EXAM INFORMATION

Your exam will consist of a scenario that will involve scene size-up, an initial assessment (and treatment), a focused history and physical examination, a detailed physical examination, and an ongoing assessment. You will be required to provide patient care and any immediate first aid required. A field assessment form will be completed, during your examination and treatment of the casualty. You will practice correct BSI procedures to protect yourself from BBP. You will be required to use rope handling and knot skills to extricate a patient from a simulated, hazardous environment. Using a method of your choice, you will explain to Mr. Ferguson the circulatory system and the pathway followed by the blood through the heart, beginning at the lungs. You will indicate whether or not the blood is oxygenated or deoxygenated. You will use all of the correct anatomical terms to communicate this. You will also explain the mechanism causing the heart to beat, using the correct nomenclature. (see EXAM Rubric)


Things to be cognoscente of, during your exam

scene size-up

ensure a safe environment for rescuers, patients, and bystanders | anticipate potentially hazardous situations | call for appropriate resources | identify potential scene hazards that may endanger the EMT or the patient | evaluate the "whole picture" of the call

initial assessment

quickly determine the nature of the illness or the mechanism of injury. A.V.P.U.

treatment

FA | CPR | O2 | AED | suction | bandage | splint | etc.

focused history

medical history | chief complaint | OPQRST | associated symptoms | summarize

physical examination

head | neck | chest | abdomen | pelvis | extremities | posterior aspect of the body | obtain baseline vital signs (see Field Assessment Form ICF 20)

detailed physical examination

secondary survey by assessing: mental status | general survey | skin | head | eyes | ears | nose and sinuses | mouth and pharynx | neck | thorax and lungs | cardiovascular system | abdomen | peripheral vascular system | musculoskeletal system | nervous system

ongoing assessment

stable casualty - every 15 minutes

unstable casualty -  every 5 minutes

reassess mental status | monitor the airway | monitor breathing rate and quality | reassess pulse rate and quality | monitor skin color, temperature, and condition | realign patient priorities as needed | reassess vital signs | repeat focused examination regarding complaint or injuries | check efficacy of interventions

documentation

a well-documented report is essential for proper transfer of care to the receiving facility. Proper documentation is necessary for defense if patient care ever needs justification in a hearing or negligence suit.

body substance isolation

infection control approach that defines all body fluids and substances as being infectious.

ropes & knots

properly dressed; loops and bights are proper size

extrication

removal of a casualty from a hazardous environment (e.g., MVA)

circulatory system

heart (chambers and valves) | blood | lungs | deoxygenated | oxygenated | nomenclature | Major veins and arteries

heart control system

heart | SA | AV | diastole | systole | pacemaker | His | bundle branch | purkinje


Sample Exam Outline

Phase I — Extrication

MVA, front-end collision with a tree, air bags have not gone off, no unusual smells, doors are all locked.
Patient is unconscious and does not respond when called to, but will flinch from painful stimuli
Vehicle door will require tying off
Patient has a cut on the right ankle, and a broken right wrist.
Patient has a broken left tibia
After patient is extricated, consciousness is slowly regained. Patient will react to verbal stimulus. After initial treatment has been performed, patient will be fully conscious.

Phase II — One-Rescuer Modalities

Patient is stable. Then, suddenly goes into Cardiac Arrest.
After initial care, each rescuer will move to an Actar and perform one-rescuer modalities (patient will prepare to assist as a bystander).
After five cycles, patient will be reassessed and there will be no change and modalities will be continued for one more cycle.

Phase III — Two-Rescuer Modalities

The rescuers will then become a two-rescuer team and work on one Actar.
The first rescuer will arrive and go through 3 cycles before the second rescuer arrives with a BVM, O2 kit, and OPAs.
Simulate intubation and perform the correct two-rescuer modalities.
After 2 more cycles, the patient will be reassessed. No change.
Continue for two more cycles and a bystander will drop off an AED.
The second rescuer will perform the AED protocols.

Phase IV — Anatomy and Physiology

Explain the function of the circulatory system
Describe the pathway followed by the blood through the heart, beginning at the lungs.
Indicate whether or not blood is oxygenated or deoxygenated.
Use all of the correct anatomical terms to communicate this.
Explain the mechanism causing the heart to beat, using the correct nomenclature.

Sample explanation, showing required nomenclature:

1.       (12) A heartbeat is a two-part pumping action that takes about a second. As blood collects in the upper chambers (the right and left atria), the heart's natural pacemaker (the SA node) sends out an electrical signal that causes the atria to contract. This contraction pushes blood through the tricuspid and mitral valves into the resting lower chambers (the right and left Ventricles). This part of the two-part pumping phase (the longer of the two) is called Diastole.

  • Two-part pump
  • L&R Atria
  • SA node
  • Tricuspid
  • Mitral
  • Distole
  • (6) A&P terms used correctly in explanation

2.       (13) The second part of the pumping phase begins when the Ventricles are full of blood. The electrical signals from the SA node travel along a pathway of cells to the Ventricles, causing them to contract This is called diastole As the tricuspid and mitral valves shut tight to prevent a back flow of blood, the pulmonary and aortic valves are pushed open. While blood is pushed from the right ventricle into the lungs to pick up oxygen, oxygen-rich blood flows from the left ventricle to the heart and other parts of the body.

  • Second part of the pumping phase
  • L&R Ventricles
  • SA node
  • Contract
  • Distole
  • Pulmonary
  • Aortic
  • (6) A&P terms used correctly in explanation

3.       (11) After blood moves into the pulmonary artery and the aorta, the Ventricles relax, and the pulmonary and aortic valves Close. The lower pressure in the ventricles causes the tricuspid and mitral valves to open, and the cycle begins again. This series of contractions is repeated over and over again, increasing during times of exertion and decreasing while you are at rest. The heart normally beats about 60 to 80 times a minute when you are at rest, but this can vary. As you get older, your resting heart rate rises. Also, it is usually lower in physically fit people.

  • Lower pressure in ventricles
  • Tricuspid and mitral  valves open, cycle repeats
  • 60 to 80 times a minute
  • Resting heart rate rises with age
  • Resting heart rate is lower in fit people 
  • (6) A&P terms used correctly in explanation

4.       (10) Your heart has a natural “Pacemeker” called the sinoatrial (SA) node. The SA node is a specialized group of cells at the top of your heart's upper-right chamber (the right atrium). Anywhere between 60 and 100 times a minute, the SA node sends an electrical impulse throughout your heart to cause it to beat (contract). 

  • Pacemaker
  • Sinoatrial node
  • Top of your heart's right atrium
  • Electrical impulse
  • (6) A&P terms used correctly in explanation

5.       (10) When the SA node sends an electrical impulse, that impulse first travels through the heart's upper chambers (the atria. It then passes through a small group of cells called the atrioventricular  (AV) node. The AV node checks the impulse and sends it along a track called the bundle of His. The bundle of His divides into a right and left bundle branch, which lead to your heart's lower chambers (the ventricles). Purkinje fibers are specialized conductive fibers located within the walls of the ventricles. They are responsible for relaying cardiac impulses to the cells of the ventricles, which allow the ventricles to contract. 

  • Atrioventricular  node
  • Bundle of His
  • Right and left bundle branch
  • Purkinje fibers
  • Ventricles
  • (6) A&P terms used correctly in explanation