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EMT Basic Final Exam Study Guide - Google Docs

Full course final exam review/study guide
Course

Emergency Medical Technician (EMS 1150)

39 Documents
Students shared 39 documents in this course
Academic year: 2019/2020
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Sinclair Community College

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EMT Basic Final Exam Study Guide

Key Terms

Embolism- obstruction of an artery Edema- fluid buildup; swelling PMS- pulse, motor, sensory Ischemia- inadequate blood supply to a part of the body Hematoma- collection of blood outside of a blood vessel Aneurysm- localized enlargement of an artery caused by a weakening in the artery wall Dilation- opening Dyspnea- labored breathing Syncope- temporary loss of consciousness, or fainting Incontinence- lack of voluntary control over urination or defecation

EMS Systems

Most states have four training and licensure levels: -EMR (Emergency Medical Responders) -EMT (Emergency Medical Technicians) -AEMT (Advanced EMT) -has training in ALS (advanced life support) including: -IV therapy (Intravenous) -administration of certain emergency medications -Paramedic

History of EMS: -Origins include: volunteer ambulances in WW1, field care in WW2, field medic and rapid helicopter evacuation in Korean conflict -EMS as we know it originated in 1966 with the publication of Accidental Death and Disability: The Neglected Disease of Modern Society -DOT (Department of Transportation) published first EMT training curriculum in early 1970s -EMS care is governed and part of the Department of Transportation -National Highway Traffic Safety Administration (NHTSA)

EMS Types: -Anglo-American model (ours) -brings patient to the hospital -Franco-German model (Europe) -brings the hospital to the patient

Levels of training: -Federal level: National EMS Scope of Practice Model provides guidelines for EMS skills -State level: Laws regulate EMS provider operations -Local level: Medical director decides day-to-day limits of EMS personnel -every 3 years resubmit for recertification (40 hours of continuing educ. required)

Public BLS (basic life support): -millions of laypeople are trained in BLS/CPR -teachers, coaches. child care providers

Emergency Medical Responders (EMR): -law enforcement, firefighters, park rangers, ski patrol, etc. -initiate immediate care and assist EMT’s on their arrival -good samaritans trained in first aid and CPR

Emergency Medical Technicians (EMT): -has knowledge and skills to provide basic emergency care -responsibility for assessment -emergency care -package and transport of patient

Advanced Emergency Medical Technicians (AEMT): -adds knowledge and skills in specific aspects of ALS -IV therapy -advanced airway adjuncts -medication administration

Paramedics: -extensive course training -wide range of ALS skills -endotracheal intubation -emergency pharmacology -cardiac monitoring; use of electrocardiogram (EKG)

-Vitals -Field impression -Intervention/Treatment -Trauma Pt -Then take vitals and attempt to get SAMPLE history -Begin secondary assessment -DCAP BTLS -Eyes check for PEARRL -check extremities for PMS (pulse, motor, sensory) -Manage secondary injuries -Reassessment -Stable: every 15 mins. take vitals -Unstable: every 5 mins. take vitals *Key things to remember: PMS before & after immobilization *When backboarding, slide the patient down and then up

  • See Trauma Patients for more details

Airway Management

Key terms -Apneic: no longer breathing -Alveoli: tiny air sacs of the lungs which allow for rapid gaseous exchange -Capillaries: smallest blood vessels -Pleural Cavity: thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung -Visceral pleura- OUTER layer -Parietal pleura- INNER layer -Positive Pressure Ventilation (PPV): process of forcing air into a patient’s lungs (aka artificial ventilation) -Patent airway: open airway

Respiratory assessment -Adequate breathing: -between 12-20 breaths/min -regular pattern -bilateral (both sides) clear and equal lung sounds -equal chest rise and fall -adequate depth (tidal volume)

-Inadequate breathing: -less than 12 breaths/min or greater than 20 breaths/min -irregular rhythm -diminished, absent, or noisy auscultated breath sounds -decreased flow of expired air at nose and mouth -Abnormal breathing: -unequal or inadequate chest expansion -increased effort of breathing -shallow depth -skin that is pale, cool, moist, or cyanotic (discoloration of skin= inadequate oxygenation) - “tripod” position -patient is leaning forward supporting body weight on another surface -Auscultation: listening to breathe sounds with stethoscope

Types of lung sounds -Rhonchi (aka coarse crackles): snoring or rattling noises heard on auscultation; indicate larger conducting airways of the respiratory tract by thick secretions of mucus. Often heard in chronic bronchitis, emphysema, aspiration, and pneumonia -Crackles (aka rales): bubbly or crackling sounds heard during inhalation. Sounds are associated with fluid that has surrounded or filled alveoli or small bronchioles. Indicate pulmonary edema or pneumonia -Wheezing: high-pitched whistling sounds. Head in asthma, emphysema, and chronic bronchitis. Also heard in pneumonia, congestive heart failure, and other conditions that cause bronchoconstriction

-assess the need to use suction -DO NOT suction longer than: -15 seconds on adult -10 seconds on child -5 seconds on infant

Basic Airway Adjuncts: -prevents obstruction by the tongue -allows for passage of air and O2 to the lungs

-OPA (oropharyngeal airway) -Indications: -unresponsive Pt without a gag reflex -apneic Pt being ventilated with a BVM (bag-valve mask) -Contraindications: -conscious Pt or Pt who has an intact gag reflex -select correct size: corner of the mouth to the earlobe -NPA (nasopharyngeal airway) -Indications: -unresponsive Pt or has an altered LOC (level of consciousness) -can be semiconscious -intact gag reflex -unable to maintain their own airway -Pts who will not tolerate an OPA -select correct size: tip of the nose to the earlobe -Contraindications: -severe head injury with blood in the nose -deviated septum -King airway -select correct size: based on Pt’s height -test cuff and inflations system -then remove air; apply lubricant if necessary -inflate cuffs -attach BVM -LMA (laryngeal mask airway)

Bag Valve Mask Ventilation (BVM) -check responsiveness: unresponsive Pt > use BVM -request additional resources if necessary -check breathing and pulse simultaneously -open airway; insert OPA or suction if needed -position mask to achieve and effective seal -ventilate the patient: 30 compression to 2 ventilations ratio -ventilate every 5 to 6 seconds; watching for chest rise & fall -watch for gastric distention (overinflation) -attach O2 if needed (15 L/min) -recheck pulse for no more than 10 seconds

Supplemental Oxygen (O2): -always give to patients who are hypoxic (inadequate oxygen) -never withhold O2 from a patient who might benefit from it - < 94% SpO -suspected shock -signs of poor perfusion -Pt complains of dyspnea (difficult or labored breathing) -normal air: 78% Nitrogen, 21% Oxygen, 1% Other gases

O2 delivery devices -Nonrebreathing masks -preferred way to give O2 (make sure reservoir fills) -adequate breathing but are suspected of having hypoxia -combination mask and reservoir bag system -make sure the reservoir bag is full before placing on Pt -10 to 15 L/min flow -Nasal Cannulas -delivers O2 through two small pubes that fit into the nostrils -1-6 L/min flow -contraindications: breathes through the mouth, has nasal obstruction -Humidification: -some EMS systems provide humidified O2 during long transport

Anatomy of the Respiratory System: -Upper airway -nasopharynx (nasal cavity) -oropharynx (mouth) -pharynx (throat) -laryngopharynx -epiglottis (flap that prevents from entering respiratory tract) -esophagus (food and water routed to the stomach) -larynx (vocal cords) -cricoid cartilage: only completely circular cartilaginous ring of the upper airway -Lower airway (starts at lower edge of larnyx and moves down) -esophagus (tube for food) -trachea (windpipe) -major bronchi -right and left mainstem bronchi branch into: -bronchioles: composed of smooth muscle and lined with mucous membranes -terminate into millions of tiny air sacs called alveoli (site for gas exchange) -Diaphragm -muscle that separates the chest cavity from the abdominal cavity

-Intercostal muscles -muscles between ribs that contract to aid inhalation

-Vital Capacity -amount of air that can be forcefully expelled from the lungs after breathing deeply -Residual Volume -air that remains in the lungs after forceful expiration -aids in CPR -Exhalation -passive process; diaphragm and intercostal muscles relax -does not normally require muscular effort -diaphragm and intercostal muscles relax

-Regulation of ventilation is primarily by the pH of cerebrospinal fluid -directly related to the amount of CO2 in the plasma -mechanism changes in patients with COPD -(Chronic Pulmonary Obstructive Disease) -have trouble eliminating CO2 through exhalation -body detects amount of O2 in blood as opposed to amount of CO -Oxygenation -process of loading O2 molecules onto hemoglobin molecules in bloodstream -Respiration -cells take energy from nutrients through metabolism -O2 is required for internal respiration to take place -exchange of O2 and CO2 in the alveoli and tissues of the body -External respiration -exchanges O2 and CO2 between alveoli and blood in pulmonary capillaries -surfactant- keeps alveoli expanded (“body soap”) -Internal respiration -exchanges O2 and CO -between systemic circulatory system and cells -aerobic metabolism (metabolism with oxygen) -produces energy (ATP) from glucose and O -Chemoreceptors monitor levels of: -O2, CO2, Hydrogen ions, CSF pH (cerebrospinal fluid)

-Ventilation/perfusion ratio -ventilation and perfusion must be matched -aka “V/Q ratio” - “V” - ventilation- air which reaches the alveoli - “Q” - perfusion- the blood which reaches the alveoli -V/Q mismatch -factors affecting pulmonary ventilation -Intrinsic factors: -ex. Infections, allergic reaction, unresponsiveness -Extrinsic factors: -ex. Trauma, foreign body airway obstruction -External factors: -ex. Low atmospheric pressure at high altitudes, poisonous environment, CO (carbon monoxide exposure) -Internal factors: -ex. Pneumonia, COPD -Circulatory compromise: -ex. Trauma emergencies -Pulmonary embolism -Tension pneumothorax -Open pneumothorax -Hemothorax (accumulation of blood in pleural cavity) -Hemopneumothorax -others include: blood loss, anemia, shock

-Pneumothorax (collapsed lung) -tall, thin men between ages of 20 and 40 are most common - “Tension” -air enters pleural space but does not exit, which increases pressure - “Open” -unsealed opening in chest wall - “Hemopneumothorax” -having both air and blood in the chest cavity - “Spontaneous” -caused by structural weakness (can rupture spontaneously)

Hypoxia -inadequacy in the amount of oxygen being delivered to the cells -Cyanosis: bluish gray color of skin; around lips, mouth, nose, fingernail beds, conjunctiva (bottom of eyelid) -late sign of hypoxia -lack of O2 causes a cell to shift from aerobic (with O2) to anaerobic (without O2) Metabolism. Aerobic takes a glucose molecule and breaks it down in the presence of oxygen, yielding the large amount of ATP. Anaerobic results in a drastically lower production of ATP and the creation of lactic acid as a byproduct -energy is needed to maintain the function of a cell’s sodium/potassium pump. If the pump fails, sodium is no longer removed from the cell in exchange for potassium. Potassium and lactic acid leave the cell and begin to collect in the interstitial fluid and eventually enter the blood. The sodium collects inside the cell and attracts water. As a result, the cell swells and eventually ruptures and dies.

Acute pulmonary edema -fluid builds up within alveoli and in lung tissue -heart muscle can’t circulate blood properly -usually result of congestive heart failure

Chronic Obstructed Pulmonary Disease (COPD) -slow process of dilation and disruption of airways and alveoli -common cause > cigarette smoking -Chronic Bronchitis: -inflammation of the lining of the bronchioles -cilia reduction; excess mucus forms -productive cough -coarse crackles -Emphysema: lung condition that causes shortness of breath (type of COPD) -damage to the alveoli in lungs -promotes retention of stale air with increased CO2 levels in lungs -unproductive cough -wheezing or rhonchi - “wet lungs” vs “dry lungs” - “wet lungs” > pulmonary edema - “dry lungs” > COPD

Pleural effusion -collection of fluid outside the lung -compresses the lung and causes dyspnea (difficulty breathing) -can stem from infection, congestive heart failure, cancer

Pulmonary embolism -passage of blood clot formed in vein into pulmonary artery -circulation cut off partially or completely -significant decreased blood flow

Hyperventilation -overbreathing to point that arterial CO2 falls below normal -Acidosis: buildup of excess acid in blood or tissues -Alkalosis: buildup of excess base in body

Carbon monoxide -displaces O2 from the hemoglobin of red blood cells

Bacterial and Viral Respiratory Infections -Tuberculosis (TB) -MRSA

Asthma -assist Pt with prescribed inhaler (Albuterol)

Pneumothorax - see Physiology of Breathing

Cardiovascular emergencies

-can assist with placing 12 leads (EKG) but cannot interpret (paramedics only)

Key terms -Arteriosclerosis: thickening and hardening of the walls of the arteries, typically with old age -Resuscitation- emergency care process that attempts to restore lost vital functions. Focuses on managing airway, oxygenation ,ventilation, and circulation

Other -Arrhythmias: heart rhythm abnormalities -Ventricular tachycardia: type of regular fast HR from improper electrical activity in the ventricles of the heart -Ventricular fibrillation: heart quivers instead of pumping due to disorganized electrical activity in the ventricles -defibrillation restores cardiac rhythms -Tachycardia: high HR -Bradycardia: low HR -Asystole: no heart electrical activity -reflects a long period of ischemia (nearly all Pts die) -Pacemakers -can malfunction and cause excessively slow heart rate -when using an AED be sure not to place an adhesive pad directly over the pacemaker Automatic Implantable Cardiac Defibrillators (AICD) -monitor heart rhythm and shock as needed -shock will not affect responders -when AED is used do not place patches directly over pacemaker

Cardiogenic shock - see Shock Types

Congestive Heart Failure -often occurs a few days following a heart attack -increased HR and enlargement of left ventricle no longer make up for decreased heart Function

Hypertensive emergency -systolic pressure greater than 160 -S/s: severe headache, strong bounding pulse, N/V, dizziness, warm skin, ALS, pulmonary edema -if left untreated can lead to: -stroke -dissecting aortic aneurysm -transport quickly

Aortic aneurysm -weakness in the wall of the aorta -susceptible to rupture -Dissecting aneurysm: occurs when inner layers of aorta become separated -primary cause is uncontrolled HTN (hypertension) -S/s: -very sudden chest pain; comes on full force -different BPs -transport quickly

Cardiac arrest -complete cessation of cardiac activity (absence of a carotid pulse) -CPR (cardiopulmonary resuscitation) -try not to interrupt CPR -deliver compressions at 100-120/min -30 compressions to 2 ventilations -do five cycles of CPR before attaching AED -once you begin CPR continue until STOP acronym -PT S tarts breathing and has a pulse -PT is T ransferred to another trained responder -You are O ut of strength - P hysician directs to discontinue -attach AED -analyzes electrical signals from heart -identifies ventricular fibrillation -administers shock when needed; clear patient -resume CPR immediately after shock

Chest pain (angina pectoris) -give Aspirin: -prevents clots from forming or getting bigger -dosage 81-324 mg (1 to 4 tablets)

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EMT Basic Final Exam Study Guide - Google Docs

Course: Emergency Medical Technician (EMS 1150)

39 Documents
Students shared 39 documents in this course

University: Sinclair Community College

Was this document helpful?
EMT Basic Final Exam Study Guide
Key Terms
Embolism- obstruction of an artery
Edema- fluid buildup; swelling
PMS- pulse, motor, sensory
Ischemia- inadequate blood supply to a part of the body
Hematoma- collection of blood outside of a blood vessel
Aneurysm- localized enlargement of an artery caused by a weakening in the artery wall
Dilation- opening
Dyspnea- labored breathing
Syncope- temporary loss of consciousness, or fainting
Incontinence- lack of voluntary control over urination or defecation
EMS Systems
Most states have four training and licensure levels:
-EMR (Emergency Medical Responders)
-EMT (Emergency Medical Technicians)
-AEMT (Advanced EMT)
-has training in ALS (advanced life support) including:
-IV therapy (Intravenous)
-administration of certain emergency medications
-Paramedic
History of EMS:
-Origins include: volunteer ambulances in WW1, field care in WW2, field medic and
rapid helicopter evacuation in Korean conflict
-EMS as we know it originated in 1966 with the publication of Accidental Death and
Disability: The Neglected Disease of Modern Society
-DOT (Department of Transportation) published first EMT training curriculum in early
1970s
-EMS care is governed and part of the Department of Transportation
-National Highway Traffic Safety Administration (NHTSA)

Students also viewed

Related documents