Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSW Ambulance > Medical/Surgical > Flashcards

Medical/Surgical Flashcards

1
Q

Where are the adrenal glands located?

A

1 on top of each kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the outer part of the adrenal gland called?

A

adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the inner part of the adrenal gland called?

A

adrenal medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three zones of the adrenal cortex?

A

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the Zona Glomerulosa (outer zone) of the adrenal cortex do?

A
  • Produces mineralocorticoids, mainly aldosterone which acts on the distal nephron and augments Na+ reabsorption & K+ and H+ excretion
  • Influences extracellular fluid space and blood pressure through sodium balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the Zona Fasciculata (middle zone) of the adrenal cortex do?

A
  • Produces glucocorticoids, predominantly cortisol, increasing blood sugar levels via gluconeogenesis & suppresses the immune system and aids metabolism
  • This zone secretes cortisol both at a basal level and as a response to the release of adrenocorticotropic hormone (ACTH) from the pituitary gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the Zona Reticularis (inner zone) of the adrenal cortex do?

A
  • Produces gonadocorticoids and is responsible for administering these hormones to the reproductive regions of the body.
  • Most of the hormones released by this layer are androgens.
  • The main androgen produced by this layer is
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is dehydroepiandrosterone (DHEA)?

A

the most abundant hormone in the body and serves as the precursor for many other important hormones produced by the suprarenal gland, such as oestrogen, progesterone, testosterone and cortisol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What hormones does the adrenal medulla produce?

A

Adrenaline
Noradrenaline

(Fight or flight hormones)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does adrenaline do?

A

rapidly responds to stress by increasing the heart rate and redistributing blood to the muscles and brain. It also increases blood sugar level by converting glycogen to glucose in the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is glycogen?

A

the liver’s storage form of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does noradrenaline do?

A

works with adrenaline in response to stress, however it can cause vasoconstriction resulting in hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is hydrocortisone?

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does hydrocortisone (cortisol) do?

A
  • regulates how the body converts fats, proteins and carbohydrates into energy
  • helps regulate blood pressure and cardiovascular function
  • controls the intermediary metabolism
  • moderates immune response
  • is essential for the resistance of the organism to noxious stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does the hormone corticosterone do?

A

works with hydrocortisone to regulate immune response and suppress inflammatory reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pathophysiology of secondary adrenal insufficiency?

A

the pituitary gland fails to produce enough adrenocorticotropin (ACTH) to stimulate the adrenal glands to produce cortisol, shrinking the adrenal glands

secondary adrenal insufficiency is much more prevalent than Addison’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the pathophysiology of iatrogenic adrenal insufficiency (subgroup of secondary)?

A

caused by chronic long-term corticosteroid use and can occur following withdrawal from 2 weeks or more of corticosteroid use or as doses are tapered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the most common symptoms of adrenal insufficiency?

A

chronic, or long lasting, fatigue
muscle weakness
loss of appetite
weight loss
abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the least common symptoms of adrenal insufficiency?

A

nausea, vomiting, diarrhoea
low blood pressure that drops further when a person stands up, causing dizziness or fainting
headache, irritability and depression
craving salty foods
hypoglycaemia, or low blood sugar
sweating
in women, loss of interest in sex, irregular or absent menstrual periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of an adrenal crisis?

A

General: High fever weakness, lethargy, weight loss, joint or muscular pain
CNS: fatigue, disorientation, headache, mood change, mental confusion
Gastro: abdominal pain, nausea, vomiting and diarrhoea
CVS: tachycardia, Low BP, postural hypotension, dehydration, syncope
Skin: hyperpigmentation of skin or buccal mucosa,mottled appearance indicating peripheral shutdown, pallor
Electrolytes: hypoglycaemia, hyperkalaemia (high potassium) , hyponatraemia (low salt)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an adrenal crisis?

A

Sudden, severe worsening of adrenal insufficiency symptoms is called adrenal crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the pathophysiology of asthma?

A
  • immune system activated causing inflammatory mediators released
  • inflammation of lower airway causing irritation and mucosal oedema resulting in turbulent air flow
  • bronchoconstriction increases residual volume, PCO2, air trapping and alveolar pressure and reduces oxygen rich air to alveoli causing decreased blood oxygenation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the pathophysiology of primary adrenal insufficiency (Addison’s Disease)?

A

adrenal glands don’t release aldosterone cortisol and adrenal androgens to meet physiologic needs, despite release of ACTH from the pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 2 phases of asthma?

A

Acute (early) phase - 1st 60 mins post stimulus exposure
Late phase - 4-8hrs post stimulus exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What cells does immunoglobulin E (IgE) bind to in the acute phase of asthma?

A

basophils
lymphocytes
mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

the acute phase of asthma, what happens when immunoglobulin E (IgE) binds to basophils, lymphocytes and mast cells?

A

it can stimulate the immune system causing MAST cells to release mediators such as histamine, leukotrienes and prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In the acute phase of asthma, what do histamine, leukotrienes and prostaglandins cause?

A
  • spasm of the bronchial smooth muscle in the small and middle airways (causing the wheeze)
  • oedema and mucous secretions
  • vascular permeability resulting in inflammation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What causes the late phase of asthma?

A

the release of chemotaxins from the MAST cells which attract inflammatory cells to try to eliminate the irritant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

In the late phase of asthma, what inflammatory cells are attracted by the chemotaxins in the MAST cells?

A

eosinophils
neutrophils and
macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the result of the inflammatory process of the late phase of asthma?

A

vasodilation, mucous secretion, bronchospasm, plasma leak and oedema which worsens clinical symptoms by promoting airway inflammation, obstruction and hyper-responsiveness

31
Q

What is the treatment for anaphylaxis in a Pt who has had adrenaline administered prior to paramedic arrival and their symptoms have resolved?

A

Continual reassessment as they may deteriorate
Minimise time on scene
DO NOT ALLOW THE PATIENT TO STAND OR WALK
POSTURE PT SUPINE (sitting with legs straight out if breathing difficulties are present)

32
Q

What is the treatment for anaphylaxis?

A
  • Adrenaline (IV by authorised paramedics if ≥ 16yrs who are unresponsive to 4 IM adrenaline)
  • Compound Sodium Lactate if hypovolaemic
  • Glucagon (if persistent hypovolaemia post compound sodium lactate)
  • Salbutamol
  • Hydrocortisone (if persistent wheeze post salbutamol)
  • Nebulised Adrenaline (if continuing signs of upper airway obstruction post IM adrenaline)
  • Minimise time on scene
  • Continual monitoring
  • Transport to ED (R1 if Pt unresponsive to treatment)
33
Q

What are the P5 protocol specific exclusions for anaphylaxis?

A

Pts who have been administered adrenaline either prior to arrival or by paramedics

34
Q

Compound sodium lactate note for anaphylaxis cardiac arrest.

A

If signs and symptoms of hypovolaemia are present, patients should be administered a bolus dose of compound sodium lactate. If the patient deteriorates into cardiac arrest a further bolus of compound sodium lactate should be administered irrespective of previous administration.

35
Q

What are the signs and symptoms of mild/moderate asthma?

A
  • Can walk, speak whole sentences in one breath (for young children can move around and speak in phrases)
  • SpO2% > 94% room air
  • Pulse rate < 100/min Adult and Paed
  • PEFR >75% of predicted Adult and > 60% Paed of predicted or best (if known) or cannot be performed
36
Q

What are the signs and symptoms of severe asthma?

A
  • Unable to complete sentences in one breath due to dyspnoea
  • SpO2% 90-94% room air
  • Pulse rate 100-120/min Adult and 100-200/min Paed
  • Accessory muscle use or ‘tracheal tug’ during inspiration or subcostal recession (abdominal breathing)
  • Obvious respiratory distress
  • PEFR 50-75% Adult and 40-60% Paed of predicted or best (if known) or cannot be performed
37
Q

What are the signs and symptoms of life-threatening asthma?

A
  • Talks in words
  • SpO2% <90% room air
  • Pulse rate > 120/min Adult and > 200/min Paed (bradycardia present when respiratory arrest is imminent)
  • Poor respiratory effort, soft/absent breath sounds
  • Reduced consciousness or collapse
  • Exhaustion/agitation
  • Cyanosis
  • PEFR <50% Adult and < 40% Paed of predicted or best (if known) or cannot be performed
38
Q

What is the treatment for severe asthma?

A
  • Minimise time on scene
  • Salbutamol NEB
  • Ipratropium bromide NEB
  • Hydrocortisone IM (6 yrs or older only)
  • Reassess every 15 mins
  • Transport to ED
39
Q

What is the treatment for life threatening asthma?

A
  • Minimise time on scene
  • Adrenaline IM (IV by authorised paramedics if unresponsive to 4 IM)
  • Salbutamol NEB
  • Ipratropium bromide NEB
  • Hydrocortisone IM
  • Reassess every 5 mins
  • Transport to ED
40
Q

What are the P5 protocol specific exclusions for asthma?

A
  • Initial severe or life-threatening presentation
  • Previous intubation/ICU admission for asthma
  • Concurrent respiratory illness
  • Suspicion of anaphylaxis
  • Pregnancy
  • Hx of COPD or heart failure
  • No access to self-administered bronchodilator
  • Bilateral crepitation on auscultation
  • Initial PEFR < 75% predicted or known physiological value
  • Nil improvement in PEFR and/or symptomatic post treatment
41
Q

What is the treatment for mild/moderate asthma?

A
  • Salbutamol NEB
  • Reassess Pt and treat as severe if no improvement after 1 nebule
  • If no P5 exclusions determine appropriate disposition
  • If P5 exclusions present transport to ED
42
Q

What are the 2 types of signs and symptoms in hypoglycaemia?

A

adrenergic
neuroglycopaenic

43
Q

What are the adrenergic symptoms of hypoglycaemia?

A

trembling or shaking
diaphoresis
lightheadedness
numbness around lips and fingers
hunger

44
Q

What are the neuroglycopaenic symptoms of hypoglycaemia?

A

reduced LOC
dizziness
headache
lack of concentration
weakness
behavioural change
irritability
tearfulness/crying

45
Q

What are the P5 exclusions for hypoglycaemia?

A

alone/no carer
unable/unwilling to eat
pregnancy
unresponsive or inadequate response to treatment

46
Q

Why do paramedics need to notify triage of glucose administration in hypoglycaemic Pts with known or suspected ETOH?

A

It may precipitate Wernicke’s encephalopathy

47
Q

What is the treatment for hypoglycaemia in Pts 28days of age or greater who are conscious and can swallow?

A

Assist to eat and drink (if available)
Glucose gel if food or drink not available
Monitor for 15 mins and retest BGL
Repeat treatment once if inadequate or nil response to treatment
Determine disposition or transport if P5 exclusions

48
Q

What is the treatment for hypoglycaemia in Pts <28 days of age who are uncconscious and/or unable to swallow?

A

Glucose 10%
Glucagon if unable to administer glucose gel 10%
Monitor for 15 mins and retest BGL
Repeat treatment once if inadequate or nil response to treatment
Determine disposition or transport if P5 exclusions

49
Q

What is the treatment for hypoglycaemia in Pts <28days of age who are conscious and can swallow?

A

Assist to feed (if available)
Administer glucose gel if breast milk/formula not available
Monitor for 15 mins and retest BGL
Repeat treatment once if inadequate or nil response to treatment
Determine disposition or transport if P5 exclusions

50
Q

What is the treatment for hypoglycaemia in Pts 28 days of age or greater who are unconscious and/or unable to swallow?

A

Glucose 10%
Glucagon if unable to administer glucose gel 10%
Monitor for 15 mins and retest BGL
Repeat treatment once if inadequate or nil response to treatment
Determine disposition or transport if P5 exclusions

51
Q

What are the indications for treatment for hyperglycaemia?

A
  • BGL 17mmol or greater
  • moderate to severe dehydration
52
Q

What are the signs and symptoms of hyperglycaemia?

A

Confusion
Acetone breath
Tachycardia
Hypotension
Kussmaul’s respiration
Vomiting

53
Q

What is the treatment for indicated hyperglycaemia?

A

compound sodium lactate
treat signs and symptoms as per specific protocol
transport to ED

54
Q

Do you transport non indicated hyperglycaemic Pts to ED?

A

yes

55
Q

What are the 3 types of seizures?

A

focal (may progress to tonic-clonic)
generalised onset
unknown onset

56
Q

What are the 2 classifications of focal seizures?

A

aware or impaired awareness
motor onset or non-motor onset

57
Q

What are the 3 classifications of generalised onset seizures?

A

motor - tonic clonic
other motor
non-motor - absence seizures

58
Q

What are the 4 classifications of unknown onset seizures?

A

motor - tonic clonic
other motor
non-motor
unclassified

59
Q

What is an aware seizure?

A

Pt has awareness during the seizure, knowledge of self and environment, consciousness is intact

60
Q

What is a motor seizure?

A

Movement or motion during seizure

61
Q

What is an unclassified seizure?

A

Seizures with patterns that do not fit into the other categories or there is insufficient information to classify the seizure

62
Q

What is the treatment for seizures?

A

protect Pt from injury
consider other causes and treat per specific protocol (eg eclampsia)
midazolam
treat associated conditions - hypo/hyperglycaemia, hyperthermia
determine appropriate disposition or transport to ED if P5 exclusions present
regularly repeat ABCD

63
Q

What key findings/do you need to know about seizure Pts?

A

time of onset
events - mechanism of injury
associated symptoms
relevant past medical Hx
medication Hx/compliance
allergies

64
Q

What are the associated symptoms of seizures?

A

fever/current febrile illness (especially paeds)
ALOC
incontinence

65
Q

What are the P5 protocol specific exclusions for seizures?

A

alone/no carer
concurrent acute illness
first seizure presentation
Hx of multi-seizure presentations
Hx of recent traumatic brain injury
seizure type/pattern different to normal
suspicion of overdose/aspiration
intoxication
unwitnessed seizure
pregnancy
increased seizure frequency
seizure involving submersion
febrile convulsions

66
Q

What is the treatment for anaphylaxis in a Pt who has had adrenaline administered prior to paramedic arrival and their symptoms have resolved?

A

Continual reassessment as they may deteriorate
Minimise time on scene
DO NOT ALLOW THE PATIENT TO STAND OR WALK
POSTURE PT SUPINE (sitting with legs straight out if breathing difficulties are present)

67
Q

What is the treatment for anaphylaxis?

A
  • Adrenaline (IV by authorised paramedics if ≥ 16yrs who are unresponsive to 4 IM adrenaline)
  • Compound Sodium Lactate if hypovolaemic
  • Glucagon (if persistent hypovolaemia post compound sodium lactate)
  • Salbutamol
  • Hydrocortisone (if persistent wheeze post salbutamol)
  • Nebulised Adrenaline (if continuing signs of upper airway obstruction post IM adrenaline)
  • Minimise time on scene
  • Continual monitoring
  • Transport to ED
68
Q

What are the P5 protocol specific exclusions for anaphylaxis?

A

Pts who have been administered adrenaline either prior to arrival or by paramedics

69
Q

What are the signs and symptoms of anayphylaxis?

A

Any ONE or MORE of the following:
* Persistent dizziness or collapse
* Pale and floppy (young children)
* Swelling of the tongue
* Swelling/tightness in the throat
* Difficulty talking/hoarse voice
* Difficult/noisy breathing
* Wheeze or persistent cough
* Persistent abdo pain and vomiting after exposure to a likely allergen (including injected medications and insect bites/stings)

70
Q

What are the signs and symptoms of adrenal crisis?

A

Reduced alertness, confusion
Lethargy, pallor, weakness
Tachycardia
Hypotension, peripheral shutdown
Hypoglycaemia
Nausea, vomiting, abdominal pain

71
Q

What are the potential precipitants of adrenal crisis?

A

Any significant illness, trauma or stress, including:
Febrile illness, infection, gastroenteritis.
Respiratory distress, abdominal pathology, labour.
Injury, trauma, environmental exposure.
Severe psychological stress.
Non-compliance with regular hydrocortisone.

72
Q

What is the management for adrenal crisis?

A

Hydrocortisone
Treat other signs and symptoms
Monitor BP
Transport to ED

Note: IV access will be easier post hydrocortisone administration

73
Q

What is intestinal malrotation

A

a birth defect where the intestine does not make the turns as it should.

  • It occurs equally in boys and girls
  • More boys have symptoms by the first month of life
74
Q

What is a volvulus?

A

A volvulus is a problem that can occur after birth as a result of intestinal malrotation. The intestine becomes twisted, causing an intestinal blockage that prevents food from being digested normally. This blockage can also cause dehydration. This twisting can also cut off the blood flow to the intestine, and the intestine can be damaged

NSW Ambulance (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions