Download section7-8review - Hatzalah of Miami-Dade

Hatzalah of Miami Dade
Test Review Chapter 35-41
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The basic airway management supplies that a BLS truck is required to have consist of
opa and npa’s in various sizes, infection control kits, gastric tubes, BVM (adult and
pediatric), oxygen supply units(both portable and installed), disposable humidifiers, and
a cpr board. Combitube would be included, but depends on local protocol. Basic
supplies for dressing open wounds should be included on the ambulance. This includes
various types of dressings, assorted sizes of band-aids, adult size pneumatic antishock
garment (PASG), but depending on your local protocol. Make sure to check with medical
control first.1029
The ambulance must be equipped with portable, durable, and waterproof jump kit that
you can carry to the patient. Think of the jump kit as the “5 minute kit,” containing
anything you might need in the first 5 minutes with the patient except for the semi
automated external defibrillator, possibly the oxygen cylinder, and portable suctioning
unit. The jump kit must be easy to open and secure. 1032
Every patient must be staffed with at least one EMT-B in the patient compartment
whenever a patient is being transported; two EMT’s are strongly recommended. Some
services may operate with a non-EMT driver and a single EMT-B in the patient
compartment. 1034
When attending the scene of a car accident, your main responsibility is to treat the
patient. Sometimes in order to do that you may need to control the traffic, if police are
slow to arrival. The purpose of traffic control is to ensure an orderly traffic flow and to
prevent another crash. As soon as possible, place appropriate warning devices, such as
reflectors, on both sides of the crash. Also always make sure to wear your reflective
vests. The idea is to, not draw the attention towards the accident so you can also use
yellow lights instead of red, because people are more attracted towards red lights.10371038
There are 3 principles for using warning lights: 1) the unit must be on a true emergency
2) both audible and visual warning devices must be used simultaneously 3) the unit
must be operated with due regard for the safety of others. Using a paramedic or police
escort is an extremely dangerous practice. When other motorist hear a siren and see a
police car passing, they might assume that the one ambulance or police car is the only
emergency vehicle and not see the ambulance. The only time an escort is justified is
when you are in an unfamiliar territory and truly need a guide more than an escort. In
such cases, neither vehicle should use warning lights or sirens. If you are being guided,
make sure that you follow at a safe distance. If you do have to use siren, be sure to tell
the patient before you turn it on. Always travel at a speed that will allow you to stop
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safely at all times, especially so that you are prepared for drivers who do not give you
the right of way.1046-1047
In order to establish a landing zone for a helicopter, the EMT-B must survey the
immediate area for any overhead or tall hazards such as power lines to telephone
cables, antennas and tall or leaning trees. The presence of these must be relayed
immediately to the flight crew, as an alternate landing site may be required. 1049
If the helicopter must land on a grade (uneven surface) extra caution is advised. The
main rotor blade will be closer to the ground on the uphill side. In this situation,
approach the aircraft from the downhill side only or as directed by the flight crew. Do
not move the patient to the helicopter until the crew has signaled that they are ready to
receive you. 1051
Extrication is the removal from entrapment or from a dangerous situation or position,
while Entrapment means being caught within a closed area with no way out or having a
limb or other body part trapped. In context extrication applies to a vehicle, but could
apply to any situation. 1059
Your first step in gaining access is the simple access, trying to get to the patient as
quickly and simply as possible without using any tools or breaking any glass. Remember,
you should not attempt to gain access to the patient or enter the vehicle until you are
sure that the vehicle is stable and that any hazards have been identified and properly
controlled or eliminated. Automobiles are built for easy entry and exit. Whenever
possible, you should try to unlock the doors (or ask the patient to unlock them) or roll
down the windows. Try to open every door using the door handles to gain access before
breaking any windows or using other methods of forced entry. 1061-1062
In a case where CPR might be necessary to be used, the patient might need to be
extracted from the vehicle first using the rapid extraction technique. A team of EMT-B’s
who are experienced in using this technique should be able to rapidly remove a patient
who is not entrapped, keeping in mind the patients condition and the group’s safety.
1062
Disentanglement involves the removal of the motor vehicle from around the patient.
Rescue personnel should coordinate with you to determine the best route of removing
the patient from the vehicle. 1063
Once the patient has been freed post a motor vehicle crash, make sure the spine is
manually immobilized, and apply a cervical collar if not previously done. Reevaluate
whether the patient needs to be immediately removed by using manual immobilization
and the rapid extrication technique or whether the patient’s condition and the scene
allow for immobilization using an extrication vest or short backboard before he or she is
moved further. In most cases it is impractical and difficult to properly apply extremity
splints within the vehicle. Extremity injuries can generally be rapidly supported and
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immobilized while the patient is being removed by securing an injured arm to the body
and, if a leg is injured, securing one leg to the other. 1064
When called to the scene of a law enforcement tactical situation, you should determine
the location of the command post (location to the incident commander) and report to
the incident commander for instructions. The command post is usually located in an
area that cannot be seen by the suspect and is out of range of possible gunfire. 1067
In recent years, a number of leadership and command systems have been developed to
improve the on-scene management of emergency situations. These programs are called
incident command systems (ICS). The incident command system is designed for use of
daily operations. However it is most effective when used to large numbers of personnel
at complex incidents such as hazardous material spills and MCI’s. 1074
The incident commander will usually appoint a safety officer who will circulate among
responding personnel. It is essential that every EMT-B understand that any order or
directive issued by a safety officer has the full authority of the incident commander and
must be immediately followed. Many times EMT-B’s cannot see a hazard or problem
they are walking into, and the safety officer is responsible for protecting all personnel
and any victims of the incident. He also may be named by the incident commander to
coordinate incoming fire, police, and EMS units. 1074-1075
As an EMT-B, you and your team cannot treat and transport all injured patients at the
same time. At a mass-casualty incident, you will often an increase demand for
equipment and personnel. You should never leave the scene with patients who are
loaded if there are other patients who are sick and wounded. This would leave patients
at the scene without medical care and can be considered abandonment. 1079
In a smaller scale mass-casualty incident, the first provider on the scene with the highest
level of training usually begins the triage process. When the backup ambulances and
crews are readily available, patients are ranked in order of severity of their conditions.
The patient with the most sever injuries is given priority attention. 1081
In many cases the closest hospital will be used for red-tagged patients, and the more
stable yellow-tagged patients will be transported to further hospitals. The transport
officer is responsible for sending the ambulance to the appropriate hospital or the next
hospital in turn. Normally, no more than 2 patients are placed in the same ambulance.
However, with severe weather, a green-tagged patient may be seated in the ambulance
next to the driver for transportation to a comfortable, safe indoor holding area at the
hospital. 1082
Triage Priorities: Red (patients who need immediate care and transport. Treat these
patients 1st, and transport asap.): airway or breathing problems, uncontrolled or sever
bleeding, decreased LOC, severe medical problems, signs of shock (hypoperfusion),
sever burns. Yellow (patients whose treatment and transportation can be temporarily
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delayed): burns without airway problems, major or multiple bon or joint injuries, back
injuries with or without spinal cord damage. Green (patients who do not require any
treatment or whose treatment and transportation can be delayed until last): minor
fractures, minor soft tissue injuries. Black (patients whoa are already dead {DOA} or
have little chance for survival. If resources are limited, treat salvageable patients
before treating these patients): obvious death, obviously nonsurvivable injury, such as
major open brain trauma, respiratory arrest (if limited resources), cardiac arrest. 1083
In the event you arrive at a hazardous site, until the Hazmat team arrives to determine
the hazard zone, you should be aware of the safety perimeters that are necessary for
hazardous materials that are toxic, and those in which there is danger of fire or
explosion. Determining a safe perimeter must involve the assessment of many factors
related to the substance, the environment, containment, and training. 1087
Patients’ skin and clothing may contain hazardous material, so a decontamination area
should be set up between the hazard zone and the treatment area. The
decontamination area is the designated area where contaminates are removed before
an individual can go to another area. Decontamination is the process of removing or
neutralizing and properly disposing of hazardous materials from equipment, patients,
and rescue personnel. Toxicity levels are measures of the health risk that a substance
poses to someone who comes into contact with it. There are 5 levels, from 0-4. The
higher the number, the greater the toxicity: level 0- includes materials that would cause
little, if any, health hazard. Level 1- materials that would cause irritation on contact.
Level 2- materials that cause temporary damage or residual injury unless prompt
medical treatment is provided. Level 3- materials that include extremely hazardous to
health. Level 4- materials that are so hazardous that minimal contact will cause death.
1089
A weapon of mass destruction (WMD), or weapon of mass causality (WMC), is any
agent designed to bring about mass death, causalities, and/or massive damage to
property and infrastructure (bridges, tunnels, airports, and seaports). These instruments
of death and destruction include nuclear, chemical, biological, and explosive weapons.
1101
Most acts of terror are covert, which means that the public safety community generally
has no prior knowledge of the time, location, or nature of the attack. This element of
surprise makes responding to an event more complex. 1102
The Dept. of Homeland Security Advisory System is posted daily to heighten awareness
of the current terrorist threat. SEVERE (red): sever risk of terrorist attack, HIGH
(orange): high risk of terrorist attack, ELEVATED (yellow): significant risk of terrorist
attacks, GUARDED (blue): general risk of terrorist attacks, LOW (green): low risk of
terrorist attacks. 1103
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The first arriving provider on the scene must begin to sort out the chaos and define his
or her responsibilities under the ICS. As the first person on scene, the EMT-B may need
to establish command until additional resources arrive. Depending on the
circumstances, you and other EMT-B’s may function as medical branch officers,
transportation or logistic officers, or staff. 1105
Biological agents are grouped as viruses, bacterium, or neurotoxins and may be spread
in various ways. Dissemination is the means by which a terrorist will spread the agentfor example, poisoning the water supply or aerosolizing the agent into the air or
ventilation system of a building. 1112
Ricin when introduced into the body causes pulmonary edema and respiratory and
circulatory failure leading to death. Ingestion causes local hemorrhage and necrosis of
the liver, spleen, kidney, and gastrointestinal tract. It will also show sign of fever,
headache, chills, and nausea, just like when it’s inhaled. Unlike other biological agents
ricin can not be transmitted from person to person, although it is very sever, it has a
very high fatality rate and a person can die within 10-12 days for ingestion. 1117-1119
The energy that is emitted from a strong radiological source is either alpha, beta,
gamma (x-rays), or neutron radiation. Alpha is the least harmful penetrating type of
radiation and cannot travel fast or through most objects. Beta radiation is slightly more
penetrating than alpha, and requires a layer of clothing to stop it. Gamma rays are far
faster and stronger than alpha and beta rays. These easily penetrate the human body
and require several inches of lead or concrete to prevent penetration. Neutrons easily
penetrate through lead and require several feet of concrete to stop them. 1120
There are no suits or protective gear designed to completely shield from radiation. The
best way to protect yourself from the effects of radiation is to use time, distance, and
shield yourself in Level C protection from the source. 1122
A gastric tube is an advanced airway adjunct that provides a channel directly into a
patient’s stomach, allowing you to remove gas, blood, and toxins or to instill
medications and nutrition. In the field, you will use a gastric tube primarily to
decompress the stomach of a patient with gastric distention, a problem that is most
common in children during artificial ventilation but is also seen in adults. 1135
Endotracheal intubation is the insertion of a tube into the trachea to maintain the
airway. First you must try to open the airway with the appropriate BLS maneuver, clear
the airway, and ventilate the patient with a BVM device. If the BLS maneuver fails to
open the airway, you should consider endotracheal intubation based on your local
protocols. When performing this patient make sure it is positioned correctly. Reassess
the positioning after you get into the ambulance to make sure it’s still in the correct
position. 1137
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The purpose of a laryngoscope is to sweep the tongue out of the way and align the
airway so that you can see the vocal cords and pass the ET tube through them. The 2
blade designs function differently to align the structures so that you can visualize the
vocal cords. The curved (Macintosh) blade is inserted just in front of the epiglottis, into
the vallecula (the space between the base of the tongue and the epiglottis), allowing
you to see the glottic opening and the vocal cords. The straight (miller) blade is inserted
into the epiglottis. 1139
When sizing an ET tube for a child, it is best to have a chart or length-based tape device
to help you with it. Generally for newborns- small infants ranges from 3.0 to 3.5 mm;
infants-1yr, is 4.0 mm; for children add 16 to the child’s age and then divide it by 4. 1141
A plastic-coated wire called a stylet may be inserted into the ET tube to add rigidity and
shape to the tube. Bend the tip of the stylet to form a gentle curve in adults. For
children and infants, you should bend it into a hockey stick shape. Do not insert the
stylet past Murphy’s eye because it could puncture or lacerate delicate airway tissues.
Rule of Thumb: keep the stylet ¼” proximal to the cuff in adults and 1” from the end of
the tube in infants and children. 1142
The Esophageal Tracheal Combitube (ETC) consists of a double-lumen tube and 2
balloon cuffs. The blue lumen is the primary one, while the clear lumen is the ventilation
port if the tube is placed in the trachea. The clear cuff at the tip of the tube seals off the
esophagus or the trachea. The blue and white pilot balloons correspond to the fleshcolored and distal cuffs. You should not attempt to insert an ETC in the following
individuals: conscious or semiconscious patients with gag reflex, children younger than
16 years old, adults shorter than 5’ tall, patients who have ingested a caustic substance,
and patients who have known esophageal disease. 1152-1153
In a prehospital setting, the choice of IV solution is limited to the isotonic crystalloids,
normal saline and lactated Ringer’s solution. D5W (5% dextrose in water) is often
reserved for administering medications. Each IV solution bag is wrapped in a protective
sterile bag and is guaranteed to remain sterile until the posted expiration date. Once the
protective wrap is torn and removed, the IV solution has a shelf life of 24hrs. 1167
There are different sizes of administration sets for different situations and patients.
Most drip sets have a number visible on the package which indicates the number of
drips it takes for a milliliter of fluid to pass through the orifice and into the drip
chamber. There are mainly 2 sizes, microdrip and macrodrip. Microdrip sets allow 60
gtt (drops)/ml through the small, needlelike orifice inside the drip chamber. It’s ideal for
medication administration or pediatric fluid. Macrodrip sets allow 10 to 15 gtt/ml
through a large opening between the piercing spike and the drip chamber. They are best
used for rapid fluid replacement. 1168
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Intraosseous (IO) needles are used for emergency venous access in pediatric patients as
defined by protocol when immediate IV access is difficult or impossible. The IO needles
are inserted in the proximal tibia with a rigid, boring IV catheter, commonly known as a
Jamshedi needle. 1171
Most local reactions require that the IV catheter be removed and reinserted at an
alternative site. Some examples of common local reactions include the follow:
infiltration, phlebitis, occlusion, vein irritation, hematoma. 1172
An unmonitored IV bag can lead to circulatory overload. Healthy adults can handle as
much as 2 to 3 extra liters of fluid without compromise. Patient presentation includes
shortness of breath, JVD, and increased blood pressure. Crackles are often heard when
evaluating breath sounds. Acute peripheral edema can also indicate circulatory
overload. 1174
Smaller catheters may be preferable for geriatric patients unless rapid fluid replacement
is needed. Some medications commonly used by older patients have the tendency to
create fragile skin and veins. Often simply puncturing a vein will cause a massive
hematoma.1175-1176
The paper on which an ECG is recorded contains a grid. As the ECG is recorded, the
paper passes underneath the pen at a rate of 25mm/sec. each little box on the ECG
paper represents 1/25 of a second, or .04 seconds. Each bigger box on the paper is
composed of five smaller boxes, making each box 5 x .04 seconds, or .20 seconds.
Finally, 5 big boxes equal 1 second. 1185
The electrical activity in the atria begins the P wave. As electrical activity occurs in the
ventricles, the QRS complex begins to form. The electrical activity continues through the
main portion of the left ventricle and gives rise to the large R wave. Electrical activity in
the last part of the left ventricle is represented as the S wave or end portion of the QRS
complex. The normal QRS interval is between .06 and .11 seconds. Then the final part is
the T wave that forms. The heart is relaxing. Then everything should repeat again. 11851187
Tachycardia refers to a fast heart rate, more than 100 beats/min to be exact. Sinus
tachycardia is a rhythm that has consistent P waves, consistent P-R intervals, and a
regular heart rate that is more than 100 beats/min, also known as a normal sinus rate
(NSR). while a Sinus rhythm is a rhythm in which the SA node acts as a pacemaker. All of
the P waves on the patients ECG should be the same. A normal rate for most people is
from 60-100 beats/min. The only difference between the 2 is the depolarization rate.
1185-1186
For any given patient, the heart rate is determined by a constant tug-of-war between
the sympathetic and the parasympathetic divisions of the autonomic nervous system. If
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the parasympathetic dominates, the rhythm is slowed. The sympathetic dominates, the
rhythm is sped up.1188
A 4-lead ECG contains 4 leads, which are electrodes attached to wires, that are attached
to the cardiac monitor. They are called limb leads. The white lead should be placed on
the right shoulder, while the black lead is on the left shoulder. The green lead goes on
the patient’s right abdomen, and the red lead goes on the left abdomen. 1191