EMT Chapters 1-41 Final

Know difference between online and offline orders

given directly by radio or cell phone (online/direct) or indirectly by protocol/guidelines (off-line/indirect), as authorized by the medical director of the service program

What are the stages of death and dying (grieving)?

denial, anger, bargaining, depression, and acceptance

What are the 3 "p" symptoms that diabetics may have?

Polyuria (excessive urine), Polydipsia (excessive thirst), and Polyphagia (excessive eating)

Define bilateral

a body part or condition that appears on both sides of the midline

Define medial

parts of the body that lie closer to the midline; inner structures

Define proximal

closer to the trunk

Define unilateral

one side

Define distal

farther from the trunk or nearer to the free end of the extremity

Define dorsal

posterior (back) surface of the body (back of the hand)

Define ventral

anterior (belly) side of the body

Define supine

lying face up

Define prone

lying face down

What are the differences with a child's airway vs. an adult's airway?

a child's airway is proportionally smaller, with a larger tongue relative to the mouth, a more anteriorly positioned larynx, and the narrowest point being at the cricoid cartilage (below the glottis), while an adult airway is narrowest at the level of the glottis and has a more cylindrical shape; this makes a child's airway more prone to obstruction and requires different airway management techniques

Know the components of the Pediatric Assessment Triangle (PAT)

appearance (muscle tone), work of breathing, and circulation

Know the areas of the spinal column and how many vertebra are in each

Cervial (7), Thoracic (12), Lumbar (5), Sacrum (5), Coccyx (4)

What are the phases of the cardiac cycle, what are the ventricles doing during diastole and systole?

ventricular contraction in an artery with each ventricle (systole); ventricular relaxation with in arteries when left ventricle is at rest (diastolic)

What is the flow of blood through the heart?

Right atrium of heart receives deoxygenated blood from the body via the superior vena cavas, The deoxygenated blood then passes into right ventricle, passing through the Tricuspid valve. Right ventricle sends deoxygenated blood through the Pulmonary valve to lungs via pulmonary artery, Oxygenated blood is sent back to the left atrium of the heart via the pulmonary vein, Oxygenated blood then enters the mitral/bicuspid valve to the left ventricle via inferior vena cava, Blood leaves left ventricle through the Aortic valve and is sent to the body through the aorta

What is the difference between a sign and a symptom?

objective findings that can be seen, heard, felt, smelled, or measured VS subjective findings that the patient feels but that can identified only by the patient

Know abnormal skin parameters and what are causes of each?

cold, pale/flushed, and wet (opposing warm, pink, dry); COLD (poor perfusion or circulation, hypothermia, shock)- PALE/FLUSHED (poor perfusion, Anemia, Anxiety, Pain, Hypoglycemia, Jaundice) - WET (shock, cardiac events, hypoglycemia, heat exhaustion/stroke, sympathetic NS - fight or flight, drugs)

What phase of the cardiac cycle makes up the systolic and diastolic blood pressures?

Systole Contracts & Diastolic Relaxes (BP is the blood forced against the artery walls)

What causes Spina Bifida

by the incomplete closure of the spinal column during embryonic or fetal development, resulting in an exposed portion of the spinal column

What causes Cerebral Palsy

Damage to the developing brain in utero, Oxygen deprivation at birth, Traumatic brain injury, Infection such as meningitis during early childhood

What causes Downs Syndrome

increased maternal age, Trisomy 21; a genetic chromosomal defect that can occur during fetal development

What are normal vitals for an adult, child, and infant?

Pulses (60-100, 80-140, 85-205) Respirations (12-20, 12-40, 30-60) BP Systolic (90-120, 85-130, 70-105)

What are your first steps once you come upon an MCI?

If there are multiple patients and not enough resources to handle them without abandoning victims, you should - Declare an MCI, Request additional resources, and Initiate the ICS and triage procedures

When do you declare a MCI?

Involves three or more patients; Places great demand on the EMS system; Has the potential to produce multiple casualties; not enough resources to handle them without abandoning victims

What are the causes of Septic Shock? What are the corresponding signs and symptoms?

causes are - severe infection (usually bacterial), dilating blood vessels, dropping BP, and decreased perfusion; high HR, high fever, mottled skin

What are the causes of Neurogenic Shock? What are the corresponding signs and symptoms?

causes are - circulatory failure by paralysis of the nerves that control the size of the blood vessels, leading to widespread dialation (in spinal cord injuries), drop in BP, and decreased perfusion; increased HR, shunted blood to vital organs, lack of nerve impulses below injury, absent sweating below injury, hypotension, low HR, and failure to control tempurature

What are the causes of Cardiogenic Shock? What are the corresponding signs and symptoms?

causes are - weakened heart muscles as a result of a heart attack/other conditions and very fast/slow HR preventing blood flow, dropping BP, and diminished perfusion; edema causing swelling, impaired respirations, abnormal lung sounds (normally wet), "feel like drowing", low BP, irregular pulse, cyanosis (lips/fingers), anxiety, nausea

What are the causes of Anaphylactic Shock? What are the corresponding signs and symptoms?

causes are -severe allergic reaction, dialating blood vessels, dropping BP, and decreased perfusion; cyanosis is a late sign, uticaria (hives), cool/clammy skin, tachycardia, severe respiratory distress, and hypotension

What are the "rights" of medication administration?

right patient, right medication and indication, right dose, right route, right time, right education, right to refuse, right response and evaluation, right documentation

What medications can the EMT assist a patient with taking? What are the routes?

Albuterol (inhalation), Aspirin/Baby Aspirin (PO), Diphenhydromine (PO), Epinephrine (IM), Glucagon (IN/IM), Ipratropium/ Atrovent (Inhalation/IN), Nalaxone (IM/IN), Nitroglycerin (Sublingual), Oral Glucose (PO), Oxygen (Inhalation), Ondansetron/Zofran (ODT)

Epinephrine Action/Indication

main hormone that controls fight-or-flight response, controlled by Sympathetic Nervous System, increases heart rate and B/P by constricting blood vessels, dilates the air passages in lungs to help with bronchial spasms during asthma and anaphylaxis reactions, acts as an antidote to reverse effects of histamine

Epinephrine Dosage

0.3mg for Adult; 0.15mg for Child

Epinephrine Contradictions/Considerations

do not give to patients with hypertension, hypothermia, or suspected MI

Oral Glucose Action/Indication

gel form sugar, given orally, that cells use for energy, treats hypoglycemia, extremely low blood sugar; A simple sugar that is readily absorbed by the bloodstream; it is carried on the EMS unit

Oral Glucose Dosage

1 tube (15 grams)

Oral Glucose Contradictions/Considerations

do not give to an unconscious patient or one who cannot protect the airway, must have a gag reflex to take, use caution in those who are not able to swallow well or who may quickly lose consciousness; unconsciousness, seizures, and possible death can occur if the body doesn’t get sugar

Nitroglycerin Action/Indication

administration of tablets or spray, used for patients having chest pain, will cause vasodilation (opening of the arteries), causing a drop in B/P and headache *Aging and improper storage may affect potency, note any findings in your report

Nitroglycerin Dosage

1 tablet/spray = 0.4mg

Nitroglycerin Contradictions/Considerations

systolic must be over 100, should not be used within 24 hours of erectile dysfunction medications, may cause mild headache/slight tingling. Possibility a MI, if no relief

Aspirin Action/Indication

given for patients with chest pain, inhibits platelet aggregation (thins blood), useful during heart attack

Aspirin Dosage

81mg tablets (4) by mouth, chewed

Aspirin Contradictions/Considerations

hypersensitivity to aspirin, liver damage, bleeding disorder, asthma, should not be given to children

Oxygen Action/Indication

administered as a gas for inhalation, reverses hypoxia, ignites easily; A gas that all cells need for metabolism; the heart and brain, especially, cannot function without oxygen

Oxygen Dosage

Nasale Canula 2-6 L/m (24-44%) Non-rebreathing mask 10-15 L/m (90%) Bag-Valve Mask 15 L/m (100%)

Oxygen Contradictions/Considerations

ignites easily, requiring caution near sources of ignition

Naloxone/Narcan Dosage

2mg IN (half dose each nostril)

Naloxone/Narcan Action/Indication

used to reverse the effects of an opioid overdose

Naloxone/Narcan Contradictions/Considerations

consult MD, effects may not last as long as opioids, repeated doses may be necessary, can cause severe withdrawal symptoms, consider your safety; side effects

What form of shock most likely occurs due to severe burns? Why does it occur?

Hypovolemic Shock; Result of an inadequate amount of fluid or volume in the circulatory system, Dehydration - the loss of water or fluid from body tissues can cause or aggravate shock

What are the indications for CPAP?

Patient is alert and able to follow commands; Patient displays obvious signs of moderate to severe respiratory distress; (COPD, CHF, Fluid in lungs following submersion incident); Patient is breathing rapidly >26 min; Pulse oximetry reading is less than 90%

What are the contraindications for CPAP?

Patient in respiratory arrest; Patient is hypoventilating; Patient cannot speak; Patient is unresponsive or cannot follow verbal commands; Patient cannot protect his or her airway; Patient has hypotension (due to CPAP increasing pressure in chest, amount of blood flow to heart is reduced)

What is a nuchal cord? How do you treat it?

umbilical cord wrapped around the fetus' neck; attempt to slip over the head/shoulder, if not possible then place clamps 2 inches apart and cut

What are the 3 stages of labor and delivery?

(1) dialation of the cervix (2) delivery of the fetus (3) delivery of the placenta

What is the difference between placenta previa and abruptio placenta?

PP - condition in which the placenta develops over and covers the cervix, usually not painful with heavy bleeding; AP - premature seperation of the placenta from the wall of the uterus, usualy severe pain with minimal bleeding

What are the two most common types of stroke?

ischemic or hemorrhagic; blood flow through the cerebral arteries is blocked or blood vessel ruptures and the accumulated blood causes increased pressure in the brain

Know the correct compression and ventilation ratios for adult and infant CPR

Adult (30:2), Infant (15:2 or 30:2 if single rescuer)

What types of patients are triaged Green, Yellow, and Red?

Minimal (no field treatment or minimal, walking wounded), Delayed (need treatment and transport, multiple injuries but no spinal injury), and Immediate (first priority, immediate care and transport, problems with ABC's/head trauma/signs and symptoms of shock)

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

Type 1 - autoimmune disorder in which the immune system produces antibodies against the pancreatic beta cells, missing the pancreatic hormone insulin, in which the insulin is the key to the door of the cell, and without insulin glucose cannot enter the cell, therefore not producing energy; Type 2 - caused by resistence to the effects of insulin at the cellular level, the lock is unable to accept the key, where there is fewer insulin receptors *obesity

What is the function of insulin in the body?

necessary for glucose to enter the cells for metabolism, regulates energy supply, controlling blood sugar, promotes glucose storage

What is the difference between eclampsia and pre-eclampsia?

Eclampsia is lead from pre-eclampsia and is characterized by life threatening seizure, Pre-eclampsia is pregnancy induced hypertension (edema of the hands/feet/face, protein in the urine, visual disturbances, headache, and anxiety)

What are the signs and symptoms of hypoglycemia?

Normal to shallow or rapid respirations; Pale, moist skin; Diaphoresis; Dizziness, headache; Rapid pulse; Normal to low blood pressure; Altered mental status; Anxious or combative behavior; Seizure, fainting, or coma; Weakness on one side of the body; Rapid changes in mental status

What are the signs and symptoms of hyperglycemia?

Long term - Wounds that do not heal, Numbness in the hands and feet, Blindness, Renal failure, Gastric motility problems (HHNS - Altered mental status, drowsiness, lethargy, Severe dehydration, thirst, dark urine, Visual or sensory deficits, Partial paralysis or muscle weakness, Seizures)

Snoring lung sounds

upper airway obstruction, usually tongue, does not require stethascope

Stridor

airway obstruction in upper neck or upper part of the chest, brassy and crowing sound heard on inspiration, often heard before listening with a stethascope

Wheezing

obstruction or narrowing of lower airway, high pitched whistling sound on expiration, heard through auscultation

Crackles

wet sounds (inspiration and expiration), indicates possible fluid in lungs, alveoli are popped open (rice krispies in milk)

Rhonchi

congested breath sounds, suggest mucus or fluid in lungs, low pitched - noisy sounds heard on expiration, associated with cough (blowing bubbles under water)

What is excited delirium, and the signs that accompany it?

serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations, or delusions; agitated delirium/exhuastive mania; signs that accompany it include hyperactive irrational behavior with possible vivid hallucinations, causing potential violent behavior - hypertensions, hyperthermia, tachycardia, diaphoresis, and dialated pupils

Define Index of Suspicion

awareness that unseen life threatening injuries may exist when determining the mechanism of injury

Define Mechanism of Injury

the forces, or energy transmission, applied to the body that cause injury

Define Kinetic Energy

the energy of a moving object

Define Potential Energy

the product of mass, gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall

What should an EMT assume with occupants, when there is a death in the passenger compartment of a vehicle?

your index of suspicion increases, and the damage suggests the prescence of high energy trauma and that passengers likely experienced the same amount of force that caused the death of the others; consider transporting to a trauma center

What is the function of Capillaries?

the oxygen is offloaded from red blood cells to produce energy; the small blood vessels that connect arterioles and venules; various substances pass through the capillary walls, into and out of the interstitual fluid, and then on to the cells

What is the function of Venules?

oxygen poor blood enters the system of veins, starting with the venules, on its way back to the heart; very small, thin walled blood vessels (the smallest branches of veins)

What is the function of Veins?

the blood vessels that carry blood from the tissues to the heart; the right side of the heart receives oxygen poor blood from these

What is the function of Arterioles?

leads to the body's capillary network; the smallest branches of arteries leading to the vast network of capillaries

What is the function of Arteries?

carry blood from the heart to all body tissues; the left side of the heart supplies oxygen rich blood to these

Define hemoptysis

the coughing up of blood

Define hematemesis

vomiting blood

Define hematuria

blood in the urine

What are the signs of hyperglycemia?

Polyuria (excessive urine), Polydipsia (excessive thirst), and Polyphagia (excessive eating)

What is assessed during the Primary Assessment?

identifying and begining treatment of immediate or imminent life threat (examine LOC and XABC's without assessing vitals)

What are the function of the skin?

(1) protects the body from the environment (2) maintain normal body tempurature (3) transmit sensory information [touch/pain/pressure/temp] from the environment to the brain

Neonatal age range

birth-1 mo.

Infant age range

1 mo.-1 yr

Toddler age range

1-3 years

Preschoolers age range

3-6 years

School age - age range

6-12 years

Adolescent age range

12-18 years

Define Avulsion

an injury in which soft tissue is torn completely loose or is hanging as a flap

Define Contusion

a bruise from an injury that causes bleeding beneath the skin without breaking the skin; ecchymosis

Define Abrasion

loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface; superficial wound (scraping your knee)

Define Hematoma

a mass of blood that has collected within damaged tissue beneath the skin or in a body cavity

What is the proper care for a patient with an abdominal evisceration?

place a sterile dressing moistened with normal saline over the wound, apply a bandage, and transport while keeping it warm and moist (never attempt to push evisceration back into the cavity)

What is Pneumothorax? What are signs and symptoms the patient may experience?

an accumulation of air or gas in the pleural cavity; dyspnea, chest pain, sharp/stabbing pain in one side that is worse on inspiration/expiration or with certain movements, possible breath sounds are absent or diminished; other signs include hypotension, jugular vein distention, and cyanosis

What is Tension Pneumothorax? What are signs and symptoms the patient may experience?

accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and that interferes with cardiac function, with potentially fatal results; trapped air shift the chest organs toward the uninjured side, reduced blood return to the right side of the heart resulting in a low BP, progressively worse in difficulty breathing, heart difficulty pumping, difficulty in ventilation with BVM, absent lung sounds on the affected side, may be cyanotic (tracheal deviation is late sign)

What is Hemothorax? What are signs and symptoms the patient may experience?

collection of blood in the pleural cavity; signs and symptoms of shock without any obvious external bleeding or apparent reason, decreased breath sounds on the affected side