LC-Ready EMT prep #2

AIRWAY At what rate should you ventilate an apenic patient who still has a carotid and radial pulse?

12 times per minute According to current American Heart Association standards for ventilation assistance for a patient who is not breathing but still has spontaneous circulation, the appropriate rate of ventilations should be 10-12 per minute. Always assure the ventilations result in chest rise and fall and that alveolar breath sounds are present during artificial ventilation.

medical burns A 10-year-old male has spilled hot water from a pan onto his chest. The skin is turning red and blisters have begun to form. You would most likely classify this type of burn as a:

A partial-thickness burn typically includes redness, severe pain, and blisters. In this case the burn is a partial-thickness burn. A superficial burn would not include blisters and a full-thickness burn would be charred, dry, and white. A fourth-degree burn goes down to the bone. That has not occurred in this case.

Your scene size-up reveals a hazardous gas has been accidentally released. You stage away from the scene at an appropriate distance but can visualize the damaged tank truck. You should next:

A scene size-up is used to identify safety hazards. Here you have to take steps to protect yourself first, but then you must take steps to protect other responders. You should immediately notify dispatch and warn other incoming units. Evacuation will be important as will triage and hazard identification, but the immediate priority will be the safety of fellow responders PREVIOUS

what happens in a stroke

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

OB/GYN ---->Which one of the following would be considered a significant mechanism of injury? A) A three-year-old falls 11 feet without loss of consciousness B) Motor-vehicle crash at 30 mph with no passenger compartment intrusion C) Six-foot male falls eight feet without a loss of consciousness D)63-year-old female falls and sustains an angulated tibia/fibula fracture

A three-year-old falls 11 feet without loss of consciousness A fall of greater than 10 feet for a pediatric patient is considered a significant mechanism of injury. For adults a serious mechanism is considered in any fall greater than three times their height. An angulated tibia/fibula fracture can be serious, but an isolated injury does not necessarily indicate more severe injuries. Passenger compartment intrusion is generally considered an indicator of significant mechanism of injury

You are caring for a neonate who you suspect is severely depressed and in need of aggressive resuscitation. Which of the below clinical findings would support your suspicion?

Although the assessment of the baby and determination of clinical status should take into consideration multiple measures, there are some clinical finings that are so significant they can individually infer that the baby's status is critical. In this situation, the respiratory rate >60/min is such a sign of criticality. Although the other findings of the APGAR, skin findings, and heart rate are abnormal for a newborn, they are not individually representative of neonatal criticality. Respiratory rate 64/minute

Beta 2

Bronchodilation Vasodilation

cardiogenic shock

Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare, but it's often fatal if not treated immediately.

what happens in a seizure

During a seizure, there are bursts of electrical activity in your brain, sort of like an electrical storm. This activity causes different symptoms depending on the type of seizure and what part of the brain is involved. Seizures can take on many different forms and affect different people in different ways.

ob/gyn During the interview of a female patient thought to be experiencing a spontaneous abortion, she relays to you a prenatal history of poor nutrition, drug abuse, and smoking. During what stage of the fetal development would these habits have the greatest potential for malformation?

Embryonic stage During the embryonic stage, cellular division of the fetus is most rapid and most susceptible to malformation due to poor maternal habits. Fertilization occurs when the mother's egg is fertilized. Implantation occurs when the fertilized egg attaches itself to the uterine wall. The fetal stage occurs after the fragile embryonic stage.

Which one of the following reasons explains why you might have a higher index of suspicion for spine injury in a pregnant female compared to a nonpregnant female?

Hormones released during pregnancy cause ligaments to stretch. Hormones secreted during pregnancy allow ligaments to stretch more than usual. This makes all joints, including the joints of the vertebrae, more vulnerable to subluxation and dislocation. Bones do not become brittle during pregnancy and the spinal column does not stretch more than usual. Perhaps a fetus might make falling backwards more common, but this should not be a reason for an increased incidence of spine injuries.

Which one of the following reasons best indicates the importance of suctioning the nose of an infant in respiratory distress?

Infants rely more upon their nose to breathe than do adults

Which one of the following reasons best indicates the importance of suctioning the nose of an infant in respiratory distress?

Infants rely more upon their nose to breathe than do adults Although infants are not really "obligate nose breathers," they do rely more upon their nose to breathe than do adults. Suctioning the nose can significantly increase airflow and minute volume. Proximity of the nasopharynx and insertion of a naspharyngeal airway has little to do with the value of nasal suction. Infants do not necessarily produce more nasal secretions compared to adults

A 90-year-old female is complaining of sharp, steady abdominal pain. When you palpate her abdomen, you feel a pulsating mass in the lower left quadrant. This finding most likely indicates a(n):

Pain and a pulsatile mass indicate an aortic aneurism. A bowel obstruction typically presents with waxing and waning pain. An ulcer can cause pain, but does not typically cause a mass. An enlarged spleen might cause a mass, but would not typically be able to be palpated. PREVIOUS

operations A factory explosion on the outskirts of your EMS response area has injured between 15 to 25 workers. According to protocols, the first unit in will implement the "START" Triage System. What are the assessment parameters that are used to determine patient placement into treatment sectors?

Perfusion status, respiratory status, mental status The START Triage System uses the "RPM" mnemonic to help identify the specific assessment parameters used to classify patients. This stands for respiratory status, perfusion status, and mental status.

medical Why does tension pneumothorax lead to shock?

Pressure built up in the pleural space compresses the heart. Shock from a tension pneumothorax is obstructive in nature. That is, it is caused by pressure in the pleural space compressing the heart and great vessels, limiting its filling capability. This causes a drop in cardiac output. The lung may collapse but typically, shock is not seen until the heart is compressed. Limited movement of the diaphragm and the chest wall may lead to difficulty and inefficient breathing, but not typically shock

There are multiple tasks the EMT is responsible for on each EMS run. If the EMT must coordinate the rescue of a patient who is entrapped under rubble from a building collapse, this is an example of which EMT role?

Provision of scene leadership There are a myriad of skills and responsibilities the EMT must assume on each EMS incident. If the EMT is called upon to coordinate the actions of multiple other people during an extrication, this is known as provision of scene leadership. Maintenance of the vehicle must occur prior to the call. Maintaining medical and legal standards occurs throughout the incident, but does not pertain directly to the extrication. Providing rescue services is one component of the scene but not the best answer.

CARDIAC Which one of the following is a sign of left-sided heart failure?

Pulmonary edema As the result of damage to the left side of the heart, blood backs up into the lungs. This may be auscultated as crackles or rales in the lungs. When the right side of the heart is in failure and not pumping properly, then fluid backs up in the abdomen, lower extremities (pedal edema), and lower back (sacral edema).

cardiac A patient presents to you with dyspnea, accessory muscle use, a diminishing pulse ox reading on oxygen, chest pain, inspiratory rales, and tripod positioning. He states that the trouble breathing started before the chest pain. He has a history of heart failure and hypertension. This patient is likely experiencing what respiratory emergency?

Pulmonary edema Given the history and presentation, the patient is likely going into pulmonary edema secondary to heart failure. The fact the dyspnea started prior to the chest pain suggests that poor oxygenation is now stressing the heart. Asthma and bronchitis are both pulmonary conditions, but typically do not present with rales. Finally, the patient may go into cardiogenic shock, but this is not a respiratory type emergency - it is a cardiac emergency.

HELP!!! A 17-year-old pregnant female presents with altered mental status. Her boyfriend notes she is 40 weeks pregnant with twins and states, "I can't wake her up." She presents confused and is flushed with obvious swelling in her hands and face. Her vital signs are pulse 90, respiration 28, blood pressure 200/112. What is the most likely immediate complication for this patient?

Seizures

TRAUMA Which one of the following would be an injury limited to medium- and high-velocity penetrating trauma?

Temporary cavity A temporary cavity is created by the cavitation associated with medium- and high-velocity penetrating trauma. Low-velocity penetrating trauma does not create this type of wound. All penetrating trauma can cause internal bleeding and rupture of gas-filled organs.

A patient has suffered a penetrating chest injury following an explosion at a construction site. You have applied an occlusive dressing to the wound and initiated PPV for ventilatory insufficiency. Shortly thereafter the patient's heart rate continues to climb, he becomes cyanotic and the pulse ox drops. The patient is now totally unresponsive, and he is difficult to ventilate. What is the most likely reason for this patient's acute deterioration?

Tension pneumothorax

MEDICAL While assessing the neck of a 72-year-old woman who is in the Fowler's position you observe bulging neck veins. She tells you she felt this way the last time she had fluid built up in her lungs. Of the following which one is the most likely underlying reason for this finding?

The heart is not pumping effectively. Bulging neck veins is a sign that the heart is not pumping effectively, which might be the case of a patient in congestive heart failure with fluid building up in the lungs. A tension pneumothorax also may have bulging neck veins as one of its signs. Flat veins would be observed in a severe anaphylactic reaction.

cardiac While assessing the neck of a 72-year-old woman who is in the Fowler's position you observe bulging neck veins. She tells you she felt this way the last time she had fluid built up in her lungs. Of the following which one is the most likely underlying reason for this finding?

The heart is not pumping effectively. Bulging neck veins is a sign that the heart is not pumping effectively, which might be the case of a patient in congestive heart failure with fluid building up in the lungs. A tension pneumothorax also may have bulging neck veins as one of its signs. Flat veins would be observed in a severe anaphylactic reaction.

AIRWAY the A six-year-old male patient is ventilated through a home respirator. You were called today because the patient's oxygen saturations have been low. As you assess the patient, you notice many secretions in the tracheostomy tube and gurgling on inhalation. You should:

The patient's parents are the best source of information on how to suction the patient's tracheostomy tube. They will likely have the knowledge and appropriate equipment. Medical control might help you, but the parents are likely a better, more immediate source of information. A rigid suction catheter will not fit in a tracheostomy tube and the tube should be suctioned prior to initiating positive pressure ventilations.

Alpha 2

Vasodilation and decreased BP.

AIRWAY Your patient states he has asthma. Asthmatics can develop wheezing. Which of the following best describes the progression of wheezing as the patient's condition worsens?

Wheezing will be heard initially on exhalation. Eventually the wheezing will be heard on inhalation and exhalation. The wheezing sound is created by turbulent airflow from bronchoconstriction and irregularities to the lumen of the bronchioles. During exhalation airflow exits the lungs with a lower velocity (due to passive exhalation). Therefore wheezing is more likely to present with minimal bronchoconstriction. During inhalation when the air is moving with higher velocity, the bronchioles open up slightly and wheezing may not be heard initially. However, once the degree of bronchoconstriction becomes severe enough, then the patient will wheeze during both the exhalation and inhalation phases.

cardiac Tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping

malaise

a vague feeling of physical discomfort or uneasiness

Cardiac tamponade

acute compression of the heart caused by fluid accumulation in the pericardial cavity

MEDICAL ---->A 70-year-old female complains of acute onset pressure in her jaw. She denies pain but notes the discomfort radiates into her neck. She is alert and her vital signs are pulse 90, respiration 20, blood pressure 160/68. You should:

administer aspirin and initiate transport. Myocardial infarction pain can present atypically and commonly is described as pressure or discomfort. In this case, you should initiate transport and administer aspirin. ALS care might be necessary, but you should not delay transport waiting for their arrival. An AED should not be attached to a conscious patient.

cardiac A 70-year-old female complains of acute onset pressure in her jaw. She denies pain but notes the discomfort radiates into her neck. She is alert and her vital signs are pulse 90, respiration 20, blood pressure 160/68. You should:

administer aspirin and initiate transport. Myocardial infarction pain can present atypically and commonly is described as pressure or discomfort. In this case, you should initiate transport and administer aspirin. ALS care might be necessary, but you should not delay transport waiting for their arrival. An AED should not be attached to a conscious patient.

A 50-year-old male has suffered a deep laceration to his leg in an industrial accident and has lost a great deal of blood. You initiate hemorrhage control and stop the bleeding with a pressure dressing. You should next:

administer high-concentration oxygen via nonrebreather mask. Blood loss is a clear indication for supplemental oxygen administration. Rapid transport and temperature regulation will be essential, but only after administering oxygen. Completing a trauma assessment also will be important, but only after completing the necessary interventions as dictated by the primary assessment.

TRAUMA A 50-year-old male has suffered a deep laceration to his leg in an industrial accident and has lost a great deal of blood. You initiate hemorrhage control and stop the bleeding with a pressure dressing. You should next:

administer high-concentration oxygen via nonrebreather mask. Blood loss is a clear indication for supplemental oxygen administration. Rapid transport and temperature regulation will be essential, but only after administering oxygen. Completing a trauma assessment also will be important, but only after completing the necessary interventions as dictated by the primary assessment.

A 31-year-old male is being arrested by police. As you arrive, police officers are attempting to restrain the patient in order to place him in handcuffs. The patient is extremely combative and is fighting with great force. As the struggle continues, one of the officers says, "I don't think he is breathing." A respiratory arrest in this type of situation is most likely associated with:

agitated delerium Agitated delirium occurs in a small number of patients who exhibit abnormal agitation and combativeness, particularly when being restrained. Respiratory arrest is unusual but can occur. It would be unlikely that officers choked the patient to the point of respiratory arrest and nothing in the question points to this happening. Pepper spray does not typically cause any such type of reaction. The patient could have an underlying respiratory problem, but in this case agitated delirium is the more likely presentation. PREVIOUS

The most important benefit of a unified command would be:

allowing more than one agency to design tactics for dealing with an incident. A unified command prevents multiple agencies from developing competing plans and tactics. It is designed to allow multiple agencies and chiefs to make decisions in a unified manner and develop one overall set of tactics for dealing with a large-scale incident. In unified command, more than one agency will share overall command of an incident.

operations You are first on scene at a motor-vehicle crash involving multiple vehicles. After ensuring that the scene is safe, you should:

attempt to determine what additional resources are necessary Assessing the need for additional resources is an essential element of the scene size-up and should be completed immediately. Treatment will occur after adequate resources have arrived. Movement of patients will come much later. Although it may be important to assess the forces that caused the crash, that is not a higher priority than obtaining adequate resources

Epinephrine is a medication administered to a patient who is experiencing an acute allergic reaction due to its alpha and beta effects. One side effect is cardiac irritability and tachycardia. What property of epinephrine is responsible for this?

beta 1 Epinephrine is the drug of choice for acute allergic reactions due to its ability to reverse some of the bronchoconstriction (beta 2 effect), and airway swelling and systemic hypotension (alpha 1 and alpha 2 effects). However, the beta 1 effect of epi causes an increase in cardiac heart rate and force of contraction which may be detrimental should the patient not be oxygenating the myocardium well. This is why epi is used with caution if the patient is over 30 years of age.

cardiac Atelectasis

collapsed lung; incomplete expansion of alveoli

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. tonic-clonic motor activity lasting 1 to 2 minutes with rapid return of consciousness that occurs in conjunction with elevated body temperature

AIRWAY Your patient has just finished actively seizing after a grand mal seizure. You should:

focusing on ABC is very important

.OB/GYN -->A one-year-old male has had a fever for three days and now has developed wheezing and severe respiratory distress. You notice his skin is hot and cyanotic around the lips. The patient suddenly begins to seize. The most likely cause of the seizure in this patient would be:

hypoxia listen...Fever often causes seizures in children, but given the findings, hypoxia is more likely. Epilepsy and toxic ingestions also cause seizures but are improbable under these circumstances.

Beta 1

increases HR, inotrophy (forced contraction of heart) increases electrical impulse in heart

medical OD to An 18-year-old female tells you that she has ingested 48 amitriptyline pills. She notes she was trying to harm herself and took the pills about 20 minutes ago. She is alert and her vital signs are pulse 120, respiration 20, blood pressure 100/60. You should first:

initiate transport immediately. Overdose and intentional ingestion patients can decompensate rapidly. You should initiate immediate transport. Poison control and ALS will be very important, but should not delay moving this patient toward the hospital. Inducing vomiting is only appropriate under very specific circumstances and is not a common treatment

A fall of greater than 10 feet for a pediatric patient is considered a significant mechanism of injury. For adults a serious mechanism is considered in any fall greater than three times their height. An angulated tibia/fibula fracture can be serious, but an isolated injury does not necessarily indicate more severe injuries. Passenger compartment intrusion is generally considered an indicator of significant mechanism of injury. PREVIOUS

na

subluxation

partial dislocation of a joint

Alpha 1

vasoconstriction