RC Health Services EMT-B Final Exam
Review
1. Understand anatomy, physiology, assessment and management of face and neck injuries.
- ANS-The head is divided into two parts: The cranium The face
The cranium contains the brain, which connects to the spinal cord through the foramen
magnum, a large opening at the base of the skull.
The most posterior portion of the cranium is called the occiput.
On each side of the cranium, the lateral portions are called the temples or temporal regions.
Between the temporal regions and the occiput lie the parietal regions.
The forehead is called the frontal region. Just anterior to the ear, in the temporal region, you
can feel the pulse of the superficial temporal artery.Factors that may contribute to airway
obstruction include:
Bleeding from facial injuries The bleeding can be very heavy, producing large blood clots in
the upper airway. These clots can lead to complete obstruction, particularly in a patient who
is not fully conscious.
Direct injuries to the nose and mouth, the larynx, or the trachea These injuries can cause
significant bleeding and/or respiratory compromise. You may need to suction the airway if
you are unable to control the bleeding. Injuries may cause loosened teeth or dentures to
become dislodged into the throat, where they may be swallowed or aspirated. Swelling that
often accompanies direct and indirect injury to the soft tissues in the face or neck When the
patient's head is turned to the side, as often is done when the patient has an altered level of
consciousness or is unconscious Possible injuries to the brain and/or cervical spine that may
be associated with facial injuries If the great vessels in the neck are injured, significant
bleeding and pressure on the upper airway are common.Because the face and neck are
extremely vascular, swelling from soft-tissue injuries may be more severe than in other
injured parts of the body.
A blunt injury that does not break the skin may cause a break in a bl
\1. Understand anatomy, physiology, assessment and management of gynecologic
emergencies. - ANS-Includes external and internal structures:External:Vaginal opening,
urethral openingClitorisLabia majora and minoraAnusPerineumInternal:Ovaries lie on each
side and produce an ovum (egg) which develops into a fetusFallopian tubes connect ovary
to uterusUterus is where fetus grows during pregnancyNarrowest part of uterus is
cervixVagina is lower part of birth canal
When a female reaches puberty, she begins to ovulate and experience menstruation. This is
called menarche, usually occurs between 11 and 16 years oldMenopause marks the end of
menstrual activity and usually occurs around age 50 Each ovary produces an ovum in
alternating months
1. Privacy: move patient somewhere private and have female conduct treatment/assessment
if possible2. Treat excessive bleeding with pads and document how many were used3.
There's a rich nerve supply so treat with sterile compresses/bandage diaper
\1. Understand anatomy, physiology, assessment of the gynecological patient. - ANS-The
placenta develops while attached to the inner lining of the wall of the uterus and is
,connected to the fetus by the umbilical cord. After delivery of the newborn, the placenta
separates from the uterus and is delivered.
The umbilical cord connects the woman and fetus through the placenta. It contains two
arteries and one vein. The umbilical vein carries oxygenated blood from the placenta to the
heart of the fetus, and the umbilical arteries carry deoxygenated blood from the heart of the
fetus to the placenta.
Oxygen and other nutrients cross from the woman's circulation through the placenta and
then through the umbilical cord to support the fetus as it grows.
The fetus develops inside a fluid-filled, bag-like membrane called the amniotic sac, or bag of
waters. This sac contains about 500 to 1,000 mL of amniotic fluid, which helps insulate and
protect the fetus. When the sac ruptures, usually at the beginning of labor, the amniotic fluid
is released in a gush. Some women may experience a small leak rather than a gush of fluid.
This fluid helps to lubricate the birth canal and remove any bacteria.
A pregnancy that has reached full term is referred to as term gestation.
Reproductive system
Hormone levels increase to support fetal development and prepare the body for childbirth.
These increased hormone levels also put the pregnant woman at an increased risk for
complications from trauma, bleeding, and some medical conditions.
As the size of the uterus increases, so does the amount of fluid it contains.
Respiratory system
Rapid uterine growth occurs during the second trimester of pregnancy. The increased size of
the uterus directly affects the respiratory system.
As the uterus grows, it pushes up on the diaphragm, displacing it from its normal position.
As the pregnancy continues, respiratory capacity changes, with incr
\1. Understand common abdominal conditions. - ANS-Appendcitis-right lower quadrant
(direct); around navel (referred); rebounding pain (pain felt on the rebound of palpation)
Cholecystitis-Right upper quadrant (direct); right shoulder (referred)
Ulcer-Upper midabdomen or upper part of back
Diverticulitis-Left lower quadrant
Abdominal aortic aneurysm (ruptured or dissecting)
-Low part of back and lower quadrants
Cystitis (inflammation of the bladder)-Lower midabdomen (retropubic)
Kidney Infection-costovertebral angle
Kidney Stone-Right or left Flank, radiating to genitalia
Pancreatitis-Upper abdomen (both quadrants); back
Pneumonia-Referred pain to the upper abdomen
Hernia-Anywhere in the abdominal area
Peritonitis-Anywhere in the abdominal area
\1. Understand continuum of care. - ANS-Previous models of emergency care often
consisted of providers who worked separately, passing the patient from one individual or
group to the next.
Gradually, emergency health care providers recognized that by working as a unified team
from first patient contact to patient discharge, it was possible to improve individual and team
performance; patient and provider safety; and, ultimately, patient outcome.
\1. Understand how to assess and manage psychiatric emergencies: - ANS-rs. The patient
may be aware of the danger his behavior poses (as with an overdose with the intent to die)
or he may lack insight into the effects of his actions (as in the case of a manic patient who
engages in reckless sexual behavior). Even if the patient perceives that his actions are
,dangerous, he may be bent on engaging in these behaviors despite the risks. (A patient with
schizophrenia who follows command hallucinations to commit theft is an example). Because
of their lack of insight and judgment, patients in psychiatric emergencies are often brought to
the attention of medical professionals by people in the community, including friends, family,
police officers, or even bystanders.
Astute psychiatrists may also recognize psychiatric emergencies during routine outpatient
care. Patients may report their inability to remain safe, either spontaneously or as elicited by
the psychiatrist. When an emergency is recognized, the clinician must:
• Perform a complete assessment of the concerning behavior
• Reduce risk by transferring the patient to an emergency department (ED) or to a psychiatric
hospital as needed
• Provide or arrange for follow-up for continuity of care
Agitation is a common element in many psychiatric emergencies and poses unintentional
danger both to self and to others. Intentional self-endangerment is often accompanied by
suicidal ideation. This article will focus on these presentations.
\1. Understand how to recognize and manage carbon monoxide and nerve agent poisonings.
- ANS-If you suspect the presence of a toxic gas, call for specialized resources such as the
hazardous materials (HazMat) team.
Never approach a contaminated patient unless you have specialized HazMat training and
are using the appropriate PPE.
The patient may have: Burning eyes Sore throat Cough Chest pain Hoarseness Wheezing
Respiratory distress Dizziness Confusion Headache Stridor (in severe cases) Seizures
Altered mental status
Most inhaled toxins can be treated by removing the patient from the exposure and applying
oxygen.
Some inhaled agents cause progressive lung damage, even after the patient has been
removed from direct exposure; the damage may not be evident for several hours.
\1. Understand pathophysiology, assessment and management of environmental
emergencies. - ANS-Factors affecting exposure include:
Physical condition
Patients who are ill or in poor physical condition will not be able to tolerate extreme
temperatures as well as those whose cardiovascular, metabolic, and nervous systems are all
functioning well.
Exertion also plays a role. For instance, a brisk walk will generate body heat when you are
out in the cold, but will also produce heat when it is
Children and older adults are more likely to experience temperature-related illness.
Infants have poor thermoregulation at birth and do not have the ability to shiver and generate
heat when needed until about 12 to 18 months. An infant's surface-area-to-mass ratio is
larger than an adult's, so infants heat up and cool down faster.
Older adults have a loss of subcutaneous tissues as they age, reducing the amount of
insulation they have. Poor circulation also contributes to increased heat loss. Medications
can also affect an older person's body thermostat, putting him or her at increased risk for
temperature-related emergencies. Older patients are also at high risk for falls, and lying
immobile on a hot or cold surface can rapidly lead to overexposure.
Hypothermia means "low temperature" and occurs when core temperature falls below 95°F
(35°C).
, To protect itself against heat loss, the body: Constricts blood vessels in the skin, which
results in the characteristic appearance of blue lips and/or fingertips Creates additional heat
by shivering
If the patient is alert, is shivering, responds appropriately, and has a core body temperature
is between 90°F to 95°F (32.2°C to 35°C), the hypothermia is mild.
Begin passive rewarming slowly, which includes placing the patient in a warm environment;
removing wet clothing; and applying heat packs or hot water bottles to the groin, axillary, and
cervical regions.
Turn the heat up high in the
\1. Understand pathophysiology, assessment and management of orthopedic injuries. -
ANS-The initial evaluation of a patient with an orthopedic injury should focus on the
ABCDE,'s (airway, breathing, circulation, orthopedic and/or neurologic disability, exposure)
during the primary survey of a trauma evaluation. The evaluation of orthopedic injuries
follows as part of a secondary survey, unless there is active hemorrhage associated with an
extremity injury or a pulseless limb. In these cases, the evaluation and management should
be a part of the circulation or 'C' part of the primary survey. Once the patient is stable and the
secondary survey is being performed, there should be a focused assessment of the injured
extremity. For those with isolated orthopedic injuries, the assessment of neurovascular
status should take priority.
\1. Understand pathophysiology, assessment and management of the trauma patient. -
ANS-the leading cause of death in young adults is trauma. Traumatic injuries may range
from small lesions to life-threatening multi-organ injury. In order to achieve the best possible
outcomes while decreasing the risk of undetected injuries, the management of trauma
patients requires a highly systematic approach. Prehospital trauma care involves first aid
and basic life support administered by emergency services personnel. In the hospital setting,
the treatment of trauma patients is traditionally divided into primary (Advanced Trauma Life
Support), secondary, and tertiary surveys. Each survey consists of an algorithm designed to
diagnose and manage injuries sequentially in order of decreasing morbidity and mortality.
Further steps are taken to provide analgesia and determine whether patients should be
transferred to specialized trauma centers as quickly as possible.
\1. Understand pathophysiology, assessment and management of wounds, burns and crush
syndrome. - ANS-There are three types of soft-tissue injuries:
Closed injuries, in which soft-tissue damage occurs beneath the skin or mucous membrane
but the surface of the skin or mucous membrane remains intact
Open injuries, in which there is a break in the surface of the skin or the mucous membrane,
exposing deeper tissues to potential contamination Burns, in which the soft-tissue damage
occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear
radiation.
You must be able to identify the following three types of burns:
Superficial (first-degree) burns Involve only the epidermis The skin turns red but does not
blister or burn through this top layer. The burn site is often painful. Sunburn is a good
example of a superficial burn.
Partial-thickness (second-degree) burns Involve the epidermis and some portion of the
dermis These burns do not destroy the entire thickness of the skin nor is the subcutaneous
tissue injured. Typically, the skin is moist, mottled, and white to red. Blisters are present.
Partial-thickness burns cause intense pain. Full-thickness (third-degree) burns Extend
through all skin layers and may involve subcutaneous layers, muscle, bone, or internal
organs The burned area is dry and leathery and may appear white, dark brown, or even
Review
1. Understand anatomy, physiology, assessment and management of face and neck injuries.
- ANS-The head is divided into two parts: The cranium The face
The cranium contains the brain, which connects to the spinal cord through the foramen
magnum, a large opening at the base of the skull.
The most posterior portion of the cranium is called the occiput.
On each side of the cranium, the lateral portions are called the temples or temporal regions.
Between the temporal regions and the occiput lie the parietal regions.
The forehead is called the frontal region. Just anterior to the ear, in the temporal region, you
can feel the pulse of the superficial temporal artery.Factors that may contribute to airway
obstruction include:
Bleeding from facial injuries The bleeding can be very heavy, producing large blood clots in
the upper airway. These clots can lead to complete obstruction, particularly in a patient who
is not fully conscious.
Direct injuries to the nose and mouth, the larynx, or the trachea These injuries can cause
significant bleeding and/or respiratory compromise. You may need to suction the airway if
you are unable to control the bleeding. Injuries may cause loosened teeth or dentures to
become dislodged into the throat, where they may be swallowed or aspirated. Swelling that
often accompanies direct and indirect injury to the soft tissues in the face or neck When the
patient's head is turned to the side, as often is done when the patient has an altered level of
consciousness or is unconscious Possible injuries to the brain and/or cervical spine that may
be associated with facial injuries If the great vessels in the neck are injured, significant
bleeding and pressure on the upper airway are common.Because the face and neck are
extremely vascular, swelling from soft-tissue injuries may be more severe than in other
injured parts of the body.
A blunt injury that does not break the skin may cause a break in a bl
\1. Understand anatomy, physiology, assessment and management of gynecologic
emergencies. - ANS-Includes external and internal structures:External:Vaginal opening,
urethral openingClitorisLabia majora and minoraAnusPerineumInternal:Ovaries lie on each
side and produce an ovum (egg) which develops into a fetusFallopian tubes connect ovary
to uterusUterus is where fetus grows during pregnancyNarrowest part of uterus is
cervixVagina is lower part of birth canal
When a female reaches puberty, she begins to ovulate and experience menstruation. This is
called menarche, usually occurs between 11 and 16 years oldMenopause marks the end of
menstrual activity and usually occurs around age 50 Each ovary produces an ovum in
alternating months
1. Privacy: move patient somewhere private and have female conduct treatment/assessment
if possible2. Treat excessive bleeding with pads and document how many were used3.
There's a rich nerve supply so treat with sterile compresses/bandage diaper
\1. Understand anatomy, physiology, assessment of the gynecological patient. - ANS-The
placenta develops while attached to the inner lining of the wall of the uterus and is
,connected to the fetus by the umbilical cord. After delivery of the newborn, the placenta
separates from the uterus and is delivered.
The umbilical cord connects the woman and fetus through the placenta. It contains two
arteries and one vein. The umbilical vein carries oxygenated blood from the placenta to the
heart of the fetus, and the umbilical arteries carry deoxygenated blood from the heart of the
fetus to the placenta.
Oxygen and other nutrients cross from the woman's circulation through the placenta and
then through the umbilical cord to support the fetus as it grows.
The fetus develops inside a fluid-filled, bag-like membrane called the amniotic sac, or bag of
waters. This sac contains about 500 to 1,000 mL of amniotic fluid, which helps insulate and
protect the fetus. When the sac ruptures, usually at the beginning of labor, the amniotic fluid
is released in a gush. Some women may experience a small leak rather than a gush of fluid.
This fluid helps to lubricate the birth canal and remove any bacteria.
A pregnancy that has reached full term is referred to as term gestation.
Reproductive system
Hormone levels increase to support fetal development and prepare the body for childbirth.
These increased hormone levels also put the pregnant woman at an increased risk for
complications from trauma, bleeding, and some medical conditions.
As the size of the uterus increases, so does the amount of fluid it contains.
Respiratory system
Rapid uterine growth occurs during the second trimester of pregnancy. The increased size of
the uterus directly affects the respiratory system.
As the uterus grows, it pushes up on the diaphragm, displacing it from its normal position.
As the pregnancy continues, respiratory capacity changes, with incr
\1. Understand common abdominal conditions. - ANS-Appendcitis-right lower quadrant
(direct); around navel (referred); rebounding pain (pain felt on the rebound of palpation)
Cholecystitis-Right upper quadrant (direct); right shoulder (referred)
Ulcer-Upper midabdomen or upper part of back
Diverticulitis-Left lower quadrant
Abdominal aortic aneurysm (ruptured or dissecting)
-Low part of back and lower quadrants
Cystitis (inflammation of the bladder)-Lower midabdomen (retropubic)
Kidney Infection-costovertebral angle
Kidney Stone-Right or left Flank, radiating to genitalia
Pancreatitis-Upper abdomen (both quadrants); back
Pneumonia-Referred pain to the upper abdomen
Hernia-Anywhere in the abdominal area
Peritonitis-Anywhere in the abdominal area
\1. Understand continuum of care. - ANS-Previous models of emergency care often
consisted of providers who worked separately, passing the patient from one individual or
group to the next.
Gradually, emergency health care providers recognized that by working as a unified team
from first patient contact to patient discharge, it was possible to improve individual and team
performance; patient and provider safety; and, ultimately, patient outcome.
\1. Understand how to assess and manage psychiatric emergencies: - ANS-rs. The patient
may be aware of the danger his behavior poses (as with an overdose with the intent to die)
or he may lack insight into the effects of his actions (as in the case of a manic patient who
engages in reckless sexual behavior). Even if the patient perceives that his actions are
,dangerous, he may be bent on engaging in these behaviors despite the risks. (A patient with
schizophrenia who follows command hallucinations to commit theft is an example). Because
of their lack of insight and judgment, patients in psychiatric emergencies are often brought to
the attention of medical professionals by people in the community, including friends, family,
police officers, or even bystanders.
Astute psychiatrists may also recognize psychiatric emergencies during routine outpatient
care. Patients may report their inability to remain safe, either spontaneously or as elicited by
the psychiatrist. When an emergency is recognized, the clinician must:
• Perform a complete assessment of the concerning behavior
• Reduce risk by transferring the patient to an emergency department (ED) or to a psychiatric
hospital as needed
• Provide or arrange for follow-up for continuity of care
Agitation is a common element in many psychiatric emergencies and poses unintentional
danger both to self and to others. Intentional self-endangerment is often accompanied by
suicidal ideation. This article will focus on these presentations.
\1. Understand how to recognize and manage carbon monoxide and nerve agent poisonings.
- ANS-If you suspect the presence of a toxic gas, call for specialized resources such as the
hazardous materials (HazMat) team.
Never approach a contaminated patient unless you have specialized HazMat training and
are using the appropriate PPE.
The patient may have: Burning eyes Sore throat Cough Chest pain Hoarseness Wheezing
Respiratory distress Dizziness Confusion Headache Stridor (in severe cases) Seizures
Altered mental status
Most inhaled toxins can be treated by removing the patient from the exposure and applying
oxygen.
Some inhaled agents cause progressive lung damage, even after the patient has been
removed from direct exposure; the damage may not be evident for several hours.
\1. Understand pathophysiology, assessment and management of environmental
emergencies. - ANS-Factors affecting exposure include:
Physical condition
Patients who are ill or in poor physical condition will not be able to tolerate extreme
temperatures as well as those whose cardiovascular, metabolic, and nervous systems are all
functioning well.
Exertion also plays a role. For instance, a brisk walk will generate body heat when you are
out in the cold, but will also produce heat when it is
Children and older adults are more likely to experience temperature-related illness.
Infants have poor thermoregulation at birth and do not have the ability to shiver and generate
heat when needed until about 12 to 18 months. An infant's surface-area-to-mass ratio is
larger than an adult's, so infants heat up and cool down faster.
Older adults have a loss of subcutaneous tissues as they age, reducing the amount of
insulation they have. Poor circulation also contributes to increased heat loss. Medications
can also affect an older person's body thermostat, putting him or her at increased risk for
temperature-related emergencies. Older patients are also at high risk for falls, and lying
immobile on a hot or cold surface can rapidly lead to overexposure.
Hypothermia means "low temperature" and occurs when core temperature falls below 95°F
(35°C).
, To protect itself against heat loss, the body: Constricts blood vessels in the skin, which
results in the characteristic appearance of blue lips and/or fingertips Creates additional heat
by shivering
If the patient is alert, is shivering, responds appropriately, and has a core body temperature
is between 90°F to 95°F (32.2°C to 35°C), the hypothermia is mild.
Begin passive rewarming slowly, which includes placing the patient in a warm environment;
removing wet clothing; and applying heat packs or hot water bottles to the groin, axillary, and
cervical regions.
Turn the heat up high in the
\1. Understand pathophysiology, assessment and management of orthopedic injuries. -
ANS-The initial evaluation of a patient with an orthopedic injury should focus on the
ABCDE,'s (airway, breathing, circulation, orthopedic and/or neurologic disability, exposure)
during the primary survey of a trauma evaluation. The evaluation of orthopedic injuries
follows as part of a secondary survey, unless there is active hemorrhage associated with an
extremity injury or a pulseless limb. In these cases, the evaluation and management should
be a part of the circulation or 'C' part of the primary survey. Once the patient is stable and the
secondary survey is being performed, there should be a focused assessment of the injured
extremity. For those with isolated orthopedic injuries, the assessment of neurovascular
status should take priority.
\1. Understand pathophysiology, assessment and management of the trauma patient. -
ANS-the leading cause of death in young adults is trauma. Traumatic injuries may range
from small lesions to life-threatening multi-organ injury. In order to achieve the best possible
outcomes while decreasing the risk of undetected injuries, the management of trauma
patients requires a highly systematic approach. Prehospital trauma care involves first aid
and basic life support administered by emergency services personnel. In the hospital setting,
the treatment of trauma patients is traditionally divided into primary (Advanced Trauma Life
Support), secondary, and tertiary surveys. Each survey consists of an algorithm designed to
diagnose and manage injuries sequentially in order of decreasing morbidity and mortality.
Further steps are taken to provide analgesia and determine whether patients should be
transferred to specialized trauma centers as quickly as possible.
\1. Understand pathophysiology, assessment and management of wounds, burns and crush
syndrome. - ANS-There are three types of soft-tissue injuries:
Closed injuries, in which soft-tissue damage occurs beneath the skin or mucous membrane
but the surface of the skin or mucous membrane remains intact
Open injuries, in which there is a break in the surface of the skin or the mucous membrane,
exposing deeper tissues to potential contamination Burns, in which the soft-tissue damage
occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear
radiation.
You must be able to identify the following three types of burns:
Superficial (first-degree) burns Involve only the epidermis The skin turns red but does not
blister or burn through this top layer. The burn site is often painful. Sunburn is a good
example of a superficial burn.
Partial-thickness (second-degree) burns Involve the epidermis and some portion of the
dermis These burns do not destroy the entire thickness of the skin nor is the subcutaneous
tissue injured. Typically, the skin is moist, mottled, and white to red. Blisters are present.
Partial-thickness burns cause intense pain. Full-thickness (third-degree) burns Extend
through all skin layers and may involve subcutaneous layers, muscle, bone, or internal
organs The burned area is dry and leathery and may appear white, dark brown, or even
