EMT-B Final Exam Comprehensive Study Guide

Respiratory and Airway Management: Key Definitions and Anatomy

Perfusion: Defined as the continuous and sufficient delivery of oxygen ( $O_2$ ) and essential nutrients to the cells and tissues of the body, coupled with the efficient removal of metabolic waste products, specifically carbon dioxide ( $CO_2$ ).
Ventilation: The mechanical process of breathing, which involves the physical movement of air into and out of the lungs.
Respiration: The physiological process of gas exchange occurring at the alveolar level, where oxygen enters the bloodstream and carbon dioxide is removed.
Cellular Respiration: The metabolic process by which cells produce adenosine triphosphate ( $ATP$ ) using oxygen and glucose. This process is divided into two types: * Aerobic: Utilizes oxygen ( $O_2$ ) for energy production. * Anaerobic: Occurs without the use of oxygen ( $O_2$ ).
Surfactant: A specialized lining within the alveoli that serves to reduce surface tension, preventing alveolar collapse. Damage to this lining, often caused by smoking, is a significant factor in the development of Chronic Obstructive Pulmonary Disease ( $COPD$ ).
Respiratory Anatomy Subdivisions: * Upper Airway: Comprises the nose, nasal cavity, pharynx, larynx, and trachea. * Lower Airway: Consists of the bronchi, bronchioles, lungs, and the alveoli.
Ventilatory Muscles: These include the diaphragm, intercostal muscles, accessory muscles used during respiratory distress, and the physical structure of the rib cage.
Pediatric Airway Characteristics and Considerations: * Pediatric patients possess a significantly smaller airway diameter compared to adults. * Pediatric patients have a larger head proportion relative to their body size; medical providers should pad behind the shoulders to achieve proper airway alignment. * The most common cause of cardiac arrest in pediatric patients is respiratory distress.

Advanced Airway Assessment and Clinical Measurement

Respiratory Sounds and Pathological Meanings: * Snoring: Indicates a physical airway obstruction, most commonly caused by the tongue falling back into the pharynx. * Stridor: A high-pitched sound indicating an upper airway obstruction at the level of the trachea or larynx, typically due to swelling or the presence of a foreign body. * Gurgling: Indicates the presence of fluid in the upper airway; this finding necessitates immediate suctioning. * Rhonchi: Indicates mucus obstruction or inflammation within the lower airway passages. * Crackles (Rales): Occur when air passes through fluid gathered in the alveoli; often associated with Congestive Heart Failure ( $CHF$ ), pulmonary edema, or pneumonia.
Airway Adjunct Sizing Protocols: * Oropharyngeal Airway (OPA): Sized by measuring from the corner of the patient's mouth to the angle of the jaw or the earlobe. * Nasopharyngeal Airway (NPA): Sized by measuring from the tip of the nose to the tip of the earlobe (tragus). The diameter should be approximately the size of the patient's little finger.
Normal Adult Vital Sign Ranges: * Heart Rate (HR): $60\text{--}100$ beats per minute. * Respiratory Rate (RR): $12\text{--}20$ breaths per minute. * Blood Pressure (BP): Between $\frac{90}{60}$ and $\frac{120}{80}\,mmHg$ . * Oxygen Saturation ( $SpO_2$ ): $94\text{--}100\%$ .
Mechanics of Breathing: * Inhalation: The volume of the thoracic cavity increases, which decreases internal pressure, allowing air to enter. * Exhalation: The process reverses as the volume decreases and pressure increases, forcing air out.
Clinical Indicators of Hypoxia: * Adequate Ventilation: Characterized by spontaneous breathing with visible and shallow chest rise. * Ventilation-Perfusion Mismatch: The most common cause of hypoxia, frequently related to underlying conditions such as $COPD$ , pneumonia, pulmonary edema, or asthma. * Severe Anxiety: Identified as the least common cause of hypoxia.

Cardiovascular Physiology and Circulatory Pathophysiology

Detailed Path of Blood Flow through the Heart: 1. Deoxygenated blood enters the Superior/Inferior Vena Cava. 2. Flows into the Right Atrium. 3. Passes through the Tricuspid Valve. 4. Enters the Right Ventricle. 5. Passes through the Pulmonary Semilunar Valve. 6. Enters the Pulmonary Artery to travel to the Lungs for oxygenation. 7. Oxygenated blood travels through the Pulmonary Veins. 8. Enters the Left Atrium. 9. Passes through the Bicuspid (Mitral) Valve. 10. Enters the Left Ventricle. 11. Passes through the Aortic Semilunar Valve. 12. Enters the Aorta for distribution to the Body.
Cardiac Cycle Phases: * Systole: The phase of left ventricle contraction where oxygenated blood is pumped to the systemic circulation. * Diastole: The phase of heart expansion where the chambers fill with blood.
Assessment of Skin Signs: * Cyanosis: Blue discoloration indicating lack of oxygen. * Diaphoresis: Profuse sweating. * Jaundice: Yellowing of the skin or eyes, indicating potential liver failure.
Anatomic and Pathological Terms: * Coronary Arteries: The specific vessels that supply blood directly to the heart muscle. * Ischemic Tissue: Refers to tissue death (necrosis) resulting from a critical lack of oxygen.
Autonomic Nervous System (ANS) Responses: * Sympathetic (Fight or Flight): Results in increased $HR$ , $RR$ , and $BP$ . Manifests as dilated pupils, sweating, trembling, dry mouth, and shallow breathing patterns. * Parasympathetic (Rest and Digest): Results in decreased $HR$ , $RR$ , and $BP$ . Manifests as pupil constriction and $SLUDD$ effects (Salivation, Lacrimation, Urination, Digestion, Defecation), and improved sexual arousal.
Electrical Conduction Pathway: * Initial impulse at the SA Node (Atria contract) $\rightarrow$ travels to AV Node $\rightarrow$ passes through the Bundle of His $\rightarrow$ divides into Bundle Branches $\rightarrow$ reaches Purkinje Fibers (Ventricles contract). * Key Electrolytes: Sodium ( $Na$ ) and Potassium ( $K$ ) are essential for cardiac conduction and muscle contraction.
Cardiovascular Conditions: * Tachycardia: An abnormally fast heart rate. * Bradycardia: An abnormally slow heart rate. * Hypertension: High blood pressure. * Hypotension: Low blood pressure. * Congestive Heart Failure (CHF): A condition where the heart is unable to pump effectively, leading to edema, jugular vein distention ( $JVD$ ), and pulmonary edema.
Special Considerations in Cardiac Assessment: * Diabetics, elderly patients, and women may present with atypical chest pain symptoms rather than traditional signs. * Chest pain that radiates specifically from the back to the front can be an indicator of an abdominal aortic aneurysm ( $AAA$ ). * CPAP (Continuous Positive Airway Pressure): Beneficially assists $CHF$ patients by improving oxygen intake and reducing the overall workload of the heart.

Patient Assessment Strategies and Diagnostic Tools

The Four Steps of Assessment: 1. Size-Up: Evaluating scene safety, gathering background information, and determining the need for additional resources. 2. Primary Assessment: Determining the general impression, assessing the $ABC$ s (Airway, Breathing, Circulation), checking vitals, determining Mechanism of Injury ( $MOI$ ) or Nature of Illness ( $NOI$ ), and making transport decisions. 3. Secondary Assessment: Obtaining patient history and performing a physical examination. 4. Reassessment: The periodic monitoring of vital signs and the patient's condition.
OPQRST Pain Assessment Tool: * Onset: When and how did the pain begin? * Provocation/Palliation: What makes the pain worse or better? * Quality: What does the pain feel like (e.g., sharp, dull)? * Radiation: Does the pain move to other locations? * Severity: Intensity of pain (usually on a scale of $1\text{--}10$ ). * Time: How long has the patient been experiencing this?
SAMPLE Medical History Tool: * S: Signs and Symptoms. * A: Allergies. * M: Medications. * P: Past medical history. * L: Last oral intake. * E: Events leading up to the injury or illness.
AVPU Scale for Mental Status: * Alert: Patient is awake and responsive. * Verbal: Responds to verbal stimuli. * Painful: Responds to painful stimuli (providers should use interdigital pressure or a trapezius pinch). * Unresponsive: No response to any stimuli.
Levels of Orientation: * $1$ : Person. * $2$ : Place. * $3$ : Time. * $4$ : Event.
Pulse Assessment Points: * Carotid: Utilized if the heart rate is extremely low or absent. * Brachial: Used for pediatric and infant patients. * Radial: Standard for adult patients. * Pedal and Femoral: Used for assessments of the lower extremities.
Airway Management Techniques: * Head-tilt Chin-lift: Used to open the airway when no spinal injury is suspected. * Jaw-thrust Maneuver: Used to open the airway when a spinal injury is suspected. * C-spine Stabilization: Manual stabilization of the cervical spine must be maintained until the head is secured, such as on a backboard. * CPR Note: Do not stop chest compressions to apply an Automated External Defibrillator ( $AED$ ).

Emergency Pharmacology for the EMT-B

Authorized Routes of Administration: * Sublingual: Under the tongue. * Oral: For conscious patients only. * The $EMT\text{-}B$ is strictly prohibited from administering medications via Intravenous ( $IV$ ) or injection routes.
Medical Direction: * Offline Medical Direction: Following preapproved clinical protocols without needing to contact a physician. * Online Medical Direction: Maintaining direct, real-time communication with a physician for authorization.
Common Emergency Medications: * Nitroglycerin (NTG): A vasodilator used for chest pain to open coronary arteries. Up to $3$ doses may be administered. It is contraindicated if the patient's systolic blood pressure is less than (<) $100\,mmHg$ or if the patient has recently used erectile dysfunction medications. * Aspirin: An anti-platelet medication that reduces blood clotting (note: it is not a "blood thinner"). It is carried on all Basic Life Support ( $BLS$ ) ambulances and used for suspected cardiac issues. * Albuterol: A bronchodilator used for asthma or $COPD$ . It dilates the bronchioles to open airways and can be administered via an inhaler or nebulizer.

Trauma, Shock, and Hemorrhage Control

Pathophysiology of Shock (Hypoperfusion): * Shock is defined as inadequate delivery of oxygen and nutrients to cells and impaired metabolic waste removal. * Compensated Shock: The body activates the Sympathetic Nervous System ( $SNS$ ), resulting in increased $HR$ and $RR$ , while maintaining a normal to high $BP$ . * Decompensated Shock: Compensation mechanisms fail; characterized by a rapid drop in $BP$ , inadequate perfusion, cold/cyanotic skin, Altered Mental Status ( $AMS$ ), and severe tachycardia. * Irreversible Shock: A terminal state near death with random, erratic vital signs.
Specific Types of Shock: * Hypovolemic: Caused by fluid or blood loss (hemorrhagic shock is the term for severe blood loss). * Anaphylactic: A severe, systemic allergic reaction. * Septic: A severe infection involving multiple systems.
Bleeding Classifications: * Arterial: Characterized by bright red blood that is spurting or pulsating from the wound. * Venous: Characterized by dark red blood with a steady, continuous flow. * Capillary: Characterized by oozing blood; this is the most common type of bleeding.
Kinetics and Trauma Patterns: * MOI (Mechanism of Injury): How the injury occurred. * NOI (Nature of Illness): The medical cause of the condition. * Energy Principle: Energy is neither created nor destroyed, only transferred and conserved. * Frontal Collision: Down and Under: Leads to injuries of the lower extremities and pelvis. * Frontal Collision: Up and Over: Leads to injuries of the head, thorax, and abdomen, with a high possibility of cervical spine ( $c\text{-}spine$ ) injury. * Side Impact: Side to Side: Leads to injuries affecting the pelvis, torso, head, and neck.
Hemorrhage Control Procedures: * Chest Wounds: Must be sealed with occlusive dressings. * Junctional Areas: Wounds in these areas should be packed. * Extremity Wounds: For severe bleeding on arms or legs, use a tourniquet.

Medical Emergencies: Stroke, Seizures, and Neurology

Stroke Professional Standards: * Signs/Symptoms: Facial droop, arm drift, slurred speech, severe headache, dizziness, confusion, and altered Level of Consciousness ( $LOC$ ). * FAST Acronym: Face, Arms, Speech, Time. * Ischemic Stroke: Accounts for approximately $87\%$ of cases; caused by a blockage. * Hemorrhagic Stroke: Accounts for approximately $13\%$ of cases; caused by a vessel rupture. * Risk Factors: Hypertension (High $BP$ ), smoking, diabetes, high cholesterol, and atrial fibrillation.
Seizure Pathophysiology and Management: * Seizure: Defined as sudden abnormal electrical activity in the brain that disrupts communication between neurons. * Epilepsy: A condition characterized by recurrent seizures throughout a person's life. * Status Epilepticus: A medical emergency where a seizure lasts longer than (>) $5$ minutes or multiple seizures occur without the patient regaining consciousness. * Postictal State: The period immediately following a seizure where the patient has not yet regained full consciousness. * Management protocols: Providers must be prepared to suction the airway immediately following a seizure. Adequate oxygenation is critical during and after seizures to reduce strain on the brain.
Neurological Anatomy and Posturing: * Reticular Activating System (RAS): A bundle of nerves in the brainstem that filters sensory information and governs the level of consciousness. * Decerebrate Posturing: A sign of severe brain damage where arms and legs are extended rigidly, toes point down, and wrists curl outward. * Decorticate Posturing: A sign of severe brain damage where legs are extended and fists are clenched tightly near the chest.