EMT National Registry Test Review
Effects of Epinephrine
Vasoconstrictor & Bronchodilator
Effects of Nitroglycerin
Vasodilator
1) BP < 100 systolic
2) Already taken 3 doses
3) Last dose within 5 minutes
4) Sexual enhancement drugs within 48
hours
4 Contraindications for Nitroglycerin
What position is used for a patient with a
protruding umbilical cord?
Knee-chest position
Define gravida
number of pregnancies
Define para
number of live births
When to ventilate patients?
When their breaths/min do not fall between 8<x<30
% oxygen by BVM
90%
Emphysema
Dead space in lungs, body retains carbon dioxide. Very prone to upper resp.
diseases like pneumonia.
Congestive Heart Failure
Heart can't pump blood sufficiently
to meet the body's needs. Commonly caused by MI. Pulmonary edema &
rales from fluid, sit patient upright (High
fowlers, legs down) and administer high
flow O2 via NRB mask.
Pulmonary embolism
Blood clot that has travelled throughout the blood stream and is blocking an
artery of the lung.
Pleural Effusion
Collection of fluid outside the lung,
compresses lung and causes dypsnea.
Stems from infection, CHF or cancer.
Spontaneous Pneumothorax
Usually caused by trauma. Pressure in
pleural pace keeps lungs inflated, pleuritic chest pain. Collapsed lung.
Transient Ischemic Attack
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Precedes 1/3 of all strokes. Blockage or
spasm of blood vessel (clots), signs &
symptoms must be gone within 24 hours.
Syncope/Syncopal Episode
Brief LOC from transiet cerebral hypoxia.
Lasts less than 30 seconds, should then
be immediately alert and oriented. From
vagal stimulation. (Fainting)
Epilepsy
Condition of reoccuring seizures.
Petit Mal Seizure
"Absence spells", usually in kids 6-12.
Staring episodes, mistaken for lack of
attention.
Grand Mal Seizure
LOC & violent muscle contractions (what
most people think of when they picture a
seizure).
Pre-ictal (aura)
Phase of Grand Mal Seizure, RIGHT before the seizure occurs.
Tonic Phase
Stiffening of the limbs during a grand
mal seizure. Breathing may cease or decrease
Clonic Phase
Jerking of limbs and face, after the tonic
phase.
Post-ical phase
After the tonic-clonic convulsions of a
grand mal seizure, the patient is altered,
disoriented, and recovering.
Status Epilepticus
Repeated seizures without a break in between. Continuous seizure lasting more
than 10 minutes, 3 or more seizures in
one hour.
Type 1 Diabetes
10%, patient does not produce ANY insulin (by beta cells of pancreas). Insulin=hormone enabling the cells to produce glucose.
Type 2 Diabetes
90%, patient doesn't produce enough insulin. (obesity, old age, pancreatic disease, insulin resistance)
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V-fib
Ventrical Fibrillation, chaotic electrical activity from many sites in the
heart. http://en.wikipedia.org/wiki/Ventricular_fibrillation
3 major heat emergencies, in order of
increasing severity
Heat Cramps, Heat Exhaustion, Heat
stroke (ALTERED LOC)
Air Embolism
FAST onset, an air bubble lodged nto
circulation. Muscle/join pain
SLOW onset. Bubbles of gas obstruct
blood vessels, from rapid ascent. AbThe Bends or Decompression Sickness
dominal/joint pain. Left lateral or supine
treatment for diving emergencies.
DON'T APPLY ICE OR TOURNIQUET.
Splint area to minimize movement, place
Snake bite treatment
at or below level of heart! Circle the bite
area and note the time.
Esophageal varices
Capillary networks of esophagus leak &
bleed out.
Cystis
UTI, bladder infection. Caused by bacteria.
Hypovolemic Shock
Fluid/blood loss, classic shock. Hemorrhagic=blood loss. Non-hemorrhagic=fluid loss/dehydration (from burns)
Obstructive Shock
Obstruction in system inhibits blood/oxygen flow. EX: clot, pulmonary embolism,
tension pneumothorax, cardiac tamponade. Inhibits heart from beating properly.
Cardiogenic Shock
Heart failure, heart isn't beating correctly (don't confuse with obstructive shock,
there is no outside agent here). Pulmonary edema
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5 types of Distributive Shock
3 stages of Shock
1) Neurogenic: Problem with brain/spinal
cord, can't communicate with site of injury's blood vessels.
2) Drug abuse: Nitro or opiates (vasodilator) causes neurogenic shock.
3) Anaphylactic: dilated blood vessels/low BP
4) Septic: from bacteria producing vasodilating toxins
5) Psychogenic: emotional (blood vessels dilate in the brain and you faint)
1) Compensated
2) Decompensated
3) Irreversible (death will occur)
Cardiac Tamponade
Collection of fluid between heart and sac,
usually from blunt or penetrating trauma. Blood leaks into pericardium and
accumulates in sac, compresses heart.
BECK'S TRIAD
Beck's Triad
Symptoms of cardiac tamponade. Jugular Vein Distention, Muffled heart sounds,
Widening systolic/diastolic BP.
Tension Pneumothorax
Worsening pneumothorax. Damage to
lung tissue. Air that's usually in the lungs
escapes into chest cavity, applying pressure to heart and organs. Complete lung
collapse on affected side. JVD
3 components of a bomb blast
Primary: shock wave, ruptures all internal organs.
Secondary: metal particles from bomb hit
& injure you
Tertiary: Being thrown by force to the
ground or against the wall.
Sprain vs. Strain
Sprain: overstretching/damaging ligaments
STrain: T for TENDON, overstretching/damaging tendon.
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Ligaments vs Tendons
Ligaments: bone to bone
Tendon: muscle to bone connection
Epiphyseal
Fracture at growing plate (kids)
Compartment Syndrome
Injured cells leak watery fluid into cell
spaces between them. This fluid pressure compresses tissue and increases
muscle pressure. Leads to muscle &
nerve damage and pain out of proportion to the injury. Potential complication
of fracture.
Crush syndrome
Results from area of body
trapped/crushed 4+ hours and artery
flow is poor. metabolic derangement, Renal failure and sometimes death.
Melena
Blood appears in feces, serious sign of
internal bleeding.
Nondisplaced fracture
Simple crack of the bone, no angulation/deformity.
Subluxation
INCOMPLETE join location/disruption
Patient Positions (7)
Organs of the Left Lower Abdominal
Quadrant
1) Supine
2) Prone
3) Fowlers: (sitting up) patient's upper
body is at a 45-60 degree angle.
4) Semi-fowlers: patient's upper body is
at less than a 45 degree angle.
5) Trendelenberg: patient's legs are elevated higher than the head.
6) Shock position
7) Lateral recumbent: (recovery position)
patient is laying on their left or right side.
-Female reproductive organs
-large & small intestines
-APPENDIX
-large & small intestines
-female reproductive organs
Organs of the Right Lower Abdominal
Quadrant
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Organs of the Right Upper Abdominal
Quadrant
-LIVER
-GALL BLADDER
-large and small intestines
Organs of the Left Upper Abdominal
Quadrant
-STOMACH
-SPLEEN
-PANCREAS
-large & small intestine
Retroperitoneal cavity
Kidneys are in this cavity
Coup contra coup
Brain hits skull on one side of the head,
then the other. Front of the brin hits, then
the back of the brain hits.
Meninges
3 layers that surrounds the brain & spinal
cord
1) Dura Mater
2) Arachnoid
3) Pia Mater
Increasing Intercranial Pressure
Usually from intercranial hematoma or
cerebral edema, can crush brain tissue
and cause great damage. CUSHING'S
REFLEX/TRIAD. Altered LOC, Dilation
of ipsilateral or both pupils, contralateral
hemiparesis (weakness on one side of
the body)
Cushing's Triad
1) Hypertension (widening pulse pressure)
2) Bradycardia
3) Respiration Changes
Herniation Syndrome
happens when ICP occurs. same symptoms as ICP.
Epidural Hematoma
accumulation of blood between skull and
dura mater (outermost layer), almost always because of linear fracture. Lucid
intervals of LOC
Subdural Hematoma
Accumulation of blood BENEATH dura
mater, outside brain. More common than
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epidural. Fluctuating LOC or slurred
speech.
Intracerebral Hematoma
Bleeding within brain tissue. High mortality rate
Flail Segment
3+ ribs fractured in 2+ places. Causes
free floating segment of the chest wall,
other internal injuries probably present.
Splint using a pillow or towel.
Different Abnormal Lung Sounds
-snoring: tongue partially blocking upper
airway
-wheezing: constriction of bronchioles in
lungs
-gurgling: fluid in UPPER airway
-stridor/crowing: partial UPPER airway
obstruction
Opiates & their effects
-Hydrocodone (Vicodin)
-Propoxyphene (Darvon)
-Heroin, morphine, codeine, meperidine
(Demerol)
These type of drugs suppress the CNS,
depressing the respiratory system, heart
rate and blood pressure.
Ventilate 40-60 bpm when their heart
rate is less than 100bpm. CPR when
heart rate is below 60 bpm.
(1 point) Does not open eyes
(2 points) Opens eyes in response to
painful stimuli
(3 points) Opens eyes in response to
voice
(4 points) Opens eyes spontaneously
When would you ventilate an infant?
Start CPR?
Glascow Coma Scale (eyes)
(1 point) Makes no sound
(2 points) Incomprehensible sounds
(3 points)Utters inappropriate words
Glascow Coma Scale (Verbal)
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(4 points) Confused and disoriented
(5 points) Oriented, converses normally
Glascow Coma Scale (Motor)
Hemothorax
Pericardial Tamponade
(1 point) Makes no movement
(2 points) Extension to painful stimuli --->
Decerebrate response
(3 points) Abnormal flexion to painful
stimuli --->Decorticate response
(4 points) Flexion/withdrawal to painful
stimuli
(5 points) Localizes painful stimuli
(6 points) Obeys commands
Same as pneumothorax, except blood is
the cause (not air). Something that can
bleed has been damaged, so now blood
fills the chest cavity.
SAME THING AS CARDIAC TAMPONADE. Peri=around & cardial=heart.
Rapid accumulation of fluid around the
heart, leading to pressure around the
heart so it can't expand and pump adequately. BECKS TRIAD
First stage of Labor
Begins with uterine contractions
Second stage of Labor
When cervix is fully dilated and ends
when infant is born.
Third stage of Labor
Begins with birth of infant & ends with
delivery of placenta.
Placenta
filters nutrients and oxygen from mom's
system to the baby.
Meconium
Fetal feces. Very dangerous if the baby
inhales it, suction if present.
Unruptured amniotic sac
Puncture the sac and push it away from
the baby.
APGAR scoring
Appearance
Pulse- >100 bpm
Grimace- vigorous w. strong cry
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Activity-moving all extremities
Respirations-normal w. good cry
0-2 score for each
Infant heart rate 60-80bpm?
Start chest compressions if not responding to ventilations. <100 is ventilations.
<60 is compressions WITH ventilations.
Transport position for pregnant women
not in labor
Left lateral if no trauma!
Pre-eclampsia
Pregnancy Induced Hypertension. Sudden weight gain, headache, edema. Left
lateral positioning. Any pregnant woman
with high BP
Placenta Abrupto
Placenta torn off endometrium, causes bleeding, abdominal pain, increased
heart rate. Fetus is lost, mom can be
saved. Code 3. Usually caused by trauma or chemicals. Left lateral position.
Placenta Previa
Placenta grows over cervix. Lots of painless vaginal bleeding (mistaken for a period). left lateral position.
Breech Delivery
Presenting part=buttocks or both legs.
Insert sterile gloved hand to create airway for infant. Delivery can be similar to
normal birth.
Limb presentation
TRUE EMERGENCY. Left lateral trendelenberg position, high flow oxygen for
mom. Leave limb out and transport, c
section is required.
Prolapsed Cord
Cord comes out before the baby does.
Left lateral trendelenberg and use hand
to keep baby from compressing it (it
should be pulsating, this means the baby
is getting oxygen). Can use knee-chest
position too.
McRobert's Maneuver
Pull knees to head to open up pelvis.
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Post Partum Hemorrhage
Bleeding in excess of 500cc after delivery. FUNDAL MASSAGE and put infant
to breast. Place pad over vaginal opening
and treat for shock, elevate hips.
Fetal Demise
Baby dies in utero and decomposes/mummifies.
Epiglottitis
Bacterial infection of soft tissue in the
area above the vocal cords, mistaken for
croup. Most commonly in children. High
grade fever >104
Croup
VIRAL infection of airway below vocal cords, laryngotracheal bronchitis.
sounds like a "seal bark"
Inflammation of meninges (layer protecting spinal cord & brain). Flu like symptoms with Nuchal rigidity (stiff neck) and
body rash of anterior trunk
1) Ischemic (from a clot)
2) Hemorrhagic (from a bleed)
Meningitis
2 types of stroke
Normal heart rate of Newborn
140-160 bpm
Normal heart rate of children 1-6 years
old
100-120 bpm
Normal heart rate of children 6+
80-100 bpm
1) Smile
2) Close eyes and raise arms, should be
Cincinnati Stroke Test (3 components)
at equal levels
3) Repeat "the sky is blue in Cincinnati"
You are assessing a 53-year-old female
who neighbors discovered acting funny.
The patient appears to be fatigued and
confused and exhibiting slurred speech.
She is breathing and has a pulse and
skin that is cool and mottled. Vital signs
are pulse 68 beats per minute, respirations 14 per minute, blood pressure
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108/60 mmHg, and temperature 92.7 degrees Fahrenheit. There are no signs of
trauma to the patient. Patient prescriptions of Verapamil, Digoxin, Synthroid,
and nitroglycerin are found in the bedroom. Allergies are unknown. The temperature in her apartment is 55 degrees
Fahrenheit. Based on the assessment
findings, which of the following conditions is most likely a contributing factor
to the patient's condition?
Hypothyroidism.
Hypothyroidism
Hypertension
Atrial fibrillation
Seizure
You have been called to the top of a
mountain resort for a patient that is complaining of a sudden onset of shortness
of breath and coughing. Your assessment of the patient reveals an anxious
patient with basilar crackles in his lungs.
The patient's vital signs include a heart
rate of 136, respirations of 28, and a
blood pressure of 176/94 mmHg. What is
your field diagnosis of this patient?
High altitude pulmonary edema, a result
of increased pulmonary pressure and hypertension caused by changes in blood
flow at high altitudes.
High altitude pulmonary edema
New onset congestive heart failure
Pneumonia
High altitude congestive heart failure
Status epilepticus
a seizure that lasts longer than 10 minutes or a seizure that begins again after one seizure stops without that patient regaining consciousness. It is a dire
medical emergency, as the patient may
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sustain bone fractures, airway occlusion,
and possible death.
Decompensated Shock
A sudden decrease in blood pressure,
tachypnea, and continued elevation of
the heart rate. (Low blood pressure, high
heart rate, and high # of breaths)
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