Questions and Answers 1 What is syncope? Syncope, commonly known as fainting, is a sudden and self-limited loss of consciousness with loss of postural tone. It is a symptom, not a diagnosis. Following an episode of syncope, patients should also experience a rapid and complete return to baseline. 2 What mechanism causes syncope? Syncope is due to a temporary episode of insufficient blood flow to the…
Questions and answers 1 What is a stroke? A stroke, more formally termed a cerebrovascular accident (CVA), is any event that disrupts blood supply to the brain and causes neurologic compromise. It is important to diagnose and treat early as lack of blood supply to the brain equates to lack of oxygen and nutrients thus leading to irreversible cell death. 2 What is a transient ischemic…
Questions and answers 1 What is a seizure? A seizure occurs when there is an abnormal surge of coordinated electrical impulses in the brain. It can have many different objective appearances such as shaking of the whole body, part of the body, or staring off. Seizures themselves are not a disease, but rather they are a symptom of several different disorders. 2 What types of seizures…
Questions and Answers 1 What is dyspnea? The word stem dys- means difficult and -pnea means breath. Combined, the word dyspnea means difficult breath. The symptom of dyspnea or shortness of breath is very subjective and is included in the patient’s history. 2 How is respiratory distress described and documented? General inspection: While collecting the history, you will already have begun a general examination of the…
Questions and Answers Obstetrical and Gynecologic Emergencies 1 What are the typical expected physiologic/anatomic changes in pregnancy? A number of changes occur. Average weight gain is 25–35 lbs (11.5–16 kg). Most weight gain is from the enlarged uterus/fetus, blood volume, breast tissue, and extracellular fluid. Physiologic changes include 1500 mL increase in blood volume, heart rate increases of 15 to 20 bpm, increased cardiac output (30%–50% above baseline), and…
Questions and Answers 1 What is sepsis and why is it important? Describing sepsis, Sir William Osler wrote: “Except on few occasions, the patient appears to die from the body’s response to infection rather than from (the infection itself).” Simply put, sepsis is a dysregulated exaggeration of the normal immune mechanisms set in place to fight infection. Sepsis may be caused by any infection, including bacterial,…
Questions and Answers Case: A neighbor calls 911 for someone continuously pounding trying to enter the apartment next door. They are worried that the person knocking is high on drugs. Police arrive to a confused male in his 20s and recognize a medical emergency. EMS is called. Meanwhile, the pale, diaphoretic male passes out across the doorway. With the noise of the sirens, the patient’s girlfriend…
Questions and answers 1 What elements of history are helpful to elicit from a patient with abdominal pain? Establish the location, severity, duration, and a description of the pain. Any associated symptoms, such as fevers, vomiting, diarrhea, dysuria, hematuria, or passing out, should be noted. Identify factors that improve or worsen the pain, such as movement or eating. Ask about any recent trauma. Women of childbearing…
Questions and answers Case: You arrive on scene to find a 69-year-old female with a past medical history of atrial fibrillation, hypertension, and heart failure and an implantable defibrillator with a pacemaker. She called because her defibrillator shocked her. 1 What are the types of implantable devices and their purposes? An implantable pacemaker is used to ensure that the heart rate is adequate when the native…
Chest Pain 1 Name some life-threatening causes of chest pain. Chest pain can be due to a variety of causes. In the prehospital setting, it is always important to consider some of the more life-threatening etiologies to chest pain. Listed here are the “serious 6” concerning etiologies for chest pain: Tension pneumothorax Pulmonary embolism (PE) Ruptured esophagus Cardiac tamponade Aortic dissection Acute coronary syndrome (ACS) 2…
Questions and Answers 1 What is an EKG? An electrocardiogram (EKG/ECG) is a graphic recording of electrical potentials produced by the cardiac tissue and measured by electrodes placed at different sites on the body. 2 How does electrical activity travel through the heart? Cardiac conduction typically starts at the sinoatrial (SA) node near the top of the right atrium ( Fig. 14.1 ). This impulse carries across…
Questions and Answers 1 What does altered mental status mean? Altered mental status is a disorder of consciousness; disorders of consciousness are divided into issues of arousal, thought content, or some combination of both. Dementia is more progressive in nature. Coma can be acute or progressive. Delirium is typically more abrupt in onset, over hours or days. Both coma and delirium can fall under the category…
Questions and Answers 1 What is hypotension? Decreased blood pressure relative to a person’s baseline blood pressure. Hypotension is a systolic blood pressure less than 90 mm Hg or a mean arterial pressure of less than 60 mm Hg for a duration of at least 30 minutes. Another definition is a decrease in a person’s baseline blood pressure of 30%. The absolute point of hypotension varies between individuals.…
Questions and Answers 1 You arrive on the scene at a local restaurant to find a 65-year-old gentleman who reportedly had a witnessed cardiac arrest. Cardiopulmonary resuscitation (CPR) was started by bystanders. How common is out-of-hospital cardiac arrest? 350,000 patients suffer an out-of-hospital cardiac arrest annually in the United States, and the overall fatality rate is over 90%. 2 After you stabilize your patient, what is…
Questions and Answers Case: You arrive on scene at a high school football game to find an adult male lying under the bleachers with first responders on scene. He has an abrasion to his forehead and there is emesis on his shirt. The EMT on the scene turns to you as you approach and your partner yells, “What are his vitals?” 1 How do you rapidly…
Questions and Answers Critical Incident Stress 1 What is a critical incident? A critical or incident is defined as a powerful or emotionally provoking event experienced by the EMS provider. This stressor typically overwhelms the person’s normal coping mechanisms and significantly differs from the ordinary events experienced on the job. Incidents such as line-of-duty death or critical injury, death of child, severe child abuse case, mass…
Questions and Answers 1 What is scene safety and how does it affect emergency medical service (EMS) providers? Scene safety is the general principle of keeping safe from all hazards while working as an EMS provider. Scene safety is critical to all emergency responders and starts the moment they receive a call. Providers face risks, including traffic accidents, infectious disease exposures, and violence. While some events…
Questions and Answers 1 What is the difference between quality assurance and quality improvement ? Sometimes used synonymously, the terms quality assurance (QA) and quality improvement (QI) refer to distinct processes with different goals. The goal of QA is to monitor and measure compliance against a standard. In this way, QA is a reactive process that detects errors after they have occurred. On the other hand,…
Questions and Answers 1 What is public health? Public health can be a very wide-ranging field that can include injury prevention, disease surveillance, and management of underserved populations. The American Public Health Association is a group based in Washington, DC, that advocates for and promotes the topic of public health. The group currently has 34 topics listed on their website, of which they are currently focused.…
Questions and Answers 1 What is direct medical oversight? While state specific, emergency medical services (EMS) agencies have providers (typically physicians or advanced practice providers) on standby to provide direct medical oversight. Direct medical oversight, also referred to as online medical control, medical command, or online medical direction, refers to orders given by a physician or designee to the prehospital provider either in person or via…