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EMT 224 (3) > EMT 224 (3) > Flashcards

EMT 224 (3) Flashcards

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1
Q

Emphysema

A

pathological changes to the lungs, happens over time, permeant enlargement of the air spaces & collapse of the alveoli
reduces the number of alveoli for gas exchange
reduces the elasticity of the remaining alveoli

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2
Q

Chronic Bronchitis

A

condition involving inflammatory changes and excessive mucus production
increase in the number and size of mucus producing glands

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3
Q

Chronic bronchitis is clinically diagnosed by:

A

the presence of cough with sputum production that is present half of time for at least 2 years

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4
Q

Emphysema signs and symptoms:

A 
Thin 
Barrel chest appearance 
Non productive cough
Wheezing and rhonchi
Pink appearance (Pink puffers)
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5
Q

Chronic Bronchitis:

A

Typically overweight
Productive cough w/ sputum
Coarse rhonchi
Chronic cyanosis

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6
Q

Upper Airway includes:

A

Naso
Oro
Laryngopharynx
Larynx

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7
Q

Lower Airway includes:

A

Trachea
Bronchial tree
Alveoli
Lungs

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8
Q

Capnography waveform Phases:

A

1: exhaled air from conducting airways
2. mix of anatomical dead space & alveolar gas (CO2 starts to rise)
3. alveolar gas is exhaled
4. inspiration

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9
Q

Peak Flow Meter:

A

is a measurement of how fast a person can exhale air

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10
Q

Increased hypoxemia and hybercarbia may be indicated by:

A

tachypnea, diaphoresis, cyanosis, confusion, irritability and drowsiness

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11
Q

COPD Pt’s may present with what on ECG’s:

A

Cardiac dysrhythmias or signs of Rt atrial enlargement; tall, peaked T-waves in leads II, III and aVF

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12
Q

Medications for prehospital to relieve bronchospasm and reduced constricted airways are:

A

Beta agonists (levalbuterol, albuterol)

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13
Q

Pulsus paradoxus:

A

abnormal decrease in systolic pressure, drops 10-15 mm Hg during inspiration

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14
Q

Well-known neurotransmitters:

A

Acetylcholine:
Norepinephrine:
Epinephrine:
Dopamine:

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15
Q

Arterial blood supply to the brain comes from the:

A

vertebral arteries and the internal carotid arteries

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16
Q

What vessels feed the frontal lobes of the brain:

A

anterior cerebral arteries

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17
Q

The circle of Willis does what:

A

provides an important safeguard, helps to ensure blood flow to all parts of the brain, in the event of a blockage

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18
Q

Veins that drain blood from the head:

A

venous sinuses

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19
Q

Brain Stem:

A

Medulla
Pons
Midbrain
Site of reticular formation

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20
Q

Cerebrum:

A

Largest part, controls conscious thought

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21
Q

Oxygen and glucose delivery to the brain are controlled by:

A

Cerebral blood flow

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22
Q

Cerebral blood flow is a function of:

A

the cerebral perfusion pressure (CPP) and the resistance of the cerebral vascular bed

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23
Q

How to measure CPP:

A

Inter cranial pressure is subtracted from the Mean arterial pressure (MAP)
MAP = diastolic blood pressure + 1/3 PP (Systolic - Diastolic)

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24
Q

ICP range:

A

10-15 mmHg or

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25
Q

MAP range:

A

70-95 mmHg

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26
Q

CPP range:

A

60-80 mmHg

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27
Q

Vascular tone of the brain is regulated by the:

A

partial pressure of arterial carbon dioxide (PCO2)

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28
Q

Cushing reflex is what:

A

Caused ICP and presents with, progressive hypertension increase of Systolic, Bradycardia, diminished respiratory effort, body is attempting to compensate for decreased cerebral perfusion

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29
Q

If both pupils are dilated and do not react to light, what may be affected:

A

Brain stem, may also occur from severe cerebral anoxia (absence of oxygen)

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30
Q

Kussmaul respiations:

A

abnormally deep and rapid

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31
Q

Cheyenne Stokes respirations:

A

regular period of breathing, followed with equal length of apnea

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32
Q

Late signs of increased ICP:

A

Increased systolic pressure
Widen pulse pressure
decrease in pulse
decrease in respiration

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33
Q

Compression of Cranial Nerve III:

A

Interrupts parasympathetic nerve actions

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34
Q

Coma is:

A

a deep state of unconsciousness, Pt can not be aroused by external stimuli

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35
Q

Two types of comas:

A

structural lesions: destroying the reticular activating system (usually effect one side of the body)

Toxic/metabolic: involve the presence of toxins/ lack of oxygen

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36
Q

AEIOU - TIPS

A 
A - acidosis or alcohol 
E - Epilepsy 
I - Infection 
O - Overdose
U - Uremia (Raised level of urea in blood)

T - trauma
I - Insulin
P - Psychosis
S - Stroke

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37
Q

Cerebral aneurysm:

A

is a weak or thin spot on a blood vessels in the brain that balloons and fills with blood

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38
Q

Eight D’s of Stroke:

A

Detection (Public & EMS)
Dispatch (Public & EMS)
Delivery (Public & EMS)

Door (EMS)
Data 
Decision 
Drug
Disposition
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39
Q

Cincinnati Stroke

A

facial drop, arm drift and speech

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40
Q

Stroke Times:

A
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41
Q

Most important care for stroke Pt:

A

besides life support, identify stroke and rapid transport to appropriate facility

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42
Q

Tonic-clonic seizures:

A

Involve whole body (grand mal seizure)

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43
Q

What can cause death following grand mal seizure:

A

Hypoxia

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44
Q

The tonic phase is:

A

marked by a sequence of extensor muscle tone activity and apnea, last only a few seconds

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45
Q

The Clonic phase:

A

a massive autonomic discharge occurs, resulting in hyperventilation, salivation and tachycardia

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46
Q

Status Epilepticus

A

Aspiration, brain damage and fracture of long bones or spine

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47
Q

Brain abscess:

A

Accumulation of purulent material (pus) surrounded by a capsule within the brain

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48
Q

Confabulation is:

A

inventing stories to fill voids in memory

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49
Q

Alzheimers:

A

nerve cells in cerebral cortex die and the brain substance shrinks

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50
Q

Multiple sclerosis:

A

progressive disease where patches of myelin in the brain are destroyed

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51
Q

Peripheral Neuropathy:

A

refers to diseases that affect the PNS

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52
Q

Types of Spina Bifida:

A

occulta, meningocele, myelomeningocele, encephalocele

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53
Q

Bells Palsy effects which nerve:

A

VII

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54
Q

Islets of Langerhans

A

made up of Alpha, Beta and Delta which secrete hormones

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55
Q

Beta cells produce

A

insulin, a small protein released when blood glucose levels rise

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56
Q

Alpha Cells produce

A

glucagon, protein released when the blood glucose level falls

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57
Q

Delta Cells produce

A

somatostatin, inhibits the secretion of growth hormone TSH

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58
Q

Normal FSBS range:

A

60-120

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59
Q

Carbohydrates metabolism acts as

A

fast energy

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60
Q

Brain is not able to store:

A

Glucose

61
Q

Hypoglycemia S&S:

A 
Progressive irritability 
Altered Mental Status 
Fainting 
Convulsions 
Coma
62
Q

hypoglycemia

A

insulin shock

63
Q

hyperglycemia

A

diabetic ketoacidosis

64
Q

hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

A

acute diabetic decompensation

65
Q

Hyperthyroidism is an:

A

excess of thyroid hormones in the blood, which may result in thyrotoxicosis

66
Q

Most cases of hyperthyroidism occur as a consequence of:

A

toxic diffuse goiter (Graves disease)

67
Q

Hyperthyroid S&S and common medications:

A

warm, flushed skin, fever, agitation, hyperactivity, weight loss

MED’s: lodine, Methimazole (Tapazole), Propylthiouracil (Propacil)

68
Q

Hypothyroid S&S and common medications:

A

Facial edema, JVD, cool skin, hypothermia, coma, weakness, weight gain

MED’s: Levothyroxine (Synthroid), Liothyronine (Cytomel), Liotrix (Euthroid)

69
Q

Graves disease is:

A

hyperthyroid issue, generalized by generalized enlargement of the Goiter gland

70
Q

Genitourinary system refers to two different body systems, they are:

A

Genito refers to genital organs and the reproductive system

Urinary refers to the system responsible for the removal of concentrated urine, and conservation of water

71
Q

Genitourinary system plays a role in:

A 
Regulation of water and electrolytes 
Regulation of the acid-base balance 
Excretion of waste products and foreign chemicals 
Production of red blood cells 
Stimulation of glucose production
72
Q

Kidneys are located:

A

on the posterior abdominal wall behind the peritoneum

superior border reaches the 12 thoracic vertebra

inferior border just above the horizontal plane of the umbilicus

73
Q

Causes of renal failure are classified as:

A

prerenal, intrarenal, and postrenal

74
Q

Prerenal disease occurs:

A

before the kidneys are reached, results from inadequate perfusion of the kidneys

75
Q

Intrarenal disease occurs:

A

results from conditions that damage both kidneys

76
Q

Postrenal disease occurs:

A

blocks the system that collects urine, obstruction to urine flow from both kidneys

77
Q

Acute Renal Failure (ARF) is a clinical syndrome that results from a:

A

sudden, significant decrease in the filtration through the glomeruli

78
Q

ARF leads to a build up of:

A

high levels uremic toxins in the blood

79
Q

ARF occurs when the kidneys are:

A

unable to excrete the daily load of toxins in the urine

80
Q

Pt’s with ARF are divided into two groups based on:

A

the amount of urine excreted in 24 hrs

81
Q

Oliguric

A

Pt’s that excrete less than 500 ml/per day

82
Q

Nonoliguric

A

Pt’s that excrete more than 500 ml/per day

83
Q

Conditions that can cause ARF:

A

Trauma, Shock, Infection, Urinary obstruction and multi-system diseases

84
Q

When kidney function deteriorates, urine output:

A

frequently decreases (oliguria) or completely stops (anuria)

85
Q

Uremia is:

and generally results from:

A

an excess of urea and other nitrogenous wastes in the blood

kidney malfunction

86
Q

Uremia must be recognized and treated early and appropriately, if not it renal dysfunction leads to:

A

Heart failure, volume overload, hyperkalemia, and metabolic acidosis

87
Q

Damaged kidneys are unable to rid the blood of waste products such as:

and may be caused by:

A

urea and creatine

hypovolemia or impaired cardiac output

88
Q

Obstruction of the renal arteries results in:

and causes:

A

decreased blood flow to the kidneys

an increase in renal vascular resistance that effectively shunts blood away from the kidneys

89
Q

A major cause of prerenal ARF in Pt’s with Heart Failure is:

A

dehydration caused by use of diuretics

90
Q

ARF S&S:

A 
Dizziness
Dry Mouth 
Thirst 
Hypotension 
Tachycardia 
Weight Loss
91
Q

ARF treatment goal is to:

A

improve the kidney perfusion and function by treating g the underlying causes

92
Q

Acute Tubular necrosis:

A

death of tubular cells

93
Q

Ischemic causes of Intrarenal ARF are associated with:

and most often the result of:

A

hypo perfusion

hemorrhage, trauma, sepsis and Pt’s undergoing cardiovascular surgery

94
Q

Drugs that can trigger Intrarenal ARF include:

A

Antibiotics, non steroidal anti-inflammatory drugs (NSAIDs), anticancer drugs, radio contrast dyes, alcohol

95
Q

Intrarenal ARF S&S:

A 
Fever
Flank Pain 
Joint Pain 
Headache 
Hypertension 
Confusion 
Seizure 
Oliguria
96
Q

Treatment goal of Intrarenal ARF:

A

restore adequate renal blood flow by resolving the underlying cause and its complication

97
Q

Postrenal ARF S&S:

A

urine retention
distended bladder
gross hematuria
peripheral edema

pain:
lower back
Abdomen 
groin
genitalia
98
Q

Chronic renal failure (CRF) is a:

A

progressive, irreversible systemic disease, that develops over months to years as internal structures of the kidneys are slowly damaged

99
Q

CRF leads to:

and requires:

A

end-stage renal failure

dialysis or kidney transplant

100
Q

In industrialized world, CRF results most often from:

A

systemic diseases (diabetes, hypertension) and autoimmune diseases

101
Q

CRF results in the build up of:

A

fluid and waste products in the body

102
Q

Azotemia is associated with CRF and is:

A

retention of excessive amounts of nitrogenous compounds in the blood

103
Q

CRF may show the following 6 systemic magnifications:

A 
Gastrointestinal 
Cardiopulmonary 
Nervous system
Metabolic or Endocrine
Personality changes 
Signs of uremia
104
Q

Dialysis is:

Usually performed:

A

used to normalize blood chemistry and remove excess fluid in Pt’s with acute chronic renal failure

3x a week, each session may last 4 to 5 hours

105
Q

Two types of dialysis:

A

hemodialysis and peritoneal dialysis

106
Q

Hemodialysis:

A

blood is pumped through a surgically constructed arteriovenous fistula

107
Q

Arteriovenous fistula is an:

and is located:

A

internal anastomosis between an artery and a vein

in the inner aspect of the Pt’s forearm

LESS often may be located in the upper arm or medial aspect the lower extremity

108
Q

Peritoneal dialysis is a:

A

dialysis membrane is the Pt’s own peritoneum

works much slower than hemodialysis

109
Q

A major complication of peritoneal dialysis is:

which usually results when:

A

peritonitis

the proper aseptic technique is not used

110
Q

Problems associated with vascular access of dialysis Pt’s:

A

bleeding from the site of puncture for dialysis, thrombosis, and infection

111
Q

Bleeding from the fistula or graft can be controlled:

Complication:

A

with direct pressure at the site

excessive pressure can cause thrombosis

112
Q

Pseudoaneurysm is a:

Paramedic treatment:

A

dilation resembling an aneurysm that occurs at the site of the graft, can rupture and may cause a large hematoma and hypovolemia

direct pressure on the hematoma and treat for blood loss, rapid transport

113
Q

Pt’s with a surgical anastomosis are instructed to:

A

check periodically for a bruit or “thrill”, which verifies unobstructed circulation

114
Q

Pt has a thrombosis during dialysis:

A

stop dialysis, fluids should be given at alternate site

115
Q

Decreased blood flow is a common trigger for:

and the reason the blood pressure should:

A

thrombosis

not be taken on the arm with vascular access

116
Q

The paramedic should consider what for a dialysis Pt with unexplained fever, malaise

A

vascular access infection

117
Q

Pt’s on dialysis are at risk of hemorrhage due to:

A

regular exposure to anti-coagulants and their decrease in platelet function

118
Q

Most dialysis Pt’s have anemia related to:

which lowers their ability to:

A

decrease in the production of erythropoietin

compensate for blood loss when they have acute hemorrhage

119
Q

How should a paramedic manage a Pt has hemorrhage at the fistula or graft:

Special care should be taken:

A

control the bleeding and immobilize the extremity

to not obstruct the circulation of anastomosis

120
Q

Hypotensive dialysis Pt’s should be managed:

Most respond to what amount of fluid challenge:

A

carefully, so not to cause fluid overload

200 to 300 mL, if no response consider more serious causes

121
Q

Dialysis may cause myocardial ischemia and chest pain, from:

A

episodes of hypotension and mild hypoxemia

122
Q

Most common ischemia rhythm disturbances related to dialysis:

What should the paramedic do if the Pt’s is in the middle of treatment

A

PVC’s

stop procedure and contact medical control

123
Q

Severe hyperkalemia often results from:

A

poor diet regulation and missed dialysis treatments

124
Q

Severe hyperkalemia often presents how:

A

weakness but often are asymptomatic

125
Q

As potassium levels rise, the conduction slows resulting in what on ECG’s:

A

prolonged P-R interval, depressed ST segments and sometimes loss o P-waves

126
Q

Pt in cardiac arrest with renal failure should be suspected of:

Based on the Pt’s Hx, medical direction may recommend:

A

severe hyperkalemia

separate administration of calcium and sodium bicarb during resuscitation

High dose albuterol to reduce the plasma potassium concentration

127
Q

Disequilibrium Syndrome refers to a group of neurological findings that sometimes occur:

A

during or immediately after dialysis

128
Q

Disequilibrium S&S:

A 
are mild
headache
restlessness
nausea
fatigue
129
Q

Disequilibrium syndrome creates an osmotic gradient between the brain and the blood, which causes:

A

water to move into the brain, resulting in cerebral edema and increased intracranial pressure

130
Q

Pt with air embolism should be treated with:

A

High flow O2 and rapid transport, placed on left side in an effort to trap the embolism where it will least likely obstruct blood flow

131
Q

Pre hospital management for Chronic or Acute renal failure:

A

Airway

Vascular access for fluid replacement, medication therapy (diuretics, anti-dysrhythmics, vasopressors)

Meticulous aseptic technique

ECG

Rapid transport to appropriate facility

132
Q

Urinary retention is the:

Caused by:

A

inability to urinate

enlarged prostate, CNS dysfunction, foreign body obstruction

133
Q

Urinary retention can be caused by which drugs:

A

parasympatholytic or anticholinergic agents

134
Q

S&S of Urinary retention:

A

severe abdominal pain associated with urgent need to urinate and a distended bladder

135
Q

Nocturia is:

A

excessive urination at night

136
Q

overflow incontinence is:

A

an overflow of urine from the bladder

137
Q

Prostatic hypertrophy in can cause delirium, especially in:

A

elderly Pt’s

138
Q

UTI’s usually develop first in the:

A

lower urinary tract (urethra or bladder)

139
Q

Upper tract infections often are associated with:

A

kidney infection or abscesses that form in the kidney tissue

140
Q

Lower UTI of the urethra and bladder occurs when:

A

enteric flora (particularly Esherichia coli, normally found in the bowel) enter the opening of the urethra

141
Q

S&S of UTI:

A

painful or difficult urination (dysuria)

urinary frequency

hematuria

cloudy or rust colored urine

flank or suprapubic abdominal pain

fever, chills and malaise (may be present)

142
Q

Pyelonephritis is:

Most often occurs as result:

A

inflammation of the kidney parenchyma (upper urinary tract)

of lower UTI

143
Q

Pyelonephritis is most common in:

A

adult women

144
Q

S&S of Pyelonephritis:

A

usually abrupt

mistaken for lower back strain

flank pain

fever

chills

145
Q

Therapeutic intervention for pyelonephritis consist of:

A

antibiotics, fluid replacement, and sometimes hospitalization

146
Q

Urinary calculi (kidney stones) are:

and are more common in:

A

pathological concretions that originate in the renal pelvis

men than women; most often occur in men between 20-50’s

147
Q

Kidney stones result from:

A

supersaturation of urine with insoluble salts

148
Q

when the level of insoluble salts or uric in the urine is high, the urine lacks:

A

citrate (a chemically that normally inhibits the formation of stones)

EMT 224 (3) (2 decks)

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