EMT STATE EXAM NC

FIRST STAGE OF LABOR

The first stage occurs from onset of true labor contractions till dilation and effacement of the uterus.

2nd stage of labor

The hallmark finding in the second stage of labor is the complete delivery of the baby.

3rd stage of labor

The third stage occurs when the placenta delivers.

Ligaments connect....

Bone to Bone

Tendons connect

Bone to Muscle

START Triage 1st Step

START triage begins by asking patients to get up and walk to a collection point

START Triage 2nd step

respirations are assessed

START Triage 3rd Step

if the patient is not breathing, the airway is opened.

START Triage 4th Step

Pulse is then assessed

START Triage 5th Step

Check mental status.

Rule of 9's:Child:BACK

child's back represents 18% of his body surface area

Rule of 9's:Child: Both Legs (Front & Back)

the front and back of both legs each represent 7%

Rule of 9's:Child:Torso (Front & Back)

child's anterior and posterior torso would represent 36%

Primary blast stage

also known as the pressure wave), damages hollow, gas containing organs of the body such as the lungs, GI system, inner ears, and sinuses.

Secondary blast

The secondary phase causes cause blunt and penetration injuries from flying debris.

Tertiary phase of blast

tertiary phase are injuries sustained from the patient being thrown back and impacting something (wall, ground, etc.).

A 71-year-old female has fallen and complains of left hip pain. On examination you note her left foot is rotated laterally. This finding most likely indicates a

femur fracture

"5 Rights" of medication administration.

right patient, right medication, right route, right dose, and right time.

If you are responsible for establishing the landing zone for the helicopter, what is the minimum size of the LZ you should prepare assuming the rescue efforts are occurring at night?

The minimum size of the landing zone at night is 100' by 100'. During daylight, the minimum LZ zone is 60' by 60'. In either situation the LZ should be square, with a marker indicating the direction of wind travel

Which one of the following is a sign of Cushing's triad (Cushing's reflex) that occurs with traumatic brain injury?

The vital signs are an increased blood pressure, slowing pulse rate, and irregular respirations (classically seen as Cheyne-Stokes).

Classes of hemorrhage

A Class III hemorrhage is said to occur when the patient has lost 30-40% of their circulating blood volume. This is a significant bleed due to the fact that the body's compensatory mechanisms are maximized, and any additional blood loss will now create significant disturbances in hemodynamic stability. In Class I and II hemorrhage, blood pressure remains acceptable, in Class IV hemorrhage the blood pressure drops dangerously low.

APGAR SCORE

Appearance: 0=blue/pale; 1=blue & pink; 2=no cyanosis-all pink

Pulse Rate: 0=Absent; 1=<100; 2=>100

Reflex: 0=no response to stimuli; 1=grimace; 2=cry or pull away

Activity: 0=None; 1=some flexion,2=flexed arms/legs resisting extension

Respiratory: 0=Absent; 1=weak, irregular; 2=strong, lusty cry

Organs in Upper Right Quadrant of Abs

The liver is found primarily within the boundaries of the upper right quadrant.

Organs in Upper Left Quadrant of Abs

The stomach and spleen are typically found in the upper left quadrant.

Bladder location

The bladder is found on the midline between the lower two quadrants.

Communication "Reflection"

Reflection is a technique where you paraphrase the patient's words to encourage more information and to build trust

Minimum safe residual pressure in oxygen tank is?

The minimum safe residual pressure in an oxygen tank is 200 psi.

Nasal cannula oxygen flow rate

1 to 6L/min

Nasal cannula oxygen concentration

24% to 44%

NRB Flow rate

12 to 15L/min

NRB oxygen delivered

90% to 100%

Venturi mask oxygen delivery

24, 28, 35, 40 percent

BVM flow rate and oxygen delivery

15L /min and nearly 100%

Cheyne-Stokes Respirations

Shows irregular respirations followed by a period of apnea

Ataxic Respirations

irregular, ineffective respirations that may or may not have an identifiable pattern.

ICP (intracranial Pressure) Signs/symptoms

decreased pulse (Bradycardia), increased B/P (Hypertension), irregular respirations.

ICP Defined

Accumulations of blood within the skull or swelling of the brain.

Triad of signs (Cushing's Reflex) are: (Usually seen with ICP)

1. Increased systolic B/P

2. Decreased pulse rate

3. Irregular respirations.

Glascow Comas Scale (GCS) Components;

Eye opening,

Verbal Response

Motor Response

GCS (Eye Opening) Ratings

Spontaneous-4

Verbal response-3

Response to pain-2

None-1

GCS (Verbal Response) Ratings

Oriented Conversation-5

Confused Conversation-4

Inappropriate Words-3

Incomprehensible sounds-2

None-1

GCS (Best Motor Response)

Obeys Commands-6

Localizes Pain-5

Withdraws Pain-4

Abnormal Flexion-3

Abnormal Extension-2

None-1

GCS Scores Total Ratings:

13-15: mild dysfunction; 15 is considered a person with no neurologic disabilities

A oxygen tank which holds 350 liters

D Cylinder (portable)

D Tank (PSI):

2000 psi

Severe allergic reaction signs:

urticaria, bronchosphasm, swelling of lips

Order of assessing a patient after scene size up:

1. Initial assessment

2. Focused Assessment

3. Complete assessment

4. Ongoing Assessment

Ethics:

Philosophy of right and wrong, of moral duties,

CQI

Circular System of continuous internal and external reviews and audits of all aspects of an ems system

General Adaptation Syndrome (stress)

1. Alarm Response

2. Reaction and Resistance

3. Recovery or exhaustion

Fight or Flight Response

The physiologic response involves the interaction of the endocrine and nervous systems.

Pulse rate:adult

60-100

Pulse rate : newborn

140-160

Pulse rate: child(6-12)

65-110

PERL: dilated signs

Cerebral hypoxia, cocaine, Epi, amphetamine

PERL: small eye signs

Narcotic, organophosphate

PERL: Unequal eyes

Brain injury, can be normal

Distended neck veins causes

Tension pneumo, cardiac tamponade , right heart failure

Define Ascites:

Fluid in abdominal cavity

Shock formula

HR (beta-1) X Stroke Volume (beta-2)= CO or BP

Unstable scenes

1. Safety always first

2. Injury

3. Index of suspicion

4. Observe before leaving

Neonatal resuscitation: assess and support

Temperature: warm and dry

Airway: position and suction

Breathing: stimulate to cry

Circulation: HR and color

Neonatal Frequent needs:

Dry, warmth, position, suction, stimulate.

Oxygen

Neonatal moderate needs:

Establish effective ventilation. BVM or endotracheal intubation.

Neonatal infrequent needs:

Chest compressions and medications

Shock symptoms (opposite of ICP)

Hypotension, tachycardia, tachypnea

Uterus location

Lower quadrants if over 3 months pregnant

Uterus location (over 6 months pregnant)?

Upper quadrants

Large and small intestine locations?

Each quadrant

Kidney location?

Upper and lower quadrant: retro peritoneal

Adrenal glands location?

On superior portion of upper quadrant

Amenorrhea

Without period. Sign of pregnancy

Anisocoria

Unequal pupils

Aura

Sensation primo to seizure

Cephalgia

Headache

Dsyconjugate gaze

Unequal eye movement

Embolus emboli

Clot or particle that travels in the blood stream

Emesis

Vomit

Exacerbate

Increase in symptoms or severity of disease

Hematuria

Blood in urine

Hemoptysis

Coughing up blood

Hypoperfusion

Shock symptoms

Hypoxia

Decreased oxygen in blood

Ischemia

Lack of oxygen in tissue/cells

Melena

Black stools

Necrosis

Death of tissue

Orthopnea

Difficulty breathing in flat positions

Paresthsia

Numbness. Can be anywhere even the face

Postictal

Period of regaining consciousness after a seizure.

Subcutaneous emphysema

Air under the skin; crepitus sound

Tinnitus

Ringing in ears. Overdose of aspirin causes this

Thrombus

Blood clot

AED pads placement with medication patch?

Do not place on top of medication patch or directly over defibrillator or pacemaker.

AED "semiautomatic"?

Means operator has to push down to shock after "shock advised" prompt

AED "no shock advised" what to do?

Do CPR for 2 mins with AED and reanalyze.

AED " no pulse or response"?

Always do CAB's then use AED

#1 Way of getting bloodborne disease is?

By sexual intercourse

#1 Way of preventing transmission of diseases is by?

Handwashing

OSHA mandates what?

Workplace safety and bloodborne pathogen procedures

Eustress

Good Stress