NREMT medical emergencies and OB

Question 1

Pain from the chest and abdomen may also be referred to the shoulder. Causes may include:

Answer 1

Pancreatitis

Gallstones

Myocardial infarction

Pneumonia

Question 2

What is hyperemesis gravidarum?

Answer 2

Hyperemesis gravidarum is a condition that occurs during pregnancy involving severe nausea and vomiting. This usually results in weight loss, dehydration and electrolyte disturbances.

Question 3

What rhythms will a defibrillator shock?

Answer 3

Ventricular fibrillation and ventricular tachycardia.

Remember the AED does not check for a pulse. It will defibrillate ventricular tachycardia with a pulse.

Question 4

What are the four abdominal quadrants? How are they identified?

Answer 4

They are created by drawing horizontal and vertical lines through the umbilicus.

Question 5

What are the three stages of labor?

Answer 5

Stage 1 - from the beginning of contractions to full dilation of the cervix

Stage 2 - From full dilation of the cervix until birth of the baby

Stage 3 - begins after the birth of the baby through expulsion of the placenta.

Question 6

What is the rate of compressions for adult CPR?

Answer 6

100 - 120 per minute. Push hard, push fast. Minimize interruptions in compressions.

Question 7

Define: Braxton-Hicks Contractions

Answer 7

Sometimes called “false labor,” Braxton-Hicks contractions are light, irregular contractions that do not lead to delivery and may occur days to weeks before actual labor begins.

Question 8

You will provide ventilations to a newborn if his/her pulse is less than ________ and provide compressions to the newborn if the pulse is less than _______.

Answer 8

If the newborn’s pulse is less than 100 you will provide ventilations at a rate of 40 - 60 minute. You will provide chest compressions at a rate of 120/minute if the heart rate is less than 60 per minute.

Question 9

Define: Breech Presentation

Answer 9

When a baby appears buttocks or feet-first for delivery.

Question 10

Define: Dialysis

Answer 10

Dialysis is a process by which an external system removes toxins and waste products from the blood when the kidneys are no longer able to do it naturally.

Question 11

List several risk factors for suicide.

Answer 11

Depression
- Alcohol or substance abuse
- Those who are single, widowed or divorced
- Family member suicide
- Feelings of hopelessness
- Prior threats of suicide
- Detailed suicide plan
- Age (15-24 and elderly populations have higher rates of suicide)

Question 12

Define: Para

Answer 12

How many live births a woman has had.

Question 13

List the five rights of medication administration.

Answer 13

Right patient.
- Right medication.
- Right dose.
- Right route.
- Right time.

Question 14

What are the five links in the American Heart Association’s Chain of Survival?

Answer 14

Immediate recognition of cardiac arrest and activation of the EMS system
2. Early CPR with a focus on chest compressions
3. Rapid defibrillation
4. Effective Advanced Life Support
5. Integrated post-cardiac arrest care

Question 15

What is the difference between an ischemic stroke and a hemorrhagic stroke?

Answer 15

An ischemic stroke is caused by a blood clot that travels to the brain. This is the most common type of stroke.

A hemorrhagic stroke is caused by a blood vessel that ruptures and bleeds into the brain tissue. This stroke may present with a severe headache.

Question 16

Your full-term pregnant patient reports that their doctor told them that they were “almost fully effaced.”

What does this mean?

Answer 16

Effacement is the thinning of the cervix which occurs in the weeks before birth.

Question 17

Your patient gets dialysis and tells you they have a fistula. What is it and how will it impact your care?

Answer 17

A fistula connects arterial and venous blood flow in an extremity. It is used to connect the patient to a dialysis machine.

You should not take a blood pressure on an arm with a fistula.

Question 18

Differentiate between type 1 and type 2 diabetes.

Answer 18

Type 1 diabetes is insulin-dependent. It generally comes on earlier in life and stems from the fact the pancreas is not creating insulin.

Type 2 patients usually have some insulin in the body but it is not used properly. Patients with type 2 diabetes often take oral medications.

Question 19

Define: Placenta Previa

Answer 19

Placenta previa is a condition in which the placenta grows in the lowest part of the uterus and partially or completely blocks the cervix.

Question 20

What are the 4 ways a toxin can enter the body?

Answer 20

Ingestion, absorption, inhalation and injection.

Question 21

What is an absence seizure?

Answer 21

An absence seizure is a type of generalized seizure that results in a loss of awareness (usually brief). In some cases mild muscle or facial twitching or loss of coordination may be observed.

There is no tonic/clonic seizure activity.

Question 22

What is the typical dosing strategy for nitroglycerin?

Answer 22

An initial nitroglycerin tablet or spray, then up to two more spaced 5 minutes apart if chest pain or discomfort continues and vital signs remain adequate.

Question 23

What does C-A-B stand for?

Answer 23

Circulation - Airway - Breathing, the American Heart Association’s approach to a patient who appears lifeless and is likely in cardiac arrest.

Question 24

Define: Angina Pectoris

Answer 24

Angina pectoris (commonly called “angina”) is a condition in which chest pain is caused by ischemia of the heart muscle because of a vessel occlusion or spasm.

It is often caused by stress or exertion which creates a need for oxygen that the body can’t keep up with. In many cases the pain subsides with rest and nitroglycerin.

Question 25

What does ROSC stand for?

Answer 25

ROSC stands for Return of Spontaneous Circulation - the return of a pulse, usually after CPR and/or defibrillation.

Question 26

What happens when a patient misses a dialysis appointment?

Answer 26

Waste products and fluid builds up in the patient. They develop edema throughout the body. Patients also develop dangerous levels of potassium and other electrolytes which can lead to cardiac rhythm problems and death.

Question 27

List three considerations for scene management when caring for multiple births.

Answer 27

Multiple births may be premature and require more aggressive care or resuscitation. Multiple births create a "mini MCI" with the mother plus two or more neonates. Make sure additional resources are called for early. Not all patients (e.g. those who haven't had prenatal care) are aware they are carrying multiple babies. Be alert for signs of additional pending births (e.g. large abdomen after delivering one baby).

Question 28

What are the indications for oral glucose?

Answer 28

A diabetic patient with an altered mental status but still able to follow instructions and maintain their own airway. If blood glucose monitoring is available the blood glucose reading should indicate hypoglycemia (BG less than 70 - 80 mg/dL)

Question 29

List the indications for administering or assisting with an inhaler.

Answer 29

Patient has respiratory distress and a history of a disease or condition that would be helped by an inhaler. The patient has an inhaler prescribed for him or her. (if assisting) Medical direction has give authorization to use the inhaler (standing orders or on-line) The patient is breathing adequately and is physically able to get the medication deep into the lungs.

Question 30

What are the four main components of blood?

Answer 30

Red blood cells, white blood cells, platelets and plasma.

Question 31

You and your partner arrive on the scene of a patient in cardiac arrest with an AED. Do you apply the AED first or begin compressions first?

Answer 31

One rescuer should begin compressions while the other applies the AED. The AHA states that high quality chest compressions are a main focus of resuscitation. Interruption of compressions must be minimal and avoided whenever possible.

Question 32

List signs and symptoms of an allergic reaction.

Answer 32

Common symptoms include itching, hives, runny nose, watery itchy eyes, wheezing, and swelling and edema of the tissues. More severe reactions include signs of shock, tightening or a sensation of closing in the throat, hoarseness and stridor.

Question 33

List the contraindications for use of an inhaler.

Answer 33

Patient has already taken the maximum dose of the medication. The patient is breathing inadequately and not able to bring the medication deep into the lungs. The inhaler is not the patient's prescribed device (for assisting with the patient's inhaler) Medical direction has not approved or directed use of the inhaler.

Question 34

List signs and symptoms of acute coronary syndrome (ACS).

Answer 34

Chest pain, pressure or discomfort which may also appear or radiate to the neck, jaw, abdomen or back. Elderly and female patients may not display pain. Patients may also exhibit anxiety, difficulty breathing, palpitations, cool and clammy skin, weakness, abnormal vital signs and/or a feeling of impending doom.

Question 35

How do you care for a newborn immediately after delivery?

Answer 35

Dry the baby and keep him or her warm. Assess the baby. The baby should be moving and crying (hopefully both of these will be vigorous). Evaluate the baby's breathing, heart rate, color, movement and cry. You will note that many of these are part of the APGAR scale but do not worry about doing a formal APGAR scoring if it keeps you from caring for the baby. Provide resuscitation if needed.

Question 36

Define: Myocardial Infarction

Answer 36

Myocardial infarction is a clinical term for heart attack.

Question 37

What is an agonist?

Answer 37

An agonist is a substance or drug that binds to a receptor site and causes the expected response. These may be naturally occurring in the body (e.g. hormones) or from outside the body (e.g. medications). The opposite of an agonist is an antagonist. The antagonist blocks the receptor from completing the expected response.

Question 38

Define: Postictal

Answer 38

A period of recovery from a seizure. It begins when a seizure ends and involves a gradual return to responsiveness. The time and course of the postictal period varies widely from patient to patient.

Question 39

What is atelectasis?

Answer 39

Atelectasis is the collapse of part or all of a lung. It results in reduced gas exchange. It also refers to the concept of alveolar collapse.

Question 40

Define: Diabetic Ketoacidosis

Answer 40

A complication of elevated blood glucose where the body can't use glucose as a fuel (because the body has no insulin). Instead, the body uses fats for fuel. This alternate process of metabolism causes a buildup of ketones (an acid) in the blood. It also causes the acetone or fruity breath odor sometimes seen in hyperglycemia.

Question 41

What happens in the lungs of the patient with chronic bronchitis?

Answer 41

The linings of the bronchiole are inflamed and excess mucus is produced. Patients present with a productive cough and chronic shortness of breath.

Question 42

List several factors that might predict the need for resuscitation of the newborn.

Answer 42

No prenatal care, premature delivery, drug use during pregnancy, history of problems during the pregnancy, meconium staining and multiple births.

Question 43

What is the difference between an inhaler and a nebulizer?

Answer 43

The inhaler is an aerosol device that sprays a fine powder which is inhaled into the lungs. The nebulizer is a device in which air or oxygen is run through a medication. The medication becomes a vapor which is continuously inhaled by the patient through a mask or mouthpiece.

Question 44

List three chronic lung (COPD) diseases

Answer 44

Emphysema, chronic bronchitis, black lung

Question 45

What is the difference between hemodialysis and peritoneal dialysis?

Answer 45

Hemodialysis is removing toxins and waste by filtering them through a dialysis machine. This is usually done 2 - 3 times per week at a dialysis center. Peritoneal dialysis is done in the home by infusing dialysis solution through a catheter into the peritoneum where it absorbs waste material, toxins and excess fluid. It is then drained from the abdomen. This may be repeated several times per day.

Question 46

Define: Pulseless Electrical Activity

Answer 46

When the ECG shows electrical activity from the heart without a palpable pulse. Electrical activity without the corresponding mechanical pumping of the heart.

Question 47

List four indications of opiate overdose.

Answer 47

Indications of injecting medications (needles present) or prescription medications present Track marks on the skin Pinpoint pupils (in many but not all opiates) Decreased respirations or respiratory arrest Information or history from family or bystanders regarding opiate use

Question 48

Define: Transient Ischemic Attack

Answer 48

A transient ischemic attack (TIA) is sometimes called a "mini-stroke." It is when a patient experiences stroke-like symptoms which resolve quickly, usually in 1 - 2 hours.

Question 49

What happens in the lungs of the patient with emphysema?

Answer 49

Emphysema is a breakdown of the alveoli which causes decreased area for gas exchange. The lungs also lose elasticity. This causes air trapping and a "barrel chest" appearance.

Question 50

Define: Ventricular Fibrillation

Answer 50

Chaotic, disorganized electrical activity of the heart which does not create a mechanical contraction of the ventricles and does not produce a pulse. This rhythm, when present, should be defibrillated.

Question 51

What is the peritoneum?

Answer 51

The membrane that lines the abdominal cavity.

Question 52

Define: Psychosis

Answer 52

Psychosis is described as a break with or loss of contact with reality.

Question 53

Differentiate the patient presentation between hypoglycemia and hyperglycemia.

Answer 53

Hypoglycemia is usually a more rapid onset and involves a more dramatic altered mental status than hyperglycemia. The hypoglycemic patient often has cool, moist skin. The hyperglycemic patient may have a fruity or acetone-like breath odor. In severe cases, respirations may be rapid and deep as the body tries to "blow off" some of the acids. The patient may have non-specific complaints such as weakness and may complain of abdominal pain.

Question 54

List the possible side effects of inhaled bronchodilator medications.

Answer 54

Tremor, palpitations, nervousness, increased pulse.

Question 55

What is dysmenorrhea?

Answer 55

Dysmenorrhea is painful menstruation.

Question 56

Define: Dyspnea on Exertion

Answer 56

Dyspnea on exertion (DOE) is difficulty breathing that comes on during periods of exertion (physical activity). This often indicates heart failure but can also indicate lung diseases (e.g. COPD) and infection. It is important to note if a patient has an onset of new dyspnea on exertion or if the patient's dyspnea on exertion has worsened.

Question 57

How do you treat excessive post-delivery bleeding?

Answer 57

Place a sanitary napkin over the vaginal opening but do not pack or insert anything into the vagina. Locate the uterus by palpating the mother's abdomen. Massage the uterus to promote contraction and slow the bleeding.

Question 58

If a medication is chronotropic, how will it affect the heart?

Answer 58

Chrono- means time. Chronotropic medications affect the heart rate.

Question 59

Define: Cholecystitis

Answer 59

An inflammation of the gallbladder most frequently caused by gallstones.

Question 60

Define: Placental abruption (abruptio placentae)

Answer 60

The placenta prematurely separates from the uterine wall - a cause of severe bleeding in the third trimester and a grave risk for mother and fetus.

Question 61

What are delirium tremens?

Answer 61

Delirium tremens (or "the DTs") are found in patients who chronically abuse alcohol. It begins about 48 - 72 hours after patients stop consuming alcohol. Delirium tremens can be life-threatening and involve visual, tactile and auditory sensations and disturbances.

Question 62

How and when do you cut the umbilical cord after delivery?

Answer 62

The umbilical cord can be cut after the baby is properly assessed and cared for. Place one clamp from the OB kit about 6 inches from the newborn. Place the second clamp 2 - 3 inches past the first clamp (away from the newborn). Cut the cord using the scissors from the OB kit. Be sure the cord is securely clamped to prevent bleeding from the newborn. Handle the newborn carefully and avoid damage or tension to the cord.

Question 63

What are the indications for nitroglycerin?

Answer 63

A complaint of chest pain. Cardiac history and nitroglycerin tablets or spray prescribed to the patient. Medical direction approved the administration (standing order or on-line). The patient's blood pressure meets your protocols for administration (usually 90 - 100 mmHg systolic)

Question 64

What are the indications for aspirin?

Answer 64

Cardiac chest pain The patient is able to chew and swallow. Medical director approves use (protocol or on-line) The patient does not have aspirin allergies or sensitivity. The patient doesn't have a history of gastrointestinal bleeding.

Question 65

Ratio of compressions to breaths in adult CPR

Answer 65

30:2 (30 compressions to two breaths)

Question 66

The appendix is located in which abdominal quadrant?

Answer 66

The appendix is located in the lower right quadrant.

Question 67

What effect will a beta blocker medication have on heart rate?

Answer 67

Beta blockers (e.g. atenolol, metoprolol) slow the heart rate. They are prescribed for hypertension and for conditions in which the heart rate must be slowed down.

Question 68

Define Eclampsia and Preeclampsia

Answer 68

Preeclampsia is the abnormal development of hypertension, edema and subsequent weight gain during pregnancy. Eclampsia is when the hypertension and edema from preeclampsia builds and leads to seizures and unresponsiveness.

Question 69

What is ascites?

Answer 69

Ascites is a build-up of fluid in the abdominal cavity. This may appear as distention or bulging. In patients who are bedridden, fluid accumulation in the abdomen may be due to heart failure. Fluid accumulates in dependent (low-lying) places. In an inactive patient this may be the abdomen. Ascites may also be due to diseases, especially cancer or cirrhosis of the liver.

Question 70

What is the difference between a "rescue" inhaler and a "controller" inhaler?

Answer 70

A rescue inhaler is used in emergencies to relieve bronchoconstriction (e.g. asthma attack). Albuterol is an example of a rescue inhaler. Controller inhalers are for long-term use and will not provide relief in an emergency. The controller inhalers usually contain a steroid which reduces chronic inflammation and mucus production. Examples include Flovent and Advair.

Question 71

Which sided heart failure (left or right) causes pulmonary edema?

Answer 71

Left sided heart failure causes pulmonary edema. Recall that blood from the venous circulation returns to the right side of the heart. It is pumped to the lungs and then back to the left side of the heart. If the left side of the heart experiences failure, blood backs up to where it came from--the lungs. Right sided heart failure results in fluid accumulation in the body's dependent areas (e.g. ankles and abdomen).

Question 72

Differentiate allergic reaction from anaphylaxis.

Answer 72

The main difference between allergic reaction and anaphylaxis is that the anaphylactic reaction is life threatening (through airway compromise and/or hypotension). An allergic reaction is the body's exaggerated immune response to an allergen. It may be localized (e.g. redness, swelling, hives) or more severe. When the reaction becomes severe it is termed anaphylaxis.

Question 73

Describe the action of Activated Charcoal.

Answer 73

Activated charcoal adsorbs poisons. It is made with a significantly increased surface area for poisons to bind to.

Question 74

What happens in the lungs of the patient with asthma during an attack?

Answer 74

A trigger (e.g. allergies, exertion, viral infection) causes the constriction of bronchioles in the lungs. This results in the classic wheezing and difficulty breathing seen in asthma attacks. Asthma, if not treated, will also cause mucus production which can make subsequent attacks worse. The difference between asthma and COPDs is that asthma is episodic. Unlike patients who have COPD and consistent symptoms, asthma patients experience symptom-free periods between attacks.

Question 75

Define: Asystole

Answer 75

"Flat line" on the ECG. No electrical activity from the heart.

Question 76

What is a STEMI?

Answer 76

STEMI is a type of heart attack identified in a 12-lead ECG. It stands for ST Elevation Myocardial Infarction.

Question 77

What is Sickle Cell Anemia?

Answer 77

Sickle Cell Anemia (SCA) is a blood disorder in which the red blood cells have a "sickle" shape instead of the normal round disc-like shape. This results in anemia, sludging (clogging) of red blood cells in capillaries, severe pain in the extremities and/or torso, stroke, priapism and more. Sickle cell trait and the subsequent disease is found in persons of African, Middle Eastern and Indian descent.

Question 78

Define: Acute Coronary Syndrome

Answer 78

A series of cardiac conditions including myocardial infarction (heart attack) and unstable angina pectoris in which the heart muscle is deprived of oxygen.

Question 79

Where is McBurney's point?

Answer 79

McBurney's Point is 1/3 of the distance from the anterior superior iliac spine to the umbilicus. It is the rough location of the appendix in the body. Tenderness here is a sign of appendicitis.

Question 80

Define: Prolapsed Umbilical Cord

Answer 80

A prolapsed umbilical cord is one that presents first (before the baby) during labor. This is a serious emergency because the baby's head in the birth canal will occlude the cord against the vaginal wall and stop delivery of oxygen to the baby.

Question 81

What is a pulmonary embolism? What are the signs and symptoms?

Answer 81

Pulmonary embolism occurs when an embolus (often from a deep vein thrombosis or DVT that has broken free from the lower legs) lodges in a blood vessel in the lung. The size of the clot depends on the severity. Large clots can cause sudden death. Smaller clots are very challenging to diagnose and may present with difficulty breathing (possibly pleuritic), rapid breathing and pulse, bloody sputum, or chest pain.

Question 82

How would you determine if delivery of a baby is imminent?

Answer 82

There are several factors but the most common are a severe urge to "push," crowning and a feeling like the mother needs to move her bowels. Labor pains less than 2 minutes apart and prior pregnancies also weigh into the decision. Women who have had children before usually deliver subsequent babies more quickly. Specifically ask about the length of labor for other children.

Question 83

What is the indication for the medication naloxone (Narcan)?

Answer 83

Naloxone is indicated in opiate overdose. This includes heroin, fentanyl, methadone and prescription narcotic medications (e.g. Oxycontin, oxycodone).

Question 84

Define: Positional Asphyxia

Answer 84

Respiratory depression or arrest caused by positioning a patient in a manner that restricts breathing. This may be seen when restraining agitated patients face-down or in other positions that limit breathing (e.g. hog-tie).

Question 85

What are the side effects of nitroglycerin?

Answer 85

Hypotension (including dizziness, rapid pulse, postural hypotension and syncope) Headache

Question 86

What are the contraindications to the administration of aspirin?

Answer 86

Allergy or sensitivity to aspirin History of a blood clotting disorder. History of gastrointestinal bleeding. Currently takes blood thinning/anticoagulant medication. History of asthmatic reaction to aspirin NOTE: Not all of these contraindications are present in every system.

Question 87

What is End Stage Renal Disease?

Answer 87

End Stage Renal Disease (ESRD) is failure of the kidneys so that they can no longer remove waste and regulate fluid balance in the body. Patients with ESRD require dialysis.

Question 88

Where on the body are the AED pads placed?

Answer 88

The upper right chest, to the right of the sternum and below the right clavicle. The other pad is placed and the lower left chest near the anterior axillary line over the lower ribs.

Question 89

List 4 signs and symptoms of ectopic pregnancy.

Answer 89

Missed menstrual cycle Abdominal pain Vaginal bleeding Rapid pulse and blood pressure (signs of shock/late signs)

Question 90

Define: Orthopnea

Answer 90

Orthopnea is difficulty breathing that is worse when reclining or lying flat. It is usually made better by sitting up or being propped up on pillows. It often indicates heart failure but is also seen in asthma and COPD.

Question 91

Define: Stroke

Answer 91

An interruption of blood supply to a part of the brain. The symptoms of stroke depend on what part of the brain is affected.