Medical Terminology and Anatomy Review, Exams of Nursing

Download Medical Terminology and Anatomy Review and more Exams Nursing in PDF only on Docsity! NREMT COGNITIVE EXAM (460 Questions and Answers) In trauma a low pulse pressure suggests? - Correct answer Significant blood loss Blood pressure has a direct effect on? - Correct answer The perfusion of the bodys tissues Cells that die during a stroke are called? - Correct answer Infarcted cells You are called to a home where a 91 year old man has had a syncopal episode and is vomiting. The caregiver who called 911 stated that the patient's bowel movements have been bright red since yesterday. The patient has not complained of any pain, but is nauseated. What is most likely wrong with this man and which choice includes appropriate treatment steps? Choices: A. He has an upper GI bleed and should be transported sitting up with high flow O2 administered via a non rebreather mask at 15 LPM. B. He has had a TIA and should be given high flow oxygen via NRB and transported on his effected side to the nearest hospital. C. He has pancreatitis and should be given high flow O2 via NRB at 15 LPM. Rapid transport in a left lateral recumbent position while keeping him warm will help avoid shock. D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while t - Correct answer D. He has a lower GI bleed and should be given O2 via nasal cannula at 4LPM and transported in a position of comfort while treating for shock Rationale: The bright red blood in the bowel movements is indicative of a lower GI bleed. Answer 1,2, and 3 all utilize an NRB to deliver high flow O2. Given that the patient is vomiting and nauseated, it would be advisable to use a nasal cannula, rather than an NRB, to help avoid potential airway compromise if the patient continues to vomit. If a patient was feeling nauseated this would likely be a_______________response. If a person was tachycardic it would likely be a___________________ response. - Correct answer Parasympathetic/Sympathetic You are assessing an 84 year old man. Upon auscultation of the lungs you discover crackles or rale sounds. He is complaining of chest pain and congestion. These signs and symptoms can indicate? Choices: A. An embolism B. Collapse of the vena cava C. Left ventricular failure D. Right ventricular failure - Correct answer C. Left ventricle failure Rationale: These are signs and symptoms of a possible failure of the left ventricle. The pump portion of the heart is unable to pump efficiently and fluid begins to back up into the lungs. A child between 3-5 would have normal vitals if they were? Choices: A. 35 breaths a minute, pulse of 88, and Systolic BP of 100 B. 24 breaths a minute, pulse of 76, and Systolic BP of 98 C. 20 breaths a minute, pulse of 100, and Systolic BP of 110 D. 20 breaths a minute, pulse of 120, and Systolic BP of 120 - Correct answer 20 breaths a minute, pulse of 100, and Systolic BP of 110 Rationale: A child between 3 and 5 (preschool-age) should have respirations between 20-30, a pulse of 80-120, and a systolic BP of 80 - 110. (Toddler 12 to 36 months) A. 30-60 minutes B. 1-2 days C. 10-15 minutes D. Proper intervention - Correct answer C. 10 to 15 minutes Rationale: Transient Ischemic Attack (TIA) is a blockage of vessels in the brain that usually subsides after a period of 10 to 15 minutes. However, if the patient's symptoms persist longer than 15 minutes, continue to treat the patient as if they are having a CVA (Cerebrovascular Accident). If resolution takes place within the 10-15 minutes, then chances are they have had a TIA. The final diagnosis of TIA is made if the symptoms resolve within 24 hours and is determined by a physician. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be... - Correct answer Low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade. You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate? Choices: A. Question the bystanders, direct them to stop CPR , check for pulse and then attach the AED, Begin chest compressions B. Check for responsiveness, Assess for breathing, Check carotid pulse , put your gloves on C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check D. Turn on power to AED, open the patient's airway, insert an adjunct and then analyze the rhythm - Correct answer C. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check Rationale: Your gloves should be on! According to the NREMT skill sheet one cycle of CPR should be performed prior to attaching AED. Inserting an adjunct is not listed on this NREMT Skill Sheet. Signs and symptoms of Cushing's phenomenon include all of the following except: Choices: A. Hypertension B. Biot respirations C. Tachycardia D. Central neurogenic hyperventilation - Correct answer C. Tachycardia Rationale: Signs and symptoms of Cushing's phenomenon include: hypertension, bradycardia, irregular respirations, central neurogenic hyperventilation, and Biot respirations. Cushing's triad signs and symptoms are caused by a significant head trauma, also referred to as herniation syndrome. The intracranial pressure increases forcing the brain stem and the midbrain through the foramen magnum. This can be a fatal injury if it is allowed to continue, and can be treated by hyperventilating the patient via positive-pressure ventilations if local protocols allow. What is Cushing's triad? - Correct answer Includes hypertension, bradycardia and apnea. ... As intracranial pressure continues to increase, the patient's heart rate will increase, breathing will became shallow, periods of apnea will occur, and blood pressure will begin to fall. A man has both legs burned on the front and back, along with the fronts of both arms. Approximately what percentage of his body was burned? Choices: A. 36 percent B. 50 percent C. 45 percent D. 54 percent - Correct answer C. 45 percent Rationale: Each leg is 18% and the front of each arm counts as 4.5 for a total of 45%. Rapid breathing is first seen in what stage of shock? Choices: A. Decompensated shock B. Compensated shock C. Irreversible - Correct answer B. Compensated Shock Rationale: A person may breath rapidly in compensated and decompensated shock, but it is FIRST seen in compensated shock. Which list includes only the "Five Rights" of medication administration? Choices: A. Medication, dose, time, route, and documentation. B. Patient, medication, dose, route, and time. C.Patient, medication, indication, dose, and time. D. Medication, dose, generic name, route, and documentation - Correct answer B. Patient, medication, dose, route, and time Rationale: The "Five Rights" of medication administration are: patient, medication, dose, route, and time. There is also generally an accepted "Sixth Right" which is 'Right Documentation,' or 'Write it Down,' however the NEMSES doesn't reference that "right." Cellular respiration and cellular metabolism are best described as: Choices: A. The exchange of respiratory gases between the systemic capillaries and the surrounding tissue beds B. The exchange of respiratory gases between the alveoli and the pulmonary capillary bed C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by-products D. The use of oxygen to create hemoglobin in the blood stream - Correct answer C. The use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by products Rationale: Cellular respiration and cellular metabolism is the use of oxygen and carbohydrates to produce energy and the creation of carbon dioxide and water by-products. You have requested helicopter transportation of a critical burn patient. The remote nature of the accident will force the helicopter to land on an incline. From which direction should you approach the helicopter? - Correct answer The downhill side Rationale: Approaching from the downhill side of the helicopter is the safest route in this situation. NIMS is best explained as: Choices A) A National system of managing large emergencies based on having private and governmental organizations work independently at the scene of a mass casualty B) A template system for providing consistent, effective processes in preparing for, responding to, and recovering from an incident C) A systematic approach of assessment used during the triage of large groups of people during a mass casualty incident D) Governmental rescue organizations taking responsibility for controlling the parts of the scene that fall within their expertise - Correct answer B) A template system for providing consistent, effective, processes in preparing for, responding to, and recovering from an incident Rationale: The National Incident Management System is designed as a template system for providing consistent, effective processes in preparing for, responding to, and recovering from an incident. How air enters the lungs: - Correct answer 1. Air travels through mouth/nose 2. Moves down the trachea 3.Left and right bronchi (the split is known as the carina) 4. Stemming off the bronchi to the bronchioles 5. From the bronchioles to the alveoli The alveoli is where gas exchange takes place Using the following terms explain how oxygen enters the bloodstream and how carbon dioxide leaves the body: Alveoli, capillaries, oxygen-rich blood, oxygen-poor blood, and carbon dioxide. - Correct answer O2 RICH 1. Within the ALVEOLI, O2 rich air is inhaled through the lungs and meets the capillaries 2. In the CAPILLARIES, O2 rich air molecules attach to red blood cells 3.02 rich red blood cells then travel back to the HEART O2 POOR 1. Carbon dioxide(within O2 POOR blood) comes from the HEART 2. O2 poor blood crosses from the heart into the CAPILLARIES 3. EXHALED from the body THESE PROCESSES OCCUR AT THE SAME TIME! Describe the process of breathing: - Correct answer INHALATION 1. Diaphragm contracts (moves downward) 2. Intercostal muscles contract (expanding rib cage) 3. Causes thoracic cavity to expand creating a NEGATIVE pressure which air fills the space. EXHALATION 1. Diaphragm/Intercostal muscles relax which creates a POSITIVE pressure in the thoracic cavity which results in air being pushed out Is exhalation an active or a passive process? - Correct answer Passive. Rationale: Unlike inhalation, there normally is no muscle contraction to exhale air. What drive is responsible for breathing control? What is the backup system? - Correct answer Carbon Dioxide Drive is our body's primary mechanism for breathing control. Increased CO2 levels will stimulate the body to increase the respiratory rate. As a backup, the Hypoxic Drive will stimulate breathing when O2 levels are sensed. What is the role of surfactant within the lungs? - Correct answer Think of surfactant as a lubricant in your lungs. Surfactant reduces surface tension inside of the alveoli. By doing this, gas exchange can take place because the presence of surfactant in the alveoli keeps them open. What is the normal rate of breathing in adults? - Correct answer 12 to 20 breaths per minute What is the normal rate of breathing in children? - Correct answer 15 to 30 breaths per minute What is the normal rate of breathing in infants? - Correct answer 25 to 50 breaths per minute What are four causes of an airway obstruction? - Correct answer 1) The tongue (most common) 2) Edema (swelling) 3) Fluid (vomitus, blood, mucous) 4) Foreign bodies (anything put into the mouth) What does a pulse oximeter measure? - Correct answer The pulse rate and the oxygen saturation of hemoglobin within arterial blood. What are 3 possible causes of getting an incorrect pulse oximeter reading? - Correct answer Nail polish Cold extremeties Carbon monoxide poisioning Tachypnea - Correct answer Rapid breathing Bradypnea - Correct answer Slow breathing Wheezing - Correct answer high-pitched whistling sound of air moving through narrowed airways Rales - Correct answer "wet" or "crackling" sounds Stridor - Correct answer High pitched sound from an airway obstruction Hypoxia - Correct answer Inadequate oxygen delivery to the cells Visceral pleura - Correct answer Membrane that covers the outside of each lung During an asthma attack, what is happening within the body? - Correct answer The bronchi and bronchioles become inflamed, causing bronchospasm and increased mucous. Resulting in the patient coughing, wheezing, and experiencing shortness of breath. What is pumonary embolsim? - Correct answer A PE is a blockage of one or more pulmonary arteries from a blood clot or other obstruction. What is the most common cause of a pulmonary embolism? - Correct answer DVTs (deep vein thromboses) becoming dislodged and traveling to the lungs are the most common cause. What are the signs and symptoms of pulmonary embolism? - Correct answer Most often, a sudden onset of shortness of breath, chest pain, tachypnea (rapid breathing), and cough will be seen. Asking about the patient's history might reveal a recent surgery, pregnancy, or extended bed rest. What is the difference between internal and external respiration? - Correct answer EXTERNAL respiration: Process of ventilation—the movement of air into the lungs and out of the lungs. During this process, gas exchange takes place, where O2 from the lungs diffuses into the bloodstream, and CO2 from the bloodstream diffuses into the lungs to be expired. INTERNAL respiration: Metabolic process that takes place a the cellular level in which oxygen and glucose react to produce energy for the cell. As a byproduct, CO2 is created and enters the bloodstream to travel to the lungs. What is perfusion and how can you detect a patients level of perfusion? - Correct answer Perfusion is the process of transporting blood throughout the capillaries of the body. Assessing a patients skin color is one of the easiest ways to determine if their body is perfusing properly. Normal skin should be pink, warm, and dry. If the skin is pale or blue, the body is not perfusing well. Altered mental status is a strong indicator that perfusion is low. If the brain is not receiving enough blood, the patients level of consciousness will diminish. Capillary refill is another great way to check perfusion status, especially in children. How can a patients position indicate respiratory distress? - Correct answer Patients in respiratory distress will likely change their position to allow for an easier work of breathing. One common position is the tripod position, in which the patient has their hands on their knees with their elbows out, leaning forward. Another common position is the sniffing position in which the patient will stick their head outward in an attempt to open the airway more. What is reffered to as an increased work of breathing? What can it lead to if not corrected? - Correct answer Increased work of breathing means that a patient is using an extra amount of energy to ventilate adequately. This can be seen as the use of accessory muscles, retractions or nasal flaring. A patient with an increased work of breathing is in respiratory distress and could eventually become so tired they fall into a respiratory arrest if they do not receive an intervention immediately. What is the equation for minute volume? - Correct answer Minute Volume = Respiratory Rate x Tidal Volume Why is minute volume important/better to use than just using the RR rate? - Correct answer A person's respiratory rate alone does not take into consideration the volume of each respiration. They could be breathing at a normal rate, but have little volume with each breath, which would not be adequate respiration. How are Cheyne-Stokes respirations categorized and what conditions can cause this breathing pattern? - Correct answer Cheyne-Stokes respirations are categorized by progressively increased respirations, followed by progressively decreased respirations, followed by a period of apnea. This respiratory pattern can be a result of stroke, brain injury, CO poisoning, or a brain tumor. You respond to the scene of a 55 year old male who is unconscious. He is breathing deep and rapid and has a blood sugar of 512. What type of respiratory pattern is this patient exhibiting and what is causing it? - Correct answer This patient's deep, rapid respirations are indicative of Kussmaul respirations, which is caused by diabetic ketoacidosis, or DKA. What lung sounds would you likely hear from a person who is suffering from an asthma attack? What causes this sound? - Correct answer Wheezing is the common sound heard from someone with asthma. High-pitched whistle sound that is typically heard on expiration. Occurs when the air is forced through small, inflamed airways causing them to vibrate. What is stridor and why is it more common in children? - Correct answer Stridor is a high-pitched sound during inspiration that is caused by a partial airway obstruction in the upper airway. Stridor is more common in children because the diameter of their airway is smaller than adults. Causing the airway to swell resulting in the sound. What is cyanosis and how does it relate to the respiratory system? - Correct answer Cyanosis is the bluish or purple coloration of the skin or mucous membranes. Cyanosis occurs when the blood in the body does not carry enough oxygen. This lack of oxygen in the blood can be due to an airway obstruction, lung disease, or hypoventilation/apnea. Explain what pulse oximetry is? - Correct answer Measures the amount of oxygen that is bound to hemoglobin in the blood, also known as the oxygen saturation. How do bronchodilators help respiratory patients? Give an example of one you would use in the field. - Correct answer Dilate the bronchi and bronchioles which decreases resistance in the lower airway and increases airflow to the lungs. Albuterol What is the correct sequence of assessment for an unconscious/unresponsive patient and why? - Correct answer C-A-B. Circulation, Airway, Breathing. Circulation is emphasized as the first thing to assess because it poses the greatest life-threat. The goal is early intervention with compressions and 11. After leaving the left ventricle blood is squeezed up the AORTIC VALVE 12. Lastly up through the AORTA where blood is pumped throughout the body 13. Arteries branch off into 14. arterioles 15. capillaries 16. veins What is the difference between systolic and diastolic blood pressure? - Correct answer Systolic blood pressure - the pressure in the blood vessels while the heart is contracting. Represented as the top number of a blood pressure (i.e. 120/80 mmHg). Diastolic blood pressure - the pressure in the blood vessels while the heart is at rest. Represented as the bottom number of a blood pressure reading (i.e. 120/80 mmHg) What are two important roles of red blood cells? - Correct answer - Transport oxygen to the cells - Transport carbon dioxide to the lungs What are 7 signs of cardiac compromise? - Correct answer 1) Abnormal blood pressure 2) Pain, pressure or discomfort in the chest or abdomen 3) Shortness of breath 4) Palpitations 5) Anxiety and/or irritability 6) Abnormal pulse 7) Sudden onset of nausea/vomiting Auscultation of the lungs reveal crackles and the patient is having difficulty breathing. Which side of the heart do you believe to be affected and why? - Correct answer Shortness of breath with crackles in the lungs is indicative of left-sided heart failure. The failure of the left ventricle to effectively pump blood to the body causes the blood to back up, or be congested, in the lungs. Right sided heart failure causes blood to back up into the body, causing pitting edema through the body. Whats the cause and what is another name for this condition? - Correct answer Cor pulmonale. The usual cause is pulmonary disease, such as pulmonary hypertension or pulmonary stenosis (obstruction within the pulmonary artery). What 4 things need to be assessed during the primary assessment of a cardiac patient? - Correct answer 1. PTs LOC using APVU scale 2. Airway 3. Breathing and ventilatory status 4. Circulation (Pulse, Major bleeding, skin color and cap refill) How might a cardiac condition be misinterpreted as a respiratory issue? - Correct answer Sometimes patients with cardiac conditions have chief complaints of difficulty breathing. This can be due to a number of reasons, but if the heart is not pumping effectively, cardiac output decreases and oxygen does not travel throughout the body as well. Patients may also have difficulty breathing due to fluid backing up into the lungs. This is typically caused by congestive heart failure. What does OPQRST stand for and why is relevant to cardiac patients? - Correct answer OPQRST is an acronym for helping EMS providers remember what questions to ask during the history portion of the assessment. It is especially useful for cardiac patients because it primarily focuses on the patient's symptoms of pain and can result in information that gives clues as to what specifically might be going on with the patient . O- Onset P- Provocation Q- Quality R- Radiate S- Severity T- Time Why is the way in which you ask questions important for the outcome of the information you obtain? - Correct answer It is important to ask open-ended questions and allow the patient to describe their symptoms without any prompting from the EMS provider. If a provider ask "Does your pain radiate to your jaw or left arm?" the patient may be likely to agree even if it's not true. Instead, the provider should simply ask "Does your pain move anywhere or stay in one spot?" What is the importance of asking your patient to rate their pain on a scale of 1 to 10? - Correct answer It is important to ask a patient to rate their pain so you can compare the score to the next time you ask the question after you have done an intervention. This is done to gauge if the intervention is improving the patient's condition. What type of information might you expect to find by exposing a cardiac patients chest? - Correct answer A big reason why exposing the chest on a cardiac patient is so important is that you may discover information that was not told to you during the history. You may discover that the patient has a scar, pacemaker, or nitroglycerin patches that indicate that the patient has a prior heart condition that they may have forgotten to mention. What types of sounds are listening for when ausculating heart sounds and what do they mean? - Correct answer One type of sound you might hear when auscultating heat tones is a murmur, which is a swishing sound between heartbeats. It may be harmless, or it could mean the patient has a congenital heart defect or heart valve disease. Clicking or snapping sounds may also indicate issues with the valves, such as stenosis. What is Acute Coronary Syndrome and how can it lead to heart attacks? - Correct answer Acute coronary syndrome is any condition that suddenly stops or reduces the flow of blood to the heart that could potentially cause damage to the heart muscle. If blood flow of a coronary artery is completely stopped, the part of the heart that receives blood from that artery does not receive any oxygen and will eventually die resulting in a heart attack. You are called out for a 56 year old female that is complaining of 10/10 chest pain that radiates to her left arm. Her blood pressure is 136/86 and she does not have any known allergies or bleeding disorders. What medication will you administer to this patient? - Correct answer The first priority is to give this patient high flow oxygen via non-rebreather to maintain her oxygen saturation above 94%. After concluding that there are no contraindications, you would want to administer aspirin. If the patient already takes nitroglycerin that is prescribed to her by her doctor, and has it available, you can assist the patient in taking the nitroglycerin. What is the dose for Aspirin and what are the contraindications? - Correct answer Patients complaining of chest pain should be administered four 81 2) Digestive: This is also known as the excretory system and its major role is eliminating waste from the body. The digestive system also is what provides us the ability to take in and process nutrients 3) Endocrine: Through the use of hormones, the endocrine system allows the body to communicate with itself. Think of hormones as chemical messengers. 4) Integumentary: Protection of the internal organs and thermoregulation from the environment. 5) Respiratory: Responsible for bringing oxygen and air into the body so that it can be transported throughout the body. 6) Reproductive: This is comprised of the major sex organs that aid in the production of offspring 7) Skeletal: Provides support, protection, and facilitates movement through the use of bones and muscle 8) Nervous: Sends and receives sensory information through neural pathways between the brain, spinal cord and muscle. 9) Renal: Responsible for eliminating waste, regulating blood pH and blood volume, and controlling electrolyte levels. 10) Lymphatic: This is the body's defense system against disease THIS CARD IS REVERSED PLEASE FLIP TO STUDY: - Correct answer Label each quadrant and list two organs that are contained with each. The spinal column is comprised of how many total vertebrae? How many of each type are there? - Correct answer The spinal column is composed of 33 vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused vertebrae in the sacrum, and 3-5 fused vertebrae in the coccyx. Define the different types of pain: Visceral, somatic, referred - Correct answer Visceral Pain - This is the type of pain that stems from the stretching of structures, ischemia(inadequate blood supply to organs), and/ or inflammation affecting the internal organs. Somatic Pain - This type of pain refers to the pain that is caused by damage or injury to the integumentary or skeletal systems, ie skin, bone, nails, muscle, or connective tissue. Referred Pain: Pain that is felt in one part of the body, but is actually coming from a different source. What is a hormone? - Correct answer Hormones are chemical substances found in the body that control certain functions of the bodies organs and tissues. Hormones play a major role in helping the body maintain homeostasis. What is the difference between type "1" and type "2" diabetes? - Correct answer Diabetes is a condition where the body is unable to produce the hormone insulin, or the body is unable to respond to it. Type 1 - The body makes little or no insulin. Often diagnosed at an early age. Type 2 - The body still produces insulin, but the body is unable to respond to it properly because of insulin resistance. Often diagnosed after the age of 40. Define the following terms associated with diabetes: Polyuria Polydispia Polyphagia - Correct answer Polyuria - Frequent urination Polydipsia - Frequent thirst or frequent drinking Polyphagia - Frequent eating What is the normal range for a capillary blood glucose reading in an adult patient? - Correct answer 80 - 120 mg/dl (can be slightly higher or lower based on whether the patient has just eaten or been fasting) Diabetes inspidus differs from diabetes mellitus in what way? - Correct answer In diabetes insipidus there is a missing hormone that controls the reabsorption of urinary fluid. These patients end up having excessive urination, more than diabetes mellitus patients. When should you withhold administration of oral glucose in the hypoglycemic patient? - Correct answer When they have a change in their level of consciousness. The last thing you want to have happen is aspiration of the medication. Ensure your patient has a patent airway and can swallow without difficulty prior to administering the medication. What is diabetic ketoacidosis? - Correct answer DKA involves the build-up different acids in the body when insulin is not readily available. It is more commonly seen with patients who have Type I diabetes because these patients do not produce insulin. DKA is a hyperglycemic emergency, where body blood sugar levels become too high. How does hyperglycemia lead to an altered mental status? - Correct answer Hyperglycemia occurs when a patient does not take their insulin, or their body is unable to use its own insulin effectively. When this happens sugar is unable to get into the cells, and instead, accumulates in the blood. The brain requires sugar as its primary source of fuel, so when sugar is unavailable the brain begins losing function resulting in altered mental status and even coma. What is shock? - Correct answer Shock is a condition that results in hypoperfusion in which not enough oxygen and nutrients are being supplied to the cells to carry out their normal function. What is distributive shock and how does it occur? - Correct answer Distributive shock: Occurs when there is widespread dilation of the vessels causing a decrease in blood pressure What is cardiogenic shock and how does it occur? - Correct answer Cardiogenic shock: Occurs when the heart cannot circulate enough blood to maintain adequate oxygen delivery What is obstructive shock and how does it occur? - Correct answer Obstructive shock: Occurs when there is a block to the blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues What is hypovolemic shock and how does it occur? - Correct answer Hypovolemic shock: Occurs when the circulating blood volume is decreased and is insufficient in delivering oxygen and nutrients to the body What is pharmacokinetics and what are the 4 processes involved? - Correct answer Pharmacokinetics refers to what happens to a substance from the time it enters the body, to the time it exits the body. The 4 processes of pharmacokinetics are absorption, distribution, metabolism, and clearance of a substance. How does Carbon Monoxide poisoning affect the body? - Correct answer Carbon monoxide is a gas that enters the body via inhalation. CO has a higher affinity to hemoglobin than oxygen, meaning it binds to the red blood cells better than oxygen does. For this reason, CO saturates the red blood cells and prevents oxygen from getting transported to the cells. This eventually leads to hypoxia, as the cells of the body become deprived of the necessary oxygen levels. How do you treat CO poisoning? - Correct answer Treatment of CO poisoning in the field requires removing the patient from the toxic environment and supplying a high concentration of oxygen in an attempt to displace the CO molecules from the hemoglobin. What should you do if you get a call for a child who ingested a toxic substance you have never heard of? - Correct answer In any situation where someone has ingested a toxic substance you don't know of, you should call the Poison Control Center at 1-800-222-1222. The Poison Control Center is a medical facility that provides immediate treatment advice via the telephone and can give you specific information about how to treat your patient based on the substance they ingested. What is toxidrome? List all 5 toxidromes - Correct answer A toxidrome is a set of signs and symptoms or characteristic effects that are associated with a certain category of substance or poison. - Cholinergic toxidrome - Anticholinergic toxidrome - Sympathomimetic toxidrome - Narcotic toxidrome - Sedative/Hypnotic toxidrome You find a patient who is unresponsive, has a very slow and shallow respiratory rate, and pinpoint pupils. What toxidrome fits the patients presentation? How would you treat this patient? - Correct answer Based on the patient's presentation, he has likely taken some form of drug from the narcotic toxidrome, which depresses the central nervous system. Treatment of this patient would require aggressive airway management and ventilations as well as a dose of Naloxone to counteract the opiate. What does SLUDGE stand for and what are the symptoms associated with? - Correct answer SLUDGE is an acronym for the signs and symptoms that someone would present with if they have organophosphate poisoning, which is a cholinergic toxidrome. S- Salivation L- Lacrimation (tears) U- Urination D- Defecation G- Gastrointestinal upset (diarrhea) E- Emesis (vomiting) How do the drugs in the sympathomimetirc toxidrome affect the body and what the signs and symptoms of this toxidrome? - Correct answer Sympathomimetic drugs produce physiological effects that mimic the sympathetic nervous system. This is the same system that is responsible for the fight or flight response. Drugs in this toxidrome are methamphetamines, amphetamines, and over the counter drugs that contain epinephrine. Signs and symptoms associated with these drugs include hypertension, tachycardia, dilated pupils, agitation, and seizures. What are the 4 routes of absorption and give an example of each one? - Correct answer Ingestion- Swallowing medications Injection- Snake bite Inhalation- CO poisoning Absorption- Pesticides What is the difference between a local reaction to a bee sting and a systemic reaction? - Correct answer A local reaction will typically present with pain, redness, and swelling around the site. A systemic reaction can result in anaphylaxis and can affect the entire body, causing dyspnea, wheezing, hypotension, and eventually shock. You are called to the scene of a 30 year old male who has overdosed on an unknown medication. You arrive to find the man laying unconscious on his bed with an empty bottle of pills next to him. How would you be able to estimate how many pills the patient may have ingested? - Correct answer To figure a rough estimate of how many pills someone has taken, look at the pill bottle fill date and the number of pills originally in the bottle. This information should be labeled clearly on the bottle. If the fill date was very recent and the bottle is empty, you can assume the patient took most, if not all of those pills at once. If the fill date was a long time ago, they may not have taken as many. What people in society are at the greatest risk for being victims of abuse or neglect? - Correct answer People who are at greatest risk of abuse or neglect are those that are dependent on others for their basic needs. This includes children, dependent elderly and adults with cognitive or emotional impairments. What is neglect and what are the 5 types of neglect? - Correct answer Neglect is a form of mistreatment in which a person responsible for the well-being of another, fails to provide care for that person, resulting in harm. The 5 types of neglect are: - Physical neglect - Emotional neglect Abandonment - Financial neglect - Self neglect What socioeconomic factors play a role in the likelihood of abuse within a family? - Correct answer Financial struggles Divorce Single parenthood Substance abuse What does bariatric mean and what are 4 complications when treating bariatric patients? - Correct answer Treatment and management of people with obesity. 1) Airway management(patients have larger tounges and minimal neck mobility which makes opening the airway/inserting an airway difficult) 2) Difficult to ventilate when lying supine because of the accessive weight on their chest 3) Transporation 4) Equipment failure (blood pressure cuffs or standard stretchers) What is a DNR? - Correct answer A DNR is a type of advanced directive that stands for Do Not Resuscitate. It is a physicians order that instructs healthcare personnel to withhold some or all interventions in the case of cardiac or respiratory arrest. What are some common health risks that can result from paralysis? - Correct answer Pressure ulcers are a major concern for paraplegics and quadriplegics and can result in infections and also sepsis. Autonomic dysreflexia is a dangerous syndrome that results from some form of stimulation below the level of paralysis which causes uncontrolled hypertension. Patients with paralysis due to spinal cord injuries are very susceptible to temperature extremes and can develop hypothermia or hyperthermia because they are unable to regulate perfusion to the skin. Loss of bladder and bowel control due to paralysis puts patients at a higher risk for urinary tract infections. What federal agency regulates all radio operations in the United States? - Correct answer The Federal Communications Commission (FCC). They are responsible for implementing and developing regulatory programs, processing licenses, educating the public, and processing complaints. What is the difference between a mobile and portable radio? Hint: Do not think cell phones/ Think mobile like a car - Correct answer A portable radio is handheld with limited range. A mobile radio is usually vehicle mounted and has a much larger range. What is a repeater used for? - Correct answer It increases the range of both portable and mobile radios. It takes low voltage transmission and broadcasts them at a higher power. Is a cellular phone a simplex or duplex radio system? - Correct answer Duplex. The cellular phone can receive and transmit at the same time, using two separate channels. What are 3 advantages of a Mobile Data Computer? - Correct answer 1) Reduce the amount of radio traffic 2) Displays address and call information 3) Allows for off-air communication between other units and dispatchers. When speaking on the radio, how should you begin your transmission? - Correct answer Who you're talking to, and then who you are. For example: "Main street command from medic one". What information is typically provided from dispatch when responding on an emergency call? - Correct answer Address. Nature of the emergency. The triaged priority of the call (code 1 or code 3). Symptoms relayed from the caller. Hazards. Need for police or staging. For effective and accurate information what should be done after you receive orders over the phone or the radio? - Correct answer Acknowledge and summarize the information. This ensures that what they said was conveyed accurately. Are protocols considered "Off-line" or "On-line" medical control? What is the difference between the two? - Correct answer Protocols are off-line medical control. They are a set of standing orders that a medical doctor has approved. On-line medical direction would be direct orders received by radio or telephone from a medical doctor. What is a scope of practice? - Correct answer It is an outline of the actions and procedures a provider is legally allowed to perform. Although there is a national curriculum, each state defines their own scope of practice. What is assault and give an example how it would relate to you as an EMT? - Correct answer 1) The threat of bodily harm to someone else that causes fear - you threaten to hit your partner if they don't stop talking What is battery and give an example of how it would relate to you as EMT? - Correct answer Physical harm caused to someone else - you physically hit your partner after they kept criticising you What is abandonment and give an example of how it relates to you as an EMT? - Correct answer Discontinuing care without assuring that someone of equal or higher expertise/certification is taking over - you take your patient to the hospital and leave them in the waiting room without transferring care to a nurse What is negligence and give an example of how it relates to you as an EMT? - Correct answer The EMT had a duty to act. They breached that duty. Harm was caused to the patient as a result of breaching their duty. - you were supposed to replace the oxygen tank when it was empty, but you forgot and went to lunch instead. On your next call, the patient needed oxygen and went unconscious because it wasn't available. What is defamation and give an example of how it relates to you as an EMT? - Correct answer Written or spoken false communication that damages someone's reputation - you post an untrue story on the office bulletin board about a co-worker not being able to perform their job What is libel and give an example of how it relates to you as an EMT? - Correct answer WRITTEN defamation - you write something defamatory on social media What is slander and give an example of how it relates to you as an EMT? - Correct answer SPOKEN defamation - you tell your partner that your boss never went to paramedic school, which isn't true. What is an emancipated minor? Can they give consent? - Correct answer Emancipated minors have been legally freed from their parent's/guardian's care and control before they reach the age of majority (usually 18 years of age). They assume full responsibility for their own care and can consent to treatment. What is the difference between expressed and implied consent? - Correct answer Expressed consent is when a person gives spoken or written permission to someone else to render care (i.e. a patient is having chest pain, calls 911, and asks for an ambulance to come help her). Implied consent is not expressly granted, but occurs based on the circumstances (an unconscious victim at the scene of a motor vehicle collision). You are treating a patient with a large laceration on the leg. Bleeding is uncontrolled but they tell you they dont want your help. Are you able to help them? Why? 3) Logistics 4) Planning 5) Operations What is a mass casualty incident? What are 3 examples? - Correct answer An incident where the resources of an agency are overwhelmed by the complexity or number of casualties. - A motor vehicle collision involving a school bus. - Natural disasters or terrorism - Building collapse - School shooting What are the four categories used in triage and what do they represent? - Correct answer Black - deceased or dying patients with a very low chance of survival Red - immediate life threats that needs immediate attention to survive Yellow - delayed patients that need treatment and transport, but are not immediate Green - minor injuries that don't need immediate attention; also referred to as "walking wounded" What are 3 components of START triage? - Correct answer Respirations, Perfusion, and Mental Status. When moving a patient, is it ever okay to move them without an initial assessment or c-spine precautions(if warranted) Why or why not? - Correct answer Yes. Known as an emergent move, it is okay to move a patient if the scene is so dangerous that leaving them in place to properly treat them will most likely cause more harm than moving them to a safer place to begin treatment. An example is a car wreck where part of the car is engulfed in flames. Why is it important to obtain a patient history? - Correct answer It is important to obtain a patient history because it can give information to the EMS provider that will ultimately help in the care that the patient will receive, such as how to treat their specific condition, or what medications to not give due to allergy. It is also important to obtain information about the incident so that an accurate portrayal of what happened can be given to the receiving facility. What are 2 ways that you can build trust with a patient to ensure you recieve a good history from them? - Correct answer One of the ways to build trust is by your appearance. If you look like a professional, the patient will likely treat you like one. This means wearing a clean, neat uniform, maintaining good personal hygiene and grooming. Another way to build trust is to have a good demeanor. Your body language says a lot about how you are feeling and someone who feels like they are a burden to you because of your demeanor will be less likely to give you information. What is a chief complaint? - Correct answer A chief complaint is what the patient is most concerned about. It is the reason that the person called for EMS assistance. In some cases such as unconscious patient, the PT will not be able to give you any history of their present illness. What are 5 other sources you could use to obtain a PTs history? - Correct answer - Family/Friends - Caregiver - Medical jewelry - Public safety officer - Bystanders What is SAMPLE history and what does it stand for? - Correct answer SAMPLE history is a mnemonic to help you remember what questions to ask when obtaining a patient's history S- Signs and Symptoms A- Allergies M- Medications P- Past medical history L- Last oral intake E- Events preceding What is OPQRST and when is it used? - Correct answer OPQRST is also a mnemonic for remembering what questions to ask. It is typically used to gain information about a persons pain, such as chest pain. O- Onset (gradual or rapid) P- Provocation (Does anything make it feel better or worse?) Q- Quality (What does the pain feel like?) R- Radiate (Does the pain move anywhere?) S- Severity (Pain scale 1-10) T- Time (How long ago did the pain start?) What are two techniques for obtaining sensitive information from a patient? - Correct answer Ask the patient questions in privacy away from other family members or bystanders. If you need to, ask people to leave the room or bring the patient into the ambulance where they will feel more comfortable talking. Ensure the patient that you are a medical professional and the information they give you will be kept confidential. Explain to the patient that accurate information is important for proper treatment. How do you obtain a history from a pediatric patient? - Correct answer It is always important to try and include the child in the history taking process to build trust, but understand that the most reliable information will likely come from a parent or caregiver. Gather information about the child's behavior as well as family history and look for signs of abuse. What are some ways to communicate and obtain history from a deaf patient? - Correct answer If the patient is hard of hearing, you can allow them to wear your stethoscope and speak into it to amplify your voice. Many people who are deaf are very good at reading lips, so be sure to communicate face-to-face and speak slowly. You may also communicate by writing questions on paper. Be sure to let the receiving facility know the patient is deaf so they can have a sign language translator available. What are some complications you might encounter while trying to obtain a history from geriatric patients? - Correct answer In many cases, obtaining history form geriatric patients may be difficult because their symptoms are non-specific or they have multiple unrelated symptoms. They may have complicated histories due to co-morbidities and obtaining a history may take a long time, which can be a real challenge with short transports. What is the purpose of the primary assessment? - Correct answer The purpose of the primary assessment is to identify and manage any life- threatening issues to a patient's airway, breathing or circulation, within the first 60-90 seconds. Identification of these issues in a timely manner is crucial for the outcome of the patient. What is a general impression and when do you form it? - Correct answer The general impression is your basic opinion of how the patient is doing based on their chief complaint and how they are presenting. The general - Do you have any previous children and how were they delivered (i.e. vaginal, cesarean)? - Do you have any abdominal pain or vaginal bleeding? - Are you having contractions? How long do they last? What is the time in between contractions? Describe the 3 stages of labor: - Correct answer First Stage: This stage begins when the mother starts having contractions and ends when the cervix is completely dilated Second Stage: Starts when the child enters the birth canal and ends when they are born Third Stage: Also known as the Afterbirth stage, this is when the placenta is delivered What is APGAR score used for and what are the components of it? - Correct answer The APGAR score is a tool used just after the birth of a baby that measures how they're doing and if further intervention is needed. It's made up of Appearance, Pulse, Grimace, Activity, and Respirations. It is used at 1 minute after birth and 5 minutes after birth. Appearance 0 - cyanotic all over 1 - pink core, cyanotic extremities 2 - pink all over Pulse 0 - pulseless 1 - <100 2 - >100 Grimace 0 - little or no response 1 - minimal response to stimulation 2 - responds vigorously, crying Activity 0 - none 1 - flexed arms and legs 2 - active Respirations 0 - not breathing 1 - slow or irregular breathing 2 - adequate breathing You suspect PID during the assessment of a 28 year-old female. What is PID and what are the signs and symptoms? - Correct answer Pelvic inflammatory disease is an infection of the female reproductive organs. Signs/symptoms include: Lower abdominal pain Fever Irregular menstruation Pain during urination/sex Vaginal discharge. What is SIDS? - Correct answer Sudden infant death syndrome is the unexplained death of a child 1 month to 1 year of age. It most often occurs during sleep and there is no definitive evidence of the cause. What is the compression/ventilation ratio for children and infants during CPR? - Correct answer Children and infants are the same One-rescuer: 30/2 Two-rescuers: 15/2 What is supine hypotensive syndrome and does it pertain to pregnant patients? - Correct answer The weight of the uterine and abdominal contents pushing on the inferior vena cava. This can lead to the mother feeling dizzy, weak, and she may even lose consciousness. The reason the patient feels weak is due to a lack of blood returning to the heart, which affects cardiac output. If an expectant mother tells you shes had one miscarriage and one live birth, how would you describe her history using the gravida/para system? - Correct answer Gravida 3, Para 1 Gravida is the number of times the woman has been pregnant (regardless of outcome). Para is defined as the number of viable live births. This mother is currently pregnant, had one miscarriage, and delivered one child = G3. She has delivered only one child = P1 What does the term "nullipara" mean? - Correct answer A woman who has never given birth What is meconium staining and what does it indicate? - Correct answer Meconium is the first stool of the infant. Meconium staining is a green, brown, or yellow tinged amniotic fluid that is a result of the infant defecating during labor, or even a considerable time before. This could be a sign of distress in the infant and requires rapid treatment. What are some factors that could present themselves on scene that would indicate neonatal resuscitation could be imminent? - Correct answer Meconium staining when the mother's water breaks. History of delivery problems. Multiple births, such as twins or triplets. A baby who is premature. History of recreational drug use by the mother. What are the signs of preeclampsia/eclampsia? Why is eclampsia considered an emergency? - Correct answer Pre- eclampsia presents itself as hypertension, protein in the urine, and pitting edema. It is considered eclampsia when the mother also has a seizure. Most often, 911 is called when the mother has a seizure and this is a true emergency. The fear is that blood flow will be reduced to the placenta and cause harm to the fetus. What is Nuchal Cord and why is it an emergency? - Correct answer Nuchal cord occurs when the umbilical cord has wrapped itself around the newborn's head. Most often, it can be slipped over the head and if needed, can be clamped and cut in place. The fear is that the cord can become compressed, cutting off the blood supply to the newborn. What is the normal blood loss during childbirth? - Correct answer 300-500 mL What is a Prolapsed Cord and why is it an emergency? - Correct answer A prolapsed cord is when the umbilical cord proceeds the fetus into the place an IV. Monitor airway, breathing, and circulation and transport rapidly. What is a cord presentation and how do you manage it in the field? - Correct answer Cord presentation means that a part of the umbilical cord has prolapsed and is being compressed against the presenting part of the fetus. You can manage this by applying pressure to the presenting part and attempting to push it back into the vagina thereby relieving pressure on the cord. You must then keep your hand there to keep pressure off the cord and rapidly transport. You can also place the mother in Trendelenburg or knee to chest position to further attempt to relived pressure on the cord. Administer Oxygen to the mother and place moist sterile dressings on the cord. What is a cephalopelvic disproportion and how is it managed in the field? - Correct answer Cephalopelvic disproportion means that the head is too large to fit through the pelvis or the pelvis is unusually small. This is characterized by frequent strong contractions without movement of the fetus as the head is unable to fit through the pelvis. This is managed by administering oxygen as needed, placing an IV, fluid resuscitation as needed, and rapid transport. What is the most common type of breech? - Correct answer Frank breech is the most common type of breech, followed by incomplete breech, and then complete breech. What does occiput posterior presentation mean? - Correct answer Occiput posterior presentation means that the baby is facing up with delivery instead of sideways or down. How is the occiput posterior managed in the field? - Correct answer This position can often result in difficult labor and delivery and may require a cesarean section. This is managed by administering oxygen as needed, placing an IV for possible fluid resuscitation, and rapid transport What are some of the signs that a patient is respiratory distress? - Correct answer A patient in respiratory distress may have a respiratory rate that is too fast (>24 breaths/min) or too slow (< 8 breaths/min). A patient in respiratory distress may also exhibit an increased work of breathing by use of accessory muscles, abnormal breath sounds such as wheezes or rales, pale or blue skin (cyanosis), or an altered level of consciousness. Where do palpate a pulse on a conscious adult or child? An unconscious patient? An infant? - Correct answer To assess a conscious patient's pulse, palpate the radial artery just proximal to the wrist. If a patient is unconscious, palpate the carotid artery on either side of the trachea. For infants, the best place to palpate the pulse is the brachial artery in the medial aspect of the bicep. What is the procedure for stopping uncontrolled bleeding? - Correct answer If you notice uncontrolled bleeding from a vein or artery during the assessment, immediately apply direct pressure with gauze or a pressure dressing. If the bleeding does not stop, and the injury is on an extremity, the use of a tourniquet may be necessary. Apply the tourniquet 2-3 inches proximal to the injury and turn until the bleeding stops. What are 3 ways to assess a patients perfusion status? - Correct answer Assess skin color (If a patient's blood pressure drops, the skin will become pale. If the blood does not have an adequate amount of oxygen, the skin will turn blue.) Skin moisture (is also an indicator of perfusion status. Stimulation of the sympathetic nervous system, such as shock, will cause the patient to sweat. Depression of the sympathetic nervous system, such as in a spinal cord injury, will cause the skin to be abnormally dry and cool.) Capillary refill: Which indicates the circulatory system's ability to restore blood to the capillary system. What is the purpose of a secondary assessment? - Correct answer The purpose of the secondary assessment is to obtain quantifiable information, or information that is based on facts, about the patient's overall health condition. This information, along with the subjective information told to you by the patient, can be used to create your field diagnosis, or what you believe to be going on with the patient. What are the 2 components of the secondary assessment? - Correct answer Obtain vital signs (Determines overall body function.) The second component is a physical head-to-toe exam which measures specific body system functions. What physical findings do you look for when assessing a patients respiratory status? - Correct answer When assessing the respiratory system, you want to be sure to expose the chest and look at chest symmetry and any deformities, such as flail chest. You also want to look for the use of accessory muscles or retractions when the patient is breathing, which may indicate respiratory distress. Lastly, auscultate the lungs to determine if there are any abnormal breath sounds. What physical findings do you look for when assessing a patients cardiovascular system? - Correct answer In addition to checking the blood pressure, the main factors for assessing the cardiovascular system consist of assessing any major bleeding, assessing pulse rhythm, rate, and quality, and evaluate the condition of the patient's skin. What are 5 aspects to assessing a patients neurological status? - Correct answer - Assess the patients level of consciousness using the AVPU scale - Assess the patient's memory by asking questions pertaining to person, place, time and event - Assess the rate, quantity, and appropriateness of the patient's speech and language - Assess the logic and organization of the patients thought and perception - Assess the patient's appearance and behavior such as facial expressions and posture What is DCAP-BTLS and what does it stand for? - Correct answer It is an easy to remember pneumonic for what types of injuries to look for when performing a thorough assessment of the patient's body. D- Deformities C- Contusions A- Abrasions P- Punctures/Penetrations B- Burns T- Tenderness L- Lacerations Due to velocity being squared, the amount of energy increases rapidly when the speed increases. What is the difference between kinetic energy and potential energy? - Correct answer Kinetic energy is the energy an object has in motion (i.e. A bullet flying through the air). Potential energy is the energy stored within an object (i.e. A car stopped at the top of a hill). Why are there less injuries sustained from motor vehicle collisions today than 40 years ago? - Correct answer Due to improvement in automobile technology and design, a car manufactured today is designed to absorb energy and protect the occupants. Cars are equipped with safety restraint systems. Due to legislation and public education, seatbelt use has drastically increased. What are 3 types of blast injuries and how do they cause injuries? - Correct answer Primary blast injury - this is the initial explosion and the blast waves that hit the person Secondary blast injury - these types of injuries are caused by flying objects or shrapnel hitting the person Tertiary blast injury - the injuries sustained when a person is thrown and hits another object, such as a building or the ground. What 3 components of the Glascow Coma Scale? Write out the entire scale - Correct answer Eye opening. Verbal response. Motor response. Eyes 4 - Spontaneous 3 - To Speech 2 - To pain 1 - None Verbal 5 - Alert and oriented 4 - Confused 3 - Inappropriate words 2 - Incomprehensible words 1 - None Motor 6 - Obeys commands 5 - Localizes pain 4 - Withdraws from pain 3 - Abnormal flexion 2 - Abnormal extension 1 - None What is the difference between a penetrating injury and a blunt injury? - Correct answer A penetrating injury breaks the surface of the skin (bullet or knife). A blunt injury results from an object hitting the body (baseball bat) What is cavitation? - Correct answer Cavitation is the void space left behind by a bullet traveling through the body. Due to the shock waves of the bullet, the space created can be larger than the object itself. What is the difference between a sprain and strain injury? - Correct answer A sprain is the stretching or tearing of ligaments. A strain is a stretching or tearing of muscles or tendons. Often you will hear, "I sprained my ankle" or "I strained my hamstring" THIS SLIDE IS REVERSED PLEASE FLIP TO STUDY!! Open... The bone has broken the surface of the skin. Likewise, a closed fracture is when there is no broken skin. - Correct answer Is the following fracture considered open or closed? Which of the following types of bone fractures is the most common in children? A) Transverse B) Linear C) Oblique, nondisplaced D) Obique displaced E) Spinal F) Greenstick G) Comminuted - Correct answer Greenstick. Part of the bone is bent and the other part is broken is more common in pediatrcs due to stronger periostenum(dense, fiborous membrane that covers the bone) is stronger, thicker, and more flexible in children than in adults. What is a linear skull fracture? - Correct answer A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone. What are the 6 P's of the musculoskeletal trauma? - Correct answer - Pain - Paralysis - Paresthesia - Pulselessness - Pallor - Pressure What is a contusion? - Correct answer Bruise. Results from blunt trauma causing broken capillaries. What is a hematoma? - Correct answer Collection of blood outside of the blood vessel. What is a crush injury? - Correct answer Compression of part of the body between two objects. What is an abrasion? - Correct answer Superficial damage to the skin causing minimal bleeding, if at all. What is a laceration? - Correct answer A deep tear or cut in the skin What is an avulsion? - Correct answer A traumatic and forcible tearing away of part of the body. What is an amputation? - Correct answer The removal of an extremity or part of an extremity. What is an impaled object? - Correct answer An external object breaks the skin and rests within the body. which gas-fill spaces of the body undergo immense pressure during descent, and expansion injuries, in which gas-filled spaces expand too rapidly during ascent. What is perfusion? What is the result of hypoperfusion? - Correct answer Perfusion is the circulation of blood throughout a tissue or organ in an amount that meets the requirements for the tissues demand for oxygen, nutrients and waste removal. Hypoperfusion occurs when a tissues oxygen demand is not met. Persistent hypoperfusion results in shock and eventually cell death and organ dysfunction if not treated. How can you identify arterial bleeding from venous bleeding? - Correct answer Arterial bleeding is the most serious type of bleed because of the high pressure and the potential to lose a lot of blood in a short amount of time. It is characterized as bright red "spurting" blood and may be difficult to control. Venous blood is a darker red color than arterial blood and is characterized by a more steady flow or gushing. It does not spurt like arterial bleeds and is easier to control. How does the human body try to control bleeding on its own? - Correct answer When bleeding occurs the body naturally tries to stop the bleeding by coagulation, or forming blood clots. Platelets aggregate at the injury site and plug the hole, preventing blood from leaking out. Clotting factors activate a reaction that triggers the formation of fibrin strands, making the clot stronger. What is hemmoragic shock? - Correct answer Hemorrhagic shock is a condition of reduced tissue perfusion due to excessive blood loss that results in inadequate delivery of oxygen to the cells of the body. What are 3 levels of shock? Describe each one - Correct answer Compensated shock: The body can still compensate for blood loss and is able to maintain blood pressure and brain perfusion by means of vasoconstriction and tachycardia. Decompensated shock: The late stage of shock when the body is no longer able to maintain blood pressure and perfusion to vital organs decreases. Irreversible shock: The final stage of shock in which the body does not respond to treatment and recovery is impossible due to extensive cell death. Why is bleeding more significant in children? - Correct answer Children do not conserve fluids well so they have a lower tolerance for blood loss. Children also have a large surface area to weigh ratio so they get cold easier which leads to coagulation problems and hypothermia in shock. Children have longer compensatory functions but an abrupt decrease in function if the problem is not managed soon enough. What are some special considerations for bleeding in geratric patients? - Correct answer Many geriatric patients take medications that affect their body's ability to coagulate and compensate for blood loss such as blood thinners, beta blockers, calcium channel blockers and antiarrhythmics. Geriatrics also tend to have other health conditions that are exacerbated by severe blood loss. What are the steps for managing external hemmorage? - Correct answer Apply direct pressure over the wound with a dry, sterile dressing. Hold the pressure dressing in place and wrap it with gauze. Its ok to add more dressings if necessary but do not remove the original one as it will break any blood clots that had formed. If the bleeding is on an extremity and direct pressure is not stopping the bleeding, apply a tourniquet 2-3 inches proximal to the injury and turn it until the bleeding stops. Be sure to mark the time the tourniquet was applied. How does body temperature affect bleeding management? - Correct answer Hypotension and hypovolemia due to severe bleeding interrupts the body's ability to thermoregulate, which can cause hypothermia. Hypothermia in a bleeding patient can lead to problems with coagulation and acidosis. What is the main function of blood and what are the four components that make up blood? - Correct answer The main function of blood is to act as a transport system for dissolved gases, hormones, enzymes, waste products and nutrients. The four components of blood are: Red blood cells (erythrocytes) White blood cells (leukocytes) Platelets Plasma THIS SLIDE IS REVERSED PLEASE FLIP TO STUDY!! Number 1 is correct. You want to place the tourniquet two inches proximal to the wound to effectively cut off blood supply to stop the bleeding. Tourniquets are used to occlude an artery to prevent blood from reaching the wound and to treat arterial bleeds. Number 2 is not effective because the tourniquet is placed below the location of the arterial bleed. Number 3 could cause further tissue damage and does not occlude the vessel proximal to the wound. - Correct answer Where should you place the torniquet based on the picture which one is correct? When is the use of a torniquet indicated? - Correct answer A tourniquet is indicated if bleeding is not controlled by direct pressure either with holding direct pressure or using a pressure dressing. What are the steps to appliying a torniquet? - Correct answer 1. Select a site that is roughly 2 inches proximal to the wound. 2. Place a commercially available tourniquet or roughly 4 inch wide flat material over the artery to be compressed. 3. If fashioning a tourniquet place a pad or rolled up gauze over the artery to be compressed. 4. Then wrap the material around the extremity and pad twice and tie a half knot over the pad. 5. Place a windlass on the half knot and tie a square knot. (a stick, pen, or another similar type of object can be used) 6. Tighten the windlass of the commercial or fashioned tourniquet by twisting until the bleeding stops and then secure the windlass in position. 7. Note the time of the tourniquet application and secure it to the patient. (this can be a piece of tape or written on the patient in permanent marker) THIS CARD IS REVERSED PLEASE FLIP TO STUDY!!! The bleeding here looks well controlled and does not need a pressure dressing or tourniquet. The patient does have some bruising around the skin tear and would likely benefit from a dressing placed for comfort and to prevent infection. In this case a non-adherent dressing would be appropriate to minimize discomfort and further damage when the dressing is removed. - Correct answer Does this wound need to have bleeding controlled and if not how would you treat this wound? What is a spinal fracture? - Correct answer Typically caused by osteoporosis is generally referred to as a compression fracture. A compression fracture is usually defined as a vertebral bone in the spine that has decreased at least 15 to 20% in height due to fracture. What is a greenstick fracture? - Correct answer One side of the bone is BENT while the other side is BROKEN. INCOMPLETE type of fracture (most common in pediatric patients) Most common because peds bones tend to be stronger/more flexible What is a comminuted fracture? - Correct answer The bone is BROKEN INTO MANY FRAGMENTS (3 OR MORE) aortic valve stenosis - Correct answer Aortic stenosis is a narrowing of the aortic valve opening. Restricting the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium. What is cardiac tamponade? - Correct answer compression of the heart by an accumulation of fluid in the pericardial sac. What is stroke volume? - Correct answer The amount of blood pumped by the left ventricle of the heart in one contraction What is the primary cause of your respiratory rate increasing during exercise, as compared to your respiratory rate at rest? - Correct answer The level of carbon dioxide in the blood is increased. Rationale: When chemoreceptors detect an increased level of CO2 in the blood, they send signals that eventually will speed the rate of breathing in an effort to blow off excess CO2. When there is excess CO2, the blood pH is lower, or more acidic. You shouldn't suction the airway of an adult patient for more than 15 seconds and should ensure that you only suction while removing the catheter due to the risk of causing? - Correct answer Hypoxia: Rationale: Suctioning removes fluid and other occlusive matter from the airway, but it also removes oxygen. Adults should not be suctioned for more than 15 seconds. The smaller airway of children and infants should be suctioned even less. When performing adult CPR, how far should you compress the chest? - Correct answer At least two inches, not more than 2.4 inches. . What is the compression rate for adult CPR? - Correct answer 100 to 120 per minute You have been dispatched for "chest pain" at a local park. Your patient is a 52-year-old male who was playing in his recreational basketball league when he experienced sudden-onset, crushing chest pain. Your patient laid down on the court after becoming dizzy and vomiting. Vitals: P 81, BP 140/70, SpO2 99%, RR 18. The patient denies all other complaints other than chest pain. The patient also denies use of ED drugs. Which of the following is not indicated for this patient? - Correct answer High flow oxygen Rationale: The patient is having chest pain and denies ED drug use - ASA, NTG, and cardiac monitoring are all indicated for this patient. The patient is not having difficulty breathing and his SpO2 is at 99% - oxygen is not indicated, especially high-flow oxygen. While performing chest compressions, where do you want to ensure your hands are located? - Correct answer The lower half of the breastbone Rationale: Correct hand placement for chest compressions is the center of the chest over the lower half of the breastbone. With any type of CPR, which of the following stays the same for all victims? - Correct answer Compression rate ALWAYS STAYS THE SAME! Between 100 and 120 compressions per minute Rationale: Everything else changes What is the mediastinum? - Correct answer Space that seperates the lungs What is not located in the mediastinum? - Correct answer The lungs Rationale: The lungs are located in the pleural cavities and the mediastinum is what separates these cavities. You are assessing your patient who is complaining of abdominal pain, nausea, and vomiting. You take the patient's blood pressure while he is supine and then take it again when he sits up. You are looking to see if his systolic blood pressure drops by 10 mmHg or his pulse rate drops by 20 bpm when he changes position, which may indicate hypovolemia. This test is commonly referred to as? - Correct answer A positive tilt test Rationale: A positive tilt test is one in which a patient's blood pressure drops more than 10 mmHg and the heart rate drops more than 20 bpm when moving from a supine to upright position. A positive tilt test indicates hypovolemia. Your diabetic patient is experiencing symptoms of hypoglycemia. You test her blood sugar with a glucometer and determine that her blood sugar level is 63 mg/dL. She is conscious and alert. The proper treatment is: - Correct answer Administer oral fluids with sugar or oral glucose Rationale: If the hypoglycemic patient is conscious and alert, you should administer oral fluids with sugar or oral glucose. Rapid transport would be proper for a patient who is not conscious or alert. Administering insulin would further lower her blood sugar and is out of your scope. A blood sugar level under 70 mg/dL requires treatment. The fetus umbilical cord is made up of how many arteries and how many veins? - Correct answer 2 arteries and 1 vein During the first 8 weeks of pregnancy, a fertilized egg is medically referred to as a: - Correct answer Embryo You are called to a 36-year-old female who is having labor pains. She appears to be in active labor and as you inspect the vagina, she begins to bleed excessively prior to crowning. You should immediately? - Correct What is cribbing? - Correct answer Vehicle stabilization. Used to transfer the weight of a load into a footprint so that the car is safe for rescuers to work with. What is a winch? - Correct answer A mechanical device that is used adjust the tension of a rope. What is a chock? - Correct answer a wedge or block placed against a wheel or rounded object, to prevent it from moving. Could be a door, window, etc. If a patient has exsanguinated, what has happened to their body? - Correct answer They have lost so much blood they are typically at the point of death. What are the different stages of hypovolemic shock? Stage 1: - Correct answer Stage 1: Person with will have lost up to 15 percent, or 750 ml, of their blood volume. This stage can be difficult to diagnose. Blood pressure and breathing will still be normal. Skin will be pale. Person may have anxiety What are the different stages of hypovolemic shock? Stage 2: - Correct answer Body has lost up to 30 percent, or 1500 ml, of blood. The individual may experience increased heart and breathing rates. Blood pressure may still be within normal range. However, the diastolic pressure, or bottom number, of their blood pressure may be high. Person may start sweating and becoming more restless. What are the different stages of hypovolemic shock? Stage 3 - Correct answer 30 to 40 % or 1500 to 2000 ml, blood dangerous syndrome that results from some form of stimulation below the level of paralysis which causes uncontrolled hypertension.loss. The top number or systolic pressure of their blood pressure will be 100 mm Hg or lower. HR will increase over 120 beats per minute (bpm). Rapid RR rate over 30 bpm. Anxiety and agitation, cool, clammy, diaphoretic skin. What are the different stages of hypovolemic shock? Stage 4 - Correct answer CRITICAL. Blood loss over 40 % or 2,000 ml. Weak pulse Rapid HR Fast and labored breathing Systolic BP under 70 mmg HG drifting in and out of consciousness sweating heavily feeling cool to the touch looking extremely pale What is crepitus? - Correct answer grating sound created by the rubbing of bone fragments Burn management includes? A. Removing jewelry and smoldering clothing B. Scraping charred skin and flushing the burn with sterile water C. Removing charred clothing that is stuck to the burn D. Applying ice to the burn - Correct answer A. Removing jewelry and smoldering clothing Rationale: Assume that the burn will cause intense swelling, which is why it's important to immediately remove any clothing or jewelry that could constrict circulation. Never apply ice and never scrape skin or clothing from a burn. The type of injury that involves a blunt blow to the chest causing cardiac arrest is termed? - Correct answer Commotio Cordis What is Commo Cordis? - Correct answer (Latin, "agitation of the heart") is an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region), at a critical time during the cycle of a heart beat causing cardiac arrest. On a hot day, what method of heat exchange is accomplished when the human body sweats? - Correct answer Evaporation Rationale: Evaporation of sweat (from a liquid to a vapor), is an important method the body performs to automatically regulate temperature. Agnosia is a cognitive disturbance. It is: - Correct answer Failure to recognize objects or stimuli despite intact sensory function. You are dispatched to a 9-year-old female not acting right. Her mom states that she has been sick for a few days and has been very sleepy for the past 12 hours. Vitals - BP: 82/62, P: 98, R: 10, SpO2: 86%. What is your first intervention? - Correct answer Ventilate with a bag-valve-mask Rationale: There is a lot of information missing from this question and you just have to go with what you're given and make the best choice. As you assess this patient, seeing respirations at 10 should alert you that she's unable to adequately breathe for herself. Both a non-rebreather and nasal cannula are not appropriate with respirations so low. You can't transport this patient without first intervening. An airbag that has not deployed after the vehicle has crashed is called a(n): - Correct answer Loaded airbag You are en route to a motorcycle vs. truck at a dangerous, high-speed intersection. Dispatch information indicates that all patients are "up and walking around, but the motorcyclist is becoming increasing belligerent and short of breath." As you initiate care of the motorcyclist, what should be your first priority? A. Perform a neurological assessment B. Maintain a patent airway C. Splinting a broken arm D. Controlling light venous bleeding - Correct answer A. Maintaining a patent airway Touch Sight Smell - Correct answer None Rationale: None of our senses can detect radiation. We must use a radiation detector in order to determine if it is present or not. Anterior - Correct answer front of the body Lateral - Correct answer away from the midline of the body; on the outer side of anterolateral - Correct answer pertaining to the front and one side Inferior - Correct answer Lower on the body, farther from the head Posterior - Correct answer the back portion of the body; located behind a structure Medial - Correct answer toward the midline Midline - Correct answer An imaginary line drawn down the center of the body, dividing it into right and left halves. Cervical Vertebrae (C1-C7) - Correct answer first set of seven bones, forming the neck C1 and C2 - Correct answer Allow the body to turn the head from side to side C1= Atlas (Connects the skull to cervical spine sits on the C2 vertebrae) C2= Axis (Line by which the head and the C1 rotate on) C1-and C2 vertebrae have a different anatomy then the rest of the spine. odontoid process (dens) - Correct answer process of the axis which passes through the vertebral foramen(opening) of the atlas (Found on the C2 vertebrae) Thoracic Vertebrae (T1-T12) - Correct answer Bones of midspine. (2nd set of bones in the spine) Purposed for stability of the body. Keeps the body upright and protects vital chest organs, joins each rib to form the rib cage. Has a C shape (kyphotic) kyphosis - Correct answer hunchback Lumbar Vertebrae (L1-L5) - Correct answer 3rd set of vertebrae. Designed for weight bearing loads and movement. Shaped like a "backwards C" (Lordotic shape) Largest vertebrae in the body The vertebrae in the _________ are the largest in the entire spine. - Correct answer Lumbar spine Sacrum - Correct answer 5 fused vertebrae that form a single bone Shaped like an inverted triangle with the base at the top Acts as a wedge between the two iliac pelvic bones Joined with the ilium at the sacroilic joints Coccyx - Correct answer four to five vertebrae fused together to form the tailbone Sacroiliac joint (SI) - Correct answer The connection point between the pelvis and the vertebral column. The two joints that are on either side of the sacrum Both joints move together as single unit to transmit upper body forces and provide shock absorption for the spine. Provide a "walking gait pattern" in normal human movement Intervertebral Disc - Correct answer Strong ligament that connects one vertebral bone to the next Discs are shock absorbing cushions between each vertebrae of the spine Allow the spine to move so we can flex our spine (move forwards, bend backwards, etc) Essential for spinal stability and proper alignment Annulus fibrosus - Correct answer Strong outer ring of fibers of the vertebral disc Nucleus pulposus - Correct answer Soft, "jelly-like" center of the vertebral disc. Serves as the main shock absorber for the vertebral disc (functions to distribute pressures in all directions within each disc)\ The spinal cord connects the __________ system from the brain to the rest of the body. - Correct answer Nervous system The spinal cord leaves the brain through a hole in the base of the skull called the? - Correct answer Foramen Magnum What are the phrenic nerves? - Correct answer 2 nerves (left and right) that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. Major function: Carries impulses from the diaphragm to the brain What type of radiation is least damaging to the human body? - Correct answer Beta radiation alpha radiation - Correct answer Alpha radiation is a heavy, very short- range particle and is actually an ejected helium nucleus. Some characteristics of alpha radiation are: Most alpha radiation is not able to penetrate human skin. beta radiation - Correct answer Beta radiation is a light, short-range particle and is actually an ejected electron. May travel several feet in air and is moderately penetrating. Can penetrate human skin to the "germinal layer," where new skin cells are produced. If high levels of beta-emitting contaminants are allowed to remain on the skin for a prolonged period of time, they may cause skin injury. gamma radiation/X radiation - Correct answer Highly penetrating electromagnetic radiation Gamma radiation or x rays are able to travel many feet in air and many inches in human tissue. They readily penetrate most materials and are sometimes called "penetrating" radiation. Left Upper Quadrant (Abdomen) - Correct answer Stomach Spleen Left lobe of liver Body of pancreas Left kidney/Adrenal gland Colon Right Lower Quadrant (Abdomen) - Correct answer Cecum(beginning of the large intestine) Appendix(sits in between small and large intestine) Ascending colon(carries feces from the cecum to the transverse colon) Right ovary and fallopian tube Right ureter(males) Left Lower Quadrant (Abdomen) - Correct answer Descending colon(part of the large intestine from the splenic flexure to the begining of the sigmoid colon/resp. for storing the remains of digested food that will be emptied into the rectum) Sigmoid colon: Part of the largest intestine that is closest to the rectum and anus. Left ovary and fallopian tube Left ureter (propels urine from the kidneys to the bladder in males) You are dispatched to a 56-year-old male with chest pain. He tells you that he's taken 2 nitroglycerin tablets, but hasn't felt any relief from his pain. Vitals: BP - 86/52, P - 62, R- 20, SpO2 - 95%, Skin - pale, cool, diaphoretic. How should you proceed? A. Transfer the patient to the gurney and transport rapidly B. Call on-line medical control for the ability to assist in the administration of 1 additional dose of nitroglycerin C. Administer oxygen and assist the patient with the administration of 1 additional tablet of nitroglycerin D. Assist the patient with the administration of 1 additional tablet of nitroglycerin - Correct answer Transfer the patient to the gurney and transport rapidly Rationale: There should be one piece of information in this question that makes it easy to answer... Blood pressure. Remember if the blood pressure is below 100 mmHg systolic, you're contraindicated from assisting in the delivery of any additional nitroglycerin. If BP is lower than 100 mm Hg systolic what drug is contraindicated? - Correct answer Nitro You are on scene, where you witness your partner walk a very large patient with a suspected c-spine injury to the ambulance without regard for immobilization. As his partner, you could be held liable under which doctrine? A. Borrowed servant B. You cannot be held responsible for your partners actions C. Good samaritan law D. Proximal liability - Correct answer A. Borrowed servant When assessing a patient with a gunshot wound, you should? A. Look for the presence of an exit wound B. Always immobilize the spine C. Cover the wound with an occlusive dressing and secure it on three sides D. Apply ice to the wound - Correct answer A. Look for the presence of an exit wound Rationale: The presence of an exit wound can alert you of the bullet's path through the body. You always want to consider spinal immobilization, but a gunshot to the hand for example, does not necessarily require spinal immobilization. In order for a structure to be classified as an organ in the body, it must be composed of how many types of tissue? - Correct answer 2 An organ is the result of the combination of two or more tissue types joining and performing a more complex task. The pediatric respiratory system differs from the adult system in several important aspects. Which of the following is not correct? A. Infants less than 1-month-old do not breath through their nose B. Children primarily rely on their diaphragm for breathing C. The tongue of a child takes up more space in their mouth than an adult D. The chest wall of children is softer - Correct answer A. Infants less than 1-month old do not breath through their nose Rationale: This is false. Very young infants have not yet developed the ability to breath through their mouth. You are working at a sporting event on a hot summer day when a 52-year- old female comes up to you and says she doesn't feel well. She is confused and sweaty. You move her inside to a cool room and have her sit down. You should do which of the following next? A. Check her blood sugar B. Have her lie down with her feet elevated C. Being active cooling D. Begin passive cooling - Correct answer A. Check her blood sugar Rationale: You don't have enough information to determine why she is confused. You need to think of other reasons that could be causing her condition other than the heat. Take her vitals, including her CBG to rule out hypoglycemia. These are the types of tricky questions on the NREMT, so just remember to think through all the possible answers before answering. You respond to a medical lab for an employee who had an unknown chemical splashed in his eye. Your patient is complaining of a burning feeling in the affected eye. You should? A. Elevate the patient's head, and pour continuous amounts of NS in the affected eye What is positive pressure ventilation? - Correct answer forcing air or oxygen into the lungs You are transporting a 29-year-old woman in her 37th week of pregnancy. You have her lie lateral recumbent on her left side to avoid supine hypotensive syndrome. This is to avoid pinching off which blood vessel? A. Inferior Vena Cava B. Portal Artery C. Superior Vena Cava D. Abdominal Aortic Artery - Correct answer Inferior Vena Cava Rationale: Based upon the anatomical placement of the fetus in the lower abdomen, the inferior vena cava will be affected. The increased weight of the fetus on the inferior vena cava will reduce the amount of blood reaching the heart, decreasing preload and cardiac output and hemodynamic stability. Your patient cut his leg with a circular saw. After twenty minutes, bleeding is controlled, but you believe the patient lost at least one liter of blood. The best position for this patient is? A. Supine B. Trendelenburg position C. On a backboard in full-spinal immobilization D. Fowler's position - Correct answer A. Supine Rationale: Patient should be laid supine. Would not need a backboard because it is only a laceration on the leg. You respond to a drowning victim who is face down in waist-deep, still water. The first thing you should do is: A. Apply the head-splint technique B. Remove the patient from the water C. Ensure airway and breathing D. Roll the patient over - Correct answer A. Apply the head-splint technique Rationale: You should do all of these things, but the first thing to do is apply the head splint. You can then roll the patient over and ensure breathing. The last thing you would do in calm, shallow waters, is remove the patient from the water. What is the head-splint technique? - Correct answer Water rescue technique for shallow waters: FACE UP- 1. Approach the victim slowly and from the head, as you get close to the victim submerge so the water is at your neck. 2. Grasp the victim's arms midway between the shoulders and the elbows. 3. Gently place the victim's arms along side of their head, and squeeze the arms against the head, this immobilizes the head and neck. 4. Position yourself along the victim's side, continue to squeeze the arms together to secure and maintain alignment of the head and spine. 5. Keep the victim in this position until help arrived FACE DOWN: Do the same thing as FACE UP EXCEPT: (1) Glide the victim slowly forward. (2) Rotate the victim toward you until their face is out of the water and they are on their back. (3) Make sure the head is immobilized and the spine stays in a straight alignment. You have been dispatched for possible chemical weapon detonation. Dispatch reports that there are multiple patients with extremely painful blistering to their exposed skin and sudden-onset difficulty breathing. What type of chemical agent do you think is causing these signs/symptoms? A. Vesicant B. Biotoxin C. Nerve D. Pulmonary - Correct answer A. Vesicant Rationale: A vesicant is a chemical agent that affects the skin, mucous membranes, and the respiratory system, including the lungs. The word vesicant comes from the vesicles (blisters) on exposed skin that are caused by this type of chemical agent. What is a biotoxin? - Correct answer Poisonous substance produced by a living organism What is a vesicant? - Correct answer A chemical agent that affects the skin, mucous membranes, and the respiratory system, including the lungs. The word vesicant comes from the vesicles (blisters) on exposed skin that are caused by this type of chemical agent. What does automaticity mean? - Correct answer Cardiac cells are able to generate their own electrical impulses Automaticity of cardiac cells refers to? - Correct answer The cells ability to spontaneously depolarize Rationale: Unlike other cells in the body, cardiac cells have the ability to generate electrical impulses spontaneously. You are on scene with a 67-year-old female in severe respiratory distress. Your patient has been a smoker for over 40 years and has developed emphysema. Prior to your arrival, she used two home nebulizer treatments with no relief. She is sitting in the tripod position and appears very tired, with a respiratory rate of approximately 40 breaths/minute. What should be your next action? A. Deliver oxygen via BVM B. Deliver oxygen via non-rebreather C. Deliver oxygen via nasal cannula