EMT Basic Final Exam Study Guide - Google Docs PDF

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EMT Basic Final Exam Study Guide Key Terms Embolism- obstruction of an artery Edema- fluid buildup; swelling PMS- pulse, motor, sensory Ischemia- inadequate blood supply to a part of the body Hematoma- collection of blood outside of a blood vessel Aneurysm- localized enlargement of an artery caused by a weakening in the artery wall Dilation- opening Dyspnea- labored breathing Syncope- temporary loss of consciousness, or fainting Incontinence- lack of voluntary control over urination or defecation

EMS Systems Most states have four training and licensure levels: -EMR (Emergency Medical Responders) -EMT (Emergency Medical Technicians) -AEMT (Advanced EMT) -has training in ALS (advanced life support) including: -IV therapy (Intravenous) -administration of certain emergency medications -Paramedic History of EMS: -Origins include: volunteer ambulances in WW1, field care in WW2, field medic and rapid helicopter evacuation in Korean conflict -EMS as we know it originated in 1966 with the publication of Accidental Death and Disability: The Neglected Disease of Modern Society -DOT (Department of Transportation) published first EMT training curriculum in early 1970s -EMS care is governed and part of the Department of Transportation -National Highway Traffic Safety Administration (NHTSA)

EMS Types: -Anglo-American model (ours) -brings patient to the hospital -Franco-German model (Europe) -brings the hospital to the patient Levels of training: -Federal level: National EMS Scope of Practice Model provides guidelines for EMS skills -State level: Laws regulate EMS provider operations -Local level: Medical director decides day-to-day limits of EMS personnel -every 3 years resubmit for recertification (40 hours of continuing educ. required) Public BLS (basic life support): -millions of laypeople are trained in BLS/CPR -teachers, coaches. child care providers Emergency Medical Responders (EMR): -law enforcement, firefighters, park rangers, ski patrol, etc. -initiate immediate care and assist EMT’s on their arrival -good samaritans trained in first aid and CPR Emergency Medical Technicians (EMT): -has knowledge and skills to provide basic emergency care -responsibility for assessment -emergency care -package and transport of patient Advanced Emergency Medical Technicians (AEMT): -adds knowledge and skills in specific aspects of ALS -IV therapy -advanced airway adjuncts -medication administration Paramedics: -extensive course training -wide range of ALS skills -endotracheal intubation -emergency pharmacology -cardiac monitoring; use of electrocardiogram (EKG)

Medical Direction: -physician medical director authorizes EMTs to provide medical care in field -appropriate care is described in standing orders and protocols -medical control can be off-line or online -Online (direct) -directions given over phone or radio -Offline (indirect) -standing orders or protocols Evaluation: -medical director maintains quality control -continuous quality improvement (CQI) -reviews and audits EMS system -refresher training or continuing education -minimizing errors is the goal

On-Scene Patient Assessment -BSMNHS (Bald Short Men Never Have Sex) -BSI -Scene Safety -Mechanism of Injury/ Nature of Illness -Number of patients -Help (additional resources) -Spine Immobilization -GLCAB5C5D (Girls Love Compliments) -General impression -Level of Consciousness (AVPU) -Chief Complaint -Airways -Breathing (5) -(Y/N), (R,R,Q), oxygen intervention, make sure O2 working, mgt. of injuries -Circulation (5) -(Pulse R,R,Q), major bleeding, (skin color, temp., condition), shock Management (HOTTI) -Decision to Transport -Trauma Pt assessment vs. Medical Pt assesment -Medical Pt then take history -Then VFIT

-Vitals -Field impression -Intervention/Treatment -Trauma Pt -Then take vitals and attempt to get SAMPLE history -Begin secondary assessment -DCAP BTLS -Eyes check for PEARRL -check extremities for PMS (pulse, motor, sensory) -Manage secondary injuries -Reassessment -Stable: every 15 mins. take vitals -Unstable: every 5 mins. take vitals *Key things to remember: PMS before & after immobilization *When backboarding, slide the patient down and then up -See Trauma Patients for more details

Airway Management Key terms -Apneic: no longer breathing -Alveoli: tiny air sacs of the lungs which allow for rapid gaseous exchange -Capillaries: smallest blood vessels -Pleural Cavity: thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung -Visceral pleura- OUTER layer -Parietal pleura- INNER layer -Positive Pressure Ventilation (PPV): process of forcing air into a patient’s lungs (aka artificial ventilation) -Patent airway: open airway Respiratory assessment -Adequate breathing: -between 12-20 breaths/min -regular pattern -bilateral (both sides) clear and equal lung sounds -equal chest rise and fall -adequate depth (tidal volume)

-Inadequate breathing: -less than 12 breaths/min or greater than 20 breaths/min -irregular rhythm -diminished, absent, or noisy auscultated breath sounds -decreased flow of expired air at nose and mouth -Abnormal breathing: -unequal or inadequate chest expansion -increased effort of breathing -shallow depth -skin that is pale, cool, moist, or cyanotic (discoloration of skin= inadequate oxygenation) - “tripod” position -patient is leaning forward supporting body weight on another surface -Auscultation: listening to breathe sounds with stethoscope

Types of lung sounds -Rhonchi (aka coarse crackles): snoring or rattling noises heard on auscultation; indicate larger conducting airways of the respiratory tract by thick secretions of mucus. Often heard in chronic bronchitis, emphysema, aspiration, and pneumonia -Crackles (aka rales): bubbly or crackling sounds heard during inhalation. Sounds are associated with fluid that has surrounded or filled alveoli or small bronchioles. Indicate pulmonary edema or pneumonia -Wheezing: high-pitched whistling sounds. Head in asthma, emphysema, and chronic bronchitis. Also heard in pneumonia, congestive heart failure, and other conditions that cause bronchoconstriction

-Stridor: abnormal, high-pitched sound caused by blockage or narrowing in the upper airways. Often heard during inspiration without the aid of a stethoscope Types of irregular respirations: -Agonal respirations: distinct abnormal pattern of breathing; sometimes gasping -Cheyne-stokes respirations: episodes of hyperventilation and apnea -commonly seen in stroke or head trauma Pts -Ataxic respirations: irregular pauses and increasing periods of apnea -can deteriorate into agonal respirations -may follow serious head injuries -Kussmaul respirations: deep and labored -associated with metabolic/toxic disorders -ex. Diabetic Ketoacidosis (DKA), also kidney failure Patient assessment cont. -Pts with inadequate breathing need to be treated immediately -Pts mental status typically correlates well with the status of the Pts airway -Respiration: actual exchange of O2 and CO2 at tissue level -even though Pt may be ventilating appropriately respiration may be compromised -skin color and level of consciousness are excellent indicators of respiration -consider oxygenation -use pulse oximetry > should be greater than 94% percent Basic Airway Management: -always assess the airway first in an injured or ill Pt -when ability to breathe is disrupted: -O2 delivery to tissues and cells is compromised -vital organs may not function normally -brain tissue will begin to die within 4-6 minutes -open the airway -no suspected spinal injury: -Head tilt-chin lift maneuver -Jaw lift -suspected spinal injury: -Jaw-thrust maneuver -Modified Jaw-thrust -determine if the Pt need and airway adjunct -causes of airway obstruction: -dentures, blood, vomit, mucus, food, other foreign objects

-assess the need to use suction -DO NOT suction longer than: -15 seconds on adult -10 seconds on child -5 seconds on infant Basic Airway Adjuncts: -prevents obstruction by the tongue -allows for passage of air and O2 to the lungs -OPA (oropharyngeal airway) -Indications: -unresponsive Pt without a gag reflex -apneic Pt being ventilated with a BVM (bag-valve mask) -Contraindications: -conscious Pt or Pt who has an intact gag reflex -select correct size: corner of the mouth to the earlobe -NPA (nasopharyngeal airway) -Indications: -unresponsive Pt or has an altered LOC (level of consciousness) -can be semiconscious -intact gag reflex -unable to maintain their own airway -Pts who will not tolerate an OPA -select correct size: tip of the nose to the earlobe -Contraindications: -severe head injury with blood in the nose -deviated septum -King airway -select correct size: based on Pt’s height -test cuff and inflations system -then remove air; apply lubricant if necessary -inflate cuffs -attach BVM -LMA (laryngeal mask airway)

Bag Valve Mask Ventilation (BVM) -check responsiveness: unresponsive Pt > use BVM -request additional resources if necessary -check breathing and pulse simultaneously -open airway; insert OPA or suction if needed -position mask to achieve and effective seal -ventilate the patient: 30 compression to 2 ventilations ratio -ventilate every 5 to 6 seconds; watching for chest rise & fall -watch for gastric distention (overinflation) -attach O2 if needed (15 L/min) -recheck pulse for no more than 10 seconds Supplemental Oxygen (O2): -always give to patients who are hypoxic (inadequate oxygen) -never withhold O2 from a patient who might benefit from it - < 94% SpO2 -suspected shock -signs of poor perfusion -Pt complains of dyspnea (difficult or labored breathing) -normal air: 78% Nitrogen, 21% Oxygen, 1% Other gases O2 delivery devices -Nonrebreathing masks -preferred way to give O2 (make sure reservoir fills) -adequate breathing but are suspected of having hypoxia -combination mask and reservoir bag system -make sure the reservoir bag is full before placing on Pt -10 to 15 L/min flow -Nasal Cannulas -delivers O2 through two small pubes that fit into the nostrils -1-6 L/min flow -contraindications: breathes through the mouth, has nasal obstruction -Humidification: -some EMS systems provide humidified O2 during long transport

Assisted and Artificial Ventilations -S/s (signs & symptoms) of inadequate ventilation: -AMS (altered mental status) -inadequate minute volume -shallow respirations -excessive accessory muscle use and fatigue -patients in respiratory arrest need immediate treatment to live -begin Positive-pressure ventilation (PPV): -mouth-to-mask technique -1-3 person bag-valve mask (BVM) -manually triggered ventilation device -PPV forces air into chest cavity -can also force air into the stomach causing gastric distention -be aware of this; can cause vomiting -You are providing adequate ventilation if: -Pt’s color improves -chest rises adequately -you do not meet resistance when ventilating -you hear and feel air escape as the Pt exhales -vital signs return to normal Capnography -monitoring of the concentration of carbon dioxide as it is exhaled from the body

-Colormetric system -pH sensitive strip enclosed in a plastic housing. This housing is then connected to the endotracheal tube. When exposed to CO2 the pH indicator changes color. When working properly the color should be purple (room air oxygen) and yellow (carbon dioxide) with each breathe

Anatomy of the Respiratory System: -Upper airway -nasopharynx (nasal cavity) -oropharynx (mouth) -pharynx (throat) -laryngopharynx -epiglottis (flap that prevents from entering respiratory tract) -esophagus (food and water routed to the stomach) -larynx (vocal cords) -cricoid cartilage: only completely circular cartilaginous ring of the upper airway -Lower airway (starts at lower edge of larnyx and moves down) -esophagus (tube for food) -trachea (windpipe) -major bronchi -right and left mainstem bronchi branch into: -bronchioles: composed of smooth muscle and lined with mucous membranes -terminate into millions of tiny air sacs called alveoli (site for gas exchange) -Diaphragm -muscle that separates the chest cavity from the abdominal cavity -Intercostal muscles -muscles between ribs that contract to aid inhalation

Physiology of Breathing: -Ventilation -physical act of moving air into and out of the lungs -air travels through the trachea -Inhalation -active muscular part of breathing -diaphragm and intercostal muscles contract -Dead Space -amount of air that does not reach the alveoli -mouth, nose, trachea, bronchi, bronchioles ~150 mL -Alveolar Ventilation -amount of O2 that gets to the alveoli -tidal volume minus dead air space -Tidal Volume -amount of air (mL) that moves in and out of the lungs in a single breath -Minute Ventilation -amount of air that moves into the lungs in 1 minute minus dead air space -ex. -12 breaths min x 500 mL (tidal volume) = 6 L -12 breaths min x 150 mL (dead air space) = 1.8 L - 6 L - 1.8 L = 4.2 L (minute ventilation)

-Vital Capacity -amount of air that can be forcefully expelled from the lungs after breathing deeply -Residual Volume -air that remains in the lungs after forceful expiration -aids in CPR -Exhalation -passive process; diaphragm and intercostal muscles relax -does not normally require muscular effort -diaphragm and intercostal muscles relax -Regulation of ventilation is primarily by the pH of cerebrospinal fluid -directly related to the amount of CO2 in the plasma -mechanism changes in patients with COPD -(Chronic Pulmonary Obstructive Disease) -have trouble eliminating CO2 through exhalation -body detects amount of O2 in blood as opposed to amount of CO2 -Oxygenation -process of loading O2 molecules onto hemoglobin molecules in bloodstream -Respiration -cells take energy from nutrients through metabolism -O2 is required for internal respiration to take place -exchange of O2 and CO2 in the alveoli and tissues of the body -External respiration -exchanges O2 and CO2 between alveoli and blood in pulmonary capillaries -surfactant- keeps alveoli expanded (“body soap”) -Internal respiration -exchanges O2 and CO2 -between systemic circulatory system and cells -aerobic metabolism (metabolism with oxygen) -produces energy (ATP) from glucose and O2 -Chemoreceptors monitor levels of: -O2, CO2, Hydrogen ions, CSF pH (cerebrospinal fluid)

-Ventilation/perfusion ratio -ventilation and perfusion must be matched -aka “V/Q ratio” - “V” - ventilation- air which reaches the alveoli - “Q” - perfusion- the blood which reaches the alveoli -V/Q mismatch -factors affecting pulmonary ventilation -Intrinsic factors: -ex. Infections, allergic reaction, unresponsiveness -Extrinsic factors: -ex. Trauma, foreign body airway obstruction -External factors: -ex. Low atmospheric pressure at high altitudes, poisonous environment, CO (carbon monoxide exposure) -Internal factors: -ex. Pneumonia, COPD -Circulatory compromise: -ex. Trauma emergencies -Pulmonary embolism -Tension pneumothorax -Open pneumothorax -Hemothorax (accumulation of blood in pleural cavity) -Hemopneumothorax -others include: blood loss, anemia, shock -Pneumothorax (collapsed lung) -tall, thin men between ages of 20 and 40 are most common - “Tension” -air enters pleural space but does not exit, which increases pressure - “Open” -unsealed opening in chest wall - “Hemopneumothorax” -having both air and blood in the chest cavity - “Spontaneous” -caused by structural weakness (can rupture spontaneously)

Continuous Positive Airway Pressure (CPAP) -many people diagnosed with obstructive sleep apnea wear a CPAP at night -increases pressure in the lungs -opens collapsed alveoli -pushes more O2 across the alveolar membrane -forces fluid back into the pulmonary circulation -Indications: -alert and able to follow commands -displays obvious signs of respiratory distress -breathing rapidly -POX (pulse oximetry) reading is greater than 90% -Contraindications: -respiratory arrest -S/s of pneumothorax or chest trauma -tracheostomy -active gastrointestinal bleeding or vomiting -unable to follow verbal commands

Respiratory Emergencies Key terms -Apnea: Pt completely stops breathing -Tachypnea: excessively rapid breathing rate -Bradypnea: abnormally slow breathing rate -Stoma: surgical opening in the front of the neck through which the Pt breathes air into the trachea

Hypoxia -inadequacy in the amount of oxygen being delivered to the cells -Cyanosis: bluish gray color of skin; around lips, mouth, nose, fingernail beds, conjunctiva (bottom of eyelid) -late sign of hypoxia -lack of O2 causes a cell to shift from aerobic (with O2) to anaerobic (without O2) Metabolism. Aerobic takes a glucose molecule and breaks it down in the presence of oxygen, yielding the large amount of ATP. Anaerobic results in a drastically lower production of ATP and the creation of lactic acid as a byproduct -energy is needed to maintain the function of a cell’s sodium/potassium pump. If the pump fails, sodium is no longer removed from the cell in exchange for potassium. Potassium and lactic acid leave the cell and begin to collect in the interstitial fluid and eventually enter the blood. The sodium collects inside the cell and attracts water. As a result, the cell swells and eventually ruptures and dies. Acute pulmonary edema -fluid builds up within alveoli and in lung tissue -heart muscle can’t circulate blood properly -usually result of congestive heart failure Chronic Obstructed Pulmonary Disease (COPD) -slow process of dilation and disruption of airways and alveoli -common cause > cigarette smoking -Chronic Bronchitis: -inflammation of the lining of the bronchioles -cilia reduction; excess mucus forms -productive cough -coarse crackles -Emphysema: lung condition that causes shortness of breath (type of COPD) -damage to the alveoli in lungs -promotes retention of stale air with increased CO2 levels in lungs -unproductive cough -wheezing or rhonchi - “wet lungs” vs “dry lungs” - “wet lungs” > pulmonary edema - “dry lungs” > COPD

Pleural effusion -collection of fluid outside the lung -compresses the lung and causes dyspnea (difficulty breathing) -can stem from infection, congestive heart failure, cancer Pulmonary embolism -passage of blood clot formed in vein into pulmonary artery -circulation cut off partially or completely -significant decreased blood flow Hyperventilation -overbreathing to point that arterial CO2 falls below normal -Acidosis: buildup of excess acid in blood or tissues -Alkalosis: buildup of excess base in body Carbon monoxide -displaces O2 from the hemoglobin of red blood cells Bacterial and Viral Respiratory Infections -Tuberculosis (TB) -MRSA Asthma -assist Pt with prescribed inhaler (Albuterol) Pneumothorax -see Physiology of Breathing

Cardiovascular emergencies -can assist with placing 12 leads (EKG) but cannot interpret (paramedics only) Key terms -Arteriosclerosis: thickening and hardening of the walls of the arteries, typically with old age -Resuscitation- emergency care process that attempts to restore lost vital functions. Focuses on managing airway, oxygenation ,ventilation, and circulation

Acute Coronary Syndrome (ACS) -umbrella term used to describe decreased blood flow in the coronary arteries which causes the heart muscle to be unable to function or muscle begins to die -chest pain usually stems from ischemia (inadequate blood supply) -if blood flow is not restored the tissue dies Atherosclerosis -buildup of calcium and cholesterol -can cause occlusion of arteries -fatty material accumulates with age Thromboembolism -blood clot floating through blood vessels -if clot lodges in: -coronary artery > Acute Myocardial Infarction (AMI) -cerebral artery > Cerebral vascular accident (CA) Coronary Artery Disease (CAD) -leading cause of death in the U.S -controllable AMI risk factors: cigarette smoking, hypertension, high cholesterol, high blood glucose level, lack of exercise, stress -uncontrollable AMI risk factors: family history, older age, being a male -myocardial ischemia (MI) -angina pectoris: severe pain in chest, often spreading to shoulder/arms -crushing or squeezing pain -serious sign -treat angina Pts like AMI -treat with nitroglycerin (NTG) Acute Myocardial Infarction (AMI) -pain signals actual death of cells in hear...