EMT 4, EMT 1, EMT 3
drug toxicity
an adverse or toxic reaction to a drug or drugs
A large puncture wound or laceration to the neck must be immediately sealed with an occlusive dressing to prevent:
an air embolus.
Quality Improvement (QI)
an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy
Hypersensitivity
an exaggerated response by the immune system to a particular substance -developing this on first exposure is sensitization
aneurysm
an excessive localized enlargement of an artery caused by a weakening of the artery wall.
NEVER use adhesive tape on a pressurized oxygen tank, as it may cause:
an explosion
sensitization
an increase in response after exposure to a stimulus -exposure to an allergen that results in hypersensitivity to the allergen
Abdominal evisceration
an open wound where organs protrude from the abdominal cavity
A tilt test is the common name for:
an orthostatic vital sign test. test them lying flat, then standing 2 minutes later
nonrebreather mask
an oxygen-delivery apparatus used to deliver high flow rates and high concentrations of oxygen via a mask that fits snugly over the patient's mouth and nose patient must already be breathing, only provides O2 to be inhaled 100% o2
vascular access device (VAD) *
an umbrella term that includes a variety of catheters, cannulas, and infusion ports that allow intermittent or continuous access to a blood vessel
aura
an unusual sensory experience that may precede a seizure
Epinephrine is used to treat
anaphylactic shock (severe allergic reaction)
________ is a common cause of subarachnoid hemorrhages
aneurysm
Percutaneous Intervention
angioplasty
ethylene glycol
anifreeze -colorful and sweet, so kids love it -may present as intoxicated Neurological Stage (30 min-12 hrs) -lack of coordination, slurred speech, AMS, NV, seizures, hallucinations Cardiopulmonary Stage (12-24hrs) -tachypnea, crackles (pulmonary edema), cyanosis, dyspnea, heart failure Renal Stage (24-72hrs) -oliguria (little urine) or anuria (no urine), hematauria, pain in flank areas
IgE-mediated anaphylactic reaction
antibodies are formed in response to allergens
Hymenoptera
ants, bees, wasps -cause anaphylaxis in some people
accelerant
any material used to start or sustain a fire oxygen is an accelerant
Capillaries
any of the fine branching blood vessels that form a network between the arterioles and venules. -walls allow exchange of nutrients, gas, and waste -all material exchange between blood and tissue cells take place through capillary walls
Major arteries
aorta, coronary artery, pulmonary arteries
respiratory arrest
apnea -weak carotid rx: -BVM
agonal respirations
apnea with gasping breaths
sucking chest wound (open pneumothorax)care
apply occlusive dressing, treat other life threatening injuries, keep one corner of dressing open.
A patient's brain cells are undergoing anaerobic metabolism. As a result, those cells: A. have too much adenosine triphosphate (ATP) to function properly. B. cannot make any energy in the form of ATP. C. are producing elevated quantities of carbon dioxide (CO2). D. are becoming dysfunctional in a highly acidic environment.
are becoming dysfunctional in a highly acidic environment.
mediastinum
area between the lungs containing the heart, aorta, venae cavae, esophagus, and trachea
potential space
area between the visceral and parietal layers -negative pressure so stuff gets sucked in if one is broken
safety zones
areas surrounding an accident involving hazardous materials, designated for specific rescue operations hot zone, warm zone, cold zone
compound presentation
arm or leg enters birth canal and presents with head or butt
Decorticate posturing
arms flexed inward and bent in toward the body and the legs are extended
irritant receptors
around airways & are sensitive to *irritating gasses, aerosols, & particles* -stimulate cough, bronchoconstriction, and increased ventilatory rate
elderly have higher blood pressures because
arteries become stiffer with age
from arteries to veins
artery - arteriole - capillary - venule - vein
oral medication
aspirin, oral glucose, activated charcoal
Focused assessment
assessment conducted to assess a specific problem; focuses on pertinent history and body regions
Apneustic respirations
associated with brainstem insult. prolonged periods of inhalation, little exhalation
The disease process that results in a buildup of fatty deposits on the inner walls of the arteries is called:
atherosclerosis
irregularly irregular
atrial fibrillation; A palpable pulse that presents with a chaotic rhythm and no predictable pattern
generalized tonic-clonic seizure stages
aura uncoscious tonic phase (muscle rigidity) (arched back) clonic phase (convulsion) postictal state
In checking a patient's blood pressure for the FIRST time utilizing a noninvasive blood pressure monitor, it is BEST to:
auscultate a manual blood pressure first.
The FIRST blood pressure the EMT takes should be done by:
auscultation method using a sphygmomanometer and stethoscope.
inferior
away from the head
Involuntary consent would most likely apply to:
a 23-year-old prisoner with a laceration to the right cheek and refusing care.
supine hypotensive syndrome
baby presses against i. vena cava when supine -lower BP, lower heart rate -tilt to left
Posterior (dorsal)
back
olecranon
back of elbow
regurgitation
backflow of blood through a defective heart valve -more common with BICUSPID valve than tricuspid -blood regurgitates into left atrium -backflow of blood in lungs - pulmonary edema
suicide bags
bag of helium or nitrogen, eliminates normal reaction to suffocation (dont struggle and panic) -low O2 atmosphere for rescuers
hip joint
ball and socket joint formed by the head of the femur and the acetabulum of the hip bone
most common joints
ball-and-socket & hinged
what triggers the compensatory mechanisms in response to shock?
baroreceptors trigger hormone release and SNS stimulation
As an EMT, you will be measuring breathing, pulse, skin, pupils, and blood pressure. The FIRST set of measurements you take are known as:
baseline vital signs
What is the final component that is performed in completing the secondary assessment of a medical patient who is alert and oriented and complaining of non-traumatic chest pain?
baseline vitals
The properly placed sphygmomanometer cuff should:
be centered over the brachial artery.
pulsus paradoxus
beats have weaker amplitude with respiratory inspiration, stronger with expiration The normal fall in systolic pressure is less than 10 mmHg. When the drop is more than 10 mmHg, severe cardiac or respiratory injury or illness, or blood l]oss
nocturnal enuresis
bed wetting
circulatory phase of cardiac arrest
begins at 4 minutes and lasts through 10 minutes of cardiac arrest -shift from aerobic to anaerobic metabolism !!2 mins of CPR and then defibrillation!!
Metabolic phase of cardiac arrest
beings at 10 minutes after cardiac arrest -heart is starved of oxygen and glucose -acid build up -sodium/potassium pump failure cells swell, rupture and die
ventral
belly side
hypothermia
below 95 degrees -critical care in first 30 min -early: shivering -deteriorating: slurred speech
hypo-
below normal
70% of carbon dioxide is carried in the blood as _______________.
bicarbonate
precipitous delivery
birth of the fetus after less than 3 hours of labor -increased risk of trauma & tearing of umbilical cord
neonate
birth to 1 month
absence (petit mal) seizure
blank stare, no motor -children complex partial seizure (one hemisphere)
pulmonary contusion
bleeding within the lung tissue that causes a disturbance in gas exchange between the alveoli and capillaries bruising -caused by flail segment -sx: dyspnea, cyanosis, blunt trauma -rx: o2
thrombus
blood clot platelet + thrombin + fibrin
hemothorax
blood in the pleural cavity/space causing collapse of the lung -chest trauma - lacerated vessels in chest -sx: shock, (late) respiratory distress, pink/red frothy sputum -rx: care as pneumothorax and shock
stethoscope is usually used to measure
blood pressure
stethoscope
blood pressure & lung sounds
sphygmomanometer
blood pressure cuff
What would be the expected clinical change to your unresponsive trauma patient who had ineffective spontaneous breathing if you are overventilating the patient during positive pressure ventilation (PPV)?
blood pressure will decrease
angi/o-
blood vessel
coronary arteries
blood vessels that branch from the aorta and carry oxygen-rich blood to the heart muscle
coronary arteries
blood vessels that branch from the aorta and carry oxygen-rich blood to the myocardium
mottling (gray-blue)
blotchy pattern shock patients or patients with blood pooling in extremities for long periods of time
Types of Trauma
blunt and penetrating
Anatomy
body structure
sepsis
body's exaggerated inflammatory response to infection tachycardia, tachypnia, and fever
ulnar shaft
bone on the pinkie side
radial shaft
bone on the thumb side
tarsals
bones of the ankle
Metatarsals
bones of the foot between ankle and toes
muscoskeletal system
bones, muscles, tendons
A ______ pulse should be assessed in all patients younger than 1 year
brachial
You are assessing a 9-month-old patient who is unconscious. You know that the BEST pulse to palpate in a patient this age is the:
brachial
unlike most other body cells, _____ cells can only use glucose for energy
brain -altered mental status
Central Nervous System (CNS)
brain and spinal cord - 3 protective layers over CNS = *meninges* - cushion of fluid = *cerebrospinal fluid*
cardiovascular control center is located in
brainstem -cardioexcitatory & cardioinhibitory centers
trade name
brand name
sternum
breastbone; flat, narrow bone in the middle of the anterior chest
Absent alveolar breath sounds
breathing inadequacy; can use artificial ventilaiton
Transient Ischemic Attack (TIA)
brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); often precedes a stroke 1-2 hours (can last up to 24)
bronch/o-
bronchi
albuterol
bronchodilator (beta 2 agonist) -has some beat 1 properties so heart rate increases
Ecchymosis
bruise
hematoma
bruise; collection of blood can compress the airway and cause obstruction
When performing the secondary assessment, the EMT would find which one of the following injuries first?
bruising in the abdomen
coronary artery disease (CAD)
buildup of fatty deposits (atherosclerosis) on the inside of the coronary arteries most common heart disease
esophageal varices
bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus -heavy drinkers, liver disease -caused by portal hypertension (hyp in liver, stomach, esophagus vein system) -s/s: hematemesis, no abdominal pain, tachycardia, dyspnea, pale cool clammy, shock, jaundice
The purpose of a thorough scene assessment by EMTs is to ensure their own well-being as well as the well-being of patients and:
bystanders
cervical collar
c-collar; foam or rigid splint placed around the neck
Which of the following is a known disadvantage to providing mechanical ventilation to an apneic patient with a pulse?
can cause drop in blood pressure
Noninvasive blood pressure monitors:
cannot palpate a blood pressure.
A reliable indicator of perfusion in children less than six years of age is:
capillary refill
most efficient indicator of perfusion in infants and children
capillary refill
3 sources of energy for body cells
carbohydrates fats proteins
Which condition can cause the pulse oximeter not to display a value?
cardiac arrest
dialated pupils indicate
cardiac arrest (will also be fixed), drug use such as LSD, amphetamines, or cocaine
Which of the following patients are particularly sensitive to the detrimental effects of overventilation?
cardiac arrest patients
nonreactive
cardiac arrest, brain injury, drug intoxication or overdose
Fixed and dialated pupils suggest?
cardiac arrest, severe head injury, severe hypoxia, extremely poor perfusion
heart rate x stroke volume =
cardiac output
Which type of shock results from cardiac insufficiency, that is, the inability of the heart to pump an adequate amount of blood?
cardiogenic shock
circulatory system is same as
cardiovascular
negligence
careless neglect, often resulting in injury
You should be especially careful when palpating this pulse, because excess pressure can cut off circulation to the brain.
carotid
Your adolescent patient is unconscious. The BEST place to check a pulse in this patient is:
carotid
artery
carries blood away from the heart
vein
carries blood towards the heart
Arteries
carry blood away from heart; oxygenated except for pulmonary circulation and umbilical vessels of fetus Arteries don't require valves because pressure from the heart is so strong that blood is only able to flow in one direction
Veins
carry blood to the heart; all veins except pulmonary veins carry oxygen-depleted blood have valves to prevent backflow
red blood cells
carry oxygen to cells, carry carbon dioxide away from cells hemoglobin on the surface of red blood cells carries O2 and CO2 (different sites)
pulmonary veins
carry the oxygenated blood from the lungs into the left atrium of the heart only veins that carry oxygenated blood
Beta 2 effects
cause smooth muscle to dilate -especially in bronchioles (lungs) and some vessels
engorged
cause to swell with blood, water, or another fluid
tension headache
caused by muscle contraction in neck and scalp -tight pain on both sides -most common recurring headache -frontal, temporal, occipital pain that radiates to neck -no appetite -gradual onset
secondary seizures
caused by some other process (ie: infection, hypoxia, hypoglycemia, hyperglycemia, drug intoxication, withdrawal, eclampsia in pregnany, degenerative brain diseases, electrolyte imbalance) -either *generalized* or *partial* seizures
Failure of the sodium potassium pump can result in:
cellular damage, swelling, and rupture.
two components of the nervous system that control consciousness
cerebral hemispheres reticular activating system (RAS)
What is the formal name of a stroke, defined as the death or injury of brain tissue that has been deprived of oxygen?
cerebral vascular accident (CVA)
cerebr/o-
cerebrum, brain
trending
changes in a patient's condition over time, such as slowing respirations or rising pulse rate, that may show improvement
A 66-year-old male has summoned your assistance because he is short of breath and his home pulse oximeter is reading 89%, despite 3 lpm of home medical oxygen. Assessment reveals an intact airway and adequate breathing. His radial pulse is normal and skin hot and dry. Vital signs are: pulse 84, respirations 18, and blood pressure 166/86 mmHg. Breath sounds are clear bilaterally. His pulse oximeter is fluctuating between 88% and 90%. In this situation you would first: *
check his SpO2 with your pulse oximeter
Assessment of a patient's neck reveals that the trachea is deviated to the left. Based on this assessment finding, the EMT should suspect an injury located to the patient's:
chest usually tracheal deviation is the result of chest injuries
thoracic region
chest area
unstable angina
chest pain that occurs while a person is at rest and not exerting himself; prolonged and worsening; not relieved by nitro >20 min = ACS
angina pectoris
chest pain that results when the heart does not get enough oxygen -increased workload on heart, physical or emotional stress -goes away after activity stops ACS (acute coronary syndrome if not resolved with rest and 3 nitro
thorax
chest; composed of *ribs, sternum, and thoracic spine*
CHART
chief complaint, history, assessment, Rx, transport
A sudden onset of abdominal pain located from the middle of the upper quadrants to the right upper quadrant area, presenting at night, and associated with a low-grade fever and greenish emesis is MOST likely caused by:
cholecystitis.
epilepsy
chronic brain disorder characterized by recurrent seizure activity
dementia
chronic condition resulting in the malfunctioning of normal cerebral processes
astma
chronic disease characterized by shortness of breath and wheezing caused by bronchiolar constriction
astma
chronic disease characterized by shortness of breath and wheezing caused by bronchiolar constriction & inflammation in bronchioles -increased mucus -kids have less area in the bronchioles, so constriction is scary
proximal
closer to point of attachment to trunk
masseter
closes jaw (mandible)
hypertension leads to
clots -stroke
hemophilia
clots can not form easily
thrombophilia
clots form too easily
Cataracts
clouding of the lens
cataract *
clouding of the lens of the eye
Dilated pupils may be a sign of:
cocaine
atelectasis
collapsed lung; incomplete expansion/collapse of alveoli -results when water washes surfactant out
clavicle
collar bone attached to manubrium
ovarian cysts
collections of fluid within a sac (cyst) in the ovary
RLQ organs
colon, right ureter, appendix, (FEM: right ovary, right fallopian tube), small intestines
ventral respiratory group (VRG)
column of neurons in anterior medulla that contains both *inspiratory neurons* and *expiratory neurons* that *stimulate intercostal muscles and diaphragm*
8 or less on GCS
comatose client
combining form
combination of the root(contains medical meaning) and the combining vowel (usually o) -always ends with a hyphen cardi/o-
flat affect
common in suicide patients whilst describing wanting to die
Bone structure
compact bone, spongy bone, bone marrow, arteries
You arrive on the scene of an automobile collision and find one of the drivers suffering from multiple injuries and an altered level of consciousness. After completion of the primary survey, you should next:
complete a rapid secondary assessment.
cardiac arrest
complete stopping of heart activity -no pulses
major sources of carbohydrates
complex sugars: sucrose (table sugar) lactose (milk and dairy sugars) starches (potatoes, bread)
tamponade
compression of an organ, such as the heart
prenatal period
conception to birth 38-42 weeks / 9 mo (full term) -broken into 3 month trimesters
endometriosis
condition in which endometrial tissue grows outside the uterus
Atherosclerosis
condition in which fatty deposits called plaque build up on the inner walls of the arteries hardening of arteries risk factors: smoking, diabetes, hypertension, high levels of low-density lipoproteins (LDLs), and low levels of high-density lipoproteins (HDLs)
hemaologic condition
condition of the blood
postmaturity syndrome / postterm pregnancy
condition that occurs during pregnancy when gestation of the fetus extends beyond 42 weeks, leading to reduced oxygen and nutrient delivery to the fetus
bradypnia
condition where the breathes are abnormally slow and fall below 10 breathes/ minute.
Reassessment
conducted following secondary assessment; 5 min for critical 15 for non critical in ambulance 1. repeat primary assessment 2. reassess and record vitals 3. repeat secondary assessment for other complaints or change in chief complaint 4. check effectiveness of interventions 5. note trends in patient's condition
temporomandibular joint
connection on either side of the head between the temporal bone of the skull and mandibular bone of the jaw
expressed consent
consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being
involuntary consent
consent that is assumed when the patient is either mentally incompetent or legally not permitted to make his own medical decisions
When a penlight is shined into one eye, the opposite eye should:
constrict
narcotics like morphine, heroin and codeine _______ the pupils
constrict
miosis
constricted pupils
wheezing is usually caused by
constriction & inflammation reducing the diameter of bronchioles in the lungs
stenosis
constriction or narrowing of a passage or opening ie: valves of heart
POLST (Physician Orders for Life-Sustaining Treatment)
continuation of life-sustaining treatment with limitations terminal illness, not expected to live long
CPAP
continuous positive airway pressure supports ventilation, does not serve as artificial ventilation alert and can breathe on their own
atrial systole
contraction of the atria
QRS complex
contraction of the ventricles -depolarization of ventricles
one brain side controls movement and sensation on the _________ side
contralateral -nerves cross over at level of medulla (level of upper lip) -face droop will be on same side as stroke
febrile seizure
convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body.
acute coronary syndrome (ACS)
coronary arteries are narrowed or blocked by fat, clots, or a spasm sudden onset -unstable angina -myocardial infraction crushing chest pressure ask "chest discomfort" -give minimum o2 (reperfusion injury): nasal cannula -caused by coronary artery disease
P wave
corresponds to contraction of the atria -depolarization of atria
hemoptysis
coughing up blood or blood-stained sputum
To adequately assess the patient's respirations, the EMT should:
count the number of respirations over 30 seconds and multiply by 2.
Narrowest part of the pediatric airway
cricoid cartilage
critical incident stress management (CISM)
critical incident stress debriefing and critical incident defusing
injury to femur
critical; severe bleeding even though its an extremity bone
You are by the side of a 2-year-old whose mother states he has had a cough for the past three days. His airway is patent and respirations labored. Intercostal retractions are accompanied by stridorous respirations. His skin is warm to hot and vital signs are as follows pulse 152, respirations 28, SpO2 97%, and temperature 100.3°F. Breath sounds are clear and equal. Based on this presentation, you would suspect and treat the patient for
croup; inflamed larynx
kidney stones (renal calculi)
crystals formed from metabolic abnormalities -20-50 -risk: hyperthyroidism, UTIs, sedentary lifestyle, dehydration, obesity -recurrent
A patient who is nonverbal from a previous stroke is in severe respiratory distress. Family states that she has multiple medical problems including high blood pressure, diabetes, heart failure, and chronic obstructive pulmonary disease (emphysema and chronic bronchitis). When assessing the patient, which one of the following signs or symptoms should raise your suspicion that the patient is suffering from heart failure, as opposed to COPD or asthma? Select one: a. Pursed lip breathing b. Diaphoresis c. Flat neck veins d. Pulmonary crackles
d. Pulmonary crackles
diabetic retinopathy *
damage to the small blood vessels of the eye from the long-term effects of diabetes mellitus
local cold injury
damage to tissues in a specific part of the body resulting from exposure to cold -ice crystals obstruct blood flow -occurs at COLDER temperatures than hypothermia
In a patient whose vessels are dilating (growing diameter), his diastolic pressure would
decrease
Beta Blockers
decrease heart rate and dilate arteries by blocking beta receptors
under 86 F body temp (BCT)
defibrillation and ALS medications wont work
hypoxemia
deficient amount of oxygen in the blood
DCAPBTLS
deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling
Your infant patient is breathing 44 times a minute with a strong cry and you are going to administer oxygen. The MOST appropriate treatment for this patient is to:
deliver oxygen via blow-by with a mask.
stages of grief / five emotional stages
denial, anger, bargaining, depression, acceptance
alcohol
depressant -rule out hypoglycemia, head trauma, and stroke first -cincy stroke scale (droop, arm, speech)
Baroreceptors
detect changes in blood pressure & tell medulla of brainstem to change stuff if something's wrong -stretch-sensitive -in aortic arch and carotid sinuses shock: trigger hormone release and SNS stimulation (compensatory mechanisms) to increase cardiac output, BP, and perfusion
metered-dose inhaler (MDI)
device consisting of a plastic container and a canister of medication that is used to form an aerosolized medication that a patient can inhale in *one breath* -astma, emphysema, chronic bronchitis -beta 2 agonist (causes bronchiodilation) EX: albuterol, levalbuterol -non beta 2 agonist (blocks PNS) EX: ipratropium bromide (Atrovent) "The medication in the inhaler relaxes and opens up the small airways in the lungs."
repeaters
devices that receive transmissions from a relatively low-powered source such as a mobile or portable radio and rebroadcast them at another frequency and a higher power
Fruity odor to breath
diabetic; high blood sugar
What is the primary smooth muscle that participates in normal inhalation called? A. Visceral pleura B. Accessory muscle C. Lung D. Diaphragm
diaphragm
diastolic hypertension
diastolic pressure over 90 mm Hg
pulse pressure
difference between systolic and diastolic pressure
dyspnea
difficulty breathing
Stridor is a high-pitched, inspiratory crowing sound commonly associated with:
difficulty breathing partial obstruction of the upper airway at the level of the larynx
orthopnea
difficulty breathing when lying down
stages of labor
dilation, expulsion, placental
neuropathy
disease of the nerves -peripheral neuropathy - weakness, numbness, tingling, or other symptoms in hands and feet
Attempting to determine the patient's nature of illness can begin with what information for the EMT?
dispatch information
EMD (Emergency Medical Dispatchers)
dispatcher can provide over-the-phone instructions for CPR or bleeding control
fibrinolytics
dissolves all clots (careful if they just has a surgery or something) contraindications: hypertension, head/face trauma, stroke or cranial bleeding, pregnant, surgery or trauma, any bleeding really
enteric-coated aspirin
dissolves more slowly in small intestine; not for chest discomfort because it takes so long
What would be a critical finding in an unresponsive medical patient that the EMT would likely identify during the rapid secondary assessment? A. Distended abdomen B. Airway occlusion C. Apnea D. Altered mental status
distended abdomen everything else would have been looked at in primary assessment
septic shock
distributive shock caused by sepsis, infection causes dialation septic shock with hypotension (systolic BP <90 mmHg) identified using Robinson Screening Tool, RAS 90-30-90 Scales, and qSOFA Score
water pill
diuretic; Medication taken to remove excess body water and fluids by urinating. people with CHF may be on this
saggital plane
divides the body into a right and left side
Anaerobic resporation
does not require oxygen
pleura
double-layered membrane surrounding each lung visceral & parietal -separated by *serous fluid* in "potential space"
pulsus paradoxus
drop in blood pressure >10 mmHg with inspiration -increased pressure in chest that suppresses the filling of the ventricles of the heart with blood -tension pneumothorax or pericardial tamponade
chemical name
drugs chemical structure; usually the first name associated with the drug
What are the first steps in neonatal resuscitation based on the inverted pyramid?
dry and warm the newborn
endocrine system
ductless *glands* secrete *hormones* that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells.
Pallor (blanching)
due to emotional stress such as fear, anemia, low blood pressure, impaired blood flow, blood loss, vasoconstriction
obstructive shock
due to obstruction of blood flow pulmonary emobolism, tension pneumothorsx, pericardial tamponade
Metabolic/Respiratory Shock
dysfunction in the ability of oxygen to diffuse into the blood
airway resistance
ease of airflow down the conduit of airway structures leading to the alveoli
tracheal tugging
effect of an aortic aneurysm in which the trachea is pulled downward with each heart contraction "pendulum motion" that moves toward obstruction
The on-board suction units in the back of the ambulance are typically powered by:
electrical vacuum pump
shock position
elevation of the feet of a supine patient 6 to 12 inches; recommended for shock that is not caused by injury
defaction
elimination of feces
>8 weeks baby
embryo
obstructive pulmonary diseases
emphysema, chronic bronchitis, asthma -emphysema and chronic bronchitis are COPD because they are progressive & chronic (usually caused by smoking)
menopause
end of menstruation and fertility, which usually occurs in a woman's late 40s or 50s
E-911
enhanced 911: provides automatic number identification (ANI) and automatic location identification (ALI) -displayed even if caller hangs up
layers of the skin
epidermis, dermis/dermal, subcutaneous
Formed elements of blood
erythrocytes, leukocytes, thrombocytes (red [most abundant], white, platelets) most of blood is plasma
Anaphylaxis/Anaphylactic reaction
exaggerated immune response to a foreign substance -vasodilation (decreases blood pressure and perfusion) -bronchoconstriction -capillaries leak fluid (increased capillary permeability) -increased mucus response -upper airway swelling -sx: epinephrine most severe form of an allergic reaction
hypercarbia
excessive level of carbon dioxide in the blood
hypercarbia / hypercapnia
excessive level of carbon dioxide in the blood
polydispia
excessive thirst
The EMT recognizes that the Health Insurance Portability and Accountability Act (HIPAA) limits the EMT's ability to:
exchange medical information regarding the patient.
cluster headache
excruciating pain on one side in temporal region or around eye -sx: tears, congestion, nausea, pallor, agitation, drooping eyelids
radiation poisoning
exposed to dangerous amounts of internal radiation -cancer and anemia
vastus medialis
extends knee
quadriceps femoris
extends leg
adductor femoris
extends thigh into crotchy area
sodium is considered a primary _______ ion
extracellular ion
eye orbit
eye socket
supine
face up
syncope
fainting
Braxton Hicks contractions
false contractions; intermittent painless uterine contractions that occur with increasing irregular frequency as the pregnancy progresses -no dilation or effacement
distal
farther from the origin of a body part or the point of attachment of a limb to the body trunk
tachy-
fast
fats are broken down into
fatty acids and glycerol
ather/o
fatty plaque
agoraphobia
fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic A patient states that she cannot leave the house to go to the hospital "because I am scared I will do something idiotic and lose it and then everyone will look at me and laugh." She states she rarely leaves the house and the last time she did, she began to hyperventilate. This caused her to return home immediately. Based on this information, the EMT should recognize the patient as suffering from:
Palpatation
feeling for the return of the pulse as the cuff is deflated
placenta
fetal organ through which the fetus exchanges nourishment and waste products Which organ allows a mechanism of nutrient, waste, and oxygen exchange between the mother and the developing fetus?
after 8 weeks baby
fetus -heartbeat
muscle cells are called
fibers because of their threadlike shape
Purkinje fibers
fibers in the ventricles that transmit impulses to the right and left ventricles, causing them to contract
sympathetic nervous system
fight or flight; the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations pupils dilate, decrease in saliva secretions, bronchioles dilate, heart rate increases, blood vessels constrict, epinephrine (adrenaline) secreted, sweat secreted, gastric juice secretions decrease
urinary (renal) system
filters and excretes waste from blood; 2 kidneys, 2 ureters, 1 bladder, 1 urethra
urinary system / renal system
filters the blood and removes waste products from the blood, concentrates waste products in the form of urine, and expels urine from the body consists of two kidneys, two ureters, one urinary bladder, one urethra
true ribs
first 7 pairs of ribs; attach directly to sternum
duodenum
first part of the small intestine
soft catheter
flexible tubing that is part of a suctioning system, also called a (French catheter). nose or trachea
Hinged joint
flexion and extension; elbow, knee, finger
FROPVD
flow restricted Oxygen powered vent. dev. - 100% O2,up 40 lpm - greatest risk of causing gastric inflation
pulmonary edema
fluid in the air sacs and bronchioles
pulmonary edema
fluid in the alveoli and bronchioles often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs
gurgling
fluid in the upper airway, need for suctioning
crackles (rales) is usually caused by
fluid surrounding and filling the alveoli (sacs in lungs)
hydrostatic pressure
force exerted on the inside of the vessel walls as a result of the, contraction of heart, blood pressure, and volume - pushes fluid out of the vessel or capillary bed. outward pressure
deep vein thrombosis (DVT)
formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins -can break free and travel to the lungs, causing pulmonary embolism -sx: redness, swelling, warmth in calf or lower leg
deep vein thrombosis (DVT)
formation of a clot in a deep vein of the body, occurring most often in the femoral and iliac veins -greatest danger is formation of VTE -s/s: warm, red limb, edema, calf pain, leg swelling
illiac crest
forms the superior border of hip bone
evidence-based decision-making steps
formulate a question search medical literature check validity of evidence change and implement protocols
J-receptors
found in alveoli near surrounding capillaries & are sensitive to increases in pressure in capillary -stimulate rapid, shallow ventilation
stretch receptors
found in the smooth muscle of the airways and measure the size and volume of the lungs -stimulate decrease in rate and volume of ventilation when stretched by high tidal volumes to protect the lungs from over-inflating
iliac crest
found on the top of the hip bone - wings of pelvis if patient is not complaining of any pain in the pelvic region and no deformities are noted, gently press in and down on these areas
FiO2
fraction of inspired oxygen; the concentration of oxygen in the air we breathe always a fraction or decimal
flail chest
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment
Anterior (ventral)
front
conductive cells
function in initiating and communicating action potentials for heart beat sequential contraction of chambers instead of whole heart all at once
38 weeks gestation
fundus (top of uterus) is palpable at the level of the xiphoid process
40 weeks gestation
fundus drops to below the xiphoid process as fetus spins around
Steps of primary assessment
general impression mental status assessment (AVPU) Airway Breathing Circulation Any life-threatening condition that is identified must be treated immediately as found before you move on to the next portion of the primary assessment. 1. Form a general impression of your patient and the environment 2. Conduct a first look test 3. Determine level of consciousness (AVPU, GCS) 4. Assess airway - if alert, open airway; if V, P, or U, open airway with jaw thrust, consider oral/nasal airway and suctioning 5. Assess breathing - determine rate, rhythm, quality for 30 seconds 6. Assess breath sounds - Mid axillary unless abnormal, then all six positions 7. Administer oxygen 15 L by nonrebreather 8. Assess pulse - determine rate, rhthym, quality for 30 seconds; if responsive palpate radial artery, if unresponsive palpate carotid artery 9. Assess skin color, temperature, and moisture 10. Assess capillary refill 11. Assess and control life threatening external bleeding 12. Perform a rapid scan (60-90 seconds) 13. Determine priority care and transport
Cystic Fibrosis
genetic disorder; alters gland secretions (like mucus secreting glands in lung) -too much mucus - blocks airways -increased lung infections and scarring sx: coughing, dyspnea, thick mucus during coughing, history of pneumonia, bronchitis and sinusitis, gastrointestinal complaints, malnutrition, dehydration, clubbing of digits
Narrowest part of adult airway
glottic opening
carbohydrates are broken down into
glucose
brain can only use ______ for energy
glucose -doesnt need insulin
oral glucose
glucose that is readily absorbed by the bloodstream; it is carried on the EMS unit. -administered to diabetic with *low blood glucose* -confusion and irratibility
A pulse oximetry reading is considered normal when it is:
greater than 97 percent.
The colder the water in which a child is submerged:
greater the chance for survival (mammalian diving reflex)
power grip
gripping with as much hand surface as possible in contact with the object being lifted, all fingers bent at the same angle, and hands at least 10 inches apart
Metacarpals
hand bones (palm)
scler/o
hardening
Atherosclerosis
hardening of the *arteries*
Defamation
harm a persons reputation; slander libel - written/media slander
what happens when body cells use anything but glucose for energy?
harmful byproducts (ketosis and acidosis)
An example of an associated sign would be when the patient with a severe headache tells you he:
has been vomiting
acute renal failure (ARF)
has sudden onset and is characterized by uremia -blood in urine -poor urine production -electrolyte disturbance -fluid balance dirturbance
obsteric
having to do with pregnancy or childbirth
cephalic delivery
head first
CID
head immobilizer
respond to painful stimuli, but not normally
head or spinal chord injury nonpurposeful movements - flexion posturing & extension posturing
A patient with a low blood sugar is unresponsive with snoring respirations. His breathing is labored and his pulse is rapid and weak. Examination of the skin reveals it to be cool and diaphoretic. Your partner informs you of the following vital signs: pulse 120, respirations 18, blood pressure 132/60, and SpO2 at 84% on room air. Which one of the following actions would you perform first? A. Administer oral glucose. B. Perform a head-tilt chin-lift. C. Provide high-concentration oxygen. D. Start positive pressure ventilation.
head-tilt chin lift airway is highest priority
Symptoms of embolic stroke
headache, seizure, unresponsiveness (less common to have headaches in thrombotic)
cardi/o-
heart
only times we limit O2
heart attack (MI from ACS) and brain attack (stroke) -reperfusion injury
astherosclerosis is a contributing factor in
heart attack (MI) and brain attack (stroke)
Which of the following components is NOT used during the evaluation of the Revised Trauma Score?
heart rate
as children age, their
heart rate and respiratory rate decrease blood pressure increase
when to cpr newborn
heart rate below 60/minute and no spontaneous breathing
3 components of the cardiovascular system
heart, blood vessels, blood
heat stages
heat cramps, heat exhaustion, heat stroke
flushing (red)
heat exposure, carbon monoxide poisoning
calcaneus
heel bone
if someone is losing sodium (in urine or sweat), they are also losing
hella water
Forming a general impression is essential in the assessment of any patient because it:
helps to determine the clinical status of a patient.
Why is an understanding of basic pathophysiology necessary?
helps you understand why certain signs and symptoms occur
97% of oxygen is carried by
hemoglobin
hyperglycemia
high blood glucose; >200mg/dL -not enough insulin to uptake all the glucose -brain has plenty of glucose (but can be affected by acidosis and ketosis) -DKA (type 1) -HHS/HHNS/NKHS (type 2)
secondary hypertension
high blood pressure caused by the effects of another disease -often renal(kidney) disease -sometimes thyroid disorders
hypertensive emergency
high blood pressure, which can lead to serious complications such as stroke or aneurysm. -systolic >160 mmHg -diastolic >94 mmHg -primary and secondary hypertension -sx: strong bounding pulse, warm skin, headache, ringing in ears, nausea, hypertension, dyspnea, chest pain, seizures semi-fowlers if no dyspnea
Your patient was struck in the head by a golf ball while watching a golfing event. The patient experienced NO loss of consciousness. His airway is patent, breathing is regular, and the peripheral pulse is absent. The patient keeps asking you "What happened?" repeatedly. Given this, what would be your priority status determination?
high priority head injuries are a big deal asking same question over and over
PSV
high-visibility public safety vests; like class 2
Class 3
higher risk areas
pelvis
hip bone -lower portion of abdominal cavity -includes sacrum, coccyx, iliac crest, pubis, & ischium -houses bladder, rectum, reproductive organs
Acetabulum
hip socket; the large circular cavity in each side of the pelvis that articulates with the head of the femur to form the hip joint
freely movable joints
hip-femur joint
You are assessing a 10-month-old infant who is acting lethargic, in the parents' judgment. His vital signs are: HR 140 and RR 28, his capillary refill is 2 seconds, and his color is good. With this information, you know that:
his vital signs are normal
uticaria
hives
suprasternal notch
hollow U-shaped depression just above the sternum, in between the clavicles
A female patient has developed bacterial peritonitis after sustaining blunt trauma to the abdomen. Damage to what organ was most likely responsible for this condition?
hollow organ
transverse plane
horizontal division of the body into upper and lower portions axial plane
Physiology
how the body works
kyphosis
hunchback an exaggerated forward curvature of the thoracic spine.
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin
You are treating a patient with the following vital signs: Blood pressure: 150/92, Pulse: 98, respirations: 16, SpO2: 96 percent. The EMT knows that this patient has:
hypertension
risk for hemorrhagic stroke
hypertension (HTN)
_____ may present similarly to stroke
hypoglycemia -assess blood glucose
Which of the following findings generally indicates that the patient has transitioned from compensated shock to decompensated shock?
hypotension
types of shock
hypovolemic cardiogenic obstructive distributive metabolic
A 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage and is now very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and weak and her skin is cool and diaphoretic. Vital signs are: pulse 132, respirations 20, blood pressure 102/78 mmHg, and SpO2 97%. She has ecchymosis to the left lower rib area as well as tenderness and instability. She also has a superficial abrasion to her forehead. Given these findings, you would suspect and treat her for what condition?
hypovolemic shock
Bradycardia is an early sign in a new born, but in infants, children, and adults it a sign of severe
hypoxia
number one cause of death in children
hypoxia (from obstructed airway / respiratory system)
sluggish or dilated pupils indicate
hypoxia/poor perfusion
how to people with COPD figure out when to breathe
hypoxic drive -have way to much CO2 (for central chemoreceptors) irrito detect small changes in -rely on absence of O2 (peripheral chemoreceptors) to stimulate ventilation
main purpose of the primary assessment is to
identify and manage threats to the airway: breathing, oxygenation, or circulation
unconsciousnes
if either the RAS or both cerebral hemispheres are damaged or not functioning properly, the patient will no longer be in an awake state
The best indication that the ventilations you are providing are immediately effective is
if they create alveolar breath sounds. This means that you are ventilating the patient with a volume that is sufficient to deliver oxygen to the alveoli
why cant you give food or water to patients with abdominal injuries
if they need surgery, they will vomit after receiving anesthesia (risking aspiration)
flail segment
immediate life threat; two or more adjacent ribs are fractured in two or more places and thus move independently from the rest of the rib cage -paradoxical movement -cause lung collapse or contusion rx: splint with hand, bulky dressing, *CPAP*
You are treating a patient whose hand and arm were entrapped in a piece of equipment, causing a crushing injury. The patient's coworkers extricated him before your arrival, and there was no associated fall, unresponsiveness, or trauma elsewhere in the body. What type of immobilization will this patient likely receive?
immobilization of the arm and hand
white blood cells
immune system
placenta previa
implantation of the placenta over the cervical opening (os) or in the lower region of the uterus -third trimester bleeding -fetus changes position and is prematurely torn away from lower portion of uterine wall -total, partial, marginal -risk: multiple deliveries, frequent pregnancies, bleeding after intercourse -s/s: *painless* bright-red bleeding, shock -rx: treat for shock, left lateral recumbent position (or raise one hip)
perineum
in females, the area between the anus and the vagina
ataxia
inability to perform coordinated movements intracranial pressure
aphasia
inability to speak
Cyanosis (blue-gray)
inadequate oxygenation or perfusion (shock), inadequate respiration, or heart attack
cardiogenic pulmonary edema
inadequate pump function increases pressure in pulmonary capillaries forcing fluid to leak into the space between capillaries and alveoli Result of any condition that causes CHF. Alveoli fill. Heart failure, cariogenic shock, increased bp & aspiration. sx: JVD, swollen lower extremities, cardiac compromise
3 main etiologies of shock
inadequate volume inadequate pump function inadequate vessel tone
shock ultimately kills you through
inadequate volume (blood loss) and inadequate pump function (LV usually isn't pumping enough blood)
When an infant or child starts to become hypoxic, initially her pulse will:
increase
CNS stimulants
increase CNS -dilated pupils -jumpy -tachycardia, tachypnea, hypertension -hallucination -seizure -stroke -violent -paranoid -grinding teeth -ex: amphetamines, cocaine, bath salts, caffeine, nicotine, -have police transport -heart can explode
hypertrophy
increase in cell size
cardiac hypertrophy
increase in the size of the heart from a thickening of the heart wall, without a parallel increase in the size of the cavity -decrease in cardiac output from decrease in stroke volume -decreases effectiveness of compensatory mechanisms
respiratory distress
increased effort; tidal volume and rate are adequate rx: -cannula -moderate to severe: CPAP -super severe: NRB
glaucoma
increased intraocular pressure results in damage to the retina and optic nerve with loss of vision; hard to transmit visual info
elderly have decreased tidal volume & therefore
increased respiratory rate
premature infant
infant weighing less than 5 lbs or born before 38th week
urinary tract infection (UTI)
infection of one or more organs of the urinary tract -s/s: hematuria, cloudy urine, burning during urination, polyuria, fever
endometritus
infection of the endometrial lining.
Tuberculosis (TB)
infectious bacterial disease, most commonly spread by inhalation of small particles and usually affecting the lungs; may spread to other organs Use HEPA or N-95 respirator
cricoid cartilage of larynx
inferior to the thyroid cartilage
Epiglottitis
inflamed epiglottis -risk: male, smoker, Haemophilus influenzae type B, thermal injury -sx: stridor, URT infection, dyspnea, high fever, sore throat, inability to swallow with drooling
-itis
inflammation
appendicitis
inflammation of the appendix -infection, blockage in intestines results in inflammation and irritation -tissue dies and ruptures -acute abdomen -more common in children (thinner appendix wall) -s/s: RLQ pain, positive markle test, NV, low grade fever and chills, loss of appetite, guarding pain and cramping, initially around the umbilicus but later localized to RLQ
Cholecystitis
inflammation of the gallbladder caused by gallstones -15-30 -RUQ to MUQ pain -presents at night -green emesis -low fever -referred shoulder pain
aspiration pneumonia
inflammation of the lungs caused by the aspiration of vomitus or other foreign matter
pancreatitis
inflammation of the pancreas -UQ pain
peritonitis
inflammation of the peritoneum -blood, pus, bacteria, acid from other organ leaks into peritoneal cavity -s/s: positive markle test, NV, severe sharp pain, fever, chills, loss of appetite
peritonitis
inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it) -caused by bursting hollow organ
gastroenteritis
inflammation of the stomach and small intestine -viral and bacterial -children -acute: hematemesis, hematochezia, melena -s/s: NVD, fever, dehydration, shock
pelvic inflammatory disease (PID)
inflammation/infection of the female reproductive tract
gastric distention
inflation of the stomach -sometimes caused by PPV
inspiration
inhalation diaphragm & intercostals contract (expand) negative pressure in chest cavity (low pressure = more stuff drawn in ) active process
proximate cause
injuries resulting from negligence
visceral pleura
inner layer; covers the lungs The membrane that envelops each lung and is directly attached to the lung tissue itself is called the:
endometrium
inner lining of the uterus
subcutaneous layer
innermost layer of the skin, containing fat tissue -"subcutaneous connective tissue"
respiratory failure
insufficient respiratory rate and/or tidal volume rx: -BVM
You have been called for a 32-year-old female with altered mental status. On scene you find the patient lethargic and confused. Although information is sketchy, it appears that she has a history of diabetes as well as renal failure for which she receives dialysis. You note no deficits in the primary assessment and the vital signs are: pulse 124, respirations 28, BP 106/68 mmHg, and SpO2 97%. Your partner reports a blood sugar reading of 774 mg/dL. Based on this information, the EMT would understand that definitive care of this patient would involve the administration of which one of the following medications?
insulin
2 hormones that regulate glucose
insulin and glucagon
dorsal respiratory group (DRG)
integrates peripheral sensory input and modifies the rhythms generated by the VRG
Dry drowning
intense laryngospasm to prevent aspiration of water
You have completed the assessment of a 32-year-old patient who is starting her seventh month of pregnancy. Which one of the following assessment findings should the EMT be most concerned about?
intermittent vaginal bleeding
potassium is considered a primary ______ ion
intracellular ion
Asking a bystander who witnessed the patient fall to the ground is a method of:
investigating the chief complaint
generalized seizures
involve both hemispheres of brain and RAS (unconscious) sx: rhythmic, tonic-clonic convulsions
partial seizures
involve just one cerebral hemisphere (conscious)
ataxic respirations
irregular rate and tidal volume
What is the final stage of shock that a hypovolemic patient will experience if the treatment provided has been either insufficient or inappropriate?
irreversible shock
While looking at your therapy regulator, you see the pressure in the tank reads 1,000 psi. What does that information mean?
it is half full (2000 psi total)
renal calculi
kidney stones
adult has 70 mL blood per
kilogram (2.2 lb)
patella
kneecap
preterm labor / premature labor
labor after 20th but before 37th week
In infants and children, retraction of the skin, muscles, and other tissues around the clavicle and between the ribs indicates:
labored breathing
ataxia
lack of muscle coordination
hypoxia
lack of oxygen in tissue cells confusion, hypotension
radius
lateral bone of the forearm
left lateral recumbent position
laying on left side no spinal injury unresponsive, pregnant,..
Kehr sign
left shoulder pain referred from the diaphragm when it is irritated by blood within the abdominal cavity
Narrowing pulse pressure (systolic and diastolic getting closer together) indicates
less blood ejected from LV (systolic), vessels constrict and increase resistance (diastolic)
Class 1
less than 25 mph
To be a medical director of an ambulance service, which one of the following requirements must the individual satisfy?
licensed physician
consensual reflex
light stimulation of one eye causes pupil constriction in contralateral (opposite side) eye
pleural lining
lining that is a smooth contact for rough tissue as well as a contributor for the thorax enlargement into inspiration; decreases surface tension in the lungs visceral pleura (inner) & parietal plera (outer)
hepta/o-
liver
jaundice (yellow)
liver disease
Radiation injury
local injury; caused by exposure to large amounts of less penetrating particles (like beta particles [high speed electrons]) -sx: hair loss, skin buns, skin lesions
abscess
localized collection of pus at the site of an infection
Parietal pain (somatic pain)
localized, intense, sharp, constant pain associated with irritation of the peritoneum -pt will be lying still, breathing slowly, knees to chest
parietal pain
localized, intense, sharp, constant pain associated with irritation of the peritoneum. Also called somatic pain -patient can point directly to pain
aortic semilunar valve
located between the left ventricle and the aorta
peripheral chemoreceptors
located in *aortic arch and carotid bodies* in the neck -eh sensitivity to CO2 and pH -way sensitive to *arterial O2*
pontine respiratory center
located in the pons of the brainstem, sends inhibitory impulses to the VRGi (inspiratory neurons) to halt inspiration and permit exhalation, also known as the pneumotaxic center
fracture
loss in continuity in structure of a bone
convection
loss of body heat to the atmosphere when air passes over the body
evaporation
loss of body heat to the atmosphere when air passes over the body
macular degeneration
loss of central vision
psychosis
loss of contact with reality
arteriosclerosis / atherosclerosis
loss of elasticity in vascular walls from thickening and hardening of the vessels
left sided heart failure
loss of the left ventricle's ability to contract normally, resulting in a fall in cardiac output; the force of the ventricular contraction is inadequate and not enough causing fluid to back up into and engorge the lung tissue -backup of blood in left atrium -backup of blood in pulmonary vein -increased pressure, capillary leaks into alveoli (pulmonary edema) -sx: high systolic BP, inspiratory rales, no JVD or peripheral edema
hypoglycemia
low blood glucose
hypoglycemia
low blood glucose; rapid onset - <60 mg with symptoms (also says <70) - <50 mg without symptoms -most dangerous
rhonchi
low, coarse sounds heard on auscultation of bronchi obstructed by sputum; obstruction of larger airway -chronic bronchitis, emphysema, aspiration, pneumonia -sound changes if person coughs or changes position
lumbar spine
lower back; formed by the lowest five nonfused vertebrae; also called the dorsal spine. -least mobile of the vertebrae -most lower back injuries involve the muscles, not the vertebrae
costal margin
lower border of rib margin formed by the medial edges of the 8th, 9th, and 10th ribs
mandible
lower jaw
xiphoid process
lower, narrow portion of the sternum
serous fluid
lubricates layers in pleural space of lungs
pulmon/o-
lung
paper-bag effect
lung ruptures if epiglottis is closed upon impact
prone position
lying face down
recovery position (lateral recumbent position)
lying on the side
Sternum
manubrium, body, xiphoid process
compliance
measure of the ability o the chest wall and lungs to stretch, distend, and expand
MOI
mechanism of injury; step in scene size-up
ulna
medial bone of the forearm
evidence-based medicine
medical care based on the latest and most accurate clinical research
on-scene medical direction
medical direction provided by an EMS medical director physician who is on scene with the EMS crew
Venous Thromboembolism (VTE)
medical emergency caused when a blood clot breaks loose and travels in the blood vessels -can go to right side of heart then lungs (CHF and pulmonary embolism)
bariatrics
medical management of obese patients
inhaled bronchodilators
medication used to open up bronchioles that are constricted due to a respiratory disease such as *asthma, emphysema, and chronic bronchitis* metered-dose inhaler (MDI) - beta2 agonist
menses
menstrual period in which the endometrium is sloughed off
dermis
middle layer of skin -thicker than epidermis -blood vessels that supply skin, hair follicles, sweat glands, oil glands, sensory nerves -elasticity and strength of skin
Know the primary concern for a patient in the postictal phase of a seizure.
might stop breathing and go into cardiac arrest -airway obstruction from drool or biting tongue
can use car seat for transport if
minimal crash damage and no injuries to anyone
Respiratory rate x tidal volume =
minute ventilation
simple sugars
monosaccharides and disaccharides glucose (95% of simple sugar in body), galactose, fructose
ingested poison
most common; absorbed in small intestine, not stomach -delayed symptoms when? how much?
coccyx
most inferior four vertebrae fused together to form the tailbone
Organs in the intraperitoneal space
most things
ventilation
movement of air in and out of the lungs; what we can help with
Supination
movement that turns the palm up
skeletal system functions
movement, provides support, strength, protection, and mineral/fat storage; blood cells made in bone marrow
Circumduction
moving the arm in a circle around the shoulder
bronchiolitis
mucosal layer in bronchioles is inflamed by viral infection -under 2 years -confused with astma
rhonchi is associated with
mucus blocking the larger bronchioles
tendon
muscle to bone
intercostal muscles
muscles between the ribs respiratory distress if muscles are retracted inward expansion during inhalation, retraction during expiration
Myocardium
muscular, middle layer of the heart contracts and ejects blood from the heart
The BEST places to assess skin color in adults are in the mucous membranes of the mouth and eyelids and:
nail beds
accessory structures of the skin
nails, hairs, sweat glands, and oil glands
generic name
name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name nonproprietary listed in US Pharmocopoeia
bilateral pinpoint pupils suggest
narcotic use; pons damage
opioid
natural or synthetic morphine-like substance that causes analgesia (pain relief), resp. depression, sedation, cough suppression, & decreased GI motility. -act on opiate receptors -heroin - common -fentanyl - synthetic opioid pain reliever much more potent than heroin -carfentanil - synthetic opioid pain reliever (Wildnil); even more powerful than fentanyl -s/s: CNS depression, respiratory depression, miosis (constricted pupils) -rx: naloxone
NOI
nature of illness; step in scene size-up
juxtacapillary receptors (J receptors)
near alveoli; detect when alveolar-capillary beds are becoming engorged with blood as a result of heart failure -feeling of SOB -shallow and rapid breathing
assume what with a diver
neck & spine injuries
pediatric respiration rates
neonate : 40-60 child : 15-30
Blow-by
neonates
Nitroglycerin
nitrate drug used in the treatment of angina -vasodilator - reduces workload of heart, and therefore the o2 demand of the heart ; also dilates coronary arteries, providing more blood flow to heart -decreased workload of heart and demand for O2 -side effect : hypotension, headache, burning under tongue -do not give if meds for erectile dysfunction: tadalafil (Cialis), vardenafil (Levitra), or sildenafil (Viagra) within 24 hours -do not give if BP less than 90 systolic / 30 systolic lower than baseline -do not give if extreme bradycardia or tachycardia one dose: one tablet/spray every 3-5 min until 3 dose max (sublingual)
sublingual medication
nitro tablets and spray
cause of AMS in hypoglycemia
no glucose, but brain can only use glucose
If there are NOT electrical events occurring in the heart, then:
no mechanical events will be occurring in the heart either
fixed pupil
no response to light or accommodation etiology: pharmacological (miotic or mydriatic) iris damage/mechaninal (surgery, trauma, ischemia) hutchinson's pupil (fized dilated pupil indicating severe brain injurt or large tumor causing downward displacement of brain leading to uncal herniation and compression of CN 3, usually in comatose pt)
primary hypertension
no specific cause (idiopathic) -may be on meds to keep BP low
NRBM
non-rebreather mask (for oxygen delivery)
A 14dashyeardashold female is complaining of neck pain after being involved in a minor car crash. She presents as stable and has no complaints other than the sharp neck pain. What would be the preferred way to mover her?
nonurgent
A capillary refill time of 3 seconds in an asymptomatic elderly male is an indicator of:
normalcy
anemia
not enough red blood cells -s/s of hypoglycemia -no hemoglobin to give red appearance to skin
>160 bpm
not enough time for ventricles in alveoli to refill between breaths -reduces preload and therefore the cardiac output
urgent move
oRequired when the patient must be moved quickly for treatment of an immediate threat to life. Performed WITH spinal precautions.
You are treating a patient whom you suspect has a tension pneumothorax. The patient has no external hemorrhage or suspected internal hemorrhage, yet he is hypotensive. What type of shock is most likely causing the drop in blood pressure?
obstructive shock
acute pulmonary edema
occurs when an excessive amount of fluid collects in the spaces between the alveoli and capillaries, disturbs normal gas exchange -risk: CHF -sx: hypoxia, dyspnea, orthopnea (difficulty breathing when lying flat, frothy sputum, tachycardia, crackles, possible wheezing -rx: CPAP & PPV (push fluid back into capillaries), cardiogenic & noncardiogenic
snoring (sonorous sounds)
occurs when the upper airway is partially obstructed by the tongue or by relaxed tissues in the pharynx. use head-tit, chin-lift maneuver (no spinal injury) jaw-thrust maneuver (spinal injury) use oropharyngeal airway (unresponsive patient without gag reflex)
If a patient with chest pain takes a daily aspirin, your medical director wants the EMT to contact an emergency department physician first before administering additional aspirin. The act of contacting the emergency department physician for permission to administer additional aspirin is an example of:
on-line medical direction
The frequency of respiration is usually calculated as the number of ventilations in:
one minute
simple partial seizure
only one cerebral hemisphere (conscious) -focal / motor -may progress to tonic clonic
intrapartum
onset of labor to delivery
OPQRST
onset, provocation, quality, radiation, severity, time
opqrst
onset, provocation, quality, radiation, severity, time
OPQRST
onset, provocation, quality, radiation, severity, time when obtaining history
patent airway
open airway; unobstructed
Which of the following findings would be considered critical in assessing the chest of a patient during the secondary assessment?
open chest wound
Naloxone (Narcan)
opiate antagonist, reverses opioid (narcotic) induced resiratory depression -blocks narcotic cell receptors -1mg in each nostril -known opiod abuse or CNS depression
accessory organs
organs that help prepare food for absorption and use by tissues of the body teeth, tongue, salivary glands, liver, gallbladder, pancreas
female reproductive system
organs that produce and transport egg cells and secrete female hormones two ovaries (produce estrogen and progesterone), two fallopian tubes, uterus, vagina, external genitals
parietal pleura
outer layer of pleura lying closer to the ribs and chest wall
acromin
outward extension of the shoulder bone
vital signs
outward signs of what is going on inside the body, including respiration; pulse; skin color, temperature, and condition (plus capillary refill in infants and children); pupils; and blood pressure.
generalized hypothermia
overall reduction in body temperature, affecting entire body; also called hypothermia or general cold emergency
ischemia
oxygen deficit in the tissues
sinoatrial (SA) node
pacemaker of the heart
constricted pupils indicate
paitent using a CNS depressant drug
skin and hypoxia
pale is early sign cyanosis is late sign
Pronation
palm down
You notice your EMT partner is taking a blood pressure without a stethoscope. This method is referred to as:
palpation
type 1 diabetes
pancreas does not secrete insulin (insulin-dependent diabetes mellitus (IDDM)) -younger -lean -prone to DKA
type 2 diabetes
pancreas secretes insulin, the insulin just sucks at controlling glucose level -dont need to take insulin -diet, exercise (non-insulin-dependent diabetes mellitus (NIDDM))
medula oblongata
part of the brain that controls breathing, heartbeat, and the size of blood vessels
If a patient cannot maintain a pulse ox reading of greater than or equals94 percent on 6 lpm via cannula and the EMT wants to increase the oxygen concentration another 10 percent or so, what oxygenation adjunct should be used? A. Partial rebreather mask This is the correct answer.B. Nasal cannula C. Nonrebreather mask Your answer is not correct.D. Venturi mask
partial rebreather mask The partial rebreather mask looks very similar to the nonrebreather mask but is equipped with a two-way valve that allows the patient to rebreathe about one-third of the exhaled air. Since the initial portion of exhaled air is principally from the patient's dead space, where gas exchange does not occur, it contains mostly oxygen-enriched air from the previous inhalation. The flow rate is typically set at 10 lpm but should be no less than 6 lpm. Partial rebreather masks can provide oxygen concentrations of between 35 and 60 percent.
ailmentary tract
passage through which food travels
intranodal tract
path by which Electrical impulses travel from the sinoatrial node to the atrioventricular node
aspiration
patient breathing blood into lungs common with midface injuries
What does abdominal muscle use in breathing indicate?
patient is struggling to exhale
What does the use of accessory muscles in the neck and chest indicate?
patient is struggling to inhale
Health Insurance Portability and Accountability Act (HIPAA)
patient privacy
nitroglycerin pills indicate
patient was having chest pains prior to arrival
pectoralis major
pecks
Cheyne-Strokes respirations
periods of apnea and dyspnea respiratory rate & tidal volume increase and decrease with random apnea brainstem injury
carotid bodies
peripheral chemoreceptors -sensitive to O2
minor consent
permission obtained from a parent or legal guardian for emergency treatment of a minor or a mentally incompetent adult
Priapusm
persistent erection that is sin of spinal chord injury
general responsibilities
personal safety and the safety of others, patient assessment and emergency medical care, safe lifting and moving, patient transport and transfer, record keeping and data collection, and patient advocacy
The "P" in the acronym SAMPLE stands for:
pertinent past history.
hemorrhagic strokes usually occur during
physical activity (working out is a headache)
Secondary Assessment
physical exam vital signs history (order changes depending on responsiveness) *EFGHI*: expose, full set of vs, give comfort measures-hx/head to toe (SAMPLE)-inspect for injuries thorough or rapid based on condition and clarity of issue
You have been called to assist another crew with the birth of a baby. On scene another EMT informs you that the mother's perineum tore and is bleeding heavily. You would:
place a sterile dressing between the mother's vagina and rectum. (no pressure)
endotracheal intubation
placement of a tube through the mouth into the pharynx, larynx, and trachea to establish an airway
organs only present during pregnancy
placenta - organ of pregnancy; in between baby and mom (provides utrients) afterbirth - placenta and membranes that are expelled from the uterus after the birth of a child umbilical cord - structure that connects fetus and placenta (provides food) amniotic sac - membranes that surround and protect the developing fetus amniotic fluid - clear, watery fluid that surrounds and protects the developing fetus
An EMT is transporting a restrained patient who is trying to spit on him. Which one of the following would the EMT be justified in doing?
placing a surgical mask over the patient's mouth
Composition of blood
plasma, red blood cells, white blood cells, platelets
what to do with placenta
plastic bag and deliver
thrombocyte
platelet; clotting
aspirin
pne
Tracheal deviation may signify
pneumothorax
do not apply CPAP to a patient suspected of having a
pneumothorax expanding pressure in chest makes lung inflation difficult in tension pneumothorax
poisonous plants
poison ivy, poison oak, poison sumac -contain *urushiol* -dont need direct contact
Diabetes symptoms
polyuria-frequent urination, polydipsia-excessive thirst, unexplained weight loss, polyphagia-extreme hunger, sudden vision changes, numbness or tingling in the hands or feet, fatigue, very dry skin, sores that don't heal well or quickly, frequent infections -tachycardia -act intoxicated -
Pale or mottled skin
poor perfusion & shock (hypoperfusion) internal or external loss of blood
visceral pain
poorly localized, intermittent, crampy, dull, or aching pain associated with ischemia, tearing, or distention of an organ -causes: ischemia, inflammation, infection, mechanical obstruction of an organ -mild pain, NV "A patient with visceral pain typically describes the pain as 'aching' and has a hard time identifying its exact location."
crackles / rales
popping sounds during inhalation -fluid in alveoli or small bronchioles -more in base of lungs because gravity -pulmonary edema, pneumonia -doesnt change with cough or movement
crackles (rales)
popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis fluid in and around alveoli
Decerebrate posturing
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
BSI precautions
practice of using specific personal protective equipment to minimize contact with a patient's blood and body fluids
therapy regulator
pressure regulator used for delivering oxygen to patients. (thing on O2 tank) needed for nrb mask
pulse definition & locations
pressure wave generated by the contraction of the left ventricle Rate, location, strength, and regularity
Barotrauma
pressure-related ear discomfort that can be caused by pressure changes when flying, driving in the mountains, scuba diving, or when the Eustachian tube is blocked -gas expands as they go up (less pressure) -eardrum, sinus, lung might burst
pulmonic semilunar valve
prevents blood backflow from pulmonary artery to right ventricle
cyanide *
prevents cell from using O2
thrombosis
process of clot formation
contractile cells / working cells
produce contractions that propel blood
Immunoglobin E antibodies
produced during anaphylaxis; IgE
An EMT has an accurate understanding of the systolic blood pressure when he tells you that the systolic blood pressure is: A. represented by the bottom number. B. caused by constriction of the arteries. C. produced when the heart contracts. D. the pressure in the veins.
produced when the heart contracts
liver
produces bile
immune response
production of antibodies by the immune system to fight off an invasion by foreign substances
diaphoresis
profuse sweating
chronic kidney disease / chronic renal failure (CKD / CRF)
progressive loss of kidney function over a period of months to years
Bronchioles
progressively smaller tubular branches of the airways lined with smooth muscle and mucous membranes. The smooth muscle can allow the bronchioles to either constrict (making it harder for air to travel through them) or dilate, in response to a stimulus.
spinal column (vertebral column)
protects the spinal cord and supports the head and body -ribs extend from it to form thoracic cavity (chest) -33 vertebrae: cervical, thoracic, lumbar, sacral, and coccyx
Albumin
protein in blood; maintains the proper amount of water in the blood
hernia
protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall
Basic functions of the respiratory system
provide body with o2 •Respiration •Ventilation •Oxygenation •Serving as a buffer to maintain a normal acid-base balance
Hallucinogens
psychedelic drugs, such as LSD, that distort perceptions and evoke sensory images in the absence of sensory input -ex: LSD, DMT, DET, mescaline, MDA, PCP, STP
Methylenedioxymethamphetamine (MDMA, Ecstasy)
psychoactive, empathy, euphoria, heightened sensation -can cause intracranial hemorrhage, seiures, hallucinations, ARDS, cerebral edema, hypperpyrexia (life threatening elevation of core temperature)
Consolidated Omnibus Budget Reconciliation Act (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA)
public access to emergency medicine regardless of ability to pay
edema
puffy swelling of tissue from the *accumulation of fluid* often from liquid leaking out of capillaries
assessment of circulation includes
pulse major bleeding skin color, temperature, condition capillary refill
widened pulse pressure
pulse pressures above 50% of systolic - indicates possible head injury - ex. 210/100
narrow pulse pressure
pulse pressures below 25% of systolic - indicates possible hypoperfusion, tension pneumothorax, pericardial tamponade ex. 80/62
right ventricle
pumps deoxygenated blood through pulmonic semilunar valve to the lungs via the pulmonary artery
right ventricle
pumps deoxygenated blood to the lungs through the pulmonary artery
left ventricle
pumps oxygenated blood to the body through aorta to major artery
too high of a hydrostatic pressure will
push fluid out of the capillary and promote edema
A ______ pulse should be assessed in all patients 1 year or older
radial
What pulse site is commonly used when the EMT elects to palpate a blood pressure?
radial
pharming
raiding others' home medicine supplies or using faked prescriptions to obtain drugs
intranasal glucagon
raises BGL by breaking and releasing glycogen stores in the liver and converting random scraps into glucose -effectiveness depends on how much glycogen is left in the liver (depleted in alcoholics)
An adult pulse rate of 110 beats per minute is considered:
rapid
inhaled poison
rapid absorption into blood; destroys lungs and leads to pulmonary edema -systemic effects -quick respiratory distress
trachypnea
rapid breathing
rapid secondary assessment
rapid head-to-toe exam before transport to identify critical injuries that require rapid intervention and transportation; rapid secondary assessment, baseline vital signs, then history. unresponsive, altered mental status, significant mechanism of injury (MOI), multiple injuries, unstable go with rapid if you're not sure followed by on-scene emergency care followed by prompt emergency transport; a modified secondary assessment is followed by on-scene care with non-emergency transport as soon as possible
acute
rapid onset, a severe course, and a relatively short duration
an increase in arterial CO2 increases the number of H+ ions in the CSF, stimulating an increase in the
rate and depth of respiration to blow off more CO2
Assess respirations for
rate, tidal volume, and consistency
direct medical oversight
real-time oversight or medical direction provided by a physician to an EMS provider seeking immediate feedback or direction; can be online or on-scene
superior vena cava
receives blood from the head and arms and chest and empties into the right atrium of the heart
right atrium
receives deoxygenated blood from the vena cava and passes it to the right ventricle through the tricuspid valve
left ventricle
receives oxygen-rich blood from the left atrium through mitral /bicuspid valve Pumps oxygenated blood into the aorta on next contraction through aortic semilunar valve
left atrium
receives oxygenated blood from pulmonary veins from the lungs
left atrium
receives oxygenated blood from the lungs
one of the best ways to prevent burnout is to
recognize the warning signs of stress
erthyrocyte
red blood cell; transports oxygen and carbon dioxide
"i vomited"
red or coffee grounds? (important tpao the hospital)
where to look for insulin
refrigerator
Alpha 2 effects
regulates Alpha 1 inhibitory receptor, when ALPHA 1 is out of control ALPHA 2 stops it
You arrive on scene for an unresponsive male patient with a suspected airway obstruction. Without performing any assessment on this patient other than knowing that he is an adult male, what is the MOST common reason for an upper airway obstruction?
relaxed tongue
Thalamus
relays messages between lower brain centers and cerebral cortex
T wave
repolarization of ventricles; preparation for next series of contractions
aerobic respiration
requires oxygen
afterload
resistance in the aortal that must be overcome by LV contraction to eject blood
ARDS (acute respiratory distress syndrome)
respiratory insufficiency marked by progressive hypoxia
cause of pediatric acute coronary syndrome
respiratory issues -sometimes congenital heart condition
15 on GCS
responsive
For the _________ __________ patient, you gather the history from the patient first. Then, you conduct the physical exam, then obtain vital signs.
responsive medical physical exam is based on chief complaint (modified secondary assessment)
resucitation
restore lost vital functions
vascular headache
result of dilation or distention of vessels or inflammation within the cranium -migrane - localized throbbing -sx: aura, hallucinations, weakness on one side of body, double vision, uncoordinated, syncope -may be caused by hypertension
emergency care for anaphylactic rxn
reversing bronchoconstriction, increased capillary permeability, and vasodilation
standard care
right care & administered properly?
Why is the right lung responsible for about 60 percent of normal oxygenation?
right lung has 3 lobes
During the primary assessment, how should you best determine the adequacy of a patient's breathing?
rise and fall of chest
baby O2
room air (21%)
mastoid process
round projection on the temporal bone behind the ear
Which of the following is a bad habit for EMTs to develop?
rushing into the scene
urinary bladder
saclike organ in which urine is stored before being excreted
A mnemonic or memory aid that is used to help the EMS provider remember the information that must be included in a patient history would be:
sample
In which part of your assessment will you determine the need for additional resources?
scene size-up
Paramedic
scope of practice includes the skills performed by the EMT and AEMT with the addition of more advanced assessment and patient management skills and provision of the highest level of prehospital care. Paramedics perform advanced assessments, form a field impression, and provide invasive and drug interventions as well as transport. Their care is designed to reduce disability and death of patients who access the EMS system
primary seizures
seizures that are thought to be caused by a genetic disorder or an unidentified cause
intervertebral discs
separate and cushion the vertebrae
severe acute respiratory syndrome (SARS)
severe and highly contagious viral respiratory infection with high fever; threatened worldwide epidemic in 2003 respiratory droplets high fever aches discomfort respiratory symptoms diarrhea dry cough
hyperemesis gravidarum
severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus
dysmenorrhea
severe pain or cramps during mensturation
anaphylactic reaction
severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse bronchial spasming
spinous process
sharp, slender projection
When investigating the patient's chief complaint, pay close attention to statements family members may make, such as: A. she has always been a diabetic. B. she just does not seem to be herself today. C. she has been taking medicine for her ulcers. D. she always walks the dog in the morning.
she just does not seem to be herself today.
tibia
shin bone
hemorrhagic hypovolemic shock
shock from the loss of whole blood from the intravascular space. Often called just hemorrhagic shock.
hypovolemic shock
shock resulting from low blood or fluid volume
hypoperfusion
shock; a deficiency of blood passing through an organ or body part - insufficient distribution of O2/nutrients & inadequate elimination of waste indicated by weak, rapid pulse, cool and clammy skin, decreasing systolic pressure, delayed capillary refill
orthopena
shortness of breath while lying flat; classic sign of heart failure
recommended airflow and vacuum amount for the suction unit in the back of the ambulance
should be powerful enough to provide an airflow of >40 lpm at the end of the delivery tube and create a vacuum of more than -300 mmHg on the gauge when the tubing is clamped or kinked.
deltoid
shoulder
scapula
shoulder blade
Midauxillary Line
side
extrapyramidal symptoms
side effects of antipsychotic medications that block or deplete dopamine -involuntary movement
stemocleidomastoid
side of neck, turns and flexes head
In the patient who is breathing adequately, oxygen administration is based on:
signs and symptoms of hypoxia.
pertinent negatives
signs or symptoms that might be expected in certain circumstances, based on the chief complaint or physical exam, but are denied by the patient or not found on examination.
protozoa
single-celled organisms are found in soil and can move; affect mostly people with compromised immune system enter through fecal-oral route mosquitos are carriers for protozoa that cause malaria
bacteria
single-celled organisms that lack a nucleus; prokaryotes sinus infection, ear infection, pneumonia (bacterial), strep, tuberculosis, UTI respond to antibiotics
It is imperative that, as an EMT at an emergency scene, you constantly pay attention to the environment around you. This is called:
situation awareness
assess pupils by
size equality reactivity
types of muscle
skeletal (voluntary), smooth (involuntary), cardiac
cranium
skull
immovable joint example
skull
brady-
slow
venules
small vessels that gather oxygen depleted blood from the capillaries into the veins
fibula
smaller bone
bronchioles
smallest branches of the bronchi
fontanelle
soft spot between the skull bones of an infant; skill bones haven't yet fused together -allows the head to pass through the birth canal during delivery & expand during development -sink in if dehydrated
voluntary nervous system
somatic nervous system; activity of skeletal muscles and movements
where to transport patient with acute coronary event
somewhere with PCI capability
intercostal space
space between the ribs
antibodies
special proteins produced by the immune system that search out antigens and combine with and help to destroy them
chemoreceptors
specialized receptors that monitor *pH, CO2, O2* levels in *arterial blood*
pulse points
specific sites on the body where arterial pulsations can be felt -pulse can be felt at the point where an artery passes over a bone near the skin surface -pulse is measured as effectiveness of the left ventricle as a pump and also provides information about the volume of blood being ejected by the left ventricle and being carried in the arteries
dysphasia
speech difficulty resulting from brain injury
problems with assessing responsiveness with painful stimuli
spinal chord can produce a reaction without the signal ever travelling to the brain
-ptysis
spitting up, coughing up
Premature Rupture of Membranes (PROM)
spontaneous rupture of the amniotic sac and leakage of amniotic fluid before labor and 37th week
types of pneumothorax
spontaneous, traumatic, tension
When determining the mental status during the primary assessment, what is typically determined FIRST in the patient?
spontaneously alert (AVPU)
Which should be treated on-scene longer, stable or unstable?
stable
crowning
stage in delivery when the fetal head presents at the vagina
decompensatory shock
stage of shock where body's compensatory mechanisms are no longer able to maintain a blood pressure and perfusion of the vital organs.; ischemia
Body Mechanics Principles
stand as close to object to be moved as possible, avoid stretching, reaching, and twisting, make use of bed elevation, lift using gluteal and leg muscles(not back), hold objects close to your center of gravity.
Despite positive pressure ventilation, a newborn's heart rate has fallen from 80 beats per minute to 40. He is breathing 40 breaths per minute and has a mottled appearance. Your next action would be to:
start cardiopulmonary resuscitation. (CPR)
Spine motion restriction (SMR)
steps taken to keep the spine in anatomic alignment and to restrict movement of the spine to prevent further injury when an existing spinal injury is suspected
scene size-up
steps taken when approaching the scene of an emergency call: taking Standard Precautions, ensuring scene safety, noting the mechanism of injury or nature of the patient's illness, determining the number of patients, and additional resourc
LUQ organs
stomach, spleen, pancreas, left kidney, small intestines
gallbladder
stores bile
bladder
stores urine
extension
straightening at the joint so that the angle between the bones is increased
critical incident stress
stress triggered by involvement in a serious or traumatic incident
high blood pressure (hypertension) associated with
stroke
unequal pupils indicate
stroke, head injury, artificial eye, eye drops, eye trauma
nontraumatic brain injury
stroke; medical injury to the brain not caused by trauma
A male patient has altered mental status secondary from a brain tumor. The EMT would classify the brain tumor as what type of cause?
structural
strokes in young person
subarachnoid hemorrhage -aneurysm due to congenital weak spot
SOAP
subjective, objective, assessment, plan
CNS depressants
substances that inhibit or decrease central nervous system functions; "barbiturates" -pinpoint pupils -bradycardia, bradypnea, hypotension -cyanosis -lethargic -nausea & aspiration of vomitus -respiratory failure -ex: heroin, narcotics, codeine, methadone, morphine, fentanyl, oxycodone, hydrocodone, hydromorphine, opium (90% of opiate/opioid are mixed overdoses)
open pneumothorax
sucking chest wound; open wound to the chest that allows air to enter the pleural space and cause lung collapse -immediate life threat rx: cover with gloved hand then occlusive dressing
seizure
sudden and temporary AMS caused by massive electrical discharge in a group of nerve cells in the brain -aura, persistent loss of consciousness, muscle spasms, war, sweaty, incontinence
Commotio Cordis
sudden cardiac arrest as the result of a blunt hit or caused by a projectile, such as a baseball, striking anterior chest -male, 13 blunt force causes ventricular fibrillation and cardiac arrest
Postural hypotension (orthostatic hypotension)
sudden drop in blood pressure upon standing "I get so dizzy when I get up off of the couch."
delirium
sudden-onset altered mental status that may involve illusions, disjointed thought processes, incoherent speech, and increased or decreased psychomotor -indicates another underlying issue
-plasty
surgical repair
lordosis
swayback stomach being to anterior and the buttocks too posterior lumbar spine is convex anteriorly
Crowing or Stridor
swelling or muscle spasms -caused by infection, allergic reactions, or burns -don't do anything but ventilate with bag-valve mask
brain herniation
swelling/bleeding around brain creates pressure and pushes on brain stem -portion of brain is pushed into another region
condyloid joint
synovial joint that does everything except rotating limited motion in 2 directions hand - up, down, side-side, not complete rotation
systolic hypertension
systolic pressure over 140 mm Hg
transition between early and late pulmonary distress
tachycardia becomes bradycardia
All of the following are TRUE regarding taking a patient's blood pressure, EXCEPT: A. taking a blood pressure requires a sphygmomanometer and a stethoscope. B. the blood pressure cuff should cover two-thirds of the upper arm, elbow to shoulder. C. there should be no clothing under the cuff. D. center the bladder of the cuff over the brachial artery.
taking a blood pressure requires a sphygmomanometer and a stethoscope.
False Imprisonment / kidnapping
taking a patient against their wishes
Aortic dissection
tear in inner lining of aorta, causing blood to get in between layers of aortic wall -frequent in *thorax* -sharp pain -can feel pulsating mass -difference of >20 mmHg in systolic BP between arms -do not administer aspirin
active rewarming
technique of aggressively applying external sources of heat to a patient to rewarm his body (esp. at head, neck, armpit) -controversial
phrenic nerve
tells diaphragm to contract exits spinal column between C3 and C5
Diencephalon
thalamus and hypothalamus
cerebellum
the "small brain" at the rear of the brainstem; functions include processing sensory input and coordinating movement output and balance -posterior & inferior of cranium -uses sensory info to coordinate self -cannot initiate muscle contraction -can hold muscles in a state of partial contraction
The normal signal for the respiratory center of the brain to stimulate the respiratory muscles to increase ventilations would be:
the amount of CO2 in the arterial blood.
dose
the amount of medication that is given to a patient at one time; ie a dose of nitroglycerin may be one tablet and a dose of epinephrine may be the contents of one auto-injector
capillary refill
the amount of time it takes for capillaries that have been compressed to refill with blood 2 sec for children, infants, and males 3 sec for females 4 seconds for elderly
peritoneal space
the anterior abdominal cavity that houses the majority of the abdominal organs and is lined by the peritoneum
cold zone
the area adjacent to the warm zone in a hazardous materials emergency. Normal triage, treatment, and stabilization are performed here. Also called support zone.
oropharynx
the area directly posterior to the mouth
nasopharynx
the area directly posterior to the nose
warm zone
the area that is established surrounding or immediately adjacent to the hot zone in a hazardous materials emergency, the purpose of which is to prevent the spread of contamination. Lifesaving emergency care is performed here. Also called contamination reduction zone.
hot zone
the area where contamination is actually present. It generally is the area that is immediately adjacent to the accident site and where contamination can still occur. Also called "exclusion zone"
pulmonary arteries
the artery carrying blood from the right ventricle of the heart to the lungs for oxygenation. -only of arteries that carries deoxygenated blood -still carries blood away from heart
pulmonary artery
the artery carrying deoxygenated blood from the right ventricle of the heart to the lungs
mammalian diving reflex
the body's natural response to submersion in cold water in which the larynx spasms, breathing is inhibited, the heart rate decreases, and blood vessels constrict in order to maintain cerebral and cardiac blood flow -slows metabolism -under 70 F -faster in young ppl
nervous system
the body's speedy, electrochemical communication network, consisting of all the nerve cells of the peripheral and central nervous systems -reactions to environment
syncope
the brief loss of consciousness caused by the decreased flow of blood to the brain; fainting -basically the equivalent of angina pectoris preceding ACS -usually upright, dizzy, cool, moist, pale -cause: vasodilation (PNS) -elevate legs
central pulses
the carotid and femoral pulses, which can be felt in the central part of the body
indications
the common reasons for using a medication to treat a specific condition ie chest pain is an indication for nitroglycerin
Acute Myocardial Infarction (AMI)
the condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by laypersons usually caused by blockage of coronary arteries
parasympathetic nervous system
the division of the autonomic nervous system that calms the body, conserving its energy pupils constrict, saliva secretions increase, bronchioles constrict, heart rate decreases, blood vessels dilate, gastric juice secretions increase
action
the effect the drug has on the body -therapeutic effect is the intended positive response by the body -mechanism of action is how the drug works to create its effect on the body ie action of nitroglycerin is dilation of the blood vessels
Acetylcholinesterase (AChE) *
the enzyme that destroys acetylcholine soon after it is liberated by the terminal buttons, thus terminating the postsynaptic potential -breaks down acetylcholine -nerve agents inhibit the action of this enzyme, allowing acetylcholine to accumulate
congestive heart failure (CHF)
the failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body, or both s/s: edema in extremities, JVD, AMS, fatigue, rales or crackling, dyspnea, orthopnea, tachypnea, chest pain, anxiety rx: Fowler's position, O2
menarche
the first menstrual period
dialysate
the fluid that passes through a semipermeable membrane during dialysis
dysarthria *
the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system -can't pronounce words correctly
angle of louis
the junction between the body of the sternum and the manubrium; the starting point for locating the ribs anteriorly
spleen function
the largest lymphatic organ in the body; serves as a blood reservoir, disintegrates old red blood cells, and produces lymphocytes and plasmids
transverse line
the line that divides the body at the waist forming a top (superior) and (inferior) segment
peritoneum
the lining of the abdominal cavity
You work in a community that has an "enhanced" 911 system. Which one of the following is true about that system?
the location of the 911 call is displayed to the call taker
postpartum hemorrhage
the loss of 500 mL or more blood in the first 24 hours following delivery -caused by failure of uterus to regain muscle tone -risk: multigravida, multiple births, big baby, prolonged labor
ischium
the lower, posterior portions of the pelvis
Tetrahydrocannabinol (THC)
the main active ingredient of cannabis substances
genitourinary system
the male organ system that includes reproductive and urinary structures.
route
the means by which a medication is given or taken ie : sublingual (under the tongue), oral, inhalation, injection (inserted by needle into muscle or vein)
triage
the medical screening of patients to determine their relative priority of need and the proper place of treatment
Mesencephalon
the midbrain; a region of the brain that surrounds the cerebral aqueduct; includes the tectum and the tegmentum
Frank-Starling Law of the Heart
the more the heart fills with blood during diastole, the greater the force of contraction during systole
bloody show
the mucus and blood that are expelled from the vagina as labor begins
frequency of ventilation
the number of ventilations in one minute respiration rate
brainstem
the oldest part and central core of the brain, beginning where the spinal cord swells as it enters the skull; the brainstem is responsible for automatic survival functions -mesencephalon, pons and medulla oblongata
antepartum
the period of pregnancy prior to the onset of labor
postictal phase
the period of time immediately following a tonic-clonic seizure in which the patient goes from full loss of consciousness to full mental status rigidity or stiffening of the muscles and loss of bladder control.
afterbirth
the placenta and other tissues are expelled after delivery of fetus -about 1 lb or 1/6 of infant
Reassessing your *stable* patient's chief complaint while en route to the hospital will enable you to NOT only establish his response to your treatment, but also:
the presence of any additional complaints.
systolic blood pressure
the pressure created in the arteries when the left ventricle contracts and forces blood out into circulation
diastolic blood pressure
the pressure in the arteries when the left ventricle is refilling
diastolic blood pressure
the pressure remaining in the arteries when the left ventricle of the heart is relaxed and refilling -higher diastolic, more resistant to blood from LV, LV has to work harder
histamine
the primary chemical mediator released from the mast cells in an anaphylactic reaction cause bronchoconstriction, vasodilation, increased capillary permeability
oxygenation
the process of delivering oxygen to the blood O2 moves with concentration gradient
respiration
the process of moving oxygen and carbon dioxide across membranes, in and out of the alveoli, capillaries, and cells
body mechanics
the proper use of the body to facilitate lifting and moving and prevent injury
plasma oncotic pressure
the pull exerted by large proteins in the plasma portion of blood (usually *albimum*) that tends to pull water from the body into the bloodstream -inward pull -keeps fluid inside vessels
peripheral pulses
the radial, brachial, posterior tibial, and dorsalis pedis pulses, which can be felt at peripheral (outlying) points of the body
ventilation-perfusion ratio
the ratio between ventilation and perfusion in the lung; matching of ventilation to perfusion optimizes gas exchange
postictal state
the recovery period that follows the clonic phase of a generalized seizure. In a postictal state the patient commonly appears weak, exhausted, confused, and disoriented and progressively improves. -strokelike symptoms: paralysis -protect airway -lateral recumbent
respiratory rhythm
the regular or irregular spacing of breaths
right atrium
the right upper chamber of the heart that receives deoxygenated blood from the venae cavae and coronary sinus
malleolus
the rounded bony protuberance on each side of the ankle
administration
the route and form by which a drug is given
indirect medical oversight
the routine duties and responsibilities of the EMS medical director, including the creation of protocols and standing orders
EMS allows patient care to begin at
the scene of injury
Peripheral Nervous System (PNS)
the sensory and motor neurons that connect the central nervous system (CNS) to the rest of the body. efferent & afferent nerves
form
the size, shape, consistency, or appearance of a medication ie nitroglycerin may be a pill or spray; oral glucose is in gel form
arteriole
the smallest kind of artery
retroperitoneal cavity
the space located behind the peritoneal cavity duodenum, pancreas, inferior vena cava, aorta, kidneys, ureters
Bachmann's bundle
the structure that relays the electrical impulse from the SA node to the left atrium in a normal heart -both atria can contract at same time
pulmonary embolism
the sudden blockage of a pulmonary artery by foreign matter or by an embolus that has formed in the leg or pelvic region -adequate ventilation, inadequate blood flow -risk: long periods of immobility, divers, airplanes, heart disease, recent surgery, long-bone fractures, cancer, deep vein thrombosis (clots in veins), estrogen therapy, clotting disorders, smokers -sx: *sudden sharp and localized chest pain, dyspnea, tachypnea*, hypoxia, normal breath sounds and adequate volume, cough up blood, syncope (fainting), tachycardia, crackles
downtime
the time from when the patient goes into cardiac arrest until CPR is effectively being performed
total downtime
the total time from when a patient goes into cardiac arrest until he is delivered to the emergency department
ventricles
the two lower chambers of the heart
ventricles
the two lower chambers of the heart, and they pump blood out to the lungs and body through arteries
In preparation for managing the emergency scene, the EMT should consider each of the following while approaching the collision scene, EXCEPT:
the types of injuries found on each patient.
baseline vital signs
the very first set of vital signs obtained on a patient
telemetry
the wireless transmission and receipt of data gathered from remote sensors
The EMT would describe diabetes as a disease state in which:
there is a problem with the metabolism of carbohydrates and other foods.
platlets
these and other clotting factors are essential for the formation of blood clots, necessary to stop bleeding
What do the popliteal, posterior tibial, and dorsalis pedis arteries have in common?
they are located in the leg
femur
thigh
amniotic sac
thin, transparent membrane that forms the sac in the uterus that holds the fetus suspended in amniotic fluid -tears at onset of labor - fluid lubricates birth canal "It protects and insulates the baby during pregnancy."
effacement
thinning of the cervix -during dilation in labor
weak pulse
thready; difficult to find or palpate
Pharynx
throat; passageway for food to the esophagus and air to the larynx
endocrine glands
thyroid gland parathyroid gland adrenal glands gonads islets of Langerbans pituitary gland
Steps in performing a head-tilt, chin-lift maneuver for opening the airway of a non-trauma patient include:
tilting the head backward with one hand.
postictal
time after a seizure
alveoli
tiny sacs of lung tissue specialized for the movement of gases between air and blood
palpate
to feel
increase in metabolism results in increase in respiratory rate
to release excess CO2
lumbar region
to the right and left of the umbilical region, near the waist
Sonorous breath sounds are typically the result of:
tongue partially blocking the upper airway
cause of AMS in hyperglycemia
too much glucose, insulin cant regulate -all the glucose goes into the cells, water follows, causing edema -
fundus
top of uterus - feels rigid; palpate to determine how far along
3 on GCS
totally unresponsive; deep coma 50% mortality when 5 or less
Medial vs. Lateral
toward midline vs away from midline
superior
toward the head
Lower airway of respiratory system
trachea, bronchi, bronchioles, alveoli
Which of the following is considered to be a critical finding of the neck in your unresponsive medical patient?
tracheal tugging
conduction
transfer of heat by direct contact
radiation
transfer of heat from the surface of one object to the surface of another without direct contact between the two -most significant mechanism of heat loss
A 40dashyeardashold man has been seriously injured in a car crash. He is unresponsive and has what you believe to be a collapsed lung. Additionally, his left leg is severely deformed and his vital signs are unstable. A passenger in the car informs you that the patient is a diabetic and has heart problems. Given this information, which one of the following is the best destination for this patient?
trauma center
special facilities for special cases
trauma center burn center obstetrical center pediatric center poison center stroke center cardiac center hyperbaric center spine injury center psychiatric center
Plan (SOAP)
treatment
You take your trauma patient's blood pressure every five minutes. This is called:
trending
Esophagus
tube that connects the pharynx to the stomach
Fallopian tubes
tubes which carry eggs (with fingerlike projections) from the ovaries to the uterus and which provides the place where fertilization occurs
venae cavae (vena cava)
two large blood vessels that drain oxygen-depleted blood from the veins into the right atrium, where it begins circulation through the heart and lungs
retinal detachment
two layers of the retina separate from each other
pregnant lady counts as
two patients - may need multiple teams
hypoglycemia most often occurs in
type 1 diabetes (because they're giving themselves insulin) -can still happen in type 2
embolic stroke
type of ischemic stroke caused by plaque or other material that moves to and blocks the cerebral artery -fast symptoms
saddle joint
type of joint found at the base of each thumb; allows grasping and rotation perpendicular movements
prolapsed cord
umbilical cord, not head, comes from vagina first -rx: tell them not to push, O2, knee-chest position, lift fetus away from pulsating cord, cover umbilical cord with moist sterile dressing, pressure on presenting part
coma
unconscious state in which a person does not respond to any stimulus, including pain
For the _________ __________ patient, you conduct the physical exam and obtain vital signs first. Then, you gather history.
unresponsive medical head-to-toe assessment as if trauma (rapid secondary assessment)
Which of the following is the best indication that your trauma patient is a high transport priority?
unresponsive to pain NOT significant mechanism of injury
convulsion
unresponsiveness accompanied by a generalized jerky muscle movement affecting the entire body
humerus
upper arm bone
atria
upper chambers of the heart receive blood from veins
maxilla
upper jaw
manubrium
upper portion of the sternum
obese position *
upright, semi-fowlers, towels behind back and neck
uremia
urine in the blood
how to wrap a chest injury
use arm or arm and pillow to splint rib
Your partner states that he is the "world's worst speller" and has great difficulty using medical terms. Which one of the following statements is appropriate?
use plain English
short backboard
used to immobilize a seated patient
absorbed poison
usually a chemical or substance from a poisonous plant that enters through the skin -localized & systemic
injected poison
usually injection of a drug or bite or sting from a bug -sub Q, IM (intramuscular), or IV (intravenous) -look for local rxn
ruptured uterus
uterus enlarges over time of pregnancy and become thin. when ruptured 5-20% mother death and 50% baby death. requires surgery if this happens. causes are trauma, large baby, prolong pregnancy/difficult labor, shock
mitral valve
valve between the left atrium and the left ventricle; bicuspid valve
tricuspid valve
valve between the right atrium and the right ventricle
pulmonary valve
valve positioned between the right ventricle and the pulmonary artery
Your patient is breathing six times a minute with minimal breath sounds. You know that the patient needs:
ventilated with a bag-valve mask.
slighty movable joint example
vertebrae
Kussmaul respirations
very deep and rapid gasping respirations diabetic ketoacidosis
angi/o
vessel
AED is designed to shock
vfib
Hepatitis B virus
virus that causes inflammation of the liver; transmitted through any body fluid often no signs or symptoms possible symptoms: fatigue nausea and loss of appetite abdominal pain headache fever jaundice dark urine
referred pain
visceral pain may feel as if it is coming from some part of the body other than the part being stimulated ie: gallbladder inflammation (cholecstitis) will feel pain in right shoulder and scapular (shoulder blade)
Laryngeal spasm (laryngospasm)
vocal chords spasm and close together -no air can pass through trachea
Larynx
voice box; passageway for air moving from pharynx to trachea; contains vocal cords
larynx
voice box; passageway for air moving from pharynx to trachea; contains vocal cords
stroke volume
volume of blood ejected from the heart in one contraction.
skeletal muscle
voluntary muscle/ mechanical movement; striated muscle attached to bones by tendons
peristalisis
waves of muscular contraction that help push food through your digestive system
When a patient is suffering from constriction of the bronchioles, the breath sound MOST likely heard on auscultation would be:
wheezing - airway narrowing
limb presentation
when an infant's limb protrudes from the vagina before the appearance of any other body part
You have established manual in-line C-spine stabilization of an unconscious trauma patient. You may release manual stabilization:
when immobilization has been completed with straps and the CID.
kidney failure
when kidneys can no longer cleanse the blood and maintain homeostasis -acute kidney injury (AKI) -chronic renal failure (CRF)
ovaries
where eggs are produced
joints
where one bone connects to another can be movable, slightly movable, immovable
carnia
where the trachea divides into left and right primary bronchi
When asking about the quality of the chest pain a patient with angina is experiencing, you are asking:
whether the pain is sharp, dull, burning, or squeezing.
wheezing
whistling sounds during expiration -constriction of bronchioles -emphysema, asthma, chronic bronchitis -others: pneumonia, CHF, anything causing bronchoconstriction rx: beta 2 agonist (albuterol) by metered dose inhaler or small volume nebulizer
leukocyte
white blood cell; immune system & eliminate dead cells & debris
Pertussis
whooping cough; highly contagious bacterial infection of the pharynx, larynx, and trachea caused by Bordetella pertussis -spread by cough droplets -more common in children -seems like a normal cold at first -coughing disrupts gas exchange in alveoli & promotes bacterial pneumonia -sx: uncontrolled coughing, cold symptoms, -rx: o2, tell them to expectorate (spit out) sputum
Assault
willful threat to inflict harm on a patient
spontaneous abortion (miscarriage)
without apparent cause, termination of a pregnancy before the fetus reaches stage of viability, generally before 20th week of pregnancy (usually 12th) the delivery of the fetus before it is viable.
para
woman who has given birth (delivered)
atypical presentations of heart attack
women, elderly, diabetics -weak -SOB -light headed
carpals
wrist bones
general impression
your view from the door before you start your physical exam. determining chief complaint
Revised Trauma Score (RTS)
~Components: Glasgow Coma Scale (GCS), Systolic blood pressure, Respiratory rate ~Follow local protocol for use of the trauma scoring system ~Do not let it interfere with patient care patient RTS score of 12 is labeled delayed, 11 is urgent, and 3-10 is immediate.
The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he states:
"A prolapsed cord can stop the flow of oxygen to the baby and must be addressed immediately."
The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what statement?
"A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output."
The EMT shows that she understands the difference between classic angina and an acute myocardial infarction (MI) when she states:
"An acute myocardial infarction results in the death of cardiac tissue; classic angina does not."
Which of the following patient remarks best reinforces your suspicion that he is in the early stages of hypovolemic shock? A. "I fell last night and think I hurt my belly; see the bruise?" B. "I must have fallen and hit my head. I am very confused and restless." C. "I have been coughing up green mucus and feel weak." D. "I have had diarrhea for the past four days."
"I have had diarrhea for the past four days." loss of fluids (pushed through vessels)
You have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you what temperature would cause a child to seize. Your response would be:
"It is not the specific temperature that is of concern, but the rate at which the body temperature rises."
While performing the reassessment of a 2-year-old male who is severely dyspneic, you note that he is now unresponsive and not breathing. He has a heart rate of 32 beats per minute and his skin is cool and diaphoretic. What instruction would you provide to another EMT who is helping you transport the patient?
"Let's start chest compressions and positive pressure ventilations."
An Emergency Medical Responder asks you why you should not overextend the airway on a pediatric patient when performing a head-tilt, chin-lift. Your reply would be:
"The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far."
Which statement regarding the role and function of the cervix during pregnancy is true?
"The cervix becomes plugged with mucus to prevent contamination of the uterus."in
Which one of the following statements concerning assessment of the pulse is correct?
"The heart rate can be determined by doubling the number of beats counted in 30 seconds."
The EMT shows understanding of the standard of care when he states:
"The standard of care is a measure of whether or not the right assessment and care have been provided to the patient."
A 82dashyeardashold male presents with rightdashhand weakness and garbled speech. Which of the following questions should the EMT ask first?
"What time did these signs start?"
Which one of the following illustrates a question that would be asked when obtaining a medical history, using the SAMPLE mnemonic, for a female patient who is crying and complaining of dizziness?
"What were you doing when the dizziness started?"
What are the important assessment parameters in determining the circulation status in a 25-year-old male who was shot in the leg, after the major bleed was controlled?
Color, temperature, and condition of the skin
As you evaluate your patient's skin color, you find it is pale and moist. Pallor and moist skin may indicate:
hypoperfusion, or shock.
Viral Respiratory Infections
• Infection of respiratory tract • Usually minor but can be serious, especially in patients with underlying respiratory diseases like COPD • Often starts with sore or scratchy throat with sneezing, runny nose, and fatigue • Fever and chills • Infection can spread into lungs, causing shortness of breath • Cough can be persistent; may produce yellow or greenish sputum
When not to give Oxygen
"Ironically, it has been shown that oxygen given to a patient with an acceptable pulse oximetry reading can be harmful." -reperfusion injury
"Am I dying?"
"We are doing everything we can for you. We need you to help us by not giving up."
noncardiogenic pulmonary edema
"acute respiratory distress syndrome" (ARDS), resulting from destruction of capillary beds that allows fluid to leak out -risk: pneumonia, aspiration of vomitus, submersion, narcotic overdose, inhalation of smoke or other toxic gases, ascent to high altitude, sepsis, trauma
cumulative stress reaction
"burnout" - Not triggered by a single critical incident, but from sustained, recurring low-level stressors, possibly in more than one aspect of one's life, develops over the years.
neurogenic shock
"vasogenic shock" distributive shock in which sympathetic nerve fibers that constrict vessels are damaged; no fluid loss spinal chord injury - effects seen below injury
Pulseless electrical activity
(PEA) Organized heart rhythm -either heart is too weak to pump, doesn't respond to electrical activity, or circulatory system has lost so much blood that there is nothing to pump No deefib
circulatory system
(aka cardiovascular system) This system works as the transportation highway for the body. It consists of the heart, blood, and blood vessels. It transports substances such as oxygen, carbon dioxide, and nutrients in the body.
AVPU scale
*Alert*, responds to *Verbal* stimulus, Responds to *Pain*, Unresponsive *used to assess level of responsiveness*
A patient with multiple broken ribs would have an initial problem with what aspect of respiration? A. Cellular respiration B. External ventilation C. Internal respiration D. Pulmonary ventilation
*Pulmonary ventilation* is movement of gases in and out of the lungs. If multiple ribs are broken, this would be a cause for pulmonary ventilation failure. Internal respiration is the gas exchange process that occurs between the cells and the systemic capillaries. Internal respiration, also known as cell/capillary gas exchange, is responsible for delivering oxygen to the cells and removing carbon dioxide from the cell. External respiration is the exchange of gases between the alveoli and capillary bed. Cellular respiration occurs inside the cells and is a function of aerobic metabolism, finally, external ventilation is a fictitious term.
compensatory shock
*near normal blood pressure and perfusion* of vital organs. 1. baroreceptors receive less signals from aorta and carotid bodies when their pressure decreases 2. baroreceptors ask hypothalamus whats happening and 3. hypothalamus sends hormone and impulse friends to constrict everything for a hot minute
Hypercarbonic drive
- "hypercapnic drive" - normally, a person's rate and depth of breathing are *regulated by [CO2] in blood*
wireless service provider rules for 911 calls
- *Basic 911:* my inactivated Envy 3 can still call 911 - *Phase I Enhanced 911:* WSP must provide PSAP with phone number and closest cell site/base station - *Phase II Enhanced 911:* WSP must provide latitude and longitude within 50 to 300 m
postpartum hemorrhage care
- *uterine massage* - massaging uterus helps stimulate smooth muscle contraction - *allow infant to suckle on breast* - oxytocin causes uterus to contract - *transport* & continue to massage
aging effects on respiratory system
- Decreased vital capacity and flexibility - Increased airway resistance - Increased risk of respiratory infection - chemoreceptors suck at detecting O2 and CO2 - cough reflex doesnt trigger (doesnt eliminate bad stuff) - less air enters and exits the lungs - less gas exchange
Types of EMS Services
- Fire Department EMS - Municipal EMS - Private EMS - Hospital-Based EMS - Law Enforcement EMS - Public Safety Officer
How to treat abdominal evisceration
- Flexing the knees to relieve pressure on the abdomen - applying moist, sterile dressing - occlusive dressing (warmth) ;(plastic wrap works) - tape on all sides
location of pulses
- Radial: writst postierior same side as thumb -Ulnar: idenditical to radial except opposite of thumb - Brachial: in bend of elbow -postierior tibial: above heel - dorsailis pedis: on top of foot a few in above big toe
appearance (PAT)
- TONE - muscle tone - INTERACTIVITY and IRRITABILITY - CONSOLABILITY -LOOK (or gaze) -SPEECH (or cry)
respiratory control centers in the brainstem
- dorsal respiratory group (DRG) - ventral respiratory group (VRG) - pontine respiratory center
white paper
- identified deficiencies in prehospital care - catalyzed significant modern ambulance and EMT improvements
Medications EMT's can administer or assist in administering
- inhaled bronchodilator - nitroglycerin - epinephrine -
central chemoreceptors
- located near the respiratory center in the medulla - sensitive to CO2 and pH in CSF
The difference in anatomy between children's and adults' respiratory system
- mouth and nose are smaller in chillins and more easily obstructed - disproportionately large tongue - narrower trachea - cricoid cartilage is less rigid and developed - easily obstructed airway
High-risk activities of the EMT with regard to patient safety would include:
- transfer of care to other providers - poor communication - carrying patients - ambulance crash - lack of spinal immobilization
methods of applying CENTRAL PAINFUL STIMULI
- trapezius pinch - shoulder - supraorbital pressure - eye socket pressure - sternal rub - chest - earlobe pinch - armpit pinch - nail bed pressure - web between thumb and index finger
20th century public health achievements
- vaccinations - motor-vehicle safety - workplace safety - control of infectious diseases - reduction in deaths from coronary heart disease and stroke - safer and more healthful foods - decline in maternal and infant mortality - use of barrier devices during sexual contact - fluoridation of drinking water - reduction of tobacco
ingested acids and alkalis
-"caustic substances" -acids will cause more damage to stomach than esophagus -acids burn and hurt immediately (only lasts 1-2 minutes), and burn a protective layer that prevents further damage -alkalis cause more severe damage (delayed recognition of pain, burn deeper & longer) -s/s: face or mouth burns, dysphagia (difficulty swallowing), dysphasia (difficulty speaking), stridor, SOB, shock, abdominal pain
sickle cell crisis
-*bone crisis* - severe large bone pain -*acute chest syndrome* - sudden chest pain -*abdominal crisis* - sudden abdominal pain -*joint crisis* - sudden painful, stiff joints -more likely to get infectons -rx: o2
official name
--Drugs meeting the requirements of the U.S. Pharmacopoeia or National Formulary are given an official name --it is commonly the generic name followed by the initials U.S.P. or N.F.
Pediatric Advanced Life Support (PALS)
--Three components: --consciousness --breathing --color --looking for the same three components as PAT
Orlowski Predictors
--patient is 3 years or age or older --patient was submerged for greater than 5 minutes --resuscitation did not begin for more than 10 minutes after rescue --patient is comatose on delivery to emergency department --patients arterial blood is very acidic (ph less than 7.1) if >3 of these, only 5% neurologically intact survival
preeclampsia
-20% of maternal deaths risk: diabetes, kidney disease, heart disease, hypertension, first pregnancy (primaparity), twins and such, s/s: high blood pressure, proteinuria, edema in face hands and feet, and headache, RUQ pain
elderly vitals
->90 BPM -fast breathing -dry skin -uncommon to have fever -sluggish pupils
insulin
-A hormone produced by the pancreas or taken as a medication by many diabetics -controls the ability of glucose to enter cells
work of breathing (PAT)
-Abnormal Breath sounds -Abnormal positioning -Retractions -Nasal Flaring -Head bobbingf
pregnancy-induced hypertension (PIH)
-BP > 140/90 mmHg on 2+ occasions at least 6 hrs apart
oxygen cylinder sizes
-D 350 L(jumbo D 500L) carried from unit to patient -M (3000 L) remain on board as a main supply tank -other sizes are A 6900, E 625, G5300, H6900, K6900 -Some labelled by M (medical) and then a number
Cutting the Umbilical Cord
-Do not tie, clamp, or cut an umbilical cord on a baby who is not breathing unless the cord is around the baby's neck. -Do not cut or clamp a cord that is still pulsating (wait 30 seconds) -Apply one clamp or tie about 6 inches from the baby. -Another clamp 3 inches further down
Cincinnati Prehospital Stroke Scale (CPSS)
-Facial droop (smile) -Arm drift (close eyes and hold arms out for 10 seconds) -Abnormal speech ("you can't teach an old dog a new trick")
Types of seizures
-Partial; focal localized in one area -Partial Complex; LOC with change in behavior. Confusion. Origin is temporal lobe. -Partial Simple; Last for 5 min, child only remembers aura. Sx only on one side of body. No LOC. -Generalized; starts in all parts of the brain. -Tonic/Clonic; muscle spasms, LOC, contraction of limbs. Confusion. Bladder incontinence. -Atonic; Sudden drop to the floor, no LOC, No convulsions, "stare". Several times per day "petit mal" -Tonic/myoclonic/clonic; "grand mal". Stiffness.
2 things necessary for consciousness
-RAS -at least one cerebral hemisphere
How to take blood pressure
-Rapidly inflate the cuff to 180mmHg. -Release air from the cuff at a moderate rate (3mm/sec). -Listen with the stethoscope and simultaneously observe the sphygmomanometer. -The first knocking sound (Korotkoff) is the subject's systolic pressure. -When the knocking sound disappears, that is the diastolic pressure (such as 120/80).
Symptoms of compensated shock
-Slight mental status change: anxiety -mild tachycardia -mild tachypnia -Delayed capillary refill time & weaker, thready peripheral pulses -Pale skin that is cool/moist (diaphoresis) -Sweating
reasons for bleeding during pregnancy
-abortion -ectopic pregnancy -placenta previa -abruption placentae
Symptoms of decompensated shock
-altered mental status (listlessness, confusion, agitation, unresponsive) -hypotension -(>120 bpm) tachycardia & progression into bradycardia -weak, absent peripheral pulses -tachypnia -white, waxy, cold skin
thyroid gland
-anterior neck -regulates metabolism, growth and development, and activity of nervous system
sensitization in IgE-mediated anaphylactic reaction
-antrogen intrduced, body recognizes as "nonself" -forms IgE antibodies to fight antigen -IgE antibodies attach to mast cells and basophils -patient is considered sensitized as long as antibody is attached to mast cells and basophils -patient is then primed for anaphylactic reaction -antigen is reintroduced -attaches to IgE antibodies, which are attached to mast cells and basophils -mast cells and basophils break down and release chemical mediators (HISTAMINE) -these mediators cause the anaphylactic reaction
pneumonia
-bacterial or viral infection of the lungs -lung inflammation and fluid/pus filled alveoli -sx: fever, cough, dyspnea, tachypnea, tachycardia, sharp and localized chest pain when breathing or coughing, crackles, wheezing, rhonchi, AMS (altered mental status), diaphoresis, cyanosis
pituitary gland
-base of brain -"master gland" -regulates growth, the thyroid and parathyroid glands, the pancreas, the gonads, metabolism of fatty acid and some basic proteins, blood sugar reactions, and urinary excretion
Dilation (1st stage of labor)
-before contractions : amniotic sac ruptures, bloody show) -beginning of contractions to complete cervical dilation and 100% effacement -contractions promote dilation and effacement -ends when contractions are regular under 4 min intervals, last at least 60 seconds, and feel intense -cervix dilates to 10 cm true labor: contractions are more frequent, last longer,
Placental Delivery (3rd stage of labor)
-begins following delivery of baby and ends with the expulsion of the placenta -5-20 minutes -dont pull cord
Expulsion (2nd stage of labor)
-begins with complete dilation and ends with delivery of the baby -contractions close >2 min apart -contractions last >60 to 90 sec -infant moves through vaginal canal -pressure in rectum indicates shes about to deliver (needs to go to the bathroom) "I feel like I have to move my bowels."
parathyroid glands
-behind the thyroid -produce a hormone necessary for the metabolism of calcium and phosphorous in the bones
solid organs
-bleed a lot - hemorrhagic shock -no pain - blood does not irritate peritoneal lining -may cause *Kehr sign* - referred pain from diaphragm that makes shoulder hurt liver, spleen, pancreas, kidneys
right sided heart failure
-blood backs up in venous system -may be caused by LV failure -may be caused by hypertension -may be caused by COPD - RV must work harder because of increased pressure in pulmonary vessels -sx: JVD, peripheral edema, liver enlargement, hypotension, low BP, clear breath sounds
Diaphragm
-bottom of thoracic cavity -muscle -exhalation: 4th or 5th intercostal space (nipple line) -inhalation: lower 60-70% of breathing effort
asthma
-bronchoconstriction -airway edema -mucus production extrinsic/allergic - rxn to irritants, seasonal, children intrinsic/nonallergic - infection, emotional distress, exercise sx: dyspnea, cough, wheezing on expiration, tachypnea, tachycardia >120bpm, accessory muscles, anxiety, runny nose/rhinitis
cyanide poisoning
-byproduct of burning plastics -rodent poisons, fruit pits -prevents delivered O2 from being used by the cell -ALS has antidote -s/s: hypoxia, AMS, smell of bitter almonds, agitation, dyspnea, burning sensation in mouth or throat, headache, confusion
capillary/cellular exchange
-carbon dioxide moves from the cells to the capillaries, and oxygen moves from the capillaries to the cells
cardiovascular system changes during pregnancy
-cardiac output increases (raised heart rate) -blood volume increases (raised BP) -supine hypotension
Gastrointestinal Bleeding
-caused by peptic ulcers, gastric erosion, varices - upper : adult males - lower : females -s/s: hematemesis, hematochezia, melena, AMS, tachycardia, shock
methanol (wood alcohol) poisoning
-causes liver to produce a bunch of alcohol -gasoline, antifreeze, windex, paints, paint remover -40 - 72 hours after ingestion -s/s: blindness, AMS, seizures, NV, abdominal pain, dilated sluggish pupils, dyspnea
long-term effects if alcohol
-cirrhosis - scarring and damage to liver -peritonitis -automobile crashes -hypertension -AMS due to liver malfunction -pancreatitis -ulcers -seizures -subdural hematoma -hypoglycemia
Basic functions of the nervous system
-consciousness -sensory input -motor function -body functions - autonomic nervous system
3 goals of a PCR
-continuum of care -legal documentation -reimbursement
cause of geriatric acute coronary syndrome
-diabetes mellitus - nerve damage; cant perceive MI pain well; weak, dizzy, dyspnea -trauma -asthma - bronchoconstriction starts everything -COPD - (emphysema, chronic bronchitis, asthma) weak lungs and all sorts of problems might occur; bleb might rupture
kids with abdominal pain
-dont know how to describe pain -are they acting different than normal - eating, irritable, consolable
diabetes mellitus (DM)
-either not enough insulin or insulin receptors dont work -abnormally high blood glucose -brain still gets glucose Type 1 & 2 -sx: light-headedness, high BGL, dehydration (polydipsia), polyphagia, polyuria (3 p's of diabetes)
impact of too much lactic acid (anaerobic respiration)
-enzymes unravel -membranes are disrupted -death -not enough energy to perform normal functions
Release of hormones (compensatory mechanism from shock)
-epinephrine and norepinephrine -epinephrine : Alpha 1, Alpha 2, Beta 1, Beta 2 -norepinephrine: Alpha 1 & Beta 1 Alpha 1 = vasoconstriction (vessel smooth muscle) Alpha 2 = cheers for Alpha 1 Beta 1 = heart rate Beta 2 = lungs; bronchiodilation
airway in children
-giant tongues -thinner, pliable trachea that is smallest at cricoid cartilage, not vocal cords (as seen in adults) -nose breathers -epiglottis is higher in airway
aging effects on endocrine system
-higher blood sugar -alteration in BP -fluid imbalance
old people with abdominal pain
-higher mortality -decreased perception of pain -wait longer to get help -vague symptoms
amniotic fluid embolism
-higher risk for embolism (increased blood volume, coagulation) -amniotic fluid, fetal cells, hair enter mother's circulation O2
stomach
-hollow organ that is main organ of digestive system -some digestion happens with saliva, but most happens in stomach's gastric juices
other changes during pregnancy
-hormones -polyuria -loosened pelvic joints
heat stroke
-hot skin -AMS -can be moist or dry -seizure
risk factors for stroke
-hypertension -atherosclerosis (thickening of lining of the arterial walls) -atrial fibrillation -myocardial infarction -diabetes -cigarette smoking -old
aging effects on cardiovascular system
-hypertension (thickening vessels from *atherosclerosis*) & (decreased baroreceptor pressure sensitivity) - Heart muscle weakens & swells, lower cardiac output -less pacemaker cells (harder to increase HR with cardiac output) & (dysrhythmias) - Calcification of heart valves (stenosis = narrowing of the heart valves) -regurgitation - backflow due to valve damage
medical complications of pregnancy
-hypertensive disorders (BP goes up during pregnancy) - swelling in hands and feet, headache, blurry vision -supine hypotensive syndrome -gestational diabetes
children at higher risk for
-hypoglycemia - use up quicker, poor glucose stores, diabetes -rapid decompensation -greenstick (bending and splintering) fracture -hypothermia (high skin: body mass, thin skin)
chest compressions for a baby
-if HR <60 bpm -120 per minute CPR
Type 2 DCS
-immediate signs and symptoms -degenerative lower spine issues -headache, dizziness, altered mental status -nausea, vomiting, deafness, tinnitus -burning inhalation -nonproductive cough -hypovolemic shock
isopropanol (isopropyl alcohol)
-in cosmetics and cleaners. -within 30 min -s/s: respiratory depression, AMS, bradypnea, shallow tidal volume, *hematemesis*, abdominal pain, shock
islets of Langerbans
-in the pancreas -make insulin, which allows glucose to enter cells, -makes glucagon, a hormone that raises the glucose level in the blood
carbon monoxide poisoning
-inhalation -what kills you in a fire -incomplete combustion of things -hogs hemoglobin -no smell or taste -shared symptoms between multiple people -s/s: NV, AMS, high pulse ox, headache, tachypnea
PABS (bath salts)
-inhibit reuptake of norepinephrine and dopamine -SNS stimulation -AMS, hallucinations, panic attacks
urinary catheter management
-look for swelling or bleeding around insertion site -drain and record time and volume -keep lower than patient
treatment for shoulder dystocia
-mcroberts position -suprapubic pressure -med direction
brain
-most highly specialized organ -3 pounds -requires hella oxygen -can't store glucose, needs constant supply -3 main divisions: cerebrum, cerebellum, brainstem (pons connects the 3)
heat cramps
-muscle spasms to calves, hamstrings, biceps -not enough electrolytes
drug withdrawal
-narcotics, sedatives, hypnotics, barbiturates, cocaine -s/s: anxiety, agitation, confusion, tremors, diaphoresis, tachycardia, hypertension, hallucinations, nausea can cause seizures or AMS
12 weeks or more gestation
-no longer protected in pelvic girdle -trauma - transport all these patients, anticipate shock, crazy blood loss (more vascular than usual)
heat exhaustion
-normal body temp -lightheaded -slower blood flow to vital organs
gonads
-ovaries and testes -produce the hormones that govern reproduction and sex characteristics
alveolar/capillary exchange
-oxygen-rich air enters the alveoli during each inspiration and passes through the capillary walls into the alveoli and are exhaled
type 1 DCS
-pain -pruritus (itching) and burning of skin (skin bends) -rash -
circulation (PAT)
-pallor -mottling -cyanosis -petechiae (pinpoint hemorrhages)
Goals of prehospital management of shock
-patent airway -adequate ventilation -adequate oxygenation (NRB mask @ 15 lpm if breathing adequately or supplemental O2 if not breathing adequately) -no not hyperventilate -stop bleeding -splint fractures -do not remove impaled objects -maintain body temperature -supine position -pelvic compression device if pelvic fracture is suspected -rapid transport -possible ALS intercept
CPAP is contraindicated when
-pneumothorax is suspected : positive pressure can will increase size of pneumo
respiratory system changes during pregnancy
-progesterone causes decrease in airway resistance -increase in oxygen consumption -increase in tidal volume -slight increase in respiratory rate
acute stress reaction
-results from exposure to a high-stress situation -signs/symptoms occur immediately or shortly after incident
epinephrine release in hypoglycemia
-secreted when BGL is dangerously low -stops insulin secretion -promotes release of glucose stores -promotes conversion of other substances into glucose -other A1, A2, B1, B2 effects (tachycardia, diaphoresis, pale, cool, clammy
adrenal glands
-sit atop the kidneys -secrete epinephrine (adrenaline) and norepinephrine, postpone muscle fatigue, increase the storage of sugar, control kidney function, and regulate the metabolism of salt and water
how to take pulse rate
-sitting or lying down -#of beats in 30 sec x 2 -go a full minute if irregular
Signs of cardiogenic shock
-skin is pale, cool, and clammy -cyanosis and mottled -slow heart rate, irregular rhythm
sickle cell anemia
-some RBCs have abnormal hemoglobin that does not carry enough O2 (RBC's take on a fragile crescent shape) -RBCs stack up and block blood flow -infection from RBCs blocking spleen (no immune WBCs produced)
hollow organs
-spill contents when ruptured, causing peritonitis -dont bleed much -lots of pain - acidic contents immediately irritate peritoneal lining; bacterial contents irritate after awhile stomach, gallbladder, urinary bladder, ureters, internal urethra, fallopian tubes, small intestine, large intestine
PCP (phencyclidine)
-stored in body fat -if sudden weight loss, drug is re-released
frequent causes of hypoglycemia
-takes insulin, doesn't eat -more activity than normal -too much insulin
abortion
-termination of pregnancy before the 24th week of gestation -miscarriage, therapeutic abortion (mom over baby's life) -complete (all tissue discharge) or incomplete (some tissue left over) -s/s: cramping, abdominal pain, backache, vaginal bleeding, shock -rx: treat for shock, emotional support -must gather tissue
SNS activation (compensatory mechanism from shock)
-triggerend by low CO -least effective -send SOS to adrenal gland for epinephrine and norepinephrine -increased HR -increased myocardial contractility and vasoconstriction
bariatric surgery complications
-ulcers, perforations, bowel obstruction
Food poisoning (exotoxin mediated)
-usually from seafood -geriatric/pediatric will have worst s/s -s/s can be hours or days after -salmonella (contaminated, undercooked) -campylobacter (poultry, milk, water) -escherichia coli (E. coli) (contaminated, undercooked, untreated water) -staphylococcus aureus (unhygienic food preparation, cold foods)
reproductive system changes during pregnancy
-uterus grows -vascular system grows -formation of mucus plug in cervix -estrogen causes vaginal mucosa to thicken -breast enlargement
Signs of distributive shock
-warm, flushed skin from vasodilation -mottled skin as pooled blood deoxygenated
gurgling
..., indicates presence of fluid in the upper airway, need for suctioning
For a patient breathing in room air, the EMT would estimate the FiO2 to be:
0.21 ambient air is 21% O2
Apgar scoring system
1 & 5 min after birth Infant condition based on: Appearance [pink = 2pt] Pulse [>100 = 2pt] Grimace (reflex irritability) [rxn to flicking soles of feet = 2pt] Activity [moving = 2pt] Respiration [respiration and cries = 2pt]
infant
1 month to 1 year
toddler
1 year to 2 years -dont like to be touched or separated
complex partial seizure
1-2min; one cerebral hemisphere (conscious) -awake but AMS, unaware of surroundings, blank stare, repetitive activity
defusing
1-4 hours after ; a session held prior to a critical incident stress debriefing (CISD) for emergency service personnel most directly involved to provide an opportunity to vent emotions and get information before the CISD
Nasal cannula flow rate
1-6 L/min
premature ventricular complexes (PVCs)
1. This early beat fires on its own from a focus in the ventricle and then spreads to the other ventricle. Causes include: hypoxia, electrolyte abnormalities, stimulants, caffeine, medications, and structural heart disease. - Wide, bizarre QRS complexes followed by a compensatory pause are seen; a P wave is not usually seen because it is "buried" within the wide QRS complex. -can produce ventricular tachycardia (vtach) (ECG steep peaks and valleys very close together) -degenerate into vfib (smaller, uneven, disorganized peaks and valleys)
Stages of Shock
1. compensatory 1.5. progressive 2. decompensatory
anatomical planes
1. coronal / frontal (vertical cut into front and back halves) 2. transverse (horizontal cut into upper and lower) 3. sagittal (vertical cut into left and right halves)
Sluggish pupils may indicate...
1. hypoxia 2. brain injury 3. substance
3 factors that control capillary blood flow:
1. local factors 2. neural factors 3. hormones
respiratory rates less than ___ and greater than ______ are a concern
10 ; 26 pay attention to whether the patient is outwardly struggling
Nonrebreather flow rate
10-15 L/min
Epinephrine only lasts
10-20 min
Rate of CPR compressions
100-120 per minute
Neonate heart rate
100-160 bpm
If you are computing a Revised Trauma Score and the patient's GCS score is 14 with a respiratory rate of 30/min, a blood pressure of 102 systolic, and a heart rate of 104, what is the patient's total revised trauma score?
11
adolescent
12-18
adolescent normal respiratory rates
12-20
Adult normal respiratory rate
12-20 breaths per minute
Normal respiratory rate
12-20 breaths per minute *8-24 breaths per minute* chest wall expands 1 inch
Adult normal BP
120-139/80-89 mmHg
face bones
14 13 immovable orbits (eyes), nasal bones, maxillae (fused bones of upper jaw), zygomatic bones (cheekbones) mandible (lower jaw) moves freely on hinge joints
Phalanges (foot)
14 toe bones 2 in big toes, 3 in everything else
Hypertension BP
140/90 mmHg or higher
What is the longest amount of time a patient should go without a vital sign reassessment?
15 minutes
48. You are providing intermittent suctioning to a patient as he has a small bleed into his airway during PPV. When performing this skill, what is the maximum amount of time you should suction prior to reoxygenating him?
15 seconds
normal child respiratory rate
15-30 per minute
6-11 years old normal respiratory rates
18-25
big name for "white paper"
1966 Accidental Death and Disability: The Neglected Disease of Modern Society
passive rewarming
1st priority; the use of the patient's own heat production and conservation mechanisms to rewarm him, for example, simply placing the patient in a warm environment and covering him with blankets
products of anaerobic glycolysis
2 ATP per glucose, lactic acid
umbilical cord (belongs to baby's body)
2 arteries - waste from baby 1 vein - nutrients from mom -mother and baby's blood never mix
You are testing orthostatic vital signs on a patient. You have just taken the vital signs while the patient was lying supine and just assisted the patient to a standing position. You should wait how long before taking the next set of vital signs?
2 minutes
Infant Capillary Refill
2 seconds
atria
2 upper chambers of the heart
sudden onset asthma
20% of cases -usually M -under 6 hours -allergens, exercise, stress -greater bronchiole smooth muscle constriction -faster response to treatment
3-5 years old normal respiratory rates
20-28
BGL readings as high as _______mg/dL can be considered normal in a diabetic
200
oxygen in ambient air
21%
1-2 years normal respiratory rates
22-37
ribs
24 (12 pairs) attached posteriorly by ligaments to the 12 thoracic vertebrae
Nasal cannula FiO2
24-44%
Class 2
25 mph or greater
normal infant respiratory rate
25-50 respiratory rate decreases with age, then increases as you get way old
vertebrae
26 small bones that make up your backbone / spinal column
fetus
3 months to birth (before this is embryo)
Flail Segment / Paradoxical movement
3+ ribs fractured in 2+ places. Causes free floating segment of the chest wall, other internal injuries probably present. Splint using a pillow or towel.
M cylinder
3,000 liters of oxygen
preschooler
3-5 years -afraid
When measuring the blood pressure, the EMT would inflate the cuff to this many points above where the pulse disappears.
30 mmHg
Distribution of blood
30-35% of blood volume contained in heart, arteries, and capillaries 60-65% of blood in the venous system mostly in venous
newborn respiratory rate
30-60 per min
CPR procedure
30:2 (compressions:breath), push hard and push fast
normal end-tidal CO2 (capnographer)
35-45 mmHg pH is 7.35-7.46 (probably because were blowing off that .35-.46 CO2 that causes acidity, bringing us just above neutral)
D cylinder
350 liters of oxygen
heart structure
4 chambers: 2 atria (right and left) and 2 ventricles (right and left)
hemoglobin
4 iron sites for O2 to bind to
What is the highest numerical value that is assigned to eye opening when computing the GCS?
4 points
birth-1 normal respiratory rates
40-60
How much blood is in the body?
5 liters normal cardiac output / circulation is 5 lpm
in CA, brain cells begin to die after
5 minutes
H cylinder
6,900 liters of oxygen
School-age and preadolescent
6-12 years -cooperative
for a pulse to be palpated, the systolic pressure must be at least
60 mmHg
The typical physiologic range for a pulse rate in a disease- and injury-free adult at rest is:
60 to 80 beats per minute.
Adult normal pulse/heart rate
60-100 bpm
The EMT recognizes which one of the following heart rates (beats per minute) as normal for a 24-year-old male?
62 60-100
E cylinder
625 liters of oxygen
palpated systolic pressure is an average of _______ mmHg lower than an auscultated systolic blood pressure
7
human blood pH
7.35-7.45
Normal blood glucose range
70-140 mg/dL
Air composition
78% Nitrogen 21% Oxygen 0.9% argon 0.03 CO2
For a patient with inserted endotracheal tube, the ventilation rate is reduced to
8 to 10 ventilations per minute while the chest compressions become continuous at 100 compressions per minute without pausing for ventilation
Slow Onset Asthma
80% of cases -usually F -over 6 hours -URT infection -greater bronchiole inflammation -slower response to treatment
normal BGL
80-120 mg/dL
two EMS systems public can access
911 and non 911
tracheal tugging
: a downward pull of the trachea and larynx observed in aneurysm of the aorta
Brief Resolved Unexplained Event (BRUE)
<1 year old issue that is over now
Hypothermia
>95 F >35 C -not dead until they have been warmed and resuscitation has been attempted
greater trochanter
A bony prominence on the proximal lateral side of the thigh, just below the hip joint.
subcutaneous emphysema
A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air caught under the skin indicator of neck or chest injury
subcutaneous emphysema
A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues. -bubbles under skin -air from broken lung leaks out into tissue
basophils
A circulating leukocyte that produces histamine. -immature mast cell that circulates in blood
tort
A civil wrong
exercise-associated hyponatremia (EAH)
A condition due to prolonged exertion in hot environments coupled with excessive hypo- tonic fluid intake that leads to nausea, vomiting, and, in severe cases, mental status changes and seizures (also known as exer- tional hyponatremia).
gastric distention
A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation.
The hypoxic drive
A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with COPD -chronic high levels of CO2 make body insensitive to hypercarbic drive -administering o2 for too long causes them to detect increased o2 and stop breathing
hypoxic drive
A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases.
anemia
A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.
cerebral plasy *
A condition of muscle caused by brain damage around the time of birth and marked by lack of muscle control and paraysis especially in the limbs
decompression sickness (DCS)
A condition resulting from nitrogen trapped in the body's tissues caused by coming up too quickly from a deep, prolonged dive. A symptom of decompression sickness is "the bends" or deep pain in the muscles and joints. -up to 72 hrs after body may produce allergic-like reaction to get rid of bubbles type 1 (mild), type 2 (serious), arterial gas embolism -rx: lateral recumbent, recompression chamber
congestive heart failure (CHF)
A condition resulting from the heart's inability to pump out all the blood that returns to it; blood backs up in the veins leading to the heart, causing an accumulation of fluid in various parts of the body LV failure -pulmonary edema when fluid is pushed out of lung capillaries -sx: dyspnea/tachypnea, tachycardia, anxiety, need to sit upright, PCC skin, abdominal distention, extremity edema, pink sputum, CRACKLES IN LUNGS
Which of the choices is TRUE regarding the difference between a sign and a symptom? A. A condition that must be described by the patient is a symptom. B. Information obtained during baseline vitals assessment are symptoms. C. Any objective physical evidence that you can see, hear, feel, or smell is a symptom. D. A vague complaint that cannot be specifically described is a sign.
A condition that must be described by the patient is a symptom
epiglottitis
A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction. -can have 50% mortality when untreated -caused by Hib (haemophilus influenzae type B) -can be caused by strep -dont put anything in mouth
communicable disease
A disease that can be spread from one person or species to another.
National EMS Scope of Practice Model
A document created by the National Highway Safety Traffic Administration (NHSTA) that outlines the skills performed by various EMS providers.
prehospital care report (PCR)
A document filled out for all emergency calls; used to keep medical personnel informed so they can provide appropriate continuity of care; also serves as a record for legal and billing purposes; may be written or electronic; if electronic, it is then an E-PCR.
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.
venturi mask
A face mask and reservoir bag device that delivers specific concentrations of oxygen by mixing oxygen with inhaled air.
Statute of Limitations
A federal or state statute setting the maximum time period during which a certain action can be brought or certain rights enforced.
thyroid cartilage
A firm prominence of cartilage that forms the upper part of the larynx; the Adam's apple.
Epiglottis
A flap of tissue that seals off the windpipe and prevents food from entering.
epiglottis
A flap of tissue that seals off the windpipe and prevents food from entering.
bag-valve mask (BVM)
A handheld device with a face mask and a self-refilling bag that can be squeezed to provide artificial ventilations to a patient. It can deliver air from the atmosphere or oxygen from a supplemental oxygen supply system.
Law of Inertia
A law formulated by Galileo that states that motion, not rest, is the natural state of an object, and that an object continues in motion forever unless stopped by some external force.
advance directives
A legal document designed to indicate a person's wishes regarding care in case of a terminal illness or during the dying process "living will"
tension pneumothorax
A life-threatening collection of air within the pleural space; the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures to the opposite side. trachea shifts to one side (toward opposite side to injury / air bubble)
power lift
A lift from a squatting position with weight to be lifted close to the body, feet apart and flat on the ground, body weight on or just behind the balls of the feet, and back locked in. The upper body is raised before the hips. Also called the squat-lift position.
emergency move
A move in which the patient is dragged or pulled from a dangerous scene before assessment and care are provided. patient is in danger
Hypothalamus
A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.
Acetylcholine (ACh) *
A neurotransmitter that enables learning and memory and also triggers muscle contraction -necessary for PNS
helminths
A parasitic roundworm, flukes or tapeworms that cause infection. introduced by ingestion of eggs
Which of the situations would allow artificial ventilation to provide better alveolar ventilation than spontaneous breathing?
A patient with a large flail chest.
traumatic asphyxia
A pattern of injuries seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck. -severe chest compression sx: bluish purple head and neck, JVD, bloodshot eyes, cyanotic and swollen tongue and lips, bleeding of conjunctivia (waterline)
spontaneous pneumothorax
A pneumothorax that occurs when a weak area on the visceral pleura ruptures in the absence of major injury, allowing air to leak into the pleural space. closed -result of weak area in lung (BLEB) risk: smokers, lanky males, COPD -sx: sudden SOB, decreased breath sounds on on side, sudden chest/shoulder pain, subcutaneous emphysema, tachypnea, diaphoresis, pallor
ectopic pregnancy
A pregnancy anywhere outside of the womb, usually in a fallopian tube -have to consider this for any female of childbearing age -5-9 weeks -can rupture and hemorrhage -risk: PID, IUD, tubal surgery -s/s: abdominal pain on one side, dull and unlocalized that befomes sharp and localized, Kehr sign (shoulder pain), may or may not bleed vaginally, shock -rx: treat for shock
boyle's law
A principle that describes the relationship between the pressure and volume of a gas at constant temperature helps explain lung function
Alzheimer's disease (AD)
A progressive disease that destroys the brain's neurons, gradually impairing memory, thinking, language, and other cognitive functions, resulting in the complete inability to care for oneself; the most common cause of dementia. -stop eating and remembering things
insulin
A protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues -more insulin, less glucose in blood -LOWERS blood glucose levels -causes glucose uptake into cells -causes glucose uptake by liver to be converted into glycogen
ventricular tachycardia
A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atrium), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest. -pumping is so rapid that heart does not refill enough to have a decent cardiac output -often becomes vfib ONLY DEFIBRILLATE IF PULSELESS, NOT BREATHING (apneic), AGONAL RESPIRATIONS< UNRESPONSIVE
malaise
A sense of unease; depression
anaphylactic shock
A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, widespread vasodilation, permeable capillaries, circulatory shock, and sometimes sudden death type of distributive shock treat with epinephrine - causes vasoconstriction (Alpha 1)
delirium tremens (DTs)
A severe withdrawal syndrome seen in alcoholics who are deprived of ethyl alcohol; s/s: restlessness, fever, sweating, disorientation, agitation, tremors, hypertension, dilated pupils, scary hallucinations, NVD, and seizures; can be fatal if untreated.
mobile data terminal (MDT)
A small computer terminal inside the ambulance that directly receives data from the dispatch center.
cardiogenic shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can result from an acute myocardial infarction (heart attack), congestive heart failure, abnormal heart rhythm, infection, OD on beta blockers or calcium channel blockers
Pediatric Assessment Triangle (PAT)
A structured assessment tool used to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, circulation to the skin.
Continuous quality improvement (CQI)
A system of internal and external reviews and audits of all aspects of an EMS system.
capillary
A tiny blood vessel where substances are exchanged between the blood and the body cells.
pulmonary vein
A vein that carries oxygenated blood from the lungs to the left atrium of the heart.
inferior vena cava
A vein that is the largest vein in the human body and returns blood to the right atrium of the heart from bodily parts below the diaphragm.
automatic transport ventilator (ATV)
A ventilation device attached to a control box that allows the variables of ventilation to be set. It frees the EMT to perform other tasks while the patient is being ventilated. can feel lung compliance like BVM
HIV
A virus that attacks and destroys the human immune system. blood & sexual contact
West Nile Virus
A virus that lives in hundreds of species of birds and is transmitted among birds by mosquitoes. 80% of affected show no symptoms
jugular vein distention (JVD)
A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or congestive heart failure tension pneumothorax (air trapped n chest cavity because of chest or lung injury) pericardial tamponade (blood filling the sac around the heart)
jugular vein distention (JVD)
A visual bulging of the jugular veins in the neck that can be caused by fluid overload, pressure in the chest, cardiac tamponade, or tension pneumothorax (late) -engorgement is called Kussmal sigh and is the result of increased vein pressure
aortic aneurysm
A weakness in the wall of the aorta that makes it susceptible to rupture. -can lead to aortic rupture suddenly, with no symptoms beforehand -frequent in *abdomen* -pulsating mass
DNR (do not resuscitate)
A written order from a physician (sometimes initiated by a patient's advance directive or by a health care proxy's request) that no attempt should be made to revive a patient if he or she suffers cardiac or respiratory arrest.
intentional tort
A wrongful act knowingly committed.
jaundice
A yellowing of the skin and eyes
A patient with a history of diabetes is confused and irritable. According to family members, he accidentally took too much insulin this morning and did not eat breakfast. Since he is conscious with an intact gag reflex, medical command orders you to administer oral glucose. Which one of the following best represents the indication for the medication? A. Confusion and irritability B. High blood sugar C. Medical command authorization D. History of diabetes
A. Confusion and irritability
You are transporting a patient in cardiac arrest. The AED is being used and a shock has been advised. Prior to administering the shock, what should you do? A. Ensure that no rescuer is touching the stretcher. B. Withhold all shocks because metal will conduct the shock into the ambulance. C. Stop the ambulance and have all rescuers exit prior to shocking with the AED. D. Move the patient from the metal stretcher to a nonmetal surface.
A. Ensure that no rescuer is touching the stretcher.
You are ventilating a patient with a drug overdose, and occasionally, you need to suction him. What are the guidelines for ventilating him prior to the suctioning in order to wash out the nitrogen and increase the functional reserve of oxygen?
A. Rate of 12/min for 5 minutes
A 31-year-old female in her third trimester of pregnancy lost her balance and fell down a flight of stairs. When treating her, the EMT should:
A. immobilize her, and then tilt the long spine board to the left.
The oxygenation principle behind mouth-to-mouth (or barrier) ventilation is:
A. our exhaled breath is 16 percent oxygen.
A patient with high blood pressure takes a medication to slow his heart rate, thus lowering his blood pressure. The EMT would recognize this action as impacting the: A. cardiac output. B. afterload. C. systemic vascular resistance. D. preload.
A. cardiac output
Which one of the following would result from increasing a patient's preload? A. Increased cardiac output B. Decreased myocardial contraction C. Increased oxygen delivery into the lungs D. Decreased blood pressure
A. increased cardiac output
Which chamber(s) of the heart is/are responsible for creating the systolic blood pressure? A. Left ventricle B. Right ventricle C. Right and left atria D. Right and left ventricle
A. left ventricle
intervention for patient not in cardiac arrest
ABC - airway, breathing, circulation
tachycardia
Abnormally rapid heartbeat greater than 100 beats/minute.
Asystole
Absence of electrical activity & heart pumping Flatline No defib
What is the disease process, not the clinical emergency, that can happen when the coronary arteries are narrowed or occluded from atherosclerotic plaque? A. Cerebral artery disease B. Acute coronary syndrome C. Pulmonary embolus D. Chest pain
Acute coronary syndrome
Beta 1 effects
Affects heart -increase in heart rate, increase force of cardiac contraction, speed up the electrical impulse of cardiac contraction, and speed up the electrical impulse traveling down the heart's conduction system
While assessing a patient with non-traumatic chest pain that is not cardiac in nature, when should the EMT perform the focused physical exam?
After obtaining the patient history
Los Angeles Prehospital Stroke Screen (LAPSS)
Age (>45) seizure history duration of symptoms wheelchair bound / bedridden BGL within 60-400 Unilateral asymmetry
arterial gas embolism (AGE)
Air enters arterial system as a result of barotrauma from holding breath during ascent. -immediate signs and symptoms -degenerative lower spine issues -headache, dizziness, altered mental status -nausea, vomiting, deafness, tinnitus -burning inhalation -nonproductive cough -hypovolemic shock
trachea
Allows air to pass to and from lungs from pharynx
Muscular System
Allows manipulation of the environment, locomotion, and facial expression. Maintains posture, and produces heat. muscles work by contracting when stimulated by nerve impulses
maximum life span
Almost all persons die before reaching the maximum life span.
efferent nerves
Also called motor nerves; nerves that carry information out of the brain and spinal cord to other areas of the body. outward
afferent nerves
Also called sensory nerves; nerves that carry information about the external environment to the brain and spinal cord via sensory receptors. inward
delayed stress reaction
Also known as PTSD, can be triggered by a specific event but psychological effects may not present until days, months, or even years later. Characterized by nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration.
External respiration
Alveoli/capillary gas exchange
Which of the following patients should the EMT be MOST cautious with when providing artificial ventilation? A. A pediatric patient who has a traumatic brain injury. B. A pediatric patient who swallowed a poison and has a heart rate of 110 per minute. C. An adult patient who was traumatized and has a blood pressure of 86/58.
An adult patient who was traumatized and has a blood pressure of 86/58. When providing positive pressure ventilation, the lack of a negative intrathroacic pressure causes a drop in preload to the heart. This in turn results in a drop in cardiac output and blood pressure. As such, if a patient is already hypotensive at the onset of PPV, the pressure may drop even further.
radiation sickness
An illness that results from excessive exposure to nuclear radiation -sx: vomiting, diarrhea, hemorrhage, appetite loss, weight loss, malaise, fever, sores, lowered immune system
midline
An imaginary line drawn down the center of the body, dividing it into right and left halves.
midclavicular line
An imaginary line on the chest that runs vertically through the center of the clavicle
activated charcoal
An oral medication that binds and adsorbs ingested toxins in the gastrointestinal tract for treatment of some poisonings and medication overdoses. Charcoal is ground into a very fine powder that provides the greatest possible surface area for binding medications that have been taken by mouth; it is carried on the EMS unit. -may be harmful if aspirated
lung
An organ found in air-breathing vertebrates that exchanges oxygen and carbon dioxide with the blood
fungi
An organism that absorbs nutrients from the environment. can affect people with compromised immune systems
icterus
Another term for jaundice in eyes
simple pneumothorax
Any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient.
You have been dispatched to an apartment for an elderly male complaining of shortness of breath. When do you start the process of forming a general impression about this patient?
As you and your partner approach him
You are dispatched to a residence for a 16-year-old female complaining of severe abdominal pain. On your arrival, the parents tell you that she was having "cramps" the day before and the condition progressively worsened overnight and then suddenly increased prior to their call. The patient is alert and oriented and her vitals are BP 90/70, pulse 110, respirations 20; her skin is warm and dry. Your primary exam reveals tenderness and guarding in the left lower quadrant but is otherwise unremarkable; you do NOT believe she has a fever. As you begin the patient interview, she responds quietly and you frequently cannot hold eye contact. Based on the information provided, what would your NEXT step be?
Ask the parents to step out of the room and repeat the interview.
A 62-year-old female was struck by a car traveling approximately 45 miles per hour. After being struck, she was thrown 15 feet onto the sidewalk, impacting the pavement with her head and chest. The primary assessment has been completed and life threats addressed. The patient's husband is by her side. When performing the secondary exam on this patient, which one of the following should the EMT perform first? Select one: a. Obtain a full set of vital signs including a pulse oximeter reading. b. Assess the patient from head to toe for additional injuries. c. Examine the head and chest for other life-threatening injuries. d. Inquire from family if the patient has any past medical history.
Assess the patient from head to toe for additional injuries.
You have been directed to a car that struck another vehicle at a moderate rate of speed. You note deformity and starring of the windshield on the driver's side. What should you do to determine if the deformity to the windshield was caused by the driver hitting his head or by the air bags?
Assess the patient's head.
When deciding whether or not to transport a patient to the hospital using lights and sirens to the hospital, what information carries the most weight in your decision? Assessment findings
Assessment findings
G cylinder
Attached to fixed systems and ambulances. Contains 5,300 liters of oxygen.
index of suspicion
Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury. ie. high speed limit means likely trauma
Which of the following is the most desirable outcome in the ventilatory management of a patient in cardiac arrest? A. Ensuring that the patient is intubated by an ALS provider B. Providing appropriate ventilations C. Attaching the pulse oximeter and monitoring the readings D. Being able to insert a simple airway adjunct
B Providing appropriate ventilations
Which of the findings is MOST suggestive of a patient who is significantly hypoxic? A. SpO2 of 95 percent in a 34-year-old patient. B. A heart rate of 58 in a six-week-old patient. C. A blood pressure of 90/60 in a 44-year-old patient. D. Diminished breath sounds in a 14-year-old patient.
B. A heart rate of 58 in a six-week-old patient.
Bystanders state that a 72dashyeardashold woman complained of chest pain and dizziness just before she fell down a flight of stairs. She is alert but confused and states that she feels nauseated and may vomit. How should the EMT position this patient for transport? A. Left lateral recumbent position on a long spine board B. Fully immobilized to a long spine board C. SemiminusFowler's with a cervical collar in place D. Supine with her head turned to one side
B. Fully immobilized to a long spine board
Which of the following scenes would MOST likely have more than one patient? A. Call to a grocery store of abdominal pain B. High school basketball playoff game where a fight reportedly broke out C. Construction site where a piece of heavy machinery rolled over D. Dispatch tells you that you are responding to a call for chest pain
B. High school basketball playoff game where a fight reportedly broke out
A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should: A. administer oxygen with a nonrebreather face mask. B. check the patient's respirations. C. examine the abdomen for specific injuries. D. obtain a full set of vital signs
B. check the patient's respirations. (airway, then breathing)
Assessment of a hypoxic patient with a history of lung disease reveals him to be using well-developed accessory muscles to exhale. As an EMT, you should recognize that the patient: A. is inadequately exhaling oxygen from his lungs. B. is using energy to exhale and is in danger of respiratory failure. C. is adequately compensating for the problem with his breathing. D.
B. is using energy to exhale and is in danger of respiratory failure.
Which statement about seizures is TRUE? A. "All seizures are caused by some form of brain injury." B. "Seizures may be caused by a variety of medical conditions." C. "Patients who have seizures are at increased risk for stroke." D. "If the cause of a seizure is unknown, it is classified as status epilepticus."
B. "Seizures may be caused by a variety of medical conditions."
oral glucose
BGL <70mg/dL, AMS, & history of diabetes (MUST have all 2) -15g
Upon the arrival at any scene by the EMT, safety and control issues of the scene size-up begin with the EMT taking what step first?
BSI precautions
triceps
Back of upper arm
What is the final component that is performed in completing the secondary assessment of a medical patient who is alert and oriented and complaining of non-traumatic chest pain?
Baseline vitals
A patient is lying on his back, working beneath an automobile, and the automobile falls off the jacks and pins him against the ground. What answer would best represent why this patient is going to suffer from an alveolar hypoventilation?
Because of the inability to inhale deeply enough because of the weight of the car
Why do pediatric patients have to rely more on the diaphragm for breathing than the adult patient does?
Because of the increased compliance of the thoracic wall in the infant
subarachnoid hemorrhage
Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.
Of the following hazards that the EMT may encounter on a scene, which one is likely to be present the MOST often?
Blood and body fluids
blood-brain barrier
Blood vessels (capillaries) that selectively let certain substances enter the brain tissue and keep other substances out
digestive system
Breaks down food into absorbable units that enter the blood for distribution to body cells. -alimentary tract, accessory organs
aspiration
Breathing fluid, food, vomitus, or an object into the lungs
You are establishing CPAP on a patient with respiratory distress. What would be an appropriate initial pressure setting if the patient has acute pulmonary edema? A. 20 to 25 cmH20 B. 15 to 20 cmH20 C. 5 to 10 cmH20 D. 1 to 5 cmH20
C. 5 to 10 cmH20
cervical spine
C1-C7 (neck) most prone to injury
cardiac arrest abc's
CAB compressions, airway, breathing
intervention for patient in cardiac arrest
CAB - compressions, airway, breathing
standard precautions
CDC precautions used in the care of all patients regardless of their diagnosis or possible infection status; this category combines universal and body substance precautions protecting yourself from disease transmission
narcotics
CNS depressants that are derived from opium (opiates) or from synthetic opium (opiodis) -agents that induce sleep
pH in CSF is a direct reflection of
CO2 levels in arterial blood -CO2 combines with water to form carbonic acid -higher CO2 = more acid
Gastrocnemius
Calf muscle
How is carbon dioxide transported in the blood?
Carbon Dioxide is converted into bicarbonate ion and then there are bond to hemoglobin; 1. Carbon dioxide diffuses out of cells into systemic capillaries; 2. only 7% of the carbon dioxide remains dissolved in plasma; 3. nearly a fourth of the carbon dioxide binds to hemoglobin forming carbaminohemoglobin; 4. 70% of the carbon dioxide load is converted to bicarbonate and hydrogen. Hemoglobin buffers hydrogen; 5. HCO3 enters the plasma in exchange for chlorine; 6. At the lungs dissolved carbon dioxide diffuses out of the plasma; 7. By the law of mass action, carbon dioxide unbinds from hemoglobin and diffuses out of the RBCs; 8. carbonic acid reaction reverses pulling HCO3 back into the RBC and converting it back to CO2
Sudden death
Cardiac arrest patient dies within 1 hour of onset of symptoms
phrenic nerve
Carries impulses to the diaphragm from the brain.
You have been dispatched for an 89dashyeardashold female patient who fell in her kitchen and was found by family members several hours later. If something goes awry on scene, which of the following offers you the most safety and security?
Carrying a portable radio with you into the house
Internal respiration
Cell/capillary gas exchange
mast cells
Cells that release chemicals (such as histamine) that promote inflammation. -in connective tissue and are concentrated around the heart, lungs, & vessels -IgE antibodies attach to these
Pneumothorax (PTX)
Collapsed lung due to trauma or a spontaneous small rupture of the lung
external oblique
Compresses abdomen; laterally flexes and rotates vertebral column
integumentary system
Consists of the skin, mucous membranes, hair, and nail
You are dispatched to an auto accident. As you approach the scene, you notice that law enforcement is there and the fire department is close behind you. There are four badly damaged vehicles involved. What would your next action be?
Contact dispatch and request additional EMS units
systole
Contraction of the heart
Once the scene is safe and controlled, you prepare to begin the primary assessment of the patient. Which of the following is TRUE regarding the primary assessment?
Critical conditions identified during the primary assessment must be treated immediately as found.
What is the term for an individual's initial exposure to an antigen that elicits a primary response from the immune system? A. Hypersensitivity B. Passive immunity C. Cellular immunity D. Sensitization
D. Sensitization
You arrive on scene and find a patient who was in a car accident and was thrown through the windshield. You identify that the head has been almost completely severed from the body, with only a few pieces of tissue on the back of the neck still intact. There is neither heartbeat nor breathing. What should you do first? A. Start CPR. B. Contact ALS for intercept. C. Fully immobilize the patient. D. Withhold resuscitation.
D. Withhold resuscitation.
Your unresponsive trauma patient has a rapidly dropping blood pressure. This indicates the patient: A. is compensating adequately. B. will not survive his injuries. C. has internal bleeding. D. is in a state of decompensation.
D. is in a state of decompensation.
myocardial infarction (MI)
Death of cardiac muscle due to ischemia
flexion
Decreases the angle of a joint
kussmaul respirations
Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body. -blowing off carbonic acid (co2)
Central neurogenic hyperventilation
Deep, rapid respirations, indicating increased intracranial pressure at least 25 breaths per minute with regular pattern
conjunctiva
Delicate membrane lining the eyelids and covering the eyeball
You have been dispatched to a residence for an 89-year-old female with a nonspecific complaint. When assessing this patient, which of the following will you do first to develop a better understanding of the emergency?
Determine if the complaint is medical or trauma related.
What should you do after collecting baseline vital signs and available patient history and arriving at a field diagnosis for your unresponsive medical patient? A. Refine your patient history. B. Treat the patient symptomatically. C. Verify your rapid assessment. D. Devise a management plan.
Devise a management plan
Assessment (SOAP)
Diagnosis (what you think it is) EX: "you think that they broke their leg"
small intestine
Digestive organ where most chemical digestion and absorption of food takes place
To best anticipate the type and extent of injuries sustained by a patient who has fallen, the EMT should consider which of the following pieces of information?
Distance fallen and type of surface landed on
frontal (coronal) plane
Divides the body into front and back portions.
What would be the best way to proceed when faced with collecting information from a patient who is also suffering from a progressive neurological disease such as dementia or from delirium when no family members or care providers are present?
Do not spend much time collecting a history.
Monitoring devices used by the EMT include each of the following, EXCEPT: A. pulse oximeter. B. ECG monitor. C. glucose meter. D. Blood pressure cuff.
ECG monitor.
As defined by the National EMS Scope of Practice Model, which of the following is a nationally recognized certification level for EMS practitioners?
EMR EMT Paramedic
medical direction
Each EMS system must have a physician as a medical director to provide medical oversight that includes overseeing patient care and delegating appropriate medical practices to EMTs and other EMS personnel
Which one of the following statements about EMS in the United States is true?
Each state has governmental control of its own EMS system, independent of the federal government.
trauma systems
Each state must develop a system of specialized care for trauma patients, including one or more trauma centers and rehabilitation programs, plus systems for assigning and transporting patients to those facilities
resource management
Each state must have central control of EMS resources so that each locality and all patients have equal access to acceptable emergency care
chain of survival
Early Access, Early CPR, Early Defibrillation, Early Advanced Care
Which one of the following would be an EMS public health initiative?
Educating the public on the benefit of wearing seat belts
In an EMS system, the first assessment of the call and the patient's condition is most often made by the:
Emergency Medical Dispatcher
distended
Enlarged or expanded from pressure
Cincinnati Stroke Scale
Facial droop, arm drift, speech
kidneys
Filter blood from the renal arteries and produce urine as waste; control fluid balance
kidney
Filters waste from the blood like urea, water, salt and proteins.
valves
Flaps of tissue that open and close to allow the flow of blood in one direction only. The heart's valves are located at the entrances and exits of its chambers. tricuspid valve pulmonary valve mitral valve (bicuspid valve) aortic valve
sartorius
Flexes, abducts, and laterally rotates thigh at the hip; flexes knee
cerebrospinal fluid (CSF)
Fluid produced in the ventricles of the brain that flows in the subarachnoid space and bathes the meninges of the brain leakage through nose or ears indicates skull fracture
Heart Anatomy
Four chambers, valves, pulmonary arteries and veins, nodes
biceps
Front of upper arm
20 weeks gestation
Fundus (top of uterus) is palpable at the level of the umbilicus
Vitals that indicate need for rapid transport
GCS <= 13 Systolic Blood Pressure <90 mmHg Respiratory Rate <10 or >29 breaths per minute or need for ventilatory support (<20 for infant under 1 year)
GCS score
GCS Motor: 6 commands, 5 localizes, 4 withdraw pain, 3 flexion pain (decorticate), 2 extension pain, 1 none. GCS Verbal: 5 oriented, 4 confused, 3 inappropriate, 2 incomprehensible, 1 none. GCS Eyes: 4 spontaneous, 3 to command, 2 to pain, 1 none (Every Year)
Which of the following findings, individually, would be sufficient to classify a trauma patient as a high priority?
GCS of 12
multiple births
Giving birth to more than one child at a time
GCS scale
Glasgow Coma Scale; A scale for measuring level of consciousness, especially after a head injury, in which scoring is determined by three factors: amount of *eye* opening, *verbal* responsiveness, and *motor* responsiveness
You are assessing a female patient who informs you that she has been pregnant four times before but only delivered once. Which one of the following shows how you should document that information on the prehospital care report?
Gravida IV; Para I
You are dispatched to transfer a patient who has confirmed tuberculosis (TB). Which of the following Standard Precautions should be employed, at a minimum, to protect yourself prior to starting your scene size-up?
Hand washing with hand sanitizing gel, gloves, HEPA or Ndash95 respirator for you and a surgical mask on the patient
What is included in the care of a patient with generalized hypothermia?
Handling the patient gently, as rough handling may cause a cardiac dysrhythmia
Acute Mountain Sickness (AMS)
Headache, Dyspnea, Nausea, Vomiting, Anorexia, Insomnia condition that occurs a result of acute exposure to high altitude due to a low partial pressure of oxygen
A patient with a slowed respiratory rate and depth from a drug overdose would MOST likely develop what problem?
High levels of carbon dioxide in the blood The level of carbon dioxide in the blood stream is largely determined by the quality of alveolar ventilation. If the patient has hypoventilation, then carbon dioxide will not get washed out and the levels will start to increase in the bloodstream. This makes the blood more acidic and can contribute to cellular death.
Side effects of epinephrine
Hypertension, tachycardia, anxiety, restlessness
Which condition will cause the pulse oximeter to produce an erroneous reading?
Hypothermia
suctioning complications
Hypoxemia, bradycardia/tachycardia, hypotension/HTN, increased ICP, atelectasis, tracheal damage, infections sucks residual volume out of lungs, sapping O2 and causing bradycardia & tachycardia
A plaintiff is suing an EMT in civil court for alleged improper care and resultant injury. Which of the following is true?
If the suit is successful, the plaintiff will most likely be awarded money.
tension pneumothorax
Immediately life-threatening condition; no relief for pressure in pleural space - the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures (heart, aorta, vena cava) to the opposite side. -can develop after applying occlusive dressing to open chest wound -sx: signs of shock, absent breath sounds on one side, cyanosis, unequal chest rise and fall, JVD, *tracheal deviation*, hypotension, hyoperfusion, tachypnea -rx: *lift dressing and allow air to escape during expiration*, rapid transport
hypoperfusion (shock)
Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients.
Diuretics
Increase urine output, less blood volume prior to shock state & will deteriorate fast
smooth muscle
Involuntary muscle - found in blood vessels and intestines -rhythmic, wavelike movements -carry liquid through body -control vasoconstriction and vasodilation
cardiac muscle
Involuntary muscle tissue found only in the heart. -"automaticity" - generates impulses without connection from CNS -has its own blood supply from coronary artery system
The EMT would recognize which of the following as an advantage of the 911 universal number?
It allows for simultaneous dispatch of EMS, law enforcement, and fire services.
Which of the following statements is TRUE regarding the secondary assessment for an unresponsive medical patient? A. It is very similar to the secondary assessment for a trauma patient with a significant mechanism of injury. B. It is very similar to the modified secondary assessment for a trauma patient with no significant mechanism of injury. C. All secondary assessments are conducted in the same way. D. It is the same as the secondary exam for a responsive medical patient.
It is very similar to the secondary assessment for a trauma patient with a significant mechanism of injury.
When assessing the chest, where should the EMT listen to breath sounds at bilaterally?
Just below the second rib at the midclavicular line and just below the fourth rib at the midaxillary line.
Beta blockers, calcium channel blockers, & implanted pacemakers
Keep the heart rate from dramatically increasing (hiding signs of compensatory stage of shock) -cardiac output doesn't increase like it usually does in this stage
Organs in the retroperitoneal space
Kidneys, ureters, pancreas, and abdominal aorta
ischemia
Lack of blood supply; death of tissue
Diaphragm
Large, flat muscle at the bottom of the chest cavity that helps with breathing
Aorta
Largest artery in the -front of spine -at navel, divides into iliac arteries, allowing blood to travel down each leg -supplies all other arteries
abandonment
Leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training.
McRoberts position
Legs flexed to chest to maximize pelvic outlet
plasma
Liquid part of blood -carries blood cells and nutrients to tissues -carries 3% of O2, the rest is on hemoglobin -transports waste to waste organs -carries CO2 to lungs for elimination
Auscultation
Listening with a stethoscope
RUQ organs
Liver, gallbladder, right kidney, colon, pancreas, small intestines
spinal chord
Long bundles of neurons that run inside of your vertebral column. It carries impulses from all parts of the body to the brain and from the brain to all parts of your body. Reflex arcs occur here.
distributive shock
Low BP - volume is not adequate to fill dilated vessels; capillaries may become permeable includes Septic (severe infection), Neurogenic (damage to the spinal cord), A Anaphylactic (reaction to substance) -caused by reduction in vascular resistance - reduced systolic BP
Which of the following is TRUE about blood pressure?
Low blood pressure indicates that there is not enough pressure in the arteries to keep the organs supplied adequately with blood.
GI bleeding
Lower GI bleeding= black and coffee grounds looking Upper GI bleeding= red or dark red -s/s: hematemesis, hematochezia, melena, dyspepsia (indigestion), hepatomegaly (enlarged liver), jaundice, constipation, diarrhea, agitation, dizziness, uncomfortable
BiPAP (bilevel positive airway pressure)
Mask that ventilates either by facial or nasal mask with inspiratory pressure is higher and expiratory pressure is lower
Pulse Oximetry (SpO2)
Measures the arterial oxyhemoglobin saturation (SaO2 or SpO2) of arterial blood. The reported result is a ratio, expressed as a percentage, between the actual oxygen content of the hemoglobin and the potential maximum oxygen-carrying capacity of the hemoglobin. A range of 95% to 100% is considered normal SpO2; values ≤90% are abnormal, indicate that oxygenation to the tissues is inadequate, and should be investigated for potential hypoxia or technical error.
Pericardium
Membrane surrounding the heart -prevents friction -lubrication
GCS score 9-12
Moderate head injury
Abduction
Movement away from the midline of the body
Mechanics of Ventilation
Movement of the Diaphragm and intercostal muscles to -increase (diaphragm/intercostals relax) pressure in the thoracic cavity inspiration -decrease (diaphragm/intercostals contract) the pressure in the thoracic cavity diaphragm - 60-70% of breathing effort intercostal muscles - 30-40%
Adduction
Movement toward the midline of the body
MCI
Multi-Casualty Incident
Altered Mental Status (AMS)
Multiple causes: most common are hypoglycemia, infection, intoxication, and neurological -lowered state of awareness -not alert but responds to either verbal or painful stimuli -like unresponsive patient, is prone to airway compromise
What organization contributed to the establishment of the minimal standards for an EMT's scope of practice in the United States?
National Highway Traffic Safety Administration
Epinephrine
Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline. -alpha1, alpha2, beta1, beta2 - basically are the SNS Used to treat shock, cardiac arrest and anaphylaxis side effects : tachycardia due to beta 1 dosage : 0.3 mg (>66lb) or 0.15 (<66lb) -can repeat dose in 5 to 15 minutes
NSR (Normal Sinus Rhythm)
Normal heart rate, abnormal can indicate a murmur. LUB DUB
Upper airway
Nose &mouth to cricoid cartilage (most inferior portion of the larynx)
upper airway of respiratory system
Nose and mouth Pharynx Nasopharynx Larynx Ends at the level of the cricoid cartilage (the ring that forms the most inferior portion of the larynx
respiratory system
O2 to CO2 A system of organs, functioning in the process of gas exchange between the body and the environment, consisting especially of the nose, nasal passages, nasopharynx, larynx, trachea, bronchi, and lungs.
Which of the following is LEAST directly related to checking the effectiveness of interventions you have performed on a trauma patient?
Obtaining a blood pressure and a pulse rate
Your written protocol requires that you administer oxygen to all patients who complain of respiratory distress. This is an example of what type of medical director authorization to practice?
Offline medical direction
Which of the following findings would be considered critical in assessing the chest of a patient during the secondary assessment?
Open chest wound
ulcers
Open sores in the lining of the digestive system -s/s: coffee-ground emesis, hematemesis, hematochezia, melena, LUQ pain before meals or during stress, shock, peritonitis
on-line medical direction
Orders from the on-duty physician given directly to an EMT in the field by radio or telephone.
spleen
Organ near the stomach that produces, stores, and eliminates blood cells
epidermis
Outer layer of skin -2 outer layers are dying and dead cells that are sloughed off as new cells replace the - *melanin* - skin's pigmentation; deepest layers of epidermis
cerebrum
Outermost layer (and largest part) of the brain; responsible for thinking and processing information from the five senses -conscious motion
Acromion
Outward extension of the shoulder blade forming the point of the shoulder.
male reproductive system
Overall function is production of offspring. Testes produce sperm and male sex hormone (testosterone), and male ducts and glands aid in delivery of sperm to the female reproductive tract. two testes, a duct system, accessory glands (including prostate gland), and penis
medications carried on the ems unit
Oxygen Oral Glucose Activated Charcoal Aspirin
humidified oxygen
Oxygen forced through distilled water and collected into the tubing; the oxygen now contains water vapour and is less irritating to delicate mucous membranes compared with plain oxygen If oxygen is being delivered to a patient over more than 60 min
LLQ organs
Part of descending colon Left ovary and fallopian tube Left ureter Left spermatic cord Small intestines
informed consent
Patient gives consent for a procedure to be performed in full knowledge of the procedure and the risk it entails
which of the following four patients could benefit from CPAP
Patient with pulmonary edema -can still breathe on their own
low blood pressure (hypotension)
Persistently less than 90/60 mm Hg. indicates not enough pressure to keep organs supplied
viruses
Pieces of genetic material surrounded by a protein coat cold, flu, HIV, hepatitis A, B, C, pneumonia (viral), severe acute respiratory syndrome (SARS), chicken pox, respiratory syntactical virus (RSV)
You have been dispatched for a young female in labor. On arrival you find an arm protruding from the vagina. Which of the following should you do next?
Place the mother in a knee-chest position.
cannula
Plastic prongs placed in nose to deliver oxygen
carina
Point at which the trachea bifurcates (divides) into the left and right mainstem bronchi.
You are entering the scene where a 32-year-old intoxicated male has fallen down 13 stairs leading to the basement. He is seated on the floor of the basement, holding a bloody towel over his face. During the initial scene sizeminusup, what is it essential that the EMT quickly identify?
Possible need of additional personnel
Abruption placentae (placental abruption)
Premature separation of the placenta from uterine wall before delivery (vascular connection) -complete (will kill fetus) -risk : cocaine, hypertension -last 20 weeks risk: hypertension, drugs, multiparity, smoking, short umbiblical cord, diabetes, trauma -s/s: tearing abdominal pain, excessive bleeding, shock -rx: treat for shock, left lateral recumbent position (or raise one hip)
blood pressure
Pressure exerted by the blood upon the walls of the blood vessels, especially arteries, usually measured by means of a sphygmomanometer and expressed in millimeters of mercury. rounded up to nearest even number
Components of patient assessment
Primary assessment (EMCA-PI) Focused history and secondary assessment Ongoing assessment Detailed secondary assessment
functions of skin
Protection from infection & mechanical harm, Thermoregulation, Cutaneous Sensation, Vitamin D synthesis, Blood Reservoir, Excretion and Absorption, regulation of water and electrolytes (sodium and chloride)
Personal Protective Equipment (PPE)
Protective equipment that blocks exposure to a pathogen or a hazardous material.
Emergency Medical Technician (EMT)
Provides basic emergency medical care and transportation to patients who access the EMS system. The interventions provided by the EMT include those performed by the EMR but with basic equipment found on an ambulance. The EMT level is similar in scope to the EMT-basic level with the addition of advanced oxygen therapy and ventilation equipment, pulse oximetry, use of automatic blood pressure monitoring equipment, and limited medication administration
Advanced Emergency Medical Technician (AEMT)
Provides both basic and limited advanced emergency medical care and transportation to patients in the prehospital environment. The AEMT provides all of the skills of the EMT with the addition of the use of advanced airway devices, monitoring of blood glucose levels, initiation of intravenous and introsseous (in-the-bone) infusions, and administration of a select number medications
Emergency Medical Responder (EMR)
Provides immediate lifesaving care to patients who have accessed the EMS system and while awaiting response from a higher-level EMS practitioner. The EMR uses basic airway, ventilation, and oxygen therapy devices; takes a patients vital signs; and provides stabilization of the spine and suspected extremity injuries, eye irrigation, bleeding control, emergency moves, CPR, automated external defibrillation, and emergency childbirth care
enteral feeding *
Provision of nutrition through a tube inserted through the nose, the mouth, or a surgical opening in the abdomen into the gastrointestinal system.
PMS
Pulse, Motor (Wiggle toes, squeeze fingers), Sensory (which finger am i touching) assessment of extremeties
consciousness
RAS and at least one cerebral hemisphere must be intact and functioning
abdominal quadrants
RUQ, LUQ, RLQ, LLQ
When performing a secondary assessment on a trauma patient with a significant mechanism of injury, what type of secondary assessment should the EMT perform?
Rapid secondary assessment
pancreas
Regulates the level of sugar in the blood -secretes digestive enzymes
Technical Assistance Program Assessment Standards
Regulation and Policy Resource Management Human Resources and Training Transportation Facilities Communications Public Information and Education Medical Direction Trauma Systems Evaluation
diastole
Relaxation of the heart
An ambulance with two EMTs arrives in front of a house for an unknown medical call in a good section of town. A bystander reports that a female patient was beaten by her husband in the driveway and then dragged back into the house. They continue by stating that the patient appeared unconscious and was bleeding from the head. Which action should the EMTs perform next?
Remove the ambulance and themselves from the scene and wait for the police.
Which of the following BEST outlines the sequences for completing the reassessment phase by the EMT while en route to the hospital?
Repeat the primary assessment, reassess the vitals, repeat the secondary assessment, assess effectiveness of interventions, and note trends in the patient's condition.
reproductive system
Reproduce offspring- produce male sex cells (sperm) and female sex cells (oocytes) sperm & ovum contribute genes
organic, traction, or inflammatory headaches
Result of tumors, infection, stroke, or inflammatory disorders within the cranium such as meningitis, hemorrhagic stroke, and tumor
reperfusion injury
Return of blood to ischemic tissues causes oxygen derived free radicals, further damaging tissues ACS and stroke -administer minimal O2
reperfusion injury
Return of blood to ischemic tissues causes oxygen derived free radicals, further damaging tissues -ACS - o2 free radicals increase inflammatory response & damage cells -heart, brain, kidneys, liver, lungs, and intestines
false ribs
Ribs 8-12 do not directly attach to the sternum. Some connect to other costal cartilages while others do not connect to the sternum at all.
evidence-based guidelines
Rigorous, explicit clinical guidelines developed based on the best research evidence available in that area.
You are dispatched to a residence for a 34-year-old male patient complaining of severe abdominal pain for the past two hours. On arrival, the patient tells you he would rate the pain as a 9 on a 1 to 10 scale. What part of the OPQRST would this information apply to?
S
SAMPLE pneumonic
S - Signs/Symptoms (Symptoms are important but they are subjective.) A - Allergies M - Medications P - Past Pertinent medical history L - Last Oral Intake (Sometimes also Last Menstrual Cycle.) E - Events Leading Up To Present Illness / Injury
sacral spine
S1-S5 (back wall of the pelvis)
Conduction system of the heart
SA (sinoatrial) node, AV (atrioventricular) node, Bundle of His, Purkinje fibers contractile & conductive cells
When assessing a sick or injured patient, which of the following indicates the appropriate order?
Scene size-up, primary assessment, secondary assessment
cardiogenic shock
Shock caused by inadequate function of the heart, or pump failure.
wet or moist skin
Shock, heat emergency, diabetic emergency
SBAR
Situation Background Assessment Recommendation
Microcirculation
Small blood vessel flow, including arterioles, capillaries, and venules
The automatic transport ventilator (ATV) may NOT be appropriate for: A. patients under the age of five.
Some ATVs cannot be used in children younger than five years of age because these ATVs do not have settings that will turn down low enough for volumes and pressures that a pediatric patient would need. These patients would need to be manually ventilated.
pressured speech
Speech that is increased in amount, accelerated, and difficult or impossible to interrupt. Usually it is also loud and emphatic. Frequently the person talks without any social stimulation and may continue to talk even though no one is listening.; they interrupt
abnormally dry skin
Spinal injury, dehydration, heat stroke, poisoning, hypothyroidism
Alcohol withdrawal syndrome
Stage 1: 8hr; nausea, insomnia, sweating, tremors Stage 2: 8-72hr; hallucinations Stage 3: 48hr; seizures Stage 4: 1-14 days; delirium tremens
off-line medical direction
Standing orders issued by the Medical Director that allow EMTs to give certain medications or perform certain procedures without speaking to the Medical Director or another physician.
stroke
Sudden loss of consciousness, sensation, and voluntary motion caused by rupture (HEMORRHAGIC) or obstruction (ISCHEMIC) (as by a clot) of a blood vessel of the brain. "brain attack"
Sacral Edema
Swelling around the low back in bedridden patients -indicates congestive heart failure
sodium-potassium pump failure
Swelling, Damage, Destruction. water follows all that Na+ (which shouldnt be there) into the cell and it explodes
TRACEM
T- thermal R- radiological A-asphyxiation C-chemical E-etiological M-mechanical damage from hazardous materials
thoracic spine
T1-T12 (upper back) 12 directly inferior to cervical spine; 12 pairs of thoracic ribs are attached for support
inferior angle of scapula
T7
Which of the following statements best describes the relationship between the EMT and the program medical director?
The EMT operates as an extension of the medical director.
Automaticity
The ability of cardiac muscle cells to contract without stimulation from the nervous system.
hemopneumothorax
The accumulation of blood and air in the pleural space of the chest.
due regard
The appropriate care and concern for the safety of others
Trendelenburg position
The body is laid flat on the back (supine position) with the feet higher than the head by 15-30 degrees,
Evisceration
The displacement of organs outside of the body.
glottic opening
The entry point into the larynx
systolic blood pressure
The force exerted against the arteries when the heart is contracting LV
large intestine
The last section of the digestive system, where water is absorbed from food and the remaining material is eliminated from the body colon
Blood Glucose Level (BGL)
The level of glucose circulating in the blood; measured using a glucometer. altered mental statys hypoglycemia - low blood glucose normal range is 70-100mg/dL (higher after a meal)
nonhemorrhagic hypovolemic shock
The loss of water, plasma protiens, and electrolytes from the intervascular space, but nothing else
pubis
The medial anterior portion of the pelvis
What is one consideration you may have to make when summoning air medical transport in a rotary-wing aircraft (helicopter)? A. Medical patients cannot be managed in a helicopter. B. A patient with mechanical ventilations should not be flown by helicopter. C. The obese patient on a backboard may not fit. D. Pediatric patients typically cannot be flown in a helicopter.
The obese patient on a backboard may not fit.
cervix
The opening to the uterus / bottom of uterus
bronchi
The passages that direct air into the lungs; contain cartilage
Despite a patient's protest not to have his blood pressure taken, the EMT places a BP cuff on his arm and takes his blood pressure. The EMT states: "See? It is just as I suspected, your blood pressure is sky high. You really need to be seen in the emergency department." The patient states he did not realize that his blood pressure was that high. In terms of battery, which one of the following is true?
The patient could charge the EMT with battery, regardless of his blood pressure reading.
abdominal aorta
The portion of the descending aorta that extends from the thoracic portion of the aorta to the distal point where the aorta divides into the iliac arteries. Arteries branching from the abdominal aorta supply the abdominal organs.
dead space
The portion of the tidal volume that does not reach the alveoli and thus does not participate in gas exchange. average 150 mL
pleural space
The potential space between the parietal pleura and the visceral pleura. It is described as "potential" because under normal conditions, the space does not exist. -negative pressure - air gets sucked in & lung collapses -only exists after break in visceral or parietal pleura
preload
The pressure of the volume in LV at the end of diastole (resting phase of cardiac cycle) synonymous with end diastolic pressure. determines force necessary to eject blood out of LV
drowning
The process of experiencing respiratory impairment from submersion or immersion in liquid. -85% male -under 5, teenager, old
You have just performed a tilt test on your patient. Which of the following outcomes would indicate a positive result?
The pulse increases by 15 bpm, and the systolic BP decreases by 15 mmHg.
Systemic Vascular Resistance (SVR)
The resistance that blood must overcome to be able to move within the blood vessels. SVR is related to the amount of vasodilation or vasoconstriction in the blood vessel. -parallels diastolic BP
return of spontaneous circulation (ROSC)
The return of a pulse and effective blood flow to the body in a patient who previously was in cardiac arrest.
cerebral hemispheres
The right and left halves of the cerebrum.
aortic valve
The semilunar valve separating the aorta from the left ventricle that prevents blood from flowing back into the left ventricle.
PSAP (public safety answering point)
The single location where 9-1-1 calls from a specific geographic area are routed for answering. -police, fire and EMT can all be accessed from same number
perfusion
The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.
What occurs when the diaphragm and intercostal muscles contract?
The thoracic cage enlarges, causing a decrease in intrathoracic and intrapulmonary pressures.
ureters
The tubes that carry urine from the kidneys to the bladder.
alveolar ventilation
The volume of air that reaches the alveoli in a minute. = tidal volume - dead space
What is the common disadvantage of both the NPA and the OPA?
They do not isolate the trachea or prevent aspiration.
Good Samaritan Law
This law deals with the rendering of first aid by health care professionals at the scene of an accident or sudden injury. It encourages health care professionals to provide medical care within the scope of their training without fear of being sued for negligence
Electrical phase of cardiac arrest
Time from arrest to about 4 min. Typically excellent response to electrical therapy. uses sugar / O2 stores
anatomical position
To stand erect with arms at the sides and palms of the hands turned forward
battery
Touching a patient or providing emergency care without consent.
Two passages at lower end of oharynx
Trachea and esophagus
In the process of delivering an infant, you notice that the umbilical cord is wrapped around the infant's neck. Which action is the appropriate FIRST step in managing this situation?
Try to slip the cord over the baby's shoulders or head.
Implied consent
Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. unconscious
nuchal cord
Umbilical cord around the fetal neck during delivery
Which of the following is one of the ten greatest public health achievements in the U.S. during the 20th century?
Vaccinations
atrioventricular valves
Valves located between the atrial and ventricular chambers on each side of the heart, prevent backflow into the atria when the ventricles are contracting. -open when the pressure in the atria exceeds pressure in ventricles
Types of headaches
Vascular headaches; cluster headaches; tension headache; organic, traction, or inflammatory headaches
Alpha 1 effects
Vasoconstriction -especially affects the skin (paleness) -sweat glands release sweat - clammy
Cardiac arrest
Ventricles of the heart are not contracting or when the cardiac output is completely ineffective & no pulses can be felt -often shows ventricular fibrillation -no pumping, cells die -brain cells die after 4-6 minutes (unresponsive, no pulse)
best tranq for patient in pain
Versed
Objective (SOAP)
Vital signs, physical exam, and lab findings
Hepatitis C Virus
Watch those needles Incubates 2 to 23 weeks Transmitted by blood only No vaccine, immune globulin doesn't work same symptoms as B
bleb
Weakend surface on the lung that can result in a spontaneous pneumothorax
Rhochi
Whistling sound heard when there is a partial obstruction of the lungs / bronchioles; fluid in bronchi
standard of care
Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.
Duty to Act
Your legal responsibility to do something in the case of an emergency
cardiac contusion
a bruise to the heart wall caused by severe blunt trauma to the chest where the heart is violently compressed between the sternum and the spinal column -heart wall can rupture -can cause electrical problems -*RV (directly under sternum) is most likely to be injured* -sx: chest pain, blunt chest trauma (DCAPBTLS), crepitus, tachycardia, irregular pulse -rx: rapid transport
bundle of his
a bundle of modified heart muscle that transmits the cardiac impulse from the atrioventricular node to the ventricles causing them to contract
sodium-potassium pump
a carrier protein that uses ATP to actively transport sodium ions out of a cell and potassium ions into the cell -Na+ moves out, against [ ] gradient -K+ moves in, with [ ] gradient
symphysis pubis
a cartilaginous joint that is the point of fusion for two pubic bones
spacer
a chamber that is connected to the metered-dose inhaler to collect the medication until it is inhaled
drug
a chemical substance that is used to treat or prevent a disease or condition
breech birth
a common abnormality of delivery in which the fetal buttocks or both lower extremities are low in the uterus and are the first to be delivered -leads to prolapsed cord -same treatment as prolapsed cord (dont push, O2, transport, prevent delivery) associated with: premature, placenta previa, multiple births, abnormalities
generalized tonic-clonic seizure
a common type of seizure that produces unresponsiveness and a convulsion that exhibits generalized jerky muscle activity. grand mal seizure. -unconscious (both hemispheres + RAS are down)
Emphysema
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness & decreased surface area for absorption -destruction of the alveolar walls and distention of the alveolar sacs is a type of COPD called: -lung tissue loses elasticity -walls of alveoli are destroyed -air trapping -pulmonary vessels are compressed or narrowed (harder for RV to pump do blood to lungs) -sx: smoker, dyspnea, accessory muscle use, thin, hyperventilation, barrel-chested, pursed lips, tachypnea, tachycardia
Emphysema
a condition in which the air sacs of the lungs are damaged and enlarged, causing breathlessness. relies on hypoxic drive
chronic bronchitis
a condition in which the bronchi & bronchioles in the lungs are constantly swollen and clogged with mucus -productive cough that lasts at least 3 consecutive months for at least two years -excessive mucus production -increased cardiac output, decreased ventilation - lots of blood flow but no gas exchange -no damage to capillary bed -scars from recurrent infection, hypoxemia, -hypercarpnia, polycythermia (increased production pf RBCs) -frequent respiratory infection -sx: smoker, cough with sputum, overweight, peripheral edema, JVD, cyanotic, hypoxemia, wheezes, crackles at base of lungs
heat stroke
a condition marked by fever and often by unconsciousness, caused by failure of the body's temperature-regulating mechanism when exposed to excessively high temperatures.
dystonia
a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement -involuntary contractions -repetitive, sometimes painful movements
distention
a condition of being stretched, inflated, or larger than normal
angina
a condition of episodes of severe chest pain due to inadequate oxygen flow to the myocardium
sudden infant death syndrome (SIDS)
a condition that occurs when an infant stops breathing, usually during the night, and suddenly dies without an apparent cause -1-1 month leading cause of death -dont try to resuscitate if rigor mortis or dependent lividity
Diabetic Ketoacidosis (DKA)
a condition typically found in *type 1* diabetics where the blood glucose level is excessively elevated and insulin level is extremely low to absent, which causes glucose to be excreted in the urine, dehydrating the patient, and causes the body to metabolize fat for energy, producing ketones and creating an acidic environment. -hyperglycemia -progresses over a few days -ketosis (acidosis) -dehydration ->350 mg/dL -causes: infection, doesnt take enough insulin, meds (thiazide, dilantin, steroids), cocaine, physical stress, diet change -poor skin turgor, Kussmaul respirations, fruity/acetone smell -usually kids discover they're diabetic after experiencing this
hyperglycemic hyperosmolar nonketotic syndrome (HHNS)/ HHS
a condition typically found in *type 2* diabetics where the blood glucose level rises excessively, causing loss of large amounts of fluid from glucose spilling into the urine, leading to severe dehydration -700-1200 mg/dL -some insulin, no ketosis -risk: elderly, recent trauma (high mortality bc of this & dehydration) -only s/s difference from DKA is no Kussmaul respirations
oropharyngeal airway
a curved device inserted through the patient's mouth into the pharynx to help maintain an open airway
osteoporosis
a degenerative bone disorder associated with an accelerated loss of minerals, primarily calcium, from the bone
Reticular Activating System (RAS)
a dense network of neurons found in the core of the brain stem; arousal and consciousness and screens info
Reticular Activating System (RAS)
a dense network of neurons found in the core of the brain stem; it arouses the cortex and screens incoming information key role in arousal/wakefulness -on/off switch of wakefulness
urinary catheter *
a device that is used to divert urine out of the bladder
small-volume nebulizer (SVN)
a device that uses compressed air or oxygen to nebulize a liquid medication into a mist that a patient can * (5-10 min) inhale gradually over time* -beta 2 agonist (causes bronchiodilation) EX: albuterol, levalbuterol
noncommunicable disease
a disease that is not transmitted from one host to another
nasopharyngeal airway
a flexible breathing tube inserted through the patient's nostril into the pharynx to help maintain an open airway measuring the airway from the tip of the nose to the tip of the earlobe.
antigen
a foreign substance that enters the body and triggers an immune response -allergen is an antigen
burn shock
a form of nonhemorrhagic hypovolemic shock resulting from a burn injury
bilevel positive airway pressure (BiPAP)
a form of noninvasive positive pressure ventilation. The BiPAP device delivers a continuous flow of air under pressure. It differs from the CPAP device in that it *provides different pressures: higher during inspiration, lower during expiration.*
continuous positive airway pressure (CPAP)
a form of noninvasive positive pressure ventilation. The CPAP device delivers a continuous flow of air under pressure.
meconium staining
a greenish or brownish yellow staining of the amniotic fluid, caused by a fetal bowel movement resulting from distress -indication of fetal hypoxia -frequent in breach births -risk fetus will aspirate it into lungs and get pneumonia
glucagon
a hormone secreted by the pancreas that raises the blood glucose level by stimulating the liver to convert stored glycogen and noncarbohydrates -RAISES blood glucose level -converts glycogen in liver (and other noncarbs) to glucose & releases it into blood -secreted at 70mg/dL
dialysis shunt *
a joining of arterial and venous systems in such a way that the repeated needlesticks required for dialysis cause a minimal amount of damage to the patient's body
Tardive dyskinesia (TD)
a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and sometimes feet mostly face
durable power of attorney
a legal agreement that allows an agent or representative of the patient to act on behalf of the patient
myxedema coma
a life-threatening late complication of hypothyroidism (low metabolism) worsened by hypothermia -resp. distress -seizures
dysbarism
a medical condition that results from pressure changes that occur when a person descends in water or ascends in altitude
Ventricular assist device (VAD) *
a medical device that is used to assist the pump function of one or both ventricles, most commonly the left ventricle
agitated delirium
a mental and physiologic state of arousal that is usually characterized by extreme strength and endurance, tolerance to pain, hostility, and hyperactive behavior, hot diaphoretic skin ; may result in sudden cardiac death; also called excited delirium. -caused by CNS stimulants and psychiatric illness
allergic reaction
a misdirected and excessive response by the immune system to a foreign substance or an allergen -local or systemic
eclampsia
a more serious form of preeclampsia, characterized by tonic-clonic seizures and coma -even higher blood pressure and more proteinuria
silent heart attack
a myocardial infarction (heart attack) that does not cause chest pain or discomfort
hypothalamus
a neural structure lying below the thalamus; directs eating, drinking, *body temperature*; helps govern the endocrine system via the pituitary gland, and is linked to emotion central (blood) and peripheral (skin) thermoreceptors
nonurgent move
a patient move made when no immediate threat to life exists
Subjective (SOAP)
a patient's description of the problem or issue
modified secondary assessment
a physical exam that is focused on a specific injury site, performed on a responsive patient with no significant mechanism of injury or critical injuries; or on a medical patient who is alert, oriented, and stable history (SAMPLE and OPQRST), then perform the modified secondary assessment based on the areas of patient's complaints, baseline vitals.
Medical Director
a physician who assumes ultimate responsibility for the patient-care aspects of the EMS system
standing orders
a policy or protocol issued by a Medical Director that authorizes EMTs and others to perform particular skills in certain situations
extension posturing
a posture in which the patient arches the back and extends the arms straight out parallel to the body. A sign of serious head injury. Also called decerebrate posturing
Flexion posturing
a posture in which the patient arches the back and flexes the arms inward toward the chest. A sign of serious head injury. Also called decorticate posturing
ostomy bag *
a pouch or bag that is attached outside the body to collect feces that are removed from the body through an opening in the abdominal wall
dialysis *
a procedure to remove waste products from the blood of patients whose kidneys no longer function
dialysis
a procedure to remove waste products from the blood of patients whose kidneys no longer function -take BP on other arim
status asthmaticus
a prolonged, life-threatening asthma attack that is refractory to oxygen and usual medication and places the patient at risk for developing respiratory failure. -rapid transport
The pressure wave generated by each individual contraction of the left ventricle is called:
a pulse
anaphylactoid reaction or non-IgE-mediated reaction
a reaction to a foreign substance that resembles an anaphylactic reaction that may occur on first exposure to the substance -NO immune system sensitization -antigen itself causes release of chemical mediators from mast cells and basophils (no IgE mediation) -same symptoms, same treatment -NO PREVIOUS EXPOSURE
rigid catheter (Yankauer)
a rigid plastic tube that is part of a suctioning system, commonly referred to as a tonsil tip or tonsil sucker. -better for chunky stuff no further than base of tongue mouth
status epilepticus
a seizure lasting longer than 5 minutes or seizures that occur consecutively without a period of responsiveness between them. This is a serious medical emergency that may be life threatening. -rapid transport (or risk brain damage) -O2
Fowler's position
a semi-sitting position; the head of the bed is raised between 45 and 60 degrees
Korotkoff sounds
a series of five sounds (four sounds followed by an absence of sound) heard during the auscultatory determination of blood pressure and produced by sudden distention of the artery because of the proximally placed pneumatic cuff
critical incident stress debriefing (CISD)
a session usually held within 24 to 72 hours of a critical incident, where a team of peer counselors and mental health professionals help emergency service personnel work through emotions that normally follow a critical incident
scope of practice
a set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT's job what you can do
acute abdomen
a sharp, severe abdominal pain with rapid onset. Acute abdomen can have a number of causes. Also called acute abdominal distress.
tracheal deviation
a shifting of the trachea to either side of the midline of the neck caused by the buildup of pressure inside the chest sign of tension pneumothorax (air trapped n chest cavity because of chest or lung injury)
anaphylactic shock
a shock state that results from dilated and leaking blood vessels related to severe allergic reaction
minimum data set
a standard established by healthcare institutions that specifies the information that must be collected from every patient -whats on PCR patient & administrative info
ischemic stroke
a stroke caused by a clot obstructing a blood vessel in the brain, resulting in an inadequate amount of blood being delivered to a portion of the brain distal to the blocked vessel
hemorrhagic stroke
a stroke caused by rupture of a blood vessel in the brain that allows blood to leak and collect in or around the brain tissue -physical activity -hypertension -sx: headache, seizure, stiff neck
Surfactant
a substance responsible for maintaining surface tension in the alveoli -prevents alveoli collapse -water in lungs washes this out -results in ARDS
fibrinolytic
a substance that acts to break up fibrin, the fine filaments of blood clots -treats ischemic stroke -makes hemorrhagic stroke worse
antidote
a substance that neutralizes the effects of a poison or a toxic substance
seizure
a sudden surge of electrical activity in the brain that affects how a person feels or acts for a short time
cardiac conduction system
a system of specialized muscle tissues that conducts electrical impulses that stimulate the heart to beat
triage tag
a tag containing key information that is attached to a patient during a multiple-casualty incident
positive pressure ventilation PPV
a technique that uses a mechanism such as a mechanical ventilator to force air into the lungs to provide breathing assistance
positive pressure ventilation
a technique that uses a mechanism such as a mechanical ventilator to force air into the lungs to provide breathing assistance 10-12 ventilations per minute CPAP
Markle test
a test for the presence of peritonitis (irritation of abdomen lining) in which the patient stands on his toes, then drops to his heels, or in which the heels are struck together or stuck on the bottom. The jarring of the torso will elicit pain when the peritoneal linings are inflamed. Also called the heel drop test heel jar test - doing this by pushing on feet when supine
Markle test
a test for the presence of peritonitis in which the patient stands on his toes, then drops to his heels, or in which the heels are struck together or stuck on the bottom. The jarring of the torso will elicit pain when the peritoneal linings are inflamed. Also called the heel drop test
intraventricular shunt *
a tube surgically placed in a ventricle of the brain that extends to a blood vessel in the neck, the heart, or the abdomen, or to an external collector to drain excess cerebrospinal fluid from the brain and keep intracranial pressure at an acceptable level
base station
a two-way radio at a fixed site such as a hospital or dispatch center.
thrombotic stroke
a type of ischemic stroke caused by a stationary clot that forms in the cerebral artery -risk: hypertension -slow symptoms
Thready pulse
a weak, rapid pulse measured at wrist
abdominal aortic aneurism (AAA)
a weakened, ballooned, and enlarged area of the wall of the abdominal aorta -if it bursts youre dead -over 60, male, hypertension, smoker -caused by atherosclerosis -s/s: sudden onset, PCC or cyanotic in legs, weak pedal pulses, pulsating mass, "Tearing" pain located to the back -do not palpate
vascular structures in abdominal cavity
abdominal aorta and branches inferior vena cava shock if severed
mittelschmerz
abdominal pain during the middle of a menstrual cycle that is associated with ovulation
involuntary guarding
abdominal wall muscle contraction caused by inflammation of the peritoneum that the patient cannot control. Also called rigidity
hydrocephalus*
abnormal accumulation of fluid (CSF) in the brain
shoulder dystocia
abnormal delivery when the fetal shoulders are larger than the fetal head and the head delivers but the shoulders are caught between the symphysis pubis and the sacrum
glaucoma *
abnormal increase in intraocular pressure that damages the optic nerve, resulting in loss of peripheral vision and eventual blindness
congenital heart disease
abnormalities in the heart at birth (responsible for 1st year deaths)
Hyperventilation
abnormally fast, deep breaths brought on by stress -reduces blood flow to the brain; decreases pulmonary inflow to heart -getting rid of too much CO2 -dizziness caused by lack of co2, constriction of cerebral arteries, less blood flow to brain -hand spasms -only have them rebreathe co2 with o2 mask if med command says so and no other underlying condition
hyperthermia
abnormally high core body temperature; core body temperature above normal 37C (98.6F)
Bradycardia
abnormally slow heartbeat lower than 60 bpm
hyper-
above normal
rectus abdominis
abs
apnea
absence of breathing
small intestine function
absorbs nutrients
autonomic nervous system
activity of smooth muscles and glands; divided into *sympathetic* and *parasympathetic* nervous systems (arousal and calming respectively)
epinephrine
adrenaline; SNS activation; vasoconstriction, reduces leakage from blood vessels, bronchiodilaton, increases heart rate and force of ventricular contractions
postpartum
after childbirth
presbycusis
age-related difficulty in hearing, particularly high-pitched tones, caused by the atrophy of the hearing receptors located in the inner ear
nerve agents *
agents that block the action of acetylcholinesterase (AChE) in the plasma of the blood, red blood cells, and nervous tissue. The most severe effects are those to the nervous tissue
Calcium Channel Blockers
agents that inhibit the entry of calcium ions into heart muscle cells, causing a *slowing of the heart rate*, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause *dilation*; used to prevent or treat angina pectoris, some arrhythmias, and hypertension
Calcium Channel Blockers
agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension slow HR, low BP
epinephrine and norepinephrine
aid body during stress by raising heart rate, blood pressure, and respiration fight-or-flight (sympathetic nervous system) / alertness -Alpha1 effects -Alpha2 effects -Beta1 effects -Beta2 effects
pneumothorax
air in the pleural cavity/space causing collapse of lung sx: absent lung sounds, pain worse on inspiration, dyspnea, tachypnea
negative pressure
air sucked in, then pushed out
While on scene with a trauma patient, when should the EMT consider requesting ALS backup?
airway is compromised
While conducting reassessments of your unresponsive medical patient, which of the following merits MOST of your attention?
airway patency
pericardial tamponade
aka cardiac tamponade; blood or fluid filling the fibrous sac around the heart, causing compression of the heart and decreasing the ability of the ventricles to effectively fill and eject blood -often from penetrating wound sx: JVD, hypotension, shock, tachycardia, hypotension, peripheral pulses dissapeaing
Minute ventialtion
aka minute volume; amount of air moved in and out of the lungs in one minute minute ventilation = tidal volume (Vt) x frequency of ventilation (f/minute) [aka respiration rate]
Multiple Organ Dysfunction Syndrome (MODS)
aka multiple organ failure, irreversible shock -hypoxia, high acid, and high CO2 cause organs to fail
sedatives (depressants)
alcohol, barbiturates, antihistamine, benzodiazepines, versed, valium, ativan
simple vs complex partial seizure
alert vs AMS
ball and socket joint (synovial)
all the motions : flexion, extension, abduction, adduction, rotation hips and shoulders
gliding joint
allows one bone to slide over another to the point where surrounding structures restrict motion; connect small bones of wrist and ankles
pivot joint
allows only rotation neck (C1 & C2) wrist
epinephrine properties
alpha 1 : vasoconstriction alpha 2 : regulates alpha 1 beta 1 : increases HR, force of contraction, and speed of electrical impulses in heart beta 2: bronchoconstriction
Biot respirations
alternating periods of apnea with breaths of the same tidal volume (depth)
O2 is packaged in
aluminum
What is located at the terminal end of the respiratory tree? A. Pleura B. Alveoli C. Capillary beds D. Pulmonary lobules
alveoli
proteins are broken down into
amino acids and peptides
Tidal Volume (TV)
amount of air inhaled or exhaled with each breath under resting conditions average 500 mL
drop report / abbreviated transfer-of care report
an abbreviated form of the PCR that an EMS crew can leave at the hospital when there is not enough time to complete the PCR before leaving.
if accessory muscles are used, exhalation becomes
an active process; energy required
croup
an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness, and a barking cough, fever 6months -4 yrs