AEMCA - Additional Review Flashcards
What are the GCS parameters?
E - Spontaneous
- Verbal
- Pain
- Absent
V - Oriented
- Confused
- Inappropriate words
- Inappropriate sounds
- Absent
M - Obeys commands
- Localizes to pain
- Withdraws from pain
- Abnormal flexion
- Abnormal extension
- Absent
What are the APGAR Parameters?
Appearance:
Pink - 2
Pink body, blue extremities - 1
Blue body, blue extremities - 0
Pulse:
> 100 BPM - 2
< 100 BPM - 1
Absent - 0
Grimace:
Strong cry/active movement to stimulation - 2
Grimace/weak movement to stimulation - 1
Floppy - 0
Activity:
Active - 2
Flexed arms and legs - 1
Absent - 0
Respiration:
Vigorous cry - 2
Slow and irregular - 1
Absent - 0
What are the LAMS score parameters?
Facial Droop:
Absent - 0
Present - 1
Arm Drift:
Absent - 0
Drifts - 1
Falls Rapidly - 2
Grip Strength
Normal - 0
Weak - 1
No grip -2
Sequence of the Upper Respiratory Tract?
Nasal cavities/sinuses, pharynx, larynx, trachea
Sequence of the Lower Respiratory Tract?
Bronchi, bronchioles, alveolar ducts/sacs, alveoli
Difference between Internal vs External Respiration?
Internal Respiration: Gas exchange between blood and tissue cells
External Respiration: Gas exchanged between air in lungs and blood
What is the #1 breathing muscle and is controlled by the phrenic nerve?
Diaphragm. If phrenic nerve is severed, then diaphragm will not work.
If C1 and C2 (atlas and axis) to C4 is damaged, what will occur?
Apnea (cessation of breathing)
What are CNS depressants?
Class of drugs that slow down activity of CNS (sedatives/tranquilizers). Can lead to dependence and addiction if misused.
Examples:
- Benzodiazepines (Ativan, Xanax, Valium)
- Barbiturates (Phenobarbital, Pentobarbital)
- Alcohol (Ethanol)
How do CNS depressants impair breathing?
Areas of the brain responsible for regulating respiration are suppressed.
1) Reduces brain’s signaling to respiratory muscles. Results in decreased drive to breathe (shallow breathing)
2) Some CNS depressants (such as benzos and barbiturates) causes muscle relaxation in the body. This includes muscles involved in breathing (diaphragm and intercostal muscles). This results in decreased breathing efficiency and reduced lung ventilation.
What is the CNS comprised of? What does the CNS do?
CNS is comprised of brain and spinal cord. Together, they integrate and process information, coordinate bodily functions, and regulate responses to stimuli.
Cerebrum: Largest part of brain. Responsible for consciousness, perception, memory, reasoning, and voluntary movement.
Cerebellum: Located below cerebrum. Responsible for coordinating and fine-tuning voluntary muscle movements, balance, and posture.
Brainstem: Connects cerebrum and cerebellum to spinal cord. Controls breathing, HR, BP, and sleep cycles.
What protects the CNS?
Meninges, CSF, blood-brain barrier
What is a priapism indicative of in an MVC?
Spinal cord injury
What is ARDS (Adult Respiratory Distress Syndrome)?
Also known as non-cardiogenic Pulmonary Edema.
- Inflammation in lungs damages alveoli, reducing normal gas exchange
- Increased permeability = fluid shift to interstitial space
- Increased osmotic pressure = pulmonary edema
- Occurs with anaphylaxis, pneumonia, sepsis, etc
What are the different lung volumes?
Inspiratory Reserve - 3300 mL
Expiratory Reserve - 1000 mL
Tidal Volume - 500 mL
Residual Volume - 1200 mL
Total Lung Capacity - 6000 mL
Vital Capacity - 4800 mL
*Residual Volume – Remains in the lungs to keep the alveoli open, even after all air expired
What is Pleurisy?
Inflammation of pleura caused by friction or a rub
- Sharp sudden and intermittent chest pain with dyspnea
- May increase or decrease with respiration
- Pleural “friction rub” may be audible
S&S of life-threatening asthma attacks?
- Silent chest (airways so constricted, they produce no wheezing)
- Decreased air entry
- Altered LOA
- Bradycardia
- Confusion
- Cyanosis
Tx for life-threatening asthma attacks?
- Epi 1:1000
- Ventolin
*Ventolin affects B2 receptors (bronchodilation)
*Ventolin slightly affects B1 receptors (increases HR minimally)
Patho of an asthma attack?
- Exposure to antigen
- Antigen stimulates massive amounts of immunoglobulin E (IgE) which is an antibody
- IgE attaches to mast cells
- Antigen binds to IgE on mast cells
- Triggers a massive release of histamine and leukotrienes
- Histamine causes vasodilation and leaky vessels
- Triggers mucous production and further constriction
What is a Pulmonary Embolism?
Blockage in the pulmonary artery/blood vessels in the lungs. Caused by a blood clot or other foreign material.
- Sometimes blood clots can form in deep veins of the body, usually in the legs (DVT)
- If this clot breaks loose from its original site, it can travel through bloodstream and reach the lungs.
4 causes of a Pulmonary Embolism?
- Air embolism (ex: IV)
- Long bone fracture
- Prolonged bed rest
- Post-surgery
S&S of Pulmonary Embolism?
- SOB/Dyspnea
- Tachycardia
- Pale, cool, diaphoretic skin
- Chest pain (increases with inspiration)
How can uncontrolled a-fib lead to emboli in the lungs?
Intra-atrial blood stasis (standstill of blood in atria)
What are the organs that lie within the retroperitoneal cavity?
ADUKPI
A - Aorta
D - Duodenum
U - Ureters
K - Kidneys
P - Pancreas
I - Inferior Vena Cava
What is the Cribiform Plate?
AKA - Ethmoid bone
- Separates brain from nasal cavity
- Thinnest part of the skull
- In a pt with facial trauma, never insert NPA as it can enter brain cavity through #cribiform plate
What is the Pterion?
- Weakest part of the skull
- Temporal lobe region
Signs of cerebral herniation?
GCS <9 or decreasing LOC with asymmetric pupillary response OR asymmetric motor response)
- Hyperventilate at 20-24 BPM
- Maintain ETCO2 at 25-35 mmHg
Cerebral hemorrhage often results in an increased ICP. Which vitals can you see notable changes in due to increased ICP?
BP, HR, Respirations.
*Pupils are not vitals, but extremely important to look at
How does ICP influence BP?
- As ICP rises, so does resistance to arterial blood flow to cranial vault
- Brain MUST be perfused. Therefore, pressure will rise in order to meet and exceed the rising ICP physiological limit
This phenomenon is referred to as a “widening pulse pressure”, where SBP increases further and further away from an unchanging diastolic pressure
How does ICP influence HR?
- Increase in ICP results in pressure on CN X (Vagus Nerve)
- CN X innervates SA node and is responsible for slowing the rate of cardiac conduction (activates PNS)
How does ICP influence the pupils?
- ICP compresses on CN III (occulomotor nerve)
- CN III innervates the eye; responsible for papillary dilation and constriction
- Compression of CN III results in a fixed, dilated pupil on the affected side.
How does ICP influence respirations?
Respiration patterns with ICP is due to pneumotaxic center. Generally seen in later stages of a closed head injury.
Pneumotaxic Center - inhibits inhalation so that the duration of inhalation is limited, preventing overexpansion of lungs. Increasing ICP levels can put pressure on brainstem, which the pneumotaxic center is a part of. This can impair its functions:
Decorticate = Cheyne-Stokes
Decerebrate = Hyperventilation
What is Beck’s Triad?
3 hallmark signs of Cardiac Tamponade (blood filling pericardial space, resulting in a lack of myocardial expansion)
- JVD (venous return unable to enter right side of heart)
- Muffled heart sounds (blood in pericardium)
- Hypotension (decreased cardiac output)
S&S: Chest pain, Tachycardia, Pulsus Paradoxus
What is the Tetralogy of Fallot?
- Ventricular septal defect
- Pulmonary stenosis
- Hypertrophy of right ventricle
- Overriding aorta
A man has a pacemaker that is “failing to capture”. How do you identify through an ECG if he has an atrial or ventricular pacemaker?
Pacemaker spikes before P wave = atrial pacemaker
Pacemaker spikes before QRS = ventricular pacemaker
When patching for CTAS 1 and 2 calls, what information do you need to include in the patch?
- Unit # identification
- # of patients, age gender, degree of distress, LOC
- Chief complaint
- CTAS level, destination, ETA to facility
- Vital signs, assessment findings, procedures performed/medications administered
*Complete radio patch within 2 minutes, optimally within 1 minute
Is the average pH lower (more acidic) in the arteries or veins?
Veins because they pick up the byproduct of metabolism (CO2)
What is Cholecystitis?
- Inflammation of gallbladder
- Often associated with fried/fatty food intake
- Sudden pain in RUQ that RADIATES INTO RIGHT SHOULDER
What is Appendicitis?
- Inflammation of appendix
- Cramping pain
- Nausea/vomiting
- Low grade fever
- Pain localized and intensifies to RLQ (McBurney’s point)
- Rebound tenderness evident
- If appendix ruptures, pain will disappear
What are esophageal varices?
Swollen and enlarged blood vessels in the esophagus.
- Varices develop when increased BP expands the blood vessels of the liver, causing them to become fragile (portal hypertension)
- Commonly seen in chronic alcoholics with damaged livers
- Bright red hematemesis
*Obstruction of hepatic portal blood flow can also result in new blood vessels forming in the esophagus and other parts of digestive system to bypass blocked blood flow. These are called varices. However, they are fragile and prone to bleeding.
- Most common psychiatric illness (10% of adults)
- Painful uneasiness about impending problems, situations
- Characterized by agitation, restlessness
- Unpleasant emotional state
- Response to stress and may arise suddenly
- Frequently misdiagnosed as other disorders.
What are these classified as?
Anxiety Disorders
What are these characteristics of?
- Intense fear, tension, restlessness
- Chest pain- feels like a heart attack!
- Sense of “impending doom
Anxiety/panic attack
- Mood disorder
- Deep feelings of sadness, worthlessness, discouragement….out of proportion
- Factor in large percentage of suicides
- Typically begins 20s 30s and 40s
- Cause is not fully understood
- Women are 2 times more likely to experience (hormonal influences)
- Can be caused by physical factors (directly or indirectly)
- Ask all depressed patients about suicidal thoughts
o Previous thoughts? Current thoughts?
o Plan in place?
o Hx. of suicidal attempts? (chemical, physical, etc.) - Be honest, empathetic and professional
What do you think these are characteristics of?
Depression
- Manic – depressive
- Swings from one end of mood spectrum to the other
- Manic phase- inflated self image, elation feelings of being very powerful
- Depressed phase – Loss of interest, feelings of worthlessness, suicidal thoughts
- Delusions/hallucinations occur in either phase
- Treatment:
o Usually on Lithium (chloride)- medication
o MAOI (Monoamine oxidase inhibitor)-less likely to cause mood switching
What are these characteristics of?
Bipolar Disorder
What is suicide defined as?
- Any willful act designed to end one’s own life
- Women attempt more often
- Men succeed more often
What are Risk Factors for suicide?
- Any previous attempts made
- Men >40 yrs old
- Single, widowed or divorced
- Drug, alcohol abuse
- Obtained means of suicide (gun, pills, etc)
How do TCA’s (Tricyclic Antidepressants) work?
- Majority of them act primarily as SSRI’s (Selective Serotonin Reuptake Inhibitor)
- Inhibits norepi and serotonin reuptake: this increases extracellular serotonin levels therefore increasing serotonin in in synaptic cleft available to bind to postsynaptic receptors
- Used for depression and OCD
- Meds: Elavil, Tofranil, Surmontil, Anafranil
S&S of TCA overdose?
- Widened QRS complex with sine wave appearance and peaked T waves (reminiscent of hyperK)
- Heart block, hypotension, respiratory depression, seizures…death
What are the receptors in the Sympathetic Nervous System?
Alpha 1 - Peripheral vasoconstriction (elevates BP)
Alpha 2 - Coronary artery dilation
Beta 1 - Elevates HR and contractility
Beta 2 - decreases smooth muscle tone in airways and vasculature (bronchodilation)
S&S of Anticholinergic OD?
Red as a Beet
- Vasodilatory response that attempts to compensate for loss of sweat production
Hot as a Hare
- Hyperthermia secondary to impaired sweat production
Dry as a Bone
- Skin, mucous membranes, axillae (lost ability to sweat)
Mad as a Hatter
- Agitation, confusion, hallucinations, coma, seizures, and/or death
Blind as a Bat
- Dilated pupils (mydriasis)
Tachycardia
- Earliest and most common symptom, due to decreased vagal tone in the AV node
Other signs and Symptoms:
Delirium
Urinary retention and decreased bowel sounds
Seizures and dysrhythmias
What do Chronotropic drugs do?
Affect the rate of cardiac circulation
3 examples of POSITIVE Chronotropic drugs?
Atropine, epi, throphyline
3 examples of NEGATIVE Chronotropic drugs?
Digoxin, AcH, metoprolol
Which organ contains:
- Reserve of blood
- Processes iron
- Metabolizes hemoglobin to bilirubin
- Acts as a lymphnode
Spleen
What are the three ossicles responsible for our sense of hearing?
Incus, stapes. malleus (ISM)
1) What is the most abundant intracellular cation?
2) What is the most abundant intracellular anion?
3) Is cation positive or negative?
1) Potassium
2) Phosphate
3) Positive
What is Dalton’s Law?
In a mixture of gases, the total pressure is equal to the sum of partial pressures of each individual gas
What is Boyle’s Law?
Pressure of a gas increases as volume decreases (inverse relationship)
What is Henry’s Law?
Solubility of gas in a liquid is proportional to partial pressure of gas above liquid
Which gas law applies to diving injuries?
Dalton’s Law
Sciatica is severe pain along the sciatic nerve, usually felt at the back of the thigh and running down the leg. What are common causes?
Disk herniation and intraspinal tumour
Dimenhydrinate and diphenhydramine is an antihistamine ____ antagonist
H1
Sartan drugs are ____ receptor blockers (treat high BP)
Angiontensin II
ADH (Vasopressin) is produced where?
The hypothalamus (but released by the posterior pituitary gland)
What is the function of ADH?
Promotes water re-absorption via kidneys to increase BP
What is the order of the three branches of the aorta from right to left?
Braciocephalic Trunk, Left Common Carotid, Left Subclavian
According to the Ambulance Act, what is the minimum amount of time that an ACR must be maintained in records?
7 years
This sensory receptor receives stimuli from within the body, especially to position and movement
Proprioceptor
What is Stable Angina?
- Pain from physical exertion or emotional stress
- Lasts 1-5 mins (up to 15 min)
- Mid-sternal and rarely radiates
- Relieved by rest, oxygen, and nitro
- SIMILAR IN QUALITY to previous episodes
- Usually no S&S of N/V, diaphoresis, SOB
What is Unstable Angina?
- Pain from slight exertion, even just at rest
- Lasts 10-15 mins (up to 30 min)
- Mid-sternal but may radiate elsewhere
- “Heaviness or tightness”, FEELS DIFFERENT THAN USUAL
- Nitro will not relieve pain
- S&S of N/V, diaphoresis, SOB
More than _____ of deaths due to AMI occur outside of the hospital within _____ hours of initial onset of symptoms
50%, 2 hours
Why can you not give ASA to an asthmatic?
Prostaglandins are released and causes bronchostriction
- Most common type of viral hepatitis
- One infected, person is immune forever
- Only hepatitis that does NOT lead to chronic liver disease
- Incubation period is 2-6 weeks (15-45 days)
S&S: Jaundice, malaise, flu like symptoms
Hepatitis A
- Can lead to cirrhosis
- Found in blood, saliva, semen, and vaginal secretions
- Incubation period is up to 200 days
- Treated with heptavax
S&S: Fly like symptoms (often mistaken for flu), fever, weakness/malaise
Hepatitis B
What does the Nephron consist of?
Functional unit of the kidney.
Nephron = Glomerulus + Bowman’s Capsule + PCT + Loop of Henle + DCT
With regards to the Loop of Henle:
a) What is the DESCENDING LIMB permeable to? What is it IMPERMEABLE to?
b) What is the ASCENDING LIMB permeable to? What is it IMPERMEABLE to?
a) Permeable to WATER (via Aquaporin Type-1 Channels), Impermeable to salts
b) Permeable to SALTS (via Na+/K+/2Cl- Co-Transporter channels), Impermeable to water
Within 2 hours, how much blood loss occurs with the following fractures?
a) Tib/fib
b) Femur
c) Pelvis
a) 500 mL
b) 1000-1500 mL
c) 3000 mL
What’s the difference between a sprain and a strain?
Sprain - Tearing of ligaments surrounding a joint
Strain - Overstretching of muscle or tendon
As per the ROSC Medical Directive:
a) What should you aim for O2 sats?
b) What should you AVOID doing?
c) What ETCO2 are you targeting?
a) 94-98%
b) Hyperventilating
c) 30-40 mmHg WITH continuous waveform capnography
