Comprehensive Review

The home stretch!

EMCA Review

Analyze this :

Calculate the following

a. Want to run an IV at 120 cc’s an hour. If you have a 10 drop set, how many gtts/min do you set the IV rate?

b. You want to give a 15Kg child epinephrine for anaphylaxis. What is the dose of 1:1000 epi that you give? 0.15mg

20 gtts/min

Question

          Under what 4 conditions can only 1 shocks be delivered to a patient?

1.

2.

3.

4.

Blunt trauma

Hypothermia

Airway obstruction

After stopping enroute with rearrest

Question What are the indications for

epinephrine for anaphylaxis?

Indications

 

Exposure to a probable allergen

ANDSigns and or symptoms of a moderate to severe allergic reaction (inc Anaphylaxis)

Question What are four purpose of IV

therapy?

Restore and maintain fluid balance

Restore and maintain electrolyte balance

Provide medications and route for them

Transfuse blood and blood products

Deliver parenternal nutrients and nutritional supplements

Question What is an isotonic solution?

What IV fluids are hypotonic?

D5W

Same conc solute inside and out-no net movement of water

What are three causes of severe SOB? Acute severe asthma-usually

secondary to ? CHF Tension pneumothorax Pulmonary emboli

Explain the concept of cerebral perfusion pressure!

CPP=MABP-ICP

Need minimum pressure for cerebral function

Things that affect flow rates for IV’s (at least 5)1. Patient positioning – 3ft above2. Vein spasms3. Pheblitis/Thrombi4. Type of fluid (viscosity)5. Amount of fluid in bag6. Height7. Tubing kinked8. Catheter size9. Catheter position10. infiltration

What is an OASIS number? Where is it normally used?

Why is it important to take the pulse within 1 minute of patient contact? What information can be obtained?

Perfusion Rate too high or too low Blood pressure (roughly) Psychological (touch) Pulse alternans irregularities

Name 6 Dispatch centers in Ontario Toronto Sudbury Renfrew North Bay Ottawa Kenora Georgian Timmins Lindsay Cambridge Kingston Hamilton London Mississauga Oshawa Windsor

What does the tachometer measure and where is it located? Speed, stopping Use of lights Use of sirens 24 clock Located either behind drivers seat or

in side compartment of ambulance If applicable, does the medics write

on it?

5 Causes of crackles upon chest auscultation CHF Cardiogenic shock Hemothroax Pneumonia Atelactasis PE ARDS tumour

What are four reasons for a Incident Report VSA Crime Scene Child Abuse Domestic dispute Equipment failure Ambulance delay (critical) Person taking notes on scene!

What are 5 classes of antihypertensives Ca channel blockers B blockers ACE inhibitors Nitrates Diuretics Alpha blockers

Give one example of each

Give three examples of anticonvulsants Depekene Dilantin Valium Lorazepam phenobarbital

What are the receptors located in the autonomic nervous system? Alpha Beta 1 and beta 2

Explain the mechanism behind the development of a tension pneumothorax? Air gets trapped in between

parietal and visceral pleura, with each breath, if it not allowed to escape, it builds up pressure, collapsing the lung. Eventually, the pressure is so high it stops venous return to heart (compression of vena cava) and bp drops, HR increases and heart may arrest

Toronto, 9145 is 10-8, 765 McLaughlin Rd south? What does this transmission

mean?

10 Causes of Chest pain please! Angina pneumo MI aneurysm CHF fractured rib Emboli chondritis Esophagitis pleurisy Regurg muscle strain Myocarditis endocarditis

Explain the development of arthersclerotic disease?

Explain the theory of relativity or say “Patient Care” in the phonetic alphabet

What does CTAS stand for?

Canadian triage and acuity scale

Why does a patient with a thoracic aneurysm complain of back pain? Tearing of the layers of the

aneurysm

5 Signs and Symptoms of a tension pneumothorax? Decreased BP Increased HR Resp distress Absent air entry on affected side JVD Tracheal shift cyanosis

How does lasix work, and how is it supplied? Normal dose? Preload reducer and diuretic Comes 40mg/4ml Depends on patient 40-160mg

What are the conditions under which you would inspect the perineum in a obstetrical patient

Ruptured membranes Prolapse cord Urge to push “baby’s coming” Near term, decreasing LOC and

history is unknown Vag bleeding with shock

What three rhythms would get cardioverted? SVT Rapid a fib Vtach with a pulse

You just turn on the LP after applying the pads and see asystole on the monitor. How do you get to see the rhythm through the paddles (2 ways) Press analyze (fastest) Flip to paddles

What are the contraindications to ASA administration?   18 years of age• alert     NOT have an allergy to ASA or other NSAID     not have current active bleeding (GI or other

disorders)     have no evidence of CVA or head injury

within 24 hours prior to Primary Care Paramedic assessment

have a history of previous use of ASA with no adverse reaction if a known asthmatic

How do you differential between MI and angina? Time of chest pain What makes it better 12 lead changes Quality of pain Past history

What is the difference between epiglottis and croup?

Croup = Laryngotracheobronchitis

Epiglottis- Haemophilus influenzae type B most common

odynophagia fever irritability stridor rapidly progressive

URI symptomsbarking coughhoarsenessinspiratory stridorlow-grade fever

What is the difference in terms of vital signs between an anterior MI and an inferior MI? Low and slow –inferior High and fast -anterior

What is the indications of giving epi for croup? Any patient who is < 8 years of age who

presents with:

 

1. A current history of an upper respiratory infection with a “barking” cough

AND

2. Stridor at rest, or an altered level of consciousness or cyanosis

What is the importance of the cover letter in a resume? Job target The ‘ask’ Why you’re the one Specific about the job-connection

Outline the pathophysiology behind acute asthma! Adrenergic stimulation or irritation

of the bronchioles resulting in bronchoconstriction.

Mucous production Histamine release from mast cells

How long would a D tank last at 12 lpm for a NRB mask? (Leaving the residue) 2000-500 =(1500) x 0.16 divided

by 12 L min =240/12 =20 minutes

What are 6 signs of raised ICP Seizure Combativeness Decreased LOC Pupil changed Resp change –ataxic Triade called …..? Rising BP etc

Signs and symptoms of acute anaphylaxsis Physical Examination shows any of the following:

         Wheezing

         Stridor

         Generalized Urticaria

         Generalized edema

         Systolic BP <90

         Decreased LOC Airway compromise

Tell me how a KED is applied Immobilize head-collar applied Undo far leg strap Slide Ked behind patient Pull up under arms. My –middle strap Baby- bottom Looks- legs Hot- head (pad behind head, top then chin) Tonight- top strap-”deep breath” Haul!

What is the chest landmark for a needle decompression?

2rd intercostal space, midclavicular line, above the 3rd rib

On the affected side!!

What patients would get intubated? VSA Unconscious GCS<8-10 Severe SOB (CHF, asthma, ) CHI trauma Airway protection –burns etc Seizure Respiratory support

What are the Criteria to rule out for the CVA protocol?

1. CTAS Level 1 or uncorrected A,B,C problem2. Symptoms of the stroke resolved prior to

arrival or assessment3. Blood sugar <3 mmol/L4. Seizure at onset or observed by paramedics5. GCS <106. Terminally ill or palliative7. Duration of out of hospital will exceed 2

hours

What is this?

Aortic valve

Give the trade name for the following: Acetaminophen- Propanolol Rantididine- Dimenhydrinate- Sertraline -

Tylenol

Inderal

Zantac

Gravol

Zoloft

What are some options if some refuses care and you want to convince them to go?

Advise Dispatch (possible delay) Physician contact

(Studies have found a significant number of patients will accept transport when advised to do so by a physician)

Police involvement Obtain witnesses signatures to refusal and

explanation provided to the patient (if witnessed)

Trace the blood from the vena cava to the carotid artery-include valves Vena cava, R atrium, tricuspid, R

ventricular, pulmonary valve, pulmonary artery , lungs, pulmonary vein, Left atrium, mitral valve, left ventricle, aortic valve, aorta, carotid artery

What features help the myocardium depolarized so that all the myocardium contracts together

“Functional Syncitium”

Intercalated discs

Gap junctions

Desmesomes

What is this?

How do you set the traction on the sager splint? 10% body weight up to maximum

of 15 lbs Traction manually until traction

applied by splint Distal neurovascular before and

after

Why does someone in a Vtach with a pulse get chest pain? Decreased diastolic filling time Increased MvO2 due to speed of

contraction! Therefore treat the rate by..?

How does insulin work in the body?

What are the questions for the aid to capacity section? That the patient can understand

The condition for which the treatment is proposed

The nature of the proposed treatment The risks and benefits of the proposed

treatment The alternatives to the treatment

presented by the paramedic including the alternative of not having the treatment

That the patient can appreciate the risks and benefits of treatment/non treatment

Why does someone with GERD get chest pain sometimes? Referred pain up the esophagus

through the cardiac spincter! (Gets better with a “pink lady”

lidocaine and maalox)

How does ASA work to help prevent further necrosis in a MI

Inhibit thromboxane A2 which is a potent platelet aggregator

Which blood type is the universal donor and why?

O RH negative

Because there are no antigens on the RBC’s

no A

No B

No RH

Name 3 kinds of WBC’s Neutrophils Eosinophils Macrophages (monocyctes) Mast cells Basophils

What are the differences in a pediatric airway?

Long floppy epiglottis Large occiput Narrowest below the

cords Large tongue Small nares Semi rigid tracheal

rings

What are three important questions to ask someone in labour? What is the expected date of

confinement (EDC) or how many weeks she is at?

Has the membranes ruptured Previous pregnancies-length and

result Colour of fluid Any problems with pregnancy

What are the components of the APGAR score and when are they done? Appearance Pulse Grimace (tone) Activity Respiration

Done at 1 minutes and 5 minutes

Explain what occurs in the development of type II diabetes in adults Overstimulation of the pancreas

and the release of insulin, so that there is decreased sensitivity of the insulin receptors to it

Down regulation eventually of insulin receptors on the body cells

What is the GCS of a person who opens eyes to pain, extends and has only moaning

Eyes- 2 Verbal- 2 Motor –2

-total 6

What are the suction levels for adults, children and infants? Adults 500 mmHg Children 200 mmHg Infants delee or bulb suction (80-

120)

An organophosphate overdose is an example of stimulation of

a.       inhibition of cholinergic fibers b.      adrenergic fibers c. sympathomimetics d. release of acetylcholine e. the CNS

What happens when a patient is acidotic? The person begins to blow off CO2

and increase the rate and depth of respiration in an attempt to drive the equation

H20 + CO2 =H2CO3 =H+ HCO3

Why does a person with severe Anemia present SOB? Anemia is the low RBC count The HGB is the what carries the O2

so when the RBC count is low, the PaO2 in the body drops and the person becomes hypoxic, and presents with SOB

A patient is on dimenhydrinate, Percocet, and coumadin. What is the history?

a. Pain, nausea and blood clotsb. Atrial fibrillation, Depression and hives or

allergies c. Hypertension, nausea and depression d. Depression, hypertension and allergies e. None of the above

What are 15 “load and go” situations? Large sucking chest wound Large flail chest Tension pneumothorax Major blunt chest injury Asthma CHF Seizure (ongoing) AMI Burns with inhalation Shock Ectopic pregancy with shock

Overdose with decreased LOC

Aortic aneurysm Cardiac arrest Head injury stroke Obstructed airway Tender abdoment Bilateral fractured femurs Pelvis fracture Amputation of thumb/limb

etc Multiple births

What are signs and symptoms of cardiac tamponade? Muffled heart sounds SOB JVD Pulses alternans Chest pain

What are signs of smoke inhalation and upper airway burns? Smoky breath odour Facial hair burned Sooty sputum Cough, drooling, stridour Hoarse voice Decreased a/e, wheezing

Explain the signs and symptoms of hyperglycemia Fruity breath due to presence of

ketones Frequent urination due to

increased osmolarity of blood Also cause of polydipsia (drinking) Conversion of fats to sugar Hunger due to cells starving

What is the danger of CO? CO binds with higher affinity to

HGB and displaces O2 Patient gets hypoxic Get cherry red appearance

What are resources to identify chemicals you may have to deal with? CANUTEC guide WHIMIS Poison control Dangerous goods placard Bystanders at a company dispatch

What is the reason that infections can cause septic shock? Bacteria release endotoxins Endotoxins cause histamine

release and vasodilation The drop in SVR causes drop in BP

What are two causes of ipsilateral pupil dilation Stroke Tumour Nerve palsy trauma

What are 10 physiological changes with age Decreased lung elasticity Higher blood pressure Changes in AV node Temp regulation is impaired Vision and hearing loss Gait and balance Dry mouth Decreased sphincter tone Diminished renal function Higher bank balances Skin thins Bones weakened More people to take you out for dinner Immune function diminished

How do you manage a frostbitten foot? Cover and protect the foot Do not rub or massage the foot Leave blisters intact Bandage toes separately Elevate and splint the foot

Describe the various levels of frostbite Frostnip- mild blanching of skin Superficial- waxy/white skin Deep- cold, hard and wooden

What is the normal blood pressure of a 4 year old? 2 x age plus 80 8 + 80=88 systolic 2/3 of that is diastolic

What are some ways to immobilize pediatric patients? KED Pedimate BB with lots of padding

What is naloxone A narcotic antagonist NARCAN

What are some differences between left and right lungs?

What are some drugs used for heart failure? Diuretics ACE inhibitors Cardiac glycosides (when assoc

with A fib)

You arrive on scene to find your patient post-ictal. The patient's medical history, gathered from the family, includes depression for which the patient is medicated. Which of the following antidepressant classes have seizures as a common adverse reaction to?

a. selective serotonin reuptake inhibitors

b. tricyclics c. benzodiazepines d. antipsychotics

What is the difference between ventilation and respiration (think anatomy) Ventilation is the mechanical

aspect of getting O2 down to the lungs and CO2 out

Respiration is either internal (at the cells) or external (at the lungs)

What are four kinds of heat related injuries? Heat syncope Heat cramps – large muscles Heat exhaustion – non specific

unwellness Heat stroke- severe altered mental

status

What are 10 signs and symtoms of hypogylcemia Combativeness Seizures Confusion Slurred speech Ataxia Tremours Hunger Syncope Weakness lethargy

What are some history questions you would want to ask someone you suspect may have the ‘bends”

Number, depth and duration of dive Water temperature,pollution When symptoms occurred

(underwater, upon surfacing (gas emboli) or > 10 minutes(DCS)

Rate of ascent Treatment rendered

What are signs and symptoms of eclampsia? Seizure Generalized edema Light sensitivity, altered sensation Headache Abdo pain Hypertension > diastolic 110 Protein in urine

Which of the following is correct?a. decreasing chronotrophy causes increased HRb. increasing dromotrophy means conduction through AV node in increasedc. decreasing preload means more blood back to the heart so increased blood pressure

d. increased chrontrophy means increased SV

Explain Boyles law PV=nRT

Or

Pressure is inversely proportional to V

What do you do if there is a cord prolapsed and the woman is in labour? Carefully insert gloved hand into

the vagina and attempt to relieve pressure on the cord

Have the women lying in trendelenburg position as much as possible

Keep cord moist Drive like MAD!!

What is important to remember when ventilating infants?

Towel or something under the should

Neutral position Mask fitting well over mouth and

nose Gentle ventilation for good chest

rise Rate ?

What would make you suspect child abuse in a call? Injuries that don’t fit description Presence of many old bruises Finger marks on child Burns to buttocks or soles of feet,

circumphrenia burns Inappropriatge interaction b/t caregivers and

child/ each other Signs of physical neglect (severe diaper rash,

dirty, dehydration with extreme pallor etc) Signs of use of object (belt, cigarette etc)

If you use a restraint on a patient what must you document? Reason for restraint Name and order of person ordering

restraint (MD, police, EMA) Method of restraint Consequences and effects of

restraint

Good luck!