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? weigh at least 40 kg be alert and responsive 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 7 contraindications 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!