Pitt EMT exam 1

What does EMS stand for?

Emergency Medical Services

In 1966, the National Highway Safety Act charged which agency with the development of EMS standards?

Department of Transportation (DOP)

What is the chain of resources in the EMS system?

Patient > citizen calls 911 > 911 dispatcher > first responders > EMT > emergency department staff > allied health staff

Which communication system is able to identify the number and location of the phone from which a caller is calling 911?

Enhanced 911

What is the role of Emergency Medical Dispatchers?

Gather information from person experiencing emergency, and potentially provide assistance and instruction as needed prior to the arrival of EMS on scene

What factors might influence our decision-making skills?

Stress, mental state, personal interests, biases

What is the role of the medical director of an EMS system?

a physician that has ultimate responsibility for patient care aspects of EMS system

What is the difference between on-line and off-line medical control?

Offline control are standing orders and protocol which remain constant in each scenario.

Online control is when a medical director is contacted via phone or radio to ask for permissions

What role does quality improvement play in EMS?

Process of continuous self-review with the purpose of identifying & correcting aspects of the system

What are standard precautions?

Equipment and procedures that protect against the blood and body fluids of the patient

What are the four routes of infection?

Inhalation

Ingestion

Absorption

Injection

What are the four main infectious diseases of concern to EMTs?

Hepatitis B

Hepatitis C

Tuberculosis (TB)

HIV/AIDS

What is the Ryan White CARE Act?

Allows EMS providers the right to determine if they have been exposed to an infectious disease

(agency Control Officer gathers facts about exposures, and contacts EMS)

What are the three stages of stress?

1- Alarm (fight or flight)

2- Resistance (coping)

3- Exhaustion (loss of ability to adapt to stressor)

What are the types of stress reactions?

-acute stress reaction

-delayed stress reaction

-cumulative stress reaction

Acute Stress Reaction

-Often linked to catastrophe

-Occurs in EMTs and patients

-Signs and symptoms develop soon after

incident.

-Physical, cognitive, emotional, and

behavioral symptoms

-Normal reactions to extraordinary

situation

-May require professional intervention

Delayed stress reaction

Also known as PTSD

can be triggered by a specific event but psychological effects may not present until days, months, or even years later.

Characterized by nightmares, feelings of detachment, irritability, sleep difficulties, or problems with concentration.

intervention from mental health professional

cumulative stress reaction

This reaction, also known as, "burnout," results from sustained low-level stressors and develop over a period of years.

What does CISM stand for? What is its role in EMS?

Critical Incident Stress Management

-a comprehensive system that includes education and resources to both prevent stress and to deal with stress appropriately when it occurs

What are the 5 emotional stages of death and dying?

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

Wheeled Ambulance Stretcher

EMT are responsible for lifting the weight of the patient when lowering/raising the stretcher

power stretcher

stretcher equipped with hydraulics that limit the effort needed from EMT to lift and lower patient

bariatric stretcher

used for obese patient

stair chair

-used to bring a conscious patient down to the waiting stretcher if the patient's condition allows him or her to be placed in a sitting position

-can be used to transfer a conscious patient up or down a flight of stairs

What is a contraindication for use of the stair chair in moving a patient?

Patient must be conscious

short spine board

Primarily for removing patients from vehicles when a neck or spine injury is suspected. A vest type can be used instead if necessary.

scoop stretcher

typically used on patients who have experiences suspected hip injury. By separating the stretcher it can be placed under the patient without having to reposition the patient much.

flexible stretcher

can be useful in restricted areas or narrow hallways

basket stretcher

A rigid stretcher commonly used in technical and water rescues that surrounds and supports the patient yet allows water to drain through holes in the bottom. Also called a Stokes litter.

recovery position

A side-lying position used to maintain a clear airway in unconscious patients without injuries who are breathing adequately.

shock position

supine patient

What situations require an emergency move?

-Hazardous scene

-Care of life-threatening conditions that require repositioning

-The necessity to reach other patients.

(Try to move the patient in line with the long axis of the spine)

What situations require an urgent move?

-Required treatment can be performed only if patient is moved

-Patient's condition rapidly deteriorating

(Performed with precautions for spinal injury)

Non-urgent move

-Patient stable

-No immediate life threat

-Patient can be assessed, treated, and moved in normal way

(Take all required precautions not to aggravate existing conditions)

Requirements for patient refusal of care. (4)

patient is:

-Legally able to consent

-Mentally competent and oriented

-Fully informed of risks

-Sign release form

What is a DNR? What does it say?

Do not resuscitate order (DNR)

Legal document expressing patient's wishes if patient unable to speak for self

Expressed consent vs. implied consent

Expressed consent: Must be informed

-patient verbally gives consent

Implied consent: Assumed consent

-it is assumed the patient would agree to the measures within their best interest

What is the scope of practice?

Regulations and ethical considerations that define extent or limits of job duties

(what an EMT can do)

What is standard of care?

Care expected from EMT with similar training for patient in a similar situation

(how the EMT should preform their job)

What is the duty to act?

Obligation to provide care

While on duty, EMT obligated to provide care if no threat to safety

What must happen to prove negligence? (something was not done, or was done incorrectly)

-EMT had duty to act

-Breach of duty—EMT failed to provide standard of care expected or failed to act

-Proximate causation—patient suffered harm because of EMT action or inaction

Who can a patient's information be shared with without breaching confidentiality?

Can be shared with other health care personnel as part of patient's continuing care

(Otherwise must be obtained through subpoena)

Examples of evidence of a crime scene. (4)

-Condition of scene

-Patient

-Fingerprints and footprints

-Microscopic evidence

Anatomical position

To stand erect with arms at the sides and palms of the hands turned forward

Anatomical term for front & back

front: anterior

back: posterior

Anatomical term for above & below.

above: superior

below: inferior

Define medial & lateral.

Medial: toward the midline or median plane

Lateral: away from the midline or median plane

Position for the unconscious non-trauma patient to allow vomitus and secretions to drain from the mouth.

Recovery Position

Where does the upper airway begin? Where does it end?

Begins at mouth/nose

Ends at glottic opening

What happens at the alveoli? How are they able to perform this function?

-Tiny sacs in grape-like bunches at the end of the airway

-Surrounded by pulmonary capillaries

-Oxygen and carbon dioxide diffuse through pulmonary capillary membranes

What is the most common airway obstruction due to altered mental status?

poor muscle tone

Maneuvers to open airway

-Head-tilt, chin-lift maneuver

-jaw-thrust maneuver

Differences in pediatric vs. adult airway.

compared to adults, children have:

-Smaller mouth and nose

-Larger tongue

-Narrow, flexible trachea

What findings indicate airway problems? (6)

-Inability to speak

-Unusual raspy quality to voice

-Abnormal breathing sounds

(Stridor, Snoring, Gurgling)

-Absent or minimal chest movements

-No air felt or heard (air exchange below normal)

-Foreign bodies in airway

3 steps in caring for an airway

1. Make it

2. Check it

3. Keep it

2 types of airway adjuncts?

-Oropharyngeal airway (OPA) - Oral Airway

-Nasopharyngeal airway (NPA) - Nasal Airway

What are the 3 most important rules to suctioning the airway?

-Suction no longer than 10 seconds at a time

-Suction only as far as you can see

-Place tip or catheter where you want to begin suctioning. Suction only on the way out

Inhalation vs. Exhalation? vs ventilation?

-inhalation is an active process; occurs when diaphragm contracts; creates negative pressure which pulls air into lungs

-exhalation is a passive process; occurs when diaphragm relaxes; creates positive pressure which pushes air out of lungs

-ventilation: process of both inhaling and exhaling

Tidal volume vs. dead space volume vs. alveolar ventilation?

-Tidal volume: amount of air moved in one breath

-Dead space air: air moved in ventilation not reaching alveoli

-Alveolar ventilation:air actually reaching alveoli

External respiration vs. internal respiration?

-External respiration: diffusion of oxygen and carbon dioxide (exchange of gases) between alveoli and circulating blood.

What is hypoxia? What are signs of hypoxia?

low oxygen level in cells

signs: Shortness of breath, Increased respiratory rate and depth, Increased heart rate, abnormal skin color

What are the stages of respiratory compensation?

-Respiratory Distress

-Respiratory Failure

-Respiratory Arrest

What is respiratory distress?

Body compensating for a respiratory challenge and meeting metabolic needs

What is respiratory failure? What are the signs of respiratory failure?

Occurs when challenge overcomes compensation or compensatory steps can no longer continue

(Also known as inadequate breathing)

Signs:

-No or poor air movement

-Diminished or absent breath sounds

-Breathing rate too rapid, too slow, or irregular

-Patient unable to speak

-Unusual noises (wheezing, crowing, stridor, snoring, gurgling, gasping)

What is respiratory arrest?

When breathing completely stops.

Oxygen delivery devices: on-rebreather

best way to deliver high concentrations of oxygen to a breathing patient

Oxygen delivery devices: nasal cannula

Best choice for a patient who refuses to wear an oxygen face mask or for titration

Oxygen delivery devices: venturi mask

Delivers specific concentrations of oxygen by mixing oxygen with inhaled air

Oxygen delivery devices: partial rebreather

-similar to nonrebreather mask

-No one-way valve in opening to reservoir bag

-exhaled air mixes with supplemental oxygen

What are the 6 components of the scene size-up?

1. BSI

2. Scene Safety

3. Nature of Illness (NOI) / Mechanism of Injury (MOI)

4. Number of patients

5. Additional Resources

6. (C-spine Consideration)

You are approaching the scene of a motor vehicle crash. What is the EMT's first priority?

Ensure the safety of the scene. The EMT is their own number one priority.

What guidelines do you use to determine the danger zone?

emergency response guide (ERG)

What is the MOI? Why is it important?

Mechanism of Injury

-forces that caused the injury

this can tell us what types of injuries we may suspect within our patient. Additionally, we can have a focused idea of where the patient may have experienced impact/trauma

What are the three collisions involved in each motor vehicle crash?

vehicle to vehicle collision

human to vehicle collision

internals to human collision

What is the NOI?

Nature of Illness

-more commonly used to medical calls

also known as the chief complaint/why the patient called EMS

Primary Assessment Steps

1. Forming a general impression

-C-Spine Decision

2. Assessing mental status (AVPU)

3. Assessing airway

4. Assessing breathing

5. Assessing circulation

6. Determining patient priority

What is the importance of the primary assessment?

-determining immediate life threats

-determining patient priority

-assessing mental status

-assessing ABCs

What findings indicate a critical patient?

1. mental status

-unconscious patient is a high priority

2. results of ABCs

-if patient has obstructed airway, inadequate breathing, or poor circulation they may be a high priority patient

What is AVPU used for? What are its components?

AVPU is used to assess mental status of a patient

A: alert

V: responsive to verbal stimuli

P: responsive to painful stimuli

U: unresponsive

How do you determine P (in AVPU) in an adult? In an infant?

in adult: sternum rub or pinch their arm

infant: something with their foot

What are the ABCs?

airway (check for obstruction)

-make it, check it, keep it

breathing (check for inadequate breathing)

circulation (Assess pulse, Assess skin, Assess bleeding, Signs/Symptoms of shock)

ABC? Or CAB?

ABC - if patient has signs of life

CAB - if patient appears lifeless/no pulse

Components of circulation assessment. (3)

-Assess pulse

-is it within normal limits

-is it unusually fast or unusually slow

-Assess skin

-color, temperature, condition

-Assess bleeding

-check for major bleeding

-gross blood sweep

(check for Signs/Symptoms of shock)

Stable vs. potentially unstable vs. unstable

Stable: No threats to ABCs found, General impression not concerning

Potentially unstable: Potential for deterioration can indicate potentially unstable category

Unstable: Threat to ABC's

What is the importance of vital signs?

Outward signs of what is going on inside the body

-Identify important conditions or trends in patient conditions

What are included in vital signs?

1. Pulse (HR)

2. Respiration (RR)

3. Skin: color, temperature, and condition

4. Capillary refill (in infants and children)

5. Pupils

6. Blood pressure

7. Oxygen Saturation

What do we measure when checking for a pulse? (4)

1. Rate

2. Quality

3. Regularity

4. Equality (between central and peripheral)

What is the normal pulse rate for an adult?

Adults 60-100 beats per minute (bpm)

abnormal pulse descriptions

Thready—when pulse feels weak and thin

Bounding - when the pulse feels abnormally strong

What are the locations to check for a pulse? Central and peripheral.

central: Carotid, femoral

peripheral: radial, brachial, pedal

What is the normal respiratory rate for an adult?

(adult at rest) 12-20 breaths per minute

What are the 4 respiratory qualities?

Normal/Non-labored

Shallow (Abnormal Finding)

Labored (Abnormal Finding)

Noisy (Abnormal Finding)

Are pediatric pulse and respiratory rate higher or lower than an adult?

higher in pediatric patients

What are the four abnormal skin colors we typically see? What do they mean?

Cyanotic (blue-gray): lack of oxygen or extreme exposure to cold

Flushed (red): anxiety/stress

Jaundiced (yellow): liver malfunction

Mottled (blotchy): poor circulation

Blood pressure by palpation vs. auscultation.

palpation: feeling. gives only systolic number

auscultation: listening. gives both systolic and diastolic

Blood pressure normal range adults

Systolic no greater than 120 mmHg

Diastolic no greater than 80 mmHg

What determines whether you perform a rapid assessment or focused assessment?

Level of consciousness of patient

Important physical findings of secondary assessment

-Neck: JVD, medical identification devices

-Chest: breath sounds

-Abdomen: distention, firmness or rigidity

-Pelvis: incontinence of urine or feces

-Extremities: pulse, motor function, sensation, oxygen saturation, medical identification devices

PMH & HPI

past medical history

history of present illness

OPQRST. What are the letters and what does it tell you?

tells history of present illness (HPI)

Onset

Provocation/Palliation

Quality

Radiation

Severity

Time