EMS Final

How to read blood pressure

top number= systolic pressure= hearts ventricle contract

Bottom number= diastolic pressure= (hearts ventricles are relaxed

carotid pulse

• the pulse felt along th large artery on either side of neck

• blood pressure is 60 mmHg (systolic)

femoral pulse

• pulse on either side of the groin

• femoral artery

• blood pressure - 70mmHg (systolic)

brachial pulse

pulse in the upper arm ( used for neonates )

radial pulse

• pulse at the wrist

• Bp is at least 80 systolic

pedal pulse

• the pulse rate obtained on the top of the foot

• 90-100mmHg systolic

What types are these examples of (CHOSINA):

• cardogenic

• hypovelimic

• obstructive

• septic

• insulin

• neurogenic

• anaphylactic

types of shock

which type of shock is mechanical

obstructive

which type of shock is pseudo

insulin

shock

lack of perfusion( the amount of oxygen given to tissues) at the cellular level

what are these geenral signs ans symptoms for:

• Skin: Pale, cool, diaphoretic

• axiety

• impending doom

• altered LOC

• Dilated Pupils

shock

What is this the general treatment for:

• high fow oxygen

• trendelenberg position

• keeping warm

• load and go transport

shock (generalized)

What are type of shock are these symptoms of

• MC by AMI

• Myocarditis and myocardial constusion

• “pump problem”

• decreased CO leading to hyperfusion

• heart beginning to fail

cardiogenic

What type of shock does this treatment apply to:

• standard shock treatment applies

• transport to cardiac facility critical

• its important to note that the patint may not tolerate supine or trendelenberg position

What type of shock is:

• circulatory faiure caused by paralysis of the nerves that control the size of the blood vessels, leading to the widespread dilation

• seen in patients with spinal cord injuries

• caused by:

  • spinal cord injury above T6

  • spinal anesthesia

  • vasmotor center depression

  • may take hours to repair

• symptoms

  • skin warm and dry

  • bradycardia

  • poikilothrmia

neurogenic

What type of shock is this:

• caused by severe infection— usually bacterial

• distributive

• due to infection that becomes systemic

• very common in icu setting

• pateints often febrile

• antibiotivcs needed to treat infection

• more gradual onset starting with SIRS

spetic

What type of shock has the following:

• distributive

• severe allergic rxn

• onset is quick

• most deaths from people with NKA and no epi pen

• uticaria, wheezes, pruritus

• use an epi-pen

anaphylactic

What type of shock has:

• the result of too much insulin causing a dangerous drop in blood glucose

  • looks similar to shock

  • skin: cool, pale and diaphoretic

  • altered mentation

  • seizures can occur

  • adminsiter oral glucose if they do not have a gagg reflex

  • must use IV for glucose implmentaton if they have a gagg reflex

  • patient must eat after

insulin

What are these parameters of

-hypotension (narrow pulse pressure)
-neck veins distended
-heart sounds muffled
-paradoxical pulse
-breath sounds equal

Becks Triad

What do these instances describe:

fracture of the base of he skull

• raccoon eyes

• battle signs

• takes a while to show up

basilar skull fracture

What airway is metionned

• oral airway

• used to maintain or open patients airway

  • It does this by preventing the tounge from covering the epiglottis

• used in patients with no gag reflex

• How to use

  • measure from te edge of the mouth to the angle of the jaw to determine correct size

  • insert with the ttip pointing to the top of the head then rotate 180 degrees until position

OPA

Which airway method does this consist of:

• can. use on patients with a gagg reflex

• patients who have a snoring problem

• patients who hav issues with ETOH

• How to use:

  • measure from the nare to the tip of the earlobe

  • use surgical lube for insertion

  • right nare is usually largest

NPA ( nasal trumpet)

What do the following procedures teach you how to do:

• Head tilt chin lift

  • do NOT perform on suspected c-spine injury

• Jaw thurst

  • use if suspected neck. injury

  • tilt head to slight sniffing position or neutral position

  • use thumbs to pull down lower jaw

how to open airway

What device should be used here:

• used to extricate patients in a sitting position when spinal injury is suspected

• DO NOT use when patient is unstable-straps need to be in specific order

  • middle

  • bottm

  • legs

  • head

  • top

• “My baby looks hot tonight”

KED- Kendrick Extrication Device

What does AVPU stand for

• Alert

• Verbal

• Pain

• Unresponsive

What is the 60 min period after a severe injury

• It is the maximum acceptable time between the injury and initiation of surgery for eriously injured truama patient

• starts at the time of injury and ends in the OR

Golden Hour

Who are these common illnesses found in :

• cardiovascular diseases

• CVA and AAA

• chronic respiratory disease

• cancer

• altered mental status

geriatric patients

When are the only instances you shoukd stop a primary survey (CASE)

• cardiac arrest

• airway obstruction

• scene unsafe

• exsanguinating hemorrhage

What are the categories of shock (CHOD)

• hypovolemic

• distributive

• obstructive

• cardiogenic

What are these common causes of ( for geriatric patients)

• lack of adequate oxygen to the brain

• low blood glucoselevel

• hypothermia

• sepsis

decreased LOC

In a Glasgow Coma Scale what does a score lower than 8 mean nd what does it measure

• eyes,verbal,motor

• Max -15 points

• Below 8= coma

What affliction does this sound like:

• an acute respiratoy syndrome in children and infants

• charcaterized by obstruction of the larynx, hoarseness, a barking cough

• swelling of pharynx, larynx, and trachea

• DROOLING

• Treatment: responds well to humidified oxygen

croup

What affliction does this sound like:

• bacterial infection of the epiglottis

• can be severe and cause airway obstruction

• STRIDOR

• high pitched cough

• moe common in non-vaccinated

epiglotitis

What affliction does this sound like

• fluid build up in the ( alveolar )

• dyspnea with shallow respirations

• MC cause is left sided heart failure

• Other causes trauma medications

• Can be seen post MI

• Severe cases: pink, frothy sputum

• RALES

• Treatment:

  • place in high fowlers

  • high flow oxygen

  • PPV is patient is unconscious

  • NO EXERTION

pulmonary edema

What affliction does this allude to:

• chronic bronchitis-inflammation of the lung tissue-“Blue Bloater”

• RALES

• WHEEZES

• RHONCHI

• skin= cyanotic

• obesity

• edema

• Emphysema- elasticity of alveoli is lost and air isi trapped - “Pink Puffer”, barrel chested, pursed lips, WHEEZES and decreased lung sounds

• Treatment:

  • Sit patient upright

  • give oxygen as needed

  • assist with MDI

  • transport for further treatment

Chronic Obstructive Pulmonary disease (COPD)

Wht affliction does this sound like:

• viral, bacteria or fungal

• can dmg lung tissue

• productive cough with colored sputum

• develops with dyspnea signs

pneumonia

What are type of stroke are these signs and symptoms of

• body is exposed to more heat than it can handle and normal mechanism for cooling is not effective

• as sweating continues, the body loses salts, brining on painful muscle cramps

• healthy individual smay experience a form of shock brought about by fluid and salt loss

• rise in body temp affects CNS and brain dmg can occur

• can be life threatening

• Flushed, hot, dry skin

• Lethargy

• Dilated pupils

• Unconsciousness/seizures

• Core body temperatures reaching 106F (41.1C)

heat stoke

What is this treatment for:

• XABC

• Remove patient from hot environment

• Remove clothing

• Apply cool packs to neck, groin, armpits

• Administer oxygen

• Transport

Heat stroke

What affliction and treatment is described here

• common in >80F weather especially in combination with high humidity

• Profuse sweating

• Light headedness

• Dizziness

• Muscle cramps

• Rapid and shallow breathing

• Weak pulse

Treatment

• move patient to a cooler environment, lay supine, give small sips of fluids by mouth unless patient is unconsciou or has N/V

• Apply moist towels over cramped muscles

• Monitor and transport

Heat exhaustion

Where do these symptoms of shock along with the acceptable treatment commonly take place:

• diarrhea or emesis

• Infection

• Trauma

• Hemorrhage

• Anaphylaxis

• Poisoning

• Cardiac events are rare

Treatment:

• ensure open airway

• Manage severe external hemorrhage provide high flow oxygen

• Place patient in supine position

• Keep patient warm

• Immediate transport

Shock in pediatrics

What type of patient do these instances describe:

• trauma involving alcohol or drugs

• Substance abusers at greater risk of traumatic injury

• Alcohol and drugs leading to high rates of fatalities

• Suspicion of alcohol or drug influence:

  • Use high index of suspicion, physical exam, history, bystanders, evidence at scene to identify

• Unique challenge of management:

  • Under the influence vs an emergency

  • Many initially refuse treatment

  • Interaction and cooperation

  • Consult local protocol, medical direction and law enforcement for assistance

Impaired patient

What type of usage is being described:

• can be shorted, injected, and smoked

  • Increased risks of strokes

  • Reduced attention

  • Insatiable hunger

  • Insomnia/hypersomnia

  • Lethargy

  • Soreness

  • Hoarse voice

  • Bruxism

  • Fever

  • Pruritus

  • Bronchospasm

  • Dyspnea

  • Rhinorrhea

  • Chest pain

Cocaine usage

What treatment are these examples used for:

• narcan

  • use for opioid OD

  • Can be given intranasal(IN)

  • Dose 4mg IN or 2mg IV

Narcotic OD

What is being described

• known as organic nitrate

• Acts as vasodilator

• 1 spray (.4mg) given SL q 5×3

• Contradictions

  • SBP<100mmHG

  • If patient suffers from erectile dysfunction and taking the following medications: viagra, Cialis, levitra

Nitroglycerin

DCAP-BLS-TIC meaning

• Deformities

• Contusions

• Abrasions

• Penetrations

• Burns

• Laceration

• Swelling

• Tenderness

• Instability

• Crepitus

What affliction is being described:

• inflammation of pancreas

• MC- gallstones stuck in bile or pancreatic duct

• Other causes: ETOH, medications, infections, trauma

• 20% are severe and may be life threatening

• Severe upper abdominal pain that radiates to the back

• Pain WORSE POSTPRANDIAL

• Cullen and Grey Turners sign in severe cases

• Stool may be yellow/ pale, less dense, and have oily or greasy texture

Acute pancreatitis

What affliction is being described:

• condition whee the appendix becomes inflamed and fills with pus

• Pain begins at umbilicus and MOVES TO RLQ

• Rupture can occur 24-72 hrs after onset o symptoms

• Severe RLQ pain

• Positive rebound tenderness

• Pain can be dull or sharp

• Pain can be exacerbated by jarring movements

  • Cough ,walking

• N/V loss of appetite, fever, chills

• Signs

  • McBurney’s point

  • Rousing sign

  • Psoas sign

  • Obturator sign

Appendicitis

What affliction is being described:

• a break of the ring of bones that connect your spine from your hip

  • Usually result from high energy injuries like car accidents or falls from a height in younger patients and most often from falls in elderly patients

• Can easily lose 1-2L of blood or more

• Treat for shock

• Apply pelvic binder to reduce bleeding

Pelvic fracture

What type of trauma is being described here:

• splenic injury - referred left posterior shoulder pain (Keyes sign)

• Liver injury- referred right posterior shoulder pain

• Severe hemorrhage

• Abdominal dissention, tenderness, guarding

• Pelvic tenderness or bony crepitation

Abdominal

What lung sound is

• continuous and high pitched

• Whistling sound produced during breathing when bronchioles restrict

Wheezes

What lung sound is: rattling noise of mucous in the lungs in the upper airway (sounds a bit bubbly)

Rhonchi

What lung sound happens when you get fluid in your lungs — sounds fluid and crackly ( popping noise)

• 2 types:

  • Coarse is high pitched

  • Fine is lower pitched

Rales

What lung sound is:

• strained

• High pitched

• Heard on inspiration caused by obstruction in the pharynx or larynx

• Sounds like a whale ( the most obvious one tbh)

• Expiratory is below

Strider

What affliction is being presented:

• hypoxia due t hemoglobin binding

• Symptoms:

  • Altered LOC

  • Cherry-red skin color or cyanosis

  • Progressive cardiac hypoxia

• Treatment

  • Remove from the source

  • High flow oxygen

  • LOC: intubation, ventilation

  • Hyperbaric chamber

CO poisoning

What afflictions and treatment do these symptoms describe

• Burn related death are more than 50%

• Mechanism- confined space or entrapment

• Classification- carbon monoxide poisoning, heat inhalation, smoke-inhalation

• Onset is delayed

• Management is high flow oxygen

Inhalation injuries

• abnormal breath sounds

• Abnormal positioning

• Retractions

• Flaring

Features to look for:

• noisy breathing, snoring,crowing,grunting, or wheezing

• Leaning forward while using the arms for support

• Retractions above the collarbone or between the ribs

• Flaring of the nostrils

Respiratory system distress in pediatric

What type o pediatric injuries are these:

• falls

• MVCs

• Auto-pedestrian or bicycle crashes

• Burns

• Drowning

• Child abuse

Most common pediatric injuries

What are the Rule of Nines

• Head + Neck=9% each

• Upper extremities=9% each

• Lower Extremities= 9 % each

• Front trunk= 18%

• Back trunk = 18%

What are the rule of 9s in kids

Head=18%

Trunk=18% front, 18% back

Each leg =14%

Each arm=9%

What type of affliction does this information describe:

• “stroke”

• 2 types: Isochemic vs Hemorrhagic

• Symptoms depend on type of CVA located in brain

• Time is tissue

• Use fast exam

CVA

What is the difference between a TIA and a CVA

TIA fully resolves with no residuals within 24 hrs

• Can’t differentiate in the acute situation

• Treat as CVA

What affliction do these symptoms describe:

• MI is caused by a blockage in the coronary arteries

• This causes myocytes to become ischemic, then necrotic

  Symptoms

  • Substernal chest pain

  • SOB

  • Nausea and committing

  • Tachycardia

  • Tachypnea

  • Lavines sign

AMI

What type of affliction do these symptoms describe

• SOB

• Tachycardia

• Tachypnea

• Substernal chest pain

• Nausea

• Vomitting

Treatment

• relieved by rest or nitro

stable angina

What affliction do these symptoms describe

• chest pain at rest

• Chest pain of increasing frequency not relieved by nitro or rest at times

unstable angina

What does APGAR stand for

• appearance

• Pulse

• Grimace

• Activity

• Respiration

What affliction is being described:

A chronic condition in which the hart is unable to pump out all of the blood that it receives. The cardinal manifestations are displeased ad fatigue and fluid retention

Heart failure

What affliction is being described here:

• very high BP

• 180/120

• Blurred vision

• Encephalopathy

• Headache

• Numbness,tingling

• Chest pain

• Evidence or end organ dmg

• Brain, heart, eyes, kidneys

Treatment: supportive care and immediate transport

Hypertensive crisis

At age containing key information that is attached to a patient during a multiple-casualty incident

• green= minor

• Yellow= delayed

• Red= immediate

• Black=decreased

Triage tag

What are the fractures that result in severe hemorrhage

• pelvic fracture

• Femur fracture

What affliction is being described:

• force applied to a flexed knee extremity appears shortened

• Tx= closed reduction under conscious sedation

• Complications= sciatic nerve injury, a vascular necrosis

Posterior hip dislocation

What type of dislocation is being described flexed

• Abducted

• Externally rotated

• flexed

anterior hip dislocation

What type of assessment is this:

- Airway / Cervical spine (C-Spine)
•Breathing - lung sounds
•Circulation - IV access / blood transfusion
•Disabilities - Neuro assessment
•Exposed/Environmental control
•Full set of VS: Family
•Give comfort measures
•History & physical
•Inspection

Primary Survey

How do you calculate cerebral perfusion pressure

• CPP=MAP-ICP

  • MAP constant + ICP increaseCPP decrease

  • MAP decrease + ICP constant = CPP decrease

What affliction is being described:

• brain forced downward

• CSF flow obstructed, pressure on brain stem

• LOC

• Decreasing, rapid progression to coma

Treatment:severe therapy needed “slight” hyperventilation indicated

Cerebral herniation syndrome

The immobilization of the spinal column as if it were a single bone to prevent movement of individual vertebrae

Spina motion restriction

Found between the subdural and the skull; the ones that immediately effect you- these are arterial and dangerous- lots of blood ;

Treatment: ICU for 24; evacuation of blood

Epidural bleed

What affliction do these symptoms describe

• blood in the subarachnoid space

• Inravascular lucid “leaks” into brain

• Fluid”leak” causes more edema

• Associated symptoms

• Berry aneurysm MC Cause

• Thunderclap headache

Subarachnoid hemorrhage

Caused by a venous bleed between dura and arachnoid slow insert with lower pressures- take hours to days

Subdural bleed

Implantation of the placenta over the cervical opening or in the lower region of the uterus

• painless bright red vaginal bleeding

• Placenta is obstructing cervix

• Transport emergently

Placenta previa

A tear in the uterine wall and placenta

• painful, dark red vaginal bleeding

• Patient cannot stand up

• Transport knee to chest or comfortable position

Placenta rupture

1. Full term

2. Preterm

3. Abortions (included planned and unplanned)

4. Living children

Ex- PAra 2-1-1-3 for. Women with 2 full term deliveries, 1 pre term delivery, 1 abortion, and 3 living children

Florida Power and Light

What affliction is being described here

• caused by mycobacterium

• Usually seen in the apex CXR

• Airborne and highly contagious when patient is symptomatic

• Most people are asymptomatic

Treatment

• supportive care

• Protect yourself and others from exposure

Symptoms

• productive cough

• Poor appetite

• Chest pain

• Coughing up blood or mucous

Tuberculosis

Acute viral infection of airways

• fever

• Malaise

• Cough

• Sore throat

• Myalgia

• Eye pain

Treatment: tamiflu and other antiviral drugs

Influenza

A chronic condition in which the pancreas produces little or no insulin

Type 1 diabetes mellitus

A chronic condition that affects the way the body processes blood sugar (glucose)

Type 2 diabetes mellitus

a life threatening condition that affects people with diabetes
-It occurs when body starts breaking down fat at a rate that is much too fast
-the liver processes fat into a fuel called ketones which causes blood to become acidic
-blood glucose 250 or higher
-much more common in type 1 diabeties

symptoms
-polydipsia
-polyuria
-polyphagia

signs
-low GCS
-confusion
-ketotic breath
-kussmal breathing
-tachycardia, hypotension, dehydration

Diabetic Ketoacidosis (DKA)

What affliction is being described

• complication with diabetes in which high blood sugar results in high osmolality without significant ketoacidosis (its not producing insulin)

• Most common in type 2 diabetics

• Symptoms

  • Dehydration

  • Weakness

  • Leg cramps

  • Vision problems

  • Leered LOC

  • Blood glucose greater than 600mg/dL

Hyperosmolar hyperglycemic state

What affliction is being described here:

• causes fluid imbalance in body

• Caused by insufficient or ineffective ADH, nothing to do with blood glucose or insulin

• S/S include severe polydipsia, and polyuria, leg cramps, and fatigue

Diabetes insipidus

What is this treatment describing:

Treatment: 1. emergency kit (ABCD): airway suction, endotracheal intubation, iv access, normal saline, thiamine, dextose, naloxone (one time)+traditional orders 2. pulse oximetry, cardiac and bp monitor 3 ABG, CBC, BMP (glucose), urine output, urine toxicology, blood alcohol, CXR, EKG, LFT... 4 NG tube, activated charcoal and naloxone (continue), psychiatry consult, suicide contract

Narcotic overdose

A powerfully addictive drug that stimulates the central nervous system, with speeded-up body functions and associated energy and mood changes; overtime , appears to reduce baseline dopamine levels

• dilated pupils

Methamphetamine

What are the different types of bandages

• gauze

• Compression

• Triangular

• Tube

What are the different types of bandaging:

• figure 8

• Reverse spiral ( use when using non elastically bandages

Types of bandaging

What treatment is this for:

• remove source

• Wear appropriate protective gear

• Remove clothing

• If dry chemical, brush from skin

• Flush copiously with water

• Remove retained agent

• Prevent secondary contamination

How to treat chemical burns

What doe these causes describe:

• sudden, unexpected loss of heart function, breathing, and consciousness

  Usually results from an electrical disturbance in the heart

• Not the same as a heart attack

Cardiac arrest

How do you suction

• always suction when the tube is being withdrawn and never done for more than 15 seconds

• The hard plastic tip is called a Yankauer- it has a small hole, cover the hole it’s your finger to function

What tool is being described:

• deliver 90-100% O2 with reservoir

• Can use with mask or connect to king airway or ET tube

• Requires 10-15 LPM O2 flow

• Bag slow and deliberate- do not push air into the stomach

Difficult ______ ventilation:

• B- beards

• O- obesity

• O- older patients

• T-toothlessness

• S-snores of stridor

BVM ( bag valve mask)

What tool is being described here

• delivers 70-90% O2

• Used in major trauma, respiratory failure and unstable patients

• Requires 10-15 LPM

Non-rebreather mask (NRBM)

What type of tool is being described:

• can deceive ore specifi prcentage of O2

• Different color pieces deliver different amounts

• Requires anywhere from 2-15 LPM flow

Venturi Mask

What tool is being described:

• used for more stable patents

• Delivers 25-40% O2

• Requires 0.5-6 LPM flow

• Never give more than 6 LPM

• Normally given 2-4 LPM

Nasal cannula

What is this an etiology of:

• loss of volume Catecholamines cause vasoconstriction

Hemorrhage