Adult Medical Treatment Guidelines Flashcards
What types of shock are associated with trauma?
Hypovolemic (bleeding)
Neurogenic (spinal injury)
Obstructive (pneumothorax)
Different types of shock
Hypovolemic (dehydration or GI bleed or bleeding)
Neurogenic (spinal injury)
Obstructive (pneumothorax)
Cardiogenic (STEMI or CHF)
Distributive (anaphylaxis or sepsis)
Obstructive (PE or cardiac tamponade)
What is happening during distributive shock?
So vasodilated that blood can’t be pumped.
Hypotension can be defined as a systolic blood pressure of less than
90mmHg
T/F - Shock may be present with a
seemingly normal blood pressure initially
True
Neurogenic shock generally presents with
Warm, dry, and pink skin with normal capillary refill time; patient
typically alert
California Poison Control Center
(800) 222-1222
Anticholinergics
Block and inhibit the activity of the neurotransmitter acetylcholine (ACh)
Acetylcholine
neurotransmitter
What kind of test does an EMT use for altered mental status?
BG
Insecticides
Organophosphate
S.L.U.D.G.E.
Salivation, Lacrimation, Urination, Defecation, GI distress, and Emesis
Acetaminophen overdose
Causes irreversible
liver failure.
Aspirin overdose
Tachypnea and altered mental status may occur later. Renal dysfunction, liver failure or cerebral edema among other things can present later.
Acetaminophen
Tylenol
Aspirin
Acetylsalicylic acid
Stimulants signs and symptoms
Increased heart rate, blood pressure or temperature, dilated pupils, and seizures.
Depressants signs and symptoms
Decreased heart rate, blood pressure or temperature, decreased respirations, and non-specific pupils.
Insecticides cause ____ pupils
Pinpoint
Bring ______, ______ and _______ to the Emergency Department for overdose or toxic ingestion.
Medication bottles, contents, and emesis
Give Narcan if altered mental status and
respiratory rate < _______
8
T/F: You should leave behind Narcan
for family or friends of
patients with suspected
opioid overdose
True
Naloxone is given ______ mg IN or Auto Injector
Naloxone is titrated to effect of adequate ventilation and oxygenation. NOT ADMINISTERED TO RESTORE CONSCIOUSNESS
2‐4 mg
Pain acronym
O - Onset - What were you doing?
P - Provocation - Make it better/worse?
Q - Quality - Sharp, dull, or stabbing?
R - Radiation - Does the pain move anywhere?
S - Severity - Scale of 1 to bear attack
T - Time - When did this happen?
Visceral refers to what?
Internal organs of the body (abdomen)
What does the Phrenic Nerve do?
Controls the diaphragm
Septicemia
Blood poisoning by bacteria. Can cause sepsis, which is the body’s reaction.
Congenital
Present from birth
Obturator
Helps to give rigidity to trach tube during insertion. Basically a stylet for a trach tube. Remove after tube change because it blocks the tube.
Where do we give oxygen to a pt with a trach tube
NRB over the trach. Pt does not breath oxygen through the mouth or nose.
Stoma
Opening in the skin. Trach tubes and colostomy bags have stomas.
Different types of bags.
IDK.
Trach tubes: Do not suction for more than ________each attempt and ________ before and between attempts.
10 seconds, pre-oxygenate
Abrupt cessation
Quitting without weening off. This is referring to addiction in protocols.
Status Epilepticus
2 or more seizures in ≤ 5 minutes or Any seizure lasting > 5 minutes.
(If duration cannot be confirmed, patient, should be assumed to be in status if actively seizing when you arrived.)
Seizure interventions
B - BG
O - Oxygen: NRB if status, BVM if <8
I - Immobilize
Eclampsia
High blood pressure results in seizures during pregnancy
Preeclampsia
High blood pressure disorder that can occur during pregnancy
Grand Mal seizures
(Generalized) are associated with a loss of consciousness, incontinence, and oral trauma.
Petit Mal
(Focal) affect only a part of the body and are not associated with a loss of consciousness. People look like they zone out.
Encephalitis
Brain inflammation
(Focal) affect only a part of the body and are not associated with a loss of consciousness. People look like they zone out.
Petit Mal
Muscle aches and pain
Myalgia
What condition speeds up the body’s metabolism?
Hyperthyroidism
ARDS
Acute respiratory distress syndrome
Septic patients are especially susceptible to ______ and ______.
Traumatic lung injury and Acute Respiratory Distress Syndrome (ARDS). Use only enough tidal volume to see the chest rise.
If CPAP is utilized on a septic pt, airway pressure should be limited to _________.
7.5cm H2O
DIC
Disseminated Intravascular Coagulation (DIC) is an ominous, late stage manifestation of sepsis characterized by extensive bruising, bleeding from multiple sites, and finally tissue death.
Ominous
Gives the impression of something bad
Disseminated
Spread throughout the body or an organ
Loss of ability to understand or express speech, caused by brain damage.
Aphasia
Difficulty speaking caused by brain damage.
Dysarthria
Thrombotic or embolic is ____% of strokes.
85%
Hemorrhagic is ________% of strokes.
15%
Cincinnati stroke screening
Facial Droop
Arm Weakness
Speech Abnormality
LAMS stands for what?
Los Angeles Motor Scale (LAMS)
What does a LAMS test consist of? How is it scored?
Facial Droop:
-Absent - 0 points
-Present - 1 point
Arm Weakness:
-Absent - 0 points
-Drifts - 1 point
-Falls rapidly - 2 points
Grip:
-Normal - 0 points
-Weak - 1 point
-No grip - 2 points
A LAMS score of _____ indicates a high likelihood of a LVO stroke
≥ 4
LVO Stroke
Large Vessel Occlusion
“woke up and noticed stroke symptoms,”
Time starts when the patient was last awake.
Approved Stroke Receiving Centers
John Muir – Concord
John Muir – Walnut Creek
Kaiser – Antioch
Kaiser – Richmond
Kaiser – Walnut Creek
San Ramon Regional
Eden – Castro Valley
Kaiser – Oakland
Kaiser – Vallejo
Marin General
Summit – Oakland
Sutter – Solano
Valley Care - Pleasanton
Keep scene time less than _____.
If available, transport a family
member or guardian with patient
10 minutes
A Stroke Alert is indicated when…
The Cincinnati Stoke Screen findings are abnormal and onset (time last seen normal) is less than 6 hours from time of patient contact
LMP
Last Menstrual Period
AAA
Abdominal Aortic Aneurysm
Micturition
The action of urinating
More than 25% of geriatric syncope is…
Cardiac dysrhythmia based
A condition in which the blood’s ability to coagulate (form clots) is impaired
Coagulopathy
__________ may have poor wound healing capabilities, and IO access may present a greater risk for infection or complicate the patient’s long-term condition due to poor wound healing.
Diabetics
Painful or difficult urination
Dysuria
ODT
Orally disintegrating tablets
An impression of __________ should be considered with severe abdominal or non-traumatic back pain, especially in patients > 50 years of age or patients with shock/poor perfusion.
Abdominal aneurysm
What are the interventions for a complete obstruction of an adults airway when they are conscious vs unconscious.
Abdominal thrusts (conscious)
Chest compression (unconscious)
An appropriate ventilatory rate is one that maintains an EtCO2 of _____ or greater
35
Adult Behavioral Levels of Agitation:
Mild, Moderate, Severe, and Excited Delirium.
Mild: Anxious/agitated but cooperative.
Moderate: Verbally confrontational, uncooperative, threatening physical posture (clenched jaw / fists) but not physically combative.
Severe: Combative, spitting, and biting. They get chemically restrained.
Excited Delirium: Combative and on PCP. They get chemically restrained.
Extremities that are restrained will have a circulation check at least every _________. The first of these checks should occur as soon after placement of the restraints as possible.
15 minutes
Use an EpiPen Junior or Pediatric Epinephrine Auto Injector on…
Patients hx of heart problems, over 50 years of age, and peds that weight ≤ 30 kg
Rapid deep breaths. Commonly DKA.
Kussmaul respirations
Alcoholics frequently develop what BG problem?
Hypoglycemia
Muscle cramps and spasms
Spasmodic Pain
The placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Abruptio Placenta
The placenta completely or partially covers the opening of the uterus.
Placenta Previa
The umbilical cord drops through the open cervix into the vagina ahead of the baby and the baby puts pressure on the cord, cutting off oxygen.
Prolapsed Cord
Gravida/Para
Gravida is the number of times a patient has been pregnant. This includes a current pregnancy. Para is the number of times a patient has given birth to a viable child.
The _________________ position keeps the pressure off of the inferior vena cava for a pregnant woman.
Left lateral recumbent
Medical term for gooch
Perineum
Shoulders stuck during child birth
Shoulder Dystocia
Period of development in womb between conception and birth
Gestation
Multiple gestation
Twins, Triplets, Quadruplets, Quintuplets, etc.
Priority symptoms Childbirth / Labor
Crowning at < 36 weeks gestation, Abnormal presentation, Severe vaginal bleeding, Multiple gestation
Breach birth intervention
Transport unless delivery is imminent, Encourage mother to refrain from pushing, Support presenting part(s) DO NOT PULL.
Prolapsed Cord & Shoulder Dystocia interventions
Prolapsed Cord & Shoulder Dystocia
T/F: Document all times (delivery, contraction frequency and length, and time cord was cut), and names of the prehospital provider who cut the cord.
True
What are the 3 most important interventions for an apneic patient with a pulse?
Open airway chin lift/jaw thrust
Nasal or oral airway
Bag‐valve mask (BVM)
What does a Dystonic Reaction look like?
Retardation. Involuntary muscle contraction.
PPH
Postpartum Hemorrhage
PPH is the loss of more than ______ of blood following vaginal birth; Minor: _____ to ______. Major: More than ______. Enough blood loss to cause the mother’s condition to deteriorate is also considered PPH.
500 ml
500 ml to 1 liter
1 liter
PPH for a C-section is The loss of more than _______of blood following a cesarean section
1 liter
The leading cause of maternal mortality in the world
PPH
Breastfeeding helps release the hormone, _______, which also helps contract the uterus.
Oxytocin
Difficult or labored breathing
Dyspnea
Uterine atony
A soft and weak uterus after childbirth. It happens when your uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth. This can lead to life-threatening blood loss after delivery.
How to stop PPH and deliver the placenta for the EMT scope. (TXA is for medic).
Initiate gentle fundal massage to encourage delivery of placenta. If the placenta is delivered, massage it until the uterus is firm. Encourage breastfeeding. Supplemental oxygen as required.
The Four T’s of Post‐Partum Hemorrhage (PPH) include:
Tone – (70% of PPH incidents) Is uterine atony which occurs when the uterus fails to contract after delivery of the baby.
Trauma - (20% of PPH incidents), which includes: Lacerations of the cervix, vagina or perineum
Tissue - (10% of PPH incidents), which includes: Retained products, placenta, membranes or clots; or An abnormal placenta
Thrombin - ( <1% of PPH incidents), which is caused by issues with coagulation
Secondary PPH is defined as a loss of more than 500 ml of blood between 24 hours postpartum and ________ postpartum.
12 weeks
A natural hormone that stimulates uterine contractions in childbirth and lactation after childbirth
Oxytocin
Problematic BG levels that require intervention.
≤ 60 or ≥ 350
Able to follow commands but symptomatic low BG = give _______ of glucose
30 Grams
The tissue that lines the abdominal wall and pelvic cavity
Peritoneal
A condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues.
Anemia
Hyperkalemia
High potassium usually from Kidney Disease
Pericarditis
Swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium)
Cardiac tamponade
Pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac of the heart.
Cardiac tamponade symptoms
Symptoms include low blood pressure, shortness of breath, and lightheadedness.
Low blood pressure (hypotension), Bulging neck veins, Heartbeat sounds that are distant or muffled when listening through a stethoscope.
Peaked T-waves
hyperkalemia
PERI-ARREST
“Crashing or circling the drain”, period just before or after arrest. Peri means around.
Remove CPAP when Systolic is ______. Why do we do this?
< 90. Obstructive pressure. Similar to problem presented during hyperventilation. The pressure in the lungs puts pressure on the heart which will decrease BP further.
T/F: CPAP is not a ventilation device. Patients with an inadequate respiratory rate or depth of respiration will need assistance with a BVM.
True
Spasmodic movements of the eyeballs into a fixed position, usually upwards.
Oculogyric
Common drugs implicated in dystonic reactions include many _____ and ______ medications
anti-emetics and anti-psychotic
Central venous catheter types
- Tunneled catheter (Broviac/Hickman)
- PICC (peripherally inserted central catheter)
- Implanted catheter (Mediport)
Hyperalimentation infusions (IV nutrition): If stopped for any reason, monitor patient for what?
Hypoglycemia
IV nutrition
Hyperalimentation
Superficial reddening of the skin around a central line is called what?
Erythema
Infant
Less than 1 year
About _____ % of snake bites are dry bites
25%
What is the difference between snake and spider bites?
Don’t ice snake bites. Mark margin of swelling / redness and time. Both are elevated.
When do we txp to a burn center?
More than or equal to 20% TBSA.
What is a major burn?
≥ 20% TBSA partial or full thickness
burns, burns with suspected
inhalation injury or high voltage
electrical burns
If your dick is burned, what percentage is that?
1%
Infant chest compression depth
1.5 inches
Children chest compression depth
2 inches
Limit changes / pulse checks to less than _______ during cpr.
5 seconds
What are the compression ratios for children under 1 month (neonates), children under 8, children over 8, and adults.
Less than 1 month - 3:1
Children 1 month - 8 years - 15:2
Children over 8 years - 30:2
Adult - 30:2
How old are newly borns?
≤ 24 hours old
How old are Neonates?
≤ 28 days old 1 month
How old are Infants?
≤ 1 year old
Tarry, blood filled, black stool
Melena
Injury happening where the limbs meet the body
Junctional Injury
Important interventions with a hypothermic patient
Check for pulse for 30-45 seconds to avoid compressions unnecessarily. Hypoglycemia leads to hypothermia, make sure to check sugar.
Sweating generally disappears as body temperature rises above ______.
104 Degrees F
For head trauma, elevate the pt’s head ______ degrees
30
Signs of major head trauma
LOC at any point
GCS ≤ 14
Any post‐traumatic seizure
Multisystem trauma requiring intubation?
Why is hyperventilation a problem for head truama?
It causes vasoconstriction
Cushing’s Triad
Increased Intracranial Pressure
1. Increased BP
2. Slow pulse
3. Altered breathing
Crush Injury Syndrome may develop after _________ in the presence of a severe crush, but usually requires at least _________ hours of compression.
1 hour, 4 hours
How long are women pregnant?
How long are woman pregnant?
40 weeks
