EMS 1055 STUDY EXAM GUIDE QUESTIONS AND ANSWERS
SURE A+
✔✔swelling - ✔✔edema
✔✔tenderness - ✔✔
✔✔instability - ✔✔pelvis
✔✔crepitus - ✔✔
✔✔Know the different etiologies of hemorrhage - ✔✔arteries: spurting bright red blood
with pulsating flow
veins: steady, slow flow, dark red color
capillaries: slow, even flow
suspect hemorrhage: sustained rate >100
traumatic injury
embolism
penetration
falls
explosions
broken bones
✔✔Know the signs and symptoms of shock - ✔✔Skin: pale, cool, diaphoretic
Anxiety
Impending doom
Altered LOC
Dilated pupils
Sustained tachycardia
Tachypnea
Decreased urine output
Thirst
Delayed capillary refill
✔✔Know the different categories of shock - ✔✔hypovolemic
distributive (neurogenic, sepsis, anaphylaxis)
obstructive or mechanical
cardiogenic
compensated
decompensated
irreversible
✔✔compensated shock - ✔✔The early stage of shock, in which the body can still
compensate for blood loss.
,Weakness, pallor, tachycardia, narrowed pulse pressure, thirst, delayed capillary refill
SBP greater than 100 mmHg
✔✔decompensated shock - ✔✔when the body can no longer compensate for low blood
volume or lack of perfusion. Late signs such as decreasing blood pressure become
evident
30-45% blood volume
Hypotension (first sign of late shock), weak,no peripheral pulse, prolonged capillary refill
SBP less than 100 mmHg
✔✔irreversibile shock - ✔✔SBP below 60 mmHg
✔✔high space shock - ✔✔Relative hypovolemia ("vasodilatory shock")
Interruption of sympathetic system
Loss of normal vasoconstriction
vascular space becomes "too large"
Neurogenic shock
Most typically after injury to spinal cord
No release of catecholamines from adrenal
Neurogenic shock symptoms
Hypotension¡Heart rate normal or slow
Skin warm, dry, pink
Paralysis or deficit
Diaphragmatic breathing
✔✔low volume shock - ✔✔Absolute hypovolemia
Loss of volume
Catecholamines cause vasoconstriction¡Minor blood loss: vasoconstriction sufficient
Severe blood loss: vasoconstriction insufficient
Clinical presentation
"Thready"pulse; tachycardia; pale, flat neck veins
✔✔Know the signs, symptoms and treatment for deadly dozen chest injuries - ✔✔1.
airway obstruction
2. flail chest
3. open pneumothorax
4. massive hemothorax
5.tension pneumothorax
6.cardiac tamponade
7.myocardial contusion
8. traumatic aortic rupture
9. tracheal or bronchial tree injury
10. diaphragmatic tears
11.pulmonary contusion
12. blast injuries
, ✔✔airway obstruction - ✔✔Secondary hypoxia
Foreign body, tongue, aspiration blood/vomit
Consider cervical spine injury
You cannot clear cervical spine in an unresponsive patient
treatment: open airway using jaw thrust, remove the object with suction. assist
ventilation, load-and-go, safe and rapid transport.
✔✔flail chest - ✔✔fracture of two or more adjacent ribs in two or more places that
allows for free movement of the fractured segment. paradoxical chest movement.
treatment: Ensure open airway
Assist ventilation
High-flow O2
Load-and-go
Stabilize with hand or circumferential compression bandage
Safe and rapid transport-Monitor for shock
✔✔open pneumothorax - ✔✔Open pneumothorax
"Sucking chest wound"
Air enters pleural space
Ventilation impaired
Hypoxia results
Signs and symptoms
Proportional to size of defect
treatment: Close chest wall defect using asherman seal, occlusive dressing, etc.
Oxygen/ventilation
Load-and-go
✔✔massive hemothorax - ✔✔Anxiety and confusion
Neck veins
Flat: hypovolemia
Rarely distended due to mediastinal compression
Breath sounds decreased
Dull if percussed
Shock
treatment: Secure an open airway
High-flow oxygen
Load-and-go
Notify medical direction early
Treat for shock¡Monitor for:
Tension hemo-pneumothorax
SURE A+
✔✔swelling - ✔✔edema
✔✔tenderness - ✔✔
✔✔instability - ✔✔pelvis
✔✔crepitus - ✔✔
✔✔Know the different etiologies of hemorrhage - ✔✔arteries: spurting bright red blood
with pulsating flow
veins: steady, slow flow, dark red color
capillaries: slow, even flow
suspect hemorrhage: sustained rate >100
traumatic injury
embolism
penetration
falls
explosions
broken bones
✔✔Know the signs and symptoms of shock - ✔✔Skin: pale, cool, diaphoretic
Anxiety
Impending doom
Altered LOC
Dilated pupils
Sustained tachycardia
Tachypnea
Decreased urine output
Thirst
Delayed capillary refill
✔✔Know the different categories of shock - ✔✔hypovolemic
distributive (neurogenic, sepsis, anaphylaxis)
obstructive or mechanical
cardiogenic
compensated
decompensated
irreversible
✔✔compensated shock - ✔✔The early stage of shock, in which the body can still
compensate for blood loss.
,Weakness, pallor, tachycardia, narrowed pulse pressure, thirst, delayed capillary refill
SBP greater than 100 mmHg
✔✔decompensated shock - ✔✔when the body can no longer compensate for low blood
volume or lack of perfusion. Late signs such as decreasing blood pressure become
evident
30-45% blood volume
Hypotension (first sign of late shock), weak,no peripheral pulse, prolonged capillary refill
SBP less than 100 mmHg
✔✔irreversibile shock - ✔✔SBP below 60 mmHg
✔✔high space shock - ✔✔Relative hypovolemia ("vasodilatory shock")
Interruption of sympathetic system
Loss of normal vasoconstriction
vascular space becomes "too large"
Neurogenic shock
Most typically after injury to spinal cord
No release of catecholamines from adrenal
Neurogenic shock symptoms
Hypotension¡Heart rate normal or slow
Skin warm, dry, pink
Paralysis or deficit
Diaphragmatic breathing
✔✔low volume shock - ✔✔Absolute hypovolemia
Loss of volume
Catecholamines cause vasoconstriction¡Minor blood loss: vasoconstriction sufficient
Severe blood loss: vasoconstriction insufficient
Clinical presentation
"Thready"pulse; tachycardia; pale, flat neck veins
✔✔Know the signs, symptoms and treatment for deadly dozen chest injuries - ✔✔1.
airway obstruction
2. flail chest
3. open pneumothorax
4. massive hemothorax
5.tension pneumothorax
6.cardiac tamponade
7.myocardial contusion
8. traumatic aortic rupture
9. tracheal or bronchial tree injury
10. diaphragmatic tears
11.pulmonary contusion
12. blast injuries
, ✔✔airway obstruction - ✔✔Secondary hypoxia
Foreign body, tongue, aspiration blood/vomit
Consider cervical spine injury
You cannot clear cervical spine in an unresponsive patient
treatment: open airway using jaw thrust, remove the object with suction. assist
ventilation, load-and-go, safe and rapid transport.
✔✔flail chest - ✔✔fracture of two or more adjacent ribs in two or more places that
allows for free movement of the fractured segment. paradoxical chest movement.
treatment: Ensure open airway
Assist ventilation
High-flow O2
Load-and-go
Stabilize with hand or circumferential compression bandage
Safe and rapid transport-Monitor for shock
✔✔open pneumothorax - ✔✔Open pneumothorax
"Sucking chest wound"
Air enters pleural space
Ventilation impaired
Hypoxia results
Signs and symptoms
Proportional to size of defect
treatment: Close chest wall defect using asherman seal, occlusive dressing, etc.
Oxygen/ventilation
Load-and-go
✔✔massive hemothorax - ✔✔Anxiety and confusion
Neck veins
Flat: hypovolemia
Rarely distended due to mediastinal compression
Breath sounds decreased
Dull if percussed
Shock
treatment: Secure an open airway
High-flow oxygen
Load-and-go
Notify medical direction early
Treat for shock¡Monitor for:
Tension hemo-pneumothorax
