EMT Final Exam

When to start CPR in a pediatric patient - right away vs. calling 911 first

If you find an unresponsive, apneic and pulseless child perform 5 cycles of CPR or 2 minutes worth before calling 911 and finding an AED. Pediatric cardiac arrest is most often is caused by respiratory failure, providing immediate CPR will immediately restore oxygenation, ventilation and circulation.

If a non respiratory distressed child suddenly collapses and you witness it, call 911 and find an AED before beginning CPR.

Implied consent and how it effects life threatening pediatric calls

When a parent or guardian is unavailable, emergency care can be provided. In school or camp settings teachers and school officials can act IN LOCO PARENTIS, or in place of a parent. Parents or guardians must be contacting ASAP, life-saving care will be provided however other interventions at the hospital may be delayed.

Minors can be legally treated as adults if they are emancipated, these conditions include, if they are married, members of the armed services, parents which also means they can provide consent for their child, and minors living away from and no longer relying on his or her parents for support.

Emergency move vs. an Urgent move

An emergency move is done before assessment and care are provided in the presence of a life-threat or inability to gain access to others who requires life-saving care.

An urgent move is done after your primary assessment for patients discovered to present w/ ALOC, inadequate ventilations, shock or extreme weather conditions.

The B’s for Bagging, when do you ventilate? Which pt’s need ventilation immediaetely

Blue, Bradypnea and Bad breathing

Ventilate when pt’s are in severe respiratory distress or failure and are not breathing adequately.

signs of inadequate ventilation include ALOC and reduced tidal volume. in addition, excessive accessory muscle use and fatigue from labored breathing are signs of potential respiratory failure.

epinephrine indications, contraindications, actions, side-effects and repeat doses

Indicated for anaphylaxis, contraindicated for chest pain of cardiac origin, hypothermia or hypertension.

action: Alpha 1, Beta 1 and 2 agonist causing vasoconstriction, increase HR and contractility along w/ bronchodilation

Side-effects include HTN, tachycardia, anxiety and restlessness

If S&S do not palliate within 5 minutes of first dose consider administering a second and final dose.

Doses are 0.3 mg for adults and 0.15 mg for children.

Acidosis vs alkalosis, which is associated with hyperventilation.

The body wants to remain near neutral at 7.35 to 7.45 potential of hydrogen (pH) level.

oxygen is neutral and carbon dioxide is acidic, the medulla oblongata (a portion of the brainstem) senses the pH changes. If too acidic (too CO2 concentrated) the medulla oblongata stimulate the phrenic nerve which innervates the diaphragm and provides the signal to increase it’s rate of contractions, subsequently increasing RR which expels CO2 and lowers acidity raising the pH.

Hyperventilation causes the body to expel excessive CO2 lowering the acidity superfluously which raising pH to an alkaline state.

When do you transport a full arrest patient who is receiving CPR and defibrillation (local and national)

Pt achieves ROSC

6-9 shocks have been delivered (or as directed by local protocol)

The AED gives 3 consecutive messages (separated by 2 minutes of CPR) that no shock is advised on a pulseless patient (or as directed by local protocol)

What is glucagon? what does it do? How is it used as a medication?

Glucagon is a hormone. A small portion of the pancreas is filled with the islets of Langerhans which houses alpha cells that produce glucagon and beta cells that produce insulin. When the body is hungry and a person skips a meal, inadvertently failing to raise their glucose level, the pancreas excretes glucagon from its alpha cells. When released, glucagon stimulates the liver and skeletal muscles to release glycogen (stored form of glucose) and convert it back to glucose for cellular fuel.

All hypoglycemic patients (<80 mg/dL, <50 is a crisis) require exogenous glucose which can be given PO by EMTs with oral glucose if they are alert and able to protect their airway. If ALS is present glucagon or glucose can by injected.

Different pupil configurations and what they mean (constricted, dilated, uneven, blown or sluggish)

uneven pupils after a head injury in an unconscious person can be caused by developing clots compressing the brain. The ipsilateral pupil will dilate due to the compression. changes in reaction over time indicate worsening brain injury.

Pupils should constrict with the introduction of light and dilate when its removed.

Blown and sluggish eyes may indicate CNS depressants or possible increased ICP.

Miosis (pinpoint pupils) is a sign of organophosphate poisoning.

some people have naturally occurring anisocoria (uneven pupils)

A pt with a blow-out fracture (break in the orbit and its floor that supports the globe of the eye) may not move their eyes together because of muscle entrapment, pts may have double vision.

Vital signs and GCS criteria for transport to the highest level of trauma center available.

Preferentially, pts presenting with a GCS of at or below 13, < 90 systolic,<10 or >29 RR (<20 in infants aged <1) or need for ventilatory support.

what three kinds of wounds require an occlusive dressing? Which of those also require you to apply direct pressure above and below the wound? Which requires a moistened dressing?

Penetrating wounds to the neck require occlusive dressing to prevent an air embolism and if direct pressure in inadequate then apply pressure above and below the injury site.

all penetrating traumas to the chest should have a vented chest seal or occlusive dressing taped on three sides to allow air out but not in. Pt should be monitored closely for signs of a tension pneumothorax such as poor compliance during ventilation, be prepared to “burp” the dressing.

if an evisceration is discovered, place a sterile dressing moistened with saline over the wound, apply a bandage and transport.

Pneumothorax vs. hemothorax - mostly the same S&S, but what would help you differentiate between them?

pneumothorax is an accumulation of air in the pleural space while hemothorax is blood.

suspect a hemothorax if a pt presents with S&S of shock without any obvious external bleeding or apparent reasons for the shock state, or pts with decreased breath sounds on the affected side.

pneumothorax may still present as diminished ipsilateral breath sounds (occurring with a lung collapse of %30-%40) but in some instances if the hole is in the chest wall you may hear a sucking sound on inhalation and a rushing sound on exhalation. this is referred to as a open pneumothorax or sucking chest wound.

How many people do you ideally need for splinting? what should you check before and after splinting? when it comes to elbows and knees, what extra rules are followed and when can you straighten or not straighten an elbow or knee? what do you do if you encounter resistance while straightening a limb for splinting?

You need 2 people for splinting. You should check pulse, motor and sensory status before and after splinting.

When it comes to elbows and knee injuries there is high possibility for vascular occlusion or a limb threat, circulation is a priority for these pts. Medical control might have you apply gentle manual inline traction to decrease deformity and restore a pulse. If no pulse returns after one attempt, or if pt reports significant pain during the attempt then splint in the most comfortable position for the pt. Assess distal neurovascular function periodically for any scenario. If able to straighten and restore a pulse splint in position with the strongest pulse.

If you encounter extreme resistance, pain or the deformity is severe such as multiple dislocations, splint in the position of deformity.

What should the EMT check before and after splinting or bandaging a patient

PMS

What is supine hypotensive syndrome and what kind of patient may experience this?

Compression of the inferior vena cava by a pregnant woman’s uterus when she lays supine and is palliated by laying the pt on her left.

newborn resuscitation - when to stimulate, oxygenate, ventilate and start CPR?

During the first minute of life (golden minute) position the airway and suction if needed, dry, warm and stimulate. If good muscle tone and adequate ventilation are not present during the first 30 seconds then BVM may be necessary.

Bag the newborn if the PR is <100 using 21% ambient temp and reassessing every 30 seconds. Newborns do not reach 85-95 percent until about 10 minutes after birth. Pulse oximetry is best taken on the right wrist.

if central cyanosis is present or oxygen saturation does not improve but breathing is adequate use blow-by with an oxygen tube or mask at 5L/m.

Start CPR if the pulse is absent or the pulse is <60 after 30 seconds of ventilation and the HR is not increasing.

In jumpSTART triage, when do you give a child rescue breaths? what kind of patient is sent to secondary triage?

Apneic peds are assess for a pulse, if present then open their airway and if spontaneous breathing is absent provide 5 rescue breaths.

After walking patients move, all underdeveloped infants and children are taken for secondary triage.

For a refusal from a patient who refuses ANY personal contact, what do you need to tell them and what do you need to include in your report

For a refusal, encourage pt up to 3 times to permit Tx. Remind them to call 911 if they change their mind or the condition worsens.

Document assessment findings, care provided, efforts to obtain permission and a signature from the pt or pt’s parent/guardian preferably witnessed by someone like a police officer.

You should inform the pt of what you found, how you’d treat, risks of Tx and denying treatment along with alternatives.

Where do you assess capillary refill on newborns

press on the forehead, chin or sternum for newborns and young infants

if you are not getting good chest rise while ventilating, what should you do next?

if too much air is leaking then reposition the mask to ensure proper seal, if inadequate still than reposition the head or use an airway adjunct. If chest rise still doesn’t occur check for an obstruction. Lastly if an obstruction is not present use a alternative method such as mouth-to-mask

What are some common names for asthma medications

generic (trade names)

albuterol (Proventil, Ventolin, Volmax)

beclomethasone (Beclovent, Beconase, Qvar, Vanceril)

cromolyn (Intal)

fluticasone (Flovent Diskus)

fluticasone, salmeterol (Advair Diskus)

ipratropium bromide (Atrovent)

levalbuterol (Xopenex)

metaproterenol sulfate (Alupent, Metaprel)

montelukast (Singulair, oral tablet)

salmeterol (Serevent Diskus)

Epinephrine is given in sever asthmatic emergencies

Epiglottitis S&S, causes, what you should do to minimize risk to patient.

Most common in children and is caused by bacterial infection typically. sudden onset in seemingly healthy individuals, S&S include pt looking ill, reporting severe sore throat and a high fever. Often found in tripod position and drooling which is a major sign, due to the inflammation of the epiglottis, the patient will struggle to swallow and develop excess saliva. A late sign is strider.

Treat children gently, place in position of comfort with oxygen and provide transport

cushing’s triad and injuries it may accompany

identifies the effects seen as ICP takes place secondary to brain swelling or bleeding. as pressure builds intracranially the midbrain and brainstem are pushed through the foramen magnum, if this process continues the pt will die.

can be identified by HTN, Bradycardia, and irregular respirations such as cheyne stokes or biot.

accompanying condition includes epidural, subdural and intracerebral hematomas, coup-contrecoup, cerebral edema and subarachnoid hemorrhages.

hypoglycemia, hyperglycemia, S&S of each

Hypoglycemia is a BGL <80 and sever <50 has a rapid onset (within minutes) skin presents as pale, cool, and moist.

absent thirst, hunger and vomiting or abdominal pain is uncommon.

Respirations are normal until severe hypoglycemia occurs with reduced tidal volume and ALOC

BP normal to low and pulse is rapid and thready

pt may present irritable, confused, seizing or coma and with ataxic gait

Hypoglycemia improves immediately with glucose administration

Hyperglycemia is >120 and symptomatic, HHNS and DKA above 400.

in type 1 diabetes (body creates antibodies against pancreatic beta cells making them insulin deficient) since type 1’s are insulin deficient, the body cannot use available glucose and burns fat instead which creates an acid waste called ketones. kidneys become overly saturated with ketones and glucose as they attempt to maintain homeostasis.

this condition causes diabetic ketoacidosis which may present with abdomen pain, body aches, N&V, ALOC and pt will exhibit kussmaul respirations (fast and deep) in an attempt to rid the body of carbon dioxide thus lowering acid levels. DKA pt’s may have a sweet fruity breath odor.

in type 2’s hyperglycemia leads to sever dehydration. since these pts are not insulin deficient their bodies do not create ketones because there is no need to use fat for energy. instead, the kidneys are simply overwhelmed by the amount of sugar your fatass just ate so the excess glucose (the amount of the kidney threshold limit roughly around 180) spill into the urine. Due to glucose being highly osmotic it pulls water out with it preventing absorption and subsequently causing dehydration.

onset may be associated with infection or illness, hyperosmolar hyperglycemic nonketotic syndrome present as ALOC, severe dehydration, thirst ,dark urine, visual or sensory deficits, partial paralysis and seizures.

hyperglycemia is a slow onset (hours to days), skin is warm and dry, polyphagia, polydipsia and polyuria along with vomiting are common. normal to low BP, rapid, weak and thready pulse.

treatment response is gradual within 6-12 hours.

if you can’t get a good blood sugar reading on a diabetic pt, and you are not sure if the sugar is high or low, what should be your default Tx

err on the side of providing glucose because hypoglycemia is more critical than hyperglycemia and the dose given is unlikely to provoke their condition significantly. when in doubt contact medical control.

Narcan indications, contraindications, actions, route and which patients should get it

indicated for opioid overdoses, contraindicated for hypersensitivity, its action is that it reverse the effects of opioids that causing respiratory depression. it can be given IM, IN, and is given to pts who are in agonal respirations or apneic, pts must have an airway in place and bagged

How much sudden blood loss in an adult patient is considered a serious amount

typical male contains 70 mL of blood per kg bw and 65 mL for woman.

an acute loss of greater than 20% of total blood volume cannot be tolerated.

What does the peripheral nervous system consist of?

somatic and autonomic nervous system

autonomic is split into sympathetic (fight or flight) and parasympathetic (rest and digest)

the PNS contains motor and sensory nerves

S&S of pulmonary contusion

should be suspected in patients with a flail chest. Can be cause by MOIs to the chest, normally develops over hours and may make the patient hypoxic

amputation; care of patients and amputated part

control bleeding and treat for shock.

apply a tourniquet, stabilize partial amputations with bulky dressings and splint to prevent further injury. for full amputations wrap according to local protocol and place in a plastic bag, on top of ice and transport it with you.

S&S of preeclampsia and eclampsia, Tx.

Preeclampsia involves new onset HTN (>140 systolic and >90 diastolic), severe and persistent headache, visual abnormalities such as seeing spots, blurred vision and sensitivity to light, edema in hands and feet, upper abdominal and epigastric pain, dyspnea and/or retrosternal chest pain, anxiety and ALOC.

eclampsia is characterized by the presence of seizures.

treat the pt by laying her on her left side, maintaining her airway, providing oxygen, prepare to suction vomit and transport with ALS intercept if available.

Meconium: definition, what causes it, what to do when you see it

Fetal stool, risk increases with gestational age, and postterm newborns (42 weeks’ gestation and beyond)

if meconium is seen and the newborn is not breathing adequately suction the mouth then nose before providing ventilations

As a newborn’s head emerges, what do you check for first?

as soon as the head is delivered, use one finger to feel whether a nuchal cord is present, attempt to gently lift over the head.

If unable to, place two clamps two inches apart and cut between, encourage the woman to push harder and possibly more often because the baby is not receiving oxygen until it’s delivered and breathing spontaneously

shaken baby syndrome: define, what are the resulting injuries

Life-threatening trauma caused by forceful shaking or being struck on the head. torn blood vessel leads to increased ICP causing coma or death.

infant often found unconscious with no evidence of external trauma, may appear to be in cardiac arrest.

call may be for infant who stopped breathing or is unresponsive

overall function of NIMS

A department of homeland security system designed to enable federal, state, and local governmental and private-sector and nongovernmental organizations to effectively and efficiently prepare for, responds to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts or catastrophic terrorism.

NIMS roles

the purpose of ICS is to ensure responder and public safety, achieve incident management goals, and ensure the efficient use of resources. span of control is 1 supervisor to 5 subordinates

Incident commander (IC) is in charge of the overall incident, finance tracks money, logistics handles equipment, operations frees up the IC if needed for tactical situation, planning reviews previous incident to plan current ones, safety officer monitors safety hazard and has the authority to stop operations whenever a rescuer is in danger, Public information officer (PIO) provides public and media information while the liaison relays the information to other agencies.

triage supervisor ensures initial assessment of pt’s and sorts, treatment sets up for each treatment category and assists in moving patients to the transportation area where the transportation officer coordinates transport and distribution to appropriate hospitals to avoid overwhelming hospitals.

continuum of care

consistent pt care across the entire health care team from first patient contact to discharge.

1 uninterrupted critical care

2 minimal interference (location with minimal interference, transfer takes place by pt’s side and should not occur while pt is being moved)

3 respectful interaction

4 common priorities

5 common language or system

scope of practice

approved skills for EMTs to perform, can be limited by the medical director but requires state approval for expansion.

which patients get a full head-to-toe vs a focused physical assessment?

all conscious patients should undergo a limited to detailed physical assessment based on their chief complaint.

unconscious pts or those who’ve sustained significant MOIs require a full head-to-toe.

Pulse pressure

difference between the systolic and diastolic (systolic-diastolic=pulse pressure) signifying the force generated by each cardiac contraction.

where does the myocardium get its blood supply from?

the coronary arteries, which begin at the first part of the aorta just above the aortic valve

difference between epidural hematoma and subdural hematoma symptoms and their onset (fast vs slow)

epidural hematoma is a collection of blood between the skull and the dura mater. nearly always caused by a blow to the head fracturing the temporal lobe and rupturing the middle meningeal artery.

onset will be rapid, pt will go in and out of consciousness and increased ICP will cause ipsilateral pupil dilation. death follows

subdural hematoma is blood accumulation under the dura mater but outside the brain. typically occurs with falls or injuries involving rapid deceleration.

pts present with slower onset of ALOC with lucid intervals along with dysarthria

S&S of diabetic ketoacidosis

kussmaul respirations (fast and deep to expel carbon dioxide and lower ph) abdominal pain, body aches, N&V and ALOC in severe cases

excited delirium and risk if a patient with that condition is not handled properly

agitated state of delirium, pt may exhibit irrational behavior and hallucinate. positional asphyxia can occur if their position obstructs their airway or prevents chest wall movement

an infant would suffer significant signs of shock after how much blood loss

1 year old has a typical blood volume of about 27 oz (800mL) and will show significant symptoms of blood loss after only 3 to 6 oz (100-200mL)

A patient with a head injury will often suffer changes in what area first as their condition deteriorates

decreased level of consciousness is the first and most telling sign of a head injury

traumatic asphyxia: cause, S&S

sudden, severe chest compression producing rapid increase of pressure within the chest.

presents with JVD, cyanosis in the neck and face and hemorrhaging into the sclera of the eye.

finding suggest injury to the heart and possible pulmonary contusion

treatment of wet, hypothermic patient who is pulseless and apneic including how many AED shocks are recommended

abruptio placenta vs placenta previa: S&S

abruptio placentae is premature separation of the placenta from the uterine wall often cause by HTN or trauma. Pt will report significant pain however vaginal bleeding may not be heavy, signs of shock such as weak, rapid pulse and pale, cool, diaphoretic skin.

placenta previa is placental development over the cervix, when early labor begins the cervix begins to dilate and the woman will experience heavy vaginal bleeding often without significant pain.

neonatal compression to ventilation ratio

3:1 ratio yielding 120 “actions per minute” (90 compressions and 30 ventilations)

causes of orthostatic hypotension in geriatric pts

gravity pulls blood down when people stand, HR and contractility increase to compensate, however in older patients, they are less sensitive to the change in BP and are more likely to pass out when the systolic drops as much as 20 mm Hg.

triage categories and examples of each

Red (immediate) airway or breathing compromise, uncontrolled severe bleeding, severe medical problems, shock, severe burns, open chest or abdominal wounds

Yellow (second priority) burns without airway compromise, major or multiple bone or joint injuries, back injuries with our without spinal cord damage

green (walking wounded) minor fractures, minor soft-tissue injuries

black (expectant) obvious death, obviously nonsurvivable injury, such as major open brain trauma, respiratory arrest (if limited resources) and cardiac arrest

heimlich maneuver - at what age do we start doing that instead of chest compressions and back blows

anyone older than 1 will receive the heimlich or chest thrusts

functions of the PCR

1 transfer of info and continuity of car

2 compliance and legal documentation

3 administrative information

4 reimbursement

5 education

6 data collection for quality improvement and research

if the heart beats too quickly, why would cardiac output decrease

v-tach typically is a HR of 150-200 and is a rhythm in which there is not enough time between contractions to let the left ventricle fill therefore less blood is pumped. typically electrical activity starts in the ventricle instead of the atrium

becks triad, causes fall all three symptoms, what condition it indicates and why it can be deadly

muffled heart tones caused by pericardial effusion compressing the heart reducing its contractility which also is responsible for the second sign, narrowing pulse pressure. last sign is JVD due to blood backing up into the neck veins

this is a cardiac tamponade which is a severe life threat that can lead to obstructive shock and requires a pericardiocentesis at a hospital

HHNS what kind of diabetic gets this and how is it different from DKA

hyperosmolar hyperglycemic nonketotic syndrome occurs in type 2 diabetics experiencing hyperglycemia, since they are not insulin deficient they do not create ketones and become acidotic. instead, type 2s overwhelm their kidneys with glucose which are osmotic in nature and prevent water absorption leading to dehydration.

when do we use the recovery position

place nonresponsive pts with adequate breathing who do not show signs of spinal, hip or pelvic injury into the recovery position

hemophilia and how it relates to intracerebral hemorrhage

reduced clotting capability leads to more dangerous risks involving intracerebral hemorrhage and increased ICP

critical burn criteria in adults and children

for adults

severe:

full involving hands, feet, face, genitalia, airway, or circumferential burns.

full covering more than 5% TBSA in any pt

part covering more than 20% TBSA ages 10-50 and 10% TBSA younger than 10 or older than 50

burns with concomitant traumatic injuries

burns to younger than 5 or older than 50 that’d be normally moderate

moderate for adults:

full involving 2-10% TBSA (excluding hands, feet, face, genitalia, and upper airway)

part covering 15-30% TBSA

sup covering more than 50% TBSA

minor burns for adults:

full covering less than 2% TBSA

part covering 15% TBSA

sup covering less than 50%

for infants and children

severe:

any full thickness burn

part covering more than 20% TBSA

moderate:

part covering 10-20% TBSA

minor:

partial thickness burn covering less than 10% TBSA

hepothermia definition and Tx

hypothermia is low core temperature of the inner organs, below 95F (35C).

move the pt from the cold environment to prevent further heat loss, do net let them walk. remove any wet clothing, place dry blankets over and under the patient. if available, provide warm humidified oxygen. handle the patient gently as they are at risk of going into ventricular fibrillation, which may not respond to defibrillation.

do not allow pts to eat or use any stimulants as they are vasoconstrictors which may further impair circulation to other areas.

if CBT is 90-95F begin passive rewarming for mild hypothermia via placement in a warm environment, removing wet clothing, and applying heat packs to the groin, axillary, and cervical region. warm fluids by mouth.

if severe active rewarming is best accomplished in the ED, prevent further heat loss with these pts, remove from cold environment, place pt in ambulance, remove wet clothing, cover with blankets and transport.

for moderate to sever hypothermia pt must be warmed from within, IVs lavage with warm fluids and extracorporeal rewarming.

physiologic changes in the pregnant patient and how it affects trauma calls (respirations, blood supply, etc)

uterine growth displaces it out of the pelvis pushing on the stomach and diaphragm. oxygen demand increase due to developing fetus. blood supply increases up to 50% by the end of pregnancy.

trauma calls are affected since they are more prone to falls, potentially bleed more and are already working with a compromised respiratory system. they are more prone to PE since their clotting ability increases.

when the EMT can place finger into the vagina of a pregnant patient and why

prolapse of the umbilical cord to avoid cutting off circulation

breech presentation to protect the newborns airway

GEMS diamond purpose

tool to help remember differences with geriatric pts

what can cause changes to signs of compensated shock in geriatrics

weaker chest muscle, enlarged and less elastic alveoli, larger and weaker left ventricle, stiffer blood vessels less sensitive chemoreceptors

what will help you see the earliest signs of shock in pediatric pts

PAT

appearance

work of breathing

circulation to the skin

ACS what conditions does it include and what are the most commons symptoms? what patients may not have those symptoms and what might they have instead?

angina pectoris and AMI, chest pain, SOB, and radiating pain are common

diabetics, older people and woman may not feel pain, older people and woman may have the chief complaint of fatigue

why burns pose a greater risk to pediatric pts

more surface area relative to body mass, greater fluid and heat loss. more likely to go into shock, develop hypothermia and experience airway problems

signs of imminent birth

crowning, perineum bulge and urges to move bowels

guiding the newborn out the canal

support head while avoiding eyes and fontanelles, let newborn rotate, feel for nuchal cord, guide head down to deliver shoulder, support and guide up if needed, support head and neck, place newborn on mothers abdomen until pulsating stops in the cord, if infant is vigorous suction is not needed unless airway is obstructed suction mouth then nose, cut cord.

about how long after birth will it take for newborns to start breathing once out of the mother?

30 seconds

diving ascent injuries and how to treat

divers holding their breath during rapid ascent, quick loss of external pressure on the chest results in ruptured alveoli as rapid air expansion occurs in the lungs. may result in pneumothorax or pneumomediastinum.

decompression sickness (the bends) occurs with rapid ascension expands nitrogen within the blood and tissue.

air embolism occurs immediately on return to the surface while the bends may not appear for several hours.

treat with oxygen and recompression with a hyperbaric chamber, recompression dissolves gasses then once equalized control decompression occurs to prevent bubble formation

epiphyseal plate and its importance in pediatric fractures

fracture in the growth section of a child’s bone that may result in growth abnormalities

rule of nines

front and back of trunk is 18 all ages, arms are 9 all ages, groin is 1 all ages, adult head is 9. child’s is 12 and infants is 18, adult leg is 18, 16.5 for child and 13.5 for infant

types of MVC and which leads to the most cases of sudden death and why?

frontal, rear-end, lateral, rollover and rotational

lateral crashes or T-Bones are a common cause of death because the cervical spine has little tolerance for lateral bending.

S&S of hypoglycemia

rapid onset, cool, moist, pale skin, is uncommon with infection, absent thirst and hunger, breathing is normal to shallow depending on severity, normal to low BP, rapid weak pulse, irritability and improves with glucose immediately.

components of the cincinnati stroke scale

facial droop, bilateral or unilateral movement

arm drift, bilaterally steady or unilaterally steady

speech, correct words without slurring or dysarthria, confusion or aphasia

2 heart rhythms an AED will defibrillate

(VT) pulseless ventricular tachycardia, too rapid of a HR disallowing normal filling of the heart

(VF) ventricular fibrillation, disorganized quivering of the ventricles

cpap indications and contraindication

indication, moderate to severe respiratory distress, alert and oriented, able to follow commands, tachypnea, pulse ox less than 90%

contraindications, low BP, respiratory arrest, S&S of pneumothorax, chest trauma, tracheostomy, ALOC, active GI bleed

GCS

eye opening

spontaneous 4, response to sound 3, responds to pressure 2, none 1

verbal

oriented conversation 5, confused conversation 4, inappropriate words 3, incomprehensible sounds 2, none 1

motor

obeys commands 6, localized pressure 5, withdraws from pressure 4, decorticate 3, decerebrate 2, none 1

which federal agency sets the education curriculum guidelines (NOT testing or licensure) for every state’s training requirements

NHTSA national highway traffic safety administration

National Fire Protection Association (NFPA 704) classification of hazmat - levels 0-4

level 0 little or no hazard - no protection needed

level 1 cause irritation on contact but mild residual injury - SCBA level C

level 2 cause temporary damage or residual injury unless prompt Tx is provided - SCBA level C

level 3 extremely hazardous to health - full protection, with no skin exposed level A or B

level 4 minimal exposure causes death - special hazmat gear level A

challenges in managing airways for down syndrome patients

round head with a flat occiput and a enlarged protruding tongue

other conditions are heart and thyroid problems

hallmark vital signs of hypoxia in pediatric patients

accessory muscle use (supraclavicular contractions), retractions (intercostal and substernal), grunting (“uh” sound as the child attempts to open up alveoli) or wheezing, head bobbing, nasal flaring and tripod positioning indicate respiratory distress and potential hypoxia

tachypnea is an early sign bradypnea is a late sign and can indicate imminent respiratory arrest

trachycardia may be an early sign of hypoxia, bradycardia (<80 in children and <100 in newborns) indicates critical hypoxia and impending cardiopulmonary arrest

skin pallor and mottling indicate compensated shock (caused by vasoconstriction) cyanosis is a late sign of respiratory failure or shock

irritable and restless in early stages and lethargic in late stages

Hight Altitude Pulmonary Edema and High Altitude Cerebral Edema S&S

HAPE: (less O2 at high altitudes cause pulmonary vasoconstriction as a response to hypoxia, capillaries leak fluid into the alveoli) coughing up pink sputum, cyanosis, rapid pulse, SOB occurs at altitudes of 8,000 or greater

HACE: (vasoconstriction in the body pushes blood to the brain while the vessels in the brain dilate to perfuse the body’s vital organ, if the blood is overwhelming leakage occurs through the permeable capillaries) severe, throbbing headache, ataxia, loss of consciousness, vomiting, and extreme fatigue typically occurs in climbers, may accompany HAPE and can become life-threatening rapidly

long-bone fractures and critical patients easiest way to splint and run

femur fractures present externally rotated and shorter then the nonfractured leg. often significant blood loss of 500-1,000 mL accompany the injury.

cut away clothing to inspect for open wounds and cover any found with sterile dressing, monitor vital signs closely, watch for hypovolemia, periodically check PMS for neurovascular status and transport. if signs of neurovascular damage is present below the injury apply traction in line with the long axis gradually returning the leg to its original position to bring back PMS

indications for helmet removal on a patient

it is a full-face helmet

it makes assessing or managing airway problems difficult and removal of a face guard to improve airway access is not possible

it prevents you from properly immobilizing the spine

it allows excessive head movement

patient is in cardiac arrest

angioedema

areas of localized swelling

seizure types

grand mal (generalized seizures) tonic (period of muscle rigidity lasting only seconds) clonic (constant muscle contractions and trembling.

generalized-onset absence seizure, brief lapse of consciousness in which the pt stares off and is unresponsive

focal-onset aware seizure, no change in LOC, pt reports numbness, dizziness or tingling. pt may report visual changes or unusual smells

focal-onset aware (motor) seizure, some muscle twitching of extremities that spread from one pert to another

focal-onset impaired awareness seizure, ALOC, abnormal reactions to the environment, results from abnormal discharges from the temporal lobe (portion of the brain responsible for sensory input) pt may be lip smacking, eye blinking, and have isolated convulsions or jerking of the body or one part of the body. pt may experience unpleasant smells, hallucinate and exhibit repetitive behavior such as constant sitting or standing

lung sounds and conditions

wheezing (constriction or inflammation of the bronchus, high pitch sound heard on exhalation) Asthma, COPD, CHF/Pulmonary Edema, Pneumonia, Bronchitis, Anaphylaxis

Rhonchi (low-pitched rattling sound caused by secretions or mucus in the larger airways, junky lungs) COPD, Pneumonia, Bronchitis

Crackles/rales (crackling or bubbling sound typically heard on inspiration caused by air passing through fluid in the alveoli) CHF/Pulmonary Edema, Pneumonia

Stridor (high pitched sound heard on inspiration as air tries to pass through obstruction in the upper airway) Croup, Epiglottitis

Decreased/absent, Asthma, COPD, Pneumonia, Hemothorax, Pneumothorax, Atelectasis