EMT Readiness Exam (TCC) 2024

EMT Readiness Exam (TCC) scope of practice - ✔The range of clinical procedures and activities that are allowed by EMS provider standard of care - ✔care that should be provided for any level of training, what is expected of you Duty to Act - ✔EMR have duty to provide care while on duty Negligence - ✔failure to provide expected standard of care 4 things of negligence - ✔duty of care breach of duty causation damages Good Samaritan Law - ✔series of state laws designed to protect care providers if they deliver care in good faith, to their level of training, and best of abilities Battery - ✔unlawful physical contact Assault - ✔verbal threat of harm, no physical contact Types of consent - ✔Expressed, implied, informed expressed consent - ✔competent patient decision to accept care Implied consent - ✔assumes patient who lacks capacity/competency to provide his own consent informed consent - ✔consent given by patients after informed of care being suggested prone - ✔face down supine - ✔face up Fowler's position - ✔a semi-sitting position; the head of the bed is raised between 45 and 60 degrees Semi-Fowler's Position - ✔client lies supine with head of bed elevated approx 30 degrees and knees may be slightly elevated (about 15 degrees)

left lateral recumbent position - ✔laying on left side Right lateral recumbent position - ✔laying on right side tripod position - ✔person sitting forward with hands on knees Superior - ✔above or over top of Inferior - ✔Below or toward feet Lateral - ✔Side of body/away from the midline of the body Medial - ✔toward the midline Anterior - ✔front of the body Posterior - ✔back of body Transfer of Care - ✔only release the patient to personnel with equal or higher medical training than yourself. Document all steps of this process body language - ✔Communication of information through body positions and gestures. nonverbal communication - ✔body language, eye contact, and gestures Lifting techniques - ✔extremity lift- 1 lifts arms/1lifts legs log roll- move from prone to supine direct carry- move from bed to stretcher power lift- lift patient on cot direct-ground lift- 3 rescuers move from ground to stretcher body mechanics - ✔-Feet position properly, left with legs not back, bend at knees, keep weight as close to you as possible (powerlift) -Clothing drag, blanket drag, shoulder drag, strap drag used for emergent moves most common cause of airway obstruction - ✔the tongue; foreign objects or other way How to open patients airway? - ✔head tilt-chin lift, modified jaw thrust(trauma) Choking (Airway Obstruction) for ADULT/pediatric(child) - ✔abdominal thrusts; if unresponsive call 911, CPR, check airway and perform 2 rescue breaths

Choking (Airway Obstruction) for INFANT - ✔face down on forearm(head lower than trunk), deliver 5 back blows; if it doesn't work turn over on back with head lower than the trunk and deliver 5 chest thrusts with 2 or 3 fingers; Unresponsive: chess compressions, after each set open airway and check for any objects, perform 2 rescue breaths Muscularskeletal system - ✔provides structure, support, and protection for the body and internal organs and allow for body movement. Responsible for production of diseasefighting white blood cells.

-Bones, muscles, tendons and ligaments Circulatory system - ✔(circulation of blood) carry well-oxygenated blood and other nutrients to body's cells, removal of waste and carbon dioxide from cells -Heart, blood vessels, blood -arteries, veins, capillaries arteries (arterial) - ✔carry O2 blood to body veins (venous) - ✔returns unoxygenated blood to heart/lungs cappilaries (capillary) - ✔exchange site between blood and tissues Digestive system - ✔break down(digest) the food we eat so it can be absorbed through intestines and used for food and energy for our cells. Also helps remove waste products from the body -Esophagus, liver, pancreas, small intestine, large intenstine Urinary system - ✔remove chemical wastes from body and help balance water and salt levels in blood -Kidneys, ureters, bladder, and urethra Endocrine system - ✔(hormone-producing glands): regulation of many of processes within human body. Regulate metabolism, physical size, strength, hair growth, voice pitch and reproduction by hormones Reproductive system - ✔produces hormones needed for sexual reproduction.

-Testes and penis(male) -ovaries, fallopian tube, uterus and vagina(female) Respiratory system - ✔exchange of oxygen and carbon dioxide. Warms and filters air as enters the body (breathing) -nose, mouth trachea, lungs, bronchi, brochioles, alveoli

Nervous function - ✔control movement, interpret sensations, regulate body activities, and generate memory and thought ○ Brain, spinal cord, nerves ○ Central NS= brain and spinal cord. ○ Peripheral NS= Sensory(incoming nerves) and Motor(outcoing nerves) ■ Autonomic nervous system= control system for heart rate, respiratory rate, digestion, perspiration, salivation.

Integumentary system - ✔skin is largest organ of body that covers systems, organs and systems. It protects body from heat and cold as well as toxins. It regulates body temperature as well as body fluids and chemical balance ○ Layers of skin, nails, hair, sweat glands, oil glands, and mammary glands ○ Epidermis, Dermis, and Subcutaneous layer Components of Patient Care Reports - ✔Patient record Legal record Continuity of Care Quality assurance Administration Consist of: Run Data(name of partner/time of call), patient data, fill in, check boxes, narrative: SOAP SOAP - ✔subjective- told by patient, family, dispatcher, objective- everything you see during assessment assessment- what you think is wrong with patient plan- what you did with patient beginning to end How to use Bag Mask Device/BVM - ✔Single rescuer: open airway(head tilt-chin lift), remove any visible obstruction, mask over mouth/nose forming AC with hand, observe chest rise with proper rate, allow for exhalation between ventilation ○ Adult- 10-12/minute ○ Child: 12-20/minute ○ Infant: 20-30/minute Double-rescuer: one person behind the head to open up the airway, insert the oropharyngeal in the mouth(little hook) or nasopharyngeal(nose tube) into the airway, remove any obstruction, place mask over mouth/nose and other person maintain tight seal using 2 hands, proper rate as above^ SAMPLE'(D) - ✔Signs/symptoms Allergies Medications

Pertinent past medical history Last oral intake Events Doctor AVPU - ✔Alert, Verbal, Pain, Unresponsive PERL - ✔Pupils that are Equal and Reactive to Light OPQRST - ✔Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing.

DCAP-BTLS - ✔Deformities Contusions Abrasions Penetrations Burns Tenderness Lacerations Swelling steps of patient assessment - ✔1. Scene Size-up ● Scene Safety ● PPE ● Evaluate MOI/NOI ● # of patients ● Evaluate need for assistance ⇩ 2. Primary Assessment(identify life-threatening issues) ● General Impression ● AVPU ● Airway ● Breathing- oxygen ● Circulation- pulse, BP ● Skin- color, temp. ● Patient Priority ⇩ 3. Secondary Assessment ● Head to Toe (DCAP BTLS) ● Baseline Vital Signs= pulse/pulse oximetry(60100), BP(120/80), respiration(12-20), temp, skin, pupils, blood glucose; capillary refill < 2 seconds ● Patient History (SAMPLE) Different places to check pulse: When and how? - ✔Carotid(neck): unresponsive

Radial(inside wrist): when person is responsive to determine BP. Brachial(bicep): for infant in CPR protocol.

Femoral(groin): circulation to legs and cardiac arrest. vital signs - ✔skin, pupils, blood glucose Normal Vital Signs - ✔Pulse rate= 60-100 (adults) Respiratory rate= 12-20(adult), 12-16(adolescents), 30-60(infant) Blood pressure= 120/80, systolic/diastolic, lower when younger How to find blood pressure - ✔Palpation(noisy)= feeling with hands the radial pulse, inflate till pulse disappears and deflate/note until returns (systolic) Auscultation= listening with stethoscope, Note when hear pulse and when it fades.

-small cuffs (high readings), Large cuffs (false slow readings) upper airway - ✔(Nose, mouth, pharynx, larynx) All outside chest cavity.

Conducts air to lower airway Warms, filters & humidifies air lower airway - ✔trachea, bronchi, bronchioles, alveoli, diaphragm (air in/out of lungs) Blood flow through the heart - ✔Right Atrium → *Tricuspid Valve* → Right Ventricle → *Pulmonic valve* → exits heart through pulmonary arteries → Lungs (gas exchange) → Back to heart via pulmonary veins → enters Left Atrium → through *Bicuspid Valve* → Left Ventricle → exits heart through *Aortic valve* → Aorta → Arteries → Capillaries → Venules → Veins → dumps blood into Superior/inferior Vena Cava Medications for chest pain(angina) - ✔Nitroglycerin: Dialates blood vessels decreases workload *Side Effects*: hypotension(lowers BP), headache, change of pulse rate, dizziness, light-headedness Epi-pen (epinephrine) - ✔severe allergic reaction with distress or shock, prescribed to them; constricts blood vessels Oral Glucose - ✔helps raise glucose levels, if low= altered mental status, ingest whole tube narcotic - ✔heroin hyperglycemia - ✔too much sugar → high blood sugar

hypoglycemia - ✔not enough sugar → low blood sugar 78% nitrogen and 21% oxygen - ✔composition of the atmosphere Anaphylaxis - ✔severe allergic reaction from bites, stings, food, pollens, chemicals, and medications.

Signs and symptoms/treat of Anaphylaxis - ✔burning, itching, breaking out/rash, rapid breathing, high/low pulse, swelling.

Use epinephrine autoinjector to treat Asthma - ✔condition affecting lungs, narrowing of air passage and wheezing COPD (chronic obstructive pulmonary disease) - ✔A group of lung diseases that block airflow/cause respiratory distress and make it difficult to breathe/shortness of breath Emphysema - ✔destruction of the alveoli, form of COPD Dyspnea - ✔shortness of breath/difficulty breathing Apnea - ✔breathing stop and starts during sleep Tachycardia - ✔rapid heart rate Bradycardia - ✔slow heart rate inspiration - ✔inhalation expiration - ✔exhalation Ventilation/Respiration - ✔breathing in and out/exchange of oxygen and CO2 in the cells -Exchange of oxygen in the alveoli and cellular level Types of heat emergencies - ✔*heat cramps*- painful muscle spasms following strenuous activity in a hot environment. Heat cramps are usually caused by an electrolyte imbalance (out of heat, sit in shade, drink liquids, try to cool down). *heat exhaustion*- prolonged exposure to heat, which creates moist, pale skin that may feel normal or cool to the touch (out of heat, sit in shade, drink liquids, try to cool down). *heat stroke*-prolonged exposure to heat, which creates dry or moist skin that may feel warm or hot to the touch. (signs= altered mental status, rapid pulse, weakness/dizziness......cool off quickly)

3 types of bleeding - ✔*Internal*= surgeon. *External*= we can control by direct pressure, bandage and tourniquet. *Arterial*- spurting blood, pulsating flow, bright red *Venous*- steady, slow flow, dark red(most external) *Capillary*- slow, even flow occlusive dressing - ✔air can't get through, sometimes soaked in vaseline Evisceration - ✔open wound of abdomen characterized by protrusion of intestines through abdominal wall/outside of body. *treat*= cut away any clothes, position on back, cover with moist/sterile dressing, then cover with Occlusive dressing flail chest - ✔2 or more ribs broken in 2 or more places Paradoxical movement - ✔abnormal movement of chest wall commonly associated with Flail Chest pneumothorax - ✔escape of air from lungs into pleural space.

Late sign= tracheal deviation hemothorax - ✔blood in the pleural cavity cardiac tamponade - ✔buildup of fluid in the pericardial space sucking chest wound - ✔open chest wound characterized by a sucking sound when patient inhales open pneumothorax - ✔(open chest injury) injury to chest that leaves a open wound tension pneumothorax - ✔restriction of breathing due to buildup of air pressure in pleural space CSF - ✔cerebrospinal fluid which is fluid that surrounds and protects brain 2 rhythms AED will shock - ✔V-fib and V-tach Sepsis - ✔widespread systematic infection/ bad infection Types of wounds - ✔abrasions: scrapes lacerations: deep cuts contusions: bruises

amputation: cutting/tearing off body part avulsion: loose flap of torn tissue/skin puncture: hole in body, penetrated Treatment of Thermal(heat) and Chemical Burns - ✔*Thermal*: Stop burning process, flush with water, remove clothes, monitor airway, cover with dressing(partial/full thickness with dry, clean dressing), provide oxygen and care for shock, eyes= keep closed *Chemical*: what chemical? if wet wash away with water, if dry brush off then flush with water *Superficial*(top layer, skin reddened), Partial thickness (top 2 layers, blisters), Full Thickness(all layers, Charring). rule of nines - ✔estimating amount of body surface burned. *Adult*: head/neck, chest, abs, each arm 4.5x2=9, front of leg, back of leg, upper back, lower back, butt= 9%, 1% to genital area *Child/Infant*: 18% to head and neck, 9% to each upper limp, 18% chest and abs, 14% each lower limb, 1% to genital Types of shock - ✔Hypovolemic Distributive Cardiogenic Obstructive hypovolemic shock - ✔hemorrhagic (caused by blood loss), dehydration, burn-shock obstructive shock - ✔Tamponade(fluid surrounding heart obstructing contraction, Pulmonary Embolism(blood clot), Tension Pneumothorax(air in chest) distributive shock - ✔anaphylaxis, sepsis, neurogenic, syncose(fainting) cardiogenic shock - ✔heart attack Stages of Shock - ✔-*Compensated* (problems with body, temporarily) -*Decompensated* (decline in mental status, unresponsive, low bp, decreased HR -*Irreversible* signs and symptoms of shock - ✔Restlessness/combativeness Change in mental status Increased pulse/heart rate Pale, cool, moist skin Respiratory/cardiac arrest

Treatment of shock - ✔Primary assessment/ABCs supported Control external bleeding Administer *oxygen* Keep in supine position *Nothing to drink/eat* Monitor vital signs How to time contractions - ✔counting from beginning of one contraction to beginning of next contraction.

Nasal Cannula (1-6 LPM) - ✔For every 1 LPM= 4% increase in concentration of oxygen; mild to moderate stress.

Non-rebreather mask (10-15 LPM) - ✔when patient requires higher concentration of oxygen; moderate to severe stress. bag-mask device - ✔when providing ventilation for nonbreathing patient breathing inadequately. Best used with 2 rescuers. Assist breathing efforts from a drug overdose Without reservoir= 50% oxygen With reservoir= 100% oxygen Common cause of seizures in small children - ✔Fever