EMR Exam #3 |161 Questions & Answers
Medical Assessment for the Emergency Medical Responder - --Accurate assessment and
treatment of problems in the primary assessment (Any immediate ABC life threats that
need correcting)
-Accurate SAMPLE history
-Assessment Based Evaluation - --Inspection, palpation and ausculation lead to physical
findings needing correction
-SAMPLE history helps to determine what is causing the physical signs and symptoms
-Medical Assessment - --YOU need to make the decisions based on your assessments
-"Dispatch Diagnosis" : set line of questions on EMD cards
- Patients may have pre-existing conditions
- Look at entire Patient and Patient history
-Medical Detectives - --Look around for clues (Sights, sounds, smells)
-observe the scene
-Look for indicators of medical conditions (Like medications)
-Talk to family, friends, caregivers, witnesses
-Chief Complaint - --What is the problem?
-What hurts/bothers you/ Feels bad
-Why did you call EMS today?
-History of Present Illness - -- what were you doing when this started
- When did this start?
-Did you try anything to make it better?
-Is today worse than usual?
-SAMPLE history - -S-Signs/Symptoms
A-Allergies
M-Medications
P-Past medical history
L-Last oral intake
E-events preceding
-OPQRST - -O-Onset
P-Provokes
Q-Quality
R-Radiation
S-Severity
T-Time
-Physical Exam - --Inspection: Look, Be thorough
,-Palpation: Hands on assessment
Auscultation: Listen with stethoscope
-Leading cause of death - -Heart Disease
-Perfusion - -Adequate blood and oxygen to the tissues
- Blood Pressure: Heart rate, Stroke volume, Peripheral Vascular Resistance
-Myocardium needs adequate perfusion too!
-Coronary Arteries - --Coronary arteries supply blood to myocardium
-Blood INSIDE chambers of heart do not exchange oxygen, nutrients, wastes with
myocardium
-Coronary Artery Disease - --Build up of plaque in coronary arteries
-Narrowing of vessels
-reduced lumen diameter leading to reduced ability to dilate, as well as blood flow
-Plaque can get stuck
-Leading to Acute Coronary Syndromes (ACS) such as angina and acute myocardial
infraction
-Management of Acute Coronary Syndromes - --TIME IS MUSCLE!
-Most patients wait 2-3 hours before seeking medical attention
-Window of opportunity for definite care is 6 hours from ONSET of symptoms
-Early reperfusion leads to decreased morbidity and mortality.
-Fibrinolytic therapy of PTCA (percutaneous transluminal coronary angioplasty) is the
definite treatment for limiting infract size
-Stabilize patient enroute to definitive care
-Angina Pectoris - --Artery narrowed due to plaque
-Stress leads to increased work load of myocardium caused increased oxygen demand
-Ischemia: O2 demand outweighs O2 supply
-May resolve with removal of stress of NTG
-"heart Cramp"
-Prinzmetal's angina: caused by vasospasm, usually at rest, most common midnight-8am
-Myocardial Infraction - --Blockage of coronary artery
-Infarction: Lack of O2 causes death of myocardial cells
-More time without blood=Larger infarct
-May occur with stress or at rest
-"Heart Attack"
-Signs and symptoms of Angina and Myocardial Infraction - -ARE SIMILAR SO DONT WAIT
TO SEE IF THEY RESOLVE. TRANSPORT TO DEFINITIVE CARE.
-Chest pain
-weakness/Dizziness
-Hard time breathing
, -Syncope
-Dysrhythmias
-Acute Coronary Syndrome Variations - --Women, diabetics, and elderly people (>75) may
present with different symptoms : Often no chest pain, ask patients why they fell
-weakness
-hard time breathing
-Patient History: Cardiac Evaluation - --Known Cardiac disease: Diagnosed cardiac
problems: AMI,CHF, angina, dysrthmias, HTN, Hospitalizations: For what, when , how long
Prior heart attacks: How many, when, treatments
-Symptoms today similar to prior cardiac events?
-NO prior diagnosis of cardiac disease: Cardiac Risk factors
-Tobacco use
-Family history of heart disease or stroke
-Hypertension-Rx, controlled with RX
-Cardiac Risk Factors: Hyperlipidemia-Blood vessels, Rx, controlled with Rx
Diabetes-type, well managed?
Obesity
-Congestive Heart Failure - --Myocardium damaged from MI, infection, age, toxic exposure,
untreated HTN, smoking
-Weakened and 'Overstretched'
-Stiff and less elastic
-Cardiomegaly from increased pressure inside chambers
-Right Sided Heart Failure - --Blood backs up into systemic circulation
-Systemic Edema: Pedal edema, Sacral edema, Ascites
-JVD: questions to ask
Is the swelling normal for you? worse than usual?
-Left Sided Heart Failure - --Blood backs up into pulmonary circulation
-Pulmonary edema
-'Pink, frothy sputum'
-"Flash pulmonary edema"
Questions to ask: Is youre breathing worse than usual? Have you been sleeping sitting up?
More pillows than usual? (Orthopnea)
-Treatment of ACS - -Assessment Finding lead to field diagnosis of ACS
-Initiate transport to appropriate facility as soon as possible
-Oxygen
-Aspirin 325mg PO if none in the last 1 hour
-Early notification of receiving facility
-paramedic intercept (
-Respiratory Distress - -Causes: Disease, Trauma, Foregin body airway obstruction, drugs
Medical Assessment for the Emergency Medical Responder - --Accurate assessment and
treatment of problems in the primary assessment (Any immediate ABC life threats that
need correcting)
-Accurate SAMPLE history
-Assessment Based Evaluation - --Inspection, palpation and ausculation lead to physical
findings needing correction
-SAMPLE history helps to determine what is causing the physical signs and symptoms
-Medical Assessment - --YOU need to make the decisions based on your assessments
-"Dispatch Diagnosis" : set line of questions on EMD cards
- Patients may have pre-existing conditions
- Look at entire Patient and Patient history
-Medical Detectives - --Look around for clues (Sights, sounds, smells)
-observe the scene
-Look for indicators of medical conditions (Like medications)
-Talk to family, friends, caregivers, witnesses
-Chief Complaint - --What is the problem?
-What hurts/bothers you/ Feels bad
-Why did you call EMS today?
-History of Present Illness - -- what were you doing when this started
- When did this start?
-Did you try anything to make it better?
-Is today worse than usual?
-SAMPLE history - -S-Signs/Symptoms
A-Allergies
M-Medications
P-Past medical history
L-Last oral intake
E-events preceding
-OPQRST - -O-Onset
P-Provokes
Q-Quality
R-Radiation
S-Severity
T-Time
-Physical Exam - --Inspection: Look, Be thorough
,-Palpation: Hands on assessment
Auscultation: Listen with stethoscope
-Leading cause of death - -Heart Disease
-Perfusion - -Adequate blood and oxygen to the tissues
- Blood Pressure: Heart rate, Stroke volume, Peripheral Vascular Resistance
-Myocardium needs adequate perfusion too!
-Coronary Arteries - --Coronary arteries supply blood to myocardium
-Blood INSIDE chambers of heart do not exchange oxygen, nutrients, wastes with
myocardium
-Coronary Artery Disease - --Build up of plaque in coronary arteries
-Narrowing of vessels
-reduced lumen diameter leading to reduced ability to dilate, as well as blood flow
-Plaque can get stuck
-Leading to Acute Coronary Syndromes (ACS) such as angina and acute myocardial
infraction
-Management of Acute Coronary Syndromes - --TIME IS MUSCLE!
-Most patients wait 2-3 hours before seeking medical attention
-Window of opportunity for definite care is 6 hours from ONSET of symptoms
-Early reperfusion leads to decreased morbidity and mortality.
-Fibrinolytic therapy of PTCA (percutaneous transluminal coronary angioplasty) is the
definite treatment for limiting infract size
-Stabilize patient enroute to definitive care
-Angina Pectoris - --Artery narrowed due to plaque
-Stress leads to increased work load of myocardium caused increased oxygen demand
-Ischemia: O2 demand outweighs O2 supply
-May resolve with removal of stress of NTG
-"heart Cramp"
-Prinzmetal's angina: caused by vasospasm, usually at rest, most common midnight-8am
-Myocardial Infraction - --Blockage of coronary artery
-Infarction: Lack of O2 causes death of myocardial cells
-More time without blood=Larger infarct
-May occur with stress or at rest
-"Heart Attack"
-Signs and symptoms of Angina and Myocardial Infraction - -ARE SIMILAR SO DONT WAIT
TO SEE IF THEY RESOLVE. TRANSPORT TO DEFINITIVE CARE.
-Chest pain
-weakness/Dizziness
-Hard time breathing
, -Syncope
-Dysrhythmias
-Acute Coronary Syndrome Variations - --Women, diabetics, and elderly people (>75) may
present with different symptoms : Often no chest pain, ask patients why they fell
-weakness
-hard time breathing
-Patient History: Cardiac Evaluation - --Known Cardiac disease: Diagnosed cardiac
problems: AMI,CHF, angina, dysrthmias, HTN, Hospitalizations: For what, when , how long
Prior heart attacks: How many, when, treatments
-Symptoms today similar to prior cardiac events?
-NO prior diagnosis of cardiac disease: Cardiac Risk factors
-Tobacco use
-Family history of heart disease or stroke
-Hypertension-Rx, controlled with RX
-Cardiac Risk Factors: Hyperlipidemia-Blood vessels, Rx, controlled with Rx
Diabetes-type, well managed?
Obesity
-Congestive Heart Failure - --Myocardium damaged from MI, infection, age, toxic exposure,
untreated HTN, smoking
-Weakened and 'Overstretched'
-Stiff and less elastic
-Cardiomegaly from increased pressure inside chambers
-Right Sided Heart Failure - --Blood backs up into systemic circulation
-Systemic Edema: Pedal edema, Sacral edema, Ascites
-JVD: questions to ask
Is the swelling normal for you? worse than usual?
-Left Sided Heart Failure - --Blood backs up into pulmonary circulation
-Pulmonary edema
-'Pink, frothy sputum'
-"Flash pulmonary edema"
Questions to ask: Is youre breathing worse than usual? Have you been sleeping sitting up?
More pillows than usual? (Orthopnea)
-Treatment of ACS - -Assessment Finding lead to field diagnosis of ACS
-Initiate transport to appropriate facility as soon as possible
-Oxygen
-Aspirin 325mg PO if none in the last 1 hour
-Early notification of receiving facility
-paramedic intercept (
-Respiratory Distress - -Causes: Disease, Trauma, Foregin body airway obstruction, drugs
