FISDAP TEST 1 REPORT STUDY GUIDE

Question 1

Effects of Hyperventilation

Answer 1

• Respiratory alkalosis (blows off too much CO2)
• Decreases O2 sats
• Leads to hypocalcemia b/c it increases bound calcium in the blood
• The hypocalcemia leads to carpopedal spasms aka cramping/tingling in hands and feel
• Promotes air trapping, damage in the lungs, and bronchoconstriction b/c it prevents full expiration
• Increases intrathoracic pressure reducing cardiac output and increasing cardiac work load (bad in CHF and cardiac pts)
• Other symptoms may include fatigue, nervousness, dizziness, dyspnea, chest pain, and tachycardia. If the pt has a history of seizures it can also precipitate one.

Question 2

Nasal Intubation Techniques

Answer 2

Blind Nontracheal Intubation Technique:

1. Use standard Precautions
2. Using basic manual and adjunctive maneuvers, open the airway and ventilate the pt with 100% O2
3. Prepare your equipment
4. Place pt in his position of comfort. If the pt is unconscious or if you suspect cervical spine injury place the pt supine and use manual inline stabilization as needed.
5. Inspect the nose and select the larger nostril as your passageway
6. Select the correct size tube, (normally 1 to 1 1/2 sizes smaller than oral tube)
7. Lubricate the tube (lidocaine can be used for longer term comfort
8. Insert the ETT into the nostril with the bevel along the floor of the nostril or facing the septum, directed posterior.
9. As you feel the tube drop to the posterior pharynx, listen at its proximal end for the pts breath sounds and observe for end tidal CO2. Sounds will be loudest when you reach the glottic opening.
10. When you are at the glottic opening, the next time the pt takes a breath in you must quickly and gently advance the ETT tube into the glottic opening. This usually occurs at 26 or 28 if male or female. Coughing or anterior displacement of the larynx indicates correct placement. Gagging or vocal chord sounds indicates esophageal placement.
11. Once placement is indicated, inflate the cuff and oxygenate the pt
12. Now secure the ETT tube and reconfirm the tube depth did not change.

Nontracheal intubation is indicated for patients who are breathing spontaneously but require definitive airway management to prevent further deterioration of their condition. Responsive patients and patients with an altered mental status and an intact gag reflex who are in respiratory failure because of conditions such as COPD, asthma, or pulmonary edema.

Contraindications include:

• Suspected Nasal Fractures
• Suspected basilar skull fractures
• Suspected increase in ICP
• Combative/Uncooperative pt
• Coagulopathy (pt on heparin or warfarin)
• Significant deviated nasal septum or other obstruction
• Hypoxemia
• Cardiac or Respiratory arrest (absolute contraind.)

Disadvantages:

• more difficult and time consuming
• big risk of epistaxis
• smaller diameter tubes must be used
• more risk of sinusitis

Question 3

Signs and Symptoms of ARDS

Answer 3

ARDS is a form of pulmonary edema that is caused by fluid accumulation in the interstitial space within the lungs. A pt with ARDS accumulates fluids as the result of increased vascular permeability and decreased fluid removal from the lung tissue as the result of a large range of lung insults. As opposed to cardiogenic pulmonary edema which is caused by a poorly functioning left Ventricle.

The cause of the S&Ss is because the fluid accumulation in the interstitial spaces causes an increase in the thickness of the respiratory membrane, reducing the ability for O2 to diffuse across it. In advanced cases, the fluids can accumulate in the alveoli as well causing surfactant washout.

S&Ss:

• There is usually symptoms present that are related to the cause of the insult to the lungs
• Tachypnea
• Tachycardia
• Crackles (rales) in both lungs
• Possible wheezing
• Severe cases may cause severe tachypnea, central cyanosis, and low O2 sats

Since ARDS is always caused by something else, treatment includes treating the underlying cause. Also CPAP can be very useful for pts approaching resp failure and may prevent need for intubation

Question 4

Techniques for Removing an Advanced Airway

Answer 4

Extubating is very rare b/c it can cause aspiration, laryngospasms, negative pressure pulmonary edema, or the pt may even deteriorate again and be difficult to re-intubate. However, if the pt is clearly able to maintain his own airway and is intolerant to the tube and ventilator, no meds are available to make him comfortable and reassessment indicates that the problem that led to the pt being intubated is resolved (such as narc overdose), extubating may be indicated.

The steps are:

1. Use PPE
2. Ensure adequate O2. One way to do this is to ensure adequate signs of Oxygenation on room air
3. Prepare intubation and suction equipment
4. Confirm pt responsiveness
5. Position on his side if possible
6. Suction the oropharynx
7. Deflate the ETT cuff
8. Remove the ETT upon coughing or expiration
9. Provide supp O2 as indicated
10. Reassess the adequacy of the pts ventilation and oxygenation

Question 5

Techniques for successful insertion of Dual Lumen Airway

Answer 5

Go over on pg 551-553 there are 2 types

Question 6

Treating a pt with an obstructed airway (adult)

Answer 6

CONSCIOUS:

1. Determine if the obstruction is complete or causing poor air exchange. If the pt can speak they can try to cough up obstruction.
2. If they cannot speak that indicates complete obstruction or poor air exchange and you should provide rapid abdominal thrusts until obstruction is relieved. If abd thrusts are ineffective or pt is obese try using chest thrusts.

UNCONSCIOUS:

1. Open air way with appropriate technique
2. Begin CPR
3. Each time you open the airway during CPR, look for an object in the victim’s mouth to remove it
4. If obstruction persists and ventilation cannot be provided, use a laryngoscope to visualize the airway and if you can se the foreign body, try to remove it with Magill forceps.

If the upper airway obstruction is caused by laryngeal edema and you have tried and failed to provide O2 and BVM ventilations then next admin crystalloid solution with IV or IM epi and diphenhydramine

Question 7

Treating a Vomiting pt

Question 8

Calculating Drip Rates

Answer 8

LOOK UP IN MOODLE

Question 9

Identifying and Treating a Bradycardic Rhythm

Answer 9

RULES: (if sinus)
regularity - regular
rate - less than 60
P waves - 1 per QRS
PRI - 0.12-0.20sec
QRS - less than 0.12sec

ACLS:

• Must be under 50bpm
• SYMPTOMATIC?
• if NO then monitor and observe
• if YES then Atropine (1mg every 3-5min up to 3mg); if Atropine is ineffective then move to TCPacing and/or dopamine (5-20mcg/kg/min) or epinephrine infusion (2-10mcg/min)

Question 10

Risk Factors Associated with Strokes

Answer 10

From Book:

• Hypertension (the biggest one)
• A-Fib (second biggest one)
• Middle aged and older patients due to disability
• Atherosclerosis
• Heart disease

From Online:

• Diabetes
• Smoking
• Birth Control Pills
• History of TIAs
• High counts of RBCs, cholesterol, or lipids

Question 11

Signs and Symptoms of Myocardial Infarction

Answer 11

• Most common is retrosternal chest discomfort, this can be pressure or tightness with or without pain
• Elderly, Women, and Diabetics present differently
• Radiation to shoulders, in-between shoulders, back, neck, one or both arms or jaw
• Light headed/dizziness
• fainting/sycnope
• sweating
• N/V
• Unexplained, sudden SOB W/ or W/out chest discomfort
• Less common is indigestion or acid reflux type feeling

Question 12

Signs and Symptoms of Uncontrolled A-Fib

Answer 12

• Sensations of a fast, fluttering or pounding heartbeat (palpitations)
• Chest pain
• Dizziness
• Fatigue
• Lightheadedness
• Reduced ability to exercise
• Shortness of breath
• Weakness

A-Fib can be:
- Occasional (paroxysmal atrial fibrillation): A-fib symptoms come and go, usually lasting for a few minutes to hours.

• Persistent. With this type of atrial fibrillation, the heart rhythm doesn’t go back to normal on its own. If a person has A-fib symptoms, cardioversion or treatment with medications may be used to restore and maintain a normal heart rhythm.
• Long-standing persistent. This type of atrial fibrillation is continuous and lasts longer than 12 months.
• Permanent. In this type of atrial fibrillation, the irregular heart rhythm can’t be restored. Medications are needed to control the heart rate and to prevent blood clots.

Question 13

Treating a pt in Cardiogenic Shock

Answer 13

1. If the pt shows signs and symptoms of shock, poor perfusion, CHF, or acute Pulmonary Edema then…
2. Treat hypoxia, place pt on ECG, oximeter, capno, insert an IV, obtain baseline vitals
3. Look for what is causing the symptoms (treatments based off cause):

• VOLUME LOSS:
  1. infuse normal saline or LR solution
• VASODILATION:
  1. Infuse normal saline or LR solution
  2. consider vasopressor
• PUMP FAILURE: is there signs of Acute Pulm Edema?
  1. If NO then maintain BP with dopamine
  2. If YES then:
  a) apply CPAP
  b) admin Nitro
  c) admin ACE inhibitor
  d) consider benzo for any anxiety
  e) maintain BP with dopamine
• ABNORMAL HEART RATE:
  1. If greater than 150 then go to Tachycardic Algorithm
  2. If less than 50 go to Bradycardic Algorithm

Question 14

Treating a pt with Cardiac Origin Chest Pain

Answer 14

1. Place them in a position of rest
2. Given O2
3. TRANSPORT
4. Get IV and 12 lead but do not delay transport for this
5. Give Aspirin and Nitro if possible
6. If pain is unrelieved consider CCB and then Morphine

If the pt has new onset angina, unstable angina, or has a history of angina but it is not relieved by O2, rest, and Nitro then TRANSPORT IMMEDIATELY.

Question 15

Treating a pt with Heart Failure

Answer 15

• DO NOT have the pt exert themselves in any way or have them lay supine. DO sit them on the caught sitting up with their feet dangling.
• Admin O2, Nitro, CPAP, if needed an anxiolytic, and if available an ACE inhibitor such as Captopril or Enalapril

Question 16

Antidotes for Alcohol Ingestion

Answer 16

• Establish and maintain airway
• determine whether other drugs are involved
• start an IV of NS or LR
• Admin 25g of D50W if hypoglycemic
• 100mg Thiamine IV
• Consider benzos

Question 17

Communicating with a patient having a behavioral emergency

Question 18

Complications of severe blood loss

Question 19

Identifying and Treating a pt with High Altitude Pulmonary Edema

Answer 19

HAPE is very similar to ARDS. Both are Non-cardiogenic pulmonary edema. HAPE is a specific type of ARDS I believe as it is caused by High Altitude but has the same end result. The common presentation is a gradual decline in their respiratory status which can even occur in a seemingly normal healthy adult when they have a sudden onset of respiratory failure and hypoxia.

Dyspnea, agitation, and confusion are very common with ARDS and HAPE, they may also have fatigue, reduced exercise ability, crackles (rales) in both lungs, possible wheezing, and in severe cases central cyanosis, or other signs of impending respiratory arrest.

Management for HAPE is the same as ARDS with the addition of RAPID DESCENT TO A LOWER ALTITUDE. CPAP is also going to be a mainline treatment.

Question 20

Identifying and treating Heat Stroke

Answer 20

HEAT/MUSCLE CRAMPS: This occurs after sweat and salt have left the body in quantities that lead to enough electrolyte loss that muscle cramping can occur. Remove them from the heat, give them a sports drink (or IV fluid if needed), educate them. NO SALT TABLETS EVER

HEAT EXHAUSTION: When enough sweat and salt are lost and in combination with vasodilation leads to decreased blood volume, venous pooling, and reduced cardiac output. Can be rapid, shallow breathing, cool/clammy skin, weak pulse, increased body temp, can be diarrhea or muscle cramps, may feel weak or loose consciousness. Remove pt from environment, place in supine position, administer a sports drink (or IV fluids if needed), remove some clothing and fan, Treat for shock if shock is suspected.

HEAT STROKE : Heat stroke occurs when the hypothalamus temperature regulation is lost causing uncompensated hypothermia, This causes cell death and damage to the brain, liver, and kidneys. At this point the skin will be hot but it CAN still be wet from earlier sweating, but new sweat will often not form.

S&Ss:

• stop sweating (skin may still be wet from previous sweat)
• hot skin skin, very high core temp
• deep resps that become shallow, rapid at first but may become low
• Hypotension with low or absent diastolic reading
• Confusion, disorientation, or unconsciousness
• CNS symptoms such as headache, anxiety, paresthesia, impaired judgement, psychosis
• Possible seizures

Treatment:

• Remove the pt from the environment
• Initiate rapid active cooling (done by removing cloths, fanning, misting, and putting a damp blanked on them; BE CAREFUL to not cause reflex hypothermia by cooling too fast which causes shivering and can increase core temp, which is why ice packs and cold water immersion are not used, the target temp is to reduce to 102F)
• Admin oxygen if the pt is hypoxic
• Admin fluid therapy if the pt is alert and able to swallow (use sports drinks if possible but if not use IV fluids)
• Monitor ECG
• Avoid vasopressors and anticholinergic drugs
• Monitor body temps

Question 21

Signs and Symptoms of Hyperglycemic Crisis

Question 22

Signs and Symptoms of Infectious Diseases

Question 23

Techniques for magnesium administration

Question 24

Braxton Hicks Contractions

Answer 24

They are PAINLESS, irregular contractions that can begin as early as 13 weeks and help prepare the body for the birthing process, they are also thought to enhance placental circulation. While Braxton Hicks contractions may become more regular as the due date approaches, there will be NO cervical dilation or shortening. Braxton Hicks DO NOT require treatment other than reassuring the mother.

Question 25

Complications associated with abnormal births

Answer 25

Abnormal Delivery situations include:
- Breech Presentation (butt or feet first, head last)
Management: Will require C-Section but if field delivery is unavoidable, assist with the normal birthing process, and as the head delivers last, when the mouth appears over the perinium, be aware that if the baby starts to breath you will have to insert your fingers to make a V over the babies mouth so that it has air to breath.
- Prolapsed Cord
Management: C-section is required. Insert 2 fingers to raise the presenting part of the fetus off the cord. place mother in knee to chest or Trendelenburg’s position. DO NOT attempt delivery, pull cord, or push cord back into vagina.
- Limb Presentation
Management: place mother in knee to chest position, DO NOT touch the limb, pull the limb, or push back in as this may stimulate the baby, C-section is required.
- Occiput Posterior

Possibly for positioning, if the delivery is actively happening then place them in the knees to chest position but if pregnant and not in active delivery do LLR

Other Delivery Complications:

• Multiple Births
• Cephalopelvic Disproportion
• Precipitous Delivery
• Shoulder Dystocia
• Meconium Staining

Question 26

Electrical Therapy Calculation for Newborns/Pediatrics

Answer 26

Defibrillation:

• 1st shock = 2j/kg
• 2nd shock = 4j/kg
• All shocks after = 4-10j/kg or adult dose

Synchronized Cardiovert:

• 1st shock = 0.5-1j/kg
• All shocks after = 2j/kg (sedate if needed but do not delay for it)

Question 27

Resuscitation of a newborn

Answer 27

First begin with tactile stimulation, flicking the soles of the feet or vigorously rubbing the newborns back with a towel. If that does not work then immediately assist ventilation with a BVM on room air (initially). If the resp rate is now within normal limits, assess the heart rate, if not keep ventilating. If the heart rate is less than 60 then begin chest compressions. Continue to maintain warmth while on route and if IV access is indicated then the umbilical vein may be best but if not possible the go for peripheral vein or IO.

Question 28

Signs and symptoms of abdominal bleeding (OB-Peds)

Question 29

Signs and symptoms of communicable diseases (OB-Peds)

Question 30

Signs and symptoms of Upper airway emergencies (OB-Peds)

Answer 30

• Stridor
• Hoarseness
• change in cry or voice
• Drooling, snoring, or gurgling
• retractions
• accessory muscle use
• nasal flaring
• Tachypnea and increased effort
• poor chest rise
• poor air entry on auscultation

Common Causes:

• FBAO
• Croup
• Epiglottitis

Question 31

Treating a child with an FBAO

Answer 31

Partial Obstruction:

• Make child as comfortable as possible and administer humified O2
• DO NOT ATTEMPT TO LOOK INTO THE MOUTH
• Intubation equipment should be ready
• Allow pt to try to remove the FBAO by coughing
• Transport he pt to the hospital so the foreign body can be removed in a controlled setting

Complete Obstruction:

• if infant aka younger than 1; you can give 5 back thrusts and 5 chest thrusts alternating
• if over 1 to adolescent you give abdominal thrusts.
• If the pt becomes unresponsive no matter the age then start CPR and check if obstruction is visible after every 2 minutes when your giving rescue breaths, if it is visible then use a laryngoscope and Magill forceps to remove

Question 32

Criteria for Rapid Extrication

Answer 32

• Injured pts who are stranded at very high locations
• Workers of bystanders involved in a trench cave in
• Persons stranded in swift-running, rising water
• Patient entrapped in vehicles with an associated fire
• Patients overcome by life threatening atmospheres
• Victims entrapped with unstable and or volatile hazardous materials

FROM INTERNET:
Rapid extrication is indicated when the scene is unsafe, a patient is unstable, or a critical patient is blocked by another less critical patient

FROM QUIZLET: (with exact question)
When a patient is experiencing a significant MOI and the patient is considered to be in serious or critical condition

Question 33

Legal Aspects of Emergency Medical Care

Answer 33

4 things needed to be proved by a plaintiff to file a negligence claim:

1. They must prove the paramedic had a “Duty to Act”
2. They must prove that there was a “Breach of Duty” (paramedic must perform care equal to those that other paramedics would give under similar situations)
3. They must also prove “Actual Damages”, meaning the paramedics actions or lack there of caused actual damage to them physically, psychologically, or financially.
4. They must prove “Proximate Cause” meaning that the pt suffered immediately from the paramedics actions or inaction, but also that the damage was reasonably “foreseeable”

Question 34

Maintaining Vehicle Equipment Readines

Question 35

Operations Within a Hazmat Scene

Answer 35

For the manager at a hazmat incident at a facility that hands you something it is a Safety Data Sheet!

Placard color meanings:
- Orange = Explosives
- Red or Green = Gases
- Red = Liquids
- Red and white = solids
- Yellow = oxidizers and organic peroxides
- White = poisonous and etiologic agents
(There are other but I think this question was either about red or green, just one of the two)

Question 36

Vehicle Positioning at a Scene

Answer 36

Park at least 100ft uphill and upwind from a hazardous scene

If there are no fire, fluids, or fumes that could be
hazardous you can park 50ft away PAST THE WRECKAGE

If you are first on scene park in front (with the wreck in front of you) of the wreckage so that your lights may be seen. If you are second then park beyond the wreckage (with the wreck behind you) to protect yourself and your vehicle.

Question 37

START Triage System

Answer 37

START (Simple Triage and Rapid Transport)
is the most widely used. It consists of triaging based on:

• ability to walk (if YES then green)
• respiratory effort (if NO then reposition/open airway, if resp start then red if not then black; if YES then if over 30bpm gets red, if under then move to pulse/perfusion)
• Pulse/perfusion (if radial pulse absent or cap refill over 2 sec then red; if radial pulse present or cap refill under 2 sec then move to neuro)
• Neuro Status (if cannot follow commands then red, if can follow commands then yellow)

Question 38

Treating a pt with Advanced Directives

Answer 38

• Living Will: is signed by the pt and a witness and it states specific care they do or do not want to receive as well as can state who gets power of attorney for health care decisions should the pt be unconscious or unable to communicate their wishes.
• DNR: Signed by the pt and a physician. Dictates which if any life-sustaining measures may be taken when the pt’s HEART and RESPIRATORY functions have ceased. If there is a valid DNR order, your duty now moves on to the loved ones effected by loss.

Question 39

Treating a Violent Patient

Question 40

S&Ss of Spinal Trauma

Answer 40

• Paralysis of extremities
• Pain with and without movement
• Tenderness along the spine
• Impaired breathing
• Spinal Deformity
• Priapism
• Posturing
• Loss of bowel or bladder control
• Nerve Impairment to extremities

Question 41

Treating a pt with a Traumatic Brain Injury

Answer 41

Airway and ventilation is big for these guys, use of a supraglottic airway and intubation is called for if needed, especially RSI if the pt cannot protect their own airway but are not completely unresponsive.

Make sure to keep your O2 and CO2 levels within normal ranges while ventilating, you don’t want to high or to low but with a TBI you definitely DO NOT want hypercapnia.

Possibly the most important thing is to maintain perfusion to the brain as best you can. This is best done by maintaining a BP of at LEAST 90mmhg to keep up perfusion pressure. Do this by bolusing serial doses of 500mL of an isotonic solution titrated to the goal target of at least 90mmhg.

IF you see a pt with a TBI and the BP actually RISES, this is a reflex response to the rising ICP and the body trying to maintain perfusion of the brain. ONLY TREAT THIS by raising the head 30 degrees, you do not want to risk bottoming out the blood pressure.

Question 42

Recognizing Multisystem Trauma in a PT

Question 43

Treating a pt with Multi-System Trauma