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Remember when assessing a patient to always get their permission to treat them

May I help you? If a person is conscious, rational, and capable of making informed decisions, he or she has a legal right to refuse care, even though ill or injured.


Remember when you have a duty to act.

On call, wearing uniform


Remember that you have a time line to submit a written child abuse report.

it's a misdemeanor to fail to report abuse. Verbally report to CPS immediately and written report within 36 hours.


When do we realign a long bone angulation fracture prior to splinting ?

2. delay in transport
3. reduction of distal circulation
4. Aggravation of the injury
5. injury to tissue, nerves, blood vessels, or muscle


What are hazards of splinting ?

1. further damage 2. delay in transport
3. reduction of distal circulation
4. Aggravation of the injury
5. injury to tissue, nerves, blood vessels, or muscle


What is the definition and meaning of CHF ?

Congestive Heart Failure Failure of the heart occurs when the ventricular heart muscle is so damaged that it can no longer keep up with the return flow of blood from the atria. It is called congestive heart because the lungs become congested with fluid once the heart fails to pump the blood effectively. Blood tends to back up in the pulmonary veins, increasing the pressure in the capillaries of the lung.


What are the significant signs of a head injury ?

A head injury is a traumatic insult to the head that may result in injury to soft tissue, bony structures, or the brain. Patient who exhibits one or more of these signs or symptoms has potentially sustained a very serious underlying brain injury:


What are signs and symptoms of Meningitis ?

An inflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium.


What does Dyspnea mean ?

Shortness of breath or difficulty breathing.


What are the signs of hypoxia ?

A dangerous condition in which the body tissues and cells do not have enough oxygen.


What causes respiratory distress with your Emphysema patient ?

1. emphysema or chronic bronchitis (have productive cough) 2. barrel chest: lungs become overinflated all the time
3. labored breathing
4. cyanosis
5. can have sudden onset
6. abnormal breath sounds may be present (Rhonchi, rales, wheezes)
Note: comes from smoking


Understand what drugs will cause central nervous system depression.

downers (give ALOC) [e.g. alcohol, THC/marijuana, barbiturate: diazapam, roofies, sedative hypnotic
Narcotics & opiates cause respiratory depression S/S:
2. respiratory depression. hypoventilation
3. pupils dilated
4. loss of coordination
5. slurred speech
6. bradycardia and hypotension


What are the conditions that need to be met for a valid DNR ?

Written original order in patient's chart = DNRPOLST
LAC "Prehospital DNR" Form
California "Prehospital DNR Form


Remember what shock means and what does it do in the body.

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.


How do you as an EMT treat a patient experiencing signs and symptoms of shock due to blood loss ?

Stop blood loss, check ABC, then put in shock position and rapid transport


Remember that the body needs oxygen and glucose for cellular function.

Glucose - one of the basic sugars; it is the primary fuel, in conjunction with oxygen, for cellular metabolism. Glucose is the major source of energy for the body. All cells need glucose to function properly, and some cells will even cease to function without it. Without glucose, or with very low levels, brain cells rapidly suffer permanent damage. Insulin is needed to allow glucose to enter individual cells, with the exception of brain cells, to fuel their function.


Remember that suicidal patients might be homicidal as well. (High Alert) True or False?



When an EMT assists a patient with their Nitro, what are the most important VS to assess ?

If the systolic BP is less than 100 mm Hg, the nitroglycerin may have the harmful effect of lowering the blood flow to the heart's own blood vessel. Nitroglycerin and sildenafil (viagra, tadalafil, vardenafil) can cause dramatic drops in blood pressure.


Remember you as an EMT should have a clear understanding of Patient Abandonment.

Abandonment is the unilateral termination of care by the EMT without the patient's consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient. Once care is started, you have assumed a duty that must not stop until an equally competent EMS provider assumes responsibility. Failure to perform that duty is a serious legal and ethical matter that exposes the patient to harm and can result in civil action against you. Abandonment may also take place in the emergency department where you are dropping off your patient. A part of your obligation as an EMT is to provide hospital personnel with a report of your assessment findings, the care you provided, and any changes in patient status that occurred during transport to the hospital. The failure to do so could result in a delay in treatment or a misdiagnosis. In such a case, a claim for abandonment might be filed against the EMT who failed to provide the report.


Remember what your actions are during an emergency delivery.

Prolapsed cord=cord presents through the birth canal before delivery of head. CANNOT deliver. TX: high blow oxygen, pillow under mother's pelvis or inverted bed pan to reduce pressure on cord; elevate presenting part of baby off the cord to prevent compression of cord & maintain fetal circulation; cover cord with sterile moist dressing to minimize temporature change & umbilical artery spasm.
Limb Presentation isleg or arm appears 1st instead of head
TX: oxygen, elevate mother's pelvis, transport immediately
CANNOT deliver, need C Section, Ask mother not to push
Breech presentation: baby's feet or buttocks appear 1st instead of head
TX: oxygen to mother; deliver baby; if head does not deliver within 3 minutes, form an airway for the baby by placing the middle and index fingers along the infant's face; hold the vaginal wall away fro the baby's nose and mouth; hold baby's mouth open slightly with finger so that baby can breathe, transport rapidly
Multiple births ismore than one baby of 2nd babies are breech
TX: When 1st baby is born, cut the cord to prevent hemmorrhage to the 2nd baby; if the 2nd baby has not delivered within 10 minutes of the 1st, transport immediately.
Expect hemmorrhage after 2nd baby has delivered; deliver placenta or placentas or transport if not delivered when mother and babies are stabilized and ready for transport; keep babies warm, suction mouth then nose.
Premature birth is before 27 weeks, susceptible to respiratory problems, infections & hypothermia
TX: keep baby warm with extra insulation; blow by oxygen; avoid contamination from birth process & do not breath into baby's face.


How to calculate the APGAR.

Appearance : 2i s Entire infant is pink 1is Body is pink, but hands and feet remain blue
0 is Entire infant is blue or pale.

Pulse: 2 is More than 100 beats/min
1 is Fewer than 100 beats/min
0 is Absent pulse

Grimace: 2 is Infant cries and tries to move foot away from finger snapped against sole of
1 is Infant gives a weak cry in response to stimulus.
0 is Infant does not cry or react to stimulus.

Activity 2 is Infant resists attempts to straighten hips and knees.
1 is Infant makes weak attempts to resist straightening.
0= Infant is completely limp, with no muscle tone.

-Respiration 2= Rapid respirations.
1= Slow respirations
0= Absent respirations


Remember what Para and Gravida mean.

Gravida= pregnancy Para=live births


Review Type 1 and Type 2 diabetes and have a clear understanding of characteristics of both.

Type 1 (juvenile onset) is AKA insulin dependent diabetes in which the autoimmune system kills the beta cells in the islets of langerhan in the pancreas. Patient needs inject insulin daily.


What happens if your patient takes too much insulin ?

When your patient takes too much insulin he or she will experience insulin shock (hypoglycemia). Insulin shock usually has a rapid onset within a few minutes. Distinct signs and symptoms includes pale, cool, and diaphoretic skin.


What are the signs and symptoms of your diabetic ketoacidosis patient ?

Note that diabetic ketocaidosis occurs for Type 1 diabetic patients. Type 2 diabetic patients get hyperosmolar hyperglycemic nonketotic syndrome. Signs and symptoms of diabetic ketoacidosis includes polyphasia, polyuria, polydipsia, kussmall respirations


Remember signs of respiratory distress, tripod position, and irregular respiratory patterns.

Normal: Breathing is neither shallow nor deepEqual chest rise and fall
No use of accessory muscles
Labored: Increased breathing effort
Possible gasping
Nasal flaring, supraclavicular and intercostal
Retractions in infants and children
Noisy: Increase in sound of breathing, including snoring wheezing, gurgling, crowing,
Grunting, and stridor.

Respiratory Distress
Agitation, anxiety, restlessness - [Lethargy, difficult to rouse]
Stridor, wheezing - [Tachypnea with periods of bradypnea or agonal respirations]
Accessory muscle use; intercostal retractions, neck muscle use - [Inadequate chest rise/poor excursion]
Tachypnea -[Inadequate respiratory rate or effort]
Mild tachycardia -[Bradycadia]
Nasal flaring, seesaw breathing, head bobbing - [Diminished muscle tone]

Tripod position: a patient is sitting and leaning forward on outstretched arm with the head and chin thrust slightly forward; significant conscious effort is required for breathing.
Respiratory failure occurs when the blood is inadequately oxygenated or ventilation is inadequate to meet the oxygen demands of the body.


Have a clear understanding about nitroglycerine.

Indication: chest pain -Repeat: 3 doese PTA
-Contraindication: Take viagara, BP lower than 100, head injury, 3 doses PTA, taken 5 minutes prior to arrvial


Have a clear understanding about all the breath sounds and what they are associated with.

Wheezing: whistling sound from partial blockage-Rales (usually heard on inspiration): caused by fluid in the lungs; crackles
-Stridor (usually heard on inspiration): caused by constriction of the upper airway (recall: upper airway ends at the larynx and the lowest part of the larynx is the subglottis); high pitched
-Rhonchi (usually head on expiration): caused by mucus; coarse gravelly sound


Understand the importance of the role that Critical Incident Stress Debriefing has on EMS workers.

Stress is the impact of stressors on your physical and mental well-being. Stressors include emotional, physical, and environmental situations or conditions that may cause a variety of physiologic, physical, and psychological responses. The body's response to stress begins with an alarm response, followed by a stage of reaction and resistance, and then recovery or, if the stress is prolonged, exhaustion. CISM - Critical incident stress management was developed to address acute stress situations and potentially decrease the likelihood that PTSD will develop after such an incident. The process theoretically is used to confront the responses to critical incidents and defuse them, directing the emergency services personnel toward physical and emotional equilibrium.
CISM can occur at an ongoing scene:
When personnel are assessed for signs and symptoms of distress while resting.
Before reentering the scene
During a scene demobilization in which personnel are educated about the signs of critical incident stress and given a buffer period to collect themselves before leaving.


CPR procedures

ADULTS: 1. Initiate EMS
2. Immediately get AED

Children and Infant

1. initiate immediately
2. get AED

1. 5 cycles of CPR
2. Initiate EMS
3. Get AED


Rescue breathing

Adult 1:5-6 sec

Child 1:3-5 sec

Infant 1:3-5 sec

have good seal
look at chest rising
no resistance


Reasons to Stop CPR

1. Patient survives

2. Higher trained personnel arrives

3. Doctor tells you to stop

4. Exhaustion