EMT Exam 2 Flashcards
What to know when giving medication
- Indications
- Contraindications (when you should’t give it)
- Side effects
- Untoward/adverse effects (more harmful and unpredictable compared to side effects)
The six rights with medication
(1) Right patient
(2) Right medication
(3) Right dose
(4) Right time
(5) Right route
(6) Right documentation
TRAMP-ED
- Time
- Route
- Amount
- Medication
- Patient
- Expired
- Documentation
Routes of administration
- Oral (PO)
- Sublingual (SL)
- Inhaled
- Intramuscular (IM)
- Intranasal (IN); Mucosal Atomization Device (MAD)
- Subcutaneous (SubQ)
- Endotracheal (ET)
- Intravenous (IV)
Pharmacodynamics (PD)
Study of effects of meds on the body
Pharmacokinetics (PK)
Study of absorption and elimination in the body; patient specific factors change how a medication is absorbed, works, and is eliminated
Ways fluids/meds can be administered into the vein
- Saline lock (includes catheter and cap/lock that contains the port for administering meds)
- Drip set (includes drip chamber, flow regulator, and drug/needle port)
Aspirin
- Dose: 81mg to 324 mg baby (chewable); 325 mg adult
- Route: Chewed/PO
- MoA: Prevents further aggregation of platelets
- Indications: Cardiac nature chest pain/discomfort
- Contra indications: Asthma (can induce heart attack), recent trauma, GI bleeding, use in children
- Side effects: GI upset, N/V, Heart burn
- Medical command: Not required
Oral Glucose
- Dose: 15 grams (1 single dose tube or 1/3 of tipple dose tube)
- Route: Buccual
- MoA: Increases blood sugar level
- Indications: AMS with a history of DM, with suspected hypoglycemia
- Contra indications: Unable to follow simple commands, Unable to protect airway
- Side effects: Possible hyperglycemia
- Medical command: Not required
- Notes: Protect patient’s airway, may be possible to give to patient with severely AMS and lowered LOC; hypoglycemia is a stroke mimic
Oxygen
- Dose: Nasal Cannula: 0-6lpm; Non-rebreather: 15lpm
- Route: Inhalation
- MoA: Provides increase % of O2 in inhaled air
- Indications: Any patient in respiratory distress or suspected shock
- Contra indications: None for emergency use
- Side effects: Long term. non-humidified use can cause dehydration and nose bleeds
- Medical command: Not required
Activated Charcoal
- Dose: 12.5-25 grams for peds (1/2 to 1bottle); 25-50 grams for adults (1-2 bottles)
- Route: Oral (PO)
- MoA: Binds to ingested particulate
- Indications: Ingestion of poison/toxin with medical command order
- Contra indications: Unable to swallow/protect airway/follow simple commands, ingestion of caustic substance, exposure to toxin/poison via means other than ingestion
- Side effects: Vomiting, black/tar stool a few days after
- Medical command: Must contact prior to administration
- Notes: If vomiting occurs, must repeat dose once
Bronchodilator Inhaler and Albuterol Treatment
- Dose: 1 Rx dose (usually 1 dose is 2 puffs) for inhaler; 2.5mg through handheld nebulizer for albuterol treatment
- Route: Inhalation
- MoA: Causes bronchodilation, allowing air to more easily pass through airway structures; B-2 agonist
- Indications: Respiratory distress with signs of bronchoconstriction, wheezing
- Contra indications: Broncho-constriction not the suspected cause of respiratory distress, patient not alert
- Side effects: Increased HR, anxiety, shaking, nervousness
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: You do not need full set of vitals sins or assessment; the albuterol treatment that is given in a nebulizer is an administered med
Nitroglycerin
- Dose: 0.4 mg (1 spray ro tablet)
- Route: Sublingual
- MoA: Dilated coronary arteries, reducing workload of the heart, thereby reducing O2 command
- Indications: Patients have chest pain as suspect to cardiac issues
- Contraindications: Non-cardiac chest pain, ED drug use in last 24-48 hours, systolic BP <100, recent dosing
- Side Effects: Light headedness, fainting, drop in BP, anxiety, increased HR
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: Must ask all patients (including females) about ED use, must be careful handing drug bs it can be absorbed into skin
Naloxone (Narcan)
- Dose: 2mg
- Route: Intranasal
- MoA: Reverses the effects of narcotics, including depressed level of consciousness and respiratory depression
- Indications: Suspected narcotic overdose, coma of unknown cause
- Contraindications: Patient breathing adequately and able to maintain own airway
- Side Effects: May precipitate withdrawal in patients dependent on narcotics
- Medical Command: Not required
- Notes: Only used to attain adequate respiratory effect
Epinephrine Auto-Injectors
Dose: 0.3 mg for adults; 0.15 for peds
Route: Intramuscular
- MoA: Sympathetic activation, bronchodilation, vasoconstriction
- Indications: Severe allergic reactions with signs of AMS or respiratory compromise
- Contraindications: Mild allergic reaction, none in true emergency setting
- Side Effects: Increased HR, anxiety, shaking, nervousness, headache, numbness in extremities
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: Don’t need full set of vitals/assessment
How many meds interact poorly with grapefruit
85+
Saline lock
Catheter is placed into the vein and lock is place over it; lock contain port for administering meds through IV if needed later
IV Drip Set
Clear plastic tubing connecting fluid bag; three important parts are drip chamber, flow regulator. drug/needle port
Right atrium
Receives blood from veins; pumps to right ventricle
Right ventricle
Pumps blood to lungs
Left Atrium
Receives blood from lungs; pumps to left ventricle
Left Ventricle
Pumps blood through the aorta to the body
Tricuspid
Mitral (Bicuspid)
Pulmonary Valve
Aortic Valve
Circulation of blood in the heart
What is the only ARTERY that carries deoxygenated blood
Pulmonary arteries
What is the only VEIN that brings oxygenated blood to the lungs
Pulmonary veins
Cardiac conduction system
A system of specialized muscle tissue that conducts electrical impulses that stimulate the heart to beat; automatic/involuntary; regulated by cardiac control centers in the brain
Pulse
The outward expression of the heart beating
Blood Pressure
- Heart at work = systole = systolic pressure
- Heart at rest = diastole = diastolic pressure
RBCs
Plasma
WBCs
Platelets
Help with clotting
Acute Coronary Syndrome (ACS)
- AKA cardiac compromise
- Blanket term for any time the heart may not be getting enough oxygen
- Symptoms often mimic non-cardiac conditions
- Treat all patients with ACS-like signs and symptoms as though they are having a heart problem
Common ACS symptoms
- Chest pain is best-known symptom
- The chest pain can be described as crushing, dull, heavy, and squeezing or will be described as only pressure or discomfort; radiates to arms, upper abdomen, and jaw
- Shortness of breath
Associated signs and symptoms of ACS
- Anxiety and feeling of impending doom
- Nausea and pain/discomfort in upper abdomen
- Sweating
- Abnormal pulse
- Abnormal blood pressure
What are the three patient populations that have atypical presentation in ACS
- Women
- Diabetics
- Elderly
Secondary assessment AFTER doing normal primary assessment for cardiac
- Use OPQRST-ASPN to get HPI
- Obtain SAMPLE history
- Take baseline vitals
- ASPN
Focused physical assessment for cardiac
- Look for perfusion (pulse in all extremities, capillary refill) in all extremities
- Lung sounds
- Inspection of chest
- Palpation of chest (rule our pleuritic chest pain)
- JVD
12 Lead EKG
- If trained and authorized to do so, obtain a 12-lead EKG for chest pain
- An EKG is a paper print out that reflects the electrical activity of the heart
- 12-lead tells us about STEMI
What does STEMI (12-lead) stand for
- ST: Segment
- E: Elevation
- M: Myocardial
- I: Infarction
Treatment for true chest pain
- Position of comfort
- O2 if appropriate
- Aspirin
- Nitroglycerin
- Transport to a cardiac center (emergency cath lab)
Coronary Artery Disease
- Underlying condition for MI
- Conditions that narrow or block arteries of heart
- Often result from fatty deposit build-up on inner walls of arteries
- Build-up narrows inner vessel diameter, restricts flow of blood
Types of coronary artery disease
- Thrombus: Blood clot on the inner surface of an artery
- Embolus: Piece of blood clot breaks loose and flows to a smaller artery
- Occlusion: Blockage of a blood vessel; reduced blood supply to myocardium causes emergency in majority of cardiac-related medical emergencies
Aneurysm
Weakened sections of blood vessels begin to dilate (balloon); bursting (rupture) can cause rapid, life-threatening internal bleeding
Electrical Malfunction of the Heart
- Malfunction of heart’s electrical system generally results in dysrhythmia (abnormal rhythm)
- Dysrhythmias include bradycardia, tachycardia, and rhythms that may present when there is no pulse
Mechanical malfunctions of the heart
- Angina pectoris
- Acute MI (AMI)
- Congestive Heart Failure (CHF)
Angina Pectoris
- Type of mechanical malfunction of the heart
- Chest pain caused by insufficient blood flow to the myocardium
- Typically due to narrowed arteries secondary to coronary artery disease
- Pain usually during times of increased myocardial oxygen demand, such as exertion or stress
AMI
- Type of mechanical malfunction of the heart
- Death of a portion of the myocardium due to lack of oxygen
- Coronary artery disease is usually the underlying reason
- Signs and symptoms: Typical ACS
CHF
- Type of mechanical malfunction of the heart
- Inadequate pumping of the heart
- Often leads to excessive fluid build-up in lungs and/or body
- May be brought on by diseased heart valves, hypertension, obstructive pulmonary disease
- Often a complication of AMI
Progression of CHF
- Patient sustains AMI
- Myocardium of left ventricle dies
- Because of damage to left ventricle, blood backs up into pulmonary circulation and lungs
- If untreated, left heart failure commonly causes right heart failure
Signs/symptoms of CHF
Signs:
- Tachycardia
- Dyspnea and cyanosis
- Normal/elevated blood pressure
- Diaphoresis
- Pulmonary edema
Symptoms:
- Anxiety/confusion due to hypoxia
- Pedal edema
- Engorged, pulsating neck veins (late sign)
Adequate Breathing
Breathing is sufficient to support life; signs include:
- No obvious distress
- Ability to speak in full sentences
- Normal color, mental status, and orientation
- Regular respirations/breathing sounds
Inadequate Breathing
Breathing is not sufficient to support life; signs include:
- Abnormal resp, diminished/absent lung sounds, poor tidal volume
What must happen for heart to function
Function of heart if to pump blood:
- Electrical function and mechanical functions must work together
- Electrical stimulation causes muscles to contract
- Pumping muscle requires oxygenated blood
- Without oxygenated blood, pumping fails
Mechanical Failure of the heart
- Loss of normal heart muscle structure
- MI
- Chronic hypertension
- Loss of normal heart valve function
- Direct trauma
- Pulseless electrical activity (PEA) indicates mechanical failure
Asystole
No electrical functional of the heart (flat line); not shockable
Ventricular Tachycardia
Too often; shockable because there is still activity
Ventricular Fibrillation
No pattern; shockable bc there is still activity
Electrical dysfunction of the heart
Sudden cardiac arrest
- Abrupt onset of dysrhythmia
- Acute blunt trauma to the chest causes commotio cordis (has to be very specific; low chance; Damar Hamlin)
- Oxygen levels are relatively normal at beginning
Asphyxial cardiac arrest
- Heart stops pumping due to systemic hypoxia
- Result of low oxygen levels in blood
- Appears with more warning than sudden cardiac arrest
- Quality ventilations are important during CPR; no point in respirations without oxygen
Agonal Respirations
- Occurs breathing occurs as a primal reflex during cardiac arrest
- Small amount of oxygen allows medulla to send impulses to respiratory muscles
- A downward spiral will end in death unless someone intervenes
Effects of cardiac arrest
- Heart fails to pump
- Blood stops moving
- Cells are robbed of essential oxygen and nutrients
- Organs are damaged and eventually fail
- Patient will die if uncorrected
- Goal is to intervene as early as possible
Pediatric cardiac arrest
- Cardiac arrests in children are generally asphyxia in nature
- Caused by choking, shock, or resp problem
- Cardiac arrest in children is usually a predictable outcome after steady and rapid decompensation
Three commonly reported types of Sudden Unexpected Infant Death Syndrome (SUIDS)
Three commonly reported types of SUID:
- Sudden infant death syndrome (SIDS)
- Unknown cause
- Accidental suffocation and strangulation in bed
Typical SUIDS patient
- Cardiac slowdown and sleep apnea
- Eventually will stop breathing and not start again
- Episode will be fatal if infant not reached in time
What to do with SUIDS patient
- Unless there is rigor mortis, provide resuscitation
- Provide emotional support to the parents
Chain of survival (adult/5 elements)
(1) Recognition and activation of the emergency response system
(2) Immediate high-quality CPR
(3) Rapid defibrillation
(4) Basic and advanced EMS
(5) Advanced life support and postarrest care
BLS Assessment
- Check responsiveness
- Call for additional resources
- Check breathing (agonal gasps)
- Check pulse for 5-10 seconds
What to do if patient wakes up/moves after CPR
- Manage airway; avoid hyperventilation
- Keep defibrillator on patient during transport in case patient goes back into arrest
- Reassess pulse every 30 seconds
- Reassess all vitals frequently (at least every 5 minutes)
- Transport
What to do if patient goes back into cardiac arrest
- Stop vehicle and resume CPR
- Analyze rhythm asap
- Deliver shock if indicated
How to treat submersion injury patient in cardiac arrest
- Treat them the same as any other cardiac arrest patient
- Be aggressive with airway management and rescue breathing
- Dry the patient
- Take precautions to make very defibrillation safe for you and your team in water environment
- May need to check pulse for longer for hypothermic patients (30 seconds)
- Only defibrillate one time
When can you terminate resuscitation
Must continue resuscitation once you start until circulation occurs, another rescuer takes over, or until cease resuscitation order from physician/authority is received
How to notify family of unsuccessful resuscitation
- Be straightforward
- Allow family time with deceased patient
- Don’t say you know how they feel
Common poisons
- Meds (PORCH)
- Pesticides
- Plants
- Foods
What is the severity of poison based on
- Nature of poison
- Concentration
- Route of entry
- Duration of exposure
- Patient’s age and health
Routes of entry for poison
- Ingested
- Inhaled
- Absorbed
- Injected
- Radiation (which could be classified as absorbed)
When do children vs adults ingest poison
A child may accidentally eat/drink toxin; an adult may purposefully and accidentally overdose from meds
Assessment for ingested poison
- What substance was involved (look for container; bring it with you)
- When did the exposure occur
- How much was ingested (estimate missing pills with dates)
- Over how long a time (med taken for first time vs chronically)
- What effects has patient experienced
- What interventions have been taken
- Patients weight
Symptoms of food poisoning
Nausea, vomiting, abdominal cramps, diarrhea, fever
Effects of acetaminophen poisoning
- 4-12 hours: Loss of appetite, nausea, vomiting
- 1-2 days: RUQ pain and jaundice
- Antidote should be given within first 12 hours
Signs and symptoms of inhaled poison
- Difficulty breathing
- Chest pain
- Coughing
- Hoarseness
- Headache, confusion, AMS
- Seizures
Assessment for inhaled poisons
- Substance involved
- When did exposure occur
- Over how long did exposure occur
- What inventions taken
- Was patient removed
- Was the area ventilated
- What effects is patient experiencing
Treatment for inhaled poison
- Move patient from unsafe environment
- Open the airway, provide high flow oxygen
- History, physical exam, vital exams
- Transport with all bottles
- Ongoing assessment en route
What is CO, how is CO poisoning caused
- CO is colorless, odorless, tasteless gas created by combustion
- Can be caused by improper venting of fireplaces, portable heaters, generators
Signs and symptoms of CO poisoning
- Headache (band around head)
- Dizziness/nausea
- Breathing difficulty
- Cyanosis
Treatment for CO poisoning
- High flow oxygen is appropriate, but since CO bonds to rbcs more strongly than oxygen, can take several hours/days to “wash” CO from bloodstream
Why is inhaling smoke dangerous
- Smoke from burning materials can contains toxins like CO, ammonia, etc and the substances can irritate skin and eyes, damage lungs, and can progress to respiratory/cardiac arrest
- Burned airway
Signs and symptoms of smoke inhalation
- Difficulty breathing
- Coughing
- Smoky breath smell
- Black (carbon) residue in mouth, nose, or sputum
- Singed nasal or facial hair
Treatment for smoke inhalation
- Move patient to safe area
- Maintain airway; provide high flow oxygen
- Monitor patient closely- airway burns may lead to swelling of airway
Treatment of absorbed poisons
- Assess for immediate life threats
- History, physical exam, vital signs
- Brush off powder, then irrigate
- Irrigate skin and eyes for at least 20 minutes and during transport
- Transport with all containers
- Ongoing assessment en route
What does alcohol abuse affect
Central nervous system
Assessment of alcohol abuse
All patients receive full assessment regardless of suspicion of intoxication
Signs and symptoms of alcohol abuse
- Alcohol on breath
- Unsteady on feet
- Slurred speech
- Flushed, warm
- Nausea/vomiting
- Poor coordination
- Blurred vision
- Confusion/AMS
Delirium Tremens (DTs)
- Abrupt cessation of drinking may cause DTs (alcohol withdrawal)
Signs and symptoms of DTs
- Confusion and restlessness
- Unusual behavior (insanity)
- Hallucinations, hand tremors, sweating
- Seizures
Patient care for alcohol abuse
- Keep suction ready for vomiting
- Stay alert for airway problems
- Monitor vitals signs
- Gather history from patient, bystanders
- Stay alert for seizures
What is substance abuse
- Any chemical substance taken for other than medical reasons
Uppers
Stimulants that affect the nervous system; may be snorted, smoked, or injected (examples are cocaine, amphetamines,etc)
Signs and symptoms of uppers
- Excitement, restlessness
- Increased pulse and respirations
- Sweating
- Hyperthermia
- No sleep for a long time
Downers
Central nervous system depressants (examples are barbiturates, rohypnol (roofies), GHB)
Signs and symptoms of downers
- Sluggishness
- Poor coordination
- Decreased pulse and respirations
What are narcotics
- Used to relieve pain or help with sleep
- Examples are opiates (heroin, codeine, morphine), oxycodone
Signs and symptoms of narcotics
- Lethargy
- Pinpoint pupils
- Cool skin
- Respiratory depression
- Coma
What are hallucinogens
- Create intense state of excitement and distorted perception
- Examples are LSD, PCP, ecstasy
Signs and symptoms for hallucinogens
- Rapid pulse
- Dilated pupils
- Flushed face
- Seeing/hearing things
What are volatile chemicals
- Produce vapors that are inhaled
- Initial “rush” then can act as central nervous system depressant
Signs and symptoms of volatile chemical inhalation
- Dazed/disoriented
- Swollen membranes in nose or mouth
- Numbness/tingling sensation inside head
- Changes in heart rhythm
- May be residue of chemical on face or in bag
Treatment for substance abuse
- Be aware of possible airway problems and respiratory distress
- Provide oxygen and assist respirations as needed
- Treat for shock
- Talk to patient to keep them calm and cooperative
- Perform physical exam
- Look for evidence of injection site (track marks)
How do infectious diseases spread
Via bacteria, viruses, other microbes
How do communicable diseases spread
- Direct contact
- Contact with secretions
Incubation period
The time from exposure to development of the first symptoms when an infection cases illness
Communicable period
The interval when the patient is shedding/releasing infectious material; when the microbe can be potentially transmitted
Factors causing infection and illness after exposure
- Virulence
- Dose
- Route
- Body’s resistance
Sepsis
Life-threatening condition resulting from an abnormal and counterproductive response to infection by the body that causes damage to tissues and organs; the body overreacts and secretes substances that, instead of helping, hurts cells, tissues, and organs
When does septic shock occur
When changes from sepsis results in shock and hypotension that do not respond to intravenous fluids
Stages of sepsis
Infection (local), sepsis (systemic), septic shock (systemic with hypotension)
Infection (local) stage of sepsis
Microbes multiply; the body mounts a normal immune response, usually including increase in wbcs
Sepsis (systemic) stage of sepsis
Body produces lactic acid and other chemicals; the ability to produce wbcs may be limited/exhausted
Septic shock (systemic with hypotension)
Lactic acid and other chemicals accumulate in the bloodstream, causing vasodilation and increased capillary permeability; leads to hypotension
Common causes of sepsis (by location)
- Lungs: pneumonia
- GI Tract: Abdominal surgery, pancreatitis
- Genitourinary Tract: Kidney/prostate infections, urinary catheter
- Skin: Long-term intravenous catheter, tracheostomy, gastrostomy tube, pressure sores
Systemic Inflammatory response syndrome (SIRS) criteria
- Temp: <96.8 deg F, >101 def F
- Heart rate over 90
- Respiratory rate over 20
- Systolic BP lower than 90
- New-onset AMS
Quick sepsis-related organ failure assessment (qSOFA)
- Resembles SIRS criteria
- Doesn’t predict whether someone is septic
- Predicts whether septic patient will have longer to stay in ICU or be more likely to die
- Factors: AMS, resp rate >22, systolic blood pressure <100mmhg
What is chicken pox caused by
Varicella-zoster virus (VZV)
Signs and symptoms of chickenpox
- Starts with vague symptoms resembling cold
- Followed by fever and itchy rash that looks like blisters
How does chickenpox spread
- Direct person-to-person contact
- Airborne from rash on skin or mucous membranes
- Dried scabs don’t spread disease
Treatment and prevention of chickenpox
- Isolation of patients until lesions dry
- Antiviral meds to shorten course of disease and prevent complications
- Vaccination
Measles
Aka rubeola, a highly infectious viral disease
Signs and symptoms of measles
- Starts with fever, cough, eye irritation
- Small white spots on inside of cheek (koplik spots)
- Red-blotchy rash
How is measles spread
It is easily spread via inhaled droplets in air, contact with nose and throat secretions
Treatment for measles
No specific treatment
Measles prevention
Vaccination, quarantine, and hand hygiene
What is mumps caused by
Paramyxovirus
Signs and symptoms of mumps
- Starts with vague symptoms such as muscle aches, loss of appetite, headache
- Progresses to swelling and inflammation of one or both parotids
- Parotitis lasts 7 to 10 days
Transmission of mumps
- Droplets
- Direct contact with saliva
Prevention of mumps
- Vaccination
- Quarantine of patients for 5 days after swelling appears
Hepatitis
General term that means inflammation of liver
Signs and symptoms of hepatitis
- Fever
- Nausea
- Loss of appetite
- Malaise
- Abdominal pain
- Jaundice a few days later
- General worse in older patients
How is hepatitis A spread
- By fecal-oral route
Treatment for hepatitis A
No specific treatment
Prevention of hepatitis A
- Hand hygiene
- Proper food prep
- Vaccination
Treatment for Hepatitis B
No specific treatment
Prevention for hepatitis B
- Vaccination
- Proper decontamination of equipment after a call
Postexposure actions for hepatitis B
- Wash exposure site with soap and water
- See health care provider right away
- Vaccination
- Possible immune globulin injection
Signs and symptoms of hepatitis B
- Nausea
- Vomiting
- Loss of appetite
- Vague abdominal pain
- Progresses to jaundice
- Younger patients have fewer or no symptoms, but much more likely to develop chronic infection
Transmission of hepatitis B
- Blood and any fluid that contains blood
- Semen
- Cerebrospinal fluid
- Amniotic fluid
- Vaginal secretions
- A few other fluids
Signs and symptoms of hepatitis C
- Similar to hepatitis B in many ways
- Nausea
- Vomiting
- Loss of appetite
- Vague abdominal pain
Transmission of hepatitis C
- Bloodborne through shared needles
- Less commonly through sex or childbirth
Is there a hepatitis C vaccine
Several safe med regimens but no vaccine
Prevention of hepatitis C
- Standard precautions
- Proper use and disposal of sharps