Block 1 Study Guide

1. What does the state office of EMS regulate?

a. The State EMS office is responsible for authorizing, auditing, and regulating all
EMS services, training institutions, courses, instructors, and providers within the
state. Designed to identify areas of improvement and assign training/education if
necessary.
2. What level of provider has extensive training in ALS?
a. Paramedic
i. EMR: CPR, splinting, pt assessments
ii. EMT: EMR+some medications, airway adjuncts, and suctioning.
iii. AEMT: EMT+ some ALS such as starting an IV and administer a few more
medications. Cannot admin cardiac meds.
1. Not applicable to CA, but services more rural areas.
3. EMT training guidelines are regulated by whom?
a. The State EMS Office
4. What is the purpose of continuing education in EMS?
a. remain current with the latest treatment guidelines
5. What kinds of skills are civilians most likely to be trained in?
a. AED and CPR, bleeding control, etc. pg 13
6. What kind of call would require ALS?
a. 3rd-degree burns, heavy blood loss, respiratory distress, any burns to face/ groin
7. What does the medical director do in an EMS system?
a. authorizes EMTs to provide medical care in the field. the care and protocols are
decided by the medical director pg 32
b. from MD comes online orders they come up with standing orders
8. What criteria are required to be licensed as an EMT?
a. high school diploma, proof of immunization of certain communicable diseases,
successful completion of a background check and drug screening, drivers license,
completion of BLS and CPR, completion of ems course, completion of written
exam, completion of practical, demonstrate mental and physical ability,
compliance with state, local and employer
9. What does the National EMS Scope of Practice Model outline?
a. the minimum guidelines an ems provider should follow. Works to create a
standard of care
10. What is the purpose of continuous quality improvement (CQI)?
a. Identify areas of improvement and appropriate education to help fix them
(always positive)
b. Its purpose is to audit EMS services (internal/external) in order to improve the
systems. This is done by reviewing reports and assessing what is good and what
needs to be improved, allowing the medical director to ID where addition
training or instruction is needed. Pg. 20
11. How would you treat a patient you suspect of having TB? What kind of mask would you
wear?
 Block 1 Study Guide
a. Surgical masks are designed to prevent the respiratory secretions of the person
wearing the mask from entering the air.
b. A KN95 or N95 surgical mask placed on the patient helps prevent the formation
of TB aerosols. Ask the patient to wear a surgical mask whenever he/she is
outside an isolation room.
c. Particulate respirator pg. 46
i. Note other respirators and their uses:
ii. Surgical mask: blocks large particles/spray, which is best applied to pts
iii. K/N95: a type of particulate mask
iv. Nonrebreather mask (O2 delivery to pt): high-yield O2 delivery
d. Rebreather mask (O2 delivery to pt): higher [M] of O2 mixed with atmospheric
air.
e. Wear a particulate respirator if you treat a patient with TB

12. What does a positive TB test indicate?

a. A positive TB test result means only that TB bacteria has been detected. It does
not indicate whether the person has active TB or latent (dormant/ inactive)
infection.
b. Signs and symptoms- flu-like symptoms need a positive TB test
13. What does OSHA require of employers?
a. EMTs need to be trained in handling bloodborne pathogens and in approaching a
person who may have an infectious or communicable disease
14. Why is a risk of exposure important in an infection control plan?
a. defines who is at risk for contact with blood and body fluids and which tasks pose
a risk of exposure. helps people take precautions
15. What is the role of compliance monitoring in an infection control plan?
a. ensure that employees understand what they should do and why it is important
b. employees document non-compliance to account for future disciplinary action pg
48
16. Who can you get a Hep B vaccine from?
a. employers are required to offer the hepatitis B vaccination at no cost to
employees with risk of occupational exposure from OSHA pg 51
b.
17. How often should you get a Tdap booster?
a. every 10 years pg 53
18. What infectious diseases offer no protection from re-infection after initial exposure?
a. syphilis, gonnarea, HIV
19. What is a cumulative stress reaction?
a. Cumulative stress results from an accumulation of various stress factors such as a
heavy workload, poor communications, the frustration of not being able to meet
the beneficiaries' needs, having to cope with situations in which you feel
powerless, lack of basic comforts, and inability to rest or relax.
b. You can tell when someone says is everything okay
c. Ex: a paramedic that starts performing badly and not caring about the patients
 Block 1 Study Guide
20. What are the different forms of stress
a. Acute stress- during a stressful event usually stress lasting a month if fore then its
PTSD
b. Delayed stress- manifests after a stressful event
c. cumulative stress- occurs after youve been exposed to prolonged stress
d. PTSD- reexperiencing something traumatic and overresponding to stimulus that
recall an event
21. What is the purpose of CISM?
a. CISM is designed to help people deal with their trauma one incident at a time, by
allowing them to talk about the incident when it happens without judgment or
criticism. this is for EMS
22. Why is it important for EMS personnel to develop non-adversarial relationships with
their co-workers?
a. Maintaining good working relationships with EMS personnel allows for better
community care in a stressful profession. This can be noticing excessive stress to
offer help, substance abuse, or changed behavior.
b. Because they depend on one another for their safety
23. How can we reduce risk of litigation in EMS?
a. provide competent care that meets current standards
b. Understand and work under our scope of practice
c. Understand local laws regulating EMS
24. Know the different types of consent including minor, implied and involuntary
a. Minor consent- A parent or guardian is required to consent for a child unless they
are emancipated (legally are treated like adults),
i. in loco parentis- if they dont have a parent present a company or
provider can make a decision for the child, or if they are married
b. Expressed consent- verbal or acknowledged consent
c. Informed consent- you explained the risks and the nature of the treatment to get
the patients consent
d. Implied Consent- allows EMS to make medical decisions if the patient is unable to
such as intoxicated, mentally impaired or suffering
e. Involuntary Consent- Consent given/granted by the court. for mentally
challenged people who are not mentally competent
i. also allows police to make decisions for their prisoners

25. How do we check for decision making capacity?

a. PPPT
i. P- person what is your name
ii. P- place where are you?
iii. P- purpose what are you here for?
iv. T- time What time, day, month is it?
v. If they answer all 4 questions then they are competent and A&Ox4
b. Over age of 18 or emancipated
26. When can patients withdraw their consent from treatment?
 Block 1 Study Guide
a. Anytime as long as they are competent. Every competent adult
b. Have to sign AMA
i. if they refuse to sign you need to get a a witness that is not an EMT
27. Who will your skills and duties be compared to as an EMT?
a. The standard of care of an EMT will be compared to how a person with similar
training, equipment, and location would act in the same situation
b.
28. Define negligence. What would be an example of it?
a. Negligence is failure to provide the same care that a person with similar training
would provide in a similar situation. Duty, breach duty, damages, causation
(cause and effect between beach of duty and damages)
i. if you find someone unconscious and as you take them to the hospital
you drop them giving them a facial laceration pg.
b. A breach of the following four factors pg 98
c. Duty: if you’re on the clock, even if you’re one minute at the end of your shift,
you must go and provide care.
d. Breach of Duty: when an EMT goes against that duty
e. Damages: there are measurable damages caused by the action of the EMT, even
something as small as the EMT causing acute stress that results in PTSD, which
requires professional treatment, causing monetary loss.
f. Causation: an EMT drop the pt and they break a bone in their hand.

29. What is abandonment? Give an example (*hint check your book for examples!)
a. termination of care without the patient’s consent and without transfer of care to
a provider as skilled or more skilled than you
b. Ex: you are caring for a patient who was in a crash and you hear of a worse crash
with more patients and hand care over to 2 injured patients as you go help the
others
30. When does transfer of care occur?
a. When an EMT gives an oral report to the emergency room doctor or nurse
b. When the EMS service arrives at the hospital to transfer the pt to another
caregiver, when the pt must be transferred to another transport.
c. NOTE: it is a good idea to get a signature on the PCR noting a transfer of care.
31. How can a patient refuse transport? What is an informed refusal?
a. If they are mentally competent and pass the A&Ox4
b. Then you Encourage the individual again to allow care and inform them of
the risks if they go
c. 2. Ask individual to sign a refusal form
d. 3. Have a witness for the refusal documentation
e. 4. Document all refusals
32. If your portable radio is not working what should you use? (*hint, it’s not your
cellphone)
a. use the mobile radio in the ambulance to contact dispatch
33. What has the weakest transmission signal?
 Block 1 Study Guide
a. Hand-held portable radio
34. What is a scanner?
a. a radio receiver that can automatically tune, or scan, two or more discrete
frequencies, stopping when it finds a signal on one of them and then continuing
to scan other frequencies when the initial transmission ceases.
35. What are the functions of the Federal Communications Commission (FCC)?
a. has jurisdiction over interstate and international telephone and telegraph
services and satellite communications
b. Allocate specific radio frequencies for ems to use, license base stations &assign
appropriate radio call signs for those stations, Establish licensing standards and
operating specifications for radio equipment used by ems providers, establish
limitations for transmitter power output PG 1522
36. What occurs during the alert and dispatch phase of EMS communications?
a. properly screen and assign priority to each call, select and alert appropriate ems,
dispatch & direct ems response unit to the correct location, coordinate ems unit
with other public safety services until the incident is over, provide emergency
medical instructions to the telephone callerso that essential care may begin
before emts arrive
37. What is the first thing you should do after being dispatched for a response?
a. You should confirm that you en-route to the dispatched location and let them
know if you have any problems
b. make sure to get nature and severity of the call, exact location, number of
patients, responses by other public safety agencies, special directions or
advisories, time at which the units are dispatched
38. What are the general guidelines of effective radio communication?
a. turn radio on and adjust volume, ensure a clear frequency when speaking pg 143
b. Keeping it short and clear. Do not waste time with pleasant remarks and friend
making. Only provide clear information. Do not yell and speak in a monotone
voice.
39. What is included in a radio report to the hospital?
a. your unit identification, the receiving hospital, the ETA, the patients age and
gender, chief complaint or your perception of it/ its severity, history of the
current problem, brief report of physical findings/ vital signs, brief report of care
given and any patient response, brief description of patients response,
determine if recieving facility have any additional questions
40. After receiving online orders from med-control what should you do?
a. repeat the order word for word then get confirmation, this eliminates confusion.
when an order doesnt sound right then ask again and question the order
41. If you can’t contact medication control for online-orders, what type of orders can you
follow?
a. medical control?
b. Use the offline (indirect) instructions
c. Offline control is when the EMS practitioner follows protocols
d. Standing orders are written by MD pg 145
 Block 1 Study Guide
42. When would you use a blanket/clothes drag to extricate a patient?
a. blanket drag is used to move a patient from a bed to a stretcher
b. clothes drag is used to move patients who are blocking another patient or in a
spot where they cannot be assessed pg 269, 281
43. When would you use the rapid extrication technique? How do you do this? (*hint long
backboard)
a. Urgent moves are performed with precaution for spinal injury
b. the vehicle or scene is unsafe, explosives or other hazardous materials are on
scene, fire or a danger of fire, the patient cant be properly assessed before being
taken out of the vehicle, the patient needs to be in supine position to be treated
(emergency), the patient has a life-threatening condition that requires them to
be rapidly transported to the hospital, the patient blocks you from a seriously
injured patient
c. Performed by 3 providers who are knowledgeable and experienced with the
procedures, one is stabilizing neck and head, the second is moving the pt onto a
long backboard, the third gives commands and performs primary assessment
d. [Link]
44. What type of situation would a direct ground lift be effective?
a. with patients with no suspected spinal injury, lying supine on the ground, use this
lift when you have to carry a patient to be placed on a stretcher
45. When should you NOT use an extremity lift to move a patient?
a. when a patient has an extremity/ spinal injury and is not in a supine or sitting
position pg 290
46. What is the direct carry technique used for?
a. It is used to transfer a patient supine on a bed to the stretcher pg 291
i. if no sheet present
47. When is the draw sheet method used?
a. similar to a blanket drag. The rescuers drag sideways the bedsheet beneath the
patient so that both the bedsheet and the patient is moved. used to transfer a
patient from bed onto a stretcher
48. How would you immobilize a patient who has a severely kyphotic spine?
a. a patient with a curved spine must be placed on their side and immobilized in
place with towel and blanket rolls
49. How do you push a wheeled ambulance stretcher?
a. Step 1: Face each other and use both hands. Step 2: Lift the backboard to
carrying height. Step 3: Turn in the direction you will walk, and switch to using
one hand. When rolling the wheeled ambulance stretcher, make sure that it is in
the fully elevated position.
50. When would you use a vest-style device?
a. A vest style device would be used to move a patient in a similar situation as the
use of a RET, but there is not a time-critical need to move them. It takes about
6-8minutes, but provides greater spinal support in moving the patient onto a
backboard.
51. When and how do you use a scoop stretcher?
 Block 1 Study Guide
a. it is split to 2 to 4 pieces and can go around a patient
b. You must have access to the patients from all sides. At least 2 rescuers are
required, one to prepare and position the stretcher and one to move the patient
c. is a device used specifically for moving injured people. It is Ideal for carrying
casualties with possible spinal injuries.
52. When is humidified oxygen recommended for use in transport?
a. When the oxygen will be administered over a long period of time
b. Humidified oxygen is used when a patient needs to be on oxygen for long periods
of time. Humidifying the oxygen prevents it from drying out and irritating the
upper airway tissues.
53. What is in a jump kit? What is the purpose of it?
a. ensure that you have immediate access to the AED. have available all of the
equipment that you will use in the entire call. have easy access to manage
patients with severe uncontrolled bleeding.
b. disposable gloves, face shield, triangular bandages, trauma shears, adhesive
tape, trauma dressings, self adhering rolled bandages, oropharyngeal, bvm with
mask for adults kids and infants, blood pressure cuff, Stethoscope, pen light,
sterile gauze, sterile dressing, adhesive strips, oral glucose, activated charcoal
54. What is the main objective of traffic control?
a. the purpose of traffic control is to ensure some orderly traffic flow and to
prevent another crash
55. What occurs during the delivery phase in the 10 phases of an ambulance call?
a. during the delivery scene you will report your arrival to the triage nurse or other
arrival personnel, physically transfer the patient from the stretcher to the bed
directed for your patient, present a complete verbal report at the bedside to the
one who is taking over the patient's care, complete a detailed report of patient
and get required signatures and leave a copy with appropriate staff member
ereports are commonly used and need to be printed
56. How do you use your ambulance lights when it’s nighttime?
a. You should always use your PA system, but you could use them in conjunction
with the high beams pg 1375
b. In accordance with local guidelines
57. Why is aggressive ambulance driving an issue?
a. it may not allow for other vehicles to have a proper reaction time to your vehicle.
b. We should drive defensively in order to ensure safety for ourselves and our pt.
Aggressive driving could be assumed that we are 1.) not building a 4 second
cushion in front of the vehicle or a safety cushion around the vehicle and 2.) it
could be assumed that you are no longer scanning the road for potential dangers.
Pg. 1372.
58. When can ambulances drive in opposing traffic lanes?
a. when you urgently have to but you have to use your lights also when the other
side is blocked
59. What should you do if you are being tailgated while responding lights/sirens?
 Block 1 Study Guide
a. never speed up to create more distance, never slam on your brakes to intimidate
the driver it will end in a crash,
b. slow down because tailgaters are impatient and will pass you pg 1317
60. Why is excessive speed unsafe?
a. because it makes it difficult for the emt to treat the patient, it is a higher risk for
a crash because the driver has less time to react pg 1372
61. What should you do if you begin hydroplaning?
a. you start hydroplaning more than 30 miles an hour
b. gradually slow down without jamming on the brakes
62. When should you use your warning lights and sirens?
a. it depends on the local rules but regardless the ems should do a risk-benefit
analysis
b. the time saved is minimal so only use it for absolute emergencies
c. also take into account how a patient reacts due to their condition. do they get
seizures triggered by flashing lights? consider if it’ll make the patients condition
worse
63. What is your primary concern on the scene of a motor vehicle crash?
a. your safety so make sure to assess the scene for hazards
64. What is a scene size up?
a. the ongoing process of information gathering and scene evaluation to determine
appropriate strategies to manage the emergency while still being aware of
possible hazards
65. What is situational awareness?
a. the ability to understand and react to the threats around you pg 1392
b. remember that scenes are always changing and pay attention to weathe traffic,
patients and bystanders
66. What is a 360 degree walk around? Why do we do this?
a. walk around and assess the mechanism of injury, downed power lines, leaking
fuels or fluids, smoke or fire, broken glass, trapped or ejected patients the # of
patients and vehicles involved
67. How/when is the rapid extrication technique used in car crashes?
a. Rapid extrication is indicated when the scene is unsafe, a patient is unstable, or
a critical patient is blocked by another less critical patient.
b. technique to move a patient from a sitting position inside a vehicle to supine on
a backboard in less than 1 minute when conditions do not allow for a standard
immobilization

68. What are some of the types of specialized rescue teams?

a. CAVE RESCUE, CONFINED SPACE RESCUE, CROSSFIELD AND TRAIL RESCUE (PARK
RANGERS), dive rescue, missing person search and rescue, mine rescue,
mountain rock and ice climbing rescue, ski slope or cross country snow rescue,
structural collapse rescue, special weapons, and tactics SWAT, technical rope
rescue, trench rescue, water, and small craft rescue, white water rescue
69. What is your role as an EMT during a search and rescue?
 Block 1 Study Guide
a. stand by the command post until the missing people have been found pg 1400
70. What are some of the hazards associated with trench rescues?
a. in a trench there is soil that weighs 100 pounds per cubic foot making it difficult
for people to expand their lungs if caught under thousands of pounds of weight
b. there is also the risk of a secondary collapse
c. when EMS personnel arrive park at least 500 feet from the trench pg 1401
71. If the incident command is already established who should you report to?
a. first, check in with the incident commander at the base staging area or other
location designated by the ic
b. b) take into consideration the level of the incident he could have section chiefs to
support if a level is at a higher scale
72. What does the U stand for in FAILURE?
a. F- failure to understand the environment
b. A- additional medical problems not considered
c. I- inadequate rescue skills
d. L- lack of teamwork or experience
e. U- underestimating the logistics of a situation
f. R- rescue versus recovery mode is not considered
g. E- equipment not mastered
73. Know the triage categories and what injuries are associated with them (Green, Yellow,
Red, Black)
a. Green- third priority, minor fractures, minor soft tissue injuries
b. Yellow- second priority, burns without airway compromise, major burn injuries,
back injuries w/o spinal cord damage
c. red-first priority, airway compromised, uncontrolled bleeding, severe medical
problems, signs of shock, severe burns, open chest or ab injuries
d. black- fourth priority, obvious death, obviously unsurvivable, respiratory arrest,
cardiac arrest
74. Know START triage and JumpSTART triage
a. use flashcards for this
b. START is for 9 or older/ at least 101 lbs it sorts patients based on priority
75. START stands for Simple Triage And Rapid Treatment
76. Is there a correlation between the color of the container and the contents?
a. In most cases, there is no correlation between the color of the drum and the
possible contents
77. What kind of chemical requires a placard regardless of size/weight?
a. explosives, poisonous gas, water-reactive solids and high-level radioactive
substances
78. What agent possesses an odor similar to almonds? What does it do?
a. Cyanide is a metabolic agent, it affects the body’s ability to use oxygen, starts in
the cellular level then rapidly affects the organ level pg 1462
79. Define a disease vector
a. When an animal spreads a disease its infected with, with another animal
 Block 1 Study Guide
80. Describe the skin lesions in smallpox (what is their size, shape, how/when do they
develop?)
a. in smallpox all the lesions are identical in their development, they begin on the
face and extremities then move to the chest/ abdomen
b. It is very contagious but most contagious when the blisters have formed pg 1465
81. Know the clinical presentation of smallpox
a. severe fever, malaise, body aches, headaches, small blisters on the skin, bleeding
on the skin, mucous membranes, incubation period 10 -12 days, duration 4
weeks pg 1465
82. How do viral hemorrhagic fevers present (aka what are their initial signs and
symptoms)? What do they do to the body?
a. initially the patient will have flu-like symptoms then progressively getting worse
such as internal and external hemorrhaging
b. it causes the blood vessels and tissues to seep blood pg 1465
83. What form of anthrax is the deadliest? Why?
a. Pulmonary anthrax or inhalation anthrax is the most deadly
b. deadly when anthrax bacteria are inhaled; the protein causes rapid swelling and
fluid buildup in the lungs
84. What is Botulinum toxin?
a. a neurotoxin that is produced by bacteria and is the most potent neurotoxin
b. this toxin affects the nervous system ability to function, voluntary muscle control
diminishes and eventually causes muscle paralysis which includes respiratory
tract
85. What are the S/S of both inhaled and ingested ricin?
a. ingested are fever, chills, headache, muscle aches, nausea, vomiting, diarrhea, ,
severe ab cramping, dehydration, gastrointestinal bleeding, necrosis of liver
spleen kidneys& gastrointestinal tract
b. inhaled- fever, chills, nausea, local irritation of nose eyes throat, profuse
sweating, headache, muscle aches, noproductive cough, chest pain, dyspnea,
pulmonary edema, severe lung inflammation, cyanosis, seizures, respitory failure
86. What are the biological agents that can be transmitted from person to person?
a. Pneumonic plague (high), Smallpox (high), viral hemorrhagic fevers (moderate)

87. What are Vesicants?

a. Blister agents that if left long enough on skin can produce vapors that burn the
respiratory tract
88. What are the different agents pg 1462
a. Chemical Agents- liquids or gases that are dispersed to kill or injure, they can
have a vapor or contact hazard also called vesicants (blister agents)-
i. sulfur mustard is a gas that is instantly absorbed and does irreversible
damage to the cells it is a mutagen that mutates, damages the cells
 Block 1 Study Guide
ii. Lewisite and phosgene are similar to sulfur mustard and are forms of
vesicants
b. Pulmonary Agents- gases that cause immediate harm to people exposed to them
i. Chlorine and phosgene (not phosgene oxime) are pulmonary agents
ii. these agents damage the lung tissue and fluid leaks into the lungs
c. Nerve Agents- classified as WMDs (weapons of mass destruction) they can cause
cardiac arrests within seconds to minutes of exposure
i. Organophosphates block an essential enzyme in the nervous system
causing the bodys organs to become overstimulated and burn out
ii. G agents- created by germans the following are listed from high to low
votality
1. Sarin(GB), Soman(GD), Tabun(GA), V Agent (VX)
d. Metabolic Agents (cyanide)- affects the bodys ability to use o2
i. Cyanide- a colorless gas that has a smell similar to almonds effects start at
the cellular level then rapidly progress and affect the organs
e. Biologic Agents- they are undetectable and sometimes have the same symptoms
as many minor illnesses
i. spread through dissemination (terrorist spreads it), disease vector(animal
to animal)
89. What are neurotoxins?
a. They are the most deadly substance known to humans but are not WMDs
because they haven’t been successful in turning them into WMDs
i. Botulinum Toxins, Ricin
90. What are the WMDs?
a. B-NICE is a good acronym Biologic weapons, Nuclear, Incendiary, chemical,
explosive
91. Phases of EMS Communications
a. Initial receipt of call: acknowledge the call, respond to the call
b. En route to call: request assistance with directions, when needed. Request
additional resources when needed
c. On the scene: report arrival at the scene, check-in; often a system will require
EMS units to transmit every 20 minutes as a safety measure, requisition
additional resources when needed, report leaving the scene
d. Arrival at the hospital (or point of transfer): notify dispatch of arrival at the point
of transfer
e. Return to service: Notify dispatch when the unit is available for another call
f. Misc: some systems require EMS units to notify dispatch anytime they are not in
station.
 Block 2 Study Guide
1. Remember medical assessment when answering questions (order of operations!)
a. Scene Size up, primary, history, secondary, vitals, reassessment
2. Review the O2 cheat sheet
a. NRB
i. Normal breathing pattern
ii. Rate is a bit abnormal 10-26 Breaths/min
iii. 10-15 L/Min
b. nasal Canale
i. For normal breathing rate and pattern
ii. Needs a little O2
iii. Maintains O2 saturation %
iv. 1-6 L/Min
c. BVM
i. Labored breathing, lethargic, cyanotic, Altered
ii. Use the OPA or NPA to keep their airway clear
iii. When a patient is breathing >8 or 28<
iv. 15- 25 L/Min of High flow O2
v. Artificial Ventilations
3. Know your lung sounds & what they indicate/where they’re heard
Upper Airway
- Stridor
- Seal barking or like squeak toy is swallowed
Lower Airway
- Coarse Crackles (rhonchi)
- Rhonchi in the bronchi
- Lung tissue infections like pneumonia
- Chunky junky sound
- Fine Crackles (Rales)
- Rales in the tails
- Fluid in the alveoli
- Watery sound
- Wheezing
a.
4. What is the difference between assisted & artificial ventilation? When do we use them?
a. Artificial Ventilation is breathing for the patient
i. mouth to mask
ii. BVM
iii. manually triggered ventilation device
b. Assisting Ventilation- improve the oxygenation and ventilatory status of a patient
i. pg 425
5. What is passive ventilation?
a. The process of expansion and contraction of the chest creates a “pump” for air
movement in and out of the chest
 Block 2 Study Guide
b. It is the act of compressing the chest to force the air out of the thorax when the
breathing muscles don’t work
c. it can be enhanced by inserting an OPA and providing supplemental O2 pg 434
6. When would you use the mouth-to-mask technique for providing ventilations?
a. When a patient cant properly ventilate themselves and needs ventilation but there
is no BVM pg 428
7. What do chemoreceptors sense?
a. pg Chemoreceptors monitor the levels of O2, CO2, H2 and PH in the
cerebrospinal fluid then sends a message back to the respiratory system to modify
the rate and depth of breathing pg 397, 448
8. What is the most significant issue with suctioning a patient’s airway? (*hint: what else
are we suctioning out besides secretions?)
a. Be careful not to hit the back of the airway because this could cause the gag reflex
to be activated causing vomit pg 409
9. What is alkalosis?
a. When someone exhales too much and breathes out the acidity causing the body
fluids to have excess base
10. What would cause hyperventilation?
a. The body is trying to make up for acidosis the build-up of acid in the blood or
body so it exhales to relieve some of this acid pg 601
11. What is hypoxemia?
a. Below the normal level of O2 in the blood
12. How many doses of epinephrine can we give? (*hint:)
a. 1 without contacting medical control, 2+ potentially after contacting medical
control
13. What would cause cardiac output to decrease? Why?
a. Hypovolemic shock
14. Where can you palpate the posterior tibial pulse?
a. the inner parts of the foot or posterior to the medial malleolus pg 201
15. What is ischemic heart disease?
a. heart problems caused by narrowed heart arteries
16. Why is ventricular fibrillation the most common cause of cardiac arrest following an
AMI?
a. Ventricular fibrillation occurs when the heart quivers unable to pump blood. The
coronary arteries can last long w/o o2 so they die off causing an AMI
17. Know 6 Rights & DDICE + why we administer them/what they do for all EMT
administered medications
a. Right Patient- make sure the label has the same name as you patient
b. Right Drug- make sure its the right medication for the patient
c. Right dose- check the label and take note of the dose
d. Right Route- Make sure the patient takes the medication properly
e. Right time- Medications that can be repeated must be given at the right time
intervals. Document the time and once you need to readminister contact medical
control to check
f. Right Documentation- Document the drug, dose, route, time of admin, and
reassessment findings after the medication was given
 Block 2 Study Guide
18. DDICE
a. DICE
b. D - Drug
c. I - Integrity
d. C - Color
e. E - Expiration
19. What is the minimum amount of chest compressions that should be delivered within one
minute?
a. 100
20. Your hip joint is formed by what?
a. A ball-and-socket joint connects the acetabulum and femuri. The acetabulum is
the part of the pelvis where leg connects to the hip joint. The acetabulum is
formed where the ilium, ischium, and pubic bones meet
21. What is cardiac output? What is it affected by?
a. Cardiac output = Heart rate x Stroke Volume (Volume per contraction)
b. Stroke Volume is affected by:
i. Preload: The filling pressure of the heart at the end of diastole.
Contractility: The inherent vigor of contraction of the heart muscles during
systole. Afterload: The pressure against which the heart must work to eject
blood during systole.
22. S&S of liver dysfunction
a. yellow eyes and skin (jaundice), nausea, abdominal pain and swelling, and
swelling of the legs
23. Where would we expect to find subcutaneous emphysema?
a. Subcutaneous emphysema occurs when air gets into tissues under the skin. This
most often occurs in the skin covering the chest or neck, but can also occur in
other parts of the body
24. What is a palpated blood pressure?
a. Getting a patient’s systolic BP by touching the elbow pit
b. This is used if you are in a loud enviornment
25. When do we do a head-to-toe exam? Why do we do it?
a. During the primary assessment and it is used to identify other injuries that need to
be protected before transport
26. What is capnography? When do we use it?
a. noninvasive measurement of the partial pressure of carbon dioxide (CO2) in
exhaled breath expressed as the CO2 concentration over time
b. It is used to measure if a patient is adequately perfused and ventilated
27. What is a pertinent negative?
a. used when the clinician documents why they DID NOT perform a procedure.
Example: If Aspirin is part of the agency protocol for Chest Pain but was not
administered, the reason should be documented.
28. How long can a person reasonably compensate for shock? What would happen as time
goes on?
a. Less than 5 minutes for compensated shock.
 Block 2 Study Guide
b. Decompensated shock: Falling blood pressure. Labored/irregular breathing.
Ashen, mottled, or cyanotic skin. Thready or absent peripheral pulses. Dull eyes
dilated pupils. Poor urinary output
29. What is negative-pressure breathing?
a. Air is sucked into the lungs due to the negative intrathoracic pressure created
when the diaphragm contracts
30. Know what residual volume is and what happens to residual volume as a person ages
a. The air that remains in the lungs after maximal expiration
b. Residual volume increases with age
31. What age do we start measuring blood pressure? (*hint 3 years of age)
a. Measure blood pressure in all patients older than 3 years
32. What is the most common cause of prehospital cardiac arrests?
a. Coronary artery disease is the most common cause
33. What do we do when we start to notice gastric distention? What is gastric distention?
a. Gastric distention is a condition in which air fills the stomach, often as a result of
high volume and pressure during artificial ventilation
b. What to do when we start to notice:
i. i. Ensure that the patient’s airway is appropriately positioned
ii. ii. Ventilate the patient at the appropriate rate
iii. iii. Ventilate the patient with the appropriate volume
c. c. Manual decompression should only be used as last resort, will result in
vomiting
i. suctions out the air
34. What do we do to relieve choking in a responsive infant?
a. 5 back slaps and 5 chest thrusts until the object comes out or the baby faints
35. What is the purpose of a secondary assessment in a medical assessment?
a. The purpose of the secondary assessment is to perform a systematic physical
examination of the patient
36. What are the functions of the sympathetic nervous system?
a. “Fight-or-Flight”
b. i. Increased heart & respiratory rate, pupil dilation, decreased digestion, increased
blood flow to muscles
37. What could cause a patient to start seizing following delivery of Narcan for an opioid
overdose?
a. Withdrawal symptoms, which include both seizures and cardiac arrest
b. Administer naloxone (Narcan) in increments of 0.4 mg
38. What is Alupent used to treat? Why?
a. Used to treat wheezing and shortness of breath that commonly occur with lung
problems (e.g., asthma, chronic obstructive pulmonary disease)
b. Maintenance inhalers are not useful for a patient suffering acute respiratory
distress and in need of immediate relief
39. What does transcutaneous mean? (*hint sometimes referred to as transdermal). What
medications are delivered this way?
a. Through the skin; delivered this way for longer-lasting effect
i. i. Nicotine patch
ii. ii. Nitroglycerin patch
 Block 2 Study Guide
40. Why do elderly patients have slower absorption rates for medications?
a. Absorption is slowed by decreased gastric acid content, which slows GI emptying
and GI motility
41. What is hypoglycemia?
a. Extremely low blood glucose level, caused by an excess of insulin
42. What is a mucosal atomizer device? What route is it used to deliver medications through?
a. The liquid medication is aerosolized and is administered into a nostril
b. Intranasal; relatively new format; head and face are very vascular so the
absorption is quick
43. When is IO (intraosseous) access used? Why?
a. Into the bone; medications given by this route reach the bloodstream through the
bone marrow; very painful, involves bone drilling
b. b. Used when patient is unconscious; often used for children who have fewer
available (or difficult to access) IV sites
44. What is JVD (jugular vein distention)
a. A visual bulging of the jugular veins in the neck that can be caused by fluid
overload, pressure in the chest, cardiac tamponade, or tension pneumothorax
45. If you can’t get an automatic blood pressure reading what should you do?
a. Get the manual BP
46. When is ETCO2 (end-tidal carbon dioxide) monitoring used?
a. To more accurately assess ventilation. Pulse oximetry cannot measure the
effectiveness of ventilation nor provide information about respiration
b. It measures the CO2 in the exhale
47. Viral hepatitis vs toxin-induced hepatitis (which one is communicable?)
a. Viral Hepatitis
48. What is MRSA?
a. A bacterium that causes infections and is resistant to many antibiotics
 Block 3 Study Guide
1. What part of the brain controls basic bodily functions like blood pressure,
breathing, heart rate, swallowing, etc? pg 209
a. Medulla Oblongata
2. Where does the spinal cord exit the brain? *hint large opening! pg 181
a. Foramen Magnum
3. How long should it take for a patient to come out of the postictal state? What is a
postictal state?
a. A postictal state is after a seizure when a patient’s muscles relax becoming
almost floppy and the patient has labored breathing trying to compensate for
the buildup of acid in their body. They will also have an altered level of
consciousness
i. They may also have stroke-like side body weakness (hemiparesis)
b. The length of this state is usually determined by the length of the seizure
4. What do we do for a patient who is having a seizure? What do we do once they come
out of the seizure? (Hint, what do we do for every patient with an ALOC?....blood
sugar!) pg 690
a. Obtain a complete set of vital signs, including the measurementof the
patient’s blood glucose level using a glucometer
i. The portable glucometer in blood using capillary or venous samples
pg 372
ii. During the postactical state get the vitals of the patient and they
should be WNL
iii. First BP should be taken manually
5. How do we transport a stable stroke patient with a paralyzed extremity? pg 696
a. Support the ABC’s
b. Suction if they are having trouble with their secretions
c. If paralyzed, they will require protection from injury because they might not
be able to keep their extremities from harms way as you move the patient for
transport
d. The patient will be scared reassure the patient
e. Transport the patient to a designated stroke center
6. Signs & Symptoms to pay attention to: pg 712
a. peptic ulcer disease
i. A classic sequence of burning or gnawing pain in the stomach that
subsides immediately after eating then beginning again 2-3 hours later
ii. The pain is in ethe upper abdomen region
iii. With some patients pain occurs immediately after eating
iv. Nausea, vomiting, belching and heart burn
1. If severe the gastric bleeding may occur
b. renal (kidney) failure
i. The pain will initially be in the flank but it often gets more severe and
radiates to the groin
 Block 3 Study Guide
ii. agitated and restlessness as they try to get in a comfortable position
iii. Nausea and vomiting
iv. A slight amount of blood during urination
c. strangulated hernia
i. A formerly reducible mask is no longer reducible
ii. Pain in the hernia site
iii. Tenderness where the hernia is plpated
iv. Red or blue discoloration over the hernia
d. AAA pg 715
i. pale
ii. sweating
iii. tearing pain t
iv. pulsating mass in the abdomen (rare)
v. Radiate severe pain to the back
7. How we treat a patient complaining of severe abdominal pain + S&S of shock pg
719
a. Treat the patient as if they went into shock
i. Maintain temperature
ii. Dont give anything by PO
iii. Give a moistened piece of gauze for the patient to suck
iv. High flow O2
b. Position so that the patient doesnt choke on vomit
c. contain any vomit so that bacteria doesnt spread
d. Ensure you are wearing gloves, mask, gowns and eye wear
8. S&S of shock
a. Increase in heart rate
b. pale cyanotic skin
c. SOB
d. Nausea and vomiting
e. Anxiety
f. Cap refill longer than 2 seconds
g. Narrowing pulse

9. S&S to pay attention to:

a. hypoglycemia
i. seizures
ii. Altered mental status (always suspect hypo if altered)
iii. Intoxicated behavior
iv. pale cool moist
v. rapid symptoms
b. hyperglycemia pg 1110
i. Intoxicated behavior
ii. Depressed LOC
 Block 3 Study Guide
iii. Gradual symptoms
iv. Warm and dry skin
v. intense thirst
vi. Kussmaul respirations
vii. Sweet odor of breath
viii. rapid weak pulse
c. DKA, (know the 3 P’s!)
i. hyperglycemia
ii. polydipsia (thirst)
iii. polyuria (urination)
iv. polyphagia (hunger)
v. dizziness, confusion, altered mental status, and possibly seizures
10. If a patient is coming at you with a baseball bat & is screaming at you what should you
do?
a. Keep your distance, call for law enforcement, and speak to them calmly and
evenly
11. When getting a SAMPLE history of a diabetic patient “the MOST important”
question to ask (at least according to your block 3 exam) is…
a. if they’ve had any recent illnesses or stress
12. How can you tell the difference between hyperglycemia and hypoglycemia in an
unresponsive patient (without using blood glucose…hint look at #14)
a. Hyper is
i. Hyper is gradual, Hypo- rapid within minutes
ii. Hyper is warm and dry skin, Hypo- pale, cool and moist
iii. Hyper is Infections are common, Hypo- uncommon
iv. Hyper is Intense thirst, Hypo- Absent
v. Hyper is increasing hunger, Hypo- Absent
vi. Hyper is Vomiting and ab pain, Hypo- Uncommon
vii. Hyper is Kussmaul respirations, Hypo- normal
viii. Hyper is sweet breaths, hypo- normal
ix. Same BP (normal)
x. Same pulse (rapid and weak- hyper is thready)
xi. Hyper- responds withing 6-12 hrs of treatment, hypo- immediate
13. Contraindications for oral glucose pg 1121
a. patient who does not have a gag reflex
14. Know the definition of an allergen pg 2289
a. A substance that causes an allergic reaction.
15. What will have the slowest onset time in an allergic reaction: injected, ingested, inhaled,
touch. Why?
a.
16. Know what a wheal is and what urticaria is pg 935
a. Wheal- a raised, swollen, well-defined area on the skin
b. Urticaria- Widespread hives
 Block 3 Study Guide
17. How long does a stinger continue to inject venom? pg 1144
a. it can continue to inject venom for up to 20 minutes. Wasps and hornets do
not have this handicap; they can sting repeatedly
18. What is the most rapidly fatal symptom of anaphylaxis? (What will kill the patient
first? Hint…ABC’s) pg 935
a. may cause respiratory distress that is severe enough to result in coma and
death.
b. The airway may swell so much that breathing problems can progress to total
airway obstruction in a matter of minutes.
19. What does epinephrine do? What are the common side effects?
a. Action- Vasoconstriction and increased cardiac contractility, bronchodilation
b. Side effects- tachycardia, sweating, pale skin, dizziness, headache,
papitations
20. Know the indications for using epinephrine, how to administer it (and what to do
with the needle/epipen after injection), the dose, side effects, etc pg 1152
a. Indication- Severe allergic reaction causing airway, breathing and
circulatory compromise or an anaphylactic reaction
b. How to administer
i. Remove the safety cap and, if possible, quickly wipe the patient’s
thigh with alcohol (Note: though it is best practice to clean the site, do
not delay administration of the drug to do so.)
1. it is possible to administer the auto-injector directly through
the patient’s clothing if severe
ii. Place the tip of the auto-injector against the lateral part of the
patient’s thigh, midway between the groin and the knee
iii. Push the injector firmly against the thigh until a click is heard.
iv. Maintain steady pressure. Hold the injector in place until the
medication
v. has been injected (10 seconds).
vi. Remove the injector from the patient’s thigh and dispose of it in the
proper biohazard container.
vii. Rub the area for 10 seconds
c. Dose
i. Adults: 0.3mg (Epipen)
ii. Children: 0.15 mg(Epipen Jr)
d. Side effects- tachycardia, sweating, pale skin, dizziness, headache,
papitations
21. What is excited delirium? What would make it worse/better? pg 2301
a. A serious behavioral condition in which a person exhibits agitated behavior
combined with disorientation, hallucinations, or delusions; also called
agitated delirium or exhaustive mania.
b. Better
i. Be an active listener by nodding, indicating understanding
 Block 3 Study Guide
ii. ​Limit physical contact with the patient as much as possible
iii. take all medication bottles or illegal substances with you to the
medical facility (of drug overdose)
c. Worse
i. Ligts and sirens
ii. Stimulant drugs or alcohol withdrawals
22. What is a functional disorder? Pg 1210
a. If the patient tells you voices are telling him or her to kill, believe it
b. a physiological disorder that impairs bodily function when the body seems to
be structurally normal. Something has gone wrong, but the root cause cannot
be identified. Schizophrenia, anxiety conditions, and depression are good
examples of functional disorders.
23. What is the single most common contributing factor to suicide? pg 1226
a. most significant factor that contributes to suicide is depression
24. What is active listening vs reflective listening? When do we use those techniques?
pg 1214
a. Reflective Listening- repeating, in question form, what the patient has said,
encouraging the patient to expand on his or her thoughts.
i. When other techniques are unsuccessful when gathering info
b. Active Listening- nodding, indicating understanding, and by limiting your
interruptions of the patient’s comments
i. When a patient is delirious but it is also helpful in general
25. When would be do a physical exam on a behavioral/psychological emergency
patient?
a. During the secondary assessment
i. vital signs
ii. tests with the monitoring devices you are equipped with
iii. Stroke assessment
iv. Glucose monitoring
26. What clinical findings would indicate brain dysfunction in the CNS?
a. the patient’s level of consciousness, speech, and voluntary muscle control will
be off
b. Take the GCS score of the patient
27. What is organic brain syndrome? pg 1210
a. A temporary or permanent dysfunction of the brain caused by a disturbance
in the physical or physiologic functioning of brain tissue
b. Causes include sudden illness; traumatic brain injury; seizure disorders;
drug and alcohol abuse, overdose, or withdrawal; and diseases of the brain,
such as Alzheimer dementia or meningitis
28. If a female with vaginal trauma loses consciousness, what should we suspect?
a. The female could have gone into shock pg 1248 ???
29. What should be our main focus when caring for a woman experiencing a
gynecologic emergency?
 Block 3 Study Guide
a. you must maintain the patients’ privacy as much as possible
b. If the patient has vaginal bleeding, treat her for hypoperfusion or shock.
Keep her warm, place her in a supine position, and provide her with
supplemental oxygen even if she is not experiencing difficulty breathing
30. What is vs what isn’t considered an obstetrical emergency
a.
31. When would we begin CPR on a newborn?
a. After you do the following and still dont get a pulse

b. If you don’t get any of these responses then

i. tap on the sole of the newborn’s foot
ii. rub the baby’s back (to stimulate breathing and circulation)
iii. Many need more stimulation so you can use position the airway, warm, dry,
suction, and use tactile stimulation
c. Assess and support- Temperature (warm and dry), airway (position and suction),
Circulation (heart rate and skin color)
d. BLS interventions-
i. Dry and warm the newborn
ii. Clear the airway with a bulb syringe
iii. Stimulate the newborn if they are unresponsive
iv. Use a BVM to ventilate if the newborn needs it
32. What situations would we insert a gloved finger into the vagina during delivery?
a. When a baby is coming out of the canal as a breech birth use 2 fingers to
open the vagina this helps avoid the baby choking
b. Prolapsed cord and you need to hold the baby off the umbilical cord
33. Know prolapsed umbilical cord & how to handle it pg 1844
a. When the umbilical cord comes out before the baby
b. Place the pregnant woman supine with the foot end of the cot raised 6 to 12
inches (15 to 30 cm) higher than the head, with her hips elevated or in the
knee-chest position: kneeling and bent forward, facedown to keep the weight
of the fetus off the prolapsed cord.
c. Carefully insert your sterile gloved hand into the vagina, and gently push the
fetus’s head away from the umbilical cord until ALS arrive
34. What is spina bifida pg 2022
a. a developmental defect in which a portion of the spinal cord or meninges
may protrude outside of the vertebrae and possibly outside of the body
b. some patients with spina bifida have partial or full paralysis of the lower
extremities, loss of bowel and bladder control, and an extreme allergy to latex
products.
35. Know the indications of fetal demise and what to do if delivering an obviously deceased
newborn pg 1847
 Block 3 Study Guide
a. The baby will have an extremely foul odor, skin blisters, skin sloughing and dark
discoloration
b. What to do
i. Do not try to resuscitate
ii.
36. Know an infant’s vital signs (HR, RR, BP) pg 415
a. Pulse- 100 to 160 beats/min
b. Respiration- 25 to 50 breaths/min
c. systolic BP- 70 to 95 mm Hg
37. Know how an infant/small childs airway differs from that of an adult
a. The back of the head is larger in a child
b. The tongue is larger and is located anterior in the mouth
c. The trachea is smaller in diameter and more flexible
d. The airway itself is lower and narrower (funnel shaped)
38. Know the characteristics in a 9 month old & 13 month old (*hint, those numbers are
specific for a reason) pg 417
a. Pulls up to stand
39. What age does separation anxiety peak? pg 418
a. older infants. This normal reaction peaks between 10 and 18 months and
involves clingy
b. behavior and fear of unfamiliar places and people
c.
40. What is the common cause of shock in infants/children?
a. Traumatic injury with blood loss (especially abdominal)
b. Dehydration from diarrhea and vomiting
c. Severe infection
d. Neurologic injury, such as severe head trauma
e. A severe allergic reaction to an allergen (anaphylaxis), such as an insect bite
or food allergy
f. Diseases of the heart
g. A collapsed lung (tension pneumothorax)
h. Blood or fluid around the heart (cardiac tamponade or pericarditis)
41. S&S of dehydration in infants/children (relate this to #56)
a. Infrequent urination or urine that has a deep yellow color
b. Severe thirst
42. Review airway & respiratory in infants & children
a. Open airway (head-tilt is for non trauma, jaw thrust for trama)
43. Using an OPA & NPA in infants/children
a. OPA-
i. In children, the only acceptable method of inserting an oral airway is
to use a tongue blade to hold the tongue down while inserting the
airway.
 Block 3 Study Guide
ii. Because the airways of children are undeveloped, rotating an
oropharyngeal airway in the posterior pharynx may cause damage
iii. Appy pressure with thumb to open chin
iv. . Insert the airway by depressing the tongue with a tongue blade
applied to the base of the tongue and inserting the airway directly
over the tongue blade
v. tongue blade is unavailable, point the airway tip toward the roof of
the mouth to depress the tongue
vi. Gently rotate the airway into position as it passes through the mouth
toward the curve of the tongue. Insert the airway until the flange rests
against the lips. 5. Reassess the airway after insertion.
b. NPA
i. Position the pediatric patient’s airway, using the techniques for OPA
ii. Lubricate the airway with a water-soluble lubricant
iii. Insert the tip into the right naris (nostril opening) with the bevel
pointing toward the septum, or central divider in the nose
iv. Carefully move the tip forward, following the roof of the mouth, until
the flange rests against the outside of the nostril
v. If you are inserting the airway on the left side, insert the tip into the
left naris upside down, with the bevel pointing toward the septum.
Move the airway forward slowly about 1 inch (2.5 cm) until you feel a
slight resistance, and then rotate the airway 180 degrees.
44. S&S of airway obstruction & what to do
a. mild airway obstruction- the child can cough forcefully, although he or she
may wheeze between coughs
i. patient can breathe, cough or talk
ii. encourage the child to continue coughing. Administer supplemental
oxygen if needed (and tolerated) and provide transport to the ED.
b. Severe airway obstruction- patient develops a weak, ineffective cough;
cyanosis; stridor; absent air movement; or a decreasing level of
consciousness.
i. Child- Abdominal thrusts (conscious) and CPR (unconscious)
ii. Infant- 5 back slaps and 5 chest thrusts
45. What is the most common cause of cardiac arrest in infants/children? pg 544
a. Respiratory arrest
46. Why does cardiac function decline in late adulthood?
a. Specifically, the heart hypertrophies (enlarges) with age, probably in
response to the chronically increased afterload imposed by stiffened blood
vessels. Bigger is not better, however. Over time, cardiac output declines,
mostly as a result of a decreasing stroke volume.
b. Some changes in cardiovascular performance are probably not a direct
consequence of aging, but rather reflect the deconditioning effect of a
sedentary lifestyle.
 Block 3 Study Guide
47. Why are head injuries a particular concern in patients who take blood thinning
medications?
a. They are higher risk for developing a subdural hematoma
b. This is caused by atrophy of the brain tissue that increases stretching of the
bridging veins. S/S dont occur for several hours, days or weeks so make sure
to get a thorough history of trauma
48. What to do if you can’t find a DNR or if it’s not valid pg 1998
a. When in doubt, your best course of action is to take resuscitative action that
is appropriate to the situation and to practice sound medical treatment
49. Why do victims of abuse make false statements or lie about their injuries?
a. A geriatric patient who is being abused by family members may lie about the
origin of abuse for fear of being thrown out of the home. pg 2000
b. ???
50. S&S of pulmonary embolism, esp. risk factors
a. S/S
i. circulation can be significantly decreased or completely blocked,
which can result in a life-threatening condition
ii. Even though the lung itself can continue the process of inhalation and
exhalation, no exchange of oxygen or carbon dioxide takes place in the
areas of blocked blood flow because there is no effective circulation.
iii. oxygen levels in the bloodstream may drop enough to cause cyanosis
iv. Cyanosis, dyspnea, decreased blood flow
v. ▪ Dyspnea ▪ Tachycardia ▪ Tachypnea ▪ Varying degrees of hypoxia ▪
Cyanosis ▪ Acute chest pain ▪ Hemoptysis (coughing up blood)
b. Risk Factors
i. Pregnancy, active cancer, and bed rest
ii. damage to the lining of the vessels, slow blood flow in a lower
extremity
51. How to reduce patient anxiety when transporting an elderly patient
a. Providing the patient low-flow oxygen may decrease nausea and anxiety. If
the patient is having problems breathing, high concentrations of oxygen are
more appropriate. Loosen restrictive clothing and transport gently in a
position of comfort. Constantly reassess your patient’s condition for signs of
deterioration. pg 1093
52. Why do elderly patients understate or minimize their symptoms?
a. g. Older patients may also not exhibit the same pain response ability because
of deterioration of their sensory systems. Provide transport to an appropriate
facility that can meet the needs of a geriatric patient.
b. ???
53. What do anti-hypertension medications such as beta blockers) do? Why would the
patient not have tachycardia?
a. prevent the heart from speeding up to compensate for when the blood
pressure drops pg 964
 Block 3 Study Guide
b. vasodilation by interfering with sympathetic adrenergic vascular tone ???
54. How to care for a tracheostomy pg 715
a. ventilate through the tube with a BVM (the standard 15/22-mm adapter on
the BVM will fit onto the tube in the tracheal stoma) and 100% oxygen
attached directly to the BVM.
b. If the patient has a stoma and no tube is in place, use an infant or child mask
with your BVM to make a seal over the stoma. Seal mouth and nose with one
hand to prevent a leak of air through the upper airway then release the seal
of the patient’s mouth and nose for exhalation.
i. If you are unable to ventilate a patient who has a stoma, try suctioning
the stoma and the mouth with a French or soft-tip catheter before
giving the patient artificial ventilation through the mouth and nose. If
you seal the stoma during mouth-tomouth ventilation, the ability to
ventilate the patient may be improved, or it may help to clear any
obstructions.
55. How to communicate with deaf, hard of hearing patients
a. Place yourself in a position where the patient can read your lips as most can
lip read
b. Make sure they didnt drop their hearing aid
c. Have Paper and pen available
d. Never shout
e. Ask short questions and give short answers
f. Learn simple phrases in sign language
i. Sick, hurt and help
56. What is cerebral palsy? How do we care for patients with cerebral palsy? pg 2022
a. group of disorders characterized by poorly controlled body movement
i. resulting from oxygen deprivation at birth
b. Care
i. Assess ABCs
ii. Observe airway because these patients may have increased secretion
production and difficulty swallowing (dysphagia), requiring
aggressive suctioning to clear the airway
iii. Don’t assume they have an intellectual disability
iv. Limbs are underdeveloped and prone to injury
v. Prone to falls
vi. Never force their extremities into any position
vii. Pad the patient for comfort
viii. transport preferred walkers or wheelchairs with the patient
ix. Be prepared to address a seizure if one occurs, and keep a suctioning
unit available. Consider requesting additional advanced life support
 Block 4 Study Guide
1. Remember to follow your trauma assessment when answering questions!
2. Review the O2 administration cheat sheet

a.
3. Know what cavitation is
a. the 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
i. Temporary cavitation injury results from a stretching of the tissues that
occurs with the pressure changes.
ii. Permanent cavitation injury results closer to the bullet path where the
pressure fluctuations are greatest and remains after the projectile has
passed through the tissue
4. Know Newtons First Law of Motion
a. objects at rest tend to stay at rest and objects in motion tend to stay in motion
unless acted on by some force
i. In a car going 30 mph, the passengers and the car are moving at 30 mph.
The passengers do not feel as though they are moving because they are
not moving relative to the car. However, when the car strikes a concrete
barrier and comes to a sudden stop, the passengers continue to travel at
30 mph. They stay in motion until they are acted on by an external
force—most likely the windshield, steering wheel, or dashboard
5. Know potential & kinetic energy
a. Potential Energy- the product of mass (weight), force of gravity, and height and
is mostly associated with the energy of falling objects
 Block 4 Study Guide
i. A worker on a scaffold has potential energy because he or she is some
height above the ground. If the worker falls, potential energy is
converted into kinetic energy. As the worker hits the ground, the kinetic
energy is converted into work, that is, the work of bringing the body to
a stop and thereby fracturing bones and damaging tissues.
b. Kinetic Energy- The energy of a moving object
i. Kinetic energy = ½ mass × velocity2 or, KE = ½ m × v
ii. The speed of the bullet (high-velocity compared with low-velocity) has a
greater impact on producing injury than the mass (size) of the bullet.
This is why it is so important to report to the hospital the type of
firearm that was used in a shooting. The amount of kinetic energy that
is converted to do work on the body dictates the severity of the injury
6. Know the 3 collisions that occur in a car accident pg 1268
a. The collision of the car against another car, a tree, or some other object
i. Mainly damage to the car
b. The collision of the passenger against the interior of the car
i. Obvious damage to the body
c. The collision of the passenger’s internal organs against the solid structures of
the body.
i. Damage internally not as easy to spot
7. What to assume with the death of an occupant in the same vehicle as another person
pg 1271
a. if one or more of the passengers are dead, you should suspect that the other
passengers have sustained serious injuries, even if the injuries are not obvious.
Therefore, focus on treating life-threatening injuries and providing rapid
transport to a trauma center, because these passengers have likely experienced
the same amount of force that caused the death of the others.
8. What is the purpose of airbags? What happens if airbags don’t deploy + what should
you do? pg 1265
a. Purpose
i. the air bag stretches the duration of impact by 0.05 second, buying the
body even more time, and the force on the upper body drops to
approximately 15 times that of gravity
ii. It also applies the force over a much larger area than the area affected
by the steering wheel or the shoulder belt, shrinking the force per unit
area
b. If the airbag has not been deployed, there is a risk that it may accidentally
activate while you are in the vehicle.
i. Make sure if you are working inside the vehicle you have sufficient
protective gear.
9. What is the purpose of a headrest? What can it prevent? 1277
a. Headrests decrease extension of the head and neck during a crash and,
therefore, help reduce injury
10. Know what arteries, arterioles, capillaries, venules, veins are
 Block 4 Study Guide
a. artery- A blood vessel, consisting of three layers of tissue and smooth muscle,
that carries blood away from the heart.
b. Arterioles- When arteries branch into smaller arteries and then into arterioles.
The arterioles, in turn, branch into the vast network of capillaries.
c. Capillary vessels- fragile divisions of the arterial system that allow contact
between the blood and the cells of the tissues
d. Venules- Once oxygen-depleted blood passes through the network of
capillaries, it moves to the venules, which are the smallest branches of the
veins
e. Veins- The blood returns to the heart via a network of larger and larger veins.
Veins have much thinner walls than arteries and are generally larger in
diameter.
11. What affects the ability of the blood to clot?
a. Platelets are tiny, disc-shaped elements that are much smaller than the cells.
They are essential in the initial formation of a blood clot, the mechanism that
stops bleeding
12. What happens after soft tissue has been damaged? (*hint, look up the wound healing
process)
a. To stop the flow of blood, the vessels, platelets, and clotting cascade must work
in unison
b. During inflammation (the next stage of wound healing), additional cells move
into the damaged area to begin repair
c. To replace the area damaged in a soft-tissue injury, a new layer of cells must be
moved into this region
d. new blood vessels form as the body attempts to bring oxygen and nutrients to
the injured tissue
e. collagen provides stability to the damaged tissue and joins wound borders,
thereby closing the open tissue. Unfortunately, collagen cannot restore
damaged tissue to its original strength
13. Know how long organs can tolerate inadequate perfusion pg 1318
a. Some organs can last longer than others
i. Brain and spinal cord die after 4-6 minutes
ii. The lungs can survive only 15 to 20 minutes
iii. Kidneys can be damaged after 45 minutes
iv. Skeletal muscle demonstrates evidence of injury after 2 to 3 hours of
inadequate perfusion
v. The gastrointestinal tract can tolerate slightly longer periods
14. How can the body better sustain hypoperfusion (*hint it has to do with body
temperature)
a. To protect vital organs, the body attempts to compensate by directing blood
flow from organs that are more tolerant of low flow (such as the skin and
intestines) to organs that cannot tolerate low blood flow (such as the heart,
brain, and lungs). pg 777
 Block 4 Study Guide
b. These times are based on a normal core body temperature (98.6°F [37.0°C]). An
organ or tissue that is kept at a considerably lower temperature may be better
able to resist damage from hypoperfusion pg 1318
15. When would infants start showing S&S of hypovolemic shock? (*hint what is their
total blood volume, and what is the least amount of blood they could lose before
showing S&S of shock?) pg 1319
a. a 1-year-old has a typical total blood volume of about 27 oz (800 mL); the child
will show significant symptoms of blood loss after only 3 to 6 oz (100 to 200
mL) of blood loss, or less than half of a can of soda.
16. How successful a person is able to compensate for blood loss is related to what in
particular? pg 1319
a. How well a patient’s body can compensate for blood loss is related to how
rapidly the blood loss occurs
17. S&S of intra-abdominal bleeding (*know the early and late signs especially!)
a. pain and distention
b. Early
i. change in mental status
1. In non-trauma patients, weakness, faintness, or dizziness on
standing is another early sign.
2. Trauma and medical- Changes in skin color or pallor (pale skin)
are often seen in both trauma and medical patients
c. Later
i. Tachycardia
ii. ▪ Weakness, fainting, or dizziness at rest
iii. ▪ Thirst
iv. ▪ Nausea and vomiting
v. ▪ Cold, moist (clammy) skin
vi. ▪ Shallow, rapid breathing
vii. ▪ Dull eyes
viii. ▪ Slightly dilated pupils that are slow to respond to light
ix. ▪ Capillary refill time longer than 2 seconds in infants and children
x. ▪ Weak, rapid (thready) pulse
xi. ▪ Decreasing blood pressure
xii. ▪ Altered level of consciousness
18. When should we suspect a GI bleed? (*i.e. what are the S&S of a GI bleed?)
a. Upper GI bleed pg 1084
i. esophagitis, esophageal varices secondary to liver failure, or a
Mallory-Weiss tear, which results from excessive retching or vomiting.
ii. Hematemesis- vomiting of blood
iii. The blood is either bright red or has the appearance of coffee grounds
b. Lower GI bleed- Bowel inflammation, diverticulosis, diverticulitis, cancer, and
hemorrhoids
i. the bleeding often manifests as melena, or dark tarry stools, as a result
of partial digestion of the blood.
 Block 4 Study Guide
19. Know the early & late signs of non-traumatic GI bleeds
a. -Early: Contusion/ ecchymosis caused by the accumulation of blood around
b. -Late: Hypovolemic Shock
i. bleeding ulcers, bleeding from colon
ii. signs: abdominal tenderness guarding rigidity pain and distension
iii. signs: dizziness faintness and weakness (older patients)
20. How do we control external bleeds? pg 1321
a. an injured blood vessel is completely cut off from the main blood supply by
direct pressure or a tourniquet.
21. What’s the most effective way to control arterial bleeds?
a. In most cases, direct pressure will control both venous and arterial bleeding. If
direct pressure is ineffective in immediately controlling severe external
bleeding, apply a tourniquet and transport. Only after the tourniquet is applied
should you administer oxygen and consider splinting the arm.
22. Know the rule of 9’s + differences between adults and children in relation to
TBSA pg 1401
a. which divides the body into sections, each of which is approximately 9% of the
total surface area
b. Children have more body surface area. Larger heads compared to adults.
 Block 4 Study Guide

c. 76

d.
e.
23. Know differences in burns (1st, 2nd & 3rd degree)
a. ▪ Superficial (first-degree) burns involve only the top layer of skin, the
epidermis. The skin turns red but does not blister or burn through this top
layer. The burn site is often painful. Sunburn is a good example of a superficial
burn.
b. ▪ Partial-thickness (second-degree) burns involve 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. Typically, the skin is moist, mottled,
and white to red. Blisters are present. Partial-thickness burns cause intense
pain.
c. ▪ Full-thickness (third-degree) burns extend through all skin layers and may
involve subcutaneous layers, muscle, bone, or internal organs. The burned area
is dry and leathery and may appear white, dark brown, or even charred. Some
fullthickness burns feel hard to the touch. Clotted blood vessels or
 Block 4 Study Guide
subcutaneous tissue may be visible under the burned skin. If the nerve endings
have been destroyed, a severely burned area may not have feeling and the
surrounding less severely burned areas may be extremely painful.
24. Know electrical burns
a. Electrical burns may be the result of contact with high- or low-voltage
electricity. High-voltage burns may occur when utility workers make direct
contact with power lines. Ordinary household current is still powerful enough
to cause severe burns as well as cardiac dysrhythmias.
b. The human body, which is primarily water, is a good conductor. Thus, electrical
burns occur when the body, or a part of it, completes a circuit connecting a
power source to the ground
c. you can also be fatally injured by touching a patient who is still in contact with
a live power line or any other electrical source
d. The entrance wound may be quite small , but the exit wound can be extensive
and deep pg 1417
e. The force of the electrical energy can also cause fractures or joint dislocations.
Second, the patient may go into cardiac or respiratory arrest from the electric
shock; although, if the patient is not in cardiac arrest on your arrival, it is
unlikely he or she will do so during transport.
25. What happens when a person is exposed to the cold?
a. Pneumonia is often a secondary infection, meaning it begins after an upper
respiratory tract infection such as a cold or sore throat
b. They can get croup
26. Know what an avulsion is
a. 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
b. Significant bleeding is common
27. Know what a sucking chest wound is and how to treat it
a. An open or penetrating chest wall wound through which air passes during
inspiration and expiration, creating a sucking sound
b. also known as an open pneumothorax
28. What should you suspect with a patient who suffered a closed soft-tissue injury?
a. A hematoma which is blood that has collected within damaged tissue or in a
body cavity
29. Know what the mandible is
a. the lower, moveable portion of the jaw
30. Where is the mastoid process located?
a. About 1 inch posterior to the external opening of the ear is a prominent bony
mass at the base of the skull
31. Where is the cricoid cartilage located?
a. A firm ridge of cartilage that forms the lower part of the larynx
32. What is another name for your eyeball?
a. globe
 Block 4 Study Guide
33. What is conjunctiva & sclera?
a. conjunctiva- conjunctiva is the delicate membrane lining the eyelids, and it
covers the exposed surface of the eye
b. Sclera- s the normally white portion of the eye and may show color changes
even before skin color change is visible
34. How to treat injuries to the eye
a. Always perform your examination using standard precautions, taking great care
to avoid aggravating any problems. You are looking for specific abnormalities or
conditions that may suggest the nature of the injury
b. If a small foreign object is lying on the surface of the patient’s eye, you should
use a normal saline solution to gently irrigate the eye
c. When you see or suspect an impaled object in the eye, bandage both eyes with
soft, bulky dressings to prevent further injury to the affected eye, do not add
force to it, apply moist sterile dressing, and cover eith protective metal eye
shield
d. For Burns After you have completed irrigation, apply a clean, dry dressing to
cover the eye, and transport the patient promptly to the hospital for further
care
e. Lacerations- do not add pressure to the eye
35. S&S of a detached retina
a. , the nerve endings are not nourished, and the patient experiences blindness.
This may be partial blindness, depending on how much of the retina is
separated.
36. Know what Cushing’s Triad is & what it indicates
a. The triad of increased systolic blood pressure, decreased pulse rate, and
irregular respirations is called Cushing reflex, and signifies increased
Intracranial pressure
37. Remember the steps of back boarding
a. Supine Immobilization- Supine Patient Skill
1. Inspect your equipment/ Gather the appropriate material
2. Take or verbalize appropriate BSI precaution/ scene safety
3. Directs assistant to maintain manual stabilization of the head
a. They plant the knuckles on the ground with their fingers under the
head
4. Assess PMSC
a. Pulse- Check to see they have a pulse
b. Motor- Can you wiggle your fingers for me or can you hold on to my
hands
c. Sensory- What finger am I touching?
d. Circulation- Do a capillary refill it should be under 2 seconds
e. *** assess this on both hands and feet
5. Apply C-Collar appropriately sized
a. Pop the flap
 Block 4 Study Guide
b. Measure with fingers and assess the length of the neck then use that
as a measure guide
i. It is better that the collar be shorter
c. Make sure the velcro goes fully around tightly but still breathable
d. Don’t move the patients neck too much which is why someone
needs to be there to stabilize the head
6. Log roll onto long board
a. On the head man’s count 3 people will grab the other side of the
patient and bring it towards them. Moving the patient 90 degrees
b. Assess the back to see if there are any deformities or wounds
c. Position the board below the patient
d. Then on the head man’s count they will need to slowly bring the
patient down on the board
7. Reposition the patient on the board
a. On the head man’s count position the patient up and over so that
8. Secure the patient on the baord using the straps
a. Start by crossing the straps on the chest like an X (under the arms)
b. Next secure the head
c. Secure the legs and the feet
d. Reassess PMSC
9.
 Block 4 Study Guide

10.
38. Know what an intracerebral hematoma, cerebral concussion & coup-contrecoup injury
are
a. Intracerebral Hematoma- bleeding within the brain tissue itself. This type of
injury may occur following a penetrating injury to the head or because of rapid
deceleration forces
b. Cerebral Concussion- Concussions are also known as mild traumatic brain
injuries
i. A temporary loss or alteration of part or all of the brain’s abilities to
function without actual physical damage to the brain
c. coup-contrecoup injury- A brain injury that occurs when force is applied to the
head and energy transmission through brain tissue causes injury on the
opposite side of the original impact

39. What is the most reliable sign of a head injury?

a. a concussion may be confused or have amnesia (loss of memory)
b. dizziness, weakness, or visual changes
c. nausea or vomiting, and the patient may report ringing in the ears. Slurred
speech and the inability
d. to focus may also be present
40. What is Beck’s Triad & what does it indicate?
a. distended or engorged jugular veins seen on both sides of the trachea
 Block 4 Study Guide
b. a narrowing pulse pressure (the difference between the systolic and diastolic
blood pressure numbers)
c. muffled heart sounds.
d. it indicates a cardiac tamponade (when the protective membrane around the
heart (pericardium), the pericardial sac, fills with blood or fluid, perhaps from a
ruptured, torn, or lacerated coronary artery or vein)
41. What is CSF and what does it do?
a. CSF primarily acts as a shock absorber
i. The brain and spinal cord essentially float in this fluid, buffered from
injury
42. What is the purpose of sensory nerves?​​983 pg read
a. When a sensory cell is stimulated, it transmits its own special message to the
brain’s
b. special sensory nerves to detect heat, cold, position, motion, pressure, pain,
balance, light, taste, and smell, as well as other sensations. Specialized nerve
endings are adapted for each cell so it perceives only one type of sensation and
transmits only that message.
43. What is the purpose of the parasympathetic nervous system? How can you tell when
it’s activated?
a. When stimulated, this system causes the heart to slow and beat more weakly
b. controls bodily functions when a person is at rest
44. What organs are contained in the mediastinum?
a. This space contains the heart, the great vessels, the esophagus, the trachea,
the major bronchi, and many nerves
45. What does the phrenic nerve do and where does it exit the spinal cord?
a. Nerve that innervates the diaphragm; necessary for adequate breathing to
occur
b. C3 through C5 nerve roots, which exits the spinal canal at the neck root and
descends caudally
46. What is peritonitis?
a. Inflammation of the peritoneum (abdominal cavity is lined by a membrane)
47. Bruising to the liver would be indicative of what?
a. Closed injury to the liver or other nearby organs.
48. What is the mesentery?
a. any fold of tissue that attaches an organ to the body wall
b. The intestinal blood supply comes from the mesentery
c. The mesentery is a fold of membrane that attaches the intestine to the
abdominal wall and holds it in place
49. What are distention & guarding from DRGERM?
a. Guarding- Involuntary muscle contractions (spasm) of the abdominal wall to
minimize the pain of movement and protect the inflamed abdomen; a sign of
peritonitis.
b. Abdominal distention- Swelling can also be the result of air in the form of gases
from the bowel or from infection
 Block 4 Study Guide
50. How should a seatbelt be worn?
a. should be worn below the anterior superior iliac spines of the pelvis and
against the hip
b. seatbelt marks = trauma center
51. How does early bruising present?
a. reddish
52. What is a sign of intra-abdominal bleeding?
a. pain and distention
b. Hematemesis
c. Melena
d. Pain, tenderness, bruising, guarding, or swelling.
e. Broken ribs, bruises over the lower part of the chest, or a rigid, distended
abdomen
53. S&S of a dislocated AC joint
a. Acromioclavicular (AC) Joint: the joint between the outer end of the clavicle
and the acromion process of the scapula
i. frequently separated during sports, such as football or hockey, when a
player falls and lands on the point of the shoulder, driving the scapula
away form the outer end of the clavicle
b. S&S:
i. the distal end of the clavicle will often stick out
ii. pt will report pain, including point tenderness over the AC joint
54. 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?
a. OK TO APPLY:
i. fracture of the femoral shaft
b. NEVER APPLY:
i. injuries of upper extremity
ii. injuries close to or involving the knee
iii. injuries of the pelvis
iv. partial amputations or avulsions with bone separation
v. lower leg, foot, ankle injury
c. if pt complains of intense pain while applying the traction splint, stop and
splint the limb in the deformed position
55. When do we use a scoop stretcher & why?
a. used for pts who have been struck by a motor vehicle
b. transfer/move pts
56. Remember 1 liter per femur!
a. 1 liter = 1,000mL
57. What is the most common & severe complication of dislocations to the knee?
a. Posterior knee dislocations, which result from extreme hyperextension of the
knee, are the most common (occur in almost half the cases)
 Block 4 Study Guide
58. What is the most commonly fractured bone in the body?
a. Clavicle (Collarbone)
59. What is a Colles fracture?
a. Fractures of the distal radius, which are especially common in older patients
with Osteoporosis, are known as Colles fractures. The term silver fork
deformity is used to describe the distinctive appearance of the patient’s arm. In
children, this fracture may occur through the growth plate and can have
long-term consequences.
60. How do you splint the wrist?
a. 1. Follow standard precautions.
b. 2. Cover open wounds with a dry, sterile dressing.
c. 3. Assess distal pulse and motor and sensory function.
d. 4. Supporting the injured limb, form the injured hand into the position of
function, with the wrist slightly bent down and all finger joints moderately
flexed. This is the position that is used to hold a can most comfortably.
e. 5. Place a soft roller bandage into the pam of the hand (step 1).
f. 6. Apply a padded board splint to the palmar side of the wrist, leaving the
fingers exposed (step 2).
g. 7. Secure the entire length of the splint with a soft roller bandage (step 3).
Assess the distal pulse and motor and sensory function.
h. 8. Apply a sling and swathe, or prop the splinted hand and wrist on a pillow
or on the patient’s chest during transport to the hospital.

i.
61. Know what striated muscle is and where its found. Is it voluntary or involuntary?
a. voluntary, skeletal muscle
62. What is atrophy?
a. death of muscle cells/ strength
i. a decrease in the size of the muscle and its inherently ability to
function
 Block 4 Study Guide
63. How do we assess a patient’s general body temperature? (*besides using a
thermometer)
a. Back of the hand to pts belly
64. How can you get the most accurate reading of a patient’s core body temperature?
a. rectal thermometer
65. When does a person lose their ability to shiver?
a. less than 90 (92F-89F) degrees which are moderate hypothermia
66. Know S&S + risk factors of generalized hypothermia
a. S&S: Note that the S&S get progressively worse as the core body temp falls
i. cold skin
ii. pale or cyanosis
iii. shivering increases early, but ceases with extreme hypothermia
iv. muscles begin to stiffen
v. difficulty speaking
vi. LOC ranges from confusion to coma
vii. bradycardia
viii. bradypnea
ix. hypotension
b. Risk Factors:
i. homeless people and those whose homes lack heating
ii. swimmers, even in the summer
iii. geriatric, pediatric, and ill individuals who are less able to adjust to
temp. extremes
iv. pts with burns, shock, head injury, stroke, infection, injuries to spinal
cord, diabetes, and hypoglycemia
67. How does the body eliminate heat? What’s the most efficient?
a. The most efficient way: Sweating (evaporation) and dilation of skin blood
vessels
b. Heat loss happens in the following ways:
● 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
68. What is radiation?
 Block 4 Study Guide
a. the transfer of heat to colder objects in the environment by radiant energy
b. a type of invisible light that transfer heat
c. causes heat loss, such as when a person stands in a cold room
d. heat can also be gained by radiation, such as when a person stands by a fire
69. What is lost when we sweat? (*hint, why do athletes drink Gatorade?)
a. Electrolytes
70. Why is sweating an effective cooling mechanism? What would interfere with a persons
ability to sweat? (*hint think about humidity)
a. for sweating to be an effective cooling mechanism, the sweat must be able to
evaporate from the body
b. high humidity will decrease the amount of evaporation that can occur
c. people standing in the hot sun and particularly those who wearing several
layers of clothing, such sports fans or parade watchers, may sweat profusely
but experience little body cooling
71. Know S&S of heatstroke, when/how it occurs + risk factors
a. S&S:
i. ALOC
ii. skin may be hot and dry, but it can also be moist and wet due to
exertion by the pt
iii. unresponsive
iv. seizures
v. rapid pulse and strong at first but then changes to slow and weak
vi. low bp
vii. high body temp - above 104 degrees F
b. When/How It Occurs: occurs when the body’s heat eliminating mechanisms
are overwhelmed
c. Risk Factors:
i. due to exertion
ii. passive exposure to a hot environment - ex: a home w/o air-con during
a heatwave or a child left in a hot car
72. How would diuretics affect a person experiencing heat-related emergencies?
a. dehydration will occur quicker
73. Why would pulse oximetry readings be inaccurate in hypothermic patients?
a. pulse oximetry reads perfusion, hypothermic pt will not have a lot of blood in
their periphery
74. How can you reduce heat loss? (*hint why do we wear beanies in the winter?)
a. insulated headwear
b. Layers of clothing that provide good insulation, such as wool and synthetic
fabrics. Protective clothing traps perspiration and prevents evaporation.
Keep head, hands, and feet covered.
 Final Study Guide
1. Respiratory
a. Anatomy of Lower airway
b. Trachea- a large membranous tube reinforced by rings of cartilage, extending from the larynx
to the bronchial tubes and conveying air to and from the lungs
c. Main Bronchi- The large air passages that lead from the trachea (windpipe) to the lungs.
d. Bronchioles- The tiny branch of air tubes within the lungs that is a continuation of the
bronchus
e. Alveoli- where the lungs and the blood exchange oxygen and carbon dioxide during the
process of breathing in and breathing out
f. Diaphragm- a dome-shaped muscular partition separating the thorax from the abdomen. It
plays a major role in breathing, as its contraction increases the volume of the thorax and so
inflates the lungs.
g. Define and understand
i. Ventilation- the simple movement of oxygen between your lungs and the environment.
1. artificial ventilation mimics ventilation by pushing a certain amount of air into
the lungs to make them expand in hopes that the patient will begin respiration
again
ii. Oxygenation
1. The addition of oxygen to any system, including the human body. Oxygenation
may also refer to the process of treating a patient with oxygen, or of combining
a medication or other substance with oxygen.
iii. Tidal volume
1. The amount of air (in milliliters) that is moved in or out of the lungs during one
relaxed breath; about 500 mL for an adult.
iv. Minute volume
1. The volume of air that moves in and out of the lungs per minute; calculated by
multiplying the tidal volume and respiratory rate; also called minute ventilation

v. Respiration
1. External Respiration- The exchange of gases between the lungs and the blood
cells in the pulmonary capillaries; also called pulmonary respiration
2. Internal Respiration- The exchange of gases between the blood cells and the
tissues.
h. Signs and Symptoms of the following
i. Asthma
1. A genetic or environmental condition that when triggered causes the
bronchioles to constrict and get lined with mucus. This makes it more difficult
to breathe and needs to be treated immediately
2. S/S
a. Wheezing
b. Bronchospasms
c. increased BP
3. Treatment
a. Highflow o2
 Final Study Guide
b. Immediate transport in high Fowler’s position or position of comfort
c. ○ Assist with prescribed MDI (ex. albuterol or epinephrine) if available
d. ○ Give bronchodilators according to local protocols
e. ○ Consider calling ALS
f. [Link]
ii. Left-sided CHF
1. When the heart can’t pump fast enough to meet the body's demands
Right
a. Jugular vein distention.
b. Right Side heart damage may result in an dependent edema, or swelling
of the feet.
2. Left
a. Pulmonary Edema: A LV decrease in pumping ability leads to piling of
blood in the pulmonary arteries. With increased pressure, liquid will
seem through the arteries into the lungs. At this point, there is
congestion in the lungs. Liquid blocks O2/CO2 transfer, causing
decreased O2 intake.
b. Pink Sputum (Frothy)
c. Diaphoretic
d. Use of accessory muscles to breathe
e. To adapt, heart rate may increase, LV will increase in mass.
f. A pt will likely not want to be supine, as it makes it harder to breathe. In
this case, the pt will want to sit upright at a 45-90º angle. (Orthopnea)
3. Treatment
a. - Nitroglycerine
b. - Diuretics
c. - High fowlers
d. - CPAP
e. - Immediate transport
iii. Anaphylaxis
1. When the body reacts to certain relatively safe substances by attacking it like a
foreign intruder
2. Risk
a. Family Allergies
b. Sensitive skin
c. sensitive immune system
3. S/S
a. Bronchoconstriction
b. Hypotension
c. - Blood vessel dilation
d. Increased blood vessel permeability
e. - Edema (swelling)
f. - Urticaria (Hives)
4. Treatment
 Final Study Guide
a. Antihistamines
b. Call ALS
c. Assist with prescribed medications
d. Epinephrine (per protocol)
e. High flow O2
f. Immediate transport
iv. Croup
1. When the Larynx, Trachea and Bronchi get inflamed as a result of a virus
2. Risk
a. 6mon to 3 yrs
b. Boys
c. Influenza Virus
3. S/S
a. Starts with a cold, cough and low grade fever that develops over 2 days
b. Stridor
c. Seal-bark cough
d. Treatment
e. Humidified O2
f. No Bronchodilators (they make the child’s condition worse)
4. [Link]
v. Pneumonia
1. An infection in the lungs is usually secondary to an illness. As the body tries to
get rid of the infection it will produce white blood cells, proteins, fluid, and red
blood cells causing the liquid to go into the lungs making it hard to breathe
2. S/S
a. cough
b. rapid breathing
c. chills/fever
d. Dyspnea
e. unilateral breathing sounds
f. Wheezing crackling in affected lung
3. Field Treatment
a. Monitor airway
b. High flow O2
c. use bronchodilators
d. Immediate transfer in high fowler
vi. Tuberculosis
1. An infection in the lungs is usually secondary to an illness. As the body tries to
get rid of the infection it will produce white blood cells, proteins, fluid, and red
blood cells causing liquid to go into the lungs making it hard to breathe
2. S/S
a. cough
b. rapid breathing
c. chills/fever
 Final Study Guide
d. Dyspnea
e. unilateral breathing sounds
f. Wheezing crackling in affected lung
3. Field Treatment
a. Monitor airway
b. High flow O2
c. use bronchodilators
d. Immediate transfer in high fowlers
i. Upper vs Lower lung sounds
i. Upper Airway
1. Stridor
a. Seal barking or like squeak toy is swallowed
ii. Lower Airway
1. Coarse Crackles (rhonchi)
a. Rhonchi in the bronchi
b. Lung tissue infections like pneumonia
c. Chunky junky sound
2. Fine Crackles (Rales)
a. Rales in the tails
b. Fluid in the alveoli
c. Watery sound
j. Medications
i. Albuterol (MDI)
1. Action: Stimulates nervous system, causing bronchodilation
2. Indication: Asthma/difficulty breathing with wheezing
3. Contraindications: Hypersensitivity; tachycardia(relative); chest pain of cardiac
origin
4. Route Given: Inhalation
ii. Epinephrine (as it relates to breathing)
1. Epinephrine (EpiPen)
2. Action: Stimulates nervous system, causing bronchodilation
3. Indication: Anaphylactic reaction
4. Contraindications: Chest pain of cardiac origin; hypothermia; hypertension
5. Route Given: IM (Intramuscular)
iii. Oxygen
1. Nasal Canula - Low flow
a. For normal breathing rate and pattern
b. Needs a little O2
c. Maintains O2 saturation %
d. 1-6 L/Min
2. NRB - High flow
a. Normal breathing pattern
b. Rate is a bit abnormal 10-26 Breaths/min
c. 10-15 L/Min
 Final Study Guide
3. BVM
a. Labored breathing, lethargic, cyanotic, Altered
b. Use the OPA or NPA to keep their airway clear
c. When a patient is breathing <8 or 28<
d. 15- 25 L/Min of High flow O2
e. Artificial Ventilations
4. CPAP
a. for people who have liquid in their lungs
b. Other reasons people may need CPAP include toxic inhalation, drowning, flail chest and
various lung infections such as pneumonia. It should be used on patients who are alert and
able to follow commands, show signs of respiratory distress, have rapid breathing, and a
pulse oximetry of less than 90%(web)
c. ***not for people who cant breathe on their own because it is a stream of continuous air
flow to get rid of the liquid in the lungs
2. Cardiology
i. Anatomy
1. The heart
a. Superior vena cava + Inferior Vena Cava > Right Atrium > Tricuspid valve
> Right ventricle> Pulmonary valve > pulmonary arteries > Lungs >
Pulmonary veins > Left atrium > Mitral Valve >Left ventricle > Aortic
valve >Aorta >
2. The vessel system
3. Superior vena cava + Inferior Vena Cava > Right Atrium > Tricuspid valve > Right
ventricle> Pulmonary valve > pulmonary arteries > Lungs > Pulmonary veins >
Left atrium > Mitral Valve >Left ventricle > Aortic valve >Aorta > arteries >
Arterioles> capillaries > venules > veins
4. Parts of blood
5. Blood is a complex, thick, red fluid composed of plasma, red blood cells
(erythrocytes), white blood cells (leukocytes), platelets, and protein molecules.
The work of the circulatory system is to accomplish movement of blood, or
perfusion.
6. Plasma is a sticky, yellow fluid that carries the blood cells and nutrients. This is
the liquid portion of the blood.
7. Red blood cells (erythrocytes) contain hemoglobin, which gives blood its red
color.
a. Hemoglobin is responsible for carrying oxygen.
i. carbon dioxide is carried by hemoglobin.
8. White blood cells (leukocytes) play a role in the body’s immune defense
mechanisms against infection.
9. Platelets are tiny, disc-shaped elements that are much smaller than the cells.
a. essential in the initial formation of a blood clot, the mechanism that
stops bleeding
10. Electrical System
 Final Study Guide
a. SA node- a cell that can depolarize its self and sends that depolarization
to the rest of the heart which causes contractions
b. - has automaticity meaning it doesn’t need nerves to trigger a
contraction
c. Bachmann's Bundle- sends the message to the left atrium so that it
could contract
d. Internodal Pathway- sends a message to AV Node
e. AV Node- a bridge between the atria and ventricles which causes the
signal to be slowed one to two-tenths of a second
f. The below causes the ventricles to contract after the message was
slowed by the AV node
g. - Bundle of His, R/L Bundle Branches, Purkinje fibers
ii. Signs and Symptoms
1. Angina Pectoris
a. the coronary vessel spasms, causing immense pain. This is an indication
that the patient may have developed artherosclerotic coronary artery
[Link] occurs when the patient’s heart can’t get enough oxygen in
times of physical or emotional stress.
b. ○ Stable angina pectoris occurs when the patient’s symptoms go away
after receiving nitroglycerin and oxygen. The patient still has pain of
coronary origin, but conditions improve after receiving treatment.
c. ○ Unstable angina pectoris occurs when there is pain or chest
discomfort relating to coronary origin. It can be developed from lack or
exercise and has less stimuli. This type is more serious,
d. and can lead to acute myocardial infarction (AMI) if not treated
e. [Link]
f. Signs & Symptoms
i. ○ Squeezing, “someone standing on my chest” chest pain under
sternum
ii. ■ Chest pain radiating to the jaw, arms (usually left),
mid-back, or epigastrium (upper mid abdomen)
iii. ■ 3-8 minutes, no longer than 15 minutes
iv. ○ Shortness of breath
v. ○ Nausea
vi. ○ Diaphoretic skin
g. Field Treatment
i. ○ Nitroglycerine per protocol
ii. ○ High flow oxygen (10-15 L/min) via non-rebreather mask
iii. ○ Immediate Transport via position of comfort
2. AMI
a. When there is a blockage in the Coronary arteries causing the muscle
tissue to die. Could be caused by a fatty blockage or unstable angina
pectoris
 Final Study Guide
b. Myocardial Infarction is a fatal condition in which the coronary artery
becomes blocked, and the heart is no longer able to receive the oxygen
that it needs to pump blood to the rest of the body. The heart muscles
are irreplaceable, so this condition is fatal when the heart cells start to
die off, because of the lack of oxygen. The dead heart cells will only
slow down the beating heart, causing more dead muscle
c. S/S
i. Bradycardia
ii. Sudden, crushing Radiating chest pain
iii. Jaw pain
iv. Left arm pain
v. Mid back pain
vi. Shoulder pain
vii. heart pain
viii. Dyspnea
ix. ab pain
x. Diaphoretic
xi. Pale cool skin
xii. Anxiety
d. Treatment
i. Nitroglycerine
ii. High flow O2
iii. Immediate transport in position of comfort
iv. CPR/BVM if needed
3. Cardiogenic Shock
a. Cardiogenic shock is defined as the heart’s failure to pump blood
adequately to the rest of the body. This can be caused by many different
conditions, but essentially if this occurs, the heart muscle is damaged,
the electrical system is broken, or there is some type of disease or injury
to the heart. The problem with cardiogenic shock is that heart cells can’t
regenerate once they are dead. When the myocardial muscle can’t keep
up and supply blood to the rest of the body, the heart cells wear out
and eventually die off
b. Pump failure
c. [Link]
d. Signs & Symptoms
i. ○ Chest pain
ii. ○ Irregular pulse
iii. ○ Weak pulse
iv. ○ Low blood pressure
v. ○ Cyanosis in lips and under nails
vi. ○ Cool, clammy skin
vii. ○ Anxiety
viii. ○ Crackles (rales)
 Final Study Guide
ix. ○ Pulmonary edema
e. Field Treatment
i. ○ High flow oxygen via nonrebreather mask
ii. ○ BVM if needed
iii. ○ Have suction ready in case the patient vomits
iv. ○ Consider ALS backup
v. ○ Immediate transport via position of comfort
4. Aortic Aneurysm
a. Abdominal Aortic Aneurysm- is when there is a weakened area of the
Abdominal Artery and as blood passes through a balloon forms and fills
with blood. This is an aneurysm and can pop at an moment which is
fatal when this happens it becomes an aortic dissection
b. Thoracic Aortic Aneurysm- is when there is a weakened area of the
Thoracic Artery and as blood passes through a balloon forms and fills
with blood. This is an aneurysm and can pop at an moment which is
fatal when this happens it becomes an aortic dissection
c. S/S
i. Sudden severe central chest pain
ii. sweating
iii. Nausea
iv. Dyspnea
v. weakness
vi. Fainting
vii. pulsating mass in abdomen
viii. lower pulses and BP
d. Treatment
i. High flow O2
ii. Immediate Transport
iii. Medications
1. Aspirin
a. Action: Anti-inflammatory agent and anti-fever agent; prevents platelets
from clumping thereby decreases formation of new clots
b. Indication: Relief of mild pain, headache, muscle aches; chest pain of
cardiac origin
c. Contraindications: Hypersensitivity; recent bleeding
d. Route Given: PO (oral)
2. Nitroglycerin
a. Nitroglycerin (Nitrostat, Nitromist)
b. Action: Dilates blood vessels
c. Indication: Chest pain of cardiac origin
 Final Study Guide
d. Contraindications: Hypotension; use of sildenafil (Viagra) or another
treatment for erectile dysfunction within the previous 24 hours; head
injury
e. Route Given: SL (sublingual) tablet or spray
3. Seizures
i. Treatment
ii. Signs and Symptoms
1. Generalized Seizures
a. Results from abnormal electrical discharges from large areas of the
brain usually involving both sides of the brain
b. S/S
i. unconsciousness
ii. severe twitching of the body’s muscles that lasts several minutes
or longer
iii. in other cases it is a brief lapse of consciousness where a patient
stares unable to respond
c. Treatment
i. Protect patient from self harm (restraint)
ii. Call for ALS backup
iii. strict airway management
2. Status Epilepticus
a. If seizures last longer than 5 minutes or are ongoing without returning
to normal
b. Usually Tonic-Clonic seizures (stiff body-random body convulsions)
c. S/S
i. Postical Confusion (after seizure confusion)
ii. Paralysis affecting arms and legs (~15 hours)
iii. Seizures that last longer than 5 minutes
d. Treatment
i. Protect patient from self harm (restraint)
ii. Call for ALS backup
iii. strict airway management
3. Febrile
a. A seizure caused by sudden high fever
iii. Causes of?
1. Epileptic- Congenital origin (present at birth whether or not genetic)
2. Structural- Tumor (benign or cancerous), Infection (brain abscess), Scar tissue
from injury, head trauma, stroke
3. Metabolic- Hypoxia , abnormal blood chemical values, hypoglycemia,
poisoning, drug overdose, sudden withdrawal from alcohol or medications
4. Febrile- Sudden high fever
4. Diabetes
a. Hyper vs Hypo
 Final Study Guide
i. ​Hyperglycemia- when the body’s glucose levels are above normal
ii. Hypoglycemia- when the body’s glucose levels are below normal
b. Blood glucose ranges
i. Hypoglycemic crisis= 40 mg/dL>
ii. Hypoglycemia= 40-80 mg/ dL
iii. Normal= 80-120 mg/dL
iv. Hyperglycemia= 120-400 mg/dL
v. DKA, HHNS, or symptomatic hyperglycemia= 400 mg/dL <
c. Signs and Symptoms
i. Hyperglycemia
1. Intoxicated behavior
2. Depressed LOC
3. Gradual symptoms
4. Warm and dry skin
5. intense thirst
6. Kussmaul respirations
7. Sweet odor of breath
8. rapid weak pulse
9. 3 Poly’s
a. polydipsia (thirst)
b. polyuria (urination)
c. polyphagia (hunger)
ii. Hypoglycemia
1. seizures
2. Altered mental status (always suspect hypo if altered)
3. Intoxicated behavior
4. pale cool moist
5. rapid symptoms
iii. DKA
1. hyperglycemia
2. polydipsia (thirst)
3. polyuria (urination)
4. polyphagia (hunger)
5. dizziness, confusion, altered mental status, and possibly seizures
iv. What are Kussmaul’s?
1. Kussmaul breathing is characterized by a deep, rapid breathing pattern. It is
typically an indication that the body or organs have become too acidic. In an
attempt to expel carbon dioxide, which is an acidic compound in blood, the
body starts to breathe faster and deeper.
5. Allergic Reaction
a. What happens to the body during Anaphylaxis?
i. Think heart, Lungs, Skin
ii. Bronchocontraction
iii. Hypotension
 Final Study Guide
iv. - Blood vessel dilation
v. Increased blood vessel permeability
vi. - Edema (swelling)
vii. - Urticaria (Hives)
b. How does Epinephrine work on the body?
i. It mimics the fight or flight hormone
ii. Vasoconstriction (reverses the vasodilation the causes hypotension) and
Bronchodilation
c. Medication
i. Epinephrine
1. Action
a. Stimulates nervous system, causing bronchodilation and constricts the
vessels
2. Indications
a. Anaphylactic reaction
3. Contraindications
a. Chest pain of cardiac origin; hypothermia; hypertension.
4. Routes
a. IM
6. Overdose/Poisoning
a. Narcotic overdose Signs (Opioids)
i. Respiratory Distress
ii. LOC
iii. Cardiac Arrest
iv. Nausea
v. Vomiting
vi. Hypotension
vii. Hypoxia
b. Treatment for Narcotic Overdose
i. Naloxone IM or IN
ii. O2 as needed
iii. BVM if respiratory assistance required
iv. Rapid Transport
c. Poisoning
i. Activated Charcoal
1. Absorbs toxic substance in the digestive tract
2. Indication
a. for oral poisonings and overdoses
3. Contraindication
a. Don’t give a person if they have a decreased LOC, overdose on
corrosives, caustics, or petroleum substance
4. Route
a. PO
 Final Study Guide
7. Stroke
a. Signs and Symptoms
i. Ischemic
1. most common type of stroke (80%)
2. When blood flow through the cerebral arteries is blocked (atherosclerosis or
embolism) and if not treated in time could cause cell death
3.
ii. S/S
1. Depending on the location of the clot a patient's symptoms vary greatly from
no symptoms to total paralysis
2. Facial drooping
3. sudden weakness on one side of the body
4. lack of muscle coordination
5. sudden vision loss in one eye
6. difficulty swallowing
7. Decreased level of responsiveness
8. speech disorders
9. Aphasia (difficulty using/ understanding words)
10. slurred speech (dysarthria)
11. sudden or severe headache
12. confusion, dizziness, weakness, combativeness, restlessness
13. tongue deviation
14. Coma
15. Treatment
16. o Aspirin
17. ○ Strict maintenance of the airway
18. ○ Maintain SpO2 of at least 94%
19. ○ High flow oxygen if they are experiencing respiratory distress or show signs
of hypoxia
20. FAST TEST
a. F- facial droop
b. A- arm weakness
c. S- slurred speech
d. T- time get to the hospital fast the first 4 hrs are vital
21. ○ Restrain patient if extremities are paralyzed to protect them
22. ○ Verbal, emotional support
23. ○ Immediate transport
iii. Hemorrhagic
iv. least common type of stroke (13%) and are more serious than Ischemic
v. Hemorrhage strokes occur when a blood vessel bursts within the brain,
vi. increasing pain and pressure in the brain.
vii. S/S
1. Depending on the location of the clot a patient's symptoms vary greatly from
no symptoms to total paralysis
 Final Study Guide
2. Facial drooping
3. sudden weakness on one side of the body
4. lack of muscle coordination
5. sudden vision loss in one eye
6. difficulty swallowing
7. Decreased level of responsiveness
8. speech disorders
9. Aphasia (difficulty using/ understanding words)
10. slurred speech (dysarthria)
11. sudden or severe headache
12. confusion, dizziness, weakness, combativeness, restlessness
13. tongue deviation
14. Coma
viii. Treatment
1. o Aspirin
2. ○ Strict maintenance of the airway
3. ○ Maintain SpO2 of at least 94%
4. ○ High flow oxygen if they are experiencing respiratory distress or show signs
of hypoxia
5. FAST Test
a. F- facial droop
b. A- arm weakness
c. S- slurred speech
d. T- time get to the hospital fast the first 4 hrs are vital
6. ○ Restrain patient if extremities are paralyzed to protect them
7. ○ Verbal, emotional support
8. ○ Immediate transport
ix. TIA
x. Transient Ischemic Attack (TIA)
xi. A mini stroke where a small blood clot interrupts blood flow to the brain giving the
patient stroke-like symptoms
xii. no actual death to the tissue occurs and the symptoms only last 24 hours
xiii. It is usually seen as a warning sign of a stroke occurring in the future ⅓ of patients that
have TIA experience a stroke soon after the TIA
xiv. S/S
1. Facial drooping
2. sudden weakness on one side of the body
3. lack of muscle coordination
4. sudden vision loss in one eye
5. difficulty swallowing
6. Decreased level of responsiveness
7. speech disorders
8. Aphasia (difficulty using/ understanding words)
9. slurred speech (dysarthria)
 Final Study Guide
10. sudden or severe headache
11. confusion, dizziness, weakness, combativeness, restlessness
12. tongue deviation
13. Coma
xv. An Ischemic stroke is when a blockage is so severe that the brain tissue starts to die
xvi. Treatment
1. Strict air way
2. High flow O2
3. Aspirin
4. Restraint to protect from injury if paralyzed
5. FAST test
a. F- facial drooping
b. A- Arm weakness
c. S- Speech difficulties
d. T- Time (get to the hospital as soon as possible)
6. verbal comfort
7. Immediate transport
b. How do you transport a stroke patient?
i. Remember we transport on the affected side
c. Cincinnati Stroke Scale Test
i. Cincinnati Stroke Test pg 691
1. Basically FAST
ii. Facial Droop- ask patient to show teeth or smile
1. Normal- both sides of the face move equally
2. Abnormal- One side doesn't move as well as the other
iii. Arm drift- ask patient to close eyes and hold both arms out with palms up
1. Normal- both arms move the same
2. Abnormal- one arm doesn't move or drifts down compared to the other
iv. Speech- Ask the patient to say the sky is blue in cincinnati
1. Normal- patient used the right words with no slurring
2. Abnormal- patient slurs words, uses inappropriate words, or is unable to speak

8. Head Injuries
a. Know locations within the cranium of each bleed:
i. Epidural
ii. When bleeding occurs outside the tough outer membrane covering the brain (dura)
and the skull after trauma to the head
iii. Subdural
 Final Study Guide
iv. When bleeding occurs inside the tough outer membrane covering the brain (dura) but
still outside the brain.
v. Dura mater and arachnoid membrane
vi. Subarachnoid
vii. When bleeding occurs inside the subarachnoid space in the brain meaning it can
engulf the entire surrounding of the brain
viii. Usually caused by the rupture of a subarachnoid hemorrhage (cerebral arteries)

ix. Intracerebral
x. bleeding within the brain tissue itself. This type of injury may occur following a
penetrating injury to the head or because of rapid deceleration forces
b. What is ICP?
i. Intracranial Pressure- Growing pressure in the skull
ii. What is Cushing’s Triad
iii. The triad of increased systolic blood pressure, decreased pulse rate, and irregular
respirations is called Cushing reflex, and signifies increased Intracranial pressure
9. Chest Injuries
a. Signs and symptoms and Treatment
i. Pneumothorax
ii. When there is a puncture in the pleural space that causes air from outside to come in
and collapse that side of the lung. The air builds up preventing the lung from
expanding properly. this could also add pressure to the heart affecting the circulation
of blood
iii. S/S
1. Cyanosis
2. sudden chest pain
3. low BP
4. increased tidal volume
5. Dyspnea
6. Tracheal deviation
7. subcutaneous emphysema
iv. Open Pneumothorax
v. “sucking chest wound” where pneumothorax occurs because of air entering the
pleural space. You want to cover the open pneumothorax with an occlusive dressing,
either vented (likely ALS) or unvented (BLS) that simply prevents the wound from
getting worse (without intervention may cause a tension pneumothorax, which would
kill due to obstruction).
vi. S/S
vii. Cyanosis
viii. sudden chest pain
ix. low BP
x. increased tidal volume
xi. Dyspnea
xii. Tracheal deviation
 Final Study Guide
xiii. subcutaneous emphysema
xiv. Sucking wound on the chest
xv. Tension Pneumothorax
xvi. Air trapped in the pleural space that pushes the mediastinum (heart, another lung)
that can restrict contractions of the heart and make breathing difficult in another lung.
xvii. Could result from high pressure in the lungs, causing a perforation in the lung tissue
itself.
xviii. S/S
1. Mechanism of injury
2. SOB
3. mental status
4. decreased lung sounds on the affected side
5. Hyperextension(barrel chestedness)
6. Hyperresonance (when you tap it it sounds like a drum)
7. Tracheal deviation
8. JVD (jugular vein distention)
xix. Commotio Cordis
xx. When a person experiences blunt trauma in a specific part of the chest at a specific
part of a person's heartbeat. The first 3 minutes are essential to get an AED
xxi. S/S
1. Unconscious
2. unresponsive after blow to chest
3. Atrial fibrillation
10. Trauma Overview
a. Three collisions
i. The vehicle with the object (vehicle-vehicle, vehicle-fixed object)
ii. The body against the vehicle (person slams into the steering wheel and goes from high
motion energy to zero in a matter of second(s).
iii. The organs slam into the body/the organs rip against the back of the body.
iv. pg. 850-851
1. note: a “coup-contrecoup” indicates an injury in which the anterior organ may
slam into the hard portions of the inner body, while the posterior portions of
the organ (or inner body organs) may tear from the posterior portion of the
body.
b. Clues for injuries
i. Windshield
ii. head trauma (head into the windshield)
iii. Steering wheel
iv. rib fractures (rib cage into the steering wheel)
v. Dashboard
vi. lower extremity fractures (knees into the dashboard)
11. Soft Tissue & Bleeding
a. Closed injuries
i. Hematoma
 Final Study Guide
ii. A hematoma is blood that has collected within a damaged tissue or in a body cavity
iii. Contusion
iv. A region of injured tissue or skin in which blood capillaries have ruptured
v. *** also called a bruise
vi. S/S
1. swelling
2. pain
3. bluish discoloration
4. Hematoma(when blood collects)
b. Open Injuries
i. Abrasions
ii. a wound of the superficial layer of the skin, caused by friction when a body part rubs
or scrapes across a rough or hard surface. An abrasion usually does not penetrate
completely through the dermis, but blood may ooze from the injured capillaries in the
dermis. Also known as road rash, road burn, strawberry, and rug burn, abrasions can
be extremely painful because the nerve endings are located in this area
iii. Avulsions
iv. 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
v. Often there is significant bleeding. If the avulsed tissue is hanging from a small piece
of skin, the circulation through the flap may be at risk. If you can, replace the flat
avulsed flap in its original position as long as it is not visibly contaminated with dirt
and/or other foreign materials. If an avulsion is complete, you should wrap the
separated tissue in sterile gauze and take it with you to the ED.
vi. Punctures/penetrations
vii. injuries are caused by the sharp edges of the object moving through the body and are,
therefore, close to the object’s path
viii. Lacerations
ix. a jagged cut in the skin caused by a sharp object or a blunt force that tears the tissue,
whereas an incision is a sharp, smooth cut. The depth of the injury can vary, extending
through the skin and subcutaneous tissue, even into the underlying muscles and
adjacent nerves and blood vessels Figure 26-6 . Lacerations and incisions may appear
linear (regular) or stellate (irregular) and may occur along with other types of
soft-tissue injury. Lacerations or incisions that involve arteries or large veins may result
in severe bleeding.
c. Types of Bleeding
i. Capillary
ii. low volume bleeding that can typically clot quickly on its own unless pt is hemophilic.
iii. Venous
iv. Continuous flow, not rhythmic, but can be heavy depending on vein-type/location.
v. Arterial
vi. bleeding that occurs because of a ruptured artery, typically identified by rhythmic,
long spurting.
 Final Study Guide
d. Bleeding Control
i. Tourniquets
ii. Make sure all tools are there
iii. BSI scene safety
iv. Cover the wound with gauze and apply direct pressure
v. Apply tourniquet and write time
vi. Treat for shock
e. Wound Healing Process
i. To stop the flow of blood, the vessels, platelets, and clotting cascade must work in
unison
ii. During inflammation (the next stage of wound healing), additional cells move into the
damaged area to begin repair
iii. To replace the area damaged in a soft-tissue injury, a new layer of cells must be moved
into this region
iv. new blood vessels form as the body attempts to bring oxygen and nutrients to the
injured tissue
v. collagen provides stability to the damaged tissue and joins wound borders, thereby
closing the open tissue. Unfortunately, collagen cannot restore damaged tissue to its
original strength
12. Environmental
a. Hyperthermia
b. A condition in which the body core temperature rises to 101°F (38.3°C) or more.
i. Signs and Symptoms
ii. tachycardia
iii. tachypnea
iv. BP drop when start going into compensated shock
v. Skin signs
vi. the skin feels hot to the touch. The skin will feel cool when the patient is in early shock
vii. Pay special attention to the patient’s skin temperature, turgor, and level of moisture
viii. Skin turgor is the ability of the skin to resist deformation. It is tested by gently pinching
skin on the forehead or back of the hand. Normally the skin will quickly flatten out. If
the patient is dehydrated, the skin will remain tented (poor skin turgor). Perform a
careful neurologic examination
ix. Treatment
1. Heat Exhaustion
x. heat prostration or heat collapse, is the most common heat emergency
xi. S/S
1. remove from hot environment
2. high flow O2
3. altered? check blood glucose level
4. Mist their body and put ice packs on the trunk of their body
 Final Study Guide
5. loosen tight clothing
6. Lie supine
7. If fully alert, encourage to drink 1 Liter of water
8. Heat Stroke
xii. when the body is subjected to more heat than it can handle and normal mechanisms
for getting rid of the excess heat are overwhelmed.
xiii. S/S
1. patients transported immediately in a cool ambulance, passively cooled with
clothing removal, and actively cooled by spraying the patient with water and
fanning to enhance evaporation. Any decline in level of consciousness is an
ominous sign. Monitor the patient’s vital signs at least every 5 minutes.
Evaluate the effectiveness of your interventions. Be careful not to overcool a
patient who is experiencing a heat emergency.
2. Inform the ED staff as soon as possible that your patient is experiencing heat
stroke, because additional resources may be required
c. Hypothermia
d. Hypothermia means “low temperature.”
e. when the core temperature of the body—the temperature of the heart, lungs, and vital
organs—falls below 95°F
i. What temp does body stop shivering?
ii. More severe hypothermia occurs when the core temperature is less than 90°F (32.2°C).
Shivering stops and muscular activity decreases
f. Air Embolisms
i. Signs and symptoms
ii. Blotching
iii. froth at mouth and nose
iv. severe pain in muscles, joints, abdomen
v. dyspnea
vi. chest pain
vii. dizziness
viii. nausea
ix. vomiting
x. Dysphasia (difficulty speaking)
xi. Treatment
xii. The most dangerous scuba emergency which occurs when bubble of air form in the
blood vessels air pressure in the lungs causes the aveoli to rupture
g. Drowning
i. Definition
ii. the process of experiencing respiratory impairment from submersion or immersion in
liquid
iii. Treatment
iv. heat will be conducted from the body to the water resulting in hypothermia
 Final Study Guide
v. Whenever a person dives or jumps into very cold water, the diving reflex, slowing of
the heart rate caused by submersion in cold water, may cause immediate bradycardia,
a slow heart rhythm.
vi. LOC and drowning may follow
vii. local protocols that often dictate that resuscitative efforts continue for up to one hour
after submersion, while simultaneously rewarming the patient. Resuscitative efforts
are not initiated for unwitnessed drowning victims who are found in a state of
decomposition.
13. Shock
a. Types of Shock
i. Neurogenic
1. Caused by a damaged cervical spine, which causes widespread blood vessel
dilation
2. S/S
a. Altered mental status
b. organ dysfunction
c. bradycardia (low heart rate)
d. warm skin
3. Treatment
a. Secure airway
b. Spinal immobilization
c. Assist ventilations
d. Admin high-flow oxygen
e. Preserve body heat
f. Transport Promptly
g. Consider ALS
ii. Obstructive
iii. An obstruction that causes the heart to not pump properly and back up
iv. not the heart's fault but an obstructions fault
v. Excess fluid in the pericardial sac, Inflamed pericardial sac, tension pneumothorax,
pulmonary embolism, aortic stenosis
vi. S/S
1. Tachycardia
2. Hypotension
3. Jugular vein distention
4. weak pulse
5. subcutaneous emphysema
6. cyanosis
vii. Cardiogenic
viii. Cardiogenic shock is defined as the heart’s failure to pump blood adequately to the
rest of the body. This can be caused by many different conditions, but essentially if this
occurs, the heart muscle is damaged, the electrical system is broken, or there is some
type of disease or injury to the heart. The problem with cardiogenic shock is that heart
cells can’t regenerate once they are dead. When the myocardial muscle can’t keep up
 Final Study Guide
and supply blood to the rest of the body, the heart cells wear out and eventually die
off.
ix. Pump failure
x. Signs & Symptoms
1. ○ Chest pain
2. ○ Irregular pulse
3. ○ Weak pulse
4. ○ Low blood pressure
5. ○ Cyanosis in lips and under nails
6. ○ Cool, clammy skin
7. ○ Anxiety
8. ○ Crackles (rales)
9. ○ Pulmonary edema
xi. Field Treatment
1. ○ High flow oxygen via nonrebreather mask
2. ○ BVM if needed
3. ○ Have suction ready in case the patient vomits
4. ○ Consider ALS backup
5. ○ Immediate transport via position of comfort
xii. Hypovolemic
1. Hemo and non Hemo pg 651
xiii. **Hemo
1. Hypovolemic shock is an abnormal decrease in blood volume that causes
inadequate oxygen delivery to the body
xiv. ***non Hemo
1. determined by the size of the blood vessels. As the diameter of the blood
vessels increases, the blood pressure in the circulatory system decreases
xv. Anaphylactic
xvi. Extreme life threatening allergic reaction. Each exposure after sensitization tends to
produce a more severe reaction than before.
xvii. S/S
1. lower BP
2. swelling
3. flushing skin
4. itching
5. bronchospasms
xviii. Treatment
1. Epinephrine
2. Antihistamines
3. Maintain airway
4. High flow O2
xix. Psychogenic
 Final Study Guide
xx. Temporary, generalized vascular dilation, not life threatening alone (may be life
threatening if there was trauma after fainting) Caused by anxiety, bad news, severe
pain, illness, tiredness, sight of blood
xxi. S/S
1. Rapid pulse
2. Low BP
xxii. Treatment
1. Determine duration of unconsciousness
2. Position patient supine
3. Record vital signs & mental status
4. Suspect head injury if patient is confused or slow to regain consciousness
5. Transport promptly
xxiii. Septic
xxiv. When the body overreacts to an infection causing damage to its own tissue. Toxins
damage vessel walls causing increased cellular permeability
xxv. Widespread dilation of vessels & plasma loss through injured vessel walls result in
shock
xxvi. S/S
1. Hypotension
2. organ damage- confusion, reduced urine output
3. skin: flushed=> cold, mottled bluish
xxvii. Treatment
1. Transport promptly
2. Consider ALS
3. Admin high flow oxygen
4. Assist ventilations
5. Keep patient warm
6. Lie supine
b. Shock Treatment
c. High flow O2
d. Lie supine or in position of comfort
e. Keep warm
f. Compensated signs
g. Compensated shock- Early stage of shock when your body is trying to compensate for blood
loss (taking blood away from skin and taking it to organs etc.) pg 496
h. S/S
i. Agitation, anxiety, restlessness, feeling of impending doom, altered mental status,
weak pulse, clammy skin, cyanosis on lips, shallow/rapid breaths, SOB, nausea,
vomiting, capillary refill longer than 2 seconds, Marked thirst, narrow pulse pressure
i. What needs a DOT placard?
j. This marking system is used in the United States when materials are being transported from
one location to another. The same marking system is also used in Canada by Transport
Canada.
k. HAZMAT Zones
 Final Study Guide
i. Cold
l. The cold zone is a safe area where personnel do not need to wear any special protective
clothing for safe operation. Personnel staging, the command post, EMS providers, and the
area for medical monitoring, support, and/or treatment after decontamination are all located
in the cold zone.
i. Warm
m. The warm zone is where personnel and equipment transition into and out of the hot zone. It
contains control points for access to the hot zone as well as the decontamination area.
i. Hot
n. The hot zone is the area immediately surrounding the release, which is also the most
contaminated area. Its boundaries should be set large enough that adverse effects from the
released substance will not affect people outside of the hot zone

EMS Systems
o. Four training levels
i. EMR
ii. CPR, splinting, pt assessments
iii. EMT
iv. EMR+some medications, airway adjuncts and suctioning.
v. AEMT
vi. EMT+ some ALS such as starting and IV and administer a few more medications.
Cannot admin cardiac meds.
vii. Not applicable to CA, but service more rural areas.
14. Paramedic
a. 1,000 to more than 1,300 hours, divided between classroom and internship training
b. increases knowledge and mastery of basic skills and covers a wide range of ALS skills
15. Medical Legal
a. Consents
i. Implied
ii. Type of consent when a patient is unable to give consent in which a medical
professional is given treatment under the assumption they'd want it
iii. Implied Consent- allows EMS to make medical decisions if the patient is unable to such
as intoxicated, mentally impaired or suffering
iv. Informed
v. When EMS explains the risks and the nature of the treatment to get the patient's
consent
vi. Letting a patient understand all the information before them giving consent
vii. Expressed
viii. Expressed consent- verbal or acknowledged consent
b. Abandonment
c. termination of care without the patient’s consent and without transfer of care to a provider
as skilled or more skilled than you
 Final Study Guide
d. Ex: you are caring for a patient who was in a crash and you hear of a worse crash with more
patients and hand care over to 2 injured patients as you go help the others
e. Negligence
f. Negligence is failure to provide the same care that a person with similar training would
provide in a similar situation. Duty, breach duty, damages, causation (cause and effect
between beach of duty and damages)
g. ex: if you find someone unconscious and as you take them to the hospital you drop them
giving them a facial laceration
16. Workplace Safety
a. Stress
i. Acute
ii. DURING a stressful event usually stress lasting a month if more then it’s PTSD
iii. Delayed
iv. stress that manifests AFTER a stressful event
v. Cumulative
vi. Cumulative stress results from an accumulation of various stress factors such as a
heavy workload, poor communications, the frustration of not being able to meet the
beneficiaries' needs, having to cope with situations in which you feel powerless, lack
of basic comforts, and inability to rest or relax.
vii. You can tell when someone says is everything okay
viii. Ex: a paramedic that starts performing badly and not caring about the patients
ix. PTSD
x. reexperiencing something traumatic and over responding to stimulus that recall an
event
xi. CISM Team
xii. CISM is designed to help EMS deal with their trauma one incident at a time, by
allowing them to talk about the incident when it happens without judgment or
criticism.
xiii. A process that confronts the responses to critical incidents and diffuses them helping
xiv. EMS balance out physically and emotionally
b. Sexual Harassment

c. Sexual harassment is any unwelcome sexual advance, request for sexual favors, or other
verbal or physical conduct of a sexual nature when submitting is a condition of employment,
submitting or rejecting is a basis for an employment decision, or such conduct substantially
interferes with performance and/ or creates a hostile or offensive work environment.

d.
i. Quid Pro Quo

ii. There are two types of sexual harassment: quid pro quo (the harasser requests sexual
favors in exchange for something else, such as a promotion) and hostile work
environment (jokes, touching, leering, requests for a date, talking about body parts).

iii. Equipment
 Final Study Guide
e. Jump kit
f. A portable kit containing the items used in the initial care of the patient
g. disposable gloves, face shield, triangular bandages, trauma shears, adhesive tape, trauma
dressings, self adhering rolled bandages, oropharyngeal, bvm with mask for adults kids and
infants, blood pressure cuff, Stethoscope, pen light, sterile gauze, sterile dressing, adhesive
strips, oral glucose, activated charcoal
i. What else do we bring with
ii. ensure that you have immediate access to the AED. have available all of the
equipment that you will use in the entire call. have easy access to manage patients
with severe uncontrolled bleeding.
h. Oxygen tank
i. How much should be in the tank?How much Flow?

j.
k. The pressure of the gas in a full oxygen cylinder is approximately 2,000 psi.
l. Most portable cylinders have a maximum pressure of approximately 2,000 psi. Most EMS systems
consider a cylinder with less than 500 to 1,000 psi to be too low to keep in service.

Know-how and when to use:

i. KED – Vest Style device
ii. ensure that you have immediate access to the AED. have available all of the
equipment that you will use in the entire call. have easy access to manage patients
with severe uncontrolled bleeding.
iii. A vest style device would be used to move a patient in a similar situation as the use of
a RET(rapid extrication technique- if they have a spinal injury), but only when there is
not a time-critical need to move them. It takes about 6-8minutes, but provides greater
spinal support in moving the patient onto a backboard.
 Final Study Guide
iv. Backboard
v. Rapid extrication- technique to move a patient from a sitting position inside a vehicle
to supine on a backboard in less than 1 minute when conditions do not allow for a
standard immobilization
1. BSI/ Scene safety
2. Stabilize the head
3. PMSC
4. Position the board
5. Apply C-Collar
6. Log roll onto the board
7. Check back for deformities
8. Reposition on the board
9. Strap patient (chest, head, legs, arms)
10. PMSC
vi. Sling
vii. Long bone immobilization
1. Summary
2. Check tools
3. BSI/ scene safety
4. Have patient manually stabilize bone
5. PMSC
6. Measure the splint on unaffected arm
7. Apply the splint in position of function
8. Secure the splint to the extremity
9. Add sling
10. Add band around arm
11. Reassess PMSC
viii. Summary- Joint Immobilization
1. Check tools
2. BSI and scene safety
3. PMSC
4. Select appropriate splinting material
5. Immobilize the bone below and above the injury site
6. Tie sling on it
7. Secure the injured extremity to body with swathe
 Final Study Guide
8. Reassess PMSC
BLS / CPR
m. Ratio, Rate, Depth
i. Adult-30:2 one rescuer &two rescuer/ 100-120 /2in or2.4inch
ii. Child-30:2 one rescuer/two rescuer 15:2/ 100-120 /1/3 approximately 2 inch
iii. Infant 30:2one rescuer /two rescuer 15:2/ 100-120 / 1.5inch
n. AED use
o. Only use it on unconscious patients and make sure to stand clear when it goes off
stop CPR and let the AED do its job pg 657
p. HOW: open it, turn it on (if it does not do so automatically), attach pads to AED wires, place
on pt with one on right side of chest the other on lower left under the heart. Allow AED to
perform a reading. If shock is advised, pt is in v-fib. Listen to instructions and be sure to clear
the patient when shock occurs.
17. What happens when patient is pulseless during transport
a. immediately begin cpr unless the patient has a dnr
18. Common Reasons for airway obstruction

a. In an adult, sudden foreign body airway obstruction usually occurs during a meal. In a child, it
occurs while eating, playing with small toys, or crawling around the house. An otherwise
healthy child who has sudden difficulty breathing has probably aspirated a foreign object.

b. By far, the most common airway obstruction in an unconscious patient is the tongue

19. How to clear airway obstructions

a. perform the head tilt–chin lift maneuver to clear an obstruction that has been caused by the
tongue and throat muscles relaxing back into the airway in any person who is found
unconscious. This should be performed on unresponsive patients with adequate or
inadequate breathing who are not suspected of having spinal trauma. If spinal trauma is
suspected, open the airway with a jaw-thrust maneuver. Large pieces of vomited food, mucus,
loose dentures, or blood clots in the mouth should be swept forward and out of the mouth
with your gloved index finger. When available, use suction to maintain a clear airway.

b. Abdominal thrusts are the most effective method of dislodging and forcing an object out of
the airway of a conscious adult or child.

20. Childbirth
a. Steps for normal delivery
i. Crowning is a definitive sign that the baby is coming and transport should be delayed
until after delivery
ii. Allow the woman to push the head out
iii. Use your hands to support the bony parts of the head
iv. Make sure the head turns the same way as the body the baby will naturally turn left or
right
 Final Study Guide
v. The next contraction the shoulder will show, you can gently guide the baby’s head
down to encourage the upper shoulder to deliver
vi. Support the head and upper body, you might need to guide the head up to dislodge
the bottom shoulder
vii. Once the body is delivered firmly support the baby because it will be very slippery
viii. Make sure to keep the neck and head neutral so that the airway maintains open
ix. If the mother is willing place the baby on her abdomen the skin to skin will keep the
newborn warm and perfused
x. After delivery and prior to cutting the cord check to see if the baby is gurgling or in
respiratory distress
xi. Suction the mouth to clear any amniotic fluid
xii. and facilitate the baby’s initiation of gas exchange
xiii. Place a clamp on the umbilical cord and milk the blood towards the placenta and then
add another clamp 2-3 inches from the first
xiv. Cut between the 2 clamps
xv. The Placenta will deliver itself usually within 30 minutes of birth
xvi. Never pull on the cord in an attempt to speed up the delivery

b. Also, first steps after birth

i. Once the body is delivered firmly support the baby because it will be very slippery
ii. Make sure to keep the neck and head neutral so that the airway maintains open
iii. If the mother is willing to place the baby on her abdomen the skin to skin will keep the
newborn warm and perfused
iv. After delivery and prior to cutting the cord check to see if the baby is gurgling or in
respiratory distress
v. Suction the mouth to clear any amniotic fluid and facilitate the baby’s initiation of gas
exchange
vi. Place a clamp on the umbilical cord and milk the blood towards the placenta and then
add another clamp 2-3 inches from the first
vii. Cut between the 2 clamps
viii. The Placenta will deliver itself usually within 30 minutes of birth
ix. Never pull on the cord in an attempt to speed up the delivery
c. Pregnancy problems
i. Pre/Eclampsia
1. A pregnancy complication that is characterized by high blood pressure, headache,
visual changes, and swelling of the hands and feet; also called pregnancy-induced
hypertension or toxemia of pregnancy.
2. s/s
a. Severe hypertension
b. ▪ Severe or persistent headache
c. ▪ Visual abnormalities such as seeing spots, blurred vision, or sensitivity to
light ▪ Swelling in the hands and feet (edema)
 Final Study Guide
d. ▪ Anxiety
ii. Abruptio Placentae
1. Premature separation of the placenta from the wall of the uterus.
2. S/S
a. Painful Vaginal bleeding >20 weeks of pregnancy
b. Premature Labor
c. Contractions
iii. Placenta Previa
1. A condition in which the placenta develops over and covers the cervix.
2. S/S
a. Vaginal bleeding after 20 weeks of gestation
b. Fetal Hypoxia
c. Preterm delivery
d. No significant pain
e. cervical dilation
d. Labor problems
i. Breech birth (breech presentation)
1. A delivery in which the buttocks come out first.
2. You can insert a gloved finger into the vagina to open the vaginal opening to ensure
the baby doesn’t get choked

ii. Prolapsed cord

1. A situation in which the umbilical cord comes out of the vagina before the fetus.
2. You can insert a gloved finger into the vagina lift the body off the umbilical cord
21. Assessment
a. GCS
 Final Study Guide

i.

b. Rule of Nines

c. 76

d.
i. Rule of Palm-

ii. One quick way to estimate the surface area that has been burned is to compare it to
the size of the patient’s palm, which is roughly equal to 1% of the patient’s total body
surface area.
 Final Study Guide

iii.

e. Apgar
22. Terrorism
a. Vesicant
i. What does it do?
ii. Blister agents that if left long enough on skin can produce vapors that burn the
respiratory tract aka chemical agents
iii. Common names
iv. sulfur mustard is a gas that is instantly absorbed and does irreversible damage to the
cells it is a mutagen that mutates, damages the cells
v. Lewisite and phosgene are similar to sulfur mustard and are forms of vesicants
b. Skeleton
c. Anatomy
i. Major Bones
ii. Sternum
 Final Study Guide
1. Sternum- midline of the chest which creates a sternal notch. It is the location
where the trachea enters the chest
2. Manubrium- the upper section of the sternum
3. Body- the rest of the sternum except for the xiphoid process
4. Xiphoid process- at the end of the sternum and is made up of a narrow,
cartilaginous tip inferiorly
iii. Legs
1. Femur- longest and strongest bone in the body
2. Femoral head- at the superior end of a femur which connects to the pelvic
girdle
3. Greater Trochanter- the projection of the lateral/superiorportion of the
junction between the femoral neck and shaft
4. Lesser trochanter- the projection of the medial/inferior portion of the junction
between the femoral neck and shaft
5. Patella- knee cap, a specialized bone anterior to the knee
6. Tibia- Shin bone
7. Fibula- lateral side of the leg opposite of shin
iv. Arms
1. Humerus- supporting bone of the arm pg 184
2. Ulna- pinky side, larger bone in the proximal forearm and helps to form the
elbow joint
3. Radius- thumb side, larger bone in the distal forearm
v. Pelvis pg 184
1. Ilium- the large broad bone forming the upper part of each half of the pelvis.
2. Ischium- the curved bone forming the base of each half of the pelvis.
3. pubis- either of a pair of bones forming the two sides of the pelvis
vi. Skull
1. Cranium- composed of many thick bones that fuse to form the shell above eyes
and ears, it protects the brain
a. Occiput- the most posterior part of the skull
b. temporal bones- side of the cranium, temples
c. parietal bones- between the occiput and temporal bones
d. frontal bones- forehead bone
e. Foramen Magnum- an opening at the bottom of the skull that allows
the brain to connect to the spinal cord
2. Face Bones (14 bones)
a. maxillae- upper non-moveable jawbones
b. zygomas- cheekbones
c. mandible- lower moveable portion of the jaw
d. orbit- eye socket 2 facial bones (maxilla and zygoma) pg 181
vii. Vertebra
viii. Vertebra (each of the 33 bones that make up the spinal column)
 Final Study Guide
1. The spinal column is split into 5 sections the following are from top to bottom
ix. Cervical spine- the first 7 vertebrae in the neck, the skull is attached to C1 (the atlas)
and C2 (the atlas) which allows people to move their head
x. Thoracic spine- the next 12 vertebrae, 1 pair of the ribs is attached to each vertebra
xi. Lumbar Spine- the 5 vertebrae
xii. Sacrum- 5 sacrum vertebrae are fused together to create one bone called the sacrum
1. its joined to the iliac bones of the pelvis with strong ligaments of the sacroiliac
joints
xiii. Coccyx- the 4 last vertebrae fused together to create the tailbone
23. Vitals
 Final Study Guide
a. How to take
i. Pulse
1. How many heartbeats a minute?
ii. Blood pressure
1. Put the Blood Pressure cuff on the patient’s upper arm and inflate it to 200! As
you slowly release the air, put your stethoscope on the elbow pit :) the first
beat you hear is the systolic pressure then listen for the last beat you hear that
is the diastolic pressure. Then Systolic/ Diastolic is your BP
24. Pupils
a. Are the pupils PEARRL?
b. Pupils Equal and Round Reactive to Light
c. Shine a light on their eyes and check to see if their pupils constrict equally
i. Lung sounds
1. Listen if the lungs are crackling, normal etc. Rhonchi, Rales, Wheezing
ii. Capillary refill
1. Squish someone's finger and wait for it to refill with blood
2. It should take under 2 seconds to refill if not the person’s circulation is
inadequate
d. What does Systolic/Diastolic Represent
i. The top number refers to the amount of pressure in your arteries during the
contraction of your heart muscle. This is called systolic pressure.
ii. The bottom number refers to your blood pressure when your heart muscle is between
beats. This is called diastolic pressure.
25. PCR
a. Who can access it?
i. PCRs are used by individual agencies to determine patterns of EMS responses
b. What happens if you make an error?
i. Everyone makes mistakes. Do not try to cover it up.
ii. write down what did or did not happen and the steps that were taken to correct the
situation.
26. Refusals
a. Who can refuse?
i. If they are mentally competent and pass the A&Ox4
ii. Then you Encourage the individual again to allow care and inform them of the risks if
they go
iii. 2. Ask individual to sign a refusal form
iv. 3. Have a witness for the refusal documentation
v. 4. Document all refusals
27. Types of Terrorist attacks
a. Single Issue group

i. These include antiabortion groups, animal rights groups, anarchists, racists, and even
ecoterrorists who threaten or use violence as a means to protect the environment
 Final Study Guide
b. Doomsday cult/Religious

i. These include groups such as Aum Shinrikyo, who carried out chemical attacks in
Tokyo in 1994 and 1995. Some of these groups may participate in apocalyptic violence.

c. Extremist political groups.

i. They may include violent separatist groups and those who seek political, religious,
economic, and social freedom

28. Pediatrics
a. In general, what do vital signs do as we get older
i. NEONATE: HIGHER HR, HIGHER RR, LOWER BP
ii. INFANT: HIGHER HR, HIGHER RR, LOWER BP
iii. HR/RR DECREASE, BP INCREASES W/ AGE
b. PAT (pediatric assessment triangle)
i. Components
1. appearance (muscle tone and mental status), work of breathing, and circulation
to the skin
ii. When is it performed?
1. When you assess an infant or child, use the pediatric assessment triangle (PAT)
to determine if the patient is sick or not sick.
2. The pediatric assessment triangle (PAT) is a structured assessment tool that
allows you to rapidly form a general impression of the child’s condition without
touching him or her.
29. Remember the Hand Technique
a. With scenario based questions and they ask what the next right step is you answer in the
following order
b. Thumb- BSI
i. Body Substance Isolation
ii. What PPE you need: Gloves, Glasses, Face shield, Gown, N95 mask
c. Index finger- Scene Safety
d. Upper palm- Immediate Life Threats
e. Middle finger- Airway
f. Ring finger- Breathing
g. Pinky finger- Circulation
h. Wrist- Medications, ALS, C-Spine
30. Triage
a. Know the Table in Chapter 39
 Final Study Guide

b.
31. Jumpstart Triage
 Final Study Guide

a.

32. Three jurisdictional levels

a. Federal – NHTSA
i. NHTSA is the federal administrative source for education standards and related
documents
b. State – State EMS Office
 Final Study Guide
i. The state EMS office is responsible for authorizing, auditing, and regulating all
emergency medical services, training institutions, courses, instructors, and providers
within the state.
c. Local – Medical Director
i. The medical director is responsible for maintaining quality control, ensuring that all
staff members who are involved in caring for patients meet appropriate medical care
standards on each call
33. ICS & Triage & HAZMAT
a. Three things that make an incident an MCI
i. involves three or more patients, places great demand on the EMS system, and/or has
the potential to produce multiple casualties
b. Know the ICS Handout
i. [Link]
art-ics-flow-chart-to-memorize/11974361
c. Span of Control
i. In incident command, the subordinate positions under the commander’s direction to
which the workload is distributed; the ideal supervisor/worker ratio is one supervisor
for three to seven workers
ii. Operations, Planning, Logistics, Finance are the main groups but they could
34. Trauma
a. Signs and symptoms of Head injury
i. Lacerations, contusions, hematomas
ii. soft area or skull depression
iii. visible fractures
iv. confusion
v. Irregular breathing
vi. Widening pulse
vii. Slow heart rate
viii. CSF leakage
ix. Failure for pupils to react
x. Unequal pupil size
xi. Loss of sensation or motor function
xii. A period of unconsciousness
xiii. Amnesia
xiv. Seizures
xv. Numbness or tingling in the extremities
xvi. Irregular respirations
xvii. Dizziness
xviii. Visual complaints
xix. Combative or other abnormal behavior
xx. Nausea
 Final Study Guide

xxi.
35. Different lying positions

a. Prone:

b. Supine:

c. Fowler:
 Final Study Guide

d. semi-Fowler:
36. Complex Seizures
a. Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a
change in sensation, such as a strange taste or smell. Complex focal seizures can make a
person with epilepsy confused or dazed. The person will be unable to respond to questions or
direction for up to a few minutes.