NREMT Review 2 Flashcards

pulse
Terms Definitions
What is epistaxis?
nosebleed
What is Battle's sign?
?
A patient with chronic altered consciousness is usually suffering from what condition?
hypoglycemia
How many thoracic vertebrae are there?
12
An "immediate" reaction to an injection occurs within what amount of time?
30 minutes
What do tendons connect?
muscle to bone
What is the minimum temperature at which an adult has a fever?
100.4°F
What are ataxic respirations?
Irregular, ineffective respirations that may or may not have an identifiable pattern.
Increased respiratory rate is often a sign of impending...
shock
Following SAMPLE inventory, one might ask OPQRST questions, especially when assessing for what condition?
a heart attack
A spinal injury at what vertebrae will allow the patient to breathe using only their diaphram, not through their intercostal muscles?
C5
How many pairs of cranial nerves are there?
12
A spinal injury at what vertebrae can cause a patient to be unable to breathe entirely?
C3
What is the most common indication of internal bleeding?
pain
What does the root "nea" mean?
Breathing

dyspnea = slow breathing
tachypnea = rapid breathing
apnea = not breathing
What is apnea?
Lack of spontaneous breathing over a period of time.
Where should you palpate pulse on an unconscious patient?
carotid artery
About what volume of blood does an adult contain?
6 liters
At what weight does a patient require 4 EMTs for lifting and transfer?
250 lbs
Capillary refill is one means of checking for adequate perfusion. What age of patient does this work best for?
less than 6
What organ is of particular concern in injuries to the Right Upper Quadrant of the abdomen?
the liver
What are contraindications for aspirin?
• hypersensitivity to aspirin
• liver damage
• bleeding disorders
• asthma
• children with fever-inducing illnesses
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 does the prefix "hyper-" mean?
high
hyperglycemia = high blood sugar
hypertensionn = high blood pressure
hyperthermia = high body temperature
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 do raccoon eyes or Battle's sign indicate?
head trauma
If an unconscious victim has a pulse but is not breathing, responders should do what?
Continue rescue breathing.
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 the dangers of atherosclerosis, particularly in geriatric patients?
• myocardial infarction (heart attack)
• stroke
• abdominal aortic aneurysm
What three factors do you consider when assessing a patient's skin?
• color
• temperature
• moisture
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
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 does C-M-S stand for?
Reminder to test for neurovascular status:

C - Circulation
M - Motor
S - Sensory
At what rate would you provide ventilations for an infant?
1 per 3-5 seconds
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 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 are common signs of head trauma in children?
nausea and vomiting
Hyperventilation may indicate what life-threatening conditions?
• a diabetic that is hyperglycemic
• overdose of aspirin
• sepsis, a person with severe infection
The left upper quadrant of the abdomen contains what major organs?
spleen and stomach
What is used to treat anaphylactic reactions?
• epinephrine
• oxygen
• antihistamines
What is the recovery position?
Patient rolled onto left side, left arm extended, right hand under cheek.
What conditions must a patient exhibit before you can begin CPR?
• unresponsive
• not breathing
• no pulse (or, a pulse < 60 for infants and children)
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 pericardial tamponade?
Compression of the heart due to fluid accumulation in the pericardium. Generally caused by blunt force trauma
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)
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 characteristics do you look for when assessing respirations?
• rate
• quality
• depth
How should you treat a hyperventilating patient?
give supplemental oxygen and transport to hospital
What are Kussmaul respirations, and what do they indicate?
Kussmaul respirations are rapid and deep, and indicate hyperglycemia.
What are the normal ranges of pulse for adults, children, and infants?
Adult 60-100
Child 70-150
Infant 100-160
How do you splint long bones?
Straighten into neutral alignment and then splint
Chest injuries necessitate prompt transport. TRUE or FALSE?
True. Err on the side of caution.
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 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 agonal breathing?
Heart has stopped, but brain is still telling respiratory muscles to fire. NOT ADEQUATE - must provide artificial respirations to patient.
What are common injuries in the flanks of the body?
injuries to the kidneys
What are rales or crackles?
Wet breath sounds on both inhalation and exhalation
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.
What five medications may be carried on a BLS unit?
• oxygen
• oral glucose
• activated charcoal
• aspirin
• epinephrine
You shouldn't remove blood soaked dressings from a wound. TRUE or FALSE?
True. Put additional dressings on it and hold them firmly in place.
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
How should you treat epistaxis? What is epistaxis?
Epistaxis is a bloody nose.

Have patient sit with head forward.
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
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
What are the two functional parts of the nervous system?
somatic (voluntary) and autonomic (involuntary)
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
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
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
What is the procedure for adult CPR?
• position patient on firm surface
• look, listen, and feel for breathing (5 to 10 seconds)
• chin tilt or jaw thrust to open airway
• give two rescue breaths (1 second each)
• check for carotid pulse, (5-10 seconds)
• no pulse, begin chest compressions, 1-1/2 to 2" deep, 30 to 2 rescue breaths. After 5 cycles, reassess.
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 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
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
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.
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
Off hours, you find an adult victim unresponsive and requiring CPR. What should your first action be?
Call EMS first, then begin CPR
What does rhonci sound like? What does this breath sound indicate?
Rhonci is a congested, low-pitched, noisy sound, more prominent during exhalation; it comes from mucus in the lungs and may indicate chronic obstructive pulmonary disease (COPD)
What are the normal systolic blood pressure ranges for adults, children, and infants, respectively?
Adults 90 - 140

Children 80 - 110

Infants 50-95
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 is the order of preference among devices/techniques for providing artificial ventilation?
1) pocket mask
2) two-person bag-valve mask
3) flow-restricted O2 device
4) one-person bag-valve mask
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 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?
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
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.
What is the flow rate and percentage of O2 delivered by a nasal cannula?
1-6 L per minute

24-44% O2 delivered
An AED can not be used while transporting a patient. TRUE or FALSE?
True. AEDs can't analyze the cardiac rhythm while the vehicle is in motion, and it isn't safe to defibrillate in a moving ambulance. Stop the vehicle if a patient loses his or her pulse and you need to use the AED.
If an infant or child is unresponsive and not breathing, but has a pulse of 54, what should you do?
Perform chest compressions if pulse is less than 60 beats per minute.
Off hours, you find a child victim unresponsive and requiring CPR. Your first action should be to call EMS. TRUE or FALSE?
False. You should first perform two minutes of CPR, and then try to contact EMS.
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 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 tachycardia, in terms of rate?
pulse rate faster than 100 beats per minute in an adult
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 normal pulse ranges for adults, children, and infants, respectively?
Adults 60 to 100

Children 70 to 150

Infants 100 to 160
What are the four phases of a coordinated continuum of care?
1) Recognition of emergency - EMS initiated (includes care by dispatchers via protocols)
2) Patient assessment, prehospital care, packaging, and transport
3) Assessment and stabilization in ER
4) Definitive, specialized care
How do you assess capillary refill on newborns and young infants?
Press on forehead. Cap refill should still be less than 2 seconds.
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 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 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.
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.
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 do you select proper size of OPA?
Measure from earlobe to corner of mouth
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.
How do you assess alertness in an infant?
If they're tracking your presence with their eyes
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?
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.
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 condition does decreased blood pressure indicate?
late sign of shock - vital organs are not getting adequate perfusion
What is bradycardia, in terms of rate?
pulse less than 60 beats per minute in an adult
How should you treat a conscious adult who has an airway obstruction?
Determine if it's mild or severe. If patient can talk or cough, it's mild. If it's severe and they're conscious, ask if they're choking and do the Heimlich maneuver until object is dislodged or patient loses consciousness.
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 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
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
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
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
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 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
How would you utilize an AED in the treatment of a patient you've witnessed having a heart attack?
Begin CPR and attach the AED as soon as it is available.
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%
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 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
/ 119
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