EMT Exam 1 Study Guide
What is the reassessment process? How often should it be done?
Repeat primary assessment Reestablish priority Reassess vitals Repeat focused assessment (regarding patients injuries or complaints) Check interventions (oxygen, ventilation, bandages, etc) Done every 5 mins for critical patient Done every 15 mins for stable patient
What are the differences between a pediatric and adult airway?
Smaller nose and mouth More space is taken by the tongue Narrower trachea Cricoid cartilage is less rigid and less developed Airway is more easily obstructed
What is the most common airway obstruction due to altered mental status?
The tongue
What are the different pathways of the secondary assessment? What do they entail?
Trauma Critical Trauma Stable Medical Responsive Medical Unresponsive
What are the rules of suctioning?
10 seconds max Suction on the way out Only go as far as you can see
Define Differential diagnosis
A list of potential diagnosis compiled early in the assessment of the patient (EMTs cannot actually make diagnoses)
AVPU
Alert Verbal Pain Unresponsive
What are the vital signs and normal ranges?
BP: 120/80 Pulse: 60-100 RR: 12-20 bpm SPO2: 95%+ Skin: warm, pink, dry Pupils: PERRL (equal, round, reactive to light)
What are the pulse locations?
Carotid, brachial, radial, tibial
What are the signs of hypoxia? How would you fix it?
Cyanosis, labored breathing, low pulse ox, bad LOC Treat by administering oxygen
What are the 4 abnormal skin colors?
Cyanotic: blue-gray Jaundiced: yellow Flushed: red Pale: white
What are the components of a hospital notification?
DESTINATION, UNIT is inbound with AGE, SEX with COMPLAINT and IMPORTANT INFO. Last vitals are, BP, HR, RR, the patient is STATUS and we will be there in ETA
How do you define, assess, and treat Respiratory Distress
Define: Increased work of breathing and shortness of breath, but the compensatory mechanisms seem to be working Assess: Shortness of breath, short sentences, increasing anxiety Treat: Nonrebreather
How do you define, assess, and treat Respiratory Failure
Define: Reduction of breathing to the point where the oxygen intake is not enough to support life Assess: Low pulse ox, RR low, cyanotic, labored breathing, diminished breath sounds Treat: BVM bagging, adjusting rates for fast or slow breathing
How do you define, assess, and treat Respiratory Arrest
Define: breathing completely stopped Assess: No chest rise, very very lowor notexistant pulse ox, no breath sounds Treat: BVM bagging, 10-12 bpm (20 for children)
DCAP-BTLS
Deformities Contusions Abrasions Punctures/Penetrasions Burns Tenderness Lacerations Swelling
What is the detailed assessment? When should it be completed
Done AFTER critical interventions Similar to RAPID Trauma DCAPBTLS Assessment
What are the 4 national levels of EMT Provider?
Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Advanced EMT (AEMT) Paramedic
What guidelines do you use to determine the danger zone
Emergency Response Guidebook (ERG)
What communication system is able to identify the number and location of the phone from which a caller is calling 911?
Enhanced 911
What are the steps to a responsive medical patient assessment?
Establish C/C SAMPLE Hx OPQRST-ASPN Perform focused medical assessment Get vitals Consult med command if needed, but care for the things you found
Requirements for a patient to refuse care
Fully informed of risks Must be alert and oriented Must be legally able to consent Refusal sheet signed
What are the parts of the primary assessment?
General Impression C-spine decision LOC (AVPU) ABC's Initial Transport Decision
What are the four main infectious diseases of concern to EMTs?
HIV/AIDS, Hepatitis B and C, Tuberculosis
What are the two methods of opening an airway? Why would you choose one over the other?
Head tilt, chin lift (non trauma or spine) Jaw thrust (trauma or spine)
What are the 3 physical exam techniques?
Inspection, palpation, auscultation
What is the difference between inspiration and expiration?
Inspiration: Active, negative pressure, contract diaphragm, air goes in Exhalation: Passive, positive pressure, relax diaphragm, air goes out
What situations require an emergency move?
Life threatening conditions, hazardous scene, other people are in the way of a priority patient
What is quality improvement and why is it important to EMS?
Looking at past trip reports and determining where the service can be improved and to continue improving EMS as a whole
What are the components of a medical command consult?
MD, I'm WHAT YOU NEED for a AGE, SEX, CC, IMPORTANT INFO. Presented with GENERAL IMPRESSION. HPI, with PMH/MEDS/Other Hx. Assessment revealed FINDINGS. Proceeded by INTERVENTIONS. Patient RESPONSE TO TREATMENT. Last vitals are, BP, HR, RR, and TREND. Again, WHAT YOU NEED. We will be there in ETA.
Components of an airway assessment
Make it, check it, keep it
Define medial and lateral
Medial: toward the midline or median plane Lateral: away from the midline or median plane
Choices for O2 administration (name, flow rate, concentration)
Nonrebreather: 12-15Lpm; 80-90% Nasal Cannula: 1-6Lpm; 24-44% Partial rebreather: 9-10Lpm, 40-60% Venturi: Varies up to 15Lpm, 24-60% Tracheostomy mask: 8-10Lpm, varies by need
Structure and function of upper airway
Nose: accepts air and warms/humidifies in nasal cavity Mouth: accepts food but can help with air Pharynx (throat): 3 sections (naso-, oro-, laryngo-) laryngopharynx provides structure and protects the opening to the trachea Glottic opening: path between pharynx and larynx Epiglottis: protects glottic opening, closes when you swallow or in response to gag reflex Vocal cords: also protects glottic opening, vibrates to create your voice Larynx: protected by thyroid cartilage and forms the adams apple, responsible for voice pitch
OPQRST-ASPN
Onset (Rapid/Gradual) Provocation/Palliation (what makes it better/worse) Quality (describe pain) Radiation (how far does the pain travel) Severity (0-10/1-10) Time (when did it start) Associated Symptoms (things that occur along with the presented problems) Pertinent Negatives (important symptoms that they are not experiencing)
What are the two types of airway adjuncts?
Oropharyngeal Airway (OPA) Nasopharyngeal Airway (NPA) use to open the airway, don't use OPA on patient with gag reflex
What is the chain of resources in the EMS system?
Patient > Citizen calls 911 > Dispatcher > First responders > EMTs > Emergency department staff > Allied health staff
What are the steps to a stable trauma patient assessment?
Perform focused history and exam Get vitals Get SAMPLE Hx
What are the steps to an unresponsive medical patient assessment?
Perform rapid assessment Assess vitals Get SAMPLE Hx if possible from others Consult med command if needed
Define Expressed Consent
Permission to receive emergency care granted by a competent adult either verbally, nonverbally or through gestures
What is the difference between portable, mobile, and base radio?
Portable: Handheld two-way Mobile: Two-way in the vehicle Base: Two-way fixed in hospital or dispatch
What are the rules to lifting and moving?
Position feet properly Use your legs, not your back Never turn or twist Do not compensate when lifting with one hand Keep the weight close to your body Use a stair chair whenever possible
Define proximal and distal
Proximal: closer to the torso Distal: farther from the torso
Components of a circulation assessment
Pulse: Rate, Rhythm, Strength, Equality Skin: Temperature, Color, Condition Gross blood sweep Shock treatment (warm up and apply o2)
What is trending? Why it is important?
Retaking vital signs to check for degradation or improvement of your patient
What are the parts of the scene size up?
Scene Safety (most important, leave if you can't make it safe) BSI/PPE Number of Patients MOI/NOI Additional Resources C-spine coinsideration
SAMPLE(R)
Signs/Symptoms Allergies Medications (Rx,OTC,Street) Pertinent Medical History Last Oral Intake Events (leading up to) (R)isk factos (what could contribute to problems)
How to determine painful stimuli in adults vs infants
Sternal rub or trap grab / tap or squeeze feet
What are the steps to a critical trauma patient assessment?
Take C-spine Perform DCAPBTLS assessment on the following body parts: Head (check for crepitation and blood coming from the nose ears or mouth) Neck&Clavicle (step off, JVD, tracheal deviation, apply collar) Chest (abnormal motion, crepitation, breath sounds) Abdomen (4 quadrants, firmness, distention, pulsating masses) Pelvis (be fcking careful here, check compression and flexion if no pain) Extremities (PMS) Back (spine, muscles) Get SAMPLE Hx from bystanders if you can Get vitals en route to hospital
Who is responsible for the care delivered in the EMS system?
The Department of Transportation
How do the cardiac and pulmonary system work together to oxygenate the body?
The heart pumps blood throughout the body, moving deoxygenated blood to the alveoli where respiration can occur, then moving oxygenated blood to the rest of the body
Define Scope of Practice
The legal range of services that EMTs can provide (determined by their level of training)
What is the purpose of the primary assessment?
To detect and treat immediately life-threatening problems
Structure and function of the lower airway
Trachea: tube protected by 16 rings of cartilage, connected by smooth muscle tissue, splits at the carina Bronchi: large air passages stemming from trachea Bronchioles: increasingly smaller air passages protected by cartilage and lined by smooth muscle Alveoli: end of smallest bronchioles, oxygen and co2 diffuse through shared membrane with capillaries (respiration)
What is the difference between ventilation and respiration?
Ventilation: moving air in and out of your chest Respiration: Exchange of oxygen and co2 within the cells, alveoli, and blood
What are standard precautions?
a strict form of infection control which assumes that bodily fluid of ANY patient is infected
What are the types of stress reactions?
acute: occurs with or shortly after an event delayed: may occur days or years after the event (PTSD) cumulative: results from prolonged recurring stressors (burnout)
Define Alveolar ventilation
air actually reaching the alveoli (TV - dead space)
What are the three stages of stress?
alarm: fight or flight resistance: the stimulus no longer induces stress exhaustion: after prolonged exposure, illness ensues
Define Tital Volume
amount of air moved in and out of the lungs in one breath (5-7mL per kg of weight)
Anatomical term for front and back
anterior/ventral and posterior/dorsal
What are the 5 emotional stages of death and dying?
denial, anger, bargaining, depression, acceptance
What is a DNR?
do not resuscitate, a document that denies the consent to perform CPR or any other method of resuscitation
Define Past Medical History (PMH)
information gathered regarding the patient's past health problems
Define history of present illness (HPI)
information gathered regarding the symptoms and nature of the patient's current concern
Define Dead space air
moved in during ventilation but not reaching alveoli (about 150mL)
Anatomical term for above and below
superior and inferior
Define Implied Consent
the assumption that a victim would give permission to treat them if he or she were conscious
Define Proximate Causation
the determination in a negligence case that your actions caused the harm to a patient
Define Duty to Act
the legal responsibility of an EMT to provide care (only when actually on duty, otherwise moral)
Define Standard of Care
the quality of care that the EMTs should provide to the patient (how you should do what you need to do)
Define Chief Complaint
the reason the EMS was called; usually in the patient's own words
What situations require an urgent move?
treatment can only be performed in the patient is moved, patient deteriorating
What is a contraindication for use of a stair chair in moving a patient?
unresponsive, spinal cord injury, airway care needed
What situations require a non-urgent move?
when there is no immediate threat to life
