Vocab:
Pathogens (P21) the organisms that cause infection, such as viruses and bacteria
Emesis (noun)
vomitus, vomiting
Aneurysm (P401) localized blood filled dilation of a blood vessel (commonly arteriole) caused by disease of weakening of the arterial wall. When the dilation bursts, it can bleed rapidly with resulting hypoxia in the areas that the artery normally supplies or hypovolemic shock which will progress to death without intervention. Two most common sites are the base of the brain (Circle of Willis) and the (abdominal) aorta.
Thrombus (P400) clot and debris from plaque found in a blood vessel (
the curly fry!) which can progressively grow in size and continue circulation until it causes an occlusion. Also known as a blood clot.
Occlusion (Occlusive Thrombus) (P400) a clot that cuts off the flood of blood in a vessel
Embolism (P400) an object (blood clot =
thromboembolism) that migrates to "occlude (block off) the flow of blood somewhere downstream in a smaller artery.
Atherosclerosis (P400) the process of plaque formation (fatty deposits,
miscellanea, and calcium) on the interior of the artery. Restricts blood flow.
Arteriosclerosis (P400) stiffening or hardening of the artery wall resulting from calcium deposits on the interior wall. Condition causes: vessel to lose elasticity, changes blood flow (streamline to turbulent), and increases blood pressure.
Crepitation (P265) the grating sound or feeling of broken bones rubbing together.
Decapitation (noun) the
separation of the head of an animal from its body
Traumatic asphyxia (P666) asphyxia produced by a sudden increase in venous pressure, common in those who have been
hanged and also seen in crush injuries (
The American Heritage Medical Dictionary)
Indications: neck and face will be a darker color than the rest of the body, bulging eyes, distended neck veins, and broken blood vessels in the face (
11th Ed. Emergency Care)
Cardiac Tamponade (P666) compression of venous return to the heart because of increased volume of fluid in the pericardium (
The American Heritage Medical Dictionary) an injury to the heart that causes blood to flood into the surrounding
pericardial sac. The sac fills with blood and compresses the heart's chambers until they will no longer fill adequately, backing up blood into the veins.
Indications: distended neck veins (
JVD), narrowed pulse pressure, signs of shock.
Flail Segment [Flail Chest] (P660-662) fracture of two or more adjacent(neighboring/consecutive)
costal bones in two or more places that allows free movement(
separation from the chest wall and instability) of the fracture segment. This leaves a portion of the chest wall unstable which directly affects breath and chest expansion.
Indications: palpate
crepitus in the
costal bones, paradoxical motion during breathing, pain at the injury sight, signs and symptoms of shock and hypoxia, patient fatigue/labored and ineffective breathing, and paradoxical motion (the affected area will push in as the rest of the chest expands and remain pushed out while the rest of the chest contracts) which will become progressively more pronounced.
Cushing's Reflex (P755) increased blood pressure and decreased pulse rate
Battle's Signs (P755) bruise behind the ear, indicates fracture of the base of the posterior portion of the cranium
Babinski's Reflex (noun) a reflex normal to patients under two years old. In patients older that two, it is a sign of damage to the
corticospinal tract (nerve paths connecting brain and spine). The big toe of the affected side will
dorsiflex and the other toes will fan out when the plantar region of the foot is gently stimulated.
Asystole (P410) a condition in which the heart has ceased generating electrical impulses/ "flatline"
Angina Pectoris (405) pain in the chest, occurring when blood supply to the heart is reduced and a portion of the heart muscle is not receiving enough oxygen. During time of exertion or stress, the portion of the heart muscle supplied by a narrowed artery becomes hypoxic resulting in intense chest pain.
Angina Pectoris:AMI what TIA:CVA
Angioplastly (noun) vascular invasive medical procedure: a narrowed or obstructed blood vessel is mechanically widened via inflation of balloons (6-20 atmospheres [14.7 psi]) in order to restore blood flow.
Preeclampsia (P589) a complication of pregnancy where the woman retains large amounts of fluid and has hypertension. She may also experience seizures and/or coma during birth, which is very dangerous to the infant.
Eclampsia (P589) severe complication of pregnancy that produces tonic-clonic seizures and coma.
Ataxia (noun) sign and symptom where a patient has severe lack of coordination over muscle movements (gross and fine motor). May also indicated a lack of coordination or the inability to walk due to gross lack of coordination.
Hemiparesis (noun) weakness on one side of the body due to damage (or lesions) to the corticospinal tract.
Ischemia (noun) inadequate perfusion (circulation of blood supply) downstream of a blockage
Aphagia (noun) inability to eat/swallow
Aphasia (noun) inability to speak. Can be spontaneous (stroke, trauma, etc.) or progressive (tumor). Aphasia can cause difficulty using language, including speaking, listening, reading, and writing.
Deposition (noun) testimony taking outside of court
Capnometry (P1049) the measurement of CO2. A graphic recording or display of capnometric measurement is capnography.
Defense Driving (noun) conscious practice of driving with anticipation for the mistakes and habits of other drivers (merging without looking/talking on a cell phone) and awareness of environmental conditions and necessary response or techniques to maintain safety.
With Due Regard (noun) term used most commonly in the phrase, "Driving with due regard to the personal safety and lives of one's self and all other persons."
Scope of Practice (noun) legally defined parameters and limits under which professions may perform interventions, treatment, procedures, and administer medications.
"The Bends" (noun) decompression sickness caused by nitrogen release from body tissue which will form bubbles. Bubbles of nitrogen can lead to joint pain and fatigue and even embolisms, stroke, and death.
Questions and Answers:
1. What is the primary responsibility of an Emergency Medical Technician?
A: Personal Safety
2. An EMT acts under the authority of whom?
A: Medical Director, a physician who assumes the ultimate responsibility for medical direction. (P16)
3. When you cover a patient's mouth, what are the risks?
A: Risks include aspiration of emesis, inability to speak, inability to breathe adequately(inadequate breathing, obstructed airway, and respiratory failure), and litigation for battery (if mouth if forcefully covered).
4. How should an EMT act during the death and dying process?
A: 1. Recognize the patient's needs (preserve the patient's dignity and sense of control, talk directly to the patient, and encourage the patient to share feelings and needs) 2. Be tolerant of angry reactions from the patient or a family member 3. Listen emphatically 4. Do not falsely reassure 5. Offer as much comfort as you realistically can (no false hope! [lies]) P38-39 for a more detailed resource.
5. When in doubt regarding a Do Not Rescusitate Order, what should you do?
A: If the DNR Order is not signed by both the patient and physician, begin resuscitative measures. If the DNR is not provided to prehospital care personnel, begin resuscitative measures. (P53)
6. When treating a pediatric, how would an EMT obtain consent to assess and treat?
A: Parents and guardians have legal authority to give consent, and consent must be obtained before care can be given. However, in the case of life-threatening illness or injury when a parent or guardian is not present, care may be given on the basis of implied consent. Minors who are legally independent (emancipated minors, etc.) minors may also give consent for themselves or their dependents. (P50)
7. Where should an EMT place their feet when lifting?
A: "They should be on a firm, level surface and positioned shoulder-width apart." (P106)
8. Who should not be transported via stair chair?
A: Patients with neck or spine injuries (patients requiring C-Spine Precautions). (P119)
9. Which patients should not receive a head-tilt, chin-lift?
A: An EMT should when no trauma or injury is suspected. Contraindications: a patient discovered unconscious, unknown MOI, and/or mechanism of injury for trauma or injury to the cervical spine (MVehicle Accident, etc.). (P145)
10. What are the advantages and disadvantges of an oropharyngeal airway?
A: An OPA will maintain an open airway and may be used for unresponsive patients. The device will prevent blockage of the upper airway by the tongue. May not be used if patient has an intact gag reflex or begins to regain consciousness. (P157)
11. The fixed suction unit on an ambulance should generate a flow of ______ and a vacuum of ____?
A: 30 Liters per minute; 300 mmHg
12. Which scene does not need additional resources?
A: Know which scenes do need additional resources: 1. Crime Scenes and Acts of Violence (P194) 2. HazMat (P192) 3. Number of Patients and Adequacy of Resources (P204), see P.204 - 205 for specific examples.
13. What is the first intervention that an ejected motorist will need?
A: C-Spine Precautions
14. Which of the following is not part of Scene Size-Up?
A: Which is? Remember, the First Five of Scene Size-Up 1. Scene Safety 2. Number of Patients 3. Nature of Illness/Mechanism of Injury 4. Need for Additional Resources? 5. Need for C-Spine?
Initial Assessment: G.I./L.O.C./C.C./ABC
15. At what height is a fall considered serious?
A: It is implied that the patient is an adult. For an adult, a fall is considered a serious MOI if it is 15 feet or greater or three times the patient's height or greater, whichever is less. Also, see if patient fell onto an object or struck an object on the way down, check vitals, and physical exam findings and, when in doubt, assign high priority for rapid transport. (P202)
16. What is the criteria for High or Low Priority?
A: High Priority (Load and Go): Unresponsive Patient, Altered Mental Status, Mechanism of Injury for Serious Trauma, Patient's Age, Trouble with the ABCs (Assisted Ventilations, Pressure Dressings, Skin Signs indicated a Circulation problem) or any life-threatening problems.
17. What are acceptable methods for assessing circulation?
A: Skin color, skin temperature, skin condition (diaphoretic, dry, etc.) capillary refill, assess amount of blood loss, pulse rate, pulse force, pulse rhythm, presence of distal pulses, and blood pressure.(P226
18. What should pupils do in response to light exposure (shielding eyes and shining pen light into them)?
A: Pupils should be: PERRL. Pupils are Equal, Round and React to Light. Pupils should constrict equally. If no reaction, shield patient's eyes from ambient light or lower intensity of ambient light then expose and observe again. If pupils do not constrict, check PT Hx for cataracts or corrective surgery or medication with properties of vasodilation (Effexor, etc.). (P233)
19. What are the ranges for Prehypertension and Hypertension?
A: Prehypertension is a systolic blood pressure of 121 mmHg to 139 mmHg. Hypertension is a systolic blood pressure over 140 mmHg. (P235)
20. When taking a patient's blood pressure, to what pressure mmHg should you inflate the cuff?
A: Inflate the cuff to 30 mmHg higher than when the pulse sound disappeared. (P237)
21: What follows the Initial Assessment?
A: First Transport Decision (Tx or Rx - Load and Go or Stay and Play)
Initial Assessment: G.I./L.O.C./C.C./ABC
22. How do we rate pain?
A: "On a scale of 1-10, 10 being the worst pain you have ever felt in your life, what would you rate this as?"
23. What are the vitals reassessment intervals?
A: After a medical intervention (medication) - two minutes and five minutes for every unstable medical or trauma patient and every fifteen minutes for a stable patient. (P312)
24. What is a "base station"?
A: A two-way radio at a fixed site such as a hospital or dispatch center.
25. What are the principles of proper radio usage?
A: See P.322, Table 13-1 for all twenty principles including: make sure your radio is on, speak slowly and clearly, brevity, use plain English, courtesy is assumed, and do not use the patient's name over the radio.
26. What should be included in a radio report?
A: Radio medical reports must contain 12 parts:
- Unit I.D. and level of provider
- ETA
- PT's age and sex
- C.C.
- Brief, pertinent Hx of present illness
- Major past illnesses
- Mental status
- Baseline vital signs
- Pertinent findings of the physical exam
- Emergency care given
- Response to emergency care
- Contact medical direction if required or if you have any questions
P.324
27. What is the difference between objective and subjective information?
A: Objective information (signs) are data that are commonly verified and quantified realities such as temperature, pulse rate, swelling, deformity, discoloration, and respiration rate.
Subjective information (symptoms) are personal reactions to a stimulus. For example, a patient with pale, cool, diaphoretic skin, prescribed nitroglycerin, and decreased respiration quality may be experiencing chest pain. The pain is an individual observation. (P339)
28. What is included in the narrative section of the prehospital report?
A: The narrative should tell the patient's story fully and appropriately ("paint a picture"). It should include both objective and subjective perninent information, pertinent negatives, correct use of medical terminology, and legible and correct spelling. Avoid codes and nonstandard abbreviations and, if you didn't write it down, you didn't do it.
29. How should an EMT perform in a situation where a patient wants to refuse treatment?
A: Patient must first meet the criteria to refuse treatment. The patient must: be a legal adult, be mentally competent, be alert and oriented times 4, not be under the influence of drugs or alcohol, be informed of the risks involved up to and including death.
Take all appropriate measures to convince or assist patient in choosing to seek treatment at the hospital.
Patient may refuse treatment by signing a refusal-of-care form (AMA - Against Medical Advice Release). Document all: wtinesses, findings, care, vitals, assessment, patient's competency, measures taken to persuade and information given concerning condition and associated risks. (P342 "Patient Refusals")
30. What are signs of difficult breathing (dyspnea)?
A:Signs of dyspnea include accessory muscle recruitment, tripod position, cyanosis, irregular respiratory rhythm, increased respiratory rate, pale or flushed skin, straining intercostal and abdominal muscles, altered level of awareness, dizziness, unconsciousness, anxiety, confusion, restlessness, fainting, combativeness, nasal flaring, pursed lips, coughing, crowing, high-pitched barking, wheezing, rattling, dysphasia, and inability to speak in full sentences. (See P374 for a complete list)
31. What is the difference between respiratory distress, respiratory failure and respiratory arrest?
A: R. Distress - increased work of breathing; a sensation of shortness of breath (P1222)
R. Failure - (think: failing = inadequate, a 79% is failing/inadequate to pass) the reduction of breathing to point where oxygen intake is not sufficient (adequate) to support life.
R. Arrest - (arrest means "to stop") when breathing completely stops
32. When an EMT arrives on scene to a bystander performing CPR, if the bystander is performing high quality CPR, what should the EMT do?
A: Skip pulse check and apply AED.
33. What is the goal of early CPR and defibrillation?
A: (P.406) If the response time of the defibrillator is longer than eight minutes, virtually no patients survive cardiac arrest.
34. What are common causes of seizures in children and adults?
A: In adults, the common cause of seizures is not taking prescribed medication (s).
In children, the common cause of seizures is fever (febrile seizures).
35. What can withdrawals cause?
A: Symptoms of alchol withdrawals include: initial euphoria, irritability, nervousness, anxiety, depression, rapid emotional changes, fatigue, dehydration, thirst, nausea, difficulty thinking clearly (befogged), bad dreams, pulsating headache, diaphoresis, nocturnal diaphoresis, "the shakes" (inhibited dopamine levels mimicking Parkinson's shakes), delirium tremens (visual, taste, and auditory hallucinations, profound confusion, disorientation, hyperactivity, and extreme cardiovascular disturbances, stroke, tonic-clonic seizures, and heart attack) and pancreatitis.
36. Where do we check for hypothermia?
A: Check core temperature. (P520)
37. Where is the coldest blood found in hypothermia patients?
A: The extremities.
38. What would procedure be for a localized cold injury?
A: Early or Superficial Cold Injury, see P523. Late or Deep Cold Injury, see P524.
39.What is the primary priority for psychiatric patients?
A: Request police assistance if necessary and follow general guidelines (P551). Your first concern is your own safety and maintain alertness to changes in behavior and movements. It is indicated to restrain a patient when: the patient's behavior interferes with or prevents treatment (P555).
40. What are signs and symptoms of excessive blood loss in female patient, especially during pregnancy?
A: Excessive blood loss is profuse when it is equal to or exceeds 500cc (500ml). A sanitary napkin will hold approximately 100cc of blood. Mother may or may not experience associated abdominal pain, and signs of shock. Treat with high-con O2 and go! (P588)
41. What are the stages of labor?
A: There are three stages of labor (P565). The first stage (dilation) begins with regular contractions where the cervix will dilate and ends with full dilation (10cm).
The second stage (delivery) begins when the baby enters the birth canal and ends after baby is born.
The third stage (afterbirth) begins after the baby is born and ends when the placenta is delivered.
42. What are the stages of pregnancy?
A: Pregnancy is divided into three stages (trimesters). The first trimester begins with conception to three months en utero. During the first trimester, the fetus is formed. During the second, formation of the fetus continues along with some uterine growth. During the last trimester, the least amount of development is done (comparatively) which is accompanied by the most uterine growth.
Pregnant women also have increased blood volume, increased cardiac output, increased heart rate, massive increase in vascularity of the uterus and related structures, blood pressure is slightly decreased, and slowed digestion. (P565)
43. What is the treatment for a cord around baby's neck?
A: Gently loosen cord by placing two fingers behind baby's neck and gently lifting over the baby's upper shoulder and head. If you cannot, clamp the cord in two places and cut carefully. Proceed with delivery.
44. What is a low birth weight?
A: 5.5 pounds or less.
45. What is the body's response to hypovolemic shock?
A: Acute blood loss causes three stages of shock. Initially, the body will attempt to compensate with increased heart rate and respirations with restricted perfusion to distal pulses resulting in pale, cool, and diaphoretic skin. In decompensated shock, blood pressure begins to drop. In irreversible shock, cell damage occurs (particularly to the brain, liver, and kidneys) and patient may still die if vitals are restored due to hypoxia to vital organs. (P632-633)
46.What are the indications for a traction splint?
A: The indications are a painful, swollen, deformed mid-thigh with no joint or lower leg injury or absent dorsalis pedis or posterior tibial pulses (distal PMS). Contraindication: pelvis, hip; or knee injury or a partial amputation and/or avulsion that traction would seperate extremity; or if there is an injury to lower third of leg that would interfere with ankle hitch.
