FINAL TEST REVIEW Flashcards
What is pulmonary edema and what does it do?
Have an excessive among of fluid in their lungs. This excessive fluid impairs oxygen diffusion into the pulmonary capillaries, leaving the patient hypoxic and severely short of breath.
Pre-hospital treatment for pulmonary edema….And what are the contraindications for this treatment?
CPAP
unresponsive patient, unable to speak, unable to protect airway, hypoventilation, hypotension (sbp less than 90), closed head injury, facial trauma, tracheostomy, active bleeding gastro, nausea/vomiting, patient is unable to sit up. Patient does not tolerate mask).
the bodies natural ability to clot.
Hemostasis
Stablility in the bodies internal environment, process the balances the supply and demand of the bodies needs, works through negative feedback.
Homeostasis
positive/ negative effects on hemostasis
Pre-existing conditions(hemophilia, Von Willebrand), liver disease, Aplastic Anemia, alcohol, drugs, diet
positive/ negative effects on homeostasis
genetic predispositions, lifestyle choices, environmental conditions, and exposure to toxin
Elicited by placing fingers under the right costal arch (below the rib cage, and asking the patient to take a deep breath. As the patient inhales the diaphragm pushes the liver and gallbladder downward. If the gallbladder is inflamed, the patient will experience pain and stop breathing as the inflamed gallbladder comes into contact with the examiner’s fingers. Sign of cholecystitis.
Murphy’s Sign
medical finding where pain is referred to the left shoulder when a patient lies down with their legs elevated. Typically associated with a ruptured spleen.
Khers Sign
foot reflex that’s normal in infants and children up to two years old. Its also known as the plantar reflex. Test occurs when the sole of the foot is firmly stroked. The big toe moves upward and the other toes fan out. In adults abnormal test findings can indicate a problem with the brain or spinal cord.
Bradinski Sign
clinical finding that indicates meningeal irritation which is inflammation of the membranes covering the brain and spinal cord. The examiner passively flexes the patient’s neck while they are lying supine. Positive sign is present when the patient involuntarily flexes their hips and knees in response.
Brudzinski’s sign
physical exam finding that indicates meningeal irritation, often caused by meningitis. The patient lies supine with their hips and knees flexed at 90 degrees. A positive sign is present if the patient experiences pain or resistance when the knee is extended beyond 135 degrees.
Kernig’s sign
medical test that involves dropping from the toes to the heels to check for appendicitis. Have the patient stand on their toes and straight knees. The clinician stands on their toes for a few seconds. The clinician suddenly drops down onto their heels. If the patient experiences abdominal pain where they land on their heels, the markle sign is positive. Indicates inflammation near the appendix.
Markle Sign
bluish-purple discoloration of the skin around the umbilicus (navel) that indicates intraperitoneal hemorrhage (bleeding within the abdominal cavity.). Sign of acute pancreatitis, ruptured ectopic pregnancy.
Cullen sign
The presence of bruising on the flanks which is usually a sign of internal bleeding, most commonly associated with severe acute pancreatitis, a ruptured abdominal aortic aneurysm, or other forms of retroperitoneal hemorrhage.
grey turners
foot reflex that’s normal in infants and children up to two years old. It’s also known as the plantar reflex. Test occurs when the sole of the foot is firmly stroked. The big toe moves upward and the other toes fan out. In adults abnormal test findings can indicate a problem with the brain or spinal cord.
Babinski reflex
controls movement of water across cellular membranes, facilitates muscle contraction, depolarization of
Sodium
vital role in repolarization. Potassium is essential for normal cell function, including generating electrical impulses. Potassium helps regulate water balance, blood pressure, and acidity levels. (chronotropic)
Potassium
essential for muscle contraction. Calcium levels that are too high or too low can lead to heart rhythm disorders and other cardiovascular diseases (Inotropic)
Calcium
the second most abundant intracellular cation, after potassium. Vital role in muscle contraction.
Magnesium
energy released due to a chemical reaction. Can be found in explosives or acid, or even from a reaction to an ingested or medically delivered agent or drug.
Chemical
energy from a moving vehicle.
Kinetic
energy stored in an object, such as a brick sitting on a building ledge.
Potential
can result from sudden and radical changes in pressure, as can occur during scuba diving or flying.
Barometric
energy transferred from hotter sources than the body, such as a flame, hot water, and steam.
Thermal
often takes the form of high voltage electrocution or a lightning strike.
Electrical
Question that does not allow for a simple yes or no question.
EX: “Can you tell me what happened?”
Brachial Plexus Injury No
loss of function of lower arms and hands is most indicative for what
Brachial Plexus Injury
These block the action of sympathetic agents by beating them to the receptor sites and preventing these agents from turning on the ignition. The receptors cannot distinguish a blocker from a stimulator until it is too late. With the blocker occupying the receptor site, the stimulating agent cannot access it to turn on the switch.
Sympatholytic
imitate the actions of naturally occurring sympathetic chemicals.
Sympathomimetics
iv drug abusers are at the highest risk for which strain of hepatitis
Hepatitis B
Epicardium protects the heart by reducing friction. This layer is the visceral portion of the pericardium on the surface of the heart, consists of connective tissue and some deep adipose tissue.
visceral pericardial layer
Tidal volume formulas
tidal volume= Minute volume/RR
minute volume: respiratory rate x tidal volume
if you encounter one of these presentations and the newborns head does not externally rotate into position or you are unable to complete the delivery, support the woman and the newborn and provide rapid transport.
cephalic presentation
Mcroberts maneuver is one of the safest methods to use in the case of shoulder dystocia. To widen the womans pelvis and flatten the lower back, hyperflex her legs tightly to her abdomen. It may be necessary to apply suprapubic pressure and to GENTLY pull on the fetus’s head.
Shoulder Dystocia
if umbilical cord is wrapped around the fetus’s neck, slip your finger under the cord and gently attempt to slip it over the fetus’s shoulder and head. If this attempt is not successful or if the cord is wrapped too tightly, carefully place umbilical clamps 2 in apart and carefully cut the cord between the clamps in a motion going away from the infant.
Nuchal Cord
RAAS- Renin, Angiotensin, Aldosterone, System. - Regulates Bp through fluid retention and vasoconstriction.
Renin that is produced in the kidneys, flowing into the bloodstream where it becomes Angiotensin 1, Angiotensin 1 binds with ACE (angiotensin converting enzyme) in the lungs, and becomes Angiotensin 2. Angiotensin 2 stimulates the production of Aldosterone, together Angiotensin 2 and Aldosterone triggers Vasoconstriction, and fluid retention in the kidneys, and tells the brain the body is thirsty.
The concurrent failure of 2 or more organs/ organ systems that were initially unharmed by the acute disorder/ injury that caused the Pt’s current illness. Condition is often reversible, especially in previously healthy Pt’s. A major cause of death in sepsis, trauma, and burns. Is an overreaction of of the complement system. Causes vasodilation via “kallikrein-kinin system.”
MODS
MODS from direct result from an injury.
Primary MODS
MODS from slower more progressive organ dysfunction.
Secondary MODS
which anticonvulsant would be most likely administered to a newborn w/ sz
Lorazepam & Diazepam
How does the body respond in early stages of hypoperfusion:
The body responds to hypoperfusion by stimulating the sympathetic nervous system, releasing catecholamines, and increasing heart rate and vascular resistance.
hardening of the arteries.
Arteriosclerosis
develops from plaque buildup, is a common type of arteriosclerosis.
Atherosclerosis
positional SOB: usually when laying flat.
Orthopnea
any part of the body other than the head leads the way, usually the buttocks. Frank: hips flexed and knees extended, with the buttocks as the presenting part.
Breech Presentation
states that a body at rest will remain at rest unless acted on by an outside force. Similarly, a body in motion tends to remain in motion at a constant velocity, traveling in a straight line, unless acted on by an outside force.
Newtons first law of motion
States that the force that an object can exert is equal to the product of tis mass (WEIGHT) and acceleration (or DECELERATION):
Newtons Second Law of Motion
The greater an object’s _______________and/or ____________, the greater the force that needs to be applied to either change the objects course or stop it
Mass/Acceleration
Mass X Acceleration =
FORCE
if a teenager w/ gyn issue answers hard NO to pregnant question, what should you do.
Give the pt privacy from parents if applicable, room to answer more honestly, ask questions in a private environment, and if that does not work, continue to consider possible pregnancy, while looking for other possible causes.
Conduct that constitutes a willful or reckless disregard for a duty of standard of care. (My own words- A hard left from what’s right)
Gross negligence
Confinement of a person w/o legal authority or persons consent.
False imprisonment
Failure to act or mistake that caused pt harm
Negligence
Organism that can live and reproduce w/o a host/ outside the human body
Bacteria
requires a living host to survive and multiply
Virus
Movement of particles or molecules from areas of high concentration to low concentration.
Diffusion
Diffusion of water across a selectively permeable membrane
Osmosis
Movement of molecules or ion into or out of the cell against its concentration (low to high) requires energy
Active transport
Form of diffusion is regulated by protein channels in the membrane and requires no energy (sodium potassium pump)
facilitated diffusion
acetylcholinesterase inhibitors
Organophosphates
These exert toxic effects at junctions (synapse) of the nerve cells of the autonomic nervous system. The conduction of an impulse from one nerve to another occurs through the release of acetylcholine (Ach) at the synapse. Ach works as a chemical messenger, crossing the synapse to depolarize the nerve on the other side of the junction.
Organophosphates
These are potent inhibitors of acetylcholinesterase, which terminate synaptic transmissions. This termination creates an abundance of Ach in the CNS and peripheral nervous system. When the muscarinic and nicotinic receptors are overstimulated, a predictable response occurs in the body.
Organophosphates and carbamates
the most common form of diabetes a condition in which blood glucose levels are elevated because the body cannot produce enough insulin to compensate for the inability to utilize insulin effectively. The pancreas usually produces enough insulin, however for reasons that aren’t fully understood, the body cannot effectively use it, a condition known as INSULIN RESISTANCE.
Type 2 Diabetes
can be related to metabolic syndrome, a cluster of characteristics including excessive fat in the abdominal area, elevated BP, and high blood lipid levels
Type 2 Diabetes
insulin dependent, becomes apparent in childhood. Hereditary disposition, disposition, environmental factors can play a factor in it. Body develops autoantibodies that incorrectly identify the body’s own tissue or substances to be destroyed. Pancreas fails to produce insulin as a result. Contributing to pancreatic destruction are autoantibodies to the Insulin-secreting beta cells in the islet of Langerhans, to insulin, and to other pancreatic substances.
Type 1 Diabetes
With this type diabetes, beta cells are the body’s only insulin source, this hormone must be administered by injection or with a pump when these cells are destroyed.
Type 1 Diabetes
Gradually increasing rate and depth of respirations, followed by a gradual decrease of respirations with intermittent periods of apnea, associated with brainstem insult.
Cheyenne stokes
Deep, rapid respirations; seen in patients with DKA.
Kussmaul
irregular pattern, rate and depth of breathing with intermittent periods of apnea; results from increased intracranial pressure.
Biot (ataxic):
Prolonged, gasping inhalation, followed by extremely short, ineffective exhalation; associated with brainstem insult.
Apneustic
slow, shallow, irregular or occasional gasping breaths; results from cerebral anoxia. Agonal gasps may be seen shortly after the heart has stopped but the brain continues to send signals to the muscles of respiration.
Agonal gasps
tachypneic hyperpnea; rapid, deep respirations caused by increased ICP or direct brain injury; drives the carbon dioxide level down and the pH up, resulting in respiratory alkalosis.
Central neurogenic hyperventilation
refers to pain originating from internal organs, this is vague and often diffuse pain over the abdominal quadrant.
Visceral” pain
means swelling and irritation within those organs, produces a sharp localized pain, as in the case of PID or appendicitis.
inflammation” pain
describes when that pain is felt in a different area of the body than where the organ is located, due to shared nerve pathways in the spinal cord.
referred” pain
pain that originates from the musculoskeletal system or skin. It can feel like a dull ache, throbbing, or sharp pain
somatic” pain
if responders at major incident need additional supplies, who would they notify
IC or if there is a logistical chief or supervisor they should be notified.
Area where contamination is present
Hot Zone
Area outside of the Hot zone, decontamination zone
Warm Area
Outside of the warm zone, treatment area.
Cold Zone
Fluid that closely matches the bloods composition of sodium. No fluid shifts.
Isotonic
3% sodium chloride- More sodium in the solution than the body, fluid shifts out of cells.
Hypertonic
Less sodium than in the cells, fluid shifts into cells.
Hypotonic
Solutions that contain Proteins that are too large to pass through the cellular membranes.
Colloids
dissolved crystals in water. Can pass through cellular membranes.
Crystaloids
5 stages of death and dying
Denial
Anger
Bargaining
Depression
Acceptance
Cations
Potassium, Calcium, Sodium, Magnesium
Anions
Bicarbonate, Chloride, Phosphate, Proteins
different between antiseptic & disinfectant
Antiseptic- Safe for living tissues
Disinfectant- used on non-living surfaces, Toxic to living tissues
Primary blast: injury due to blast itself. Give examples of body systems affected.
injury: lungs, eardrums, compressible organs; pressure wave damages air filled cavities
Injury d/t due to missles being propelled by blast (shrapnel), can cause blunt and penetrating wounds
Secondary blast injury
injuries due to impact w/ another object (thrown against wall)
tertiary blast injury
collateral injuries such as burns, crush, and toxic inhalation
quaternary blast injury
long term damage from biological, chemical, or radioactive contaminants added to explosive device
quinary blast injury
Explain the Electrical System of the heart and the rates.
A.) Electrical system starts in the SA node. Firing rate for the SA is 60-100
B.) If the SA node fails the Impulses then come from the AV node- firing rate of 40-60
C.) If the AV node fails the impulse comes from the Ventricals (bundle branches, bundle of his) Firing rate of 20-40
first year of life infant has naturally acquired passive immunity-why?
He or she maintains so of the mother’s immunities.
Genetic term for a group of hereditary diseases of the muscular system characterized by the weakness and wasting of groups of skeletal muscles, leading to increasing disability. The various forms differ in age of onset, rate of progression, and mode of genetic transmission. Duchenne muscular dystrophy is included in this group. It is a sex-linked recessive disease (affecting only males).
muscular dystrophy
Gap between dendrites and Axons. A gap that allows for a better fine level of control than if the cells were touching each other.
Synapse
Physiologic adaptation to the effects of drugs, need increasingly larger doses to achieve the same effect.
Tolerance
A physical tolerance to the therapeutic and adverse clinical effects of a medication.
Habituation
A physiologic state of adaptation to a drug caused by chronic use, usually characterized by tolerance to the effects of the drug and withdrawal if use of the drug is stopped (especially abruptly).
Physical Dependence
Emotional state of craving a drug to maintain a feeling of well being.
psychological dependence
L-side- a stroke in the left side of the brain affects the
Right side of the body
R-side- stroke in the R side brain affects the
Left side of the body
Why should we not hyperventilate an apneic pt?
May decrease venous return to the heart, d/t increasing thoracic pressure
difference between nasogastric and orogastric tubes
naso- through the nose, oro- through the mouth. OG tubes do not run the risk for nasal trauma like NG tubes do, and the can be used in severe facial trauma. OG tubes are typically bigger than NG.
PASG- anti shock/ who would benefit the most
Hypovolemic Shock- you can use these in pregnancy
primary component of immune system
Mast cells and Basophils
Pumping sodium out of cel and potassium in has an added benefit
Moving glucose into cell
intubation-types/ways- know them.
Cric
Oral
Nasal
formed in the bone, matures in the thymus
T-Cells
formed in the bone, matures ing the bone.
B Cells
which antibodies respond in allergic reaction and where they are stored
IgE, IgG, B-cells, T-cells
IgE & IgG- blood stream
How the body responds during times of hypoperfusion
Body releases catacolimines that increase cardiac contraction, ^ HR, vasoconstriction, and ^ vascular resistance. Triggers RAAS. Compensates for BP and HR.
If it continues stress on the heart will ^, ends up w/ decreased cardiac output tissue perfusion decreases. Capillary’s start leaking
paralytic that triggers muscle contraction, and cause prolonged depolarization. Muscles contract and take a long time to relax.
Depolarizing
prevents muscle contraction does not allow for recontraction
non-DEPOLARING
New born resuscitation algorithm
Antenatal counseling team debriefing and equipment check.
-Birth
-Term gestation? Good tone? Breathing or crying? (yes, infant stays with mother for routine care: warm and maintain normal temperature, position airway, clear secretions if needed, dry. Ongoing evaluation.) (No: warm and maintain normal temperature, position airway, clear secretions if needed, dry and stimulate.)
-Apnea or gasping? HR below 100/min? (No: labored breathing or persistent cyanosis? Position and clear airway SpO2 monitor supplementary O2 as needed consider CPAP, postresuscitation care team debriefing) (yes: PPV, SpO2 monitor, consider ECG monitor).
-HR below 100/min? (no: postresuscitation care team debriefing)(Yes: Intubate if not already down, chest compressions, coordinate with PPV, 100% 02, ECG monitor, consider emergency UVC).
-HR Below 60/min? (No: IV epinephrine, IF HR persistent below 60/min, consider hypovolemia, consider pneumothorax) (Yes: back to HR below 100/min).
difference between adults and kids in Car vs Person.
Small children are short, so a vehicle’s bumper is more likely to strike them in the pelvis or torso, causing severe injuries from direct impact.
Waddell Triad:
1. The bumper hits the pelvis and femurs instead of the knees and tibias.
2. The chest and abdomen hit the grille or low on the hood of the vehicle (sternal and rib fractures as well as abdominal injuries)
3. The head strikes the vehicle and then the ground (leading to skull and facial fractures, facial abrasions, and closed head injury).
Although children are less likely than adults to fly over the hood of a vehicle, they are more likely to be run over the vehicle as they are propelled to the ground by the impact.
TBI often kills young patients.
Adult injuries are generally lateral and posterior because adults tend to turn to the side or away from the impact
different blades and tubes, for different intubations
Blade sizes range from 0-4, sizes 0,1,2 are appropriate for infants and children, where as sizes 3 and 4 are considered adult blades.
-ET tubes range in size from 2.0 to 10.0 mm in inside diameter. Sizes from 5.0 to 10.0 mm are equipped with distal cuff.
correct tube size based off age
age in years/4)+4 uncuffed
-(age in years/4)+3.5 cuffed tubes.
what % of body weight is water and where is it?
What % is where?
60%
Intracellular
20% is extracellular, 12% of that is interstitial, 5% is plasma.
Chemicals in sympathetic and parasympathetic (pg 344)
how they work:
-Sympathetic: also called the adrenergic system/thoracolumbar system, Function: fight or flight, increases body system activities, neurotransmitter: norepinephrine. Deactivating enzymes: monoamine oxidase (MAO), Catechol-0-methytransferase (COMT).
-Parasympathetic: cholinergic system, craniosacral system. Action: maintain vegetative state, normal body activity.
Neurotransmitter: acetylcholine. Major Nerves: vagus nerves (CN X). Deactivating enzyme: acetylcholinesterase.
neurotransmitters for such
-Sympathetic: norepinephrine and epinephrine
-parasympathetic: ACh.
