COPR Flashcards
What is hematemsis?
Vomiting blood
What is a normal HCO3- value?
22 - 26 mEq/l
What is an oblique fracture?
A break in a bone running across it at an angle other than 90 degrees
What is the mechanism of action of salbutamol?
Selective B-2 stimulation allows for smooth muscle relaxation of the bronchioles. Has some B-1 effects, causing an increase in HR
What is bradypnea?
Slow breathing
What are the four indications for the usage of haloperidol?
- Acute psychosis
- Chronic psychosis
- Aggressive behaviour
- Agitated behaviour
What is the mechanism of action of haloperidol?
Blocks post synaptic dopamine receptors in the brain
What is afterload?
The pressure or resistance against which the ventricles must pump to eject blood
What is the pediatric dosage of diazepam?
- 1-0.3 mg/kg IV/IM q 5 minutes PRN
0. 5 mg/kg PR
What is slander?
The act of injuring a person’s character, name or reputation by false or malicious states spoken with malicious intent or reckless disregard for the falsity of those statements
What is a prolapsed cord presentation?
Occurs when the umbilical cord precedes the fetal presenting part
What is Malfeasance?
A breach of duty by performance of a wrongful or unlawful act
What is the pediatric dosage of epinepherine for bradycardia/VF/VT/PEA/asystole?
0.01 mg/kg IV (1:10000)
What is the pediatric dosage of epinepherine for asthma/anaphylaxis?
0.01 mg/kg (1:1000) IM/SQ max 0.5 mg
What are the five contraindications for the usage of sodium bicarbonate?
- Alkalosis
- Severe pulmonary edema
- ABD pain of unknown origin
- Hypocalcemia
- Hypernatremia
What does Beck’s triad represent?
Cardiac tamponade
What are two causes of hyperpnea?
- Emotional stress
- Diabetic ketoacidosis
What is the classification of ketamine? (4)
- Hypnotic
- Amnesic
- Analgesic
- Anesthetic
What is mandated reporting?
Spousal abuse, child abuse/neglect, elder abuse, sexual assault, GSW’s, stabbings, animal bites, communicable diseases
What is a bruit?
The sound of turbulent blood flow around a partial obstruction
What are four contraindications for the usage of calcium chloride?
- VF
- Digitalis toxicity
- Hypercalcemia
- Renal or cardiac disease
What are the three contraindications of ASA?
- GI bleed
- Asthmatics sensitive to ASA
- Hypersensitivity
What is a bulla?
Vesicle with a diameter greater than 1cm
What is lordosis?
Exaggerated lumbar concavity (swayback)
What is the classification of haloperidol?
Antipsychotic
What are eight predictors of serious internal injury?
- Ejection from vehicle
- Death in same passenger compartment
- Fall from higher than 6m
- Rollover of vehicle
- High-speed vehicle collision
- Auto-ped collision
- Motorcycle crash
- Penetration of head, chest or abdomen
What is the function of the olfactory nerve?
Sensory
What are the three indications for the usage of atropine?
- Symptomatic bradycardia
- Organophosphate poisioning
- Premedication of succinylcholine in children 16 or less years old
What are the two indications for the usage of norepinepherine?
- Severe hypotension
- Vasodilatory shock
What is a muscle sprain?
It is the tearing of a joint capsule’s connective tissue
What is the contraindication of the usage of oxytocin?
Uterine or cervical surgery
What is PEEP?
- Positive End Expiratory Pressure
- Prevents alveoli from closing, achieves lung recruitment, but too much can decrease blood return to the heart, decreasing cardiac output
- Natural, physiological PEEP is 5cmH20
What is bronchophony?
Abnormal clarity of patient’s transmitted voice sounds
How is summarization used as a feedback technique?
Briefly review the interview and your interpretation of the situation. Ask open-ended questions, if needed, to allow the patient to clarify details
What is a normal PR interval?
0.12-0.20 seconds
What are the two contraindication for the usage of salbutamol?
- Hypersensitivity
- Ischemic chest pain
How quick does the respiratory system work when acting as a buffer?
Minutes to hours
What are four examples of vasodilator anti-hypertensive medications?
- Diazoxide (Hyperstat IV)
- Hydralazine (Apresoline)
- Minoxidil (Loniten)
- Sodium Nitroprusside (Nipride, Nitropress)
What is an occiput posterior presentation?
Occurs when the infant’s face is facing the mother’s front during the descent through the birth canal
What is Auto-PEEP?
It occurs when the pressure at the end of the exhalation does not return to the baseline pressure, causing increased thoracic pressure resulting in decreased blood return to the heart
What does it mean to be biphasic?
A waveform that is partly positive and partly negative
What are the four T’s of emergency care?
Triage, Treatment, Transport, Transfer
What does it mean to be competent?
It is the ability to make an informed decision about medical care
What is the classification of norepinephrine?
Sympathomimetic
How is interpretation used as a feedback technique?
State your interpretation of the information
What is the cylinder factor of an H tank?
3.14
What is the dopamine infusion dosage for ROSC in ACLS?
5-10mcg/kg/min
What is the pediatric dosage of magnesium sulfate for patients with TDP/Hypomagnesemia/Refractory VF?
25 - 50 mg/kg IV/IO mixed in 5ml
What are four contraindications for the usage of nitroglycerin?
- Hypotension (SBP < 90 mmHg)
- Severe bradycardia/tachycardia
- Increased ICP or intracranial hemorrhage
- ED medications in the past 24 hours
What is the mechanism of action of metoprolol?
Beta I receptor blockade resulting in negative chronotropic, inotropic, and dromotropic response. End result is a decrease in myocardial oxygen consumption and work load
According to ACLS, what is the joule dosage for wide regular tachycardia?
100J
What is the pediatric dosage of ketorolac?
0.5 mg/kg IM/IV q 4 - 6 hrs, max 30 mg/day
What is the classification of salbutamol? (2)
- Bronchodilator
- Sympathomimetic B-2 agonish
What are the four components of the patient assessment?
- Primary assessment
- Focused history and secondary assessment
- Ongoing assessment
- Detained secondary assessment
What is the pediatric dosage of metoclopramide?
0.15 mg/kg IM/IV max 10 mg
What is the impartiality test?
Asks whether you would be willing to undergo this procedure or action if you were in the patient’s place
What is mechanical ventilation?
It serves to support or improve patients ventilation system, oxygenation while minimizing lung injury
What is the dosage of magnesium sulfate for patients experiencing status asthmaticus/severe bronchospasm?
2 g in 100 ml NS over 10 - 30 min
What is the pediatric dosage of hydromorphone?
0.01 - 0.02 mg/kg SQ
What is the pediatric dose for midazolam?
0.05 - 0.2 mg/kg IV/IM/IN titrate to effect. Max 2.5 mg IV, max 5 mg IM/IN
What are the two disorders of an acid-base imbalance?
- Acidosis
- Alkalosis
What is pulse quality?
The strength, which can be weak, thready, strong or bounding
What are the three classifications of dimenhydrinate?
- Antiemetic
- Antihistamine
- Anticholinergic
What is cardiogenic shock?
Persistent hypotension and tissue hypoperfusion due to cardiac dysfunction in the presence of adequate intravascular volume and left ventricle filling pressure
What are three elements of nonverbal communication?
- distance
- relative level
- stance
What is compliance?
How easily the lungs expand
What is the mechanism of action of norepinepherine? (5)
- Stimulates alpha and beta receptors, primarily alpha
- inotrope
- chronotrope
- Increases coronary artery blood flow
- Causes severe vasoconstriction (increasing SVR)
What is indication for the usage of naloxone?
Decreased LOC and respiratory depression in a suspected opioid overdose
What is the adult dosage for glucagon when facing a beta blocker overdose?
2 - 5 mg IV
What is an impacted fracture?
It is a break in a bone in which the bone is compressed on itself
What is the mechanism of action of naloxone?
It displaces opioids from receptors, reversing the effects of narcotic overdose
What is the pediatric nebulized dosage of Atrovent?
125 - 250 mcg mixed with ventolin and/or NS to a minimum of 2cc
What are five other delivery complications?
- Multiple births
- Cephalopelvic disproportion
- Precipitous delivery
- Shoulder dystocia
- Meconium staining
What lab value of an ABG will represent the metabolic system is responsible for the disorder?
HCO3- level
What is the cylinder factor of an E tank?
0.28
What is metabolic acidosis?
It is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body
What is systole?
The contraction of the heart (usually referring to ventricular contraction) during which blood is propelled into the pulmonary arteries and aorta; when the term is used without reference to a specific chamber of the heart, the term implies ventricular systole
What are the four contraindications for the usage of meperidine?
- Hypersensitivity
- Undiagnosed abdominal pain
- Head injury
- MAO inhibitors
What does decorticate mean?
Arms flexed, legs extended
What is the classification of etomidate? (2)
- Sedative
- Hypnotic
What are nine signs of inadequate breathing?
- Altered mental status
- SOB
- Retractions
- Asymmetric chest wall movement
- Accessory muscle use
- Cyanosis
- Audible sounds
- Abnormal rate or pattern
- Nasal flaring
What is the mechanism of action of calcium chloride? (3)
- Essential component for functional integrity of nervous and muscular systems
- Enhances automaticity
- Positive inotrope
What are four examples of angiotensin converting enzyme inhibitor medications?
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Prinivil, Zestril)
- Ramipril (Altace)
How much blood may be lost from a femur fracture?
1500ml
According to ACLS, what is the joule dosage for narrow irrgeular tachycardia?
120-200J biphasic
200J monophasic
What is a pathogen?
Microorganisms capable of producing disease, such as bacteria or viruses
What is muscle cramping?
It is muscle pain resulting from overactivity, lack of oxygen, and accumulation of waste products
What is respiratory alkalosis?
It is a condition in which increased respiration elevates the blood pH beyond the normal range (7.35-7.45) with a concurrent reduction in arterial levels of carbon dioxide.
What is the pediatric MDI dosage of Atrovent?
1 - 2 puffs
What is an arterial line?
An angiocatheter is inserted into an artery to monitor real-time blood pressure and to obtain samples for arterial blood gas measurements
What is the pediatric dosage of diphenhydramine?
1-2 mg/kg IM/IV/IO (max 50mg)
What is the mechanism of action of glucagon? (2)
- Stimulates the release of glycogen from the liver, for glycogenolysis
- Smooth muscle relaxant
What is the medical director?
A physician who is legally responsible for all the clinical and patient-care aspects of an EMS system
What are the atrioventricular (AV) valves?
Valves in the heart that separate the atria from the ventricles; the tricuspid valve separates the right atrium and the right ventricle, the mitral valve separates the left atrium and left ventricle
What are the six indications for the usage of calcium chloride?
- Hyperkalemia
- Hypocalcemia
- CCB overdose
- Hypomagnesaemia
- Respiratory depression of after administration of MgSO4
- To prevent hypotension from calcium channel blockers
What is borborygmi
Loud, prolonged, gurgling bowel sounds indicating hyperperistalsis
What is the membrane potential?
The difference in electrical charge across the cell membrane
What is the respiratory effort?
It is how hard the patient works to breath
What lab value of an ABG will represent the respiratory system is responsible for the disorder?
PaCO2
What is PIP?
- Peek Inspiratory Pressure
- Greatest pressure measured during the inspiratory phase. The pressure is used to deliver the tidal volume by overcoming the non-elastic (airways) and the elastic (lung parenchyma) resistance
According to ACLS, what is the joule dosage for wide irregular tachycardia?
Defibrillation dose (do not sync)
What is atrophy?
Skin surface thins and markings disappear, semitransparent parchment like appearance
What is diastole?
Phase of cardiac cycle when ventricles relax
What is the relative refractory period?
It corresponds with the downslope of the T wave; cardiac cells can be stimulated to depolarize if the stimulus is strong enough
What is the classification of pancuronium?
Neuromuscular-blocking agent (Non-depolarizing)
What is defamation?
An intentional false communication that injures another person’s reputation or good name
What is the pediatric dosage for organophosphate poisoning of atropine?
0.05mg/kg IV/IM/ETT, repeat q 10-20 min to decrease signs and symptoms
What is Vt?
- Tidal volume
- Volume of gas inhaled/exhaled for one respiratory cycle
What are the two causes of acid-base disorders?
- Respiratory
- Metabolic
What are four physicial assessment techniques?
- Inspection
- Palpation
- Percussion
- Auscultation
How is explanation used as a feedback technique?
Share factual or objective information related to the message
What are the three main chemical buffers?
- Bicarbonate
- Phosphate
- Protein
What are the four indications for the usage of furosemide?
- Circulatory overload due to:
- acute pulmonary edema
- CHF
- Hypertensive emergency
What is perfusion?
The passage of blood through an organ or tissue
What are the two indications for the usage of dobutamine?
- Decreased heart function due to cardiac contractility
- Systolic BP 70-100mmHg with no signs of shock
What is the classification of amiodraone?
Antidysrhythmic
What is a dislocation?
It is a complete displacement of a bone end from its position in a joint capsule
What is tachycardia?
A pulse rate faster than 100
What is the apex of the heart?
The lower portion of the heart, the tip of the ventricles (approximately the level of the fifth left inter-coastal space); points leftward, downward and forward
What are three patient responses to questioning?
- pour out information easily
- reveal some things and conceal others
- resist responding
What is the classification of oxytocin? (4)
- Hormone
- Uterine stimulant
- Oxytocic
- Uterotonic
What is the BLS adult HCP algorithm?
- Pt is unresponsive
- Activate emergency response and get an AED
- Check pulse Is there a definite pulse within 10 seconds
- Begin CPR 30:2
- AED arrives
- Check rhythm
- If shockable, give 1 shock and resume CPR
- If not shockable, resume CPR
What is a papule?
Elevated firm spot with varying color from brown to red or pink to purpilish red and has a diameter less than 1cm
What is peripheral vascular resistance?
The resistance of the flow of blood determined by blood vessel diameter and the tone of the vascular musculature
What is tidal volume?
The amount of air one breath moves into and out of the lungs
What is Ti?
- Inspiratory time
- Can fluctuate to achieve adequate Vt.
- ## Long Ti is utilized to give more time to deliver the Vt, increasing alveolar distension and gas exchange
What is cultural imposition?
The imposition of your beliefs, values, and patterns of behaviour on people of another culture
What is Administrative Law?
A law that is enacted by governmental agencies at either the federal/provincial/territorial level
What is the adult dosage for dopamine?
2-20 mcg/kg/min IV. Start slow and titrate quickly as necessary for desired effects
What is percussion?
The production of sound waves by striking one object against another
What is the adult nebulized dosage of Atrovent?
250 - 500 mcg mixed with ventolin q 20 minutes x3
What are four abnormal delivery presentations?
- Breech presentation
- Prolapsed cord
- Limb presentation
- Occiput posterior
What is the infant nebulized dosage of salbutamol?
1.25 mg
What is the classification of enoxaparin?
Anticoagulant
What is pulse rate?
The number of pulses felt in one minute
What is Biot’s respirations?
It is rapid, deep respirations (gasping) with short pauses between sets
What is Confidentiality?
The principle of law that prohibits the release of medical or other personal information about a patient without the patient’s consent
According to ACLS, what is the dosage of amiodarone in tachycardia with a pulse?
150mg over 10 mins
What is the mechanism of action of renin blocker medications?
Reduces blood pressure by blocking renin stimulation of angiotensinogen and inhibiting the RAAS
What is the mechanism of action of hydromorphone? (3)
- Hydrogenated ketone derivative of morphine that acts as a narcotic analgesic. It has a shorter duration of action than morphine. It is approximately 8 times more potent on a milligram basis than morphine.
- Exerts its principal pharmacological effect on the CNS and GI tract. Binds to opiod receptors ( mu and delta) in the CNS producing analgesia and euphoria
- Multiple actions but works primarily on the CNS and organs containing the smooth muscle
What does the QRS complex represent?
Ventricular depolarization
What is the classification of acetaminophen?
- Analgesic
- Antipyretic
What is the classification of clopidogrel?
Antiplatelet agent
What is the indication for the usage of etomidate?
Induction for RSI
What is the most common cause of right ventricular failure?
Left ventricular failure
What is Proximate Cause?
Action or inaction of the paramedic that immediately caused or worsened the damage suffered by the patient
What is hypothermia?
Decrease in the body’s core temperature
What are the three contraindications to the usage of acetaminophen?
- Hypersensitivity
- Liver disease
- Major burns
What are the four indications of amiodarone?
- Refractory VF/pulseless VT
- Polymorphic VT and wide complex tachycardia of unknown origin
- Control of hemodynamically stable VT
- Runs of VT post cardiac arrest
What is feedback?
A response to a message
What are the H’s and T’s?
- Hypovolemia
- Hypoxia
- Hydrogen ions (acidosis)
- Hypo/hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
What is cleaning?
Washing an object with such cleaners as soap and water
What is turgor?
The normal tension of the skin
What are the two adult dosages of adenosine?
- 6mg rapid IV push
- 12mg rapid IV push
What is the peak systolic pressure?
Opening of the aortic valve during LV systole, allows blood to rapidly eject into the aorta
What are nine feedback techniques?
- silence
- reflection
- facilitation
- empathy
- clarification
- confrontation
- interpretation
- explanation
- summarization
What is the mechanism of action of clopidogrel?
Inhibits the P2Y12 of ADP receptor on the platelet which inhibits platelet aggregation by blocking the activation of glycoprotein IIb/IIIa pathway
What are the semilunar valves?
The valves in the heart that are shaped like half-moons; the pulmonic valve prevents the backflow of blood from the pulmonary arteries into the right ventricle; the aortic valve prevents the backflow of blood from the aorta into the left ventricle
What is the adult dosage of propofol?
25 - 75 mcg/kg IV as needed
What is the pediatric dosage of dimenhydrinate?
1.0 mg/kg IV/IM max 25mg
What is hypernatremia?
Higher than normal sodium level in blood
What is the classification of adenosine?
Antidysrhythmic
What is a normal female systolic blood pressure before menopause?
110-140
What is respiratory acidosis?
It is a condition that occurs when the lungs are unable to remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2 causes the pH of the blood and other bodily fluids to decrease, making them to acidic
If it is noted the pt has symptomatic tachycardia, what is the next step?
Synchronized cardioversion
What is hyponatremia?
Lower than normal sodium level in blood
What is stroke volume?
The amount of blood ejected from a ventricle with each heartbeat
What is the classification of fentanyl?
Narcotic analgesic
What are the three contraindications for the usage of TXA?
- Hypersensitivity
- Active thromboembolic disease (PE, CVA, DVT)
- Unable to initiate bolus within the time limit
What is heart failure?
A condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body
What is gravidity?
Number of times a woman has been pregnant
What is the adult IV dosage of meperidine?
25 - 50 mg
What is intrinsic PEEP?
Inadvertently applied PEEP caused from air trapping or over inflated lungs
What is the respiratory rate?
The number of times a patient breathes in one minute
What is a fissure?
Linear red crack ranging into the dermis
What is excoriation?
A linear, may be hollow or crusted, caused by a loss of epidermis leaving the dermis exposed
What is the adult dosage for glucagon when facing an esophageal foreign body?
1 mg IM/IV
How is facilitation used as a feedback technique?
It encourages the speaker to provide more information
What are the two contraindications for the usage of magnesium sulfate?
- Heart block
- Myocardial damage
What is MAP?
- Mean Airway Pressure
- Effects oxygenation and influences ventilation: too high ventilation may drop due to decreased compliance from overdistension, too low hypoventilation may occur due to atelectasis
What is the adult IM dosage of morphine?
5 - 10 mg
What is eclampsia?
It is the development of seizures in a woman with severe preeclampsia
What are the four contraindications for the usage of ketamine?
- Hypersensitivity
- Increased ICP
- Seizure disorder
- Uncontrolled HTN
What is the mechanism of action of meperidine? (3)
- Less potent then morphine; 60 - 80 mg of meperidine roughly equivalent to 10 mg of morphine
- CNS depressant, providing both analgesia and sedation
- Does not have the hemodynamic properties as morphine but has the tendency for physical depedence and abuse
What is an ectopic pregnancy?
Refers to the abnormal implantation of the fertilized eggs outside of the uterus
What is erosion?
A depression in the epidermis, caused by tissue loss
What is the classification of metoprolol?
Beta-adrenergic receptor blocking agent
What is subcutaneous emphysema?
Crackling sensation caused by air just underneath the skin
What is hypertension?
A blood pressure higher than normal
What is a pulmonary embolism?
The presence of a blood clot in the pulmonary vascular system
What are the three indications for the usage of glucagon?
- Hypoglycemia
- Beta blocker overdose
- Esophageal foreign body
What is nulligravida?
Woman who has not been pregnant
What is the adult maintenance dosage of amiodarone?
1mg/min over 6 hours 150mg in 250ml NS infuse at 100ml/hr
What is the dosage of etomidate?
0.1-0.3 mg/kg over 15-30 seconds
What are myocardial cells?
They are working cells of the myocardium that contain contractile filaments and form the muscular layer of the atrial walls and the thicker muscular layer of the ventricular walls
What is hyperpnea?
It is a normal rate, but with deep respiration’s
How is reflection used as a feedback technique?
To check your understanding and to reassure the speaker, echo her message back to her using your own words
What is apnea?
It is an absence of breathing
What is a closed fracture?
A broken bone in which the bone ends or the forces that caused the break do not penetrate the skin
What is the mechanism of action of tenecteplase?
Converts thrombus-bound plasminogen to plasmin, which degrades the fibrin matrix of the thrombus
According to ACLS, if the QRS is equal to or greater than 0.12 seconds, what are the next four steps?
- IV access and 12 lead if available
- Consider adenosine only if regular and monomorphic
- Consider antiarrhythmic infusion
- Consider expert consultation
What are four causes of bleeding during pregnancy?
- Abortion
- Ectopic pregnancy
- Placenta previa
- Abruptio placentae
What are three indications for the usage of nitroglycerin?
- Possible ischemia due to:
- Unstable angina
- AMI
- Pulmonary edema
What are eight contraindications for the usage of enoxaparin?
- Hypersensitivity
- Hemophilia
- Severe liver damage
- Shock
- Active bleeding
- IM injections
- History of heparin induced thrombocytopenia
- Do not use concurrently with unfractionated heparin
What is hypokalemia?
Lower than normal potassium level in blood
What are four causes of tachypnea?
- Fever
- Anxiety
- Exercise
- Shock
What is a postpartum hemorrhage?
Is the loss of 500cc or more blood immediately following the delivery
What is ascites?
Bulges in the flanks and across the abdomen, indicating edema caused by congestive heart failure
What are four examples of central adrenergic inhibitor anti-hypertensives?
- Cloninide (Catapres)
- Methyldopa (Aldomet)
- Guanabenz (Wytensin)
- Guanfacine (Tenex)
What are the five indications for the usage of epinepherine?
- Symptomatic bradycardia
- Cardiac arrest
- Anaphylaxis
- Severe asthma
- Croup/stridor
What is the indication for the usage of pancuronium?
Achieve paralysis to facilitate endotracheal intubation
What are the three regulating systems that maintain the body’s pH?
- Chemical buffer
- Respiratory system
- Renal system
What are three causes of Kussmaul’s respirations?
- Renal Failure
- Metabolic Acidosis
- Diabetic Ketoacidosis
What are five adventitious breath sounds?
- Crackles
- Wheezes
- Rhonchi
- Stridor
- Pleural rubs
What are six ways auto-PEEP can be corrected?
- Decreasing inspiratory time
- Decreasing the respiratory rate
- Adjusting the pressure support (PS) flow term up
- Increasing flow rate
- Bronchodilatory therapy
- Increasing PEEP level
What is metabolic alkalosis?
It is a condition in which the pH of the tissue is elevated beyond the normal range (7.35-7.45). This is a result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations
What is the indication of usage for ASA?
Acute coronary syndrome
What is spider angioma?
Reddish legs radiate from the red spot
What is pressure control ventilator mode?
Uses constant flow of gas, time cycled serves to administer breaths at fixed intervals, pressure limited to pre-set pressure that once reached remains for the duration of the inspiratory time
What is an open fracture?
A broken bone in which the bone ends or the forces that caused the break to penetrate the surrounding skin
What is the classification of furosemide?
Diuretic
What is preeclampsia?
- It is a condition during pregnancy that is characterized by hypertension and protein in the urine
- Usually occurs after week 34 and can develop after the baby is born
What is Breach of Duty?
An action or inaction that violates the standard of care expected from a paramedic
What is the classification of ipratropium bromide (Atrovent)?
Anticholinergic
What are three active listening skills?
- Facilitation
- Reflection
- Clarification
What are four contraindications for the usage of haloperidol?
- Parkinson’s
- CNS depression, coma
- Underlying correctable causes
- Previous history of neuroleptic malignant syndrome
According to the Centre for Conflict Resolution, what are five basic styles to approaching conflict?
- Competing/controlling
- Avoiding
- Accommodating
- Compromising
- Collaboration
What is the classification of lidocaine?
Anti-arrhythmic (Class 1b)
What are the three contraindications of the usage of clopidogrel?
- Hypersensitivity
- Active pathological bleeding
- Reference to local protocols
What is the indication for the usage of TXA?
Trauma with all of the following:
- Less than 3 hours since time of injury
- Systolic BP < 80 mmHg or HR > 110
- Suspicion of significant hemorrhagic blood loss
What is the adult dosage of epinepherine for asthma/anaphylaxis?
0.3-0.5 mg IM/SQ 1:1000 or 0.1 mg IV 1:10000
What is the pediatric dosage of propofol?
1.0 mg/kg IV
What are crackles?
Light crackling, popping, non-musical sounds heard usually during inspiration
What is the volume control ventilator mode?
Tidal volume is maintained at the expense of peak airway pressure, increasing the risk of barotrauma
What occurs with a cephalopelvic disproportion?
Occurs when the infant’s head is too big to pass through the maternal pelvis easily
What is the mechanism of action of beta adrenergic blocker anti-hypertensives?
Competes with epinepherine to occupy beta-adrenergic receptors in the heart, blood vessels, lungs and CNS
What is a vesicle?
Elevated area with a diameter less than 1cm and contains serous fluid
What is shoulder dystocia?
Occurs when the infant’s shoulders are larger than the head
What is the dosage for eclampsia and seizure prophylaxis in pre-eclampsia of magnesium sulfate?
2 - 4 g IV/IO in 100 ml over 10 - 30 min with a maintenance infusion of 1g/hr
What is the mechanism of action of vecuronium? (3)
- Skeletal muscle relaxant
- Paralyzes skeletal muscle including respiratory muscles
- Acts by competitively binding to nicotinic cholinergic receptors. The binding of vecuronium decreases the opportunity for acetylcholine to bind to the nicotinic receptor at the post junctional membrane of the muscular neural junction. As a result, depolarization is prevented, calcium ions are not released and muscle contraction does not occur
What are the two indications for the usage of adenosine?
- Stable narrow complex tachycardia
- Monomorphic wide complex tachycardia
What is a normal QT interval?
Less than 0.38 seconds
What is Grey-Turner’s sign?
The discoloration over the flanks suggestive of intra-abdominal bleeding
What is cor pulmonale?
It is hypertrophy of the right ventricle resulting from disorders of the lungs; CHF secondary to pulmonary hypertension
What are four maternal complications during pregnancy and delivery?
- Postpartum hemorrhage
- Uterine rupture
- Uterine inversion
- Pulmonary embolism
What is the indication for the usage of meperidine?
Pain relief
What is multipara?
Woman who has delivered more than one baby
What are Korotkoff sounds?
The sounds of blood hitting arterial walls
What is the pediatric IV/IM/SQ dose of naloxone?
0.1 mg/kg 2- 3 min, max 2.0 mg per dose
What is bradycardia?
A pulse rate slower than 60
What is the second dosage of Amiodarone IV/IO used in ACLS?
150mg
What is systole?
Phase of cardiac cycle when the ventricles contract
What is the classification of glucagon?
Pancreatic hormone
What is pulse pressure?
The difference between systolic and diastolic blood pressure
What is the dosage of clopidogrel for those patients over the age of 75?
75mg PO
What is the adult dosage of succinylcholine?
1.5 mg/kg IV, max dose 150 mg
What is the adult dosage of diphenhydramine?
25-50 mg IM/IV/IO
What is the main antiarrhythmic infusion that ACLS refers to?
Amiodarone
What is the normal duration of a QRS complex?
0.11 second
What is the mechanism of action of diphenhydramine? (4)
- Competes with free histamine for binding and blocks H1 histamine receptors
- Antagonizes the effects of histamine on Histamine (HA) receptors, leading to a reduction of the negative symptoms brought on by histamine
- CNS depressant
- Has antiemetic properties
What is a normal pH?
7.35 - 7.45
What is the mechanism of action of metoclopramide? (2)
- Antagonizes central and peripheral dopamine receptors, as well as 5HT4 receptor agonistic properties, which raises the threshold of activity in the chemo-receptor trigger zone, resulting in Antiemetic effects
- Increases the amplitude and tone of gastric contractions, increases peristalsis and causes accelerated gastric emptying and intestinal tract
What are the two contraindications for the usage of dobutamine?
- Untreated hypovolemia
- Vasodilatory shock (septic, neurogenic, anaphylactic)
What does the P wave represent?
Atrial depolarization
What is the classification of dopamine?
Sympathomimetic
What is right ventricular failure?
The right ventricle fails as an effective forward pump, causing back pressure of blood into systemic venous circulation and venous congestion
What are three sources of difficult interviews?
- Patient’s physical condition
- Patient’s fear of talking
- Patients intentions to deceive
What is whispered pectoriloquy?
Abnormal clarity of patient’s transmitted whispers
How is silence used as a feedback technique?
It gives the patient time to gather her thoughts and add to what has been said
What is ischemia?
Decreased supply of oxygenated blood to a body part or organ
What is the pediatric dosage of sodium bicarbonate?
1 mEq/kg slow IVP, repeat 0.5 mEq/kg q 10 min PRN
What are wheezes?
Continuous high-pitched musical sounds similar to a whistle
What is an epiphyseal fracture?
A disruption in the epiphyseal plate of a child’s bone
What are six examples of beta adrenergic blocker medications?
- Esmolol (Brevibloc)
- Propranolol (Inderal)
- Metoprolol (Lopressor)
- Nadolol (Corgard)
- Timolol (Blocadren)
- Atenolol (Tenormin)
What is purpura?
Reddish-purple blotches with a diameter more than 0.5cm
What is a normal pulse rate?
60-100
What is the indication for the usage of propofol?
Induction and maintenance of sedation
What is the adult dosage of calcium chloride?
8-16 mg/kg over 3 minutes
What does DCAP-BTLS stand for?
- Deformities
- Contusion
- Abrasions
- Penetration
- Burns
- Tenderness
- Laceration
- Swelling
What is the contraindication for the usage of dopamine?
Untreated hypovolemia
What is Parity?
The number of pregnancies carried to full term
What is the mechanism of action of pancuronium? (3)
- Skeletal muscle relaxant
- Paralyzes skeletal muscles including respiratory muscles
- Competitive acetylcholine antagonist on neuromuscular junctions displacing the Ach from its post-synaptic nicotinic Ach receptors and causes no spontaneous depolarization
What is the classification of meperidine?
Narcotic analgesic
What is petechiae?
Reddish-purple spots with a diameter less than 0.5cm
What surface of the heart is being viewed when reading the following leads:
I, aVL?
Lateral (High)
What is the classification of acetylcysteine?
Mucolytic agent
What is active listening?
The process of responding to your patient’s statements with words or gestures that demonstrate your understanding
What is the His-Purkinje system?
The portion of the conduction system consisting of the bundle of His, bundle branches, and Purkinje fibres
What are nine contraindications to the usage of midazolam?
- Hypersensitivity
- Narrow-angle glaucoma
- Patients in shock with depressed vital signs
- Alcoholic coma
- Myasthenia Gravis
- Acute pulmonary insufficiency
- COPD
- Pregnancy
- Renal failure
What is the classification of sodium bicarbonate? (2)
- Alkalinizing agent
- Electrolyte
What is the mechanism of action of angiotensin converting enzyme inhibitors medications?
They reduce blood pressure by blocking the conversion of angiotensin I to angiotensin II
How is confrontation used as a feedback technique?
Help the patient focus on one particular factor of the interview
What is minute ventilation?
The amount of gas, in litres, exhaled by the lungs in one minute
- Determining factors: pH, PaCO2, disease states
- VE = Vt x RR
What is the mechanism of action of enoxaparin?
Potentiates antithrombin III (which inhibits coagulation) and decreases the formation of thrombin
What are the three indications for the usage of lidocaine?
- VF/VT
- Stable VT with a pulse
- Wide-complex tachycardia of unknown origin
What is a telangiectasia?
Red, thread like line
What are the three indications for the usage of rocuronium?
- Maintain paralysis post intubation after RSI
- Maintain patient and crew safety in a combative patient, after patient intubation
- To ease ventilation and/or oxygenation of intubated patients
What is a normal female systolic blood pressure after menopause?
120-150
What is empathy?
Identification with an understanding of another’s situation, feelings, and motives
What is the adult IV dose of naloxone?
0.4 - 2.0 mg IV q 2 - 3 min
What is the pediatric dosage of amiodarone for VF/pulseless VT?
5mg/kg (max 300mg) diluted in 5ml NS rapid IV push. Repeat up to 15mg/kg/24hr
What is the dose of lidocaine for a patient with VF/VT?
1.0 mg/kg with subsequent doses of 0.5 mg/kg q 10 min (max 3.0 mg/kg)
What is auscultation?
Listening with a stethoscope for sounds produced by the body
What is ecchymosis
Reddish-purple blotches with varying sizes
What is the function of the acoustic nerve?
Sensory
What is a venous star?
Bluish legs that radiate from a blue center
What is the adult dosage of D50?
25g IVP, may repeat once
What is the adult dose of pancuronium?
0.04 - 0.1 mg/kg IV; repeat dose of 0.01 - 0.02 mg/kg q 20 mins