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EMRG 1300- Advanced Skills Theory > EMRG 1300- Final Exam Review > Flashcards

EMRG 1300- Final Exam Review Flashcards

1
Q

What are the indications for ALS IV Therapy?

A
  • Actual or potential need for IV med or fluid therapy
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2
Q

What are the conditions for IV cannulation?

A
  • Age= >2 yrs
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3
Q

What are the conditions for 0.9% NaCl fluid bolus?

A
  • Age= >2 yrs
  • SBP= hypotension
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4
Q

What are the contraindications for IV cannulation?

A
  • Suspected fracture proximal to the access site
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5
Q

What is the contraindications for 0.9% NaCl fluid bolus?

A
  • Fluid bolus
  • Pulmonary edema is a sign of fluid overload
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6
Q

What is the tx for 0.9% NaCl maintenance infusion?

A

Age= >2ys to <12 yrs
- Infusion= 15 ml/hr

Age= >12 yrs
- Infusion= 30-60 ml/hr

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7
Q

What is the mandatory patch point for IV therapy?

A
  • Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive pt’s >2 yrs to <12 yrs with suspected DKA
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8
Q

What is the tx for NaCl fluid bolus?

A

Age= >2yrs to <12 yrs
- Infusion: 20 ml/kg
- Reassess every: 100 ml
- Max volume: 2000 ml

Age= >12 yrs
- Infusion: 20 ml/kg
- Reassess every: 250 ml
- Max volume: 2000 ml

  • Max volume of NaCl is lower for pt’s in cardiogenic shock & ROSC
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9
Q

What are the clinical considerations for ALS IV therapy?

A
  • “PCP Assist IV” authorizes a PCP to cannulate an IV at the request and under direct supervision of an ACP
  • Microdrips and/or volume control administration sets should be considered when IV access is indicated for pt’s <12 yrs of age
  • An IV fluid bolus may be considered for a pt who doesn’t meet trauma TOR, where it doesn’t delay transport and should not be prioritized over management of other reversible causes
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10
Q

BLS IV Therapy- A paramedic shall monitor an IV line for a pt who has:

A
  1. An IV line TKVO, as follows:
    a. The flow rate to maintain IV patency for a pt<12 yrs of age is 15ml/hr of any isotonic crystalloid solution
    b. The flow rate to maintain IV patency for pt >12 yrs of age is 30-60 ml/hr of any isotonic crystalloid solution; or
  2. An intravenous line for fluid replacement with,
    a. A max flow rate infused of up to 2 ml/kg/hr to a max of 200 ml/hr
    b. thiamine, multivitamin preparations
    c. Drugs with their level of certification, or
    d. potassium chloride (KCl) for pt’s >18 urs of age, to max of 10mEq in a 250 ml bag
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11
Q

When should use an escorts for IV therapy?

A
  1. Unless within their level of certification, a paramedic shall request a medically responsible escort in the event a pt requires an intravenous:
    a. Is being used for blood (or blood products) administration
    b. Is being used to administer potassium chloride to a pt, who is <18 yrs of age
    c. Is being used to administer a medication (including pre-packaged)
    d. That requires electronic monitoring or uses a pressurized IV fluid infuser, pump, or central venous line; or central venous line; or
    e. For a neonate or pediatric pt <2 yrs of age
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12
Q

BLS IV Therapy, The paramedic shall: (pre-transport)

A
  1. Confirm physicians written IV order with sending facility staff
  2. Determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site
  3. Note condition of IV site prior to transport
  4. Confirm amount of fluid remaining in bag;
  5. Determine amount of fluid required for complete transport time and obtain more fluid if applicable; and
  6. Document all pre-transported IV information on the ACR
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13
Q

BLS IV Therapy- The paramedic shall: (During Transport)

A
  1. Monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required
  2. If the IV becomes dislodged or interstitial, discont the IV flow and remove the catheter with particular attention to aseptic technique; and
  3. Confirm condition of catheter if removed
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14
Q

When should the IV bag be changed?

A

150 mls

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15
Q

What is the purpose of IV therapy?

A
  1. Restore & replace intravascular volume
  2. Administer medications & or emergency pharmacological tx
  3. Maintain venous access in emergency situations
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16
Q

What does PCP Autonomy mean?

A
  • Is authorization for a PCP to independently cannulate an IV according to the IV and fluid therapy MD
  • PCPs authorized in PCP Autonomous IV are authorized to administer IV therapy according to applicable MD
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17
Q

What does PCP Assist mean?

A
  • Authorizes a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP
  • Pt must require a peripheral IV in accordance with indications in the MD
  • PCPs authorized for PCP assist IV are not authorized to administer fluid or medication
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18
Q

What does hypotonic mean?

A
  • Lower solute in the solution then the cell- causes water to go into the cell (NS, LR)
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19
Q

What does hypertonic mean?

A
  • Higher solute in the solution causes water to leave the cell (mannitol)
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20
Q

What does isotonic mean?

A
  • Equal inside and outside the cell
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21
Q

What is the pathophysiology of emphysema?

A
  • Destruction of the alveolar walls which can lead to large, permanently inflamed alveolar air spaces
  • Several factors can contribute to this destruction:
    1. Genetic deficiency of the protein present to inhibit breakdown of elastase during an inflammatory response
    2. Cigarette smoking stimulate the release of elastase
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22
Q

Sign and symptoms of Emphysema

A
  • Dyspnea initially on exertion, then even at rest
  • Hyperventilation with prolonged expiratory phase & accessory muscle use
  • Barrel chest from hyperinflation
  • Tripod positioning to facilitate breathing
  • Fatigue contributes to weight loss
  • Clubbed fingers
  • Increased red blood cells
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23
Q

Pathophysiology of Congestive Heart Failure

A
  • Occurs when the heart is unable to pump sufficient blood to meet the metabolic needs of the body
  • As a result, blood backs up into either the pulmonary circuit, systemic circuit, or both
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24
Q

Pathophysiology Left Sided Heart Failure

A
  • left ventricle is commonly damaged during an MI
  • Left side is unable to pump the blood for pulmonary vessels as a result blood backs up and works its way into the alveoli
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25
Q

Pathophysiology Right Sided Heart Failure

A
  • Usually occurs from left sided heart failure, as blood backs up from the left side and into the lungs, right side has to work harder to pump
  • Eventually right side can’t keep up and it too fails
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26
Q

Pathophysiology of Asthma

A
  • Disease that involve periodic episodes of severe but reversible bronchial obstruction in person with hypersensitive/ hyper responsive airways
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27
Q

With asthma, bronchi and bronchioles respond to the stimuli in 3 ways:

A
  1. Inflammation of the mucosa with edema
  2. Constriction of smooth muscle (bronchoconstriction)
  3. Increased secretions of thick mucus in the passages
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28
Q

What are the s/s of asthma?

A
  • Cough, dyspnea, tightness in the chest
  • Agitation as obstruction increases
  • Wheezes as air passes through narrowed bronchioles
  • Rapid, laboured breathing w accessory muscle use
  • Thick, tenacious mucus coughed up
  • Tachycardia
  • Resp failure- decreased LOC, cyanosis
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29
Q

Pathophysiology of Bronchoconstriction

A
  • The airway becomes narrower, which blocks the flow of air and makes it harder to breathe
  • Airway become inflamed ad lead to s/s of coughing, wheezing, and SOB
  • Ventolin stimulates beta cells which relax smooth muscles in the airways so they can open up
30
Q

Pathophysiology of Bronchitis

A
  • Results in inflammation & obstruction to the bronchi, repeated infections and chronic coughing
  • Clinically diagnosed with a cough w sputum production occurring for at least 3 months of the year for at least 2 consecutive years
31
Q

What are the s/s of bronchitis?

A
  • Constant, productive cough
  • Tachypnea
  • SOB
  • Frequent secretions that are thick
  • Cyanosis and hypoxia
32
Q

What is the patho of chest pain?

A
  • Ischemia is decreased blood supply to the cells- anaerobic metabolism- lactic acid production
  • Localized accumulation of lactic acid irritates and nerve endings
33
Q

What is angina pectoris?

A
  • Occurs when there is a deficiency of O2 fo the heart muscle.
  • Can occur when the heart is working harder than usual and needs more O2 or when blood supply to the myocardium is impaired
34
Q

What is acute myocardial infarction?

A
  • Part of the coronary muscle is deprived of blood flow until that part subsequently dies
  • Most common cause is plaque rupture and thrombus formation
35
Q

How does ASA work?

A
  • Anticlotting
  • Interferes with the production of clotting factor
  • Works by stopping the clotting action on platelets and can slow down the clotting process
36
Q

How does Nitro work?

A
  • Vasodilator that dilates the coronary vasculature
  • Relaxes peripheral vasculature and may reduce after load to reduce the cardiac work load
37
Q

What are the indications of STEMI bypass?

A

Transport to PCI center if the pt meets all of the following:
1. >18 yrs
2. chest pain or equivalent with cardiac ischemia/ MI
3. Time from onset of current episode of pain <12 hrs
4. 12-lead ECG indicates and AMI/ STEMI

38
Q

What are the contraindications of STEMI bypass?

A
  1. CTAS 1 & paramedics is unable to secure airway
  2. 12-lead is consistent w LBBB, paced rhythm, or STEMI imitators
  3. Transport to PCI >60 mins from pt contact
  4. Pt is experiencing a complication requiring PCP diversion
    a. moderate to severe resp distress or CPAP
    b. Hemodynamic instability or SBP <90 mmHg
    c. VSA without ROSC
39
Q

Cardiac arrest management

A
  • Good CPR and the short time to defib is the most important determinant of survival from cardiac arrest
40
Q

What should you limit hands off to?

A
  • Limit hands-off time to less than 10 secs for rhythm analysis
41
Q

What is the airway management during cardiac arrest?

A
  • Begin w OPA & BVM
  • Ensure ETCO2 is applied
  • Introduce advanced airway when possible (extrication)
  • Once advanced airway- compression become asynchronous
42
Q

What are reasons to prioritize an advanced airway?

A
  • Vomit or airway full of secretions
  • Prolonged resus
  • Poor seal w OPA/ BVM
43
Q

What are the joule settings for 24 hrs-8 yrs?

A
  • Initial dose= 2 J/kg
  • Subsequent dose= 4 J/kg
44
Q

What are the joule settings?

A
  • Zoll= 120J, 150J, 200J
  • Lifeppak= 200J, 300J, 360J
45
Q

What are the steps to safely defibrillate?

A
  1. Stop CPR at 2 min interval and check rhythm and confirm no pulse
  2. Once shockable rhythm is confirmed, have compressor resume compressins
  3. Select “energy select” on monitor until you select desired joule settings
  4. Press charge
  5. Monitor will alert and the “shock” button will flash when monitor is ready to defib
  6. Clear the pt- “I’m clear. you’re clear, all clear”
  7. Once clear- press flashing shock button
  8. Immediately resume CPR
46
Q

What are situations you may not run the arrest for 20 mins?

A
  1. Any criteria listed under “primary clinical consideration”- leave after 1 analysis
  2. Refractory v-fib/ v-tach- leave after 3rd consecutive shock
  3. ROSC
  4. Extenuating circumstances
47
Q

What are the indications for a SGA?

A
  • Need for ventilatory assistance or airway control AND
  • Other airway management is ineffective
48
Q

What are the conditions of the SGA?

A
  • Absent gag reflex
49
Q

What are the contraindications for SGA?

A
  • Airway obstructed by a foreign object
  • Known esophageal disease
  • Trauma to oropharynx
  • Caustic ingestion
50
Q

What is tx for SGA?

A
  • Max 2 attempts for an SGA
  • Primary method: ETCO2
  • Secondary: ETCO2 (waveform), chest rise, auscultation
51
Q

What are the conditions of medical TOR?

A
  • Age= >16 yrs
  • LOA= Altered
  • Arrest not witnessed by paramedics
  • No ROSC 20 mins of resus
  • No defib delivered
52
Q

What are the contraindications of a medical TOR?

A
  • Known or reversible cause of the arrest unable to be addressed
  • Pregnancy presumed to be >20 week gestation
  • Suspected hypothermia
  • Airway obstruction
  • Non-opioid drug OD/ toxicology
53
Q

What are the conditions of the trauma TOR?

A
  • Age= >16 yrs
  • LOA= Altered
  • No palpable pulses AND
  • No defib delivered AND
  • Rhythm asystole AND
  • No signs of life at any time since fully extricated OR
  • Signs of life when fully extricated with the closest ED >30 mins transport OR
  • Rhythm PEA with closest ED >30 min transport
54
Q

What are the contraindications of trauma TOR?

A
  • Age= <16 yrs
  • Defib delivered
  • Signs of life at any time since fully extricated medical contact
  • Rhythm PEA and closest ED <30 min transport
  • Pt’s w penetrating trauma to head, neck, or torso and LTH is <30 min transport
55
Q

DNR Standard- what are considered basic/ advanced cardiac life support inventions?

A
  1. Chest compression
  2. Defibs
  3. Artificial ventilations
  4. Insertion OPA, NPA, SGA
  5. Endotracheal intubation
  6. Transcutaneous pacing
  7. Advanced resus drugs
56
Q

What does a DNR document need to have on it?

A
  1. The name of the pt (surname & first name)
  2. A checkbox that have been checked to identify that one of the following conditions has been met;
    a. A current plan of tx exists that reflect the pt’s expressed wish when capable, or consent of the SDM when pt is incapable, that CPR not be included
    b. The physician’s current opinion is that CPR will not benefit the pt and is not part of tx plan, and physician has discussed this with capable pt or the SDM when pt incapable
  3. A checkbox has been checked to identify the professional designation
  4. Printed name of the healthcare
  5. A signature by the appropriate healthcare
  6. The date the form was signed
57
Q

ETCO2 for hyperventilation

A
  • Less than 35 mmHg
58
Q

ETCO2 for hypoventilation

A
  • Greater than 45 mmHg
59
Q

Phase 1 of end tidal waveform

A

A-B= inspiratory baseline (low CO2 as its inspired air)
- B is start of alveolar exhalation

60
Q

Phase 2 of end tidal waveform

A

B-C= exhalation upstroke (dead space mixes with lung gas)

61
Q

Phase 3 of end tidal waveform

A

C-D= continuation of exhalation (gas is all alveolar now, rich in CO2)
- D is the end tidal value peak concentration

62
Q

Phase 4 of end tidal waveform

A

D-E= start of inspiration

63
Q

Hyperventilation- low CO2 levels

A
  • They are blowing off large amounts due to increased rate of breathing
  • Can be caused by: anxiety, bronchospasm, pulmonary embolism
  • Cardiac arrest, hypotension, decreased cardiac output, cold
64
Q

Hypoventilation- High CO2 levels

A
  • They are reading CO2 due to the slow rate of breathing
  • Can be caused by: OD, sedation, intoxication, positictal states, head trauma, stroke, tiring CHF
  • Fever, sepsis, SOB
65
Q

ETCO2 and Cardiac Output

A
  • When cardiac output is normal: ETCO2 measures ventilation
  • When cardiac output is decreases: ETCO2 measures cardiac output
66
Q

Why the sudden spike in ETCO2?

A
  • Large amounts of acidic blood are suddenly returned to the lungs and high amounts of CO2 diffuses into the alveoli
  • This flood of CO2 causes a remarkable sharp rise in the ETCO2 levels to much higher than normal
67
Q

What are the indications of ROSC MD?

A
  • Pt with ROSC after the resus was initiated
68
Q

What are the conditions for ROSC fluid bolus?

A
  • Age= >2 yrs
  • SBP= Hypotension
  • Other= chest auscultation is clear
69
Q

What are the contraindications of ROSC fluid bolus?

A
  • Fluid overload
70
Q

What is the tx for ROSC MD?

A
  • Titrate O2 94-98%
  • Avoid hyperventilation and target ETCO2 to 30-40 mmHg with continuous waveform capnography
71
Q

What is the tx for ROSC fluid bolus? (age= >2 yrs to <12 yrs)

A
  • Infusion: 10 ml/kg
  • Interval: immediate
  • Reassess: 100 ml
  • Max. volume= 1000 ml
72
Q

What is the tx for ROSC fluid bolus? (age= >12 yrs)

A
  • Infusion: 10 ml/kg
  • Interval: immediate
  • Reassess: 250 ml
  • Max. volume: 1000 ml

EMRG 1300- Advanced Skills Theory (5 decks)

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