nremt_exam_20230205144429 Flashcards
(71 cards)
1
Q
National Highway Traffic Safety Administration (NHTSA)
A
The lead agency for coordinating and promoting evidence-based emergency medical services (EMS) and the 911 system.
2
Q
Public Safety Answering Point (PSAP)
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The designated call-receiving site that directs high-priority calls to the apporpriate emergency services.
3
Q
Hand-Off Procedure
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- S = Situation (Overview of Present Issue)* B = Background (Patient History)* A = Assessment (Pertinent Findings)* R = Recommendations (Actions Needed)
4
Q
CBNRE Agents| Terrorism
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- C = Chemical* B = Biological* N = Nuclear* R = Radiological* E = Explosive## FootnoteThe CNBRE agents are technologic hazardous agents (i.e. “weapons of mass destruction”) that are intended to cause widespread harm and/or fear amongst a population.
5
Q
TRACEM-P Harms| Exposure
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- T = Thermal* R = Radiological* A = Asphyxiation* C = Chemical* E = Etiological* M = Mechanical* P = Psychological## FootnoteThe TRACEM-P harms are types of hazards that EMS personnel may be exposed to (during terrorist incidents).
6
Q
SLUDGEM| Nerve Agents
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- S = Salivation (Stimulation of Salivary Glands)* L = Lacrimation (Stimulation of Lacrimal Glands)* U = Urination (Relaxation of Internal Sphincter of Urethra)* D = Defacation (Relaxation of Anal Sphincter)* G = Gastrointestinal Upset (Changes to GI Muscle Tone)* E = Emesis (GI System Effects)* M = Miosis (Contraction of Pupil)## FootnoteSLUDGEM is a mnemonic that refers to the common signs/symptoms of nerve agent poisioning.
7
Q
Maximum Visibility of Emergency Vehicles| Night Operations
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- On: Red Warning Lights* Off: Headlights* Off: Fog Lights* Operating: Traffic Directional Boards
8
Q
NFPA 704 Placard| HAZMAT
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- Blue = Health Hazard* Red = Fire Hazard* Yellow = Reactivity* White = Specific Hazard## FootnoteNFPA = National Fire Protection Assocation
9
Q
Triage| Mass Casualty Incidents (MCI)
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- Priority 1 (Red): Treatable Life-Threatening Illnesses/Injuries* Priority 2 (Yellow): Serious, Non-Fatal lllnesses/Injuries* Priority 3 (Green): “Walking Wounded”* Priority 4/0 (Black): Dead or Fatally Injured
10
Q
Priority 1 (Red)| Triage
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- Airway/Breathing Difficulties* Uncontrolled/Severe Bleeding* Decreased/Altered Mental Status* Severe Medical Problems* Shock (Hypoperfusion)* Severe Burns## FootnotePriority 1 = In Critical Condition
11
Q
Priority 2 (Yellow)| Triage
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- Burns w/o Airway Difficulties* Major/Multiple Bone or Joint Injuries* Back Injuries w/ or w/o Spinal Cord Damage## FootnotePriority 2 = In Need of Ambulance Support
12
Q
Priority 3| Triage
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Patients with minor musculoskeletal injuries or minor soft-tissue injuries.## FootnotePriority 3 = Likely NOT in Need of Ambulance Support
13
Q
Priority 4/0| Triage
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- Exposed Brain Matter* Cardiac Arrest (for >20 Minutes)* Decapitation* Severed Trunk* Incineration## FootnotePriority 4/0 = Too Late to Save
14
Q
START| Triage
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- R = Respiration* P = Pulse* M = Mental Status
15
Q
Privileges of Ambulatory Driving| Vehicle Operations
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- Able to park the ambulance anywhere (if no harm is done to property/people).* Able to proceed past red stop signals, flashing red stop signals, and stop signs.* Able to exceed the posted speed limit (if people/property are not endangered).* Able to pass other vehicles in no-passing zones after properly signaling.* Able to disregard regulations for direction of travel and turning in certain directions.
16
Q
DCAP–BTLS
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- D = Deformities* C = Contusions* A = Abrasions* P = Penetrations/Punctures* B = Burns* T = Tenderness* L = Lacerations* S = Swelling
17
Q
Past Medical History (PMH)| Secondary Assessment
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- S = Signs/Symptoms* A = Allergies* M = Medications* P = Pertinent Past History* L = Last Oral Intake* E = Events Leading to Illness
18
Q
History of Present Illness (HPI)| Secondary Assessment
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- O = Onset* P = Pain/Palliation* Q = Quality* R = Radiation* S = Severity* T = Time* AS = Associated Signs* PN = Pertinent Negatives
19
Q
Beck’s Triad| Cardiac Tamponade
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- Hypotension (Narrowing Pulse Pressure)* Muffled Heart Sounds* Jugular Vein Distention (JVD)## FootnoteBeck’s Triad represents the three hallmark signs/symptoms of cardiac tamponade.
20
Q
Cushing’s Triad| Intracranial Pressure (ICP)
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- Hypertension (Widening Pulse Pressure)* Bradycardia* Irregular Respirations## FootnoteCushing’s Triad represents three hallmark signs/symptoms of increased intracranial pressure.
21
Q
Ryan White CARE Act
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The law that established a procedure by which emergency response personnel can seek to find out if they have been exposed to potentially life-threatening disease while providing patient care.
22
Q
Stress Reactions
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- Acute Stress Reaction (Soon After Incident)* Delayed Stress Reaction (Long After Incident)* Cumulative Stress Reaction (Years of Low-Level Stressors)
23
Q
Situations Requiring Emergency Moves
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- The scene is hazardous.* Care of life-threatening conditions requires patient re-positioning.* It is necessary to reach other patients.## FootnoteEmergency moves should be performed only when absolutely necessary.
24
Q
Urgent Move
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- The patient’s condition is deteriorating.* The required treatment can be performed only if the patient is moved.
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Requirements of Refusal of Care
* Legally Able to Consent* Mentally Competent/Oriented* Fully Informed of Risks* Signed Release Form
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Requirements of Negligence
* The EMT had a *duty to act*.* There was a *breach of duty*.* There was *proximate causation*.## Footnote**Breach of Duty:** The EMT failed to act OR failed to provide care at the *standard* expected.
27
Types of Shock
* **Cardiogenic:** The heart fails in its ability to pump blood.* **Hypovolemic:** Loss of blood volume via *severe bleeding* or *dehydration*.* **Distributive:** Loss of blood vessel tone (leading to hypotension).* **Obstructive:** Blood is physically prevented from flowing.## Footnote*Distributive shock* encompasses **neurogenic shock**, **anaphylactic shock**, and **septic shock**.
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Compensated Shock
* Slight Mental Status Changes (e.g. Anxiety; Feelings of Impending Doom)* Increased Heart Rate (Tachycardia)* Increased Respiratory Rate (Tachypnea)* Delayed Capillary Refill Time* Diaphoresis (i.e. Pale, Cool, Moist Skin)## Footnote**Compenstated shock** occurs when the body is able to sustain normal physiological function despite hypoperfusion.
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Causes of Obstructive Shock
* Tension Pneumothorax* Cardiac Tamponade* Pulmonary Embolism
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Decompensated Shock| Hypotensive Shock
* Decreased Blood Pressure (Hypotension)* Altered Mental Status## Footnote**Decompensated shock** occurs when the physiological compensatory mechanissm failed in their effort to sustain perfusion.
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Irreversible Shock
The state in which inadequately perfused organ systems begin to die, which is commonly followed by *patient death*.
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Infant Physiologic Reflexes| Life Span Development
* **Moro Reflex:** The infant throws out arms, spreads fingers, and grabs with fingers/arms *when startled*.* **Palmar Reflex:** Infant grasps when object is placed in palm.* **Rooting Reflex:** Infant turns head toward the side touched, when cheek is touched while *hungry*.* **Sucking Reflex:** Infants starts sucking when lips are stroked.
33
Pediatric Repiratory Anatomy Considerations| Airway Assessment
* The *mouth* and *nose* are smaller (i.e. more easily obstructed).* The *tongue* take up proportionally more space within the oral cavity.* The *trachea* is softer (i.e. more flexible) and narrower (i.e. more easily obstructed).* The *chest wall* is softer (i.e. less rigid).
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Compsensation for Hypoxia| Respiratory Assessment
* Shortness of Breath* Increased Respiratory Rate (Tachypnea)* Increased Heart Rate (Tachycardia)* Use of Accessory Muscles
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Stages of Respiratory Compensation
* **Respiratory Distress:** Body's compensating mechanisms are meeting increased metabolic demand (and characterized by *increased work of breathing*).* **Respiratory Failure:** Body's compensating mechanisms fail to meet elevated metabolic needs (and characterized by severe *hypoxia* and *hypercapnia*).* **Respiratory Arrest:** The complete stoppage of breathing.## FootnoteRepiratory failure is indicative of *inadequate breathing*.
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Respiratory Failure
* No/Poor Movement of Air* Diminished/Absent Breath Sounds* Rapid/Slow/Irregular Ventilation Rate* Inability to Speak* Unusual Breathing Noises (Wheezing, Crowing, Stridor, Snoring, Gurgling, Gasping)
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Oxygen Therapy Devices
* **Nonrebreather Mask:** O2 @ 12–15 LPM* **Bag-Valve Mask:** O2 @ 12–15 LPM* **Nasal Cannula:** O2 @ 2–6 LPM* **Tracheostomy Mask:** O2 @ 8–10 LPM
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Pulse| Vital Signs
* **Adult/Adolescents:** 60–100 BPM* **Preschooler/School-Age:** 70–110 BPM* **Toddler:** 90–130 BPM* **Infant/Newborn:** 110–160 BPM
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Brachial Pulse vs. Radial Pulse
* Measure the **brachial pulse** for infants of 1 year old or younger.* Measure the **radial pulse** for patients of 1 year old or older.## FootnoteThe **carotid pulse** should be measured if the radial pulse nor brachial pulse can be measured/accessed.
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Respiration| Vital Signs
* **Adult/Adolescents:** 12–20 BPM* **Preschooler/School-Age:** 20–32 BPM* **Toddler:** 24–40 BPM* **Infant/Newborn:** 30–60 BPM
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Respiratory Sounds| Vital Signs
* **Snoring:** Patient's airway is blocked/obstructed.* **Wheezing:** Medical condition involving bronchocontriction.* **Gurgling:** Fluids are present in the airway.* **Crowing:** Medical condition that cannot be treated on-scene.
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Skin Abnormalities| Vital Signs
* **Pale:** Poor Circulation (due to Blood Loss, Hypotension, Shock, or Distress)* **Cyanotic:** Hypoxia (due to Inadeuate Breathing or Heart Dysfunction)* **Flushed:** Heat Exposure* **Jaundiced:** Liver Abnormalities* **Mottled:** Shock
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Pupil Abnormalities| Vital Signs
* **Dilated:** Drug Usage; Blood Loss* **Constricted:** Narcotics Consumption* **Unequal:** Stroke; Head Injury; Eye Injury* **Unreactive:** Drug Usage; Brain Hypoxia
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Blood Pressure| Vital Signs
* **Adult:** Systolic ≤ 120 mmHg* **Adolescent** Systolic @ 110–120 mmHg* **Infant:** Systolic @ 90 mmHg* **Birth:** Systolic @ 50–70 mmHg
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Common Medications| Secondary Assessment
* **Hypertension:** Captopril, Lisinopril, HZTC* **Diabetes (Insulin):** Humalog, Humalin, Lantus, Metformin* **Mental Disorders:** Xanax, Celexa, Lexapro, Paxil, Seroquel
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Verbal Report| Communications
* Patient's Chief Complaint* History of Present Illness/Injury* Treatment Administered *En Route* + Patient Response* Vital Signs taken *En Route** Assessment Findings (+ Pertinent Negatives)
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Elements of Prehospital Care Report| Documentation
* General Impression of Patient* Narrative Summary of Events throughout the Call* Patient History; Assessment Findings; Treatments Administered* Transport Information
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Six Rights of Medication Administration| Pharmacology
* Right **Patient*** Right **Medication*** Right **Route*** Right **Dose*** Right **Time*** Right **Documentation**
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Routes of Administration| Pharmacology
* **PO =** Oral* **SL =** Sublingual* **INH =** Inhalation* **IN =** Intranasal* **IM =** Intramuscular* **SubQ =** Subcutaneous* **IO =** Intraosseous* **ET =** Endotracheal* **IV =** Intravenous
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Administerable/Assistable Medications
* Oxygen* Aspirin* Nitroglycerin* Naloxone (Narcan)* Activated Charcoal* Oral Glucose* Albuterol/Inhaler* Epinephrine Pen
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Pediatric Inadequate Breathing| Respiratory Emergencies
* Nasal Flaring* Retractions* Grunting* Seesaw Breathing
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Pathophysiological Indications of C-PAP| Respiratory Emergencies
* Congestive Heart Failure (CHF)* Pulmonary Edema* Drowning* Asthma* Chronic Obstructive Pulmonary Disease (COPD)* Respiratory Failure
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Sign/Symptom Indications of C-PAP| Respiratory Emergencies
* Pulse Oximetry < 90%* Respiratory Rate > 25 BPM* Use of Accessory Muscles during Breathing## FootnoteAt least **two** of these conditions must be experienced for C-PAP to be indicated.
54
Contraindications of C-PAP
* Severely Altered Mental Status* Inability to Protect Airway* Inability to Follow Commands* Inability to Sit Up* Lack of Normal/Spontaneous Respirations* Hypotension (< 90 mmHg)* Inability to Maintain Mask Seal* Nausea/Vomiting* Chest Trauma (Tension Pneumothorax)* Shock* Upper Gastrointestinal Bleeding (or Gastric Surgery)
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Side Effects of C-PAP
* Hypotension* Pneumothorax* Increased Risk of Aspiration* Drying of Corneas
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Dosage of C-PAP
* 5–10 cm H2O## FootnoteThe dosage of C-PAP should be *gradually increased* from 5 cm H2O to 10 cm H2O.
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Lung Auscultation Abnormalities
* **Wheezing:** Narrowed Air Passageways in Lungs (e.g. Asthma; Emphysema; COPD)* **Crackles/Rales:** Fluid in the Alveoli* **Rhonchi/Snoring:** Secretions in Larger Airways (e.g. Pneumonial Bronchitis)* **Stridor:** Partial Obstruction of Trachea/Larynx
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Asthma
## Footnote**Wheezing** is a hallmark indication of an Asthma attack.
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Congestive Heart Failure (CHF)
An inability to pump blood out of the heart that results in increased pressure within the pulmonary capillaries (and the lungs)## FootnoteCHF results in **pulmonary edema**.
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Pulmonary Edema (PE)
## FootnoteAn abnormal accumulation of fluid in **or** around the alveoli that results in *hypoxia* and *shortness of breath*.
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Signs/Symptoms of CHF/PE| Congestive Heart Failure + Pulmonary Edema
* Respiratory Distress (Dyspnea)* Anxiety* Pale + Diaphoretic Skin* Tachycardia* Hypertension* Hypoxia* Crackles/Wheezes* Pink/White Sputnum* Pulmonary Edema
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Signs/Symptoms of Pneumonia
* Coughing (w/ **Green** Mucus)* Shortness of Breath* Fever + Chills* Sharp/Pleuritic Chest Pain* Headaches* Confusion* Fatigue* Pale + Diaphoretic Skin## Footnote**Pneumonia** is an infection of one or both lungs caused by bacteria/viruses/fungi.
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Signs/Symptoms of Spontaenous Pneumothorax
* Sharp/Pleuritic Chest Pain* Decreased/Absent Breath Sounds on Injured Lung* Shortness of Breath (Dyspnea)* Hypoxia + Cyanosis* Tachycardia* (Jugular Vein Distension)* (Hypotension)
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Spontaneous Pneumothorax
A collapse of the lung without injury or any other obvious cause.## FootnoteIndividuals who are *thin*, *tall*, or *smoke* are at highest risk of experiencing a spontaneous pneumothorax.
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Signs/Symptoms Pulmonary Embolism
* Sharp/Pleuritic Chest Pain* Shortness of Breath (Dyspnea)* Hypoxia + Cyanosis* Tachycardia * Tachypnia* Anxiety* Cough (w/ Bloody Sputnum)## Footnote**Pulmonary embolism** is the blockage of blood supply to the lungs that often results from Deep Vein Thrombosis (DVT)
66
Epiglottitis
* Sore Throat* Difficulty/Painful Swallowing (Drooling)* Muffled Voice* Sick Appearance* Fever* Tripod Position* **Stridor**## Footnote**Epiglottitis** is the obstruction of the glottic opening due to infection (and subsequent inflammation/swelling) of the epiglottis.
67
Croup
* **Loud Seal-Bark Cough*** Hypoxia* Altered Mental Status* Fever* Dyspnea/Stridor (w/ Relief when Upright)* Restlessness## Footnote**Croup** is a viral illness that results in inflammation of the larynx, trachea, and bronchi (and the constriction of the lung airways).
68
Bronchiolitis
* **Cold-Like Symptoms** (Runny Nose; Fever; General Illness)* Hypoxia* Dypnea## Footnote**Bronchiolitis** is a viral illness (often caused by RSV) that results in the inflammation/constriction of small airways.
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Cystic Fibrosis
* Coughing (w/ Blood and Mucus)* Fatigue* Pneumonia (i.e. Fever, Coughing, Dypnea, Green Sputnum, Loss of Appetite)* Abdominal Pain + Distention* Nausea* Weight loss## Footnote**Cystic Fibrosis** is a genetic disease that causes thick, sticky mucus to accumulate in the lungs and digestive system.
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Cardiac Implants
* **Cardiac Pacemaker:** An implanted pacemaker that enables the heart beat in a normal, coordinated fashion (when the body's natural pacemaker fails).* **Implanted Defibrillator:** A miniature defibrillator surgically implanted in the chest/abdomen that detects lethal cardiac rhythms and shocks the patient.* **Ventricular Assist Device:** A mechanical device that pumps blood for the heart when one or both ventricles are weak/incompetent.
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Causes of Altered Mental Status
* S = Sugar, Stroke, Seizure* N = Narcotics* O = Oxygen* T = Temperature, Toxins, Trauma
