327 Exam Flashcards
What are the four types of Shock
1- Cardiogenic
2- Obstructive
3- hypovolemia
4- Distributive
What is the ideal MAP adequate tissue perfusion?
=>65mmHg
What are normal Lactate levels and levels in shock
0.5mmol/L normal
>4mmol/L in shock
Signs of Compensated shock
- Weak and light headed
- Pallor
- Tachycardia
- Diaphoretic
- tachypnea
- Decrease Urine
- weak pulse
- thirst
Signs of Decompensated shock
- Hypotension
- ALOC
- Cardiac Arrest
Treatment for Hypovolemia
- Stop bleed
- High flow O2
- Compund sodium Lactate 250ml bolus to maintain radial pulse
What are the six Ps of ischemia
1- pain
2- pallor
3- paralysis
4- perishingly cold
5- parasthesia
6- pulselessness
Dislocation management
No neruo compromise- immobilise in position found and manage pain
Neuro compromise- pain management- gentle traction not over 5kg
Explain Ottawa ankle rule
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
Management of impaled objects
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
What is the sign for your base of skull fracture
Raccoon eyes
dilated pupil
battle signs
What are the neck veins in hypovolemia
Flat neck veins
Explain nurogenic shock
An injury to the spine occurs. Blocking sympathetic nervous signal. Allowing unopposed parasympathetic stimulation.
Causing, hypotension, bradycardia warm dry pink skin
Two causes of obstructive shock
1- tension pneumothorax
2- cardiac tamponade
What is beck triad and what condition is it used for
1- Hypotension
2- distended neck veins
3- muffled heart signs
Signs of cardiac tamponade
Explain a tension pnumothorax
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.
Clinical manifestations of tension Pneumothorax
1- distended neck vein - collapsed vena cava
2- subcutaneous emphysema
3- Dyspnea
4- air hungry
5- lack of air sounds on that side
Explain cardiac tamponade
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
Treatment for Tension Pnumo
O2
Position
Pain management
Chest decompression
Explain process for chest decompression
SMART
Second intercostal space
Mid clavicular line
Above the rib Below
Right angles to the chest
Towards the spine
Treatment for haemothorax
Load and go
Fluid titrate to bp 90-100mmhg
What is ICP
Intracranial pressure
Pressure of brain and contents within the skull
What is CPP
Cerebral perfusion pressure
Pressure required to perfume the brain
What CPP is requred for the brain?
> 60mmHg to perfuse the brain
What’s normal dangerous and severe ICP
Normal 5-15mmhg
Dangerous >15mmhg
Herniation syndrome >20mmhg
What’s the formula to calculate MAP
SBP + 2 * DBP /3
Pt has a BP of 83/50
What’s the MAP
=83+2*50/3
=83+100/3
=183/3
=61mmhg
When does ICP=20
When the patient is showing symptoms of increased ICP
Unequal pupils
Decrease LoC
Etc
What’s the formula for CPP
CPP= MAP-ICP
Explain Cushing reflex
^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
What is Cushing’s triad
- One Irregular respirations
- two bradycardia
- three hypertension
Metoclopramide MOA, Dose, Route, Prep.
Inhibits Dopamine 2 and 5HT3 receptors in the CTZ.
10mg IV
10mg in 2mL
Ondansetron MOA, Dose, Route, Prep
Ondansetron Blocks 5HT3 receptros in the stomach
4mg IV
4mg in 2mL
Morphine MOA, Dose, Route, Prep
Blocks opioid recpetors in the CNS blocking the pain action potential
2.5-5mg IV
10mg 1mL
Fentanyl Dose, route, prep
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
Naloxone MOA, dose, route, Prep
Blocks opioid receptors
400mcg 1mL
400mcg IM
Ketamine
Prep and dose
Prep- 200mg in 2ml
dilute with 18mL of NaCl
Dose- 0.25mg/Kg Max 30mg bolus
Adrenaline infusion protocol
1mg 1:10,000 diluted in 90mL of CSL
5mcg/min (30 drips/min).
Define the rules of nine
Signs of airway involvements burns
HISSCA
* Hoarse voice
* Inspiratory stridor
* seesaw breathing
* singed nasal or facial hair
* Carbon material
* anterior neck burns
Whats the burns management
- Cool running water 20 minutes
- Pain releif
- clean dry dressing
- fluids
- transport
parklands formula for fluids
4mLs * %BSA * Weight (Kg)
Half given over first 8 hours
What is Kehr sign
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.
in trauma what does grey turners sign indicate
Retroperitoneal Haemorrhage
whats the lethal triad
- hypothermia
- coagulopathy
- acidosis
an Increase in partial pressure of CO2 causes what to cerebral vascular
Incease in pCO2 (hypoventilation) causes promotes cerebral Vasodialation.
a decrease in partial pressure of CO2 causes what to cerebral vascular
Hypervetialtion causes vasoconstriction, decreasing blood flow.
Signs and symptoms of Subarachnoid Harmorrhage?
- Severe headache
- Coma
- Vomiting
- Cerebral herniation syndrome possible
Acute Epidural Signs and Symptoms
- Initial LOC followed by a period of lucid intervals
- Vomiting
- Headache
- ALOC
- ipsilateral dilated pupil (dilated pupil on same side of head injury)
Acute subdural haematoma signs and symptoms
- Fluctuations in LOC
- Headache
- focal neuro signs; eg weak to one side, slurred speech
Treatment for patients with TBIs?
Assist ventilation
High-flow oxygen
One breath every 6–8 seconds
SpO2 >95%
Maintain EtCO2 at 35 mmHg
Check BGL
3 complications of SMR
- Airway compromise and aspiration
- Hypoxia
- Pressure sores
when is compund sodium lactate indicated for burns patients
Adults TBSA >20%
Paeds TBSA >10%
Explain Crush syndrome
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
Management of Crush syndrome
- Compund sodium lactate 10mL/kg bolous
- Pain management
- Calcium glucnate (ICP)
- Sodium Bi carb (ICP)
What are the normal mild moderate and sevre levels for Hyperkalemia
- 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
Describe the pathophys of Compartment syndrome
- 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.
Signs and symptoms of Compartment syndrome
6 Ps of ischemia
What is paramedic management of crush injury
- care of the injury
- Pain relief
- plint fractures
- ice packs on severe contusions
What is Rhabdomyolysis
breakdown of muscle fibres resulting in the release of myglobin into the bloodstream
Casues of Rhabdo
- Crush Injuries
- Compartment syndrome
- Ischemia or Necrosis of Muscle (DVT)
- Hyperthermia
- Seizures
- Severe exertion such as marathon running
- Trauma
- Electrolyte Disorders
- Other metabolic causes
Symptoms of Rhabdo
- Dark or red urine
- general weakness
- muscle stiffness
- muscle tenderness
treatments for Rhabdo
Aggressive fluids
treat hyperkalemia if present
Hyperkalemia on ECG
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
Signs and symptoms of Cholinergic Toxicity
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
Management for Cholinergic toxicity
- 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.
Anticholinergic Toxidrome – Signs & Symptoms
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
Anti Cholinergic Likely suspects:
- TCA
- *Droperidol
- Olanzapine
- promethazine
Anti Cholinergic likely treatment
- Supportive
- Treat hyperthermia
- IF TCA- Sodium Bicarb
Sympathomimetic Toxidrome – Signs & Symptoms
MATHS
* Mydriasis
* Aggitation
* Tachycardia
* Hypertension
* Seizure
Opioid Toxidrome Sings and symptoms
CPR 3H
* Coma
* pinpoint pupils
* Resp Depression
* Hypotension
* Hypothermia
* Hyporeflexia
