what do you do for labored, contstriction, or lack of tidal volume
assist ventilations with BVM
What do you do for acid in eyes
irrigate, if contacts take them out
Signs and Symptoms of tension pneumothorax
progressive shortness of breath
increased altered level of consciousness
neck vein distention
tracheal deviation
What organ could be affected by trauma to the upper right quadrant
liver
flail chest is charcterized and defined by
paradoxical motion
2 or more ribs broken in two or more places
subcutaneous emphysema what is it and how to treat
A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues. treat by positive pressure ventilations
Daughter is power of attourney and wants father to recieve care, father is AxO x4 and does not want care
Respect patient wishes because he is concious without altered mental status
Open fracture and bleeding PPE
gloves, mask, goggles
What EMS statistic is needed to reduce speed limit in given area
Fatalities and injuries that have happened on that stretch of road
Triage color green
ambulatory,
yellow
delayed
red
immediate
black
dead/ expectant
you are treating a 300 pound male who cannot walk what should you do
call for assistance
triage in the
cold zone
Pedatric/ infant breath rate
18-30
Cardiac arrest in children is caused most likely by
hypoxia, resp distress or failure
Croup is characterized by
hoarseness, “barking” cough, inspiratory stridor and varying degrees of respiratory distress resulting from swelling in or obstruction in the region near the larynx.
Steps to treating bleeding
first direct pressure then tourniquet is direct pressure does not stop the bleeding
Signs and symptoms of meningitis
fever, rash, stiff neck, altered mental status
specifcally in infants: Swelling of fontanelles
Apgar scale
appearance, pulse, grimace, activity, respiration
when treating allergy primary concern is
AIRWAY
when to start chest compression on newborn
pluse under 60
ruptured spleen in child
bleeding and pain
right upper quadrant
Liver, Right Kidney, Colon, Pancreas, Gallbladder
left upper quadrant
liver, spleen, left kidney, stomach, colon, pancreas
left lower quadrant
Part of descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
right lower quadrant
cecum, appendix, right ovary and tube, right ureter, right spermatic cord
Signs and symptoms of epiglottitis
Sudden onset, high fever
“Hot-potato” voice
Dysphagia, drooling
No cough
Prefers to sit upright, lean forward (tripod position)
Appears toxic and stridulous
when babies head appears out of vaginal canal check for
nuhical cord
place baby where until umbillical cord is done pulsating
at the height of the vaginal canal
transport pregnant women in what position and why
left lateral recumbant to take pressure of the heart and vena cava
questions for pregnant mom
how many weeks along are you
how far apart are contractions
Signs of imminent delivery
Crowning, Urge to bear down or go to the bathroom, “It’s Coming”, and Contractions of increased frequency & intensity.
preclampsia
abnormal condition associated with pregnancy marked by high blood pressure proteinuria, and edema.
eclampsia
true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma
ovarian cyst signs and symptoms
lower pain on either side, nausea, bleeding, ask when last menstrutal cycle was
PID signs and symptoms
-onset is usually after menses
-sudden pelvic pain, profuse vaginal exudate, fever, metrorrhagia, discharge
When to massage fundus
stops bleeding and cramping after delivery
woman is bleeding after sexual assualt
use pad or sterile gauze and put under her to collect the blood
breech birth
Baby is delivered feet or buttocks first
when can you insert a gloved finger into the vaginal canal
if umbillical cord is around the babies neck
perineum tearing
tearing from vagina to anus after delivery
preciptitous delivery
perineum tearing and emergency delivery
bleeding from shunt
don’t let this question confuse you
hold pressure at place of bleeding
Pancreatitis symptoms
upper abdominal pain, swollen and tender abdomen, nausea, vomiting, fever, increased heart rate, weight loss, and diabetes.
important to note if they are chronic drinkers
petite mal seizure
blank out for 3-5 seconds, still conscious, eyes may flutter
zone out
Focal Motor Seizure
Starts in a group of muscles a “focus”
May progress to include the whole entire arm
May progress to a Grand Mal Seizure
grand mal seizure
They may have an “aura”
Tonic-Clonic phase
Loss of consciousness
clenched teeth, biting the cheek or tongue, incontinence
post-itcal phase
status epilepticus
A condition in which seizures recur every few minutes or last more than 5 minutes.
example question: Patient is zoned out, could be poison, OD or low blood sugar or seizure, question gives you the age of the patient and no other signs or symptoms, because of the lack of signs of poison or pills or history of diabetes it is most likely
seizures
Appendicitis signs and symptoms
rebound tenderness, young, pain near umbilical region, right lower quad
eptopic pregnancy
implantation of the fertilized egg in any site other than the normal uterine location happens in first trimester
abruptio placentae
premature separation of the placenta from the uterine wall, third trimester
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus, third trimester
spontaneous abortion
when the fetus and placenta deliver before the 20th week of pregnancy; commonly called a miscarriage
subarachnoid hemorrhage
worst headache, assess bp will be low, cushing triaid, slow pulse, unbalanced respirations
Left sided heart failure
shortness of breath
right sided heart failure
- Jungular Vein Distention
- Ascending Dependent Edema
- Weight Gain
- Hepatomegaly (Liver Enlargement)
steps when assessing unconc patient
check for responsiveness, check for pulse, check for chest rise and fall
communicable disease PPE and decom
mask, gloves, goggles, disinfect with approved germicidal agent
Oral Glucose Indications
hypoglycemia, able to swallow
when to extricate before giving care
direct life threat/ scene saftey threat ex: fire in car
OPIOD indications
pinpoint pupils, respiratory arrest, cyanosis, track marks
Cholecystitis
inflammation of the gallbladder
Cholecystitis S/S
severe midepigastric or right upper quadrant pain radiating to back and referred to right scapula usually after meals
fat intolerance
flatulence
indigestion
diaphoresis
n/v
chills
low grade fever
possible jaundice
clay-colored stools with common bile duct obstruction
when approaching a psych patient
calm them down, be reassuring, deescalate the situation
carbon monoxide poisoning
-carbon monoxide binds with hemoglobin and reduces oxygen supply to tissues
-cannot be seen. smelled, or tasted
-s/s include: nausea, vomiting, headache, weakness, and unconsciousness, Altered LOC, high SPO2
-death may occur with prolonged exposure
-prevention by ensuring proper ventilation when using fuel-burning devices
-gas-burning devices should be inspected annually
-flues and chimneys should be unobstructed
-carbon monoxide detectors should be installed and inspected regularly
NPA indications
concious with gag reflex
Suction Catheter for oropharynx
yonker tip/ ridgid tip
spontaneous pneumothorax
increaed heart rate, hypoxia, chest pain
Tension pneumothorax
S/S
JVD, diminished/absent lung sounds, tracheal deviation towards unaffected side, poor BVM compliance
pneumonia
swollen avoli, crackles, fever, warm dry and flushed, transport and give oxygen
chronic bronchitis
lungs constantly inflamed, barrel chest
systolic pressure
Blood pressure in the arteries during contraction of the ventricles.
diastolic pressure
Blood pressure that remains between heart contractions.
Contraindications of nitroglycerin
(Contraindications:) Cerebral hemorrhage, sexual enhancement drugs, hypotension-systolic blood pressure < 100.
important stroke question to ask
when was the last time they were seen normal
pulmonary edema s/s
Severe dyspnea and air hunger
Cough productive of frothy, blood tinged sputum
Tachypnea and tachycardia
Cold, clammy skin
Cyanosis
Extreme apprehension
Confusion, stupor
caused by left sided heart failure
transport shock patient in
supine
agonal respirations treatment
BVM
Heart Failure S/S
Shortness of breath, fatigue, and weakness, weilling in the legs, feet abdomen. Reapid or irregular heartbeat with S3 or S4 heart sounds, persistent cough or wheezing, and weight gain from fluid etention. Treatment: balance of medication, devices, and lifestule changes to heald the heart contract normally.
TIA
mimic stroke, symptoms go away in 24 hours
CVA
ruptured artery in brain hemmorragic shock
Ischemic stroke symptoms
facial droop, weak, slurred speech, time
cardiogenic shock
post MI, irregular pulse, low BP, thready pulse rate fast, pale, cool, clammy
BVM if respirations are
under 12 or over 20 (not exact) and do not have good lung sounds, under 8 ventilate
wheezing
High pitched sound heard in the lungs with asthmatics or lung disease lower airway
Rhonchi
Rattling noise of mucous in the lungs, upper airway
crackles
(rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration lower airway
stridor
upper airway, indicated foreign object
if ventilations are not going in what should you do
resposition
Nasal Canula flow rate
1-6
BVM flow rate
15-25
NRB flow rate
10-15 LPM
Nebulizer flow rate
6-8 lpm
if patient collaspes with airway obstruction
check for pulse, start w chest compressions
what to ask when approaching chocking vicitm
Are you chocking? Tell them to cough, when no air is entering the lungs start back blows and chest thrust
threat patient w humidified oxygen if
swollen throat, croupy cough, assessory muscle use, or stridor, not if anaphylatic
when patient is having trouble breathing, to get their history ask
yes or no questions
landing zone
100 by 100 ft
when to request additional assitance
too many for your team to handle, requested before even exiting ambulance
Quaility improvement for EMS
critiquing what went well and what could be improved upon, internal and external review
Rapid extraction
can be necessary even if CSPine is indicated
BSi PPE for profuse bleeding
Gloves, eye protection, mask
Notify law enforcement when hospice death
doesn’t add up to natural causes
USing TC
extracation when needing to remove piece of car from patient
Minor on scene transporting parent
take them in ambulance with you or call law enforcement to transport them
Using power grip hand go
10 inches apart
When driving proceed through intersections
like no one can hear the sirens
when correcting an error on document
line through it and initial
triage where
in cold zone
community relations example
offer BP check to whole community
WHn patient is unoconcious and unrepsonsive first always
check pulse and start CPR
black and tarry stool
upper GI bleed
Lower GI bleed
bright red stool
When to remove a penetrating object?
- Obstructs airway
- Impedes CPR
usually just stablilize
3 year old is drooling and oesn’t want to eat? what does he most liekly have?
epiglottitis
Signs of respiratory distress in children
grunting, intercostal retractions, nasal flaring
You arrive on scene and CPR is in progress what shuld you do
apply AED
AED Shockable Rhythms
V-tach and V-fib
what to do for gurgling respirtations
suction
pumonary edema
Abnormal accumulation of fluid in the interstitial spaces of the lungs. Blood backs up into pulmonary circulation because left ventricle can’t pump it forward (Can occur acutely, such as with MI Or can occur as an exacerbation of chronic HF)
Emphysema
A serious disease that destroys lung tissue and causes breathing difficulties.
pink and skinny
check pulse of hypothemic oatient for at least
30 seconds
signs and symptoms of congestive heart failure
-Cough (frequent, productive, hemoptysis)
-Progressive dyspnea with exertion
-Orthopnea
-Pitting edema of legs and feet or generalized edema of face, hands, or sacral area
-Heart palpitations
-Progressive fatigue or syncope with exertion
-Moist rales in lower lobes, indicating pulmonary edema
What does nitroglycerin do
- Vasodilator, opening up vessels to increase blood supply to the heart
- Smooth muscle relaxant
what position to place nitro patient in
supine
responding to cardiac arrest
start w compressions then go to AED
after delivery of baby
dry and warm keep at vaginal opening level
hypothermia treatment
remove from cold, take off wet clothing, wrap in blankets, severe cases EMS ASAP
gunshot wound, shortness of breath how to treat
ventilate, immoblize, take vitals and apply occlusive dressing
puncture wound apply what
3 sided occlusive dressing
head inury and blood thinner causes
hemorrraging
bubbling/ bleding from chest apply
fully occulsive dressing
femur fracture
lower than hip, deformities, less angulation that hip dislocations
hip discolation
rotates whole leg
knife is implaed
stablilize with bulky dressings
pulmonary contustion
trauma to the chest
aorta dissection
tearing pain to the back
Annurism
when a vessel wall weakens and balloons
aorta rupture
dead
Nose bleed
lean forward and pinch nose
Rule of (s
arm – 9, 1/2 arm 4.5, head 9, palm 1
neck puncture wound
occlusive dressing
spleen
-Upper left of the abdomen, behind the stomach and below diaphragm.
-Lymphoid tissue
-Blood vessels are connected to the spleen by splenic sinuses.
-Function: Filter unwanted materials from the blood (including old RBC) and to help fight infections.
-Up to 10% of the population has one or more accessory spleens that tend to form at the hilum of the original spleen.
eccomosis
bruising, often caused by internal bleeding
solid organ rupture
results in internal bleeding, abdominal distention, eccomosis
any kind of abdominal pain first thing you do
two Es: expose and examine region
pulmonary embolism
A blood clot that breaks off from a large vein and travels to the blood vessels of the lung, causing obstruction of blood flow.