Final Exam Review (ED&T) Flashcards
Factors that can affect a critically ill patient’s cognitive function include:
Health condition, sleep disturbances, medications
The most sensitive indicator of neurologic status change is
Changes in LOC
Signs of an adverse reaction to contrast medium include
Urticaria, facial flushing, and restlessness
Which type of seizure is characterized by brief, involuntary muscle movements?
Myoclonic
A seizure in which a person loses consciousness and has stiffening and jerking of the muscles
Generalized tonic - clonic
A type of focal partial seizure, also known as a simple partial seizure.
Jacksonian
A type of seizure that causes sudden loss of muscle strength
Akinetic
A collection of blood between the dura and the arachnoid layers of the meninges
Subdural Hematoma
ACE inhibitors correct heart failure by?
Reducing Afterload
Which sign is characteristic of cardiac tamponade?
Beck’s Triad
What is included in Beck’s Triad?
Hypotension, JVD, and muffled heart sounds.
When auscultating a patient’s lungs, you hear crackles. These are caused by:
Collapsed or fluid filled alveoli snapping open
What is Phenylephrine used for?
Managing mild to moderate hypotension.
Which type of heart failure results in increased CVP?
Right sided heart failure
Why do ET Tubes have inflatable cuffs?
To prevent the backflow of oxygen.
Your patient’s ABG shows, pH 7.25 PaO2 48, and PaCO2 55. What do you expect in the patient presentation?
Acute respiratory failure
Which strategy is recommended to prevent ventilator associated pneumonia (VAP)?
Elevating the head of the bed 30-45 degrees.
A patient diagnosed with asthma who was previously wheezing suddenly stops wheezing and continues to show signs of respiratory distress. Your assessment findings would indicate that:
He’s in imminent danger of respiratory collapse.
A possible cause of a ventilator low pressure alarm is:
Endotracheal tube disconnected from ventilator
The stomach’s major functions include
Breaking down food into chyme, serving as a temporary storage area for food, and moving the gastric contents into the small intestine.
The kidneys secrete erythropoietin when?
Oxygen supply in tissue decreases
How might severe hypotension effect the kidneys?
It can result in acute tubular necrosis following ischemic renal injury.
Your DKA patient is presenting with hyperkalemia, hypovolemia, hyperglycemia, and acidosis. Which do you treat first?
The hypovolemia.
Which common drug we carry on the ambulance is contraindicated in a thyroid storm?
Aspirin
To expand plasma volume or to replace clotting factors you would expect to give?
Fresh Frozen Plasma (FFP)
When is Whole Blood given?
To treat patients who need all the components of blood, such as those who have sustained significant blood loss due to trauma or surgery.
When are Packed RBCs given?
In the case of severe anemia with hemodynamic instability, severe hypoxia, or acute end-organ injury. Or in prevention there of.
A solution that causes fluid to shift from the intracellular space to the extracellular space?
Hypertonic solutions
Your patient has second and third degree burns to his anterior chest, anterior abdomen, and entire right arm. Using the rule of nines, the percent of total BSA involved can be estimated at:
27%
Your patient has hypotension and severe respiratory distress within 6 hours of transfusion. What do you suspect?
Transfusion related acute lung injury (TRALI).
The hospital gave your patient insulin, glucose, and calcium gluconate. What do you suspect their issue is?
Severe hyperkalemia. The insulin/glucose to drive K+ back into the cells and the calcium gluconate as a cardioprotective measure by increasing threshold potential to restore the normal gradient with resting membrane potential that was altered by the hyperkalemia.
Administration of IV potassium for hypokalemia should be in a concentration that does not exceed?
Administer a concentration that should not exceed 40 to 60mEq/L
Signs of Hypomagnesemia may include?
Tremors, hyperactive deep tendon reflexes, and tetany.
Remember the opposite is true if you give too much mag. Look for hypoactive reflexes, flaccidness, and respiratory depression.
How might too much antacids and sodium bicarbonate affect sodium?
May cause hypernatremia
Examples of passive rewarming?
Warmed blankets, turning up the heat in the ambulance.
A patient who responds only to pain and then only flexes, mutters incomprehensible words when shouted at loudly, and opens his eyes only to pain is given what Glasgow Coma Scale score?
GCS 8
The most common causes of syncope are?
Vaso vagal and ventricular dysfunction
Your patient isn’t shivering, has Osborn waves on the ECG, and presents with stiff and rigid muscles. What’s going on?
The patient is suffering from severe hypothermia.
Your trauma patient is presenting with increasing blood pressure, slowing heart rate, and erratic respirations. What does this indicate?
The Cushing’s Reflex due to increased ICP.
Note In addition to increasing BP you will may also see widened pulse pressure (increasing systolic, decreasing diastolic).
Normal body temperature range?
36.5 to 37.5
What are the temperature ranged for hypothermia?
ACLS 2020: Mild, 34-36, Moderate, 30-34c and Severe, <30
Portage: Mild, 32-35c, Moderate, 29-32c and Severe, <29c
Your patient suffered barotrauma due to a diving accident. What might that include?
Decompression illness, arterial gas embolism, and nitrogen narcosis.
You’ve responded to frequent flier who you have picked up many times for alcohol intoxication. He tells you that he “hasn’t been feeling good for 3 days”, he appears confused and you note a course tremor to his hands. Appropriate assessment would include?
Looking for trauma, hypoglycemia, and delirium tremens.
Hyperglycemic hyperosmolar nonketotic acidosis differs from diabetic ketoacidosis because significant production of ketone bodies is prevented by the action of?
insulin
Treatment of Wernicke’s encephalopathy includes?
Thiamine and supportive measures.
Your diabetic patient presents with decreased mental function, deep rapid respirations, and tachycardia. You haven’t taken a BGL yet. What might you expect?
Hyperglycemia as these are signs of diabetic ketoacidosis.
Bystanders state your patient has a thyroid condition. She presents with decreased LOC, hypothermia, ETCO2 50, and begins to seize. What might you suspect the issue is?
A myxedema coma due to severe hypothyroidism.
In the earliest stages of hypoglycemia, you would expect to see which change in the patient?
Changes in mental status
Your patient is suspected of having encephalitis. What treatments may you expect?
ICP monitoring, seizure control, and neurological exam.
The injury that classically presents with unconsciousness immediately after the accident followed by a lucid interval and then a decreasing level of consciousness is most likely?
An epidural hematoma.
You respond to a 16 y/o soccer player who fainted on the field. He was reportedly running hard and playing well prior. He appears confused and his skin is hot and dry to touch. Your partner gives you the following VS: T-40C, P-126, R-32, B/P-90/48. You suspect?
Heat stroke
Your monitoring of magnesium sulfate administration should include?
Monitoring deep tendon reflexes, ECG, having calcium gluconate ready, and ensuring the mag isn’t running too quickly.
Patients who develop heatstroke due to exertion, may develop which condition due to lactic acid accumulation?
metabolic acidosis
An ECG of a patient with hyperkalemia would show?
Tall, tented T waves, prolonged PR intervals, and a widened QRS.
Which 2 signs are associated with hypocalcemia?
Chvostek’s and Trousseau’s
Which drug is the first–line diuretic in the treatment of head injury?
mannitol
Early signs and symptoms of hyponatremia include?
Change in LOC, abdominal cramps, and muscle twitching.
Korsakoff’s psychosis is a late complication of persistent _____ and results in memory deficits, confusion, and behavioral changes.
Wernicke’s Encephalopathy
Signs and symptoms of Hyperglycemic hyperosmolar nonketotic coma (HHNK) include?
Excessive thirst, dry mouth, increased urination, polyphagia, tachycardia, drowsiness, confusion, fever, warm/dry skin.
Ventilation of the head injury patient should be guided by oximetry to maintain a saturation of at least?
94%
Appropriate treatment of heat stroke?
Remove them from hot environment, start cooling measures, O2, administration of IV normal saline.
One of the most severe complications of a near drowning is?
ARDS
A patient presents with signs of shock, JVD, distant heart sounds, and a narrowing pulse pressure. The lung fields are clear. Which condition is most likely the cause?
Pericardial tamponade
Your patient has polymorphic VT and is unstable. What do you select for cardioversion?
It’s wide and irregular, so give the defibrillation dose (not synchronized).
Energy selected as per the manufacturers recommendation of your defibrillator. With a Lifepak 15 that’s 200j, 300j, then 360J.
Atrial Flutter and SVT should be cardioverted initially with?
They’re narrow and regular, so the dose is 50 to 100J
A pleural effusion is an abnormal accumulation of?
Fluid within the pleural space
Common signs and symptoms of acute pericarditis may include?
Arrhythmias (IE global ST elevation), chest pain that decreases when the patient sits up and leans forward, a pericardial friction rub, low-grade fever, palpitations, edema, fatigue, and a cough.
Is pain generally reproducible on palpation with ischemic chest pain?
No, however, it is possible in some cases, and so increased pain with palpation can not always rule out an MI.
Management for myocardial contusion should be the same as when treating what condition?
Cardiac tamponade
A pleural effusion is most likely to have which signs and symptoms?
Chest pain, dyspnea, decreased breath sounds, and a fever.
Factors that predispose a patient to pulmonary embolisms include?
Recent surgery, pregnancy, and atrial fibrillation.
The following describes what?
Usually a result of a deceleration injury, 90% will die immediately due to exsanguination, and can present in patients with no signs of chest trauma.
Traumatic aortic rupture
What differentiates a probable SVT in children from a possible sinus tachycardia?
SVT rates are usually ≥220 in infants, and ≥180 in children.
Your patient presents with painful swallowing, pleuritic chest pain, subcutaneous emphysema, and hematemesis. What might you suspect is happening?
Esophageal rupture
Pulsus paradoxus is a sign of ______ and is characterized by ________?
It’s a sign of pericardial tamponade and is characterized by a drop in systolic blood pressure during inspiration.
Beck’s Triad is the “classical” diagnosis of cardiac tamponade and includes?
Hypotension, distended neck veins, and muffled heart sounds.
What is the primary cause of heart disease in children?
Congenital heart disease is the primary cause of heart disease in children
Care of a patient with eclampsia should include?
Manage airway, give O2, protect from injuries if seizures recur, minimize noise and light, administer mag sulfate, consider versed, transport patient on left side, and monitor for signs of mag toxicity.
What are common causes of excess of catecholamines?
An overdose of cocaine or other stimulants, alcohol withdrawals, and MAOI interactions with certain foods.
What is papilledema?
It is swelling of the optic nerve, which can happen if the BP is severely elevated, and in other circumstances like brain tumour or hemorrhage which increase ICP.
What might you expect to find in catecholamine excess?
Palpitations, diaphoresis, pallor, and headache.
You’re patient is 36 weeks pregnant, has an altered LOC, and has experienced a major motor seizure. What do you suspect?
Eclampsia
Emboli leaving the right side of the heart can cause?
Pulmonary embolisms
Superior vena cava syndrome is most commonly associated with?
Malignancies
What is the most common cause of an arterial occlusion?
Embolus
Examples of what can cause compartment syndrome?
A closed fracture, crush injury, muscle swelling after exercise, a dressing or cast that’s too tight, or a snake bite.
DVT’s are the result of what? What can they cause? How are they treated? Are they always symptomatic?
DVTs occur as a result of a blood clot in the thigh, calf or pelvis. They are the primary cause of pulmonary embolisms. They are treated with anticoagulants and can be asymptomatic.
What are some signs and symptoms of an arterial occlusion?
- Sudden severe pain in the arm or leg
- Diminished or absent arterial pulses
- Arterial bruits
- Numbness or tingling in the affected area
- A sensation of coldness in the affected area
- A line of color and temperature demarcation at the level of the obstruction
Explain superior vena cava syndrome.
Characterized by gradual, insidious compression/obstruction of the superior vena cava (often due to a cancerous tumour). Diagnosis is often delayed until significant compression of the superior vena cava has occurred. Physical examination often reveals facial or upper extremity edema. Dyspnea is common.
Treatment of arterial occlusions could include?
0xygen, IV, pain control, transport.
DO NOT elevate the affected limb
Claudication is best described as?
Severe pain in a calf muscle due to inadequate blood supply which typically occurs with exertion and subsides with rest.
Predisposing factors for DVTs?
Prolonged bed rest, trauma, surgery, childbirth, and hormonal contraceptives.
If you suspect a DVT, you should assess for?
Fever, swelling, redness, heat, and homan’s sign.
What is Homan’s sign?
A positive Homans’s sign is when the patient experiences calf pain with dorsiflexion of the foot. It is thought to be associated with the presence of a thrombosis (DVT).
An acute arterial occlusion is the sudden blockage of an artery due to?
Trauma, thrombus, embolus, tumor, or idiopathic means.
The earliest sign of compartment syndrome is?
Intense, deep pain out of proportion to the injury.
First priority in treating a patient with known Hx of NIDDM, presenting with altered mental status and suspected hyperglycemia?
Ensure airway patent
eye roll LOL
The risk of ventilating a DKA patient below their intrinsic rate is?
Mixed acidosis: respiratory on top of metabolic. Always try to assist ventilations at their intrinsic rate. If intubated the same applies.
Your patient’s BGL reads “high”. They are exhibiting all the symptoms of DKA. You have already managed your ABC’s and are assisting respirations at their intrinsic rate with a BVM. Your next intervention is?
Start an IV and administer a bolus of normal saline.
500 to 2000mL in the first hour.
DKA develops primarily in Type 1 diabetics with a ________ onset; HHNKS is primarily in Type 2 diabetics and has a _______ onset.
Faster; gradual
Signs of hypocalcemia?
Chvostek and Trousseu’s signs, muscle spasms/rigidity, and a prolonged QT interval.
Chvostek sign
The twitching of the facial muscles in response to tapping over the area of the facial nerve.
Trousseau’s sign
Involuntary contraction of the muscles in the hand and wrist (i.e., carpopedal spasm) that occurs after the compression of the upper arm with a blood pressure cuff.
List some examples of patients at risk of developing hypokalemia.
Excessive GI losses, taking loop diuretics such as furosemide, excessive use of beta agonists.
What electrolyte derangement could be caused by a significant crush injury?
Hyperkalemia
What electrolyte derangement could cause a widening QRS (sine wave)?
Hyperkalemia
What electrolyte derangement could be caused by profound dehydration or SIADH?
Hypernatremia
What electrolyte derangement could cause Torsades de pointes?
Hypomagnesemia