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Comprehensive Review The home stretch! EMCA Review.

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1 Comprehensive Review The home stretch! EMCA Review

2 Analyze this :

3 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

4 Question Under what 4 conditions can only 1 shocks be delivered to a patient? Blunt trauma Hypothermia Airway obstruction After stopping enroute with rearrest

5 Question What are the indications for epinephrine for anaphylaxis? Indications Exposure to a probable allergen AND Signs and or symptoms of a moderate to severe allergic reaction (inc Anaphylaxis)

6 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

7 Question What is an isotonic solution? What IV fluids are hypotonic? D5W Same conc solute inside and out-no net movement of water

8 What are three causes of severe SOB? Acute severe asthma-usually secondary to ? CHF Tension pneumothorax Pulmonary emboli


10 Explain the concept of cerebral perfusion pressure! CPP=MABP-ICP Need minimum pressure for cerebral function

11 Things that affect flow rates for IV’s (at least 5) 1. Patient positioning – 3ft above 2. Vein spasms 3. Pheblitis/Thrombi 4. Type of fluid (viscosity) 5. Amount of fluid in bag 6. Height 7. Tubing kinked 8. Catheter size 9. Catheter position 10. infiltration

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

13 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

14 Name 6 Dispatch centers in Ontario TorontoSudbury RenfrewNorth Bay OttawaKenora GeorgianTimmins LindsayCambridge KingstonHamilton LondonMississauga Oshawa Windsor

15 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?

16 5 Causes of crackles upon chest auscultation CHF Cardiogenic shock Hemothroax Pneumonia Atelactasis PE ARDS tumour

17 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!

18 What are 5 classes of antihypertensives Ca channel blockers B blockers ACE inhibitors Nitrates Diuretics Alpha blockers Give one example of each

19 Give three examples of anticonvulsants Depekene Dilantin Valium Lorazepam phenobarbital

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

21 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

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

23 10 Causes of Chest pain please! Anginapneumo MIaneurysm CHFfractured rib Embolichondritis Esophagitispleurisy Regurgmuscle strain Myocarditis endocarditis

24 Explain the development of arthersclerotic disease?

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

26 What does CTAS stand for? Canadian triage and acuity scale

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

28 5 Signs and Symptoms of a tension pneumothorax? Decreased BP Increased HR Resp distress Absent air entry on affected side JVD Tracheal shift cyanosis

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

30 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

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

32 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

33 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

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

35 What is the difference between epiglottis and croup? Croup = Laryngotracheobronchitis Epiglottis- Haemophilus influenzae type B most common odynophagia fever irritability stridor rapidly progressive URI symptoms barking cough hoarseness inspiratory stridor low-grade fever

36 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

37 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

38 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

39 Outline the pathophysiology behind acute asthma! Adrenergic stimulation or irritation of the bronchioles resulting in bronchoconstriction. Mucous production Histamine release from mast cells

40 How long would a D tank last at 12 lpm for a NRB mask? (Leaving the residue) =(1500) x 0.16 divided by 12 L min =240/12 =20 minutes

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

42 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

43 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!

44 What is the chest landmark for a needle decompression? 2 rd intercostal space, midclavicular line, above the 3 rd rib On the affected side!!

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

46 What are the 7 contraindications for the CVA protocol? 1. CTAS Level 1 or uncorrected A,B,C problem 2. Symptoms of the stroke resolved prior to arrival or assessment 3. Blood sugar <3 mmol/L 4. Seizure at onset or observed by paramedics 5. GCS <10 6. Terminally ill or palliative 7. Duration of out of hospital will exceed 2 hours

47 What is this? Aortic valve

48 Give the trade name for the following: Acetaminophen- Propanolol Rantididine- Dimenhydrinate- Sertraline - Tylenol Inderal Zantac Gravol Zoloft

49 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)

50 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

51 What features help the myocardium depolarized so that all the myocardium contracts together “Functional Syncitium” Intercalated discs Gap junctions Desmesomes

52 What is this?

53 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

54 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..?

55 How does insulin work in the body?

56 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

57 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)

58 How does ASA work to help prevent further necrosis in a MI Inhibit thromboxane A2 which is a potent platelet aggregator

59 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

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

61 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

62 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

63 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

64 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

65 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

66 What are the suction levels for adults, children and infants? Adults 500 mmHg Children 200 mmHg Infants delee or bulb suction (80-120)

67 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

68 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

69 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

70 A patient is on dimenhydrinate, Percocet, and coumadin. What is the history? a. Pain, nausea and blood clots b. Atrial fibrillation, Depression and hives or allergies c. Hypertension, nausea and depression d. Depression, hypertension and allergies e. None of the above

71 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

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

73 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

74 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

75 What is the danger of CO? CO binds with higher affinity to HGB and displaces O2 Patient gets hypoxic Get cherry red appearance

76 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

77 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

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

79 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

80 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

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

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

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

84 What is naloxone A narcotic antagonist NARCAN

85 What are some differences between left and right lungs?

86 What are some drugs used for heart failure? Diuretics ACE inhibitors Cardiac glycosides (when assoc with A fib)

87 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

88 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)

89 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

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

91 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

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

93 Which of the following is correct? a. decreasing chronotrophy causes increased HR b. increasing dromotrophy means conduction through AV node in increased c. decreasing preload means more blood back to the heart so increased blood pressure d. increased chrontrophy means increased SV

94 Explain Boyles law PV=nRT Or Pressure is inversely proportional to V

95 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!!

96 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 ?

97 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)

98 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

99 Good luck!

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