NREMT Part I + II Flashcards
1
Q
9-8-8
history, public health, EMT role
A
National suicide and crisis lifeline
2
Q
EMD
history, public health, EMT role
A
Emergency medical dispatcher
3
Q
Quality Improvement (QI)
history, public health, EMT role
A
continuous review and auditing of all aspects of the Ems system to identify areas of improvement
4
Q
EMS is also designed for what?
history, public health, EMT role
A
public health education and prevention efforts
5
Q
EMS system evolved from what?
history, public health, EMT role
A
Battlefield medicine, ambulance operated by funeral homes and volunteers
6
Q
EMS quality varied until what year
history, public health, EMT role
A
1970s
7
Q
white paper
history, public health, EMT role
A
published in 1966. “accidental death and disability; the neglected disease of modern society” beginning of modern EMS
8
Q
DOT
history, public health, EMT role
A
US department of transportation
9
Q
EMT NSC
what is? and when was it developed?
history, public health, EMT role
A
EMT National Standard Curriculum first developed in 1970s by DOT
10
Q
AHA
history, public health, EMT role
A
American Heart Association. increases emphasis on heart disease prevention, science, education in 1980s
11
Q
NHTSA
history, public health, EMT role
A
National Highway Traffic Safety Administration. 1990s started work on EMS Agenda for the future
12
Q
Public Access defibrillation started when/
history, public health, EMT role
A
1990s
13
Q
NEMSES
When did it start
history, public health, EMT role
A
National EMS Education Standard. 2000s
14
Q
What major additions did NEMSES add in 1990s
history, public health, EMT role
A
Administration of beta agonist meds, anticholinergic meds, OTC analgesics, BGL monitoring, CPAP, SPo2, Assisting higher level providers
15
Q
Clinical Care
history, public health, EMT role
A
Outlines the scope of practice and associated equipment
16
Q
Highest risk of harm
Reasons EMS is called
history, public health, EMT role
A
- Airway obstruction
- Respiratory distress/arrest
- Cardiac arrest
- Hypovolemic shock
- anaphylaxis
- stroke
- inhalation injury
17
Q
EMT scope
whats in it?
history, public health, EMT role
A
- Everything in EMR scope
- Oral OTC analgesics (Aspirin, Narcan.Others not in our CO scope? )
- Anticholinergic meds (Not in Colorado right?exmpl: Atropine for poisoning)
18
Q
Routine EMT activites that are high risk for patients
history, public health, EMT role
A
- transfer of pt care
- lifting and moving pts
- transportation
- Spinal Precautions
- Medication administration
19
Q
QI or CQI
history, public health, EMT role
A
quality improvement
continuous quality improvement
1.review/auditing of EMS to identify areas of improvement
2.medical director responsible for this
20
Q
Integrated public health examples
history, public health, EMT role
A
1.immunization clinics
2.prevention education
3.saftey and wellness events
4.public CPR training
21
Q
Priority of saftey after yourself
workforce saftey/wellness/moving pt/pt restraint
A
1.partner
2.patient
3.bystanders
22
Q
Stages of grief
workforce saftey/wellness/moving pt/pt restraint
A
1.Denial
2.Anger
3.Barganing
4.Depression
5.Acceptance
23
Q
Acute stress
workforce saftey/wellness/moving pt/pt restraint
A
immediate physiological and psychological reaction. triggers “fight or flight response”
24
Q
Delayed stress
workforce saftey/wellness/moving pt/pt restraint
A
stress reaction that developes after event. PTSD is an example
25
Cumulative Stress
## Footnote
workforce saftey/wellness/moving pt/pt restraint
1.exposure to stress over long period of time.
2.leads to burnout
26
Signs of stress or burnout
## Footnote
workforce saftey/wellness/moving pt/pt restraint
1. Anxiety/irritability
2. HA. Poor concentration
3. loss of appitite, hard to sleep
4. loss of interest
5. increased alcohol/drug use
27
CISM
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Critical Incident Stress Management
28
CISM componants
## Footnote
workforce saftey/wellness/moving pt/pt restraint
1. diffusing sessions (4 hours after incident)
2. debreifing sessions (24-72 hours after incident)
3. trained peer councilors and mental health professionals
4. NOT for pt care crituiqe or performance evaluation
5. information is confidential
29
Pathogens
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Cause infections diseases
30
Viral infections
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Resistance to antibiotics
31
Epidemic vs Pandemic
## Footnote
workforce saftey/wellness/moving pt/pt restraint
epidemic: widespread disease in community at certain time
pandemic: outbreak of disease across several countries or conitents
32
OSHA
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Occupational saftey and health administration
1.oversees woreplace saftey and infections disease precautions
33
where do you report exposure to?
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Designated infection control officer
34
Single most important way to prevent infection spread
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Handwashing
35
minimum PPE
## Footnote
workforce saftey/wellness/moving pt/pt restraint
Gloves
Eyeprotection
36
PPE for significant body fluid contact
gown
mask
faceshield
37
PPE for suspected airborne disease
HEPA or N95
38
Staging for PD
being called to a scene but maintain a clear distance until snece is cleared for saftey
39
Power grip
palms up and fingers wrapped
40
Emergency Moves
scene is dangerous and pt must be moved before providing care
41
Emergency move examples
1.armpit forearm drag
2.shirt drag
3.blanket drag
42
urgent move
when pt has potentially life threatening injury/illness must be moved quickly for evaluation
43
Rapid extraction
type of urgent move
1. for pt in motor vehicle
2. multiple rescuers and long backboard
44
Non-urgent moves
1. direct ground lift
2. extremity lift
3. direct carry
4. drawsheet method
45
log roll min people to perform
3
46
Hipaa law is?
Federal law requires the creation of national standards to protect sensitive patient health information from being disclosed
47
Cultural competence
Ability to provide care to patients with diverse values, beliefs, and behaviors
48
HIPAA
Stands for health insurance portability and accountability act.
Established in 1966
49
4 components necessary to prove negligence
Duty to act
Breach of duty
Damage
Proximate cause
50
Negligence
Deviation from the standard of care that a reasonable person would use in a particular set of circumstances
- type of tort
- no intent to harm the pt
- breach of duty to act
51
Standard of care vs scope of practice
Scope is what you are allowed to do care is how well you need to be able to do it
52
5 types of consent
Expressed
Implied
Minor
Involuntary
Informed
53
Informed consent
Define
For patients who are alert and competent. They have to be informed of care plan and associated risks of accepting or refusing
54
Expressed consent
Define
The patient must be alert and competent. Can be given verbally or non verbally. Not as indepth as informed consent. For more basic assessments or procedures
55
Implied consent
Assumption of consent for an unresponsive or incompetent patient. Incopentancy may be due to alcohol, drug, head injury, hypoxia, hypoglycemia, or mental incompetence. Can be used for patients who refused care then passed out
56
Minor consent
Consent required from parent or guardian. It's implied consent if unable to reach parent or guardian. Not required for emancipated minors who are married or pregnant, already a parent, member of the armed forces, emancipated by court.
57
Involuntary consent
Mentally incompetent or in custody of law. Consent must be obtained from the entity of appropriate legal authority
58
Hospital destination
Patients ability to pay should not figure into where they are transported
Document why the facility was chosen
When in doubt, consult medical direction
59
Components of a competent patient that can refuse transport
A&o x4
Legal age
No communication barriers (language or hearing)
Not impaired by drugs/alcohol
Not impaired by illness or injury
60
When can an emt release confidential patient information
Continuity of care
Billing
Emt has received a supenia
Reporting crime, abuse, assault, negligence, certain injuries, communicable diseases
61
Crime scene
| special reporting considerations
Document position of patients and everything you touched
Report anyone or anything that seems suspicious
62
Emts professional ethics should reflect what?
Emt code of ethics published by national association for emts
63
E-PCR
Electronic patient care report
64
FCC
Federal communications commission
- regulates all radio operations in the U.S
- Alocated specific frequencies for EMS
65
Portable radios
Hand held vary limited range unless used with a repeater system
66
Mobile radios
Vehicle mounted greater range than portable radios repeater system is still required
67
Base station
Transmitter/receiver fixed location in contact with all components of radio system
68
Repeater
Type of base station low powered transmissions rebroadcast at higher power to improve range
69
MDC's
Mobil Data Computers
- digital information reduces radio traffic
- displays information such as address of call, routing info, and call details
70
Guidelines for radio communications
Notify dispatch when en route, on scene, en route to hospital, at hospital, back in service
71
Do's for radio communication.
- correct radio/frequency
- insure no other radio traffic before transmitting
- push to talk button for 1 sec before speaking
-state who you are talking to then who you are THEN speak
- use clear text, not radio codes (unless approved locally)
- use affirmative and negative instead of yes and no
- use copy to confirm receipt of transmission
- always repeat orders for med direction to ensure accuracy
72
Do NOT's of radio communications
- please or thank you
- protected information (patients name)
73
Who is subpoenaed to give a deposition or testify in court
The person who wrote the PCR
74
Documentation rule (4)
-if you did it document if you didn't do it don't say you did
- it's better to document well than to explain why you didn't do it later
- if your times are inaccurate, the rest of your PCR may be called into question
- spelling counts
75
Minimum data set for PCR
- times
- patient information (at least 2 sets of vitals + a lot more)
- administrative info
- narrative
76
FACT
| For documentation
- factual (objective information Fancy word)
- accurate
- complete
- timely
77
SOAP documentation
- Subjective
- Objective
- Assessment
- Plan
78
CHART documentation
- CC
- history
- assessment
- treatment
- transport
79
HEENT
-Head
-Ears
-Eyes
-Nose
-Throat
80
Pertinent negatives
S/S you expect, but the patient denies
E.X. patient experiences trauma but denies neck pain
E.X. patient has chest pain but denies dyspnea
81
Associated symptoms
- patient complaints that are in addition to cheif complaint
E.X. cheif complaint is chest pain patient also complains of mild difficulty breathing
82
Errors of ommision
- something that should have been included on the PCR but was left out
83
Errors of commission
- something was included on the PCR that was incorrect
84
Special reporting situations
- death
- MCI
- suspected abuse or neglect
- suspected crime
- animal bites
-disease outbreak
85
S in SOAP Componants
Subjective
-CC
-HPI (History of present illness)
-Hx
-Medications
-Allergies
86
O in SOAP componants
Objective
-Vitals
-physical exam
-Diagnostic data
87
A in SOAP compantants
Assessment
- combines objective and subjective
- possible problems, field impression
88
P in SOAP componants
Plan
-treatment initiated
-response to treatment
89
Shock
| Basic definition
Inadequate perfusion
90
Axial skeleton
skull
spinal column
thoracic cavity
91
How many vertabrae in the spinal column
33 (9 fused)
92
What does the thoracic cavity store?
Heart
lungs
trachae
esophagus
great vessels
93
What is the Appendicular skeleton
Arms
Legs
Pelvis
Shoulder girdle
94
What forms the shoulder girdle
Clavial
scapula
humerus
95
what bones form the pelvis
Illium
Ischium
Pubis
96
Basic joint types (3)
Symphasis: joint with limited motion
Ball and socket: distal end is capable of free motion (Shoulder)
Hinge joint: bones can move only uniaxially (knee)
97
Componants of upper airway
-Nose and mouth
-Nasopharynx
-oropharynx
-larynx
-Epiglottis
98
What is the most common cause of upper airway obstruction
tongue
99
Componants of lower airway
-trachea
-Carina
-left and right mainstem bronchi
-bronchiols
-alveoli
100
Carina
where trachea branches into left and right mainstem bronchi
101
Surfactant
substance that helps keeps the alveoli from collapsing
102
intercostal muscle location
inbetween ribs
103
O2 % in atmospheric air
21%
104
O2 % in exhaled air
16%
105
External respiration
exchange of O2 and Carbon dioxide between alveoli and pulmonary capillaries
106
Internal respiration
Gas exchange between bodies cells and systemic capillaries
107
Cellular respiration
Aerobic metabolism
-uses O2 to break downglucose to create energy
108
Carbon dioxide drive
-Main mechanism of breathing control
-brain stem monitors CO2 levels in blood and CSF
109
Tidal Volume
amount of air inhaled or exhaled in one breath
110
Normal tidal volume of healthy adult at rest
400 - 500 mL
111
Residual volume
amount of air in lungs after completely exhaling (keeps the lungs open)
112
Inspiratory/expiratory reserve volume
the amount of air you can still inhale or exhale after a normal breath
113
Dead space (VD)
the amount of air in the respiratory system not including the alveoli
-where air collects but no gas exchange is involved
114
Average adult Dead Space volume
150ml
115
Minute ventilation
Respiratory rate x tidal volume
116
Which side of the heart is stronger (has a greater workload)
Left (receiving O2 blood from lungs and sends to body)
117
Layers of the heart (Inner to outer)
-Endocardium (Smooth thin lining)
-Myocardium (thick middle muscular)
-Epicardium (outer most layer of heart & inner most layer of pericardium)
118
Atrial kick
atria pumps blood into the ventricals just before the ventricals contract
119
What action of the heart causes the pulse
Left ventricular contraction
120
When do the hearts valves close
during ventricular contraction
121
heart electric nodes and impulse rates
- Sinoatrial (SA) : 60-100
- Atrioventricular (AV) : 40 - 60
- Bundle of His : 20 - 40
122
Contractility
Hearts ability to contract
123
Preload
- created by blood volume in left ventrical after diastole
- based on the amount of blood coming back to the heart
124
What does increased preload lead to
| (think basic anatomy)
- increased stretching of ventricals
- increased myocardial contractility
125
Afterload
- Resistance heart must overcome during ventricular contraction
126
What does increased afterload lead to
| (Dont over think it sweet thang)
decreased cardiac output
127
what is the one artery in the heart that carries deoxygenated blood
Pulmonary artery
128
what is the one vein in the body that carries oxygenated blood
Pulmonary vein
129
Systemic Vascular Resistance (SVR)
Resistance of bloodflow throughout the body (excluding pulmonary system)
130
SVR is determined by the size of what
Blood vessels
131
what do constricted/ dialated blood vessels do to the SVR
- Constriction: increases SVR and BP
- Dialation: Decreases SVR and BP
132
Componants of blood (4)
- plasma
- red blood cells
- white blood cells
- Platelets
133
Plasma
liquid componant of blood; made mostly of water
134
Red blood cells
Erythrocytes
- O2 carrying component of blood
135
White blood cells
Leukocytes
-fight infection
defend against invading organisms
136
Platelets
Essential for clot formation to stop bleeding
137
Systolic blood pressure
pressure exerted during left ventrical contraction
138
Parts of epidermis
| (its okay, this wasnt in our textbook)
Germinal layer: produced new skin cells
Stratum corneal layer: Top epidermal layer, consists of dead skin cells
139
Dermis contains what structures
- blood vessels
- nerve endings
- sweat glands
- hair follicles
140
subcutaneous tissue
- Fatty tissue
- deepest layer of skin
- layer above muscle
141
ATP
Andenosine Triphosphate
- Cellular energy
- body uses O2 to convert nutrients into ATP
- cells recieve exponentially moreATP if there is adequate O2 supply
142
Waste products of Aerobic metabolism
- water
- carbon dioxide
143
Anaerobic Metabolism
Creation of energy without an adequate O2 supply
- by product is lactic acid
144
Ventilation
pulmonary ventilation
- movement of air in and out of lungs
145
neonate
Birth to one month of age
146
Infant
one month to one year
147
Toddler
one to 3 years of age
148
Preschooler
3 to 6 years of age
149
Typical newborn weight
6-8 lbs (3-3.5 kilograms)
150
Newborn head makes of what % of weight
25%
151
Most significant source of heatless on newborns body
Head
152
What is lost then gained in the first couple weeks of neonate
weight
153
when are newborns fontanels fully fused
18 months
154
Depressed fontanelles indicates
hypovolemia (Dehydration)
155
Bulging fontanelles indicates
Infection or increased ICP
156
Infants are obligate ___ breathers
Nose
157
Rapid breathing in an infant can lead to
fluid and body heat loss
158
Hyperventilation in infants presents an increased risk of
barotrauma
159
barotrauma
Injury to tissues in bodies air cavities
160
4 typical reflexes of neonates
- startle
- grip
- rooting
- sucking
161
Development milestones at 6 months
- teething
- sit upright
- track objects visually
162
Development milestones at 12 months
- know own name
- recognize parents/caregivers
- walk with assisstance
- speak a few words
- still communicate distress primarily through crying
163
Toddler development milestones
- walk
- climb
- distinguish basic shapes/colors
- potty trained
164
Preschooler development milestones
- physically coordinated
- communicate well verbally
- know name and address
- dress themselves
- can count to 10 or beyond
165
Toddler/preschooler special communicaiton recommendations
- seperation anxiety is common
- speak to caregiver and child directly
- words taken literally
- Do not lie
166
School age children
6 - 12 years
167
School age physiology
- permanent teeth grow in
- musculoskeletal system growing rapidly
168
School age development milestones
- read and write
- develope basic problem solving
- establishing self image and morals
- large social cirlce
- understand concept of death
- look up to authority figures
169
School age communication considerations
- use understandable terms
- do not talk down to them
- respect privacy rights for this age group
170
Adolescents
12 to 18 years
171
Adolescent physiology
- Puberty occurs
- significant physical growth over 3 year period
- eating disorders are common (Up to 25) more common in females
172
Adolescent developmental milestones
- argumentative
- hypercritical
- egocentric
- do not anticipate consequences of own actions
- peer pressure
- high risk of depression/suicide
- preoccupied with body image/physical appearance
- become sexually active
173
Adolescent communication recommendations
talk about sensitive matters without caregivers present if possible
174
Adulthood stages
- Early adulthood: 20 - 40
- Middle adulthood: 40 - 60
- Late adulthood: over 60
175
What is the leading cause of death in young adults
accidental trauma
176
mild physical decline usually developes at what age
middle adulthood
177
continued physical and mental decline is common at what age
late adulthood
178
