EMS and Cardiac Emergencies: Key Questions and Answers | Exams Nursing | Docsity (2024)

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EMT FISDAP READINESS TEST BANK Where are Beta 1 receptors found? - ✔Heart and Kidneys Stimulation of Beta 1 receptors result in an increase of what? - ✔Heart: Inotropy, Chronotropy, Dromotropy Kidneys: Renin-Angiotensin-Aldosterone System = Vasoconstriction = Increase blood pressure Which node is located at the junction of the superior vena cava and the right atrium, is typically supplied by the Right Coronary artery, and fires at a rate of 60-100 bpm. - ✔SA Node Atrial depolarization characterized by smooth, round, upright deflection less than 0.11 secs long and less than 2.5mm tall is referred to as what on the ECG? - ✔P wave Carvedilol (Coreg) Metropolol (Lopressor) Atenolol (Tenormin) Propranolol (Inderal) Bisoprolol (Zebeta) Acebutolol (Sectral) Comolol (Brevibloc) - ✔Beta Blockers - used for blood pressure and cardiac problems Epinephrine Norepinephrine Vasopressin Dopamine Phenylephrine Dobutamine - ✔Vasopressors The middle of phase 3 to beginning of phase 4 in the cardiac cycle where cardiac cells are partially refractory and partially repolarized and certain cells can be depolarized in response to electrical stimulus. - ✔Relative Refractory Period (Partial flush of the toilet) Treatment for Beta Blocker Overdose - ✔Glucagon: 1-5mg IV/IO (1st Line Drug) Calcium Chloride: 500mg - 1g IV/IO Swelling of affected limb, pain and tenderness, inflammation/redness, warm to touch on affected limb, pain on dorsiflexion (Homan Sign) are all signs of? - ✔DVT Treatment of DVT - ✔Supportive Care, Position of Comfort, Establish IV, Cardiac Monitor, Pulse Ox, O2, Monitor vitals for embolism. Do not massage affected limb. The pressure gradient that drives coronary blood pressure. The difference between aortic diastolic pressure and left ventricular end diastolic pressure that perfuses the coronary arteries. - ✔Coronary Perfusion Tachycardia, Difficulty Breathing, Diminished Lung Sound, Pulse Quality Changes, and unequal chest rise are early signs and symptoms of? - ✔Tension Pneumothorax Air is entering the pleural space but cannot escape. Positive pressure ventilation can make it worse. Criteria for Unstable Dysrhythmia - ✔Ischemic Chest Pain ALOC Hypotension/Hypovolemia Signs of Shock Acute Heart Failure Restriction of of cardiac contraction, falling cardiac output, and shock as a result of pericardial fluid accumulation are characteristics of? - ✔Cardiac Tamponade Hypotension, SOB, Lightheadedness, Chest Pain, Syncope, Palpitations, Extremity Swelling, and Muffled heart sounds are signs and symptoms of? - ✔Cardiac Tamponade Indications for Dopamine - ✔Cardiogenic Shock Distributive Shock after fluids Hemodynamically significant Hypotension Symptomatic Brady (2nd Line drug) AHA Guidlines for Terminating CPR efforts in field(4) - ✔Arrest was not witnessed No bystander CPR was administered ROSC was not achieved after complete ALS care in the field No shocks were administered Epinephrine MOA (4) and Dose - ✔Beta 1 = Inotropy, Chronotropy, Dromotropy Alpha 1 = Vasoconstriction = Increased aortic diastolic pressure Beta 2 = Bronchial smooth muscle relaxation = Bronchodilation Adequately perfused kidneys produce how many mLs of urine per hour? - ✔30-50mL Tachycardia with irregular pulse, labored breathing with diffuse crackles/rales in all lung fields, pale/cool/diaphoretic skins, and low blood pressure are signs of what type of shock? - ✔Cardiogenic What is one of the most helpful steps to formulating a field diagnosis? - ✔Considering and ruling out various conditions A sudden nervous system reaction that causes temporary generalized vasodilation leading to syncope describes what type of shock? - ✔Psychogenic Allowing full recoil of the chest in CPR enhances blood return to the heart by what mechanism? - ✔Negative intrathoracic pressure If someone has a syncopal episode and then complains of headache and inability to walk without feeling dizzy, you should suspect? - ✔Head Injury Treatment for neurogenic shock includes IV fluids, temperature management, and possibly? - ✔Atropine 0.5mg up to 3mg Suppress vagus nerve to increase cardiac output. What is the most important criteria for bystander CPR to meet prior to EMS arrival? - ✔Compressions Which system is primarily responsible for tissue perfusion? - ✔Cardiovascular The recommended fluid resuscitation for a patient in shock with no suspected TBI is? - ✔250mL up to 4x, maintain systolic of 80-90mmHg What type of metabolism takes over when inefficient cellular metabolism produces lactic acid? - ✔Anaerobic Accumulation of lactic acid and other waste products in the blood inhibits what interaction? - ✔hemoglobin from binding with and carrying oxygen What should you do if you are working a cardiac arrest patient and the capnography spikes from <20mmHg to >40mmHg? - ✔Assess pulse for up to 10 seconds Tendency to gather or rely on information that confirms your existing views and downplays/avoids info that does not confirm your hypothesis or field differential is what kind of bias? - ✔Confirmation Bias The primary focus of running a megacode should be on? - ✔teamwork and minimal interruptions of CPR What causes increased afterload following Alpha-1 stimulation? - ✔Arteriolar constriction What senses decrease in blood flow and activates the vasomotor center in response? - ✔Baroreceptors Increased rate of breathing that leads to respiratory alkalosis occurs during which stage of shock? - ✔Compensated Hyperventilating a cardiac arrest patient reduces what? - ✔coronary perfusion What is a procedure that would require a sterile co*ckpit approach? - ✔RSI What causes hypovolemia in septic shock patients? - ✔Fluid leaks out of vascular space What intervention is indicated for a ROSC patient who remains comatose besides vitals, 12-lead, and temperature regulation? - ✔ET Intubation No pulse with CPR and JVD is indicative of? - ✔Cardiac Tamponade Crushing chest pain with ST-Elevation in V1-V4 would indicate an infarct in which artery? - ✔Left Anterior Descending Pedal edema, enlarged abdomen, and JVD are associated with failure of which ventricle? - ✔Right An S3 heart sound in older adults signifies? - ✔Heart Failure A run of VTach is classified by how many sequential PVCs? - ✔3+ Point of maximal impulse is anatomically located where? - ✔Left anterior chest Midclavicular 5th ICS When cardiac cell wall permeability changes and sodium rushes into the cell, it initiates? - ✔Depolarization The right atrium, right ventricle and part of the left ventricle are supplied by that artery? - ✔Right Coronary Artery Decreased cardiac output with a HR >150 is caused by decreases in? - ✔Stroke volume and ventricular filling What type of angina is characterized by awaking a person at rest/sleep? - ✔Unstable (Prinzmetal) Slurring in the upstroke of the first part of QRS complex is called a? - ✔Delta wave Pain in legs while walking that is relieved after sitting down for a little while is indicative of? - ✔Peripheral arterial disease Fever, chills, SOB, hx of mitral valve prolapse, and flat painless red lesions on palms of hands is indicative of? - ✔Endocarditis (Janeway lesions) A heart experiencing an extended refractory period would reflect what on an ECG? - ✔Prolonged QT A tachycardic pacemaker rhythm is called? - ✔runaway pacemaker The volume of the blood that enters the ventricles by atrial contraction is called? - ✔Atrial Kick A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should: - ✔Transport at once and be prepared to treat him for shock. -Given the onset and nature of the patient's pain (eg, sudden onset, tearing sensation), you should suspect that he has an acute dissection of the abdominal aorta. Administer high-flow oxygen and transport him at once. What can an acute aortic dissection cause? - ✔Acute aortic dissection can quickly cause an aneurysm, which could rupture and cause profound shock. A 72-year-old woman is found unresponsive in her poorly ventilated home. Her skin is flushed, hot, and dry, and her respirations are rapid and shallow. She is wearing a gastrointestinal (GI) tract. Although this is a serious condition, it is not a condition you can treat; internal bleeding cannot be controlled in the field. You can, however, treat his signs and symptoms of shock by administering high-flow oxygen and keeping him warm by covering him with a blanket. Therefore, this should be your most immediate concern. Furthermore, the patient requires prompt transport What are the S/S of a gastrointestinal (GI) bleed including abdominal pain? - ✔vomiting blood (hematemesis); the passage of dark, tarry stools (melena); and bright red rectal bleeding (hematochezia) -If blood loss is significant, the patient may have signs of shock (eg, tachycardia, diaphoresis, tachypnea, hypotension). Why isn't hemoptysis a sign of a GI bleed? - ✔coughing up blood is a sign of a pulmonary injury You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because: - ✔Rewarming too quickly can cause a fatal cardiac dysrhythmia What should you do when caring for a patient with hypothermia? - ✔When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). What is rewarming shock? - ✔a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. You receive a call to a restaurant where a 34-year-old man is experiencing shortness of breath. When you arrive, you immediately note that the man has urticaria on his face and arms. He is conscious, but restless, and is in obvious respiratory distress. You should: - ✔place a nonrebreathing mask set at 15 L/min on the patient. -Initial management of a patient with a suspected allergic reaction is to ensure a patent airway and provide high-flow oxygen. Positive-pressure ventilation may be required if the patient is breathing inadequately. After ensuring a patent airway and adequate ventilation and oxygenation, you should inquire whether the patient has a prescribed epinephrine auto-injector. If so, you should contact medical control and obtain permission (if required by local protocol) to assist the patient with the auto-injector. What are the early S/S of viral hepatitis? - ✔Loss of appetite (anorexia), vomiting, fever, fatigue, and muscle/joint pain. What is the function of insulin? - ✔facilitates the entrance of glucose into the cells. What is insulin? - ✔Insulin is a hormone produced by the beta cells in the islets of Langerhans of the pancreas. It promotes the uptake of glucose from the bloodstream into the cells, where it is used in the production of energy. What is glucagon? - ✔Glucagon, a hormone produced by the alpha cells in the pancreas, facilitates the conversion of glycogen to glucose (glycogenolysis) in the liver. The two MOST important steps in treating a patient with a contact poisoning are: - ✔avoiding self-contamination and removing the irritating or corrosive substance from the patient as rapidly as possible. A 24-year-old female presents with a rash to her left leg and swollen, painful knee joints. She tells you that she and her friends returned from a hiking trip in the mountains a week ago. She is conscious and alert with a blood pressure of 112/62 mm Hg, a pulse of 84 beats/min, and respirations of 14 breaths/min. Her symptoms are MOST likely the result of: - ✔Lyme disease What are the S/S of Lyme disease? - ✔The first symptom of Lyme disease, a rash that may spread to several parts of the body, begins about 3 days after the bite of an infected tick. The rash may eventually resemble a target bull's-eye pattern in one third of patients. After a few more days or weeks, painful swelling of the joints, particularly the knees, occurs. What is Rocky Mountain spotted ever? - ✔occurs within 7 to 10 days after being bitten by an infected tick. Its symptoms include nausea, vomiting, headache, weakness, paralysis, and possibly cardiopulmonary failure. What are other common causes of hypoglycemia? - ✔Taking a regular dose of insulin but not eating or taking insulin and exercising heavily. A middle-aged man was found floating face down in a small pond. When you arrive at the scene, bystanders are present, but no one has removed the patient from the water because they thought he was dead. After reaching the patient, you should: - ✔move him to a supine position by rotating the entire upper half of his body as a single unit. -After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. What are the key findings to an altered mental status? - ✔An abnormal speech pattern, such as slurring or incoherent words An elderly man is found unresponsive in his kitchen. The patient's wife tells you that her husband has diabetes and that he took his insulin, but did not eat anything. You should suspect: - ✔Hypoglycemia. -Because insulin promotes the uptake of glucose into the cells, if the patient does not replace this glucose by eating, the glucose level in the blood will fall to dangerously low levels. What happens to a patient in hyperglycemia? - ✔Hyperglycemia occurs when a patient does not take his or her insulin. In such cases, glucose accumulates in the bloodstream and is not able to enter the cells. In the absence of glucose, the cells begin to metabolize fat, which results in the production of ketoacids and leads to hyperglycemic ketoacidosis (diabetic coma, hyperglycemic crisis). Which of the following actions should be carried out during the primary assessment of an unresponsive patient? - ✔Components of the primary assessment for both responsive and unresponsive patients include assessing and managing the airway and assessing and managing circulation, which includes controlling any major bleeding; assessing the rate, regularity, and quality of the pulse; and assessing the color, condition, and temperature of the skin Which of the following mechanisms cause respiratory and circulatory collapse during anaphylactic shock? - ✔Bronchoconstriction and vasodilation -During anaphylaxis, histamines released from the immune system cause two negative effects that result in shock (hypoperfusion): vasodilation, which causes the blood pressure to fall, and bronchoconstriction, which impairs breathing Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic shock? - ✔as a bronchodilator and vasoconstrictor, it improves the patient's breathing and constricts the blood vessels and increases the patient's blood pressure. A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and complains of nausea and lightheadedness. You should: - ✔transport him on his side. -The patient is experiencing heat exhaustion and should be transported to the hospital for evaluation, especially since he experienced a syncopal episode (fainting). A known diabetic female is found unresponsive. Her respirations are rapid and shallow; her skin is cool, clammy, and pale; and her pulse is rapid and weak. Which of the following would BEST explain the likely cause of her condition? - ✔Insulin overdose -The patient has classic signs of insulin shock, a condition caused by a low blood glucose level (hypoglycemia). Common causes of insulin shock include insulin overdose (accidental or intentional), failure to eat (or not eating enough), and excessive exertion. You are dispatched to a residence for a 20-year-old male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began reveals two small puncture wounds, redness, and swelling. You should: - ✔give supplemental oxygen, splint her leg to decrease movement, and keep her leg below the level of her heart. -Treatment for a snake bite involves keeping the patient calm, administering oxygen, splinting the affected extremity to decrease movement (helps slow the spread of venom), keeping the extremity below the level of the heart, and transporting the patient to the hospital. Do NOT apply ice to a snake bite; it may constrict the blood vessels and force venom further into the bloodstream. What are other names for a diabetic emergency? - ✔Diabetic ketoacidosis, diabetic coma, hyperglycemic crisis What are the general rules to follow when attempting to rescue a patient from the water? - ✔"reach, throw, row, and then go" When using PCR for research or quality assurance. What should you delete? Pt's name/ emt's name/ response times/ treatments rendered - ✔PTS name 6 yo child fell at the park. No adult around. Type of consent? Implied/ legal/ expressed/ pediatric - ✔Implied First to arrive. Using START, you should identify pts who? Ambulatory/ deceased/ unresponsive/ breathing - ✔Ambulatory Partner comes to work dirty and leaves trash. Best describe these actions? Unethical/ unprofessional/ dangerous/ negligent - ✔Unprofessional Verbal consent to treatment is called? Expressed/ implied/ defined/ legalized - ✔Expressed Elderly pt cut her hand, bleeding is controlled. She answers questions slowly and often pauses. Vitals are BP 110/80, 64, 14. What should you do? Allow adequate time unless condition worsens/ yes or no ?/ document altered mental/ direct questions to someone else - ✔Allow adequate time MCI, pt asks for help. Disoriented and R 32. According to START, you should? - ✔Immediate MCI, how should report info to trans ambulance? Neuro status and vitals/ medical and SAMPLE/ pt's hospital pref/ MOI and who was at fault - ✔Neural status and vitals Pt cond should be corrected during Pri survey? 12 yo dyspnea from allergic reaction/ 28 yo rapid pulse stung by several bees/ 22 yo ab pain baseball bat/ 45 yo mod chest pain, no palp BP - ✔12 yo dyspnea from allergic reaction 58 yo heavy chest pressure. Ask you what is cause. You should? Hospital staff will explain/ heart not getting enough O2/ acute MI/ can't explain bc HIPAA - ✔Hospital staff will explain Legal case against you. What is your best defense in court? Complete and thorough report/ dispatch records/ partner's supporting testimony/ immediate recollection of events - ✔Complete and thorough report Alert 67 yo refuses care and requests to release form? What should you do? Explain risks/ restrain and trans/ provide supportive care and allow refusal/ ask PD to place in protective custody - ✔Explain risk Pt shot in head no signs of life. Brain matter on floor. You should? Cover pt and contact coroner/ leave scene untouched and contact PD/ resus measures and tran/ permit fam to view and emotional support - ✔Leave scene untouched and contact PD Most effective way to stop spread of infectious diseases? Gloves all pts/ good hand washing/ avoid bodily fluids/ face shield all calls - ✔Good hand washing START, open airway, he begins breathing and is unresponsive. This pt should be classified? - ✔Immediate Finalizing PCR, notice incorrect pulse reading. What should you do? - ✔Single horizontal line, correct, initial Arrive large fight, pointed to stab victim. You should? Drive away and stage/ quickly load and tran/ treat and request ALS/ treat and request police - ✔Drive away and stage Pt dead when you arrive. Rigor mortis already set in. you should? Direct fam to contact coroner and leave scene/ *tell bad news and emotional supp/ pt dead nothing you can do/ fam sign refusal and clear scene - ✔tell bad news and emotional supp Honor DNR when? Given appropriate paperwork/ fam requests/ confirm with physician/ pt's cond is irreversible - ✔Given appropriate paperwork Upon entering home elderly called 911 for chest pain you should? Gen impress/ check BP/ collect meds/ load and go - ✔Gen impression A medical director issues permanent written orders that allow you to treat patients under certain circ*mstances. This is known as: Standing order/ online medical direction/ advance directive/ designated agent - ✔Standing order When approaching unsafe scene, you should: Park ambulance so that you can easily make a quick retreat/ wear Kevlar vest to reduce threat of gunshot wound or stabbing/ leave on lights and sirens to scare off perpetrators/ stand clear view so that you can be identified as medical personal - ✔Park ambulance so that you can easily make a quick retreat Suspect a chemical of mass destruction? 75 people become sick with sudden onset of vomiting and diarrhea at parade/ you smell an unfamiliar bitter odor at scene of multi vehicle collision/ 20 ppl complain of abdominal cramping at triathlon/ 100 people evacuated with nausea from office building with a new furnace - ✔75 people become sick with sudden onset of vomiting and diarrhea at parade Pt's wife called for medical emergency. On arrival, pt is upset and refusing care. He wants to go back to bed. You should: Evaluate mental status/ treat pt according to wife wishes/ advise that you need his permission to treat/ let police handle patient - ✔Evaluate mental status Pt has several open sores on arm. The pt states that they haven't healed despite taking antibiotics. Have pt wear surgical mask/ admin o2 via nasal/ apply a sterile dressing or bandage/ don gloves and gown immediately - ✔Don gloves and gown immediately Upon arrival for shift, what would you do? Check ambulance supplies/ repair broken equipment/ decontaminate ambulance/ copy previous crew checklist - ✔Check ambulance supplies 2 yo F with flu like symptoms. She is in care of a babysitter and her parents can't be reached by phone. What should you do? Treat and release with babysitters consent/ contact law enforcement for temporary custody/ stay on scene until parents can be contacted/ *trans under implied consent - ✔trans under implied consent You need pts agreement in order to share treatment info when you are? Giving condition info to pts roommate/ speaking to reporting agency about victim of elder abuse/ providing info to hospital for treatment purposes/ notifying family member of pt location - ✔Giving condition info to pts roommate/ Verify with law that pt has been searched/ obtain vitals and trans immediately/ reassess scene for additional pts/ continue with pri assess away from the police - ✔Verify with law that pt has been searched You are resus a pt following cardiac arrest when a family member asks you to stop your efforts. You should: Continue resus per protocol and ask to see the physician signed DNR order/ ask a team member to call online med director for permission to stop/ immediately stop CPR and turn off AED/ delay trans of pt while family searches for the advanced directive - ✔Continue resus per protocol and ask to see the physician signed DNR order School bus crashed into tree. 15 children are unharmed, 10 have abrasions and minor lacerations, and 2 children are unconscious. What should you do? Relocate unharmed children to safe location/ contact the school/ call for additional ambulance/ question bus driver about crash - ✔call for additional ambulance Technique to comm with a deaf pt? Write questions on paper/ face pt and speak loudly/ speak slowly with exaggerate lip movement/ request interpreter - ✔Write questions on paper How should an epipen be discarded? Sharp container/ red biohazard bag/ return to pt for disposal/ trash can on scene - ✔Sharps container Pt coughing up bright red blood every time he yells or coughs and is spitting up secretions. What should you wear? Face shield/ goggles/ protective gown/ HEPA mask - ✔Face shield While returning to lunch a women flags you down, she found a young child on the roadside who appears to be hit by a car she is not sure if the child is breathing. What should you do? Alert dispatch that you have been flagged for a possible emergency/ grab necessary equipment and have woman show you the locations/ have dispatch call for ALS backup and move to safety while waiting/ calmly explain that you are currently off duty and call 911 - ✔Alert dispatch that you have been flagged for a possible emergency Appropriate method to obtain pts medical history? Remain at eye level and ask open ended questions/ multitask while gathering info/ stand over the pt and maintain authoritative appearance/ provide choices following each question - ✔Remain at eye level and ask open ended questions Following a motor vehicle collision, which pt requires emergency moves? 50 yo who cannot be assessed in position found/ 53 yo with severe neck pain/ 24 yo with numbness in extremities/ 64 yo with previous back injuries - ✔50 yo who cannot be assessed in position found 23 yo F sudden onset of diff breathing while gardening. BP 90/ 60, P 144, R 26 and labored, wheezing in all lung fields. She has a prescribed epinephrine auto injector. What should you do? Admin o2 and contact medical control/ admin o2 via nasal cannula and reassess/ ask if she knows what insect stung her/ assist with metered dose inhaler - ✔Admin o2 and contact medical control/ You need to access unconscious patient inside vehicle via rear passenger window? Place spring loaded window punch to the corner of window/ take axe and work around edges/ hydraulic cutting tool to remove rear door/ use a halligan tool to pull off window - ✔Place spring loaded window punch to the corner of window Triage upon opening airway he is breathing and unresponsive? Immediate/ deceased/ delayed/ minor - ✔Immediate When is it acceptable to disturb evidence at a crime scene When it is necessary for proper patient care/ when the investigator states it is permissible/ when entering and exiting the crime scene/ when police have cleared the scene for safety - ✔When it is necessary for proper patient care The process by which an agency in one state grants automatic certification to an EMT from another state? Reciprocity/ reexamination/ transfer/ professional courtesy - ✔Reciprocity Process in which teams of professional and peer counselors provide emotional and psychological support? Critical incident stress management/ peer psychiatric counseling/ post traumatic incident review/ quality improvement of conference - ✔Critical incident stress management 80 yo Spanish speaking patient not responding to questions alert and choking? Simple hand gestures/ find interpreter/ speak louder/ check for hearing aids - ✔Simple hand gestures Example of definitive care (when you're doing something to fix somebody) Trauma pt going to surgery to repair a lacerated liver/ hypovolemic pt receiving IV fluid therapy en route to the hospital/ geriatric receiving o2 for respiration difficulty/ pediatric pt receiving x ray for possible femur fracture - ✔Trauma pt going to surgery to repair a lacerated liver After assess you determine pt is dead. Police suspect foul play. What should you do? Avoid disturbing the scene/ leave area immediately/ document time of death/ take pics for documentation - ✔Avoid disturbing the scene 20 yo pt is reluctant to answer questions pertaining to abdominal discomfort? Reassure her that you are there to help her/ ask family for her medical history/ repeat question in firm but pleasant tone/ advise that she needs to be truthful - ✔Reassure her that you are there to help her BSI procedures? Are the responsibility of each individual/ only required when blood is visible/ are not required in the care of children/ does not include the wearing of a mask - ✔Are the responsibility of each individua A dying pt has signed a DNR, you should? Contact medical control before providing care/ clear the scene once the order has been verified/ treat the pt since the DNR orders only apply to hospital care/ provide emotional support to the pt and fam members - ✔provide emotional support to the pt and fam members Unconscious pt is sitting in driver's seat in a vehicle that has just been involved in a motor vehicle collision. The doors are locked and you have a simple tool kit and the rescue truck is 20 min away. You should: Use hammer to break the rear passenger window/ prepare equipment while waiting for rescue truck/ use screwdriver and hammer to pry open the driver's side door/ use hammer to break driver's side window - ✔Use hammer to break the rear passenger window Defamation in writing - ✔Libel 28 yo PT driver motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. Most appropiate? - ✔Jaw thrust without head tilt M fell while water skiing. Unconsciouse. Suspect? - ✔Head and spine injury 81 yo F helthcare facility fell out of bed. Nurse suspects hip fracture. Which medication should concern you the most? - ✔Coumadin a 45 year old male fell asleep outisde while doing yard work. His face and lower legs are bright red with blisters and painful on examination. You should suspect - ✔Both superficial and partial thickness burns Before assessing the respiratory adequacy of an unconscious infant or child, you should Routinely suction the mouth to remove oral secretions Insert and OPA or an NPA Ensure that his or her head is in a hyperextended position Squeeze before placing the bulb syringe in the nose Squeeze after placing the bulb syringe in the mouth Squeeze before placing the bulb syringe in the mouth - ✔Squeeze before placing the bulb syringe in the mouth A 3 year old drank some drain cleaner. It would be most helpful to? Administer activated charcoal transport immediately administer glucagon induce vomiting - ✔transport immediately A cord is wrapped around a baby's neck during childbirth. This is called Neck cord Nuchal cord Circumferential cord Prolapsed cord - ✔Nuchal cord Scald injuries to a child's lower extremity can be indicative of? Abuse radiant heat accidents chemicals - ✔Abuse You have assisted a mother in delivering a premature newborn. Assessment after 5 minutes shows newborn has central cyanosis and heart rate of 90. What should you do? Begin chest compressions Continue to dry and warm the newborn Administer oxygen via blow-by Provide ventilatory assistance - ✔Provide ventilatory assistance You are treating a 3 month old, apneic patient with a pulse of 110. In preparing to ventilate this infant, you should? Institute 2 min of CPR and then ventilate place a small towel under their shoulders open the airway with an OPA and bag every 6 seconds attach the AED and wait instructions - ✔place a small towel under their shoulders Normal response for a healthy 9 month old infant. Gaze follows parents pays no attention to you when entering ribs clearly visible upon inspiration extremities feel cool to the touch - ✔Gaze follows parents 2 year old is restless, irritable, and febrile with a distinct cough. The parent states that the child is calmer in a steam shower. You should suspect? Influenza bronchitis croup epiglottis - ✔croup 13 month old lying supine in crib, crying. Fever of 104.5, rash on body and some spots are purple. You should? Transport put on surgical mask open airway apply high-flow oxygen - ✔put on surgical mask 20 year old female is pregnant for the first time with twins. What is she considered? Gravida I| Gravidarum primigravida - ✔primigravida Neonatal 2 week old female is dyspneic and lethargic to respond. Vitals are P 58, R 4 and irregular. What should you be concerned about? Altered mental status cerebral hypoxia respiratory acidosis cardiac arrest - ✔cardiac arrest During assessment of a crying infant, you discover a sunken fontanelle. Your next question should be? Birth defects fallen recently how many wet diapers has the baby produced - ✔how many wet diapers has the baby produced When assessing distal circulatory function in a 3 year old, a reliable indicator is? Pulse ox BP Cap refill Skin temp - ✔Cap refill Your neighbor has asked you to check on her 2 month old baby. The baby is sleeping and vitals are P 130, R 40, and he continues to sleep even when you try to wake him up. What should you do? Call for EMS tell your neighbor that he is sleeping soundly check on the baby again in a few hours recommend that your neighbor call the pediatrician - ✔Call for EMS 4 year old is having trouble breathing. He is drooling and sitting forward in a chair with his mouth wide open. He has a 103.2 temp. you should suspect? Epiglottitis croup hyperthermia asthma attack - ✔Epiglottitis 3 year old child involved in a motor vehicle collision needs to be secured on an adult backboard. You should? Secure the feet first, then the torso secure the head first, then the torso place padding under the child's head place padding under the child's torso - ✔place padding under the child's torso When inserting an OPA in a child you should? Hold the tongue in position Use tongue depressor - ✔Hold the tongue in position Pediatric airways differ from adult airways in that Trachea is more rigid child's tongue takes up less space oral airways devices cannot be used on children all structures are smaller and can be more easily obstructed - ✔all structures are smaller and can be more easily obstructed 10 year old patient was injured while skating, upon assessment you note a visible deformity of the forearm. The fingers are pale and cool without a palpable pulse. You should apply? A rigid splint apply oxygen and call for helicopter transport - ✔tilt the backboard to the left immediately 5 year old is actively seizing, his respirations are slow and skin is pale. His parents say he had seized several times in the last 15 minutes without waking up. You should suspect that the? Seizure is about to end and you should wait to treat him child will become postictal and will regain consciousness child is in status epilepticus and medication is required child is in diabetic ketoacidosis and medication is required - ✔child is in status epilepticus and medication is required Nausea, vomiting, vagin*l discharge, irregular periods and abdominal pain are signs and symptoms of? Pelvic inflammatory disease ruptured ectopic pregnancy endometriosis cystitis - ✔Pelvic inflammatory disease What effect can excessive traction have on the umbilical cord during placental delivery? Uterine rupture umbilical bleeding abruptio placenta - ✔abruptio placenta The cessation of menses with associated decrease of estrogen secretion is called? Menopause menarche myometrium mitted schmerz - ✔Menopause 24 year old female in her second trimester of pregnancy presents with mild contractions. There is no regular pattern to the contractions, and they have not increased in intensity since they began. She denies vagin*l bleeding or any other symptoms. This patient is most likely experiencing? Braxton Hicks contractions premature labor a placenta previa a threatened abortion - ✔Braxton Hicks contractions A 20 year old female feels faint and has severe pain between her shoulder blades. Her skin is cool and clammy. Vital signs are BP 82/48, P 134, R 22, and SPO2 92%. What should you suspect? Sexual transmitted infection spontaneous abortion pelvic inflammatory disease rupture ectopic pregnancy - ✔rupture ectopic pregnancy A woman is 36 weeks pregnant and complaining of painless vagin*l bleeding. The most likely cause is? Abruptio placenta placenta previa spontaneous abortion bloody show - ✔placenta previa A 4 year old male is sitting upright and drooling. He has swallowed a marble that is completely blocking his airway. What should you do? Start chest compressions perform abdominal thrusts provide back blows suction the airway - ✔perform abdominal thrusts To relieve pressure on the vena cava when transporting a pregnant patient, you should? Place on left side place in recovery raise the patient's legs place in semi fowler's - ✔Place on left side A maternal condition that occurs when the placenta separates from the uterine wall and is a cause of pre birth bleeding is? Abruptio placenta uterine rupture placenta previa ectopic pregnancy - ✔Abruptio placenta 32 week pregnant female complaining of facial swelling, headache, vomiting, and experiencing visual disturbances last 12 hours. You should suspect? Gestational diabetes eclampsia severe migraine pre eclampsia - ✔pre eclampsia 35 week pregnant woman. Following scenarios most life threatening? Hypertension and experiencing visual disturbances fever and pain on urination sharp lower abdominal pains contracts with mucous discharge - ✔Hypertension and experiencing visual disturbances One sign of respiratory distress in a neonate? Grunting increased activity barrel chest tachycardia - ✔Grunting Assess on infant. Which artery should you take for pulse? Brachial radial carotid femoral - ✔Brachial 50 year old fell from her bicycle after hitting a bump in the road. She is now bleeding from her vagin*. You should Gently pack the vagin* with sterile dressing transport the patient with legs elevated transport patient in the left lateral recumbent apply external sterile bulky dressing - ✔apply external sterile bulky dressing If a patient presents vagin*l bleeding within the first 20 weeks of pregnancy you should suspect? Abruptio placentae ruptured uterus placenta previa Spontaneous abortion - ✔Spontaneous abortion Placenta previa occurs when the placenta.. Separates from the uterus is abnormally positioned separates from umbilical cord disrupted - ✔is abnormally positioned What is the difference between respiration and ventilation? - ✔Respiration refers to the exchange of gases in the alveoli, ventilation refers to the movement of air into the lungs. Respiration is needed to provide O2 to cells and remove waste products. Also regulates pH of blood. What are the structures of the upper airway? - ✔nose, mouth, tongue, jaw, pharynx and larynx What structure is considered a landmark that divides the upper airway from lower? - ✔The larynx, anything above is upper. The larynx and below are lower. What are the structures of the lower airways? - ✔larynx (includes adam's apple/thyroid cartilage, cricothyroid membrane, cricoid cartilage), trachea, bronchi, bronchioles, alveoli Describe the anatomy of the larynx. - ✔From superior to inferior. Thyroid cartilage, cricothyroid membrane, and cricoid membrane. The thyroid cartilage and cricoid cartilage are anterior to the larynx, and the cricothyroid membrane is posterior to both structures. True or false: the lungs are completely equal in the midsaggital plane. - ✔False, right lungs has 3 lobes, left lung only has 2 lobes. Together they have 5 total. Also, the right bronchi is inferior to the left bronchi. What are the structures of the lungs in order of ventilation? - ✔bronchioles, and alveoli True or false: the lungs use muscles found in the lateral lobes to expand and contract? - ✔False: the lungs are hollow organs and contain no muscles. When the diaphragm contracts it expands the thoracic cavity. The pleural space has a negative pressure and the lungs expand. This results in a slightly negative pressure (compared to the atmosphere) and air rushes in. True or false: Air rushes into the lungs because of negative pressure. - ✔True, when the lungs expand, they are creating a vacuum because they are expanding the volume of the container. This increase in volume causes influx of air into the container until the pressure is equalized with the atmosphere. True or false: The parietal pleura lines the lungs and the visceral pleura lines the lungs. The space between is called the anterior pleura. - ✔False: the visceral pleura lines the lungs, the parietal pleura lines the body cavity and the pleural space is the space in between both where body fluid allows for both to smoothly glide. What muscles are involved in inhalation? - ✔The diaphragm, cervical muscles (neck), intercostals, abdominal muscles, and pectoral muscles. What muscles are involved in expiration? - ✔none, expiration (if done passively) is achieved by the relaxation of the diaphragm. What is the primary driver of respiration? (Why would we increase/decrease RR?) - ✔The CSF in the brain has chemoreceptors sensitive to CO2. When there is too much CO2. The pH changes. These sensors feed back to the medulla oblongata, which stimulates the phrenic nerve which innervates the diaphragm. They cause an increase in activity of the diaphragm. This increases the RR which causes us to increase tidal volume. This means more CO2 is exhaled. And brings our pH back to normal. We also have the less sensitive hypoxic drive What is hypoxic drive? - ✔Backup system to control respiration. Chemoreceptors in brain, aorta, and carotid arteries. But they are "satisfied" by a small amount of O2, which means it is not as sensitive as pH control of CO2 What two areas of the brain are involved in respiration? - ✔medulla-controls rhythm, initiates inspiration, sets base pattern for respirations, and stimulates diaphragm to contract. pons-changes depth of inspiration, expiration or both. True or false: arteries bring oxygenated blood to organs/capillaries - ✔True in most cases with one exception. Arteries (away) bring blood away from the heart. Usually this is oxygenated blood. But the pulmonary arteries bring oxygen poor blood away from the heart, to the lungs to be oxygenated. What is the tidal volume? - ✔amount of air moved in/out of lungs in single breath. Usually 500 ml in adult What is inspiratory reserve volume? - ✔Deepest breath you can take after normal respiration What is expiratory reserve volume/Vital Capacity? - ✔maximum amount you can breathe out after normal breath. What is residual volume? - ✔Remaining gas in lungs after exhalation. This is to keep lungs inflated What is dead space? What structures are considered part of dead space? - ✔Part of respiratory system not involved in active respiration. Air moves through here but little to no respiration occurs. Mouth, trachea, bronchi and bronchioles considered dead space What is minute volume? What does it measure? - ✔Minute volume = RR x tidal volume. Volume of air moving through lungs in 1 minute. Can be estimated quickly. Count RR rate. If normal check to see chest rise and fall (tidal volume). If chest rise and fall is weak and/or little air coming out of nose, then the person has small minute volume. Alveolar Minute Volume - ✔Volume of air moved through lungs in 1 minute minus the dead space. Alveolar Minute Volume = (tidal volume - dead space) x RR Alveolar Ventilation - ✔Volume of air that reaches alveoli. Alveolar ventilation = tidal volume - dead space Name the characteristics of normal breathing - ✔1. Normal rate (12-20) 2. regular pattern of inhalation/exhalation 3. clear bilateral lung sounds 4. regular and equal chest rise/fall 5. adequate depth (tidal volume) What are the characteristics of inadequate breathing (adults)? - ✔Chapter 6 1. labored breathing (activating accessory muscles of respiration) 2. 12< or >20 breaths/minute 3. muscle retractions above clavicles or between ribs and below rib cage 4. pale/cyanotic skin 5. cool, damp, clammy skin 6. tripod position Chapter 10 1. 12< or 20> 2. irregular rhythm 3. diminished, absent or noisy auscultated breath sounds 4. reduced flow of expired air at nose/mouth 5. unequal or inadequate chest expansion 6. labored breathing 7. shallow depth 8. pale, cyanotic, cool or moist skin 9. retractions around ribs or above clavicles What are agonal gasps? What should you do if a pt has agonal gasps? - ✔Pt in cardiac arrest has occasional gasping breaths because respiratory center in brain continues to send signals to breathing muscles. Artificial ventilations and chest compressions. Where are the alpha-1 receptors located? What is their effect? - ✔location-blood vessels constricted blood vessels, skin is pale, cool, clammy They essentially increase BP 3. apprehension 4. tachycardia 5. anxiety Late 1. mental status changes 2. weak (thready) pulse 3. cyanosis 4. Dyspnea Cellular respiration (Metabolism)? - ✔Cells take energy from nutrients through series of chemical processes. What is the difference between external and internal respiration? - ✔External - process of breathing fresh air into respiratory system and exchanging O2 and CO2 between alveoli and blood in pulmonary capillaries internal - exchange of oxygen and CO2 between systemic circulatory systems and cells of body What are the critical periods in which a cell needs O2? - ✔0-1 minute: cardiac irritability 0-4 minute: brain damage not likely 4-6 minute: brain damage possible 6-10 minute: brain damage likely more than 10: irreversible brain damage What is intrapulmonary shunting? What is the cause of it? - ✔It's when blood enters lungs from right side of heart bypasses alveoli and return to left side of heart in unoxygenated state. Can be caused by nonfunctional alveoli due to diseases What factors can lead to hypoxia due to circulatory compromise? - ✔1. obstruction of blood flow due to a. pulmonary embolism b. pneumothorax c. heart failure d. cardiac tamponade 2. Decreased ability of blood to carry O2 a. blood loss b. anemia c. shock (vasodilatory shock) What is labored breathing? How do you tell someone has it? - ✔Pt with inadequate breathing may appear to be working hard to breathe. Look for use of accessory muscles which are not used during normal breathing What are Cheyne-Stokes Respirations? What do they indicate? - ✔Irregular respiration where pt breathes w/ increasing rate/depth that is followed by apnea, followed again by period of increasing rate/depth of respiration. Can occur in people with strokes/head trauma What are ataxic respirations? - ✔When pt has irregular ineffective respirations that may or may not have identifiable pattern What are Kussmaul respirations? What do they indicate? - ✔Deep, rapid respirations Seen in pt's with metabolic acidosis, or those with diabetes You arrive on scene with a pt that is conscious but experiencing respiratory distress. What are two devices that can assess their respiration? - ✔1. Pulse oximetry (measures O2 bound to hemoglobin) 2. Capnography device (measures end tidal CO2) How would you use a pulse oximeter? - ✔1. clean pt's finger, and remove nail polish as needed. Place finger into probe and turn on. 2. Palpate radial pulse to ensure accuracy and correlation w/ pulse ox Normal reading between 98-100. Less than 90% pt requires treatment unless chronic condition. Oxygen applied when SPO2 drops below 94% What can cause an inaccurate pulse ox? - ✔1. Hypovolemia 2. Severe peripheral vasoconstriction (chronic hypoxia, smoking or hypothermia) 3. Time delay in detecting respiratory insufficiency 4. Dark/metallic nail polish 5. Dirty fingers 6. CO poisoning You encounter an unconscious pt. They have a pulse but inadequate breathing. What should you do if they are a) found in their bed or b) found underneath a tree? - ✔You need to open the airway. If head trauma is suspected, use a jaw thrust. If head trauma is not suspected, use a head-tilt-chin-lift maneuver You encounter an unconscious pt. They have a pulse but inadequate respirations. You open the airway and find vomit. What should you do? - ✔You should suction the pt using How do you use suction equipment? - ✔Can use rigid (Yankauer/tonsil tips) or nonrigid (french/whistle-tip). Use rigid unless you are suctioning a stoma or suctioning nose/liquid at back of mouth. Make sure to measure for proper size. Don't touch back of throat, don't want to activate gag reflex. Turn on to at least 300 mmHg. Attach appropriate tubing. Suction for no more than 15 seconds for adults, 10 seconds for children, and 5 seconds for infants. Rinse with water. Asthma Signs and Symptoms? - ✔1. wheezing on inspiration/expiration 2. Bronchospasm Anaphylaxis Signs and Symptoms? - ✔1. Flushed skin/hives (urticaria) 2. Generalized edema 3. hypotension 4. laryngeal edema w/ dyspnea 5. wheezing/stridor Most rxns occur w/in 30 mins, administer epi using epipen. O2 also helps Bronchiolitis signs and symptoms? - ✔1. Dyspnea 2. wheezing 3. Coughing 4. fever 5. dehydration 6. Tachypnea 7. Tachycardia Often due to RSV infection, severe bronchiole inflammation. Occurs most frequently in infants, especially boys. Provide O2 therapy, allow pt to remain in comfortable position. Reassess frequently and be prepared to manage airway/positive pressure ventilation Bronchitis Signs and Symptoms - ✔1. Chronic cough w/ sputum production 2. Wheezing 3. cyanosis 4. Tachypnea Type of COPD, can be due to tobacco. When excess mucus created. Carbon Monoxide Poisoning - ✔1. flu like symptoms 2. headache 3. dizziness 4. fatigue 5. nausea 6 . vomiting 7. chest pain remove them from scene, administer high flow o2 by nonrebreathing mask. May need full airway control w/ airway adjunct and bvm ventilation CHF - ✔1. Dependent edema 2. decreased breath sounds on affected side 3. subcutaneous emphysema 4. JVD Effects tall and thin people more. Caused when air leaks into pleural space from opening in chest/lung surface. Lung collapses and pleural spaces no longer contact Pulmonary edema - ✔caused by CHF, where heart can't pump blood away as fast as it collects in pulmonary arteries. So you have edema in lungs. 1. difficulty breathing w/ exertion 2. sudden attack of respiratory distress 3. suffocation feeling 4. cold sweats 5. tachycardia 6. cool, diaphoretic, cyanotic kin 7. adventitious breath sounds like crackles/wheezing 8. tachycardia 9. hypertension initially then hypotension pulmonary embolus - ✔1. sharp chest pain 2. sudden onset 3. dyspnea 4. tachycardia 5. clear breath sounds initially 6. hemoptysis (coughing up blood) 7. tachypnea tension pneumothorax - ✔1. severe shortness of breath 2. decreased/altered level of consciousness 3. neck vein distension 4. tracheal deviation (late sign) 5. hypotension, signs of shock (late sign) Respiratory syncytial Virus (RSV) - ✔1. cough 2. wheezing 3. fever 4. dehydration Look for signs of dehydration, infants w/ RSV often refuse liquids. Humidified O2 can be helpful TB - ✔1. cough 2. fever 3. fatigue 4. productive/bloody sputum bacterial infection, can be dormant for years. High prevalence for people living in close contact. Need to wear gloves, eye protection, N-95 respirator How would you differentiate COPD and CHF? - ✔COPD emphysema - thin w/ barrel chest, pink puffer, tripod position, flat neck veins, dry lungs, shortness of breath on exertion, rhonchi, wheezing, no mucus bronchitis - obese, difficulty w/ expiration, flat neck veins, blue bloat, lungs wet, shortness of breath on exertion, rhonchi, wheezing, frequent/chronic cough, excessive thick mucous CHF - abdominal distention, edema (sacral/pedal), tachycardia, increased RR, anxiety, inability to lie flat, cyanotic, confused LOC, blue skin, wet lungs, shortness of breath all the time, sudden onset of shortness, crackles, wheezing, coughing may be present, pink frothy sputum What are the types of normal breath sounds? - ✔1. Vesicular 2. Bronchol-vesicular 3. Bronchial (tubular) What are vesicular breath sounds? - ✔description - soft pitched, low intensity gentle sighing location - over peripheral lung, best heard at base characteristics - best heard on inspiration (5:2) ratio What are bronchiole-vesicular sounds? - ✔description - moderate intensity and moderate pitch blowing sounds, created by air moving through larger bronchi location - between scapula and lateral to sternum characteristics - equal inspiratory and expiratory What are bronchial (tubular) lung sounds? - ✔description - high pitched, loud harsh sounds created by air moving through trachea location - anteriorly over trachea, generally not heard over lung tissue characteristics - louder than vesicular sounds, have short inspiratory phase and long expiratory phase (1:2 ratio) What are the types of adventitious lung sounds? - ✔1. crackles (rales) 2. gurgles (rhonchi) 3. friction rub 4. wheeze 5. stridor What are crackles? - ✔description - fine short, interrupted crackling sounds, best approximated by rolling hair between fingers. Best heard on inspiration but can be heard on both. May not be cleared by coughing cause - air passing through fluid/mucous in air passageway location - most often heard in lower lung lobes associated w/ - pulmonary edema, CHF, pneumonia, pulmonary fibrosis, bronchitis What are gurgles (rhonchi)? - ✔description - continuous low pitched gurgling sounds w/ moaning/snoring quality. Best heard on inspiration but can be heard on both. Can be altered by coughing. cause - Air passing through narrowed air passages as a result of secretions, swelling, tumors location - Loud sounds can be heard over most lung areas, but predominate over the trachea and bronchi associated w/- Secretions, Obstructions, Pneumonia, Bronchitis, COPD Friction rub - ✔description - Superficial grating or creaking sounds heard during inspiration and expiration. Not relieved by coughing. cause - Rubbing together of inflamed pleural surfaces location - Heard most often in areas of greatest thoracic expansion (e.g., lower anterior and lateral chest) associated w/ - Pleuritis, Pulmonary embolism, COPD, Pneumonia Wheeze - ✔description - Continuous, high-pitched, squeaky musical sounds. Best heard on expiration. Not usually altered by coughing. cause - Air passing through a constricted bronchus as a result of secretions, swelling, tumors location - Heard over all lung fields associated w/ - Asthma, Allergic reaction, Airway obstruction, COPD A 16 year old asthmatic female in a tripod position complains of increased shortness of breath. SpO2 is 79%. You should administer oxygen at? - ✔10 lpm via nonrebreather mask A 34 year old man is saying he is choking, You note stridor and hoarseness in his voice. What should you do? - ✔Encourage him to cough An unresponsive trauma patient is gurgling. When you suction the oropharynx with a rigid catheter, the patient gags. You should? - ✔Assess insertion depth of the catheter Thin 54 year old male with a nonproductive cough complains of difficulty breathing. Sitting upright with hands on his knees and you see retractions. Notice oxygen tubing around the house. You should suspect medical history of? - ✔Chronic Bronchitis Semiconscious patient's dentures completely loosened. You should? - ✔Remove dentures Carbon dioxide and oxygen exchange at the alveolar level by which process? - ✔Diffusion 20 year old female unable to cath breath after minor car crash, numbness and tingling to hands and face. Vitals are P 118, R 24. What should you do? - ✔High flow oxygen with a nonrebreather mask Which term best describes respiratory difficulty? - ✔Dyspnea What is the amount of air that normally reaches the alveoli in an adult? - ✔350 mL A 77 year old female has dyspnea, speaks in short word burst, and breathes with pursed lips. Lung sounds are diminished, distant, and clear. Vital signs are BP 152/90, P 86 and irregular, R 23. What should you suspect? - ✔Empysema An 18 year old male is cyanotic and complains of sharp chest pain and difficulty breathing after lifting weights. Vital signs are BP 110/66, P 88, R 22. What is the most likely cause? - ✔Spontaneous pneumothorax An unresponsive 43 year old male is cool, pale, diaphoretic, and breathing 6 times a minute. Which device should you use to administer oxygen? - ✔Bag-valve mask A 42 year old male complains of shortness of breath after being sprayed with super- heated steam. He has burns to his face, neck and upper chest. Vital signs are BP 112/66, P 124, R 28 shallow and labored. What should you do? - ✔Assist his ventilations What are the structures that brach off the trachea into the lower airway? - ✔Bronchi What is the term for high-pitched whistling sounds heard during expiration? - ✔Wheezing The use of accessory muscles and nasal flaring are signs of what type of breathing? - ✔Labored What is the term for abnormal breath sounds that result from an obstructed airway? - ✔Stridor A 53 year old male is sleepy, diaphoretic, difficult to arouse, and breathing 8 times a minute. What should you suspect? - ✔Respiratory Failure An alert 32 year old female complains of difficulty breathing. She speaks in 2-3 word sentences and has oxygen saturation of 92%. What should you do? - ✔Apply high flow oxygen. A 56 year old female has a complete airway obstruction from a piece of food. She becomes unconscious while you asses her. What should you do? - ✔When a patient has a completely obstructed airway and become unconscious the first thing you should do is start chest compressions. A male complains of mild respiratory distress. He smokes 4 packs of cigarettes a day and reports a consistent cough and frequent respiratory infections. Chest sounds reveal bilateral rhonci. What should you suspect? - ✔Chronic bronchitis (sounds like snoring, excess mucus) A febrile 44 year old male complains of shortness of breath and has dull chest pain. He has been coughing up "rusty" sputum for the last three days. What is the most likely cause? - ✔Pneumonia a 75 year old female complains of a sudden onset of right sided chest pain and dyspnea. She is recovering from a recent hip surgery. What should you expect? - ✔Pulmonary embolism How should you insert a nasopharyngeal airway? - ✔First step is to face the bevel towards the septum. Apply a water soluble lubricant, do not use an oil based lubricant. What is the Name of the hollow, semi flexible tube that carries in held air from the larynx to the lungs? - ✔Trachea What is the most common location for an airway obstruction - ✔Pharynx What part of the respiratory system contains the vocal chords? - ✔larynx What is directly posterior to the nose? - ✔nasopharynx What ring shaped structure forms the lower portion of the larynx? - ✔Cricoid Cartilage Where is Sellick's Maneuver applied? - ✔cricoid cartilage What happens to your diaphragm during inhalation? - ✔Contracts What is the name of the cartilaginous Ridge in the trachea at which the right and left lungs split? - ✔Carina What is directly posterior to the mouth? - ✔Oropharynx How many lobes are in the lungs? - ✔5 3 on the right and two on the left. What is the name of the passageway shared by the digestive tract and the respiratory systems for air and food? - ✔Pharynx 56 year old female struggling to breathe with wheezing. She is unable to hold her head up or follow commands. What should you do? - ✔Check airway for foreign body obstructions What nerve primarily controls respiration? - ✔Phrenic Unresponsive 16 year old male has snoring respirations after diving in a pond and nearly drowning. You should? - ✔Compressions Which is an indication of an upper airway obstruction? - ✔Stridor What is the sound of a lower airway obstruction? - ✔Wheezing An adult is breathing at a rate of 6 beats per minute. You should? - ✔Ventilate the patient via bag-valve mask Prescribed inhalers are helpful for patients with an obstructive pulmonary disease because they? - ✔Activate Beta 2 receptors A 50 year old is not breathing and has a faint pulse. You should? - ✔BVM A patient has a history of COPD. Before assisting him in self-administering his inhaler you should? - ✔Shake vigorously During a long transport you are administering oxygen - ✔Consider using a humidified oxygen A 45 year old female is complaining of breathing difficult. Her lung sounds are clear but she is becoming cyanotic on the lips - ✔Deliver oxygen via nonrebreather at 15 lmp The valve between the right atrium and the right ventricle is called the ______ valve - ✔Tricuspid Blood entering the left atrium arrives via the _______ - ✔Pulmonary vein The first part of the aorta as it leaves the heart is the ______ - ✔Ascending aorta Your patient is in ventricular tachycardia. What is most important when determining the treatment of this patient? - ✔Whether he has a pulse ECG findings associated with hypokalemia include: - ✔U waves and flat T waves The presence of inverted T waves on an ECG indicates: - ✔myocardial ischemia The pressure in the left ventricle at the end of diastole is called: - ✔preload Typical stroke volume is about ________ of the volume of the left ventricle. - ✔two- thirds The first phase of the cardiac cycle is: - ✔diastole For a resting potential in a cardiac cell to exist, there must be a: - ✔adequate number of potassium ions inside the cell and sodium ions outside the cell. The proportion of the left ventricular volume that is pumped out of the heart during systole is the: - ✔ejection fraction Beta-blockers generally have what effect? - ✔Decreased myocardial contractility What will occur with an increase in peripheral vascular resistance? - ✔Decreased stroke volume If the stroke volume decreased, what would occur to maintain the blood pressure at its current value? - ✔Increased heart rate and increased peripheral vascular resistance You have administered a drug with potent beta-1 effects. What effect should you most anticipate? - ✔Increased heart rate You have administered a medication to a patient, resulting in a decreased speed of cardiac impulse conduction. This drug is most accurately described as having a ________ effect. - ✔negative dromotropic Which endocrine substances acts as a marker for congestive heart failure? - ✔BNP The total duration of ventricular depolarization is represented by the ________ on the ECG. - ✔QT interval Name some symptoms of right-sided heart failure - ✔JVD Peripheral edema Liver and spleen engorgement The anterior surface of the heart is best viewed by ECG leads: - ✔V1-V4 While monitoring a patient's cardiac rhythm, you note that there is no electrical activity after a PQRST complex for a period equal to exactly three of the previous R-R intervals. This is most accurately described as: - ✔sinus block The difference between apical and peripheral pulse rates that results from decreased cardiac output when the atria fail to contract is known as: - ✔pulse deficit Elastic and smooth muscle fibers are primarily found in the tunica ________ of blood vessels. - ✔media ________ is a drop in systolic blood pressure of more than 10 mmHg with inspiration. - ✔Pulsus paradoxus Measures to treat cardiogenic shock include: - ✔Increasing the contractile force Improving preload Reducing peripheral resistance Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock include all of the following: - ✔Tachypnea Altered mental status Cold, diaphoretic skin The heart sound produced by the closing of the aortic and pulmonary valves is: - ✔S2 The most common cause of death resulting from myocardial infarction is: - ✔dysrhythmia A junctional escape beat occurs when: - ✔the rate of the SA node is slower than that of the AV node Release of acetylcholine at the neuroeffector junction would result in a(n): - ✔negative chronotropic effect Myocardial ischemia may result in: - ✔ST segment depression Auscultation of an S3 is associated with: - ✔congestive heart failure Excessive preload over time would lead to: - ✔weakening of the left ventricle The base of the heart lies at the level of the ________ rib. - ✔Second What occurs during depolarization of a cardiac cell? - ✔The cell becomes more positively charged Poiseuille's law specifically states that blood flow through a vessel is directly proportional to the ________ of the vessel's radius. - ✔Fourth power Your patient in atrial fibrillation has a heart rate of 108 on the monitor, but her radial pulse is 88. The patient is experiencing: - ✔pulse deficit The amount of resistance that must be overcome by the left ventricle during systole is called: - ✔Afterload Signs and/or symptoms of a dissecting thoracic aneurysm include: - ✔Difficulty breathing Chest pain Hypotension The QRS complex represents: - ✔Ventricular depolarization Give the formula for blood pressure - ✔Stroke volume × heart rate × systemic vascular resistance Name 3 rhythms that cardioversion can treat - ✔Supraventricular tachycardia Ventricular tachycardia with a pulse Rapid atrial fibrillation Common chief complaints and symptoms associated with cardiac disease include: - ✔Chest pain Syncope Dyspnea The lead to the left of the sternum at the fourth intercostal space is: - ✔V2 Palpate Percuss Auscultate Heart sound S2 may be heard at the end of systole by auscultating over the ________ intercostal space. - ✔Second The fourth heart sound, S4, is: - ✔an atrial gallop sound Skin color is best evaluated by observing the: - ✔Nail beds and conjunctiva Cyanosis is caused by increased: - ✔Deoxyhemoglobin What sound is produced when the tricuspid and mitral valves close during systole? - ✔S1 For you to assess for jugular venous distention, your patient should be ________ at a ________-degree angle. - ✔Sitting,45 The sounds auscultated when assessing the blood pressure are the ________ sounds. - ✔Korotkoff The difference between systolic and diastolic blood pressures - ✔Pulse pressure During the cardiac cycle, the S2 heart sound indicates the ________ of the ________ valves. - ✔Closing Aortic and pulmonic During ventricular systole, the ventricles contract while the: - ✔tricuspid and mitral valves close The valve between the right atrium and right ventricle is the ________ valve. - ✔Tricuspid Blood entering the left atrium arrives via the: - ✔Pulmonary vein The mitral valve is open during: - ✔Diastole What is the correct sequence of cardiac electrical activity? - ✔SA node Internodal pathways AV node Bundle of His Bundle branches Purkinje fibers On a properly calibrated ECG machine, 1 mV is equivalent to a height of ________ boxes. - ✔10 small A 12-lead ECG that reveals ST elevation in all of the precordial leads most indicates myocardial: - ✔injury to the right ventricle, left ventricle, and septum An action potential begins in a myocardial cell when ________ enters the cell, giving it a ________ charge. - ✔Sodium Positive Which artery supplies blood primarily to the left ventricle and posterior wall? - ✔Left coronary The middle tissue layer of the heart is the: - ✔Myocardium The ability of a cardiac cell to propagate the electrical impulse to another cell - ✔Conductivity The right atrium, right ventricle, and part of the left ventricle are supplied by the: - ✔right coronary artery A loud S3 heart sound, when heard in older adults, often signifies: - ✔Heart failure The volume of blood that the atria contract to the ventricles - ✔Atrial kick Depolarization, the process by which muscle fibers are stimulated to contract, occurs when: - ✔cell wall permeability changes and sodium rushes into the cell Paroxysmal nocturnal dyspnea is defined as: - ✔acute shortness of breath that suddenly awakens a person from sleep What condition could cause the blood pressure to vary between the left and right arm? - ✔Aortic aneurysm Unstable angina often ________ - ✔Awakes people from their sleep A prolonged QT interval indicates that the heart: - ✔is experiencing an extended refractory period, making the ventricles more vulnerable to dysrhythmias Cardiac tamponade can be differentiated from a tension pneumothorax by the presence of: - ✔Equal breath sounds Which of the following meds helps the body transport sugar into the cells? - ✔Insulin A 32 year old patient is found unconsious in the snow. You cannot detect a pulse or respiration rate within 10 seconds. What should you do? - ✔assess her pulse for 30-45 seconds An adult male is sitting alone in a dark room, rocking back and forth. he mutters to his sock puppet "are you feeling sad?" what should you do? - ✔introduce yourself and start an assessment a 42-year-old man complains of difficulty breathing and pain in his chest and shoulders. he recalls feeling a sharp pinprick on his arm while cleaning out his basem*nt. what type of spider bite is this man most likely suffering from? - ✔black widow a car battery exploded in your patients face. he denies breathing difficulty. you should? - ✔begin irrigating eyes with clean water a 19 year old female is unresponsive after taking a whole bottle of her sleeping medicine about 4 hours ago. you sould? - ✔apply high-flow oxygen a 32 year old male complains of photophobia (sensitivity to light) and vomiting. the most likely cause is? - ✔migrane a 68 year old patient reports abdominal pain, vomiting and a loss of appetite, as well as black, tarry stools what should you expect? - ✔upper GI bleeding a 21 year old male is unresponsive, has constricted pupils, slow, shallow respirations, you should suspect: - ✔narcotic overdose a patient tells you he had anemia, you should expect him to present with? - ✔jaundice your epileptic patient complains of persistent metallic taste in her mouth. you should suspect: - ✔a seizure may occur patient is having a tonic-clonic seizure and is not breathing. you should: - ✔prevent patient from further injury an 18 year old male states "the CIA is after me" you notice he has covered his head and windows with aluminum foil. when you ask why he says "in order to block out the government radio waves" vitals are BP138/34, P122, R24. you should suspect? - ✔paranoid schizophrenia a patient is running a high fever, vomiting and reporting pain that has shifted from around her belly button to the lower right area of her abdomen you should suspect? - ✔appendicitis 72 year old female has slurred speech and left arm weakness prior to EMS arriving. what do you think happened - ✔transient ishemic attack middle aged patient outside a homeless shelter. coughs up pink sputum and passes out - ✔don a N95 respirator prior to continuing assessment a 42 year old female states she is "having the worst headache of my life". vomiting. BP180/90, P68, R14 what should you suspect? - ✔migraine 5 employees feel "light-headed". they have respiratory problems after working in a packing company. - ✔toxic substance exposure charicteristics of transient ischemic attack - ✔it resolves within 24 hours strongly indicates syncope - ✔blacked out for a few seconds patient has DKA and is now unconscious and breathing deeply. what should you suspect? - ✔hyperglycemia when treating a patient with altered behavior - ✔consider any possible medical causes elderly patient has been drinking all afternoon. en route to the hospital he has become confused and slow to respond to questions - ✔check blood glucose levels a 15 year old soccer player is hot, pale and semiconscious. what should you do? - ✔remove patient from hot environment stung by a bee - ✔*apply ice cold compress to area there is an unresponsive medical patient. what is the primary focus? - ✔*chief complaint a 23 year old female complains of fever, muscle aches, and congestion, is pale; BP94/60, P120, R24. roommate feels the same - ✔influenza patient is at a fertilizer plant and spilled lye all over their body - ✔brush off power and irrigate to assess possible stroke patient for abnormal speech - ✔ask patient to repeat a common phrase a 40 year old unconscious patient was working in 90F weather for the last 5 hours - ✔move patient to a cool environment, remove clothing give a cold pack, and give oxygen elderly patient is malnourished and wearing inadequate clothes for the current temperature. they are lying on soiled bedding and has a strong smell of urine all over the house. caregiver daughters says mother refused to get out of bed most days. won't do housekeeping, and not taking medication - ✔report suspicion of neglect to medical director and local abuse agency when administering epinephrine auto-injector - ✔firmly apply injection to thigh for ten seconds virus and bacteria can be classified as - ✔pathogens seeing and hearing things not present. which type of drug? - ✔hallucinogen Cincinnati prehospital stroke scales assess for - ✔facial droop employee was cleaning the bathroom and came out gagging and coughing. eyes are red and watering. has dyspnea - ✔move patient to well ventilated area signs of hypoglycemia - ✔cold, clammy skin When assessing for arm drift you should ask the patient to? - ✔hold arms out with palms out and eyes closed a 46 year old male has a sudden onset of left sided weakness and slurred speech. BP188/92, P58, R12. what should you suspect - ✔transient ischemic stroke contraindication of administration of oral glucose - ✔unconsciousness a 38 year old has a history of hypothyroidism. is hypertensive, tachycardia, hyperthermic, and there is an empty bottle of synthroid nearby what should you do? - ✔contact poison counter or medical command a 87 year old has a productive cough over the past three days and confusion over the past day. there is rhonci and wheezing in the right lung. BP116/92, P92, R24 and temperature is 101F. what should you suspect? - ✔pneumonia 50 year old male that went through renal dialysis and is bleeding profusely from the shunt. you should classify the bleeding as? - ✔life threatening that requires immediate surgical intervention an alert 56 year old female has severe headache and weakness in the left arm. BP188/92, P106, R14 - ✔stroke a 72 year old male has weak hand grips, blurred vision, and unable to tell what day it is he has type II diabetes - ✔*evaluate facial droop patient has a bee allergy, was stung and says their throat is itchy. lips are swelling, patient has a EpiPen. what should you do? - ✔Assist with EpiPen assessment findings that suggest a gastrointestinal GI bleed would be - ✔*bright red blood from the rectal area a 35 year old patient has fallen and has a deformed right lower leg. The distal extremity is pulsless and the skin is cool and cyanotic. You should - ✔Realign the injured extremity Pt is bruising around the eyes and behind ears. What should you suspect? - ✔Brasilar skull fracture 24 yo F is unconscious after being struck by a car. She has ineffective breathing and bloody secretions in mouth. You should? - ✔Immediate suction oropharynx 53 yo F hit by car. Unresponsive w/ deformity to the left femur and pelvic instability. Diminished lung sounds on L side. You should? - ✔Immobilize long backboard 28 yo M, blunt trauma to R anterior chest. Pale, cool, diaphoretic and responsive to verbal. R 38 and shallow with paradoxical movement. What should you do? - ✔02 with positive pressure ventilations What is the most likely cause of periorbital echymosis? - ✔Basilar skull fracture 30 yo M shot in mid thigh. Bleeding continues after partner applies direct pressure. You should? - ✔Tourniquet 28 yo PT driver motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. Most appropriate? - ✔Jaw thrust without head tilt M fell while water skiing. Unconscious. Suspect? - ✔Head and spine injury Appropriate care for amputated extremity? - ✔Wrap in dry gauze, seal in plastic bag, and place in cool water 28 yo pt driving motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. Most appropriate? - ✔Control bleeding Pt was stabbed in chest and knife was removed prior to arrival. You notice blood and bubbles leaking from the wound. You cannot find occlusive dressing. You should? - ✔Cover wound with plastic wrapper sealed on 3 sides Chest wound, crackling sensation produced by air blowing into surrounding tissues is called subcutaneous ______? - ✔Emphysema 40 yo M crashed snowmobile, skin cold and pale, BP 198/96, P 48, respiration is slow and irregular. What should you suspect? - ✔Traumatic Brain Injury Arrive at motor vehicle collision, pt extricated herself from vehicle and is walking around complaining of neck pain. You should? - ✔Immobilize on a backboard 42 yo M has metal impaled in lower right leg. Obvious open fracture and no pulse in R foot, what should you do? - ✔Stabilize with bulky dressing prior to transport 16 yo M complains of extreme pain to chest. You notice his shirt is splashed with battery acid. BP 150/100, P weak, R 24. You should? - ✔Remove shirt and flush with saline water 38 yo M large bruise LUQ, following motorcycle collision. What should you suspect? - ✔Injury to spleen Unresponsive 18 yo F supine, bleeding in mouth from the nose, R20. What should you do? - ✔Suction oropharynx Snowmobile rider is thrown 15 ft from vehicle. His finger is deformed and sternum is tender to palpation. Pt states "I think I'll be okay" and refuses trans. What should you do? - ✔Ask if you're able to assess the pt Treating abdominal evisceration - ✔Cover with moist sterile dressing 30 yo F was in minor motor vehicle accident. She is standing outside of the vehicle and complains of lower back pain. You should immobilize her using a? - ✔Long spine board 23 yo M received burns to feet while stomping fire. He is still wearing the shoes. The rubber soles and laces melted together. What do you do? - ✔Cut shoe laces and remove shoes 40 yo M fell off ladder has a broken leg, and the left knee now bends the wrong way. You should? - ✔Check for PMS in the leg 24 yo M has burns to the eyes, nose and mouth when the radiator cap on his car blew off. Treat for? - ✔Respiratory swelling Patient was found dead at the scene. GCS scale? - ✔3 22 yo M is ejected from the vehicle. He complains of numbness and tingling in his extremities. What should you do? - ✔Stabilize cervical spine Appropriate management for an avulsion of the ear - ✔Bandage in correct anatomical position 32 yo M has sustained facial trauma after falling off the roof. He has snoring respirations. What should you do? - ✔Modified jaw thrust 4 yo M, arm amputated from farming accident, how should you manage the amputated limb? - ✔Seal in plastic bag and place in container of cool water Adult was pinned between 2 vehicles. Pt is conscious but confused and unable to follow directions. Has bruising on both sides of anterior chest, weak carotid pulse, no peripheral pulse, clear breath sounds, distended neck vein. What should you suspect? - ✔Pericardial tamponade 59 yo M is trapped in the car by broken gas pedal through his foot. He's gone into cardiac arrest. You should - ✔Pull out of car Knife impaled at 4th intercostal space, left sternal border, pulseless and not breathing. You should? - ✔Remove knife from chest Pt is bleeding profusely from scalp. You should? - ✔apply direct pressure with sterile gauze Pt with JVD, muffled heart sounds, clear breath sounds. You should suspect: - ✔Pericardial tamponade Pt suffering from most severe brain injury - ✔Unconscious 34 yo with decerebrate posture Cause of bilateral periorbital ecchymosis - ✔Basilar skull fracture Pt with 4in stick in their eye. You should? - ✔Stabilize with gauze, place paper cup over affected eye, put dressing over the unaffected eye Pt with severe steam burns to the hand and wrist. You should? - ✔Remove the watch 62 yo M is unresponsive next to a ladder. BP 80/48, P 60, R 24. What should you suspect? - ✔Neurogenic shock Pt with several wounds oozing blood. After scene size up, you should? - ✔Ensure adequate airway Pt with diminished breath sounds on one side. Chest rise is unequal. You should suspect? - ✔Pneumothorax 18 yo M fell off skateboard. He struck his head on the concrete and immediately started screaming. Alert and oriented to name only. You should? - ✔Immobilize and expedited transport 25 yo assault victim is spitting up light pink sputum. Has bright red blood spurting from 2in laceration to L forearm. What should you do? - ✔Apply direct pressure to wound An early indicator of shock indicates? - ✔Tachycardia Patient has a 3 cm laceration above his left eye. It is bleeding profusely you should? - ✔Apply several 4x4 dressing to the wound using pressure to hold An altered 24 yr M. stabbed in the abdomen. Sitting, holding contents and complaining of dizziness. He does not want to be touched. Vitals BP 70/40, P 120, R 20 you should? - ✔Lay him down and apply a moist dressing A 2 year old female is lethargic to respond. She has dry mucous membranes and a tearless cry. What should you suspect? - ✔hypovolemia You have just delivered a baby girl who remains cyanotic and is not responding to stimulation and oxygen therapy. Heart rate is 90. You should - ✔Begin positive pressure ventilations A 6 month old is febrile, cyanotic, and grunting with labored breathing. You should? - ✔apply blow by 02 and trans Before assessing the respiratory adequacy of an unconscious infant or child, you should - ✔Ensure the airway is patent and clear of obstructions Febrile seizures in children are most often the result of a/an - ✔Abrupt rise in body temp A 4 year old patient has sustained blunt trauma to the chest. Based on the MOI you should suspect - ✔Minimal external signs with serious internal injury 7 year old presents with a pencil in his left cheek, you should? - ✔check for airway patency 37 week pregnant woman with tearing abdominal pain and weak, vitals are 90/60, 140, and 26 with pale, cool, diaphoretic skin, you should suspect? - ✔abruptio placentae Which may indicate that a fetus was in distress before delivery? - ✔meconium A 2 year old child presents with a fever, lethargy, and screaming upon neck flexion. You should suspect? - ✔Meningitis A conscious child has a significant airway obstruction due to an illness. You should? - ✔give o2 and transport immediately With pediatric patient, your assessment should begin? - ✔At first sight A child is postictal. You should? - ✔ensure open airway Shortly after delivery, a mother experiences dyspnea and becomes hypotensive. No excessive bleeding is noted and the uterus seems firm. You should suspect? - ✔pulmonary embolism Compared to adults in shock, pediatric patients? - ✔Stay in compensated shock longer Pre-eclampsia becomes eclampsia when - ✔A seizure occurs 38 year old female reports left sided abdominal pain that radiates to the back. Vitals are 90/64, 118, 20. You should suspect? - ✔a ruptured ectopic emergency 33 year old female was in a motor vehicle collision. She is 36 weeks pregnant. First responders have removed the patient from the vehicle and immobilized her and they cannot obtain a blood pressure. You should? - ✔tilt the backboard to the left immediately 5 year old is actively seizing, his respirations are slow and skin is pale. His parents say he had seized several times in the last 15 minutes without waking up. You should suspect that the? - ✔child is in status epilepticus and medication is required Nausea, vomiting, vagin*l discharge, irregular periods and abdominal pain are signs and symptoms of? - ✔Pelvic inflammatory disease What effect can excessive traction have on the umbilical cord during placental delivery? - ✔abruptio placenta The cessation of menses with associated decrease of estrogen secretion is called? - ✔Menopause 24 year old female in her second trimester of pregnancy presents with mild contractions. There is no regular pattern to the contractions, and they have not increased in intensity since they began. She denies vagin*l bleeding or any other symptoms. This patient is most likely experiencing? - ✔Braxton Hicks contractions A 20 year old female feels faint and has severe pain between her shoulder blades. Her skin is cool and clammy. Vital signs are BP 82/48, P 134, R 22, and SPO2 92%. What should you suspect? - ✔rupture ectopic pregnancy A woman is 36 weeks pregnant and complaining of painless vagin*l bleeding. The most likely cause is? - ✔placenta previa A 4 year old male is sitting upright and drooling. He has swallowed a marble that is completely blocking his airway. What should you do? - ✔perform abdominal thrusts To relieve pressure on the vena cava when transporting a pregnant patient, you should? - ✔Place on left side A maternal condition that occurs when the placenta separates from the uterine wall and is a cause of pre birth bleeding is? - ✔Abruptio placenta 32 week pregnant female complaining of facial swelling, headache, vomiting, and experiencing visual disturbances last 12 hours. You should suspect? - ✔pre eclampsia 35 week pregnant woman. Following scenarios most life threatening? - ✔Hypertension and experiencing visual disturbances One sign of respiratory distress in a neonate? - ✔Grunting Assess on infant. Which artery should you take for pulse? - ✔Brachial 50 year old fell from her bicycle after hitting a bump in the road. She is now bleeding from her vagin*. You should - ✔apply external sterile bulky dressing If a patient presents vagin*l bleeding within the first 20 weeks of pregnancy you should suspect? - ✔Spontaneous abortion Placenta previa occurs when the placenta.. - ✔is abnormally positioned Assisting a home birth and baby's head just delivered. You should? - ✔Examine for nuchal Alert & oriented 4 year old patient has possible head injury from a fall. Vitals are P 120, R 18. How should you transport? - ✔Fully immobilize with towel under his scapulae Painless bright red vagin*l bleeding late in the third trimester. You should suspect? - ✔Placenta previa Signs or symptoms of a pre delivery emergency? - ✔Hypertension 24 year old woman presents with vagin*l bleeding following sexual assault, controlling bleeding would best be done by - ✔placing a dressing @ the vagin*l opening A patient is in labor and has a strong urge to push. The baby's head is not yet visible, but the umbilical cord is protruding, you should? - ✔place her in knee-chest position and transport A pale 2 year old male turns his face away and hides when you approach. Vital signs are P 150 R 32 with audible wheezing what should you be most concerned about? - ✔skin color Which signs and symptoms most suggest pre eclampsia? - ✔Hypertension and excessive water retention The period of time during which intrauterine fetal development occurs is called? - ✔gestation gestation - ✔uterine rupture 2 year old patient has a respiratory rate of 30 breaths per minute. This is considered? - ✔normal