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Paramedicine > 327 Exam > Flashcards

327 Exam Flashcards

1
Q

What are the four types of Shock

A

1- Cardiogenic
2- Obstructive
3- hypovolemia
4- Distributive

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2
Q

What is the ideal MAP adequate tissue perfusion?

A

=>65mmHg

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3
Q

What are normal Lactate levels and levels in shock

A

0.5mmol/L normal
>4mmol/L in shock

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4
Q

Signs of Compensated shock

A
  1. Weak and light headed
  2. Pallor
  3. Tachycardia
  4. Diaphoretic
  5. tachypnea
  6. Decrease Urine
  7. weak pulse
  8. thirst
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5
Q

Signs of Decompensated shock

A
  1. Hypotension
  2. ALOC
  3. Cardiac Arrest
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6
Q

Treatment for Hypovolemia

A
  1. Stop bleed
  2. High flow O2
  3. Compund sodium Lactate 250ml bolus to maintain radial pulse
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7
Q

What are the six Ps of ischemia

A

1- pain
2- pallor
3- paralysis
4- perishingly cold
5- parasthesia
6- pulselessness

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8
Q

Dislocation management

A

No neruo compromise- immobilise in position found and manage pain

Neuro compromise- pain management- gentle traction not over 5kg

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9
Q

Explain Ottawa ankle rule

A

1- palpate for pain on the lateral and medial malleolus start distal and move 6 cm proximal
2- palpate for tenderness over navicular and 5th metatarsal
3- get the patient to walk for continuous steps
One of the three a positive 25 to 50% chance of a fracture

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10
Q

Management of impaled objects

A

1- do not remove except airway obstruction
2-Apply very bulky padding
3- transport object in place
4- no unnecessary movement
5- have the object cut to size for transport when necessary

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11
Q

What is the sign for your base of skull fracture

A

Raccoon eyes
dilated pupil
battle signs

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12
Q

What are the neck veins in hypovolemia

A

Flat neck veins

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13
Q

Explain nurogenic shock

A

An injury to the spine occurs. Blocking sympathetic nervous signal. Allowing unopposed parasympathetic stimulation.
Causing, hypotension, bradycardia warm dry pink skin

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14
Q

Two causes of obstructive shock

A

1- tension pneumothorax
2- cardiac tamponade

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15
Q

What is beck triad and what condition is it used for

A

1- Hypotension
2- distended neck veins
3- muffled heart signs

Signs of cardiac tamponade

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16
Q

Explain a tension pnumothorax

A

Injury to the lung leading to air escaping into the plural space. Building up causing it to tension (pressure). Putting pressure on the effected lung.
This will also collapse the low pressure vena cavas decreasing venous return leading to a block in the vena cava.

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17
Q

Clinical manifestations of tension Pneumothorax

A

1- distended neck vein - collapsed vena cava
2- subcutaneous emphysema
3- Dyspnea
4- air hungry
5- lack of air sounds on that side

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18
Q

Explain cardiac tamponade

A

Fluid filling within the pericardium. Squeezing the heart prevent heart filling. Build up of blood in the vena cava leading to Distended neck veins and becks triad

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19
Q

Treatment for Tension Pnumo

A

O2
Position
Pain management
Chest decompression

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20
Q

Explain process for chest decompression

A

SMART
Second intercostal space
Mid clavicular line
Above the rib Below
Right angles to the chest
Towards the spine

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21
Q

Treatment for haemothorax

A

Load and go
Fluid titrate to bp 90-100mmhg

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22
Q

What is ICP

A

Intracranial pressure
Pressure of brain and contents within the skull

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23
Q

What is CPP

A

Cerebral perfusion pressure
Pressure required to perfume the brain

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24
Q

What CPP is requred for the brain?

A

> 60mmHg to perfuse the brain

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25
Q

What’s normal dangerous and severe ICP

A

Normal 5-15mmhg
Dangerous >15mmhg
Herniation syndrome >20mmhg

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26
Q

What’s the formula to calculate MAP

A

SBP + 2 * DBP /3

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27
Q

Pt has a BP of 83/50
What’s the MAP

A

=83+2*50/3
=83+100/3
=183/3
=61mmhg

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28
Q

When does ICP=20

A

When the patient is showing symptoms of increased ICP
Unequal pupils
Decrease LoC
Etc

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29
Q

What’s the formula for CPP

A

CPP= MAP-ICP

30
Q

Explain Cushing reflex

A

^ICP >mean arterial pressure leads to cerebral ischaemia

stage one cerebral ischaemia stimulate sympathetic nervous system alpha-1 receptors cause vasoconstriction leading to hypertension Beta-2 leads to increase in heart rate

stage two hypertension leads to Baro receptor activation in the aortic arch leads to stimulation of the parasympathetic nervous system leading to activation of muscarinic two receptors leading to bradycardia

stage three hypertension puts pressure on the brainstem of the rest centre leading to irregular breathing

31
Q

What is Cushing’s triad

A
  • One Irregular respirations
  • two bradycardia
  • three hypertension
32
Q

Metoclopramide MOA, Dose, Route, Prep.

A

Inhibits Dopamine 2 and 5HT3 receptors in the CTZ.
10mg IV
10mg in 2mL

33
Q

Ondansetron MOA, Dose, Route, Prep

A

Ondansetron Blocks 5HT3 receptros in the stomach
4mg IV
4mg in 2mL

34
Q

Morphine MOA, Dose, Route, Prep

A

Blocks opioid recpetors in the CNS blocking the pain action potential
2.5-5mg IV
10mg 1mL

35
Q

Fentanyl Dose, route, prep

A

600mcg 2mL

Initial Dose 240mcg undiluted IN (Spray in alternate nostrils)
̶ First Spray 120mcg (0.4mL) - Patient receives 90mcg
̶ Second Spray 90mcg (0.3mL) - Patient receives 90mcg
̶ Third Spray 60mcg (0.2mL) - Patient receives 60mcg

36
Q

Naloxone MOA, dose, route, Prep

A

Blocks opioid receptors
400mcg 1mL
400mcg IM

37
Q

Ketamine
Prep and dose

A

Prep- 200mg in 2ml
dilute with 18mL of NaCl
Dose- 0.25mg/Kg Max 30mg bolus

38
Q

Adrenaline infusion protocol

A

1mg 1:10,000 diluted in 90mL of CSL
5mcg/min (30 drips/min).

39
Q

Define the rules of nine

A
40
Q

Signs of airway involvements burns

A

HISSCA
* Hoarse voice
* Inspiratory stridor
* seesaw breathing
* singed nasal or facial hair
* Carbon material
* anterior neck burns

41
Q

Whats the burns management

A
  • Cool running water 20 minutes
  • Pain releif
  • clean dry dressing
  • fluids
  • transport
42
Q

parklands formula for fluids

A

4mLs * %BSA * Weight (Kg)
Half given over first 8 hours

43
Q

What is Kehr sign

A

Pain in the left shoulder caused by irritation of the under surface of the diaphragm by blood leaking from a ruptured spleen. The pain impulses are referred along the phrenic nerve.

44
Q

in trauma what does grey turners sign indicate

A

Retroperitoneal Haemorrhage

45
Q

whats the lethal triad

A
  1. hypothermia
  2. coagulopathy
  3. acidosis
46
Q

an Increase in partial pressure of CO2 causes what to cerebral vascular

A

Incease in pCO2 (hypoventilation) causes promotes cerebral Vasodialation.

47
Q

a decrease in partial pressure of CO2 causes what to cerebral vascular

A

Hypervetialtion causes vasoconstriction, decreasing blood flow.

48
Q

Signs and symptoms of Subarachnoid Harmorrhage?

A
  • Severe headache
  • Coma
  • Vomiting
  • Cerebral herniation syndrome possible
49
Q

Acute Epidural Signs and Symptoms

A
  • Initial LOC followed by a period of lucid intervals
  • Vomiting
  • Headache
  • ALOC
  • ipsilateral dilated pupil (dilated pupil on same side of head injury)
50
Q

Acute subdural haematoma signs and symptoms

A
  • Fluctuations in LOC
  • Headache
  • focal neuro signs; eg weak to one side, slurred speech
51
Q

Treatment for patients with TBIs?

A

Assist ventilation
High-flow oxygen
One breath every 6–8 seconds
SpO2 >95%
Maintain EtCO2 at 35 mmHg
Check BGL

52
Q

3 complications of SMR

A
  1. Airway compromise and aspiration
  2. Hypoxia
  3. Pressure sores
53
Q

when is compund sodium lactate indicated for burns patients

A

Adults TBSA >20%
Paeds TBSA >10%

54
Q

Explain Crush syndrome

A

Crushed muscle tissue becomes damaged due to the crush and necrotic due to ischaemia
Cellular lysis (destruction/damage) results in the release of metabolic by products, such as;
Myoglobin
Phosphate and potassium
Lactic acid
Uric acid

55
Q

Management of Crush syndrome

A
  1. Compund sodium lactate 10mL/kg bolous
  2. Pain management
  3. Calcium glucnate (ICP)
  4. Sodium Bi carb (ICP)
56
Q

What are the normal mild moderate and sevre levels for Hyperkalemia

A
  • 3.5-5 mEq/l Normal
  • 5.5-6.0 mEq/L - Mild
  • 6.1-7.0 mEq/L - Moderate
  • 7.0 mEq/L and greater – Severe
57
Q

Describe the pathophys of Compartment syndrome

A
  • fluid is introdued to a fixed volume compartment
  • leads to an increase in pressure collapsing or blocking the capillarys decresing perfusion
  • Skeletal muscle responds to perfusion y releasing inflammatroy mediators
  • capilleries become leaky
  • myocites breakdown and attract water further increasing fluid and pressure.
58
Q

Signs and symptoms of Compartment syndrome

A

6 Ps of ischemia

59
Q

What is paramedic management of crush injury

A
  1. care of the injury
  2. Pain relief
  3. plint fractures
  4. ice packs on severe contusions
60
Q

What is Rhabdomyolysis

A

breakdown of muscle fibres resulting in the release of myglobin into the bloodstream

61
Q

Casues of Rhabdo

A
  • Crush Injuries
  • Compartment syndrome
  • Ischemia or Necrosis of Muscle (DVT)
  • Hyperthermia
  • Seizures
  • Severe exertion such as marathon running
  • Trauma
  • Electrolyte Disorders
  • Other metabolic causes
62
Q

Symptoms of Rhabdo

A
  1. Dark or red urine
  2. general weakness
  3. muscle stiffness
  4. muscle tenderness
63
Q

treatments for Rhabdo

A

Aggressive fluids
treat hyperkalemia if present

64
Q

Hyperkalemia on ECG

A

Peaked T waves – 5.5 - 6 mEq/L
Wide QRS – 7 - 7.5 mEq/L
Flat/lost P waves – 7 – 8 mEq/L
Fusion with T wave forming sine wave - >9 mEq/L

65
Q

Signs and symptoms of Cholinergic Toxicity

A

Bumbbels and sledge
D iarrhoea
U rination
M iosis
B ronchorrhea/bronchospasm
B radycardia
E mesis
L acrimation
S alivation

S alivation
L acrimation
U rination
D efecation
E mesis
GI Cramping
E mesis

66
Q

Management for Cholinergic toxicity

A
  • Supportive ABC’s
  • Prevent Cross- contamination to paramedics
  • Decontamination of the Patient
  • All contaminated clothing should be removed and quarantined
  • Atropine - until the patient is dry of secretions and has adequate air entry. Large doses may be required in severe cases until the desired clinical endpoints are attained.
67
Q

Anticholinergic Toxidrome – Signs & Symptoms

A

Central inhibition leads to;
* Agitated (hyperactive) delirium
* Confusion
* Visual Hallucinations
* Mumbling incoherently
* Fluctuating LOC

Peripheral inhibition leads to;
* Hot & Dry skin
* Flushed Appearance
* Mydriasis – (Pupil Dilation)
* Tachycardia
* Decreased gastric motility & bowel sounds
* Urinary Retention

68
Q

Anti Cholinergic Likely suspects:

A
  • TCA
  • *Droperidol
  • Olanzapine
  • promethazine
69
Q

Anti Cholinergic likely treatment

A
  • Supportive
  • Treat hyperthermia
  • IF TCA- Sodium Bicarb
70
Q

Sympathomimetic Toxidrome – Signs & Symptoms

A

MATHS
* Mydriasis
* Aggitation
* Tachycardia
* Hypertension
* Seizure

71
Q

Opioid Toxidrome Sings and symptoms

A

CPR 3H
* Coma
* pinpoint pupils
* Resp Depression
* Hypotension
* Hypothermia
* Hyporeflexia

Paramedicine (11 decks)

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