EHS Written Midterm

Hemothorax

can be the result of blunt or penetrative trauma to the chest/open or closed injuries

* Early signs and symptoms are the same for shock
* Treatment
* Same for pneumothorax and shock

Traumatic asphyxia

when severe and sudden compression of the thorax causes a rapid increase in chest pressure

* Signs and symptoms
* bluish/purple discoloration of the face, head, neck, and shoulders
* JVD
* Bloodshot eyes that are protruding from the socket
* Cyanotic and swollen tongue and lips
* Bleeding of conjunctiva
* Treatment
* Emergency care for any chest wounds and shock

Cardiac contusion

when the heart is violently compressed between the sternum and spinal column

* Signs and symptoms
* Chest pain/discomfort
* Signs of blunt trauma to the chest (swelling, bruising, crepitation, deformity)
* Tachycardia
* Irregular pulse
* Treatment: rapid transport

Commotio cordis

 sudden cardiac arrest from blunt trauma

* Treatment: CPR and early defibrillation

Pericardial tamponade

trauma causes bleeding to the sac surrounding the heart = inward compression of the heart = decreased cardiac output

* Signs and symptoms
* Similar to a tension pneumothorax
* Except breath sounds are normal
* Worsen as pericardial sac fills with more blood
* PVD
* Signs of shock (hypoperfusion)
* Tachycardia
* Decreased BP
* Narrow pulse pressure
* Weak pulses
* Dyspnea
* Cyanosis
* Treatment
* Early recognition
* Rapid transport
* Maintain airway and use NRB

Flail Chest

 2+ ribs are broken in 2+ places

* Creates a segment of the chest that is unattached to the rest of the rib cage


* Contraindicated
* Placing the patient on the injured side
* Stabilizing patient with devices that compromise chest wall motion
* Ideal treatment: CPAP/positive airway ventilation using BVM
* Used only if the patient shows signs of respiratory distress/failure

Sucking Chest Wounds

open chest wound that pulls air into the thoracic cavity

* Treatment
* Cover wound with gloved hand
* Dress wound and tape on 3 sides

Tension pneumothorax

caused by air leaking into the chest cavity from a damaged lung with no opening through the outer chest

* Signs
* Rapid deterioration
* Severe respiratory distress
* Signs of shock
* Absent breath sounds on one side
* Cyanosis
* Unequal movement of the chest
* Distended neck veins
* Deviation of trachea to the uninjured side
* Treatment
* Early recognition and rapid transport

Informed consent

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* Signing documents
* I.e. scheduled surgery

Expressed Consent

Doing actions that demonstrate they want to be helped

Implied Consent

If they could make a decision, they would want to be helped

Minor Consent

Parent making decision for the child

Involuntary Consent

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* Treating someone who doesn't want treatment but needs it
* I.e. suicidal patient

eupnea

normal respirations

tachypnea

fast breathing

bradypnea

slow breathing

Biot’s breathing pattern

quick breathing but spaced out

* brain damage

wheezing lung sounds

* lower airway
* need stethoscope
* narrowing/inflammation = bronchiole diameter reduced

rales/crackles lung sounds

* lower airway
* need stethoscope
* fluid in/around alveoli

snoring lung sounds

* upper airway
* dont need stethoscope
* partial obstruction by tongue

stridor/ crowing lung sounds

* upper airway
* dont need stethoscope
* “crow cawing”
* partial obstruction at larynx

gurgling lung sounds

* upper airway
* dont need stethoscope
* fluid in airway

rhonchi lung sounds

* lower airway
* need stethoscope
* mucus blocks larger bronchioles

cushing’s reflex

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* Increased intracranial pressure: opposite of shock
* Increased systolic BP
* Decreased pulse
* Decreased respirations

Presence of a closed head injury and signs of shock mean?

* cushing’s reflex
* another injury present

reasons for splinting

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* Prevents movement of bone fragments, bone ends, and dislocated joints = reduced chance for further injury
* Reduce pain and minimize common complications from bone and joint injuries

general splinting rules

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* Assess CMS
* Cut away clothing to expose injury site
* Place sterile dressing over the open wound
* Align extremity with gentle traction if there is a severe deformity, absent pulses, or cyanosis
* Pad the splint
* Maintain manual traction
* Assess CMS

Types of fractures

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* Open fracture: fracture with an associated open wound
* Closed fracture: no break in the skin
* Hairline fracture: small crack in the bone that does not create instability

bones

skull bones

Compensatory shock

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* Body is able to maintain near-normal blood pressure and perfusion of vital organ
* Blood is shunted away from non-vital areas (i.e. skin and gastrointestinal tract)
* Pulse pressure may be narrowed
* Pulse pressure = systolic - diastolic

Projectile vomiting is a sign of?

head injury → trauma >:C

suction technique for liquid (blood, vomitus, secretions), food particles, or small objects

suction out

suction technique for thick vomitus, solid objects (teeth, foreign bodies, food)

place pt on side and perform finger sweep

evisceration treatment

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* Expose the wound
* Position the patient
* Prepare a moist dressing and cover with an occlusive dressing
* Administer high concentration via NRB
* Be prepared to treat for shock

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* S&S of basilar skull fracture

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* Signs
* Battle’s signs: bruising behind the ear
* Raccoon eyes: bruising under the eyes
* CSF rhinorrhea: CSF leakage from nose
* CSF otorrhea: CSF leakage from ear
* Haemotympanum: blood in ear
* Bump
* Cranial nerve pulses
* Optic nerve problems: optic nerve gets stuck in tract/orbit
* Symptoms

Glasgow coma scale

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* 3 minimum, 15 max
* Eye opening
* Spontaneous → 4
* To verbal command → 3
* To pain → 2
* No response → 1
* Verbal response
* Oriented and converses → 5
* Disoriented and converses → 4
* Inappropriate words → 3
* Incomprehensible sounds → 2
* No response → 1
* Motor response
* Obeys verbal commands → 6
* Localizes pain → 5
* Withdraws from pain (flexion) → 4
* Abnormal flexion in response to pain (decorticate rigidity) → 3
* Extension in response to pain (decerebrate rigidity) → 2
* No response → 1

Oxygen NC vs. NRB vs. BVM

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* NC: 1-6 lpm
* NRB: 15 lpm
* BVM: artificial ventilation/respirations + high flow O2

abdominal anatomy

Hollow organs

(hollow) will not bleed but will spill contents into the abdominal cavity

* Stomach
* Gallbladder
* Urinary bladder
* Ureters
* Internal urethra
* Fallopian tubes
* Small intestine
* Large intestine

Solid organs

major bleeding and severe shock

* Liver
* Spleen
* Pancreas
* Kidneys

vascular structures

large stationary structures that carry lots of blood

* Abdominal aorta and its branches
* Inferior vena cava

tort

civil wrong that causes harm or injury to another person

assault

willful threat to inflict harm on a patient

* Does not have to be physical

battery

touching a patient unlawfully without his consent

Negligence

no intent to do any harm to the patient but breaches the duty to act

1) duty of care

2) breach

3) causation

4) damages

eye anatomy

orbital fracture S&S

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* Diplopia: double vision
* Decrease in vision
* Loss of sensation above the eyebrow, over the cheek, upper lip
* Nasal discharge
* Tenderness to palpate
* Bony step-off
* Patient is unable to follow finger upward

lid injury S&S

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* Control bleeding with light pressure from a dressing
* Cover lid with gauze soaked in saline

globe injury S&S

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* Best treated at the hospital
* Apply patches lightly to both eyes
* No cold packs

corneal injury S&S

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* Flush with sterile water/saline
* Do not attempt to remove object if flushing is not effective
* Place eye patch and transport

Chemical eye burns S&S

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* Immediately irrigate with water/saline and continue for at least 20 min/arrival at the hospital
* Contacts must be removed

impaled object in the eye/extruded eyeball S&S

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* Stabilize object/extruded eyeball
* Cover both eyes

Types of Hypovolemic Shock

(inadequate volume)

* Hemorrhagic shock: loss of RBC
* Non-hemorrhagic shock: loss of fluid without RBC

Types of Distributive Shock

(inadequate vessel tone)

* Septic shock
* Anaphylactic shock
* Psychogenic shock
* Neurogenic shock

septic shock

infection = vessels cant contract

anaphylactic shock

chemicals released in anaphylactic reaction = vasodilation and increased capillary permeability

Psychogenic shock

sudden nervous system reaction = temporary vascular dilation = drop in BP = fainting

Neurogenic shock

muscles in blood vessels are cut of from nerve impulses = no contraction

inadequate pump function

* Cardiogenic shock: something wrong with the heart
* Obstructive shock: something blocking heart function

complete spinal cord injury

total loss of motor and sensory function below level of injury

incomplete spinal cord injuries types

spinal cord is injured but not completely through all 3 major tracts (motor, light touch, pain tracts)

* central cord syndrome
* anterior cord syndrom
* brown-sequard syndrom

central cord syndrome

middle of the spinal cord is injured = weakness/paralysis and loss of pain sensation to the upper extremities but good function in the lower extremities

anterior cord syndrome

loss of sensation to pain and motor function below site of injury but able to feel light touch

Brown-Sequard syndrom

loss of motor and sensation below injury, but the effects differ on each side of body

* I.e. patient loses motor and light touch on right side but loses pain sensation on left side

position of comfort for abdominal injuries

supine with legs bent at the knees

* If injury to lower extremities, hips, pelvis, or spine is not suspected

Mechanics of lifting and moving 

* Keep the weight of the object as close to the body as possible
* To move a heavy object, use the leg, hip, and gluteal muscles plus contracted abdominal muscles
* “Stack”: shoulders, hips, feet as one unit
* Reduce the height/distance through which the object must be moved

portable stretcher

standard stretcher

stair chair

used in narrow spaces, small elevators, stairways

Backboard

* Short backboards: immobilize noncritical sitting patients before moving them


* Full body vacuum mattress

Scoop stretcher

advantage is that it can be used in confined areas that are too small for conventional stretchers

reeves

rapid spine motion restriction in tight spaces

Electrical burn

* Produced by electrical current flow in the body


* High voltage electricity
* Entry and exit wound: everything in between is damaged

Chemical burns

* Produced by acids, alkalis, and other heat-generating chemicals


* Severity is dependent on
* Type of chemical
* Chemical concentration
* Duration of exposure to the chemical
* Treatment: immediately flush area with saline

Thermal burns

* Associated with heat applied to the body


* Severity is dependent on
* Time exposed to the heat source
* Temperature of the heat
* Potential for inhalation injury

Flame burn

caused by flame :/

Contact burn

* Touching something hot


* E.g. touching a stove

Scald burn

caused by hot liquid, superficial

flash burn

* Something explodes and flashes


* Lighting a fire with too much gas

other types of burns

* steam burn
* gas burn
* chemical burns

Rules of Nines

Voluntary muscles (skeletal)

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* Most are attached at one or both ends of the skeleton
* Muscles become shorter and thicker = muscle contraction

Involuntary muscles (smooth)

* Found in walls of organs


* Help move food through digestive system

Cardiac

Only found in walls of the heart

When does an EMT straighten a fracture?

* Severe deformity


* Distal extremity is cyanotic or lacks pulses

What joints should an EMT not attempt to straighten a deformity?

* Wrist


* Elbow
* Knee
* Hip
* Shoulder
* \*major nerves are arteries are close to these joints\*

central pulses

* Carotid


* Femoral

peripheral pulses

* Radial


* Brachial
* Posterior tibial
* Dorsalis pedis

On-line medical direction

EMS provider and physician communicate directly in real time providing immediate feedback

On-scene medical direction

feedback and medical direction regarding the diagnosis, condition, and emergency care provided by the physician who is on-scene with crew

off-line medical direction

following local protocol

stages of grief

* Denial: not me.


* Anger: why me?
* Bargaining: okay, but first let me…
* Depression: okay, but I haven't…
* Acceptance: okay, I am not afraid

3 meninges

layers of tissue that enclose the brain, brainstem, and spinal cord (outer to inner)

* Dura mater
* Arachnoid
* Pia mater

CSF

produced and circulated throughout the brain

* cushions/protects
* Combats infection
* Cleanses brain and spinal cord

Scene safety

* Be sure to not approach scenes that appear unsafe, can call the police or get someone to make the scene safe first


* When knocking on the door, stand to the side of the door and on the side w/ the door handle
* If someone answers the door with a weapon, can run away if you feel unsafe
* ALWAYS PROTECT YOU AND YOUR PARTNER FIRST

vehicle

* Do have stop at bus stops when the sign is out


* Careful when driving through intersections, where most accidents happen 
* Do not trust other people’s cars to stop, drive in a way that is not going to hurt people 
* Ambulances can pass in no passing lanes, proceed past a stop sign/red light only having made sure it is safe to do so, can make sounds and have lights to warn people, can go above the speed limit (safely)
* Make sure to check the ambulance after every call to stock and make sure all equipment that is needed is there

Five rights of medication administration

* Right patient


* Right medication
* Right route
* Right dose
* Right date (time)

START Triage

C-Spine injury S&S

* MOI = car accidents, falls in adults that are greater than 20 feet, when force was applied to the body 
* Not only looking for neurological deficits, can be physical symptoms 
* Signs = crepitus in the cervical spine region, pt cannot move their neck w/out pain, fails C-spine clearance test, unconscious after traumatic MOI
* Symptoms = neck pain, impaired coordination/balance, difficulty breathing, loss of bladder control 

kinematics of trauma

* Science of analyzing mechanisms of injury (MOI)


* Kinetics = deals with the movement of bodies and VELOCITY is super important
* Faster change in speed results in more force extended 
* Impacts = energy is absorbed 
* Can be through a vehicle, body, organ 
* In falls, the impact is transmitter through the body and skeletal system
* In penetrating = the velocity determines the damage 
* In blast injuries = there is a pressure wave, blast wave, patient displacement, then take care of HAZMAT 
* In crashes = look where the majority of the damage to car was done 
* Front = look at the up and over pathway and down and under pathway 
* Rear = the head and neck will be pushed back 
* Lateral = the patient endured the brunt of the impact, injuries everywhere
* Rollover = multisystem trauma if not restrained 
* Pedestrian = extent of injury depends on where the person was hit (still a priority one)
* Motorcycle = impact can be angular, head-on, involve ejection from vehicle