AMLS QUESTIONS Flashcards
Anaphylaxis
SxSy - Itching, urticaria, nausea, stridor, bronchospasm, severe abdominal pain, respiratory distress, tachycardia, shock, edema of lips, tongue or face. Treatment- IM - IV Epi, Benadryl, Corticosteroid, O2
Epiglottitis
SxSy - Sore throat,pain on swallowing, muffled voice, tripod positioning, fever,stridor,noted pain of larynx, low spo2.Treatment- Humidified O2,Antibiotics.
Asthma
SxSy - Dyspnea, shark fin waveform, expiratory wheezes, tripod positionTreatment- IM - IV Epi, Beta2 agonists, steroid if needed, Needle decompression if warranted
Bronchiolitis
SxSy - coughing, wheezing, diff breathing, runny nose, fever, tachypneaTreatment- SPO2, ETCO2 monitoring, racemic epi, steroids if needed
Chronic Obstructive Pulmonary Disease (COPD)
SxSy - cyanosis, fatigue, dyspnea, chronic cough, producing increased sputum, , wheezing, frequent respiratory infectionsTreatment- supplemental o2, duoneb (albuterol 2.5 mg and ipratropium bromide 0.5mg), methylprednisolone (125mg), mag sulfate (1-2G) if impending respiratory failure, epinephrine (0.01 mg-kg max 0.3mg) if impending respiratory failure
Pneumonia
SxSy - Cough, dyspnea, pleuritic chest pain, increased WOB, crackles and rhonchi.Treatment- Antibiotics, CPAP
Pneumothorax-Tension Pneumothorax
SxSy - Diminished or absent breath sounds, tracheal deviation, hypotension, dyspnea, JVD.Treatment- Needle Decompression
Pulmonary Edema
SxSy - Crackles, rhonchi, pink frothy sputum, dyspnea, HTN.Treatment- CPAP, diuretics, NitroPaste, Morphine
Pulmonary Embolus
SxSy - “S1Q3T3”, dry air hunger, sudden onset chest pain, Decreased SpO2Treatment- IV 02 Monitor
Tuberculosis
SxSy - Persistent cough, night sweats, weight loss, hemoptysis, chest pain. (incubation period of 4-12 weeks.)Treatment- Surgical mask for Pt, N95 for the provider. Routine Pt care
Paroxysmal Nocturnal Dyspnea-acute onset SOB at night
SxSy - Early sign of Left heart failureTreatment-
Acute Myocardial Infarction- Necrotic heart tissue as a result of an occlusion of a Coronary artery or its subdivisions.
SxSy - Classic, Atypical, Anginal Equivalents (see question 14)Treatment- STAMP, Primary PCI
Angina Pectoris- Chest pain caused by an inadequate blood supply from narrowed coronary arteries filling with plaque.
SxSy -Anginal Equivalents (See Yellow Sheet),Treatment- STAMP,
LEFT HEART FAILURE
SxSy: pulmonary EdemaTreatment: CPAP, Nitro, morphine
RIGHT HEART FAILURE
SxSy: Dry SOB, hypotension, JVD, peripheral edemaTreatment: NO NITRO-NO MORPH- right EKG, fluids support preload
Cardiac tamponade
SxSy - Electrical Alterans, Muffled heart tones, narrowing pulse pressure, JVDTreatment- Rapid Transport, Pericardiocentesis “Tap the Sac”
Pulmonary Edema
SxSy - Crackles, rhonchi, pink frothy sputum, dyspnea, HTN.Treatment- CPAP, diuretics, NitroPaste, Morphine
Pulmonary Embolus
SxSy - “S1Q3T3”, dry air hunger, sudden onset chest pain, Decreased SpO2Treatment- IV 02 Monitor
Paroxysmal Nocturnal Dyspnea-acute onset SOB at night
Sx-Sy- SOB awakens pt at nightTreatment: sit upright
Ectopic Pregnancy- implantation of the fertilized ovum outside the uterus.
SxSy - Vaginal bleeding with-without abdominal pain. Belly pain in women of childbearing age should be considered ectopic until proven otherwise.Treatment- O2,IV,Monitor- TRANSPORT
Epidural Hematoma- an accumulation of blood between the inner table of the skull and the dura mater. Frequently associated with a skull fracture.
SxSy - Cushing’s Triad ( Systolic Hypertension, Bradycardia, Irregular Respiratory Pattern), AMS,Unilateral pupil dilation, N-V, DizzinessTreatment- maintain an Spo2 of 94% ,Systolic of 90
Encephalitis-general inflammation of the brain that causes focal or diffuse brain function.
SxSy -Headache,N-V,Fever, AMS,Behavioral changes, Stiff neck,photophobia.Treatment- Diuretics (Osmotic & Loop), Corticosteroids, Surgical Shunt.
Seizure
SxSy - convulsions- blank stare- altered LOCTreatment- Control Seizure - treat the cause (i.e BDZ, Mag Sulfate, Temp control, Glucose)
Stroke (ischemic)
BLOCKAGE- Sx-Sy: hemiparesis, numbness in body, AMS, dissiness, N-VTreatment- ABC’s, last known normal, stroke scale, do they meet fibrinolytic therapy indications, check bgl (treat only if blg less than 60 mg-dL), 12 lead, o2 sat 94-98%, hx (is pt on blood thinners)
Stroke (hemmorhagic)
BLEED Sx-Sy: SUDDEN ONSET headache, LOC, irregular breathing, weakness, N-V, Sz, AMS, gaze, neck pain, visual disturbanceTreatment- ABC’s, last known normal, stroke scale, do they meet fibrinolytic therapy indications, check bgl (treat only if blg less than 60 mg-dL), 12 lead, o2 sat 94-98%, hx (is pt on blood thinners)
Gastrointestinal Bleed
SxSy - Hypotension, blood in stool, horrible smellTreatment- Treat for shock-
Appendicitis-infection or fluid build up within the appendix.
SxSy -localized RLQ pain or R lower back originating at the periumbilical region. Pain begins to travel as infection worsens. Fever, N-V, Positive Psoas sign.Treatment- IV, Analgesics, Antiemetics
Bowel Obstruction
SxSy - Nausea-Vomiting-Abdominal pain, cramping feeling like a knot, irregular eating and bowel regimen, auscultation of bowel shows high-pitched or absent. Percussion sounds: hollow, palpation may cause pain, firm, distended.Treatment- IV access, IV-IO no PO meds, treat for N-V-D and pain managment. CT scan, full lab panel, nasogastric tube, surgical intervention.
Pancreatitis-Inflammation of the Pancreas
SxSy - Flank - Epigastric pain, N-V-D, jaundice, ABD distentionTreatment- Supportive care, Pain management, FLD,
Hyperosmotic Hyperglycemic Nonketotic Syndrome (HONK)
SxSy - Hyperglycemia, AMS, Partial paralysis - muscle weakness, Comatose, Sz, NormocapniaTreatment- Fluid administration
Hypoglycemia-Hyperglycemia
SxSy - ↓ BgL < 45mg-dl, AMS, Decreased LOC, Rapid,Weak Pulse Rx Glucacon, dextrose. ↑ BgL > 150mg-dl, Tachycardia, Tachypnea, AMS, diaphoresis, Polyphagia, Polydipsia, PolyuriaTreatment- Rx ↑ Insulin, fluid bolus 500ml, followed by 250 ml-hr
Pancreatitis-Inflammation of the Pancreas
SxSy - Flank - Epigastric pain, N-V-D, jaundice, ABD distentionTreatment- Supportive care, Pain management, FLD,
Diabetic Ketoacidosis (DKA)-BGL over 350 mg-dL.an acute endocrine emergency in which insulin deficiency and excessive glucagon levels combine to create a hyperglycemic, acidotic,volume-depleted state.
SxSy - Tachycardia, Tachypnea, AMS, diaphoresis, Polyphagia, Polydipsia, Polyuria, Fruity breath, Fever, HypercapniaTreatment- Insulin, fluid bolus 500ml, followed by 250 ml-hr
Diabetes Mellitus-Defective insulin production or utilization
Type 1-pancreatic beta-cell destruction resulting in the body being incapable of producing insulin. Daily insulin is required.Type 2-cellular insulin resistanceStrict dietary control
Rhabdomyolysis-Breakdown of muscle tissue resulting in myoglobin being released into the bloodstream. Common in athletes, and prolonged falls and crush injuries.
Sx-Sy- dark urine output, localized muscle weakness, painRx- Calcium chloride 1 gram IV, Nebulized Albuterol (up to a max dose of 20 mg).
Addison’s Disease (Adrenal Insufficiency)-failure of the adrenal cortex to produce a sufficient amount of cortisol
RECENT USE OF CORTICO Sx-Sy-Fatigue, Anorexia, salt craving, increased pigmentation, muscle-joint pain-Rx-Glucocorticosteroids
Cushing Syndrome-Excess cortisol production or corticosteroid hormones
Sx-Sy- “Moon Face”, “Buffalo Hump”, Muscle wasting, bone thinning, weight gain or obesity, stretch marks, easy bruising, thin extremities, high blood pressure, hyperglycemia, thinning of skinRx- Supportive Care
Hypoparathyroidism- low serum levels of PTH or resistance to its actions.
Sx-Sy-Muscle spasm,paresthesia, tetany, Sz ( as a result of hypocalcemia)Rx-O2,IV,Monitor, BDZ for Sz, Calcium Chloride
Troussea Sign
pulling hand down like a bird hand puppet- LOW CALCIUM
Chostek Sign
abnormal face twitch- LOW CALCIUM
kussmaul resp
deep labored- keto acidosis
Hyperthyroidism-Hyperactivity of the thyroid gland
Sx-Sy- apprehension, agitation,edginess, heart palpitations, weight loss, heat intolerance, excessive sweating.SOB,Disorientation, ABD pain, Diarrhea, Chest pain, Palpable goiters, Cardiac failure,Fever,AMS,Jaundice,WeaknessRx-Supportive Care (O2,IV,Monitor)
Hypothyroidism- Decreased or absent function of the thyroid.
Sx-Sy- cool, dry, yellow skin and thin eyebrows, coarse hair, ataxia, altered mental, delayed reflexesRx- Supportive Care
Metabolic Acidosis- deficiency of Bicarb and excess hydrogen within the body.
Sx-Sy-N-V,ABD pain, rapid deep respiratory pattern,AMS,Shock, kussmaul respirationsRx-Supportive Care, Bicarb
Metabolic Alkalosis-the body retains bicarb in response to hydrogen and chloride loss, or renal impairment preclude the excretion of bicarb.
Sx-Sy-Anorexia,N-V,confusion, AMS,hypotension,paresthesia, weakness Rx-Supportive Care
Hyponatremia (Levels below 135 mEq-L)
Sx-Sy-agitation, dehydration,hallucination,weakness,lethargy,Sz,ABD pain,cramps,headacheRx- Fluid Resuscitation
Hypokalemia- Low Potassium (less than 3.5mEq-L)
Sx-Sy- FLAT T, ST depression, Weakness, N-V, lethargy, confusion, paresthesia,hypotension, dysrhythmiasRx-O2,IV,Monitor, IV Potassium
Hyperkalemia- (levels greater than 5.5 mEq-L)
Sx-Sy- TALL T WAVES- WIDE QRS-generalized weakness, muscles cramps, tetany,paralysis,palpitations, dysrhythmia.Rx-Sodium Bicarbonate 44mEq-L, Albuterol 5-20mg
Hypocalcemia-Low Calcium ( less than 4 mEq-L)
Sx-Sy- Sz, Hypotension, tetany, Dysrhythmia, Trousseau sign, chvostek sign.Rx- Calcium Chloride 100-300mg
Hypomagnesemia-Low Mag Levels (1.2 mg-dl or less), Common Electrolyte imbalance
Sx-Sy-Tremors,hyperreflexia,tetany,N-V-D, AMS, Sz, Torsades de Points, PVCs, cardiac arrestRx- Mag Sulfate 2 g IVPB
H1N1 influenza (Swine Flu)
SxSy - fever, chills, nonproductive cough, weakness, headache, sore throat.Treatment- Antiviral medication, supportive care.
Malaria
SxSy - Pain in abdomen or muscles, chills, fatigue, fever, night sweats, shivering-sweating. N-V-D. Fast heart rate, headache, mental confusion-pallorTreatment- Antiparasitic- Antibiotics. Prior to going to areas with high malaria cases, antimalarial drugs given.
Meningitis
SxSy - petechial rash, purpura, fever, headache, stiff neck, photophobia, AMS, LOC, N-V-D, tirednessTreatment- Vaccination for bacterial,
Chicken Pox (varicella)
SxSy - Blister, scab, ulcers, red spots, fatigue, fever, loss of appetite, headache, itching, sore throat, swollen lymph nodesTreatment- Analgesic, antiviral cream-powder, antihistamine