Houston nremt Flashcards
Components of hematology
Blood, bone marrow, liver, spleen, kidney.
The study of blood
Forming organs and include study of blood disorders. Red blood cell disorders, white blood cell disorders, platelet disorders, coagulation problems
Hematopoiesis
Making of cells
Blood volume
6 to 8 L of blood
Plasma consist of
Water 90–92% by volume, proteins 6–7% by volume, other 2–3% by volume. Fats, carbs, electrolytes, gases, and messengers.
Red blood cells: laboratory analysis of red blood cells
The number of red blood cells is called hematocrit
Red blood cells contain what
Hemoglobin which allow for oxygen transport borh effect
What do White’s blood cells do
Combat infection perform phagocytosis
Granulocytes: neutrophil basophils
Store histamine
Eosinophils
Initiate the immune response
Granulocites consist of
Neutrophil basophils eosinophil lymphocytes monocytes
Auto immune disease
Where the body destroys good and bad
Inflammatory process, platelets
Clotting mechanism (thrombocytopenia , thrombocytosis)
Immunity
Subpopulation of lynphocytes known as T cells and B cells, T cells develop cellular immunity. Be cells produce humoral immunity
Hemostasis: controlling blood loss by
Vascular spasms, platelet plugs, stable fibrin blood clots
Blood types
A, B, Ab, o
Universal donor
O
Universal recipient
Ab
Anemias
It’s a sign, not a separate disease process
Anemias signs and symptoms
May not present until the body is stressed. Differentiate chronic anemia from acute episode. Treat signs and symptoms
Anemias treatment
Maximize oxygenation and limit blood loss establish IV therapy if indicated
Sickle cell disease
Sickle cell crisis is they vaso-occlusive
Sickle cell crisis management
Two large bore IVs with IV bolus and morphine for vasodilation and pain
Polycythemia
Overproduction of erthrocytes. Occurs in 50-year-old or younger or with secondary dehydration. Results in bleeding abnormalities. Epistaxes, spontaneous bruising, G.I. bleeding.
Polycythemia management
Follow general treatment guidelines
Leukopenia/neutropenia
To view white blood cells or neutrophils. Follow general treatment guidelines and provide supportive care
Leukocytosis
And increase in the number of circulating white blood cells, often due to infection.
Leukemia
Cancer of hematopoietic cells. Initial presentation acutely ill, fatigued, febrile, week, anemic, and often have a secondary infection
Leukemia management
Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.
Lymphomas
Cancers of the lymphatic system
Lymphomas signs and symptoms
Swelling of the lymph nodes, fever, night sweats, anorexia, weight loss, fatigue
Tx lymphomas
Follow general guidelines for treatment. Utilize isolation techniques to limit risk of infection
Thrombocytosis
Abnormal increase in the number of platelets
Thrombocytopenia
Abnormal decrease in number of platelets
Hemophilia
Deficiency or absence of blood clotting factor. Deficiency is sex linked, inherited disorder.
Hemophilia signs and symptoms
Numerous bruises, deep muscle bleeding, joint bleeding
Hemophilia management
Treat patients similar to others. Administer supplemental oxygen. Establish IV access. Be alert for recurrent or prolonged bleeding. And prevent additional trauma
Disseminated intravascular coagulation
System activation of Quoggy Laois and cascade. Results from sepsis, hypotension, OB complications, severe tissue or brain damage, cancer, major hemolytic reactions
Multiple myeloma
Cancerous disorder of plasma cells. Pathological fractures are common
Mechanisms of heat gain and loss
Thermal gradient by the wind and relative humidity
Thermogenesis – heat production
Work induced, diet induced, Thermo regulatory
Thermolysis heat loss
Conduction, convection, radiation, evaporation, respiration.
Thermoregulation
Body temp 98.6 axillary. Core temp is 99.6 rectally.
The hypothalamus, heat dissipation
Sweating and vasodilation
Heat conservation
Shivering and vasoconstriction
Hyperthermia
Signs of Thermolysis, diaphoresis, increased skin temperature, signs of Thermolytic inadequacy, altered mentation or altered LOC
Manifestations
Heat cramps, isolated muscle loss of electrolytes, heat exhaustion, compensated, heatstroke, non-compensated.
Rolls of dehydration in heat disorders
That dehydration prevents Thermolysis
Signs and symptoms. Of heat disorders
Nausea, vomiting, abdominal distress, vision disturbances, decreased urine output, poor skin turgor, signs of shock
Treatment. For heat disorders
Oral fluids if the patient is alert and oriented, IV fluids if the patient has altered mental status or is nauseated
Hypothermia
Mechanisms of heat conservation And boss depends upon predisposing factors, aged patient, health of patient
Medications. Cold injuries/disorders
Prolonged or intense exposure, coexisting weather conditions
Preeventative measures
Dress warm and ensure plenty of rest. Eat appropriately or at regular intervals. Limit exposure to cold environment.
Degrees of hypothermia
Mild and severe. Mild is Compensated severe is Decompensatef
Signs and symptoms of hypothermia
ECG will have Pathognomonic J waves, Osborn waves. Eventual on set of bradycardia. Ventricular fibrillation probable below 86°F
Treatment for hypothermia
Active rewarming. Active external rewarming, active internal rewarming, rewarming shock. Cold diuresis
Resuscitation Bls
Perform pulse and respiration checks for long periods. Administer one high energy defibrillation with AEd. Follow CPR, rewarming, rapid transport.
Resuscitation ALS
Intubate and administer one plhigh energy defibrillation and possibly initial medications. Establish IV access, began rewarming, and transport rapidly. Avoid further resuscitation until the core temperature is 86°F
Tissue layers of the heart
Endocardium, myocardium, pericardium
Left coronary artery separates into two
Circumflex. And left anterior descending
Systolic pressure
Strength and volume of cardiac output
Mean arterial pressure
One third pulse pressure added to diastolic pressure
Nervous control of the heart
Sympathetic and parasympathetic
Sympathetic: catecholamines
Epinephrine and Norepinephrine
Sympathetic consist of
Catecholamines, alpha-1, alpha-2, beta-1, beta-2, Beta three.
Alpha-1
Vasoconstriction increased Peripheral vascular resistance. Increased preload
Alpha two
Inhibits the release of norepinephrine fight or flight
Beta one
Increased heart rate, force, contractility
Beta two
Bronchodilator smooth muscle dilation in bowl
Beta three
Adipose tissue/fat
Parasympathetic decreases
Heart rate, strength of contractions, blood pressure, naptime
Parasympathetic increases
Digestive system, kidneys
Chrontrophy
Rate
Introphy
Force
Stomp trophy
Electricity
Rolls of electrolytes
Sodium, potassium, calcium, magnesium.
Cardiac conductive system properties
Excitability conductivity automaticity contractibility
Cardiac depolarization
Resting potential, action potential, repolarization.
Each myocardial cell has this
Sodium – potassium pump giving it the ability to beat on it’s own
Components of cardiac conductive system
Sa node internodal artial pathways atrioventricular node av junction bundle of his left and right bundle branches (purkinje fibers)
Bipolar limb leads
Einthoven triangle: leads one, two, three
Precordial leads
V1-v6
Argumented uni polar leads
AVR, a VL, AVF
ECG components
P-wave, QRS complex, T-wave, u wave
Time intervals PR interval – PRI – or P – Q interval, P QI
0.12–0.20 seconds
QRS interval
0.08–0.12 seconds
ST segment interval
.42 seconds
QT interval
0.33–0.42 seconds
Refractory period/Absolute
Heart may not be during this time
Refractory period – relative
Heart beats on the r wave (r on t phenomenon)
ST segment changes
ST segment elevation
Associated with myocardial infarctions
Ischemia injury Nercrosis
Ischemia
Represented by T wave inversion, acid creates sub sternal, crushing chest pain
Injury
Represented by ST segment elevation this means they’re having an acute heart attack
Nercrosis
Represented by Pathological Q waves
Interpretation of rhythm five step procedure
Analyzing rate – six second method Analyzing rhythm Analyzing P waves Analyzing PR interval Analyzing QRS complex
Analyzing great – six second method
Heart rate calculator rulers – RR interval, triplicate method
Analyzing rhythm
Regular, occasionally irregular, regular irregular, irregularly irregular.
Analyzing P waves
Are P waves present? Are P waves regular? Is there one P-wave each QRS complex? Are the P waves up right or invert it? Do all P waves look alike?
Analyzing pr interval
Is it greater than 0.20 seconds?
Analyzing QRS complex
Do all the QRS complexes look like? What is the QRS duration?
Dysfunction of the spinal cord, nerves, or respiratory muscles. Pathophysiology
PNS problems affecting respiratory function may include trauma, polio,myasthenia gravis, viral infections, tumor.
Dysfunction of the spinal cord, nerves or respiratory muscles. Assessment
Rule out dramatic injury. Assess for numbness, pain, or signs of PNS dysfunction
Dysfunction of the spinal cord, nerves or respiratory muscles. Management
Follow general management principles. Maintain the airway and support breathing. You cervical spine precautions if indicated
CNS dysfunction. Pathophysiology
Causes can include Trumatic /atrumatic brain injury, tumors, and drugs.
CNS dysfunction assessment
Evaluate potentially treatable causes, such as narcotic drug overdose or CNS trauma. Carefully evaluate breathing pattern
CNS dysfunction management
Follow general management principles. Maintain the airway and support breathing use cervical spine precautions indicated
Hyperventilation syndrome assessment
Focus history and physical exam, sample and OPQrst history. Fatigue, nervousness, dizziness, dyspnea, chest pain. Numbness and tingling in hands, mouth and feet. Presence of Tachynea and tachycardia. Spasms of fingers and feet
Hyperventilation syndrome management
Maintain the airway. Support breathing. Pervide high flow oxygen or assist ventilations as indicated. Do not allow the patient to rebreather exhaled air. Reassure the patient. No paper bag coach
Spontaneous pneumothorax – pneumothorax
Occurs in the absence of want or penetrating trauma
Spontaneous pneumothorax risk factors
Young tall skinny lanky man
Spontaneous pneumothorax assessment
Focused history sample and OPQrst history. Presence of risk factors. Rapid onset of symptoms. Sharp, pleuritic chest or shoulder pain. Often precipitated by coughing or lifting
Spontaneous. Pneumothorax physical exam
Decreased or absent breath sounds on affected side Tachynea diaphoresis and Pallor
Spontaneous pneumothorax management
Maintain the airway. Support breathing. Monitor the tension pneumothorax. Plearle decompression may be indicated if patient becomes cyanotic, hypoxic, and difficult to ventilate. JVD and tracheal deviation away from the affected side
Pulmonary embolism pathophysiology
Obstruction of a pulmonary artery, so typically occurs from the right heart, and Embloi may be air, thrombus, fat or anniotic. Foreign bodies may also cause Embolus
Pulmonary embolus risk factors
Recent surgery, long bone fractures, pregnancy, pregnant, postpartum, oral contraceptive use, tobacco use.
Pulmonary embolism assessment
Focus history and physical exam, sample and OPQrst history, presence of risk factors, unexplained tachycardia, sudden onset of severe dyspena, and pain, cough up blood – Tinged
Pulmonary embolism physical exam
Anxiety, syncope, diaphoretic, JVD, hypotension warm, swollen extremities
Pulmonary embolism management
Maintain the airway. Support breathing. High flow oxygen or assisted ventilations as indicated. Intubation may be indicated. Establish IV access. Monitor vital signs closely. Transport to appropriate facility
Carbon monoxide inhalation
Carbon monoxide is an odorless colorless gas. Results from the combustion of carbon containing compounds. Often builds up to dangerous levels and confined spaces such as minds, auto’s, and poorly ventilated homes. Hazardous to rescuers
Carbon monoxide inhalation pathophysiology
Binds to hemoglobin, 200–300 times affinity than that of oxygen prevents oxygen from binding and creates hypoxia at the cellular level
Carbon monoxide inhalation assessment
Focused history and physical exam, sample and OPQrst history, determine source and length of exposure. Presence of headache, confusion, agitation, lack of coordination, loss of consciousness, and seizures.
Carbon monoxide inhalation management
Ensures scene safety. Interest seen only if properly trained and equipped. Remove the patient from the toxic environment. Maintain the airway. Support breathing. I flew oxygen or assisted ventilations as indicated. Establish IV access. Transport promptly.
Upper respiratory infection
Frequent patient complaint, common pediatric complaint, rarely life-threatening.
Upper respiratory infection pathophysiology
frequently caused by viral and bacterial infection. Affect multiple parts of the upper airway. Typically resolved after several days of symptoms.
Pneumonia
Infection of the Lungs. Problem in a immune suppressed patients
Pneumonia pathophysiology
Bacterial and viral infections, hospital acquired versus community acquired. Infection can spread throughout lungs ALveloi why may collapse resulting in a ventilation disorder
Pneumonia management
Maintain the airway. Support breathing. High flow oxygen or assisted ventilation as indicated. Monitor vital signs. Establish IV access. Avoid fluid overload. Medications – antibiotics, beta– agonist
Lung cancer pathophysiology
Majority are caused by carcinogens secondary to cigarette smoke or occupational exposure. Maystar elsewhere and spread to lungs High mortality. Types, epidermoid, small cell and large cell carcinomas
Toxic inhalation pathophysiology
Includes inhalation of heated air, chemical irritants, and steam. Airway obstruction due to edema and laryngospasm due to thermal and chemical burns
Toxic inhalation assessment
Focus history and physical exam, sample and oh history, determine nature of substance, length of exposure and LOC
Toxic inhalation management
Ensure scene safety. Enter scene only if properly trained and equipped. Remove the patient from the toxic environment. Maintain airway. Early, aggressive management may be indicated. Support breathing. IV access. Transport promptly.
Status asthnaticus
A severe prolonged attack I cannot be broken by bronchodilators. Greatly diminished breath sounds. Recognize intermittent respiratory arrest. Aggressively manage airway and breathing. Transport immediately.
Components of patient assessment. Body substance isolation
Goggles, mask, gown, breathing support, etc.
Body substance isolation
Always wear the appropriate personal protective equipment to prevent exposure to contagious diseases
Treatment for tuberculosis patient
You may place a surgical mask on the patient while you wear a niosh-approved respirator. Monitor the patient’s airway and breathing carefully
Components of patient assessment
Body substance isolation. Seen safety. Location of all patients. Mechanism of injury. Nature of illness. The initial assessment. Mental status. Airway assessment. Breathing assessment. Priority determination.
Mechanism of injury
The combined strength, direction, and nature of forces that injured your patient. With trauma, try to determine the mechanism of injury during the scene size up
Nature of illness
To determine the nature of illness, use by standards, family members, or the patient. Use the scene to give clues to the patient condition. Remember that the patient’s illness may be very different from the chief complaint.
Scene safety
Scene safety simply means doing everything possible to ensure a safe environment for yourself, your crew, other responding personnel, your patient, and any other bystanders – in that order. Look for potential hazards during scene size up. Wait for the police before entering a potentially hazardous scene
Location of all patients
Scene size up also includes a search of the area to locate all of the patients. Follow local protocol when you respond to a mass casualty incident. The incident commander to Direct the response and coordinates responses at a multiple casualty incident. But the medical director is ultimately responsible for all medical treatment
The initial assessment
The initial assessment is designed to identify and immediately correct life-threatening patient conditions of the airway, breathing, and circulation. ABC’s
Initial assessment steps
Form a general impression. Stabilize the cervical spine. Assess the baseline mental status. Assess the airway. Assess breathing. Assess circulation. Determine priority.
The general impression
The general impression is the initial, intuitive evaluation of the patient to determine the general clinical status and priority for transport
Mental status
Alert, verbal, painful stimuli, unresponsive
Airway assessment
If the patient is responsive and can speak clearly, assume the airway is patent. If the patient is unconscious, but airway may be obstructed. So open the airway. Suction fluids from your patients airway. Immediately use a bag valve mask to ventilate patients who are not moving air. Use and oropharyngeal airway for unconscious patients without a gag reflex. The nasopharyngeal airway rest between the tongue in the posterior pharyngeal wall. Endo tracheal intubation or needle cricoidthrotomy
Breathing assessment rate
Quality, pattern
The circulation assessment consist of evaluating the polls and skin and controlling hemorrhage. To assess an adult circulation, feel for a radio polls. Palpate for a carotid polls. Control major bleeding. Assess the scan. Evaluate your patients feel if you suspect circulatory compromise. Apply pneumatic antishock garments according to your local protocol.
Circulation assessment
For sure priority determination
Once the initial assessment is complete, determine the patient’s priority. In route to hospital, establish an IV.
The focused history and physical exam. Types of patients.
Trauma patients with significant mechanism of injury. Trauma patient with isolated injury. Responsive medical patient. Unresponsive medical patient.
Sustained significant mechanism of injury
Exhibits altered mental status from the incident
Predictors of serious internal injury
Injection from vehicle, death in same passenger compartment, fall from higher than 20 feet, rollover of vehicle high speed motor vehicle collision, vehicle passenger collision, motorcycle crash, penetration of the head, chest, or abdomen
Mechanism of injury considerations for infants and children
Fall from higher than 10 feet, bicycle collision, medium speed vehicle collision with resulting severe vehicle deformity.
Evaluate the trauma scene to determine the mechanism of injury
Bent steering wheel indicates potentially serious injuries
Rapid trauma assessment
Not a detailed physical exam fast, Systematic assessment for other life-threatening injuries dcap btls vital signs, skin condition, sample
The isolated trauma pt
No significant mechanism of injury, shows no signs of systemic involvement, does not require extensive history, does not require comprehensive physical exam
The responsive medical patient assessing the responsive patient with medical emergency is entirely different from assessing the trauma patient for two reasons
Reason one. The history takes precedence over the physical exam reason to. The physical exam is aimed at identifying medical complications rather than signs of injury. Begin treatment while you’re assessing your responsive medical patient
Chief complaint
The pain, discomfort, or dysfunction causing patient to call for help; what seems to be the problem?
Past medical history
General state of health, childhood and adult diseases, psychiatric illnesses, accidents and injuries, surgeries and hospitalizations patterns, exercise and leisure activities, environmental hazards, use of safety measures.
Family history
Ami cva iddm exc
Social history
Recreational drugs, quiet, disruptive
Baseline vital signs
Blood pressure, pulse, respiration, temperature, pupils, orthostatic vitals, if possibly hypovolemic.
Additional assessment techniques
Pulse oximetry, cardiac monitoring, blood glucose determination.
Assessment for the unresponsive medical patient; initial assessment.
Rapid medical assessment, brief history, ongoing assessment, detects trends and determines changes,
Ongoing assessment for unconscious patient
Mental status, airway patency, breathing rate and quality, pulse rate and quality, skin condition, transport priorities, vitals signs.
Focused assessment unresponsive patient
Effects of interventions, management plans, reevaluate the ABCs, evaluate your interventions affects, perform your focused assessment again
The prenatal period
Is the time from conception until delivery of the fetus
Reproductive system
Uterus increases in size. Vascular system. Formation of mucous plug in the cervix. Estrogen causes vaginal mucosas to thicken. Breast enlargement.
Cardiovascular system. Physiological changes of pregnancy
Cardiac output increases. blood volume increases
Physiological changes of pregnancy. Gastrointestinal system
Hormone levels. Peristalsis slowed
Physiological changes of pregnancy; urinary system
Urinary frequency is common. Never empty
Physiological changes a pregnancy Musculoskeletal system
Loosened pelvic joints
Physiological changes of pregnancy. Fetal circulation
Pulmonary system does not receive blood while in the years, baby receives blood, and nutrients by mom through the umbilical cord. When the baby is born, the pulmonary arteries are opened up to allow blood, and perfusion to take place.
General assessment of the obstetric patient. Initial assessment
History – sample – pre-existing medical conditions, diabetes, heart disease, hypertension, seizure, pain, vaginal bleeding, are they in labor, physical examination. EDC
General management of the OBsetric pt
Do not perform an internal vagina examination in the field. Always remember that your caring for two patients, the mother and the fetus. ABC, monitor for shock
Complications of pregnancy trauma
Transport all trauma patients at 20 weeks or more gestation. Anticipate the development of shock.
Complications of pregnancy trauma. Trauma management.
Apply c-collar for cervical stabilization and immobilize on a longboard. Administer high flow oxygen concentration. Initiate two large bore IVs for protocol. Place patient tilted to the left to minimize supine hypotension. Reassess patient. Monitor the fetus.
Pregnancy medical conditions
Any pregnant patient with abdominal pain should be evaluated by a physician
Causes of bleeding during pregnancy
Abortion, ectopic pregnancy, placenta previa, abruptio placenta
Abortion
Termination of pregnancy before the 20th week of gestation
Different classifications of an abortion
Less than 12 weeks is define as a spontaneous abortion
Signs and symptoms abortion
Cramping, abdominal pain, backache, vaginal bleeding
Treatment for abortion
Provide emotional support and treat for shock
ECtopic Pregnancy
Assume the any female of childbearing age with lower abdominal pain is experiencing an ECtopic pregnancy, which is life-threatening. Transport the patient immediately.
Placenta previa
Usually presents with painless bleeding. Never attend vaginal exam. Treat for shock. Transport immediately – tx is delivery by C-section
Abruptio placenta
Signs and symptoms very. Classified as partial, severe, or complete. Life-threatening. Treat for shock, fluid resuscitation. Transform left lateral recumbent position
Hypertensive disorders
Preeclampsia and eclampsia symptomatic with a blood pressure over 140/90, difference between the two seizures one is chronic hypertension, chronic hypertension superimposed with preeclampsia, transient , supine hypertensive syndrome? Treat by placing patient in left lateral recumbent position or elevate right hip, monitor fetal heart tones and maternal vital signs, if volume is depleted, initiated IV of normal saline
Gestational diabetes
Consider hypoglycemia when encountering a pregnant patient with altered mental status. Signs include diaphoresis and tachycardia, it would glucoses below 60. Drawl red top tube of blood, IV normal saline, give 25 g of D50. If blood glucose is above 200. Draw a red top tube of blood. Aminister 1 to 2 liters of ns by Iv protocol
Braxton Hicks contractions
False labor that increases in intensity and frequency but does not cause cervical changes
Maternal factors/preterm labor
Cardiovascular disease, renal disease, diabetes, uterine, cervical abnormalities, maternal infection, trauma, contributory factor
Placental factors/preterm labor
Placenta previa, abruptio placenta
Preterm labor\fetal factors
Multiple just station, excessive am atomic fluid fetal infection
Puerperium
The time. Surrounding the birth of the fetus
Stages of labor
Stage one dilation, stage to expulsion, stage three placental stage.
Management of a patient in labor
Transport the patient in labor unless delivery is imminent. Maternal urge to push or the presence of crowning indicates immediate delivery. Delivery at the scene or in the ambulance will be necessary.
Abnormal delivery situations
Breech presentation, prolapse cord, limb presentation, multiple births, cephalopelvic disproportion, precipitous delivery, shoulder dystocia,
Breach presentation
The butt or both feet present first. If the infant starts to breath with its face pressed against the vaginal wall, form a V and press the vaginal wall away from the infants face. Continue during transport.
Prolapse cord
The umbilical chord precedes the fetal presenting part. Elevate the hips, administer oxygen, and keep warm. If the umbilical cord seems in the vagina, insert to go to fingers to raise the fetus off the cord. Do not push the cord back. Wrap cord and sterile moist towel. Transport immediately; do not attempt delivery
Limb presentation
Place the mother in knee - chest position, administer oxygen in transport immediately. Do not attempt delivery.
Other abnormal presentations
Whenever an abnormal presentation or position of the fetus makes normal delivery impossible, reassure the mother. Administer oxygen. Transport immediately. Do not attempt field delivery in these circumstances.
Multiple births
Follow normal guidelines, but have additional personnel and equipment. In twin births labor starts early and babies are smaller. Prevent hypothermia
Cephalopelvic disproportion
Infants head is too big to pass through the pelvis easily. Causes include oversize fetus, hydrocephalus, canjoin twins, or fetal term tumors. If not recognize, can cause uterine rupture. Usually requires c section. Give oxygen the mother and start IV. Rapid transport.
Precipitous delivery
Occurs in less than three hours of labor. Usually in patients in grand multi para, fetal trauma, tearing of cord, or maternal ace rations. Be ready for rapid delivery, and attempt to control the head. Keep the baby warm
Shoulder dystocia
Infants shoulders are larger than his head. Turtle sign. Do not pull on Avon said. If the baby does not deliver, transport patient immediately
Maternal complications of labor and delivery\postpartum hemorrhage
Defined as loss of more than 500 mL of blood following delivery. Establish two large war IVs of normal saline. Treat for shock is necessary. Follow protocols if applying antishock trousers.
Maternal convocations of labor and delivery\ uterine rupture
Tearing or rupture of the uterus. Patient complains of severe domino pain and will often be in shock. Abdomen is often tender and rigid. Fatal heart tones are absent. Treat for shock. Give high flow oxygen and start to large bore IVs of normal saline. Transport Pt rapidly.
Field assessment left sided heart failure
Pulmonary edema. Coffee with copious amounts of clearer pink tinged sputum. Labor breathing, especially with exertion. Abnormal breath sounds. Including rails, rhonchi, wheezes. Pulses paradox and pulses alternans. Remember lower lobes are heard by auscultation of posterior thorax, proxysmal nocturnal Dyspne, Orthopnea signs and symptoms sympathetic nervous system.
Left-sided heart failure\field assessment\medications
Diuretics. Vasodilator, ace inhibitors, beta blockers, calcium channel blockers medis to increase cardiac contractial force
Field assessment right-sided heart failure
Peripheral pitting edema wherever gravity pulls it, extremities or sacral. The new system congestion, liver and spleen engorgement, JVD, ascites, fluid in the abdominal space, pericardial effusion
Heart failure field assessment management
Avoid supine positioning. Avoid exertion such as standing or walking. Maintain airway. Administer oxygen. Establish IV access. Limit fluid administration. Monitor ECG. Consider medication administration. Morphine, nitroglycerin, lasix, enalypril (vasotec) dopamine\dobutamine promethazine, nitrous oxide
Cardiac Tamponade
Results of fluid accumulation between this visceral pericardium and parietal pericardium. Increased intra-pericardial pressure impairs diastolic filling. Typically worsens progressively in till correctly
Epidemiology
Acute onset typically the result of trauma or MI. Benign presentations maybe caused by cancer, pericarditis renal disease and hypothyroidism
Field assessment patient history
Determine participating causes. Patient relates a history of dyspnea and Orthopnea
Field assessment exam
Rapid, wheat poles, decreasing systolic pressure, narrowing pulse pressures, pulses paradox, faint, muffled heart sounds, electrical alternans
Field assessment management
Maintain airway. Mr. oxygen. Establish IV access. Consider medication administration, morphine sulfate, nitrous oxide, furosemide, dopamine/dobutamine, rapid transport, pericardiocentisis, is the definite treatment, insertion of cardiac needle in aspiration of fluid from pericardium, procedures should be performed only if allowed by local protocol. Procedure should be performed only by personnel adequately trained in the procedure.
Hypertensive crisis causes
Typically occurs only in patients with history of hypertension. Primarily cause and noncompliance with prescribed antihypertensive medications. Also occurs with toxemia of pregnancy
Hypertensive emergencies risk factors
Age related factors, race related factors.
Hypertensive emergency initial assessment
change in mental status, signs and symptoms, headache accompanied by nausea and/or vomiting, blurred vision, shortness of breath, vertigo, tinnitus
Hypertensive emergency history
Known history of hypertension, uncompliance with medications
Hypertensive emergencies management
Maintain airway. Administer oxygen. Establish IV access. Consider medication administration. Morphine sulfate, furosemide, nitroglycerin, sodium nitroprudside, labetalol
Cardiogenic shock
General inability of the heart to meet the bodies metabolic needs. Often remains after correction of other problems. Severe form of pump failure. High mortality rate.
Cardiogenic shock causes
Tension pneumothorax and cardiac Tamponode impaired ventricular emptying. Impaired myocardial contractility. Trauma.
Cardiogenic shock management
Maintain airway. Administer oxygen, identifying tree underlying problem, establish IV access, consider medication administration, vasopressors, dopamine, dobutamine, levophed
Atherosclerosis
Progressive degenerative disease of the medium-sized and large arteries. Results from buildup of bats on the interior of the artery. Fatty build up results in plaques and eventual sternosis of the artery
Aneurysm
Ballooning of an arterial wall, usually the aorta, that results from a weakness or defect in the wall
Types of aneurysms
Atherosclerotic, dissecting, infectious, congenital, traumatic.
Abdominal aortic aneurysm signs and symptoms
Tearing abdominal wall, back\flank pain, numbness in legs, hypotension, urge to defecate
Abdominal aortic aneurysm
Often the result of atherosclerosis
Endocrine glands
Have systemic effects. Backed on specific target tissues in specific ways. May have single or multiple targets
Hypothalamus
Located deep within the cerebrum. Some cells relay messages from the autonomic nervous system to the central nervous system. Other cells respond as gland cells to release hormones. Body thermostat.
Posterior pituitary
ADH, Oxytocin
Anterior pituitary
Growth hormone thyroid stimulation hormone, follicles stimulation hormone
Thyroid gland
T4 t 3 calcitonin
Parathyroid gland
Pth
Thymus gland
Thymosin WBC
Pancreas
Combination Organ, exocrine tissues secrete digestive enzymes into small intestines, endocrine tissues secrete hormones. Insulin, glucagon, somatostatin
Adrenal Medulla
Inner segment of adrenal gland. Closely tied to autonomic nervous system
Adrenal cortex
Outer layers of endocrine tissue which secrete steroidal hormones
Gonads
Female\ovaries and male/testes
Pineal gland
Located in the roof of the Thalamus. Related to the body’s biological clock, melatonin. Impacted in seasonal affective disorder
Placenta
Releases hCG throughout just station
Digestive tract
Gastrin and secretin
Heart
Anh
Kidneys
Renin
Disorders of the pancreas
Diabetes mellitus glucose metabolism, metabolism, anabolism and catabolism, insulin is required for glucose metabolism, presence of enough insulin to meet cellular means. Ability to bind in a manner to stimulate the cells adequately. When unable to obtain energy from glucose, the body begins to use stored fat. This produces ketones and ketosis
Regulation of blood glucose
Hypoglycemia and hyperglycemia role of the pancreas, liver, and kidneys. Osmotic diuresis an glucosuria patient at risk for all kinds of problems, pe ami cva
Arterial fibrillation treatment
Electrotherapy\consider if ventricular rate over 150 and symptomatic. Synchronize cardioversion, diltiazem, verapamil, digoxin, beta blockers, procainamide, quinidine. Anticoagulant. (Heparin or warfarin)
Type one second degree AV block
PR interval is variable and drops a QRS complex
Type two second degree AV block
PR interval is fixed and drops a QRS complex
Third-degree AV block
No communication between atria and ventricles
AV block treatment
Transcutaneous pacing for acutely symptomatic patients. Treat symptomatic bradycardia. Avoid drugs that may further slow AV induction
Accelerated junctional rhythm. Characteristics
Inverted P waves in lead two, PRI of .12 seconds, normal QRS complex duration
Paroxysmal junctional tachycardia treatment
Vagal maneuvers, adenosine, verapamil, electrical therapy, use rate is less than 150 and patient is hemodynamically unstable. Synchronize cardioversion starting at 100 Jules
Premature ventricular contractions\malignant pvcs
More six\minutes, r on t phenomenon, couplets or runs of ventricular tachycardia, multi focal PVC PVC are associated with chest pain
Malignant PVC tx
NOn malignant PVCs do not require treatment in patients without cardiac history just administer oxygen
Ventricular tachycardia treatment
Perfusing patient, administer oxygen and establish IV access. Consider immediate synchronized cardioversion for hemodynamically unstable patients. Amiodarone 150 MG IV infused in 10 minutes maybe repeated once. Lidocaine 1.0–1.5 MG\KG IV bolus. If PVCs are not suppressed, repeat doses of 0.5–0.75 MG\KG to Max dose of 3.0 MG\KG. it PVCs are suppressed administer lidocaine drip 2–4 in mG\minute. Reduce the dose in patients with decreased output or decreased hepatic function and patients less than 70 years old
Non-perfusing patients in V tach
Follow ventricular fibrillation protocol
Torsades de pointes polymorphic v tach
Caused by the use of antidysrhythmic drugs
Torsades De pointes tx
Do not treat as standard ventricular tachycardia. Administer magnesium sulfate one – 2 g diluted in 100 ml D5W over 1–2 minutes. Amiodarone 150–300 MG
Ventricular fibrillation treatment
Initiate CPR. Witnessed\defibrillate ones at the highest energy. Non-witnessed\CPR for two minutes, defibrillate once at highest energy, control the airway and establish IV\Io access. Administer epinephrine 1:10,000 every 3–5 minutes. Consider second line drugs such as lidocaine, amiodarone, procainamide, or magnesium sulfate. Consider 40 units of vasopressin IV, one time only, either first or second line with epinephrine
Asystole treatment
Administer CPR and manage airway. Treat for ventricular fibrillation if there is any doubt about the underlying rhythm. Administer medications\epinephrine and possibly consider and treat the causes.
Pulseless electrical activity
Electrical impulses are present, but with no accompanying mechanical contractions of the heart. Treat the patient, not the monitor
Pulseless electrical activity causes
Hypovolemia, cardiac Tampanode tension pneumothorax, hypoxemia, acidosis, massive pulmonary embolism, ventricular wall rupture.
Pulseless electrical activity treatment
Prompt recognition and early treatment. Epinephrine 1 mg every 3–5 minutes
Disturbances of ventricular conduction aberrant conduction bundle branch block
QRS complex greater than 0.12 seconds
Disturbance of ventricular conduction causes
Ischemia or necrosis of a bundle branch
Disturbances of ventricular conduction pre-excitation syndromes
Excitation buying impulse that bypasses the AV node
