EMT Final Exam practice

cardiogenic shock

cardiogenic shock

-the type of shock caused by inadequate function of the heart. This develops when the heart cannot maintain sufficient output to meet the demands of the body

-caused by any disease or event which prevents heart pumping

-can occur directly after AMI up to 24 hours

Obstructive shock

The type of shock that results when conditions that cause mechanical obstruction of the cardiac muscle also impact pump function

ex. cardiac tamponade, tension pneumothorax

Beck's triad

Signs of a cardiac tamponade. JVD, narrowing BP pressures, muffled heart sounds

Distributive shock

The type of shock when there is widespread dilation of the small arterioles, venules, or both. Blood pools in the expanded vascular beds and tissue perfusion decreases

Types of distributive shock

Septic shock caused by severe infections; neurogenic shock caused by damage to the spinal cord (bradycardia, low BP, warm skin); anaphylactic shock caused by allergic reaction; psychogenic shock

Hypovolemic shock

The type of shock that results from an inadequate amount of fluid or volume in the system

-15% of blood volume

How do you treat for shock?

Keep the patient warm, control bleeding, put the patient in a position of comfort, and administer high-flow oxygen

brain damage without oxygen

-without enough oxygen, cardiac arrest or brain damage occurs within about 4 minutes

-permanent brain damage within 6 minutes

-death likely within 10 minutes

FBAO

-signs of blockage include inability to cough or speak or inability to ventilate patient

-bending patient forward at the waist, support chest with one hand, use heel of hand to give 5 back blows between shoulder blades

-then 5 abdominal thrusts

-alternate between the two until object is dislodged

-if patient loses consciousness, give CPR starting with chest compressions

-given even if patient has a pulse, so don't check

-before giving breaths, look inside mouth for any visible objects

FBAO in children

-using thigh for support, lay facing down along forearm; ensure head is lower than the body

-give 5 firm back blows between blades

-5 chest thrusts; place 2 to 3 fingers in the middle of the chest just below the nipples. push down 1.5 inches.

-alternate, unless lose consciousness, then CPR

mouse to mouth/mouth to nose

-mouth to mouth performed when patient does not have adequate breathing and artificial ventilation not available

-open airway

-place barrier device

-pinch nose and form seal around patient's mouth

-check for FBAO if you do not see chest rise and fall

-give 1 breath every 5 to 6 seconds for adults and 1 every 3 for peds

Steps of CPR

Determine unresponsiveness. Check for breathing for up to 10 seconds. Check carotid pulse for up to 10 seconds. Begin CPR until AED is available. Give 30 compressions at 100 beats/min and then 2 breaths over the course of 1 second. Once an advanced airway is inserted, ventilate at a rate of 8-10 breaths/min and do not stop compressions.

This is exactly the same for children, except two-rescuer CPR is 15:2. If patient experiences a return of spontaneous circulation, ventilate at a rate of 10-12 breaths/min.

compression to breath ratios

under 8 years old:

-2 provider: 15:2

-1 provider: 30:2

-one third of chest diameter

older:

-30:2 always

-2 inches

AED procedure

-if cardiac arrest was not seen by EMS, give 5 cycles of 30:2 before defibrillating

-if cardiac arrest was seen, one EMT begins compressions and the other applies AED

-if only one EMT available, apply AED immediately

-check for pulse 2 minutes after defib

-if no shockable rhythm, wait 2 minutes and re-analyze

When to place left lateral

If patient has adequate breathing and is uninjured. To maintain a patent airway in an unresponsive patient.

What to do if you fail to ventilate

If the breath doesn't go in successfully, reposition the patient and try again. If there is still nothing, assume there is a foreign body obstruction and begin CPR on an unresponsive apneic patient. Continue to attempt ventilations and open the mouth and look in every time.

Pneumothorax signs

-dyspnea, pleuritic chest pain that worsens during inspiration and expiration, absent or decreased breath sounds

-rupture of visceral lining

Pulmonary embolism signs

-dyspnea, acute chest pain, hemoptysis, cyanosis, tachypnea, hypoxia, tachycardia?**

GCS Eye Opening

Spontaneous = 4

To voice = 3

To pain = 2

None = 1

GCS Verbal Response

Oriented = 5

Confused = 4

Inappropriate words = 3

Incomprehensible words = 2

None = 1

GCS Motor Response

Obeys commands = 6

Localizes pain = 5

Withdraws (pain) = 4

Flexion (pain) = 3

Extension (pain) = 2

None = 1

Rule of nines (adults)

Head = 9%

Front = 18%

Back = 18%

Each arm = 9%

Groin = 1%

Each leg = 18%

Rule of nines (child)

Head = 18%

Front = 18%

Back = 18%

Each arm = 9%

Each leg = 14%

Cushing's triad

Sign there might be an increase in intracranial pressure. Hypertension, bradycardia, and abnormal breathing.

Appendicitis pain

-pain to the RLQ

-rebounding pain

-fever

peritonitis

-inflammation of peritoneum

-abdominal pain, lack of appetite, markle test

markle heel drop

markle test; used to assess a patient with abdominal pain, patient drops down onto heels, pain will be felt in region of pain source

cholecystitis pain

RUQ pain, referred to the right shoulder

gastrointestinal bleeding

-hematemesis

-hematochezia (blood in stool)

-melena (dark, tarry stool)

esophageal varices

-weakening of blood vessels in esophagus

-alcoholism

-vomiting large amounts of bright red blood

Aortic aneurysm pain

Lower back and lower quadrants pain; tearing

Mallory Weiss syndrome

When the junction between the esophagus and the stomach tears. Alcoholism and eating disorders can cause this

Three P's of diabetes

Polyuria, polyphagia, and polydipsia. When the patient has hyperglycemia, glucose is excreted by the kidney and the process requires a large amount of water.

DKA

Without glucose in the cells, the body will break down fat. When fat is used as an immediate energy source, chemicals called ketones and fatty acids are formed as waste products and are hard for the body to excrete

signs: Kussmaul respirations, vomiting, abdominal pain, tachycardia

Kussmaul respirations

Help the body blow off excess acids (CO2) which are deep, rapid breaths

Signs of hyperglycemia

gradual onset, warm and dry skin, fruity breath, Kussmaul respirations (rapid and deep), restlessness, slurred speech, gradual response to treatment, diabetic coma

Diabetic coma

Or hyperglycemic crisis. A state of unconsciousness resulting from ketoacidosis, hyperglycemia, and dehydration