Theory Final Review

Front 1

Which of the two following conditions are most closely related?

Back 1

Pregnancy induced hypertension and preeclampsia

Front 2

A 32 year old female was injured in an incident of domestic violence. You note a laceration to her pubic region. Direct pressure does not stop the bleeding. What should you do?

Back 2

Apply a trauma dressing to the external vaginal area.

Front 3

A 28 year old female is in her 32nd week of pregnancy. She complains of intense pain, and experiences vaginal bleeding. When you palpate the uterus, you find that it is firm. You should suspect

Back 3

abruption placenta

Front 4

A 25 year old female complains of excessive menstrual bleeding. In order to get a better idea of how severe the bleeding is, what question might you ask her?

Back 4

How quickly does she saturate a menstrual pad?

Front 5

Describe 5 complications associated with pregnancy

Back 5

Ectopic Pregnancy, Spontaneous abortion, PIH, Preeclampsia, Abruptio Placentae, Placenta Previa.

Front 6

A 20 year old female is 10 weeks pregnant. She experiences vaginal bleeding and abdominal cramps. What is the most likely cause of these symptoms?

Back 6

Spontaneous abortion

Front 7

Which of these complications to pregnancy is most life threatening to the mother during the first trimester?

Back 7

Ectopic pregnancy

Front 8

Most newborns have an APGAR score between

Back 8

8 and 10.

Front 9

Which of these conditions is most likely to occur during the 2nd trimester of pregnancy?

Back 9

Preeclampsia

Front 10

A woman is most likely to experience nausea and vomiting ("morning sickness") when she is

Back 10

10 weeks pregnant.

Front 11

These four drugs are related to pregnancy and complications:

* Terbutaline
* Oxytocin
* Midazolam
* Magnesium Sulfate

Explain when you would need to use them and what their actions are.

Back 11

Terbutaline: Pre-term labor, beta2 specific smooth muscle relaxent

Oxytocin: Postpartum Hemorrhage, Stimulates uterine contractions

Midazolam: Eclamptic Seizures, Benzodiazepine

Magnesium Sulfate: Eclamptic Seizures and signs of toxemia, Mechanism unknown

Front 12

You arrive at the home of a 29 year old female who is in labor. Her contractions are roughly three minutes apart. You can see the umbilical cord protruding through the vaginal opening. At this point, you should

Back 12

transport the patient emergently

Front 13

A 17 year old patient is 28 weeks pregnant. She complains of severe swelling of her hands and feet. When you test her blood pressure you find that it is 160/100 mm Hg. You should suspect

Back 13

preeclampsia.

Front 14

Which of these complications is most likely to require a cesarean section?

Back 14

Cord prolapse

Front 15

Which of these factors is LEAST likely to affect maternal mortality during childbirth?

Back 15

Duration of pregnancy

Front 16

Which of the following complications of pregnancy is usually painless?

Back 16

Placenta previa

Front 17

Which of these women is most likely in the active portion of the first stage of labor?

Back 17

A woman whose contractions occur five minutes apart and last 60 seconds

Front 18

A female patient is presenting with urinary urgency and frequency, a moderate fever and suprapubic tenderness. The most likely cause is

Back 18

a urinary tract infection

Front 19

Premature birth increases an infant's risk for all of the following EXCEPT

Back 19

meconium aspiration

Front 20

You have just helped a 22 year old female give birth to a baby. She begins to have to have forceful contractions and to push vigorously. She seems to produce additional amniotic fluid. You should suspect that the mother is

Back 20

birthing another baby.

Front 21

The stages of labor, from shortest to longest, are:

Back 21

third stage, second stage, first stage

Front 22

If a follicle does not fully develop during ovulation and fills with fluid, it causes a(n)

Back 22

ovarian cyst.

Front 23

You are LEAST likely to administer fluids to a patient whose shock is caused by

Back 23

myocardial infarction

Front 24

Which of the following physiological responses does NOT maintain blood pressure?

Back 24

Increased respiration rate

Front 25

ALL patients with shock should receive

Back 25

supplemental oxygen

Front 26

What type of pulse pressure may indicate shock?

Back 26

Low

Front 27

Which of the following medications would be most dangerous to a patient in hypovolemic shock?

Back 27

Diuretics

Front 28

Anaerobic metabolism leads to

Back 28

insufficient ATP

Front 29

List and briefly describe the main 3 phases of shock. You can use v/s changes, systemic changes seen, signs/symptoms that clearly differentiate one phase from the other.

Back 29

Compensated Shock:
-Initial response to inadequate tissue perfusion with decreased amounts of oxygen and glucose reaching the body's cells.
-Increased Heart Rate
-Increased Blood Pressure to Normal or Increased Levels
-Increased Respiration Tachypnea
-Poor Capillary Refill
-Skin Signs may be normal or Pale, Cool, Diaphoretic (except Warm and Moist w/ Distributive Shock)
- + Increase Systemic Inflammatory Response Syndrome

Decompensated Shock:
-Unable to compensate any longer due to the widespread inadequate tissue perfusion with decreased amounts of oxygen and glucose reaching the body's cells.
-Increased Hear Rate
- -- Decreased Blood Pressure
-Increased Respiration Tachypnea
-Pale, Cool, Diaphoretic
-++Increase Systemic Inflammatory Response Syndrome

Irreversible Shock:
- The body has used up most of it's natural hormones in response to the inadequate perfusion and has reached a critical point and rapidly deteriorates; cell death
-Increased or Decreased Heart Rate
- --- Significant Decreases in Blood Pressure
-Decreased Respirations
-Cool, Mottled
-+++Increase Systemic Inflammatory Response Syndrome
-Organ Failure
-Resuscitation Unlikely

Front 30

Which of the following is the LEAST important component of shock treatment in the prehospital setting?

Back 30

Pain management

Front 31

The proper order for the three stages of shock is:

Back 31

compensated, decompensated, irreversible.

Front 32

you are LEAST likely to provide additional care (beyond airway and fluid maintenance) for shock caused by

Back 32

dehydration

Front 33

Which of these is NOT a factor that could affect a patient's presentation of shock?

Back 33

Patient's gender

Front 34

Which of these shock patients is MOST likely to present with the common signs and symptoms of shock?

Back 34

A 39 year old female taking a diuretic

Front 35

How does the body compensate for shock? Chapter 13 described several Systemic responses under the Pathophysiology of Shock- Name the system and describe how it compensates, there are 4 major systems-Be very specific.

Back 35

Nervous
Respiratory
Urinary
Endocrine

Sympathetic Nervous System is stimulated causing alpha (vasoconstriction) to shunt blood from organs and tissues to more important organs such as the brain and heart; beta-1 effect, inotorpic (contractility), chronotropic (rate), dromotropic (conductivity) responses to try and meet the demand of oxygen that the person needs because of the loss of volume.
Adrenal Gland
-Releasing inotropic agents epinenphrine, nor-epineprhine, and dopamine which causes vasoconstriction, increased contractility, and increasing the heart rate. These increase cardiac output to help provide the body's cell with more oxygenated blood.
Kidneys
-Release renin to absorb water and to stop the kidneys from excreting water which will begin a build up of waste products causing acidosis.
Pancreas
-Glycogen is released increases the glucose concentration in the blood
Respiratory System
-Increase in ventilation to increases oxygen diffusion to enrich the blood with more oxygen to deliver it to the tissues
Aldasterone and cortisol is also released to further assist with the preservation of vital organs

Front 36

Which of these types of shock is caused by a problem with the vascular system?

Back 36

Distributive shock

Front 37

Which of the following is NOT one of the three components necessary for maintaining adequate perfusion?

Back 37

A filter

Front 38

In the expanded acronym for treating shock, ABCDE, D and E stand for

Back 38

oxygen Delivery and achieve Endpoints.

Front 39

List the subtypes of Distributive shock

Back 39

The subtypes of distributive shock septic/sepsis shock (widespread infection), anaphalaxis (sever allergic reaction), Spinal Shock/Neurogenic Shock (injury to the spinal cord caused peripheral vasodilation), Toxic shock syndrome

Front 40

You are transporting a 23 year old male who fell off of a third-story balcony. The patient starts to feel faint, and you discover that his blood pressure has dropped from 118/84 to 91/53 mm Hg. He has probably just entered

Back 40

decompensated shock

Front 41

An 8 year old female has bacterial pneumonia that has developed into septic shock. You have administered two boluses of isotonic saline, but her blood pressure remains dangerously low. What further step should you take?

Back 41

Administer a vasopressor.

Front 42

What is one major difference between the symptoms of hypovolemic and distributive shock?

Back 42

Skin temperature

Front 43

All patients with unexplained _______ should be assumed to be in shock until proven otherwise.

Back 43

tachypnea

Front 44

A 30 year old male is confused and lethargic. His skin is cool and sweaty. His vital signs are P 121, R 27, BP 122/91. He is probably experiencing which type of shock?

Back 44

Compensated shock

Front 45

Which of these is LEAST likely to indicate hypovolemic shock?

Back 45

Warm skin temperature

Front 46

A 7 year old female was stung by a bee. She has developed hives on most of her body, and has difficulty breathing. In addition to standard shock airway and fluid management, you should administer

Back 46

epinephrine

Front 47

Describe where in the coagulation cascade Asprin and Heparin work (be specific) - (2 pts).

Back 47

Heparin: Activates anti-thrombin III, which prevents thrombin formation; this directly affects where in the presence of calcium activation of prothrombin and converts thrombin.

Aspirin: blocks platelet aggregation by reducing the production of thromboxane A2; inhibits platelet stickiness; Affects both the platelet aggregation stage of both intrinsic and extrinsic pathways.

Front 48

List the characteristics for Hepatitis A & B (compare and contrast the differences) - (2 pts).

Back 48

The inflammation of the the liver is described as hepatitis. Hep A constitutes as nearly half of all the cases of hepatitis and is transmitted through the fecal and oral routes. Signs and symptoms of Hep A are nausea, diarrhea, anorexia, abdominal pain, jaundice. It is usually spread through unsanitary food preparation but can also be transmitted through personal contact.

Hepatitis B can be treated through the parenteral route. the signs and symptoms of Hep B are closely related to Hep A; abdominal pain, nausea, anorexia, and jaundice. can be transmitted through exchange of bodily fluids. The greatest risk to health care providers are needle sticks.

Front 49

What is the difference between a virus and a bacteria (2 pts)?

Back 49

A virus is a genetically wrapped material in a protein coat, where in bacteria is a single celled organism that is found in all environments. A virus will infect a cell with the sole purpose and function to replicate itself and is unable to reproduce without a host. Bacteria are capable of reproducing themselves without a host and cause the destruction of the cells through the release of toxins. Bacterial infections can be treated with antibiotics and viruses can be treated with the use of antiviral medications.

Front 50

Describe tuberculosis

Back 50

TB is cause by bacterium that these bacteria quickly multiply in the lungs but can be controlled by the T-cell mediated response. This is one of the greatest threats to public heath throughout the United States and commonly occurs in the lungs. If there is an infection outside of the pulmonary system then it's considered extrapulmonary tuberculosis. Tuberculosis is transmitted by respiratory droplets. The primary symptoms of pulmonary tuberculosis are coughing, weight loss, fever, night sweats, and hemoptysis (blood in the sputum). TB can be treated with anti-fungals.

Front 51

Describe SaO2 and PaO2, including their relevancy to prehospital treatment (2 pts).

Back 51

The binding and unbinding characteristics (affinity) of oxygen and hemoglobin are represented by a visual representation in the form of a graph that is called the Oxyhemoglobin Dissociation Curve. It relates the amount of oxygen that is attached (bound) to hemoglobin (Sa02) to the concentration of oxygen in the blood (partial pressure, Pa02). The curve is divided into an upper section which represents what's going on in the lungs and a lower section which is describing what is happening in the tissues (oxygen release). As hemoglobin travels through the body to reach areas of low oxygen concentration, the hemoglobin will unbind or release those bound oxygen molecules to those tissues of lower oxygen levels and this will be represented as a shift to the left on the dissociation curve. When hemoglobin is located in areas of higher oxygen concentration, lungs, the oxygen molecules will easily bind to the hemoglobin and this action will be represented as a right shift on the dissociation curve.

Front 52

Affect

Back 52

When assessing a patient with a possible behavioral condition make sure to have a clear entrance and exit route, don’t approach patient unless you visually see and feel that it is safe, don’t appear threatening, remain friendly, actively listen, and try to evaluate the patient as best you can. While assessing the patient there are several things you should be looking for to help you in acquiring an accurate field impression and one important thing that should be observed is the patients affect. Affect can be described as Does the patient express a high level of emotion or seem ambivalent (flat)? Is the patient talking in a monotone voice or not interested in talking at all?

Front 53

Suicide Risk Factors

Back 53

Older male patients are more likely to commit suicide. Other high risk factors for suicide can surround the person's social history, such as recent stress, divorce, or death of someone close to the person. Other factors that can increase the risk of a person becoming suicidal would be feeling of hopelessness, past suicide attempts, and mental health related factors such as depression and physical health such as in a person with an acute or chronic illness.

Front 54

Risk factors for stroke and two types

Back 54

A stoke is a disruption in the blood supply to the brain caused either by a hemorrhage or a clot. The most common risk factors include Hypotension, Diabetes, Smoking, Atrial Fibrillation and Atherosclerosis. As mentioned before strokes are caused either by a clot or a hemorrhage. If there is a clot it is called an Ischemic stroke and they can either be Embolic: which is when a clot travels from another location in the body or Thrombotic: which is when a clot develops within a cerebral artery or one of the smaller branches. If there is a bleed within the cranial cavity it’s called a hemorrhagic stroke and it’s due to a rupture of one or more arteries of the brain.

Front 55

Restrain your pt

Back 55

When to restrain your patent? If violence is imminent, then it may be necessary to anticipate the need to use physical or chemical restraint especially if the pt is at risk for harming themselves or others.
Chemical restraints are the use of medications to mildly sedate the patient and control their agitation to achieve control of a violent and dangerous situation. The paramedic should be careful when using chemical restraint due to the chance of over-sedation which is dangerous and cause further harm to the pt condition. Paralytic agents are not appropriate unless indicated for an underlying medical or traumatic condition. Some Pre-hospital chemical restraints: Benzodiazepines (Midazolam,Lorazepam), Butyrophenone (Haloperidol)

You should always continue to document, monitor, and provide humane care to your pt. You should also note that restraints of any kind should not be used to punish or teach the patient a lesson.

Field equipment such as Kerlix bandages, can be useful when emergency restraint is needed for the safety of the patient and the crew. Always reassess the pt distal circulation, motor function, and sensation after applying restraints.

Front 56

Describe osmotic diuresis and its relationship to diabetes mellitus.

Back 56

In diabetic patients osmotic diuresis may occur due to the excessive amounts of glucose that makes its way to the tubules in the kidneys. Through osmosis water follows the glucose into the kidneys where the water will turn into urine and cause the patient to urinate excessively

Front 57

List and briefly describe the four types of acid-base disorders.

Back 57

Respiratory Acidosis
-CO2 is built-up due to the lungs not removing adequate amounts which disrupt the body's acid-base balance
-Due to this CO2 build-up the body will become more acidic
-This condition can be caused by secondary problem to chest injury, depression of the central respiratory center, decreased alveolar ventilation; pneumonia, and COPD.
-Signs and symptoms include, but not limited to, coma, tachycardia, headache, respiratory distress, paranoia, depression, tremors, and paralysis.

Metabolic Acidosis
-Increase quantity of acid in the body fluids
-Can be caused from certain meds, diabetes, diarrhea, and vomiting
-If acid overwhelms the respiratory capacity Acidema (arterial pH >7.35) can occur
-Sign and symptoms include, but not limited to, Kussmaul's Respirations, Altered, N&V, Tachycardia, Hypotension, Lethargy, Cardiac Dysrhythmias, and Flushed Skin

Metabolic Alkalosis
-pH inequality due to an increased amount of acidic substances
-Diuretics, loss of acid-containing gastric secretions from nasogastric suction, vomiting, or excessive urine and stool discharge causing acid loss
- Alkalemia (arterial pH > 7.45) occurs when alkalosis overwhelms the pH buffering system
-Signs and symptoms include, but not limited to, decreased rate and depth of respirations, hypovolemia, hypokalemia, hyperactive reflexes, seizures, and polyuria

Respiratory Alkalosis
-Breathing excessively causing the expulsion of CO2 resulting in low levels of carbon dioxide levels.
-Respiratory alkalosis can be caused by anxiety, hyperventilation, coma, liver failure, fever, and CNS disorders.
-Signs and symptoms include, but not limited to, dizziness, panic, seizures, numbness of toes and fingers, and cardiac dysrhythmias

Front 58

Describe the pathophysiology of Hyperosmolar Hyperglycemic Nonketotic Syndrome.

Back 58

-Occurs in Type II Diabetes

-Pathophysiology and symptoms are closely related to DKA

-Severe hyperglycemia, blood glucose levels exceed 600mg/dL

-Electrolyte Imbalances

-Insulin utilization by the body does not efficiently occur and thus alternative energy sources are metabolized within the body.

-Increase glucogenesis and glycogenesis

-Metabolic acidosis and excess keytones (Ketonemia) can develop

-Common in elderly patients: signs and symptoms ranging from poor skin turgor, dry mucous membranes, sunken eyes, hypotension, altered mental status, seizures, unconsciousness, and possibly death.

-Patients with Other signs and symptoms include weakness, increased thirst, nausea, lethargy, confusion and ultimately, convulsions, and coma. Common pathophysiology and signs/symptoms of diabetic ketoacidosis

Front 59

Describe the appropriate assessment and treatment for diabetic ketoacidosis and hypoglycemia (include protocol-based treatment).

Back 59

Focus on improving circulatory volume, maintaining tissue perfusion, assessing and correcting blood glucose levels, reducing serum osmolality, clearing ketones from urine and serum, correcting electrolyte imbalances, and identifying precipitating factors.

Hypoglycemia
-Determine Level of Consciousness
-Airway, Breathing, Circulation
-Oxygen (15L non-rebreather mask)
- Cardiac Monitor
- Vascular Access
- Obtain Blood Glucose and if below 60mg/dL; hypoglycemic, administer:
- 50% Dextrose 25 Grams (50ml) IV/IO
- Glucagon 1mg IM/SC, if unable to establish IV. Only 1 time
- Repeat blood glucose. Repeat Dextrose if extended transport time.
- Assess and document response to therapy
- Contact Base (additional medication dosages and fluid bolus)

Signs and Symptoms
Anxiety
Hunger
Dizziness
Headache
Altered mental status
Abnormal behavior
Loss of consciousness
Diaphoresis

Hyperglycemia (Diabetic Ketoacidosis)
-Determine Level of Consciousness
-Airway, Breathing, Circulation
-Oxygen (15L non-rebreather mask)
- Cardiac Monitor
- Vascular Access
- Obtain Blood glucose if greater than 300mg/dL; Diabetic Ketoacidosis, administer:
- IV Fluid Resuscitation NS (Isotonic Solution) (20mg/kg Bolus per Paramedic Book)
- Assess and document response to therapy
- Contact Base (additional medication dosages and fluid bolus)

Signs and Symptoms
Increased thirst
Excessive hunger
Urination
Malaise
N&V
Lethargy or Somnolence
Kussmaul's Respirations
Acetone Breath

Front 60

Describe the differences between diabetes type I and II (include pathophysiology, signs & symptoms).

Back 60

Type I Diabetes
-Insulin-Dependent Diabetes Mellitus (IDDM, And Juvenile Onset Diabetes (JODM)
-Beta cells in the pancreas are unable to secret insulin which is the way that glucose is able to enter the body's cells. Without insulin glucose will not be absorbed into the cells.
-The person is required to self-administer external sources of insulin (needle injection or auto-pump)
-Diagnosed during childhood, adolescence, and early adulthood

Type II Diabetes
-Adult Onset Diabetes (AODM) or non-insulin-dependent diabetes (NIDDM)
-Resistant to the effects of insulin or insulin-secretion deficiency which inhibits optimal glucose metabolism
-They have the ability to secrete endogenous (internal or natural) insulin
-The small amounts of insulin that is produced can usually keep diabetic ketoacidosis from developing
-Risk factors: greater than 45 years old, history of diabetes, various ethnicities (Mexican, African, Native, Asian Americans), hypertension

Hyperglycemia (diabetic coma)
-Inability of insulin in the body to trigger cells to absorb glucose from the blood, resulting in abnormally high blood glucose levels
-Signs and symptoms include, but not limited to, the three P's: Polyuria (excessive urination), Polydipsia (excessive thirst), Polyphagia (excessive hunger), fatigue, weight loss, Kussmaul's respirations, acetone breath, and visual difficulties

Hypoglycemia (insulin shock)
-Glucose levels are inadequate to effectively fuel the body's cells (Below 60mg/dL)
-Caused by a lack of insulin or lack of fuel (glucose) to utilize
-Signs and symptoms include, but not limited to, tremors, sweating, hunger, altered mental status, pale, diaphoretic, headache, loss of consciousness, nausea, tingling sensations, combativeness, etc

Front 61

Identify conditions / situations in which air medical transport should be considered.

Back 61

Air medical transport should be considered by weighing the risks against the benefits. Having a helicopter land and take off can be a very dangerous event and thus should be utilized only when appropriate. Significant Mechanisms of Injury, such as traffic collisions, falls with significant injuries, and burns are only a few of the MOI that should immediately be considered for air transport.

When transport by ground of a "sick" patients may exceed 20 minutes it might be pertinent to call in an air ship for transport. Also when there is going to be a prolonged extrication of a patient from an entangled vehicle, or when the patient is in a remote location that an ambulance will have a difficult time reaching.

Air medical transport is not just for significant traumas; it is also used from inter-facility transfers and significant medical conditions that require immediate medical attention, such as with a patient with a document STEMI. Other medical conditions that require a speedy transport to a particular hospital such as strokes, should also meet the criteria of air medical transport

If the patient will benefit from air medical transport then it should be utilized.

Front 62

Time permitting, what information should be relayed to the aircrew (patient information) prior to their arrival at the LZ?

Back 62

-Patient Report
Mechanism of Injury (brief)
Number of Patients
Age, Weight
Injuries
Glasgow Coma Scale
Advanced Treatment (if needed)
Patient Destination

Front 63

Describe various safety precautions when working around a helicopter at an EMS scene.

Back 63

-Never approach by yourself, make contact with the pilot (use hand signals, radio communication)
-Approach from the front or side or from uphill if on a slope (never approach from the rear)
-Approach in a semi-crouched position
-Park ambulance at least 50 feet away
-No smoking within 100 feet
-Do not have any sheets or loose object on the gurney while moving patient to the helicopter
-Don not wear hats
-Don't turn your back to the helicopter
-Only radio communication that should be said while the helicopter is landing or taking off is too warn them of a danger by announcing the danger three times so the pilot will take the appropriate actions
-Be aware of any people that have come to see what's going on
-Don't leave gurneys unattended
-Ensure a obstacle free and debris free LZ for the winds generated from the helicopter can have a disastrous affect.
-Do not hold up an IV bag or use IV pole
-Watch your own safety as well as the safety of others on the scene
-Stay away from the tail of the helicopter; very dangerous

Front 64

Describe the advantages and disadvantages of air medical transport.

Back 64

Advantages:
Faster transport time to appropriate health care facility
Advanced medically trained professionals on board
Reach areas that are otherwise inaccessible

Disadvantages:
Time lost while waiting for arrival to scene, LZ
Limited work space while in the helicopter (harder to perform certain medical tasks)
Increased risk of harm to the public and rescuers
Unable to obtain certain vital signs because of noise restraints (ie lung sounds)
Sometimes causes more harm than good due to misuse

Front 65

List several possible hazards that can be encountered during a confined-space rescue.

Back 65

Oxygen Deficiency
Mechanical Hazards
Electrical Hazards
Toxic Environments
Engulfment
Collapse, Secondary Collapse
Self-Entrapment
Falling Objects
Explosions/Fire (concentration of certain chemicals ignite)

Poor Visibility
Poor Access/Egress