EMCA Review Comprehensive Review The home stretch!
Calculate the following • Want to run an IV at 120 cc’s an hour. If you have a 10 drop set, how many gtts/min do you set the IV rate? • You want to give a 15Kg child epinephrine for anaphylaxis. What is the dose of 1:1000 epi that you give? 20 gtts/min 0.15mg
Question Under what 4 conditions can only 1 shocks be delivered to a patient? 1. 2. 3. 4. Blunt trauma Hypothermia Airway obstruction After stopping enroute with rearrest
Question • What are the indications for epinephrine for anaphylaxis? Indications Exposure to a probable allergen ANDSigns and or symptoms of a moderate to severe allergic reaction (inc Anaphylaxis)
Question • What are four purpose of IV therapy? Restore and maintain fluid balance Restore and maintain electrolyte balance Provide medications and route for them Transfuse blood and blood products Deliver parenternal nutrients and nutritional supplements
Question • What is an isotonic solution? • What IV fluids are hypotonic? Same conc solute inside and out-no net movement of water D5W
What are three causes of severe SOB? • Acute severe asthma-usually secondary to ? • CHF • Tension pneumothorax • Pulmonary emboli
CPP=MABP-ICP Need minimum pressure for cerebral function Explain the concept of cerebral perfusion pressure!
Things that affect flow rates for IV’s (at least 5) • Patient positioning – 3ft above • Vein spasms • Pheblitis/Thrombi • Type of fluid (viscosity) • Amount of fluid in bag • Height • Tubing kinked • Catheter size • Catheter position • infiltration
What is an OASIS number? • Where is it normally used?
Why is it important to take the pulse within 1 minute of patient contact? What information can be obtained? • Perfusion • Rate too high or too low • Blood pressure (roughly) • Psychological (touch) • Pulse alternans • irregularities
Name 6 Dispatch centers in Ontario • Toronto Sudbury • Renfrew North Bay • Ottawa Kenora • Georgian Timmins • Lindsay Cambridge • Kingston Hamilton • London Mississauga • Oshawa • Windsor
What does the tachometer measure and where is it located? • Speed, stopping • Use of lights • Use of sirens • 24 clock • Located either behind drivers seat or in side compartment of ambulance • If applicable, does the medics write on it?
5 Causes of crackles upon chest auscultation • CHF • Cardiogenic shock • Hemothroax • Pneumonia • Atelactasis • PE • ARDS • tumour
What are four reasons for a Incident Report • VSA • Crime Scene • Child Abuse • Domestic dispute • Equipment failure • Ambulance delay (critical) • Person taking notes on scene!
What are 5 classes of antihypertensives • Ca channel blockers • B blockers • ACE inhibitors • Nitrates • Diuretics • Alpha blockers Give one example of each
Give three examples of anticonvulsants • Depekene • Dilantin • Valium • Lorazepam • phenobarbital
What are the receptors located in the autonomic nervous system? • Alpha • Beta 1 and beta 2
Explain the mechanism behind the development of a tension pneumothorax? • Air gets trapped in between parietal and visceral pleura, with each breath, if it not allowed to escape, it builds up pressure, collapsing the lung. Eventually, the pressure is so high it stops venous return to heart (compression of vena cava) and bp drops, HR increases and heart may arrest
Toronto, 9145 is 10-8, 765 McLaughlin Rd south? • What does this transmission mean?
10 Causes of Chest pain please! • Angina pneumo • MI aneurysm • CHF fractured rib • Emboli chondritis • Esophagitis pleurisy • Regurg muscle strain • Myocarditis • endocarditis
Explain the theory of relativity or say “Patient Care” in the phonetic alphabet
What does CTAS stand for? Canadian triage and acuity scale
Why does a patient with a thoracic aneurysm complain of back pain? • Tearing of the layers of the aneurysm
5 Signs and Symptoms of a tension pneumothorax? • Decreased BP • Increased HR • Resp distress • Absent air entry on affected side • JVD • Tracheal shift • cyanosis
How does lasix work, and how is it supplied? Normal dose? • Preload reducer and diuretic • Comes 40mg/4ml • Depends on patient 40-160mg
What are the conditions under which you would inspect the perineum in a obstetrical patient • Ruptured membranes • Prolapse cord • Urge to push • “baby’s coming” • Near term, decreasing LOC and history is unknown • Vag bleeding with shock
What three rhythms would get cardioverted? • SVT • Rapid a fib • Vtach with a pulse
You just turn on the LP after applying the pads and see asystole on the monitor. How do you get to see the rhythm through the paddles (2 ways) • Press analyze (fastest) • Flip to paddles
What are the contraindications to ASA administration? ·weigh at least 40 kg ·be alert and responsive ·NOT have an allergy to ASA or other NSAID ·not have current active bleeding (GI or other disorders) ·have no evidence of CVA or head injury within 24 hours prior to Primary Care Paramedic assessment • have a history of previous use of ASA with no adverse reaction if a known asthmatic
How do you differential between MI and angina? • Time of chest pain • What makes it better • 12 lead changes • Quality of pain • Past history
What is the difference between epiglottis and croup? • Croup = Laryngotracheobronchitis • Epiglottis- Haemophilus influenzae type B most common • odynophagia • fever • irritability • stridor • rapidly progressive URI symptoms barking cough hoarseness inspiratory stridor low-grade fever
What is the difference in terms of vital signs between an anterior MI and an inferior MI? • Low and slow –inferior • High and fast -anterior
What is the indications of giving epi for croup? • Any patient who is < 8 years of age who presents with: 1. A current history of an upper respiratory infection with a “barking” cough AND 2. Stridor at rest, or an altered level of consciousness or cyanosis
What is the importance of the cover letter in a resume? • Job target • The ‘ask’ • Why you’re the one • Specific about the job-connection
Outline the pathophysiology behind acute asthma! • Adrenergic stimulation or irritation of the bronchioles resulting in bronchoconstriction. • Mucous production • Histamine release from mast cells
How long would a D tank last at 12 lpm for a NRB mask? (Leaving the residue) • 2000-500 =(1500) x 0.16 divided by 12 L min • =240/12 • =20 minutes
What are 6 signs of raised ICP • Seizure • Combativeness • Decreased LOC • Pupil changed • Resp change –ataxic • Triade called …..? • Rising BP • etc
Signs and symptoms of acute anaphylaxsis • Physical Examination shows any of the following: • ·Wheezing • ·Stridor • ·Generalized Urticaria • ·Generalized edema • ·Systolic BP <90 • ·Decreased LOC • Airway compromise
Tell me how a KED is applied • Immobilize head-collar applied • Undo far leg strap • Slide Ked behind patient • Pull up under arms. • My –middle strap • Baby- bottom • Looks- legs • Hot- head (pad behind head, top then chin) • Tonight- top strap-”deep breath” • Haul!
What is the chest landmark for a needle decompression? • 2rd intercostal space, midclavicular line, above the 3rd rib • On the affected side!!
What patients would get intubated? • VSA • Unconscious GCS<8-10 • Severe SOB (CHF, asthma, ) • CHI trauma • Airway protection –burns etc • Seizure • Respiratory support
What are the 7 contraindications for the CVA protocol? • CTAS Level 1 or uncorrected A,B,C problem • Symptoms of the stroke resolved prior to arrival or assessment • Blood sugar <3 mmol/L • Seizure at onset or observed by paramedics • GCS <10 • Terminally ill or palliative • Duration of out of hospital will exceed 2 hours
What is this? Aortic valve
Give the trade name for the following: Tylenol Inderal Zantac Gravol Zoloft • Acetaminophen- • Propanolol • Rantididine- • Dimenhydrinate- • Sertraline -
What are some options if some refuses care and you want to convince them to go? • Advise Dispatch (possible delay) • Physician contact (Studies have found a significant number of patients will accept transport when advised to do so by a physician) • Police involvement • Obtain witnesses signatures to refusal and explanation provided to the patient (if witnessed)
Trace the blood from the vena cava to the carotid artery-include valves • Vena cava, R atrium, tricuspid, R ventricular, pulmonary valve, pulmonary artery , lungs, pulmonary vein, Left atrium, mitral valve, left ventricle, aortic valve, aorta, carotid artery