# Differentiate: The onset of pain and quality of pain of: Acute Myocardial Infarction (AMI) Dissecting Aneurysm

AMI: Onset of pain- will be acute with additional signs/symptoms. Quality of pain - will most likely be described as tight or pressure, increasing over time. Dissecting Aneurysm: Onset of pain- will be acute without additional signs/symptoms. Quality of pain- will most commonly be described as tearing or burning from the onset.

Component 7: Care for the Medical Patient for NREMT® EMT

Describe:

Medical Emergencies

These are caused by illness or disease processes (Nature of Illness).

NOI

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What are the six major processes in order of assessment?

Scene Size-up
Primary Survey/Resuscitation
History Taking
Secondary Assessment
Vital Signs
Reassessment

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List the causes/types of infectious diseases.

bacteria
viruses
fungi
parasites

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List a minimum of five common communicable diseases.

Covid
Influenza
Herpes Simplex
HIV
Hepatitis
Meningitis
Tuberculosis
Methicillin-resistant Staphylococcus Aureus (MRSA)

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True or False:

A mask should be placed on the patient with tuberculosis.

(TB)

True

As of 2020, a minimum for mask, gloves, and eye protection (PPE) should be worn.

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If blood enters the heart from the superior vena cava, what is the order the blood will go through the chambers and ventricles?

Drop of blood path from the superior vena cava

Right atria
Right ventricle
Pulmonary artery (carries deoxygenated blood)
Lungs
Pulmonary vein (returns oxygenated blood)
Left atria
Left ventricle

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What do we call a group of symptoms caused by cardiac ischemia including myocardial infarctions and angina?

Acute Coronary Syndrome

(ACS)

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Define:

Referring to medical terminology, define the term acute.

It is the experience of sudden and most likely severe complaints of onset of symptoms.

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Describe:

Pathophysiology of acute myocardial infarction.

(AMI)

This happens when there is an occlusion of a coronary artery causing ischemia progressing to injury of the cardiac tissue and then to infarction.

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Define:

infarction

Death of a localized tissue.

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Fill in the blank.

A temporary and transient blockage to the cardiac blood flow resulting in chest discomfort or pain is called ________ ________.

Angina Pectoris

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What is the cardiac muscle’s ability to have its own electrical system not dependant on the nervous system called?

automaticity

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What is the stroke volume multiplied by the heart rate called?

cardiac output

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Differentiate:

The onset of pain and quality of pain of:

Acute Myocardial Infarction (AMI)
Dissecting Aneurysm

AMI:

Onset of pain- will be acute with additional signs/symptoms.
Quality of pain - will most likely be described as tight or pressure, increasing over time.

Dissecting Aneurysm:

Onset of pain- will be acute without additional signs/symptoms.
Quality of pain- will most commonly be described as tearing or burning from the onset.

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What is a late vital sign finding of cardiogenic shock?

Hypotension, the drop in blood pressure below 90 mm Hg.

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Define:

Orthopnea, and what disorder does it present with most commonly?

It is an increase or inability to breathe when lying flat, most commonly associated with patients suffering congestive heart failure (CHF).

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What cardiac disorder frequently presents with jugular venous distension (JVD) and pedal edema?

Congestive Heart Failure

(CHF)

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List:

Signs/symptoms of acute myocardial infarction

Acute onset of chest pain or discomfort
Diaphoresis
Dyspnea
Nausea/vomiting
Syncope
Additional pain in the jaw, arms, neck, and/or back
Death

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True or False:

Best practices suggest we give high flow oxygen via a non-rebreather mask (15 Lpm) for a patient who has no difficulty breathing, pulse oximetry of 97%, complaining of severe and acute chest pain radiating to their jaw that woke them from their sleep.

False

Routine high-flow oxygen is no longer recommended unless the patient is hypoxic (SpO₂ <94%), dyspneic, or shows signs of heart failure or shock.

Excess oxygen can lead to increased oxidative stress and worsen myocardial injury in normoxic AMI patients.

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List:

Dysrhythmias that may present during a cardiac event

Tachycardia
Bradycardia
Ventricular Tachycardia (V-Tac)
Ventricular Fibrillation (V-Fib)
Pulseless Electrical Activity (PEA)

Or the EKG could be normal.

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List:

Components of high-quality CPR

Correct ventilation/compression ratio
Appropriate depth
Full recoil
Adequate breaths or ventilations
Minimizing interruptions

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True or False:

CPR must be immediately initiated as soon as the patient is determined as pulseless.

True

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What cardiac dysrhythmia(s) is the Automatic External Defibrillator (AED) designed to shock?

Ventricular Fibrillation (V-Fib) and Ventricular Tachycardia (V-Tach)

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True or False:

The automatic external defibrillator (AED) will shock asystole.

False

The AED is designed to sense electrical activity in the cardiac muscle. Asystole is the absence of any electrical activity.

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# True or False: Even though angina most often occurs during exertion, we as EMTs should not differentiate angina from an acute myocardial infarction (AMI) in the field.

True ## Footnote Diagnosis of an AMI or angina should be done by a physician.

# List: Lobes of the cerebrum

* Frontal * Parietal * Temporal * Occipital

# List: Common types of headaches

* Tension * Migraines * Sinus

# Differentiate: Ischemic stroke and a hemorrhagic stroke

* **Ischemic Stroke**: is a blood vessel in the brain that is blocked either by thrombosis or an embolism. * **Hemorrhagic Stroke**: is the result of a ruptured aneurysm in a vessel of the brain.

# List: Signs/symptoms of a **cerebral vascular accident**. | (CVA)

* Facial drooping * Speech disturbances * Acute onset of a headache * Hemiparesis * Confusion * Loss of balance * Combativeness * Vision disturbances

# True or False: Just like differentiating between angina and an acute myocardial infarction, EMTs should differentiate an ischemic stroke from a hemorrhagic stroke.

False ## Footnote Diagnoses and differentiating require a physician's evaluation and tests.

# Fill in the blank. Transient Ischemic Attacks (TIA) are considered as a \_\_\_\_\_\_\_\_\_\_\_\_\_ to having a stroke.

precursor

# True or False: The treatment for a patient presenting with stroke signs/symptoms should be given high flow oxygen (O₂) and oral glucose.

False ## Footnote Oxygen is only given if the patient is hypoxic. Oral glucose should only be given if hypoglycemia is confirmed or strongly suspected and the patient can swallow.

What are **two** common types of seizures?

* **Generalized** (tonic/clonic) * **Partial** (focal) seizures

Which **phase** of a seizure does an **aura** present?

before ## Footnote Not all seizures present with auras, and some auras may present as a partial seizure and progress to a generalized seizure.

# True or False: All patients suffering first-time seizure activity should be evaluated by a doctor.

True

What is the medical term for **fainting**?

syncope

# Define: Altered Mental Status | (AMS)

It is defined as any changes to a person's awareness of person, place, time, and event that are not considered normal for the patient.

Explain the mnemonic utilized when attempting to discover the cause of a patient suffering from **altered mental status** (AMS) from an unknown cause.

**A**lcohol/**a**cidosis **E**pilepsy, **e**ndocrine, **e**lectrolytes **I**nsulin **O**piates and/or other drugs **U**remia (kidney failure) **T**rauma, **t**emperature **I**nfection **P**oisoning or **p**sychogenic **S**hock, **s**troke, **s**eizure, **s**yncope

What does the mnemonic **BE FAST** represent?

**B**alance **E**yes (pupil response) **F**acial drooping **A** drift **S**peech **T**ime frame from last seen *normal*

Why would a patient be incontinent after a generalized seizure?

The spasmatic electrical activity in the brain causes all muscles to erratically contract. This would lead to the urinary sphincters to spasm and leak urine.

# True or False: Providing oxygen (O₂) for a patient in a postictal state may shorten the postictal time frame.

True

# List: Potential causes of an **acute abdomen**.

* Cholecystitis and/or cholelithiasis * Ulcers * Pancreatitis * Appendicitis * GI bleed(s) * GERD (gastroesophageal reflux disorder/disease * Esophageal Varices

What is the medical term for a patient **vomiting blood**?

hematemesis

A patient complaining of having **abdominal pain** and **coffee-ground emesis** is most likely suffering from what disorder?

Gastrointestinal Bleed | (GI Bleed)

What is the most common pertinent history of a patient presenting with esophageal varices?

alcoholism

What are **kidney stones** (nephrolithiasis) caused by?

Uric acid that is crystalizing urine.

# Fill in the blank. While palpating a patient's abdomen, they complain of shoulder pain. This is commonly called \_\_\_\_\_\_\_\_ \_\_\_\_\_.

referred pain

What are two things the brain needs to survive?

* Oxygen (O₂) * glucose

What is the **endocrine system** responsible for?

Production, secretion, and communication of hormones.

# List: Types of diabetes

* Diabetes mellitus type 1 * Diabetes mellitus type 2 * Gestational

What is the most common *first presentation* of a diabetic emergency: a **hypoglycemic patient** or a **hyperglycemic patient**?

hyperglycemic patient

# List: The "Polys" of diabetes

* Polyuria * Polyphagia * Polydipsia

What is the function of **insulin**?

It is a hormone that enables glucose to move into cells.

What **hyperglycemic syndrome** causes profound dehydration?

Hyperosmolar hyperglycemic nonketotic syndrome | (HHNS) ## Footnote It is a hyperglycemic emergency seen in type 2 diabetics, marked by high blood sugar and profound dehydration without ketoacidosis.

# True or False: It is an acceptable treatment to provide oral glucose buccally for the unresponsive diabetic emergency.

False ## Footnote Oral glucose in an unresponsive patient will cause airway obstruction and possible aspiration.

What is the name of the disease of a patient that is born with a **decreased ability to clot blood**?

hemophilia

# Fill in the blank. The study of the recognition, treatment, and management of blood related disorders is called \_\_\_\_\_\_\_\_\_\_\_\_.

Hematology

What should we do with the epi-pen **after** administration?

Dispose of it properly in a Sharps container.

What must happen before the body can identify an **allergen**?

The body must be **exposed** to the allergen at least **once** for the sensitization process.

# List: common allergens

* food * medication(s) * chemicals * plants * insect/animal bites or stings

Why is **angioedema** including the lips, tongue, and larynx considered critical/lethal?

It is considered critical/lethal due to **airway obstruction, narrowing, or occlusion**. Early recognition/suspicion and airway management are crucial.

# True or False: A patient can be hypersensitive to an allergen and still not progress to anaphylaxis.

True

What does the presence of **stridor** indicate?

It is a **high-pitched sound** on inspiration indicating **partial upper airway obstruction**, often at the larynx or trachea due to swelling, foreign body, or trauma.

What is the **contraindication** for the administration of the epi-pen?

There are **no contraindications** if the patient is in true anaphylaxis. Anaphylaxis is an emergent life threat.

How often should a patient with a severe allergic reaction be reassessed?

**Every 5 minutes**, staying alert for any signs of progression to anaphylaxis.

# List: Routes that toxin(s)/poison(s) enter the body

* Injection * Ingestion * Inhalation * Absorption

Is alcohol a central nervous system (CNS) **stimulant** or **depressant**?

CNS **depressant**

# Differentiate: Addiction and tolerance

* **Addiction:** is a physical and psychological need/desire to consume a particular substance (alcohol, stimulants, hallucinogens, etc...) * **Tolerance:** results when the abuse/addiction of a substance will no longer have the same effect and will require more of the substance to reach the individual goal/high.

# Define: dependence

It develops when a substance is misused so frequently that a psychological and physical need emerges.

What is it called when a person's reactions or behaviors are extreme and outside of societal norms?

behavioral crisis

# True or False: A patient's history of depression is a critical insight as to the risk of suicide.

True

What is the **disorder** called that results from spasming and swelling of the **smaller airways** (bronchioles)?

asthma

The acronym **COPD** stands for what respiratory disorder?

Chronic Obstructive Pulmonary Disease/Disorder

# List: Signs/symptoms of emphysema

* Chronic exertional dyspnea * Pursed lip breathing * Barrel chest * Decreased lung sounds * Chronic or worsened cyanosis

# List: Potential treatments for patients with an **exacerbated chronic respiratory complaint (respiratory crisis treatment)**

* High flow oxygen (O₂) * Assistance with medication (metered dose inhalers MDI) * Position of comfort (POC), typically Semi-Fowler's * Assisted positive pressure ventilation (PPV) * Transport

# Fill in the blank. Hyperventilation syndrome is commonly associated with an \_\_\_\_\_\_\_ \_\_\_\_\_\_\_.

anxiety attack

What will the lung sound be when assessing the lung sounds on the affected side of a patient with a suspected **pulmonary embolism**?

Initially, the lung sounds will be clear in the affected area and possibly progress to diminished and/or absent.

What is an indication for the administration of a metered-dose inhaler (MDI) or a small-volume nebulizer (SVN)?

The patient is presenting with **dyspnea**, most likely with a history of chronic respiratory illness. Suspected bronchial spasms are commonly associated with wheezing.

Component 7: Care for the Medical Patient Flashcards

A review of common illnesses, treatments, and the NREMT Management of the Medical Patient skill sheet. (78 cards)