Example of a symptom?
Headache
Does not involve the presence of a symptom
A 61-year old female who us unconscious with facial cyanosis
Would not be performed during scene size up
rapidly assessing patients respiratory status
While en route to the scene of a shooting, the dispatcher advises you that the caller states that the perpetrator has fled the scene. You should
confirm this information with law enforcement personnel at the scene
Upon arriving at a potentially unsafe scene you should
ensure that you are safe
As you are talking to the pt your partner directs your attention to a handgun which is located on a nearby table. You should
position yourself in between the patient and the gun and ask your partner to request law enforcement assistance
True statement regarding the MOI is correct
the MOI may allow you to predict the severity of a patient’s injuries
Most effective way to determine whether your patient’s problem is medical or traumatic in origin is to
perform a careful and thorough assessment
During an EMS call you should take standard precautions
upon exiting the ambulance but before pt contact
Treatment and transport priorities at the scene of a mass casualty incident should be determined after
all of the patients have been triaged
When is it most appropriate to consider requesting additional ambulances at an accident scene
When you determine there are multiple patients
Goal of primary assessment
identify and rapidly treat all life-threatening conditions
Observations made when forming a general impression of a patient would include all of the following except
pulse and strength
When approaching a 32 y/o male who is complaining of traumatic neck pain you should
ensure that the patient can see you approaching him
Least level to cause an altered LOC
acute anxiety
Patient who does not have AMS
pt with an acute allergic reaction and dizziness
Pt who does not respond to questions but moves or cries out when his or her trapezius muscle is pinched is also said to be
responsive to painful stimuli
An elderly patient has fallen and hit her head. You assess her LOC as unresponsive using AVPU. Initial care should focus on
airway breathing and circulation (ABC’s)
What is AVPU?
means of assessing LOC - Alert Verbal Pain Unresponsive
Pt short term memory is most likely intact if they correctly answer questions regarding
date and event
29-y/o male w/ head injury opens his eyes when you speak to him, is confused as to the time and date, and is able to move extremities on command. GCS score is
13
Injured patient gets 9 on GCS. He is assigned a score of 2 for eye opening, 3 for verbal response, and 4 for motor. What clinical findings are consistent with GCS score?
opens eyes in response to pain, used inappropriate words, and withdraws from pain
When inspecting pt pupils with penlight, the pupils should normally react to light by
constricting
When you shine light into one pupil, the normal reaction of the other pupil should be to
become smaller
Most likely cause the pupils to remain significantly constricted
overdose of an opiate drug
Open airway of unresponsive pt with suspected trauma?
jaw-thrust maneuver
Most correct statement regarding stridor
high-pitched, crowing upper airway sound
Indicates that pt has a patent airway
forceful coughing
Pt is unconscious, has ineffective breathing and has bloody secretions. Partner is holding c-spine. I should?
immediately suction the oropharynx
40 y/o crashed motorcycle, semiconscious, has snoring respirations, has laceration to the forearm with minimal bleeding. You should
open his airway with the jaw-thrust maneuver
After performing a head tip-chin lift to open the airway of an unresponsive pt with pulse, you should
suction as needed and insert airway adjunct
pt with spontaneous respirations is breathing
without assistance
supplemental O2 via nonrebreathing mask should be administered to pt
with difficulty breathing and adequate tidal volume
33 y/o male unresponsive. Patent airway and respirations are rapid and shallow. Initial action should be to
provide assisted ventilations
If a patient develops difficulty breathing after primary assessment you should immediately
reevaluate airway status
normal adult respiratory range
12-20 breaths per minute
Normal respiratory rate should not increase ____ Breaths/min in children and ___ BPM in infants
30, 50
Most effective method of assessing the quality of air movement in lungs
auscultating breath sounds with stethoscope
Abnormal breath sound that indicates obstruction of the upper airway
stridor
clinical signs of labored breathing do not include
shallow chest movement
When pt respirations are shallow
tidal volume will be easily noticeable
Sign of respiratory distress seen most commonly in peds pt’s
seesaw breathing
Adult pt who is not experiencing difficulty breathing will
be able to to speak in complete sentences without unusual pauses
You should suspect that a patient is experiencing respiratory failure if he/she
has bradycardia and diminished muscle tone
During the primary assessment circulation is evaluated by assessing
pulse quality, external bleeding, and skin condition
Palpable pulse is created by
pressure waves through the arteries caused by cardiac contractions
Most accurate guide to palpating a pulse
tips of index and long fingers over the pulse point
In responsive pt that are over 1 y/o you should palpate the pulse at the
radial artery
Carotid pulse not recommended in infants because
you may inadvertently compress the trachea
When palpating carotid pulse of a responsive older pt you should
avoid compressing both carotid arteries simultaneously
Call to daycare for unresponsive 8 m/o. Arrive and perform an assessment and determine infant isn’t breathing. Next action should be
assess for a brachial pulse for 5-10 seconds
If you can’t palpate pulse in an unresponsive pt, you should
immediately begin CPR
Unresponsive 62 y/o. Primary assessment = apneic and pulseless, you should
start CPR and attach AED ASAP
Most likely cause pt pulse rate to be slower than normal
beta-blocker meds
When palpating pt pulse you notice it is grossly irregular. You should
count the pulse rate for a full minute to obtain an accurate reading
normal resting adult pulse
60 and 110 BPM
bradycardia - pulse less than ____
tachycardia - heart rate grater than ____
60 BPM/100 BPM
Pulse with constant pattern is
regular
You notice that there is a short interval between pulsations. This indicates the pulse is
rapid
62 y/o with crushing chest pain, pulse is rapid and irregular. In addition to administering O2 you should
transport at once and consider requesting medics
black people, changes in color are apparent in certain areas such as
lips or oral mucosa
In infants and small children, skin color should be assessed on
palms and soles
poor peripheral circulation will cause the skin to appear
ashen
Bluish tint to skin
cyanosis
cyanosis is caused by
decreased blood O2
normal skin color, temperature, and condition should be
pink warm and dry
Pt with HTN would be expected to have skin thats
flushed and red
40 y/o
pain in RUQ
conscious and alert with stable vitals - skin and sclera are jaundiced - what do you suspect
liver dysfunction
Cap refill
2 secs
6 m/o male
vomiting and diarrhea
cap refil - 4 secs
peripheral circulation is decreased
cap refill time is most reliable in
children who are younger than 6
external bleeding from an extremity can usually be controlled by a combination of
direct pressure and elevation
39 y/o
stab wound to the groin
conscious - screaming in pain - attempting to control the bleeding which is bright red and spurting
apply direct pressure to the wound
full body scan should take no longer than
60-90 secs
after primary assessment, a rapid scan of the body should be performed in order to
identify less obvious injuries that require immediate treatment
Gently palpate a pt pelvis only if
pt does not complain of pelvic pain
Warrants immediate transport
severe chest pain and cool, pale skin
When performing a full body scan, what part of the body is assessed last?
Posterior
As you assess the head of a pt with suspected spinal injury, your partner should
maintain stabilization of the head
50 y/o male - AMS
wife says he had a “small stroke” 3 years ago but otherwise in good health - responsive but unable to follow commands. After administering O2, you should
prepare for immediate transport
Golden period begins when an injury occurs and ends when
the patient receives definite care
After first 60 minutes of experiencing a significant injury
the body ability to compensate for shock decreases
Unstable pt should be reassessed at least every
5 min
during 30 min transport of stable pt you should reassess him/her at least
2x
part of pt assessment that focuses on obtaining additional info about pt CC and any med problems that they may have
history taking
CC is
most serious thing pt is concerned about
You enter the residence and find pt sitting in chair in obvious distress. 1st action is to
introduce yourself
Question used to determine CC
What seems to be the matter?
When interviewing pt you can show them that you understand the situation by
repeating statements back to them
50 y/o male found unconscious in car
no witnesses
when gather med hx info for pt EMT should
determine if pt has medical alert bracelet or wallet card
What is SAMPLE
Signs and symptoms Allergies Meds PMHx Last oral intake Events leading up to
What is SAMPLE report?
intake; patient history; not for unconscious pt
What question would you ask to ascertain the M in SAMPLE history?
how much tylenol do you take daily
Patient response that would establish the E in SAMPLE
I was mowing the lawn when the pain began
Palliating factors regarding pt pain involve those that
alleviate the pain
pertinent negative identified
59 y/o man c/o CP but denies SOB
Statement regarding secondary assessment is correct
focuses on a certain area or region of the body as determined by the CC; you may not have time to perform a secondary assessment if you must continually manage life threats that were determined during primary assessment
WHen using pulse oximeter as part of assessment of a pt, it is important to realize that
any situation that causes vasoconstriction or loss of RBC’s such as anemia or bleeding, may result in an inaccurate or misleading value
End-tidal carbon dioxide (ETCO2) is defined as the
maximal concentration of CO2 at the end of an exhaled breath
A low ETCO2 reading, as measured by capnography would most likely be observed if
An endotracheal (ET) tube is correctly placed on the trachea
EMT would most likely not perform ___ on a responsive pt with HA and no apparent life threatening conditions
systematic head to toe exam
Goal of full-body scan that is performed during secondary assessment is to
locate injuries not found in the primary assessment
full-body scan should be performed on
pt with significant MOI and unresponsive medical patients
MVA young female sitting on curb confused obvious respiratory disress pale, moist skin partner holds c-spine i perform primary assessment. After performing any immediate life saving treatment i should
perform a rapid scan of her entire body and prepare for immediate transport
Battle signs
bruising behind ear
a decrease in BP may indicate
loss of vascular tone
pressure exerted against walls of the artery when the left ventricle contracts is called the
systolic BP
diastolic pressure represents
minimum amount of pressure that is always present in the arteries
BP 140/94 mm Hg. The lower number represents the pressure from the
ventricles relaxing
BP cuff that is too small will give a
false high systolic and diastolic
proper size BP cuff
should cover 2/3 the length from the armpit to the crease in the elbow
BP is usually not measured in
children younger than 3 y/o
When auscultating BP in pt upper extremity, you should place head of stethoscope over
brachial artery
When you use the palpation method to obtain a BP, the measurement you obtain is the
systolic BP
Crackling sound produced by air bubbles under skin is called
subcutaneous emphysema
Jugular venous distention suggests a problem with blood returning to the heart if the patient is
sitting up at 45 degree angle
most accurately describes paradoxical movement of the chest wall
only one section of the chest rises on inspiration while another area falls
When performing reassessment you,
repeat the primary assessment
Pharmacology is
study of drugs and their action on the body
Meds with antagonistic properties is one that
blocks receptor sites and prevents other chemicals from attaching to them
Example of a brand (trade) name of a drug
Tylenol
Advil, Nuprin, and Motrin are brand (trade) names for the genetic medication
ibuprofen
Example of a drug’s generic name
aspirin
Motrin can be obtained
over the counter (OTC)
Correct statement regarding parenteral meds
Parenteral meds are absorbed more quickly than enteral meds
Med route most appropriate to use in an unconscious pt when IV access cannot be obtained
intraosseous
Subcutaneous injections deliver the meds
between skin and muscle
How is nitroglycerin delivered by EMT
sublingually
Medication route delivers a drug through the skin over an extended period of time, such as nitroglycerin or nicotine patch?
transcutaneous
a mucosal atomizer device MAD is used to deliver certain meds vi
intranasal route
Meds encased in gelatin shell taken by mouth are
capsules
Activated charcoal is an example of a
suspension
oral glucose comes in a
gel
As you assist a female who presents with signs and symptoms of an allergic reaction administer her epic pen..after you administer 100% O2 you should
contact medical control
Peer assisted administration
administer meds to yourself or your partner
Binding or sticking to a surface
adsorption
Maximum dose of activated charcoal for a 7 y/o boy who weighs 22 kg
44 g
Activated charcoal is frequently suspended in sorbitol, a complex sugar that
facilitates movement through the digestive system
Correct statement regarding glucose
Glucose is a simple sugar that is readily absorbed by the bloodstream
Aspirin prevents the
aggregation of platelets
When given to pt with cardiac-related chest pain, nitroglycerin
relaxes the walls of the coronary arteries
Not a characteristic of epinephrine
decreases HR and BP
Correct statement regarding epi-pen
epi-pen delivers a preset amount of the drug
With the flowmeter set at 6 L/min the nasal cannula will deliver up to
44% O2
The medication Alupent suggests that the patient has a history of
asthma
The medications simvastatin (Vytorin) and clopidogrel (Plavix) suggest a history of
cardiovascular disease
BLS is defined as
noninvasive emergency care that is used to treat conditions such as airway obstruction, respiratory arrest, and cardiac arrest
How long without O2 is brain damage likely
5 min
After establishing that an adult pt is unresponsive, you should
assess for breathing
Which is not a BLS intervention
cardiac monitoring
Most prehospital cardiac arrests occur as the result of
a cardiac arrhythmia
Correct statement regarding ventricular fibrillation (v-fib)
survival rates decrease by 7% to 10% for each minute that V-fib persist
60 y/o woman collapsed 7 min ago - unresponsive, apneic, and pulseless. You should?
begin CPR and apply the AED as soon as its available
Correct statement regarding use of the AED in children
AED use in children in up to 8 y/o involves pediatric pads and an energy reduces
Open an airway with suspected spinal injury
jaw-thrust
If jaw-thrust maneuver is unsuccessful you should
carefully attempting head tilt chin lift
Pt should be placed in recovery position when he or she
is unconscious, uninjured, and breathing adequately
When ventilating an apneic adult with a simple barrier device you should deliver each breath
while watching for adequate chest rise
If gastric distention is so severe that it makes positive-pressure ventilation extremely difficult or impossible, you may have to
apply manual pressure to the abdomen
CPR will not be effective if the pt is
prone
A complication not associated with chest compressions
gastric distention
60 y/o M found to be unresponsive, pulseless, and apnea. You should
begin CPR until an AID is available
Afterpt airway is intubated during 2-rescuer CPR you should
deliver 1 rescue breath every 6-8 secs
The impedance threshold device (ITD) may improve circulation during CPR by
limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filing
In MOST cases, cardiopulmonary arrest in infants and children is caused by
respiratory arrest
An apneic infants child should be ventilated an max of
20x/min
Proper depth of chest compressions on a 9 month old
1/3 the diameter of the chest or about 1 1/2”
max # of chest compressions that should be delivered/minute to a 4mo infant
100
When assessing the pulse of an unresponsive infant you should palpate the
Brachial artery
Correct compression/ventilations when performing 2 rescuer child CPR
15-2
CPR should be initiated when
a valid living will is unavailable
Most appropriate treatment for a pt with mild upper airway obstruction
administering O2 and transport immediately
Abdominal thrusts in a conscious child or adult with severe upper airway obstruction are performed
until he or she loses consciousness
Technique used to dislodge a foreign body airway obstruction in a pt who is in advanced stage or pregnancy or very obese
chest thrusts
Initial attempt to ventilate an unresponsive apneic 30y/o M is met with resistance and you do not see chest rise. Your second ventilation attempt is also unsuccessful. You should
perform 30 chest compressions
Initial treatment to dislodge a severe foreign body airway obstruction in a responsive infant involves
back slaps
Index of suspicion is
your awareness and concern for potentially serious underlying and unseen injuries or illness
You and EMT partner arrive at the residence of a 50 y/o M c/o weakness. Primary assessment reveals that he is critically ill and will require aggressive treatment. Closest hospital is 25 miles away. You should?
manage all threats to airway, breathing, and circulation and consider requesting an ALS unit
When forming general impression of a pt with a medical complaint it is important to remember that
the conditions of many medical pt may not appear serious at first
Upon initial contact with a pt who appears to be unconscious you should
attempt to elicit a verbal response by talking to the pt
Primary assessment of an elderly woman reveals that she is conscious and alert but experiencing difficulty breathing. Hx of emphysema, HTN, and CHF. As you asses circulatory status you should direct your partner to
administer O2 with the appropriate device
In addition to looking for severe bleeding, assessment, or circulation in the conscious pt should involve
checking the radial pulse and noting the color, temp, and condition of skin
When assessing a pt with a medical complaint, which of the following would most likely reveal the cause of his or her problem
history taking
What will most reliably allow you to determine the nature of pt illness
asking questions related to the CC
58 y/o M - c/o chest discomfort and nausea - conscious and alert - BP 140/90 - pulse 104 - respirations 16/min - partner applied supplemental O2 - prior to assisting the pt with one of his prescribed nitroglycerin tablets you ask him if he takes meds to treat erectile dysfunction and he tells you that he does. You should
ask him what he takes, how much, and when he last took it
The secondary assessment of a medical pt
is not practical if the pt is critically ill or your transport time is short
When performing a secondary assessment with a conscious pt with non traumatic abdominal pain and stable vitals you should
focus on the CC
Assessment finding indicative of a cardiovascular problem
Jugular venous distention
33 y/o F - lower abdominal quadrant pain - conscious and alert - moderate pain - unable to locate radial pulse - you should?
assess rate, regularity and quality of her carotid pulse
End-tidal carbon dioxide (ETCO2) monitoring is clearly indicated for pt who presents with
respiratory distress
Reassessment of pt with a medical complaint should begin by
repeating the primary assessment
Primary prehospital treatment for most medical emergencies
address pt symptoms more than the actual disease process
EMT Least likely administer to a pt with a medical complaint
naloxone (Narcan)
AMS and signs of circulatory compromise you should
limit your time at the scene to 10 min or less, if possible
The determination of whether a medical pt is a high-priority or low-priority transport is typically made
after the primary assessment has been completed
Correct statement regarding SARS
SARS is caused by a virus and usually starts with flulike symptoms that deteriorate to pneumonia and respiratory failure
Factors that increase the risk for developing MRSA include
prolonged hospitalizations, especially in an intensive care unit
In contrast to viral hepatitis, toxin-induced hepatitis
is not a communicable disease
Pt with tuberculosis pose the greatest risk o transmitting the disease when they
cough
Hep B is more virulent than Hep C which means that it
has a greater ability to produce disease
Typical CC of patient with infectious disease
fever, rash, nausea, and difficulty breathing