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EMR Slideshow 3
Modules 21 to 30 - basic EMR course
122
Medical
Not Applicable
07/23/2013
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Term
What is rebound tenderness?
 Definition
Pain that is felt most when pressure is removed or
released (fairly suddenly) after palpation
Term
What is melena and haematochezia?
 Definition
Melena: black tarry stool, usually caused by blood that has run all or most of the course of the GI tract
Hematochezia: red runny stool due to fresh blood
Term
Name 13 GI and GU conditions
 Definition
GI: aneurysm, appendicitis, evisceration, hepatitis, intestinal obstruction, ruptured spleen, peptic ulcer, cholecystitis, diverticulitis
GU: ectopic pregnancy, gynecological disorders, PID (pelvic inflammatory disease), menstrual, urinary tract infection
Term
What are the signs of a ruptured abdominal aortic aneurysm (AAA)?
 Definition
- hypotension
- quiet patient guarding the abdomen
- rapid and shallow breathing
- tense, often distended abdomen
- tachycardia
- possible history of high blood pressure
- possible symptoms mimicking an MI
Term
What are the signs of appendicitis?
 Definition
Hallmark Signs / Symptoms:
- initially: diffuse periumbilical pain
- later: intense RLQ with rebound tenderness
Other:
- abdominal pain / cramping
- N/V
- chills
- low-grade fever
- anorexia
Term
What are the hallmark signs of hepatitis?
 Definition
Hallmark:
- intermittent RUQ pain
- jaundice
Other:
- sudden onset malaise
- weakness
- anorexia
- nausea & vomiting
- dark-colored urine
Term
What are possible causes of intestinal obstruction?
 Definition
- adhesions (organs sticking together or to peritoneum)
- hernias (protrusion of a bowel through the peritoneum)
- fecal impaction (stool that cannot be passed)
- polyps (small tissue growths, possibly cancerous)
- tumors (large tissue growths, possibly cancerous)
Term
What are the signs of a peptic ulcer?
 Definition
Hallmark:
- patient self-medicates with antacids
- burning in epigastric or LUQ region
Other:
- pain develops before meals or during stressful periods
- sudden onset pain
- pain relieved by food intake, antacids or vomiting
- hematemesis
- melena stool
Term
What are the signs of cholecystitis and what is it?
 Definition
Hallmark Signs / Symptoms:
- RUQ pain radiating to R shoulder and / or scapula
Other:
- low-grade fever
- nausea & vomiting
- RUQ tenderness to palpation
- shaking chills
- jaundice
- family history
Gallbladder infection
Term
What is a diverticulum and what are the signs of diverticulitis?
 Definition
A diverticulum is a sac or pouch that develops (usually with age) in the wall of the colon
Hallmark Signs / Symptoms:
- LLQ/RLQ pain
- alternating bowel habits
(diarrhea/constipation)
Other:
- fever
- bright red rectal bleeding
- sometimes no pain
Term
What are the signs of ectopic pregnancy?
 Definition
Hallmark Signs / Symptoms:
 Unilateral RLQ or LLQ pain
 Possibility of being pregnant
Other:
 Hypovolemia
 N/V
 Possible vaginal bleeding
 As a precautionary measure, every woman of child-bearing age, 11 to 50, should be asked if there is any chance they are pregnant if they are complaining of abdominal pain
Term
What is PID?
 Definition
Pelvic Inflammatory Disease - infection of the fallopian tubes 'surrounding' the pelvis
Hallmark Signs / Symptoms:
 Lower abdominal pain with a high fever
Other:
 Peritonitis
Term
What is Mittelschmerz?
 Definition
 intense pain caused by release of an egg from ovary, characteristically in the
middle of menstrual cycle
(menstrual cramps happen at the time menstrual period)
Term
What does UTI mean and what are the signs?
 Definition
Urinary Tract Infection
Hallmark Signs / Symptoms:
 Burning on urination
Other:
 Urinary frequency
 Hematuria
 Abdominal pain
 Fever / chills
 Malaise
(less common in males - suspect venereal disease)
Term
What do you do in an acute abdomen?
 Definition
 Initiate high flow oxygen (after
determining rate of respirations)
 Position patient supine with legs drawn up and knees flexed
 Perform a GI/GU special assessment
 Give nothing by mouth
 Anticipate hypovolemic shock
 Consider saving any vomit (emesis), especially if food poisoning or drug overdose
Term
What is the difference between Type 1 and Type 2 diabetes mellitus?
 Definition
Type 1: insulin dependant (IDDM), needs injections of insulin because produces virtually no insulin (juvenile or early onset DM)
Type 2: commoner, non-insulin-dependent diabetes (NIDDM), produces inadequate amounts of insulin relative to sugar intake, controlled by diet or oral
hypoglycemics, (adult or late onset DM)
Term
What are the two types of diabetic emergency? What numbers define them? What are the three types of diabetes?
 Definition
Hypoglycemia (blood glucose BGL <3.8 mmol)
Hyperglycemia (BGL >7 mmol)
Third diabetic condition in gestational diabetes - diabetes in pregnancy.
Term
Describe what happens in hyperglycaemia.
 Definition
 Lack of insulin causes glucose to build-up in blood in
extremely high levels
 Kidneys excrete glucose via urine, so more urine produced
 Without the ability to use glucose, body uses fat for fuel, causing inefficient metabolism
 Ketones are formed, producing diabetic ketoacidosis, a life-
threatening emergency
 Onset takes days to weeks, not an immediate onset
Term
What are the signs of hyperglycaemia?
 Definition
 Nausea/Vomiting
 Abdominal pain
 Kussmaul respirations (deep, rapid breathing)
 Unconsciousness or altered LOC
 Dehydration
 “Fruity” breath odor
 Rapid, weak pulse
 Normal or slightly low BP
 Varying degrees of unresponsiveness
Term
What are the signs of hypoglycaemia?
 Definition
Hallmark:
 Sudden mentation changes
 Appear to be drunk
 Violence or aggression
Other:  Normal or rapid
respirations
 Pale, moist skin
 Sweating
 Dizziness, headache
 Rapid pulse
 Normal to low BP
 May mimic a CVA
 Altered mental status
 Hunger
 Fainting, seizure, or coma
 Weakness on one side of the body
Term
In a patient with hypoglycaemia, when must you NOT give oral glucose?
 Definition
If they are unconscious or unable to follow commands because of risk of aspiration
(unconscious patients are dealt with by EMTs or EMT-Ps with IV dextrose or glucagon injections)
Term
What other questions on top of AMPLE do you ask in diabetes?
 Definition
 Do you take insulin or any pills to manage blood sugar?
 Have you taken your appropriate dose of insulin (or pills) today?
 Have you changed the type of insulin taken?
 Have you eaten normally today? What? When?
 Have you had any illness, unusual amount of activity, or stress today?
Term
What are the 5 classes of allergen?
 Definition
 Insect bites, stings and animals
 Medications
 Plants
 Food
 Chemicals
Term
Describe what happens in an allergic reaction
 Definition
An allergic reaction is caused by body’s immune system over-responding to an allergen (includes releasing leukotrienes and histamines)
 Ranges from minor to severe
 May start at any point in life
 May disappear (unusual)
 Usually gets more severe and faster onset with each subsequent exposure
Term
Name 9 immune / bite / sting conditions
 Definition
Allergic Reaction
Anaphylactic Reaction
Bites & Stings
 Insect Stings
 Spider Bites
 Snake Bites
 Scorpion Stings
 Tick Bites
 Dog/Bat Bites
 Coelenterates
Term
What are the hallmark signs of a mild allergic reaction?
 Definition
 Localized urticaria (itchy hives)
 Wheals (raised swollen patch)
 Pustules (raised bumps)
Term
What is anaphylaxis?
 Definition
An extreme allergic/immune reaction to an allergen that involves multiple body systems that is life-threatening
Term
What percentage of people are allergic to bee, hornet, yellow jacket, and wasp stings?
 Definition
5%
Term
What are the hallmark sign of anaphylaxis?
 Definition
 Swollen tongue/lips
 Wheezing
 Systemic urticaria (generalised itchy rash)
Term
Describe the signs of anaphylaxis, system by system
 Definition
 Skin: flushing, itching, hives, swelling, cyanosis
 Respiratory: SOB, wheezing, stridor, laryngeal edema / spasm, bronchospasm
 Cardiovascular: vasodilation, increased HR, decreased BP
 GI: N/V, abdominal cramp, diarrhea
 Nervous: dizziness, headache, convulsions
Term
How long does the effect of an Epi-pen last?
 Definition
About 20 minutes
- but anaphylactic reactions may last longer so speed to ALS intercept or hospital is important
Term
What does epinephrine do and what is released in an allergic reaction, the effects of which epinephrine seems to correct?
 Definition
Histamine causes:
 Bronchoconstriction
 Vasodilation
 Increase membrane permeability
Epinephrine causes:
 Bronchodilation – β2 stimulation
 Vasoconstriction – α stimulation
 Decreases membrane permeability (inhibiting histamine release)
Term
What is the difference between a localised and anaphylactic allergic reaction?
 Definition
Anaphylaxis causes swelling to face, airway, throat, tongue as well as to where allergen applied, it is life-threatening with low BP, tachycardia, tachypneia.
Localised reaction causes local reaction without these generalised effects.
Term
How long does a bee sting continue to inject venom once separated from the bee?
 Definition
20 minutes
Term
How do you remove a sting?
 Definition
With something with an edge like a credit card (not tweezers because it can inject more venom)
Term
What is damaged by the venom from 1. black widow and 2. brown recluse spiders?
 Definition
1. Nerve damage - produces neurotoxin which can inhibit / depress respiration
2. Local tissue damage - produces a cytotoxin which can cause necrotizing fasciitis (destruction of whole segments of muscle and surrounding tissue - nasty)
Term
What type of venom does a pit viper like a rattlesnake produce?
What are the signs and symptoms?
 Definition
A digestive enzyme, not a paralytic or neurotoxin
 Characteristic puncture marks about 1⁄2 an inch apart
 N/V
 Weakness / fainting / shock
 Psychosomatic complaints
 Sweating
 Pain
Term
What is a coelenterate?
 Definition
Jellyfish
Term
How do you treat a jellyfish sting?
 Definition
- inactivate using alcohol
- scrape stings off using and edge e.g. credit card
Term
What diseases can you get from a tick bite?
 Definition
Rocky Mountain Spotted Fever and Lyme disease
- look for a bulls-eye pattern around the bite
Term
Name two examples of absorbed poisons
 Definition
Poison oak and poison ivy
Term
If you suspect poisoning, what do you ask the patient?
 Definition
 What substance did you take?
 What did you take with the substance?
 When did you take it or (become exposed to it)?
 How much did you ingest?
 What actions have been taken? (ingest anything or vomit)
 How much do you weigh?
 Have you done this before?
 Contact the poison center
Term
What do WHMIS and MSDS stand for?
 Definition
WHMIS - Workplace Hazardous Materials Information System
MSDS - Material Safety Data Sheet
Term
How does a sedative hypnotic kill? Name three examples.
 Definition
Causes central nervous system (CNS) depression which may cause respiratory depression and/or arrest
Alcohol, barbiturates, benzodiazepines.
Term
What condition can you get if you stop drinking alcohol suddenly after prolonged period of excessive drinking? When can it start and how long does it last?
 Definition
Delirium Tremens
May develop 1 to 7 days after
stopping drinking and may take 48+ hrs for symptoms to disappear
Term
What are the signs of delirium tremens?
 Definition
 Agitation and restlessness
 Fever
 Sweating
 Confusion and/or disorientation
 Delusions and/or hallucinations
 Seizures
 Nausea/vomiting
Term
What are the signs and symptoms of opioid / narcotic poisoning?
 Definition
 Pinpoint pupils
 Decreased respirations
 Decreased ventilatory volume
 Depressed to absent respirations
 Altered LOC
 Cyanosis
Term
What are the signs of sympathomimetic overdose and what does it do?
 Definition
Hallmark Signs / Symptoms:
 Dilated pupils
 Unusually high energy or attentiveness levels
 Hypertension
Stimulates CNS causing:
 Tachycardia
 Fear / Paranoia
 Delusions
 Seizures
 Cardiac arrhythmias / arrest
 N/V
Term
Give three examples of sympathomimetic CNS stimulants
 Definition
 Caffeine
 Ecstasy / Eve
 Cocaine (crack, meth, ice)
 Ephedrine
Term
What are the signs of marihuana use?
 Definition
 Impaired motivation
 Numerous empty pizza boxes
 Tachycardia
 Paranoia
 Hallucinations
Term
What do anticholinergic drugs do and what are the signs of overdose?
 Definition
Block effects of parasympathetic nervous system (very similar to a sympathomimetic reaction, but different)
Hallmark Signs / Symptoms:
 “Hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter"
Other:
 Tachycardia
 Hypertension
 Cardiac arrhythmias
 Seizures
Term
Give an example of an anticholinergic drug
 Definition
 Diphenhydramine (Benadryl)
 Jimson weed
 Gravol
 Haldol
 Anti-depressants e.g. fluoxetine (Prozac), sertraline (Zoloft)
 Tricyclic Anti-depressants e.g. amitriptyline (Elavil), imipramine (Tofranil)
Term
What are the symptoms and signs of cholinergic drug poisoning?
 Definition
Signs / Symptoms: SLUDGE
S Salivation
L Lacrimation
U Urination
D Defecation
G GI irritation
E Eye constriction/Emesis
Term
Give two examples of cholinergic poisons
 Definition
 Organophosphates & Carbamates
 Insecticides
 Some wild mushrooms
 Lawn-care chemicals
 Flea collars
 Chemical Warfare Agents such as sarin and soman
Term
What are the symptoms / signs and toxic dose of aspirin?
 Definition
Signs and symptoms
 Nausea/vomiting
 Hyperventilation
 Ringing in ears
 Confusion
 Seizures
Toxic dose is 150mg/kg
(about 36 capsules for an 80kg person)
Term
How does acetaminophen kill and what is the toxic dose?
 Definition
Delayed liver failure - may not be apparent until a week later
Toxic dose is 150mg/kg - about 36 capsules for an 80 kg person
Term
What is the difference between dementia and delirium?
 Definition
Dementia: progressive change in mental status over period of years
Delirium: rapid, temporary change in cognitive status due to a an outside factor (e.g. alcohol)
Term
What are the signs of dementia?
 Definition
Hallmark Signs / Symptoms:
 Forgetfulness (not oriented to person, place, time and/or event)
Other:
 Medical alert
 Environment (long-term care facility, hospital...)
Term
What are the signs of depression?
 Definition
Hallmark Signs / Symptoms:
 Air of tearfulness
 Profound sadness / melancholy
Other:
 Diminished interest in almost activities
 Significant weight loss or gain (+/- 5%)
 Insomnia / hypersomnia
 Feelings of worthlessness
 Excess of inappropriate guilt
 Diminished ability to think or concentrate
 Indecisiveness
 Recurrent thoughts of death
 Self mutilation / scarification (not to be confused with tattoos
and piercings)
Term
What are the warning signs for suicide risk?
 Definition
 Does the patient have an air of tearfulness, sadness, deep despair, or hopelessness?
 Does the patient avoid eye contact speak slowly or project a sense of vacancy?
 Does the patient seem unable to talk about the future?
 Is there any suggestion of suicide?
 Does the patient have a previous Hx. of same?
Term
What type of suicide attempt methods do females tend to use?
 Definition
Passive
Generally, males are more likely to use violent means to commit suicide (guns, hangings...) while females are more likely to use passive means (pills, carbon monoxide...)
Term
What are the signs / symptoms of Critical Incident Stress?
 Definition
 Sleep disturbances
 Memory problems / poor concentration
 Flashback phenomena
 Depression
 Feeling numb
 Change in interpersonal interactions
 Increased smoking / caffeine / other drug intake
 Being overly vigilant of the environment
 Excessive humor or silence
 Unusual behavior for the individual
 Crying spells
Term
What form of consent is appropriate if a patient is not mentally competent?
 Definition
When a patient is not mentally competent, the law assumes that there is implied consent.
Remember the Mental Health Act Form 10 and that you cannot restrain patient unless it is an emergency - danger to themselves or others.
Term
What temperature is mild hypothermia and what are the signs?
 Definition
Core body temperature <35 degrees (body compensates by peripheral vasoconstriction)
Hallmark Signs / Symptoms:
 Shivering
Other:
 Tachycardia
 Tachypnea
 Red then pale then cyanotic skin
 Peripheral and circumoral cyanosis
 Loss of fine motor function
 Anxious / Withdrawn
Term
What levels of core body temperature are defined as moderate and severe hypothermia?
 Definition
Moderate: 32 to 35 degrees
Severe: <32 degrees
Note
 Pulse checks on hypothermic patients may need to be as long as 60 seconds
 Weather does not need to be below freezing for patients to be hypothermic
 Patients on vasodilators, infants & geriatrics are more susceptible to cold emergencies
Term
What are the signs of moderate hypothermia?
 Definition
(Core body temperature is between 32 and 35)
Hallmark Signs / Symptoms:
 Absence of shivering – no longer compensating
Other Signs / Symptoms:
 Confused / Sleepy
 Loss of all motor coordination
 Bradypnea
 Bradycardia
Term
How long do you check a hypothermic patient's pulse for?
 Definition
May need to be as long as 60
seconds
Term
What is the maximum number of times that you should defibrillate a hypothermic patient?
 Definition
Once only
Term
How far should you allow a systemic cold injury patient to walk? Explain your reasoning.
 Definition
Do not allow patient to walk because it causes reperfusion of extremities delivering cold blood to the core, resulting in secondary hypothermia, harder to treat
 Remove wet clothing & cover with blankets
 Handle the patient gently
 Do not massage extremities or allow patient to eat or use stimulants
Term
Should you actively rewarm superficial or deep frostbite?
 Definition
OK to actively rewarm superficial but NOT deep frostbite
Term
What are the signs of deep frostbite?
 Definition
Hallmark Signs / Symptoms:
 Hard, frozen body part with no motor/sensory
 White, waxy appearance
Other Signs / Symptoms:
 Blisters
 Swelling
 Red, purple, mottled, cyanotic or waxy appearance
Term
What mechanisms cool the body?
 Definition
Body cools itself by sweating (evaporation) and dilation of blood vessels
Term
What are the signs of heat exhaustion?
 Definition
 Pale, cold, clammy skin
 Dry tongue and thirst
 Dizziness, weakness, or fainting
 Usually normal vital signs
 Pulse may increase
 Blood pressure may decrease
 Normal or slightly elevated body temperature
Term
What is heat stroke and what are the signs?
 Definition
Body’s cooling mechanisms overwhelmed no longer functional
Hallmark Signs / Symptoms:
 Not sweating – no longer compensating
 Hot, red / flushed, dry skin
Other Signs / Symptoms
 Changes in behavior
 Decreased or absent LOC
 Pulse rate is rapid, then slows, then stops
 Blood pressure drops
Term
How do you treat generalized heat injury situations?
 Definition
Unlike cold emergencies (passive rewarming),
heat emergencies require rapid, aggressive cooling
 Utilize as many of the 5 methods of transferring body heat as possible:
 Convection
 Conduction
 Evaporation
 Radiation
 Respiration
Term
When should you suspect spinal injury in a submersion incident?
 Definition
Suspect spinal injury if:
 Submersion has resulted from a diving mishap or long fall
 Patient is unconscious
 Patient complains of weakness, paralysis, or numbness
Term
What are the two forms of ascent diving incidents?
 Definition
Ascent problems:
 air embolism and
 decompression sickness
Descent problems usually due to sudden increase in pressure as the person dives
Bottom problems are not commonly seen
Term
What causes 'the bends'?
 Definition
Occurs when bubbles of gas obstruct blood vessels
Can result from rapid ascent
Most common symptom is abdominal and/or joint pain and/or tooth pain
Symptoms may develop after hours
Can also develop if air-travel comes too soon after scuba diving
Term
What are the signs of 'the bends'?
 Definition
Blotching
Froth at the mouth and nose
Severe pain in muscle, joints, or abdomen
Dizziness, nausea, and
vomiting
Dysphasia (difficulty speaking)
Dyspnea and/or chest pain
Difficulty with vision
Paralysis and/or coma
Irregular pulse or cardiac
arrest
Term
What position do you transport a patient with 'the bends' and why?
 Definition
Place the patient in the left lateral recumbent position with his or her head down, why?
....Because it traps air bubbles in right atrium and prevents them getting into the systemic (left side of heart) circulation
Term
What are the important factors regarding old people and heat incidents?
 Definition
Body loses the ability to respond to environment
Decreased muscle mass and body fat results in less insulation
Temperatures that threaten older patients may not seem uncomfortable to responders
Term
What do the terms amniotic sac, para and gravida mean?
 Definition
Amniotic Sac  The fluid-filled bag-like membrane in which the fetus develops, also protects fetus
Para  Number of live births the woman has had or the number of times the woman has been a parent
Gravida  Number of pregnancies the woman has had (including miscarriages, terminations)
Term
What does primagravida mean?
 Definition
A woman who is experiencing her first pregnancy
Term
Does the BP increase or decrease in a normal pregnancy?
 Definition
Blood Pressure decreases by approx. 10-15 mmHg
Term
What is the second trimester of pregnancy?
 Definition
2nd trimester is 12 to 28 weeks
1st is 0 to 12 weeks
3rd is 28 to 40 weeks
Term
Name 4 obstetric complications.
 Definition
- 1st & 2nd Trimester
 Ectopic Pregnancy
 Spontaneous Abortion
- 3rd Trimester
 Abruptio Placenta
 Placenta Previa
 Hypertensive Emergencies
 Preeclampsia
 Eclampsia
 Supine Hypotensive Syndrome
- Delivery
 Childbirth
 Post-partum hemorrhage
 Birth trauma
 Meconium compromise
 Multiple gestation
- Delivery Complications
 Breech birth
 Limb presentation
 Cord presentation
 Fetal demise (death)
- Other
 Sexual assault
Term
What are the signs of ectopic pregnancy?
 Definition
Hallmark Signs / Symptoms:
 Unilateral RLQ or LLQ pain
 Possibility of being pregnant
Other Signs / Symptoms:
 Hypovolemia
 N/V
 Possible vaginal bleeding
Term
What do abruptio placentae and placenta praevia mean?
 Definition
Abruptio placenta -
premature separation of the placenta from the uterine wall
Placenta praevia -
placenta has partially or completely covered the cervix
Term
What is the difference between eclampsia and pre-eclampsia?
 Definition
Pre-eclampsia is hypertension and swelling of ankles / hands.
Once the pregnant woman then progresses to suffer a convulsion, it is called eclampsia.
Term
What is supine hypotension syndrome?
 Definition
Dizziness / light-headedness while lying flat with hypotension due to the weight of the baby / uterus pressing on inferior vena cava (large vein to right of aorta in abdomen). So transport pregnant women in the left lateral supine position.
Term
What are the three stages of delivery?
 Definition
 First stage
Dilation of the cervix – mom’s body preparing for delivery (1 to 32 hours average 10 hours)
 Second stage
Delivery of infant – child is in the birth canal (0 to 6 hours average 2 hours)
 Third stage
Delivery of placenta (usually within 30 minutes of delivery)
Term
How do you deal with the cord at delivery?
 Definition
Clamp cord twice, 6 cm away from infant and another 4 cm further away then cut cord between the clamps
Term
What does APGAR stand for?
 Definition
Appearance
Pulse
Grimace
Activity
Respiration
Term
How hard should you pull on the umbilical cord to help the placenta to separate?
 Definition
DO NOT tug on the umbilical cord
Transport as soon as delivery of baby completed - do not delay for placental delivery
Term
What is meconium and when is it a problem?
 Definition
Meconium is the baby's first bowel movement resulting from baby becoming hypoxic.
If this happens before birth, it can get into the amniotic fluid, staining it yellow / green. If this meconium is then aspirated, it can cause damage so urgent suction is needed.
Term
Is a breech delivery faster or slower than head first?
 Definition
Slower.
Protect the baby's airway while awaiting the head delivery.
Term
What position do you transport in a case of limb presentation?
 Definition
The “knee-chest” position - a true emergency.
Term
What do you do if there is a cord prolapse?
 Definition
Insert fingers into the vagina, push the vaginal wall off the cord, reducing kinking. Continue this all the way to hospital.
Term
What genital examination should you do in a case of sexual assault?
 Definition
None other than if there is significant bleeding. Preserve evidence and document carefully.
Term
What is the difference between kinetic and potential energy?
 Definition
Kinetic energy is the energy of a moving object and depends on the mass and speed
Potential energy is the product of weight, gravity, and height
Term
What does MOI stand for?
 Definition
Method of injury
Term
What type of motor vehicle accident is responsible for the highest incidence of deaths and spinal cord injury?
 Definition
Lateral collisions
May be intrusion into passenger compartment (no bumpers etc at side) and C spine injuries common.
Term
What type of collision is notorious for causing 'whiplash' injury?
 Definition
Read end collision.
Term
What height of a fall is considered to be significant?
 Definition
Either 15 feet or three times the person’s height is considered significant
Term
What causes cavitation in a bullet wound?
 Definition
Pressure waves cause cavitation
Term
What is more significant, the speed or size of the bullet?
 Definition
Speed is more critical:
 Doubling speed quadruples damage
 Doubling size doubles damage
 EK = ½mv2
Term
What is Newton's Second Law?
 Definition
Force (F) is Mass (M) times Acceleration (A)
 F=MA
It is not speed that kills but the sudden stop at the end
Term
Describe the Power Lift technique
 Definition
Tighten back in normal upright position
Legs apart about 15"
Adjust your orientation and position
Reposition feet
Grasp with arms extended down side of body
Lift by straightening legs
Keep shoulders back
Arms and hands palm up
Hands at least 10" apart
Term
What is a Diamond Carry?
 Definition
One rescuer at head end
One rescuer at foot end
One rescuer on each side of the patient’s torso
Term
How many straps should you use on a backboard when carrying downstairs and is it head or feet first?
 Definition
4 straps at least
Carry downstairs feet first (upstairs head first - head up)
Term
What is the limit that two should lift?
 Definition
Do not attempt to lift a patient who weighs over 250 lb with only two EMS practitioners
Term
Describe an arm to arm emergency drag
 Definition
 Patients left wrist is held by the rescuer’s right hand
 The patient’s wrists are crossed
 The rescuer’s arms go under the patient’s axillae
Term
Which is easier to carry a big person - a Fire-fighter's Carry or a Pack-strap Carry?
 Definition
Pack-strap Carry
Term
When should a scoop stretcher be used?
 Definition
 Bilateral femur fractures
 Unstable pelvis
 Bilateral thoracic trauma
 Any major trauma involving multiple fractures where log-rolling would aggravate injuries
Term
What is the correct term for spinal immobilization?
 Definition
Spinal Motion Restriction
Term
What conditions require spinal motion restriction?
 Definition
 Motor vehicle crashes
 Pedestrian-motor vehicle collisions
 Motorcycle crashes
 Hangings
 Diving accidents
 Falls
 Blunt or penetrating trauma to head,neck, chest or abdomen
 Recreational vehicle accidents
 Unwitnessed unknowns
Term
What are the signs and symptoms of a spinal injury?
 Definition
 MOI to support it
 Pain or tenderness of spine
 Deformity of spine
 Tingling in the extremities
 Loss of sensation or paralysis
 Incontinence
 Priapism
Term
When must you NOT move the head into a neutral in-line position in suspected C Spine injury?
 Definition
If:
 Muscles spasm
 Pain increases
 Numbness, tingling, or weakness develop
 Detect crepitus or encounter resistance
Note - If a patent airway is not obtainable with modified jaw thrust, the neck must be moved (head tilt chin lift)
Term
What is shock?
 Definition
State of collapse and failure of the
cardiovascular system
Leads to inadequate circulation and blood-flow prioritization – keeping the vital organs perfused
Term
What causes neurogenic shock?
 Definition
Also known as Spinal Shock or container failure
 Damage to the cervical spine may affect control of the size and muscular tone of blood vessels
 The vascular system increases in diameter
 Blood in the body cannot fill the enlarged system resulting in a lowered BP = hypoperfusion
 Other possible causes: anaphylaxis, sepsis
Term
What are the different types of shock?
 Definition
Cardiovascular:
 Cardiogenic (pump failure)
 Neurogenic (spinal shock)
 Hypovolemic (loss of blood volume)
Non-Cardiovascular:
 Respiratory (severe lack of oxygen)
 Anaphylactic (affects circulation and respiratory systems)
 Psychogenic (fainting syncope)
 Septic (severe infection)
 Metabolic (electrolyte imbalance)
Term
What are the signs of decompensated shock?
 Definition
 Falling blood pressure
 Labored, irregular breathing
 Ashen, mottled, cyanotic skin
 Thready or absent pulse
 Dilated pupils
 Depressed LOC (late sign)
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