminent if surgical interventions are not completed rapidly. A subdural hematoma usually occurs after falls or injuries involving strong deceleration forces. They are more common than epidural hematomas and may or may not be associated with skull fractures. Patients commonly experience fluctuating levels of consciousness and slurred speech. Hypovolemic shock (due to hemorrhage) is unlikely to occur from a closed head injury. The cranial vault cannot contain a volume of blood large enough to cause hypovolemia. Bleeding into the brain (subdural or subarachnoid) can cause loss of consciousness from direct damage of neurons, or from mass effect of the blood pushing against the brain, with the potential for a cerebral herniation. A subarachnoid hemorrhage will cause bloody CSF and meningeal irritation (e.g., neck rigidity, headache). Trauma and ruptured aneurysms are common causes.

An adult patient may be suffering from an ischemic stroke. After administering high-flow oxygen therapy, which of the following should be the next priority?

Correct answer: Establish a timeline of onset and provide rapid transport An ischemic stroke is the most common type of stroke, accounting for more than 80% of all strokes. A blockage (blood clot/thrombosis, embolus, or plaque) does not allow blood flow to a specific area of the brain or brainstem. Atherosclerosis is a calcium and cholesterol buildup that forms plaque inside the walls of a blood vessel. Blood clots or plaque buildups may occur elsewhere in the body, break off, and then be carried to the brain. A timeline of symptoms is important in the case of an ischemic stroke. Ideally, thrombolytic therapy (clot-dissolving medications) should be administered within three hours of onset; mechanical methods of treatment should be administered within six hours of onset. Spend as little time on-scene as possible.

Which of the following is an indication for humidified oxygen?

Correct answer: Extended transport Humidified oxygen is generally used for extended transport or for specific conditions, such as croup. Dry oxygen is not considered harmful for short-term use. An oxygen humidifier consists of a small, single-patient-use bottle of water through which tubing for oxygen flows before it reaches the patient. Always refer to medical direction or local protocols for further guidance. Chronic obstructive pulmonary disease (COPD) exacerbation, dyspnea, and respiratory arrest are not necessarily indications for humidified oxygen therapy. As above, refer to medical direction and local protocols.

A two-year-old is in a postictal state. His mother says he has been ill for several days and had a fever just before becoming unconscious and experiencing the seizure, which lasted less than a minute. She denies any medical history. The child is lethargic but acknowledges his mother's presence. Which of the following has most likely occurred?

Correct answer: Febrile seizure Febrile seizures are common in children between six months and six years of age. These seizures commonly occur on the first day of febrile illness. Febrile seizures are characterized by generalized tonic-clonic seizure, do not last longer than 15 minutes, and have a short or absent postictal phase. Assessment of ABCs, cooling measures, and rapid transport are appropriate. Epilepsy is a congenital seizure disorder. The first seizure can occur at any time throughout life. As this patient recently had a fever and has not had a seizure in the past, epilepsy is not as likely as a febrile seizure. A patient with severe hypoglycemia may experience a seizure; there is no indication that this patient has hypoglycemia or a history of diabetes. Partial seizures occur in only one part of the brain. Simple partial seizures are not associated with a change in the level of consciousness.

What is the name of the middle layer of the heart?

Correct answer: Myocardium The heart wall is comprised of three layers: epicardium (outer), myocardium (middle), and endocardium (inner). The myocardium is the functional muscle tissue of the heart, the middle layer of the heart tissue. The epicardium is the outer layer of the heart. The endocardium is the innermost layer of the heart. The pericardium is the thin double-layered sac that encloses the heart. If this sac fills with blood or fluid, cardiac tamponade occurs.

Which of the following is part of the upper airway?

Correct answer: The uvula The upper airway begins at the mouth and nose. It includes everything superior to the vocal cords, part of the larynx. Other parts of the upper airway include the nasopharynx, oral cavity, tongue and remaining parts of the mouth, uvula, laryngopharynx, and larynx, which includes the thyroid cartilage, cricoid cartilage, epiglottis, glottis, and vocal cords. The lower airway begins below the vocal cords. It includes the trachea, carina, mainstem bronchi, smaller bronchi, bronchioles, and alveoli.

A trauma patient does not respond verbally or with eye-opening in response to painful stimuli and speech. He extends his arms and legs during the motor response test. What is the GCS score?

Correct answer: Four The Glasgow Coma Scale (GCS) is an evaluation tool used to determine level of consciousness. It evaluates eye opening, verbal response, and motor response. A lower score suggests a more severe extent of brain injury. Survivability is not assessed with GCS but is assessed via the Revised Trauma Score, another scoring system. Eye-opening scoring: spontaneous eye opening = 4 points eye opening in response to speech = 3 points eye opening in response to pain stimuli = 2 points no eye-opening = 1 point Verbal response scoring: responding with an oriented conversation = 5 points responding with a confused conversation = 4 points responding with inappropriate words = 3 points responding with incomprehensible sounds = 2 points not responding verbally = 1 point Motor response scoring: following basic commands = 6 points responding locally to pain = 5 points withdrawing from painful stimuli = 4 points abnormal flexion (decorticate posturing) = 3 points abnormal extension (decerebrate posturing) = 2 points no motor response = 1 point This patient gains one point for not opening his eyes to stimuli (both verbal and pain), one point for no verbal response to verbal stimuli, and two points for abnormal extension of his extremities (decerebrate posturing).

Which of the following is a complication of improper hand placement during chest compressions?

Correct answer: Fractured ribs When performing chest compressions during CPR, proper hand position and technique are important. In an adult, the heel of one hand should be placed on the lower half of the sternum, with the other hand placed on top of the first. Chest compressions should be done in cycles of 30 followed by two assisted ventilations. Compressions should be at a depth of 2 to 2.4 inches (5 to 6 cm) and at a rate of 100 to 120 per minute. If compressions are not done correctly, adequate circulation and perfusion will not occur. Potential complications of compressions can include fractured ribs or sternum and a lacerated liver. Fractured clavicles, gastric distension, and a lacerated spleen are not likely complications of chest compressions.

Which of the following organs is not part of the endocrine system?

Correct answer: Gallbladder The gallbladder is a small pouch extending from the bile ducts and serves as a reservoir for the temporary storage and concentration of bile. Bile is formed in the liver. The gallbladder and liver make up the biliary system. The endocrine system is comprised of any of various glands producing hormonal secretions that pass directly into the bloodstream. The endocrine glands include the thyroid, parathyroids, anterior and posterior pituitary, pancreas, adrenals, pineal, and gonads.

While assisting a full-term pregnant female in delivering her baby, what may be required to deliver the lower (second) shoulder?

Correct answer: Guide the head up slightly After the head is delivered, it will rotate to one side on its own. At the next contraction, the upper shoulder should be visible. Guide the head down slightly by applying gentle downward traction to help the upper shoulder deliver. Support the head and upper body as the shoulders deliver. Guiding the head up slightly to help deliver the lower shoulder may be required. Massage of the uterus in a firm, circular, kneading motion can help slow bleeding. Do not apply resistance to the head or attempt to slow the delivery in any way.

Which of the following types of oxygen tanks has the largest volume of oxygen?

Correct answer: H-size tank Oxygen tanks vary in the amount of oxygen carried and the duration of therapy available, depending upon the size of the tank. A list of oxygen cylinder sizes carried on ambulances and their respective oxygen volume is listed below. D-size: 350L Jumbo D-size: 500L E-size: 625L M (MM)-size: 3,000L G-size: 5,300L H, A (M4), or K-size: 6,900L

A 66-year-old patient complains of right upper quadrant pain and general malaise, and has a yellowish tint to his skin and the sclera of his eyes. Which of the following is the most likely cause of his complaints and findings?

Correct answer: Hepatitis Hepatitis (inflammation of the liver) or liver insult/injury will most commonly cause right upper quadrant pain and jaundice (yellowing of the skin and sclera). Liver insult may be caused by gallstones/gallbladder insult, viral hepatitis, or drug and alcohol use. Chronic renal failure may present with lethargy, nausea, headaches, cramps, and extremity edema if untreated. It may progress to seizures or coma in later stages. Pancreatitis, which may also be caused by gallstones, is an inflammation of the pancreas. Other causes include alcohol abuse and other diseases. Common signs and symptoms include upper left quadrant pain, nausea, vomiting, abdominal distension, and tenderness. Pneumonia typically presents with a cough, fever, and dyspnea and may occasionally cause pain that radiates to the upper abdomen.

An adult took an overdose of diazepam, a benzodiazepine. Which of the following symptoms would one expect to encounter during the physical examination?

Correct answer: Hypersomnolence Isolated benzodiazepine overdose, as described in the vignette, classically presents with CNS depression and normal vital signs. Many patients are arousable and able to provide an adequate history. However, most intentional ingestions of a benzodiazepine involve other drugs, the most common being alcohol and opioids, in which case, respiratory compromise is a possibility. Overdose is usually suspected on the basis of history and the clinical scenario. Any number of sedative-hypnotic medications share clinical features with benzodiazepines in overdose, including alcohol, barbiturates, GHB, and chloral hydrate. Patients with a clinically obvious ingestion manifest slurred speech, ataxia, and altered mental status (drowsiness). Ensure that the patient has a patent airway and transport.

A 26-year-old patient with acute abdominal pain has a respiratory rate of 20 breaths per minute and an oxygen saturation of 76%. Concerns arise about an inaccurate oxygen saturation. Which of the following will not interfere with the accuracy of a pulse oximeter?

Correct answer: Hypertension Common reasons for an inaccurate pulse oximetry reading include the following: hypovolemia severe peripheral vasoconstriction (secondary to chronic hypoxia, smoking, or hypothermia) time delay in detecting respiratory insufficiency dark/metallic nail polish dirty fingers carbon monoxide poisoning

Which of the following is not a common side effect of nitroglycerin?

Correct answer: Hypertension Common side effects of nitroglycerin include hypotension, headache, and changes in heart rate (tachycardia or bradycardia).

Brainstem herniation

Cushing's triad -hypertension -bradycardia -decreased respirations Secondary brain damage and neurological deterioration resulting from significant edema, elevated intracranial pressures, with resulting Contralateral and caudal shifts of brain structures.

A five-year-old is unconscious, but breathing adequately. When inserting an oropharyngeal airway, which of the following is true?

Correct answer: If the airway is too large, it may obstruct the larynx An oropharyngeal is designed to keep the tongue from blocking the airway and allows for easier suctioning. An oropharyngeal airway is indicated in patients who are unconscious and do not have an intact gag reflex. Oropharyngeal airways are contraindicated in patients who may have ingested caustic or petroleum-based products, as the airway may induce vomiting. One should begin by measuring for an appropriately sized airway in children by placing the flange at the central incisor, with the bite block segment parallel to the hard palate; the tip of the airway should reach the angle of the jaw. Alternatively, length-based resuscitation tape (Broselow tape) may be used to appropriately size an airway. After choosing an appropriately sized oropharyngeal airway, position the patient's airway via the head-tilt/chin-lift or jaw-thrust maneuver, depending on the scenario. In children, avoid hyperextension of the neck. Depress the tongue with either a tongue blade or the airway tip, and slowly insert the airway. Rotate the airway into position, following the curve of the tongue. The flange should rest against the lips. Reassess the airway after it is in place. If the airway is too small, the tongue may obstruct the airway; if the airway is too large, the airway may obstruct the larynx.

What is the correct anatomical location of the cricoid cartilage?

Correct answer: Inferior to the thyroid cartilage, at the lowest portion of the larynx The cricoid cartilage is a ring of firm cartilage and is located inferior to (below) the thyroid cartilage at the lowest portion of the larynx. The carina is the level at which the trachea divides into the two mainstem bronchi. The epiglottis is at the base of the oropharynx, superior to (above) the location of the cricoid cartilage.

An unresponsive 8-month-old infant is found at a preschool facility. The infant has a palpable pulse of 46 beats per minute without notable respirations. Which of the following is the most appropriate next step?

Correct answer: Initiate CPR, beginning with chest compressions CPR should be initiated on an infant without a palpable pulse or a pulse less than 60 beats per minute; chest compressions are started before ventilations in CPR. A patient who is not adequately breathing and has a palpable pulse should be given assisted ventilations; the rate of assisted ventilations for a child is a breath every three to five seconds (twelve to twenty breaths per minute). Children in this scenario should be placed in a position that allows for the management of the airway. High-flow oxygen would not be appropriate for a patient who is not breathing adequately.

A patient is found pulseless and apneic. If three rescuers are available, what is the most appropriate next step?

Correct answer: Initiate two-person CPR, beginning with chest compressions, while the third rescuer applies an automatic external defibrillator (AED) CPR should be initiated in any patient who does not have a palpable pulse. Two-rescuer CPR is preferred as it reduces fatigue, facilitating effective chest compressions. High-quality CPR and rapid defibrillation are important links of the chain of survival; however, CPR should not be delayed to attach an AED or to make other preparations for entry into an ED. As there are three rescuers available, the application of the AED can be completed while CPR is taking place. This patient will require assisted ventilations, as he is apneic; however, chest compressions are completed prior to ventilations in CPR.

A 20-year-old male has a suspected closed head injury and a closed femur fracture. He is cool, clammy, and anxious. His respirations are 22 breaths per minute, his heart rate is 120 beats per minute, and his blood pressure is 100/48 mmHg. Which of the following is the most likely cause of his shock?

Correct answer: Internal bleeding around the femur fracture Hypovolemic shock, due to an inadequate amount of fluid or volume in the circulatory system, can be caused by bleeding (hemorrhagic) or dehydration (non-hemorrhagic). Common signs and symptoms include an altered mental status; rapid, weak pulse; hypotension; tachypnea; cyanosis; and cool, clammy skin. Since this patient has a closed femur fracture, he has the potential to lose up to one liter of blood. An open femur fracture may lose even more blood. In either event, hypovolemic shock is not unusual in these scenarios. A closed head injury is not likely a cause of shock; it should be noted that a damaged cervical spine may cause neurogenic shock. While excessive vomiting and diarrhea can cause dehydration and possibly subsequent hypovolemic shock, and an infection may lead to septic shock, there is no indication that the patient suffered any recent infection. Severe pain may cause psychogenic shock, but this is less likely than hypovolemic shock due to internal bleeding.

A 75-year-old woman complains of severe upper right quadrant abdominal pain. She also notes intermittent pain from her abdomen to her right shoulder. Her abdomen is rigid and distended. Which of the following is most likely?

Correct answer: Internal bleeding secondary to a lacerated liver Abdominal pain with referred pain to the right shoulder is an indication of irritation of the phrenic nerve, which runs from the cervical spine (C3-C5) through the shoulder to the diaphragm. Coupled with right-sided pain and a rigid, distended abdomen, this is indicative of a lacerated liver with internal bleeding. If the pain were left-sided, a lacerated spleen would be suspected. A nonpenetrating bleeding ulcer or Mallory-Weiss tear would likely present with hematemesis (vomiting of blood) or melena (dark, tarry stool containing digested blood).

A patient presents with hives, hypotension, and wheezing on inspiration. Which of the following interventions would most likely benefit this patient?

Correct answer: Intramuscular epinephrine Most external allergic reactions remain localized; anaphylaxis is possible if the immune response is severe enough. Common signs and symptoms of localized allergy are sudden pain, swelling, localized heat, urticaria, and redness at the site. Anaphylaxis may present with bronchospasms, wheezing, chest tightness, coughing, dyspnea, hypotension, anxiety, and gastrointestinal complaints. Epinephrine via an auto-injector is the common prehospital treatment for anaphylaxis. Albuterol, via a metered dose inhaler, is a common treatment method for an acute asthma exacerbation. Diphenhydramine is often used for patients with allergic reactions; however, this patient has respiratory involvement and therefore should be given epinephrine. Ondansetron is an oral medication used to treat nausea and vomiting.

Which of the following is a sign of increased pressure within the chest?

Correct answer: Jugular vein distension Increase in chest pressure may occur due to trauma, pneumothorax, hemothorax, or constrictive pericarditis and cardiac tamponade. Jugular vein distension, hypotension, and collapse of the lung may occur if chest pressure is increased. A palpable carotid pulse is a normal finding.

A 19-year-old male presents with costovertebral angle tenderness with guarding. He is conscious, with a respiration rate of 16 breaths per minute, a pulse rate of 108 beats per minute, and a blood pressure of 138/80 mmHg. He denies injury and states that the pain began this morning when he awoke. Which of the following organs is most likely involved?

Correct answer: Kidneys The kidneys are approximately five inches (thirteen centimeters) long and are just anterior to the costovertebral angle. Tenderness in that area is common in patients with kidney insult. Hematuria may also be seen. If blood loss is significant, the patient may show signs of shock. Due to the uncertainty of diagnosis in patients with hematuria and flank pain, rapid transportation is appropriate. The costovertebral angle is the area between the ribs and the spine. The organs in this area are the kidneys. Kidneys often cause pain in the costovertebral angle. It could be kidney stones or infection. The liver is in the upper right quadrant of the abdomen and is unlikely to cause costovertebral angle pain. The head of the pancreas connects with the duodenum slightly to the right of the midline. It is most likely to cause epigastric pain, radiating to the back. The gallbladder is a pear-shaped, hollow structure located under the liver and on the right side of the abdomen. Its primary function is to store and concentrate bile, a digestive enzyme produced by the liver. It is less likely to cause costovertebral angle pain.

A full-term 20-year-old female is being transported to the hospital. The umbilical cord begins to present at the opening of the birth canal. Which of the following is the best position in which to place the patient during transport?

Correct answer: Knee-chest position A prolapse of the umbilical cord is when the umbilical cord presents out of the vagina prior to the fetus. This is a medical emergency, because the fetus's head may compress the cord during birth. Do not attempt to push the cord back into the vagina. This condition commonly occurs early in labor after the amniotic sac ruptures; there is typically time for transport. The patient should be in either a supine position with the foot of the cot raised 6-12 inches (15-30 cm) higher than the head and the hips elevated on a pillow or folded sheet, or in the knee-chest position: kneeling and bent forward, face down. These positions help keep the weight of the fetus off of the prolapsed cord. Alternate positions may cause extra weight to be placed on the umbilical cord. A sterile-gloved hand should be used to gently push the fetus's head away from the umbilical cord; this position should be maintained until arrival at the hospital. The cord should be wrapped in a sterile towel, moistened with saline. High-flow oxygen and rapid transport are appropriate.

Which of the following is the cause of angina pectoris?

Correct answer: Lack of adequate oxygenation to the heart Angina pectoris, or cardiac chest pain, occurs when the demand for oxygen from the heart exceeds the supply.

What anatomical structure marks the end of the upper airway and the beginning of the lower airway?

Correct answer: Larynx The larynx is a structure formed by independent cartilaginous structures, the epiglottis, the glottis, and the vocal cords (superior aspect), the thyroid cartilage (middle structure), and the cricoid cartilage (inferior aspect), which lies opposite the 6th cervical vertebra. The cricoid cartilage of the larynx marks the end of the upper respiratory tract. The lower respiratory tract includes the trachea, bronchi, bronchioles (23 bifurcations) and alveoli. The carina is the location where the trachea divides into the two mainstem bronchi. The glottis is the space between the vocal cords and the narrowest portion of the adult airway; the glottis is the superior part the larynx. The oropharynx is the posterior portion of the oral cavity; it is above the larynx and is also part of the upper airway.

A patient is complaining of stomach pain. She says she has a history of peptic ulcers. In which region of the abdomen is the stomach located?

Correct answer: Left upper quadrant The left upper quadrant contains the stomach, spleen, and a portion of the pancreas. The right upper quadrant contains the liver, gallbladder, duodenum of the small intestines, and a portion of the pancreas. The left lower quadrant contains the large and small intestines; of the large intestines, the left lower quadrant contains the descending and left half of the transverse colon. The right lower quadrant contains the large and small intestines; of the large intestines, the right lower quadrant contains the ascending, the right half of the transverse colon, and the appendix.

Which of the following drugs is a commonly abused hallucinogen?

Correct answer: Marijuana Commonly abused hallucinogens include LSD, marijuana, mescaline (peyote), psilocybin (mushrooms), bufotenin, dimethyltryptamine, and hashish. Cocaine (sympathomimetic), alcohol (sedative/hypnotic), and amphetamines (sympathomimetic) are not classified as hallucinogens.

An unconscious three-year-old is in need of an oropharyngeal airway (OPA) to keep his tongue away from his posterior airway. Which of the following is considered the best way to determine the appropriate size OPA in a pediatric patient?

Correct answer: Measure using a length-based resuscitation tape (Broselow tape) A length-based resuscitation tape (Broselow tape) is considered the best method to estimate the correct size for an airway adjunct in the pediatric population. Alternatively, measuring can be completed by placing the airway next to the face with the flange at the level of the central incisors and the bite block segment parallel to the hard palate. The tip of the appropriate-sized OP airway should reach the angle of the jaw.

Which of the following is the most common cause of brain injury?

Correct answer: Motor vehicle crashes Brain injuries can be caused by penetrating objects (e.g., bullet, knife) or as a result of external forces exerted on the skull. The most common cause of brain injuries in the US, motor vehicle collisions, account for approximately 50% of all TBIs. When a passenger hits his or her head on the windshield in a motor vehicle crash, the brain continues to move forward until it comes to an abrupt stop when it strikes the inside of the skull. This rapid deceleration results in compression injury (bruising) to the anterior portion of the brain. "Coup" (pronounced "koo") contusions occur at the area of direct impact to the skull and occur because of the creation of negative pressure when the skull, distorted at the site of impact, returns to its normal shape. "Contrecoup" (pronounced, "kontra-koo") contusions are similar to coup contusions but are located opposite the site of direct impact. Cavitation in the brain, from negative pressure due to translational acceleration impacts from inertial loading, may cause contrecoup contusions as the skull and dura matter start to accelerate before the brain on initial impact. Alternate reasons for brain injury include other traumatic causes (e.g., blast injuries), blood clots or hemorrhages.

Which of the following terms indicates the portion of the airway located above the roof of the mouth and the soft palate?

Correct answer: Nasopharynx The nasopharynx is the most superior portion of the pharynx and upper airway. The nostrils lead to the nasopharynx and warm, filter, and humidify the air. The pharynx consists of the nasopharynx, oropharynx, and laryngopharynx. The oropharynx is the posterior portion of the oral cavity; it is above the larynx. The epiglottis is a leaf-shaped flap that allows air to pass into the trachea but prevents food/liquid from entering the airway (trachea). The trachea is a semirigid, enclosed air tube made up of rings of cartilage that are open in the back. It is located just inferiorly to the larynx.

An adult patient was involved in a motor vehicle crash with major compartment intrusion. She is conscious but disoriented with a current Glasgow Coma Scale score of nine. She is hypotensive and bradycardic with a thready, irregular carotid pulse. Her abdomen is flat and non-tender on palpation. Her extremities remain warm and dry, and she extends her legs when stimuli are applied. Which of the following types of shock is most likely causing her signs and symptoms?

Correct answer: Neurogenic shock Neurogenic shock is shock due to damage of the spinal cord. This can be from brain conditions, tumors, pressure on the spinal cord, or spina bifida. In neurogenic shock, the muscles in the walls of the blood vessels are cut off from the sympathetic nervous system and the impulses that cause them to contract. Therefore, below the level of the injury, vessels dilate, increasing the size and capacity of the vascular system and causing blood to pool. Some signs and symptoms of neurogenic shock include an absence of sweating below the level of injury, bradycardia, hypotension, and warm skin.

In addition to DCAP-BTLS, which of the following should be assessed in the extremities of a trauma patient?

Correct answer: Neurovascular status In addition to evaluating for specific injuries (DCAP-BTLS), the neurovascular status of the extremities should be assessed in a conscious patient: distal pulses, motor function, sensory function. Assessment should include palpating the radial, posterior tibial, and dorsalis pedis pulses, asking the patient to make a fist and/or wiggle the toes (this should be stopped if any pain is elicited), and checking for sensation in the extremities (i.e., the tips of fingers/toes, lateral and medial surfaces of the limbs). Retractions (muscle movement above the clavicles indicating abnormal breathing) and paradoxical motion (unilateral chest rise on inspiration) are related to assessment of the chest. Peripheral reflexes are not part of the prehospital assessment.

How far in may a suction catheter tip be inserted?

Correct answer: Never past the base of the tongue An EMT-B should make sure that the catheter never goes farther than the base of the tongue. He or she is allowed to suction only the mouth and oropharynx. An EMT-B should make sure that the catheter never goes farther than the base of the tongue; this is well past the last (third) molar. If a suction catheter tip reaches the epiglottis or vocal cords, it has been inserted too far.

A four-month-old is bleeding from his head. EMS has been at this home several times before to treat injuries of this child. Injuries sustained match the child's age and ability, as the parents have stated. Which of the following is the most appropriate next step?

Correct answer: Notify the proper authorities Signs of abuse vary in pediatric patients. Some signs and symptoms include injuries (bruises, burns) at varying stages of healing, injuries to the genitals/buttocks, unusual patterns of injuries, femoral fractures without obvious trauma, inappropriate parental concern, lack of supervision, a delay in seeking care, suspicious circumstances, and a history inconsistent with injury. It is the responsibility of EMS personnel to report suspected abuse to law enforcement or child protection agencies. Confronting or questioning the parents may cause unrest and potentially denied access to treat the child. A parent or legal guardian still maintains the right to consent to or deny care of a child. While suspected cases should be reported, EMS personnel may not act outside the law.

In which of the following settings would an occlusive dressing not be required?

Correct answer: Open humeral fracture An occlusive dressing is a dressing that serves to prevent air and liquids from entering or exiting a wound. These dressings may be made from petroleum gauze, aluminum foil, or plastic. They are typically used for open chest wounds (to prevent tension pneumothorax from developing), abdominal eviscerations (to prevent mesenteric necrosis and hypothermia), penetrating back wounds (to prevent peritonitis), and neck injuries (to prevent mediastinitis).

Which of the following is true regarding internal cardiac pacemakers?

Correct answer: Pacemakers may be placed in the abdomen of particularly thin patients An internal cardiac pacemaker is a device implanted beneath a patient's skin to regulate his or her heart rate. Commonly, the pacemaker is placed on the nondominant side of the chest, so as not to hinder normal activities. In particularly thin patients, it may be placed in the abdomen. Some pacemakers include an automated implanted cardioverter defibrillator, which monitors the patient's heart rhythm and can slow an accelerated rate. Automated external defibrillator (AED) pads or defibrillator paddles should not be placed directly over pacemakers during defibrillation.

Which of the following is known as the sniffing position?

Correct answer: Patient sitting upright with the head and chin thrust slightly forward The sniffing position is a position indicative of a patient, typically a child, who is having difficulty breathing. The patient is sitting upright with their head and chin thrust slightly forward, which makes them appear to be sniffing. This position is also used during positioning of the head for children to help ensure that the trachea does not become kinked. The supine position is when a patient is lying flat on their back, face up. The tripod position, also a position seen in patients who are having difficulty breathing, is when a patient is sitting and leaning forward on outstretched arms with the head and chin thrust slightly forward. A patient sitting upright with their head elevated is said to be in the Fowler position; this position is often used to help conscious patients be comfortable and breathe easier.

Which of the following is defined as repeating a statement in order to ensure comprehension?

Correct answer: Reflection Reflection is restating a patient's statement to confirm your own understanding. Empathy is being sensitive to a patient's feelings and thoughts. Facilitation is encouraging the patient to talk more or provide more information. Clarification is asking the patient to explain what he or she meant.

Which of the following is true regarding chronic obstructive pulmonary disease (COPD)?

Correct answer: Patients with COPD typically have elements of chronic bronchitis and emphysema, but rarely one or the other COPD is characterized by persistent, progressive airflow limitation, which arises from structural lung changes due to chronic inflammation as a result of inhaling noxious particles or gases. Chronic inflammation causes narrowing of the small airways and decreased elastic recoil of the lung, which diminishes the capacity of the airways to remain open during expiration. The resulting increase in air trapping and hyperinflation contributes to progressive airflow limitation. Symptoms of COPD include dyspnea, poor exercise tolerance, chronic cough with or without sputum production, wheezing, and respiratory failure or cor pulmonale. COPD is categorized based on the degree of irreversible airway obstruction (emphysema) and the presence of significant inflammation (chronic bronchitis), with or without reversible airway disease (asthma). Clinical manifestations of COPD vary significantly between patients. Smoking cessation is the single most clinically efficacious and cost-effective way to prevent COPD, to slow progression of established disease, and to improve survival.

A motor vehicle accident is caused when an unrestrained man is driving a car 55 miles per hour and strikes a pole. Which of the following is the most likely injury he will sustain when his knees strike the dashboard?

Correct answer: Pelvic fracture A pelvic fracture is often the result of direct compression in the form of a heavy blow that crushes the pelvis. In a motor vehicle crash, a patient's knees may impact the dashboard and transmit the force along the line of the femur, driving the femur into the pelvis. Not all pelvic fractures result from violent trauma; even a simple fall can produce a fracture of the pelvis. Patella, tibia, and fibula fractures are not likely results of a motor vehicle crash in which the patient's knees strike a dashboard.

Which of the following is not a result of left ventricular heart failure?

Correct answer: Peripheral edema Left ventricular heart failure causes fluid to back up into the lungs. Subsequently, pulmonary edema may occur, which causes a patient to experience dyspnea, hypoxia, and crackles in the lungs. As fluid continues to build up in the lungs, blood further backs up into the heart, specifically the right ventricle. The most common cause of right ventricular heart failure is left ventricular heart failure. Right ventricular heart failure can result in jugular vein distension, hepatomegaly, portal hypertension, ascites, and peripheral edema. All of these are the result of fluid backup within the body.

Which of the following should be included in the "O" section of a document completed using the SOAP method?

Correct answer: Physical findings on examination The SOAP method is a common form of documentation. SOAP stands for Subjective, Objective, Assessment, and Patient care. A subjective statement or finding (symptom) is that which can only be identified by the person giving that statement. An objective statement or finding (sign) is that which can be seen, heard, felt, smelled, or measured. The chief complaint and past medical history would be subjective findings, as described by the patient. Treatment provided would fall under the Patient Care section.

A 20-year-old patient has sustained a hand injury. When splinting the patient's hand, how can a position of function be maintained?

Correct answer: Place a soft roller bandage into the palm of the hand When splinting an injury to the wrist or hand, the limb should be supported and the hand placed into the position of function (wrist slightly bent down and all finger joints moderately flexed). This may be completed by placing a soft roller bandage into the palm. Alternate positioning of the hand is inappropriate.

Which of the following is not a cause of vaginal bleeding in pregnancy?

Correct answer: Preeclampsia Preeclampsia is a possible complication during pregnancy, typically found in primigravada patients. It usually develops after the 20th week of gestation and is characterized by severe hypertension, proteinuria, headaches, visual abnormalities, edema, and anxiety. Ectopic pregnacy (when an embryo develops outside of the uterus), spontaneous abortion (miscarriage), and abruptio placentae (the placenta separates prematurely from the uterine wall) are all potential causes of bleeding during pregnancy.

Which of the following is not a common cause of altered mental status?

Correct answer: Pregnancy Pregnancy is not a common cause of altered mental status. The mnemonic AEIOU-TIPS is often helpful to remember the possible causes of altered mental status. Alcohol Epilepsy, endocrine disorders, electrolyte imbalance Insulin (i.e., hypoglycemia) Opiates and other drugs Uremia (kidney failure) Trauma (particularly head trauma), temperature (hypothermia/hyperthermia) Infection Poisoning, psychogenic causes Shock, stroke, seizure, syncope, space-occupying lesions, subarachnoid hemorrhage

Which of the following terms describes the pressure in the heart as blood volume increases prior to contraction?

Correct answer: Preload Preload is the stretch of ventricular myocardial tissue just prior to the next contraction. Therefore, cardiac preload is determined by end-diastolic volume (EDV). When venous return increases, end-diastolic volume increases and stretches or lengthens the ventricular muscle fibers, increasing tension on the heart. Afterload is the force that resists the work of the heart during contraction. Arterial (aortic) pressure is the major component of afterload influencing the ejection fraction of the ventricular contraction. As afterload increases in the normal heart, stroke volume can be maintained by increases in preload. In shock, with decreased circulating volume and therefore diminished preload, this compensatory mechanism to sustain cardiac output is impeded. The stress response with acute release of catecholamines and sympathetic nerve activity in the heart increases contractility and heart rate. Contractility is a measure of contractability, the intrinsic ability of cardiac muscle to develop force at a given muscle length. It is affected by the degree of overlap of muscle fibers, (too short or too long) and the concentration of calcium ions. Systolic blood pressure is the pressure that blood exerts against the walls of arteries as it passes through them during the contraction phase of the cardiac cycle.

Which of the following is not a common sign of airway obstruction in an unconscious patient?

Correct answer: Rhonchi Airway obstruction can be partial or complete. An inadequate or non-patent airway may result in permanent disability or death. Potential signs of an airway obstruction in an unconscious patient include noisy breathing (e.g., snoring, bubbling, gurgling, crowing, or stridor), extremely shallow breathing, and apnea. Obvious trauma, blood, or obstructions may be seen on assessment of the airway. Rhonchi are low-pitched rattling sounds caused by mucinous secretions in the airway. Rhonchi are commonly heard in patients with chronic obstructive pulmonary disease (COPD), pneumonia, or bronchitis.

Which of the following is a common cause of error when using an automated external defibrillator (AED)?

Correct answer: Presence of fine ventricular fibrillation An automatic external defibrillator will indicate a shock if ventricular tachycardia or ventricular fibrillation are analyzed. An AED will rarely fail. The most common causes for error when using an AED are the presence of fine ventricular fibrillation, use of an AED on a moving patient (physically or moving during transport), and turning off the AED before analysis/shock is completed. Other less common reasons include battery failure, application of the AED to a patient not in cardiac arrest, not pushing the analyze/shock button when instructed to do so or pushing the power button in lieu of the analyze/shock buttons. All rescuers should be clear of a patient during analysis and defibrillation via an AED.

An adult patient has greater than 36% total body surface area burns, mainly affecting his back and lower extremities. After the burning process has been stopped and smoldering clothing removed, which of the following should be the initial treatment for this patient?

Correct answer: Provide airway control and high-flow oxygen therapy The first responsibility in caring for burn patients is to stop the burning process. The patient should be moved away from the burning area and wrapped in a fire blanket, if available. Smoldering clothing and/or jewelry should be removed, if possible. Do not pull at clothing/accessories if resistance is felt; this may further exacerbate damage to the tissue. High-flow oxygen should be given to patients with large burn areas, as inhalation of irritants is likely. Cover the burns in a dry sterile dressing to prevent further contamination. Do not use ointments, lotions, or antiseptics and do not intentionally break blisters. Treat any life-threatening conditions as they are found. Treat for shock and cover the patient in warm blankets to prevent heat loss and hypothermia. Transport immediately, preferably to a certified burn center, or at least a trauma center. Other injuries, not including life-threatening conditions, can wait until a secondary assessment is performed during transport. Assessment and treatment of non-life-threatening conditions on the scene delay transport and access to a higher level of care.

A two-year-old child is postictal. His mother states that she witnessed a tonic-clonic seizure that lasted about 45 seconds. She says he has been ill for several days. Today, he has a fever that has not been well controlled with over-the-counter medications. His temperature is 102°F (38.9°C). Which of the following is the most appropriate treatment option for this child?

Correct answer: Provide oxygen via blow-by, remove his clothes, cool him with damp towels, and provide transport Febrile seizures are common in children between six months and six years of age. These seizures commonly occur on the first day of febrile illness, but may occur at any time. Febrile seizures are characterized by generalized tonic-clonic seizure, do not last longer than 15 minutes, and have a short or absent postictal phase. Assessment and treatment of ABCs, cooling measures (e.g., clothing removal, use of damp towels), and rapid transport are appropriate. Children often refuse an oxygen mask, so responders/guardians may have to hold the mask in front of the child's face (blow-by method). An anticonvulsant is not part of the pretreatment for a child who has experienced a febrile seizure.

A 66-year-old, with a history of aortic aneurysm surgery a few months ago, has sudden onset dyspnea. Her breath sounds are diminished on the right side, and retractions are noted. Which of the following is the most likely cause of her symptoms?

Correct answer: Pulmonary embolism A pulmonary embolism can be caused by a blood clot or foreign body (e.g., air bubble). Blood clots commonly form in a vein, likely in the pelvis or legs, and break off and travel throughout the circulatory system. No exchange of oxygen and carbon dioxide occurs in the area of blocked blood flow. The severity of cyanosis and dyspnea is directly related to the size of the embolism and the affected area. Other common signs and symptoms include tachycardia, tachypnea, hypoxia, chest pain, and hemoptysis. Deep vein thrombosis (DVT) is a blood clot in the deep veins. DVTs can lead to pulmonary embolism. Risk factors for a DVT include a sedentary lifestyle, recent injury, recent surgery, or venous stasis (lack of blood flow) within the legs. Common signs and symptoms of venous stasis include edema/swelling of the legs and ankles, aching legs, discoloration of the skin, and skin ulcers. Atherosclerosis is a buildup of cholesterol into plaque on the inside of the walls of the blood vessels. Blockage typically occurs in a coronary artery, which can lead to an acute myocardial infarction. Hemophilia is a genetic disorder in which patients have a decreased ability to form clots. Common complications include joint problems, intracerebral hemorrhage, and thrombosis due to treatment.

A 48-year-old patient has a history of chronic hypertension and called for help after experiencing a sudden severe pain in the chest and upper back that started about an hour ago. He describes the pain as "deep," and constant. He has no other associated symptoms. He takes medication for chronic hypertension. He is afebrile, blood pressure is 118/70 mmHg in both upper extremities, pulse rate is 122/min, and respiration rate is 22/minute. After administering high-flow oxygen, which of the following is the most appropriate next step?

Correct answer: Rapid transport Diagnosing aortic dissection requires a high index of suspicion, as it may mimic other more common conditions that cause chest pain. Prompt diagnosis is critical in this patient with an ascending aortic dissection, as immediate mortality is approximately 40% and 1% per hour, thereafter; 5-20% die during or shortly after surgery. Treatment is surgical repair. Aortic dissection is the separation of the layers within the aortic wall; tearing of the intimal layer results in the propagation of the dissection due to blood entering the newly created space. The mortality rate is high. Uncontrolled hypertension is the primary cause of aortic dissection. There is no one sign or symptom which positively identifies an acute aortic dissection. Common signs and symptoms include sudden onset, severe deep chest pain, or pain between or radiating to between shoulder blades, often described as "sharp" or "tearing." Rapid transport without delay is appropriate. Neither nitroglycerin nor aspirin is appropriate for an aortic dissection.

Which of the following is the appropriate step if the stomach appears to be distending during assisted ventilation?

Correct answer: Recheck and reposition the head, watching for rise and fall of the chest wall If gastric distension is observed, the head should be repositioned and ventilation reattempted. It is important not to expel gastric contents, which may lead to aspiration. Ventilation, if appropriate, should not be withheld. Pressing on the patient's abdomen may lead to gastric content expulsion and risk of aspiration. Suctioning is not appropriate in this scenario.

Cardiopulmonary resuscitation is being performed on a patient who is showing obvious signs of gastric distension. Which of the following is a general concern with gastric distension?

Correct answer: Regurgitation of stomach contents, with possible aspiration into the patient's lungs Gastric distension is the condition that can occur when air is forced into the stomach secondary to artificial ventilations. If a patient is ventilated too forcefully or the airway is not opened adequately, excess gas can open the esophagus, allowing for air to enter the stomach. In addition to gastric distension, hyperventilation can lead to vomitus and subsequent aspiration. Gastric distension may lead to reduced lung volume by elevating the diaphragm. Gastric distension does not prevent adequate chest compressions or increase pressure on the lungs and is not likely to result in gastric rupture.

A 20-year-old asthmatic patient is experiencing shortness of breath. On scene, the patient advises he has a meter-dosed inhaler in his backpack but needs assistance in getting it. What is the mechanism of action of albuterol via a metered-dose inhaler?

Correct answer: Relaxes airway smooth muscle Albuterol, administered via a metered-dose inhaler, is a bronchodilator, which works through relaxation of the smooth muscles of the airway. It is often used for asthmatics to counteract an inflamed or swollen airway or excessive mucus production. Bronchodilators do not provide moisture to the lungs or affect alveolar blood flow or overall lung compliance.

Nitroglycerin is a prehospital treatment for patients experiencing cardiac-related chest pain. How does nitroglycerin help to relieve pain?

Correct answer: Relaxes peripheral arteries Nitroglycerin is a vasodilator; however, "the actions of nitroglycerin on the determinants of myocardial oxygen consumption are complex: it does not directly alter contractility and reflexly increases heart rate; however, it predominantly decreases arterial resistance and venous tone thus leading to expected decrease in myocardial wall tension." Contrary to popular mythology, nitroglycerin does not appreciably increase blood flow in sclerotic coronary arteries. Nitroglycerin does not constrict peripheral arteries, increase smooth muscle contractions, or increase myocardial oxygen demand. Nitroglycerin relaxes peripheral arteries, reduces venous tone, and relieves the demands on cardiac muscle.

A non-ambulatory, 150-kg patient requires transport from a fourth-floor apartment. The elevator is too narrow to be of use for this patient if she remains in a stretcher. Which of the following is the most appropriate next step?

Correct answer: Request lifting assistance from dispatch and stand by awaiting their arrival Obesity is the result of an imbalance between calories consumed and calories used. Many cases of obesity may be attributed to a low metabolic rate or genetic predisposition. If transport is required, plan early for extra help; additional providers and/or specialized equipment may be necessary. Do not risk dropping the patient or injuring a team member by lifting too much weight. Using a stair chair may allow the patient to fit in the elevator, but will not address the weight each member has to lift to transport the patient. A scoop stretcher is not likely to fit in the elevator. It would be inappropriate to ask a family member to assist in lifting the patient; this may injure the family member if they are not familiar with appropriate body mechanics.

You are assessing the vital signs of a child at a local elementary school. Which of the following would be considered a normal set of vitals for a healthy eight-year-old child?

Correct answer: Respirations 20 breaths per minute, pulse 98 beats per minute, BP 104/73 mmHg Vital signs in children need to be carefully interpreted within the overall history, context of appearance, work of breathing, and circulation to the skin (the Pediatric Assessment Triangle) and the entire physical assessment. Normal values vary with age, and more important than identifying "normal" signs in a pediatric patient is to be aware of indications of respiratory distress/failure and circulatory shock. Serial assessments showing a trend over time may be more accurate and more useful. Pay attention to extremes. Bradycardia indicates critical hypoxia or ischemia. Rapid respiratory rate of >60 breath/min (any age) or <20 bpm (children under 6), or <12 bpm (older children) are considered red flags. A "normal" respiratory rate alone never guarantees adequate oxygenation or ventilation. Blood pressure may be difficult to assess in children, because of lack of cooperation, confusion about cuff size, and remembering normal values for a specific age. And a normal blood pressure may be misleading. Hypertension is not a clinical problem for children in the field. A low blood pressure definitely indicates hypotensive shock, and a "normal" value may be compensated shock. Vital Signs per Age Age Respiratory Rate (breaths/min) Heart Rate (beats/min) Minimum Systolic BP (mm Hg) Infant (birth to 12 mo) 30-60 100-160 > 60 Toddler (1-3 yr) 24-40 95-150 > 70 Preschooler (4-5 yr) 22-34 80-140 > 75 School-age child (6-12 yr) 18-30 70-120 > 80 Adolescent (post-puberty) 12-16 60-100 > 90

Which of the following conditions is the most common cause of cardiac arrest in children?

Correct answer: Respiratory arrest In most cases, cardiac arrest in children is the result of respiratory arrest. Respiratory arrest can lead to cardiac arrest and death if left untreated. Respiratory arrest in children can be caused from injury (blunt or penetrating), infections, foreign body in the airway, submersion (drowning), electrical shock, poisoning/drug overdose, and sudden infant death syndrome. The primary age group for pediatric cardiac arrest is infancy, when sudden infant death syndrome, infection, or child maltreatment precipitates respiratory failure. In toddlers and school-aged children, the most likely causes are hemorrhagic shock and blunt trauma from either vehicle-related injuries or falls.

After receiving three consecutive "no shock advised" messages from an automatic external defibrillator (AED), which of the following is the most appropriate next step?

Correct answer: Resume CPR, beginning with chest compressions Rapid defibrillation is the treatment of choice for VF of short duration, such as for victims of witnessed out-of-hospital cardiac arrest. If, during a cardiac arrest encounter, six AED shocks are delivered, or if the AED returns three consecutive messages (separated by one minute of CPR) that no shock is advised, resume CPR and follow local protocols regarding transport. It is not appropriate to delay CPR and reanalyze the patient's cardiac rhythm. Artificial ventilations are continued without chest compressions after a return of spontaneous circulation (ROSC) in a patient who is not breathing adequately.

If a peanut is aspirated, where is it most likely to become lodged?

Correct answer: Right mainstem bronchus Aspiration of a foreign body, such as a solid or semisolid object, may lodge in the larynx or trachea and can be a life-threatening emergency if the object is large enough to cause a complete obstruction of the airway. Smaller objects create less obstruction and may pass beyond the carina, resulting in less severe signs and symptoms. Because the right main bronchus is in almost a direct line with the trachea, foreign objects traversing the trachea are more likely to enter the right main bronchus. Complications of a foreign body aspiration depend on the dimensions and orientation of the object, and include cough, hemoptysis, asphyxia, pneumothorax, tracheobronchial rupture, or cardiac arrest.

A 12-year-old patient has been stung by a bee. He still has the stinger attached, so his mother calls for assistance in removing it. What is the proper procedure for removing a bee stinger that is still partially embedded in a patient's skin?

Correct answer: Scrape it away with a rigid object If a stinger is left in place, it may continue to inject venom for up to 20 minutes. To remove a stinger, gently scrape the skin with the edge of a sharp, stiff object (e.g., a credit card). Using tweezers or forceps or squeezing the skin may inject more venom into the wound.

What is the appropriate treatment for an open pneumothorax?

Correct answer: Seal the wound with an occlusive dressing An open pneumothorax, or "sucking chest wound," requires emergent care and transport. After ensuring a patent airway and oxygenation, the wound should be sealed with an occlusive dressing, to prevent air from being sucked into it. An improvised occlusive dressing may be taped on three sides (to simulate a flutter valve); this allows air to escape, but not re-enter, the chest cavity. Some commercial occlusive dressings contain a one-way valve. Leaving an open pneumothorax open allows for more air to enter the chest cavity. A gauze, even one soaked with sterile saline, will not create a seal over an open pneumothorax. Needle decompression is typically performed by ALS personnel or the emergency department staff for cases of a closed pneumothorax.

A patient has sustained a basilar skull fracture. Which of the following is not specific to a basilar skull fracture?

Correct answer: Seizures Basilar skull fractures are associated with high-energy trauma to the head (e.g., falls, motor vehicle crashes). A linear fracture can occur at the base of the skull; diagnosis is made with a CT scan. General signs and symptoms of a head injury may present (e.g., visible injury, altered mental status, widening pulse pressure, bradycardia, unreactive pupils, amnesia, seizures, numbness/tingling in the extremities, visual complaints, nausea/vomiting, posturing, etc.). Additionally, specific signs of a basilar skull fracture can present; these include cerebrospinal fluid drainage from the ears, raccoon eyes (ecchymosis under the eyes), and the Battle sign (ecchymosis behind one ear over the mastoid process). Depending on the severity of the injury, some specific signs may not appear until up to 24 hours after the injury. Treatment should be focused on ABCs and spinal immobilization. Seizures can be seen in all instances of head injury.

Which of the following is not a sign or symptom of preeclampsia?

Correct answer: Seizures Preeclampsia is a possible complication during pregnancy, typically found in primigravida patients. It can develop after the twentieth week of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema, and anxiety. The condition can progress into eclampsia, which is defined by the onset of seizures due to hypertension. Any pregnant patient should be rapidly transported in a postictal state.

What are the two types of nerves within the peripheral nervous system?

Correct answer: Sensory and motor The peripheral nervous system is broken down into the sympathetic nervous system (fight-or-flight response) and the parasympathetic nervous system. The nervous systems within the peripheral nervous system act in contrast to one another. That is to say, the sympathetic nervous system can cause tachycardia if stimulated, and the parasympathetic nervous system will cause bradycardia if stimulated. There are two types of nerves within the peripheral nervous system: sensory and motor. Sensory nerves carry information from the body to the brain, and motor nerves carry information from the brain to the body.

Which of the following is not a cause of hypovolemic shock?

Correct answer: Severe infection Hypovolemic shock is inadequate fluid/volume in the circulatory system. Common causes of hypovolemic shock are bleeding (hemorrhagic shock) and dehydration, as from inadequate fluid intake, diarrhea and/or vomiting. Severe infections are a common cause of septic shock, a type of distributive shock in which there is widespread dilation of small arterioles and/or venules causing decreased tissue perfusion.

A patient with a cardiac history is complaining of chest pain. Which of the following is not considered a common sign or symptom associated with cardiac insufficiency?

Correct answer: Significant numbness or tingling on one side of the body Acute coronary syndrome (ACS) is a group of symptoms caused by myocardial ischemia; the most notable symptom is chest pain that is described as pressure, heaviness, or "crushing." It should be noted that not all patients have chest pain during ACS or an acute myocardial infarction (AMI). Additional signs and symptoms of ACS/AMI include weakness, syncope, dyspnea, nausea/vomiting, and pain that radiates to the lower jaw, neck, arm, or abdomen; other signs/symptoms include diaphoresis, pulmonary edema (pink frothy sputum), and irregular cardiac rhythm. Any patient complaining of nontraumatic chest pain should be assumed to have an AMI until that is ruled out by a physician. Weakness, numbness, and tingling on one side of the body are more typically associated with a cerebrovascular accident (stroke).

A 21-year-old man has epistaxis. He has no other signs of trauma. What is the best position in which to place him?

Correct answer: Sitting, leaning forward with the head tilted forward Epistaxis, or nosebleed, is a common occurrence. Blood loss, even if unseen, may be great enough to cause shock. Typically, a nosebleed may be treated by having the patient sit, leaning forward with the head tilted forward, and applying direct pressure for at least 15 minutes by pinching the fleshy part of the nostrils together. The patient may apply this pressure. Applying ice over the nose or placing gauze between the upper lip and gum and having the patient stretch the upper lip tightly, pushing it up into and against the nose, are other treatment options. Blood from a nosebleed may be swallowed, so it is appropriate to monitor for nausea and vomiting. Placing the patient in a supine position or where the head is tilted backward may cause blood to be swallowed or possibly aspirated into the lungs.

Approximately how much blood is in the average human body?

Correct answer: Six liters The textbook's method for calculating total blood volume estimates that blood represents about 7% of body mass. Gilcher's rule of fives is used correctly for diffusion differences based on body habitus, as adipose and muscle distribute fluid differently: The U.S. population average body mass has increased in recent years to ~88.8 kg/195.8 lb (male), and ~76.4 kg/168.4 lb (female). Given these parameters, the average volume is 6.2L for men and 5.3L for women. Hypovolemic shock, is the major contributor to early mortality from trauma (and the number one cause of death in those under 45 years of age). A 10% loss of blood volume can generally be well tolerated (resultant tachycardia). A 20-25% loss of volume typically results in a failure of compensatory mechanisms (hypotension, orthostasis, decreased cardiac output), more than 40% blood loss is associated with overt shock (marked hypotension, decreased cardiac output, and lactic acidemia).

What is the average length of the first stage of labor in a primigravida patient?

Correct answer: Sixteen hours The average length of the first stage of labor (the dilation of the cervix) in a primigravida patient is sixteen hours. Typically a patient in the first stage of labor, regardless of the number of prior pregnancies, will not deliver prior to transport.

During the primary assessment, what is assessed after a patient has been determined to be unresponsive, to have no life-threatening bleeding, and to have a patent airway and adequate breathing?

Correct answer: Skin condition After level of consciousness, airway, breathing, and circulation have been assessed and life-threatening conditions treated, the patient's skin condition is assessed. This assessment includes skin color, temperature, moisture, and capillary refill if indicated. Assessing the skin is a good estimation of circulation, perfusion, blood oxygen level, and body temperature. Vital signs, to include blood pressure, palpation of the body, and auscultation of organs, are all part of the secondary assessment.

Which of the following conditions is often associated with an increased likelihood of a latex allergy?

Correct answer: Spina bifida Spina bifida is a birth defect caused by the incomplete closure of the spinal column during fetal development, resulting in an exposed portion of the spinal cord. Even with surgical intervention, the child may have spinal and neurological damage. Adequate maternal intake of folic acid reduces the risk of spina bifida. Often, patients with spina bifida have partial or full paralysis, incontinence, and an extreme allergy to latex products. Each ambulance should have latex-free products. Patients with cerebral palsy (a group of disorders characterized by poorly controlled body movement), epilepsy (seizures), or obesity are not at a greater risk of developing a latex allergy.

During a high school football game, a 15-year-old male was hit in the chest and abdomen during a hard tackle. Bystanders stated it took him a minute or two to get up, but he seemed fine for the remainder of the quarter. At half time, the player complained of sharp, left upper quadrant pain of his abdomen that radiated to his left shoulder. Which of the following was the most likely cause of his pain?

Correct answer: Splenic injury Left upper quadrant abdominal pain can be indicative of a splenic injury; occasionally this pain radiates to the left shoulder. If the abdomen becomes rigid and/or distended, the spleen may be lacerated. Since the spleen is made of delicate tissue, it is particularly susceptible to injury. The spleen is very vascular, and its injury may lead to severe internal bleeding. Right shoulder pain coupled with a rigid, distended abdomen is indicative of a lacerated liver with internal bleeding. Gallbladder injury generally causes pain in the right upper quadrant of the abdomen, just under the margin of the ribs.

Which of the following is described as a brassy, crowing sound that is most prominent on inspiration?

Correct answer: Stridor Stridor is a brassy, crowing sound that is most prominent on inspiration. It is most often heard before auscultating and is likely indicative of an airway obstruction. Rhonchi is a low-pitched sound that is prominent on expiration. It is indicative of mucus in the lungs and is often accompanied by a productive cough. Wheezing is a high-pitched whistling sound, loudest on expiration. An obstruction or narrowing of the lower airway will commonly cause wheezing. Crackles are wet, crackling breath sounds heard on inspiration and expiration that may be the result of fluid within the lungs.

Which of the following is not part of the RICES mnemonic?

Correct answer: Support Closed soft-tissue injuries are treated using methods explained in the mnemonic RICES. The patient and affected injured area should be rested. Ice or a cold pack and compression (pressure over the injury) may help to slow bleeding and reduce swelling. If possible, the injured area should be elevated above the patient's heart and splinted appropriately.

Which of the following signs and symptoms would most likely indicate compensated shock in a child?

Correct answer: Tachycardia Hypovolemia is the most common cause of shock in children in the out-of-hospital setting. Vomiting/diarrhea from illness or bleeding from falls/injuries are the most common causes. Shock is a physiologic state characterized by inadequate oxygen and nutrient delivery to meet tissue demands. In children, losses of more than 5% of body weight result in compensation through adjustments in cardiovascular physiology (i.e., 1L of blood weighs slightly more than 2.2 pounds; a 40-pound child losing 1L of blood will go into compensated shock). In compensated shock, the body maintains perfusion to vital organs. Tachycardia is often the most sensitive vital sign change. Decompensated shock occurs when the child's resilience is overcome and presents as poor perfusion (extreme pallor and cold, mottling of skin), tachypnea, extreme tachycardia, hypotension, altered mental status, and oliguria/anuria (renal failure). Hypotension is a profound and ominous sign of decompensated shock in children.

A 34-year-old male patient is agitated and confused. Which of the following signs would help indicate cocaine use?

Correct answer: Tachycardia Sympathomimetics (e.g., cocaine, amphetamine/methamphetamine, epinephrine, albuterol) are stimulants that mimic the effects of the sympathetic nervous system. Common signs and symptoms of use/overdose include hypertension, tachycardia, dilated pupils, agitation, seizures and hyperthermia. It should be noted that anticholinergics (e.g., atropine, diphenhydramine) have similar signs and symptoms. Pinpoint pupils are generally only seen with opiate (e.g., morphine, heroin, methadone, oxycodone) use/overdose. Hypotension and sedation may be seen with opiate or sedative-hypnotic (e.g., diazepam) use.

An adult female patient fell approximately twenty feet onto the ground. She is complaining of pain in both of her arms and severe abdominal pain. A deformity is noted to the humeri bilaterally, about four inches above the elbows. Her abdomen is distended, rigid, and painful on palpation. Her heart rate is 130 beats per minute, and her capillary refill is delayed. Her skin is cool, pale, and diaphoretic. Findings suggest an internal injury. Which of the following is the appropriate way to obtain a blood pressure reading?

Correct answer: Take the blood pressure of the thigh A thigh-sized sphygmomanometer is used in obese patients, patients with exceptionally well-developed arm muscles, or to take a blood pressure reading of the thigh in patients who have injuries to both arms. Taking a blood pressure reading over an injury may cause increased damage to the affected area. It is not appropriate to avoid obtaining a blood pressure reading if one is able to be measured.

A three-year-old female patient has copious amounts of mucus in her oropharynx that may cause aspiration. To avoid hypoxia, what is the maximum amount of time that a pediatric patient should be suctioned?

Correct answer: Ten seconds Aspiration may increase mortality by 30-70%. Therefore, appropriate suctioning is paramount. Suctioning should be performed in patients with fluids or secretions in the airway, as they may obstruct the airway or be forced into the lungs during assisted ventilations. Suctioning should not be done for more than 15 seconds for an adult, 10 seconds for a child, and 5 seconds for an infant.

Which of the following occurs during the inhalation phase of a spontaneously breathing patient?

Correct answer: The air pressure within the thorax decreases During the inhalation phase, the diaphragm contracts and moves down slightly, enlarging the chest cavity from top to bottom; additionally, the intercostal muscles contract, moving the ribs up and out. The enlargement of the chest cavity creates a negative pressure allowing air to be pulled into the lungs. During exhalation, the diaphragm and intercostal muscles relax, decreasing the chest cavity, increasing pressure within the lungs, and forcing air out.

A 13-year-old near-drowning patient has inadequate respirations and requires artificial ventilation. Which of the following is the most likely cause of resistance felt on ventilation?

Correct answer: The airway is obstructed due to water When assessing a drowning patient, water may obstruct the airway, making ventilations difficult. Suctioning should be completed according to protocol. Ventilations should not be withheld. Inhaling small amounts of water (either fresh or salt) irritates the larynx and can initiate a muscular spasm (laryngospasm) as a mechanism to prevent further entry of fluid. Laryngospasm can also prevent assisted ventilation. When the drowning person loses consciousness, the spasm relaxes, allowing further entry of water to the lungs. After rescue, this can also obstruct assisted ventilation. There are no indications in this scenario that the patient has a swollen epiglottis or a collapsed trachea. Epiglottitis, a life-threatening inflammatory disease of the epiglottis, will cause the epiglottis to swell, but it is not related to drowning or near-drowning. The trachea should not be affected by a drowning or near-drowning event. Additionally, there is no indication that a COPD patient will have greater resistance during resuscitation than a patient without COPD.

A 6-year-old patient is experiencing a partial foreign body airway obstruction that has progressed to a complete airway obstruction. Which of the following is the narrowest part of a child's upper airway?

Correct answer: The cricoid ring In children younger than eight years old, the narrowest part of the airway is the cricoid ring. It lies inferiorly to the thyroid cartilage and forms the lowest part of the larynx. It forms the first ring of the trachea and is the only ring within the trachea that forms a complete ring. The carina is where the trachea divides into the two mainstem bronchi (left and right) that leads to the lungs. The vocal cords are the lateral borders of the glottis. The cricothyroid membrane is the elastic tissue that connects the thyroid cartilage to the cricoid ring.

What is the definition of a postictal state?

Correct answer: The period following a seizure characterized by labored breathing and altered mental status The postictal state is the the period following a seizure, typically lasting five to thirty minutes, characterized by lethargy, confusion, nausea, hypertension, headache, and other symptoms of disorientation. Because of the lactic acidosis created by sustained muscular contraction, breathing typically becomes fast and deep in an effort to quickly reduce CO2 levels and compensate for changes in pH. An aura is a sensation experienced prior to a seizure, that can often serve as a warning sign that a seizure is about to occur. Status epilepticus is a condition in which seizures recur every few minutes or a seizure lasts longer than thirty minutes. Epilepsy is a disorder in which abnormal electrical discharges occur in the brain, causing seizures and possibly unconsciousness.

A 70-year-old male awoke to find that he could not move the left side of his body. This patient has most likely suffered a cerebrovascular accident (CVA). Which area of the brain has most likely suffered insult in this scenario?

Correct answer: The right hemisphere of the cerebrum A cerebrovascular accident (CVA), or stroke, is an interruption of blood flow to an area of the brain, causing loss of function. Symptoms vary by the area of the brain that is affected. Unilateral visual disturbances, facial drooping, and loss of motor function are common. The cerebrum (gray matter) is broken down into four lobes: frontal, parietal, temporal, and occipital. The brain can be divided into left and right hemispheres, each lobe having a section of each hemisphere. The frontal lobe is involved in voluntary muscle control and storage of memories. The left hemisphere portion of the frontal lobe controls the right side of the body, and the right hemisphere portion of the frontal lobe controls the left side of the body. Therefore, if the right hemisphere is injured, the left side of the body is affected. The brain stem is made of up the midbrain, the pons, and the medulla oblongata. The midbrain is involved in maintaining a level of consciousness, muscle tone, and posture. The pons is responsible for respiratory patterning and depth. The medulla oblongata functions to maintain an appropriate pulse, blood pressure, and respiratory rate.

A 16-year-old patient was struck in the mouth by a thrown baseball, knocking an incisor out of its socket. Which of the following is not true about the proper management of a permanent tooth avulsion?

Correct answer: The tooth should be rinsed immediately with copious amounts of water Bleeding will occur when a tooth is violently displaced from its socket; therefore, direct pressure should be administered. Suctioning and/or removal of cracked or loose teeth may be required to maintain a patent airway. Handle any avulsed tooth by the crown, not the root. Place the tooth in a special tooth storage solution, if available, or in cold milk or sterile saline. Reimplantation is recommended from 20 minutes to 1 hour after the incident.

Which of the following is an absolute contraindication to injectable epinephrine use in a life-saving allergic situation?

Correct answer: There are no contraindications There are no absolute contraindications to the use of injectable epinephrine in a life-threatening allergic situation. Some products include the following contraindications: hypersensitivity to sympathomimetic amines; narrow-angle glaucoma; nonanaphylactic shock; thyrotoxicosis, in obstetrics when maternal blood pressure is in excess of 130/80 mm Hg and in hypertension and other cardiovascular disorders. Injectable epinephrine may aggravate angina or induce cardiac arrhythmias. Caution is suggested, particularly in patients receiving drugs that sensitize the myocardium. Peripheral constriction and cardiac stimulation may occur, inducing pulmonary edema; and decreased urine output may occur in patients with renal compromise.

Which of the following is not part of the upper airway?

Correct answer: Trachea The trachea is part of the lower airway tract. Everything superior to the vocal cords, the nose, mouth, jaw, oral cavity, pharynx (nasopharynx, oropharynx, and laryngopharynx) and larynx form the upper airway.

Which of the following is not part of the upper airway?

A 16-year-old football player collided with the goal post. His only complaint is pain on the left side of his chest. Inspection reveals a bruise to the left lateral chest wall. Mildly reduced breath sounds are heard on the left side, but he displays no shortness of breath. Which of the following is most likely?

Correct answer: Traumatic Pneumothorax A pneumothorax occurs when there is an abnormal collection of air in the pleural cavity. There are three classifications of pneumothorax: primary, when there is no readily apparent cause and a lack of a significant underlying lung disease; secondary, which is related to an underlying lung disease such as COPD or tuberculosis; and traumatic, which is a result of a traumatic injury. Based on the information provided, traumatic pneumothorax seems most likely. Tension pneumothorax results from the progressive increase of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, an increased percussion note, and a hyper-expanded chest that moves little with respiration. A flail chest is when three or more ribs are fractured in two or more places. The sternum may also be fractured. The detached portion of the chest wall moves opposite of normal; this is called paradoxical motion. Paradoxical motion is a late sign of a flail chest; absence of paradoxical chest movement does not rule out a flail chest. A spleen is very susceptible to injury from blunt trauma. Injury can lead to internal bleeding, left upper quadrant pain, and a distended abdomen.

A 28-year-old female is involved in a motor vehicle accident. She is unresponsive and apneic. All attempts at opening her airway using the jaw-thrust maneuver have failed. What is the most appropriate next step?

Correct answer: Use the head-tilt/chin-lift maneuver to open her airway The head-tilt/chin-lift maneuver may be used on a trauma patient when the jaw-thrust maneuver fails to open the airway. The head-tilt/chin-lift maneuver should not be used if spinal injury is suspected unless there is no alternative way of opening the airway. An open airway is the primary goal and should be ensured in all patients.

A patient with a cardiac history complains of feeling faint every time he bears down in an attempt to have a bowel movement. Which of the following is most likely causing his complaint?

Correct answer: Vagus nerve stimulation The ability of the gastrointestinal tract to move feces through the system slows with age. Older patients may often have to strain to complete a bowel movement. Straining may cause stimulation of the vagus nerve, causing a vasovagal response. A vasovagal response is a drop in heart rate with dizziness or passing out. These patients are stable but should be worked up for alternative causes to their symptoms. Supine hypotensive syndrome is the drop in blood pressure in a pregnant patient when the uterus compresses the vena cava while they are in the supine position. Syncope is defined as fainting; this patient maintained consciousness and only complained of feeling faint. There is no indication that this patient is suffering from anxiety.

Which major blood vessel carries deoxygenated (oxygen-poor) blood to the heart?

Correct answer: Vena cava Deoxygenated blood flows from the body to the heart via the superior and inferior vena cava. Deoxygenated blood is pumped from the heart to the lungs via the pulmonary artery. Oxygenated blood returns from the lungs to the heart via the pulmonary vein. Oxygenated blood is then pumped from the heart to the body via the aorta.

Which of the following is not a sign of labored respirations and inadequate oxygenation?

Correct answer: Vesicular breath sounds Vesicular breath sounds are considered normal breath sounds and do not indicate any form of respiratory inadequacy, distress, or failure. Adventitious breath sounds, nasal flaring, and inadequate chest expansion are all indicators of inadequate breathing. Other signs are dyspnea/shortness of breath, altered mental status associated with shallow/slow breathing, anxiousness in an adult patient, listlessness in a pediatric patient, bradypnea/tachypnea, irregular breathing rhythm, decreased or noisy breath sounds, an inability to speak more than a few words between breaths, excessive coughing, the tripod position, breathing through pursed lips, and pale, cool, clammy or cyanotic skin.

The Glasgow Coma Scale assigns a numerical score to three individual parameters when assessing a patient's overall level of consciousness following an injury. Which one of the following is not evaluated as part of the Glasgow Coma Scale?

Correct answer: Visual acuity The Glasgow Coma Scale (GCS) is an evaluation tool used to determine the level of consciousness. It evaluates eye opening, verbal response, and motor response. A lower score suggests a more severe extent of brain injury. Survivability is not assessed with GCS but is assessed via the Revised Trauma Score, another scoring system. Eye-opening scoring: spontaneous eye-opening = 4 points eye-opening in response to speech = 3 points eye-opening in response to pain stimuli = 2 points no eye-opening = 1 point Verbal response scoring: responding with an oriented conversation = 5 points responding with a confused conversation = 4 points responding with inappropriate words = 3 points responding with incomprehensible sounds = 2 points not responding verbally = 1 point Motor response scoring: following basic commands = 6 points responding locally to pain = 5 points withdrawing from painful stimuli = 4 points abnormal flexion (decorticate posturing) = 3 points abnormal extension (decerebrate posturing) = 2 points no motor response = 1 point Visual acuity is not a parameter of the GCS.

Which of the following is a common sign/symptom of hyperglycemia, but not of hypoglycemia?

Correct answer: Vomiting Two of the most common, life-threatening conditions associated with diabetes are hyper- and hypoglycemia. Both are emergencies and require immediate intervention, so recognition is critical. Presentation can appear similar in both, presenting with hypotension, weak/rapid pulse, and altered mental status. Hyperglycemia is the most common symptom of diabetes mellitus. While mild hyperglycemia is often asymptomatic, more significant hyperglycemia causes increased urine glucose levels and osmotic diuresis, presenting symptomatically as increased urinary frequency, polyuria, and polydipsia, possibly leading to orthostatic hypotension and dehydration. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious acute complications of diabetes; DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia without ketoacidosis. The most common precipitating factor in the development of DKA and HHS is infection. Precipitating factors also include discontinuation of insulin, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs (e.g., corticosteroids, thiazides, antipsychotics). HHS usually evolves over several days to weeks, and DKA can present in less than 24 hours. Symptoms and signs of diabetic ketoacidosis include symptoms of hyperglycemia with the addition of nausea, vomiting, and, in children, abdominal pain. Lethargy and somnolence are symptoms of more severe decompensation. Patients may be hypotensive and tachycardic due to dehydration and acidosis; they may breathe rapidly and deeply to compensate for acidemia (Kussmaul respirations). They may also have fruity breath due to exhaled acetone. In the absence of timely treatment, DKA progresses to coma and death. Hypoglycemia typically has a rapid onset and an almost immediate response to treatment. Symptoms are nonspecific and include tremor, palpitations, anxiety/arousal, sweating, hunger, paresthesias, seizure, coma, and cognitive, behavioral, or psychomotor changes.

When is it not appropriate to apply pressure to a bleeding head wound?

Correct answer: When a skull fracture is suspected Excessive pressure to an open bleeding head wound is inappropriate if a skull fracture is suspected. Intracranial pressure may be increased or bone fragments may be pushed into the brain. A cervical spine injury, neurological deficits or an altered mental status do not prohibit the use of direct pressure on an open head wound. However, neurological deficits or an altered mental status may be signs of a skull fracture.

A 22-year-old female fell from a two-story apartment window onto concrete. She is conscious, alert, and denies any loss of consciousness, but she does complain of cervical spine pain. Which of the following is likely to be seen?

Correct increase: Unequal pupils Head and spinal injuries should be suspected in patients with a significant mechanism of injury. Significant mechanisms of injury include motor vehicle crashes, falls of greater than 20 feet for adults and 10 feet for children, blunt trauma, rapid deceleration injuries, hangings, axial loading injuries, diving accidents, and penetrating trauma to the head, neck, back, or torso. Head and spinal injuries may present with an altered level of consciousness, seizures, nausea, vomiting, decreased movement and/or numbness and tingling in the extremities, decreased motor function, unequal pupillary reaction to light, and blood or cerebrospinal fluid leaking from the ears, nose or mouth. Dyspnea, abnormal capillary refill time, and urticaria (hives) are not typically seen as a result of head or spinal cord injuries.

Costovertebral angle tenderness (CVAT), also known as CVA tenderness, Murphy's punch sign, Pasternacki's sign, or Goldflam's sign (Latin: succusio renalis), is a medical test in which pain is elicited by percussion of the area of the back overlying the kidney Correct answer: Kidneys The kidneys are approximately five inches (thirteen centimeters) long and are just anterior to the costovertebral angle. Tenderness in that area is common in patients with kidney insult. Hematuria may also be seen. If blood loss is significant, the patient may show signs of shock. Due to the uncertainty of diagnosis in patients with hematuria and flank pain, rapid transportation is appropriate. The costovertebral angle is the area between the ribs and the spine. The organs in this area are the kidneys. Kidneys often cause pain in the costovertebral angle. It could be kidney stones or infection. The liver is in the upper right quadrant of the abdomen and is unlikely to cause costovertebral angle pain. The head of the pancreas connects with the duodenum slightly to the right of the midline. It is most likely to cause epigastric pain, radiating to the back. The gallbladder is a pear-shaped, hollow structure located under the liver and on the right side of the abdomen. Its primary function is to store and concentrate bile, a digestive enzyme produced by the liver. It is less likely to cause costovertebral angle pain.

Melena

Dark or tarry stools

Triage

During a mass casuality, triage 1) highest priority= red s/s: signs of shock/hypoperfusion, severe burns, open or abd injuries 2) delayed= yellow s/s: burns without airway compromise, major or multiple bone/joint injuries, back injuries with or w/o spinal cord damage 3) minimal= green s/s: minor fracture, minor soft-tissue injuries 4) expectant= black s/s: obvious death, obvious nonsurvivable injury (open head injury)

A call is received in February for a 7-year-old with general malaise and vomiting. The patient's mother states that overnight, all three of her children started showing signs of a "bug." In addition to malaise, the children are lethargic, slightly confused, nauseated, and complain of headaches. Which of the following is the most likely cause of these symptoms?

During the primary assessment, what is assessed after a patient has been determined to be unresponsive, to have no life-threatening bleeding, and to have a patent airway and adequate breathing?

Dysphagia

Dysphagia is difficulty swallowing or inability to swallow; therefore, this patient is at risk for aspiration of the medication.

What are the causes of dyspnea?

Dyspnea is difficulty breathing. Common cause of dyspnea include pulmonary edema, hay fever pleural effusion, airway obstruciton, hyperventilation syndrome, environ./ industrial exposure, carbon monoxide posioning, and drug overdose

Meconium

Fetal stool, seen as green fluid during the rupture of the amniotic sac -if aspirated, may result is resp distress, obstruction, or fetal death post-term deliveries are a higher risk for meconium if present in newborns suction mouth then nose

gastroenteritis

Gastroenteritis is a family of conditions that typically involve infection combined with gastrointestinal complaints. It should be noted that some cases of gastroenteritis are not caused by infectious conditions (e.g., adverse reactions to medications, exposure to toxins, chemotherapy). Cases vary in duration from a few days to several weeks. Common signs and symptoms include abdominal pain, nausea, vomiting, diarrhea, anorexia, and fever. If diarrhea or vomiting persists, dehydration may occur. Shock may be possible.

Alkalosis

Generally not caused by hyperglycemia -Commonly occurs due to hyperventilation in the absence of alt. pathology Rates: 20-40 bpm depending on depth

Hemophilia

Hemophilia is a genetic disorder in which the body has a decreased ability to form clots.

Hyperglycemia

High Blood Sugar, Gradual onset of s/s than hypo S/S: intense thirst/hunger, increased urination (Polyuria), abd pain, vomiting; rapid, weak, thready pulse, restlessness w/ progression to coma, slurred speech; and an unsteady possibility is sweet fruity breath and rapid, deep (kussmaul) respirations in diabetic ketoaidosis

An alert and oriented patient may be suffering from carbon monoxide poisoning. Which of the following is the best treatment for this patient?

High-flow oxygen via nonrebreather mask

Adult pt has history of type 2 diabetes Symptoms: dark urine and generalized weakness for last few days Resp: 18bpm and O2 sat: 92% Pulse: 126 bpm Bp: 100/70 mmHG after applying high flow O2: blood gluce is 650 mg/dl if pt not receive medical attention what is likely to occur?

Hyperosmolar Hyperglycemic nonketotic syndrome (HHNS) is a condition found in pts with type 2 diabetes mellitus when hyperglycemia is uncontrolled Onset is often associated with infection/ illness, but not consistently S/S: Alt mental, drowsiness, lethargy, severe dehydration, thirst, polyuria, dark urine, visual sensory deficits, partial paralysis, muscle weakness, and seizures -often also polydispia and in severe cases unconsciousness

Arterial bleeding

Indicated by bright red spurting blood, may require tourniquet if direct p or a p dressing is not effective

Medical Director

Indivi. who authorizes EMS personnel to provide medical care in the field -physician who authorizes/delegates to the EMS personnel the authority to provide medical care

Mechanism of injury: Secondary type

Injuries result from the impact of debris from the blast striking the body, such as pentrating or blunt injuries and eye penetration (evident or occult, w/out noticeable s/s)

Routes an auto-injectable syringe of epip administrered?

Intramuscular, thigh is common place for administration 0.3 mg of epinephrine or epipen jr for pt. under 3 years of age, delivers 0.15 mg of epinephrine Side effects: sweating, tachycardia, pale skin, dizziness, headache, and palpitations Epinephrine is hormone that controls fight/flight response used in analyaxsis (severe allergic rxn) Used in the case of severe allergic rxn ORDER FROM MEDICAL DIRECTION IS REQUIRED -check meds is not expired No contradictions in life threat but contact medical direction -pt doesn't need to be in severe resp. distress/arrest (yet) to have an epip -Med not need to be stored in the fridge before use -History of heart disease is not a contradiction -Make sure pt no history of heart disease or acute coronary syndrome

Partial-thickness burn

Involves the epidermis and some portion of the dermis -skin is moist, mottled, and white to red Blisters are common; these burns can cause intense pain

Which of the following is the cause of angina pectoris?

Lack of adequate oxygenation to the heart Angina pectoris, or cardiac chest pain, occurs when the demand for oxygen from the heart exceeds the supply. Angina pectoris is often a warning sign of a myocardial infarction in the future. There are two types: stable angina pectoris and unstable angina pectoris. Stable angina pectoris is characterized by cardiac chest pain that is usually relieved with rest, supplemental oxygen, and/or nitroglycerin. Alternate non-chest-pain signs and symptoms include radiation of pain to the jaw, arm, or epigastrium, dyspnea, nausea, and sweating. Unstable angina pectoris is characterized by cardiac chest pain typically not relieved with rest or nitroglycerin. Some patients require multiple doses of nitroglycerin for relief. Alternate non-chest-pain signs and symptoms are those of stable angina pectoris. Unstable angina is often a sign of an impending heart attack. It is the most dangerous form of angina. It is not caused by exertion and tends to be highly unpredictable and hard to relieve. Unstable angina pectoris patients require rapid intervention in times of distress.

If injured, which of the following will likely result in the greatest blood loss?

Liver Solid organs, such as the liver, spleen, diaphragm, kidneys and pancrease can bleed significantly and cause rapid blood loss Abd pain is commmon w/ internal bleeding from solid organ injury -Each organ will exhibit diff S/s if damaged -risk of int. bleeding is much greater with injury to solid organs such as the liver Hollow organs: gallbladder, stomach, urinary bladder and small and large intestine (including appendix and rectum) are more likely to lead to infection if damaged

Hypoglycemia

Low blood glucose level, often caused by normal insulin dosing with a change in routine Ex. increased exercise, delayed/skipped/inadeq. sized meal, increased insulin use, or presence of an acute illness Onset is rapid: Pale, C,C skin, shallow breaths, HTN, Rapid, weak pulse, and alt mental. Oral Glucose is mainstay treatment Contradictions: inability to swallow, and unconsciousness

Abused Hallucinogens

Marijuana, LSD, mescaline (peyote), psilocybin (mushrooms), bufotenin, dimethyltryptamine, and hashish

Pathophysiology of abruptio placentae

May result in shock -is the premature separation of the placenta from the uterine wall Most common causes: HTN and trauma Severe pain is common; degree of vaginal bleeding is dependent upon the severity of the separation -if blood loss is severe, the pt. may exhibit sings of shock

Quality Control

the assurance that the appropriate medical care standards are met on each call; this is the responsibility of the medical director.

Two-year old in postictal state, ill several days and had a fever just before becoming unconscious and experiencing the seizure, which lasted less than a min. Denies past med, child lethargic but acknolwedges mother's presence

Most likely Febrile seizure, common in children between 6 months- 6 yrs. of age -seizures commonly occur on the first day of febrile illness charac by tonic clonic seizure and do not last longer than 15 minutes, and have short or absent postictal phase _Assessment of ABCs, cooling measures, and rapid transport are appropriate

Neonatal Sepsis

Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life. Late onset sepsis occurs after 1 week through 3 months of age.

When is it appropriate to elevate an extremity to control bleeding?

Not appropriate to elevate an extremity to control bleeding -Previously recommended, but no data exists to support--> elevation may aggravate other injuries

Partial seizures

Occur only in one part of the brain, are not associated with a change in the LOC

Sign of Septic Shock

Occurs due to a severe bacterial infection -Warm skin/ fever, tachycardia, and hypotension Cardiogenic and hypovolemic shock will present with cool and clammy skin

Isovolumetric Contraction

Occurs early in systole, when the ventricles contract with no corresponding chnage in volume

Supine Hypotensive Syndrome

Occurs when a preg pt. lies supine and the preg uterus compresses the inferior vena cava -blood return to the heart is decreased and results in subsequent hypotension of teh mother bc of risk, any pt in the 3rd trimester of preg should be positioned on LEFT during transport

Evisceration

Open abd injury in which organs protrude from the peritoneum ONLY PERFORM VISUAL ASSESSMENT -if clothing close to the wound, clothing should be cut around the wound, leaving a border of intact cloth outside the injured area -sterile moist dressing with sterile saline solution secured w/ a bandage or tape DO NOT USE ADHERENT MATERIAL, material that loses substance when wet ex. toilet pper, facial tissues, pper towles, absorbent cotton

A 19-year-old is complaining of general malaise and shortness of breath. She is sweaty, breathing very shallowly, and has pinpoint pupils. Which of the following is the most likely cause of her signs and symptoms?

Opioid overdose typically presents with sedation/unconsciousness, bradypnea, cyanosis and pinpoint pupils. As respirations continue to decrease in opioid overdose, respiratory and subsequent cardiac arrest are possible. Adequate airway and ventilation are paramount. Naloxone is an antidote that reverses the effects of opioid overdose; it is given intravenously, intramuscularly, or intranasally. As naloxone begins to work, the patient may regain levels of consciousness and will no longer be able to tolerate an oropharyngeal airway, if used.

Scope of practice

Outline of care that the EMT is able to provide for a pt -may include actions that are/ are not required to particular pt

Rule of Nines

Palm of a pts hand is approx 1% of their total body SA -used to estimate the approx body SA of larger burns

What is the definition of a thromboembolism?

Part of a blood clot that breaks off from its original position and occludes a smaller vein or artery -the death of body tissues is called infarction, this is commonly caused by an interruption of blood supply to the tissue. Perfusion is the flow of blood through body tissues and vessels. An occulsion is a blockage as in tubular structure like a blood vessel -if a thromboembolism causes a complete occlusion in a blood vessel, perfusion may be restricted, causing ischemia (lack of oxygen to tissue), which can lead to infarction

Which of the following signs is present if an infant receives a 1 for skin color during an Apgar assessment?

Peripheral cyanosis -if new born is pale or blue, score is zero -pink body, but hands/feet = blue is score 1 (Peripheral cyanosis) -entire newborn is pink score is 2 Cardiac insuff, neonatal sepsis, and central pontine demyelination are not eval through APGAR scoring

What is peripheral edema?

Peripheral edema is swelling of your lower legs or hands. The cause may be simple, such as sitting for too long on a plane or standing for too long. Or it may involve a more serious underlying disease. Edema occurs when something disrupts the usual balance of fluids in your cells. As a result, an abnormal amount of fluid accumulates in your tissues (interstitial space). Gravity pulls the fluid down into your legs and feet. Peripheral edema is common in older adults and pregnant women, but it can occur at any age. It may affect one or both legs. If its onset is sudden and painful, you should see a doctor as soon as possible.

Medical Control

Physician instructions that are given directly by radio or cell phone (online/direct) or indirectly by standing protocol/guidelines (off-line/indirect), as authorized by the medical director of the service program.

58 year old female complaining of chest pressure and experiencing difficutly breathing Skin signs: pale and cool states that pain began an hour prior to EMS arrival What is the next most appropriate step?

Place the pt. in a position of comfort -typically a Fowler or semi-fowler position if the pt is not breathing adequately high-flow o2 is appropriate to administer

Pleutritic Chest pain

Pleuritic chest pain is a sharp pain that worsens with inspiration. It can be associated with conditions like pneumothoraces, but is not commonly associated an AMI.

Which of the following is a concern in a patient with a neck injury?

Possibilities: cervical spine tenderness, subcutaneous emphysema, tracheal deviation, and laryngeal fracture -Subcutaneous emphysema is the presence of air in the soft tissues of the neck; commonly occurs due to blunt trauma Noted w/ characteristic crackling sensation upon palpation of the neck -Air embolism: when air exists w/in the vascular system. if a vein is punctured w/in the neck, air may be sucked through to the heart. If enough air is present in the R atrium, and R ventricle, cardiac arrest may occur

Superficial burn

Prehospital care of superficial burn involves providing simple first aid to treat pt. stymptoms. In severe cases, pts may develop second-degree burns, which could require aggresive fluid resuscitation and skin care -involves the epidermis; skin will turn red but does not blister burn site can be painful ex. sunburn

Which of the following is true reagarding chronic obstruction pulmonary disease (COPD)?

Pts. with COPD typically have elements of chronic bronchitis and emphysema, but rarely one of the other -characterized by persistent, progressive airflow limitation, which arises from structural lung changes due to chronic inflmmation as a result of inhaling noxious particles or gases -Chronic inflammation causes narrowing of the small airways and decreased elastic recoil of the lung, which diminishes the capacity of teh airways to remain open during expiration. the resulting increase in air trapping and hyperinflation contributes to progressive airflow limitation. Symptoms of COPD include: dyspnea, poor exercise tolerance, chronic cough w/ or w/out sputum production, wheezing, and respiratory failure or cor pulmonale -Characterized based on the degree of irreversible airway obstruction (emphysema) and the presence of significant inflammation (chronic bronchitis), w/ or w/out reversible airway disease (asthma). Clinical manifestations of COPD vary significantly btwn pts. -Smoking cessation is the single most clinically efficacious and cost-effective way to prevent COPD, to slow progression of established disease, and to improve survival

Pulmonary embolism

Pulmonary embolism is the blockage of an artery in the lungs, typically by a clot. These clots can develop in leg or pelvis veins and then detach and move to a pulmonary artery. Dyspnea and chest pain are common. Risk factors include trauma, cancer, history of blood clots or heart failure, the presence of a pacemaker or central venous catheter, extremity paralysis, obesity, sedentary lifestyle, recent long-distance travel, and recent surgery. typically arises from a thrombus that originates in the deep veins of the lower extremities. An embolus dislodges from the thrombus, travels to the lung, and gets caught in an artery of the lung; large thrombi can lodge at the bifurcation of the main pulmonary artery (saddle embolus) or the lobar branches and cause severe hemodynamic collapse.

A patient has sustained a possible arm fracture. He has swelling, bruising, and deformity to the lateral bone of his right forearm. Which of the following is most likely fractured?

Radius is on the outer, thumb (lateral) and ulna more towards medial Tibia is medial, fibula is lateral

Epiglottis

Rapid onset of signs and symptoms *life-threatening infection of the soft tissue above the vocal cords; can swell to two to three times its normal size -bacterial infections are the most common cause -more common in infants and children than in adults and has a rapid onset pts may look ill, have a very sore throat and high fever, and are comonly in the tripod position to assist w/ breathing

Disastolic Blood pressure

Residual Pressure that remains in the arteries during the relaxation phase of the ventricles

Gallstones

Right upper quadrant pain, nausea, vomiting, anorexia, fever, chills, and rebound tenderness

Which chamber of the heart is responsible for sending poorly oxygenated blood to the lungs to be replenished with oxygen?

Right ventricle The right ventricle pumps poorly oxygenated blood from the heart through the pulmonary valve into the lungs via the pulmonary arteries. Oxygenated blood returns from the lungs to the heart via the pulmonary veins into the left atrium. Oxygenated blood passes from the left atrium through the mitral valve into the left ventricle and is then pumped into the body via the aorta. Blood returns from the body via the vena cava into the right atrium. Poorly oxygenated blood then flows from the right atrium through the tricuspid valve to the right ventricle.

Sedative-hypnotic drugs (e.g., barbiturates, benzodiazepine, muscle relaxers, lithium)

Sedating substances. Common presentation includes slurred speech, sedation or coma, hypoventilation, and hypotension.

What is the common presentation of a superficial partial-thickness burn?

Skin that is pink, moist, and soft and exquisitely tender when touched As our understanding of thermal injury improves, classifications are changing, and focus is placed more on the depth of the burn as a measure of severity, with more accurate descriptions as superficial, partial-thickness and full-thickness. A superficial (first-degree) burn involves only the epidermis, most commonly seen as a sunburn. The patient will present with mild to moderate erythema and pain at the site of the burn without blistering. Superficial partial-thickness and deep partial-thickness burns are the two types of second-degree burns. A superficial partial-thickness burn involves the epidermis and superficial (papillary) dermis, often resulting in thin-walled, fluid-filled blisters. These burns appear pink, moist, and soft and are exquisitely tender when touched by a gloved hand. Deep partial-thickness burns extend into the reticular dermis. Skin color is usually a mixture of red and blanched white, and capillary refill is slow. Blisters are thick-walled and commonly ruptured. A full-thickness (third-degree) burn extends through the skin to the subcutaneous layer, muscle, bone and/or internal organs. The affected area is dry, leathery, dark brown or charred and may feel hard to the touch. Clotted blood vessels or subcutaneous tissue may be visible. If the nerve endings are destroyed, sensation may be lacking. A full-thickness burn is often surrounded with less severe burns that are painful.

A 60-year-old male complains of substernal chest pain. He is exhibiting the class s/s of an acute myocardial infarction. which of the following symptoms would not be present?

Somnolence or drowsiness -an acute myocardial infarction (AMI) is a medical emergency, as heart muscle can be permanently damaged w/in 30 minutes. -presents with chest pain/ discomfrot that is typically described as pressure or heaviness, nausea/vomiting and sweating -pain associated with AMI can last several hours -alt. non-chest-pain symptons include sudden onsent of weakness, nausesa, sweating, irregular heart beat, syncope, and dyspnea -Aspirin due to its platelet aggregation inhibition, nitroglycerin, due to its vasodilating effects, and oxygen are all acceptable prehospital treatments for a suspected AMi. Pain may/may not be alleviated with nitroglycerin

Air splint

Stabliize injuries below the elbow or knee

Nasal Cannula

Used in pts who cannot tolerate NRB, have specific illnesses (COPD, bronchopulmonary dysplasia)

Which of the following is described as a brassy, crowing sound that is most prominent on inspiration?

Stridor is a brassy, crowing sound that is most prominent on inspiration. It is most often heard before auscultating and is likely indicative of an airway obstruction. Rhonchi is a low-pitched sound that is prominent on expiration. It is indicative of mucus in the lungs and is often accompanied by a productive cough. Wheezing is a high-pitched whistling sound, loudest on expiration. An obstruction or narrowing of the lower airway will commonly cause wheezing. Crackles are wet, crackling breath sounds heard on inspiration and expiration that may be the result of fluid within the lungs.

Which of the following supplies blood to the upper extremities?

Subclavian arteries The aorta receives oxygenated blood from the left ventricle to disseminate to the body. The carotid arteries branch from the aorta and supply blood to the head and brain. The subclavian arteries also branch from the aorta and supply blood to the upper extremities. As the aorta moves inferiorly, it branches into the iliac arteries at the level of the umbilicus; the iliac arteries supply blood to the groin, pelvis, and legs. As the iliac arteries continue to progress inferiorly, they become the femoral arteries.

Subdural Hematoma

Subdural hematoma (SDH) typically occurs with a sudden acceleration/deceleration injury, and tearing of the bridging veins of the dura, resulting in a hematoma between the dura mater and arachnoid. Because these are commonly veinous injuries, they often present more slowly; acute symptoms usually develop gradually 1-2 days after the initial injury. Because of the mechanism of injury, however, they also typically have accompanying parenchymal damage. The elderly and alcoholics tend to have more extensive brain atrophy, and are more susceptible to development of acute SDH. Children under 2 years of age are also at increased risk. Immediate evaluation is critical, as diagnosis is based on CT scan.

A 6-month-old infant has a recent history of vomiting and diarrhea. Which of the following signs would best indicated the possibility of dehydration?

Sunken fontanelle -severe dehydration in infants may present with dry gums/lips, sunken yes, loose skin w/o elascitiy, a sunken fontanelle, lethargy, irritability, and/or a refusal of bottles

Systemic vascular resistance

Systemic vascular resistance is the resistance to blood flow within all of the blood vessels except the pulmonary vessels.

What is the correct supplemental oxygen flow rate for a nonrebreather mask?

Ten to fifteen liters per minute The correct supplemental oxygen flow rate for a nonrebreather mask is ten to fifteen liters per minute. At this rate, along with a reservoir bag, up to 95% oxygen may be delivered. Flow rates for various devices: Nasal cannula: 2 - 6 L/min (delivers FiO2 of 24 - 44%) Simple mask: 6 - 10 L/min (delivers FiO2 of 40 - 70% Nonrebreather: 10 - 15 L/min (delivers FiO2 of 66 - 95%) Bag-valve mask: 10 - 15 L/min (delivers FiO2 nearly 100%)

Infarction

The death of body tissue, commonly caused by interruption of blood supply to the tissue

Epidermis components

The germinal layer is the base part of the epidermis; it produces new cells that gradually rise to the surface. The stratum corneal layer is the dead layer of skin at the top of the epidermis.

What is the goal of CPR?

The goal of CPR is to restore spontaneous breathing and circulation. Often, defibrillation and advanced interventions, such as medications provided by ALS, are required to achieve this outcome

Liason Officer

The liaison officer is the person who relays information, concerns and requests among responding agencies.

Which chamber of the heart is responsible for pumping blood to the lungs?

The right ventricle pumps poorly oxygenated blood from the heart through the pulmonic valve into the lungs via the pulmonary artery. Oxygenated blood then goes to the left atrium of the heart via the pulmonary veins, through the mitral valve to the left ventricle and then through the aorta to the systemic circulation. Blood returns to the heart via the vena cava (inferior/superior) into the right atrium, through the tricuspid and into the right ventricle.

An unresponsive diabetic pt. has deep respirations at a rate of 32 breaths per minute. Blood glucometry determines a blood glucose level of 464 mg/dl. Which of the following statements regarding the patient's ventilatory status is true?

The patient is hyperventilating, likely due to metabolic acidosis. -Kussmaul respirations (deep, rapid, respirations) are commonly seen in pts. with metabolic acidosis due to hyperglycemia (diabetic ketoacidosis) -Hyperventilation occurs as an attempt by the body to reduce the acidity by releasing more Co2 (i.e decreasing Co2 levels w/in the body) -kussmaul respirations do not affect blood glucose levels

Which of the following statements concerning an infant's or child's airway is true?

The tracheae of infants and children are smaller than those of adults and are more easily obstructed by secretions, blood or swelling.

Pelvic Binder

Used to provide temporary stabilization of the pelvis to reduce hemorrhage from bone ends, venous disruption, and pain

4 separate chambers of the human heart: two atria and two ventricles. From what vessel does the left atrium receive blood?

Through the pulmonary veins Oxygenated blood returns from the lungs to the left atrium via the pulmonary veins. Oxy blood then pumped from the left ventricle to the body via the aorta. Deoxygenated blood flows from teh body to the right atrium via the superior and inferior vena cavae. Deoxy blood pumped from right ventricle to the lungs via the pulmonary arteries

Purpose of an incident command system

To ensure responder and public safety, achieve incident management goals, and ensure the efficient use of resources

A 16 year-old football player collided with the goal post. His only complaint is pain on the left side of the chest. Inspection reveals a bruise to the left lateral chest wall. Mildly reduced breath sounds are heard on the left side, but he displays no shortness of breath. Which of the following is most likely?

Traumatic Pneumothorax -occurs when there is an abnormal collection of air in the pleural cavity. There are 3 classifications of pneumothorax: primary when there is no readily apparent cause and a lack of significant underlying lung disease; secondary, which is related to an underlying lung disease such as COPD or tuberculosis; and traumatic, which is a result of a traumatic injury. Based on the information provided, traumatic pneumothorax seems most likely -tension pneumothorax results from the progressive increase of air w/in the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, an increased percussion note, and a hyper-expanded chest

Traumatic Asphyxiation

Traumatic asphyxiation is the result of a sudden, severe compression of the chest, producing a rapid increase in intrathoracic pressure. Common presentation will be that of distended neck veins, cyanosis in the face and neck, and hemorrhage in the sclera of the eye. An underlying injury to the heart and possibly pulmonary contusion are likely to accompany traumatic asphyxiation. Ventilatory support with supplemental oxygen and immediate transport are necessary.

A 63 year old patient has been found unresponsive and pulseless. CPR has been initiated by another rescuer. An automated external defibrillator is available. What is the most appropriate next step?

Turn on the automated external defibrillator (AED) -applied as soon as available -application of the AED pads is done after the AED is turned on. unable to analyze heart rhythm if not turned on

How many lobes are there in a normal left lung?

Two -The Human Body has two lungs. The right lung is divided into three lobes (upper, middle, and lower), while the left lung has two lobes (upper and lower).

Pancreatitis

Upper Left and Right quadrant pain that radiates to the back and worsens after eating, nausea, vomiting, abdominal distension, and tenderness

Which of the following is the opposite of urinary incontinence?

Urinary retention Incontinence is the inability to postpone voiding or bowel movements. If a patient is unable to void, they are suffering from urinary retention. A common cause of urinary retention is an enlarged prostate. If urinary retention progresses, renal failure may occur.

When removing a complete foreign body airway obstruction in a chocking 4 year old?

Use Abd. Thrusts Abd. thrusts used in removing severe airways obstructions in responsive adults and hildren older than 1 year of age -Back Blows with alt. chest thrusts are reserved for the removal of foreign body airways obstruction in infants

Pneumonia Symptoms

Vary btwn cases, dependent upon the cause and severity of the illness as well as the patient's age and overall health -Fever (hot skin), tachy, hyptotension, dyspnea, wheezing/crackles/rhonchi on lung asuc, dehydration, chest pain, weight loss, and alt mental status

Nitroglycerin

Vasodilator that is indicated for pts with cardiac chest pain -can be taken as a tablet or spray sublingually, skin patch -can be an effective medication to help reduce chest pain caused by ischemia -allowed to repeat doses if pain remains after 5 minutes; bp should be assessed before administration of initial or repeat nitro Contraindications: A patient with SBP: <100 mmHG, ED meds in the last 24-72 hours or within previous 48 hours ex. (Viagra/sildenafil,Cialis/tadalafil, Levitra/vardenafil), patient not prescribed medication, head injury, or taken their maximum dose (typically 3, if pain still persistent after 5 min.) Example nitro should be withheld from 55 year old pt with his own prescribed nitro, who took tadalafil 32 hours ago, who complains of chest discomfort and diaphoresis, and who has a bp of 150/60 mmHg

Which of the following dysrhythmias may deteriorate to ventricular fibrillation?

Ventricular Tachycardia -Rapid heart rhythm usually between 150-200 bpm. Electrical actibity begins in the ventricle, instead of the atrium. Not sufficient time for the ventricle to fill wiht blood, leading to a subsequent drop in bp. Patients may complain of weakness or lightheadness or may be unresponsive -in some cases of ventricular tachycardia... may deterioate into ventricular fibrillation

Congestive Heart Failure (CHF)

When damaged ventricular heart muscules are no longer able to keep up with the return flow of blood from the atria -blood tends to back up in the pulmonary veins, cause lung congestion and subsequent pulmonary edema

Placenta Previa

When the placenta develops over and covers the cervical opening -pts may experience heavy vaginal bleeding often w/o pain

Sniffing position

When the pt spontaneously flexes the neck slightly forward and extends their head up and back in order to open a partially obstructed upper airway

What is the appropriate sizing of a sphygmomanometer?

Wrapped around the arm 1 to 1.5 times, taking up two-thirds the length from the armpit to the crease in the elbow

Standard of Care

Written, accepted levels of emergency care expected by reason of training and profession this level of care is established by local customs, statutes, ordinances, protocols, medical literature, textbooks, administrative regulations, and case law Purpose: ensure that pts. are not exposed to unreasonable risk or harm

esophageal rupture

a middle-aged man with a history of alcohol abuse who experiences chest pain and subcutaneous emphysema after recent vomiting or retching

Pleuritic chest pain

a sharp pain that worsens with inspiration. It can be associated with conditions like pneumothoraces, but is not commonly associated an AMI.

vignette

a short scene or story

mediastinum

a space btwn the lungs that contains the heart,great vessels, esophagus, trachea, major bronchi, and many nerves

Emphysema

a type of COPD, a loss of elastic material within the alveolar air space, more common than chronic bronchitis, the alt. form of COPD -adventitious breath sounds (crackles, rhonchi, wheezing) may be heard on lung auscultation -Dyspnea, chronic cough, chronic sputum, and long expirtion phases are possible in pts with COPD

Air splints

a type of formable splint, are used to stabilize injuries below the elbow or knee.

Cystitis

a urinary tract infection of the bladder. These infections may cause inflammation and could potentially cause renal damage as well.

abrasion

a wound of the superficial layer of skin; it does not typically penetrate completely through the dermis

Cor pulmonale (Right Sided Heart Failure/ Right Ventricular Failure):

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

Ascites

an accumulation of fluid in the abdomen

angioedema

an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are swelling within the upper skin

Assisted ventilations

approx tidal volume that should be admin to an adult is 600 ml or 6-7 ml/kg enough to cause a noticeable rise of the patient's chest over ventilation may cause a pneumothorax, potentially harmful alteration to the Co2 level in the blood, as well as gastric distension and subsequent aspiration of vomitus and therefore avoided

occiput

back of head or skull -children/ infants have a proportionally larger occiput which can cause the head to flex which the pt is in supine, which may lead to an obstruction

hematoma

blood that has collected within damaged tissue or in a body cavity

Gastrointenstinal (GI) bleeding

can occur in the upper GI track (esophagus to the upper small intestine) or the lower GI tract (from the upper small intestine to the anus) Common causes of upper: esophagitis, esophageal varices, and Mallory-Weiss tear, vomiting bright red blood or coffee ground appearance Common lower: bowel inflammation, diverticulosis/diverticulitis, malignancy or hemorrhoids, melena, dary tarry stools (present due to partially digested blood)

Mechanism of injury: Primary type

caused by the impact of a supersponic blast wave on the body, preferentially affecting hollow or gas-filled structures. typical injuries include pulmonary barotrauma (blast lung), tympanic membrane rupture and middle ear damage, abdominal hemorrhage an intestinal perforation. -eyeball rupture and mild traumatic brain injury (concussion) are also included in this category

Sympathetic nervous system stimulation

constricted blood vessels causing pale, cool, clammy skin; tachy, increased froce of heart contraction, and bronchodilation

Aortic dissection

defined as separation of the layers within the aortic wall. Tears in the intimal layer result in the propagation of dissection (proximally or distally) secondary to blood entering the intima-media space. Mortality is quite high. Patients often describe sudden onset of severe chest pain that mimics acute myocardial infarction, or a sudden onset of tearing or ripping pain between the shoulder blades, depending on the location of the dissection. Patients sometimes describe pain as knifelike, sharp, or stabbing.

Which of the following is considered to be part of the third stage of labor?

delivery of the placenta -labor begins with uterine contractions and the dilation of the cervix. the first stage of labor ends when the cervix is fully dilated. the second stage of labor is the delivery of the baby. the third stage of labor is the delivery of the palcenta

What is dysuria?

difficult or painful urination

Dysarthria

difficulty speaking

Dysphagia

difficulty swallowing or eating

Common seizure causes

epilepsy, tumors, infections, head injury or scar tissue from previous head injury, stroke, hypoxia, hypoglycemia, poisoning, drug overdose, withdrawal or fever

Credentialing

established process to determine the qualifications necessary to be allowed to practice a particular profession, or to function as an organization

Hypersomnolence

excessive sleeping for long periods

Approx how much time after a myocardial infarction are 90% of myocardial cells dead in the affected areas?

four to six hours -pain associated with an acute myocardial infarction is the death of myocardial cells where blood flow is obstructed. Some myocardial cells begin to die after thirty minutes. After 2 hrs. half o the cells in the affected area can be dead. more than 90% of the affected cells will die after 4-6 hours. -in many cases, opening the coronary artery with thrombolytic therapy or angioplasty can prevent damage, if done w/in 90 min.

Hypovolemic shock

major contributor to early mortality from trauma and the #1 cause of death in those under 45 years of age -10% loss of blood volume can generally be well tolerated ( tachycardia ) -20-25% loss results in failure of compensatory mechanisms (hypotension, orthostasis, decreased cardiac output) ->40% overt shock (marked hypotension, decreased cardiac, and lactic acidemia)

Peritoneum

membrane that lines the abdominal cavity

myocardium

muscle tissue of the heart

Cardiogenic Shock

occurs when the heart lacks enough power to force the proper volume of blood throughout the body

paraparesis

partial paralysis of the legs and lower body

Preeclampsia

possible complication during pregnancy, typically found in primigravida pts. -can develop after the 20th week of gestation and is charac by severe hypertension, headaches, visual abnorm, edema, and anxiety can progress to eclampsia, which is defined y the onset of seizures due to hypertension

Which of the following is the appropiate step if the stomach appears to be distending during assisted ventilation?

recheck and reposition the head, watching for rise and fall of the chest wall -if gastric distention is observed, the head should be repositioned and ventilation reattempted. It is important not to expel gastric contents, which may lead to aspiration. -Ventilation, if appropirate, should not be w/held. Pressing on the pt's abdomen may lead to gastric content expulsion and risk of aspiration. Suctioning is not appropriate in this scenario.

Spinal immobilization

required for any pt in which a spinal injury is suspeted, such as MVA crashes; ped-motor vehicle crashes; a fall of more than 20 feet in an adult or 10 feet in a child; blunt trauma, penetrating trauma to the head, neck , back, and torso; rapid decel injuries

Mechanism of injury: Quinary type

result from toxic materials absorbed by the body from the blast. these materials can affect the immune system and perhaps the autonomic nervous system, leading to an immediate hyperinflammatory state. -Fever, diaphoresis, low central venous pressure, and tissue edema are typical of this category

Regarding insertion of OPA airway in child...

rough insertion can cause bleeding, aggravating the airway problems or cause vomitus -ensure that the tongue isn't pushed back into the pharynx -if the airway is too large, it may obstruct the larynx OPA of an aadult should not be rotated like in an adult, it should be inserted straight in

Which of the following is NOT a cause of hypovolemic shock?

severe infection, which is a common cause of septic shock, type of distributive shock in which there is a widespread dilation of small arterioles and / or venules causing decreased tissue perfusion -hypovolemic shock= inaedquate fluid/ volume in the circulatory system common causes: bleeding (hemorrhagic shock) and dehydration, as from inadequate fluid intake, diarrhea and/ or vomitting -poor skin turgor common sign

Approx how much blood is in the average human body?

six liters -blood represents about 7% of body mass increase in body mass in the US so average male volume is 6.2 and female is 5.3

Arterioles

smallest branch of an artery and only exist to connect blood flow from arteries to capillaries; is the tunica media, as above that cause the regulation of blood flow throughout the arteries

Tunica Media

smooth muscle in the middle layer of the artery that can contract/dilate to regulate blood flow through the artery and to subsequent capillary beds

Mallory-Weiss tear

tear that occurs in the esophageal mucosa at the junction of the esophagus and stomach caused by severe retching and vomiting and results in severe bleeding.

hemoptysis

the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions.

Perfusion

the flow of blood through the body tissues and vessels

Kyphosis

the forward curling of the back caused by an increased curvature of the spine.

Ataxia

the loss of full control of bodily movements

General adaptation syndrome

the three-stage response to stress. These stages include an alarm response, a reaction and resistance stage, and recovery. Exhaustion may substitute for recovery if the stress is prolonged.

Nuchal cord

umbilical cord wrapped around a baby's neck on delivery, possible birth complication

NRB Mask

used in patients with adequate breathing but who are suspected of or showing signs of hypoxia Early signs: restlessness, irritability, apprehension, tachycardia, and anxiety Late signs: alt mental status, weak/thready pulse, and cyanosis Delivered at a rate of 10-15 l/min up to 95% oxygen

Traction Splints

used to secure mid-shaft fractures of the femur; provides stabilization of the fracture and alignment of the limb to reduce pain and potential neurovascular compromise Contraindications: injuries to pelvis, hip fractures, multiple fractures of the leg (knee injury, lower leg, foot or ankle) NOT USED FOR UPPER EXTREMITIES

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