final exam Flashcards
1
Q
Dromotropic effect
A
Affects conduction speed in AV node and the rate of electrical impulses in the heart
Positive or negative-positive dromotropy increases conduction velocity (epi stimulation)
Negative dromotropic decreases velocity (vagal stimulation)
2
Q
Zone of coagulation
A
Source of most damage, little to no blood flow
3
Q
Mumps
A
Viral disease with symptoms of fever, swelling/ tenderness of one of the salivary glands (parotid)
Mumps in males past puberty may have inflammation of testicles
Transmitted by droplets or direct contact with saliva
4
Q
Delayed cord clamping
A
Holding baby below level of placenta increases blood volume and decreases probability of anemia
Clamp cord when it’s done pulsating (2 min mark), 15cm from neonates’ abdomen and then 5-7cm from first clamp
5
Q
Stage 1 of labour
A
Dilation and effacement
Broken further into two parts: early labor and active labor
Longest of three stages
Uterine contractions gradually increase in frequency, strength, and length, fetus descends into the pelvis, cervix softens/ shortens/ thins/ dilates until full dilation of 10cm
6
Q
Identical twins
A
One egg is released from ovary and fertilized by one sperm:
- Embryo splits then implants in the womb causing separate placentas and separate inner sacs
- Embryo implants in womb and then splits causing a shared placenta and separate inner sacs
- Embryo implants in womb and splits later causing a shared placenta and shared inner sac
7
Q
Main causes of post-partum hemorrhage
A
Tone- exhausted uterus that cannot contract
Tissue- parts of placenta still retained and clotting is compromised
Trauma- uterine rupture/lac during delivery
Thrombin- coagulation abnormalities
8
Q
Schizophrenia
A
Condition where reality is interpreted abnormally
Risk factors: family hx, pregnancy/birth complications, taking mind-altering drugs during teen years
Onset: late teens
9
Q
Common insulins
A
Insulin Aspart (Novolog), Insulin Lispro (Humalog), Humulin, Levemir, Insulin Glargine (Lantus)
10
Q
Depression
A
Mood disorder causing a persistent feeling of sadness and loss of interest
Onset during late teens to mid 20s
Signs of depression: suicidal tendency, anxiety, hopelessness, mood swings, change in body weight, uncontrollable emotions, feeling low, insomnia
11
Q
Phases of normal delivery
A
Decent- fetus moves down toward pelvis and becomes engaged
Flexion- fetal chin to chest
Internal rotation- fetal occiput turns down toward the maternal pelvis
Extension- birth with head facing down
Restitution- babys head rotates to the side
External rotation- fetus turns to deliver shoulder
Expulsion- birth of baby
12
Q
Foramen ovale
A
Shunt (opening in septum) allowing blood to travel from right atrium to the left atrium
13
Q
cold zone in CBRNE
A
patients in a cold zone will be decontaminated and where medics operate
14
Q
how far do you stay away from a CBRNE accident
A
1 km, upwind
15
Q
Laxatives
A
Used to relieve constipation by using an enzyme that swells in the presence of liquid causing
sensation of the bowels being full causing expulsion
Cause bloating, gas, abdominal cramps, nausea, constipation
16
Q
Renal changes in pregnancy
A
Dilated renal pelvis and ureters, increased renal plasma flow, increased GFR (glomerular filtration rate), increased creatinine clearance
17
Q
What is the leading cause of death among children >1 years
A
Trauma by MVC, falls, submersions
18
Q
Superficial frostbite
A
Waxy white skin, cold numb area becomes painful during rewarming, edema and blistering
occur, eschar forms and peels away leaving red shiny skin
19
Q
Proton pump inhibitors
A
Decrease gastric acid levels by interfering with the final step in gastric acid production
Designed to be slow released
20
Q
Common hypothyroid meds
A
Levothyroxine (Synthroid)
21
Q
External bimanual uterine compression
A
Can be started without delivery of placenta
Squeeze symphysis pubis and fundus together for 5-10 min until bleeding stops
22
Q
Short acting beta agonist
A
Relievers/ rescue medications that provide short term rapid relief of asthma symptoms by
reversing bronchospasm and open the airways
Acts on B2 cells of the smooth muscle in the airways to relax bronchial smooth muscle
23
Q
Neonatal complications of shoulder dystocia
A
Clavicle fracture, fetal acidosis, humeral fracture, brachial plexus palsy (transient/permanent hypoxic brain injury), death
24
Q
Shoulder dystocia
A
Impaction of anterior shoulder against the symphysis pubis after delivery of the head or posterior shoulder impacted against sacral promontory
25
Cold water drowning
Activates mammalian diving reflex causing bradycardia, peripheral vasoconstriction, reuced
oxygen demand
26
AV graft
Made when veins are not suitable for a fistula
Form of vascular access created by inserting a synthetic tube to connect a vein to an artery in the arm
27
What is the suffix for beta blockers
“LOL”
28
Boyles law
At a constant temperature, volume of gas is inversely proportional to its pressure
The pressure of gas increases as its volume decreases assuming constant mass and temperature
29
Hyperthyroid meds
Works by depleting excess thyroid hormones and measured by TSH
30
What is the suffix of ACE inhibitors
“Pril”- can also be ezetimibe (vytorin)
31
thyroid hormones in thermogenesis
releases hormones to increase metabolic rate in cells activating brown fat
containing mitochondria to burn fat and produce heat
32
Deep partial thickness
Extends to dermis, damages hair follicles and sweat/ sebaceous glands
33
What are the positions a mother should be placed in if there is a cord prolapse
Knee-chest, exaggerated Sims
34
Heat stroke temperature threshold
Most dangerous heat related condition with a core temp of 40 celcius or higher
35
Sedatives- hypnotics
Affect CNS (brain/ spinal cord) and have a relaxing, calming effect
Main groups include: benzodiazipines, barbiruates, hypnoitics (norbenzodiazpinies)
36
Oral diabetic medication
Effective for type II diabetes by stimulating insulin release from pancreatic beta cells
Also decrease glycogenosis- process of converting glycogen to glucose
37
Post delivery system- temperature regulation
Risk of hypothermia due to large surface area and immature regulation and little fat so compensates with vasoconstriction and an increased metabolism
38
Decompression sickness (the bends)
Nitrogen is compressed in tissues/blood from increase pressure then turns back into a gas when
surfacing (henrys law) because it cannot be exhaled fast enough
Can cause joint pain, affect the spinal cord, embolism/ CVA type symptoms
Can occur 1-36 hours after a dive
39
Bronchiolitis
Caused by respiratory viruses but most with respiratory syncytial virus
Differentiate from asthma as it proceeds a viral infection and associated with fever
40
Radiation burns
Types of ionizing radiation: alpha (mild), beta (moderate), gamma (severe- accounts for most of
major injury)
Severity is based on amount of radiation and time spent during exposure
41
Insulin
Used for all types of diabetes but sole drug in type I and added to oral therapy in type II
Needs to be IM (protein) so PO would be absorbed by GI tract and stomach acid
Can be rapid-acting, short-acting, intermediate acting, and long-acting forms
42
Peritoneal dialysis
Kidney failure that uses lining of abdomen to filter blood inside the body causing excess water/ waste to pass from blood to peritoneum into dialysis fluid to be drained and discarded
43
Post delivery system- ventilation
Fluid is forced from neonates' lungs to nose/mouth due to compression during delivery, so lungs inflate establishing functional residual capacity within lungs and allows gas exchange to occur
44
Childbearing years are considered
14years- 50 years
45
Maternal risk factors of pregnancy
Older then 35 and younger than 20, smoking, alcohol, twins/ triplets/ etc., history of miscarriage, obesity, anorexia
46
Methicillin-resistant staphylococcus aureus (MRSA)
Resistant to penicillin and other antibiotics
Transmitted through unwashed hands- risk increased by antibiotic therapy, prolonged hospital
stays, exposure to infected patients
Incubation period is 5-45 days and communicable period varies
In community acquired cases it results in soft tissue damages- most infections clear following
incision and drainage alone
47
Ductus arteriosus
Artery that joins pulmonary system directly to aorta
48
Steroids
Anti-inflammatory drugs that reduce infiltration of mediators of the inflammatory response in
airway cells and reduce creation of proinflammatory substances (prostaglandins, leukotriene,
macrophages)
49
Opioids
Opioids bind to receptors found at base of spinal cord, brainstem, thalamus, hypothalamus, and limbic system resulting in decreased painful sensations
Can be opioids agonists and antagonists
50
Compensatory mechanism of hypothermia
Body attempts to compensate with thermogenesis and shivering occurs until 32 Celsius which
after it stops, and hypothermia progresses rapidly
51
Oxygenated/deoxygenated blood in neonates
Oxygenated blood passes via umbilical vein to fetus and deoxygenated blood is carried out via 2 umbilical arteries
52
Primary apnea
Absence of spontaneous respirations after birth, often self-limiting/reversed with minimal resuscitation efforts
53
LVAD
Implantable pump assissting ventricles with patients that have advanced heart failure
Can be pulsatile (pulse similar to human heart) or non-pulsatile (no pulse)
Pump problems are uncommon so treat underlying cause
Mental status, skin color, end tidal, cap refill to assess perfusion
54
Sympathomimetics
Drugs that mimic or enhance actions of andogenous catcholamines of the sympathetic nervous
system
Directly activate adrenergic receptors or indirectly activate by increasing norepi and epi
Naturally occuring catecholamines: dopamine, norepi, epi
55
Bipolar disorder
Extreme mood swings that include emotional highs (mania/ hypomania) and lows (depression)
Biological tendencies: physical changes in the brain
Genetics: more common in people with first degree relatives with the condition
Risk factors: first degree relative, periods of high stress, drug/alcohol abuse
Onset: 25 years
56
Hypothermia
Caused by exposure to cold leading to a body temp of <35 Celsius
57
Placenta previa
When placenta partially/fully covers the cervix
Occurs when blastocyte implants to close to the cervix- unable to deliver baby vaginally
58
Carboxyhemoglobin levels- 80%
Immediately fatal
59
Ectopic pregnancy
Fertilized egg implants outside the uterus in the fallopian tubes, abdominal cavity, or low in the cervix
Diagnosed <12 weeks, often at 6 weeks
One of the most dangerous 1st trimester complications
60
Where should the fetal SPO2 be placed
Right hand (accurate reading), if on left hand or lower limbs it will have lower saturation due to being mixed with poorly oxygenated blood that was shunt
61
Amniotic fluid embolism
Amniotic fluid/ fetal cells/ hair enters maternal pulmonary circulation causing cardiovascular collapse
Occurs in labor or 30 min after delivery
62
Common short acting beta agonists
Ventolin (Albuterol), Levalbuterol (Xopenex), Ipratropium (Atrovent), Spriva, Albuterol/Ipratropium (Combivent)
63
Tuberculosis
Communicable when active lesion develops in the lungs and bacteria are expelled into air by coughing- transmitted by airborne droplets
signs and symptoms
Persistent cough for >3 weeks and night sweats, headache, fever, fatigue, weight loss, hemopytis,
hoarseness, chest pain
64
Surface area of burns
Rule of nines: divides body into 11 sections worth 9% each, final 1% is genetalia
Rule of palms: pts palm is equal to 1% of TSBA- helpful when burn is >10% TBSA or
irregularly shaped
How much TBSA burns are fatal
Burns over 70% of the TBSA are usually fatal
Burn and radiation that together affect >30% of the TBSA are probably fatal
65
chronotropic effects
changes heart rate
66
HIV
Bloodborne and transmitted from mother to infant in birth or donated blood
Pathogen envelops infected cells and attacks immune system and body organs- communicable
period unknown
Believes to span from onset of infection throughout life
67
APGAR- A (second A)
Appearance: 0- blue, pale, 1- body pink, extremities blue, 2- completely pink
68
Kawasaki disease
Acute febrile illness with unknown etiology that affects <5 years of age
69
Common H2 inhibitors
Pepcid, Ranitidine (Zantac)
70
Fraternal twins
Two eggs are released, and each egg is fertilized by separate sperm causing each embryo to implant in womb separately- separate placentas and separate inner sacs
71
Preeclampsia
Hypertensive disorder that occurs after 20 weeks, can also develop up to 10 weeks after delivery
72
Opioids toxicology
Large impact of chemoreceptors that maintain instinct to breathe by making them less sensitive
there is an increase in PCO2 leading to hypoventilation causing decreased LOA and possible
death
Naloxone is the antidote as it is an opioid antagonist competing and displacing opioids at their
receptor sites
73
NSAIDS
Anti-inflammatory, analgesic, antipyretic properties
Reduces production of prostaglandins
Cox-1 and COX-2 are main enzymes that create prostaglandins
74
APGAR-R
Respiration: 0- absent, 1- slow, irregular, 2- vigorous cry
75
Hypoglycemia
Risk factors are apnea, pre/eclampsia, smaller babies/twins
Presents with seizure, pale skin, poor tone, lethargy, apnea
76
Abruptio placenta
Partial/full detachment of placenta at 20 weeks when vascular structures are torn away from uterine lining
Significant bleeding or can present as vaginal bleeding
Leading cause of maternal (5-8%) /perinatal (10%) deaths
77
Risk factors of preeclampsia
History of preeclampsia/ family history, first pregnancy, diabetes, lupus, high blood pressure, kidney disease, obesity (BMI >30), twins/triplets/etc., age (<18/>35)
78
chemotherapy <7 days ago
PPE: non-permeable gown, booties, double gloves, N95, face mask
If contanimated must use special wipes to inactivate cytotoxins
79
Cord prolapse
Umbilical cord proceeds neonate through cervix causing it to become compressed by following neonate
Leads to fetal hypoxia or death secondary to cord compression between fetus and pelvis/ uterine wall
80
Causes of ectopic pregnancy
Swollen tube, pelvic inflammatory disease, IUD, previous ectopic pregnancy, advanced maternal age, tobacco
81
Secondary apnea
Apnea that exceeds 20 seconds and occurs from difficult labor, airway obstruction, hypoglycemia, respiratory muscle weakness, narcotics/ CNS depressants
82
What is preferential streaming
Cardiovascular system is adapted to ensure the most highly oxygenated blood is delivered to myocardium and brain
83
Dementia
Loss of cognitive functioning that interferes with persons daily life/ activities
Risk factors: smoking, high blood pressure, diabetes, obesity, lack of physical activity, poor diet, high alcohol consumption, low levels of cognitive engagement
84
Reduced hormonal activity in thermolysis
decrease in demand from thyroid and adrenal glands helps reduce
heat production
85
Thermolysis
Release of stored heat through the parasympathetic nervous system
86
Anticholingeric- dry patient
Block action of acetlycholine by blocking nicotinic and muscarinic receptors
Available via substances: TCAs, antipsychotics (quetiapine), cold/ sleep medications/..;
(antihistamines), scopolamine, gravol, jimson weed, atropine
87
Airway differences in pediatrics
Tongue is larger in proportion to mouth, pharynx is smaller, epiglottis is larger and superior, larynx is more anterior and superior (C3-C4) and narrowest at cricoid, trachea narrow and less rigid
Nasal passages easily blocked by secretions
88
What is the suffix for calcium channel blockers
“Ine”
89
Common epilepsy medications
Dilantin, valproic acid, lamotrigine, carbamazepine, levetiracetam
90
Post delivery system- hemodynamics
Pulmonary vascular resistance decreases as lungs are functioning and blood flow increases causing oxygen to be carried throughout the body
91
Antihyperlipidemic agents
Excessive buildup of fats in the system can cause strokes and MIs
HDL= good and LDL= bad
Used to lower the amount of LDL in the system by assisting back to the liver for removal
92
Common antipsychotics
Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Aripiprazole (Abilify)
93
Heat cramps cause
Imbalance between sodium and water loss during prolonged exertion in hot environments
94
General changes of pregnancy
Weight gain, increased BMR, increased water retention, decreased serum Na, K, CA levels
95
Hypothyroid drugs
Stimulates release of TSH and mimic natural actions of the thyroid hormones replaced by the
body
96
Deep frostbite
Cold hard skin affecting deeper tissue layers, perfusion is not stored leading to nonviable skin,
skin may mummify and amputation if required
97
Maternal complications of shoulder dystocia
Soft tissue injuries, anal sphincter damage, cervical/vaginal tears, uterine rupture, PPH
98
Anxiety
Persistent worry that interferes with daily activities
Traumatic events, inherited traits, underlying health issues, and medication side effects can trigger anxiety
99
Pulmonary stenosis
Pulmonary valve is too narrow/stiff affecting blood moving from heart to pulmonary artery
100
Fourth degree burns
Destroying skin plus bone tissue and tendons
101
periphreal vasodilation in thermolysis
blood vessels widen alowing heat release leading to diaphoresis to cool
the body
102
Evaporation in environmental emergencies
Conversion of liquid to gas
103
Parkland burns formula (consensus formula)
Amount of fluid needed in 1st 24 hours
4ml solution x body weight (kg) x % of body surface area burned
Half in first 8 hours and second half given over next 16 hours
104
Radiation in environmental emergencies
Transfer of heat via electromagnetic waves
105
Partial-thickness burn- 2nd degree
Epidermis and dermis, painful and often caused by hot liquids, steam, or grease
106
vasoconstriction in thermogenesis
blood shunted from peripheries to the core resulting in piloerection and upright
hair traps more air increasing insulation and limiting sweating
107
Thiazide diuretics
Inhibits NaCl reabsorption into distal convoluted tubule of the kidney- happens through
suppression of NaCl cotransporter
Used to treat HTN, heart failure, kidney failure or diabetes
108
Braxton hicks' contractions
False-labor pains that are uterine contractions that are not felt until the 2nd/3rd trimester.
Body's way of preparing for labor, not indicating that labor has begun
109
Beta blockers
Reduce 02 demand of the heart muscle
Affect beta 1 (cardiac stimulation) and beta 2 (bronchial relaxation) cells
Blocks effects of epi/ norepi to reduce HR and dilated blood vessels reducing BP
110
Fenestrated cannula
Small hole in the cannula allowing increased airflow to the upper airway allowing pt to talk
111
Hemodialysis
Process using man-made membrane to remove wastes from the blood to restore proper balance of electrolytes and eliminate extra fluid from the body
112
Lice
Small insects that live in hair and feed on blood through the skin
Pubic/crab lice are transmitted through intimate or physical contact and communicable period is
over when all lice eggs are destroyed
113
APGAR- G
Grimace (reflex irritability): 0- flaccid, 1- some flexion of extremities, 2- active motion (sneeze/ cough/ pull away)
114
Ectopic pregnancy definition
Any egg that attaches outside the uteruses, usually in fallopian tubes
115
Common opioids
Morphine, Hydromorphone (Dilaudid), Oxycodone, Fentanyl, Hydrocodone (Vicodin), Codeine, Tramadol (Ultram), Percocet
116
Pediatric hearts
Myocardium is less contractile making ventricles are less compliant and less tension during contraction
Cardiac output is rate dependent
Vagal sympathetic tone is most dominant- more prone to bradycardias
117
Viral hepatitis
Inflammation of the liver caused by a virus with 6 distinct forms
All present with same signs and symptoms
A and E are not blood borne infections (fecal oral)
118
Health conditions that complicate pregnancy
Diabetes, cancer, high blood pressure, STIs, kidney problems, epilepsy, anemia
119
Thermogenesis
Production of heat through sympathetic nervous system
120
Superficial burn- 1st degree
Epidermis only, skin is red and painful
121
Full- thickness burn- 3rd degree
All layers of skin destroyed, skin is white/ pale, brown/ leathery, or charred
No pain sensation and usually requires skin grafting
122
Precipitous labor
Delivery of a baby within 3 hours of regular contractions that can increase risk of perineal lacerations and postpartum hemorrhage from uterine atony
123
Carbon monoxide poisoning
Should be considered when a group of people in same place have nausea/ headahe
Dont expect cherry red appearance
CO displaces O2 in alveoli and hemoglobin due to binding to receptor sites 250x easier then O2
124
Contaminated water impact
Pollution increases risk of pulmonary infections
Antibiotics may be necessary to prevent infections
125
Meningitis
Inflammation of the meninges caused by bacteria, viral, or other microorganisms
Presents with fever, decreased LOA, projectile vomiting from increased ICP, petechial rash, headache, or nuchal rigidity (stiff neck)
Can progress to seizure, come, death, or permanent disability
126
Acute respiratory distress syndrome
Process impacting alveoli/capillaries causing increased capillary permeability leading to non-
cardiogenic pulmonary edema that transitions to atelectasis, decreased lung capacity,
ventilation/perfusion mismatch and hypoxia
127
Brudzinski sign
Involuntary flexion of the arm, hip, knee when neck is flexed
128
Henrys law
At constant temperature the amount of gas dissolved in a liquid is proportional to the partial
pressure of gas above the liquid
129
Nitrates
Oldest class of drugs to treat angina
Dilates blood vessels and increase O2 supply to the heart by relaxing and dilating medium-large
coronary arteries and veins and reduces fluid backup in ventricles to reduce cardiac workload
130
Early labor
Mild irregular contractions with unpredictable length that can occur over a few days
Initial cervical changes occur including effacement and dilation up to 3-4cm, bloody show, SROM
131
Pediatric blood volume
~800ml of blood
Great ability to compensate by constricting peripheral vasculature= increase of systemic vascular resistance (maintaining a BP and an increased heart rate)
132
Antinausea
Goal is to block nausea sensation in the brain or reduce the cause of the nausea
Nausea is often caused from serotonin (used to expel what is in the system- out)
133
Gastroenteritis
Stomach flu that has many types of infections/ irritations of GI tract
Causes nausea, vomiting, fever, abdominal cramps, diarrhea
134
Risk factors of amniotic fluid embolism
Advanced age, expecting multiples, fetal distress, issues with placenta, preeclampsia/ eclampsia, polyhydramnios, cervical tears, labor induction medications/procedures, c-section delivery, operative assisted deliveries
135
What is CBRNE
Chemical, Biological, Radiological, Nuclear, Explosive
136
Loop diuretics
Inhibit Na/K/Cl transport proteins in loop of Henle causing a reduction in reabsorption of sodium
increasing diuresis
May lose too much potassium so may be on supplements of K
137
Ductus venosus
Continuation of umbilical vein which bypassess blood from the liver and connects unblilcal vein to inferior vena cava
138
Behavioral emergencies
Abnormal behavior that threatens a person's health and safety or the health and safety of another
139
Viral hemorrhagic fevers
Ebola, rift valley, hantavirus, Crimean Congo, and Marburg
Spread to others via direct contact with blood or body fluids.
140
Superficial partial thickness
skin is red and involves blisters or moisture present, painful, will heal spontaneously but may
scar
141
Calcium channel blockers
Relax smooth muscle to decrease peripheral resistance
Used to treat hypertension
2 types: 1 localizes smooth muscle and 2 decrease cardiac workload, HR and contractions
142
cytotoxic drugs
detrimental to cells within the body that are present in body fluids up to 7 days
143
AIDS
Patient is vulnerable to numerous bacterial, viral, and fungal infections
Infections include pneumonia in infants and compromised immune systems, loss of vision due to
cytomegalovirus, reddish/purple skin lesions, atypical TB, cryptococcal meningitis
144
Patent ductus arteriosus
Connection between aorta and pulmonary artery does not close properly after birth leaving an opening for blood to flow when it shouldn't
Small openings may close on their own
145
What is the suffix for proton pump inhibitors
“Zole”
146
What is the suffix for cholesterol medication
“Statin”
147
Croup
Swelling of the trachea, larynx, and bronchi causing respiratory distress and a barking cough
Parainfluenza
Epiglottitis
Inflammatory condition of epiglottis leading to near/complete airway obstruction
Presents with drooling, dysphagia, distress
148
Active labor
Strong regular contractions with a progressive dilation to 10cm that do not stop until birth occurs often accompanied with bloody show, SROM may not occur
149
MR SOPA
M- mask- good seal
R- respiration airway to mouth using manual maneuvers (sniffing position)
S- suction mouth/nose
O- open mouth using manual maneuvers
P- increase pressure to achieve chest rise
A- alternate airway
150
Smoke inhalation
Contains many toxic chemicals
Majority of deaths are from inhalation of toxic gases, upper airway compromise, pulmonary
injury
Inhalation can cause thermal burns to airway, hypoxia, tissue damage/toxic effects caused by
chemicals in smoke
151
Histamine 2 inhibitors
Histamine stimulates the release of acid and pepsin in the stomach, but this medication inhibits
that response
152
Atrial septal defects
Hole in the wall of the heart between left/right atria causing blood to flow from left atrium and mix with right atrium
Hole may close on its own as the heart grows during childhood
153
air embolism in drowning
Gas expands causing tissue damage and forcing air into circulation- either arterial or pulmonary
circulation and multiple bubbles or varying sizes can impact cerebral, cardiac, or pulmonary
blood flow
154
Common oral diabetics
Metformin (Glucophage), Januvia (Sitagliptin), Glyburide (Glynase), Sitagliptin/Metformin (Janumet)
155
Saltwater impact
Osmolarity similar to blood so hemolysis is unlikely
156
Types of diuretics
Thiazide (hydrochlorothiazide), loop (lasix, furosemide), potassium-sparing (spironolactone), osmotic (mannitol), carbonic anhydrase inhibitor (acetazolamide)
157
Burn shock
Hypovolemis shock (fluid loss) and distributed shock (fluid shift)
158
What happens to the heart and lungs during a baby's first breath
Surface tension on alveoli collapses and opens alveoli for spontaneous oxygenation
Pulmonary resistance decreases and blood flow from placenta stops
Pressure on the right side of the heart becomes greater than the left when fetus is in utero
Pressure in the aorta causes the left side of the heart to increase systemic vascular resistance causing the fetal shunt to close within first few hours
159
Simple congenital heart defects
Atrial/ventricular septal defects, patent ductus arteriosus, pulmonary stenosis
May get better without surgery
160
Antipsychotics
Blocks levels of dopamine being secreted and absorbed by the body at medulla, brainstem, and hypothalamus point
Cross blood brain barrier
Accompanied by sedative effects- confusion, decreased ability to regulate body temp, weight gain
161
What are the classes of antiarrhythmics
Sodium channel blockers, beta-blockers, potassium channel blocker, calcium channel blocker
162
Chickenpox
Varicella, highly contagious producing fever, photosensitivity, and vesicular rash that gradually
crusts over leaving scabs
Can lead to herpes zoster (shingles)
Transmission by direct contact or droplet spead of respiratory secretions
163
Complex congenital heart defects
Can cause life-threatening symptoms requiring immediate treatment
Tetralogy of fallot
164
Full term pregnancy
37-42 weeks
165
Heat syncope cause
Hypovolemia from volume depletion and vasodilation
Pathophysiology of heat syncope
Orthostatic hypotension leads to decreases brain perfusion resulting in LOC
166
Excited delirium
Acute onset of agitation, aggression, distress, and possibly sudden death
Associated with drugs that alter dopamine processing and hyperthermia- meth and cocaine
Believed to be from acidosis, rhabdomyolysis and hyperkalemia
S&S: aggression, panic, screaming, increase pain tolerance, unexpected physical strength, tachypnea, diaphoresis, inappropriate clothing, reflection attraction
167
Scabies
Transmission is skin on skin contact and is communicable until mites and eggs are destroyed by
treatment
168
Kernigs sign
Loss of ability to flex leg when supine or sitting
169
Zone of hyperemia
Least affected area, cells typically recover in 7-10 days
170
Gestational diabetes signs and symptoms
Increased thirst, frequent urination, nausea, fatigue, sugar in urine, frequent bladder/skin infections, yeast infections, blurred vision, dry mouth
171
What systems change during pregnancy
Circulatory system, respiratory system, genital tract, GI system, metabolism
172
Common hyperthyroid meds
Methimazole (Tapazole), Propylthiourcil (Propyl-Thyracil)
173
Influenza
Causes acute respiratory illness
Only mildly ill and recover in 7-10 days- no med care/ antiviral medication
Antiviral drugs may be used to reduce morbidity/mortality for high-risk groups or severely ill
174
Frostnip
mild frostbite, mild blanching and mild pain, reversible with no permanent damage
175
shivering in thermogenesis
maximal vasoconstriction occurs and the body signals need for involuntary shivering
to generate heat
176
ACE inhibitors
Used to treat HTN by lowering SBP by blocking angiotensin-converting enzyme (ACE)
By inhibiting release of angiotensin II and aldosterone it decreases reabsorption of sodium in
kidneys forcing it from the system
177
Antibiotic resistant organism
Overuse/misuse of antibiotics make pathogens resistant to antibiotic drugs commonly prescribed
Some infections are untreatable
178
GI changes in pregnancy
Increased esophageal pressure, decreased esophageal sphincter tone, increased gastric pressure, delayed gastric emptying, decreased contractility of gallbladder
179
Risk factors of abruptio placenta
Trauma, multiple fetuses, short umbilical cord, previous c sections, preeclampsia/eclampsia, >35 years
180
Thermoregulation
Center is in the anterior hypothalamus monitoring peripheral and central receptors
Peripheral receptors found in skin, muscles, and mucous membranes- more cold receptors in
these areas
Central receptors: found in great veins, spinal cord, hypothalamus, and viscera- more warm
receptors than cold ones
181
Common anticoagulants
Warfarin (Coumadin), Eliquis (Apixaban), Enoxaparin (Lovenox), Heparin
182
Cardiovascular changes in pregnancy
Increased blood volume, increased cardiac output, increased stroke volume, increased heart rate, decreased systemic/ peripheral vascular resistance, decreased Hb concentration
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Signs and symptoms of placenta previa
Bright red, painless bleeding
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Conduction in environmental emergencies
Transfer of heat from hotter to colder object
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How to calculate a pulse of a pediatric patient
150 - (5 x age) = ~rate
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Benzodiazepines
Used to treat anxiety, slow brain activity by depressing limbic system and working on GABA
receptors in the brain to reduce neuronal excitement
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Post partum hemorrhage
Occurs right after delivery (<24hrs) or up to 12 weeks later and bleeding can occur over several hours and diluted with urine/fluid
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Respiratory syncytial virus
Leading cause of lower respiratory tract infections in infants, elderly and immunocompromised
people
Transmitted by direct or indirect contact (hands/items)
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Common antiplatelet medication
ASA (asaphen, Entrophen, novasen), Dipyridamole (Aggrenox), Clopidogrel (plavix), Trigrelor (Brilinta)
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Non-fenestrated cannula
Little to no voicing
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Diuretics
Decrease BP by decreasing blood volume and sodium retention and increase elimination of
water, sodium and electrolytes
By decreasing blood volume, it reduces BP by reducing peripheral resistance and cardiac output
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Nuchal cord
Umbilical cord is wrapped around infants' neck- slip overhead/body
If cord is tight, it will impede delivery so cut/clamp cord and delivery quickly
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Long-acting beta agonist and corticosteroids
Prevents asthma symptoms (controllers) by relaxing muscles lining the airways
Long-acting beta agonists must be used with corticosteroids
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APGAR- A
Activity- 0- absent, 1- arms and legs flexed, 2- active movement
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Central venous catheter
Flexible synthetic tube placed in the vena cava used when waiting for a fistula or whe one is not possible
Can be placed in the groin in femoral vein
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Risk factors for an impacted shoulder
Prior shoulder dystocia, gestational diabetes, postdate deliveries, maternal short stature, high pregnancy weight/ weight gain, abnormal pelvic anatomy, previous instrumented delivery
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Measles
Highly communicable airborne disease characterized by fever, conjunctivitis, and coryza
Onset of coughing, blotchy red rash and whitish grey spots on buccal mucosa
Transmits by airborne, aerosolized droplets or diect contact with nasal/ pharyngeal secretions
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Risk factors of placenta previa
Have had a baby, previous c-section, scars on uterus from previous surgery/procedure, history of placenta previa, IVF, carrying more than one fetus, >35 years, smoking, cocaine
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Addisons disease
Also called adrenal insufficiency and occurs when body doesn't make enough cortisol and aldosterone
Often have related autoimmune diseases
Results from stress on the body causing glands to make extra cortisol in response
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Tetralogy of Fallot
Pulmonary stenosis, large ventricular septal defect, overriding aorta (aorta is out of place in-between the ventricles causing oxygen poor blood to flow directly into the aorta instead of blood vessels carrying blood to the lungs), right ventricular hypertrophy
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APGAR- P
Pulse: 0-absent, 1-below 100bpm, 2-over 100 bpm
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APGAR scores meaning
0-3: severely depressed
4-6: moderately depressed
7-10: excellent condition
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Common laxatives
Senna (senokot), Bisacodyl (Dulcolax), Docusate (Colace), PEG 3350 (Miralax)
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Potassium-sparing diuretics
Increase diuresis without causing potassium to leave the body by stopping entry of aldosterone
into the nephron preventing sodium and water retention
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Spontaneous abortion (miscarriage)
Loss of pregnancy naturally before 20 weeks- most happen first trimester
Chromosomal problems cause most miscarriages
Common in 1 in 4 pregnancies
Presents with bleeding (light or with clots and tissue) and cramping for approx. 1 week- can also be massive bleeds with hypovolemia
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Hyperemesis gravidarum
Severe nausea/vomiting during pregnancy (>3 times per day)
Can lead to dehydration, vertigo, weight loss, preterm labor
Caused by high levels of pregnancy hormones- human chorionic gonadotropin (HCG
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Lightning injuries
Arrest is secondary to hypoxia due to global depolarization- myocardium recovers on own but
delay for respiratory center to recover/ thoracic tetany causing respiratory arrest
Lightning carries 100 million volts/ 200,000 amps
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Signs and symptoms of preeclampsia
BP >140/90, severe headache, blurred vision, upper abdo pain, N/V, proteinuria, edema
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Impact of blood flow in thermolysis
blood plays a role in temperature regulation so a decrease in cardiac output
limits body's ability to generate and maintain a constant temperature
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TCA’s
Narrow therapeutic window, in overdose TCA’s cause loss of vascular tone by blcoking alpha
receptors, muscarinic receptors (hot/ dry skin), tachycardia, loss of bowel sounds, Na channels
within cardiac cycle
Blockage of na channels slow action potential causing prolonged QT wave- very wide QRS and
causes lethal arrhythmias is untreated
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Febrile seizures (pyrexia)
Usually <6 but average is 1-2 years
Hx of illness associated with fever spikes
S&S: generalized short tonic-clonic seizures (5 min), full body uncoordinated muscle activity, grunting, incontinence, increased secretions follow by postictal phase
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Pertussis (whooping cough)
Caused by Bordetella pertussis bacteria
Onset characterized by irritating cough that is paroxysmal in 1-2 weeks
Transmits by direct contact with discharged from mucous membraned and airborne droplets
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Stage 3 of labor
Lasts from birth of baby until placenta delivers
Lengthening of cord, sudden gush/trickle of blood, uterine contraction
Most dangerous stage of labour
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Daltons law
Partial pressure
The total pressure of a mixture of gases is the sum of the partial pressure of each gas
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Dehydration
Results from any body fluid loss- excessive vomiting/diarrhea, exposure to heat/cold, illness causing poor fluid intake
S&S: poor skin turgor, dry mucous membranes, obvious weight loss, tachycardia >130bpm, depressed fontanelle in newborn, lethargy, irritability
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Freshwater impact
Lower osmolarity compared to blood so large ingestion can increase blood volume leading to red
blood cell breakdown
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Zone of stasis
Decrerased blood flow and inflammation and necrosis can develop up to 48 hours later
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Anticoagulants
Make the blood less viscous by increasing levels of antithrombin
Heparin works with antithrombin, and warfarin works to inhibit vitamin K effects on clotting
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Vancomycin-resistant enterococci (VRE)
Normal organisms of GI tract, urinary tract, and genitourinary tract
Hospital-acquired infection with a transmission by direct contact with contaminated surfaces or
equipment
Only infected patients can transmit
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Metabolic changes in pregnancy
10%-20% increase in BMR, insulin resistance, fat deposition
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SIDS
healthy infant that dies of unknown causes
Highest risk in first 6 months but anytime within first year
Risk factors: sleeping prone, co-sleeping, smoking, low birth weight, overeating, lack of breastfeeding, <20 maternal age, no prenatal care
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Common benzodiazepines
Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Diazepam (valium), Midazolam (Versed), Oxazepam
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External uterine massage
Only used when the placenta has been delivered
Smooth circular movement to massage uterus- reassess every 10-15 min
If bleeding continues go to bimanual compression
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Premature birth
<37 weeks
Risk of hypothermia, usually require resuscitation, poor lung compliance, no surfactant (starts being produced at 26-28weeks)
225
Fistula
Surgical connection between an artery and vein to increase blood pressure and amount of blood flow through vein
Enlarge veins to be capable of delivering the amount of blood flow necessary to provide an adequate hemodialysis treatment
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Epilepsy drugs
Reduce instances of seizures by suppressing seizure activity by controlling voltage-dependent
sodium channels
The drugs are aimed at delaying the movement of positive ions into the cells to stop the
abnormal firing and maintain homeostatic balance
227
Common steroids
Fluticasone (Flovent), Budesonide (Plumicort), Advair, Symbicort
228
What defines PPH
500ml of blood or more severe PPH is 1 liter
229
Ventricular septal defect
Hole in the wall between left and right ventricles causing blood to flow from left ventricle and mix with right ventricle
If hole is large heart/lungs need to work harder to pump blood and can cause fluid to buildup in the lungs
230
Effects of aspirated water
Be reabsorbed into vasculature, cause decrease lung compliance, lead to loss of surfactant,
atelectasis, and hypoxia
231
Causes of renal failure
Diabetes (most common), hypertension, autoimmune diseases, genetic diseases, nephrotic syndrome
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inotropic effects
changes contractility of the heart
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Barotrauma
Can occur in any gas filled space but often occurs in middle ear, sinuses, GI system, or lungs
Occurs because of Boyles law and as long as ears pop there should be no issue
Conditions of barotrauma: tympanic membrane rupture, tinnitus, vertigo, nausea vomiting
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What drugs does dialysis remove
Barbiturates, lithium, isoniazid, theophylline/caffeine, methanol/metformin, ethylene glycol, Depakote/ dabigatran
235
Drowning
Process of experiencing respiratory impairment from submersion or immersion in a liquid
Submersion- act of being completely covered by a liquid
Immersion- being partly covered by a liquid
Described as fatal or non-fatal
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When is the start of pregnancy counted
From the 1st day of the last menstrual period
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Pediatric abdomen
Distended abdomen due to weak abdo walls and size of organs
Liver/spleen extend below rib cage
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Antiplatelet medication
Interferes with clot formation- normally platelets enter site of injury that is activated by thrombin
and collagen to increase clotting
239
Frequency of contractions
Measured as intervals between the time the contraction starts to the start of the next contraction
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Epilepsy
Recurrent seizures unprovoked by illness due to abnormal neuronal firing
Occurs in isolated area of the brain or generalized seizures
Can experience an aura prior
241
Gestational diabetes
Diabetes caused by pregnancy due to carbohydrate metabolism
Excess glucose is transferred to the fetus and stores as fat (mother doesnt produce/ use all insulin required)
Condition often resolves but can reoccur later in life
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Pulmonary over pressurization syndrome (pops)
During ascent air can be trapped within lungs from breath holding, bronchospasm, or mucus
plugs causing alveolar rupture
Presents with dyspnea, pleuritic pain, sub-q emphysema, or pneumothorax
243
Respiratory system changes in pregnancy
Increased thoracic diameters, increased tidal volumes, increased minute ventilation, decreased peak expiratory flow rate, decreased residual volume, decreased functional residual capacity, widened forced vital capacity, widened maximum breathing capacity
244
Convection in environmental emergencies
Loss of heat from moving air
245
Tetanus
Vaccine preventable disease
Tetanus bacillus found in intestine of horses and other animals, transmission when tetanus spores
enter body by a puncture wound with animal feces, street dust, or soil
246
Chemical tissue destruction via chemicals
Reduction: hydrocholric acid
Oxidation: sodium hypochloride
Corrosion: phosphorus
Protoplasmis posions: formic acid
Desecration: sulfuric acid
Vesication: mustard gas
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Duration of contractions
How long one contraction lasts times from when the contraction starts to when it ends
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Psychiatric emergencies
Person becomes suicidal, homicidal, or psychotic episode and experiences delusions/ hallucinations that result in loss of contact with reality
May undertake risky behaviors or violence
249
Common antidepressants
Amitriptyline (Elavil), Nortriptyline, Trazodone, Mirtazapine (Remeron), Bupropion (Wellbutrin), Paxil (Paroxetine), Zoloft (sertraline), Effexor (Venlafaxine)
250
Stage 2 of labor
Starts when cervix is fully dilated and pr feels the urge to push, end when baby is born
Frequency 2 min, length 60-90 sec
251
Pediatric chest and lungs
Thin with little musculature and subcutaneous fat causing it to be more pliable without as much protection
More vulnerable to pulmonary contusions, cardiac tamponade, and diaphragmatic rupture
Signs of hemothorax/pneumothorax are more subtle
Alveoli clusters develop over the first 8 years of life
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Sources of chemical burns
Acids, alkalis/ bases, corrosive materials, oxidizing agents, phosphorus, vasicants
253
Antianginals
Increase blood and O2 supply to the heart while reducing workload of the heart
Can be accomplished by vasodilation or reducing vasospasm
254
Pathophysiology of hyperthermia
Body is unable to compensate so heat gain exceeds heat loss, initial compensatory mechanisms
fail
255
Pediatric central nervous system
Prone to febrile seizures due to influx in temperature regulation
Blood brain barrier is poorly formed so barbiturates, opioids, antibiotics, and bilirubin cross barrier easier with prolonged effects
256
Antidepressants
TCA, and SSRIs (selective serotonin reuptake inhibitors)
Alters levels of serotonin, dopamine, and noradrenaline keeping them at normal levels
Used to treat depression, OCD, and anxiety
257
Rubella
Low grade fever, headache, runny nose, swollen lymph node glands, diffuse rash
Transmits with direct contact with nasopharyngeal secretions of an infected person
Mild uncomplicated illness in ids but in 3–4-month pregnancy can cause abnormalities: deafness,
cataracts, mental retardation, heart defects
