Final Review Flashcards
Perfusion is a function of:
BP, HR, CO, SV, SVR
___ is a state of collapse & failure of the cardiovascular system
Shock
The time just before or just after cardiac arrest
Peri-arrest period
Conditions that preceded the onset of a disease
Premorbid conditions
Premorbid conditions that affect healthy adults
Drug toxicity, electrolyte imbalance, pulmonary embolus
Chosen from a differential list used to base a treatment plan
Working diagnosis
M in “M-T SHIP”
Medication issues, metabolic causes
T in “M-T SHIP”
Trauma, tumor, toxins
S in “M-T SHIP”
Seizure, stroke
H in “M-T SHIP”
Hypoxia, hyper/hypothermia, hyper/Hypoglycemia, hypertensive crisis, hypovolemia, hyper/hypokalemia
I in “M-T SHIP”
Infection & uremia
P in “M-T SHIP”
Psychiatric/behavioral disorders
Tendency to gather & rely on information that confirms existing views
Confirmation bias
Allowing initial viewpoints to distort your estimates
Anchoring bias
Operational practice designed to enhance communication & teamwork
Crew resource management
Concept describing the relationship between myocardial contractility & cardiac output
Frank-Starting mechanism
Resistance to blood flow within all vessels except pulmonary vessels
SVR
The blood pressure required to sustain organ perfusion
Mean arterial pressure
MAP is roughly ___ in the average person
60
MAP formula
MAP = DBP + 1/3 (SBP-DBP [pulse pressure])
Pulse pressure is found by this formula
SBP - DBP
Control of the cardiovascular system is a function of the:
Autonomic nervous system
A decrease in SBP below 80 mmHg stimulates the ___ to increase arterial pressure through vasoconstriction
Vasomotor center of the medulla oblongata
Time that a tissue can be deprived of oxygen before it starts to die
Warm ischemic time
Major cause of death following septic, traumatic, and burn injuries
MODS
Multi-organ dysfunction syndrome
Group of plasma proteins that functions to eliminate invading bacteria
Complement system
Pediatric patients can compensate for blood loss up to as much as:
30%-35%
Fluid challenge volume for an adult with moderate or severe hypotension
250 mL followed by reevaluation of BP, up to 4 doses
Shock classification that divides types of shock into central or peripheral shock
Weil-Shubin classification
Beck triad of cardiac tamponade
JVD
Narrowing pulse pressures
Muffled heart tones
___ occurs when the heart is unable to sufficiently circulate blood to sustain peripheral perfusion
Cardiogenic shock
2 main causes of obstructive shock:
Cardiac tamponade & tension pneumothorax
If the septic patient is normotensive after initial fluid therapy, administer ___ to maintain BP & renal precision
Dopamine
If the septic patient is hypotensive & vasodilators in “watml shock, administer:
Norepinephrine
If the septic patient is hypotensive in “cold” shock, administer:
Epinephrine
Fluid bolus dose for septic patients:
30 mL/kg
Neurogenic shock usually results from:
Spinal cord injury
A characteristic sign of neurogenic shock is:
Absence of seating below the level of the cord injury
Disruption or loss of normal GI motility
Ileus
___ occurs when there is widespread dilation of resistance or capacitance vessels (arterioles & venules)
Distributive shock
___ medications initiate or alter cellular activity by binding to receptor sites and promoting a response
Agonist
___ medications prevent chemicals from reaching receptors and initiating or altering particular cellular activity
Antagonist
Binding of ___ receptors causes vasoconstriction, while ___ receptor binding causes vasodilation
Alpha; beta
Concentration of a medication required to initiate cellular response
Potency
Ability of a medication to initiate or alter cell activity therapeutically
Efficacy
___ antagonists temporarily bind with receptor sites, displacing other chemicals
Competitive
___ antagonists permanently bind with receptors and block activation by agonist chemicals
Noncompetitive
___ bind to receptors but do not initiate as much cellular activity or change as others
Partial agonists
Careful titration of medication doses may be required in:
Pediatric or geriatric patients
Medication metabolism in the liver is affected by the:
Cytochrome P-450 system
Patients at extremes of age are prone to ___ medication reactions
Paradoxical
Ideal body weight formula for men:
50+(2.3 X height in inches over 60”)
Ideal body weight formula for women
45.5+(2.3 X height in inches over 60”)
Risks associated with meds in pregnancy class __ outweigh any potential benefits to the mother
X
Possibility of fetal harm in 1st trimester from meds in pregnancy class __ are remote
A
Meds in pregnancy class __ have not been studied thoroughly enough to determine risks to the fetus in the first trimester
B
Meds in pregnancy class __ should only be given if the potential benefits outweigh the risks to the fetus
C
Meds in pregnancy class __ have known fetal risks, but benefits to the woman may be acceptable if the benefits outweigh the risks
D
Several smaller doses of a med may be capable of producing the same effects of a single larger dose
Cumulative action
Completely unexpected adverse reactions not known to occur with a particular med
Idiosyncratic reactions
Reduction of available receptors for a particular drug resulting in tolerance
Down-regulation
Decreased efficacy of a drug due to frequent usage
Tolerance
Condition in which repeated doses of a medication within a short time frame may cause tolerance/decreased efficacy
Tachypnylaxis
Physical tolerance and psychological dependence on a medication
Habituation
Physical, emotional, or behavioral need for a particular substance
Dependence
Undesirable medication interactions
Interference
Med combination that produces a greater effect than the sum of the individual effects
Synergism
Enhancement of the effects of a medication by another
Potentiation
Two medications binding together creating an inactive substance
Neutralization
Percentage of unaltered medication that reaches systemic circulation
Bioavailability
Insulin restriction, glucagon secretion, and inhibition of norepinephrine release are the agonist effects of what type of receptors?
Alpha 2
Agonist binding of ___ receptors causes vasodilation of mesenteric arteries
Dopaminergic
The ___ of a medication is lower for medications with a higher potency
threshold dose
% Of RBC’s in the intravascular space
hematocrit
A drug’s bioavailability is altered by all administration routes except:
IV
In addition to GI motility, pH, and presence of food/liquid, GI medications are subjected to ___
first pass metabolism
GI medications pass from the GI tract into the ___ and then to the ___
Portal vein; liver
Alteration of a medication via metabolism within the GI tract before it reaches systemic circulation
first-pass effect
___ is the amount of time needed in an average Person to metabolize or eliminate 50% of a substance in plasma
half-life
All Beta agents have a ___ effect on the heart.
stimulant
In the lungs, alpha agents cause:
Minor bronchoconstriction
Parasympathetic blocker that opposes the vagus nerve to speed up the heart after excessive vagal stimulation/firing has caused bradycardia
atropine
Parasympathetic agent used primarily to induce vasoconstriction & increase bp
Norepinephrine
Sympathetic agent used to increase renal perfusion, increase HR & myocardial contractility, and constrict peripheral vessels
dopamine
___ blockers will reduce HR & BP
Calcium-channel
Clopidogrel (plavix) is a ____
platelet inhibitor
Ach binds with ___ receptor sites
Nicotinic
Onset/duration time of succinylcholine:
30-60 sec/ 3-8 min
Rare, but immediately life-threatening side effect of succinylcholine
Malignant hyperthermia
Onset/duration of rocuronium
1-3 min/15-60 min
___ antagonizes muscarinic receptors to Cause bronchodilation and decreased mucus production
Ipratropium bromide
Antidysrhythmic meds are classified using;
Vaughan-Williams classification scheme
___ is used to treat desthythmias, but not included in VW classification
Adenosine
During Cardiac cycle phase __, cardiac cells are at rest
4
Na and Ca+ slowly enter the cell during phase __
2
Depolarization occurs after/during phase ___ of the cardiac cycle
0
During phase ___, sodium ions rapidly enter the cell thru sodium channels in cardiac cells
0
___ exits the cardiac cell during phase 1
Potassium
Period during which cardiac myocytes are unable to fire or conduct an impulse
Refractory period
Class __ antidesrhythmics slow movement of sodium thru ion channels in certain cardiac cells
1
___ is a class 1 antidesrhythmic that blocks sodium channels in the purkinje fibers & ventricles
Lidocaine
antidysrhythmics Class ___ is composed of beta-adrenergic blocking agents
2
Antidysrhythmic Class ___ medications increase the duration of phases 1,2,3 of the cardiac cycle
3
Class __ antidysrhythmics are comprised of calcium channel blockers
3
Calcium channel blockers slow conduction at the ___
AV node
___ causes marked reduction in the cardiac conduction velocity
Adenosine
Patients taking alphanadrenergic receptor agonist meds at home are often more prone to ___
Orthostatic hypotension & tachycardia
Alpha-blockers generally work to _____
Lower BP & decrease systemic vascular resistance
Ach activates receptors in the heart to produce:
Bradycardia & conduction delays
Competitive muscarinic receptor agonist
Atropine sulfate
___ is used to treat bradycardia caused by vagal stimulation
Atropine
Stimulation of alpha-2 receptors suppresses:
Release or norepinephrine
First sign of IV occlusion:
Decreasing drip rate or presence of blood in tubing
The ___ contains epithelial cells that form a continuous barrier to medication absorption
Urinary tract
___ is an anticholinergic drug derived from plant sources
Atropine
You should suspect altered medication metabolism in a pt with:
HX of Chronic alcoholism
IM administered medications have a bioavailability of:
75-100%
Administration of ___ is indicated in eclampsia when seizures do not respond to Mag sulfate
Diazepam (valium)
AKA Diazepam
Valium
___ can be administered to suppress preterm labor, which may be necessary in case of cord prolapse
Terbutaline
___ is useful in treating hyperemesis gravidarium
Diphenhydramine
Brain damage is irreversible after _ _ _ minutes without adequate oxygenation
10
Clinical state characterized by increased RR and work of breathing
Respiratory distress
Normal resting minute ventilation volume of an average person
6 L/min
Resting alveolar minute volume is approximately:
4 L/min
Pulmonary artery blood flow is approximately:
5 L/min
Average v/q ratio is:
4:5 L/min, or 0.8 L/min
Most Common airway obstruction in an unresponsive patient:
The tongue
Hypoventilation is typically directly linked to
PaCO2 levels in the blood
___ occurs when Carbon dioxide elimination exceeds carbon dioxide production
Hyperventilation
Condition caused by blood bypassing the alveoli and returning to the left side of the heart unoxygenated
Intrapulmonary shunting
Pulmonary edema is related to __
Left sided heart failure
Peripheral edema is a result of __
Right sided heart failure
Positive pressure ventilation increases ___
Afterload
The resistance against which the ventricle must contract
Afterload
Increased afterload causes decreased ___
Cardiac output
The greater the pressure used to ventilate a patient, the greater the decrease in ___
Preload
Low levels of oxygen in arterial blood
Hypoxemia
Clinical finding in which SBP drops 10 mmHg during inhalation
Pulsus paradoxus
Irregular rate, rhythm, and depth of breathing resulting from increased ICP
Ataxic respirations
Softer, muffled breath sounds
Vesicular
Low-pitched, continuous breath sounds that indicate mucus or fluid in airways
Rhonchi
Loud high-pitched breath sounds upon inspiration
Stridor
A caprograph with a prolonged alveolar plateau is indicative of:
Bradypnea
A capnograph with a short alveolar plateau is typically a result of
Hyperventilation
Point on a capnograph that best reflects alveolar Carbon dioxide levels
Point d. Alveolar plateau
An up-sloping, “shark fin” capnograph is characteristic of:
Bronchospasm/ prolonged expiratoryphase
An inspiration downstroke that fails to reach 0 and increases gradually, indicates:
Rebreathing/ air trapping
Ability of alveoli to expend during ventilation
Compliance
Oxygen tank duration of flow is calculated by:
Current tank psi - safe residual pressure x cylinder constant / flow rate in Lpm
Cylinder constant for a D tank
0.16 LPM
Cylinder constant for a M tank
1.56 LPM
Cylinder constant for a H tank
3.14 LPM
NRB mask can deliver up to ___% oxygen concentration
90%
Positive pressure ventilation impairs venous return, namely by:
Decreasing preload
Generally accepted therapeutic pressure range forCPAP
5-10 cmH2O
10 Rights of med administration
Right patient
Right medication
Right dose
Right route
Right time
Right documentation
Right assessment
Right to refuse
Right evaluation
Right patient education
Parasympathetic blocker that opposes the vagus nerve
Atropine
___ is contraindicated for sedation in PTs with possible TBI
Ketamine
___ have potent anti-seizure, anxiolytic, and sedative properties
benzodiazepines
At high doses, benzo’s cause ___
hypotension
Diazepam, lorazepam, and midazolam are pregnancy class ___, because they have demonstrated potential fetal harm
D
benzodiazepines should bbe administered to pregnant PT’s when ___
there is no safer alternatives available
___ is a competitive benzodiazepine antagonist
Flumazenil
Succinylcholine is a ___ paralytic
competitive nondepolarizing
Albuterol can promote cellular uptake of ___
potassium
Lidocaine is a class ___ antidysrhythmic
1B
Lidocaine is a ___ channel blocker, and works primarily in the ___
sodium; ventricles
Potassium channel blockers work in the:
atria & ventricles
Amiodrone is a ___ channel blocker
Potassium
___ channel blockers may be used to increase myocardial oxygen delivery
calcium
___ and ___ are calcium channel blockers commonly used prehospital
Verapimil & diltiazem
___ is a alpha-2 receptor agonist (blocks epi & norepi) used to treat HTN
Clonidine
___ is unlikely to be effective in treating bradycardia caused by blocked cardiac conduction
Atropine
Nebulized epinephrine is used to treat ___
airway edema & bronchospasm
Norepinephrine is indicated in conditions that involve ___
loss of vasomotor tone
Dopamine is the primary prehospital medication for ___
hypotension refractory to fluid resuscitation
Dopamine dosage for chronotropic & inotropic effects
5-10 mcg/kg/min
Dopamine dosage for vasoconstriction effects
10-20 mcg/kg/min
Recommended dose of TXA:
1 gram IV drip over 10 minutes
When drawing blood samples, tubes should be filled in this order:
Red, blue, Green, Lavender
“10% dextrose” means there are ___ grams per mL
100
(10,000 mg/100 mL = 100 mg/mL)
Formula for calculating flow rate for IV med administration
Volume to be infused X drip set rate ‘/, infusion time in minutes
failure to match ventilation & perfusionn
V/Q mismatch
Airway assessment LEMON stands for:
Look externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck mobility
Analgesic dose for Ketamine
0.2-0.3 mg/kg
Sedation dose for Ketamine
2 mg/kg
Standard dose for Succinylcholine
1-2 mg/kg
Standard dose for Vecuronium
0.1-0.2 mg/kg
Standard dose for Rocuronium
0.6-1.2 mg/kg
Infection of the larynx, trachea, and bronchi
Laryngotracheobronchitis
Laryngotracehobronchitis is a common cause of:
Croup
___ is characterized by stridor, hoarseness, and a barking cough
Croup
__ is a more common underlying cause of croup
Viral infection
Severe, rapidly progressive inflammation of the epiglottis & surrounding tissues
Epiglottitis
S&S of Epiglottitis
sore throat, fever, drooling, hoarseness
__ & __ are collectively classified as COPD
Chronic bronchitis & Emphysema
Triad of airway alterations found in asthma
Bronchospasm, ^ mucous production, peripheral airway edema
An ill looking PT who reports recent illness with chest pain, productive cough, fever, and who presents with a “vibration” sensation when palpating the chest as the PT breathes is likely suffering from:
Pneumonia
Inhalation of ___ causes acute upper respiratory irritation
Ammonia
The effects of inhaling __ depend on the concentration and amount/length of exposure
Chlorine
Inhalation of ___ has a delayed onset of pulmonary edema
Phosgene
Lung sounds caused by fields of wet alveoli popping open as the lungs inflate
Crackles
Trauma triad of death:
hypothermia, coagulopathy, acidosis
Titration of BP to __ -__ mm Hg may be preferred for hemmorhagic shock patients
80-90
A __ scar does not extend past the borders of the wound margins, & tends to form in ppl with lighter skin
Hypertrophic
A ___ scar grows over the wound margins & can be larger than the wound area
keloid
Dead tissue
gangrene
Wet gangrene can cause ___ and lead to death
sepsis
Death of tissue from bacterial infection
necrotizing fasciitis
Topical burn injury
scalding
The presence of ___ may be a sign of impending upper airway compromise
stridor
PTs with burns greater than __% of TBSA will need fluid resuscitaiton
20
Consensus/Parkland formula for fluid resuscitation of burn PTs
2-4 mL X weight (kg) X TBSA burned
When using the Parkland/Consensus formula, __% of the fluid should be given in the first __ hours
50; 8
Acid & alkali burns should initially be treated with:
flushing
Indications for morphine in ACS
Symptoms that are refractory to, or not relieved by nitrates
