Final Review - LK Flashcards
What’s the difference between Peritonitis and Acites
What it is
Peritonitis-Inflammation/infection of peritoneum
Ascites -Fluid buildup in peritoneal cavity
Cause
Peritonitis - Infection, rupture, trauma
Ascites -Liver failure, cancer, CHF
S/S
Peritonitis - Pain, rigidity, fever, N/V
Ascites - Swelling, discomfort, breathing difficulty
Emergency?
Peritonitis - YES – requires urgent care
Ascites - NO (unless infected), managed medically
Cushings Triad?
1.Hypertension
Widening pulse pressure (high systolic, low/normal diastolic)
2.Bradycardia
Slow heart rate, often irregular
3.Irregular respirations
Cheyne-Stokes, ataxic breathing, or other abnormal patterns
Visceral pain
dull, cramping, poorly localized (organ-based)
GTPALM
G - Gravida - # of past pregnancies, including present one
T – Term – # of term babies born (not including present baby)
P – Pre-term – # of pre-term babies born, less than 37 weeks
A - Abortus – # of pregnancies resulting in abortion
L – Living - # of living children
M – Multi - # of multiple births
S/S of compensating shock?
Cardiovascular:
Tachycardia – fast heart rate (first major sign)
Cool, pale, clammy skin – due to peripheral vasoconstriction
Delayed capillary refill – especially in children
Weak, thready pulse – especially peripherally
Normal or slightly elevated blood pressure
Neurological:
Anxiety, restlessness, agitation – early signs of hypoxia to the brain
Altered mental status – may progress as perfusion worsens
Respiratory:
Increased respiratory rate (tachypnea) – to compensate for acidosis and hypoxia
S/S of decompensated shock?
Cardiovascular:
Hypotension – falling or low blood pressure (classic sign of decompensation)
Weak or absent peripheral pulses
Profound tachycardia (but can also slow before arrest)
Neurological:
Altered LOC – confusion, lethargy, unresponsiveness
Dizziness or syncope
Respiratory:
Tachypnea may progress to bradypnea or apnea
Shallow or irregular breathing
Skin:
Cold, pale, mottled, or cyanotic (especially lips, fingers)
Prolonged capillary refill or none at all
Diaphoresis (sweating) continues
Other:
Oliguria/anuria (low or no urine output)
Thirst, nausea, vomiting
Acidosis (often metabolic, leads to further cardiac instability)
AEIOUTIPS
A Alcohol Acidosis, Allergies (anaphylaxis)
E Epilepsy Electrolytes, Encephalopathy
I Insulin Hypoglycemia / Hyperglycemia, Inborn errors
O Overdose Oxygen deprivation (hypoxia), Opioids
U Uremia Urinary issues, Underdose (e.g., meds)
T Trauma Tumor, Temperature extremes (hypo/hyperthermia)
I Infection Intracranial infection (e.g., meningitis)
P Psychiatric Poisoning, Pain
S Stroke Shock, Seizure, Subarachnoid hemorrhage
Deadly Dozen Hidden 6
Aortic dissection
Tracheobronchial tears
Myocardial contusion
Pulmonary contusion
Esophageal tear
Diaphragmatic tear
Deadly Dozen Lethal 6
FBAO
Tension pneumothorax
Open pneumothorax
Massive hemothorax
Cardiac tamponade
Flail chest
4 lobes of the brain?
- Frontal
- Parietal
- Temporal
- Occipital
Function of the Frontal lobe?(5)
-Voluntary movement (motor cortex)
Speech production (Broca’s area – usually in the left hemisphere)
-Executive functions – decision-making, planning, judgment
-Emotional control and behavior
-Personality
Function of the Parietal?(3)
Sensory processing (touch, pain, temperature – somatosensory cortex)
Spatial awareness and body positioning
Mathematical and analytical thinking
Function of the Temporal lobe?(4)
Hearing (auditory cortex)
Language comprehension (Wernicke’s area – usually left side)
Memory formation (hippocampus)
Emotions
Function of the Occipital?(2)
Visual processing (primary visual cortex)
Interpreting visual stimuli – color, shape, motion
What are the modes of infection transfer?(infection control)(6)
1.Direct Contact – Person-to-person contact (e.g., touching, sexual contact, kissing)
Examples: colds, influenza, strep throat
- Indirect Contact – Transfer via objects (fomites)
Examples: bedding, door handles, syringes, equipment
Diseases: hepatitis B, AIDS
- Droplet Transmission – Large respiratory droplets within 1 meter
Examples: coughing, sneezing, talking
Diseases: influenza, colds
4.Airborne Transmission – Smaller droplets carried more than 1 meter
Diseases: tuberculosis, meningitis, SARS
5.Vehicle Transmission – Contaminated substances (e.g., food, water, blood)
Examples: AIDS via blood transfusion, salmonella via undercooked chicken
6.Vector Transmission – Through insects
Example: malaria from mosquitoes
4 types of tissues?
Epithelial tissue
Connective tissue
Muscle tissue
Nervous tissue
Epithelial Tissue - Where are the simple squamous typically located?
Lines blood vessels/alveoli
Permits base exchange of
nutrients/wastes/gases
Epithelial Tissue - Where are stratified squamous typically located?(3)
- Outer layer of skin
- mouth
- vagina
Protects against abrasion, drying, infection
Epithelial Tissue - Where are simple cuboidal typically located?(2)
Lines kidney tubules and glands
Secretes/absorbs H2O and small molecules
Epithelial Tissue - Where are stratified cuboidal typically located?(1)
Lines ducts of sweat glands
Secretes H2O and salt
Epithelial Tissue - Where are Simple Columnar typically located?(1)
Lines most digestive organs
Secretes and reabsorbs H2O and small
molecules
Epithelial Tissue - Where are Stratified Columnar typically located?(3)
Lines epididymis, mammary glands, larynx
Secretes mucous
5 Sub-tissues types of Connective tissues?
1.Loose
2.Dense
3.Cartilage
4.Bone
5.Blood
3 Types of Muscle Tissue?
Skeletal
Cardiac
Smooth
2 Types of Nervous tissue?
- Neurons
- Neuroglia
3 parts of a neuron?
- Dendrites
- Cell body
- Axon
Neurons go through Mitosis after birth ? TRUE of FALSE
FALSE
What is the purpose of Schwann Cells?
Increase nerve transmission speed
What is the purpose of Astrocytes?
Form the blood brain barrier
3 layers of the skin?
- Epidermis
- Dermis
- Hypodermis (dont count this one)
Epidermis contains 4 accessory types of cells?
- Keratinocytes - Protects underlying tissues from light, heat, microbes, and many chemicals
- Melanocytes - Produces the pigment melanin
- Langerhans Cells - bone marrow and migrate to skin surface. Interact with “helper T-cells” in immune response.
- Merkels Cells - flattened portion of
a sensory neuron to function in the
sensation of touch
3 Functions of the Dermis?
- Composed of connective tissue containing
collagen and elastic fibres which maintain
strength, extensibility, and elasticity of the
skin - Blood vessels, nerves, glands, and hair
follicles are embedded in the dermis
3.Contains nerve endings that are sensitive to
heat and cold
Hypodermis, tell me 4 things about it?
1.Subcutaneous layer
2.Not a true skin layer
3.Connects underlying muscle and bone to
skin
4.Nerve endings run through this layer into
dermis
5.Sensitive to pressure
Skeletal System - How many Axial bones?
80
Skeletal System - How many bones?
206
4 sections of the spine?
- Cervical (7)
- Thoracic (12)
- Lumbar(5)
- Sacral (5) fused
- Coccyx (4) fused
2 classifications for bones?
- Compact
- Spongy
5 Classification types for bones?
- Long
- Short
- Flat
- Irregular
- Sesamoid
3 functional Classification of joints?
1.Synarthrosis joint
2.Amphiarthrosis joint
3.Diarthrosis joint
Synarthrosis joint, function and examples
Immovable (skull sutures)
Amphiarthrosis joint, function and examples
Slighty movable joint( distal articulation between Tibia and fibula)
Diarthrosis joint, function and examples
A freely movable joint (Knee)
3 structural classification for joints? Synovial (Freely movable)
1.Fibrous
2. Cartilagous
3. Synovial
Fibrous joint, characteristics?
bones are held together by fibrous connective tissue
Cartilaginous joint, characteristics?
Bones are held together by cartilage
Synovial joint, characteristics?
surrounded by articular capsule and frequently by accessory ligament
During childhood bones throughout the body enlarge by
appositional growth and long bones lengthen by addition
of bone material at the_____________
Epiphyseal side
3 basic functions of the nervous system?
- Sensory
- Integrative - changes and decides on response
- Motor
Increase speed of nerve
impulse conduction and
insulate and maintain
the fiber?
Myelin Sheath
Sensory Neurons function(4)
1- Forms afferent division of PNS
2-Connects a sensory receptor in peripheral
tissue with brain/spinal cord, and gives us
info about our world and our position
within it.
3-Proprioceptors monitor joints & skeletal
muscle mvmt
4-Visceral receptors monitor digestion,
respiration, CV, urinary, reproductive,
taste, pain, pressure
Motor Neurons, function?(3)
1-Forms efferent division, carries info from CNS to
other organs & tissues
2–Somatic motor neurons innervate skeletal muscle
3–Visceral motor neurons innervate peripheral sites
Cardiac muscle, smooth muscle, glands
Interneurons function?(2)
1-Found only in brain/spinal cord (CNS)
2-Connect neurons & responsible for distributing
sensory info and coordinating motor activity
What 2 elements are critical in nerve impulse control?
Na+ & K+
Nerve impulse - Normal resting membrane potential?
-70mV
List the steps in Nerve impulse conduction?
1.Resting state
2.depolarization
3.Absolute refractory
period
4.Relative refractory
period
5.Repolarization
Characteristics of Chemical synapse?
- slower
2.work both as positive and negative feedback loops - Can be excitatory or inhibitory.
Travel via blood stream from gland to effector
organ
Requires adequate blood flow
Characteristics of electrical synapse?
Ionic current spreads directly b/w adjacent
cells through gap junctions.
Each gap junction contains ~100 connections
and ions are able to flow back & forth
Physically touch each other and have
essentially holes into one another
Structures of the CNS, 4 regions?
1-Brain Stem
Bridge between brain and spinal cord
Consists of Medulla Oblongata, Pons, and Midbrain
2-Cerebrum
Largest part of the brain
3-Cerebellum
Superior to the brain stem
4-Diencephalon
Consists of Thalamus, Hypothalamus
4 characteristics of the Medulla Oblongata? Brain Stem
1-90% of major
sensory/corticospinal tracts cross explaining why the left side controls the right and vice versa
2-This area controls heart rate and force of contractions, as well as vessel diameter
3- Breathing rhythmicity controlled here as well
4-Vomit center, hiccups, coughing, swallowing
Pons, 2 characteristics? Brain Stem
1-Acts as a bridge for signal transmission in
the brain and from the spinal cord
2-Pneumotaxic area and apneustic area here as well
Control amount of air inhaled by lungs and when to breath respectively
Midbrain, 2 characteristics? Brain Stem
1.Is a pathway for signals to pass from the
cerebrum to the spinal tract, medulla, and
pons
2.Subconscious motor control is coordinated
here along with the neurotransmitter
Dopamine
Parkinson’s disease is centered here
Thalamus, 5 characteristics? Diencephalon
80% made up by Thalamus
1-Major sensory relay for body to brain
2-Emotions, alertness, memory controlled here
3-Learning and cognition as well
4-Relay for visual message information from
retinas
5-Sensory integration of pain and arousal here
Hypothalamus, 5 characteristics? Diencephalon
1.Relay for smell, taste, vision
2.Major regulator of homeostasis
3.Sensors for
Osmotic pressure (thirst center)
Blood temperature
Glucose levels
Hormone levels (negative feedback
with pituitary)
4.Helps regulate smooth and cardiac muscle
5.Emotions controlled
Rage
Aggression
Pain
Pleasure
Sexual arousal
Cerebellum, 3 characteristics?
1-Second biggest part of the brain
2-Back part of the head
3-Helps monitor/control fine motor movement,
posture, and balance
Alcohol effects this area the most causing
ataxia
Secondly, alcohol then affects pathways both
to and at the medulla from the cerebellum
Cerebrum, 2 characteristics?
1-Higher level of
thought controlled
here
2-Left and Right
hemispheres each
with 4 Lobes
Frontal
Parietal
Temporal
Occipital
Ventricles, how many internal cavities filled with CSF lined with cells of ependyma?
4
Approx how much CSF in adults
80-120ml
Created to absorb approx 20ml/hr
3major functions of CSF?
1-Mechanical protection
Shock absorber
2-Chemical protection
Huge buffer, if gets too far out of normal
range causes major brain malfunctions
3-Circulation
Circulates nutrients and removes waste to
blood
3 layers of the Meninges
- Pia Mater
- Arachnoid Mater
- Dura Mater
the Meninges cover brain and spinal cord to______
cauda equina at the base of the spinal cord (approx L1-L4)
Spinal cord - Efferent message transmission?
From the brain
Primarily the cranial nerves
Spinal cord - Afferent message transmission?
From the periphery
Reflex loop here as well
Nervous System - Somatic Sensation?
1-Information and stimulus we receive from the
outside environment
Pressure, heat, wind, body position, etc
2-Most reactions to these stimuli are
processed in the spinal cord
Nervous System - Visceral Sensation?
Generally we are unaware of
Control/reaction mechanisms to Internal Environment
BP, digestion, HR, etc
2 types of axons carry painful sensations?
1-Myelinated – carry very localized sensation of
fast “prickly” type pain (injection or deep cut)
2-Unmylenated – slow and carry generalized
“burning/aching” pain
II – Optic Nerve
Function: Vision (sensory)
Transfers visual information from the retina to the brain
I – Olfactory Nerve
Function: Smell (sensory)
Detects odors from the nasal cavity
III – Oculomotor Nerve
Function: Eye movement (motor)
Controls most eye muscles, pupil constriction, and eyelid elevation
IV – Trochlear Nerve
Function: Eye movement (motor)
Moves the eye downward and laterally (superior oblique muscle)
V – Trigeminal Nerve
Function: Sensation and chewing (mixed)
Facial sensation (touch, pain), and controls muscles for mastication (chewing)
VI – Abducens Nerve
Function: Eye movement (motor)
Controls lateral rectus muscle for outward gaze
VII – Facial Nerve
Function: Facial expressions, taste (mixed)
Controls facial muscles, taste from front 2/3 of tongue, tear and saliva production
VIII – Vestibulocochlear Nerve
Function: Hearing and balance (sensory)
Detects sound and helps with equilibrium
IX – Glossopharyngeal Nerve
Function: Taste, swallowing, salivation (mixed)
Taste from back 1/3 of tongue, monitors blood pressure, assists in swallowing
X – Vagus Nerve
Function: Parasympathetic control (mixed)
Controls visceral functions: heart rate, digestion, respiratory rate; also speech and taste
XI – Accessory Nerve
Function: Head and shoulder movement (motor)
Controls sternocleidomastoid and trapezius muscles
XII – Hypoglossal Nerve
Function: Tongue movement (motor)
Controls muscles of the tongue for speech and swallowing
Neurons, function(2) & Features(3)
Function:
Main cells responsible for transmitting electrical signals (nerve impulses)
Handle communication within the nervous system
Key Features:
Do not divide (no mitosis after birth)
Consist of:
Cell body – contains nucleus and organelles
Dendrites – receive signals
Axon – sends signals to other neurons or effectors
Create and propagate action potentials
Neuroglia (Glial Cells) function(3), features(2)
Function:
Support, protect, nourish, and insulate neurons
Do not send electrical signals
Maintain homeostasis within nervous tissue
Key Features:
Can divide (undergo mitosis)
Types include:
Astrocytes – form blood-brain barrier, regulate ion balance
Schwann cells – form myelin sheath in PNS
Oligodendrocytes – form myelin in CNS
Others include microglia and ependymal cells
How many bones in the skull?
22
_________________ is the
location where the spinal
cord meets the brain stem
(medulla, pons, and
midbrain).
Foramen magnum
Potential spaces of the Meninges?(3)
1-Epidural space
Between the bones of the skull and the
dura mater
2-Subdural space
Between the dura and the arachnoid
3-Subarachnoid space
Between the arachnoid and pia mater
(normally contains CSF)
Head injuries - Primary injury (2)
1-Initial damage to brain tissue from direct trauma
2-The best management of primary brain injury is
injury prevention
Head injuries - Secondary injuries(2)
1-Occurs as a result of the brain’s reaction to the primary injury. (Coupe contrecoup)
2-Injury→Swelling→ICP→Ischemia→Injury….
Diffuse Axonal injury
Blunt trauma to head
Most severe injury caused by blunt
trauma
Generalized contusion and
fractures of brain tissue causing
generalized edema, bleeding, and
ICP.
S/S may include anything found in
cerebral contusions to extreme
levels, including herniation. MOI is
valuable.
Epidural Hematoma, venous or Arterial bleed?
Arterial
Blunt trauma causes a linear fracture in the temporal/parietal
area
→laceration to middle meningeal artery
→rapid arterial bleeding between dura mater and skull
Subdural Hematoma, venous or Arterial bleed?
Venous
Bleeding occurs in arachnoid mater due to damage of
bridging veins. Venous bleeds are slower than arterial
bleeds and therefore often cause slower onset of
symptoms.
Intracerebral Hemorrhage, venous or arterial bleed?
typically arterial
Intracerebral
Hemorrhage
Bleeding within the
tissues of the brain,
caused by blunt or
penetrating trauma
S/S would reflect
increasing ICP or CVA
symptoms (See ICP
section).
4 patients you should be most concerned about in primary or secondary head injuries?
Elderly
ETOH abuse
Hemophilia
Anticoagulants
You should have a high index of suspicion for
any patient who has decreased hemostasis.
This includes:
Secondary injury :Anoxic Brain injury 2 characteristics
Lack of oxygen to brain tissues due to airway obstruction,
respiratory or cardiac arrest, asphyxiation, etc, causes
permanent brain damage after 4-6 minutes of anoxia
Spasm of cerebral arteries following anoxia continues
death of brain cells despite resuscitation attempts (no
reflow phenomenon)
Death of cells causes Swelling→ICP→Ischemia→Injury.
The process may be delayed with hypothermia.
Cerebral perfusion pressure (CPP) is the
mean arterial pressure (MAP) minus the
intracerebral pressure (ICP)
CPP=MAP-ICP
What is normal ICP
ICP=5-10 mmHg
When does herniation begin?
CPP=MAP-ICP
25mmHg
MAP=
MAP=(2x diastolic)+ Systolic/3
Cushing’s Triad
- increased BP
- Decreased HR
- Inregular RR (Cheyne-Stokes)
Herniation Syndrome
Cushing’s plus one of the following?
1-Blown pupil or pupils
2-Posturing
3-GCS of 9 or less with a sudden
drop of 2 or more
Distinction between spinal cord and spinal column?
Spinal column-> bundle of nerves = 33 vertebrae
Spinal cord->A nervous tissue structure — part of the central nervous system (CNS)
Function:
Transmits nerve impulses between the brain and the body
Controls reflexes through reflex arcs
Positive MOI - spinal trauma - TAKE C-Spine (8)
1-High speed MVC (> 100km, rollover, or ejection)
2-Falls >1m or five stairs
3-Axial load
4-Motorized recreational vehicle trauma
5-Bicycle collision with object
6-Other medical risk factors (osteoporosis)
7-Unconscious trauma patient
8-paresthesia abnormal skin sensations such as:
Tingling
Pins and needles
Numbness
Burning
Prickling
Where is T6 ?
roughly nipple line
Neurogenic Shock S/S (4)
Bradycardia
Hypotension
Hypoventilation
PWD Hypothermic Pale warm dry
BLS Treatment for neurogenic shock?
BVM
Suction
NS - Normal Saline
Prevent hypothermia
AEIOU TIPS?
Alcohol, apnea, anaphylaxis
Epilepsy, environmental (heat / cold)
Insulin (diabetes)
Overdose
Uremia
Trauma
Infection
Psychiatric, poisoning
Stroke, shock
Headache - A generalized headache caused by
contraction of the muscles of the scalp and
neck
Pain generally comes from neck and up
along back of head or through temples
Most of you probably have one from class
Tension
Headache - Caused by dilation of cerebral blood vessels
More blood = more pressure
Usually results from hypertension,
commonly with a diastolic pressure of
120mmHg
May have an aura
May be generalized/localized
Typically recurrent
Vascular(Migraine)
Headache - Originate in the hypothalamus
Are a result of abnormal serotonin levels
May last up to 2 hours and occur 2 or 3
times per night, waking the patient up
Generally more intense at night
Follow biological rhythm not only at
nights, but seasonally/annually
Cluster
Headache - Can be mere nuisance to life threatening
Viral infections can either directly or indirectly
cause headache
May produce intense congestion in the nasal
passages, which at times causes a blockage
of the sinus drainage passages
Severe headache may also result from viral
infections that specifically attack the brain
and its coverings, such as encephalitis and
meningitis
infection
CVA 5 characteristics
1-Are caused by a disruption of
blood flow to any part of the
brain
2-Lack of oxygen leads to
infarction and eventual
necrosis
3-Present with contralateral
symptoms that vary in
severity
4-Different locations in the brain
create different S/S
5-Ischemic, and hemorrhagic,
Transient Ischemic Attack
CVA what % are Ischemic & Hemorrhagic?
Ischemic 90%
Hemorrhagic 10%
What is an Occlusive Stroke? Thrombotic
Caused by a clot occurring at the site of atherosclerosis or other damage
TIA’s are warning signs like Angina is for the heart
Onset may be slow or preceeded by ++ TIAs as clot forms and breaks off
What is an Occlusive Stroke? Embolus (2)
1-Clot formation, breaks free and travels to brain
2- Rapid onset
Hemorrhagic Stroke?(3)
1- A rupture of a cerebral artery causes bleeding
into brain tissue
Two problems:
-Ischemia
-Intracranial pressure
2-Primarily caused by hypertension BP 220>/110> indicator for hemorrhagic
3-Usually a rapid onset from headache to coma
TIA - Transient Ischemic Attack
Is a temporary occlusion of a cerebral
artery that resolves itself within 24 hours
Is a grave predictor of future stroke, with 30% chance of CVA occurring soon after
TIA S/S
Headache
Dizziness
Photophobia
Numbness
Altered LOC or Coma
Altered pupillary reflexes
Altered CN assessment
Other symptoms may include:
Unexplained HTN
AV Blocks
Positive Babinski
What are the components of FAST+ assesement?
- Facial droop
- Arm drift & Leg strength
- Speech
- Time
Treatment for a Stroke?
- Upper body slighty elevated
- O2 therapy
- Rapid Transport
- D50W 12.5 q 10m max 25g to BGL 3.0
LAMS(Los Angeles Motor Score)
2 main types of Seizures
1.Generalized - Both hemispheres of the brain
2. Partial - involves only 1 hemisphere
Seizures can use 200+ times O2 and glucose in the brain- TRUE OR FALSE
TRUE
Absence seizures- 4 characteristics
1-‘Spaced out’ appearance
2-Last only a few seconds
No general postictal state
3-Patient will have no memory of
event
4-Children may grow out of them,
or they may develop tonic-clonic
seizures
(Grand Mal ) tonic Clonic seizure - 5 characteristics
Characterized by a sudden
onset of loss of coordination and
consciousness
Violent jerking of body,
contraction and relaxation of
opposing muscle groups
Lasts 3-5 minutes normally, but
can last 30 minutes
Longer the seizure,
longer/deeper the postictal state
May present with incontinence
Partial Seizure - 5 characteristics
1-Present in a single muscle
group
2-Can also have sensory
symptoms such as vertigo,
hallucinations, auditory or visual
disturbances
3-No decrease in LOC
4-No postictal phase
5-Can develop into deeper/more
severe seizures
Jacksonian Seizures- 4 characteristics
1-A form of epilepsy involving brief
alteration in movement, sensation
or nerve function caused by
abnormal electrical activity in a
localized area of the brain
2-Generally repetitive
3-Smacking lips, twitch of
hand, etc
4-Seizures of this type typically
cause no change in awareness or
alertness.
Todd’s Paralysis, 2 Characteristics
1-Condition after a seizure
Pt’s postictal state resembles that of a stroke pt
Hemiparalyis, CSS deficits, slurred speech
Corrects itself as postictal state lessens
2 ALS meds for seizures
1- Valium (diazepam)
2- Versed (midazolam)
Systemic Inflammatory Response Syndrome (SIRS)
HR more than >90
RR more than >20
Temp >38 or <36
++ WBC count
Altered LOC
3 Alcohols
Ethanol - Alcohol, mouthwashes, perfumes
Isopropanol - rubbing alcohol, antifreeze, cleaning products
Methanol - industrial solvent, commonly windshield washer fluid
3 Sympathomimetics
Cocaine
Methamphetamine
MDMA
4 Depressants
Benzodiazepines
Opiates
Gamma-Hydroxybutyrate
Huffing
2 Cholinergics
Organophosphates
Anticholinergics
Overdose & poisioning - most frequent route
Inhalation
Overdose Poisioning - Absorption - 6 Characteristics
1-Includes the eyes
2-Generally slower
3-Intact skins provides barrier to some but not all poisons
4-Causes absorption into systemic circulation
5-Affected by blood flow/temp to area
6-Some parts of body absorb more quickly (ie sole of foot vs skin folds)
7-Lipid soluble chemicals more likely to absorb easily through skin (organophosphates)
Overdose poisioning - Ingestion characteristics
1-Patient had to have been awake to take it
2-Slow absorption
Intentional
Suicide
Poisoned by other
3-Unintentional
Improper hand washing, smoking, eating, swallowing concentrated solid or liquid aerosols during inhalation
4-Occurs most in children
Overdose poisioning - Injection characteristics 3
1-Subcutaneously, Intramuscularly,
Intravenously
2-IV drug use
Accidental high pressure injection
Through a laceration
3-Prescribed medication
Deadly dose of Methanol?
30ml(1mg/kg) potentially fatal
MOA of Alcohol withdraw
Due to constant surplus of ETOH, cells lose GABA receptors. After ETOH is taken away, the net result is excess
excitatory stimulation.
Peak period of Alcohol withdraw symptoms?
up to 7 days
3 severe Alcohol withdrawal symptoms?
Hallucinations
Agitation
Delirium
Sympathomimetic - Cocaine - MOA
increase serotonin, noepinephrine, dopamine
Bruxism?
Is repeated clenching of the
jaw.
3 Amphetamines
Meth
MDMA
Ecstasy
5 Depressant Opiates
Codeine
Fentanyl
Morphine
Demerol
Heroin
What are Depressant Benzodiazepine used for?
1.seizure control
2. anxiety
3.alcohol withdrawal
4. insomnia
5. control of drug-associated agitation
3 characteristics of Benzodiazepine
1- sedative-hypnotic agents
2- Benzos mimic GABA
Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the CNS
3- Enhanced GABA neurotransmission results in
Sedation
Striated muscle relaxation
Anticonvulsant effects
Vasodilation
Cannabinoid Hyperemesis Syndrome
Long term chronic users are at risk of developing use related cyclical vomiting and intense abdominal
cramping
CO poisoning, 2 characteristics?
1- CO binds to Hgb 210x more than O2.
2- No O2 is transported to mitochondria
Salicylates, lethal doses 14kg toddler.
21 adult ASA tablets
1 teaspoon of oil of wintergreen
1 bottle of pepto bismol
Damaging - 2 primary mechanisms of Salicylates
1- Directly poisonous to neural tissue
2- Dramatically increases metabolism and breakdown of fuel sources in the body while inhibiting aerobic respiration.
Why is Acetaminophen toxic in large doses?
Large amounts of acetaminophen overwhelm normal metabolism and takes a side pathway which creates a toxic metabolite, eventually causing liver damage
S/S of liver failure
Jaundice
Hepatic encephalopathy- decline in brain function ->unable to adequately remove toxins
Hypoglycemia
Coagulation dysfunction
Lethal dose of TCAs
8 times the prescribed dose
Nemonic for TCA Tricyclic Antidepressants
Dry as a bone
Red as a beet
Mad as a hatter
Hot as a hare
Blind as a bat
Cholinergics-Organophosphates - poisioning MOA
Inhibits acetylcholinesterase, which increases the amount of Acetylcholine in the synaptic cleft.
Neuromuscular junctions (activates muscles)
Parasympathetic nervous system (“rest and digest” responses)
Central nervous system (learning, memory, attention)
Nemonic for Organophosphate Poisoning
S - salivation
L - lacrimation
U - urination
D - defecation
G - gastroenteritis
E – emesis
M - Miosis
_______
D-Diaphoresis/Diarrhea
U-Urination
M-Miosis
B-Bradycardia
B-Bronchospasm
E-Emesis
L-Lacrimation
S-Salivation
Organophosphate Poisoning - Nicotinic Effects
M - mydriasis (pupil dilation)
T - tachycardia
W - weakness
H - hypertension, hyperglycemia
F - fasciculations
What’s the signifigance of ETCO2 in Cardiac arrest?
ETCO₂ reflects perfusion from chest compressions
Higher ETCO₂ = better cardiac output from compressions
Respiratory Emergencies - Biots
Several short burst/clusters of breaths
followed by periods of apnea
Head injuries/ICP
Extrinsic Asthma
Is an allergic reaction
Requires a “trigger”, which is anything that carries a protein that is recognized by your body as a pathogen and causes inflammation.
Intrinsic Asthma
Hypersensitivity is due to
abnormal inflammation in the lung itself.
Does not require a
pathogenic protein
Obstructive Disease-Asthma - Pathophysiology
Long term compensation causes:
Air trapping ->Muscular tiring ->Hypoxia-> Dehydration
Deadly consequences of air trapping
Dead air space
Barrel chest
Pneumothorax
Obstructive Disease-Asthma - Timeline
Blue bloaters
Chronic Bronchitis
Pink Puffers
Emphysema
Cardiogenic Pulmonary Edema
Empyema
Collection of pus/exudates in pleural space
Generally from previous lung infection that has
spread
Bacterial
Post surgery
Trauma
Abscesses
Left shift in the Oxygen Hemoglobin Dissociation Curve
Right shift in the Oxygen Hemoglobin Dissociation Curve
What is the approximate systolic blood pressure at the radial, brachial and carotid pulse points?
Radial - 80
Brachial - 70
Carotid - 60
A thickening and/or hardening of the walls of arteries refers to
Arteriosclerosis
When is Pulse Oximetry inaccurate?(5)
1-A reduction in peripheral blood flow produced
by peripheral vasoconstriction (hypovolemia,
severe hypotension, cold, cardiac failure,
some cardiac arrythmias) or peripheral
vascular disease.
2-Bright ambient light may cause the oximeter to
be inaccurate.
3-Shivering may cause difficulties in picking up
an adequate signal.
4-Nail polish may cause falsely low readings.
5-The units are not affected by jaundice, dark
skin or anemia.
I- Gel sizing - 90Kg +
5 - orange
I- Gel sizing - 50-90kg
4 - Green
I- Gel sizing - 30-60Kg
3-yellow
BIAD-Troubleshooting - DOPE
Displacement
Obstruction
Pneumothorax
Equipment
a synergistic action in which the effect of 2 drugs given simultaneously is greater than the effect of the drugs given separately?
Potentiation
uncontrollable dependence on a substance to such a degree that cessation causes severe reactions?
Addiction
the interaction of 2 or more drugs to produce a certain effect
Synergism
an acquired tolerance from repeated exposure to a particular stimulus
Habituation
Fastest rate of absorption?
IV: 30-60 seconds
Slowest rate of absorption?
Oral: 30-90 min
what gauge of needle is used for subcutaneous injection
25 gauge
Isotonic, hypertonic, hypotonic? normal saline 0.9%
Isotonic
Isotonic, hypertonic, hypotonic? Ringer Lactacte
Isotonic
Isotonic, hypertonic, hypotonic? D5W
Isotonic
Isotonic, hypertonic, hypotonic? 2/3 - 1/3
Isotonic
Isotonic, hypertonic, hypotonic? 0.3% Normal Saline
hypotonic
Isotonic, hypertonic, hypotonic? 3.0% Normal Saline
hypertonic
Crystalloids
IV fluids made of water and dissolved small molecules (like electrolytes or glucose)
Examples:
Normal Saline (NS)
Lactated Ringer’s (LR)
D5W (Dextrose 5% in Water)
Colloids
IV fluids containing larger molecules (like proteins or starches) that stay in the blood vessels longer
Examples:
Albumin
Dextran
Hetastarch
60 drop set means what?
60 drops equal 1ml
IV Catheters colors - orange
14G
IV Catheters colors - grey
16G
IV Catheters colors - Green
18G
IV Catheters colors - pink
20G
IV Catheters colors - Blue
22G
IV Catheters colors - Yellow
24G
IV Catheters colors - Violet
26G
When should large bore IVs be used?
(14 to 16 gauge) should be used for patients in shock, cardiac arrest, or other life-threatening emergencies in which rapid fluid replacement is required.
Veins have 3 layers
1- Tunica intima (inner layer)
2- Tunica media
3- Tunica externa (outer layer)
TKVO
Approx 150ml/hr
Determining Flow Rates
What is a raised bony bump located on the front of the tibia (shin bone), just below the patella (kneecap).
Tibial Tuberosity
