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West Coast EMT Block 4 Study
Guide
Questions and Answers 2024
Know what cavitation is - ANSWER-Results from rapid changes in tissue and fluid pressure that occur with the passage of the projectile, can result in serious injury to internal organs distant to the actual path of the bullet. Know Newton's First Law of Motion - ANSWER-The first law states that objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted upon by an outside force. Kinetic Energy - ANSWER-The energy of a moving object. Reflects the relationship between the mass (weight) of the object and the velocity (speed) at which it is traveling. Potential Energy - ANSWER-The product of mass (weight), force of gravity, and height and is mostly associated with the energy of falling objects. The energy stored within an object. Know the 3 collisions that occur in a car accident. First Collision: - ANSWER-The collision of the car against another car, a tree, or other objects. Does not directly affect patient care except making extrication difficult The damage to the car can indicate how severe the patient's injury is and help determine the mechanism of injury. Know the 3 collisions that occur in a car accident. Second Collision: - ANSWER-The collision of the passenger against the interior of the car. This damage is caused by the kinetic energy produced by the passenger's mass and velocity is converted into the work of stopping the passenger's body. It can cause severe traumatic injury that can be apparent during the scene size up or primary assessment. The most dramatic injury occurs when the passenger is not restrained. Know the 3 collisions that occur in a car accident.
Third Collision: - ANSWER-The collision of the passenger's internal organs against the solid structures of the body. These injuries may not be as obvious as external injuries but they are often the most life-threatening. When the car hits an object, the internal organs also hit the inside structure of the body which can result in compression or stretching (tearing). What to assume with the death of an occupant in the same vehicle as another person? - ANSWER-Suspect that the other person has sustained serious injuries even if the injuries are not obvious. Treat life-threatening injuries and provide rapid transport to a trauma center. These passengers have likely experienced the same amount of force that caused the death of the other. What is the purpose of airbags? What happens if airbags don't deploy + what should you do? - ANSWER-Air bags gently cushions the occupant as the body slows and decelerates to decrease the severity of the impact of the second and third collision. If the airbags did not inflate during the accident, there is a chance they will deploy during extrication which can cause severe injury to the EMT. Extreme caution must be used when extricating a patient whose airbags did not deploy. What is the purpose of a head rest? What can it prevent? - ANSWER- Headrests decrease the extension of the head and neck during a crash and help reduce injury (mainly whiplash injury). Arteries - ANSWER-A blood vessel, consisting of three layers of tissue and smooth muscle, that carries blood away from the heart. Arterioles - ANSWER-The smallest branch of arteries leading to the vast network of capillaries. Capillaries - ANSWER-The smallest blood vessels that connect arterioles and venules; various substances pass through capillary walls, into and out of the interstitial fluid, and then on to the cells. Venules - ANSWER-Small, thin-walled blood vessels of the veins. Veins - ANSWER-Blood vessels that carry blood from the tissues to the heart.
How successful a person is able to compensate for blood loss is related to what in particular? - ANSWER-It is related to how rapidly the blood loss occurs. The age and pre-existing health of the patient should also be considered. Movement, removal of bandages, external environment, or body temperature may also affect the blood's clotting factors in cases of external bleeding. S&S of intra-abdominal bleeding (*know the early and late signs especially!) - ANSWER-Early signs: Pain and distention. referred pain. Late signs: Tachycardia, weakness, fainting, or dizziness at rest, thirst, nausea and vomiting, cold moist skin, dull eyes and slightly dilated pupils, shallow rapid breathing, capillary refill time longer than 2 seconds in infants and children, weak rapid pulse, decreasing blood pressure, and altered level of consciousness. When should we suspect a GI bleed? - ANSWER-Vomiting dark red blood (UPPER gi tract) Vomiting bright red blood and rectum (LOWER gi tract) Bloody diarrhea Know the early & late signs of non-traumatic GI bleeds - ANSWER-Early: Contusion/ ecchymosis caused by the accumulation of blood around Late: Hypovolemic Shock How do we control external bleeds? - ANSWER-Direct even pressure Pressure dressing and/or splint Tourniquets What's the most effective way to control arterial bleeds? - ANSWER-Direct pressure and tourniquet. Know the rule of 9's + differences between adults and children in relation to TBSA - ANSWER-Adult Head: 4.5% each side = 9% whole head Torso: 9% chest & 9% abdomen = 18% one side (18% anterior and 18% posterior = 36% whole torso) Arms: 4.5% each side = 9% whole arm Legs: 9% each side = 18% whole leg Groin: 1% Infant Head: 8% each side = 18% whole head Torso: 18% each side = 36% whole torso Arms: 4.5% each side = 9% whole arm Leg: 6.7% each side = 13.5% whole leg Groin: 1%
Know differences in burns (1st, 2nd & 3rd degree) - ANSWER-Superficial (first-degree) burn: Involves only the top layer of the skin, the epidermis. The skin turns red but does not blister or burn through this top layer. often painful. Partial-thickness (second-degree) burns: Involves the epidermis and some portion of the dermis. These burns do not destroy the entire thickness of the skin nor is the subcutaneous tissue injured.
- Skin is moist, mottled, and white to red. Blisters are present. Pain. Full-thickness (third-degree) burn: Extends through all layers of skin, sometimes muscle bones, and internal organs are affected too.
- Dry and leathery. Feels hard to touch. Appear white, dark brown, or even charred. Severely burned areas may not feel anything. Know electrical burns - ANSWER-There must be a complete circuit between the electrical source and ground for the electricity to flow. Any substance that prevents this flow is an insulator, any substance that allows the flow of current is a conductor. The type of electric current, the magnitude of current, and voltage have effects on the seriousness of burns. When an electric current enters the body, the skin is burned at the entrance wound as well as everywhere along the path until the current grounds and exits the body. In addition to tissue damage by the heat, significant chemical changes take place in the nervous, cardiovascular, and muscular systems of the body causing disruption of the body's normal functions. What happens when a person is exposed to cold? - ANSWER-If the body or any parts of it is exposed to cold environments, the complicated mechanisms that regulate internal temperature may be overwhelmed. Cold exposure can cause injury to individual parts of the body such as the feet, hands, ears, or nose, or the body as a whole. Hypothermia: When core temperature of the body drops below 95 °F. Progressive loss of body heat begins because the body cannot regulate its temperature. Know what an avulsion is - ANSWER-An avulsion is an injury that separates various layers of soft tissue (usually between the subcutaneous layer and fascia) so they become either completely detached or hang as a flap. Know what a sucking chest wound is and how to treat it - ANSWER-Sucking chest wound is an open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound. Also
Immediate emergency medical car and transport. Clear and maintain the airway and provide oxygen and us occlusive dressings to seal the open wound and prevent air from being sucked into the chest. What should you suspect with a patient who suffered a closed soft-tissue injury? - ANSWER-Suspect internal bleeding and damaged internal organs. Remain alert for signs of shock. Know what the mandible is - ANSWER-Jaw bone Where is the mastoid process located? - ANSWER-One inch posterior to the external opening of the ear is a prominent bony mass at the base of the skull. Where is the cricoid cartilage located? - ANSWER-The other portion of the larynx. A firm ridge of cartilage below the thyroid cartilage. What is another name for your eyeball? - ANSWER-The globe What is conjunctiva & sclera? - ANSWER-Conjunctiva: The delicate membrane that lines the eyelids and covers the exposed surface of the eye. Sclera: The tough, fibrous, white portion of the eye that protects the more delicate inner structures. How to treat injuries to the eye: Foreign objects - ANSWER-- Use a normal or sterile saline solution to flush out small particles from the eye. Flush from the nose side towards the outside
- Removing small objects from under the eyelid with a moist, sterile, cotton-tipped applicator:
- Gently pull the eyelid away from the eyeball 2) Gently place the cotton- tipped applicator horizontally along the center of the outer surface of the lid.
- Roll the eyelid over the cotton-tip applicator. 4) Remove any small particles on the inside of the eyelid with a sterile cotton-tipped applicator. Objects that are impaled in the eye should only be taken out by a physician. The care for that requires stabilization and immediate transport. Bandage the object in place to support it, cover the eye with a moist, sterile dressing, and then surround the object with a doughnut-shaped collar made from a roller gauze or a small gauze pack. How to treat injuries to the eye: Burns - ANSWER-Chemical burns: Flush with water or sterile saline irrigation solution. After, apply a clean, dry dressing to cover the eye, and transport. Thermal burns: Cover both eyes with sterile dressing moistened with sterile saline. Transport promptly.
Light burns: Cover each eye with a sterile, moist pad and an eye shield. Have patients lie down and transport. How to treat injuries to the eye: Laceration and Blunt Trauma - ANSWER- Laceration: Usually controlled by gentle pressure. Don't use pressure if the globe itself is bleeding. Apply a moist, sterile dressing to prevent drying. Cover the injured eye with protective metal eye shield or sterile dressing. Transport. Blunt Trauma: Cover the eye and provide transport. S&S of a detached retina - ANSWER-Painless but flashing lights, specks, or "floaters" in the field of vision. Know what Cushing's Triad is & what it indicates - ANSWER-It indicates a traumatic head injury. A Cushing Triad is increased blood pressure (hypertension), decreased heart rate (bradycardia), and irregular respiration such as Cheyne- Stokes respiration and Biot respiration. Also referred to as herniation syndrome where the intracranial pressure is so great it pushes the brainstem and midbrain through the foramen magnum (the hole at the base of the skull). Intracerebral hematoma - ANSWER-Bleeding within the brain itself. It can occur following a penetrating injury to the head or because of rapid deceleration forces. Once symptoms appear the patient's condition often deteriorates. High mortality rate. Cerebral Concussion - ANSWER-Mild traumatic brain injury. A closed injury with temporary loss or alteration of part or all of the brain's abilities to function without demonstrable physical damage to the brain. Coup-contrecoup injury - ANSWER-Rapid deceleration results in compression injury to the anterior of the brain along with stretching and tearing in the posterior of the brain. As the body moves forward, the brain strikes the front of the skull and begins its motion back; as the head hits the headrest the brain strikes the back of the skull. What is the most reliable sign of a head injury? - ANSWER- Decreased level of consciousness What is Beck's Triad & what does it indicate? - ANSWER-Signs and symptoms of cardiac tamponade are referred to as Beck Triad. Jugular vein distention, muffled heart sounds, and narrowing pulse pressure, where systolic and diastolic blood pressures start to merge.
into the peritoneal cavity.
Guarding: Contracting the stomach muscles to minimize the pain of abdominal movements; a sign of peritonitis. How should a seatbelt be worn? - ANSWER-Seat belt should lie below the anterior superior iliac spines of the pelvis and against the hip joints. How does early bruising present? - ANSWER-Red areas are early signs of bruising. What is a sign of intra-abdominal bleeding? - ANSWER-Bruising or discoloration, tenderness. S&S of a dislocated AC joint - ANSWER-The distal end of the clavicle will often stick out, and the patient will report pain, including point tenderness over the AC joint. When to apply a traction splint/when should you NOT apply a traction splint? What happens if your patient complains of intense pain while applying the traction splint? - ANSWER-Apply traction splint to the femoral shaft fractures Do not apply traction splint:
- Injury to the upper extremities
- Injury close to or involving the knee
- Injury to the pelvis
- Partial amputation s or avulsions with bone separation
- Lower leg, foot, or ankle injury If the traction causes more pain, stop and splint the limb in the deformed position. When do we use a scoop stretcher & why. - ANSWER-Used for patients who have been struck by a motor vehicle. It can be sectioned into two or four pieces and can be fitted around a patient who is lying on the ground or other relatively flat surface. Remember 1 liter per femur! (also 1 liter = 1,000mL hint, hint) - ANSWER- Remember 1 liter per femur! (also 1 liter = 1,000mL hint, hint) What is the most common & severe complication of dislocations to the knee? - ANSWER-Posterior knee dislocations, which results from hyperextension of the knee, are the most common. There is a high risk of injury to the popliteal artery. What is the most commonly fractured bone in the body? - ANSWER-The clavicle or collarbone
How do you splint the wrist? - ANSWER-Step 1: Support the injured limb and move the hand into the position of function. Place a soft roller bandage in the palm. Step 2: Apply a padded board splint on the palmar side with fingers exposed. Step 3: Secure the splint with a roller bandage. Know what striated muscle is and where it's found. Is it voluntary or involuntary? - ANSWER-Skeletal muscles that attach to the bones and usually cross at least one joint. Voluntary What is atrophy? - ANSWER-Decrease in the size of the muscle and its inherent ability to function. How do we assess a patient's general body temperature? (*besides using a thermometer) - ANSWER-Place the back of your hand on the patient's skin at the abdomen. If the skin feels cool, he/she is likely experiencing a cold emergency. How can you get the most accurate reading of a patient's core body temperature? - ANSWER-Insert the thermometer in the rectum. When does a person lose their ability to shiver? - ANSWER-As cold exposure worsens and hypothermia gradually becomes severe. Know S&S generalized hypothermia - ANSWER-Signs and symptoms worsen as hypothermia progresses: Shivering, foot stamping, constricted blood vessels, rapid breathing, altered level of consciousness; withdrawn Loss of muscle coordination and muscle stiffness, slowing respiration and slow pulse, confused and sleepy Coma, weak pulse and dysrhythmia, unresponsive Apparent death and cardiac arrest Risk factors of generalized hypothermia - ANSWER-Risk factors of generalized hypothermia include geriatric, pediatric, and ill people. Patients with injuries such as burns, shock, head injury, stroke, generalized infection, injuries to the spinal cord, diabetes, and hypoglycemia. How does the body eliminate heat? What's the most efficient? - ANSWER-The most efficient way is sweating (evaporation) and dilating skin blood vessels to increase the rate of heat radiation. Conduction: The transfer of heat from a part of the body to a colder object or substance by direct contact. Ex: Touching a cold object Convection: When heat is transferred to circulating air, such as when cool air moves across the body surface. Ex: Standing in windy weather
Evaporation: Conversion of any liquid to gas, a process that requires energy or heat. Natural mechanism by which sweating cools the body. Radiation: Transfer of heat by radiant energy. Ex: when a person stands in a cold room. Respiratory: Causes body heat loss as warm air in the lung is exhaled into the atmosphere and cooler air is inhaled. What is radiation? - ANSWER-Transfer of heat by radiant energy. A type of invisible light that transfers heat. Ex: when a person stands in a cold room. What is lost when we sweat? (hint, why do athletes drink Gatorade?) - ANSWER- Electrolytes and water is lost when we sweat. Why is sweating an effective cooling mechanism? What would interfere with a person's ability to sweat? (hint think about humidity) - ANSWER-The sweat must evaporate from the body. People standing in hot sunny weather with layers of clothing will make the body produce more sweat but with no cooling effect. High humidity will also decrease the evaporation of sweat Know S&S of heat stroke, when/how it occurs - ANSWER-Signs and symptoms include: Hot, dry, flushed skin, altered level of consciousness, unconsciousness, seizures in some cases, pulse becomes weak and blood pressure falls. Occurs when the body is subjected to more heat than it can handle and normal mechanisms for getting rid of the excess heat are overwhelmed. The body temperature rises rapidly to the level at which the tissues are destroyed Risk factors of heat stroke - ANSWER-Risk factors include patients who are involved in vigorous physical activity or when they are outdoors or in a closed, poorly ventilated, humid space. Also occurs during heat waves among people who live in buildings with no air conditioning or with poor ventilation. May also occur in children left unattended in locked vehicles on a hot day. How would diuretics affect a person experiencing heat-related emergencies? - ANSWER-Dehydration will occur quicker Why would pulse oximetry readings be inaccurate in hypothermic patients? - ANSWER- Because of the lack of perfusion in the extremities.
