EMT Test 3 (small)

Traumatic Asphyxia: Definition & Mechanism

Sudden massive compressive force to chest forcing blood backward from right heart into head/neck veins.

Traumatic Asphyxia: Key Signs & Symptoms

Bilateral scleral hemorrhage, facial/neck cyanosis, petechiae, JVD, and altered mental status.

Traumatic Asphyxia: Treatment Steps

Extricate, airway/breathing assessment, high-flow O₂ via NRB, spinal immobilization, shock care, rapid transport.

Subcutaneous Emphysema: Definition & Sensation

Air escaping into chest/neck soft tissues, causing a crackling (bubble wrap) feeling when palpated.

Subcutaneous Emphysema: Treatment Focus

Treat the underlying injury (pneumothorax/airway tear); the emphysema itself requires no specific treatment.

Flail Chest: Definition

Three or more adjacent ribs fractured in two or more places each, creating a free-floating segment.

Flail Chest: Paradoxical Movement

The flail segment moves inward during inhalation and outward during exhalation.

Flail Chest: Primary Danger

The underlying pulmonary contusion (bruised lung filling with blood/fluid), not just mechanical movement.

Flail Chest: Treatment

High-flow O₂, ventilatory assistance with BVM, position of comfort, rapid transport. Do NOT tape/splint.

Tension Pneumothorax: Pathophysiology

Air enters pleural space and cannot escape, compressing lungs and kinking great veins, reducing cardiac output.

Tension Pneumothorax: Signs & Symptoms

Severe respiratory distress, unilaterally absent breath sounds, JVD, hypotension, and late tracheal deviation.

Tension Pneumothorax: Expected Vitals

Elevated HR (120s-140s), dropping BP (70-80 systolic), elevated RR (28-36), falling SpO₂.

Tension Pneumothorax: Treatment

High-flow O₂, BVM if needed, ALS for needle decompression, or partially unseal occlusive dressing.

Ruptured Diaphragm: Definition & Key Sign

Diaphragm tears (usually left), causing abdominal organs to herniate upward. Bowel sounds heard in chest.

Ruptured Diaphragm: Treatment

High-flow O₂, BVM as needed (no CPAP), semi-Fowler's position, spinal immobilization, rapid transport.

Pulmonary Contusion: Definition & Presentation

Bruising of lung parenchyma; respiratory distress and hypoxia develop over hours (delayed presentation).

Pulmonary Contusion: Key Signs

Hemoptysis (blood-tinged sputum), progressive hypoxia, decreased breath sounds on affected side, chest pain.

Cardiac Tamponade: Definition

Blood accumulates in the pericardial sac, compressing the heart and preventing it from filling.

Beck's Triad (Cardiac Tamponade)

JVD, hypotension, and muffled/distant heart sounds.

Cardiac Tamponade: Additional Signs

Narrowing pulse pressure, pulsus paradoxus, tachycardia, and clear bilateral breath sounds.

Cardiac Tamponade: Treatment

High-flow O₂, request ALS, and rapid transport for definitive pericardiocentesis.

Concussion: Definition

Temporary disruption of neurological function from blunt head trauma without structural brain damage.

Concussion: Signs & Symptoms

Brief LOC, retrograde/anterograde amnesia, confusion, headache, nausea, dizziness, tinnitus, normal focal neuro exam.

Increased Intracranial Pressure (ICP): Pathophysiology

Brain swelling increases pressure in rigid skull; body raises BP to perfuse brain, triggering reflex bradycardia.

Cushing's Triad (Late ICP)

Hypertension (widening pulse pressure), bradycardia, and irregular respirations (Biot's or agonal).

ICP: Expected Vitals

Systolic BP 180-220 (rising), HR 40-60 (bounding), irregular RR, declining GCS.

ICP: Key Treatment Rules

Airway management, SpO₂ >94%, 30° head elevation. Do NOT hyperventilate routinely.

Basilar Skull Fracture: Definition

Fracture of skull base connecting intracranial space with sinuses, middle ear, or nasal cavity.

Basilar Skull Fracture: Signs

Battle's sign (delayed mastoid bruising), raccoon eyes (delayed), CSF rhinorrhea/otorrhea, hemotympanum.

CSF Detection: Halo Test

Drop fluid on gauze; blood forms central red dot, CSF forms clear yellowish outer ring.

Basilar Skull Fracture: Contraindications

Do NOT pack ear/nose to stop drainage; do NOT use a nasopharyngeal airway (NPA).

Epidural Hematoma: Definition & Source

Rapidly expanding arterial bleed (usually middle meningeal artery) between skull and dura mater.

Epidural Hematoma: Key Clinical Pattern

Brief initial LOC, followed by a lucid interval, then rapid, progressive neurological deterioration.

Subdural Hematoma: Definition & Source

Slower-onset venous bleed (torn bridging veins) between dura mater and brain surface.

Subdural Hematoma: Risk Groups & Signs

Common in elderly and alcoholics; presents with gradual headache, progressive AMS, and focal deficits.

Heat Cramps vs Heat Exhaustion vs Heatstroke Skin

Cramps: normal. Exhaustion: cool, clammy, pale. Heatstroke: hot (dry or wet).

Heat Exhaustion: Expected Vitals

HR elevated (100-120), BP low, RR slightly elevated, temperature below 104°F, mental status intact.

Heatstroke: Defining Feature & Temp

Altered mental status (confusion, seizures, coma) and core temperature above 104°F (40°C).

Heatstroke: Treatment Order

Cool first, transport fast: remove clothes, apply ice to axillae/groin/neck, wet and fan, oxygen.

Hypothermia: Definition & Mild S/S

Core temp <95°F (35°C). Mild (90-95°F): vigorous shivering, confusion, slurred speech, cold/pale skin.

Moderate Hypothermia: Critical Transition

Shivering stops (86-90°F); patient stops generating heat. Muscle rigidity and bradycardia begin.

Moderate/Severe Hypothermia: Handling Rule

Handle with extreme gentleness; rough movement can precipitate ventricular fibrillation (VF).

Severe Hypothermia: Pulse Check Rule

Check pulse for up to 60 seconds before concluding pulselessness; "not dead until warm and dead."

Why Hypothermia Worsens Bleeding

Cold temperatures impair the enzymatic clotting cascade, preventing blood from clotting effectively.

Rule of Nines: Adult Head, Torso, Legs

Head: 9%. Chest/Back: 18% each. Each Arm: 9%. Each Leg: 18%. Groin: 1%.

Rule of Nines: Pediatric Head & Legs

Head: 18% (double adult). Each Leg: 13.5% (smaller than adult). Torso/Arms same.

Rule of Palm

The patient's own palm equals 1% BSA; used for small/scattered burns.

1st vs 2nd vs 3rd Degree Burns

1st: red/dry. 2nd: blisters, moist, very painful. 3rd: leathery, charred, painless.

Burn Treatment: Primary Goals

Stop burning, assess airway, dry sterile dressings, keep warm, prevent hypothermia, infection, and shock.

Impaled Objects: General Treatment Rule

Do NOT remove; stabilize in place with bulky dressings, control surrounding bleeding, transport.

Impaled Objects: Two Exceptions for Removal

1) Impaled in cheek causing airway obstruction. 2) Prevents effective CPR chest compressions.

Open vs Closed Pneumothorax

Closed: intact chest wall, air from lacerated lung. Open: air enters through chest wall defect.

Open Pneumothorax: Treatment

Apply commercial vented chest seal (or improvised 3-sided occlusive dressing), high-flow O₂, transport.

Tension PTX after Dressing Placement

If tension signs develop after sealing open wound, partially unseal one edge of dressing.

Dressing vs Bandage

Dressing: sterile, placed directly on wound. Bandage: non-sterile, secures dressing, provides compression.

Musculoskeletal: Tendon vs Ligament

Tendon: connects muscle to bone. Ligament: connects bone to bone at joints.

Musculoskeletal: Cartilage vs Fascia

Cartilage: low-friction joint shock-absorber. Fascia: dense sheets encasing/compartmentalizing muscles.

Open Fracture: Treatment Key Points

Control bleeding around bone, do NOT push bone back, cover with moist sterile dressing.

Splinting: Joint vs Long Bone Rules

Joint: splint in position found. Long bone: immobilize joint above and below fracture.

Splinting: PMS Assessment

Assess Pulse, Motor, and Sensory before and after splinting; loosen splint if new deficits appear.

Hypovolemic Shock: Signs & Treatment

Tachycardia, cool clammy skin, hypotension (late). Control bleeding, O₂, keep warm, elevate legs.

Cardiogenic Shock: Key Signs & Contraindication

Shock signs plus JVD and pulmonary edema. Sit upright, O₂; do NOT elevate legs.

Neurogenic Shock: Unique Vitals

Paradoxical normal or low heart rate (bradycardia) and warm, dry skin below injury.

Early (Compensatory) vs Late (Decompensatory) Shock

Early: normal BP, tachycardia, cool skin. Late: falling BP (systolic <90), altered mental status.

Paraplegia vs Quadriplegia vs Hemiplegia

Paraplegia: lower body/legs. Quadriplegia: all four limbs. Hemiplegia: one side of body (brain injury).

Rapid Head-to-Toe vs Focused Assessment

Rapid: high-energy MOI or unresponsive. Focused: low-energy, isolated injury in alert patient.

Cervical Collar Measurement & Application

Measure shoulder to chin. Apply while partner maintains manual in-line stabilization; do not release manual hold.

Long Spinal Board: Order of Securing

Secure torso first, then secure head last with lateral blocks and forehead tape.

Brown-Séquard Syndrome: Definition

Hemisection spinal cord injury (usually penetrating) causing mixed bilateral sensory and motor deficits.

Brown-Séquard Syndrome: Ipsilateral vs Contralateral Loss

Ipsilateral: motor, fine touch, vibration loss. Contralateral: pain and temperature sensation loss.