NREMT Emergency Medical Technician (EMT) Cognitive Exam flashcards

Management of acute decompensated CHF focuses on improving oxygenation, reducing fluid overload, and managing symptoms.

• Oxygenation is critical, often requiring high-flow oxygen.
• Diuretics and vasodilators (like nitroglycerin) can reduce fluid and preload.
• Positioning (sitting upright) helps reduce respiratory effort.

Memory trick: When the heart fails and lungs fill with fluid, think 'O2, Position, and 'NO' more fluid!'

Initial prehospital medication management for suspected AMI focuses on improving oxygenation, reducing cardiac workload, and preventing further clot formation.

• Oxygen for hypoxia or respiratory distress.
• Aspirin (162-324 mg chewable) to inhibit platelets.
• Nitroglycerin (sublingual) for chest pain and vasodilation (if BP allows).
• Morphine (ALS) for pain relief if nitro is insufficient.

Memory trick: MONA: Morphine, Oxygen, Nitro, Aspirin (but order matters!)

Bradycardia (heart rate <60 bpm) is considered stable when the patient exhibits no signs of hypoperfusion (e.g., normal mental status, adequate blood pressure, no chest pain).

• Initial management focuses on assessment, supportive care, and monitoring.
• Oxygen administration and IV access (if allowed by scope) are common initial steps.
• Avoid aggressive interventions unless the patient becomes symptomatic/unstable.

Memory trick: Slow heart? Check stability first, then decide the next burst!

A DNR order is a legal document or medical order indicating that a person does not wish to receive cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing.

• Must be valid and readily available.
• Requires verification, often with family or medical control.
• Directs EMS to withhold resuscitation efforts.
• Allows for comfort care to be provided.

Memory trick: DNR: Don't Resuscitate, Respect the Request.

The immediate prehospital care for a patient suspected of having a heart attack, focusing on oxygenation, pain relief, and reducing cardiac workload/ischemia.

• Recognize signs/symptoms of AMI (chest pain, radiation, diaphoresis, dyspnea).
• Administer oxygen if SpO2 <94% or signs of hypoxia/distress.
• Assist with aspirin administration (unless contraindicated).
• Consider nitroglycerin if BP allows and pain persists.

Memory trick: Oxy-Aspirin for the chest pain fight, then transport in the fading light.

Pulmonary embolism is a life-threatening blockage of a pulmonary artery, often presenting with sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia, often with risk factors like recent immobility.

• Sudden onset of symptoms is common.
• Risk factors include recent surgery, immobility (long flights), birth control.
• Can be difficult to diagnose prehospital, requiring high suspicion.

Memory trick: Short of breath, chest pain sharp, after a long trip – think 'PE is a deadly trap!'

Immediate intervention for rapid heart rhythms causing signs of instability (e.g., hypotension, altered mental status, signs of shock, acute heart failure, ischemic chest discomfort).

• Identify unstable tachycardia (HR >150 bpm with symptoms of instability).
• Prioritize synchronized cardioversion.
• Sedation may be considered before cardioversion if time and patient condition allow.
• Do not delay cardioversion for unstable patients.

Memory trick: Fast heart, unstable signs? Shock 'em quick, no time for lines!

A spontaneous pneumothorax occurs when air leaks into the space between the lung and chest wall (pleural space) without any external trauma, causing the lung to collapse.

• Sudden onset of sharp, pleuritic chest pain.
• Dyspnea (shortness of breath).
• Diminished or absent breath sounds on the affected side.
• Often seen in tall, thin males, or those with underlying lung disease.

Memory trick: Pleuritic pain, one lung's gain? Air's gone astray!

The very first intervention for an unresponsive, apneic, and pulseless adult patient.

• Prioritize chest compressions over ventilations initially.
• Compressions should be at least 2 inches deep and 100-120/min.
• Minimize interruptions to compressions.

Memory trick: Push hard, push fast, save a life that's passed.

Immediately after delivering an AED shock, resume chest compressions for 2 minutes without checking for a pulse, to maximize blood flow.

• Minimizing 'hands-off' time is crucial for patient outcomes.
• The AED will prompt reanalysis after 2 minutes of CPR.
• High-quality CPR is the cornerstone of cardiac arrest management.

Memory trick: Shock delivered? Good! Now get back to pumping that chest, immediately!

Atrial fibrillation is a common cardiac dysrhythmia characterized by disorganized electrical activity in the atria, leading to an irregularly irregular ventricular response.

• Rapid, irregularly irregular pulse.
• Palpitations ('fluttering' sensation).
• Can lead to dizziness, weakness, fatigue.
• Risk of stroke due to clot formation in the atria.

Memory trick: Irregularly irregular, atrial flutter's a blur!

Identification of a life-threatening condition where the inner layer of the aorta tears, allowing blood to flow between the layers, causing severe pain and potential organ damage.

• Sudden, severe, 'tearing' or 'ripping' pain in chest or back.
• Pain often radiates to back, abdomen, or neck.
• Blood pressure differences between arms (>20 mmHg difference is significant).
• Pulse deficits or unequal pulses.

Memory trick: Tearing pain, BP's not the same, Aorta's torn, a dangerous game.

When an Automated External Defibrillator (AED) indicates 'Shock Advised,' it means the patient's cardiac rhythm is a shockable rhythm (Ventricular Fibrillation or Pulseless Ventricular Tachycardia).

• Indicates a shockable rhythm (VF/pVT).
• Requires immediate defibrillation.
• Followed by immediate resumption of chest compressions.
• Minimizes interruptions in CPR.

Memory trick: Shock advised? Clear the deck, then pump the chest!

Sequence of medications administered in the field for suspected cardiac chest pain.

• Oxygen for hypoxia or respiratory distress.
• Aspirin (162-325 mg chewable) to inhibit platelet aggregation.
• Nitroglycerin (0.4 mg sublingual) for pain relief and vasodilation, if BP allows.
• Morphine for severe pain if NTG ineffective.

Memory trick: Oxy-Aspirin first, then Nitro for thirst!

Acute pulmonary edema, often from CHF, requires aggressive oxygenation, positive pressure ventilation (CPAP), and often medications to reduce preload and afterload.

• CPAP improves oxygenation and reduces work of breathing.
• High-flow oxygen is critical for hypoxia.
• Nitroglycerin can help reduce preload and afterload (if BP allows).

Memory trick: Lungs are drowning? Give them air, push the water out, and sit them upright!

A fracture at the base of the skull, often indicated by CSF leakage (clear fluid) from the ears or nose, 'raccoon eyes', or Battle's sign.

• High suspicion with clear fluid leakage from ears/nose after head trauma.
• Primary concern is protecting the brain and spinal cord.
• Do NOT pack or apply direct pressure to the leakage site.

Memory trick: Clear fluid from the ear, spinal immobilization is near, oxygen high, to the trauma center we steer.

An open fracture involves a break in the bone where the skin is also broken, exposing the bone to the outside environment.

• High risk of infection due to contamination.
• Do not attempt to reduce the fracture.
• Prioritize sterile dressing and immobilization.

Memory trick: Open bone, sterile cover, then stabilize the zone.

Flail chest occurs when three or more adjacent ribs are fractured in two or more places, creating a free-floating segment of the chest wall.

• Characterized by paradoxical motion of the chest wall.
• Impairs ventilation and gas exchange.
• Primary treatment involves oxygen and stabilization of the flail segment.

Memory trick: Flail chest, oxygen high, stabilize the segment, don't let them sigh.

A pattern of injuries, including abdominal organ damage (especially small bowel), lumbar spine fractures, and sometimes head or chest injuries, resulting from the use of a lap belt without a shoulder harness during a collision.

• Small intestine is highly vulnerable to compression against the spine.
• Can cause rupture, mesenteric tears, and severe internal bleeding.
• Often presents with abdominal pain, distention, and signs of shock.

Memory trick: Lap belt tight, small bowel in fright, against the spine, a painful plight.

For minors, consent for treatment must generally be obtained from a parent or legal guardian. In their absence, implied consent may apply for life-threatening conditions, or medical control should be consulted for guidance.

• Parents/legal guardians provide consent for minors.
• Implied consent for minors is typically reserved for life-threatening emergencies.
• Medical power of attorney must be verified.
• Contact medical control when facing consent dilemmas with minors.

Memory trick: Guardians Guide, Emergencies Grant, Control Confirms Care.

Patients with acute pulmonary edema and severe hypoxia require high-flow oxygen, typically delivered via a non-rebreather mask, to improve oxygenation.

• Acute pulmonary edema causes severe hypoxia.
• Non-rebreather mask delivers highest FiO2.
• Monitor SpO2 and adjust oxygen as needed.

Memory trick: Severe Shortness? Non-Rebreather's Best!

Aspirin is an antiplatelet medication given early in suspected Acute Myocardial Infarction (AMI) to prevent further clot formation in the coronary arteries.

• Inhibits platelet aggregation
• Reduces mortality and reinfarction rates
• Administered orally, typically 162-325 mg
• Contraindicated if true aspirin allergy or active bleeding

Memory trick: MONA doesn't always come in order; think ASAP!

Immediately following an AED shock, chest compressions must be resumed without delay to maintain vital organ perfusion.

• Minimize hands-off time.
• Resume CPR for 2 minutes.
• Do not check pulse or rhythm immediately after shock.

Memory trick: Shocked? Start Pumping!

The standard progression for controlling external bleeding involves several steps, starting with the least invasive and moving to more aggressive interventions if bleeding persists. This ensures effective control while minimizing potential complications.

• Direct pressure is first step.
• Pressure dressing follows if direct pressure fails.
• Tourniquet for severe, uncontrolled arterial bleeding.

Memory trick: Press, Dress, Tourniquet to Rest.

In emergency situations, when a minor is injured or ill and a parent or legal guardian is not present, consent for treatment is implied.

• Applies when parents/guardians are unavailable.
• Allows EMTs to provide necessary emergency care.
• Based on the assumption that a reasonable parent would want their child to receive care.

Memory trick: Kids need care, parents not there, implied consent is the fair share.

Tachycardia is a heart rate over 100 bpm. It is classified as stable if the patient is symptomatic but without signs of acute circulatory compromise, and unstable if there are signs of shock, acute heart failure, or severe hypotension.

• Stable: HR > 100 bpm, symptomatic (palpitations, lightheadedness) but vital signs relatively maintained.
• Unstable: HR > 100 bpm with hypotension, altered mental status, signs of shock, or acute heart failure.
• EMT management differs significantly between stable and unstable.

Memory trick: Fast Heart, Check for Shock!

A competent adult patient has the right to refuse any specific medical intervention, even if they accept other care, provided they understand the risks.

• Must assess patient's decision-making capacity.
• Must clearly explain risks and consequences of refusal.
• Requires thorough documentation, including a signed refusal of care form.

Memory trick: Refuse, explain, capacity check, document the wreck.

For an unresponsive diabetic patient suspected of severe hypoglycemia, the critical intervention is the rapid administration of glucose, typically intravenously (dextrose) by ALS, or glucagon intramuscularly if IV access is not immediately available.

• Suspect hypoglycemia in unresponsive diabetics, especially with cool/clammy skin.
• Oral glucose is contraindicated due to aspiration risk.
• EMTs should request ALS for IV dextrose or administer IM glucagon (if protocol allows).
• Rapid reversal of symptoms is expected with glucose administration.

Memory trick: Low Sugar? Call ALS for IV Sugar!

When an unresponsive patient exhibits slow or shallow breathing, the immediate priority is to ensure adequate ventilation and oxygenation to prevent hypoxia.

• Airway and breathing are always the top priorities in an unresponsive patient.
• Slow/shallow respirations indicate respiratory compromise.
• Oral glucose is contraindicated in unresponsive patients due to aspiration risk.

Memory trick: Airway Before Anything Else!

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are commonly used for pain and inflammation but can cause adverse effects, particularly in the elderly.

• Common side effects include GI irritation, bleeding, and ulcers.
• Can cause fluid retention and worsen hypertension or heart failure.
• May impair kidney function, especially in dehydrated or elderly patients.

Memory trick: Elderly patients 'N'eed 'S'pecial 'A'ttention with 'I'mmense 'D'rugs.

In the START triage system, a 'Green' tag (Minor) is assigned to patients who are ambulatory, have minor injuries, and can follow commands.

• Ambulatory patients who can walk to a designated area.
• Injuries are minor and not life-threatening.
• They are the 'walking wounded' and are assessed last.

Memory trick: Red for 'Run' (immediate), Yellow for 'Slow' (delayed), Green for 'Go' (minor), Black for 'No' (deceased).

A critical condition in infants characterized by significant fluid loss, leading to signs of hypovolemic shock such as lethargy, sunken fontanelles, tachycardia, and prolonged capillary refill.

• Infants are highly susceptible to dehydration due to higher metabolic rate and body surface area.
• Signs include lethargy, sunken fontanelle, dry membranes, absent tears, prolonged cap refill, tachycardia.
• Requires rapid transport to advanced care for IV fluid resuscitation.

Memory trick: Rapid Ride to Rehydrate!

For suspected AMI, aspirin is the most critical initial medication to prevent further clot formation.

• Aspirin inhibits platelet aggregation.
• Administer chewable aspirin (162-325 mg).
• Contraindications include allergy or active bleeding.

Memory trick: Aspirin Always Saves Arteries!