Paramedic National Registry Review
Assessment Sequence Correct Answer: BSI
Scene Size Up
Scene Safety
MOI/NOI
Number of Pt.
Additional
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Consider C-Spine
Primary Survey
General Impression
AVPU
Chief Complaint/Life Threats
Airway, Breathing, Circulation
Treatment/Transport
Medical Assessment Correct Answer: History of Present Illness
Past Medical History
Secondary Assessment
Vitals
Field Impression
Interventions
Reassessment
Verbal Report
Trauma Assessment Correct Answer: SAMPLE
Secondary Assessment
Assess baseline vitals
Manage secondary injuries
Reassess
Stridor, Snoring, Gurgling Correct Answer: Stridor - harsh, high-pitched sound, swelling, foreign body in upper airway.
Snoring - tongue
Gurgling - fluids in upper airway, suction
CDC Trauma Guidelines for Transport Correct Answer: IF YES TO STEP ONE OR TWO TRANSPORT TO A LEVEL 1 TRAUMA CENTER
Step 1: Physiological Criteria
GCS below 14
Systolic below 90
Respirations <10 or >29 (<20 under 1yr)
Ventilation assistance needed
Step 2: Anatomic Criteria
Penetrating wounds head, neck, torso, high extremities
Chest wall instability
Amputation proximal to wrist/ankle
Longbone fx x2
Crushed/devolved/mangled/pulseless extremity
Pelvic fx
Open/depressed skull fx
Paralysis
IF YES TO STEP THREE OR FOUR TRANSPORT TO TRAUMA CENTER, NOT NECESSARILY LEVEL ONE
Step3: MOI Criteria
Adult falls >20' / Children >10' or 2x height
Vehicle intrusion >12" occupant side or 18" anywhere
Partial or complete ejection
Death in same passenger compartment
Vehicle data consistent with high injury risk
Auto vs. Bed thrown, run over or >20mph
Motorcycle crash >20mph
Step 4: Special Considerations
Elderly falls <55yrs
Systolic <100 in >65yrs
Pediatric Trauma
Bleeding and anticoagulants
Burns
Pregnancy >20 weeks
EMS Judgement
IF BURNS WITH NO FURTHER TRAUMA USE A BURN CENTER
GCS Correct Answer: Eyes - 4 spont, 3 speech, 2 pain, 1 absent
Verbal - 5 orient, 4 not orient, 3 inapp, 2 incomp, 1 absent
Motor - 6 obeys, 5 pain loc, 4 pain withdraw, 3 flexion (decorticate), 2 extension (decerebrate), 1 absent
Decorticate Correct Answer: Elbows, wrists, fingers flexed
Legs extended and internally rotated
Decerebrate Correct Answer: Worse condition consistent with brain stem injury
Extended and internally rotated elbows and legs, trismus, legs stiff and feet extended
Babinski's Response Correct Answer: Signifies CNS Problems
Big toe moves upward and other toes fan out when stroking bottom of foot
Pupils Symptoms Correct Answer: Dilated (mydriasis) - cardiac arrest, shock, cerebral hypoxia, cocaine, epinephrine, amphetamines
Constricted (miosis) - narcotics, CNS disorders, glaucoma meds, bright light
Unequal - brain injury, bring tumor, stroke, artificial eye, some eye medications, eye injury or disease
Anisocoria - normal unequal pupils
Nystagmus - rapid involuntary movements of the eye(s)
JVD Correct Answer: Best seen at 45 deg angle
May be caused by: diaphragmatic rupture, tension pneumothorax, cardiac tamponade, right heart failure, traumatic asphyxia, chronic bronchitis
Flat Neck Veins Correct Answer: Best seen supine
May be caused by hemothorax, dehydration, shock
Apneustic Breathing Correct Answer: CNS Injury or Shock
Long, deep breaths that are stopped during inspiration then a period of apnea
Biot's (ataxic) Respirations Correct Answer: Usually Increased ICP
Irregular periods of breathing or gasping with apnea
Cheyne-Stokes Respirations Correct Answer: Neurological Conditions
Increasing in rate and depth, decreasing in rate and depth with periods of apnea
Hyperventilations Correct Answer: Emotional event or neurological condition
Rapid and shallow
Kussmaul's Respirations Correct Answer: DKA
Rapid and deep
Rales/Crackles Lung Sounds Correct Answer: Fluid in small airways/alveoli [Show Less]