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Paramedic > 119 Mod 2 (Bleeding, Shock, and Fluids) > Flashcards

119 Mod 2 (Bleeding, Shock, and Fluids) Flashcards

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1
Q
A

SVT

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2
Q
A

Junctional Escape

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3
Q
A

V Tach

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4
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I

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5
Q
A

A Fib

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6
Q

A 25 year old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned.

A. 46%

B. 57%

C. 36%

D. 28%

A

57

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7
Q

A laceration to a large artery can exsanguinate in less than ___ mins

A

2

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8
Q

A partial thickness burn is also known as ____________ and ________ degree burns (2)

A full thickness burn is also known as?

A

First and second - partial

3rd - Full - every layer - needs skin graft

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9
Q

A patient fell from a roof and has normal pink skin, BP 98/62, HR 70, RR 18, and is unable to move or feel legs. What type of shock is this?

Not decomp comp irreversible

A

Neurogenic- Spinal

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10
Q

A patient fell from a roof and is presenting with flushed skin, BP 80/42, HR 54, RR 0, and absent reflexes. What shock are they suffering from?

Not comp decomp irreversible answer

A

Neurogenic shock

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11
Q

A patient fell from the roof and presents with pale skin, BP 82/52, HR 124, RR 22, unstable pelvis. What shock is it?

Neurogenic

Hypovolemic

Spinal

Obstructive

A

Hypovolemic shock

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12
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but their bp drops to 82/40 and is disoriented is in _____________ shock

Comp decomp or irreversible

A

Decompensated shock

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13
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but is normotensive (normal bp) is in _____________ shock

A

Compensated shock

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14
Q

According to the ___________ formula for burns, you give ______% in the first 8hours

A

Parkland burn formula

50% in the first 8 hours

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15
Q

Acetaminophen

class / dose / for / contra

A

for mild discomfort, FEVER, 100.4

dose: 325mg

contra: head injury, hypotension, resp dis, vomit, liver disease, allergic, less that 3 mos

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16
Q

Acetazolamide

A

Diamox

for: edema from CHF, glaucoma

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17
Q

Battle signs vs Raccoon Eyes are a sign of fractures where?

A

Battle - basilar skull
Raccoon - anterior cranial fossa

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18
Q

Beck’s Triad is indicative of what?

A

Cardiac tamponade

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19
Q

Cheyne-Stokes
Biots,
and
Apneustic,

symptoms

A

Cheyne-Stokes - gradual increase and decrease with periods of apnea
(brain inj)

Biot’s - ABNORMAL, equal depth, with regular apnea
(brain stem inj)

Apneustic - prolonged inspire with prolonged expire (ICP)

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20
Q

Bleeding or swelling occurs within a compartment in a patient with which of the following conditions?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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21
Q

BP 188/101, and a hx of blood thinners. Sudden severe headache, blurry vision, and AMS.

Subdural hematoma

epidural hematoma

intracranial hematoma

A

intracranial hematoma

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22
Q

Burn shock is what type of shock?

A

Hypovolemic shock - loss of plasma/fluid

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23
Q

Burning Epigastric Pain affects which organ?

A

Stomach

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24
Q

Calculate the TBSA using the rule of 9s (1st degree burns – entire back, entire left arm, back of leg)

A

0%

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25
Q

Calculate the TBSA using the rule of 9s (3rd degree and 2nd degree burns – entire back, entire left arm, back of leg)

A

36%

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26
Q

Commotio cordis occurs at what part of the cardiac cycle?

A

the upstroke of the T wave

Blow to the chest disrupting the heart. During the precise moment of the heart repolarizing leading to arrhythmia.

Can lead to V-Fib , needs cpr and rapid defib.

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27
Q

Coughing blood is called

A

Hemoptysis

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28
Q

What are the 3 Cushings Triad signs?

and when would you expect it?

how would you treat?

A

Bp - up
Hr - down
RR - Irregular

may be seen in patients with increased
ICP from head trauma or tumors.

Hyperventilate - to 30-35 ETCO (20 BPM) to vasoconstrict blood

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29
Q

Define Afterload

A

the force the heart must overcome to pump blood out to the body. (Pressure of vascular resistance).

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30
Q

Define ARDS

A

Acute Respiratory Distress Syndrome

low O2 in blood,

caused by sepsis, trauma, flail chest, pneumo,

signs are severe dyspnea SOB, hypoxemia (low oxygen levels in the blood), tachypnea (rapid RR)

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31
Q

Define Biots

A

Irregular pattern, rate, periods of apnea

ICP

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32
Q

Define Blood Pressure in an equation (___x___)

A

Cardiac output x Vascular Resistance

Blood pressure is the force of blood pushing against the walls of blood vessels, measured as systolic/diastolic pressure.

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33
Q

Define Brown-Sequard Syndrome

A

cervical spinal injury resulting in paralysis (hemiparaplegia) on one side of the body and loss of sensation on the opposite side (hemianesthesia)

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34
Q

Define Cardiac output

A

amount of blood pumped by the heart per minute

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35
Q

Define cardiac output in an equation (___x___)

A

HR x Stroke Volume

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36
Q

Define Cauda Equina Syndrome

A

compression of the spinal nerve roots, resulting in motor and sensory deficits

caused by a herniated disk, tumor, trauma, or spinal stenosis.

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37
Q

Define Cheyne - Stokes

A

Increasing rate, gradual decrease,
intermittent periods of apnea

brainstem injury

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38
Q

Define Critical Burns

A

partial more than 30%

full more than 10

Inhalation injuries

Partial or Full involving hands, feet, joints, face, genitalia (2nd or Third)

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39
Q

Define Ejection fraction

A

Percentage of blood leaving the heart each time it contracts

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40
Q

Define Epithelialization

A

Formation of fresh tissue to heal a wound

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41
Q

Define Exsanguation

A

loss of the total blood volume, death

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42
Q

Define
Hyperextension
Hyperflexion
Compression
Rotation
Lateral Stress
Distraction

(spinal traumas)

A

Hyperext - head neck movement (mvc, neck inj, dive)

hyperflexion - head onto chest (thrown, dive)

compression - downward fall

Rotation - roll fall (mvc, bike)

Lateral - direct lat force (t-bone)

Distraction - strectching - hanging

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43
Q

Define Joule’s Law

A

The relationship between heat, current and resistance

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44
Q

Define Myositis

A

Inflammation of the muscle, caused by infection

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45
Q

Define Preload

A

the amount of blood that fills the heart before it pumps it out to the body.

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46
Q

Define Preload

A

pre contraction pressure in the heart, which increases as the blood builds up

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47
Q

Define Sterlings Law

A

the bigger the pump the harder the squeeze.

the heart will pump harder when it is filled with more blood.

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48
Q

Define Stroke Volume

A

the amount of blood pumped out of the heart with each beat.

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49
Q

Define Systole

A

the period when the heart contracts and pumps blood out to the body.

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50
Q

Define the 6 types of shock, signs, and treatment

A
  1. Hypovolemic shock: This occurs when there is a significant loss of blood or other fluids in the body.

Signs include low blood pressure, rapid heart rate, cold and clammy skin, decreased urine output, and altered mental status.

Treatment involves stopping the bleeding, replacing fluids and blood products, and addressing the underlying cause.

  1. Cardiogenic shock: This occurs when the heart cannot pump enough blood to meet the body’s needs.

Signs include low blood pressure, rapid heart rate, shortness of breath, chest pain, and cool and clammy skin.

Treatment involves addressing the underlying cause, such as a heart attack, and supporting the heart’s function.

  1. Distributive shock: This occurs when there is widespread vasodilation, causing blood to pool in the body’s tissues and not enough blood to circulate to vital organs.

Types of distributive shock include
septic shock,
anaphylactic shock, and
neurogenic shock.

Signs include low blood pressure, rapid heart rate, warm and flushed skin, and altered mental status.

Treatment involves identifying and treating the underlying cause, providing supportive care, and administering vasoactive medications.

  1. Obstructive shock: This occurs when there is a blockage in the circulatory system, preventing blood from flowing properly.

Examples include
pulmonary embolism,
cardiac tamponade, and
tension pneumothorax.

Signs include low blood pressure, rapid heart rate, shortness of breath, and chest pain.

Treatment involves addressing the underlying cause, such as removing the blockage, and providing supportive care.

  1. Dissociative - Co poisioning
    Oxgenation
  2. Neurogenic
    damage to symp ns - epi/nor-epi
    give epi, fluids, and pace if needed
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51
Q

Define
Hematuria
Hematachezia
Hematocrit

A

Hematuria - blood in urine
Hematachezia - bright red stool
Hematocrit - red blood cells in total blood volume

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52
Q

Delivering a patient to a facility before the loss of pulses is important in patients with which of the following conditions?

Pick one:

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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53
Q

Describe signs for each degree of burns

A

First Degree - redness - just epidermis

Second Degree - blisters - epi to dermis

Third Degree - Charing, cap refill absent, full

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54
Q

Dexamethasone

class / dose / for / contra

A

Steroid

dose: 10mg IV

for: Severe Asthma, Anaphylaxis, croup

contra: hypersensitive, fungal infection, premature infant

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55
Q

Diastole is

A

the period when the heart is RELAXED and fills with blood.

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56
Q

Difficulty swallowing

A

DysphaGIA

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57
Q

Do you remove contacts with Eye burns

A

No, flush only

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58
Q

Dobutamine

A

Sympathomimetic

dose: 5-20 mcg per kg/min

for: heart failure, low cardiac output

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59
Q

Dopamine

class / dose / for / contra

A

alpha beta adrenergic receptor stim / dopaminergic

dose: 2-20 mcg/kg/min IV drip

for: shock (hypovolemic, anaphylactic, septic, cardio

contra: dysrhythmia, uncorrected hypovolemia

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60
Q

Epinephrine 1:1 (for allergic)

class / dose / for / contra

A

Adrenaline

dose: 1mg in 1ml

for: severe allergic reaction with resp dis, severe asthma

contra: none during anaphylaxis

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61
Q

Euphoria, Tingling, and AMS
are signs of what Water Emergency

A

Nitrogen Narcosis

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62
Q

Fentanyl

class / dose / for / contra

A

Opioid

dose: 1mcg/kg (max 200mcg)

for: severe pain

contra: allergic, uncorrected resp distress, hypo 90

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63
Q

Flank Pain and Hematuria is a sign of what organ affected? also what is Hematuria?

A

Kidneys - Retroperitoneal Cavity

Hematuria - Blood in urine

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64
Q

For a severe burn patient which step is first Intubate or Vitals?

A

Put out fire
Open airway
O2
INTUBATE
nasogastric tube stomach
IV
VITALS
remove clothes
Determine burn %
Dress burns, sterile

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65
Q

for High Altitude PE (HAPE) what is contra indicated

A

Signs - pulmonary hypertension

No Nitro
No Furosemide

poss CPAP and lower altitude

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66
Q

For Pelvic Binder what should you do before applying

what location are you looking for

A

Empty pockets

look for “Greater Trochanter”

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67
Q

Capital Regional
and
Southern MD
are what Level Trauma centers?

A

Level II

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68
Q

The part of the brain which controls body temperature is called:_______________

A

Hypothalamus

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69
Q

How do you avoid Supine Hypotension Syndrome?

A

Do not lay Pregnant woman on her back, tilt to her Left.

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70
Q

How does a paramedic determine which level trauma center

(according to nancy and her life on the streets)

A

with life threats… to the closest appropriate trauma center, with preference given to Level I or Level II trauma centers (pg 1428)

consider the specific resources of each (pg 1429)

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71
Q

How does the body react when cold or hot

does it vasoconstrict or vasodilate?

A

to warm up (when cold): it vasoconstricts

to cold down (when hot): it vasodilates

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72
Q

How long do you Irrigate chem burns

A

atleast 15-20 mins

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73
Q

How many c is 98.5f (normal)

how many c is 90f

how many c is 82f

how many c is 100.4f

A

98.5°F = (98.5 - 32) / 1.8 = 36.94°C
90°F = (90 - 32) / 1.8 = 32.22°C
82°F = (82 - 32) / 1.8 = 27.78°C
100.4°F = (100.4 - 32) / 1.8 = 38°C

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74
Q

How many collisions does a patient suffer in an MVC?

A

3

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75
Q

How many Shocks do you give a Hypothermia patient?

A

1

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76
Q

How much blood can the abdominal cavity hold?

A

Over 3000mL

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77
Q

How much blood loss would you expect to lose from a femur fracture?

A

1500mL

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78
Q

How would you most likely treat flail chest if the pt was found to be unresponsive?

High flow O2

BVM ventilations

Pain management and O2

A

BVM ventilations

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79
Q

HR x Stroke Volume =

A

Cardiac Output

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80
Q

If your patient is dehydrated their lab values would show?

A

Increased blood urea nitrogen (BUN): Dehydration can cause the BUN level to rise, as the kidneys reabsorb more water and concentrate the urea in the blood.

Increased hematocrit (Hct): Dehydration can cause the Hct level to rise, as the blood becomes more concentrated due to a loss of fluid volume.

BUN levels are 10-20mg/dL

normal hematocrit levels are 38-52%.

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81
Q

If your patient is hypoventilating, what will happen to their ETCO2 levels?

A

ETCO2 will increase

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82
Q

In a Near Drowning patient what might you consider for treatment

A

Airway, C-Spine, Rescue Breathing

Then on land:
02 pulse, abc, CPR, suction, IV

Poss: PEEP, if ET - nasogastric tube
place on side

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83
Q

In MD, TXA can be administered how many hours after the injury?

A

1 Hour in MD, 3 hours Nat Reg

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84
Q

In the rule of 9s how much is the patients palm?

A

1%

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85
Q

TBI patient without suspicion of herniation syndrome should be ventilated at a rate of ___.

A

10-12 bpm (ETCO2 35-45)

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86
Q

Increased pressure leads to reduced blood flow (ultimately causing muscle ischemia and muscle death in patients with which of the following conditions?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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87
Q

Infection caused by “Clostridium perfringens”, tissue destruction

A

Gangrene

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88
Q

Ketamine

class / dose / for / contra

A

Sedative-hypnotic; analgesic

for PAIN:
dose: 0.2mg/kg (over 1-2 mins) max dose 20mg
2nd dose: same as above 0.2/max20

for SEDATIVE:
dose: 1mg/kg (max 100mg) IV,
4mg/kg IM (max 400)

contra: Eye injury, CP, AB pain, Headache, Pregnant/Breastfeed, hypersensative

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89
Q

LeFort fracture I, II, III symptoms of each

A

LeFort I: involves a horizontal fracture of the maxilla above the teeth, causing mobility of the upper jaw and nasal septum. Symptoms: mobility of upper jaw, nasal septum, and teeth; facial swelling, pain, and bruising. Treatment: stabilization of the jaw, pain management, and surgery.

LeFort II: involves a triangular-shaped fracture that extends from the nose to the maxilla to the orbits. Symptoms: mobility of the entire midface, including the nose and orbits; facial swelling, pain, and bruising. Treatment: stabilization of the jaw and midface, pain management, and surgery.

LeFort III: involves a fracture that separates the facial bones from the skull base. Symptoms: mobility of the entire midface and orbits, including the zygomas and maxilla; facial swelling, pain, and bruising; possible CSF leak. Treatment: stabilization of the jaw and midface, pain management, and surgery.

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90
Q

Low blood volume and Hypoperfused tissue are signs of what type of shock?

A

Hypovolemic Shock

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91
Q

Medications typically do not relieve the pain of which of the following conditions?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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92
Q

Midbrain, pons, and medulla, collectively

A

Brainstem

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93
Q

Mild Abdominal Pain Radiating to the back is a sign of what organ affected?

A

Pancreas

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94
Q

Morphine

class / dose / for / contra

A

Opioid

dose: 0.1mg/kg (max initial dose 20mg)
2nd dose: 0.05mg/kg (max of 10mg)

for: severe pain

contra: allergic, uncorrected resp distress, hypo 90

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95
Q

Name one of the primitive reflexes

A

Moro (startle)

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96
Q

Name the organs in the RUQ and LUQ

A

RUQ - Gall bladder, Intestine, Liver

LUQ - Pancreas, Intestine, Spleen, Stomach

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97
Q

Name two indications for ketamine.

A

Sedative and treatent of pain, or excited dlirium.

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98
Q

Numbness and tingling occurs in patients with which of the following conditions?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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99
Q

On GCS Scale what does decorticate vs decerebrate get

A

cort - 3 arms to the core

cerebrate - 2 arms extended

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100
Q

Out of the following pairs of acute coronary syndrome imitators which ones normally have a narrow QRS

A

Benign early repolarization and LVH

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101
Q

Pain in the Left Shoulder is a sign of
what nerve affected?
and
what organ affected?

A

Left Shoulder =

Phrenic Nerve, (c3, c4, c5 - keep diaphram alive)

Diaphragmatic irritation

Spleen (LUQ)

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102
Q

Pain that is out of proportion to the injury is commonly seen in which of the following?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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103
Q

Parkland Burn Formula

A

4mL x TBSA x kg, given over 24 hours

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104
Q

Part of the brain for movement

A

Cerebellum

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105
Q

Patient fell from a roof – pale skin, absent radial pulses, weak and rapid carotid pulse, JVD, hyperresonance right side. What type of shock do they have?

A

Hypovolemic Shock

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106
Q

Patient was involved in MVC 1 week ago. Now complaining of blurry vision, projectile vomiting, and confusion. What do they have?

Subdural hematoma

epidural hematoma

intracranial hematoma

A

Subdural hematoma

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107
Q

Protruding organs of any kind should be covered in what type of dressing?

A

Moist sterile

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108
Q

Pt has hx of alcoholism, hit on head with beer bottle. Initially unconscious but then woke. AMS.

Subdural hematoma

epidural hematoma

intracranial hematoma

A

epidural hematoma

The hit caused a temporal bone fracture and tear in meningeal artery

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109
Q

Pump Failure would cause what type of shock?

A

Cardiogenic Shock

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110
Q

Searing or burning pain that is localized are symptoms of which of the following conditions?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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111
Q

Seizures, Headache, Joint pain and EYElid twitching are signs of what Water Emergency

A

Decompression Sickness

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112
Q

Shock secondary to an INFECTION in the blood is ______________ shock

A

Distributive shock

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113
Q

Signs of Hyperkalemia include

what would their ecg look like?

Treatment?

A

hyperkalemia - peaked T waves, widened QRS complexes, and a loss of P waves.

In severe cases, hyperkalemia can cause ventricular fibrillation or asystole.

Treatment
Fluids
Calcium chloride 0.5-1g Slow IV over 3-5mins max 1g
Sodium bicarb 50 mEq IV over 5mins

peds less.

Crush syndrome - sodium bicarb

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114
Q

Solution that does not contain proteins or other large molecules, used in shock fluid resuscitation

A

Crystalloids

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115
Q

structure and function of the epidermis:

how many layers

what is the outer-most layer

what is the job of the epidermis

A

5 layers

Outermost (dead skin) - stratum corneum

epidermis (outermost) - barrier against water, dust, dirt, microorganisms

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116
Q

Supra Pubic Tenderness (above pubic bone)
affects which organ?

A

Bladder

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117
Q

Tension Pneumothorax is _____________ shock

A

Obstructive shock

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118
Q

The area of concern may feel firm in a patient with which of the following conditions?

(Pick one of the following)

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

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119
Q

The body cannot tolerate blood loss of _____

it is a class III hemorrhage

A

30-40%

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120
Q

The effect of one medication is greatly enhanced by the presence of another medication, which does not have the ability to produce the same effect,” is the definition of _______________?

A

Potentiation

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121
Q

The larges portion of the brain, for reasoning

A

Cerebrum

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122
Q

The most common infection of the hand in the US

A

Paronylhia

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123
Q

True of False: When percussing over solid organs or fluids, you would expect to hear a dull sound?

A

True

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124
Q

True or False a tourniquet can only be used for arterial bleeding?

A

False

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125
Q

True or False Posturing is a sign of Herniation Syndrome

A

TRUE

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126
Q

True or False: A fall from less than 10 feet fits a trauma transport

A

False… 20 feet

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127
Q

True or false: blunt force trauma can cause dissection of major arteries.

A

True

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128
Q

True or false: the axial skeleton includes the skull, chest, and spine.

A

True

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129
Q

True or false? A hip fracture is the same as a pelvic fracture.

A

False

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130
Q

True or false? All gunshot wounds will have an exit wound.

A

False

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131
Q

True or false? All trauma arrest patients do not require bilateral needle decompression.

A

False

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132
Q

True or false? An epidural bleed is bleeding that happens between the brain and the dura.

A

False

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133
Q

True or false? An epidural bleed is considered an arterial bleed.

A

True

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134
Q

True or false? Burn patients will be hypotensive right after a severe burn due to burn shock.

A

False

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135
Q

True or false? Compartment syndrome can compromise circulation and nerves.

A

True

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136
Q

True or False? Crush syndrome can only happen when a large object for a long period of time.

A

True

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137
Q

True or false? For gunshot wounds, exit wounds are typically smaller than the entrance wound.

A

False

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138
Q

True or false? Sodium bicarb will reduce potassium levels

A

False

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139
Q

True or false? The s/s of neurogenic shock is very similar to “traditional shock”, such as hypovolemic shock.

A

False

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140
Q

True or False? There is a high chance that a crush syndrome pt will go into cardiac arrest when rescued.

A

True

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141
Q

True or false? Water is one of the best for treating chemical injuries.

A

True

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142
Q

True or false? You can potentially lose 1500-3000mL of blood from a pelvic fracture.

A

True

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143
Q

True or False
Do NOT give hypovolemia patient anything by mouth

A

True,
they will vomit

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144
Q

True or False

You should NOT rub a patient with frost bite

A

True

do not rub

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145
Q

Using the consensus formula, how much of the total amount of fluid needs to be administered in the first 8 hours?

A. 50%

B. 75%

C. 25%

D. 10%

A

50%

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146
Q

What 2 things can occur hours or days after a near drowning

A

PE and Pneumonia

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147
Q

What accounts for more than half of the bodys blood volume

A

Plasma

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148
Q

What are 3 signs/symptoms of Inferior Wall STEMI with right ventricular involvement

A

hypotension
JVD
clear lungs

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149
Q

What are signs of Heat Stroke (3)

A

Irritable
dehydration
Red, Hot, and Dry

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150
Q

What are signs of High Alt Cerebral Edema (HACE)

A

Headache, ATAXIA, ams

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151
Q

What are signs of High Alt PE
(HAPE)

A

Dysnea, COUGH, cyanosis, Frothy Sputum

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152
Q

What are the 3 forms of radiation and which is most harmful

A

Alpha
Beta
Gamma- Most dangerous

also note:
Ionizing - most dangerous
nonionizing - safe

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153
Q

What are the 3 layers of meninges?

A

dura mater (outer layer),
arachnoid mater (middle layer),
and pia mater (innermost layer).

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154
Q

What are the 3 Paralytic drugs and their doses

A

Succinylcholine 1-2mg/kg

Vecuronium 0.1mg/kg

Rocuronium 1mg/kg

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155
Q

What are the 2 types of Distributive Shock? (and their causes and treatment for each)

A

Anaphylactic - Allrg React Fluids/Pressor (epi) /Diphan

Septic - Infected blood - Fluid/Pressors (epi) /Antibiotic

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156
Q

What are the 3 zones of burn injuries

and 3 layers of skin

A

zones:
hyperemia - outer
stasis - middle
coagulation - inner

skin:
epidermis - top
dermis - middle
hypodermis - bottom

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157
Q

What are the 6 types of shock

A

Cdd hon

Cardiogenic
Distributive
Dissociative

Hypovolemic
Obstructive
Neurogenic

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158
Q

What are the 5 blast injuries

A
  1. primary - blast wave
  2. secondary - blast force
  3. Tertiary - impact with object
  4. Quaternary - burns, inhalation
  5. Qunary - long term damage
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159
Q

What are the steps of an Airway Management Plan (things you may do in order)

A

A. Airway Adjuncts - positioning, opa, npa, bvm, suction

B. SGA - iGel, King, CPAP, BiPAP

C. Intubation/RSI

D. Cric Surgery/Needle Decompress

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160
Q

What are the contraindications of dopamine

A

tachycardia, arrhythmias (vfib)

Note: give fluids first for hypovolemia

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161
Q

what are the adverse reactions of fentanyl

A

respiratory depression, hypotension, bradycardia, and nausea/vomiting.

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162
Q

what are the adverse reactions of morphine

A

respiratory depression, hypotension, bradycardia, and nausea/vomiting.

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163
Q

What are the bodys 4 ways of cooling

A

Radiation
Conduction
Convection
Evaporation

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164
Q

What are the components of Beck’s Triad?

A

Hypotension, JVD, muffled heart tones

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165
Q

What are the components of Beck’s Triad?

A

Hypotension, JVD, muffled heart tones

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166
Q

What are the different types of burns?

A

thermal, chemical, and electrical.

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167
Q

What are the following terms as far as bites

Hymenoptera
Erythema
Angioedema
Pruritus
Loxoscelism
Melittin

A

Hymenoptera - bees and ant venom
Erythema - redness
Angioedema - swelling of face/lips/tounge
Pruritus - itching
Loxoscelism - tissue damage (spider bite)
Melittin - pain from venom

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168
Q

What are the Level 1 trauma centers in dc

and va (northern)

A

Medstar WHC

Inova Fairfax

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169
Q

What are the Level 2 trauma centers in dc and va (northern)

A

Medstar Georgetown

Alexandria

(PG and Suburban in MD)

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170
Q

What are the ligaments of the Knee

A

ACL, LCL, MCL, PCL

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171
Q

What are the parts of the spinal column

A

cervical 7
thoracic 12
Lumbar 5

7 12 and 5

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172
Q

What are the signs and symptoms of a basilar skull fracture, and how should it be managed?

A

Signs and symptoms include raccoon eyes, Battle’s sign, CSF leakage from the ears or nose, and vertigo.

Management involves maintaining a patent airway and transporting the patient to the hospital for further evaluation.

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173
Q

With an open abdominal wound, and how should it be managed?

A

Management involves covering the wound with a moist sterile dressing and transporting the patient to the hospital.

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174
Q

What are the signs and symptoms of heat stroke?

A

Confusion, altered mental status, hot and dry skin, and rapid pulse.

aggressive cooling and hydration, along with supportive care. This may include moving the patient to a cool environment, removing excess clothing, applying cool water to the skin, and using ice packs or cooling blankets. Intravenous fluids may be given to maintain hydration, and medications such as benzodiazepines or muscle relaxants may be used to control seizures or muscle rigidity. In severe cases, intubation and mechanical ventilation may be necessary.

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175
Q

What are the signs and symptoms of hypothermia, and how should it be managed?

A

Signs and symptoms include shivering, confusion, lethargy, and bradycardia.

Management involves rewarming the patient gradually and administering warm fluids.

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176
Q

What are the signs of compensated shock?

A

Vital signs: Normal blood pressure, tachycardia, tachypnea, mild decrease in urine output

Symptoms: Anxiety, restlessness, increased thirst, mild peripheral vasoconstriction, normal or slightly elevated body temperature

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177
Q

What are the signs of decompensated shock?

A

Vital signs: Hypotension, tachycardia, tachypnea, decreased urine output

Symptoms: Weakness, altered mental status, cool and clammy skin, decreased peripheral pulses, delayed capillary refill, decreased skin turgor, oliguria

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178
Q

What are the signs of irreversible shock?

A

Vital signs: Profound hypotension, bradycardia, respiratory failure, hypoxia

Symptoms: Unresponsive, dilated and fixed pupils, absent peripheral pulses, cool and mottled extremities, anuria, metabolic acidosis

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179
Q

What are the signs of Neurogenic Shock and not
Herniation or TBI

and how do we treat?

A

Neuro-
low bp
low hr
Flush RED skin
loss of sympathetic tone

give epi drip and pressors

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180
Q

What are the steps for a Morgan Lens

(specifically which direction for eyes)

A

Instruct patient to
look DOWN
insert
under upper lid
THEN look UP,
drop into lower lid

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181
Q

What are the steps for RSI

A

Assess and prepare the patient: Make sure that the patient has adequate ventilation and oxygenation, establish vascular access, and administer pre-oxygenation with 100% oxygen for at least three minutes.

Pre-medicate: Administer sedative agents such as etomidate, midazolam, or ketamine to induce unconsciousness, and administer a paralytic agent such as succinylcholine or rocuronium to facilitate intubation.

Intubation: Once the patient is sedated and paralyzed, the paramedic will insert the laryngoscope and visualize the vocal cords, then insert an endotracheal tube (ETT) into the trachea. Once the ETT is in place, confirm correct placement using waveform capnography or chest auscultation.

Confirm and secure the airway: Secure the ETT in place, confirm that the patient is still adequately oxygenated, and monitor the patient’s vital signs and oxygen saturation.

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182
Q

What are the symptoms and treatment of a flail chest?

A

Symptoms: paradoxical chest wall movement, chest pain, and dyspnea.

treatment: Oxygen therapy, pain management, positive pressure ventilation, and possible surgical fixation.

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183
Q

What are the symptoms and treatment of a hemothorax?

A

symptoms: Dyspnea (SOB), CP, decreased breath sounds on the affected side, and signs of SHOCK.

treatment : Chest tube and fluids

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184
Q

What are the symptoms and treatment of a pulmonary contusion?

A

symptoms: Dyspnea, chest pain, hemoptysis, and decreased breath sounds on the affected side.

Treatment: Oxygen therapy, analgesia, positive pressure ventilation, and fluid resuscitation.

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185
Q

What are the symptoms and treatment of a spinal cord injury?

A

Symptoms: Paralysis, loss of sensation, and loss of bowel/bladder control.

Treatment: Immobilization, spinal precautions, and transport to a trauma center.

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186
Q

What are the symptoms and treatment of a tension pneumothorax?

A

symptoms: Dyspnea, tracheal deviation, hypotension, JVD, and absent breath sounds on the affected side.

treatment: Needle decompression followed by chest tube insertion.

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187
Q

What are the symptoms and treatment of a traumatic brain injury?

A

Symptoms: Altered mental status, headache, vomiting, and seizures.

Treatment: Airway management, hyperventilation (herniating) to lower intracranial pressure, and transport to a trauma center.

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188
Q

What are the symptoms and treatment of cardiogenic shock?

A

Symptoms: Tachycardia, hypotension, pulmonary congestion, and signs of poor tissue perfusion.

Treatment: Oxygen therapy, vasopressor support, inotropic support, and possible mechanical circulatory support.

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189
Q

What are the symptoms and treatment of hypovolemic shock?

A

Symptoms: Tachycardia, hypotension, cool/pale/clammy skin, and altered mental status.

Treatment: Rapid fluid resuscitation with crystalloids or blood products.

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190
Q

What are the symptoms and treatment of neurogenic shock? Besides can’t feel legs.

A

Symptoms: Bradycardia, hypotension, and warm/dry skin.

Treatment: Vasopressor support, fluid resuscitation, and spine immobilization.

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191
Q

What are the symptoms and treatment of septic shock?

A

Symptoms: Fever or hypothermia, tachycardia, hypotension, and altered mental status.

Treatment: Antibiotics, fluid resuscitation, and vasopressor support as needed.

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192
Q

What are the three classic signs of shock?

A

Tachycardia, tachypnea (RAPID HR), and hypotension.

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193
Q

What are the three components of the “Trauma Triad of Death”?

A

Hypothermia, acidosis, and coagulopathy.

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194
Q

What are the two Level 1 trauma centers in Maryland

A

Shock Trauma (UM)

Hopkins

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195
Q

What are the two main types of forces that can cause injury in a motor vehicle accident?

A

contact forces and non-contact forces.

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196
Q

What are the two types of Direct Brain Injury Categories

A

Focal - epi/sub (slow) dural hematoma (brain bleeds)
coup-countrecoup injury

Diffuse - concussion, axonal injury (whole brain) cushings, decor/decereb

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197
Q

What are the typical injuries from a head on crash (8, name atleast 4)

A

facial, abdominal, neck trauma
pulmonary contusion
flail chest
myocardial contusion
pericardial tamponade
pneumo or hemo thorax
ruptured aorta
fractured sternum, rib

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198
Q

What are two concerns for a burn patient

A

infection
hypothermia

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199
Q

What area in the meninges is located between the arachnoid and the pia mater in which CSF flows?

A

The subarachnoid space

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200
Q

What can you check, for patient with initial hemorrhagic shock

A

absent cap refill

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201
Q

What can you give High Altitude Cerebral Edema (HACE)

A

Signs - AMS, LOC

Dexamethasone 8mg + O2

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202
Q

What Category Trauma would someone over 55 y/o, on Blood thinners, Provider Judgement

A

Cat D - All others

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203
Q

What Category Trauma would someone with 12 inch intrusion in car, or fall greater 20ft, death in same compartment?

A

Cat C - Mechanical

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204
Q

What Category Trauma would someone with a GCS less than 13 be?

A

Cat A - physio

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205
Q

What Category Trauma would someone with gunshot or 2 long bone fractures, or stab wound be?

A

Cat B - physical

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206
Q

What Category Trauma would an infant with resp less than 20?

A

Cat A - physio

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207
Q

What chart does the hospital use for burns?

A

Lund and Browder Chart

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208
Q

What class of drug is Naproxen

A

NSAID

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209
Q

what class of drug is paroxetine

A

SSRI

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210
Q

What class of medication is diltiazem?

A

Class IV, antiarrhythmic

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211
Q

What defines Neurogenic Shock

A

Injury above T6

loss of epi/nor-epi

loss of autonomic function

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212
Q

What does a Level 1 trauma center have that level 2 does not?

A

Level 1 should have cardiac, microvascular

both have Ortho and Neuro, anesthesiologist

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213
Q

What does a Level 1 trauma center have that level III does not

A

cardiac,
orthopedic,
neurosurgical, and
anesthesiology care

and surgeons

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214
Q

What does a positive halo test look like?

A

Ring around a blood sample on a 2x2

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215
Q

What does an ECG with hypokalemia look like?

A

Hypokalemia, which is a low level of potassium in the blood, can cause several ECG changes, including:

ST segment depression
Shallow T-wave inversions
Appearance of a U wave
Prolonged QT interval
Increased risk of ventricular arrhythmias, such as torsades de pointes.

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216
Q

What does clubbing of the fingernails indicate?

A

Chronic respiratory disease

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217
Q

What does elastin do?

A

Elastin is a protein found in the extracellular matrix. It allows tissues to stretch and then return to their original shape, elastin helps maintain the elasticity of the vessels, allowing them to constrict and dilate

218
Q

What does Kehr’s Sign indicate?

A

Splenic injury

219
Q

What does the Babinski test assess?

A

It test damage to the corticospinal tract for voluntary motor control

220
Q

What does TXA do?

A

It SLOWS the break down of clots and fibrin

221
Q

What drug to you give for Torsades?

A

Mag Sulfate 2g over 2mins

222
Q

What effects will administering a Beta-2 agonist have on the respiratory system?

A

Bronchodilation

223
Q

What fluid is prefered for Burn shock

A

Lactated Ringers - electrolytes

224
Q

What gives red blood cells its reddish color?

A

Hemoglobin

225
Q

What indicates Kehr’s Sign?

Left shoulder pain

Right shoulder pain

Left leg pain

A

Left shoulder pain

226
Q

What is a 4th Degree burn

A

burn to bone, mostly chem burns

full thickness past muscle and tissues, all

227
Q

What is a “decompression sickness”?

A

a condition caused by a rapid decrease in pressure, leading to the formation of nitrogen bubbles in the blood.

228
Q

What is a “hemothorax”?

A

a collection of blood in the pleural cavity.

229
Q

What is a Neutral Sedative? (and dose)

A

Etomidate - 0.3mg/kg

good for low bp

230
Q

What is a “secondary injury”?

A

an injury that occurs after the initial traumatic event and is often caused by hypoxia or hypoperfusion.

231
Q

What is a sign of TBI

(not in Neuro, or Herniation)

what should the bp be?

A

nausea, vomitting, AMS

keep bp 110

232
Q

What is Boyles Law

A

Gas Pressure decrease as volume increase (and vice versa)

233
Q

What is it called, a person lacking blood clotting factors

A

hemophilia

234
Q

What is missing from a Level III trauma center

A

They do not have surgeons

235
Q

What is most affected by a primary blast injury?

A

Hollow organs

236
Q

What is normal body temp? What is hypo and and hyper

A

norm = 98.6 = 37 c

hypo = 95 and below

hyper = 100.4 and above

237
Q

Profuse diaphoresis is a sign of what type of heat stroke

A

exertional

238
Q

What is TBI (brain injury)

A

Traumatic Brain Injury

239
Q

What is the appropriate fluid resuscitation for a patient with hypovolemic shock?

A

crystalloid

240
Q

What is the best treatment for an avulsed scalp injury?

A

Replace the avulsed tissue back in place and apply a moist sterile dressing to the wound.

241
Q

What is the body’s physiologic response to hemorrhage (3 things)

A

Clotting is activated,
vasoconstriction,
platelet aggregation

242
Q

What is the contraindicated Sedative for low Bp and Trauma bleeds

and dose

A

Versed - benzo, lowers bp

(0.05 - 0.1mg/kg)

243
Q

What is the correct anatomic location of V8

A

Level with v6 on the mid scapular line

244
Q

What is the definition of colloid solutions?

A

Solutions that contain large molecules that remain in the intravascular space.

245
Q

What is the definitive treatment for an open femur fracture?

A

Traction splint

246
Q

What is the Detailed version of the rule of nines chart TBSA

A

Lund-Brower

247
Q

What is the difference between 1st, 2nd, and 3rd degree burns and treatment of each

A

1st degree burn: involves the epidermis only, causing redness, pain, and mild swelling.

Treatment: cool water, pain management.

2nd degree burn: involves the epidermis and part of the dermis, causing blistering, severe pain, and swelling.

Treatment: cool water, sterile dressings, pain management, and possible fluid resuscitation.

3rd degree burn: involves the entire epidermis and dermis, and may involve deeper tissues. The skin may appear charred or white, and the person may experience no pain due to nerve damage.

Treatment: IV fluids, wound care, pain management, and possible surgery.

248
Q

What is the difference between a concussion and a contusion?

A

A concussion is a temporary loss of consciousness or cognitive function, while a contusion is a bruise on the brain.

249
Q

What is the difference between a coup and contrecoup injury?

A

coup injury - occurs at the site of impact,

contrecoup injury - occurs on the opposite side of the brain due to the brain bouncing off the skull.

250
Q

What is the difference between a hematoma and an ecchymosis?

A

A hematoma is a collection of blood outside the blood vessels, while an ecchymosis is a bruise.

251
Q

What is the difference between a partial-thickness and a full-thickness burn?

A

A partial-thickness burn - affects the outer layer of the skin and may cause blistering, while a

full-thickness burn - affects all layers of the skin and may cause charring.

252
Q

What is the difference between a simple and a comminuted fracture? (Not compound)

A

A simple fracture is when the bone breaks but does not penetrate the skin, while a comminuted fracture is when the bone is broken into multiple pieces.

253
Q

What is the difference between a simple and a compound fracture?

A

Asimple fracture - is a closed break in the bone,

compound fracture - is an open break in the bone with a wound that communicates with the fracture site.

254
Q

What is the difference between a simple pneumo and a tension pneumo?

A

hemodynamic stability

255
Q

What is the difference between an epidural and subdural hematoma?

A

An epidural hematoma - occurs between the skull and dura mater

subdural hematoma - occurs between the dura mater and brain.

256
Q

What is the difference between arterial and venous bleeding?

A

Arterial bleeding is bright red, spurting, and rapid,

venous bleeding is dark red, oozing, and slower.

257
Q

What is the difference between compensated and decompensated shock?

A

Compensated shock is when the body is still able to maintain blood pressure and tissue perfusion,

decompensated shock is when the body’s compensatory mechanisms fail.

258
Q

What is the difference between “hypovolemic” and “hemorrhagic” shock?

A

Hypovolemic shock - is caused by a loss of fluid,

hemorrhagic shock - is caused by a loss of blood.

259
Q

What is the difference between isotonic, hypotonic, and hypertonic solutions?

A

Isotonic solutions have the same osmotic pressure as blood

hypotonic solutions have a lower osmotic pressure than blood

hypertonic solutions have a higher osmotic pressure than blood.

260
Q

What is the difference between
Ligaments
and
Tendons

A

Ligaments - Bone to Bone

Tendons - Muscle to Bone

261
Q

What is the difference between synthetic and natural colloids?

A

Synthetic colloids are made from non-biological materials, while natural colloids are made from blood products or albumin.

262
Q

What is the dose of Mag Sulfate for asthma?

A

2 grams of magnesium sulfate in 100 mL of normal saline to be administered intravenously over 20 minutes for the treatment of acute severe asthma.

263
Q

What is the dose of TXA?

A

1g

264
Q

What is the formula for Kinetic Energy

A

KE=m/2 x v^2

265
Q

What is the hallmark sign of a third-degree burn?

A

Charring or white, leathery skin.

266
Q

What is the hallmark sign of compartment syndrome?

A

Pain out of proportion to the injury that is worsened with passive stretching. accompanied by paresthesias, pallor, pulselessness, and paralysis.

267
Q

What is the initial treatment for a partial-thickness burn?

A

Cool water for 10-15 minutes

268
Q

What is the maximum volume that may be administered in a single IM administration?

A

5mL

269
Q

What is the most common burn agent in an industrial setting?

A

Hydrofluoric acid

270
Q

What is the most common cause of airway obstruction in trauma patients?

A

Blood

271
Q

What is the most common cause of burns in children?

A

Scald injuries from hot liquids or food.

272
Q

What is the most common cause of death in a patient with a head injury?

A

Brain herniation

273
Q

What is the most common cause of death in a patient with multiple trauma?

A

Hypovolemic shock

274
Q

What is the most common cause of hypovolemic shock?

A

Hemorrhage

275
Q

What is the most common cause of irreversible shock?

A

Prolonged hypotension

276
Q

What is the most common cause of obstructive shock?

A

Pulmonary embolism

277
Q

What is the most common mechanism of injury in a penetrating trauma incident?

A

Gunshot wound

278
Q

What is the most common sign of a basilar skull fracture?

A

Racoon eyes (periorbital ecchymosis) and Battle’s sign (postauricular ecchymosis)

279
Q

What is the most common sign of a significant chest injury?

A

Dyspnea and tachypnea

280
Q

What is the most common sign of hypovolemic shock?

A

Tachycardia

281
Q

What is the most common type of lightning injury?

A

Flash injuries from close proximity to the lightning strike.

treatment: managing any life-threatening injuries or complications, such as cardiac arrest or respiratory distress. The patient should be assessed for burns, fractures, or other injuries, and appropriate interventions should be taken. Cardiac monitoring and electrolyte management may be necessary, as lightning strikes can cause cardiac arrhythmias and electrolyte imbalances.

282
Q

What is the most concerning for pulmonary blast injuries

A

Arterial air embolism

283
Q

What is the most effective treatment for a patient with a flail chest?

A

Positive pressure ventilation with endotracheal intubation

284
Q

What is the most effective treatment for a patient with a suspected pelvic fracture and hypotension?

A

Pelvic binder and fluid resuscitation

285
Q

What is the most effective treatment for a patient with heat exhaustion?

A

Move the patient to a cool, shaded area and provide fluids for rehydration.

Rest, fluids, and cooling measures

286
Q

What is the most important factor in determining the severity of a burn?

A

Total body surface area (TBSA) involved

287
Q

What is the most reliable indicator of a tension pneumothorax?

A

Hypotension and tracheal deviation away from the affected side

288
Q

What is the most reliable indicator of shock in the pediatric population?

A

Tachycardia

289
Q

What is the most reliable indicator of shock?

A

Altered mental status

290
Q

What is the order in which a Wound Heals? (4 steps, HINC)

A
  1. Hemostasis - vasocontrict/clotting
  2. Inflammation - wbc combat
  3. Neo-Vascularization - New vessels form
  4. Collagen Synthesis - scar tissue
291
Q

What is the Parkland formula

A

4mL x KG x % BSA

half of this in first 8 hours

ONLY 2nd degree burns or greater

292
Q

What is the parkland formula for

80kg with 20% burns

(and how much in first 8)

A

4mL x 80 kg x 20% = 6,400 mL

3200 in first 8

293
Q

What is the “platinum 10 minutes”

A

Goal of max time spent on-scene for critical trauma patient

294
Q

What is the preferred type of fluid
for a patient with a traumatic brain injury?

A

Isotonic crystalloid, such as normal saline,

due to its ability to maintain intravascular volume without causing cellular edema.

page 911

295
Q

What is the preferred type of fluid in a patient with suspected internal bleeding?

A

Crystalloid solution such as normal saline

296
Q

What is the primary concern in treating a patient with a snake bite?

A

Preventing the spread of venom throughout the body.

Treatment: administering appropriate antivenom if available. The patient should be assessed for signs of systemic toxicity, such as respiratory distress, hypotension, or altered mental status. The affected limb should be immobilized and kept below the level of the heart to slow the spread of venom. Pain management and fluid resuscitation may be necessary, and the patient should be transported to a hospital as soon as possible.

297
Q

What is the primary concern in treating a patient with frostbite? and treatment?

A

Preventing further tissue damage and rewarming the affected area.

should be done in a controlled manner to avoid causing further damage. The patient should be moved to a warm environment and any wet clothing should be removed. The affected area can be soaked in warm water (104-108°F) for 15-30 minutes, or until the skin becomes soft and pliable. Pain medication may be given to help manage discomfort, and the patient should be monitored for signs of infection.

298
Q

What is the primary goal in the treatment of hypovolemic shock?

A

Fluid replacement

299
Q

What is the primary treatment for a patient in neurogenic shock?

A

Administer vasopressors to increase vascular tone and blood pressure

300
Q

What is the primary treatment for a patient in septic shock?

A

Broad-spectrum antibiotics and fluid resuscitation

301
Q

What is the primary treatment for a patient with severe hypothermia?

A

rewarm the body gradually and avoid rapid rewarming, which can cause cardiac arrest.

302
Q

What is the proper treatment for a chemical burn?

A

Remove contaminated clothing and flush with cool water for 20-30 minutes

303
Q

What is the recommended fluid replacement for a patient in hemorrhagic shock?

A

Balanced crystalloid solution (such as lactated Ringer’s solution)

304
Q

What is the Trauma Lethal Triad

A

hypothermia,
coagulopathy (poor blood clotting), and
acidosis

305
Q

What is the treatment for a chemical burn to the eye?

A

Flushing with copious amounts of water for at least 20 minutes

306
Q

What is the treatment for decompensated shock?

A

Rapid fluid resuscitation, vasopressors, and identification and management of the underlying cause.

307
Q

What is treatment for a severe spider bite or stingers

A

remove - scrape out stinger
1. epi IM (1mg in 1ml) 1:1,000
2. diphenhydramine (25-50mg) (ped 1-2mg)
3. poss dexamethasone
4. Albuterol and Atrovent

abc’s and poss pain meds

308
Q

What is Waddell’s Triad?

A

Injuries you see on a pediatric patient when they get hit by a car (head trauma, leg trauma, and chest trauma)

309
Q

What is your first action after getting ROSC

A

Initiate targeted Temp

310
Q

What is your primary concern with a patient with burns to the face and tongue?

A

Airway management

311
Q

What kind of triage should you do for several
lightning strike patients

A

reverse triage, dead may be in respiratory arrest

transport all

312
Q

What labs indicate that the patient has an infection?

A
313
Q

What medication should be administered to a patient in anaphylactic shock?

A

Epinephrine

314
Q

What organ is primarily responsible for medication removal from the body?

A

Kidneys

315
Q

What part of the brain regulates temp

A

Hypothalamus

316
Q

What percent 2nd degree burn gets Fluid

A

over 20% 2nd degree start IV FLUIDS

317
Q

What percent burn is a child both legs (also what is % for face)

A

33% (just face is 12)

Child 1 year to 15
Infant birth to 1

318
Q

What percent burn is a infant with face, torso, and 1 leg

A

49.5%

319
Q

What percent burn is an adult with torso, 1 arm, and face?

A

36%

320
Q

What percent of partial thickness burn goes to burn center

A

over 10%

321
Q

What sedative is contraindicated for occular trauma or ICP

what is it good for and dose

A

Ketamine - good for bp and airway (Beta 2 properties)

but bad for ocular/icp

(dose 1mg/kg)

322
Q

What should you do (and not do) for snake bites

A

Do: place extremity below heart,
avoid constriction (jewelry),
clean w/ antimicrobial
note the time and type of snake

Dont: ice or suck venom out

323
Q

What should you first do to manage a crush syndrome patient?

A

Ensure a rescue plan is being developed

324
Q

What should you not do as far as treatment when it is below 30 degrees outside

A

With hold IV meds (too cold out), defib and pace might not work

325
Q

What site do you NDT on an adult patient

A

5th intercostal ANTERIOR axillary (above the 6th rib)

326
Q

What solution do you use to keep broken teeth

A

dont rinse

place teeth in normal saline (lactated ringers - for electrolytes)
in a cup

(go to UM, has dental school)

327
Q

What temp does a patient CBT stop shivering

A

90-82 degree stops shivering (too cold)

95-90 shivering

328
Q

What triad indicates herniation syndrome?

A

Cushings Triad

329
Q

What type of bruising is behind the ear?

A

Battle signs

330
Q

What type of bruising pattern is around the belly button?

A

Cullen’s sign

331
Q

What type of burn is this?

A

3rd Degree

Full thickness - fluid oozing, pus (plasma)

332
Q

What type of burn is this?

A

2nd Degree

333
Q

What type of burn is this?

A

2nd Degree

334
Q

What type of burn is this?

A

Third Degree (Eschar)

335
Q

What type of burn is this?

A

2nd Degree

Deep partial thickness

336
Q

What type of burns are full thickness?

A

3rd Degree

337
Q

What type of burns are partial thickness?

A

2nd Degree

338
Q

What type of burns are superficial?

A

1st Degree

339
Q

What type of burns have blistering?

A

2nd Degree

340
Q

What type of posturing has the arms moving inward?

A

Decorticate

341
Q

What type of shock and treatment?

A 50-year-old female who has been bleeding from a ruptured ectopic pregnancy. She is in decompensated shock with a blood pressure of 70/40 mmHg, heart rate of 120 beats per minute, respiratory rate of 30 breaths per minute, and decreased urine output.

A

Decompensated

Treatment: rapid fluid resuscitation, oxygen via non-rebreather mask, and transport to the hospital.

low bp is an early sign, rr is also an indication of decompensated.

342
Q

What type of shock and treatment?

A 30-year-old male who has been in a car accident and is experiencing mild shock. His blood pressure is 110/70 mmHg, heart rate is 110 beats per minute, respiratory rate is 20 breaths per minute, and he has mild diaphoresis.

A

Compensated

Treatment: oxygen via non-rebreather mask and IV fluids.

in compensated shock, the body’s compensatory mechanisms are able to maintain adequate organ perfusion, and the patient’s vital signs are relatively stable. The patient may have an elevated heart rate and respiratory rate, but their blood pressure is maintained within normal limits, and they do not have signs of inadequate organ perfusion.

343
Q

What type of shock is burn shock fall under

A

Hypovolemic shock

344
Q

What type of shock?

An 80-year-old male who has had a ruptured aortic aneurysm. with a blood pressure of 50/30 mmHg, heart rate of 40 beats per minute, respiratory rate of 8 breaths per minute, and unresponsive with fixed and dilated pupils.

Is it Comp decomp or irreversible

A

Irreversible shock

345
Q

What type of shock?

ARDS, renal failure, liver failure and sepsis

Comp decomp or irreversible

A

Irreversible

346
Q

What type of shock?

Diaphoretic, hypotensive, narrowing pulse pressure, nausea and vomitting

Comp decomp or irreversible

A

Decompensated

347
Q

What type of shock?

Vitals organs begin to die because of inadequate perfusion

A

Irreversible

348
Q

What type of trauma looks like a lemon?

A

epidural

349
Q

What type of trauma may be most likely caused by secondary blast injuries?

A

Penetrating trauma

350
Q

What would Grey Turner’s sign look like?

A

retroperitoneal bruising (flanks)

351
Q

Whats the difference between Decompression sickness (Bends) and Nitrogen Narcosis?

A

Decompression sickness (DCS), divers who ascend too quickly from a deep dive. It is caused by the formation of nitrogen bubbles in the blood and tissues due to rapid decompression.

Symptoms-DCS joint pain, skin rash, dizziness, and difficulty breathing.

Nitrogen narcosis - diver is exposed to high partial pressures of nitrogen at depth

Nitro-symptoms: euphoria, confusion, and impaired judgment.

Nitrogen narcosis is a reversible condition that resolves when the diver ascends to shallower depths,

DCS may require hyperbaric oxygen therapy to treat.

352
Q

Whats the difference between Dopamine and Dobutaline

A

Dopamine and dobutamine are medications used to treat heart failure and shock.

Dopamine increases blood pressure and cardiac output

Dobutamine specifically targets the heart’s beta-1 receptors to increase cardiac output.

353
Q

Whats the difference between Neurogenic shock and spinal shock

A

Neuro- spinal inj abv T6
disruption of sympathetic from T1-L2
loss of epi/nor-epi

Spinal - injury, bleeding

354
Q

Whats the dose of TXA

(and how many drops a min with a 15 drop set)

A

1g (1,000 mg) mixed in 100mL of Normal Saline (over 10 mins)

15 drop set, 100mL = 150 gtts/min

355
Q

What’s the GCS score? Eyes do not open, no response to sound, decorticate posturing.

A

5

356
Q

What’s the GCS score? Eyes open to pain, incomprehensible sounds, and withdraws from pain.

A

8

357
Q

When are vasopressors used?

A

Dopamine for Hypovolemic shock and Cardiogenic shock.

Dopamine is given at a dose of 2 to 20 mcg/kg/min as a continuous infusion.

Epinephrine: It is a potent vasoconstrictor for

Distributive shock, such as septic shock and anaphylactic shock. Epinephrine is given at a dose 1g to 1mL

358
Q

When assessing a trapped crush injury pt, what can help you determine if a pt has crush syndrome?

A

12 Lead

359
Q

When do we use TXA?

A

Suspected HEMORRHAGIC shock due to Trauma (BP less than 90)

Less than 3 hours (md 1 hour)

Older than 15 y/o

TXA is last step after manage life threats

360
Q

When do you fly a burn patient out?

A

If the patient is more than 30 mins by ground from burn center

361
Q

When do you give magnesium sulfate

A

for Torsades and

362
Q

When providing O2 to patients whats the rate for:

  1. Herniation
  2. Head- injury

how many per min for children and infants with herniation?

A
  1. herniation - 20 bpm (q 3 secs)
  2. head injury - (10-12 bpm)

child - 25bpm
infant - 30bpm

363
Q

When should Spinal precautions be taken?

A

spinal pain, deformity
loss of sensation, neuro deficit

younger than 15:
neck pain
mvc
torso injury
(and/or can’t assess)

(at min c collar)

but if they cant walk, GCS less thann 15, unresponsive
BOARD THEM.

364
Q

Where do you place a tourniquet

A

Both 3” above, high and tight in axilla or groin is acceptable depending on the situation.

But distal is recommended.

365
Q

Where do you transport a patient with trauma and burns?

A

To the Trauma center first for initial care

366
Q

Where do you transport Chemical burns?

A

To the closest hospital for decon before burn center

367
Q

Which endocrine gland is often referred to as the “master gland”.

A

Pituitary

368
Q

Which if the following is not considered a toxin released by the body due to crush syndrome?

Potassium

Myoglobin

Calcium

Lactate

A

Calcium

369
Q

Which imitator normally has a widened QRS complex

A

AV sequential pacemaker

370
Q

Which Level trauma center will be able to provide ATLS - advanced Trauma Life support BEFORE transfer to higher level trauma center

A

Level IV

(lowest level)

371
Q

Which Newton’s Law of Motion States: An object in motion will remain in motion unless acted on by another force.

A

1st Law

372
Q

Which Newton’s Law of Motion States: For every action there is an equal and opposite reaction.

A

3rd Law

373
Q

Which Newton’s Law of Motion States: force = mass (kg) x acceleration (m/s2).

A

2nd Law

374
Q

Which of the following conditions can be caused by a long compressive force?

(Pick one)

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

crush injury

375
Q

Which of the following conditions may result in immediate cardiac arrest?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

commotio cordis

376
Q

Which of the following conditions occurs after a direct blow to the thorax, directly over the heart?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

commotio cordis

377
Q

Which of the following conditions occurs due to the inelasticity of fascia?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

378
Q

Which of the following conditions occurs during the critical portion of the heart’s repolarization period?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

commotio cordis

379
Q

Which of the following does not meet the burn center criteria?

Burns to the hands

6% partial thickness burns

Inhalation burns

4% full thickness burns

A

6% partial thickness burns

380
Q

Which of the following is not considered a life threatening injury that should be found during primary assessment?

Airway comp

Cardiac tamponade

Tension pneumo

Flail chest

A

Cardiac tamponade

381
Q

Which of the following is not likely considered a cause of compartment syndrome?

Closed fracture

Tree fell on pt

Open compound fractures

A

Open compound fractures

382
Q

Which of the following is not typically an immediate concern for a burn pt?

Airway management

Infection

Fluid resuscitation

Hypothermia

A

Fluid resuscitation

383
Q

Which of the following is true about managing a severe burn patient?

A) Apply moist dressings over the burns to prevent the skin from drying out.

B) Do not start transporting before at least 2 IVs are established

C) Focus on giving pain medications first since you know that burns can be painful.

D) If your patient is hypotensive, look for alternative causes.

A

D) If your patient is hypotensive, look for alternative causes.

384
Q

Which of the following vitals would you see in a patient in hemorrhagic shock?

A

Increased HR, decreased BP, increased RR

385
Q

Which of the following would not be considered an early sign of increased intracranial pressure?

Confusion

Increase in BP

Nausea/vomiting

Blurry vision

A

Increase in BP

386
Q

Which patients go to a burn center? (5)

A

Electrical (lightning or more than 120 volts)
2nd Degree greater than 10%
All 3rd Degree
Burns to the face, hands, feet, major joints, genitals, perineum
Circumfrential burns to extremities or torso

Extra note: Smoke inhalation (hyperbaric)

387
Q

Why are ped patient injuries different from adult (ped struck)

A

children are shorter so the are more likely to be run over

388
Q

With a serious bleeding patient the first thing you should do is?

A

PPE!

389
Q

With Electric burn what are the two rhythms to expect

A

VT/ VFIB (use early defib/cpr)

390
Q

With facial burns what simple thing can you do to minimize edema

A

Elevate stretcher 30 degrees

avoid pillow if ears burned

391
Q

With the Rule of Nines what are the percents for:

Head
One Arm
One Leg

(for Infant, Child, Adult)

A

ADULT
Head 9
One Arm 9
One Leg 18

CHILD
Head 12
One Arm 9
One Leg 16.5

INFANT (not the most accurate)
Head 18
One Arm 9
One Leg 13.5
(or their palm 1% area)

ALL: TORSO 18 on each side //crotch 1

392
Q

You are hyperventilating your head injured patient who has signs of cerebral herniation. What is your target ETCO2 for your hyperventilation?

A

Ventilate between 30-35

393
Q

You are treating a patient with altered mental status, a blood pressure of 70/40, and no peripheral pulses. You attach the patient to the cardiac monitor/defibrillator and the patient is in atrial fibrillation at a rate of 190. What is the preferred treatment, including dose? (Oxygen has already been applied, and IV access already obtained)

A

Synchronized Cardiovert at 120-200 jules

394
Q

You have treated a sucking chest wound with a dressing. They experience SOB. What should you do?

A

Burp the dressing

395
Q

Your patient is having an ST segment elevation MI (STEMI) with ST segment elevation in leads V5, v6, an I. Which coronary artery is likely involved?

A

LCX

left circumflex artery

396
Q

Your patient was assaulted and presents with diminished R lung sounds, slight SOB, and strong radial pulses. NDC?

A

Manage with O2, perform reassessment during transport

397
Q

What is Nexium for

A

Gerd

398
Q

What is Nexium for

A

Gerd

399
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but is normotensive (normal bp) is in _____________ shock

A

Compensated shock

400
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but their bp drops to 82/40 and is disoriented is in _____________ shock

Comp decomp or irreversible

A

Decompensated shock

401
Q

Acetazolamide

A

Diamox

for: edema from CHF, glaucoma

402
Q

Flank Pain and Hematuria is a sign of what organ affected? also what is Hematuria?

A

Kidneys - Retroperitoneal Cavity

Hematuria - Blood in urine

403
Q

What is the order in which a Wound Heals? (4 steps, HINC)

A
  1. Hemostasis - vasocontrict/clotting
  2. Inflammation - wbc combat
  3. Neo-Vascularization - New vessels form
  4. Collagen Synthesis - scar tissue
404
Q

What Category Trauma would someone with a GCS less than 13 be?

A

Cat A - physio

405
Q

Define Afterload

A

the force the heart must overcome to pump blood out to the body. (Pressure of vascular resistance).

406
Q

What is the difference between a partial-thickness and a full-thickness burn?

A

A partial-thickness burn - affects the outer layer of the skin and may cause blistering, while a

full-thickness burn - affects all layers of the skin and may cause charring.

407
Q

What are the symptoms and treatment of a tension pneumothorax?

A

symptoms: Dyspnea, tracheal deviation, hypotension, JVD, and absent breath sounds on the affected side.

treatment: Needle decompression followed by chest tube insertion.

408
Q

What are the symptoms and treatment of a pulmonary contusion?

A

symptoms: Dyspnea, chest pain, hemoptysis, and decreased breath sounds on the affected side.

Treatment: Oxygen therapy, analgesia, positive pressure ventilation, and fluid resuscitation.

409
Q

What are the three classic signs of shock?

A

Tachycardia, tachypnea (RAPID HR), and hypotension.

410
Q

What type of shock and treatment?

A 50-year-old female who has been bleeding from a ruptured ectopic pregnancy. She is in decompensated shock with a blood pressure of 70/40 mmHg, heart rate of 120 beats per minute, respiratory rate of 30 breaths per minute, and decreased urine output.

A

Decompensated

Treatment: rapid fluid resuscitation, oxygen via non-rebreather mask, and transport to the hospital.

low bp is an early sign, rr is also an indication of decompensated.

411
Q

The part of the brain which controls body temperature is called:_______________

A

Hypothalamus

412
Q

On GCS Scale what does decorticate vs decerebrate get

A

cort - 3 arms to the core

cerebrate - 2 arms extended

413
Q

Which of the following is not considered a life threatening injury that should be found during primary assessment?

Airway comp

Cardiac tamponade

Tension pneumo

Flail chest

A

Cardiac tamponade

414
Q

What type of trauma may be most likely caused by secondary blast injuries?

A

Penetrating trauma

415
Q

What is Waddell’s Triad?

A

Injuries you see on a pediatric patient when they get hit by a car (head trauma, leg trauma, and chest trauma)

416
Q

Which of the following does not meet the burn center criteria?

Burns to the hands

6% partial thickness burns

Inhalation burns

4% full thickness burns

A

6% partial thickness burns

417
Q

Calculate the TBSA using the rule of 9s (3rd degree and 2nd degree burns – entire back, entire left arm, back of leg)

A

45%

418
Q

What type of burns have blistering?

A

2nd Degree

419
Q

What type of burns are superficial?

A

1st Degree

420
Q

What type of burns are full thickness?

A

3rd Degree

421
Q

What type of burns are partial thickness?

A

2nd Degree

422
Q

What’s the GCS score? Eyes do not open, no response to sound, decorticate posturing.

A

5

423
Q

What’s the GCS score? Eyes open to pain, incomprehensible sounds, and withdraws from pain.

A

8

424
Q

How much blood can the abdominal cavity hold?

A

Over 3000mL

425
Q

How much blood loss would you expect to lose from a femur fracture?

A

1500mL

426
Q

In the rule of 9s how much is the patients palm?

A

1%

427
Q

TBI patient without suspicion of herniation syndrome should be ventilated at a rate of ___.

A

10-12 bpm (ETCO2 35-45)

428
Q

Beck’s Triad is indicative of what?

A

Cardiac tamponade

429
Q

What type of posturing has the arms moving inward?

A

Decorticate

430
Q

You have treated a sucking chest wound with a dressing. They experience SOB. What should you do?

A

Burp the dressing

431
Q

True or false: blunt force trauma can cause dissection of major arteries.

A

True

432
Q

Commotio cordis occurs at what part of the cardiac cycle?

A

the upstroke of the T wave

Blow to the chest disrupting the heart. During the precise moment of the heart repolarizing leading to arrhythmia.

Can lead to V-Fib , needs cpr and rapid defib.

433
Q

What should you do (and not do) for snake bites

A

Do: place extremity below heart,
avoid constriction (jewelry),
clean w/ antimicrobial
note the time and type of snake

Dont: ice or suck venom out

434
Q

A partial thickness burn is also known as ____________ and ________ degree burns (2)

A full thickness burn is also known as?

A

First and second - partial

3rd - Full - every layer - needs skin graft

435
Q

What type of burn is this?

A

2nd Degree

Deep partial thickness

436
Q

What percent of partial thickness burn goes to burn center

A

over 10%

437
Q

Define Critical Burns

A

partial more than 30%

full more than 10

Inhalation injuries

Partial or Full involving hands, feet, joints, face, genitalia (2nd or Third)

438
Q

What solution do you use to keep broken teeth

A

dont rinse

place teeth in normal saline (lactated ringers - for electrolytes)
in a cup

(go to UM, has dental school)

439
Q

What are the typical injuries from a head on crash (8, name atleast 4)

A

facial, abdominal, neck trauma
pulmonary contusion
flail chest
myocardial contusion
pericardial tamponade
pneumo or hemo thorax
ruptured aorta
fractured sternum, rib

440
Q

What are the 5 blast injuries

A
  1. primary - blast wave
  2. secondary - blast force
  3. Tertiary - impact with object
  4. Quaternary - burns, inhalation
  5. Qunary - long term damage
441
Q

When providing O2 to patients whats the rate for:

  1. Herniation
  2. Head- injury

how many per min for children and infants with herniation?

A
  1. herniation - 20 bpm (q 3 secs)
  2. head injury - (10-12 bpm)

child - 25bpm
infant - 30bpm

442
Q

True or False Posturing is a sign of Herniation Syndrome

A

TRUE

443
Q

Whats the difference between Pharmacodynamics and Pharmacokinetics

A

Pharmacodynamics: how Drugs affect the body.

Pharmacokinetics: how the body affects drugs.

444
Q

What does Rhonchi indicate?

A

Pneumonia

445
Q

What is Lovastatin for?

A

Cholesterol

446
Q

Whats the dose of Iptroprium bromide

A

500mcg

447
Q

Whats the difference between heat stroke and heat exhaustion

A
448
Q

What med do you give for wheezing

A

Albuterol

449
Q

How many times to you a pulseless hypothermia patient?

A

Defib once ASAP

450
Q

What med do you give for a black widow bite with muscle spasms

A

Midazolam

451
Q

A 5 y/o has seizures after a dog bite, what might she have?

A

Rabies

452
Q

What are the signs of an Arterial Gas Emboli?

A
453
Q

How does Over pressure happen?

A

Holds breath during accent

454
Q

How many jules do you defib a hypothermic vfib patient?

A

200j biphasic

455
Q

With a hypothermic patient, what is different when administering meds?

A

Increase intervals between cardiac meds

the metabolism of drugs may be decreased, leading to slower clearance and prolonged effects.

456
Q

What meds slow the clotting process?

A

blood thinners and beta blockers

457
Q

Pericardial tamponade is what kind of shock

A

Obstructive

458
Q

What type of shock is an MI

A

cardiogenic

459
Q

Define Preload

A

is the volume of blood present in the ventricles at the end of diastole, just before systole begins. It determines the initial length and tension of the myocardial fibers and influences stroke volume.

460
Q

What is the main concern for dental injuries?

A

Airway compromise

461
Q

What would cause the rupture of the abdominal aorta

A

Blunt Trauma

462
Q

If a patient struggles to breathe with an occlusive dressing what should you do first

A

Burp it

463
Q

What are the signs and symptoms of hypovolemic shock?

A

tachycardia, hypotension, cool and clammy skin, altered mental status, and decreased urine output.

Other signs may include pale skin, weak or absent peripheral pulses, and delayed capillary refill time.

464
Q

How should fluids be administered in the prehospital setting to a patient in shock?

A

Two large-bore IV catheters or One intraosseous drilled needle

The initial fluid bolus should be 20 mL/kg of isotonic crystalloid solution

465
Q

What is the difference between compensated and decompensated shock?

A

decompensated shock occurs when these compensatory mechanisms fail and blood pressure falls,

Compensated - vasoconstriction and tachycardia, BP level, resp irregular but up

466
Q

What are the early signs of TBI

A

loss of consciousness, confusion, disorientation, memory loss, headache, dizziness, nausea or vomiting, blurred vision, sensitivity to light or noise, and fatigue.

467
Q

What are the early signs of Herniation

A

Cushings Triad - brady, irreg rr, hypertension (opposite direction of shock)
altered mental status, confusion, agitation, restlessness, and lethargy. Other signs may include pupillary changes, such as unilateral or bilateral dilation or non-reactivity, and motor deficits

decerebrate or decorticate posturing.

(doesnt have to be both cushings and posturing, either or)

468
Q

What are the signs and symptoms of Cardiac Tamponade

A

Becks Triad

dyspnea (difficulty breathing), tachycardia (rapid heart rate), hypotension (low blood pressure), jugular venous distension, muffled heart sounds, pulsus paradoxus (a decrease in systolic blood pressure during inspiration), and signs of shock

469
Q

What are the signs and symptoms of Pulmonary Contusions?

A

dyspnea (difficulty breathing), chest pain, tachypnea (rapid breathing), hemoptysis (coughing up blood), cyanosis (blue discoloration of the skin and mucous membranes), and signs of shock

470
Q

Is a shrapnel injury considered a primary or secondary blast injury?

A

Secondary

471
Q

the physiological process of hemostasis is achieved through ___________________

A

vasoconstriction and platelet aggregation

472
Q

Organs that lay in the retro parentaneal space

A

kidneys

and
adrenal glands, ureters, aorta, inferior vena cava, pancreas, and parts of the duodenum and colon.

473
Q

Describe GCS pneumonic you use

A
474
Q

What are the head and legs burn percent for

adult, child and infant

A
475
Q

19 y/o M, Unbelted MVC, steering wheel deformed, Lefort III fracture, clinched teeth,
O2 84% you should do what?

A

RSI

476
Q

What are the injuries for Waddell’s Triad?

A

Fracture of the femur
Dislocation of the hip joint
Injury to the pelvic ring

477
Q

Which burn patients go to the burn center?

A

Burns involving the face, hands, feet, genitalia, perineum, or major joints

Second-degree burns greater than 10%

Third-degree burns greater than 5%

Electrical burns

Chemical burns

Inhalation injuries or burns

Burn injuries in patients with preexisting medical conditions that could complicate care, such as diabetes or heart disease

Burn injuries in patients who require special social, emotional, or rehabilitative support, such as children or elderly patients.

478
Q

when a person jumps and lands on their feet, the axial load injury that can occur is called a?

A

compression fracture of the vertebrae, blunt trauma

skull, brain, spine, chest, abdominal organs, pelvis, femur fractures

479
Q

What organs may be injured from pressure changes from an explosion

A

Lungs, Ears, G.I. tract, Brain, Cardiovascular system, aortic rupture

480
Q

What directly affects cardiac output

A

stroke volume

481
Q

Whats the blood return to the heart called

A

Preload

482
Q

Define Afterload

A

The pressure against vascular resistance

483
Q

What burns are suspicious for abuse?

A

Patterns, outlines
Hands, Feet, Butt, genitals
Various stages of healing
Inconsistent with story
Other signs of abuse, bruises, etc

484
Q

A condition in which blood volume results in inadequate perfusion?

A

hypovolemic shock

485
Q

What type of shock is pump failure?

A

Cardiogenic shock

486
Q

when applying a tourniquet, the provider should remember to

A

Apply the tourniquet proximal to the bleeding site, 2-3 inches above the wound.

Tighten the tourniquet until the bleeding stops or the distal pulse is no longer palpable.

Secure the tourniquet in place and note the time of application.

487
Q

What type of shock is Pericardial Tamponade?

A

Obstructive shock

488
Q

What two type of meds interfere with the blood clotting process

A

Blood thinners and beta blockers

489
Q

Statin is for?

A

Cholesterol

490
Q

What would percussion of the chest be able to indicate?

A

Hemothorax - dullness

pneumothorax - hyperresonance

491
Q

Prolonged exposure to CO could lead to what kind of shock

A

Dissociative shock

492
Q

Flushed red skin sitting in closed up car on a hot day could indicate? Temp 104

A

Classic Heat stroke

493
Q

Ecg is Vtach, Pulseless and apneic, 90 degrees out, how would your treatment differ from any other patient?

A

increase intervals between cardiac meds

494
Q

Rattle snake in the ankle how would you treat?

A

place at heart level and rapid transport

495
Q

Patient with core temp of 82 has V-Fib what do you defib at

A

Defib at 200j biphasic

496
Q

Accended 5 mins later mild chest pain, dysnea, and then goes unresponsive what is the cause?

A

Arterial gas emboli

497
Q

Pump Failure would cause what type of shock?

A

Cardiogenic Shock

498
Q

Tension Pneumothorax is _____________ shock

A

Obstructive shock

499
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but is normotensive (normal bp) is in _____________ shock

A

Compensated shock

500
Q

A person in a MVC is tachypneic (rapid rr) and tachycardic (rapid hr) but their bp drops to 82/40 and is disoriented is in _____________ shock

Comp decomp or irreversible

A

Decompensated shock

501
Q

Shock secondary to an INFECTION in the blood is ______________ shock

A

Distributive shock

502
Q

Dobutamine

A

Sympathomimetic

dose: 5-20 mcg per kg/min

for: heart failure, low cardiac output

503
Q

What is the body’s physiologic response to hemorrhage (3 things)

A

Clotting is activated,
vasoconstriction,
platelet aggregation

504
Q

Pain in the Left Shoulder is a sign of
what nerve affected?
and
what organ affected?

A

Left Shoulder =

Phrenic Nerve, (c3, c4, c5 - keep diaphram alive)

Diaphragmatic irritation

Spleen (LUQ)

505
Q

Mild Abdominal Pain Radiating to the back is a sign of what organ affected?

A

Pancreas

506
Q

Flank Pain and Hematuria is a sign of what organ affected? also what is Hematuria?

A

Kidneys - Retroperitoneal Cavity

Hematuria - Blood in urine

507
Q

What is a “decompression sickness”?

A

a condition caused by a rapid decrease in pressure, leading to the formation of nitrogen bubbles in the blood.

508
Q

What are the signs of compensated shock?

A

Vital signs: Normal blood pressure, tachycardia, tachypnea, mild decrease in urine output

Symptoms: Anxiety, restlessness, increased thirst, mild peripheral vasoconstriction, normal or slightly elevated body temperature

509
Q

What are the signs of decompensated shock?

A

Vital signs: Hypotension, tachycardia, tachypnea, decreased urine output

Symptoms: Weakness, altered mental status, cool and clammy skin, decreased peripheral pulses, delayed capillary refill, decreased skin turgor, oliguria

510
Q

What are the signs of irreversible shock?

A

Vital signs: Profound hypotension, bradycardia, respiratory failure, hypoxia

Symptoms: Unresponsive, dilated and fixed pupils, absent peripheral pulses, cool and mottled extremities, anuria, metabolic acidosis

511
Q

What type of shock and treatment?

A 30-year-old male who has been in a car accident and is experiencing mild shock. His blood pressure is 110/70 mmHg, heart rate is 110 beats per minute, respiratory rate is 20 breaths per minute, and he has mild diaphoresis.

A

Compensated

Treatment: oxygen via non-rebreather mask and IV fluids.

in compensated shock, the body’s compensatory mechanisms are able to maintain adequate organ perfusion, and the patient’s vital signs are relatively stable. The patient may have an elevated heart rate and respiratory rate, but their blood pressure is maintained within normal limits, and they do not have signs of inadequate organ perfusion.

512
Q

What type of shock?

An 80-year-old male who has had a ruptured aortic aneurysm. with a blood pressure of 50/30 mmHg, heart rate of 40 beats per minute, respiratory rate of 8 breaths per minute, and unresponsive with fixed and dilated pupils.

Is it Comp decomp or irreversible

A

Irreversible shock

513
Q

What are the 6 types of shock

A

Cdd hon

Cardiogenic
Distributive
Dissociative

Hypovolemic
Obstructive
Neurogenic

514
Q

Define the 6 types of shock, signs, and treatment

A
  1. Hypovolemic shock: This occurs when there is a significant loss of blood or other fluids in the body.

Signs include low blood pressure, rapid heart rate, cold and clammy skin, decreased urine output, and altered mental status.

Treatment involves stopping the bleeding, replacing fluids and blood products, and addressing the underlying cause.

  1. Cardiogenic shock: This occurs when the heart cannot pump enough blood to meet the body’s needs.

Signs include low blood pressure, rapid heart rate, shortness of breath, chest pain, and cool and clammy skin.

Treatment involves addressing the underlying cause, such as a heart attack, and supporting the heart’s function.

  1. Distributive shock: This occurs when there is widespread vasodilation, causing blood to pool in the body’s tissues and not enough blood to circulate to vital organs.

Types of distributive shock include
septic shock,
anaphylactic shock, and
neurogenic shock.

Signs include low blood pressure, rapid heart rate, warm and flushed skin, and altered mental status.

Treatment involves identifying and treating the underlying cause, providing supportive care, and administering vasoactive medications.

  1. Obstructive shock: This occurs when there is a blockage in the circulatory system, preventing blood from flowing properly.

Examples include
pulmonary embolism,
cardiac tamponade, and
tension pneumothorax.

Signs include low blood pressure, rapid heart rate, shortness of breath, and chest pain.

Treatment involves addressing the underlying cause, such as removing the blockage, and providing supportive care.

  1. Dissociative - Co poisioning
    Oxgenation
  2. Neurogenic
    damage to symp ns - epi/nor-epi
    give epi, fluids, and pace if needed
515
Q

What type of shock?

Vitals organs begin to die because of inadequate perfusion

A

Irreversible

516
Q

What type of shock?

Diaphoretic, hypotensive, narrowing pulse pressure, nausea and vomitting

Comp decomp or irreversible

A

Decompensated

517
Q

What type of shock?

ARDS, renal failure, liver failure and sepsis

Comp decomp or irreversible

A

Irreversible

518
Q

True or false? A hip fracture is the same as a pelvic fracture.

A

False

519
Q

How many collisions does a patient suffer in an MVC?

A

3

520
Q

BP 188/101, and a hx of blood thinners. Sudden severe headache, blurry vision, and AMS.

Subdural hematoma

epidural hematoma

intracranial hematoma

A

intracranial hematoma

521
Q

Patient was involved in MVC 1 week ago. Now complaining of blurry vision, projectile vomiting, and confusion. What do they have?

Subdural hematoma

epidural hematoma

intracranial hematoma

A

Subdural hematoma

522
Q

What does Kehr’s Sign indicate?

A

Splenic injury

523
Q

What indicates Kehr’s Sign?

Left shoulder pain

Right shoulder pain

Left leg pain

A

Left shoulder pain

524
Q

How much blood can the abdominal cavity hold?

A

Over 3000mL

525
Q

How much blood loss would you expect to lose from a femur fracture?

A

1500mL

526
Q

A patient fell from a roof and is presenting with flushed skin, BP 80/42, HR 54, RR 0, and absent reflexes. What shock are they suffering from?

Not comp decomp irreversible answer

A

Neurogenic shock

527
Q

Which of the following would not be considered an early sign of increased intracranial pressure?

Confusion

Increase in BP

Nausea/vomiting

Blurry vision

A

Increase in BP

528
Q

Patient fell from a roof – pale skin, absent radial pulses, weak and rapid carotid pulse, JVD, hyperresonance right side. What type of shock do they have?

A

Hypovolemic Shock

529
Q

True of False: When percussing over solid organs or fluids, you would expect to hear a dull sound?

A

True

530
Q

A patient fell from the roof and presents with pale skin, BP 82/52, HR 124, RR 22, unstable pelvis. What shock is it?

Neurogenic

Hypovolemic

Spinal

Obstructive

A

Hypovolemic shock

531
Q

How would you most likely treat flail chest if the pt was found to be unresponsive?

High flow O2

BVM ventilations

Pain management and O2

A

BVM ventilations

532
Q

Pain that is out of proportion to the injury is commonly seen in which of the following?

cardiac tamponade

crush injury

compartment syndrome

commotio cordis

A

compartment syndrome

533
Q

What are signs of Heat Stroke (3)

A

Irritable
dehydration
Red, Hot, and Dry

534
Q

Burn shock is what type of shock?

A

Hypovolemic shock - loss of plasma/fluid

535
Q

Seizures, Headache, Joint pain and EYElid twitching are signs of what Water Emergency

A

Decompression Sickness

536
Q

What are signs of High Alt PE
(HAPE)

A

Dysnea, COUGH, cyanosis, Frothy Sputum

537
Q

What type of shock is burn shock fall under

A

Hypovolemic shock

538
Q

True or False a tourniquet can only be used for arterial bleeding?

A

False

539
Q

True or False Posturing is a sign of Herniation Syndrome

A

TRUE

540
Q

What are the signs of Neurogenic Shock and not
Herniation or TBI

and how do we treat?

A

Neuro-
low bp
low hr
Flush RED skin
loss of sympathetic tone

give epi drip and pressors

541
Q

What are 3 signs/symptoms of Inferior Wall STEMI with right ventricular involvement

A

hypotension
JVD
clear lungs

Paramedic (24 decks)

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