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NREMT Exam Study Solution Update
history of EMS system - Correct answer funeral homes; produced an environment in which funeral home operators were serving competing business interests and patients received little care until they arrived at the hospital "White Paper" - Correct answer Accidental Death and Disability: The Neglected Disease of Modern Society; published in 1966 by the National Academy of Sciences; spotlighted inadequacies of prehospital care in the US, especially in trauma Components of the EMS system: public access - Correct answer refers to how the public accesses the EMS system Components of the EMS system: clinical care - Correct answer outlines the scope of practice and associated equipment Components of the EMS system: medical direction - Correct answer physician oversight of patient care Components of the EMS system: integrated health services - Correct answer prehospital service providers work cooperatively with hospital personnel to ensure continuity of care Components of the EMS system: information systems - Correct answer the information technology component of the EMS system Components of the EMS system: prevention - Correct answer the EMS system's role in preventing injury and illness Components of the EMS system: research - Correct answer the move toward EMS care based on evidence based medicine Components of the EMS system: communications - Correct answer communication systems used to activate EMS system, dispatch responders, and communicate with medical direction
Components of the EMS system: human resources - Correct answer attempts to professionalize EMS occupations Components of the EMS system: legislation and regulation - Correct answer ensures the EMS system conforms to various local, state, and federal requirements Components of the EMS system: evaluation - Correct answer the quality improvement component of the EMS system Components of the EMS system: finance - Correct answer addresses the funding sources of the EMS system Components of the EMS system: public education - Correct answer focuses on the EMS system's role in the larger public health system Components of the EMS system: education systems - Correct answer addresses the quality of EMS training emergency medical responder (EMR) - Correct answer provides basic, immediate care including bleeding control, CPR, AED, and emergency childbirth (previously known as first responder) emergency medical technician (EMT) - Correct answer includes all EMR skills, advanced oxygen and ventilation skills, pulse oximetry, noninvasive blood pressure monitoring, and administration of certain medications (previously known as EMT-basic) advanced emergency medical technician (AEMT) - Correct answer includes all EMT skills, advanced airway devices, intravenous and intraosseous access, blood glucose monitoring, and administration of additional medications paramedic - Correct answer includes all preceding training levels, advanced assessment and management skills, various invasive skills, and extensive pharmacology interventions; this is the highest level of prehospital care outlined in the National EMS Educations Standards EMT roles and responsibilities - Correct answer 1. equipment preparedness
EMT priorities, in order - Correct answer 1. his or her own safety
- safety for partners, patients, and bystanders how to maintain scene safety - Correct answer addressing scene-specific hazards, appropriate infection control precautions, and safe lifting and moving techniques acute stress - Correct answer an immediate physiological and psychological reaction to a specific event; the event triggers the body's "fight or flight" response delayed stress - Correct answer a stress reaction that develops after the stressful event; it does not interfere with the EMT's ability to perform during the stressful event; PTSD is an example of delayed stress causes of stress - Correct answer 1. long hours, low pay, lack of sleep
- dangerous situations, exposure to death and dying
- challenging interactions with patients, family members, etc
- working holidays, birthdays, anniversaries, etc
- nonemergency transports and aggressive system-status management Critical Incident Stress Management (CISM) - Correct answer - defusing sessions, when needed are held within 4 hours of the incident
- debriefing sessions are held 24-72 hours after the incident
- CISM teams consist of trained peer counselors and mental health experts
- participants can, but are not required to, share their feelings
- CISM is meant to facilitate the process of dealing with critical incident stress; it is not used as a critique of patient care or any other type of performance evaluation
- the information shared during CISM is confidential stages of grief - Correct answer denial, anger, bargaining, depression, acceptance standard precautions - Correct answer body substance isolation precautions; to be implemented for all patient contacts and based on the assumption that all body fluids pose the risk of infection what is the single most important way to prevent the spread of infection - Correct answer handwashing
minimum PPE - Correct answer gloves and eye protection expanded PPE - Correct answer use disposable gown and mask for significant contact with any body fluid (e.g. childbirth); use high efficiency particulate air (HEPA) mask or N-95 respirator for suspected airborne disease exposure what to do upon encountering a hazmat incident - Correct answer 1. maintain a safe distance and attempt to keep others out
- call for specially trained hazmat responders
- look for placards without entering the scene and utilize the Emergency Response Guidebook to determine evacuation distance
- do not enter a hazmat scene until cleared by hazmat specialists
- do not begin emergency care until all patients have been decontaminated or otherwise cleared by hazmat crews what to do upon arriving at a crime scene - Correct answer 1. EMS should not enter a crime scene unless law enforcement has determined it is safe
- EMS providers may be advised to respond to the call but maintain a safe distance away until cleared by law enforcement; this is sometimes called "staging for PD" what to do upon arriving at an accident scene - Correct answer federal law requires EMS workers wear an approved highly reflective traffic safety vest when working on roadways, around traffic, or at an accident scene safe lifting techniques - Correct answer 1. power lift- keep object close to the body, use legs to lift (legs bent, back straight), use a power grip with palms up and all fingers wrapped around the object
- position the stretcher to reduce the height of the lift
- preplan the lift to reduce distance and avoid problems
- get enough help emergency move - Correct answer used when the scene is dangerous and the patient must be moved before providing patient care (e.g. armpit forearm drag, shirt drag, and blanket drag)
competently perform the indicated assessment and treatment within their scope of practice sources that help establish standard of care - Correct answer 1. National EMS Education Standards
- state protocols and guidelines
- medical direction
- EMS agency's policies and procedures
- reputable textbooks
- care considered acceptable by similarly trained providers in the same community advance directives - Correct answer written instructions, signed by the patient, specifying the patient's wishes regarding treatment and resuscitative efforts DNR - Correct answer specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest living will - Correct answer broader than DNRs; address healthcare wishes prior to entering cardiac arrest- may include the use of advanced airways, ventilators, feeding tubes, etc Good Samaritan laws - Correct answer designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed assault - Correct answer attempt to inflict harm; physical contact is not required to be guilty of assault; a person can be guilty even if another person only perceived that they intended to inflict harm battery - Correct answer physically touching another person without their consent informed consent - Correct answer required from all patients who are alert and competent; patient must be informed of care plan and associated risks of accepting or refusing care and transport
expressed consent - Correct answer requires an alert and competent patient; given verbally or nonverbally; not as in-depth as informed consent- often used to obtain consent for more basic assessments or procedures implied consent - Correct answer allows assumption of consent for emergency care from an unresponsive or incompetent patient (alcohol, drugs, head injury, hypoxia, hypoglycemia, mental incompetency); can be used to treat a patient who initially refused care but later loses consciousness or becomes otherwise incapacitated minor consent - Correct answer consent required from parent or legal guardian; implied consent can be used when unable to reach a parent or guardian and treatment is needed; not required for emancipated minors involuntary consent - Correct answer used for mentally incompetent adults or those in custody of law enforcement; consent must be obtained from the entity with the appropriate legal authority what is the most common reason EMTs are sued civilly - Correct answer negligence four requirements the plaintiff must prove in a civil suit of negligence - Correct answer 1. duty to act
- breech of duty
- damage
- causation gross negligence - Correct answer involves an indifference to and violation of a legal responsibility; exceeds simply negligence; can result in civil and/or criminal charges abandonment - Correct answer termination of care without transferring the patient to an equal or higher medical authority; transfer of care must include a verbal report to an equal or higher medical authority factors in deciding hospital destination - Correct answer 1. patient's request or medical direction
- the closest appropriate facility or specialty facility
- written protocols or triage guidelines
- hospital diversion or bypass
presumptive signs of death - Correct answer indicate the need to begin resuscitation and include unresponsiveness, pulselessness, and apnea definite signs of death - Correct answer indicate that resuscitation should not be initiated and include decomposition, rigor mortis (stiffening of the body), dependent lividity (settling of blood within the body, reddish blue discoloration), and decapitation in which situations must law enforcement or the medical examiner be notified - Correct answer any scene where the patient is dead on arrival, suicide attempts, assault or sexual assault, child abuse or elder abuse, suspected crime scene, and childbirth how to approach a crime scene - Correct answer 1. ensure scene safety
- provide patient care as needed
- avoid any unnecessary disturbance of scene
- remember and note the position of patient(s)
- remember and report everything you touched at the scene
- cut around (not through) holes in clothing when exposing the patient
- note anything or anyone suspicious on or near the scene
- discourage sexual assault patients from changing clothes or showering
- try to get a same-sex provider to assist with sexual assault patients
- leave once you are no longer needed on the scene therapeutic communications - Correct answer interaction with the patient and ability to obtain clinical information interpersonal communications - Correct answer the ability to send and receive information between at least two people portable radios - Correct answer hand-held transmitter/receiver with a very limited range, unless used with a repeater mobile radios - Correct answer vehicle-mounted transmitters and receivers; have a greater range than portable radios, but distance is still limited unless used with a repeater repeater - Correct answer a type of base station that receives low-power transmissions from portable or mobile radios and rebroadcasts at higher power to improve range
base station - Correct answer a transmitter/receiver in a fixed location that is in contact with all other components in the radio system Federal Communications Commission (FCC) - Correct answer regulates all radio operations in the US and has allocated specific frequencies for EMS use only sample format for relaying patient information to medical direction - Correct answer 1. unit designation, certification level, destination, and estimated time of arrival (ETA)
- patient's age, sex, and chief complaint
- patient's level of consciousness
- history of present illness or mechanism of injury
- any associated symptoms or pertinent negatives
- patient's vitals
- patient's physical exam
- patient's history, medications, and allergies
- treatment provided and response to treatment
- any requests for additional interventions
- echo any orders provided by medical direction 6 aspects of therapeutic communication - Correct answer compassion, competence, confidence, conscience, commitment, and questioning patients purposes of the PCR - Correct answer continuation of care, legal document, billing, research and continuous quality improvement minimum data set - Correct answer information that should be included on every PCR- time, patient information, administrative information, narrative F.A.C.T. documentation - Correct answer factual, accurate, complete, timely associated symptoms - Correct answer patient complaints in addition to the chief complaint (e.g. chief complaint is chest pain, but patient also complains of mild difficulty breathing)
adduction - Correct answer movement toward the midline of the body (e.g. with arms straight out at your sides, move them down to anatomical position) extension - Correct answer straightening the joint (increasing the angle of the joint) flexion - Correct answer bending the joint (decreasing the angle of the joint) supine - Correct answer lying on your back, face up prone - Correct answer lying on your stomach, face down Fowler position - Correct answer seated with head elevated recovery position - Correct answer lying on the left or right side; reduces the risk of aspiration; unresponsive patients with adequate breathing and no c-spine injury should be placed in the recovery position how many bones are there in the human body - Correct answer 206 ligaments - Correct answer connect bone to bone tendons - Correct answer connect bone to muscle cartilage - Correct answer connective tissue that allows smooth movement of joints axial skeleton - Correct answer consists primarily of the skull, spinal column, and ribcage (thoracic cavity) frontal bone - Correct answer forehead parietal bone - Correct answer top of head, between frontal and occipital bones occipital bone - Correct answer posterior portion of the skull temporal bone - Correct answer lateral bones, above the cheekbones
maxillae - Correct answer forms the upper jaw, above upper teeth mandible - Correct answer moveable portion of lower jaw zygomatic bone - Correct answer cheekbones foramen magnum - Correct answer opening in the occipital bone where brain connects to spinal cord how many vertebrae in the spinal column - Correct answer 33 (9 are fused) spinal column in descending order (superior to inferior) - Correct answer - cervical spine: C1-C
- thoracic spine: T1-T
- lumbar spine: L1-L
- sacrum: 5 fused vertebrae
- coccyx: 4 fused vertebrae thoracic cavity - Correct answer houses the heart, lungs, trachea, esophagus, and great vessels manubrium - Correct answer upper portion of the sternum body of the sternum - Correct answer middle portion of the sternum xiphoid process - Correct answer inferior tip of the sternum appendicular skeleton - Correct answer 1. bones of arms, legs, and pelvis
- shoulder girdle- formed by clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm)
- joints humerus - Correct answer upper arm radius - Correct answer lateral bone of forearm ulna - Correct answer medial bone of the forearm carpal bones - Correct answer wrist bones
cardiac muscle - Correct answer heart muscle biceps - Correct answer anterior humerus muscle triceps - Correct answer posterior humerus muscle pectoralis - Correct answer anterior chest muscle latissimus dorsi - Correct answer posterior chest muscle rectus abdominis - Correct answer abdominal muscles quadriceps - Correct answer four muscles, anterior femur muscles biceps femoris - Correct answer posterior femur muscle, part of hamstring gluteus - Correct answer three muscles, buttocks components of the upper airway - Correct answer 1. nose and mouth
- nasopharynx- upper part of throat behind the nose
- oropharynx- area of the throat behind the mouth
- larynx- voice box
- epiglottis- valve that protects the opening of the trachea what is the most common cause of upper airway obstruction - Correct answer tongue components of the lower airway - Correct answer 1. trachea
- carina- where the trachea branches into left and right mainstem bronchi
- left and right mainstem bronchi- primary branches of the trachea leading to left and right lungs
- bronchioles- smaller branches of the bronchi
- alveoli alveoli - Correct answer - only place in the respiratory system where oxygen and carbon dioxide are exchanged
- in contact with pulmonary capillaries, which diffuse carbon dioxide from the body to the alveoli
- alveoli diffuse oxygen from the respiratory system to the body
surfactant - Correct answer substance that helps to keep alveoli from collapsing pleura - Correct answer - two thin, smooth layers of tissue with thin film of fluid in between to allow frictionless movement across one another
- during inhalation, as the chest expands, the parietal pleura pull the visceral pleura, which pull the lungs visceral pleura - Correct answer lines the outer surface of the lungs parietal pleura - Correct answer lines the inner surface of the chest cavity diaphragm - Correct answer - primary muscle of respiration
- separates thoracic cavity from abdominal cavity
- usually under involuntary control but can be controlled voluntarily
- esophagus and great vessels pass through the diaphragm
- dome shaped until it contracts during inhalation; during inhalation it moves down and expands the size of the thoracic cavity intercostal muscles - Correct answer located between the ribs; contract during inhalation and expand the thoracic cage inhalation - Correct answer an active process that requires energy in which the diaphragm and intercostal muscles contract, the thoracic cage expands, pressure in the chest cavity decreases, and air rushes in exhalation - Correct answer a normally passive process that does not require energy in which the diaphragm and intercostal muscles relax, the thoracic cage contracts, pressure in the chest cavity rises, and air is expelled external respiration - Correct answer the exchange of oxygen and carbon dioxide between the alveoli and pulmonary capillaries internal respiration - Correct answer gas exchanged between the body's cells and the systemic capillaries cellular respiration - Correct answer aka aerobic metabolism; uses oxygen to break down glucose to create energy
agonal breaths - Correct answer dying gasps, slow and shallow, will not move air into alveoli; sign of abnormal breathing circulatory system - Correct answer aka cardiovascular system; includes all blood vessels, capillaries, and the heart heart - Correct answer a muscular organ with two pumps, one on the left side and another on the right left pump of the heart - Correct answer receives oxygenated blood from the lungs and sends it throughout the body; the stronger of the two pumps, with a greater workload than the right pump right pump of the heart - Correct answer receives deoxygenated blood from the body and sends it to the lungs to drop off carbon dioxide and pick up oxygen on its way to the left heart septal wall - Correct answer divides the heart into left and right sides endocardium - Correct answer smooth, thin lining on the inside of the heart myocardium - Correct answer thick muscular wall of the heart epicardium - Correct answer outermost layer of the heart and innermost layer of the pericardium pericardium - Correct answer fibrous sac surrounding the heart atria - Correct answer - the two upper chambers of the heart
- blood returning to the heart on both sides enters the atrium
- pump blood into the ventricles just before the ventricles contract (called the "atrial kick" and helps increase cardiac output) ventricles - Correct answer - lower and larger chambers of the heart
- receive blood from the atria and send it out of the heart during ventricular contraction (this creates a palpable pulse) left ventricle - Correct answer sends oxygen-rich blood throughout the body under high pressure
right ventricle - Correct answer sends oxygen-depleted blood to the lungs under low pressure heart valves - Correct answer one-way valves between the atria and ventricles that allow blood to move in a downward direction into the ventricles during atrial contraction; then close during ventricular contraction to prevent regurgitation of blood back into the atria three locations from which the heart can generate electrical impulses - Correct answer 1. sinoatrial node- primary power plant; generates impulses between 60-100 times per minute
- atrioventricular junction- backup pacemaker; generates electrical impulses at about 40-60 per minute
- bundle of His- final pacemaker; generates impulses only at about 20- per minute contractility - Correct answer heart's ability to contract; adequate contractility requires adequate blood volume and muscle strength preload - Correct answer the precontraction pressure based on the amount of blood coming back to the heart; increased preload leads to increased stretching of the ventricles and increased myocardial contractility afterload - Correct answer the resistance the heart must overcome during ventricular contraction; increased afterload leads to decreased cardiac output systemic vascular resistance - Correct answer - the resistance to blood flow throughout the body (excluding the pulmonary system)
- determined by the size of blood vessel: constriction increases SVR and can increase blood pressure, dilation decreases SVR and can lower blood pressure one artery that carries deoxygenated blood - Correct answer pulmonary artery one vein that carries oxygen-rich blood - Correct answer pulmonary vein
