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379 Cards in this Set

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Which of the following vital signs is out of the normal range for an infant?
Respirations: 40
Pulse: 90
BP 60
Pulse.
Normal Ranges for Infants:
Respirations 25-50
Pulse 100-160
BP 50-95
At what rate would you provide ventilations for an infant?
1 per 3-5 seconds
What's the maximum time you would use suction to clear the airway of an infant?
5 seconds
How do you assess alertness in an infant?
If they're tracking your presence with their eyes
Which of the following vital signs is out of the normal range for a child?
Respirations 25
Pulse 145
BP 70
Blood Pressure
Normal Ranges for Children:
Respirations 15-30
Pulse 70-150
Blood Pressure 80-110
What is the maximum time you would use suction to clear a child's airway?
10 seconds
What is the rate at which you'd provide ventilations for a child?
1 every 3-5 seconds
Capillary refill is one means of checking for adequate perfusion. What age of patient does this work best for?
less than 6
What are contraindications for flow-restricted, O2 powered ventilation devices?
• Not to be used on infants or children
• Not for patients with COPD
• Not for patients who need C-spine or have chest injuries
What are risks of flow-restricted powered ventilation devices?
gastric distention

pneumothorax
How long should each breath administered by a bag-valve mask be?

What volume?
one second per squeeze

enough volume for visible chest rise, 500-600 mL
What lift is best for moving a patient out of a narrow space?
Extremity lift
At what weight does a patient require 4 EMTs for lifting and transfer?
250 lbs
What BSI precautions should you use when suctioning?
gloves, goggles, mask

(fluids become aerosolized and can contact mucus membranes of eyes, nose, and mouth of responder)
Where should you palpate pulse on an unconscious patient?
carotid artery
What is the flow rate and percentage of O2 delivered by a nasal cannula?
1-6 L per minute

24-44% O2 delivered
What is the flow rate and percentage of O2 delivered by a nonrebreather mask?
10-15 L per minute

90% O2 delivered
What is the flow rate and percentage of O2 delivered by a bag-valve mask?
15 L per minute

approx 100% O2 delivered
What BSI precautions are ALWAYS indicated?
gloves and goggles
What three factors help you evaluate mechanism of injury (MOI)?
• force applied
• length of time force was applied
• areas of body involved
What are signs of airway obstruction?
• obvious trauma, blood, or obstruction
• noisy breathing
• extremely shallow or absent breathing
What are indications for use of an AED?
• unresponsive
• not breathing
• no pulse
What are the criteria for high-priority transport?
• difficulty breathing
• poor general impression
• unresponsive w/ no cough or gag reflex
• severe chest pain (+ low bp)
• pale skin
• complicated childbirth
• uncontrolled breathing
• inability to respond to commands
• severe pain anywhere
• any paralysis
What does JVD indicate?

How is it assessed?
Jugular vein distention in a patient sitting at a 45° angle indicates blood is having difficulty returning to heart
What are criteria for significant MOI?
• ejection from vehicle
• death in vehicle
• fall ≥ patient's height
• vehicle rollover
• high-speed vehicular collision
• vehicle/pedestrian crash
• motorcycle or bicycle crash
• unresponsive or altered mental status after trauma
• penetrating trauma to chest, abdomen, or head
Increased respiratory rate is often a sign of impending...
shock
You respond to a patient with dypsnea, who has chronic congestive heart failure that is controlled by meds. He ate a pastrami sandwich an hour ago, and now is having trouble breathing. What is likely to be his problem?
acute pulmonary edema
What are some conditions that may precipitate the onset of acute pulmonary edema in persons with chronic congestive heart failure controlled by meds?
• stop taking meds
• eat salty foods
• stressful illness
• recent heart attack
• abnormal heart rhythm
What are the normal ranges of respirations per minute for adults, children, and infants?
Adult 12-20
Child 15-30
Infant 25-50
What are the normal ranges of systolic blood pressures for adults, children, and infants?
Adult 90-140
Child 80-110
Infant 50-95
What are the normal ranges of pulse for adults, children, and infants?
Adult 60-100
Child 70-150
Infant 100-160
Where would you check for capillary refill in an infant?
On the forehead. Should take less than 2 seconds to return to normal color
What does "alert and oriented times 4" mean?
?
AVPU is an acronym to help measure Level of Consciousness (LOC)

What do the letters in the acronym AVPU stand for?
A - AWAKE and ALERT
V - responds to VERBAL stimulus
P - responsive to PAIN
U - UNRESPONSIVE
What do the letters in the acronym PERRL stand for?
P - Pupils
E - Equal,
R - Round,
R - Regular in size
L - and reactive to Light
What does it mean if one pupil is completely dilated while the other is normal size?
?
Pressure regulators on O2 bottles reduce the pressure FROM what psi TO what psi?
From 2,000 psi to 40-70 psi
Treatment of blunt trauma to the abdomen entails...
• C-spine and log-roll onto backboard
• monitor vitals
• treat for shock
• prompt transport
Describe how de-oxygenated blood moves through the heart and lungs to be re-oxygenated.
The superior and inferior venae cavae bring oxygen-poor blood (blue) to the right atrium. It is then pumped through the right ventricle to the pulmonary arteries, which move it into the lungs. O2/CO2 exchange occurs in the pulmonary capillaries, then pulmonary veins carry the O2-rich blood to the
What happens when the heart doesn't get enough oxygen?
When the heart doesn't get enough oxygen, the electrical system is compromised, the heart doesn't beat properly, and blood pressure drops.
What are signs that a victim may be experiencing an aortic anyeurism?

How should they be transported?
• on all fours, trying to get the pressure off
• sharp, ripping pain, 10 of 10
• pain radiates to back
Immediate transport, lying on side
What is syncope?
?
What is vasogal syndrome?
?
Hypoxia may be a sign of many different problems, such as...
• heart attack
• pulmonary edema
• narcotic or sedative overdose
• inhalation of smoke or toxic fumes
• stroke
• chest injury
• shock
• COPD
• asthma
• premature birth
How is the symptom hypoxia treated?
with high-flow supplemental oxygen
What type of dressing would you apply to a burn?
sterile dry dressing
(gel dressings are better, however)
What types of burns are automatically critical?
• circumferential
• respiratory
• genitalia
• hands
• face
What must responders be careful of when dealing with crush victims?
Lifting the weight could release a rush of built-up lactic acid and fluids that could kill the patient.
How do you splint joints that are definitely deformed?
Splint in place
How do you splint long bones?
Straighten into neutral alignment and then splint
What is ecchymosis?
bruising
What is syncope?
fainting
What is hematemisis?
vomiting blood
What is hemoptysis?
coughing up bright red blood
What is hypovolemic shock?
shock due to loss of blood or fluid volume

hypo (low) volemic (volume)
What is pulmonary edema?
A backup of blood in the lungs
What is tachypnea?
Rapid breathing
What is epistaxis?
nosebleed
What is cardiogenic shock?
shock caused by heart failing to generate enough pressure to move the blood.
What is neurogenic shock?
arteries not receiving nerve impulses to contract
What causes septic shock?
leaky and dilated blood vessels due to bacterial toxins
What part of the autonomic nervous system is responsible for the fight or flight response?
Sympathetic
If perfusion is failing, the sympathetic nervous system releases hormones such as...
epinephrine
How many bones in the human body?
206
How many vertebrae in the human body?
33 in 5 sections
About what volume of blood does an adult contain?
6 liters
The left upper quadrant of the abdomen contains what major organs?
spleen and stomach
The right upper quadrant of the abdomen contains what major organs?
liver and gallbladder
The left lower quadrant of the abdomen contains what major organs?
descending colon
The right lower quadrant of the abdomen contains what major organs?
appendix
How many thoracic vertebrae are there?
12
How many pairs of ribs are there?
12
What 5 questions should you ask a person with a head/spinal injury?
• What happened?
• Where does it hurt?
• Does your neck or back hurt?
• Can you move your hands and feet?
• Did you hit your head?
What level of O2 should you provide to a patient with COPD?
Start at 2 mL and give more until symptoms have improved.
What is the danger in giving a patient with COPD too much O2?
Patients with COPD rely on their hypoxic drive to tell them when to breathe; a surplus of O2 indicates they don't need to breathe
How many EMTs does it take to perform a rapid extrication?
Three trained EMTs
You are called for an unresponsive medical patient. Would you take baseline vitals or do DCAP-BTLS first?
DCAP-BTLS
What is the order of assessment in the focused history for an unresponsive medical patient?
• DCAP-BTLS
• baseline vital signs
• SAMPLE
• Reevaluate transport decision
You are called for a responsive medical patient. Would you take baseline vital signs or get the SAMPLE answers from the patient first?
SAMPLE first, then baseline vitals
What is the order of assessment in the focused history for a responsive medical patient?
• history of this illness
• SAMPLE and OPQRST
• focused physical exam
• baseline vitals
• reevaluate transport decision
You respond to a trauma patient who has experienced a significant MOI. Would you take baseline vital signs first or get answers to SAMPLE questions?
baseline vitals before SAMPLE
What is the order of assessment for a trauma patient with significant MOI?
• DCAP-BTLS
• baseline vital signs
• SAMPLE
• reevaluate transport decision
What is the order of assessment in the focused history of a trauma patient without significant MOI?
• focused physical exam
• baseline vital signs
• SAMPLE
• reevaluate transport decision
What do raccoon eyes or Battle's sign indicate?
head trauma
What is Battle's sign?
?
What does subcutaneous emphysema indicate?
Patient has a pneumothorax or a damaged larynx or trachea
What are rales or crackles?
Wet breath sounds on both inhalation and exhalation
What do rales or crackles often indicate?
cardiac failure
What are the essential steps of a focused physical exam for chest pain?
• skin
• pulse
• bp
• visible evidence of trauma to chest
• palpate chest
• listen to breath sounds
What are the essential steps of a focused physical exam for abdominal pain?
• skin
• pulse
• bp
• visible evidence of trauma to abdomen
• palpate abdomen
What are the essential steps of a focused physical exam for dizziness?
• skin
• pulse
• bp
• adequacy of respirations
• level of consciousness
• visible and palpated signs of head trauma
What are the essential steps of a focused physical exam for joint or bone pain?
• skin
• pulse (distal and proximal)
• movement
• sensation adjacent and distal to affected area
What are the essential steps of a focused physical exam for shortness of breath?
• skin
• pulse
• bp
• rate and depth of respirations
• assess for airway obstruction
• listen to breath sounds
In what contexts would you do a detailed physical exam?
• patient is stable
• problem cannot be readily identified on scene
• a trauma patient without significant MOI
What is the difference between the SAMPLE and OPQRST inventories? What is each attempting to establish?
SAMPLE is a general medical history

OPQRST is a focused history of the specific problem or chief complaint
Signs of N meningitis include:
• pinpoint red rash
• purple/black rash
• stiff neck
• won't lift legs or curl into fetal position
• fever
• altered level of consciousness
What are risk factors for meningitis?
• male
• newborns
• older people
• weak immune systems (AIDs or cancer)
• brain, spinal cord, or back surgery
• children with past head trauma
• children with shunts, pins, etc in brain or spinal cord
• children with VP shunts
What is the minimum temperature at which an adult has a fever?
100.4°F
What is the body's primary method for compensating for decreased perfusion?
increasing heart rate
At what ages do children experience febrile seizures?
6 months to 6 years old
Characteristics of febrile seizures include:
• occurs on first day of illness
• generalized tonic-clonic seizures
• last less than 15 minutes
• short postictal stage
• may be sign of a worse problem
• persistent fever can lead to more seizures
What questions should you ask parents of a kid who has been poisoned?
• what substance?
• how much?
• how long ago?
• changes in behavior or LOC?
• any choking or coughing? (airway problems)
What is leading cause of death for children?
traumatic injuries - more than all other causes combined
What are most common causes of trauma to infants, toddlers, and older children, respectively?
infants and toddlers: falls and child abuse

older children: vehicle accidents

always assess for neck and head injuries
What are common signs of head trauma in children?
nausea and vomiting
What are the respective criteria for mild, moderate, and critical burns on children?
< 10% partial thickness = MILD

> 10% partial, < 20% partial = MODERATE

> 20% partial, any full thickness, any to hands, feet, genitals, or airway = CRITICAL
What is the leading cause of death in infants (younger than 1 yo)?
Sudden Infant Death Syndrome (SIDS)
What are the components of the Pediatric Assessment Triangle?
Appearance (muscle tone and AVPU)

Work of Breathing (tachypnea, nasal flaring, chest retractions, head bobbing, position)

Circulation to skin (pallor, mottling, cyanosis)
An EMT-P can transfer care of a patient to an EMT-B. True or False?
False. Transfer of care can only be made to someone of equal or greater training. An EMT-P (paramedic) cannot transfer care to an EMT-B (EMT basic)
What are signs of impending circulatory collapse?
• tachycardia
• tachypnea
• low bp
• weak pulse
• clammy skin
What is pleuritic chest pain?
a sharp stabbing pain on one side that is worse during inhalation and exhalation, or with certain movements of chest wall
What might pleuritic chest pain indicate?
?
What is anaphylaxis?
a reaction to an allergen, usually w/in 30 minutes of exposure
What are signs of anaphylaxis?
• airway swelling
• dilation of blood vessels all over body
• lowered bp
• widespread itching
generally within 30 minutes of exposure
What are pleural effusions?
a collection of fluid outside the lung on one or both sides of the chest cavity; this compresses the lungs, causing dyspnea
What might pleural effusions indicate?
• an irritation in the chest cavity
• an infection
• congestive heart failure
• cancer
What is used to treat anaphylactic reactions?
• epinephrine
• oxygen
• antihistamines
You must consult medical control when treating a patient having an anaphylactic reaction. TRUE or FALSE?
True
If you suspect a mechanical obstruction of the airway, how should you proceed?
After ruling out neck or head injury, do head tilt, chin lift.
How does spontaneous pneumothorax generally occur?
In patients with underlying asthma or emphysema, a weakened portion of the lung may rupture during coughing
What is an embolus?
Anything in the circulatory system that moves from its point of origin and lodges at a distant site, obstructing blood flow to the area
What is a pulmonary embolism?
Passage of a blood clot formed in a vein, usually in legs or pelvis, that breaks off and circulates through right heart and into pulmonary artery, where it lodges and blocks blood flow.
What causes pulmonary embolism?
Most often pulmonary embolisms are caused by slow blood flow in legs, caused by chronic bed rest or following a fracture or recent surgery.
10% are immediately fatal
What percentage of pulmonary embolisms are immediately fatal?
10%
What are signs of pulmonary embolism?
• dyspnea
• cyanosis
• acute chest pain
• coughing up blood
• tachypnea
• hypoxia
Oxygen can reach the lungs through a hole in the chest. TRUE or FALSE?
False. Oxygen must pass through the trachea in order to reach the bronchi and be perfused.
How long should you wait before repeating a dose of nitroglycerine?
5 minutes
When should you take vital signs if you're aiding patient in administering nitroglycerine?
before and 5 minutes after
You're responding to a patient who has taken nitroglycerine, but it isn't working as it has in the past. What might be happening?
May be a heart attack instead of angina
What questions would you ask a patient who has taken nitro but isn't experiencing any relief?
• How much was needed in past to obtain relief?
• How much have you taken (including dose from patches)?
• Have you used an ED drug in the past 24 hours?
What particular vital sign must be considered prior to administering nitroglycerin?
Blood pressure. Must NOT be less than 100 systolic
What are the steps in administering medication?
1) obtain order from medical control
2) verify proper medication & prescription (must be patient's own)
3) verify form, dose, and route
4) check expiration date and condition
5) reassess vital signs every 5 minutes
6) document: time, vitals, actions taken, patient response, side effects
What does nitroglycerin do?
Increased blood flow and drops bp by
• relieving spasms in blood vessels
• causing coronary arteries to dilate
• relaxing veins throughout body
What does epinephrine do?
• dilates passages in lungs
• constricts blood vessels, increasing bp
• increases heart rate
What intervention counters the body's histamine (which is released during an allergic reaction)?
epinephrine
What are contraindications for aspirin?
• prior hypersensitivity
• liver damage
• bleeding disorders
• asthma
• children with fever-inducing illnesses
Name the two types of tips used with suctioning equipment?
Yankhauer, which are rigid tonsil tips

French or Whistle tips, which are nonrigid plastic catheters.
Hyperventilation may indicate what life-threatening conditions?
• a diabetic that is hyperglycemic
• overdose of aspirin
• sepsis, a person with severe infection
What are the percentages of inspired O2 provided respectively by a nasal cannula, nonrebreather mask, and bag-valve mask?
nasal cannula - 44%
nonrebreather mask - 90%
bag-valve mask - 100%
Which medications can an EMT-B help patients self-administer?
• aspirin
• epinephrine via an auto-injector
• metered dose inhaler meds
• nitroglycerin
Which medications can an EMT-B administer?
• oxygen
• oral glucose
• activated charcoal
What five medications may be carried on a BLS unit?
• oxygen
• oral glucose
• activated charcoal
• aspirin
• epinephrine
What great vessels lie directly below the manubrium of the sternum?
the arch of the aorta and the pulmonary artery (exiting heart)
What is the ability of the alveoli to expand called?
compliance
What movements does a ball and socket joint allow?
• flexion and extension
• adduction and abduction
• internal and external rotation
What is hypovolemia?
Low blood volume, which can lead to hypovolemic shock (inadequate perfusion). It is caused by rapid and/or significant blood loss.
What are early signs of hypoxia?
• tachycardia
• anxiety
• irritability
• restlessness
• apprehension
What are late signs of hypoxia?
• altered mental status
• weak, thready pulse
• cyanosis
• shortness of breath (dyspnea)
What is urticaria?
hives
What do ligaments connect?
bone to bone, in joints
What do tendons connect?
muscle to bone
What is the primary method the body uses to compensate for decreased perfusion?
increased heart rate
What is atherosclerosis?
accumulation of fatty material in arteries
What are the dangers of atherosclerosis, particularly in geriatric patients?
• myocardial infarction (heart attack)
• stroke
• abdominal aortic aneurysm
What are indications of abdominal aortic aneurysm in a geriatric patient?
• abdominal pain radiating through to back, occasional flank pain
• pulsating mass just above and left of navel
• decreased blood flow to one leg
• compensated, then decompensated shock
• syncope (fainting)
What are signs and symptoms of gastrointestinal bleeding?
• vomiting of blood or material that looks like coffee grounds (digested blood)
• black, tarry stools
• weakness, dizziness
• syncope
What is the physiological reason for hyperventilation?
Body attempting to compensate for acidosis (acid in blood), either from high blood glucose, overdose of aspirin, or severe infection
What may be the problem if blood pressure of a geriatric patient drops when they move from lying, to sitting, and then to standing?
• dehydration
• shock
• cardiac disorder
Children compensate for blood loss better than adults. TRUE or FALSE?
True. Remain suspicious of shock when a child experiences abdominal or chest trauma, whether or not they show signs of shock.
What are signs a child may have internal bleeding?
• tachycardia
• poor capillary refill
• mental status changes
What are the steps in scene size-up?
1) BSI precautions
2) Scene safety
3) Consider MOI/NOI
4) Determine # of patients
5) Consider need for addt'l resources
6) Consider C-Spine immobilization
Where is the costovertebral angle, and why is it important?
It's the angle formed by the junction of the spine and the tenth rib on the posterior aspect of the thorax. The kidneys lie beneath the back muscles in the costovertebral angle.
What are the steps in an initial assessment?
1) Form a general impression and get chief complaint: TREAT anything LIFE-THREATENING immediately
2) Assess mental status (AVPU and orientation)
3 Assess or establish airway
Considerations for your general impression of a patient with severe respiratory distress are ...
• Immediate threats to life?
• calm or anxious?
• stable or unstable (e.g., bee sting - likely to deteriorate)
• AVPU and LOC
• Is Airway compromised?
• What is compromising breathing?
What are characteristics of normal breathing?
• normal rate and depth
• regular rhythm of inhalation and exhalation
• good audible chest sounds on both sides
• regular rise and fall on both sides of chest
• movement of abdomen
How does the hypoxic drive work?
areas in the brain and in the walls of the aorta and in the carotid arteries sense when oxygen is low and send impulses to increase respiration. Much less sensitive and powerful than the CO2 sensors in the brain stem that would otherwise control respirations.
Name the major artery branches and the parts of the body that they supply.
• coronary arteries - heart
• carotid arteries - head
• hepatic arteries - liver
• renal arteries - kidneys
* mesentric arteries - digestive system
Name three serious consequences of a heart attack
• sudden death
• cardiogenic shock
• congestive heart failure
What are the two sections of the autonomic nervous system?
sympathetic - fight or flight

parasympathetic - relax, digest
What happens to heart rate, blood pressure, and lungs when the sympathetic nervous system is active?
heart rate goes up, blood pressure goes up, lungs dilate
What happens to heart rate and blood pressure when the parasympathetic system is active?
heart rate decreases, blood pressure drops as blood vessels dilate
What are the two functional parts of the nervous system?
somatic (voluntary) and autonomic (involuntary)
What are the two anatomical parts of the nervous system?
central nervous system - brain and spinal cord

peripheral nervous system - 31 spinal nerve pairs, 12 cranial nerve pairs
How many pairs of cranial nerves are there?
12
How many pairs of spinal nerves are there?
31
What is aspiration?
Introduction of foreign material into lungs.
What is Cheyne-Stokes breathing?
An irregular breathing pattern in which the patient breathes with an increasing rate and depth, followed by a period of apnea; followed again by the same pattern. Indicates stroke or serious head injury.
What conditions is Cheyne-Stokes breathing associated with?
• stroke

• serious head injuries
What does dyspnea mean?
shortness of breath
How would you go about gathering information when assessing a nonviolent behavioral patient?
get patient away from parents, relatives, caregivers to ask questions
How much water should a person drink in a day if they are in the heat or doing work?
3 liters or more
What is the term used to describe when skin is freezing, but deeper tissues are unaffected?
frostnip
Petit mal seizures typically occur in children of what age?
4 - 12 years old
A hypoglycemic patient would have high blood pressure. TRUE or FALSE?
False. Their blood pressure would be low.
Envenomation is caused by ...
an insect sting
An "immediate" reaction to an injection occurs within what amount of time?
30 minutes
More than 2/3 of patients that die of anaphylactic shock do so within ___ minutes.
30 minutes
An irregular heat beat may be a sign of what type of problem?

How should you treat it?
Irregular heat beat signifies cardiovascular problems. If there are any other signs of cardiovascular distress, call for ALS and cardiovascular support or arrange for an intercept by paramedics
What are some possible problems signified by abnormally flushed and red skin?
• high blood pressure
• fever
• heat stroke
• sunburn
• thermal burns
• infection
Skin temperature can suggest physical state of patient. What do warm, hot, cool, and cold skin temps suggest?
warm - normal
hot - fever, sunburn, hyperthermia
cool - early shock, mild hypothermia, inadequate perfusion
cold - profound shock, hypothermia, frostbite
If a patient's blood pressure is dropping and heart rate is increasing, what condition may be occurring?
shock - inadequate perfusion, possibly caused by loss of blood
What is hypoperfusion?
Not enough blood circulating in organs or tissues. Also called "shock"
What does a pulse oximeter measure?
It's a photoelectric device that monitors the oxygen saturation of hemoglobin in the capillary beds; used to assess the effectiveness of oxygenation
What percentages are pulse oximeter values normally between?

What factors affect these readings?
Generally between 95% - 100%

• requires unobstructed access to capillary beds - no nail polish
• vasoconstriction (narrowing of blood vessels from hypoperfusion or cold extremities) will affect values
• any chemical that displaces O2 in hemoglobin will affect values.
When should use of a pulse oximeter be foregone?
• hypoperfusion is present
• known anemia
• cold extremities
• CO or other toxic inhalants may have affected patient
Define "emergency"
An event or situation that requires immediate intervention to minimize or prevent serious damage or death
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
How does interruption of oxygen supply affect heart cells, brain cells, nervous system cells, and muscle cells, respectively?
• heart cells - damaged after a few seconds
• brain cells - die in 4-6 minutes
• nervous system cells - die in 4-6 minutes and cannot be replaced
• muscle & other cells can last longer
What is perfusion?
circulation of blood within an organ or tissue in adequate amounts to meet the cell's current needs
How do you treat an abdominal evisceration?
Cover with a sterile dressing moistened with sterile saline, and secure with a sterile bandage. Cover with something to prevent heat from escaping
What would the focused exam of an imminent birth mother entail?
• length and frequency of contractions?
• pain relative to the contractions?
• inspect vaginal opening re:
- bloody show
- rupture of amniotic sac
- crowning
• other complaints?
What chest injury signs indicate a life threat to be treated immediately?
• penetrating wound
• paradoxical movement / flail chest
• hypoperfusion
What are signs of pneumothorax?
• increasing respiratory distress
• distended neck veins
• deviated trachea (side opposite)
• tachycardia
• low bp
• cyanosis
• decreased breath sounds on pneumothorax side
What are symptoms of spontaneous pneumothorax?
• sudden sharp chest pain
• increasing difficulty breathing
What causes the sharp, sticking pain often experienced with chest injury? What is that pain called?
Pleurisy or pleuritic pain is caused by irritation or damage to the pleural surfaces.
What is hemoptysis, and what causes it?
Hemoptysis is coughing up of blood. It is generally caused by a laceration of lung tissue. Blood enters the bronchial passages and is coughed up.
What are the potential causes of dyspnea in a person with a chest injury?
• airway obstruction
• damage to chest wall
• loss of normal control of breathing
• accumulated air or blood compressing lungs
What are treatment priorities for a person with a chest injury having difficulty breathing?
• prompt, vigorous support of O2 and ventilations via a bag-valve mask
• prompt transport
What are the principal signs of hypovolemic shock?
• rapid, weak pulse
• low blood pressure
What are the likely causes of shock in a person who has experienced a chest injury?
• lacerated structures in the chest cavity - heart, great vessels, lungs
• insufficient oxygenation by poorly functioning lungs
What is hypoxia?
When tissue or cells do not have enough O2
What is the hypoxic drive?
The respiratory drive that causes the body to breathe when O2 levels are low. The normal respiratory drive senses buildup of CO2, but patients with chronic respiratory drive always have CO2 in their blood, so their bodies rely on the hypoxic drive to control breathing
What are the two components of blood pressure, and what does each measure?
Systolic pressure - pressure on the artery walls during each contraction (systole) of the ventricles

Diastolic pressure - residual pressure in the arteries during the relaxation phase of the heart cycle
How much oxygen is in the air we breathe?

What makes up the balance?
21% oxygen
78% nitrogen
1% other gases
How much oxygen is in exhaled air?
(The air supplied to a victim via a pocket mask)
16% oxygen
What are the TREATABLE life-threatening cardiac arrhythmias that an AED is able to detect and treat?
ventricular fibrillation

ventricular tachycardia
What does diaphoretic mean?
very wet, as if bathed in sweat. Used to describe skin condition.

diaphoretic skin is a late sign of shock
Where should one assess the skin color of children and infants?
palms of hands and soles of feet
What does jaundiced skin indicate?
liver disease or dysfunction: the skin and sclera (normally white portion of eye) turn yellow
How should inadequate breathing be treated?
• airway management
• supplemental oxygen
• ventilatory support
Where should you palpate the pulse on unresponsive patients older than 1 yo?
carotid artery (in the neck), and only with gentle pressure
Where should you palpate for pulse in responsive patients older than 1 yo?
radial artery (at the wrist)
Where should you palpate for pulse on an infant?
brachial pulse, on the medial side of the upper arm.

Elevate infant's arm over their head to check for brachial pulse
How do you assess capillary refill on newborns and young infants?
Press on forehead. Cap refill should still be less than 2 seconds.
Describe the structures of the lungs and how they interrelate
• R lung - 3 lobes, L lung - 2 lobes
• R main bronchi and L main bronchi
• Major bronchi, one to each lobe
• Bronchioles - small diameter airways
• Alveoli - grapelike sacs where exchange of O2 and CO2 occur
• Pulmonary capillaries - network of tiny blood vessels that transport O2 and CO2
How does exchange of O2 and CO2 occur between the alveoli and the pulmonary capillaries?
When you inhale, O2-rich air goes in alveoli; the O2 crosses through the very thin tissue of the alveoli and pulmonary capillaries through diffusion (molecules moving from area w/ high concentration to area of low concentration); high CO2 in pulmonary capillaries passes into alveoli at the same time, and is then exhaled.
What is the pleural space?
The potential space between the parietal pleura lining the chest wall and the visceral pleura lining the lungs. A thin film of fluid generally causes the two surfaces to stick together, so there is no space, unless a problem occurs to create the space - fluid, blood, air, etc.
How do the lungs expand and contract?
The parietal pleura is a very smooth tissue lining the chest wall. The visceral pleaura is a layer that covers each lung. They are sealed against each by a thin film of fluid. When the chest wall expands by the diaphram pulling down and the intercostal muscles contracting, the surface tension between the pleura causes the lungs to expand too.
What muscle contractions occur during an inhalation?
The diaphram contracts and moves down, expanding thoracic cage top to bottom; the intercostal muscles contract, raising ribs up and out; pressure w/in thoracic cage falls, causing air to rush in and fill lungs
What happens to cause exhalation?
Generally does not require muscular effort. The diaphram and intercostal muscles relax, and the size of the thoracic cavity decreases, compressing the lungs and pushing air out the trachea.
What compensatory mechanisms are activated when blood pressure gets low?
• heart rate increases
• arteries constrict
• blood flow is redirected to vital organs
• blood flow to skin and extremities is decreased
How should you test neurovascular status (as before securing a patient to a long board in C-spine)
• palpate radial pulse
• palpate posterior tibial pulse
• check capillary refill
• check sensation in index finger/pinkie/thumb
• check sensation in big toe/lateral foot
• ask them to open hand, make fist
• ask them to extend foot, wiggle toes
When should you test neurovascular status?
• During rapid or focused trauma exam
• Before splinting
• After splinting
What does P-M-S stand for?
Reminder to test for neurovascular status:

P - Pulse
M - Motor
S - Sensory
What does C-M-S stand for?
Reminder to test for neurovascular status:

C - Circulation
M - Motor
S - Sensory
How does an allergic reaction affect the circulatory system?
• decreased blood pressure
• increased pulse
• loss of consciousness / coma
What is CQI?
Continuous Quality Improvement

internal and external audits and reviews of all aspects of a call
What two passageways are located at the bottom of the pharynx? Which is anterior?
trachea (anterior) - opening protected by the epiglottis

esophagus (posterior)
What are the first signs of peritonitis?
• severe abdominal pain
• tenderness
• muscular spasm
• nausea and vomiting
• abdominal distention
What is peritonitis?
Irritation of either the visceral peritoneum (the membrane lining abdominal organs) or the parietal peritoneum (membrane lining the abdominal wall). Usually from blood, pus, bile, pancreatic juice or aminiotic fluid.
What are common signs and symptoms of abdominal injuries?
SIGNS: tachycardia to compensate for blood loss; firmness in abdomen upon palpation; rapid pulse, rapid and shallow respirations, low blood pressure (shock-like)
SYMPTOMS: localized pain and difficulty moving
Which nerves supply the diaphram?

Where do they connect to spinal cord?

Why is this important?
Phrenic nerves, which exit the spinal column at C3, C4, and C5. Important because if there's an injury above those vertebrae, patient won't be able to breathe on their own.
When assessing respirations of a person with a chest injury, what should you note in addition to rate?
That they are actually moving air. Listen and feel at the mouth and nose. They could be inhaling and exhaling, but due to injury, not actually move air.
What's the first step in preventing further cold injury to a patient with hypothermia?
Remove wet clothing and keep patient dry
What is ischemia?
Inadequate circulation of oxygenated blood to the tissues. Often used in describing the effects of a heart attack.
What is Battle's sign? What does it indicate?
Bruising behind one ear, over the mastoid process. It is a sign of head trauma
Where would a patient experience pain from a kidney stone?
Radiating to genitalia
What are some visual indications of the force exerted in a car wreck?

(Establishing severity of MOI)
• crushing of car
• intrusion into passenger compartment
• seats torn from mountings
• steering wheel collapsed
Patients with chest injuries often have what kind of breathing pattern?
Rapid, shallow breaths (tachypnea) because it hurts to breathe.
How should you position and splint a dislocated extremity?
Splint in the position of the deformity; do NOT try to put the joint back in place.
Name 5 ways the body loses heat.
• conduction (direct contact)
• convection (circulating air)
• evaporation (of sweat)
• radiation (colder ambient temp)
• respiration (warmer air exhaled)
What is the difference between ventilation and respiration?
Ventilation is the body's ability to move air in and out of the chest and lung tissue (neuromuscular)

Respiration is the exchange of gases in the alveoli of the lung tissue
Which organs are retroperitoneal?

What does that mean?
Retroperitoneal means behind the peritoneum, or abdominal cavity. The kidneys, the pancreas, and the urinary bladder are the organs that are retroperitoneal. The inferior vena cava and the aorta are also in this plane.
What is hyperventilation syndrome?
A panic attack: overbreathing to the point that arterial carbon dioxide falls below normal and the resulting alkalosis precipitates symptoms.
How are blood pressure and pulse different in head injuries as compared to spinal shock?
head injury: pulse down, bp up

spinal shock: pulse up, bp down
After assisting a patient in using an MDI (metered-dose inhaler), what should you do?
• Take and record another set of vitals

• Note patient's response to treatment

• Check lung sounds
How many respirations a minute can be considered hyperventilation?
20 (very deep) to 40 (shallow)
What is the more common term for a cerebrovascular accident?
stroke
What are some possible consequences of letting blood sugar get too low?
• lose consciousness
• seizures
• death
Name some life-threatening conditions indicated by hyperventilation
• a diabetic with very high blood glucose levels
• overdose of aspirin
• severe infection
What physiological effect does hyperventilation have on the body?
Hyperventilation is the body's attempt to compensate for acid buildup by lowering arterial carbon dioxide (which is also acidic). Occurs when a diabetic is experiencing ketoacidtosis, when someone has overdosed on aspirin (acetasalicylic acid), or when a person has a severe infection.
If you hear gurgling when assessing the airway, what should you do?
Suction
What are time guidelines for using suction on an adult patient?
15 seconds of suction max, followed by 2 minutes of ventilation
Why are there limits on how long you can use suction on a patient?
Because you're depriving the patient of oxygen while you're suctioning.
What are contraindications for aspirin?
• hypersensitivity to aspirin
• liver damage
• bleeding disorders
• asthma
• children with fever-inducing illnesses
What is epinephrine an antidote for?
histamine, which dilates small blood vessels, swells airway tissues, and causes bronchial spasms
What are the signs of pericardial tamponade?
• jugular vein distention (JVD)
• decreased heart sounds
• narrowing blood pressure
• chest pain
What is pericardial tamponade?
Compression of the heart due to fluid accumulation in the pericardium. Generally caused by blunt force trauma
Heart pain caused by not getting enough oxygen is termed _______ _______.
angina pectoris
What body temp indicates hypothermia?
< 95°
What are some signs of hypothermia?
• low bp
• slow pulse
• slow, shallow respirations
• blue, cold skin
• may require a rectal thermometer to get a useful reading
What is indicated when a hypothermic patient is no longer shivering?
It's a danger sign.
What are some DONTs re: hypothermic patient treatment?
No food, no stimulants, no walking (transport)
What body temperature indicates hyperthermia?
greater than 101°
What are common signs of hyperthermia?
dizziness, weakness, nausea, headache, dry mouth, thirst

normal vitals except for rapid pulse
How would you treat hyperthermia?
• provide O2
• place patient in shock position
• give water
• transport on side
What are signs of heat stroke?
• changes in behavior
• pulse changes from being rapid to being slow
• body temp up to 106°F
• low bp - danger!
• stop sweating - critical!
• skin is hot, dry, flushed
• respirations are rapid by adequate
How should you treat heat stroke?
• need to get body temp down!
• ice packs, wet blankets
• supplemental O2
• notify hospital
What are common injuries in the Right Upper Quadrant (RUQ) of the abdomen?
injuries to the liver
What are common injuries in the Left Upper Quadrant (LUQ) of the abdomen?
injuries to the spleen (highly vascular, lots of blood)
What are common injuries in the flanks of the body?
injuries to the kidneys
Following SAMPLE inventory, one might ask OPQRST questions, especially when assessing for what condition?
a heart attack
What does SAMPLE stand for?
S - Signs and symptoms
A - Allergies and reactions
M - Medications
P - Pertinent past history
L - Last oral intake
E - Events leading up to the injury or illness; what has occurred btwn onset and EMT arrival; activity when it started
What three factors do you consider when assessing a patient's skin?
• color
• temperature
• moisture
How often should you reassess a stable patient's vital signs?

How often should you reassess an unstable patient's vital signs?
stable - every 15 minutes

unstable - every 5 minutes
What does the prefix "hypo-" mean?
low
hypoglycemia = low blood sugar
hypotension = low blood pressure hypoperfusion = low level of circulation
hypothermia = low body temperature
What does the prefix "hyper-" mean?
high
hyperglycemia = high blood sugar
hypertensionn = high blood pressure
hyperthermia = high body temperature
What are the vital signs?
• respirations
• pulse
• blood pressure
• skin condition (adults)
• cap refill (children)
• pupil reaction
• level of consciousness (LOC)
Under what circumstances would you withhold supplemental O2 from a hypoxic patient?
Under NO circumstances would you withhold supplemental O2 from a patient
What is one quick way to assess if a patient has experienced a hip injury?
Always compare position of the greater trochanter (hip bone) with that on the opposite side
What condition does decreased blood pressure indicate?
late sign of shock - vital organs are not getting adequate perfusion
Chest injuries necessitate prompt transport. TRUE or FALSE?
True. Err on the side of caution.
What might blank eyes or rapidly moving eyes indicate?
Central Nervous System dysfunction
Whom should you contact if restraints are necessary in treating a patient?
medical control and law enforcement
What does treatment of a patient with a penetrating abdominal injury entail?
• allow patient to remain in position of comfort if spine injury ruled out
• monitor vitals and treat or preempt shock
• suspect internal bleeding
• inspect for exit wounds; if found, apply a dry, sterile dressing
• if object still in place, stabilize
What is the clinical term for shortness of breath?
dyspnea
What conditions should you check for in a geriatric patient showing signs of delirium?
• hypoxia - inadequate perfusion
• hypovolemia - shock due to low blood volume
• hypoglycemia - shock due to low blood sugar
What is Cushing's reflex?

What does it indicate?
widening pulse pressure (systolic minus diastolic), low pulse, irregular respirations

increased intracranial pressure; often seen in terminal stages of acute head injury
You respond to a call by a patient with shortness of breath, who is diaphoretic with poor capillary refill. What other signs might you look for? What condition is likely?
Check for rales, cyanosis, use of accessory muscles for breathing, jugular vein distention, and pedal edema. Could be Chronic Obstructive Pulmonary Disease (COPD).
What is an OPA?
oralpharyngeal airway
When might you use an OPA on a conscious patient?
If they aren't breathing and you're going to ventilate with a bag-valve mask
What is the primary respiratory drive in a healthy person?
brain stem nerves reacting to levels of CO2 in the arterial blood, causing the person to breathe accordingly
What are the indications for use of an OPA?
• unconscious patients with a gag reflex
• apneic patients (either conscious or unconscious) being ventilated by a BVM
• patients with possible spinal injuries
What are contraindications for use of an OPA?
• conscious patients
• any patient with an intact gag reflex
How do you select proper size of OPA?
Measure from earlobe to corner of mouth
What are indications for use of an NPA?
• semi-conscious or unconscious patients with intact gag reflex who are unable to maintain airway
• altered mentals status (AMS)
• patient recovering from seizure
Contraindications for use of an NPA include?
• severe head or facial trauma, particularly if blood is coming from nose
• history of fractured nasal bones
How do you measure for proper size NPA
tip of nose to earlobe
Once airway has been opened, how long should you assess whether spontaneous breathing is present?
At least 5 seconds, no more than 10 seconds
How do slow and fast respiratory rates affect tidal volume?
Both result in reduced tidal volume
What are ataxic respirations?
irregular, ineffective respirations that may or may not have an identifiable pattern
What is tidal volume?
amount of air, in milliliters, that is moved in and out of the lungs in one breath. An average male exchanges 500 mL.
What is the space inside the thorax that contains the heart, great vessels, trachea, and major bronchi? Where is it in relation to lungs?
The mediastinum, a space between the right and left lungs, covered in tough connective tissue
What is angina pectoris?

What causes it?
heart pain caused by not getting enough oxygen
How long can brain cells go without oxygen before brain damage occurs?
4-6 minutes
What is metabolism
The chemical processes whereby cells take energy from nutrients
What is spontaneous pneumothorax?
a collapsed lung, not caused by trauma. Air escapes from the lung into the pleural space, and the negative vacuum pressure is lost
What are three worst-case scenarios of an asthma attack?
• anaphylactic shock
• coma
• death
What is generally the onset of an asthma attack?
An exaggerated allergic reaction to an inhaled, ingested, or injected substance.
Can also be triggered by severe emotional stress, exercise, or respiratory infections
What are some signs of asthma?
• normal inhale, wheezing exhale
• no air movement (severe cases)
• cyanosis
• respiratory arrest (can develop quickly)
What is asthma?
Acute spasm of bronchioles, associated with excessive mucus production and swelling of mucus lining of respiratory passages.
What are signs of Chronic Obstructive Pulmonary Disease?
• chronic production of sputum
• chronic cough
• difficulty expelling air from lungs
• long expiration phases
• wheezing
• abnormal breathing sounds (rales, crackles, rhonci, wheezes
What two forms does COPD usually take?
• chronic bronchitis (blue bloater)

• emphysema (pink puffer)
What is chronic bronchitis?
An ongoing irritation of the trachea and bronchi. Excess mucus is constantly produced, obstructing small airways and alveoli. Obstructed alveoli expand and can't contract.
What is emphysema?
Chronic stretching of the alveoli due to obstruction, making it difficult to expel gases. Emphysema is when the elasticity has been lost and "holes" occur as the alveoli walls fall apart.
What happens in acute pulmonary edema?
Fluid accumulates in the space between the alveoli and the pulmonary capillaries, disrupting the exchange of O2 and CO2.
What two dangers are associated with electrical burns?
• large amount of deep tissue damage

• cardiac or respiratory arrest from the shock
What are signs of inadequate breathing?
• shallow depth
• labored breathing
• unequal or inadequate chest expansion
• rate > 20 or < 12
• lung sounds diminished, absent, or noisy
• irregular rhythm
• reduced exhale at nose and mouth
• retracted skin
• blue, cool, moist or clammy skin
What is agonal breathing?
Heart has stopped, but brain is still telling respiratory muscles to fire. NOT ADEQUATE - must provide artificial respirations to patient.
What is apnea?
Lack of spontaneous breathing over a period of time.
What are ataxic respirations?
Irregular, ineffective respirations that may or may not have an identifiable pattern.
What should you do if you are called to an unconscious patient in the prone position?
• Log roll body and head as a unit to the supine position (suspect spinal injury)
• Assess airway
• Ensure breathing is adequate
After establishing a patent airway, how long should you wait for patient to start breathing on their own?
At least 5 seconds, but no more than 10.
How is breathing regulated in the body?
An area of the brain stem regulates breathing through nerves that sense when the level of carbon dioxide in the blood gets too high. It sends impulses down spinal cord, telling diaphram and intercostal muscles to contract. The higher the CO2, the stronger the impulse. The hypoxic drive is the backup.
What are the 5 sections of the spinal column and how many vertebrae or in each?
Cervical - 7
Thoracic - 12
Lumbar - 5
Sacrum - 5 (fused)
Coccyx - 4 (fused)
What does the thorax protect?
heart, lungs, esophagus, and the great vessels (aorta and the two venae cavae).
The hip joint socket is called the __________.
acetabulum
Kussmaul
?
Where are the superior and inferior venae cavae located?
On the right side of the spinal column; superior vena cavae is above the heart; inferior vena cavae is below the heart.
What major organs does the right upper quadrant (RUQ) of the abdomen contain?
• liver
• gallbladder
• portion of colon
What organ is of particular concern in injuries to the Right Upper Quadrant of the abdomen?
the liver
What major organs does the left upper quadrant (LUQ) of the abdomen contain?
• stomach
• spleen
• portion of colon
What organs are in the Right Lower Quadrant of the abdomen?
• cecum (first portion of large intestine)
• ascending colon (part of large intestine)
• appendix - attached to lower border of cecum
Tenderness and pain in the Right Lower Quadrant of the abdomen may indicate what?
appendicitis
Name the % of body burnt, using the rule of nines, if victim has burnt:
1) face
2) torso front
3) back
4) one lower extremity
5) one upper extremity
6) penis
1) face - 9%
2) front torso - 18%
3) back torso - 18%
4) each lower extremity - 18%
5) each upper extremity - 18%
6) male genitals - 1%
Where is the inguinal ligament? What lies beneath it?
Between the lateral edge of the pubic symphisis and the anterior superior spine of the pubis on each side. The femoral vessels lie beneath.
What are indications of labored breathing in children?
• nasal flaring
• indention above clavicles
• intercostal retractions (in spaces between ribs)
What are common positions that patients may take when they are having difficulty breathing?
• tripod
• sniffing position - common for children; sitting upright with head and chin thrust forward slightly
What characteristics do you look for when assessing respirations?
• rate
• quality
• depth
How do you determine the quality of a patient's respirations?
• rhythm - regular or irregular
• effort - normal or labored
• noise - silent or noisy
What does OPQRST stand for?

What does it help describe?
O - Onset of pain
P - Palliation - does anything make it better or worse
Q - Quality of the pain - sharp, dull, crushing
R - Region and Radiation of pain
S - Severity of pain, 1 to 10
T - Timing of pain: constant or intermittent; duration
The Trendelenburg position used for transport differs from the shock position in what way?
In the Trendelenburg, the whole body is flat on backboard, with feet elevated 6 to 12 inches; in the shock position, only the legs are on an incline.
What's the difference between hyperventilation and hyperventilation syndrome?
hyperventilation is in response to physical problems, mainly acid in blood

hyperventilation syndrome occurs absent physical problems; usually brought on by psychological stress
What is an epiphyseal fracture?
a fracture to the growth section of bone in children
What is a greenstick fracture?
an incomplete fracture that may still cause deformity - occurs in children
How should you treat a hyperventilating patient?
give supplemental oxygen and transport to hospital
What is pre-eclampsia and when does it develop?
High blood pressure caused by pregnancy. It develops after the 20th week of gestation.
What is cavitation?
When the impact of a force injury extends the injury beyond points of contact.
What is the most common indication of internal bleeding?
pain
How should you treat epistaxis? What is epistaxis?
Epistaxis is a bloody nose.

Have patient sit with head forward.
What happens to respiratory rate and pulse in compensated shock?
Both increase
What systolic blood pressure indicates decompensated shock in an adult?
90 mm Hg
Blood or fluid accumulating in the sac around the heart is called _________ _________
pericardial tamponade
How should you transport a pregnant woman?
on her left side, if possible
What is a flail chest?
Two or more ribs broken in two or more places. Pack the ribs down and wrap the chest.
Signs of pericardial tamponade include
• soft or muffled heart tones
• weak pulse
• low blood pressure
• narrowing pulse pressure
• jugular vein distention
What is hemothorax, and how might it come about?
blood in the pleural space; most often it occurs from blunt trauma to the chest
A bone broken into more than two fractures is a __________ fracture.
Comminuted.
How would you recognize and treat a comminuted fracture?
It gives a feeling of crepitus.

Stabilize, ice, and treat for shock
When you encounter a possible fracture, what should you assess in distal parts?
P-M-S

Pulse
Motor function
Sensation
What is the most common complication in a head injury?
cerebral edema
With congestive heart failure (CHF) patients, what, in addition to medications, should you pay particular attention to?
events that led up to the current problem:
A spinal injury at what vertebrae can cause a patient to be unable to breathe entirely?
C3
A spinal injury at what vertebrae will allow the patient to breathe using only their diaphram, not through their intercostal muscles?
C5
What are Kussmaul respirations, and what do they indicate?
Kussmaul respirations are rapid and deep, and indicate hyperglycemia.
If a conscious adult patient with chest pain becomes unconscious, what should you check first?
pulse
Why is labored breathing particularly alarming in children and infants?
After a sustained time, they become exhausted and don't have the strength or energy to maintain their breathing.
In children and infants, cardiac arrest is generally caused by respiratory arrest.
When evaluating the mechanism of injury (MOI) of a fall, what should you consider?
• height of fall
• surface body struck
• part of body that hit first, and the path of energy displacement.
What is septicemia and what are its signs in geriatric patients?
Septicemia is the presence of microorganisms or their toxic products in the bloodstream. Signs include:
• tachycardia
• tachypnea
• altered mental status
• chills
• cough
• burning urination