2024 OCEMT FINAL EXAM ACTUAL QUESTIONSAND ANSWERS SOLVED 100%

2024 OCEMT FINAL EXAM ACTUAL QUESTIONS AND ANSWERS SOLVED 100% What are the respiratory rates when we should consider a BVM? - less than 8 ventilate, over 25 How do we determine adequate respirations? - equal chest rise and fall improved skin signs Wheezing - high pitched sound in lungs = lower airway Ronchi - loud rumbling, thick secretions (congestion) Crackles (Rales) - wet, gurgling Stridor - strained, high-pitched sound upper airway Corrective action if we no longer see visible chest rise while performing PP ventilation - reposition the airway still not rise and fall = obstruction, so suction Oxygen flow rates for: Nasal cannula - 1-6 L Oxygen flow rates for: Non-rebreather mask - 10-15LOxygen flow rates for: BVM - 15-25L Oxygen flow rates for: Nebulized breathing treatment - 6-8L What to ask and how to approach a patient who is possibly choking - "are you choking" if conscious with airway patent= allow them to cough it out if conscious with no airway= Heimlich Witness patient collapses.......what should your first objective be - chest compressions When do we simply encourage them to cough? - if they are moving air and they can talk a little bit How to treat a patient with a STOMA that is not with adequate respirations - BVM over stoma, and suction if needed (frenchie if clogged) When to treat a patient with humidified oxygen? Hint: think of croup in a pediatric patient. - upper respiratory infection breath in hot air swollen airway = to help get swelling down How to ask questions to a patient with extreme SOB (shortness of breathe) , what to ask and when...... - onset and provoctionsudden? onset? NPA vs. OPA (when they are indicated and contra-indicated) - Not breathing OPA = no gag relex, unconscious NPA = gag reflex, conscious -- facial trauma When to suction a patient and what suction catheter would be best for oropharynx - secretions, gurgling sounds, airway not patent yanker tip, rigid tip catheter Signs and symptoms of "Spontaneous Pneumothorax" and "Tension Pneumothorax" - S.P = diminished lung sounds to one side, fast breathing, increased heart rate, chest pain T.P = JVD, TD, tachycardia, diminished lung sounds, hypnotic skin signs Signs and symptoms of Pneumonia and its etiology - chills fever cough wheezing/ crackles green septum treatment: bls or als, transport with O2 assess: lung sounds, respirations, vital signsSigns and symptoms of Chronic Bronchitis and its etiology - shortness of breath, wheezing etiology: irritation of lung passage ways cause: smoking Difference between Systole and Diastole - systole (contraction) and diastole (relaxation) difference between both = pulse pressure If a patient regains their pulses after the use of an AED, what should we assist with? - ventilations Know the major contraindications with NTG (nitroglycerin) - low blood pressure erectile disfunction pills When dealing with a possible stroke patient, what questions are important to ask? - "when were they last seen normal" When assessing a patient with agonal respirations......what is our course of action? - bag them agonal = 2-4 breaths per min How to position a patient that appears to be in shock? - supine, with legs up Which chamber of the heart, when in failure is responsible for causing pulmonary edema? - right sided failure (#1 cause= left sided failure) (#1 cause of left sided heart failure= Myocardial infraction)What are the physical signs and characteristics of a patient that has heart failure? - difficulty breathing chest pain pulombary dema Jvd What (2) cardiac arrhythmia's will the AED shock? - V-fib Pulseless V-Tach The vessels that carry oxygenated blood versus the vessels that carry de-oxygenated blood....HINT, all vessels flowing away from heart are arteries. All veins flowing back to heart are Veins. - O2 blood = arteries No o2 blood veins Signs, Symptoms, and etiology of cardiogenic shock - massive heart attack and in shock irregular pulse = fast low blood pressure pale, cool, clammy TIA vs CVA - TIA= symptoms that mimic a stroke and go away after 24 hours CVA= Rupture of an artery with bleeding into the brain (hemorrhage)Subarachnoid Hemorrhage - Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates. "Worst headache of my life" blood pressure = hypertensive pulse pressure = widening pulse= slow respirations = unbalanced How the patient will present with "Left Sided Heart Failure" and their chief complaint - shortness of breath Sequential steps we take for initiating CPR - check response check pulse check clear airway, absent breath sounds, chest rise and fall No pulse = start compressions When treating a patient with a possible communicable disease, how should we handle our equipment? - proper PPE disinfect What are "Track Marks" on a patients arm and what type of OD would you suspect? - track marks = injection sightOD = narcotic abuse Considerations before administering oral glucose gel - hypoglycemia and ability to swallow apply in check/gums 15 grams Why and when do we remove a patient from an enclosed space before we treat? - a space that they need to be removed due to exposure unable to treat them When would we consider contacting poison control? - ingested a cleaner What is your priority when treating a patient with a possible communicable disease? - PPE N95 mask Signs and symptoms of possible narcotic overdose - pinpoint pupils slow breathing - respiratory arrest track marks cyanotichypotension treatment = transport, bag, intranasal narcan Signs and symptoms of internal bleeding - Discoloration/bruising, nausea, coughing up blood, painful/swollen/firm tissue, signs of shock Cholecystitis - inflammation of the gallbladder pain in the right shoulder after eating a fatty meal How to talk with a psych patient that appears suicidal - Do not say= tough it out, you're fine what you want to do= #1 calm them down and deescalate Signs and symptoms of Carbon Monoxide poisoning, what may be the cause? - hallmark sign = headache light headed/dizzy altered level of conciousness inaccurate spo2 furnace on How to remove a stinger from insect sting - scrap with a cardA patient with sickle cell anemia may need what? - O2 How to treat a patient that presents with heat related illness? - put them in a cool enviornment If bleeding from dialysis shunt, how and where do we control the bleeding? - direct pressure on shunt Signs and symptoms of pancreatitis - LUQ pain that radiates to back or left shoulder, brought on by large meal chronic use of alcohol low grade fever, possible jaundice if common bile duct involved, Altered LOC, tachycardia. Petite mal seizures - seizures without loss of consciousness but with cessation of ongoing behavior Focal motor seizures - A subtype of simple seizures in which abnormal brain activity remains localized to a specific motor area. Grand mal seizures - seizures characterized by loss of consciousness Status epilepticus seizures - rapid succession of epileptic seizures over 5 minutes Signs and symptoms of appendicitis - right lower quadrantAbdominal pain or cramping; N&V; Low grade fever and chills; lack of appetite; abdominal guarding more susceptible = 23 yr old When delivering a child, how do we address if cord is wrapped around baby's neck? - unwrap it What role does the placenta play - exchanges nutrients, waste and o2 between mother and baby Ectopic pregnancy - A pregnancy outside of the womb, usually in a fallopian tube 1st trimester Abruptio placentae - premature separation of the placenta from the uterine wall painfull 3rd trimester Placentae previa - painless bleeding 3rd trimester Spontaneous abortion - miscarriage1st trimester = within 20 weeks How do we position a pregnant female during transport and (WHY!!!!!) - left lateral recumbent to take pressure of the aorta What signs will be present for immediate delivery of newborn. Certain questions to ask mother and what to visualize - need to push or have bowel movement having contractions crowning Pre-eclampsia and Eclampsia.....understand the difference and how to treat - Pre-eclampsia = hypertension 140/90, swelling in hands and feet eclampsia= post seizure Ruptured ovarian cyst - NO FEVER Ruptured ovarian cysts present with acute abdominal pain without fever bleeding Pain from ruptured ovarian cysts may occur at any time throughout the menstrual cycle but often present around the time of ovulation Ask: when was your last menstrual periodPelvic Inflammatory Disease - abdominal pain discharge fever PID shuffle = hallmark sign When and why would we "massage the fundus" of mother after delivery? - To top the bleeding How to position mother if ONLY an umbilical cord is present upon inspection? - supine with legs up = knee to chest If a female has been sexually assaulted and bleeding from the vagina, what is the best way to treat? - vaginal pad Breech birth - Baby is delivered feet or buttocks first When would an EMT place gloved fingers into the vaginal opening during pregnancy related complications? - to relieve pressure from umbilical cord around babies neck perineum tearing? - tearing from vaginal canal to anus Normal respiratory rates for pediatrics, and adolescents - 6 year old = 18-30 respirations Integumentary system and its role - skin = protective barrier, regulate temperature What is the leading cause in Bradycardia for pediatrics? - respiratory failure due to hypoxiaCroup signs and symptoms as well as its etiology - seal bark cough stridor in pediatrics What type of bleeding requires direct pressure? As well as a tourniquet? - arterial bleed = uncontrollable bleeding still continues to bleed = tourniquet Signs and symptoms of meningitis - fever, headache, stiff neck, altered mental status, rash APGAR score.....what is our course of action for a child is bluish in color on extremities only and crying - dry, stimulate, wrap up and keep warm How to treat an allergic reaction and what is our primary concern versus Anaphylaxis - concern = swelling of airway treat= o2 When do we consider chest compressions on an a newborn? What abnormal vitals would we be concerned with? - pulse under 60 Signs and symptoms of a ruptured spleen on an child? - pain upper left quadrant bleedingdistended abdomen bruising/contusion Signs and symptoms of Epiglottitis - Sudden onset, high fever "Hot-potato" voice Dysphagia, drooling No cough Prefers to sit upright, lean forward (tripod position) Appears toxic and stridulous under 5 years old After the head of a newborn has been delivered, what should we observe for that would indicate a possible respiratory complication? - any obstructions to the babies airway = the amniotic sac is filled with Meconium (stool) When and why do we place the newborn at the level of the placentae (or vaginal opening) - to cut the umbilical cord at the level of the vaginal opening Regardless of any type of traumatic injury, if a patient is unresponsive our first priority should be? - ABC's or life threats Best way to treat frostbite on extremities would be...... - Remove from cold enviornment actively rewarm = slowly w/ blanketsGSW (gun shot wound) patient with injuries to thoracic cavity becomes increasingly SOB (shortness of breath), how can we assist the patient? - ventilate = non rebreather When treating a puncture injury to the chest wall, how do we want to place our semiocclusive dressing? - 3 sides occlusive dressing = lift one side of the inclusive dressing Head injuries and blood thinners, why is this such a bad combination and how may the patient present? - bleed out When we see bubbling and bleeding from a penetrating chest injury, what is our best dressing to apply? - full occlusive = to prevent air from coming in/out Main difference between a femur fracture and hip dislocation? HINT, they'll both present with outward rotation and shortening of extremity - obvious shortening and obvious rotation femur = hip dislocation = How to treat an OPEN femur fracture - Splint, sterile dressing, control bleeding and transport repare for shock If a knife is impaled into a bony structure on sternum, what do we do with the knife? - leave in place and stabilize with bulky dressings unless instructing with CPRSigns and symptoms of "Pulmonary Contusion" and what may have caused the injury - Trauma to the chest coughing up blood = hallmark sign bruising rupture of blood vessels = leaking into lungs rapid breathing Aortic Dissection - Tearing pain = hallmark sign hypertension diagnosis in which the arterial wall splits apart check cms on both sides How do we position a patient with a nose bleed - lean forward pinch the nose Rule of Nines.......burn to arm - part of arm = 4 1/2 full arm = 9 A laceration to the medial aspect of his neck, worried about subcutaneous emphysema, what dressing would be most appropriate? - full occlusive What are the recommended landing zones for air medical? 100' x 100' lame question here's the answer! - 100x100A patient presents with acute status cardiac symptoms, is delaying getting on the gurney, what's the best course of action? - explain the risks When do we consider requesting additional resources? - before scene safety before getting of rig, call dispatch Place bloody clothing in a brown paper bag. why? - for evidence DNR paperwork needs to be present to follow DNR protocols, what do we do if they are not? - Start CPR What is Quality Improvement in relation to EMS? - internal and external review of treatment, call, how we handled it and what we can do better and improve on Ex.- protocol we do, sucks - take it to the board to improve on When would we consider a "Rapid Extrication" even if C-spine is indicated - immediate danger cardiac arrest What BSI/PPE should we consider wearing if a patient has profuse bleeding? - gloves googles mask Consider notifying law enforcement with unusual circumstances surrounding death of a hospice patient.... Intentional OD - something does not add up to natural causeslook for cues Only a competent adult over the age of 18 may refuse treatment and transport regardless of illness/injury - TRUE When should we consider requesting heavy rescue tools in a TC? IE jaws of life - Crush car hallmark sign: remove car from patient When treating a patient that will need transport, what should we do with their minor on scene? - take them with us in the car seat call law enforcement When lifting a patient using "Power Grip" how many inches should our hands be apart? - 10 What color does "Black on the Triage Tag" represent? - expectant = dead Does everyone hear our sirens while driving code 3? How should we proceed thru intersections? - No, so consider stopping/slowing down at intersections because most don't hear it How do we correct an error on our documentation? Accepted legal form of correction - x through it and initial it Of the Hot, Warm, and Cold zones during a Haz Mat incident, which zones would be best for an EMT to triage? - cold Examples of community relations in EMS would be? - blood pressure checkpneumonia vs pulmonary edema vs csf - pneumonia = fever (contagious), dry/warm/flushed, ronchi CSF= fever (noncontagious), cool/clammy pulmonary edma= no fever, swollen ankles Signs and symptoms of ischemic stroke - slurred speech facial droop arm drift patient is zoned out - low blood sugar over dose poisoning seizure look @ age and other clues to know how to answer = seizure precipitous delivery - very rapid delivery - perineum tearing meningitis under 1 years old - Tense, bulging fontanelle (soft spot) Fever, cold hands and feet Refusing food vomiting Fretful, dislike being handledDrowsy, floppy, unresponsive Rapid breathing or grunting Pale, blotchy skin. Spots/rash. Unusual cry, moaning Stiff neck, dislike bright lights Convulsions/seizures meningitis over 5 years old - headache, pain in his back, or a stiff neck anerysm - a localized weak spot or balloon-like enlargement of the wall of an artery pulmonary edema - fluid in the air sacs and bronchioles Left sided congestive heart failure - When the left side of the heart fails, blood flows back into the lungs, causing difficulty breathing, anxiety, and cerebral hypoxia. Right sided congestive heart failure - When the right side of the heart fails, blood flows back into the venous system. Symptoms of right-sided heart failure include cyanotic nail beds, jaundice, and lower-extremity edema. chronic bronchitis and emphysema - COPD (chronic obstructive pluomanry disease) -Chronic bronchitis is a clinical diagnosis: chronic cough productive of sputum for at least 3 months per year for at least 2 consecutive years. -Emphysema is a pathologic diagnosis: permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar wallspneumothorax - collapsed lung when to check vital signs on an adult - where to check vital signs on a child - how long to check a pulse for hypothermia - 30 secs how long do you check pulse - 10 seconds sign/symptoms of cognitive heart failure - Shortness of breath (dyspnea) when you exert yourself or when you lie down. Fatigue and weakness. Swelling (edema) in your legs, ankles and feet. Rapid or irregular heartbeat. Reduced ability to exercise. Persistent cough or wheezing with white or pink blood-tinged phlegm. Increased need to urinate at night. What does nitroglycerin do? - 1. Vasodilator (the coronary arteries), opening up vessels to increase blood supply to the heart 2. Smooth muscle relaxant blood pressure will drop how do you position a patient who is given nitroglycerine - supinesubdural bleed - caused by a venous bleed between dura and arachnoid slow onset with lower pressures cardiac arrest when you first arrive - start compressions first 1st thing you do with chest pain and can't breath - O2 via non rebreather or assisted ventilations patient is having palpitations and heart is beating really fast, 1st thing you do is? - check pulse bowel movement of black tarry stool, what type of GI bleed is this? - Upper GI bleed 1st trimester - ecotopic pregnant spontaneous abortion 2nd trimester - pre-ecclmapsia 3rd trimester - abrutio placentia previa placentia gestational diabetes - diabetes during pregnancy 2nd and 3rd trimesterWhere is the spleen located? - left upper quadrant kid drooling and does not want to drink anything, what is it ? - epiglottis 2 year old who is grunting, with nasal flaring, and intercostal retractions - respiratory distress when delivering a newborn we look at the airway/mouth for ? - Meconium CPR is already being done when you get there what do you do? - Place AED Traumatic accident with a traumatic injury, breathing is labored. What do you do? - assist with ventilations with BVM acid splashed in their eyes, what do you do? - flush them when tightening a tourniquet, you stop till when - till it stops bleeding tension pneumothorax - JVD and tracheal deviation traumatic abdominal injury to upper right abdominal, what is that - liver bright red blood spurting - arterial bleed Paradoxical movement - a section of the chest that moves in the opposite direction to the rest of the chest during the phases of respiration. Typically seen with a flail segment flail chest - two or more ribs broken in two or more placesadult in respiratory failure, that was struck in the chest (traumatic injury). they are developing a subcutaneous emphysema, what is it? first thing you do? - air under the skin provide positive pressure ventilations when lifting a patient what should you do? - use you legs go on somebody that has been assaulted, and has DNA on clothing, what do you do? - perceive clothing with paper bag Daughter calls and says "I think something is going on with my dad". That dad says they're fine, but daughter has power of attorney. What do you do? - We listen to the dad if he is oriented times 4 person place time person power of attorney only works if person is altered patient has an open fracture and bleeding, what PPE precautions do you take - googles gloves mask MIC green - minorMCI yellow - delayed MCI red - immediate MCI black - dead Obese patient (300+) on level 15, what do you do? - call for asistance what zone do you triage for - cold zone