Emergency Medical Responder by jennyyingdi

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									                                             Emergency Medical Responder
                                              Comprehensive Final Exam
                                                  Study Guide 2009

Congratulations to those of you who are on the “Hootie Hoot” list! Those who are still working to complete your skills keep
at it---the finish line is in sight. Those of who have not yet started your skills---a wise man once said “The most difficult
part of getting something done is starting”. That same wise man also said “I will start checking out on my skills
immediately on Monday because I don’t want to wake up Christmas morning to find Coach King standing in my room with
a spine board, head blocks, straps, void pads, hand restraints, splint, triangle bandages (aka sling, sloth, swaft, swootch,
swatch, squach, squaft, squash and of course my favorite…triangle thingy thing) , sticky roll stuff, O2 tank, NRM, nasal
cannula, tourniquet, pencil, bulky dressing, Fred the head, OPA, NPA, suction machine, lotion, BVM, 10 min. timer and
Quint, saying the wound continues to bleed.” 

PART I: The following covers questions from chapters 14-21, 23-32, & 34. The majority of these chapters deal
directly with your skills.

 **PART I A: Part I A deals with those chapters that were not covered directly in your skills.


        Ch. 34 Special Rescue Situations:
            - BSI/ Scene safe. When attempting to gain entry into a vehicle to access your patient your best method of
               entry is a door.
            - If you must break a window to gain access to your patient, you should choose the window farthest from
               the patient. Using a spring loaded window punch is the best method to break the glass. This tool looks
               similar to a Phillips screw driver and is included on most EMS utility knives.

        Ch 32 Water Emergencies:
           - The definition of “drowning” is suffocation due to submersion.
           - A person should not walk through fast moving water that is above the knee.

        Ch 31 Multiple Casualty Incidents and Incident Command:
           - The definition of a multiple casualty incident is an emergency that has 3 or more patients.
           - The First Responder’s main responsibility when arriving on the scene of an MCI is to triage patients.
               Triage can best be described as a system used to determine the other of emergency care and transport.
           - During triage, a First Responder will perform an initial assessment of the patient, determine the urgency
               of their injuries and assign a priority tag to the patient (black-deceased, red-immediate, yellow-delayed,
               green-minor).

        Ch 30 Hazardous Materials:
           - When the First Responder suspects an accident involves a hazardous material, the responder should
               position himself uphill and upwind of the incident, observe colored cloud vapors from a distance, use
               binoculars to read any markings on container and observe any unusual conditions or damage to hazmat
               containers.
           - The responder should NOT use their senses to smell, taste, or feel the hazmat.
           - A hazardous material is defined as materials that pose a risk to health and property if not properly
               controlled. A First Responder is expected to make an initial identification that an incident involves a
               hazmat.

        Ch 29 EMS Operations:
           - Equipment needed for airway management include, but is not limited to; OPA’s, NPA’s, pocket masks,
               BVM’s, and barrier devices.
           - Equipment needed to auscultate blood pressure includes a sphygmomanometer (BP cuff) and
               stethoscope.

        Ch 28 Geriatric Patients:
           - As a person becomes older, muscle strength begins to diminish and bone structure begins to weaken. As
               a result, less force is required to produce injury to the elderly. Often times a minor fall can result in a
               major injury for the elderly patient.
           - The elderly population often lives on a very limited income that is insufficient to provide even the basic
               essentials for living. Many of the elderly can not afford food, adequate shelter, safety, or medication.
           - A First Responder should always be respectful of the elderly patient and address him or her by their last
               name (ex. Mr., Mrs. / Ms. Brown)
      Ch 27 Infants and Children:
              Be sure to know the following in addition to what you learned about infants and children during CPR.

          -   For the exam, be sure to know your numbers for infants and children (pulse rate, resp. rate, BP).
              Understand that infants and children, in general, have a faster resp. and pulse rate than adults.
          -   A high fever in a child is especially dangerous. High fever is the number one cause of seizures in infants
              and children.
          -   Remember, the most common cause of Cardiac arrest in infants and children is a respiratory problem.
          -   Know what the “sniffing position” is and when/ how you would perform it.
          -   Remember the child’s head is proportionately larger than an adult’s and this presents unique problems for
              the responder during Emergency care. (i.e. their airway closes off more easily)
          -   If a child or infant hasn’t learned to talk yet, the responder should observe the child’s interaction with his
              caregivers to assess LOC.

      Ch 26 Child Birth
         - Responders should always take BSI precautions when assisting a patient who is in labor as body fluids
             and blood are expelled during the birthing process.
         - After delivery, the responder should flick the baby’s feet to stimulate breathing.

**PART I B: Deals with Chapters that were covered directly in the skills portion of this course. In addition to
            what you learned during the skills portion of this course, be sure to know the following regarding
            patient assessment and treatment of injuries and illnesses.



      Ch 25 Musculoskeletal Injuries (i.e. Injuries to the Muscular and Skeletal Systems) (i.e. Broken bones)
         - Prior to splinting, always manually stabilize musculoskeletal injuries above and below the injury to prevent
             further damage.
         - If a responder does not have his BLS bag he may use an improvised splint made from any available
             material that can provide support to the injury.
         - The responder should be sure to immobilize the injury and the joints above and below the injury making
             sure the hand or foot is immobilized in a position of function.
         - Always expose the injury if it is covered up with clothing etc. and always remove any jewelry on the
             injured extremity as it can cut off circulation as the injured extremity swells.
         - **Remember, the order of priority for a First Responder in general are---BSI, Scene Safe, Manual
             Stabilization of C-spine, ABC’s. Manual stabilization of c-spine comes before ABCs because a
             spinal injury can directly cause respiratory and circulation problems. **Applying a C-collar
             (mechanical stabilization) DOES NOT come before ABCs. You would apply the C-collar, if you had
             one, after assessing the head and neck during the physical assessment.
         - Remember PMS, pulse, motor, sensory in all 4 extremities. If patient is unconscious or unresponsive,
             you can check for sensation by applying a painful stimulus to the extremity (use a pen cap to stroke the
             bottom of the foot or hand).
         - Only elevate a fractured limb if it is immobilized.

      Ch 24 Spinal Injuries:
         - Know what neutral, inline position means. What does neutral mean and what does inline mean?
         - Know when you can release manual stabilization of the C-spine
         - Know what part of the spine is most susceptible to injury.
         - Know your Spine Board skill backward and forward (i.e. know it really, really well).
         - Understand that spine injuries and head injuries often occur together. Patients with gunshot wounds to
             the head, neck, or torso MAY also have a spine injury depending of the path of the bullet.
         - Know that spine injuries can affect pulse, respiration, as well as mental status.
         - Never elevate the limbs of spinal injury patients.

      Ch 23 Injuries to Head, Face, and Neck:
         - A closed wound has no associated opening of the skin. An open wound is associated with opening of the
              skin.
         - Never apply direct pressure to an open, DEPRESSED OR CREPITUS related injury to the head (crepitus
              is a grating sensation when two broken pieces of bone rub together). Instead, apply a loose dressing to
              the area. You may apply direct pressure to open injuries to the head that do not have depressions or
              crepitus such as lacerations.
    -   Never stick anything into the ear such as probes, dressings, etc. DO NOT apply direct pressure to the
        ear. Instead place a loose dressing over the opening of an injured ear.
    -   Remember never remove penetrating objects unless they obstruct the airway.
    -   Never replace extruded or eviscerated organs. (i.e. don’t stick the eyeball back in if it fell out.) Treat
        extruded or eviscerated organs by wrapping them in a moist dressing (sterile if possible) and securing
        them in place.
    -   If you bandage one eye, bandage both eyes. If the uninjured eye moves, the injured eye will move. To
        prevent this bandage both.

Ch 21 Burn Injuries:
   - The responder’s top priority for all burn patients after BSI, Scene Safe, is to remove the patient from the
       source of the burn and stop the burning process (stop, drop and roll, wet the patient down and or remove
       smoldering clothing etc.) Second priority if Airway, Breathing, Circulation. Bandage/cover burns during
       Detailed Physical Exam.
   - You should bandage burns with a dry sterile dressing or a sterile dressing made specifically for burns.
   - Never put ice directly on a burn or directly on to exposed unprotected skin.
   - Never put grease, fat, butter etc. on a burn to stop the burning process.
   - Be aware that patients who have been electrocuted are susceptible to cardiac arrest.

Ch 20 Injuries to the Chest Abdomen and Genitalia:
   - Apply occlusive dressing to all puncture or evisceration injuries to these areas.
   - To relieve diminished breath sounds or respiratory distress in a patient who has a sucking chest wound,
        lift the unsecured side of the occlusive dressing to release air as the patient exhales (burp the dressing).
   - Know what a flail chest is.
   - Know what paradoxical breathing is.
   - Never insert anything into a patient’s vagina or rectum. If genital or rectal area is injured, apply and
        secure a bulky dressing to the area.
   - Never examine or ask to examine the genitalia of a rape victim. Calm them and encourage them NOT to
        wash up or use the restroom (as this will destroy evidence).

Ch 19 Soft Tissue Injuries:
   - A laceration is a soft tissue injury in which all layers of skin are open and the tissues immediately below
       the skin are damaged.
   - An abrasion is the simplest form of an open wound that damages skin at the surface.
   - A puncture is an injury that tears through the skin and damages tissues in a straight line.
   - An avulsion is a soft tissue injury in which flaps of skin are torn loose or torn off.
   - An evisceration involves organs protruding from the abdomen.
   - An extrusion involves and eyeball removed from the eye socket.
   - Remove superficial foreign matter from the surface of the wound with a sterile gauze pad, but DO NOT try
       to clean the wound or pick out any particles or debris from the injury with your fingers. This may cause
       infection or cause the wound to start bleeding again. Apply direct pressure to stop bleeding and
       bandage.
   - Wrap amputated body parts in a dressing (sterile if possible), place in a plastic bag, and keep amputated
       part cool. DO NOT unprotected amputated part directly on ice. This will cause injury to the tissue.
   - NEVER have a patient experiencing a nose bleed blow his nose. This will remove clots which are helping
       to stop the bleeding. Have nose bleed patients apply gently pinch the nostrils together, and lean forward
       slightly. You may apply a cold compress at the nose and face as well. Be sure the skin is protected. Note
       DO NOT apply ice directly to unprotected skin. Applying ice directly to the skin will injure the skin (frost
       bite). (Yes, you can cause frost bite to your skin by applying ice or a frozen compress directly to
       unprotected skin).

Ch 18 Bleeding and Shock:
   - Arterial bleeding- bright red and spurting. (may include laceration, avulsion,eviceration, extrusion)
   - Venous bleeding- dark red and flowing (may include laceration, avulsion, evisceration, extrusion)
   - Capillary bleeding- dark red and oozing (abrasion)
   - Hypoperfusion (Shock) is defined as inadequate delivery of oxygenated blood to the cells of the body.
       (hypo= not enough, perfusion= adequate supply of oxygenated blood to cells. Word origin not on exam)
   - Know signs of early stages of shock and late stages of shock.
   - Different types of shock:
           o Hypovolemic shock is shock caused by fluid loss including blood loss, plasma loss (the clear stuff
              that oozes from burns in burn patients), vomiting, diarrhea, and severe dehydration. (hypo= not
              enough, volemic= volume word origin not on exam)
            o    Hemorrhagic shock is shock caused when body loses a significant amount of blood from the
                 circulatory system caused by uncontrolled internal and/or external bleeding. (hemo=
                 bleeding/blood, rrhage= excessive word origin not on exam)

            Hypovolemic and Hemorrhagic shock have two distinct stages:

                 1. Compensated shock (early stage shock) where signs of shock are present and systolic
                       pressure is 90 mmHg and above.

                 2. Decompensated shock (late stage shock) where signs of shock are present and systolic
                        pressure is below 90 mmHg.

            o    Anaphylactic shock is shock caused by an allergy or an allergic reaction. Patients can have
                 allergic reactions to insect stings, food, medication, plants etc. Anaphylactic shock is
                 extremely dangerous because the airway can completely close off due to swelling. If
                 patient has an epi-pen the responder may ASSIST the patient administering the epi-pen to the
                 thigh. Monitor airway and breathing closely.

Ch 17 Behavioral Emergencies:
   - When responding to behavioral emergencies (behavior that is unacceptable or intolerable) always
       introduce yourself and explain that you are there to help.
   - Psychiatric and psychological problems include, but are not limited to depression, phobias, panic attacks,
       anxiety, bizarre thinking, paranoia and schizophrenia.
   - Always be calm and provide honest reassurance to the patient when responding to a behavioral,
       psychiatric or psychological emergency.

Ch 16 Environmental Emergencies:
   - Hypothermia is defined as body heat being lost faster than it is generated and the core body temp being
       too low.
   - Hypothermia symptoms include; cool or cold skin, shivering, decreased mental status, initially rapid then
       slow pulse, lack of coordination, stiff or rigid posture, muscle rigidity, impaired judgment, complaints of
       muscle/joint stiffness.
   - Treatment for hypothermia includes; O2, remove from cold environment (do not allow pat. to walk or exert
       himself), protect from further heat loss, remove wet clothing, cover front and back with dry blanket.
   - Hyperthermia is defined as the body generating too much heat causing the core body temp to be too
       high. Also described as a heat emergency.
   - Sweating helps cool the body. As sweat changes to vapor heat is lost by evaporation. However,
       the body’s ability to lose heat through evaporation is significantly reduced in high humidity.
   - Heat Exhaustion is a type of heat emergency where the patient has moist, pale, normal to cool, skin who
       has been exposed to excessive heat while working or exercising. Circulatory system begins to fail due to
       fluid and salt loss. Individual perspires heavily and becomes very thirsty. If not treated, progression to
       heat stroke can occur rapidly. If showing signs of altered mental status treat for heat stroke.
   - Treatment for Heat Exhaustion includes O2, removing patient from hot environment, loosen or remove
       clothing, cool patient by fanning (be careful not to chill patient), if patient is conscious and does not have
       altered mental status provided fluids (water).
            o Heat Cramps are signs that often accompany heat exhaustion. Treat conscious patient who does
                not have an altered mental status and is having heat cramps by removing from hot environment,
                replenish fluids by giving water.
   - Heat Stroke is a life threatening condition where the body’s temperature regulating mechanism fails and
       is unable to rid the body of excess heat causing the body temperature to rise above 105 degrees. Patient
       will present with altered mental status, hot slightly moist to dry skin, rapid shallow breathing, full and rapid
       pulse, possible convulsions, and generalized weakness.
   - Treatment for Heat Stroke includes O2, removing patient from hot environment, loosen or remove
       clothing, apply wet wrappings (sheet) soaked in COOL (not cold) water to body, cool patient by fanning
       (be sure not to chill the patient), wrap cold packs or ice bags in cloth and place under arm pits, on wrists,
       ankles, groin, and on either side of the neck, place in recovery position if needed.

Ch 15 Medical Emergencies:
   - Never stick anything in the mouth of a seizing patient. The responder’s priority for an actively seizing
       patient is to protect the patient from injuring himself.
   - The most important piece of information to obtain when treating a patient with stroke like symptoms is
       determining when the symptoms first started.
             -   Stroke like symptoms include; headache, fainting or dizziness, confusion, numbness or paralysis usually
                 to face and/or extremities, difficulty with speech or vision, seizures, altered breathing patterns, unequal
                 pupils, loss of strength typically to one side of the body, high blood pressure.
             -   Treatment for stroke like symptoms includes; activate advanced life support immediately, maintain open
                 airway, provide O2 15 l/m, be prepared to provide ventilations and CPR if necessary.
             -   Always consider internal bleeding in patients with abdominal pain and be alert for signs and symptoms of
                 shock.

        Ch 14 Cardiac and Respiratory Emergencies:
           - Asthma is best described as airway obstruction due to bronchospasm. If patient has inhaler prescribed to
               him/her you may ASSIST them in using it.
           - Treat a patient who is hyperventilating by calming and reassuring them. It is important to get them to
               slow their breathing rate down. You may also provide LOW FLOW O2 (4-6 l/m) via nasal cannula as
               breathing rate begins to return to normal. NEVER attempt to treat hyperventilation by having patient
               breath into a paper bag.
           - Place chest pain patients in a position of comfort.
           - Patients experiencing difficulty breathing often sit upright and lean forward with their hands on their
               knees. This is called the tripod position.


PART II :        Deals with chapters 1-14. You will be held accountable for all information contained in these
                 chapters. Below is a reminder of some of the more important points to study, but is not an
                 exhaustive review of every single question from these chapters.

             -   Be sure to know your numbers. Respiratory rates, pulse rates, blood pressures, ventilatory rates etc.
             -   Be sure to know all CPR information extremely well, including AED and FBAO.
             -   Be able to evaluate vital signs and determine appropriate care based on them.
             -   Know the different types of crashes and injuries involved with each.
             -   Know the 3 different types of impacts.
             -   Know the 3 different phases of an explosion
             -   Know about Legal and Ethical Issues and the Wellbeing of the First Responder
             -   Know your body directions (superior, inferior etc.)
             -   Know Patient Assessment and the order in which we conduct it.
             -   Know how to properly lift and move patients
             -   Know Airway, Breathing, and Circulation backwards, forwards, upside down, right side up, and diagonally.
             -   Know the different types of consent.
             -   Know BSI, PPE, vaccinations needed by first responders, diseases responders may be exposed to etc.
             -   Know about negligence, abandonment, scope of care, protocols, standing orders, direct orders, online,
                 offline, duty to act, advanced directives etc.


I am very confident that each of you will do extremely well on your comprehensive final exam. Carefully study your notes,
your skills sheet, and the items on this study guide. Relax and be a savvy test taker. In other words, look for clues in
other questions and remember you are looking for the BEST answer of the answers given. Pay close attention to exactly
how the question is worded and exactly what the question is asking. Feel free to contact me (Before 11:00 pm or after
6:00 am please) if you have any questions or concerns.

May the Force be with you…always,

Coach King

								
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