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NREMT MUST KNOW CONCEPTS STUDY GUIDE
Medical Direction - Correct answer Oversight of the patient-care aspects of an EMS system by the Medical Director. Protocols - Correct answer lists of steps, such as assessments and interventions, to be taken in different situations. Protocols are developed by the Medical Director of an EMS system Offline Direction - Correct answer consists of standing orders issued by the medical director that allows EMTs to give certain medications or perform certain procedures without speaking to the medical director or another physician. Online Direction - Correct answer consists of orders from the on-duty physician given directly to an EMT-B in the field by radio or telephone. Standing Orders - Correct answer A policy or protocol issued by a Medical Director that authorizes EMT-Bs and others to perform particular skills in certain situations. HEPA Mask - Correct answer High Efficiency Particulate Air respirator; used for patients with suspected TB; worn by the EMT provider to prevent airborne transmission Hepatitis B - Correct answer infectious inflammation of the liver caused by the hepatitis B virus (HBV) that is transmitted sexually or by exposure to contaminated blood or body fluid Hepatitis C - Correct answer inflammation of the liver caused by the hepatitis C virus, transmitted by exposure to infected blood (rarely contracted sexually) Tuberculosis - Correct answer Infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis. Most commonly affects the respiratory system and causes inflammation and calcification of the system. Acute Stress - Correct answer short term ; fight or flight response ; effects disappear quickly after it is over
Scope of Practice - Correct answer What we are allowed to do or trained to do Standard Care - Correct answer the degree of care that a reasonably prudent person should exercise under the same or similar circumstances Duty to Act - Correct answer an obligation to provide care to a patient Good Samaritan - Correct answer a person who voluntarily offers help or sympathy in times of trouble Expressed Consent - Correct answer Permission that must be obtained from every conscious, mentally competent adult before emergency treatment may be provided Implied Consent - Correct answer The consent it is presumed a patient or patient's parent or gaurdian would give if they could, such as for an unconscious patient or a parent who cannot be contacted when care is needed. Treatment of a Minor - Correct answer Must be given by legal guardian Involuntary - Correct answer Mentally incompetent person Advanced Directive - Correct answer a legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health care Polst - Correct answer Physicians orders for life sustaining treatment. May include order for DO NOT RESUSCITATE PCR - Correct answer Prehospital care report Emergency Move - Correct answer a move made when there is an immediate danger to the patient.
inferior - Correct answer away from the head or below point of reference dorsal - Correct answer Toward the back/spine ventral - Correct answer Toward the front/ belly medial - Correct answer Toward center of body lateral - Correct answer Away from center of body bilateral - Correct answer Both sides unilateral - Correct answer One side ipsilateral - Correct answer Same side contralateral - Correct answer opposite side proximal - Correct answer Near the point of reference distal - Correct answer Far from point of reference mid clavicular - Correct answer the line through the center of the clavical mid axillary - Correct answer line drawn veritcally from the middle of the armpit to the ankle plantar - Correct answer Sole of foot palmar - Correct answer Palm of hand quadrants of the abdomen - Correct answer Describing where an abdominal organ or pain is located is made easier by dividing the abdomen into four imaginary quadrants. *Right upper quadrant (RUQ) *Left upper quadrant (LUQ) *Right lower quadrant (RLQ) *Left lower quadrant (LLQ)
vertebrae - Correct answer the 33 bones of the spinal column Ribs - Correct answer Vertebrosternal = 'True ribs" -ribs 1-7 attach directly to the sternum through their costal cartilage. Vertebrochondral = "False ribs" =ribs 8-10 costal cartilage articulate indirectly with the sternumb by joing the costal cartilages of ribs above. Vertebral Ribs = "Floating ribs" ribs 11 and 12 no anterior attachment. upper airway - Correct answer (Nose, mouth, pharynx, larynx)FUNCTION:*Conducts air to lower airway *Protects lower airways *Warms, filters & humidifies air lower airway - Correct answer trachea, bronchi, bronchioles, and aveoli (gasses travel through the structers to and from the blood) cricoid cartilage - Correct answer the ring-shaped structure that forms the lower portion of the larynx diaphragm - Correct answer muscular partition that separates the thoracic cavity from the abdominal cavity and aids in respiration by moving up and down phrenic nerve - Correct answer stimulates the diaphragm edema - Correct answer swelling perfusion - Correct answer The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries. hypo perfusion - Correct answer Also known as shock (decreased blood flow through an organ, as in hypovolemic shock; if prolonged, it may result in permanent cellular dysfunction and death.) cerebrum - Correct answer large part of the brain that controls the senses and thinking cerebellum - Correct answer the "little brain" attached to the rear of the brainstem; its functions include processing sensory input and coordinating movement output and balance
cellular respiration - Correct answer ..., process that releases energy by breaking down glucose and other food molecules in the presence of oxygen carina - Correct answer ..., the fork at the lower end of the trachea where the two mainstem bronchi branch. bronchioles - Correct answer ..., smallest branches of the bronchi pleura - Correct answer ..., membrane surrounding the lungs visceral pleura - Correct answer ..., inner layer of pleura that surrounds each lung parietal pleura - Correct answer ..., pleura that lines the inner chest walls and covers the diaphragm pleural space - Correct answer ..., the small potential space between the parietal and visceral layers of the pleura intercostal muscles - Correct answer ..., Muscles which move the rib cage during breathing signs of mild hypoxia - Correct answer Tachypnea Dyspnea Pale cool clammy skin ( early) Elevation of blood pressure Agitation Disorientation and confusion ( from high carbon dioxide levels) Headache signs of severe hypoxia - Correct answer Tachypnea Dyspnea Cyanosis Tachycardia may lead to dysrhythmias and eventually bradycardia Confusion Loss of coordination sleepy appearance Head bobbing Slow reaction time
Altered mental status dyspnea - Correct answer ..., difficult or labored respiration cyanosis - Correct answer ..., A bluish discoloration of the skin and mucous membranes patent airway - Correct answer ..., An airway that is open and clear of obstructions. snoring sounds - Correct answer ..., airway blocked, open patients airway promt transport crowing - Correct answer ..., A breathing sound similarto the cawing of a crow; may indicate that muscles around the larynx are in spasm. gurgling - Correct answer ..., indicates presence of fluid in the upper airway, need for suctioning stridor - Correct answer ..., a whistling sound when breathing (usually heard on inspiration) upper airway n-95 - Correct answer ..., Mask used for a patient with TB tonsil tip - Correct answer ... Rigid suction french tip - Correct answer ...Soft suction oropharyngeal - Correct answer ..., -curved plastic device used to establish an airway in a patient by displacing the tongue from the posterior wall of the oropharynx -used in unconscious patients who do not have a gag reflex nasopharyngeal - Correct answer ..., flexible airway inserted through the patients nose retractions - Correct answer ..., Movements in which the skin pulls in around the ribs during inspiration.
immediately when pressure is released. An abnormal finding is slow (greater than 2 seconds) return of pink tonewith respiratory or cardiovascular diseases that cause hypoxia. Penetrating truma - Correct answer Made a cut through Blunt force trauma - Correct answer No cut but internal problem Hypercapnia - Correct answer Too much carbon dioxide Flexion posturing - Correct answer (Formerly known as decorticate posturing). Client flexes one or both arms on the chest and may extend the legs stiffly. Indicates nonfunctioning cortex. Lesions of cerebral hemispheres or internal structures of brain cause this posturing. Extension posturing - Correct answer A posture in which the pt arches the back and extends the arms straight out parallel to the body. A sign of serious head injury Occluded - Correct answer closed off Dyspnea - Correct answer difficult or labored respiration Hypoperfusion - Correct answer inadequate perfusion also known as shock Secondary assessment - Correct answer after immediate life- or limb- threatening injuries/illnesses have been identified, this more thorough evaluation is performed to identify more subtle, yet still important, injuries Physical exam, Baseline vitals, History - Correct answer Three major steps in secondary assessments Cerebrospinal fluid - Correct answer clear liquid produced in the ventricles of the brain Jugular vein distention - Correct answer the visible bulging of the jugular vein when the Pt is in semi-fowlers position or full fowlers position. this is indicative of inadaquate blood movement through the heart and/or lungs
Tension pneumothorax - Correct answer a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels Pericardial tamponade - Correct answer filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart. Sputum - Correct answer material expelled from the lungs by coughing What is PMS - Correct answer Pulses motor function Sensation MOI falls - Correct answer Adults 20 feet children/infants more than 10 feet or 2or3 times their height Glasgow coma scale - Correct answer Used for head trauma- Score 3-15, based on Eye opening, Verbal response and Motor response. less than 13 - Correct answer Rapid transport (what's the number on the GCS) Brain herniation - Correct answer Increasing intracranial pressure related to the presence of lg pocket of blood (hematoma) Ruq - Correct answer contains majority of liver, gallbladder, small portion of pancreas, right kidney, small intestines, and colon. Luq - Correct answer stomach spleen left lobe of liver body of pancreas L kidney and Llq - Correct answer contains parts of the small and large intestines, left ovary, left fallopian tube, left ureter Rlq - Correct answer contains parts of the small and large intestines, right ovary, right fallopian tube, appendix, right ureter
Pericardial tamponade - Correct answer filling of the pericardial sac with fluid, which in turn limits the filling and function of the heart. Stages of shock - Correct answer 1. Compensatory Shock 2. Decompensatory Shock 3. Irreversible Stage If patient been in cardiac arrest for more than 5 min and no CPR has been done what do you do - Correct answer Provide 2 min of CPR before ard aed shock then pulse check? - Correct answer No aed shock then 2min CPR then pulse check V-fib - Correct answer completely erratic rhythm with no identifiable waves; fatal V-tach - Correct answer Ventricular tachycardia (an increased ventricular heart rate). Asystole - Correct answer the absence of a heartbeat Pea - Correct answer pulseless electrical activity. Heart is doing something but not pumping Stop ambulance when using aed - Correct answer True and shut off engine Can I aed on 1-8 year olds - Correct answer Yes but prefer to use less electrical dose If u can't it is ok How many shocks can I give - Correct answer 2-3 with CPR in-between Common diseases from wheezing - Correct answer Asthma Emphysema Chronic bronchitis Common diseases from rhonchi - Correct answer Aspiration Pneumonia Emphysema Chronic bronchitis
Common diseases from crackles - Correct answer Pneumonia Pulmonary edema Dyspnea - Correct answer difficult or labored respiration Apnea - Correct answer absence of breathing Hypoxia - Correct answer deficient amount of oxygen in tissue cells Respiratory Distress - Correct answer Indicates that a patient is breathing but is having trouble doing so. May lead to respiratory arrest. Respiratory Failure - Correct answer The reduction of breathing to the point where oxygen intake is not sufficient to support life Respiratory arrest - Correct answer When breathing completely stops. COPD - Correct answer chronic obstructive pulmonary disease; chronic bronchitis - bronchiole lining inflamed, excess mucus formed; emphysema - walls of alveoli break down; HYPOXIC DRIVE (not in asthma) Emphysema - Correct answer obstructive pulmonary disease characterized by overexpansion of the alveoli with air, with destructive changes in their walls resulting in loss of lung elasticity and gas exchange Chronic bronchitis - Correct answer obstructive pulmonary disease characterized by excessive production of mucus and chronic inflammatory changes in the bronchi, resulting in a cough with expectoration for at least 3 months of the year for more than 2 consecutive years. Pneumonia - Correct answer acute inflammation and infection of alveoli, which fill with pus or products of the inflammatory reaction Pulmonary embolism - Correct answer blockage of the pulmonary artery by foreign matter or by a blood clot Acute pulmonary edema - Correct answer occurs when an excessive amount of fluid collects in the spaces between the alveoli and capillaries, disturbs normal gas exchange
Aortic aneurysm - Correct answer congenital or developed weakness in wall of lower lumbar region (aorta), balloons out, anterior abdominal wall pulses, untreatable if ruptures Aortic Dissection - Correct answer damage may result in fatal bleeding, dissection is a condition where the inner layer of the wall of the aorta begins to tear; patient may complain of pain in the chest, abdomen or back will exhibit signs of shock CHF - Correct answer Congestive Heart Failure failure of the heart to pump blood away from the heart causing accumulation of fluid in the tissues and lungs Cardiac arrest - Correct answer The heart and breathing stop suddenly and without warning Neurological deficit - Correct answer any deficiency in the nervous system's functioning, typically exhibited as a motor, sensory, or cognitive deficit Stroke - Correct answer A medical injury to brain that is not related to truma Ischemic stroke - Correct answer the most common kind of stroke Hemorrhagic stroke - Correct answer stroke caused by the rupture of a blood vessel in the brain Thrombotic stroke - Correct answer type of stroke caused by a blood clot blocking an artery in the brain Embolic stroke - Correct answer a type of ischemic stroke that causes a clot to travel to the brain, mostly from the left side of the heart TIA - Correct answer transient ischemic attack; temporary interference with the blood supply to the brain Seizure - Correct answer sudden, transient disturbances in brain function resulting from abnormal firing of nerve impulses (may or may not be associated with convulsion)
Epilepsy - Correct answer chronic brain disorder characterized by recurrent seizure activity Status epilepticus - Correct answer a condition in which there are continuing attacks of epilepsy without intervals of consciousness Grand mal - Correct answer generalized tonic-clonic (it is sudden cry, fall, rigidity, followed by muscle jerking; shallow, irregular breathing; possible loss of bladder or bowel control; usually lasts seconds to minutes, followed by some confusion, a period of sleep (postical lethargy), and then return to full consciousness. Simple partial seizures - Correct answer begins in one area can move, patient aware and conscious, expreience change in taste/smell cause nausea Complex partial seizure - Correct answer impairment of consciousness for a few min or less; usually has rhythmic movements of face or extremities Petit mal - Correct answer milder form with loss of consciousness for a few seconds. Common in children. May disappear by late adolescence Febrile seizure - Correct answer convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Syncope - Correct answer a sudden, and generally temporary, loss of consciousness and postural tone, due to inadequate flow of oxygenated blood to the brain (fainting) Glucose and sodium bring what with them? - Correct answer Water Glycogen - Correct answer Storage form of glucose Glucagon - Correct answer a hormone secreted by the pancreas Normal glucose - Correct answer 80- Glucose after meal - Correct answer 120-
Hypothalamus - Correct answer a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion Convection - Correct answer Body heat lost to surrounding air, which becomes warmer then rises and is then replaced by cool air and then repeat the cycle Radiation - Correct answer Body heat is lost to the atmosphere or nearby objects without physically touching them Conduction - Correct answer Body heat is lost through direct physical touch of other objects 5 Stages of hypothermia - Correct answer Shivering Apathy and decreased muscle function Decreased level of responsiveness Decreased vital signs Death Heat cramp - Correct answer muscle pain or spasm due largely to the loss of salt from the body from sweating, or inadequate intake of salt Heat exhaustion - Correct answer Occurs when the body's cooling mechanism have been expended Skin is normal to cool in temp Pale or Gregory in color And sweaty Heat stroke - Correct answer The failure of the heat-regulating ability of an individual under heat stress. Skin will be hot and red possibly not sweating What temp and humidity are bad for the body to regulate temp - Correct answer 90 degrees and 75 humidity Low velocity injuries - Correct answer A knife or other impailed object in the body exerts damage to the immediate area of impact and it's underlying structures. The length of the object used is important
Medium and high velocity injuries - Correct answer Med/High velocity projectiles are from pellets or bullets. The damage caused, depends on the Trajectory and the dissipation of energy. Dissipation of energy is affected by Drag,Profile,Cavitation, & Fragmentation. Primary phase injuries - Correct answer Are due to the pressure wave of the blast. Injuries primarly effect the gas-containing organs, such as the lungs, stomach, intestines, inner ears and sinuses. Death may occur from this stage w/o any sign of external injury Cavacation - Correct answer Is the cavity that is formed by a pressure way Secondary phase injuires - Correct answer Are due to flying debris propelled by the blast They are usually lacerations fracture burns Tertiary phase injuries - Correct answer Are due to being throw and then landing on the ground similar to being ejected out of a car A loss of 15% of blood volume is - Correct answer Significant and can lead to shock When can I apply a splint on scene - Correct answer To extremity fractures only if the patient is stable and there is no life threat Epistaxis - Correct answer bleeding from the nose Good indicator of internal blood loss - Correct answer Weak pulse the into fast pulse Also no radial pulse body brings blood to core Narrow pulse pressure indicates - Correct answer Significant loss of blood Factors that may increase bleeding - Correct answer Movement Low body temp clotting less effective Medication anticlotting like aspirin Intravenous fluids Removal of bandages
