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
What electrolyte derangement could be caused by a hypoparathyroidism leading to tetany (muscle spasms).
Hypocalcemia, which leads to neuromuscular irritability.
What electrolyte derangement could be caused by excessive water intake or diabetes insipidus?
Hyponatremia
What drugs might be used to treat hyperkalemia? Briefly explain why.
- Calcium chloride (or gluconate) to stabilize the myocardium
- Sodium bicarbonate to shift K+ into cells, and treat metabolic acidosis
- Insulin to shift potassium into cells
- Glucose to prevent hypoglycemia with insulin infusion plus help the myocardium function more effectively.
- Salbutamol to shift potassium into cells by beta agonist actions
What is SIADH?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH).
What is diabetes insipidus?
Results when the secretion of or response to the pituitary hormone vasopressin (antidiuretic hormone) is impaired which results in production of very large quantities of dilute urine. Often leads to dehydration and insatiable thirst. Occurs in diabetics as the body tries to flush out excessive blood sugar.
The most common presenting complaint with acute pancreatitis is?
Left upper abdominal pain
Aortic aneurysms differ from aortic dissections in that?
Aneurysms arise primarily in the abdominal aorta, whereas dissections typically arise from the aortic arch.
Briefly describe the presentation of appendicitis.
Periumbilical pain followed by a shift in pain to the RLQ. Classic signs include McBurney’s sign, Rovsing’s sign, and psoas sign. Patients may experience nausea and vomiting with a low-grade fever (37.2 to 38c).
What are the common symptoms of a black widow spider bite?
Pain, redness, and swelling to a local area of reaction (commonly an extremity) in conjunction with muscle spasms, severe pain, diaphoresis, and vomiting.
Some of the most common causes of bowel obstruction include?
Tumors, hernias, and adhesions
Cholangitis is?
An infection of the bile duct.
Acute cholecystitis often presents with tenderness under the right costal margin, a condition known as?
Murphy’s sign
Pain most often associated with diverticulitis occurs in the?
Descending colon, on the left side of the abdomen.
Outpouchings of the colonic mucosa are known as?
Diverticula
Which bacteria can produce reactions that often lead to electrolyte imbalances and hypovolemia if eaten in food?
Shigella, salmonella, and e-coli.
The presence of Grey Turner’s sign in the patient with acute pancreatitis indicates?
Significant hemorrhage
You’re treating a 24 year old male patient. He is presenting with abdominal pain, nausea, diarrhea, fatigue, and a low-grade fever. He appears to have a yellowish tinge to his skin. He tells you that he recently returned from a trip to Mexico. What differential should you suspect?
Hepatitis
Which hepatic viruses are contracted through the fecal/oral route?
Hepatitis A and E
Your patient presents with a sudden onset of acute, severe, generalized abdominal pain with nausea and vomiting. During your assessment of the abdomen, you note that bowel sounds are quiet. This leads you to suspect?
A perforated ulcer
Brief points regarding pyelonephritis?
It is uncommon in men. In the elderly symptoms are often asymptomatic There is pain on percussion of the costovertebral angle. Symptoms include chills, fever, flank pain, and nausea/vomiting. A microscopic urine analysis is usually done to culture bacteria and look for any blood cells present.
S&S that often indicate a rupture of an abdominal aortic aneurysm?
Sudden, intense and persistent abdominal or back pain described as a “tearing” along with hypotension and tachycardia.
Describe volume resuscitation for a patient with a ruptured aortic aneurysm?
Careful volume resuscitation with isotonic crystalloids. The goal is to maintain a MAP of 60 to 65mmHg. Raising the BP too much can worsen the hemorrhage and too much fluid dilutes coagulation factors. The patient will need packed red blood cell products and immediate surgical intervention.
Briefly describe your treatments for severe pancreatitis.
Have the patient sit up and lean forward. Strict NPO precautions. Start an IV and give fluids as indicated. Administration of opioids and antiemetics as required.
List some potential causes for a severe, potentially life-threatening upper GI hemorrhage.
Rupture of an esophageal varix, peptic ulcers, Mallory-Weiss syndrome, and gastritis.
What is Mallory-Weiss syndrome?
A tear or laceration of the mucous membrane, most commonly at the point where the esophagus and the stomach meet (gastroesophageal junction).
Cessation of sweating is a major symptom of?
Heat stroke
A seizure that consists of 10 to 30 seconds of loss of awareness or consciousness, eye fluttering, and an occasional loss of muscle tone is known as?
Petit mal seizure
Which seizure is characterized by distinctive auras?
Complex partial
A tonic-clonic seizure is also known as a?
Grand mal seizure
The phase of a generalized seizure which the patient experiences rhythmic muscle spasms, and a clenched jaw is known as?
Clonic phase
Following a seizure, patients may present with?
Confusion, fatigue, headache, incontinence.
See also postictal phase
Management of a seizure should include?
Airway, 02, IV, BGL, administration of versed, suctioning
Depending on situation and/or protocols, other types of medication to stop the seizure may be used.
Which type of seizures cause widespread malfunction?
Generalized seizures
Placenta previa can be differentiated from abruptio placenta by?
Painless, bright red vaginal bleeding
Abruptio placenta is typically painful with dark red bleeding
Following the delivery of the placenta, your patient’s vaginal bleeding seems to increase. What you should do to provide emergency care for this patient?
Administer 02 and firmly massage the fundus.
Your female patient is 16 weeks pregnant and complaining of cramping abdominal pain, and has bright, red, vaginal bleeding. You should suspect?
Late abortion
List some causes of uterine rupture?
Blunt abdominal trauma, surgically scarred uterus, and prolonged labor.
Signs and symptoms of a uterine rupture may include?
Severe abdominal pain, may or may not have vaginal bleeding. Absent fetal heart, and a tender or rigid abdomen.
Major causes of upper GI hemorrhage include?
Gastritis, varices, and Mallory-Weiss Syndrome.
Hematemesis is what?
Vomiting of red blood and is indicative of upper GI bleeds.
Main treatment for rapid DIC?
Correction of the cause and blood products.
Some causes for DIC?
Retained dead fetus, infection with gram negative organism, shock, blood transfusion reaction, cancers (like leukemia), pancreatitis, and liver disease.
Von Willebrand’s Disease differs from Hemophilia by?
Having a factor VIII deficiency
During packaging of a patient with hemophilia for transport, what should you keep in mind?
Gently move the patient to prevent trauma.
Should hemophiliacs take NSAIDs like aspirin?
NO. If you don’t immediately know why, google hemophilia.
Which type of epistaxis would most benefit from pinching the nostrils together for 10 minutes?
Anterior epistaxis
When treating a patient you suspect has internal bleeding, you should recall?
That blood can accumulate within the tissue and be self limiting. One of the best indicators is the MOI. Ringers Lactate is the most practical choice for prehospital administration (if available). Whole blood is the most desirable choice for fluid replacement.
Applying pressure to the proximal arterial pulse points helps treat what?
Patients with external hemorrhaging.
Your patient has a hemothorax. You recall that each thoracic cavity can contain up to ________mL of blood.
3000mL of blood
How do neck veins typically present in a hemothorax?
Neck veins are typically flat
Your patient has a hemothorax. You recall that bleeding into the thorax can be more severe due to?
Decreased pressure there
The lowest body temperature at which cardiac resuscitation is possible and the recovery prognosis is favorable is at least?
30 C
The general signs of heat loss include?
Diaphoresis, increased skin temperature, flushing.
When the core temperature of the body drops to below _____, an individual is considered to have moderate hypothermia.
34 C
According to ED and T practice quiz ACLS range = 30-34c
The ECG deflection associated with hypothermia and seen at a core temperature below 32°C ?
J wave
Also called an Osbourne wave
The portion of the brain responsible for temperature regulation is?
The hypothalamus.
The first essential step in the treatment of a patient with heatstroke is?
To remove them from the hot environment.
When cooling a patient with heatstroke, you should lower the patient’s body temperature to no lower than?
39 C According to the ED and T practice quiz
38C **According to Tintinallis
What is a common sign of severe hypothermia?
Lack of shivering
Improper application of heat packs while rewarming a severely hypothermic patient may cause what?
The return of cool blood and acids from extremities to the core of a hypothermic patient being rewarmed by the application of heat packs may result in rewarming shock.
What is the usual cause of malignant hyperthermia? What drug in the hospital is used to treat it?
It results from a hypermetabolic response to a drug combination of depolarizing muscle relaxants and general anesthetics. It can develop during anesthesia or the postoperative period. Muscular rigidity is usually the first sign. Dantrolene is the drug treatment at hospital.
What condition caused by Neisseria meningitidis, can cause profound shock, purpura, sepsis, shock and DIC, and the diagnosis is confirmed by a lumbar puncture?
Meningococcemia
You suspect your patient may have Meningococcemia. What is vital to remember?
Paramedics should protect themselves with appropriate BSI including masks.
When should you suspect Reye’s syndrome?
In children presenting with:
- Acute onset of encephalopathy without metal or toxin exposure.
- Pernicious nausea and vomiting.
- Altered mental status following URI or chickenpox.
- Recent treatment with salicylates
Treatment of Reye’s syndrome should include?
A, B, C, support, obtaining a BGL, IV access, monitoring of ICP.
Guidelines for handling cardiac arrest patients (as pertains to pharmacology) with severe hypothermia.
As per AHS, give meds as per cardiac arrest protocol, except prolong medication repeat times to twice normal, and limit Epi to 3 doses.
When caring for a patient with a chemical burn, it is important to know if the chemical is an acid or an alkali because?
Alkalis continue to destroy cell membranes through liquefaction necrosis.
Because very moist mucosa lines the airway, how might this effect inhalation burns?
Supraglottic structures may absorb heat and prevent lower airway burns.
The stage of the burn process characterized by catecholamine and pain-mediated reaction is called?
The emergent phase.
Your patient is a 3-year-old child, with partial-thickness burns over 20% of his body. This burn would be considered?
A critical burn.
Cooling of burns should take no longer than?
1 to 2 minutes.
Death in the immediate postburn period is typically a consequence of?
Related trauma injuries.
The effects of heat, according to Jackson’s theory of thermal wounds, cause structural proteins to break down. The term for this altering of the usual substance of something?
Denaturing
Burns are classified by their depth. The classification in which you would expect to see blisters, intense pain, white to red skin, and moist and mottled skin is?
A partial thickness burn.
Management of patients with electrical burns includes ECG monitoring because?
Electrical current may induce any number of cardiac dysthymias.
Electrical burns are considered very serious because?
The burn heats the victim from the inside out, serious vascular and nervous injury may occur, and the resulting tissue death causes the release of toxic materials.
If a burn injury occurred in an enclosed space, always consider the possibility of?
Inhalation injury
Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes?
4 ml x patient weight (kg) x BSA burned
AKA the Parkland Formula
What denotes the fluid shift phase of the burn process?
Chemicals are released to initiate an inflammatory response. It results in a fluid shift from the intracellular space to the extracellular space.
Full thickness burns are characterized by?
Full thickness burns are characterized by eschar and areas that are white and dry.
Your burn injury patient’s skin is white and parchment-like, and he complains of little pain. This burn would be classified as what type of burn?
Full thickness
When intubating a burn patient, what is important to remember about O2?
To administer high concentration 02 to reduce the half-life of any C02 inhaled.
Note The half-life of carboxyhemoglobin in fresh air is approx 4 hrs
What type of radiation is uncommon outside of nuclear reactors and bombs?
Neutron radiation
One type of radiation is only a significant hazard if the patient inhales or ingests contaminated material. This type of radiation is?
Alpha radiation
When using the “rule of nines” to determine the total body surface area burned, the difference between infants and adults includes the recognition that?
The head of an infant is nearly twice as large proportionally as the head of an adult.
When estimating the size of a small burn, the best method to use is?
The rule of palms.
The scene size-up when responding to burn patients should include?
Extinguishing smoldering shoes, belts, or clothes.
According to the ED and T practice quiz.
Burns resulting from exposure to heat are called?
Thermal burns
The “pressure” of the electric flow is known as?
Voltage
The area nearest the heat source that suffers the most damage is called the zone of?
Coagulation
When trying to determine the stage of acetaminophen overdose, it is important to establish?
A time line.
The definitive treatment for acetaminophen overdose is the administration of?
n-acetylcysteine
Possible presentation of a patient on amphetamines?
Dilated pupils, hyperactivity, cardiac dysrhythmias, and seizures.
One of your major objectives in treating a poisoning patient is?
The prevention of aspiration.
According to the ED and T practice quiz
How can you reduce the intake of a surface-absorbed toxin?
By removing clothing and cleaning the skin with soap and water.
You’ve been called for a 3 year old patient who has taken an overdose of phenobarbital. You recall that phenobarbital belongs to the class of?
Barbiturates
What is the antidote for benzodiazepine overdoses?
Flumazenil
An absolute contraindication in the treatment of cocaine overdose is?
Giving beta blockers
Cyanide enters the body by?
Ingestion, absorption, or inhalation.
You’ve been dispatched to a call for a 18 year old male who has taken PCP. Important considerations to recall include?
PCP can cause bizarre delusions and violent and aggressive outbursts. Patients who have taken PCP have high pain tolerances and almost superhuman strength. Paramedics should speak in a soft, quiet voice, and try to provide a dark, quiet environment for the patient. If the situation is unsafe, withdraw until you have appropriate resources to manage safely.
When treating a lithium overdose, it is important to recall that?
Treatments will be supportive. Activated charcoal does not bind with lithium. Severe toxic cases will require hemodialysis.
Clinical signs and symptoms of LSD overdose include?
Psychosis, rambling speech, hallucinations, suggestibility, and dilated pupils.
What is methaqualone?
A sedative hypnotic drug with pharmacological effects similar to barbiturates. Also known as Quaalude. It’s highly addictive.
What is Darvon?
A type of opioid analgesic prescribed to treat mild to moderate pain.
What is Dexedrine?
A potent CNS stimulant prescribed to treat ADHD and narcolepsy.
Your patient has been working in the field and when you arrive he presents with sweating, constricted pupils, lacrimation, excessive salvation, wheezing, cramps, vomiting, diarrhea, and urinary incontinence. You suspect?
Organophosphate poisoning
Remember SLUDGEM
What drug would you use to treat organophosphate poisoning?
Atropine 2-4mg IVP q5min PRN (until symptoms resolve)
What signs and symptoms are associated with an aspirin overdose?
Altered LOC, vomiting, tinnitus, hyperthermia, tachypnea, respiratory alkalosis, metabolic acidosis, organ failure, and dysrhythmias including a wide QRS and/or AV block.
The mnemonic associated with TCAs is known as the “3 C’s and an A,” which stands for?
Coma, convulsions, cardiac dysrhythmias, and acidosis
What toxic alcohols are associated with morbidity and mortality?
Ethylene glycol, methanol, and isopropanol.
If you suspect a mixed overdose of TCAs with benzodiazepines you should?
Treat with sodium bicarbonate as indicated for acidosis but DO NOT give flumazenil to counteract the benzos in this case because it may cause seizures.
Perfusion to cortex disrupted from spasm of small arteries, sustained during a period of hypoxia (cardiac arrest, airway obstruction, near-drowning).
Anoxic brain injury
Trauma to the head causing loss of consciousness, followed by brief lucid period then rapid decompensation?
Epidural hematoma
Open skull injuries with bleeding should be managed by?
Minimal pressure to limit bleeding, but to avoid depressing the skull into brain tissue.
In a high-mechanism trauma patient presenting with decreased LOC, always suspect and continually reassess for signs of?
A head injury.
What should be considered for any patient with no known history of trauma that presents with decreased LOC and decorticate/decerebrate posturing? (other than the obvious)
Toxic ingestion causing hypoventilation causing cerebral hypoxia, abuse, and organic brain syndrome (structural vascular lesions or malignancies).
As per ED and T practice quiz
Meningitis is inflammation of the protective coverings over the brain and can cause neck stiffness, photophobia, irritation and neurological dysfunction. Meningitis is caused by?
Any bacterial or viral infection that has infected the meninges (onset would be consistent with recent bacterial or viral infection).
This type of intracranial bleed is most likely in elderly patients or alcoholics, and is the result of bleeding from the bridging veins/arteries and may have underlying cerebral contusion.
Acute subdural hematoma
What burn area percentage is considered critical?
According to Portage:
Adults with 2nd degree burns is 20%
Peds with 2nd degree burns is 10%
For 3rd degree burns it’s 10% for both Adults and Peds
In what order to you give meds to treat hyperkalemia?
Calcium gluconate, sodium bicarbonate, insulin, glucose, beta 2 agonists (IV), furosemide, kayexalate.
Which breathing pattern associated with flail chest?
Paradoxical breathing
What is a very late sign of tension pneumothorax?
Tracheal deviation from the injury
Pink or blood tinged sputum is commonly seen with?
- Lung cancer
- Pulmonary edema
- Bronchial infection
- TB
The pulmonary edema characteristic of ARDS is caused by?
Accumulation of fluid in the interstitial spaces
You’ve responded to a call for a 20 month old female patient who has swallowed a marble. On arrival you note no air movement. Which interventions would be appropriate?
- If you see the marble, attempt to remove it
- Remove the marble with Magill forceps
- Attempt to push the marble down
DO NOT perform a blind finger sweep due to risk of making the obstruction unnecessarily worse.
What is frequently associated with sternal fracture?
Myocardial contusion
A traumatic diaphragmatic tear is likely to present similar to which other type of thoracic injury?
Tension pneumothorax
Management of epiglottitis should include?
- Rapid transport
- Allow the child to sit up
- Avoid additional stress
Consider 5mg epinephrine 1mg/mL nebulized if the patient has significant respiratory distress.
Obstructed breathing is not always _________?
noisy breathing
A few minutes after you’ve inserted a needle and decompressed a tension pneumothorax, you notice the the patient’s dyspnea is getting worse and breath sounds on the injured side are becoming diminished. Which action would you take?
Insert a second needle
Right sided heart failure is characterized by?
Lower extremity edema
While doing an assessment for pulmonary embolism, you may commonly find evidence suggestive of?
A deep vein thrombus.
Two conditions in which respiration is frequently dependent on hypoxic respiratory drive and use of supplemental oxygen may induce respiratory depression?
Chronic bronchitis and emphysema.
It’s also kind of like the Easter Bunny, we have all heard of it, but no one has seen it.
During your initial assessment, your general impression of the patient’s respiratory status should include?
- Position
- Mental status
- Skin colour
- Ability to speak
Your patient has received chest trauma yet did not initially present with crackles. However, as the assessment continues, they are heard in both the lower lung fields. This condition is most likely a result of?
Pulmonary contusion
Croup is characterized by?
Barky cough and stridor
The two major problems associated with traumatic asphyxia are?
restriction of chest excursion and venous return
What are ominous signs of possible life-threatening respiratory distress?
Altered mental status and extreme respiratory fatigue.
What are the five main effects of a drug/overdose?
- increased amount of transmitter/precursors
- binding/blocking receptor sites
- potentiating effects
- blocking reuptake
- metabolism/Excretion
What are the three subtypes of drug overdose
Acute
Acute on chronic
chronic toxicity
What is an acute drug overdose?
new medication, recreational use of drugs, intentional/unintentional overdoses
What is an “acute on chronic” drug overdose described as?
intentional overdose of prescription medication
What is a chronic toxicity drug overdose classified as?
The inability to excrete or metabolize current medications, or a change in drug dosage that does not jive well with the body
What is GHB a precursor to?
GABA
What is the antidote for benzodiazepines?
Flumazenil
TCA and Cocaine are both ________blockers and can cause ________ of the QRS
sodium channel blockers, widening
Signs and symptoms of Benzo/barbi OD? (4 major points)
- CNS depression/progressive stupor and coma
- Decreased respiratory effort
- decreased motor activity
- hypothermia
Calcium channel blockers effect both _____ and _______
heart rate and dilation of blood vessels
B1 selective beta blockers affect which area within the cardiovascular system
reduction in rate
What is a major difference between CCB and beta blocker toxicity?
the impact on glucose.
Beta blockers can cause hypoglycemia due to the lack of beta 2 stimulated hepatic glycogen breakdown as well as alpha cell mediated pancreatic release of glucagon.
Calcium channel agonism is responsible for releasing insulin from pancreatic beta cells. This blockage can cause hypoinsulinemia; AKA hyperglycemia.
Is it possible to have DKA with a low blood sugar?
YES
sodium-glucose cotransporter II inhibitors are a medication typically used for type 2 diabetics and cause the increased excretion of glucose.
If the diabetic patient has a reduced sensitivity to insulin and is taking these particular medications, DKA can occur with a low blood sugar.
SURPRISE MOTHERFUCKER
What is the main concern with ASA overdose?
metabolic acidosis due to ASA overwhelming the capabilities of the liver to adequately break down the medication.
coma, respiratory depression, and renal insufficiency will accompany as a myriad of manifestations
What is the toxic dose for Acetaminophen
150 mg/kg (according to every other resource), 200 mg/kg according to Jarrod.
Stage 1 acetaminophen overdose is classified as a time frame of ______ hours after ingestion and the typical symptoms are?
0.5-24 hours
Nausea, vomiting, abdo pain
Stage 2 acetaminophen overdose is classified as a time frame of ______ hours after ingestion and the typical symptoms are?
24-48 hours
Relief of GI symptoms although pain in the right upper quadrant may occur
Stage 3 acetaminophen overdose is classified as a time frame of ______ hours after ingestion and the typical symptoms are?
2-3 days hepatic failure (jaundice), coagulopathy, renal failure, hypoglycemia, and shock
Stage 4 acetaminophen overdose is classified as a time frame of ______ hours after ingestion and the typical symptoms are?
2 days-8 weeks
recovery or death. Get on it bruh.
lethal dose of ASA?
200 mg/kg
What does KULT stand for regarding metabolic acidosis
Ketones, Urea, Lactate, Toxins
what drug has been the leading cause of death when overdosed
TCA
Severe TCA toxicity typically occurs at _________ however a dose of ________ may be fatal
20 mg/kg, 10 mg/kg
How much fluid is normally in the pericardial sac?
Up to 50mL
How much fluid is normally pleural space?
About 10mL
