Test review

What are the 2 shockable cardiac arrest rhythms an AED can correct?

Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT).

• VF: chaotic ventricular electrical activity → no effective contraction.

• pVT: ventricles beating extremely fast → no effective cardiac output.

• Shockable = VF + pulseless VT

• NOT shockable = asystole + PEA

🧠 Hook: “V-Fib & V-Tach = Voltage problem → shock.”

What is asystole?

Asystole = absence of detectable cardiac electrical activity, appearing as a flatline.

• No organized electrical activity

• No pulse

• Not shockable

• CPR + epinephrine + identify/treat reversible causes

🧠 Hook: “Flatline = nothing to shock.”

What is PEA?

Pulseless electrical activity (PEA) = organized electrical activity is present, but the heart produces no palpable pulse/effective circulation.

• Electrical activity ≠ mechanical pumping

• Not shockable

• CPR + epinephrine + search for reversible causes

🧠 Hook: “PEA = electricity, but no pulse.”

What is ventricular tachycardia (VT)?

VT = abnormally rapid rhythm originating in the ventricles.

If the patient has a pulse → VT with a pulse.
If no pulse → pulseless VT → cardiac arrest and shockable.

🧠 Critical: VT is only a shockable arrest rhythm when pulseless.

What is ventricular fibrillation (VF)?

VF = chaotic, disorganized ventricular electrical activity causing the ventricles to quiver instead of effectively contracting.

• No effective cardiac output

• No pulse

• Shockable

If an AED says “no shock advised,” what do you do?

Immediately resume CPR, beginning with chest compressions.

The AED will periodically reassess the rhythm and tell you when to stop for analysis.

🧠 Never just stand there waiting.

What are the basic priorities in adult cardiac arrest?

Recognize arrest → activate EMS/get AED → CPR → AED/defibrillation → airway/ventilation/oxygenation → continued CPR and reassessment.

For a shockable rhythm: shock → immediately resume CPR.

For a non-shockable rhythm: CPR + epinephrine + identify reversible causes.

How many CPR cycles are performed?

For a 2-minute CPR/AED cycle, perform approximately:

5 cycles of 30:2 compressions-to-ventilations for a single adult rescuer.

• 30 compressions

• 2 breaths

• Repeat for ~2 minutes

• AED then analyzes rhythm

🧠 “30:2 × 5 ≈ 2 minutes.”

What is high-performance CPR?

CPR designed to maximize blood flow to the brain and heart by:

• Minimizing interruptions

• Effective chest compressions

• Correct rate/depth

• Full chest recoil

• Appropriate ventilation

• Early defibrillation

• Defined team roles

• Coordinated tasks

• Clear communication

🧠 Main idea: maximize compression time and minimize hands-off time.

What are the major roles in a team-based cardiac arrest?

Think:

Compressor → Airway/ventilation → AED/monitor → Team leader

Everyone has a defined job, communicates clearly, and coordinates actions.

Goal: don't have 4 people doing the same thing while nobody manages the AED.

What is the difference between adult and pediatric cardiac arrest causes?

Adults: most commonly cardiac causes, especially coronary artery disease/acute coronary syndrome.

Children: most commonly respiratory/asphyxial causes that progress to cardiac arrest.

🧠 Adult = heart problem.
Pediatric = oxygen problem.

What is the difference between sudden cardiac arrest and asphyxial cardiac arrest?

Sudden cardiac arrest: primarily a cardiac/electrical problem causing the heart to suddenly stop effectively pumping.

Asphyxial arrest: lack of oxygen → respiratory failure → hypoxia → bradycardia → cardiac arrest.

🧠 Sudden = heart first.
Asphyxial = oxygen first.

What is commotio cordis?

Sudden cardiac arrest caused by a blunt impact to the chest at a vulnerable moment during the heart's electrical cycle.

Usually produces ventricular fibrillation.

Example: baseball or hockey puck strikes the chest.

🧠 “Perfectly timed chest hit → VF.”

What happens physiologically in hypoglycemia?

Blood glucose becomes too low → the brain does not receive enough glucose → altered brain function.

The body also releases stress hormones, producing signs like:

• Sweating

• Shaking

• Anxiety

• Rapid pulse

• Hunger

• Altered mental status

• Seizures/coma if severe

🧠 Brain needs glucose → low glucose = brain dysfunction.

What happens physiologically in hyperglycemia?

Blood glucose is excessively high.

High glucose pulls water out of cells and causes dehydration through increased urination.

Signs can include:

• Thirst

• Frequent urination

• Dry mouth/skin

• Weakness

• Altered mental status

What is DKA?

Diabetic ketoacidosis (DKA) = insufficient insulin → cells cannot adequately use glucose → body breaks down fat → ketones accumulate → metabolic acidosis.

Classic presentation:

• Hyperglycemia

• Dehydration

• Frequent urination/thirst

• Nausea/vomiting

• Abdominal pain

• Altered mental status

• Kussmaul respirations = deep, rapid breathing

• Fruity/acetone breath

🧠 DKA = “No insulin → fat → ketones → acid.”

What is the difference between Type 1 and Type 2 diabetes?

Type 1:

• Pancreatic beta cells produce little/no insulin

• Usually requires insulin

• Often develops earlier in life

Type 2:

• Body becomes resistant to insulin

• Insulin may still be produced

• Often associated with lifestyle/genetic factors

• Can be managed through lifestyle, medications, and sometimes insulin

What are the signs/symptoms of hypoglycemia vs hyperglycemia vs DKA?

	Hypoglycemia	Hyperglycemia	DKA

Glucose

Low

High

High

Mental status

Altered/confused

Altered if severe

Altered

Skin

Sweaty

Dry

Dry

Urination

—

Frequent

Frequent

Thirst

—

Increased

Increased

Breathing

Usually normal

Usually normal

Deep/rapid Kussmaul

Breath

Normal

Normal

Fruity

Other

Shaking, hunger

Weakness

Vomiting, abdominal pain

🧠 Cold/sweaty = think low.
Hot/dry/thirsty = think high.
Deep breathing + fruity breath = DKA.

What is normal adult blood glucose, and what is it measured in?

Blood glucose is measured in mg/dL (milligrams per deciliter).

A typical normal fasting blood glucose is approximately 70–100 mg/dL.

For EMT purposes, <70 mg/dL is generally considered hypoglycemia.

What specifically secretes insulin?

Beta cells of the pancreas, specifically within the islets of Langerhans.

🧠 Beta → insulin.

What is a seizure?

A seizure is abnormal electrical activity in the brain that can cause changes in:

• Movement

• Sensation

• Behavior

• Consciousness

What are the major types of seizures and how do they affect the patient?

Generalized seizures: involve both sides of the brain.

• Tonic-clonic: loss of consciousness → stiffening → rhythmic jerking.

• Absence: brief staring/loss of awareness, usually lasting seconds; little/no major motor activity.

• Atonic: sudden loss of muscle tone → patient may collapse.

• Myoclonic: brief, sudden muscle jerks.

Focal/partial seizures: begin in one specific area of the brain.

• Focal aware: patient remains aware.

• Focal impaired awareness: awareness is impaired; may stare or perform repetitive movements.

🧠 Generalized = both sides.
Focal = one area.

What are the 3 stages of a generalized tonic-clonic seizure?

1. Aura → 2. Seizure → 3. Postictal

• Aura: warning sensation before seizure, if present

• Seizure/ictal: abnormal activity with loss of consciousness, stiffening, jerking

• Postictal: recovery period; confused, tired, possibly combative

What is an aura?

An aura is a warning sensation experienced before a seizure.

Can include:

• Strange smell/taste

• Visual changes

• Odd sensations

• Déjà vu

• Anxiety or unusual feeling

It can be part of a focal seizure and may precede a generalized seizure.

What do you do for a patient who had a seizure?

During seizure:

• Protect from injury

• Move dangerous objects away

• Do NOT restrain

• Do NOT put anything in their mouth

• Don't force anything between teeth

After seizure:

• Assess airway, breathing, circulation

• Oxygen/ventilatory support as needed

• Check blood glucose

• Assess for injuries

• Monitor mental status/vitals

• Determine cause/history

• Transport when indicated

What is the difference between a witnessed and unwitnessed seizure?

Witnessed: you know what happened and can obtain details about onset, duration, movements, etc.

Unwitnessed: assume the patient could have been injured or had another medical problem.

Therefore, perform a careful assessment for:

• Trauma

• Medical causes

• Altered mental status

• Hypoglycemia

• Drug/medication issues

• Pregnancy-related complications when applicable

🧠 Unwitnessed = don't automatically assume “just a seizure.”

27. What is the Cincinnati Prehospital Stroke Scale (CPSS)?

A rapid stroke screening tool using 3 assessments:

1. Facial droop

2. Arm drift

3. Speech

What constitutes an abnormal CPSS finding?

Facial droop: ask patient to smile → one side of face doesn't move normally.

Arm drift: patient holds both arms out → one arm drifts downward.

Speech: ask patient to repeat a phrase → speech is slurred, incorrect, or abnormal.

Any one abnormal finding = positive/abnormal CPSS.

🧠 F-A-S = Face, Arm, Speech.

What does an abnormal CPSS mean?

A positive CPSS increases the likelihood of an acute stroke, but it does not definitively diagnose a stroke.

You still need a complete assessment and rapid transport.

Why is time critical with stroke?

Some strokes are caused by a blood clot blocking blood flow to the brain.

The longer brain tissue is deprived of oxygen, the more brain cells can be damaged.

Time-sensitive hospital treatment can restore blood flow in appropriate patients.

🧠 “Time is brain.”

What are the major types of stroke?

Ischemic stroke: blood vessel is blocked → decreased blood flow to brain.

Hemorrhagic stroke: blood vessel ruptures → bleeding into/around brain.

🧠 I = Ischemic = Impaired flow.
H = Hemorrhagic = Hemorrhage/bleeding.

What is an antibody, pathogen, allergen, and histamine?

Antibody: protein produced by the immune system that recognizes specific foreign substances.

Pathogen: disease-causing organism, such as a bacterium, virus, fungus, or parasite.

Allergen: substance that triggers an allergic immune response.

Histamine: chemical released during allergic reactions that contributes to vasodilation, increased vascular permeability, itching, swelling, etc.

What is anaphylaxis and what happens physiologically?

Anaphylaxis = severe, systemic, life-threatening allergic reaction.

Massive mediator release causes:

Vasodilation → decreased blood pressure

and

Increased vascular permeability → fluid leaves blood vessels → swelling

It can also cause bronchoconstriction and airway swelling.

What are the signs/symptoms of anaphylaxis?

Possible findings:

• Hives

• Itching

• Flushed skin

• Swelling/angioedema

• Wheezing

• Difficulty breathing

• Throat/tongue swelling

• Hoarse voice/stridor

• Hypotension

• Tachycardia

• GI symptoms

• Altered mental status

• Shock

What is most concerning sign / symptom of anaphylaxis?

Airway compromise and/or respiratory distress, followed by hypotension/shock.

🧠 Anaphylaxis kills through airway/breathing/circulation problems.

What does epinephrine do during anaphylaxis?

Epinephrine:

• Vasoconstricts → raises blood pressure

• Bronchodilates → opens airways

• Decreases airway swelling

• Helps counteract the allergic reaction

🧠 Epi = squeeze vessels + open lungs.

What is the “Ready → Check → Inject” system for epinephrine?

Ready: remove the auto-injector from its carrier.

Check: confirm medication/device and expiration according to your protocol.

Inject: administer into the outer thigh, typically through clothing if necessary, according to the device instructions.

Then activate EMS/transport and reassess.

Hepatitis A vs B vs C — transmission and prevention

Hepatitis A

• Primarily fecal-oral

• Contaminated food/water

• Vaccine available

• Hand hygiene/sanitation prevents transmission

Hepatitis B

• Blood/body fluids

• Sexual contact

• Needles

• Perinatal transmission

• Vaccine available

• Avoid blood/body-fluid exposure

Hepatitis C

• Primarily blood-to-blood

• Especially contaminated needles/equipment

• No vaccine

• Prevent blood exposure/needle sharing

🧠 A = Alimentary/fecal-oral
B = Blood + body fluids
C = primarily Circulating blood

What are the signs/symptoms of influenza?

Influenza = viral respiratory infection.

Common:

• Fever

• Chills

• Headache

• Body aches

• Fatigue

• Cough

• Sore throat

• Runny/stuffy nose

🧠 Flu = sudden systemic illness + respiratory symptoms.

What are the signs/symptoms of measles?

Classic:

• Fever

• Cough

• Runny nose

• Red eyes/conjunctivitis

• Koplik spots inside mouth

• Characteristic rash that spreads from face/head downward

🧠 Measles = 3 C's: cough, coryza, conjunctivitis + rash.

What are the signs/symptoms of mumps?

• Fever

• Headache

• Muscle aches

• Painful swelling of salivary glands, especially parotid glands

• Swollen/tender area around jaw/cheeks

🧠 Mumps = swollen cheeks/jaw.

What are the important signs/symptoms of tuberculosis (TB)?

TB is a bacterial infection, usually affecting the lungs.

Classic pulmonary findings:

• Persistent cough

• Coughing up blood may occur

• Fever

• Night sweats

• Weight loss

• Fatigue

TB can be transmitted through airborne respiratory particles, especially with prolonged exposure.

🧠 TB = chronic cough + night sweats + weight loss.

What is sepsis?

Sepsis = life-threatening organ dysfunction caused by a dysregulated response to infection.

Physiologically, infection triggers an excessive systemic inflammatory response → vasodilation, increased capillary permeability, impaired circulation → inadequate tissue perfusion → organ dysfunction.

Possible findings:

• Fever or abnormally low temperature

• Tachycardia

• Tachypnea

• Altered mental status

• Hypotension

• Weakness

• Poor perfusion

• Signs of infection

🧠 Infection → systemic response → poor perfusion → organ dysfunction.

What is pre-eclampsia vs eclampsia?

Pre-eclampsia: pregnancy-related condition involving high blood pressure, often with signs of organ involvement.

Eclampsia: pre-eclampsia + seizures.

🧠 “Eclampsia = seizure added.”

Critical EMT point:

A pregnant/postpartum patient with seizure + hypertension → think eclampsia.

What is an LVAD?

Left ventricular assist device (LVAD) = mechanical pump that assists the left ventricle in pumping blood to the body.

Important EMT point:

An LVAD patient may not have a palpable pulse or normal blood pressure, because the device may produce continuous blood flow.

Assess perfusion and patient condition, not simply whether you can find a pulse.

What is a fistula?

An arteriovenous (AV) fistula is a surgically created connection between an artery and vein, commonly used for hemodialysis access.

Do NOT:

• Take BP on that arm

• Draw blood from it

• Compress it unnecessarily

🧠 Fistula arm = protect it.

What is a pacemaker?

A pacemaker is a device that provides electrical stimulation to the heart when the heart's own electrical system isn't adequately maintaining the appropriate rate/rhythm.

External defibrillation can still be performed when indicated.

What is syncope?

Syncope = temporary loss of consciousness caused by temporary inadequate blood flow to the brain, followed by spontaneous recovery.

Important: syncope is a symptom, not a diagnosis.

Potential causes include cardiac problems, abnormal rhythms, dehydration, bleeding, etc.

🧠 Passed out + came back = syncope, but find the cause.

What is an incubation period?

Time between exposure to an infectious pathogen and onset of symptoms.

🧠 Exposure → incubation → symptoms.

What is a latent period?

The time between becoming infected and becoming capable of transmitting the infection.

Important distinction:

Incubation = exposure → symptoms.
Latent = infection → ability to transmit.

These periods can overlap but are not necessarily the same.

What can vaccines prevent, and what can they NOT do?

Vaccines train the immune system to recognize specific pathogens/antigens, reducing the risk of infection and/or severe disease depending on the vaccine.

They cannot:

• Treat every infection after it has already occurred

• Guarantee 100% immunity

• Protect against pathogens they weren't designed for

🧠 Vaccine = prevention, not a cure.