EMT Section 4 Exam

How should you administer intranasal naloxone (between nostrils) Is it administered by mL or mg? What is the maximum amount of fluid per nostril?

0.4-0.5mg Intranasal. Alternate nares up to a maximum of 2.0mg

Addiction

A change in behavior caused by the biochemical changes in the brain after continued substance abuse

What is "AMI" and how does it differ from ACS?

AMI is an acute myocardial infarction which is a type of ACS

At what stage in the patient assessment is the priority transport decision made?

After primary assessment

Describe the mechanism of aspirin and how it helps patients in a heart attack

Aspirin works to stop platelets from clotting which helps a pt. during a heart attack as it prevents blood clots in the heart

Describe the mechanism of aspirin and how it helps patients in a heart attack

Aspirin works to stop platelets from clotting which helps from clotting which helps a pt. during a heart attack as it prevents blood clots in the heart

Unlike traumatic injuries, which can be highly visible, what is the danger of many medical injuries or complaints in terms of their severity?

Blood pressure drops. They may not be revealed in initial assessment, might not look as serious

What is the best way to treat a patient with rales/crackles/wet lung sounds in all lung fields, with signs of severe respiratory distress, is fully alert and oriented, and has very low oxygen saturations?

CPAP, it will provide positive pressure and increased PEEP and will help transport pt. to better treatment in hospital

Is chest pain in AMI reproducible or easily provoked? Describe common signs and symptoms of AMI What is the most common reason people with AMI (a heart attack) do not seek medical attention?

Chest pain in a heart attack is not easily provoked and can be described as a heavy pressure or squeezing sensation, often accompanied by shortness of breath, nausea, and pain radiation Common Reason: People don't seek medical attention is denial or fear of the consequences

What is "pleuritic chest pain?" What can this often indicate in patients with coughing and unilateral decreases in breath sounds if they have a history of lung disease?

Chest pain on one side that feels worse on inspiration, a pt that has this along with coughing and unilateral decreases in breath sounds could indicate a spontaneous pneumothorax

During assessment, what is the best way to determine the nature of a patient's illness?

Chief Complaint

What are the three leading chief complaints of a pulmonary embolism? What are some of the main risk factors?

Chief Complaints: Chest pain, Shortness of breath, and hypoxia Risk factors: Hypertension, BP in lungs and right side of heart increase, cardiac arrest

How do you medically manage a patient who is tachycardic, hypertensive, and agitated or anxious with rapid exposure?

Coach them down and assist ventilations

Define "infectious disease"

Communicable diseases caused by organisms or viruses that enter and multiply within the human body

Describe signs of symptoms which make airborne or droplet diseases likely to spread (e.g. produce the smallest or farthest-traveling contagious particles)

Cough and Sneezing

In patients with a history of heavy alcohol use or abuse, what life-threatening condition can occur if suddenly attempting to quit drinking?

Delirium Tremen Withdrawals

What scene safety/personal safety measures must you take in a patient who has been poisoned via the absorption route?

Do not expose yourself, if it is dry powder or chemical brush it off and remove all patients clothing and jewelry. Flush everything off for long time

In patients who have signs and symptoms of anaphylaxis (multi-systemic), which drug should ALWAYS be given first/is most important? Why?

Drug: Epinephrine Why: We should always give it first because anaphylaxis is a type of distributive shock which dilates the blood vessels and epinephrine is a vasoconstrictor

Describe the difference between early and late signs of hepatitis. Why do some of the early signs make hepatitis so difficult to notice or detect?

Early: Sore throat, cough, loss of appetite, vomiting, fever, muscle pain, (can be mistaken for the flu) Late: Jaundice, right upper quadrant abdominal pain

Is epinephrine an artificial or natural substance in the body? What two lifesaving effects does it have on the body in anaphylaxis? How will it impact vital signs?

Epinephrine is a natural substance in the body. It is a vasoconstrictor and bronchodilator. It will allow for adequate breathing and raises the blood pressure

What must you do after administering any medication in terms of evaluation?

Evaluate its effectiveness and monitor for any side effects or changes in the patient's condition

Why does learning a patient's medical history often help reveal the underlying problem?

Finding out the meds they take, family/own medical history will help you know whats going on

If you need to administer a medication but are unable to reach medical control, and the patient is in severe distress, what should you do?

Follow local protocols

Describe unique medical emergencies which require transport to specialized resource hospitals.

Heart attack (MI), stroke, trauma

What is one of the most high-risk settings for acquiring MRSA?

Hospital Setting

What is the first step you should take when decontaminating a patient with a dry chemical or dry powder exposure?

If it is dry powder or chemical brush it off and remove all patients clothing and jewelry, flush everything of for a long time

Through which route do most poisonings occur?

Ingestion

What effect do Tylenol (acetaminophen) overdoses have on the body that makes them so deadly?

Liver Failure

What is a MAD device?

Mucosal Atomizer Device (used for naloxone)

Which type of airway adjunct should you place (OPA/NPA) if managing an airway in a narcotic overdose? Why?

Nasopharyngeal because if they wake up your fingers won't be near their mouth and it also does not affect the gag reflex

What is the mechanism of nitroglycerin in patients with cardiac chest pain? In other words, if it helps reduce their pain, what action is the nitro taking on the body to help relieve it?

Nitroglycerin relaxes and widens the blood vessels, allowing more blood to flow to the heart, which helps relieve chest pain in patients with cardiac issues

What makes opiate overdoses lethal? What is the only appropriate indication that naloxone should be given in a suspected overdose?

Opiates themselves are not lethal, the bodies response is Patient goes into respiratory arrest and stops breathing

What is a difference between the pain present in angina vs the chest pain in AMI?

Pain present in angina is usually caused by exertion, sudden fear, periods of emotional or physical stress, and may last for up to 15 min. Usually it is described as a crushing or squeezing pain, and may last for up to 15 min. Usually it is described as a crushing or squeezing pain, and can radiate to the jaw and or the arms. Chest pain during an AMI isn't caused by exertion and may occur anytime. It does not resolve in minutes and can last between 30 min and several hours. I may or may not be relieved by Nitroglycerin.

What are the dangers in administering naloxone? Why must we titrate the administration to effect?

Patient can get violent, agitated, vomit We titrate to avoid these dangers

Why might you have increased concern about internal bleeding in a trauma patient with a history of prolonged alcohol abuse?

Patient will not be able to clot, more likely to bleed out

Dependence

Physical dependence on a substance characterized by the symptoms of tolerance and withdrawal

In patients who have an LVAD, what clinical findings may be absent upon assessment? Why?

Pulse may be absent upon assessment because the device helps pump blood, making the heart's natural pulse less noticeable

If we suspect a patient has a life-threatening opiate overdose, what intervention should we be performing first?

Secure their airway and ventilate with a BVM

Describe signs and symptoms associated with delirium tremens. What causes this condition?

Shaking, confusion, high blood pressure, fever, and hallucinations Cause: Alcohol withdrawal

Know the differences between common illicit and prescription drugs and which ones have a stimulant effect vs a depressant or narcotic effect

Stimulant: Nicotine, cocaine, caffeine Depressant: Alcohol, prescription pills Narcotic: Methadone, oxycontin

If concerned about loss of motor function or changes in pupillary response, what body system is most likely affected?

Sympathetic nervous system (your brain or nuerosystem is affected)

What is "ACS" (acute coronary syndrome) used to describe? Is a heart attack included in this?

Term used to describe a range of heart conditions (ST-elevation myocardial infarction (STEMI), Non-ST elevation myocardial infarction (NSTEMI) Yes

The slideshow from Toxicology notes a drug called "Calcium Channel Blockers," the most common of which is amlodipine, which can treat high blood pressure and other issues. This, in addition to "-statin" drugs (prescribed for high cholesterol) suggest your patient has medical history impacting which major organ or body system?

The Heart

Tolerance

The diminishing effect with regular use of the same dose of a drug, requiring the user to take large and larger doses before experiencing the drug's effect

Withdrawal

The discomfort and distress that follow discontinuing the use of an addictive drug

When an AED states "no shock advised" when analyzing a patient during a pause in CPR, what does this mean?

There is not a shockable rhtym

Why might patients who hyperventilate experience pain or numbness and tingling in their hands and feet? What is the treatment for these patients?

They might be experiencing alkalosis (build up of body fluid) The best treatment for these persons is for them to pass out and their body will regulate itself again

What is the purpose of defibrillation?

To shock a fibrillating (chaotically shaking) heart with a specialized electric current in an attempt to restore a normal, rhythmic beat

What physical signs indicate a patient is in severe respiratory distress?

Tripod position, accessory muscle usage, nasal flaring

Know what types of drugs hydrocodone, oxycodone, codeine, and methadone are, and what effects they would have in an overdose?

Types of drugs: Opiates from the narcotic family are CNS depressants Effects: Cause pin point pupils, severe respiratory depression

What is the leading cause of death from AMI?

Ventricular defibrillation

If a patient is in cardiac arrest but you learn they have their own internal AICD (defibrillator) what should you do when the AED arrives?

Wait for the AED and follow its instructions, as the patient's defibrillator may already be treating the cardiac arrest

For healthy individuals, we are driven to breathe based off of our brain stem's detection of what levels in the body? And are we driven to breathe because these levels are increased or decreased?

We are driven to breathe based on CO levels and we are driven to breathe based off the levels increasing

We frequently see repeat patients in EMS. Why must we avoid making assumptions about, or downplaying the nature of a patient complaints, even if their history is familiar?

You could miss something because they might have a new problem this time