When a patient is placed on a long backboard, which of the following areas is secured first?

ICS roles:

• Incident Commander

• Triage Officer

• Staging Officer

• Incident Commander = command role

• Triage Officer = patient care role

• Staging Officer = support/logistics role

Common LOWER airway pediatric infections

• Pneumonia

• Bronchiolitis

• RSV

RSV: classic patient

• Infant or young child

• Bronchiolitis

• Wheezing

• Increased work of breathing

• Copious secretions

Renal calculi signs

KIDNEY STONES

• severe flank pain

• radiates to groin

• restless patient

• hematuria possible

Pancreatitis signs

• epigastric pain radiating to back

• nausea/vomiting

• worse after eating/alcohol

CPAP indications

• COPD exacerbation

• pulmonary edema/CHF

• pneumonia with respiratory distress

compartment syndrome symptoms

• tenderness

• pain

• numbness

Liver/gallbladder referred pain location?

Right shoulder

Diaphragm irritation can cause pain where?

Shoulders (referred pain)

Treatments for a patient with pulmonary edema from Congestive Heart Failure (CHF)?

• nitro

• CPAP

• supplemental oxygen

Liver vs spleen referred pain

Liver → right shoulder
Spleen → left shoulder

Stable seated MVC patient needing SMR (Spinal Motion Restriction) extrication?

Short backboard/KED for vehicle extrication

Unresponsive patient with severe foreign body airway obstruction → treatment?

Start CPR/compressions

How to prevent gastric distention during bag-valve mask ventilation?

Deliver each breath slowly over 1 second with only enough volume for visible chest rise

Chemical suicide commonly releases what gases?

• Hydrogen sulfide

• Hydrogen cyanide

Acute myocardial infarction vs pulmonary embolism

Acute myocardial infarction:

• crushing/radiating pain

• diaphoresis

• nausea

Pulmonary embolism:

• pleuritic pain

• clear lungs

• hemoptysis

• sudden dyspnea

Systemic vascular resistance

The resistance blood encounters as it flows through blood vessels.

• Vasoconstriction ↑ SVR

• Vasodilation ↓ SVR

organophosphate poisoning

Found in:

• Pesticides

• Nerve agents

Think: SLUDGEM + Miosis + Wheezing

organophosphate poisoning signs

• Vomiting

• Diaphoresis

• Excessive urination

Addison's disease

Endocrine disorder in which the adrenal glands do not produce enough hormones: weakness, weight loss, low blood pressure

Thyroid storm

Endocrine emergency—extreme overactivity of the thyroid gland

• fever

• rapid heart rate

• hypertension,

• agitation

Cholelithiasis

Gallstones, which are hardened deposits that form in the gallbladder or bile ducts

EMS provider levels in order

First Responder/EMR → EMT → Advanced EMT → Paramedic

Upper GI bleed: Most common causes?

Ulcer → Erodes a blood vessel

Varices → Ruptured esophageal veins

Mallory-Weiss → Tear after forceful vomiting

Lower gastrointestinal bleed causes

• hemorrhoids (Swollen veins in rectum/anus)

• ulcerative colitis (Inflammation of colon lining)

• diverticulosis (Small pouches in colon wall)

APGAR — Appearance scoring

0 = blue/pale all over
1 = body pink, hands/feet blue
2 = completely pink

By which route is an auto-injectable syringe of epinephrine administered?

Parental (via injection or infusion)

Amphetamine/stimulant overdose signs

• hypertension

• tachycardia

• agitation

• dilated pupils

Semi-Fowler position is used for?

Breathing difficulty/respiratory distress

Effects of positive pressure ventilation

Increases intrathoracic pressure and decreases blood return to the heart (preload)

Lower airway lung sounds

Crackles (rales), wheezing, rhonchi

Upper airway sounds

Snoring respirations and stridor

Abruptio placentae vs uterine rupture

Abruptio placentae = painful bleeding/rigid abdomen
Uterine rupture = tearing pain and contractions suddenly stop

Dirty bomb vs biological agent

Dirty bomb = radiation exposure
Biological agent = infectious disease exposure

Activated charcoal is NOT used for?

Acids, alkalis/corrosives, inhaled poisons

SLUDGEM

Used to recognize organophosphate (cholinergic) poisoning

Salivation
Lacrimation
Urination
Defecation
Gastric upset
Emesis
Miosis (pinpoint pupils)

Grey-Turner sign

Bruising/flank discoloration from internal abdominal bleeding or pancreatitis

Murphy’s sign

Pain when breathing in during RUQ palpation → gallbladder inflammation (cholecystitis)

Neurogenic shock signs

Warm flushed skin, bradycardia, hypotension

cholecystitis

Inflammation of the gallbladder, usually associated with gallstones, causing abdominal pain and potential infection.

Cholecystitis signs

• Right upper quadrant pain

• right shoulder pain

• bloating/indigestion

• pain after fatty foods

Hepatitis signs

Right upper quadrant pain, jaundice/yellow skin, fatigue, nausea, decreased appetite

Signs of increased work of breathing in pediatrics

Head bobbing, tachypnea, nasal flaring

Hypovolemic shock positioning

Supine position

A 72-year-old patient complains of right upper quadrant abdominal pain and general malaise. On examination, you observe yellowing of the skin and sclera. What is the most likely cause of these symptoms?

Hepatitis (an inflammation of the liver)

Peripheral capillary cellular exchange

O₂ leaves capillaries → enters cells
CO₂ leaves cells → enters capillaries

Which anatomical structure marks the end of the upper airway and the beginning of the lower airway?

Larynx

Opioids vs stimulants overdose

Opioids (fentanyl, heroin):

• Pinpoint pupils

• Respiratory depression

• Decreased LOC

Stimulants (cocaine, meth, MDMA):

• Dilated pupils

• Tachycardia

• Hypertension

• Agitation

General impression: no pulse patient

No pulse = cardiac arrest

Which is the correct anatomic placement for lead V1?

fourth intercoastal space at the right sternal border

JumpSTART: Apneic child after airway repositioning but pulse present?

Give 5 rescue breaths → reassess breathing → assign category

ICS Command Staff positions

P-I-S

• Public Information Officer

• I Liaison Officer (Interagency liaison)

• Safety Officer

ICS General Staff positions

Operations

Planning

Logistics

Finance/Administration

ICS Sections

Operations

Planning

Logistics

Finance

Operations = Do

Planning = Think

Logistics = Supply

Finance = Pay

12-lead ECG chest lead placement

V1 = 4th ICS, RIGHT sternal border

V2 = 4th ICS, LEFT sternal border

V3 = between V2 and V4

V4 = 5th ICS, midclavicular line

V5 = anterior axillary line, level with V4

V6 = midaxillary line, level with V4

Vesicular breath sounds

considered normal and do not indicate any form of respiratory inadequacy, distress, or failure

Nitroglycerin action

_____

dilates ______

increases _____

decreases _____

Vasodilator

• Dilates coronary arteries

• Increases blood flow to heart

• Decreases workload of heart

Nitro vs Albuterol vs Epinephrine vs Aspirin

Nitro = vasodilator

Albuterol = bronchodilator

Epinephrine = vasoconstrictor + bronchodilator

Aspirin = antiplatelet

Which are components of blood? 

Red blood cells, white blood cells, platelets, plasma, erthrocytes

Vagus Nerve Stimulation (VNS) is to…

to break episodes of Supraventricular Tachycardia (SVT) or to stop active epileptic seizures in patients with a history of implanted devices.

Common OTC medications

Aspirin

Ibuprofen (Advil, Motrin)

Acetaminophen (Tylenol)

Diphenhydramine (Benadryl)

Sphygmomanometer sizing

(BP cuff)

1–1.5 arm circumferences

2/3 length from armpit to elbow

Abruptio placentae vs placenta previa

Abruptio placentae

= Painful bleeding

= Rigid/tender abdomen

= Severe abdominal pain

Placenta previa

= Painless bleeding

= Soft abdomen

CPAP complications

• Less venous return → Hypotension

• Air enters stomach → Gastric distention

• Tight mask → Claustrophobia/intolerance

CHF vs COPD

CHF:

• Crackles

• JVD

• Peripheral edema

• Pink frothy sputum

• Orthopnea

COPD:

• Wheezing, rhonchi

• Barrel chest, thin, "pink puffers”

• Prolonged exhalation

• Accessory muscle use

Definitive signs of a fracture

• Deformity

• Crepitus

• False motion

• Exposed bone (open fracture)

What do you reassess after every intervention?

• ABCs

• Chief complaint

• Response to treatment

• Vital signs

Which biological toxin is easily produced and can cause severe respiratory failure and pulmonary edema when inhaled?

Ricin

• Derived from castor beans

• Highly toxic

• Can be aerosolized as a powder

• Causes respiratory failure and pulmonary edema

What systolic blood pressure is needed to palpate major pulses?

• Carotid pulse

• Femoral pulse

• Radial pulse

• Femoral pulse ≈ 70 mmHg

• Radial pulse ≈ 80–90 mmHg

• Carotid pulse ≈ 60–70 mmHg

AMI vs Aortic Dissection?

AMI: Crushing chest pain + irregular rhythm

Aortic Dissection: Tearing chest pain → back + unequal/absent pulses

signs/symptoms of preeclampsia?

• Protein in urine

• swelling of the hands and feet

• headaches

What findings suggest a possible cervical spine injury?

• Altered mental status

• Loss of movement/sensation in extremities

• Neck pain, tenderness, deformity, or spasm

Abandonment vs Negligence

Abandonment

• Ending care without transferring care to someone with equal or higher training.

• Example: EMT leaves a patient before another provider takes over.

Negligence

• Failure to provide the standard of care, causing harm.

• Example: Failing to give oxygen when it is clearly indicated.

Cardiac compromise

any condition that prevents the heart from pumping blood and oxygen adequately to the rest of the body

Acute peritonitis symptoms

• Fever

• Rebound tenderness

• Rigid abdomen

Findings suggesting worsening splenic rupture/internal abdominal bleeding?

• Increasing left shoulder pain (Kehr's sign)

• Increasing abdominal distention

• Rigid abdomen

• Signs of shock (tachycardia, hypotension)

Which arteries supply the upper extremities?

Subclavian arteries

What is Crew Resource Management (CRM)?

Improves:

• Team communication

• Team coordination

• Situational awareness

• Decision-making

tuberculosis

airborn infection primarily affecting the lungs

What is urticaria?

Hives:

• Raised wheals

• Itchy (pruritic)

• Blanching

• Allergic reaction finding

tPA for ischemic stroke: strongest evidence for symptom reversal within what timeframe?

Within 3 hours of symptom onset

GHB overdose: What are the key findings?

GHB = CNS depressant

↓

Brain slows down

↓

Respiratory drive decreases

General CPAP candidate criteria?

Moderate to severe respiratory distress

SpO₂ < 90%

Able to tolerate and maintain mask

Signs of ectopic pregnancy?

• Early pregnancy (1st trimester)

• Vaginal bleeding

• Unilateral lower abdominal pain

• Signs of shock (tachycardia, hypotension, pallor)

By age 80, approximately what percentage of vital capacity remains?

~50% of a young adult's vital capacity

What does National Highway Traffic Safety Administration (NHTSA) provide for EMS?

EMS Education Standards

What is cardiac automaticity?

The ability of cardiac cells to generate electrical impulses without nervous stimulation.

Automaticity = heart beats on its own

How is a suspected hip fracture immobilized for transport?

Scoop stretcher with pillows/padding

Classic signs of preeclampsia?

• Hypertension

• Severe headache

• Blurred vision

• Proteinuria

• Edema (hands/face)

High-speed deceleration → Think?

Traumatic aortic rupture

Primary vs Secondary vs Tertiary vs Quaternary Blast Injuries

Primary = Pressure (ears, lungs)

Secondary = Shrapnel (penetrating trauma)

Tertiary = Thrown (blunt trauma)

Quaternary = Burns/toxins/crush injuries

______________________________

Primary = Pressure → Air-filled organs

Secondary = Shrapnel → Penetrating trauma

Tertiary = Thrown → Blunt trauma/fractures

Quaternary = Quite everything else → Burns, inhalation, crush

hypertensive emergency symptoms

“worst headache,”

altered mental status

Ringing in ears

epistaxis

Primary Blast Injury (pressure wave) most affected organs

• Lungs

• Middle ear

• GI tract

What is anisocoria?

Unequal pupil size

perfusion triangle three components:

heart (pump), blood vessels (container), and blood volume (fluid).

Opioid overdose: causes Hyperventilation or Hypoventilation

Hypoventilation

Pulmonary embolism: breathing pattern

Tachypnea (hyperventilation)

Why?

Less oxygen from blocked pulmonary blood flow

↓

Patient breathes faster to compensate

Beck’s triad

hypotension, jugular vein distension, and muffled heart sounds.

Abdominal quadrants and associated organs?

RUQ → Liver, Gallbladder, kidney, pancreas

LUQ → Spleen, liver, stomach, pancreas, kidney

RLQ → Appendix, small intenstines

LLQ → Sigmoid colon, small intestines

Intrinsic vs Extrinsic airway obstruction

Intrinsic (inside airway)

• Tongue obstruction

• Airway swelling (allergic reaction)

• Airway swelling (infection)

Extrinsic (outside airway)

• Foreign body (food)

• Facial/mandible trauma