1 Flashcards
Atropine: Pedi
0.02mg/kg
Atropine: Adult
0.5-1.0mg
Bicarb: Pedi
1mEq/kg
Bicarb: Adult
1mEq/kg
Bretylium: Pedi
5mg/kg
Bretylium: Adult
5mg/kg
EPI 1:1000: Pedi
0.01 mg/kg………CODE 0.1 mg/kg
EPI 1:10,000: Adult
0.3-0.5 mg
EPI 1:10,000 Pedi
CODE ONLY 0.01 mg/kg
Haldol: Adult ONLY
2-5mg
Lidocaine: Pedi
1.0 mg/kg
Lidocaine: Adult
1.0-1.5 mg/kg
Mag sulfate: Adult ONLY
1-2 grams over 1-2 minutes
Morphine: Adult ONLY
2-5mg
Narcan: Pedi
0.1mg/kg
Narcan: Adult
0.4-2.0mg
Oxytocin: Adult ONLY
10-20 units
Valium: Adult ONLY
2-10 mg
IV Tourniquet (Venous constricting band)
occludes venous return but allows arterial flow
Colloids increases intravascular space the most but take longer to get in due to protein size and molecular weight
hespan/dextran
IV solution closest to plasma
Lactated Ringers (LR)
Hemorrhagic shock best fluids
blood (definitive), field-lactated ringers 3x loss
Fluid replacement adult trauma
20 ml/kg or 3x estimated blood loss
Tric OD
sodium bicarbonate
Asthma
Albuterol 2.5 mg, EPI 0.3-0.5mg 1:1000 solution SQ, Bronkosol…NO BENADRYL (adult doses)
Heroin Demerol, and organophosphates
constricted pupils
Administration of a HYPERtonic solution in a hydrated PT
draws water from cells to intravascular space
Movement of gas from higher concentration to lower concentration
diffusion
Decreased O2 in blood
hypoxemia
Decreased O2 in lungs
hypoxia
Hyperventilation syndrome in PT
resp. ALKALOSIS
RESP. acidosis is corrected with
hyperventilation of PT
Excretory function of blood is to
remove urea/creatine lactic acid and wastes; particularly lactic acids form cells
Hypoxic drive or PT’s with COPD, stimulus to breathe
decreased O2 levels
Normal CO2 levels
35-45
pH above 7.45
alkalosis
pH below 7.35
acidosis
RESP. ACIDOSIS
pH less than 7.35 and pCO2 greater than 40
METABOLIC ACIDOSIS
pH less than 7.35, pCO2 greater than 40 & HCO3 or PO2 less than 24
RESP. ALKALOSIS
pH greater than 7.45 and pCO2 less than 40
METABOLIC ALKALOSIS
pH greater than 7.45 and pCO2 less than 40 & HCO2 or PO2 greater than 24
EXAMPLE: Blood gas
pH 7.15, pCO2, 60 and PO2 Resp. acidosis
Resp. Acidosis
CNS/COPD/Narcotics/Asthma/Cardiac Arrest & Drowning
Resp. Alkalosis
Sepsis/Cirrhosis/ASA OD/Anxiety & Pregnancy or Hyperventilation Syndrome
Metabolic Alkalosis
Vomiting/Diuresis, sodium bicarb, Crushing dz (disease)
Acidosis
not breathing or below normal rate (cardiac arrest)
Alkalosis
breathing to fast (Hyperventilation syndrome)
Fresh water drowning
hemodilution, electrolyte imbalance and hypoxia with resp. acidosis
SCENARIO: Fresh water drowning
NOT RESP. ALKALOSIS
Primary concern in treating a near-drowning victim
mgmt. of HYPOXIA and ACIDOSIS
Intubation of a child under 8 years of age
uncuffed
Intubation
check lung sounds, AFTER check cuffs for leaks, BEFORE ventilate via other means prior to intubation
Kussmaul resp.
rapid breathing assoc. with DKA
Not an airway sound
Cough: Stridor/wheezing/snoring are airway sounds
Size of ET for Pedi
Pinky diameter of PT ET diameter
Ventilation via other means
hyperventilate prior to intubation, if unsuccessful after 30 seconds of attempted intubation ventilate again
Left the PT in the ER without turning over to equal or higher medical personnel
abandonment
Negligence
breech of duty/duty to act/proximate cause, damages or harm; INTENT not needed
Legal document that indicates end of life request regarding resuscitation
DNR; WHAT COLOR PAPER DOSE IT HAVE TO BE PRINTED ON YELLOW
Malicious writing
libel
Malicious spoken terms
slander
Dyspnea
difficulty or painful breathing
The Hering-breur reflex
prevents overexpansion of the lungs
Hypoxia drive or PT’s with COPD, stimulus to breathe
decreased O2 levels COPD
Wheezing
whistle sound on inspiration (lower airway)
Wheezing
constriction
Whistling sound during exhalation
consider asthmatic broncholitis
Rhonchi
fluid/mucous in LARGE airway
Croup
stridor at night with seal bark
Rales usually heard in
lower airway (alveoli) fluid
Tension pneumothorax treatment
O2, decompress, transport, IV enroute
Pulmonary Emboli s/s
Dyspnea/SOB/pleuritic pain/Tachycardia
Anaphylaxis
Classic sign is HYPOTENSION
Anaphylaxis
Uticaria/SOB/facial swelling/tachypnea and HYPOTENSION hallmark of anaphylaxis
Pneumonia
Fever/rhonchi/hot and dry skin NO PEDAL EDEMA
EPI dose for asthma
0.3-0.5 mg SQ 1:1000
Chronic bronchitis
blue bloater, fat, increased mucous production, chronic cough
Emphysema
SOB, barrel chest/thin and pursed lip breathing pink puffer
Cough up pink tinged sputum
s/s Left sided heart failure/Pulmonary edema
CHF
Left sided ventricular damage
Pink puffers (emphysema) and Blue Bloaters (Chronic bronchitis)
COPD
Upper airway sound produced with inspiration difficulty
stridor
Lung sounds to bronchoconstriction
wheezing
Neurogenic/anaphylactic & septic shock cause HYPOtension due to
vasodilation
Smaller airway sound with fine crackling
Rales
Rumbling sound/fever/no edema
pneumonia
Treatment Pulmonary edema
LMNO
LMNO
O2, Lasix (40 mg) slow IVP, Morphine sulfate (2 mg) slow IVP and Nitro (0.4 mg) sublingual
Primary concern near drowning
hypoxia and acidosis
Fresh water drowning
Hemodilution or hemolysis
21 y/o with chest pain after coughing
Spontaneous Pneumothorax
**REMEMBER: 20-30 y/o, thin, smokers and males more prone to spontaneous pneumothorax**
prone to spontaneous pneumothorax
Orthopnea
difficulty breathing while lying down
As volume in thoratic cavity increases
pressure decreases exhalation (PASSIVE)
Respirations
exchange of gases between internal/external environment
Pink-puffer
increase RBC production to increase hemoglobin capacity to breathe, Skin color is pink not BLUE
JVD best evaluated in
semi-fowler position @ 45 degrees
Due to bronchiolar spasm a PT with asthmatic bronchiolitis will show
expiratory wheezing
As approach any scene
make sure scene is safe
Libel
malicious writing
Slander
malicious spoken
Triage
sort
Last (Black) priority in MCI
is Cardiac Arrest
START
Triage simple triage and rapid transport
Separate the walking wounded
in MCI
MCI
Can you walk, breathing, pulse, circulation
In any MCI scenario you
treat airway, bleeding, AMS, and then FX’s. Immediate life threats are first except cardiac arrest/major burn PT (tagged dead/black) then potential life threats…BLS before ALS…
First Medic on scene with MCI
Triage
MCI- Most critical PT
person walking around aimlessly repeating things over & over with AMS
MCI START System
RR greater than 30, Cap Refill less than 2 seconds- R to painful Stimulus/unconscious/alert & disoriented are all Critical, immediate PT’s (Key is any AMS)
One of first signs hypovolemic shock
Tachycardia
Earliest sign of any shock
AMS
Jaw thrust or Modified jaw thrust
trauma PT to open airway
Trauma
Give 3 times estimated blood loss of LR or 20 ml/kg
Traumatic asphyxia most commonly caused
crush injury to chest or abdomen
Tension pneumothorax s/s
dypnea/madiastinal shift away from affected area/JVD
S/S Neurogenic shock
hypotension/bradycardic/warm/dry skin BELOW level of injury following trauma
ICP will also see
bradycardia/vomiting/irregular or unequal pupils NOT HYPOTENSION CUSHINGS
Trauma victim pulse 40 & BP 200/120
increased ICP Cushing’s triad
Clear fluid leaking from ears/nose
Basilar skull fx
Allow CSF/blood to drain from ears/nose with head trauma because
the bleeding relieves pressure and will decrease chance of ICP
Glascow Coma Scale (GCS)
Motor (6), Verbal (5), Eye Opening (4) GCSscale 15
Scenario Burn to Anterior chest and abdomen and anterior upper extremities (2)
rule of nines27
Place for decompression
2nd or 3rd intercostals space (midclavicular line)
Scenario
MVA PT. with HR 120, BP 40 palp, PT Hypovolemic shock
a severly angulated fx
pinching or cutting of nerves and blood vessels
Beck’s triad
Muffled/distant heart sounds, narrowing pulse pressure, decreased BP (NOT FLAT NECK VEINS)
A PT with major burns has hypovolemic shock
due to plasma loss
23 y/o sharp chest pain & increasing SOB
spontaneous pneumothorax
Delivery of placenta
end of 3rd stage of labor
26 y/o multi gravid with prior C-Sections, C/C
full term with contractions 3-4 minutes apart/TEARING pain, little amount of bleeding abruptio placenta
Abruptio placenta
DARK red blood and Pain classic differentiation
Abruptio placenta
minimal dark red bleeding, rigid uterus & shock/ can also be described as tearing pain
Placenta previa
placenta covers cervical opening
Placenta previa
BRIGHT red blood and Painless classic differentiation
Placenta previa
placenta covers cervical opening
Primary concern with prolapsed cord
Compromised blood supply to fetus
APGAR
0-2 scale for appearance, pulse, grimace, activity, resp. rate (under 6 intervention required)
APGAR
1 and 5 minutes
OB PT over 3 months transport
On left at least 15 degrees to avoid SUPINE HYPOTENSIVE SYNDROME or pressure on inferior vena cava from uterus
Seizures from TOXEMIA (ECLAMPSIA)
9th month (can occur all of 3rd trimester!) Tx: 5-10 mg valium Toxemia of pregnancy usually in 9th month pregnancy but again, can occur any time in 3rd trimester
Preeclampsia presentation
Hypertension, edema
Common cause uterine bleeding 1st trimester
Threatened abortion/incomplete abortion/ruptured ectopic pregnancy… NOT PLACENTA PREVIA
1st Stage
contractions to dilation
2nd Stage
dilation to crowning full dilation/delivery
3rd Stage
delivery to placenta delivery
Serous membrane covering abdominal organs
Visceral
All s/s kidney stones
frequent urination
Bilateral dilated pupils usually
cerebral hypoxia
23 y/o working out in gym with explosive headache
subarachnoid aneurysm
Severed C4
total paralysis motor and resp. paralysiscan’t breathe on own
Countercoup
injury to opposite side of the head/or opposite side of impact
T4 injury
paralysis below nipple line
T10 injury
paralysis below the umbilicus PT loss of feeling below the nipple lineT4 spinal injury
Part of the brain that effects vision
Occipital/injuryvision affected
Seizures
valium/diazepam 5-10 mg
Stimulation of Sympathetic NS
Increased HR and blood vessel constriction INCREASES Peripheral vascular resistance BETA RECEPTOR STIMULATION
Cardiac Tamponade
JVD, narrowing pulse pressure (systolic closer to diastolic), clear lungs, muffled distant heart sounds
Pain in chest that is searing and tearing with radiation to neck and No Pedal Pulses
Aortic Aneurysm
If stroke volume does not change, but HR decreases
Cardiac output decreases
Rapid Wide Bizarre
V-TACH
Inotropic
contractility
85 y/o with severe headache, NV, dizzy, BP 210/120
Hypertensive crisis
60 y/o PT weighs 110 lbs., heart palpitations P-145, BP-110/60, RR-24, EKG-Wide complex tachycardia TREATMENT
Lidocaine 1-1.5 mg/kg or 50 mg IVP
Rhythm strip shows some kind of 2nd degree type 2 block
O2/monitor and transport
Adenosine
slows conduction through AV node… slows all cations
Digitalis toxicity
A-Fib
PT takes digitalis is weak/dizzy, VS WNL (WNL means we never looked in court do not use)(VS normal range)
monitor, IV and transport
Pulse pressure
difference between systolic and diastolic
Heat stroke
Aggressive cooling methods then 2 IV’s WIDE OPEN
Profuse sweating
heat exhaustion
Burns cause massive generalized swelling
due to plasma movement into interstitial tissues
Best method on LSD PT
talk down/reorient
Hypoglycemia S/S
weak and rapid pulse, weakness and incoordination, seizures cool and clammy
Kussmauls
deep and gasping respirations seen in DKA/Hyperglycemia
Hypoglycemia
stupor, stumbles, slurred speech, bizarre Bx, cool/clammy skin
DKA
Kussmaul respirations-deep, rapid, gasping
Tricyclic OD what is not treatment
Ipecac 30 mg
Story does not match injury
suspect abuse (ALL AGES)
Valium routes of administration for 17 lb seizure Pedi
RECTAL, IV & IM
Bile
enzyme produced in liver and stored in gall bladder
Occipital lobe
vision
Orthopnea
place PT in sitting position
Uticaria
Hives
Pryrogenic reaction
fever, chills, nausea, vomiting (common in blood transfusions)
Best defense
hand washing
Hep-A
Fecal/oral route
Fever/chills/night sweats and blood in cough
TB without hemotypsis-HIV
Children (1-8) fluid replacement
20cc/kg (one year and up as 20cc/kg-adult fluid bolus dosage)
Croup aka LARYNGOTRACHEOBRONCHITIS
occurs at night, seal bark, stridor… Do not lay flat and keep calm. Do not examine throat or laryngospasm can occur. Use humidified oxygen. THE MOST DANGEROUS DISORDER CAUSING UPPER AIRWAY STRIDOR—CROUP
Life threatening infection…bacterial that causes upper airway obstruction with reluctance to swallow due to pain and high fever
Epiglotitis (DROOLING)…Do not lay flat. Keep calm. Do not examine throat or laryngospasm can occur. O2 humidified
Epiglotitis scenario will say sitting upright/fever/drooling
don’t lay supine
20 lbs. Pedi how you measure ET tube answers were 6 Cuff, 6 Uncuffed, Diameter of index finger, and length based tape. I picked 6 uncuffed, Broslow Tape
weight based tape
Infant
uncuffed due to till 8 y/o-narrowest area of airway crichoid
Pediatric Lidocaine dose
1 mg/kg of body weight
Child 18 y/o or under C/C headache, stiff neck, vomiting
MENNINGITIS
Asthma attack
primary problem-Bronchoconstriction with bronchospasms
Epiglotitis
rapid ONSET fever higher than 101 degrees usually
Croup
Slow onset fever usually between 100-104 degrees
Spinal cord injury occurs above C4, what happens to the PT. I put quadriplegic with no ability to breathe.
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