EMT FISDAP READINESS TEST BANK

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

Time frame that starts at the patient contact by EMS and ends with definitive therapy of catheter passing through lesion of coronary vessel. - ✔EMS-to-Balloon-Time Time from patient entering ED to catheter passing through lesion of coronary vessel. ✔Door-to-balloon-time Time from patient entering ED to fibrinolytic therapy administration. - ✔Door-to-needletime Time frame for door-to-balloon - ✔<90mins Time frame for door-to-needle - ✔<30mins Principle symptom of Coronary Artery Disease or Acute Coronary Syndrome that occurs when supply of O2 is to the myocardium is insufficient to meet demand and cells become ischemic? - ✔Angina Pectoris Chest pain that occurs at rest and is caused by coronary artery vasospasm? Risk for Dysrhythmia, MI, Heart Block and Death - ✔Prinzmetal Angina (PA) Which electrolyte flows into cardiac cells to initiate depolarization? - ✔Sodium (Na+) Which electrolyte flows out of cardiac cells to to initiate repolarization? - ✔Potassium (K+) Which electrolyte plays a major role in depolarization of pacemaker cells to maintain depolarization and myocardial contractility? - ✔Calcium (Ca++) Which electrolyte stabilizes cell membrane and acts in concert with K+ and opposes actions of Ca++? - ✔Magnesium (Mg++) Hypokalemia results in? - ✔increased myocardial irritability Hyperkalemia results in? - ✔decreased automaticity/conduction Hypocalcemia results in? - ✔decreased contractility and increased irritability Hypercalcemia results in? - ✔Increased contractility Hypomagnesemia results in? - ✔decreased conduction Hypermagnesemia results in? - ✔increased myocardial irritability

Four properties of the Cardiac Conduction System - ✔Excitability - cells respond to electrical impulse Conductivity - cells pass impulse to one another Automaticity - hearts ability to generate its own electrical impulse Contractility - hearts ability to contract when stimulated Affects of RCA occlusion in terms of the SA node ischemia? - ✔SA node becomes ischemic = slower firing rate (<60-100) or cease fire completely causing another automaticity foci to take over such as AV (40-60) or Purkinje (20-40).

Which electrolytes are responsible for depolarization? - ✔Sodium and Calcium influx Which electrolyte is responsible for repolarization? - ✔Potassium outflow Indications for CPAP (5) - ✔Alert and able to follow commands Moderate to Severe Respiratory Distress Hyperventilation SpO2 <90% Systolic >90mmHg Contraindications for CPAP (8) - ✔Respiratory Arrest Hypoventilation ALOC Chest Trauma/Pneumo Tracheostomy GI bleed or Vomiting Inability to fit CPAP Excessive Facial Hair/Dysmorphic features During what phase of circulation do coronary arteries receive blood? - ✔Diastolic Coronary circulation begins from aorta at the? - ✔Right and Left Coronary Arteries The right coronary artery has how many branches and supplies blood to where? - ✔9 Right Atrium, SA/AV node, and Right Ventricle Inferior Left Ventricle Left Coronary Artery is the largest and shortest coronary vessel. It divides into what and supplies blood to where? - ✔Left Anterior Descending and Circumflex Coronary arteries.

Left Ventricle, Septum, and at times the AV node and atria.

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 cockpit 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

medical alert bracelet that states she is a diabetic and is allergic to sulfa drugs. You should be MOST suspicious for: - ✔Heat stroke.

-classic heat stroke commonly affects children and older adults, and typically occurs when the patient is in a hot, poorly ventilated space for a prolonged period of time.

Signs of narcotic (opiate) overdose - ✔altered mental status; slow, shallow breathing; pupillary constriction (miosis), hypotension; and bradycardia.

-Narcotics are central nervous system depressants that, when taken in excess, suppress the vital functions necessary for life, such as breathing, heart rate, and blood pressure.

S/S of methamphetamine overdose - ✔Increased heart rate and blood pressure, pupillary dilation, agitation and hyperthermia.

Your FIRST action in managing a patient with an altered mental status should be to: ✔Determine if the patient is breathing adequately.

-When treating a patient with an altered mental status, you must first ensure a patent airway and determine if the patient is breathing adequately. If the patient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breathing adequately (ie, fast or slow rate, shallow breathing [reduced tidal volume]), assist his or her ventilations.

Propoxyphene (Darvon) is categorized as which type of drug? - ✔Propoxyphene (Darvon) is in the narcotic (opiate) class of drugs. Other narcotics include heroin, morphine, codeine, and meperidine (Demerol).

Which of the following structures is responsible for regulating body temperature? ✔Hypothalamus.

-The hypothalamus, which is located within the brain stem, regulates body temperature by acting as the body's thermostat. During a heat-related emergency, the hypothalamus can "reset" the body's normal temperature to a much higher temperature in response to the environment and the body's inability to eliminate heat.

When insulin levels in the blood remain high: - ✔Glucose is rapidly taken out of the blood to fuel the cells -Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream.

If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock What is insulin shock? - ✔If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock

What happens when insulin levels are too low? - ✔if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia) What happens in the absence of glucose? - ✔the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing (Kussmaul respirations) that is accompanied by a fruity or acetone breath odor.

What does hyperglycemia cause? - ✔It causes the patient to eliminate excess water from the body through urination *(diuresis)*, resulting in dehydration What accompanies insulin shock (hypoglycemic crisis) - ✔Presents with cool, clammy skin and a rapid onset.

What is a diabetic coma? - ✔Hyperglycemic crisis, typically presents with warm, dry skin and a slow onset, sometimes over a period of days What are the signs of CNS depressants? - ✔Like benzos (sedative-hypnotic) they include a decreased level of consciousness, hypoventilation, bradycardia, and hypotension.

What are sympathomimetic drugs? - ✔They mimic the effects of the sympathetic (fight or flight) nervous system; therefore, restlessness or hyperactivity, hypertension, tachycardia, and pupillary dilation.

What formula is used to calculate a patient's weight into kilograms? - ✔-Weight (in pounds)/2.2= weight in kg -(weight in pounds)/2 then minus 10% of the kg and round to the nearest tenth.

Which of the following signs or symptoms is MOST suggestive of a systemic reaction following ingestion of a poison? - ✔Tachycardia and hypotension.

-Once an ingested poison gets into the body, it can affect multiple organ systems. Signs that this is occurring include tachycardia or bradycardia, hypotension or hypertension, weakness, restlessness, and an altered level of consciousness, among others.

What are local effects of ingested poison? - ✔nausea and vomiting as the poison irritates the gastric lining, burns in and around the mouth, and painful or difficult swallowing (dysphagia).

A 73-year-old male presents with confusion; cool, pale, clammy skin; absent radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells you that he has had abdominal pain for a week and began vomiting a coffee-ground substance yesterday. His past medical history includes hypertension and gastric ulcer disease.

Your MOST immediate concern should be that: - ✔The patient is likely bleeding from his

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

experiencing breathing difficulty. You should: - ✔remove him from the mechanical ventilator and ventilate him manually.

-If a ventilator-dependent patient experiences a sudden onset of respiratory distress, you should first remove him or her from the mechanical ventilator and begin manual ventilation with a bag-valve-mask device; attach the bag directly to the tracheostomy tube Assessment and treatment of a patient with severe abdominal pain should include: ✔Patients with severe abdominal pain should be given supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and immediate transport. Most patients with abdominal pain prefer to lie on their side with their knees drawn up into their chest (fetal position), which takes pressure off the abdominal musculature and often affords them some relief.

Hypoxia-induced unresponsiveness during a submersion injury is usually the result of ✔Laryngospasm -When a patient falls into the water or becomes panicked when in the water, he or she begins to swallow large amounts of water. Even a small amount of water near the larynx can cause a spasm, which closes off the airway. This results in hypoxia, loss of consciousness, and cardiac dysrhythmias.

Which of the following statements regarding heatstroke is correct? - ✔Not all patients experiencing heatstroke have dry skin.

What is heat stroke? - ✔Heatstroke occurs when the body is exposed to more heat than it can eliminate and normal mechanisms for eliminating heat, such as sweating, are overwhelmed. The core body temperature then rises rapidly to the point where tissues are destroyed. Heatstroke can develop in patients during prolonged vigorous physical activity or when they are in a closed, poorly ventilated, hot and humid space. High humidity impairs a person's ability to eliminate heat via the sweating mechanism.

What are the S/S of a heatstroke? - ✔Many patients with heatstroke have hot, dry, flushed skin; however, early in the course of heatstroke, the skin may be moist due to residual perspiration, as with exertional heatstroke. As the core body temperature rises, the patient's level of consciousness decreases. Untreated heatstroke will result in death.

A 34-year-old female complains of persistent fever, fatigue, and night sweats. During your assessment, you note that she has purple blotches on her arms and legs. She MOST likely has: - ✔HIV/AIDS -Signs of human immunodeficiency virus (HIV) infection include persistent fever, weight loss, fatigue, a cough, and night sweats. The presence of purple skin blotches (malignant lesions called Kaposi's sarcoma) is consistent with acquired immunodeficiency syndrome (AIDS), also known as late-stage HIV infection

What are the S/S of tuberculosis? - ✔Patients with tuberculosis (TB) also present with fever, fatigue, weight loss, a cough, and night sweats; however, skin lesions are not common.

Which of the following statements regarding lightning-related injuries is correct? - ✔The cardiovascular and nervous systems are most commonly injured during a lightning strike.

-The cardiovascular and nervous systems are most commonly injured during a lightning strike; therefore, respiratory or cardiac arrest is the most common cause of lightningrelated deaths, especially if CPR is delayed.

What is mild hypothermia? - ✔a core body temperature (CBT) between 93.2°F and 96.8°F (34°C and 36°C). Mildly hypothermic patients are usually alert and shivering in an attempt to generate heat through muscular activity. Their skin is typically pale due to the body's constriction of blood vessels at the skin to retain heat.

What is moderate hypothermia? - ✔In moderate hypothermia (CBT between 86°F and 93.2°F [30°C and 34°C]), shivering stops and muscular activity decreases. As the CBT falls further, all muscle activity stops What is severe hypothermia? - ✔n severe hypothermia (CBT < 86°F [30°C]), vital functions decrease (eg, level of consciousness, BP, pulse, respirations) and the patient is at risk for life-threatening cardiac dysrhythmias. The muscles become rigid and the patient appears stiff. The patient may appear dead; although a pulse is present, it may not be palpable.

The bite of a brown recluse spider is characterized by: - ✔delayed onset of pain, swelling, and blister formation at the site.

-The venom of a brown recluse spider is cytotoxic; that is, it causes tissue and cellular damage. The bite itself is usually painless; however, the patient typically begins to complain of pain within a few hours. The area becomes swollen and tender, developing a pale, mottled, cyanotic center and possibly a small blister. Over the next several days, a scab of dead skin, fat, and debris will form and dig down into the skin, producing a large ulcer that may not heal unless promptly treated. The bite of a brown recluse spider is very small; therefore, puncture marks are not visible.

The bite of a black widow spider is characterized by: - ✔the black widow spider bite is characterized by immediate pain. Its venom is neurotoxic; that is, it supresses the central nervous system. The patient typically complains of intense muscle spasms, especially of the abdomen, and systemic signs of nervous system involvement (eg, dizziness, chest pain, difficulty breathing).

A 44-year-old woman was bitten on the ankle by an unidentified snake while working in her garden. She is conscious and alert, has stable vital signs, and denies shortness of breath. Her only complaint is a burning sensation at the wound site. Your assessment

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 circumstances. 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/

14 yo shooting victim is pulseless and apneic. Pupils are fixed and lividity is present.

What should you do?

Protect against scene intrusion/ CPR/ search for pt identification/ search for other victims - ✔Protect against scene intrusion Cpr in progress and family member state's pt didn't wish to be revived. You should?

Continue with resuscitation/ call pts physician/ cease resus effort/ contact medical control - ✔Continue with resuscitation Pt trapped in vehicle upside down and showing signs of hypoperfusion. You can only access left arm and head. Medical treatment should begin after?

Scene safety/ get pt GCS/ rapid trauma survey/ *pt is freed from vehicle - ✔pt is freed from vehicle 2 days after a call you realize you forgot to document that you checked a pts blood glucose prior to him refusing trans and signing refusal form. You should?

Add an addendum to report with correct info, current date and initials/ disregard the mistake since the pt was not transported to hospital and medical director knew about reading/ inform supervisor of error and let him know that it won't happen again/ complete now refusal and return to pt residence to have him resign - ✔Add an addendum to report with correct info, current date and initials What criteria does the START triage system use to determine pt priority Pulse rate, respiratory rate, mental status/ mental status, pulse rate, blood pressure/ bp, mental status, peripheral pulse/ pulse rate, respiratory rate, bp - ✔Pulse rate, respiratory rate, mental status Organization best suited to deal with a downed power line Electric company/ ambulance crew/ construction company/ fire department - ✔Electric company Pt with leukemia and obviously near death. A valid DNR is present. You should: Provide o2 and any other supportive care/ ask family if they are sure about DNR order/ attempt resuscitation if pt appears to be viable/ clear scene and explain nothing can be done - ✔Provide o2 and any other supportive care While responding to a call with lights and sirens, you approach a school bus that is displaying warning flashers. You should: Wait until the warning flashers are turned off and the bus pulls to the side of the road/ change the tone of the siren and drive around the bus with extreme caution/ turn off your siren temporarily and proceed past the bus before activating again/ announce on the PA speaker that you are going to pass the bus and then proceed carefully - ✔Wait until the warning flashers are turned off and the bus pulls to the side of the road Trauma pt with history of hepatitis. You should wear gloves and?

Goggle and mask/ n95 mask and level b suit/ gown and mask/ n95 and Tyvek suit ✔Goggle and mask You are beginning to assess a 35 yo man with a cut to his wrist. He is reluctant to reveal his past medical history. You should?

Take bsi precautions/ continue assess/ take VS and wait for ALS to arrive/ refuse to handle the pt until he answers your question - ✔Take BSI precautions When does scene size up start?

En route to the call/ arrive on scene/ see the pt/ receive the call - ✔Arrive on scene Considering scene safety, priorities from most to least?

You, your crew, other rescuers, bystanders, the pt/ your crew, the pt, equipment, other rescuers/ the pt, your partner, you, bystanders - ✔You, your crew, other rescuers, bystanders, the pt Which pt would benefit most from a helicopter transport: 30 yo male pulseless and apneic with history of asthma/ *15 yo F in a motor vehicle crash victim still trapped bp 78 over 42/ 28 year old F in labor crowning; hospital 45 minutes away/ 38 year old male burn pt with first degree burns to 55% of body - ✔15 yo F in a motor vehicle crash victim still trapped bp 78 over 42 Valid pt refusal should be: Signed by a legally and mentally competent pt/ signed by everyone on scene/ signed by pt and notarized by a witness/ cosigned by 1 care physician - ✔Signed by a legally and mentally competent pt You are the 1st ambulance at a 2 vehicle collision. What should you do?

Scene safety/ count # of injured/ determine MOI/ request additional resources - ✔Scene safety 26 yo pt complains of chest pain, productive cough, and not feeling well over last 2 days. "he just flew back from Africa last week." You should?

Put on n95 mask on yourself/ listen to lung sounds/ take vitals/ HEPA mask on pt - ✔Put on n95 mask You have just reported for duty with your ambulance company. You should?

Do inventory and equipment check/ assign call duties with your partner/ do an inspection of the vehicle/ notify dispatch that you are in service - ✔Do inventory and equipment check 18 yo pt has gunshot wound in the arm during a fight. Become increasingly anxious and pushes hands away during primary assessment. What would you do?

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

Ensure the airway is patent and clear of obstructions - ✔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 life threatening infection Temp greater than 100 Fahrenheit inflammatory process - ✔Abrupt rise in body temp A 4 year old patient has sustained blunt trauma to the chest. Based on the MOI you should suspect Good chest rise with no diaphragmatic breathing Minimal external signs with serious internal injury Multi rib fractures due to fragile bone structure Dark ecchymosis around the umbilical area - ✔Minimal external signs with serious internal injury A mother has just delivered a newborn with central cyanosis. The newborns vitals are P 82, R 30. You should?

Initiate active warming begin positive pressure ventilations administer blow by O2 suction the airway and stimulate - ✔begin positive pressure ventilations A 37 year old female in the later stages of pregnancy has been experiencing abdominal pain and vomiting for the last two days. She responds to verbal stimulus. Vital signs are BP 100/70, P 116 R 24, skin cool and dry, How should you position her?

In Fowler's position on the stretcher Semi Fowlers with knees bent Left lateral recumbent with knees bent Supine with a pillow under her knees - ✔Left lateral recumbent with knees bent What is the proper way to size an OPA for a child?

Tip of the nose to the corner of the mouth corner of mouth to the angle of the mandible the length of the index finger of the child middle of the mouth to the ear lobe - ✔corner of mouth to the angle of the mandible A 6 year old is shy and withdrawn. He has multiple contusions in various stages of healing. His mother states "he fell on the playground." What should you suspect?

Sexual abuse Emotional abuse Neglect Physical abuse - ✔Physical abuse Where should you apply pressure to access for uterine contractions?

Left and right upper quadrants abdomen below the navel abdomen above the navel left and right flank - ✔abdomen below the navel A 14 year old jumped off a 4 foot wall, landing on her feet. She is complaining of tingling below waist, lower back pain, and cramping in both feet. Vital signs are BP 106/74, P 112, and R 20. You should Immobilize to a long spine board Transport in a position of comfort Apply bilateral soft splints to lower extremities Coach her to slow her breathing - ✔Immobilize to a long spine board Which of the following indicates decompensated shock in a pediatric patient?

Shallow breathing rapid heart rate pale cool and diaphoretic loss of consciousness - ✔loss of consciousness A 3 year old is unresponsive and apneic on the floor of a restaurant. He was choking, turned blue, and collapsed. What should you do?

Begin chest compressions Perform a blind finger sweep Give 5 abdominal thrusts Give 5 back blows - ✔Begin chest compressions In centimeters what is the correct depth of chest compressions for a 7 year old child?

1.5 6 5 2 - ✔5 What is the proper method for suctioning a newborn's airway with a bulb syringe?

Squeeze after placing the bulb syringe in the nose

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

gentle manual traction a cold pack and rapid transport significant traction until pulse returns - ✔gentle manual traction 7 year old presents with a pencil in his left cheek, you should?

Remove the pencil stabilize the pencil check for airway patency control bleeding - ✔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?

Supine hypotensive syndrome imminent delivery abruptio placentae placenta previa - ✔abruptio placentae Which may indicate that a fetus was in distress before delivery?

Presence of a greenish material in the amniotic fluid meconium - ✔meconium A 2 year old child presents with a fever, lethargy, and screaming upon neck flexion. You should suspect?

Meningitis Influenza febrile seizure ear infection - ✔Meningitis A conscious child has a significant airway obstruction due to an illness. You should?

Insert OPA examine the upper airway for white spots place the child in a supine position give o2 and transport immediately - ✔give o2 and transport immediately With pediatric patient, your assessment should begin?

At first sight after you intro yourself after parents consent at first contact - ✔At first sight

A child is postictal. You should?

Note length of seizure administer blow by o2 ensure open airway protect patient from injury - ✔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?

Abruptio placenta pulmonary embolism post delivery trauma uterine rupture - ✔pulmonary embolism Compared to adults in shock, pediatric patients?

Stay in compensated shock longer do not require treatment as quickly are less likely to become hypovolemic become hypertensive sooner - ✔Stay in compensated shock longer Pre- eclampsia becomes eclampsia when A seizure occurs constant hyperten occurs systolic above 170 third trimester begins - ✔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?

Pelvic inflammatory disease kidney stones a ruptured ectopic emergency cholecystitis - ✔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?

Load and go to the nearest trauma center tilt the backboard to the left immediately loosen the backboard straps as soon as possible

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, vaginal 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 vaginal 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 vaginal 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 vagina. You should Gently pack the vagina 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 vaginal 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

Assisting a home birth and baby's head just delivered. You should?

Examine for nuchal guide and rotate turn face up and suction - ✔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 fully immobilize in Trendelenburg position secure child's safety seat to the stretcher allow the patient to sit on his mother's lap - ✔Fully immobilize with towel under his scapulae Painless bright red vaginal bleeding late in the third trimester. You should suspect?

Placenta previa abruptio placentae ectopic pregnancy spontaneous abortion - ✔Placenta previa Signs or symptoms of a pre delivery emergency?

Hypertension Back pain crowning gush of amniotic fluid - ✔Hypertension 24 year old woman presents with vaginal bleeding following sexual assault, controlling bleeding would best be done by Packing a vaginal canal with gauze apply direct pressure placing a dressing @ the vaginal opening bending the patient's legs upward - ✔placing a dressing @ the vaginal 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?

Clamp the cord in 2 places and cut between them place her in knee-chest position and transport cover the cord with a dry sterile dressing encourage her to bear down and push - ✔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?

Heart rate skin color respiratory rate breath sounds - ✔skin color Which signs and symptoms most suggest pre eclampsia?

Hypertension and excessive water retention inability to sleep supine and acid reflux hypoglycemia and swollen extremities polyuria and postural hypotension - ✔Hypertension and excessive water retention The period of time during which intrauterine fetal development occurs is called?

Gravidity gestation parity primi gravity - ✔gestation You are assisting a vaginal delivery and the mom is crowning. The infant's head suddenly disappears and the mother begins to complain of sharp, intense, constant abdominal pain. You should suspect?

Placenta previa multiple births uterine rupture transition to phase III of delivery - ✔uterine rupture 2 year old patient has a respiratory rate of 30 breaths per minute. This is considered?

Too fast inadequate normal too slow - ✔normal From the atmosphere, what structures does air pass through during ventilation? ✔Starts in atmosphere, then nose, nasopharyngeal space/orophargyneal space (if mouth breather), then pharynx, larynx, trachea, bronchi, bronchioles, alveoli What is the purpose of the nasal passages and nasopharynx? - ✔To warm/humidify air as it passes through

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

Where are the muscarinic receptors located? What is their effect? - ✔location - heart effect - decreased HR, decreased force of contraction Muscarinic is parasympathetic system and do complete opposite of Beta-1 which is sympathetic What hormones activate the sympathetic nervous system? - ✔Epineprhine and norepineprhine, which are released from he adrenal gland after stimulation by the sympathetic nervous system. These hormones stimulate heart and blood vessels.

What is pathophysiology? - ✔Study of how normal physiologic processes are affected by disease What is respiratory compromise? - ✔Inability of body to move gas effectively. Can result in decreased O2 (hypoxia) and increased CO2 (hypercarbia) What factors can impair ventilation? - ✔1. Obstruction a. foreign objects - toys, food, teeth tongue etc b. physiological - induced by asthma, allergic rxns, infection 2. Impairment a. brain injury - to medulla/pons b. breathing muscles - diaphragm, c. nerves - neuromuscular disease like cerebral palsy can affect phrenic nerve 3. Other factors a. drugs - opioids can reduce RR b. loss of consciousness - can cause impaired ventilation c. trauma to chest wall - impair expansion of lungs What factors can impair respiration? - ✔1. air (too little O2, too much CO2, toxins like CO) 2. impaired movement of gas across cell membrane (due to fluid in alveoli, mucus or other secretions) 3. Blood vessels become clogged (pulmonary embolism) What is the V/Q ratio? - ✔How much gas is being moved effectively, versus how much blood is flowing around the alveoli where gas exchange (perfusion occurs) example - pt w/ pulmonary embolism might have regular ventilation, but blockage might impair exchange or perfusion. So Q is compromised.

What happens in the body when there is respiratory compromise? - ✔1. O2 levels fall and CO2 levels rise

2. Brain detects increase in CO2 3. Body increases RR to try to manage CO2 levels 4. If increased respiration does not clear CO2, then blood is acidic 5. Blood o2 levels begin to fall, activating hypoxic drive 6. Cells that are able switch to anaerobic metabolism, producing lactic acid which further drops pH Glottis - ✔Space between vocal cords and narrowest portion of adult's airway. Lateral borders of glottis are the vocal cords. They contain defense reflexes that protect lower airway, and spasm to prevent foreign substances from entering trachea Carina - ✔The branching area of the left and right bronchi Mediastinum - ✔Area between the lungs which is surrounded by tough connective tissue. Contains heart, great vessels, esophagus, trachea, major bronchi and nerves.

What is the term used to describe the amount of gas in air or dissolved in fluid? How is this relevant to ventilation? How is this relevant to respiration? - ✔Partial pressure of gas, measured in mmHg. When lungs expand, partial pressure of air is less than that in atmosphere. Air rushes in during ventilation.

Inhalation In oxygen rich lungs, PO2 > PO2 oxygen poor blood. O2 diffuses across alveoli into blood.

In CO2 rich blood, PCO2 > PCO2 of lungs so CO2 diffuses from blood to lungs, and then is exhaled out What does it mean if someone says they are "keeping the airways patent"? - ✔Keeping airway patent = maintaining open airway so air can enter/leave lungs freely How is regulation of breathing different in those with COPD? What does research indicate about assisting in respiration with COPD sufferers? - ✔COPD sufferers have difficulty removing CO2 from body. Overtime, respiratory control centers in brain adjust to this new baseline of CO2. In late stage COPD hypoxic drive is activated. Some research suggests that providing high flow O2 could negatively affect body's drive to breathe.

What is Dyspnea? - ✔Shortness of breath Signs and symptoms of Hypoxia? - ✔Early 1. Restlessness 2. Irritability

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. Crackles (pulmonary edema) 3. Orthopnea 4. Paroxysmal nocturnal dyspnea Common Cold - ✔1. cough 2. runny/stuffy nose 3. sore throat COPD - ✔slow process of dilation/disruption of airways/alveoli caused by chronic bronchial obstruction Croup - ✔1. fever 2. barking cough 3. stridor 4. mostly seen in pediatric patients inflammation/swelling of pharynx, larynx and trachea. Typically seen in young children Treat w/ humidified O2 Diphtheria - ✔1. difficulty breathing/swallowing 2. sore throat 3. thick gray buildup in throat/nose 4. fever Emphysema - ✔1. barrel chest 2. pushed lip breathing (pink puffers) 3. dyspnea on exertion 4. cyanosis 5. wheezing/decreased breath sounds Most common form of COPD. Loss of elastic material in lungs Epiglottitis - ✔1. Dyspnea 2. High fever 3. stridor 4. drooling 5. difficulty swallowing 6. severe sore throat 7. tripod/sniffing position Life threatening, caused by bacterial infection of epiglottis in children, risk of complete airway obstruction. Try to keep them from crying. Do not put anything in mouths.

Provide quick transport to ER, focus on maintaining patent airway

Flu - ✔1. cough 2. fever 3. sore throat 4. fatigue Hay Fever - ✔coldlike symptoms, caused by allergic response.

Hyperventilation - ✔over breathing to the point of arterial CO2 falls below normal.

Alkalosis of blood occurs.

1. anxiety 2. dizziness 3. numbness 4. tingling of hands/feet 5. painful spasms of hand/feet 6. Pt's feel they cannot catch breathe occurs when someone experiences psychological distress. Maybe be as high as 40 breaths/min or low as 20. Verbally instruct pt to slow breathing, and if that doesn't work, give supplemental O2 and provide transport Pertussis - ✔1. coughing spells 2. whooping sound 3. fever airborne bacterial infection, coughing spells can last for a minute where pt turns red.

May vomit/want to avoid eat/drink Pleural Effusion - ✔collection of fluid outside lung on one or both sides that compresses lung/lungs and causes dyspnea.

Lung sounds = decreased breath sounds from lungs where fluid is. Pt's feel better sitting upright, but only treatment is fluid removal in hospital Pneumonia - ✔1. dyspnea 2. chills/fever 3. cough 4. green, red or rust colored sputum 5. localized wheezing or crackles Infection of lungs, often secondary infection. Affects people who are chronically/terminally ill. May hear wheezing, crackles, friction rubs or rhonchi. Provide airway support, supplemental O2 pneumothorax - ✔1. sudden chest pain w/ dyspnea

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

Stridor - ✔description - A harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx. cause - Obstruction or narrowing of the upper airway. location - Less than severe stridor can be auscultated over the larynx. Severe stridor can be heard without a stethoscope. associated w/ - Obstruction in Larynx, Obstruction in Trachea, Croup, Epiglottitis Laryngeal edema What are the two purposes of inserting an OPA? - ✔1. lift the tongue 2. Make it easier to suction oropharynx Indications/contraindications for OPA? - ✔Indications a. unresponsive pt's w/o gag reflex b. any apneic pt ventilated w/ a BVM Contraindications a. conscious pt's b. any pt (conscious or unconscious) w/ BVM Indications/contraindications for NPA? - ✔indications a. semiconscious/unconscious pt w/ intact gag reflex b. pat's who otherwise will not tolerate OPA contraindications a. severe head injury w/ blood draining from nose b. history of fractured nasal bone What is the recovery position? - ✔used to help maintain clear airway in unconscious pt who is not injured and is breathing on his or her own w/ normal respiratory rate and adequate tidal volume Bag Valve Mask - ✔use w/ or w/o oxygen. Use for pt's in respiratory arrest, cardiopulmonary arrest, and respiratory failure.

CPAP - ✔Continous Positive Airway Pressure increases pressure in lungs, opens collapsed alveoli, pushes more oxygen across alveolar membrane, and forces interstitial fluid back into pulmonary circulation. indications - alert pt able to follow commands, obvious signs of moderate to severe respiratory distress, pt is breathing rapidly (over 26 breaths/min), pulse oximetry is less than 90

contraindications - pt who is in respiratory arrest, Si/sx of pneumothorax or chest trauma, pt who has a tracheostomy, active Gi bleeding/vomiting, pt unable to follow verbal commands Which patient would be classified as "immediate" during and MCI? - ✔8 year old female with no respirations after 5 positive pressure ventilations.

A 13 year old female watching a horror movie states she can't catch her breath and her fingers are numb. Respirations are 30 and deep with Sp02 of %100. She is speaking in clear sentences, has clear and equal breath sounds. You should? - ✔Calmly reassure her, encouraging her to calmly slow her rate of breathing.

You have inserted an OPA for a 21 year old apneic male. How many times per minute should you ventilate him with a BVM? - ✔10 to 12 Proper technique to suction patient's airway includes? - ✔Oxygenating and ventilating before and after suctioning.

When ventilating patient with BVM, what is the appropriate oxygen flow rate? - ✔15 liters/min An obese man complains of sever difficulty breathing. His skin is cool and moist and breathing 22 times per minute. He indicates he never goes to the doctor and often feels dizzy after walking. You should? - ✔Apply a nonrebreather mask at 10 liters/min A 42 year old asthmatic patient complains of chest pain, shortness of breath and a violent cough that produces brownish sputum. What is the most likely cause? ✔Pneumonia An 89 year old patient complains of difficulty breathing and a productive cough that has gotten worse over the past 12 hours. You should suspect? - ✔Pneumonia As the diaphragm and intercostal muscles relax, the chest cavity? - ✔Decreases in size, causing exhalation During initial assessment of an adult's respiratory status, you should? - ✔Evaluate both the respiratory rate and the rise and fall of the chest In which group of patients are you likely to encounter "see-saw" breathing? ✔Pediatrics Which sequence correctly traces the path oxygen takes from the atmosphere to the lungs? - ✔Mouth, Pharynx, trachea, bronchi, alveoli.

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 superheated 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

How often should you ventilate a patient who is apneic and has a pulse? - ✔5-6 A 14 year old female Is short of breath. She has a history of cystic fibrosis. Lung sounds reveal coarse rhonchi. What is the most likely cause of her condition? - ✔mucous secretions A 64-year-old woman with a complete laryngectomy is in respiratory arrest you should?

- ✔suction the stoma completely When ventilating a patient with a bag valve mask device you should? - ✔use two rescuers whenever possible A 28-year-old patient is experiencing Dyspnea and wheezing which medication should you request from medical control? - ✔albuterol inhaler 20 year old male complains of sudden onset shortness of breath. He is breathing at 24 times per minute and his pulse oximetry is 85% you should? - ✔Administer oxygen via non-rebreather mask 15 lpm A 34-year-old male says he's choking. You note Stridor and hoarseness in his voice what should you do? - ✔encourage him to cough Which condition could be considered an upper airway obstruction? - ✔Epiglottitis An 18-year-old male complains of shortness of breath. He has a history of asthma and self administered two doses of his prescribed metered dose inhaler with no relief. Vital signs are P104 R 22 SP02 91% what should you do? - ✔Administer oxygen by nonrebreather mask Which of the following conditions is most likely to cause decreased compliance while ventilating via bag valve mask? - ✔tension pneumothorax A febrile 2 year old male in respiratory distress with crackles in the lower left lung field.

You should suspect? - ✔Pneumonia Which of the following shows a sign of lower respiratory tract problem? - ✔Expiratory wheezes and long expiration A 64 year old male complains of dyspnea and is coughing up blood tinged sputum.

Upon auscultation you note cracks bilaterally. What should you suspect? ✔Tuberculosis

Which statement indicates that the patient is suffering from a CHF rather than Pneumonia? - ✔feels like I'm drowning when I sleep When suctioning blood, fluid, and mucous from the oropharynx, the most appropriate device is? - ✔A rigid tip suction catheter The reason for assessing the radial and the carotid pulse simultaneously is to? ✔Confirm Cardiac Rhythm Problem A patient presents with a sudden onset of shortness of breath crackles, hypertension, and jugular distension. You Should suspect? - ✔Acute Pulmonary Edema A 73 year old male is dyspneic. You note jugular vein distension and dependent edema.

Vital signs are BP 158/93, P 130 R 36. What should you suspect? - ✔Congestive Heart Failure A 19-year-old female began choking after eating a hot dog. When you first arrived on scene, she was coughing and drooling.Now, she is drowsy, slow to respond, and unable to cough. You should? - ✔Perform abdominal thrusts A 65 year old male is having trouble breathing. He is moderately overweight and has been coughing up yellowish phlegm. He smokes two packs of cigarettes a day and reports having episodes like this for many years - ✔Chronic bronchitis Which of the following can be present with a sudden onset of difficult breathing and diminished breath sounds - ✔pneumothorax A semi-conscious 34 year old male begins to gag after insertion of an OPA - ✔Insert an NPA An 18 year old febrile patient complains of malaise for several days. He is taking an oral antibiotic for an upper respiratory infection. Vital signs are bp 128/72, P118 and weak, R22 with rhonchi - ✔Bronchitis Which of the following assessment findings should cause you to suspect a history of COPD? - ✔Barrel shaped chest A thin 75 year old male complains of difficulty breathing. He states he has smoked "3 packs of cigarettes a day for 30 years." He has bilateral wheezes - ✔Emphysema 16 asthmatic female is in tripod position complains of increased shortness of breath.

SPO2 is 79% you should administer oxygen at - ✔10 lpm via nonrebreather

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. - ✔twothirds 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

An accelerated junctional rhythm has a rate between ________ and ________. - ✔60, 100 The mitral valve is also known as the ________ valve. - ✔Left atrioventricular A decrease in preload results in a(n): - ✔decrease in cardiac output Your patient has a history of progressively worsening angina that comes on at rest. This most commonly indicates ________ angina. - ✔Unstable An early sign of hyperkalemia is: - ✔tall, peaked T waves on an ECG The intrinsic firing rate of the AV node is ________ to ________ beats per minute. ✔40, 60 The predominant effect of a drug with primarily alpha properties would result in: ✔Vasoconstriction The pericardial cavity normally holds about ________ mL of straw-colored lubricant. ✔25 The right atrioventricular valve is referred to as the ________ valve. - ✔Tricuspid The left atrioventricular valve is referred to as the ________ valve. - ✔Mitral The right ventricle pushes blood to the lungs through the: - ✔Pulmonary artery During which phase of the cardiac cycle does ventricular filling begin? - ✔Diastole The pressure in the ventricle at the end of diastole is called: - ✔Preload Give the formula for cardiac output - ✔Stroke volume x heart rate Cardiac muscle is different from smooth muscle in the fact that it has: - ✔Automaticity The intrinsic rate of the Purkinje system is: - ✔15-40 bpm Ventricular repolarization is represented on the ECG by the: - ✔T wave Normal interval time for the PR interval is: - ✔0.12-0.2 seconds Normal interval time for the QRS complex is: - ✔0.04-0.12 seconds

Normal interval time for the QT interval is: - ✔0.33-0.42 seconds A potassium level of 3.0 would commonly be associated with which ECG finding? ✔Flattening T wave What is the normal range for potassium serum levels? - ✔3.5-5.0 A potassium level of 8.0 would commonly be associated with which ECG finding? - ✔T wave merging with QRS A parasympatholytic agent used to treat symptomatic bradycardia is: - ✔Atropine The loading dose of norepinephrine is: - ✔8-10 mcg/min Myocardial ischemia is caused by an imbalance of: - ✔oxygen supply and demand Vasospasms associated with chest pain are known as: - ✔Prinzmetal's angina A pathological Q wave indicating infarction should measure: - ✔0.04 seconds The maximum window of time a fibrinolytic can be administered is: - ✔6 hours after onset of symptoms Name the 3 phases of cardiac arrest - ✔Metabolic phase Electrical phase Circulatory phase You are transporting a cardiac arrest when you achieve ROSC. You now want to keep the patient's systolic blood pressure in the range of: - ✔80-100 mmHg You run a 12-lead ECG on a patient exhibiting chest pain. It reveals ST segment elevation in leads II, III, and aVF, with reciprocal in leads aVL and I. You suspect: ✔Inferior MI A 12-lead ECG shows ST segment elevation in leads V1, V2, V3, and V4 with reciprocal changes in leads V5, V6, II, III, and aVF. You suspect: - ✔Septal-anterior MI Elevations in brain natriuretic peptide (BNP) in the blood have become the "marker" for which condition? - ✔Congestive Heart Failure a vascular murmur sound heard over the carotid artery area on auscultation during systole - ✔Carotid bruits The standard sequence for examining the chest is: - ✔Inspect

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 basement. 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

a 20 year old male in a college dorm room complains of fever, headache, and a stiff neck. he has an altered mental status, and you notice red blotches on his skin. which of the following are the most appropriate BSI precautions - ✔gloves and HEPA mask an unconscious patient has one pupil that is significantly larger than the other and not reactive to light. the most likely cause is: - ✔stroke what is hyperglycemia - ✔high blood sugar when assessing a patient for facial droop you should? - ✔ask the patient to smile or show his teeth an alert patient has a severe headache/weakness of the left arm you should suspect? ✔stroke a 28 year old patient is outside at a concert and appears confused. he is unable to answer your questions. you should - ✔look for medical identification necklace or bracelet your first priority when dealing with a patient who is exhibiting behavior issues is ✔ensure the safety of yourself and your partner which of the following most accurately describes insulin? - ✔it helps glucose move into the cells a patient with a headache. how should you position him on the cot? - ✔supine an unconscious 33 year old patient was found lying prone in a local park. he was apneic. you should: - ✔put in supine, check airway you have been dispatched to a behavioral emergency. the police are on scene and have asked you to evaluate the patient. you should - ✔ask police to help secure the scene an 18 year old female has progressively became lethargic at a party. vitals are BP90/60, P48, R4, you should suspect: - ✔narcotic overdose a 20 year old female is resting after running for 30 minutes. she normally runs 5 miles every day but today she "can't catch her breath". flushed skin, fast and weak pulse, fast respirations with wheezing, complains of itching arms and chest - ✔anaphylaxis unresponsive patient with arms and legs violently jerking. what phase of generalized seizure is this? - ✔clonic

a 78 year old male Alzheimer's patient has bruising on his back, neck and stomach. caregivers insist that he fell out of bed. what should you do? - ✔immediately notify law enforcement to take a report elderly patient complains of abdominal pain and back pain. has tarry stools for three days. what should you suspect? - ✔GI bleeding patient's family reports a glucometer reading of 57mg/dL. this reading is considered: ✔Low 82 year old female complains of nausea and vomiting for two days. she ran out of her prescription heart medication last week. BP158/92, P92 irregular, R18 - ✔administer oxygen and monitor vitals patient is at an outdoor garden center on a hot and humid day. patient is pale, wheezing and has hives. what should you suspect? - ✔bee sting a 16 year old female with severe abdominal pain "hasn't had a period in two months and the pain started this morning" BP90/70, P130, R28. skin is pale and cool. what should you suspect? - ✔hypovolemic a hiker is found in the mountains. patient is flushed and their mucous membrane is slightly blue - ✔low oxygen level a 23 year old male with bipolar disorder. depressed and locked himself inside the bathroom - ✔call law enforcement to secure the scene patient has irregular respirations and is agitated. is pacing back and forth. skin is cool and clammy - ✔hypoglycemia epinephrine side effects on the cardiovascular system - ✔constricts blood vessels a 71 year old male is unconscious and cold to the touch at a park. he is a resident of the Alzheimer's center. outside temperature is in the low teens. what do you keep in mind when trying to obtain a pulse? - ✔*pulse should be palpated in two places a 31 year old male is vomiting and has diarrhea for 10 hours. complains of weakness and light headedness upon standing. pale and diaphoretic. vitals should be: ✔BP90/60, P124, R20 a 20 year old female is unconscious after being submerged in a lake for three minutes. she has a pulse and agonal breathing. - ✔ventilate using a BVM

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

18 yo M holding right shin after sports related injury. Deformity and swelling; pedal pulse present. You should? - ✔Apply board splint in position found Pedestrian hit by car. Pale, cool, and diaphoretic. Oriented to name only and has difficulty breathing. BP 80/40, P 120, R 28 and shallow. 90% SP02. You should? ✔BVM 81 yo F healthcare facility fell out of bed. Nurse suspects hip fracture. Which medication should concern you the most? - ✔Coumadin You are treating a patient with agonal respirations and gunshot wound to the chest. You notice an open skull fracture leaking brain matter. There is no radial pulse, you should?

- ✔Asses a carotid pulse and assist ventilations a 45 year old male fell asleep outside 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 You arrive on scene of a car crash. The driver is alert and complaining of severe chest and abdominal pain. His radial is weak and rapid. Skin is cool, pale, and moist. The patient has a history of cardiac problems. You should? - ✔Rapidly extricate onto a long spinal board and transport 47 male shot in back has cool and clammy skin with arm weakness. BP 130/90, P 76, R 24. You should suspect - ✔Spinal cord injury Injury that is most likely to require routine assessment and transport - ✔Deformed Wrist Injury After securing pt on long board, you should immediately assess - ✔PMS 23 yo soccer player was kicked in the chest. He is alert with rapid, shallow R and complains of chest pain. Pale, cool, and wet. You should? - ✔Non Rebreather 25 yo in R distress after being stabbed in the chest. Blood is bubbling from 2 cm laceration to L chest wall. Lung sounds diminished on L side. You should? - ✔Apply occlusive dressing Early signs of decompensated shock? - ✔Low blood pressure Pt stabbed in RUQ. What organ is injured? - ✔Liver Pt with chemical burn on eye and is wearing contact lenses. You should? - ✔Remove contact lenses and administer irrigation solutions

A baseball player was hit by a baseball in the left eye and complains for double vision.

What should you do? - ✔Restrict spinal movement First concern with conscious pt who received partial thick burns to the face is treating? ✔airway problems 22 yo F had an accident on moped. She is lying on ground; breathing well. Still wearing helmet. You should? - ✔Leave helmet in place while she is stabilized 32 yo M is unconscious after being struck in the head by a baseball bat. Has pulse but breathing is slow. Minor bleeding from a laceration at the left temple. Partner is maintaining manual C-spine stabilization. You should? - ✔Measure and apply a rigid c collar 28 yo M is fleeing from police and sustained 1 cm laceration shallow on forearm while climbing a rusted chain link fence. Refusing transport. What should you be concerned with? - ✔Infection Which is an open wound? - ✔abrasion Woman struck in face with softball bat. Unconscious. BP 74/50, P 60, R 8. What do you do? - ✔Insert an oral airway and admin 02 via BVM 21 yo football player hit from the side and landed head first onto the ground. Was ambulatory on scene and oriented to name only. Refusing transport and care. What should you do? - ✔Ask the team coach for assistance Pt cut wrist. Wound is bleeding rapidly and is spurting with each heartbeat. Pt most likely severed? - ✔Artery Pt presents with pain and bruising to RUQ following motor vehicle collision. You should suspect injury to the? - ✔Liver 50 yo M has obvious deformed right lower leg after falling from the roof. You notice a tear in the skin over the deformity. What should you do? - ✔Realign and splint the leg 35 yo driver collided into telephone pole and is unconscious and unresponsive with severe bleeding in the mouth. You should? - ✔rapid extrication to long spine board Most important factor with person struck in chest with baseball - ✔Speed of the ball 75 yo is involved in motor vehicle collision and can't feel legs. BP is 80/40, P 60, R 24, you should suspect? - ✔Neurogenic Shock

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

A mother has just delivered a newborn with central cyanosis. The newborns vitals are P 82, R 30. You should? - ✔begin positive pressure ventilations A 37 year old female in the later stages of pregnancy has been experiencing abdominal pain and vomiting for the last two days. She responds to verbal stimulus. Vital signs are BP 100/70, P 116 R 24, skin cool and dry, How should you position her? - ✔Left lateral recumbent with knees bent What is the proper way to size an OPA for a child? - ✔corner of mouth to the angle of the mandible A 6 year old is shy and withdrawn. He has multiple contusions in various stages of healing. His mother states "he fell on the playground." What should you suspect? ✔Physical abuse Where should you apply pressure to access for uterine contractions? - ✔abdomen below the navel A 14 year old jumped off a 4 foot wall, landing on her feet. She is complaining of tingling below waist, lower back pain, and cramping in both feet. Vital signs are BP 106/74, P 112, and R 20. You should - ✔Immobilize to a long spine board Which of the following indicates decompensated shock in a pediatric patient? - ✔loss of consciousness A 3 year old is unresponsive and apneic on the floor of a restaurant. He was choking, turned blue, and collapsed. What should you do? - ✔Begin chest compressions In centimetres what is the correct depth of chest compressions for a 7 year old child? ✔5 What is the proper method for suctioning a newborn's airway with a bulb syringe? ✔Squeeze before placing the bulb syringe in the mouth A 3 year old drank some drain cleaner. It would be most helpful to? - ✔transport immediately A cord is wrapped around a baby's neck during childbirth. This is called - ✔Nuchal cord Scald injuries to a child's lower extremity can be indicative of? - ✔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? - ✔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? - ✔place a small towel under their shoulders Normal response for a healthy 9 month old infant. - ✔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? - ✔croup 13 month old lying supine in crib, crying. Fever of 104.5, rash on body and some spots are purple. You should? - ✔put on surgical mask 20 year old female is pregnant for the first time with twins. What is she considered? ✔primigravida Initiate CPR on infant if heart rate is less than? - ✔60 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? - ✔cardiac arrest During assessment of a crying infant, you discover a sunken fontanelle. Your next question should be? - ✔how many wet diapers has the baby produced When assessing distal circulatory function in a 3 year old, a reliable indicator is? - ✔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 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 3 year old child involved in a motor vehicle collision needs to be secured on an adult backboard. You should? - ✔place padding under the child's torso When inserting an OPA in a child you should? - ✔Hold the tongue in position Pediatric airways differ from adult airways in that - ✔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? - ✔gentle manual traction

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, vaginal 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 vaginal 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 vaginal 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 vagina. You should - ✔apply external sterile bulky dressing If a patient presents vaginal 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 vaginal 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 vaginal bleeding following sexual assault, controlling bleeding would best be done by - ✔placing a dressing @ the vaginal 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