Torrington EMS - 1

Airway, Respiration and Ventilation

100

Your 54 year old male patient is eupnic while lying in bed. This means he is? Having a seizure. Breathing normally. Breathing abnormally. In a postictal state.

What is breathing normally. Rationale: Eupnic, from eupnea, is a normal resting respiratory pattern.

200

Dyspnea would likely be seen in someone who is __________? Asleep, Complaining of breathing difficulties, Breathing at 18 a minute and regular, Under the age of 18

What is complaining of breathing difficulties. Rationale: Dyspnea is shortness of breath or having difficulty breathing.

300

You are dispatched to the report of a choking. A 2 year old girl has attempted to swallow a penny which has become lodged in her throat, causing a partial airway obstruction. Which of the following breath sounds would you most likely hear with this child? Cheyne-Stokes, Crackles, Stridor, Rales

What is Stridor. Rationale: Stridor is a high pitched inspiratory and or expiratory sound indicating an obstruction in the upper airway. This can be caused by a foreign body airway obstruction or medical conditions like croup. Wheezing is usually associated with lower respiratory problems like asthma. Rales are associated with the lower portions of the airway being partially blocked by fluid or swelling which result in a popping sound during inhalation as the alveoli pop open. Cheyne-Stokes is a respiratory pattern characterized by a crescendo from apnea to hyperpnea.

400

You arrive on scene to a MCI vehicle accident involving multiple vehicles. Your triaged patient is a 4 year old boy who has multiple fractures and is pulseless. You and your partner begin CPR: At a ratio of 15:2 with a compression depth of one third the diameter of the chest, At a rate of 100 compressions per minute with one breath every 5-6 seconds, With 12 to 20 breaths per minute with a tidal volume of 800ml for each breath, With chest compressions at a rate of 30:2 with one breath every 3-5 seconds

What is At a ratio of 15:2 with a compression depth of one third the diameter of the chest. Rationale: AHA CPR Guidelines say that 2 person CPR by healthcare professionals on a child is to be done at a 15:2 ratio with one breath every 3-5 seconds. Compressions are at least 100 per minute for everyone, and compression depth on pediatrics is 1/3rd the anterior-posterior diameter of the chest.

500

Paradoxical motion of the chest during exhalation is often an indication of what type of injury? Pneumothorax, Hemopneumothorax, Clavicle fracture, Flail segment

What is Flail segment. Rationale: A loose segment of ribs known as flail segment (or flail chest) allows the lung to protrude from the open section and causes the paradoxical or uneven movement.

Trauma

100

On which side is the ulna located? The thumb side of the arm, The little toe side of the leg, The big toe side of the leg, The pinky finger side of the arm Rationale: The ulna is the outside bone of the arm in line with the pinky finger.

What is The pinky finger side of the arm. Rationale: The ulna is the outside bone of the arm in line with the pinky finger.

200

Ligaments? Bind muscle to bone, Bind muscle to muscle, Bind bone to bone, None of the above

What is Bind bone to bone. Rationale: Tendons connect muscle and bone. Ligaments connect bone to bone.

300

The secondary blast phase of an explosion is dangerous because ________________? Of flying pieces of projectile, Of its force that could propel the victim against a stationary object, Of the wave of pressure that injures the organs, The secondary phase is not dangerous

What is Of flying pieces of projectile. Rationale: Primary injuries result from a change in environmental pressure as the energy from the explosion is released. Secondary injuries result from pieces of flying material and debris. Tertiary injuries occur when the person is propelled through the air into a stationary object.

400

Dispatch has called you and your partner Scott to a residence where a 26 year old man has suffered an accidental self inflicted gunshot wound. Law enforcement is on scene and a deputy escorts the two of you into the house were the man is lying supine on the floor holding his stomach. His respiration's are approximately 16 breaths a minute and his pulse is 115 BPM. Moving the patient's hands away reveals intestines protruding from a hole approximately 3 inches in diameter. This type of wound is called ________________________ and is best managed by _______________________? a sucking chest wound / covering the wound with a 3 sided dressing in order to allow air to escape, - an avulsion / gently maneuvering the protruding organs back into the peritoneum, - an evisceration / placing a moist sterile dressing over the protruding organs, - a peritoneal protrusion / raising the patient's legs up approximately 6-12 inches during transport

What is an evisceration / placing a moist sterile dressing over the protruding organs. Rationale: Penetrating wounds to the abdomen can expose organs and is referred to as an evisceration. An avulsion is flap of skin/tissue that is torn away. Treatment for this evisceration includes a moist or occlusive dressing, high flow O2 with an IV set, along with c-spine precautions, depending on the type of intrusion.

500

Which of the following statements best reflects burn injuries? Burns are classified based on the size and area of the burn, - The mortality rates from burns is dependent upon socioeconomic status, gender, and age of the patient, - A leg submerged in 134 degree water for 10 seconds will cause the same severity of injury to a patient regardless of age, - A patient who is dehydrated will be able to tolerate a burn better than a hydrated person because there is less fluid to rupture from the vasculature and cause damage

What is The mortality rates from burns is dependent upon socioeconomic status, gender, and age of the patient. Rationale: A small child's tissues are not capable of withstanding the same temperatures for the same time as an adult. Injury is quicker and more severe. One of the factors influencing the body's ability to resist burn injuries is water content. The MORE hydrated you are, the more resistance your body will have. Burns are not classified by size of the burn, but by the depth of the burn. About 2/3 of all fire related deaths are men. Most deaths associated with fire happen in low income households.

EMS Operations

100

The manner in which you must act is called? Standard of practice, Standard of care, Standard of action, Standard of adaptation

What is Standard of care. Rationale: Standard of care requires you to act and behave a certain way toward individuals.

200

Disposable medical equipment, other than sharps, that becomes contaminated should be? Put in a red biohazard bag, Sanitized with antiseptic, Sterilized, Thrown in the trash

What is Put in a red biohazard bag. Rationale: If it is disposable, throw it away in a red biohazard bag if it is contaminated... as long as it is not a sharps.

300

Which of the following is an appropriate situation in which to use an emergency move? The patient is in danger of fire, When there is potential for violence, When a non critical patient is blocking access to a critical patient, All of the above

What is All of the above. Rationale: All of the choices are appropriate situations to use an emergency move on a patient. Others include possible life threatening exposure to chemical or electrical hazards. Unsafe traffic conditions, or a confined critical patient that needs moved in order for you to give assistance. Yes the scene appeared safe when you did your size up or you would not be in there, right?

400

Signs of child abuse can often be deceptive. One sign that should lead you to suspect child abuse is a child... With a screaming mother at the scene, With a broken leg from falling down the stairs, Telling you she fell on her bike, With several injuries at different states of healing

What is With several injuries at different states of healing. Rationale: Injuries in different states of healing on a child are sometimes a sign of child abuse. A screaming mother does not constitute abuse and the other two answers happen all the time to kids.

500

You arrive on scene to find a 78 year old man who is sitting in a chair and staring off into space. His breathing is labored and you can hear wet lung sounds. You get no answer when you try to get his name. Your requests for him to move his toes go without response. Immediate treatment for this patient would include? Aggressive IV therapy, High flow O2, Transporting in a supine position, Administration of epinephrine

What is High flow O2. Rationale: Oxygen is about all you can do for this patient at a basic or intermediate level. For higher level caregivers, medications like Furosemide, a diuretic, can be administered to help clear fluid in the lungs.

Medical / Obstetrics / Gynecology

100

Which of the following is the way the body loses heat? Refraction, Subduction, Conduction, None of the above

What is Conduction. Rationale: Conduction, convection, wind, and water chill, radiation, evaporation, and respiration all cause heat loss.

200

Oral glucose is used for? An unconscious diabetic person with low blood sugar, Diabetic coma, Treating ketoacidosis, Hypoglycemia

What is Hypoglycemia. Rationale: A diabetic person must be conscious for taking oral glucose and should also have low blood sugar levels.

300

Three glands of the endocrine system are? Adrenal, gonads, and thyroid, - Gonads, hypophilis, and adratic, - Thyroid, hypophilis, and adrenal, - Pancreas, thyroid, and bile

What is Adrenal, gonads, and thyroid. Rationale: The adrenal, gonads, and thyroid are three of the many glands of the endocrine system. Hypophilis and adratic are made up words.

400

You and your partner Ingo arrive on scene to find a 55 year old man who is showing signs of aphasia. He shows positive for right arm drift and the right side of his face is drooping slightly when he tries to speak. This patient should be transported? On their left side, In Fowler's, On their right side, Trendelenburg

What is On their right side. Rationale: A patient who is showing signs of a stroke should be transported with the affected side down with the head elevated about 6 inches.

500

What does the prefix edem- mean? Swelling, Skin, Lungs, Under

What is Swelling. Rationale: The prefix edem- means swelling.

Cardiology and Resuscitation

100

A patient with chest pain describes how it feels. This is a? Symptom, Sign, Cardiac response, Regulatory mechanism

What is Symptoms. Rationale: Symptoms are those things felt by the patient that are conveyed to the EMT.

200

You are called to a nursing home for a possible heart attack. The patient is a 67 yr old woman who is having chest pains. You arrive to find her sitting in bed with her two adult children sitting by quietly. As you begin your assessment, the woman suddenly goes unconscious. She is pulseless and apneic. As you prepare to defibrillate the patient, her son stands up and says, "She has a DNR. Leave her alone!" What would be your best course of action? As per informed consent, continue treating this woman with CPR and defibrillation if necessary, - Request that the sister verbally confirm that such a document exists, - Request that he produce a valid DNR with the patient's and doctor's signatures. - Discontinue treatment of the patient as is normally stated in a Do Not Resuscitate order.

What is Request that he produce a valid DNR with the patient's and doctor's signatures. Rationale: Unless a valid DNR is present, the best course of action would be to continue treating the patient with CPR and defibrillation. A simple statement of a DNR's existence is not sufficient to withhold care. It could be considered negligence and abandonment.

300

You and your partner Devin have just arrived at a home where a woman in her 70's was reported to have passed out. You enter the residence to find a man in his 20's performing rescue breathing on the elderly woman who is supine on the floor. Devin attaches the AED and advises the man to move away. He pushes the analyze button and no shock is advised. The two of you begin CPR, delivering approximately_______________________. After 1 cycle of CPR an elderly gentleman enters the room and shows you a valid looking DNR signed by the patient and her doctor. What should you do? 12 breaths and 200 compressions over 2 minutes / Call medical control and ask for guidance, - 6 breaths and 100 compressions over 1 minute / Respect the DNR, - 12 to 20 breaths and 100 compressions over 1 minute / Respect the DNR, - 6 breaths and 100 compressions per minute / Contact the signing doctor to verify authenticity

What is 6 breaths and 100 compressions over 1 minute / Respect the DNR. Rationale: AHA Guidelines specify that a 30:2 compression to ventilation ratio be used during CPR on this patient. The ratio would yield approximately 6 breaths per minute and 100 compressions. On the second part of the question: If someone shows you a valid DNR you should respect it and discontinue resuscitation.

400

Dispatch has reported a possible heart attack and bystanders are doing CPR. A 46-year-old woman was out mowing her lawn when neighbors saw her fall straight to the ground. You arrive to find two people doing what appears to be effective CPR. According to the AHA, What should you do after taking BSI precautions? Assess for pulse - Direct rescuers to stop CPR - Attach AED, -- Briefly question rescuers about arrest events - Turn on AED - Attach AED to patient, -- Attach AED to patient - Turn on the AED - Analyze rhythm, -- Briefly question rescuers about arrest events - Attach AED - Deliver shock

What is Briefly question rescuers about arrest events - Turn on AED - Attach AED to patient. Rationale: According to the AHA: Answer 1 is incorrect because you should turn the AED on first, which will include the prompt to attach the pads. Answer 3 is incorrect because you would want to have the rescuers stop CPR prior to making a pulse check. Answer 4 is incorrect because it recommends shock regardless of analysis.

500

The heart muscle has the ability to contract without neural stimulation. This is called? Automaticity, Contractility, Autonetronic, Diastole

What is Automaticity. Rationale: Automaticity is the ability of the heart muscle to generate and utilize it's own electrical impulses to contract.