Dale's Paramedic Pearls Flashcards by Jeff Nienhaus

A build up of blood or other fluid in the pericardial sac that puts pressure on the heart, which may prevent it from pumping correctly.

Cardiac Tamponade

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S/S- Dyspnea and orthopnea, clear lung sounds, rapid and weak pulse, decrease in systolic BP, pulsus paradoxus, narrowing pulse pressure, muffled heart tones.

Cardiac Tamponade

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S/S- Acute onset of chest pain or SOB, altered mental status or unconsciousness, general weakness, restlessness, confusion, coma, dyspnea, productive cough, labored breathing, paroxysmal nocturnal dyspnea, tripoding, tachycardia.

Cardiogenic Shock

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Treatment for flailed chest?

Stabilize flail segment with a bulky dressing. Do not use a sandbag.

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Treatment for a sucking chest wound?

Occlusive dressing sealed on 3 sides. Monitor for loss of compliance while bagging.

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High HR, Low BP, think?

Bleed or dehydration

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Flat jugular veins when supine?

Bleed, dehydration, or HHNK

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Hot skin in a shock patient, think?

Septic Shock

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Female patient on birth control and/or smoking with SOB, think?

Pulmonary Embolism

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Hives and laryngeal edema, think?

Allergic reaction or Anaphylactic Shock

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Cool, clammy skin, think?

Shock

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Sudden onset of vomiting or diarrhea, think?

Allergic reaction or Anaphylactic Shock

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S/S- Cool, clammy skin above, warm dry skin below, low BP, low HR.

Neurogenic Shock

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Difference between Neurogenic Shock and Spinal Shock?

Spinal Shock is temporary

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Hives? Think?

Allergic reaction or Anaphylactic Shock

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Person on ACE inhibitor with laryngeal edema and stridor, think?

Allergic reaction or Anaphylactic Shock

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Black, tarry stools, think?

Lower GI bleed

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Bright red blood in stool (hematochezia), think?

Hemorrhoid

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Patient states “My heart is beating out of my chest”, think?

SVT

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Most common cause of SVT?

Wolff-Parkinson White Syndrome (WPW)

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Crushing substernal chest pain, think?

Myocardial Infarction

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Treatment for MI?

MONA
Morphine 2-4mg IVP
Oxygen
Nitro .3-.4mg sublingual
Aspirin 160-325mg PO

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Sudden onset of SOB?

Pulmonary Embolism

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Patient has JVD, think?

Right side failure

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Any female of child bearing age with abdominal pain, think?

Ectopic pregnancy

Tall, skinny males with sudden onset of SOB, think?

Spontaneous Pneumothorax

Tall, skinny people affected. Genetic disease that presents with weakness in arterial walls. Often aneurysm history, think?

Marfrans Syndrome

#1 cause of pulmonary edema?

Left side failure

#1 cause of left side failure?

Myocardial Infarction

#1 cause of right side failure?

Left side failure

Only reason not to disrobe a trauma patient?

The environment

S/S- Vaginal bleeding with pain, sudden sharp, tearing pain, stiff, boardlike abdomen, massive hemorrhage, 3rd trimester.

Abruptio Placentae

S/S- Lightheadedness, breathlessness, weakness, headache, nausea, vomiting, @6600ft.

Acute Mountain Sickness

S/S- Progressive weakness, fatigue, decreased appetite, weight loss, hyper pigmentation of the skin, vomiting or diarrhea.

Addison's Disease (Hypoadrenalism)

S/S- Short term memory loss, shuffling gait, stiffness of body muscles, aphasia, psychiatric disturbances, decorticate.

Alzheimers

Angina caused by artery spasm?

Prinzmetals angina

S/S- Sudden onset of chest discomfort, radiating pain, epigastric pain, SOB, elevated BP during episode, pain lasting 3-5 minutes as long as 15 minutes.

Angina Pectoris

Angina that occurs with activity and is relieved by rest?

Stable angina

Angina that occurs with rest and lasts beyond 15 minutes?

Unstable angina

S/S- dyspnea, wheezing, cough, one or two word dyspnea, pulsus paradoxus, tachycardia, decreased O2 saturation, agitated, anxious?

Asthma

2 stages of asthma?

Stage 1- Bronchospasm | Stage 2- Inflammatory response

Treatment for asthma?

Albuterol Oxygen Epinephrine

S/S- Localized bite, redness, swelling, muscle spasms of large muscle groups, nausea and vomiting, sweating, seizures, paralysis, decreased LOC?

Black Widow spider bite

Treatment for muscle spasms in Black Widow bite?

Diazepam (Valium) 2.5-10mg IVP Calcium Gluconate .1-.2mg/kg of 10% solution IV Anti venom if available

S/S- Painless, small erythematous macula surrounded by a white ring, chills, fever, nausea and vomiting, joint pain, tissue necrosis days, to weeks after bite?

Brown Recluse spider bite

S/S- Headache, nausea and vomiting, confusion, tachypnea, agitation, loss of coordination, chest pain, LOC, seizure, cyanosis, bright cherry red skin?

CO poisoning

S/S- Wenckebach and PVC's on monitor, blunt trauma to the sternum?

Cardiac Contusion

S/S- Respiratory symptoms, malaise, low grade fever, rash that starts on the face and trunk?

Chicken Pox

S/S- Produces considerable quantities of sputum, productive cough for at least 3 months per year for 2 or more years, overweight, cyanotic, rhonchi, right heart failure if they JVD,

Chronic Bronchitis

Classic sign of right sided heart failure?

JVD and peripheral edema

S/S- Localized numbness, weakness, drowsiness, ataxia, slurred speech and excessive salivation, paralysis of tongue and larynx, drooping of eyelids, double vision, dilated pupils, abdominal pain, nausea and vomiting, LOC, seizure, respiratory failure, hypotension?

Coral snake bite

Red on yellow will kill a fellow? Type of snake.

Coral snake bite

S/S- GI bleeding, recent weight loss, intermittent abdominal cramping, pain, nausea, and vomiting, diarrhea and fever?

Crohns Disease

S/S- Loud seal bark cough, tachypnea, grunting while breathing, wheezing, acute respiratory distress during the night?

Croup

S/S- Burning sensation in the mouth and throat, headache, confusion, combative behavior, hypertension, tachycardia, seizures, coma, pulmonary edema?

Cyanide Poisoning

S/S- Joint and abdominal pain, fatigue, paresthesis, CNS disturbances, associated with diving?

Decompression Illness, "The Bends"

S/S- Slow onset, diuresis, dry, warm skin, excessive hunger and thirst, malaise, tachycardia, feelings of physical weakness, kussmaul respirations, fruity or acetone like smell, hyperglycemia, acidic pH, hypokalemia, decreased mental function, coma?

Diabetic Ketoacidosis (DKA)

Caused by the body burning fat instead of sugar?

DKA

3 classic signs of diabetes mellitus type 1?

Polyuria (Excessive Urination) Polydipsia (Excessive Thirst) Polyphagia ((Excessive Hunger)

S/S- Lower left side pain, low grade fever, colicky pain, nausea and vomiting, tenderness on palpation, cool, clammy skin, tachycardia, diaphoresis, hematochezia?

Diverticulitis

S/S- Barrel chest, decreased chest excursion with prolonged expiratory phase, rapid resting respiratory rate, thin, pink in color, hypertrophy of accessory muscles, pursed lips, clubbing of fingers, right heart failure (JVD, peripheral edema, or hepatic congestion). Severe signs include: confusion, agitation, somnolence, one to two word dyspnea, use of accessory muscles, pink puffers?

Emphysema

Kussmaul Sign?

JVD upon inspiration/Pulsus paradoxus

S/S- Decreased LOC, fever, headache, drowsiness, coma, tremors, stiff neck and back, seizures?

Encephalitis

Cushings Reflex?

BP up, pulse same or down, erratic breathing

S/S- Muffled voice or cry, sore throat, pain with swallowing, difficulty swallowing, drooling, stridor?

Epiglottitis

S/S- Agitation, emotional changeability, insomnia, poor heat tolerance, weight loss despite increased appetite, weakness, dyspnea, tachycardia?

Graves Disease (Hyperthyroidism)

S/S- Cramps in fingers, arms, legs, or abdominal muscles, mentally alert, weakness, dizziness, moist and warm skin?

Heat Cramps

S/S- Increased body temp, cool and clammy skin, rapid and shallow breathing, weak pulse, possible diarrhea, muscle cramps, weakness, headache, anxiety, paresthesia, impaired judgement?

Heat Exhaustion

S/S- >105 temp, cessation of sweating, hot skin that is dry or moist, very high core temp, deep respirations that become shallow, rapid at first but may slow, rapid full pulse may slow later, hypotension with low or absent diastolic reading, confusion or disorientation, unconscious, seizures?

Heat Stroke

S/S- Blunt or penetrating chest trauma, signs and symptoms of shock, dyspnea, dull percussive sounds over site collecting blood?

Hemothorax

Treatment for hemothorax?

O2 2 large bore IVs Monitor breath sounds

S/S- Weight gain, moon face appearance, buffalo hump, thinning or transparent skin, mood swings, impaired memory or concentration. Too much cortisol?

Hyperadrenalism (Cushings Syndrome)

S/S- Diaphoresis, increased skin temp, flushing, altered LOC?

Hyperthermia

S/S- Altered mental status, bizarre behavior, diaphoresis, tachycardia, seizure, quick onset, blood sugar <90?

Hypoglycemia

S/S- Temp between 90-95, lethargy, shivering, lack of coordination, pale, cool dry skin, early rise in BP, heart and resp?

Mild Hypothermia

S/S- Temp <90, no shivering, dysrhythmias, loss of voluntary muscle control, hypotension, undetectable pulse and respirations, J-waves on ECG?

Severe Hypothermia

S/S- Fatigue, decreased mental function, lethargy, cold intolerance, constipation, decreased appetite with increased weight gain?

Hypothyroidism (Myxedema)

S/S- Altered mental status, one or two word dyspnea, cyanosis, hemoptysis (coughing up blood), hypoxia, cough, hoarseness, vague chest pain, fever, chills, pleuritic chest pain, crackles, wheezes, diminished breath sounds heard in affected lung, profound wait loss (severe)?

Lung Cancer

Treatment for marine animal injection?

Establish and maintain airway Apply light constricting band between wound and heart to occlude lymphatic flow Apply heat or hot water Inactivate or remove stinger

S/S- Full body rash, hacking cough, runny nose, high fever, watery red eyes, kopliks spots (red spots with blue-white centers that appear in the mouth). Viral disease?

Measles

S/S- High fever, headache, stiff neck, nausea and vomiting, discomfort looking into bright lights, confusion, sleepiness, seizure. Classic sign is high fever. 6 year old kid with high temp for 2 days?

Meningitis

S/S- Chest pain, elevated BP during episode, chest pain that last more than 30 minutes, pain radiates to arms, neck, or back. Acute onset of nausea and vomiting, nitro and rest offer no relief, feeling of impending doom?

Classic sign of MI?

Crushing substernal chest pain

Most heart attacks occur where?

Left ventricle

S/S- Fever, headache, loss of appetite, pain and swelling in parotid gland, viral?

Mumps

S/S- Altered level of consciousness, impaired judgement, drunkedness, also know as "rapture of the deep"?

Nitrogen Narcosis

S/S- Penetrating chest trauma, sucking chest wound, frothy blood at wound site, dyspnea, hypovolemia. Has to be 3mm or larger to be a problem?

Open Pneumothorax

Treatment for Open Pneumothorax?

High flow O2 | Cover opening with sterile occlusive dressing taped on 3 sides

S/S- Tremor, rigidity, bradykinesia (slow movement), postural instability. Caused by lack of dopamine in the brain?

Parkinson's Disease

Treatment for Pit Viper bite?

``` Keep patient supine Immobilize limb with splint Maintain extremity in neutral position Do not apply constricting band O2 IV Crystalloid Fluids Transport ```

#1 cause of bleeding in 3rd trimester?

Placenta Previa

S/S- Painless, bright red vaginal bleeding. Takes place in 3rd trimester?

Placenta Previa

What is Becks Triad?

JVD Narrowing Pulse Pressure Muffled Heart Sounds

S/S- Substernal chest pain, irregular pulse, abnormal heart sounds, low BP, narrow pulse pressure, change in voice?

Pneumomediastinum

S/S- Chills, deep productive cough, yellow to brown sputum often streaked with blood, pleuritic chest pain. More prone to get disease if on steroids?

Pneumonia

S/S- Trauma to the chest, chest pain on inspiration, hyperinflation of chest, diminished breath sounds to affected side?

Pneumothorax

Treatment for Pneumothorax?

Chest Decompression

Difference between Pneumothorax and Tension Pneumothorax?

Tension has: JVD Tracheal Deviation Sometimes narrowing pulse pressure

Treatment for Open Pneumothorax?

First, cover with gloved hand and place occlusive dressing over the wound

S/S- Excessive salivation, lacrimation, diaphoresis, abdominal cramps, nausea and vomiting, diarrhea, decrease LOC, eventually coma?

Poisonous Plant or Mushroom ingestion

What is SLUDGE?

``` Salivation Lacrimation Urination Defecation Gastrointestinal Upset Emesis ```

What is Hemoptysis?

Coughing up blood

S/S- Blunt or penetrating chest trauma, increasing dyspnea, hypoxia, increasing crackles, diminishing breath sounds, hemoptysis, signs and symptoms of shock?

Pulmonary Contusion

S/S- Sudden onset of severe unexplained dyspnea, possible pleuritic chest pain, possible cough, labored breathing, tachypnea, tachycardia?

Pulmonary Embolism

Treatment for PE?

High flow O2 and Transport

What is a Thrombus?

Blood Clot

When someone is hyperventilating, what metabolic disorder are they in?

Respiratory Alkalosis

S/S- Sore throat, rhinorrhea, chills, myalgia, headache, diarrhea, cough, sputum production, respiratory stress, respiratory failure?

Severe Acute Respiratory Syndrome (SARS)

S/S- Thrombosis in the brain, gradual onset, often occurs after periods of rest?

Occlusive Stroke

S/S- Facial drooping, headache, confusion, dysphasia, aphasia, dysarthria, vision problems, hemiparesis, hemiplegia, paresthesia, inability to recognize touch, gait disturbances, uncoordinated fine motor movements, dizziness, incontinence, coma?

Stroke

S/S- Complains of worst headache of their life?

Hemorrhagic Stroke

Treatment window for suspected Occlusive Stroke?

3-4.5 Hours

Most common emboli?

Thrombi

S/S- Chest trauma, severe dyspnea, vent/perfusion mismatch, hypoxemia, hyperinflation of affected side of chest, diminished then absent breath sounds, cyanosis, diaphoresis, altered mental status, JVD, hypotension, hypovolemia, narrowing pulse pressure?

Tension Pneumothorax

S/S- High fever (106 or higher), irritability, delirium or coma, tachycardia, hypertension, vomiting, diarrhea. Usually as the result of ingestion of thyroid product?

Thyrotoxic Crisis or Thyroid Storm

S/S- Dry mouth, blurred vision, urinary retention, constipation, confusion, hallucinations, hyperthermia, respiratory depression, seizures, tachycardia, hypotension, cardiac dysrhythmias?

Tricyclic Antidepressant Toxicity

Treatment for Tricyclic Antidepressant overdose?

Sodium Bicarb

S/S- Nausea, weakness, fatigue, rapid weight loss, fever, night sweats, cough, chest pain, hemoptysis?

Tuberculosis

When caring for TB patients what BSI precaution must you wear?

N95 Respirator

What is the division of the Upper and Lower GI System?

Ligament of Treitz

S/S- Abdominal discomfort, upset stomach, gas pain, tearing pain in upper quadrants, nausea and vomiting, hematemesis, melena, tachycardia?

Upper GI Bleed

What is myalgia?

Muscle pain

S/S- fever, chills, myalgias, fatigue, usually viral?

Upper Respiratory Infection

S/S- Coarse tremor of hands, tongue, eyelids, nausea and vomiting, general weakness, increased sympathetic tone, tachycardia, sweating, hypertension, orthostatic hypotension, anxiety, irritability, hallucinations, poor sleep?

Withdrawal Syndrome

Normal vital signs at birth?

Resp- 30-60 HR- 100-180 Systolic BP- 60-90

Normal vital signs for preschool age (3-5)?

Resp- 22-34 HR- 70-110 Systolic BP- 95-110

Normal vital signs for Adolescence?

Resp- 12-26 HR- 60-90 Systolic BP- 112-128

What does APGAR stand for?

``` Activity Pulse Grimace Appearance Respiration ```

How often after birth do you evaluate the APGAR score?

1 and 5 minutes following birth

Name 5 components of the Initial Impression?

1. Form a general impression 2. C-spine control as needed 3. Assess baseline mental status 4. ABC's 5. Determine priority

The way we evaluate oxygenation of blood in the body?

Fick Principle

Normal PaCO2 level?

35-45mmHg

Normal PaO2 level?

80-100mmHg

Rhonchi?

Mucus in the airway

Crackles?

Fluid in the lower airway, pulmonary edema

Stridor?

Upper airway obstruction, FBAO, epiglottitis in children older than 3-4

Wheezing?

Fluid in lower airways, bronchoconstriction, associated with asthma

What causes snoring respirations?

Soft tissues in back of the throat, usually tongue

Best way to determine good respirations?

End tidal CO2 detector or Capnogram

Least advised way to insert ET tube?

Digitally

Right side hypertrophy brought on by long term hypertension?

Cor Pulmonale

What is Pulsus Paradoxus?

Drop in pulse and 10mmHg BP during inspiration

What is the most frequent infection that affects smokers?

Bronchitis, then pneumonia

A liquid protein substance that coats the alveoli in the lungs?

Surfactant

Alveolar collapse that prevents the use of that portion of the lung for ventilation and oxygenation?

Atelectasis

What is the exchange of gases between a living organism and the environment?

Respirations

What is air movement in and out of the lungs? Does not guarantee respirations.

Ventilation (Mechanical)

What is the average volume of gas inhaled and exhaled in one respiratory cycle?

Tidal Volume (500ml)

What gives you the best seal when using BVM?

E-C, 2 person BVM

Nasal intubation is contraindicated in the presence of what?

Apnea

Primary concern of Cheyne-Stokes respirations?

Minute volume

Treatment for Pulmonary Edema?

Nitro Lasix Morphine CPAP

A selective Beta-2 agonist that can be used as a breathing treatment? Can also stop contractions.

Terbutaline

What is Kussmaul's Sign?

Rise of jugular vein upon inspiration

What is Succinylcholine and its dose?

Used for Rapid Sequence Intubation, 1-1.5mg/kg

Any abnormal condition that effects the hearts arteries that produces various effects, especially reducing the flow of O2 and nutrients to the myocardium?

Coronary Artery Disease (CAD)

Most common form of CAD?

Atherosclerosis

Occlusion of arteries with fatty deposits and cellular debris?

Atherosclerosis

Calcification of the arteries causing loss of elasticity?

Arteriosclerosis

S/S- Pedal edema, ascites, pulmonary edema, dyspnea, orthopnea, cough, decreased BP, nausea and vomiting, pitting edema, anxiety, confusion, JVD, weak pulse, decreased urine output?

CHF

Backwards left sided heart failure presents with what?

Pulmonary Edema

Forwards left sided heart failure presents with what?

Hypotension

Right sided heart failure presents with what?

Peripheral edema

Wheezing in cardiac patient caused by left sided failure and fluid in the lungs is know as what?

Cardiac asthma

S/S- Weak, strong, weak, strong, pulse quality alteration?

Pulsus Alterans

Monitor shows varying amplitude of weak, strong, weak, strong?

Electrical Alterans

A condition involving sudden fainting which usually lasts for less than a minute and may include seizures. Before the attack patient becomes pale and during recovery the patient often feels hot and flushed. Fainting occurs due to a lack of O2 in the brain due to heart rhythm problems involving slowing of the heart.

Stokes Adams Syndrome

Anti-hypertensive that blocks the cellular uptake of calcium. Causes a decrease in SA and AV node automaticity. Examples are Verapamil, Cardizem. Chief side effects are hypotension and bradycardia.

Calcium Channel Blocker

Blocks Beta-1 and Beta-2 receptor sites. Decreases HR and BP. Examples are Propranolol, Acebutolol, Esmolol, Metoprolol, Atenolol.

Beta Blockers

Beta Blocker overdose treatment?

Glucagon

What is the separation of the tunica medica from the tunica adventitia, causing referred pain to the left shoulder, upper back, and chest?

Aortic Aneurysm

S/S- Pain referred to lower back, possible pulsating mass in abdomen and feeling of impending bowel movement?

Abdominal Aortic Aneurysm

S/S- Tearing chest pain that radiates to the back or shoulder blades, radial pulse discrepancy?

Thoracic Aneurysm

What is a common cause of an idioventricular rhythm?

AAA

Role of ASA in the patient with chest pain?

ASA is a platelet aggregate. It makes platelets slippery keeping the clot from getting larger.

What is the S1 sound?

Mitral and Tricuspid valves closing

What is the S2 sound?

Aortic and Pulmonic valves closing

When is the S3 and S4 sound heard?

CHF, elderly with heart disease, indicative of valve failure

The heart is what kind of pump?

Sodium Potassium Pump

Cardiac Output=

Stroke Volume x Heart Rate

What law states the greater the volume of blood entering the heart during diastole, the greater the volume of blood ejected during systolic contraction?

Starlings Law

A nerve plexus of the autonomic nervous system supplying the heart and neighboring structures?

Cardiac Plexus

Blood and IV fluids have what kind of osmolarity?

Isotonic

Rhythm Hallmarks- Chaotic and irregular, no pulse/breathing?

V-Fib

Rhythm Hallmarks- Long PRI

1st degree heart block

Rhythm Hallmarks- PRI grows then drops a beat, usually grouped beats.

2nd degree, type 1 (Wenckebach)

Rhythm Hallmarks- PRI constant with conducted beats, dropped beats present.

2nd degree, type 2 (Classical)

Rhythm Hallmarks- No correlation between P's and QRS's?

3rd degree heart block, complete block

Rhythm Hallmarks- No P wave or inverted P wave?

Junctional Rhythm

Treatment for Stable V-Tach?

150mg Amiodarone IV, given over 10 minutes. Repeat as needed to a max dose of 2.2g in 24 hours.

Treatment for Unstable V-Tach?

Synchronized Cardioversion

You see Asystole on the monitor, what is your next step?

Check in another lead

Asystole on the monitor, what is first drug of choice?

Epinephrine 1mg IV/IO every 3-5 minutes. Could also use Vasopressin 40u for 1st or 2nd dose of Epi.

Vagal or Valsalva maneuvers will only work on what type of rhythms?

SVT's

What is the treatment for a patient with stable SVT?

Vagal maneuver first, then | Adenosine 6mg, 12mg, 12mg

What is the most common reperfustion rhythm?

2nd degree, type 1 (Wenckebach)

When ST elevation is seen across all leads, think?

Pericarditis

Treatment for patient with atrial flutter?

IV O2 Supportive care Transport

When does the relative refractory period begin?

At the apex of the T wave

What does Nitro do?

Dilates coronary arteries, reducing the workload on the heart.

Treatment for Morphine overdose?

Narcan 2-4mg IVP

What causes heart blocks and yellow vision?

Digitalis Toxicity

Treatment for a hypertensive emergency?

IV at TKO O2 Transport

What is a decrease in arterial perfusion at the calf muscle, causing pain?

Claudication

Angiotensin causes what to the blood vessels?

Constriction

Good cholesterol?

HDL

Bad cholesterol?

LDL

Low levels of calcium in the blood that may lead to dysrhythmias?

Hypocalcaemia

The law that the volume flow of an incompressible fluid through a circular tube is equal to pie/8?

Poiseuille's Law

This is the difference between systolic and diastolic pressures?

Pulse Pressure

Mean Arterial Pressure (MAP)=

1/3 pulse pressure+ diastolic

Beta-1 response to Epi does what?

Increase HR

This part of the brain controls higher thought and judgement, sight, memory and cognitive function?

Cerebrum

This part of the brain controls fine motor control?

Cerebellum

What is the Parasympathetic Neurotransmitter?

Acetycholine

What is the Sympathetic Neurotransmitter?

Norepinephrine

Brain can last how long without perfusion?

3-6 seconds

SVT is considered when the HR is over how many BPM?

160

What is the short period immediately after depolarization in which myocytes are not yet repolarized and are unable to fire or conduct an impulse?

Absolute Refractory Period

This period is between the effective refractory period and the end of the refractory period; a period of a few milliseconds following the absolute refractory period during which the excitation threshold of neural tissue is raised and a stronger than normal stimulus is required to initiate an action potential?

Relative Refractory Period

What is Becks Triad, and what is it associated with?

JVD Muffled Heart Tones Narrowing Pulse Pressure Seen in Cardiac Tamponade

What type of overdose can cause numbness, tingling, and seizures?

Lidocaine OD

Dose for Dopamine drip?

2-10mcg/kg/min

What system is designed to keep blood pressure up?

Renin/Angiotensin

IV flow is least affected by the length of the catheter as opposed to its?

Diameter

What is the Beta-1 response to Epi?

Increased HR

At what MAP is the brain profused?

60mmHg

Norepinephrine works on what receptor sites?

Alpha, Beta, Dopaminergic Receptors

What nerve does acetycholine work on?

Vagus Nerve

What contains 50% of of the sugar volume in the entire body?

Cerebral Spinal Fluid (CSF)

Also known as the oculomotor nerve, this nerve allows for pupil constriction and eye movement?

3rd Cranial Nerve

With a head injury and brain swelling you will sometimes see constricted pupils, this is due to pressue on the tentorium of the brain on which cranial nerve?

3rd Cranial Nerve

Also called the trigeminal nerve, this never is responsible for most facial sensations?

5th Cranial Nerve

Also called the facial nerve, when this nerve swells it can cause facial paralysis or Bells Palsy which can be confused for a stroke?

7th Cranial Nerve

Also called the vagus nerve, this nerve is the connection between the brain and numerous organs?

10th Cranial Nerve

Stages of Seizure?

``` Aura Tonic Clonic Postseizure Postictal ```

A sensation the patient gets before a seizure? Also the first stage of seizure.

Aura

This phase of seizure includes body wide rigidity?

Tonic Phase

This phase of seizure involves rhythmic contractions of major muscle groups?

Clonic Phase

This phase of seizure is when all the muscle relax, the eyes may roll back?

Postseizure

The phase of seizure is the reset period for the brain? May last several minutes or several hours.

Postictal

This type of seizure involves the whole body?

General Seizure

This type of seizure just involves part of the body?

Partial Seizure

These are also known as "fake" seizures?

Pseudoseizures

Also called Tonic/Clonic, this type of seizure leaves the patient unconscious and involves shaking and jerking the entire body?

Grand Mal Seizures

This seizure, also called an absence seizure, involves 10-30 seconds of seizure activity marked by starring episodes or loss of motor control?

Petit Mal Seizure

This type of seizure lasts longer than 4-5 minutes or

Status Epilepticus

Treatment for Status Epilepticus?

Vailum

A common chronic neurologic disorder that is characterized by recurrent unprovoked seizures?

Epilepsy

Sedative hypnotic drugs that provide muscle relaxation and mild sedation, includes Diazepam (Valium), and Medazolam (Versed)?

Benzodiazepines

Sustained contractions of both agonist and antagonist muscles. Twisting movements which when prolonged may produce abnormal postures?

Dystonia

Treatment for Dystonic Seizures?

Benedryl 25-50mg

A movement disorder which consists of effects including diminished voluntary movements and the presence of involuntary movements, similar to tics or chorea?

Dyskinesia

Involuntary movements of the tongue, lips, face, trunk, and extremities? Generally caused by extended use of Halodol.

Tardive Dyskinesia

A delayed stress reaction?

Post Traumatic Stress Disorder (PTSD)

S/S- Hallucinations and delusions.

Schizophrenic Patient

Suicide is most likely to occur at what age and condition?

40-50 with terminal disease

A condition in which a person is overly concerned with physical health and appearance to the point that it dominates his or her life?

Somatoform Disorder

Periods of apnea and rapid breaths? Usually involved with a head injury and increased intracranial pressure?

Biot's Respirations

Respirations caused by stroke and intracranial pressure?

Cheyene-Stokes Respirations

Treatment for patient with Cheyne Stokes respirations?

Ventilate at 20BPM

Elevated BP, Slow or normal HR, erratic respirations?

Cushings Syndrome/Triad/Reflex

Best sign of Intracranial Pressure?

High BP

Why is the patients skin pink distal to the injury in neurogenic shock?

A lack of Sympathetic response

A rare and usually fatal disease of the brain, characterized by progressive dimentia and gradual loss of muscle control, that occurs most often in middle age and is caused by a slow virus?

Mad Cow Disease (Creutzfeldt-Jakob disease)

Tumors of the adrenal gland which produce excess adrenaline?

Pheochromocytoma

Damages the motor neurons in the brain and spinal cord?

Lou Gehrigs Disease (ALS-Amyotrophic lateral sclerosis)

A syndrome that results when the pituitary gland produces excess growth hormones? Includes abnormal and and feet growth.

Acromegaly

Inadequate cellular perfusion?

Shock

Shock causes what type of acidosis?

Metabolic

Types of Shock?

``` Cardiogenic Hypovolemic Neurogenic Anaphylactic Septic ```

Type of shock where there is an impaired pumping power of the heart

Cardiogenic Shock

Treatment for Cardiogenic Shock?

Dopamine 5-10mcg/kg/min

Type of shock where there is a decrease in blood/water volume? Cool, pale, clammy skin, BP low, HR up?

Hypovolemic Shock

Earliest sign of hypovolemia?

Anxiety and restlessness

First organ affected by lack of O2?

Brain

Type of shock with an injury to the brain or spinal cord that disrupts communication between nerves and arteries causing relative hypovolemia? Warm, dry, red skin, low BP, slow HR?

Neurogenic Shock

Type of shock with a quick onset, allergic reaction, stridor is an ominous sign? Low BP, pulmonary or laryngeal edema?

Anaphylactic Shock

Treatment for Anaphylactic Shock?

Epinephrine 1:1000 IM

What does the CNS due in Anaphylaxis?

Widespread vasodilation

The antibody responsible for Anaphylaxis?

IgE- Immunoglobulin E

Type of shock with an infection that enters the blood stream and is carried throughout the body? Fever, skin flushed, maybe have breathing issues. History of infection or fever.

Septic Shock

In lead II, which lead is positive?

LL-Left Lower

Bacteria produce what to harm our body?

Endo/Exotoxins

PE mimics what?

Right Side Failure

Addison's Disease?

Hypoadrenalism

How does asthma display on ETCO2?

Shark Fin

1 cause of chronic bronchitis?

Smoking

Somnolence means?

Sleepiness

Too many RBC's, called?

Polycythemia

Graves' disease also called?

Hyperthyroidism

Cushing's syndrome, also called?

Hyperadrenalism

Myxedema, also called?

Hypothyroidism

Best position to evaluate JVD on patient?

45 degree angle

What kind of drug is verapamil?

Calcium channel blocker

Cancer patient in a nursing home is cold and clammy with a fever of 101. Recently returned from the hospital for surgery, has a non-healing sore, suspect?

Septic Shock

Abnormal distribution and return of the blood as seen in Anaphylaxis, Sepsis, or Neurogenic Shocks?

Distributive Shock

3 stages of shock?

Compensated Decompensated Irreversible

In this stage of shock, the body has teh ability to maintain its metabolic demands. Normal BP, possible skin mottling, heart rate up, and contractility is normal.

Compensated Shock

In this stage of shock, the body is unable to meet metabolic demands. Hypotensive, bradycardia. Heart rate moving from tachy to brady?

Decompensated Shock

This stage of shock results in death (cell death). Embolisms flushed into circulation, causes MODS.

Irreversible Shock

A loss of how much blood, will result in a drop in blood pressure?

20%

A loss of how much blood, will result in a narrowing pulse pressure?

15%

Never give more than _____ of fluid to anyone.

3 Liters

Blood loss needs to be replaced by _____ at a rate of _____.

Crystalloids, 3:1

When a normal person lays down the neck veins should do what?

Bulge out

What is the most lethal disorder of the diabetic family? Death due to dehydration.

HHNK

Drugs administered to a patient in shock have _____ effects because the organs (liver and kindneys) cannont metabolize them properly.

Prolonged

Treatment for Spinal Shock

Treat with IV fluids if BP is low. Condition is generally temporary.

Oliguria means?

Sunken eyes

Signs of head trauma?

Cushings Reflex (elevated BP, slow HR, erratic resp.)

What is the key concern with facial fractures?

Airway

What type of facial fracture presents as a slight instability involving the maxilla?

Lefort 1 Fracture

What type of facial fracture involves both the maxilla and the nasal bones?

Lefort 2 Fracture

What type of facial fractures involve the entire facial region below the brow ridge?

Lefort 3 Fracture

This injury includes a stretch or tear to the ligament of a joint that commonly leads to pain and swelling?

Sprain

This injury involves the stretching or tearing of a muscle by excess stretching or overuse?

Strain

This is a wrist fracture involving a break at the end of the radius bone of the forearm?

Colle's Fracture

What bone is on the thumb side of the forearm?

Radius

A partial or incomplete dislocation?

Subluxation

Preferred splint for bilateral femur fractures?

Sager Splint

What is the absolute contraindication of a PASG?

Pulmonary Edema

This device can be used for bilateral femur fractures, pelvic fractures, massive lacerations to the lower legs, or AAA?

MAST (Military Anti-Shock Trousers) or PASG (Pneumatic Anti-Shock Garment)

Before placing a traction splint, check what other areas for injury?

Pelvis, knee, and ankle.

This occurs when 2 or more ribs are broken in 2 or more places?

Flailed Chest

This is involved with a crushing traumatic chest injury, resulting in bulging eyes (exothalamus), bloated blue tongue, red/purple looking face, and extreme JVD?

Traumatic Asphyxia

#1 cause of death in crush injuries?

Bleeding

This is a condition which skeletal muslce tissue breaks down rapidly leaking myoglobin and potassium into the bloodstream that may cause kidney failure?

Rhabdomyolysis

What is the fatal process of total hypovolemia?

Exsanguination (bleeding out)

You are working a building collapse and you find a worker whose legs have been pinned under a large I-Beam for 12 hours. What do you suspect?

Crush Injury/Compartment Syndrome

Shutting off blood supply to an extremity?

Compartment Syndrome

When assessing a trauma patient, what is the least likely sign to be of diagnostic value?

Auscultation

Shock patient without bowel sounds, think?

Obstructed Bowel

When palpating the abdomen for pain, start where?

At a site away from the injury.

Umbilicus brusing?

Cullen's Sign

Bruising of the flanks?

Grey Turner Sign (predicts a severe attack of pancreatitis)

Formula used for fluid resuscitation for a burn patient?

Parkland burn formula

What is the Parkland burn formula?

4ml x weight(kg) x burned body surface area - 50% given in first 8 hours - Remaining given over next 16 hours

How many liters of blood in the body?

6 Liters

How much blood can be lost from a pelvic fracture?

2000-4000ml (2-4L)

Never do what, to a patient with suspected pelvic fracture?

Never log roll or rock the pelvis when palpating for injury

Slow relapse into a coma, alcoholics and elderly are more prone to this?

Subdural Hematoma

This occurs rapidly, commonly associated with damage to the middle meningeal artery?

Epidural Hematoma

This artery is the third branch of the first part of the maxillary artery. Runs across the temporal area of the brain.

Middle Meningeal Artery

A condition associated with penetrating trauma with hemisection of the spinal cord and complete damage to all spinal tracts on the involved side?

Brown Sequard Syndrome

GSW to the parietal (top) region of the head, how do you stop the bleeding?

Apply digital pressure around the wound

MVA patient has facial fractures and facial edema, when bagging with a BVM you hear stridor and air leaking around the seal. What is your action?

Stridor likely due to obstruction, clear airway, consider cricothyrotomy

In an adult, what is the percentage of area burned if the patients entire leg was involved?

18%

In an adult, what is the the total percentage of area burned if the patients entire arm, from shoulder to fingers, was burned?

In an adult, what is the total percentage burned if just the front to the patient was burned, from lower abdomen to neck?

18%

In an adult, what is the total percentage of area burned if the burn involves the entire head?

In an adult, what is the percentage of area burned, if the genital area is involved?

MVA patient has facial fractures and facial edema, when bagging with a BVM you hear stridor and air leaking around the seal. What is your action?

``` Clear airway (Stridor likely due to obstruction) Cricothyrotomy ```

Patient shot in left chest and he has equal breath sounds and JVD, what is his problem?

Possible cardiac tamponade, usually associated with cardiac contusion

You have a patient who was in a motorcycle accident, his foot feels wet in his boot, think?

Possible tibia/fibula or ankle fracture

Your patient in unconscious, hypotensive, and has a mandible fracture, blood and broken teeth are found in the mouth. How do you maintain the airway?

Suction and ET, or nasal intubation

You have a conscious 22 YOM who has been stabbed in the chest, the patient has dyspnea and decreased breath sounds on the ipsilateral (same) side, and distended neck veins. What does he have, and how do you treat it?

- Tension pneumothorax | - Relieve pressure by decompression of the chest.

You have a 24 YOM involved in an MVA with a hematoma over the right eye. Patient is unconscious with slow respirations, pupils are unequal. What is your first treatment?

C-Spine Airway Breathing- BVM Protect airway

You have been on the scene of an MVA and have treated critical patients and are now on the way to the hospital. What do you do next?

``` Detailed Exam Reevaluate interventions, ABC's Obtain additional vitals Treat secondary injuries Trending ```

You have a 35 YOM involved in a motorcycle accident. He is complaining of severe ankle pain. He states his boot feels full of water despite being on dry ground. After completing the primary survey, what do you do next?

Focus on ankle, cut and remove boot Rapid Trauma assessment Cover all life threats Focused assessment

You find a 2 YO who has just been pulled from a swimming pool, he is apneic, cyanotic, with a pulse of 90. What do you do?

Airway C-Spine BVM with high flow O2

IV access in trauma?

2 large bore IV's or 1 central access

Treatment for eviscerated bowel?

- Cover with moist dressing | - Cover the moist dressing with occlusive dressing

What would you expected to see in an airbag deployment from frontal impact?

Burns to the face, hands, and arms

Patient presentation includes what?

Evaluation of: Appearance Mentation Behavior

Least valuable information you can obtain about a patients medical history?

Family History

Do not perfrom the Heimlich maneuver on which type of patient?

Drowning victim

Airway good with C-Spine injury?

Modified jaw thrust

Treatment for chemical burns by Sodium (Na)?

Brush it off Rinse with oil NO water contact

Ammonia and bleach are what kind of poisons?

Alkaline/base

Acid burn is a _____ burn.

Coagulation

Alkaline burns are _____ burn.

Liquification

Patient has massive facial trauma, what is the best way to protect the airway?

Intubation

What suction device would you use on a patient that has debris and broken teeth in the airway?

Yankauer Suction Device

Jugular vein laceration, will lead to what?

Air Embolism

If Cerebrospinal Fluid is visible, there is likely a fracture where?

Cribiform Plate

How to determine if fluid is CSF?

``` Halo test Blood sugar (should be 50% of normal) ```

If you had a patient that needed morphine, it would be important to know what?

If their addicted to heroin or other narcotics

Worst type of wound?

Puncture Wound

Having a hard time controlling bleeding?

Add more dressings

Treatment for laceration to the forearm?

Direct pressure Immobilize Elevate

In relation to ribs, where do you decompress the chest?

Above the ribs

Normal pH?

7.35-7.45

Shock patient will be more acidic or alkalotic?

Acidic

Co2 stays the same, pH decreases, sodium bicarb decreases?

Metabolic Accidosis

Dose of Lidocaine in treatment of PVC's?

1-1.5mg/kg | Repeat every 5-10 minutes to max of 3mg/kg

Treatment for polymorphic V-Tach with a pulse?

Magnesium Sulfate 1-2g mixed in 100ml D5W, given over 5-60 minutes

What is the first step in EVERY scenario?

BSI | Scene safety

Co2 stays the same, pH increases, sodium bicarb increases?

Metabolic Alkalosis

Co2 increases, pH decreases, sodium bicarb stays the same?

Respiratory Acidosis

Co2 decreases, pH increases, sodium bicarb stays the same?

Respiratory Alkalosis

Metabolism that can proceed only in the presence of O2?

Aerobic Metabolism

Metabolism that takes place in the absence of O2?

Anaerobic Metabolism

Patient that has vomited for 3 days is likely in what?

Metabolic Alkalosis

NaHCO3?

Sodium Bicarbonate

Ectopic pregnancy in 1st trimester, how do you transport?

Position of comfort

Ectopic pregnancies occur how many weeks from implantation?

6-12 weeks

You are called to a 23 YOF. You find her curled up like a ball in the fetal position complaining of right side abdominal pain. She has nausea and has been vomiting. What would you suspect?

Ectopic pregnancy

What is mittelschmerz?

Pain during ovulation

This is a way to identify the position of the fetus during delivery. A common and systematic way to determine the position of a fetus inside a womans uterus.

Leopold's Maneuver

This is a measure of the size of the uterus used to assess fetal growth and development. It is measured from the top of the pubic bone to the top of the uterus in centimeters.

Fundal Height - Full Term= Xyphoid Process - 20 weeks= Umbilicus - 12-16 weeks= Pubis

Fetal heart tones are best heard where?

Between the pubis and umbilicus

During pregnancy, heart rate increases _____ to _____ BPM

15-20

Blood pressure decreases by _____ to _____mmHg by the 2nd trimester.

10-15

Normal weight gain during pregnancy is approximately how much?

20lbs.

A mother can lose _____ to _____ blood volume and show minimal changes during pregnancy.

30-35%

This stage of labor begins with the onset of contractions that cause progressive changes in the cervix, and ends when the cervix is fully dilated?

Stage 1

This term describes the shortening, or thinning of tissue in the cervix. Occurs during the first stage of labor.

Effacement

This stage of labor begins once the mother is fully dilated and ends with the birth of the baby?

Stage 2

This stage of labor begins right after the birth of the baby and ends with the separation and subsequent delivery of the placenta?

Stage 3

This is the term used for a woman who has given viable births one or more times?

Para

This term describes a person who is pregnant for the first time?

Primagravida

This term describes a woman who has never been pregnant?

Nuligravida

This term describes the number of pregnancies, regardless of outcome?

Gravida

This is the term used to describe a woman that has had 7-10 kids, and very likely to have a precipitous delivery?

Grandmultipara

This is a rapid or sudden labor of less than 3 hours of the onset of labor. Occurs in 3rd trimester?

Precipitous Delivery

A woman is having contractions 3 minutes apart and lasting 60 seconds. What is the first step in treatment?

Determine Gravida Tell her not to bear down Prepare for delivery Check for crowning

What is a nuchal cord?

Cord wrapped around the babies neck

How to manage a nuchal cord?

Slide cord from neck around head or use finger under cord to relieve pressure

If patient pregnant patient presents with a prolapsed cord, what is your treatment?

Relieve pressure on the cord Make sure cord is pulsating Cover with wet, sterile dressing Place mother with butt in the air and transport

Corrected order to suction newborn?

Mouth first, then nose. Suction no longer than 10 seconds.

S/S- Pregnant patient with blurred vision, headache, hypertension, protein in urine, peripheral edema. Occurs in 3rd trimester.

Preeclampsia

Treatment for eclampsia?

Mag Sulfate

What is Shoulder Dystocia?

Stuck shoulder in birth canal.

This is the termination of pregnancy before 6 months or 20 weeks. Before the fetus is viable.

Abortion

Where does fertilization take place?

Fallopian Tubes

This organ contains the baby during pregnancy?

Uterus

Treatment for SIDS?

Do not start interventions | Support family and treat as crime scene

Treatment for pregnant trauma patient?

``` C-collar, C-spine immobilization Backboard O2 2 large bore IV's, administer crystalloids Transport tilted to the left Reassess frequently Monitor the fetus ```

Sight of the ovarian cyst?

Graffian Follicle

What is the make-up of the umbilical cord?

2 arteries | 1 vein

When do you start CPR on a neonate?

HR is less than 60 BPM, or the patient is not responding to supplemental O2 ventilations.

While enroute to the hospital with an OB patient, you notice delivery is eminent. What do you do next?

Pull over and deliver child | Call for additional help, due to having 2nd patient

This substance stimulates contractions of the myepithelial cells causing milk to be ejected into the ducts?

Oxytocin

These receptors can be used to relax the uterine wall during preterm labor?

B2 Adrenergic receptors (Terbutaline)

What is another way (other than drug therapy) to slow contractions during preterm labor?

Fluid bolus

25 YOF with a vaginal bleed. How do you tell if shes developing hypovolemia?

``` Tilt Test (orthostatics) Pale, flat jugular veins ```

This condition is when the placenta fails to detach from the uterus. As it exits, pulls on the inside surface turning the organ inside out. Very rare.

Uterine Inversion

How to determine if the 26 YOF complaining of vaginal bleeding is in shock?

Orthostatics, pulse increase by 10-20, BP decrease by 10-20 more.

Treatment for preterm labor?

500ml fluid bolus

Endometrial tissue that forms in the uterus and can extend into the vagina?

Endometriosis

Infection of the uterus?

Endometritis

Female with lower abdominal pain and fever has what?

Endometritis

Pedi Dose: | Epinephrine 1:10,000 (#1 Drug for Pedi Emergencies)

.01mg/kg IV/IO

Pedi Dose: | Epinephrine Infusion 1:1000

.1mcg/kg/min

Pedi Dose: | Atropine (#2 Drug for Pediatrics)

.02mg/kg ET/IV/IO

Pedi Dose: | Lidocaine

1mg/kg ET/IV/IO

Pedi Dose: | Lidocaine Infusion

20-50 mcg/kg/min

Pedi Dose: | D50 dilute D25

.5mg/kg IV/IO

Pedi Dose: | Defibrillation

2J/kg, 4J/kg, 4J/kg

This occurs when bilirubin (a byproduct of the breakdown of Red Blood Cells) builds up faster than a newborns liver can break it down and pass it from the body.

Jaundice Bilirubin

Also know as a middle ear infection. Can be a cause of a brain abscess.

Otitis Media

This reflex is positive if the toes point upward when the bottom of the foot is stroked. Opposite in infants.

Babinski's Reflex

Wheezing in a child under 1 year, caused by a virus.

Bronchiolitis

Why do infants dehydrate faster than adults?

Increased body surface area in relation to their mass.

How to obtain best seal in assisting an infants breathing ?

EC 2 person method

If a newborn is not breathing after one minute you should first do what?

Warm and stimulate

#1 indicator of hypoxia in a child?

Bradycardia

The mother of a 4 YOM states her child has had a sore throat since yesterday. He has a high fever and difficulty swallowing. No cough is present and he is drooling. Think?

Epiglottitis

How to determine if pediatric patient has croup?

Seal-bark cough

Treatment for croup?

Racemic Epinephrine .25-.75mg

Any child with fever, think? Even more so with Petechiae (red/purple rash).

Meningitis

Stiff or painful neck commonly associated with meningitis.

Nuchal Rigidity

Death from Meningitis usually comes from what?

MODS

If an injured child is apathetic and does not cry, think what?

Child abuse

CPR should be initiated on a newborn when HR does not go up after O2 administration and stimulation, or is less than _____ BPM to begin with?

A kid is injured in a pool and floating, what should you do first?

Place patient on back board while still in the water.

This gland lies underneath the breastbone, processes T-Lymphocytes, disappears with age.

Thymus

Teenager who has flu like symptoms and has taken aspirin, now comatose.

Rye's Syndrome

This makes elderly patients more susceptible to supdural hematomas when they fall?

Brain atrophy

This spinal condition is the most likely to impair breathing and cause acidity issues, decreased tidal volume.

Kyphosis

Spinal deformation also called bubble butt.

Lordosis

"S" shaped spine.

Scoliosis

Degenerative disease of the spinal column?

Spandolosis

This substance facilitates the entry of glucose into the cells?

Insulin

Where is insulin produces?

In the Pancrease, Islet of Langerhans, by beta cells

Diabetics with high glucose cannot get it to the cells due to low insulin. Cells then burn fat resulting in production of ketones. This is the initial process of?

DKA and kussmaul respirations

Also knows as juvenile diabetes, is an autoimmune disease that results in the destruction of insulin-producing beta cells of the pancrease.

Diabetes Mellitus Type 1

This is the most common disorder when Type 1 Diabetes goes untreated?

DKA

2 signs of DKA?

Warm and dry skin | Kussmaul respirations

2 signs of Insulin Shock?

Cool and moist skin | Normal respirations

Also called non-insulin dependant diabetes, is a disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency?

Diabetes Mellitus Type 2

Type 2 diabetes treated with?

Metformin (decreases hepatic glucose production)

This results from an extremely high sugar content in the blood, causing a shift of water from the intracellular fluid into the blood. Resulting in cellular dehydration.

HHNK (Hyperglycemic Hyperosmolar Nonketonic Coma)

_____ with high blood sugar will be dehydrated.

Diabetics

Patient has DKA, what is the first thing that would be of most help?

Patient has orange peel skin, think?

Diabetic

This branch of civil law that involves a conflict between 2 parties. Most likely to be sued under this branch.

Tort Law

This means "the thing speaks for itself". Replaces reasonable doubt.

Res Ipsa Loquitur

What a state permits a paramedic practicing under its license or certification to do.

Scope of Practice

Scope of practice is defined by what?

State legislature

4 components of negligence.

Breach of Duty Duty to Act Actual Damages Proximate Cause

When the EMT does not act within an expected and reasonable standard of care.

Breach of Duty

4 parts of "Breach of Duty"

Duty to act You breached your duty Injury of some kind You caused the injury

Failure to perform an act that is either an official duty or a legal requirement.

Nonfeasance

The performance of a lawful action in an illegal or improper manner.

Misfeasance

Wrongdoing or misconduct especially by a public official.

Malfeasance

The EMT's responsibility to act reasonable within the standards of his or her training.

Duty to act

When a patient is physically or psychologically harmed in some noticeable way.

Actual Damages

Reasonable cause and effect. (Dropping a patient during lifting)

Proximate Cause

Liberated/Freed

Emancipated

Type of consent where there is an assumption on behalf of a person unable to give consent that he or she would have done so.

Implied Consent

Type of informed consent that occurs when the patient does something, either through words or by taking some sort of action, that demonstrates permission to provide care.

Expressed Consent

Accidental overdose of patient on medication by EMS.

Negligence

A threat of violence.

Assault

Unlawful touching

Battery

Unilateral termination of care by the EMT without the patients consent and without making provisions for transferring care to another medical professional with skills at the same level or higher.

Abandonment

Business standards, practices, and procedures.

Ethics

Personal values and standards.

Morals

Verbally making false statements that injures a persons good name.

Slander

A written or false statement that causes injury to a persons good name.

Libel

STD that is caused by spiral shaped bacteria (Treponema Pallidum) and whos s/s include an ulcerative lesion of the skin or mucous membrane at the site of infection, commonly in the genital region.

Syphilis

STD that results in infection caused by the gonococcal bacteria. S/S include pus containing discharge from the urethra and painful urination in males. In females it will include odiferous discharge, when untreated it turns into PID

Gonorrhea

S/S- Shuffled gait, belly pain, may be in fetal position, pain with intercourse.

Pelvic Inflammatory Disease

STD that is caused by bacteria Chlamydia Trachomatis. Causes blindness.

Chlamydia

This attacks the T-Cell lymphocytes and Neurons.

AIDS

Type of cancer that is acquired by HIV patients. Presents as dark blotches on the plantar surfaces.

Kaposi's Sarcoma

The most uncommon sign to see with AIDS virus is what?

Overweight patient

This quandrant contains: Spleen tail of pancrease, stomach, left kidney, and colon.

ULQ

This quandrant contains: Liver, gallbladder, head of pancreas, part of the duodenum, right kidney, colon.

URQ

This quandrant contains: Small intestine, descending colon, left ovary and fallopian tube.

LLQ

This quandrant contains: Appendix, ascending colon, small intestine, right ovary/fallopian tube.

LRQ

Also known as the Master Endocrine Gland.

Pituitary Gland (controlled by hypothalamus)

Hormone releasing hormones are released by what?

Hypothalamus

The metabolic center of powerhouse of the cell. Small, rod shaped organelles.

Mitochondria

Pivot bone between the Atlas and Axis. A fracture of this bone is known as the hangmans fracture.

Dens (Odontoid Process)

A portion of the brain that lies between the midbrain and the medulla.

Pons

What vertebrae is injured if the patient cannot feel anything below the umbilicus?

T-10

This nerve controls the diaphragm?

Phrenic Nerve

A process in which molecules move from an area of higher concentration to an area of lower concentration.

Diffusion

The movement of water across a semipermeable membrane (the cell wall) from an area of lower to higher concentration of solute molecules.

Osmosis

The protein mediated transport (helper protein) of of a compound across a biomembrane that is not ion-driven; a saturable transport system

Facilitated Transport

Histamine is released by what?

Mast Cells

Also known as the Atlas?

C1 Vertebrae

Also known as the Axis?

C2 Vertebrae

An increase in the actual number of cells in an organ or tissue, usually resulting in an increase in size of the organ or tissue.

Hyperplasia

Decrease in cell size.

Atrophy

When a cell is replaced with another type of cell.

Dysplasia

Increase in cell size.

Hypertrophy

Vision is controlled by what part of the brain?

Occipital Lobe

Also called Cephalgia.

Headache

A point one third along a line drawn from the hip to the umbilicus. The point of maximumm sensitivity in acute appendicitis.

McBurney's Point

Universal blood donor.

O-

Universal blood recipient

AB+

Lower concentration than plasma

Hypotonic

Same concentration as plasma

Isotonic

Greater concentration than plasma

Hypertonic

Chief extracellular cation

Sodium

Chief intracellular cation

Potassium

Gatekeeper of the sodium-potassium pump.

Calcium

Cations are _____.

Positive

Anions are _____.

Negative

Where is the T10 vertebrae located?

Umbilicus

Where is the T4 vertebrae located?

Nipple-line

These vertebrae keep the diaphragm alive?

T3-4-5

This also means the same side as the injury.

Coup

This also means the opposite side of the injury?

Contre Coup

What is the most commonly fractured bone in the body?

Clavicle

This gland secretes chemical substances directly into the blood via ductless gland. It's hormones seep into the bloodstream.

Endocrine Gland

This gland secretes hormones through ducts that flow through tubes to its target.

Exocrine Gland

This is also known as the dual function gland.

Pancreas

Controls the levels of blood calcium by initiating release of calcium from bones into the blood.

Parathyroid

Area low in pH and with a high temperature causes the O2 to fall off the hemoglobin and thus supplies O2 to working muscles which generate heat. Response of hemoglobin to changes in pH.

Bohr Effect

The superior segment of the sternum

Manubrium

Any disease producing agent.

Pathogen

Obligate intracellular parasites. Kill by invading host cells.

Virus

These harm the body by releasing endo/exo toxins.

Bacteria

When pressure is applied to the right upper quandrant of the abdomen in a specific manner to determine the location of gallbladder problems.

Murphy's Sign

Inflammation of the gallbladder.

Cholecystitis

The process of bile breaking down fat.

Emulsification

Where is bile made.

Liver

Chief intracellular buffer.

Phosphate Bicarb

Chief extracellular buffer.

Sodium

The landmark for the 7th cervical vertebrae.

Vertebral Prominence C7

How does a calcium channel blocker work?

HR and BP drops due to relaxation of the muscles in the heart and veins.

Usually described as having a curtain over part of their field of vision?

Detached retina

Blood in the anterior chamber of the eye?

Hyphema

S/S- Painless loss of monocular (one eye) vision.

Renal artery occlusion

Also called yellowing of the eye?

Sclara ictirus

If a patient is unable to gaze up or down with one eye or fails the H-Test what would you suspect?

Orbital Fracture

Triage Tags: Green

Minor. Walking wounded.

Triage Tags: Black

Dead/Dying. No respirations after head tilt.

Triage Tags: Red

Immediate. Resp over 30/pulse (none radial)/ AMS

Triage Tags: Yellow

Delayed. Pulse with good mental status.

Triage Tags: If a Red tagged patient goes into cardiac arrest?

Give him a black tag. Dead.

Function of an EMS commander at the scene?

Command EMS

Where do you park your apparatus at the scene of a chemical spill?

Upwind and uphill, in the cold zone.

When dispatched to a GSW, what is the first step in providing care?

Scene safety

When can you restrain a patient?

When they are a danger to themselves or others.

A major incident is defined as what?

An incident that requires all or more available resources.

Any incident that outstrips the capacity or resources of the agency?

Mass Casualty Indicent

Field commanders role at an MCI?

Command

Talking and recieving information over the radio?

Duplex

Who takes command at an EMS scene?

1st medic on scene

A command system used in large incidents, establish the strategic objectives and priorities and develop a plan to manage the incident?

Unified command system

Who's responsibility is it to assess the incident, establish the strategic objectives and priorities and develop a plan to manage the incident?

Incident command

Protocols, policies, and procedures?

Indirect medical control

What information can you give to a reporter?

Nothing

Most technical part of a rescue?

Extrication/access

Miniature transmitter that picks up radio signals and rebroadcasts them, extending the range of the radio communications system.

Repeater

Device used to change a signal or data into code?

Encoder

A device that does the reverse of an encoder, undoing the encoding so that the origianl information can be retrieved

Decoders

This is the science and technology of automatic measurement and transmission of data by wire, radio, or other means from a remote source as from space vehicle to a recieving station for recording and analysis.

Telemetry

Most hospital communications are received on?

450-470Hz

If you have a patient that is down a steep embankment you need what?

Stokes Basket

This sends messages from a vehicle to the repeater, to the communication center?

Mobile Communications Device

Mild Hypothermia occurs between what body temperature?

90-95 degrees

Severe Hypothermia occurs at what body temperature?

below 90 degrees

In the Hypothermic patient, at what temperature does A-Fib begin?

86 degrees

How many shocks can you give for a Hypothermic patient in V-Fib?

One

Cold injury that presents as white and waxy?

Deep frostbite

Treatment for frostbite?

Passive rewarming

Acute and involuntary muscle pains, usually in lower extremities, abdomen, or both, that occur because of profuse sweating and subsequent sodium losses in sweat?

Heat Cramps

This will present with a bounding pulse turning weak and thready, body temperature over 105 degrees?

Heat Stroke

A female firefighter has been in a working fire on a summer afternoon. She came out unable to speak. Cool clammy skin. Nausea and SOB. Vitals 90/60, HR 130, R 24. What is your treatment?

High Flow O2 IV Monitor Likely suffering from heat exhaustion

An infestation of the skin with the mite (sarcoptes scabei), it spreads rapidley when there is skin to skin contact. They burrow under the skin and often create a rash in the belt line.

Scabies

Where do lice life?

Surface of the skin

What % of rattlesnake bites are dry and no venom is injected?

25%

Disease from ticks. Effects joints and organs. Classic hallmark is a bulls eye bite mark.

Lyme Disease

Who does cyanide kill?

Cellular asphyxiant

Treatment for Cyanide poisoning?

Amyl Nitrate Sodium Nytrite Sodium Theosulfate

Why is Epinephrine good for anaphylaxis?

It dilates the bronchioles and constricts the arteries. Alpha and beta properties.

Phenol must be removed with what?

Solvent (alcohol)

A toxic, colorless crystalline solid with a sweet tarry odor. It is a significant component in the aroma of Islay Scotch Whiskey?

Phenol

Treatment for lye/lime contamination?

Brush off

Treatment for sodium (metal) contamination?

Saturate with oil. | DO NOT use water

Treatment for Organophosphate contamination?

Atropine 2-5mg

Treatment for Gycol/antifreeze contamination?

Sodium Bicarb 1meq/kg and 86% ETOH

Treatment for Methyl Alcohol contamination?

ETOH

Treatment for pediatric organophosphate poisoning?

Atropine .05mg/kg

How do you remove a stinger?

Scrape with a credit card

Treatment for lye inhalation?

Remove to fresh air

Treatment for lye ingestion?

Large quantity of water or milk. Do not induce vomiting.

Treatment for lye skin contact?

Flush skin with water for at least 15 minutes, remove contaminated clothing and shoes.

Treatment for lye in the eye?

Flush eyes with water for 15 minutes, lifting eyelids occasionally.

4 levels of radiation?

Alpha Beta Gamma Neutron

Type of radiation with little penetrating energy and are easily stopped by the skin?

Alpha

Type of radiation that has greater penetration and can travel much further than alpha particles. They can penetrate the skin but can be blocked by simple protective clothing.

Beta

Type of radiation that is very penetrating and easily passes through the body and solid materials?

Gamma

Type of radiation emitted from a strong radiological source, fastest moving and most powerful form of radiation. Easily penetrates through lead and require several feet of concrete to stop them?

Neutron

Hallmark of radiation exposure?

GI disturbances

Classification of mushroom that causes the most poisonings.

Amantia Phalloides

Dose: Epinephrine in cardiac arrest

1:10,000 1mg every 3-5 minutes

Dose: Epinephrine in asthma/anaphylaxis

1:1000 .3-.5mg IM

Dose: Vasopressin in cardiac arrest

40u, one time to replace 1st or 2nd epi

Dose: Amiodarone in V-Fib/V-Tach

300mg IV, then 250mg

Dose: Amiodarone in V-Tach with a pulse

150mg IV given over 10 minutes

Dose: Adenosine in SVT

6mg, 12mg, 12mg

Dose: Atropine in bradycardia or 2nd degree blocks

.5-1mg, max of 3mg

Dose: Lidocaine in PVC's

1-1.5mg/kg up to 3mg/kg

Dose: Magnesium Sulfate in Eclampsia/V-Fib/Torsades.

1-4g IV/IM

Dose: Sodium Bicarb in late cardiac arrest/Tricyclic OD/Acidosis

1meq/kg followed by .5meq/kg every 10 minutes

Dose: Verapmil in SVT refractory to Adenosine

2.5-5mg initially up to 10mg over 30 minutes

Dose: Dopamine in hypotension not from hypovolemia

2-20mcg/kg/min IV infusion

Dose: Aspirin in chest pain, suspected MI

160-324mg PO

Dose: Nitroglycerin in angina, pulmonary edema

1 tab up to 3 times, .4mg SL

Dose: Morphine Sulfate in pain, MI, and pulmonary edema

2-5mg IV up to 10mg for pain relief, 5-15mg IM

Dose: Nalaxone in narcotic OD

1-2mg IV/IM

Dose: Albuterol for asthma, bronchospasm, COPD

2.5mg in 2.5ml NS

Dose: Ipratropium in ashtma, bronchospasm, COPD

500mcg nebulized

Dose: Furosemide in CHF, pulmonary edema

40-80mg IV or double patients current dose

Used as an RSI drug. (Sedative)

Etomidate

Dose: Succinylcholine in RSI to induce paralysis to facilitate intubation.

1-1.5mg/kg

Dose: D50 in hypoglycemia

25mg in 50ml

Dose: Glucagon in hypoglycemia, beta blocker OD

1mg IM

Dose: Diazepam (Valium) inducing amnesia

2-10mg IV/IM

Dose: Lorazepam (Ativan) for seizures

.5-2mg IV

Dose: Oxytocin (Pitocin) for postpartum vaginal bleeding

10-20 units in 500ml D5W IV drip/IM

Dose: Midazolam (Versed) premedication for cardioversion, anxiety, seizures

2-8mg IV

Dose: Diphenhydramine (Benadryl) for allergic reactions

25-50mg IV/IM

Beta 1 specific drug that induces a very strong cardiac reaction. Also known as king beta.

Isoproterenol

Dose: Procanimide used as an antiarrhythmic

20mg/min until arrhythmia is abolished or hypotension. Also if the QRS widens more than 50%. No more than 17mg/kg.

Dose: Bretylium for V-fib/V-Tach

5mg/kg then 10mg/kg for total of 30mg/kg

This drug is used in conjuction with atropine for organophosphate poisoning

Pralidoximine (2pam, protopam)

Early beta blocker given for HTN. Sympathetic blocker.

Propranolol

Most common Tricyclic Anti-Depressant

Amitriptyline (Elavil)

Also known as a potassium sparring diuretic used for edema and HTN

Spironolactone

This drug is a diuretic, causes potassium problems. Used to protect the kidneys from a surplus of potassium caused by other drugs.

Hydrochlorothiazide HCTZ

This drug is an osmotic diuretic, used for cerebral edema.

Mannitol (Osmotrol)

This drug potentiates morphine. Used for nausea and vomiting.

Promethazine (Phenergan)

Dose: Promethazine (Phenergan) for nausea and vomiting.

12.5-25mg IV, commonly given as suppository

Dose: Methylprednisolone (Solu-Medrol) used in anaphylaxis, COPD, and asthma.

125-250mg

Beta 2 sympathomimetic used in asthma.

Isoetharine (Bronkosol)

Sympathomimetic bronchodilator with alpha and beta properties. Also stops contractions.

Terbutaline (Brethine)

3 Ways to ease breathing problems:

1. Dilate bronchioles with a Beta 2 agonist- Albuterol (proventil) or alupent (metaproternolol) 2. Dilate bronchioles with a xanthine bronchodilator- Aminophyline, theophyline. 3. Dilate bronchioles with a parasympathetic blocker- Ipratropium Bromide (atrovent)

Treatment for pulmonary edema.

Nitro Morphine Lasix

Treatment for ACE inhibitor laryngospasms.

Benadryl 25-50mg

Drug of choice for gran-mal seizures.

Diazepam (Versed) 5-10mg IV/IM

What type of drug is Diazepam (Versed)

Benzodiazepine

Will narcan work with benzodiazepine OD?

Lidocaine overdose with present with what symptoms?

Numbness Tingling Seizures

Treatment for Anti-Freeze poisoning.

Sodium Bicarb and 30-60ml of 86% ETOH

Reye's Syndrome is caused by what type of OD?

Aspirin

This vitamin assists in cellular metabolism of sugar.

Thiamine

Alcoholics take thiamine to ward off what syndrome?

Korsikoffs or Wernickes

This disease is treated with Isonizid, Rifampicin, Pyrazinamide, and Ehambutol?

Tuberculosis

What is the fastest way to administer a medication?

What is the slowest way to administer a medication?

This calcium channel blocker is used for PSVT, A-Fib, and A-Flutter. #1 side effect is hypotension.

Verapamil

This drugs most significant side effect is respiratory depression.

Morphine

A dystonic seizure (head fixed to one side, only eye movement) is caused by what type of overdose?

Phenothiozine (Haldol)

A condition characterized by involuntary muscle spasms and twitches of the face and body.

Tardive diskinesia

1 grain = how many mg's?

60mg

How do you dispose of a needle with no sharps container?

One handed method slipping the needle into the sheath

This type of drug causes the body to speed up?

Amphetamines

This type of drug causes the body to slow down?

Barbiturates

Important question to ask if someone took 40 aspirin?

What did you take with it?

Treatment for aspirin overdose?

Sodium Bicarb | Activated charcoal

Patient who has OD'd on aspirin will be in what kind of metabolic disorder?

Metabolic acidosis | Resp. alkalosis

Pupils in heroin OD?

Pinpoint, slow to respond

Pupils in ectasy OD?

Wild eyed

Treatment for cocaine OD?

Supportive care

Disease that causes a decrease in body core temperature?

Myxedemia (hypothyroidism)

Disease that causes an increased tolerance to cold?

Graves disease (hyperthyroidism)

Mass x velocity(squared)

Kinetic energy formula

Gas law that states as a balloon goes up the pressure drops so the balloon expands.

Boyles Law

Gas law that states the amount of gas in a liquid is directly proportional to the pressure of the gasses above.

Henry's Law

Patient with esophageal varicies will also have what other disease?

Cirrhosis

Cause of petechiae?

Meningitis

Also known as "ringing in the ears"

Tinnitis

Symptom of meningitis, the patient cannot extend the leg at the knee when the thigh is flexed?

Kernigs Sign

This is a method for removing waste products such as potassium and urea as well as free water from the blood when the kidneys are in renal failure.

Hemodialysis

A type of cellulitis that involves inflammation of the tissues of the floor of the mouth, under the tongue. Often occurs after an infection of the roots of the teeth or a mouth injury.

Ludwig's Angina

A condition caused by lack of Vitamin C. S/S include tiredness, muscle weakness, joint and muscle aches, rash on the legs, bleeding gums, lack of wounds healing.

Scurvy

An increase in blood pressure within a system of veins. Esophageal varices.

Portal hypertension

Contraindication for nasal intubation.

Not breathing

Where should you palpate with abdominal pain?

Side opposite the pain

Where do you stand when knocking on the door?

Door knob side

When dealing with a mental patient, where should you position yourself?

Close to the door

What is the proper rescue knot?

Figure 8 on a bite

A condition characterized by loss of memory and disorientation associated with chronic alcohol intake and a diet deficient in thiamine.

Wernickes Syndrome

Disease that causes a decrease in body core temperature?

Myxedemia (hypothyroidism)

Disease that causes an increased tolerance to cold?

Graves disease (hyperthyroidism)

Mass x velocity(squared)

Kinetic energy formula

Gas law that states as a balloon goes up the pressure drops so the balloon expands.

Boyles Law

Gas law that states the amount of gas in a liquid is directly proportional to the pressure of the gasses above.

Henry's Law

Patient with esophageal varicies will also have what other disease?

Cirrhosis

Cause of petechiae?

Meningitis

Also known as "ringing in the ears"

Tinnitis

Symptom of meningitis, the patient cannot extend the leg at the knee when the thigh is flexed?

Kernigs Sign

This is a method for removing waste products such as potassium and urea as well as free water from the blood when the kidneys are in renal failure.

Hemodialysis

A type of cellulitis that involves inflammation of the tissues of the floor of the mouth, under the tongue. Often occurs after an infection of the roots of the teeth or a mouth injury.

Ludwig's Angina

A condition caused by lack of Vitamin C. S/S include tiredness, muscle weakness, joint and muscle aches, rash on the legs, bleeding gums, lack of wounds healing.

Scurvy

An increase in blood pressure within a system of veins. Esophageal varices.

Portal hypertension

Contraindication for nasal intubation.

Not breathing

Where should you palpate with abdominal pain?

Side opposite the pain

Where do you stand when knocking on the door?

Door knob side

When dealing with a mental patient, where should you position yourself?

Close to the door

What is the proper rescue knot?

Figure 8 on a bite

A condition characterized by loss of memory and disorientation associated with chronic alcohol intake and a diet deficient in thiamine.

Wernickes Syndrome