EMT-B Basic Final Exam Review
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Who sets the curriculum for all EMS courses?
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DOT
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Provides national standards for EMT testing and certification.
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National Registery
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Physician who authorizes/delegates authority to provide medical care in the field.
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Medical Control
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Recognition, patient assesment, continued assesment and stabilization in hospital, definitive care.
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Continuum of Care
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Types of stress include:
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Cumulative, post-traumatic stress reaction, eustruss, acute stress, and chronic stress
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S/S of stress include:
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Increased respiratory rate, heart rate, and B/P, vasodilation, dialted pupils, tensed muscles, increased glucose levels, perspiration, deacreased blood flow to gastrointestinal tract, irritability, inability to concentrate, difficult or increased sleeping, anxiety, guilt, loss of appetite, decreased sexual activity, loss of interest in work, alcholism, drug use.
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Management of stress includes:
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Eliminate stressors, change partners, get rid of negative personalities, change work hours, reduce overtime, change your attitude, don't obsess over what you can't change, excercise, diet.
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Fight or Flight response:
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During an acute stress response, the autonomic nervous system is activated and the body increases level of cotricol, adrenilen, and other hormones that produce an increased heart rate, quick breathing, and higher BP. Blood is shunted from extremities to the big muscles to \"fight or flight\".
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Routes of transmission include:
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Direct - touch or droplets Indirect - spread by inanimate objects Mechanical (vector born) - by insects Biological - Transmissions by which the germs live or grow Airborne - sneezes, coughs Dust - may carry pores, may remain for long periods.
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Control and prevention of contamination include?
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Hand washing, gloves, eye protection, gowns, masks, mask, respirators, barrier devices, and immunizations.
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Duty to Act is?
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An obligation to provide care.
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Duties include:
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Duty to: -Respond -Obey laws and regulations -Operate an emergerncy vehicle reasonably and prudently -Provide care and transportation to expected standard -Provide care and transport consistent with the scope of practice and local medicine protocol -Continue and transport through to its appropriate conclusion
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The scope of practice is?
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Descriptionof what assessment and treatment skills and EMT may legally perform.
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Implied consent is?
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Consent in which a patient is unable to give consent and is provided treatment under the implication they would want treament.
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Informed consent is?
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Permission for treatment given by a patient after the potential risks, benefits, and alternatives to treatment have been explained.
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Ethics
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The discipline dealing with what is good and bad.
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Standard of care is?
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The degree of medical care and skill that is expected of a resonably competent EMT acting in the same or similar circumstances.
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Confidentiality is?
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Communication between you and the patient is considered confindential and can only be released to other medical staff or with a court order.
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Definite signs of death include:
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Obvious mortal damage, dependent lividity, rigor mortis, putrefaction.
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Obvious mortal damage:
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Injuries such as decapitation or non survivable injury.
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Dependent lividity
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Blood settling to the lowest part of the body. \"Pooling\"
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Rigor mortis
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Stiffening of body muscles caused by chemical changes in the body. Develops in the face and jaw, gradually extending downward. Onset is affected by body's ability to lose temp (thin=fast, fat body=slow). Occurs between 2-12 hours after death
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putrefaction
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Decomposition of body tissue. Occurs between 20-96 hours.
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Anterioir
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Front side of body
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Posterior
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back of the body
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Midline
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Imaginary line drawn vertically from middle of the forehead through the umbilicus floor
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Midclavicular
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Referring to the middle of the clavicle parallel to the midline
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Midaxillary
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Referring to middle of armpit parallel to the midline
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Superior
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Towards the head of the body
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Inferior
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Towards the feet
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Proximal
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Structures closer to the trunk
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Distal
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Structures further from the trunk
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Medial
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Towards middle
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Lateral
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Towards the outside
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Ventral
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Belly side of the body
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Dorsal
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Spinal side of the body
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Palmar
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The palms
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Plantar
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The soles of the feet
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Apex
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Tip of a structure
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Bilateral
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Both sides
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Unilatral
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One side
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Ipsilateral
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Refers to the same side of the body
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Flexion
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bending of a joint
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Extension
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Straightning of a joint
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Adduction
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Moving towards midline
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Abduction
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moving away from midline
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Skull (cranium) contains:
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Occiput temporal regions, parietal region, mandible, zygomas, maxillae, orbit
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Spine consists of:
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Cervical (7), Thoracic (12), Lumbar (5), Sacrum (5), Coccyx (4)
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Thoracic contains:
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Ribs (12), spine, sternum, clavical, scapula, lungs, heart, diaphragm.
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Pelvis consists of:
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Illium (crest), ischium (butt bone), and pubis.
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Femur
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Bone located in the thigh
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Patella
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the bone located at the knee
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Tibia
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Anterior bone in the lower leg
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Fibula
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Posterior bone in lower leg
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Tarsals
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Bones in the ankle
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Metatarsals
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the bones that lead to the toes. Also called phalanges
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Humerus
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Sopporting bone of the forearm
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Radius
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Bone in forearm \"on the thumb side\", larger in the proximal forearm.
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Ulna
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Bone in forearm \"on the little finger side\", larger in the distal forearm.
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Carpals
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Bones in the wrist
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Metacarpals
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Bones in the foot leading to the phalanges
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The RUQ contains:
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Liver, gallbladder, bile duct, colon, pancreas
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LUQ contains:
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Stomach, spleen, pancreas, colon
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RLQ contains:
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Cecum, small intestines, appendix
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LLQ contains:
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intestines
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Skeletal muscle (voluntary):
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Attaches to the skeleton
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Striated muscle:
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Also called skeletel muscles
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Smooth muscle (involuntary):
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Gastrointestinal tract, urinary systems, blood vessels, bronchi
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Cardiac Muscle
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Only in the heart.
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Upper airway consists of:
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Nasopharynx, nose, pharynyx, mouth, oropharynx, epiglottis
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Lower airway consists of:
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Larynx, trachea, alveoli, bronchioles, bronchi, carina, lungs
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Primary respiratory drive is?
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The brain
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Secondary respiratory drive is?
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hypoxic drive. (When oxygen falls, this will stimulate breathing)
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Main difference between adult and children airway?
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Children have smaller and less rigid airways.
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Adult resp rate is?
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12 to 20
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Child resp rate it?
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15 to 30
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Infant resp rate is?
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25 to 50
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When assessing breathing, breathing should appear:
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easy, not labored. You should not be able to see or hear a pt breathing.
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Inadequate breathing means:
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a person cannot move enough air into the lungs with each breath, thus not meeting metabolic needs.
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Signs of adequate breathing in an adult include:
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Non-labored, normal rate, regular rhythm, good audible breath sounds, regular rise and fall of chest, movement of abdomen.
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Signs of adequate breathing in a pedi include:
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non-labored, normal rate, regular rhythm, good audible breath sounds, regular rise and fall of chest, and movement of the abdomen.
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Inadequate signs of breathing in adult include:
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Muscle retractions, pale or cyantoic, cold and damp skin, tripod position, and noisy breathing.
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Signs of inadequate breathing in an pedi include:
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muscle retractions, pale or cyanotic, cold and damp skin, tripod position, nasal flaring, and seesaw respirations.
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Normal heart adults are:
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60 to 100
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Normal child heart rates are:
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70 to 150
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Normal infant heart rates are:
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100 to 160
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Heart:
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A hollow organ that consists of 2 atrias and 2 ventricles. It is an involuntary muscle, controlled by autonomic nervous system.
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Passageway through the heart:
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Blood arrives via the inferior/superior vena cava. It enters the right atrium, goes through the triscuspid valve and into the right ventricle, and then goes through the pulmonary valve to the lungs. The blood then reenters the heart through the pulmonary vein into the left atrium, through the mitral valve, then the left ventricle through the aortic valve.
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Arteries carry?
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Oxygenated blood
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Veins carry?
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Deoxygenated blood
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Capillaries allow:
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Exchange of oxygen and CO2.
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The body holds how many liters of blood?
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5-6 liters.
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How long does it take the body to pump the entire supply of blood?
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one minute.
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Normal Systolic BP in an adult:
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90 to 140 systolic.
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Normal systolic BP in a child:
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80-110 systolic
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Normal BP in infants:
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50-95 systolic
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Systolic is?
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the increased pressure that is caused along the artery with each contraction of the ventrical pulse.
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Diastolic is?
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The residual pressure that remains in the artiers during the relaxing phase of the heart's cycle, when the left ventricle is at rest.
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Proper size for BP cuff:
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Designed to wrap around the arm 1 to 1 1/2 times and take up 2/3 of the length of the arm from armpit to elbow. Small cuff=false high reading, large= false low reading.
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What is trending?
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Taking vitals more than once to see how your pt is doing.
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Emergency movement/lifting is:
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Moving a pt before initial assessment. *Clothes drag, blanket, arm and arm-to-arm drag
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Urgent movement/lifting is:
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Used for pts with AMS, inadequate ventilations, or shock.
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Rapid Extrication is required in what situation?
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When the pt is in an unsafe vehicle, pt cannot be properly assessed, pt needs immediate intervention/transport, pt requires supine position, or pt blocks access to another seriously injured pt.
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Non-urgent movement/lift is used when:
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The patient and scene are safe.
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Backboard:
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usde for most situations, needs multiple people to make it safe
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Scoop Stretcher
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used when log rolling is not an option
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Stokes Basket
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For high/low angle rescue, caves, etc.
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Stair Chair
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Can be used for small areas or hallways.
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Ambulance stretcher (wheeled)
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Can be used for most situations when there is room and it can roll easily.
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Blankets
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For small spaces or when it is hard to get other equipment into the area.
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The brain can function for how long before the brain may become severly damaged?
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4-6 minutes
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Cells in the kidney can live how long without oxygen?
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up to 45 minutes
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How much O2 is in the air we breathe?
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21%
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How much O2 is in the air that we exhale?
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16%-17%
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If mouth-to-mask without O2 attatched is given, how much air is the pt receiving?
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16%-17%
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Explain the process of breathing.
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O2 reaches body tissues and cells through two seperate but realted processes - breath and circulation. As we inhale, O2 moves from the atmosphere into the lungs then passes from the alveoli in the lungs into the capillaries to oxygenate the blood. At the same time, CO2 produced by the cells in the tissues in the body, moves from the blood into the alveoli. The blood enriched with O2 travels through the the body by pumping of he heart. On exhalation, CO2 is expirated.
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What is hypoxia?
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Dangerous condition in which the the body's tissues and cells do not have enough oxygen Without interventions, the pt will die within minutes.
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Heart Attack
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Tissues begin to die from lack of O2, weakened heart then pumps blood poorly to rest of body, resulting in systemic shock.
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Pulmonary Edema
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Fluid accumulates in the lungs, making the exchange of )2 and CO2 in the alveoli less efficient.
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Acute narcotic or sedative overdose
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Resp may decrease and become shallow.
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smoke inhalation/toxic fumes
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Causes pulmonary edema and destroys lung tissue, causing problems with gas exchange.
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Stroke
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May cause hypoxia due to facial drooping or may damage respiration center of the brain.
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Chest Injury
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Pain interferes with full chest expansion, thus limiting ventilations. Lung damage itself is secondary to pulmonary contusion, can also prevent gas exchange.
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Shock
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Occurs as a result of injuries that affect the circulatory system. When the circulatory system fails, hypoxia being to set in.
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COPD
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Chronic irritation of the lungs and passageways produces alveolar damage and poor gas exchange.
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Asthma
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Narrowing of the respiratory passages and buildup of mucus causes trapping of air and poor gas exchange.
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Premature Birth
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Pulmonary surfactant is decreased in some premature infants, therefore, prematurity is often associated with hypoxia. The more premature an infant, the worse the hypoxia.
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What is hypoxic drive?
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Backup system to control respirations when O2 levels fall.
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Oral Adjuncts:
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are used to keep the tongue from blocking the upper airway. Use to make it easier to suction the oropharynx if neccesary.
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Oropharyngeal adjunct Indications:
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Used on unconscious pts who have no gag reflex and used with BVM.
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Oropharyngeal adjunct contraindications:
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Conscious pt, any pt who has a gag reflex.
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Nasopharyngeal adjunct indications:
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Semiconscious or unconscious pt with itnact gag reflex, pts who will not tolerate an oral airway.
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Nasopharnygeal adjunct contraindications
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Sever head injury wit hblood draining from the noise, hx of fx nasal bones.
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How do you correctly measure the size of a nasal airway?
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From the tip of the nose to earlobe.
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When suctioning:
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Must keep airway clear so that pt can be ventilated properly. If it is not clear, fluids will be forced into the lungs and possibly cause a lung infection.
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Types of suction devices include:
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Plastic, rigid suction tips (Tonsil or Yankauer) Nonrigid plastic catheters call French or Whistle-tip.
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Preferred oropharynx suctioning device is:
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Yankauers (tonsil tip)
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Preferred nasopharynx suctioning device is:
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French whistle.
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How do you maintain the airway in a pt who is not injured and breathing on his/her own wit hnormal rate and adeqaute tidal volume?
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place in the recovery position.