Midterm Flashcards

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1
Q

Emphysema

A

PP:
- Destruction of the alveolar walls/ distention of alveolar sacs

SxSx:
- “Pink Puffers”
- Thin, Barrel chested
- Pursed lips
- Difficulty breathing on exertion
- Tachypnea, Tachycardia, Wheezing

Tx:
- Sit patient up
- High flow O2
- Inhaler
- Rapid transport

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2
Q

Chronic Bronchitis

A

PP:
- Excessive mucus production
- Inflammation, swelling and thickening of the bronchi and bronchioles

SxSx:
- Hypoxia
- Overweight
- “Blue Bloaters”
- Productive cough
- Rhonchi

Tx:
- Sit patient up
- High flow O2
- Inhaler
- Rapid transport

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3
Q

Asthma/ Status Asthmaticus

A

ASTHMA
- Sensitivity in lower airways to allergens and irritants
- Causes: Bronchospasm, Edema, Increased mucus secretion

SxSx:
- Accessory muscle use
- Tripod
- Wheezing/ silent chest
- Anxiety/ apprehension
- Chest tightness

Tx:
- Sit up patient
- High flow O2
- Inhaler
- Rapid Transport

STATUS ASTHMATICUS
- Does NOT respond to O2 or meds

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4
Q

Pneumonia

A

PP:
- Acute infectious disease/ infection in lower airway
- Fluid/ pus filled alveoli = poor gas exchange

SxSx:
- History of illness/ antibiotics
- Dehydrated ?
- Fever/ hot skins
- Shortness of breath/ chest pain
- Rhonchi, but can have wheezing/ rales

Tx:
- Sit up
- High flow O2

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5
Q

Pulmonary Embolism

A
  • Obstruction of blood flow in pulmonary arteries
  • Causes: Deep vein thrombosis, immobile patient, recent surgery, long bone fractures, birth control, smokers

PP:
- Blockage of blood flow in pulmonary artery or arteriole
- Hypoxia because poor blood flow/ gas exchange
- Severity based on clot size/ location

SxSx:
- Fear/ Anxiety
- Sudden onset of dyspnea and sharp/ stabbing chest pain
- Hypoxia signs (sense of doom, tachypnea)
- Cough (blood?)
- Clear lungs

Tx:
- Sit up patient
- High flow O2
- Rapid transport

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6
Q

Spontaneous Pneumothorax

A
  • “Collapse lung”
  • Usually males, young, thing
  • Coughing, lifting heavy objects or straining

PP:
- Lining rupture = air entering pleural cavity = lung collapse
- Pressure builds= decrease gas exchange in affected lung

SxSx:
- Tachypnea
- Pale/ cyanotic
- Subcutaneous emphysema
- Dyspnea
- Chest pain
- Diminished/ absent lung sounds on affected side

Tx:
- Sit up patient
- O2
- Rapid Transport

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7
Q

Pulmonary Edema

A

PP:
- Excessive amount of fluid that builds between alveoli and capillaries
- Can result in hypoxia

SxSx:
- Tripod with legs dangling
- Pale/ cyanotic
- JVD
- Swollen ankles
- Dyspnea
- Chest pain
- PINK, frothy sputum
- Crackles/ rales

Tx:
- Sit up with dangle legs
- High flow O2/ PPV
- Rapid transport

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8
Q

Hyperventilation Syndrome

A

PP:
- “Blow off” excessive amounts of CO2
- Eliminating too much CO2 = signs will worsen

SxSx:
- Fatigue
- Nervousness/ anxiety
- Chest tightness
- Numbness/ tingling around mouth, hands, feet
- Tachypnea
- Tachycardia
- Carpopedal spasms

Tx:
- Remove from environment
- Calm/ reassure
- DO NOT USE O2

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9
Q

Acute Coronary Syndrome/ Coronary Artery Disease

A

ACS: sudden, reduced blood flow to the heart

CAD: Plaque build up in the wall of the arteries that supply blood to the heart, which are called coronary arteries. (TWO TYPES)

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10
Q

Atherosclerosis

A

Fatty plaque build up

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11
Q

Arteriolosclerosis

A

Hardening of the arteries

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12
Q

Angina

A

-Worsening symptoms/ not relieved = AMI

PP:
- Inadequate O2 supply to the heart (Myocardial Infarction)
- Stress endued
- Pain will go away

SxSx:
- Chest discomfort possibly radiating to left arm or neck
- Cool, clammy, possibly sweating profusely
- Shortness of breath
- Nausea or vomiting

Tx:
- O2, low flow, O2 sat of >94%
- Keep patient calm
- NTG/ ASA if prescribed

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13
Q

Myocardial Infarction

A

PP:
- Complete blockage of coronary artery

SxSx: (SAME AS ANGINA)
- Chest discomfort possibly radiating to left arm or neck
- Cool, clammy, possibly sweating profusely
- Shortness of breath
- Nausea or vomiting

Tx:
-NTG and or ASA

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14
Q

Aneurysm/ Dissection- Thoracic and Abdominal

A

Aortic Aneurysm
- Weakening in lining of aorta = ballooning

Aortic Dissection
- Tear in inner lining of aorta
- Blood enters= separation of the linings

SxSx:
- Described as “tearing” or ripping”
- Radiate to back, flank, arm

Tx:
- High flow O2
- Rapid transport to facility with surgical resources

Abdominal Aortic Aneurysm (AAA)
- Like thoracic but in abdomen
- Same SxSx
- Pulsating mass in skinny folks

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15
Q

Congestive Heart Failure (CHF)

A
  • Heart isn’t adequately eject blood out of the ventricle
  • Left and Right sided heart failure
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16
Q

Left Heart Failure

A

PP:
-Lung side
- Left ventricle cannot pump blood out to the body effectively
- “Traffic jam” of blood from the lungs

SxSx:
- Chest pain/ shortness of breath
- Rales
- Pale, cool, sweaty skins
- Anxiety
- High BP/ rapid heart rate
- Pink frothy sputum (late/ serious)

Tx:
- Sit up, dangle legs
- High flow O2, PPV
- Rapid transport

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17
Q

Right Heart Failure

A

PP:
- Right ventricle cannot pump blood out to the lungs

SxSx:
- Lower extremity edema
- JVD
- Abdominal distention

Tx:
- Sit up, dangle legs
- High flow O2, PPV
- Rapid transport

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18
Q

Peritonitis

A

PP:
- Inflammation of the peritoneum
- Usually from blood, pus, bacteria, etc leak into the peritoneal cavity

SxSx:
- Abdominal pain or tenderness
- Nausea, vomiting, diarrhea
- Fever and chills
- Positive markle
- DOES NOT WANT TO MOVE

Tx:
- O2 as needed
- Position of comfort
- Transport!
- Control airway

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19
Q

Appendicitis

A

PP:
- Inflammation of the appendix
- Can lead to rupture, peritonitis, and shock

SxSx:
- Umbilical pain, localized to the RLQ
- Nausea, vomiting
- Fever
- poor skin signs
- Hypotension
- rebound tenderness upon palpation

Tx:
- O2 as needed
- POC
- Transport
- ALS
- control airway

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20
Q

Pancreatitis

A

PP:
- Inflammation of the pancreas
- Triggered by alcohol, gallstones, or infection

SxSx:
- ABD pain in the epigastric area
- ABD tenderness and distention
- Mild Jaundice
- Severe ABD pain that can radiate from umbilical region to back of shoulders
- Fever
- Shock

Tx:
- POC
- Treat for shock
- Transport
- O2 as needed

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21
Q

Cholecystic

A

PP:
- Inflammation of the gallbladder

SxSx:
- RUQ pain, referred pain to the right shoulder
- Projectile vomit
- Shock

Tx:
- Same treatments

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22
Q

GI Bleeding

A

PP:
- Bleeding in GI tract

SxSx:
- Hematemesis- vomiting of blood
- Hematochezia- pooping of blood
- Melena- digested blood/ poop
- Fowel smelling bowel movements and vomit
- ALOC
- Poor skins/ shock
- Syncopal episodes
- ABD pain/ discomfort

Tx:
Same plus ALS if unstable patient=

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23
Q

Esophageal Varices

A

PP:
- Bulging, engorgement or weakening of the blood vessel
- Common in alcoholics

SxSx:
- Vomit large amounts of blood
- No ABD pain
- Signs of shock
- Jaundice skins
- Dyspnea
- Tachycardia

Tx:
- Fowlers position
- Same as GI bleeding

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24
Q

Kidney Stones

A
  • Calcium or uric acid crystals that form in the kidney and pass through urinary system
  • Pain, usually in flanks
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25
Q

Hypoglycemia

A

-AKA insulin shock
- EMERGENCY
- Inadequate amount of glucose in the blood stream
- Can mimic: head injuries, alcohol intoxication, drug use, seizure disorder, behavioral disorders, hypoxia, stroke

SxSx:
- Rapid onset
- Cool, moist skins
- Decreased LOC
- Maybe combative
- Headache
- normal BP/ pulse
- shallow respirations
- hungry

Tx:
- 15 grams of glucose or 3 tablets

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26
Q

Hyperglycemia

A
  • Aka Diabetic Ketoacidosis
  • Abnormally elevated blood sugar
  • Not enough insulin to transport sugar into cells/ too much sugar

SxSx:
- Slow onset
- Dry, warm skins
- Acetone breath (fruity odor)
- Increased thirst/ polyuria
- Kussmaul respirations
- Dehydrated, hypotensive, tachycardia, nausea/ vomiting, abd pain, ALOC

Tx:
Insulin

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27
Q

Allergic Reaction

A
  • Hives, urticaria
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28
Q

Anaphylaxis

A
  • Mild symptoms + angioedema, bronchocontriction, signs of shock
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29
Q

Ischemic Stroke

A
  • Cerebral artery is blocked
  • Thrombus: clot forms in artery (most common)
  • Embolus: Clot travels from another part of the body and lodges in cerebral artery (faster onset)
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30
Q

Hemorrhagic Stroke

A
  • Rupture of an artery or a burst aneurysm
  • Very sudden onset
  • “WORST HEADACHE EVER”
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31
Q

Transient Ischemic Stroke

A
  • Same s/s as CVA
  • Symptoms resolve (1-2 hours)
  • Precursor for strokes
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32
Q

Generalized Seizure/ Status Epilepticus

A
  • Grand Mal
  • Last longer than 5 min
  • Recurrent seizures without lucid interval
  • Four stages: Aura, Tonic, Clonic, Postictal state
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33
Q

Absence Seizures

A
  • Petite Mal
  • Blank stare, unaware of surrounding
  • Last a few seconds
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34
Q

Febrile Seizures

A
  • Caused by high fever (Rapid spike)
  • 6 months- 6 years
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35
Q

Simple Partial Seizure

A
  • One part of the body
  • Generally stays awake
  • Can spread into generalized
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36
Q

Complex Partial Seizure

A
  • Same as a simple partial, but patient isn’t aware of surroundings
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37
Q

Syncope

A
  • Fainting/ sudden and temporary loss of consciousness
  • Generally from a standing position
  • Becomes responsive after becoming supine
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38
Q

Glucose

A
  • Simple sugar absorbed through digestive tract and used as fuel
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39
Q

Insulin

A
  • Produced in pancreas
  • Secreted when glucose levels are high
  • Assists glucose to moves from blood into cells
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40
Q

Glycogen

A
  • Stores many simple glucose molecules together in liver
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41
Q

Glucagon

A
  • Produced in pancreas
  • Secreted when glucose levels
  • Converts glycogen backs into glucose
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42
Q

FAST
ED
BE

A

Face drooping
Arm weakness
Speech Difficulty
Time to call 911

Eye deviation
Denial

Balance
Eye

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43
Q

Carbon Monoxide Poisoning

A

-Sticks better than O2
- Tasteless, colorless, odorless gas
- Caused by incomplete combustion

SxSx:
- Headache
- Nausea, vomiting
- Confusion
- Late sign: CHERRY RED SKINS

44
Q

Alcohol Withdrawls

A

STAGE ONE:
- 8 hours from last drink
- Nausea, insomnia, sweating, tremors

STAGE TWO:
- 8-72 hours from last drink
- Worsening symptoms
- Hallucinations start

STAGE THREE:
- 48 hours plus from last drink
- Same S/S
- Seizures can happen in this stage

STAGE FOUR:
- 1-14 days since last drink
- Delirium Tremens/ DT’s
- True medical emergency, life threatening
- Loss of memory, hallucinations, fevers, sweating, insomnia, confusion, psychosis
- Can last three days

45
Q

Narcotic Overdose

A
  • Respiratory depression or arrest
  • Pinpoint pupils
  • Hypotension
46
Q

CNS Stimulants

A
  • Excite the CNS
  • Cocaine, crack, meth, PCP, diet pills, MDMA/ ecstacy

SxSx:
- Excitable
- Nervous
- Hypertension
- Dilated Pupils
- Tachycardia

47
Q

CNS Depressants

A
  • Depresses the CNS
  • Alcohol
  • Benzodiazepines (Xanax/ Alprazolam, Ativan, Valium)

SxSx:
- Euphoria
- Drowsy
- Dilated pupils
- Sluggish
- Bradypnea

48
Q

Stroke SxSx

A
  • Slurred speech/ difficulty breathing
  • Facial droop
  • Paralysis/ weakness to one side of body
  • Headache
49
Q

Stroke Treatment

A
  • Monitor ABC’s
  • O2 sat >94%, O2 not needed unless ABC issue
  • Check blood sugar
  • Position of comfort
  • Rapid transport
50
Q

Ingested Poisoning

A
  • Most common
  • Absorbed into the GI tract/ small intestine

SxSx:
- Swelling or burns around mouth
- Nausea, vomiting, diarrhea
- ALOC (AEIOUTIPS)
- ABD pain

Tx:
- Activated Charcoal an hour with in ingestion

51
Q

Activated Charcoal

A

Indications:
- Ingested poison with in a hour of ingestions

Contradictions:
- ALOC
- Acids or Alkalis (Bleach, ethyl, alcohol)
- UNABLE to swallow

Dosage:
- 1g/ kg body weight
- Adults 30- 100g
- Children: 12.5- 25g

Action:
- absorbs poison in the stomach, preventing absorption into the blood stream (coats the drug)

Side effects:
- Black Stool
- Vomtting (repeat dose if patient vomits with in 30 mins)

52
Q

Inhaled Poisoning

A
  • Breathing in a poison
  • Rapid absorption and onset
  • Can be accidental or abused

SxSx:
- Dyspnea
- Chest pain
- Stridor, hoarseness, coughing, wheezing, crackles
- Dizzy, headache, ALOC, seizures

53
Q

Injected Poisoning

A
  • Under the skin, into the muscle or directly into bloodstream

SxSx:
- Swelling at injection site
- Euphoria
- Nausea/ vomiting
- Weakness, fever, chills

54
Q

Absorbed Poisoning

A
  • Enters the body through skin or mucous membrane contact

SxSx:
- Liquid or powders on skin
- Burns
- Itching, reddness, swelling
- rashes
- oozing blisters

55
Q

Organophosphate/ Pesticide Exposure

A
  • includes insecticides and nerve agents
  • Salvation
  • Lacrimation
  • Urination
  • Defecation
  • GI upset
  • Emesis (vomiting)
  • Miosis (construction of pupils)
56
Q

Emphysema vs Chronic Bronchitis

A

Emphysema:
- Thin, barrel chested
- Pink complexion
- Non productive cough
Chronic Bronchitis
- Overweight
- Blue complexion
- Productive cough

57
Q

Asthma Types

A

Extrinsic:
- “Allergic Asthma”
- Irritants in the air
Intrinsic:
- Infection, emotional distress, or exercise

58
Q

Two types of Pulmonary Edemas

A

Cardiogenic
- CHF, left sided

Acute Reparatory Distress Syndrome
- Destruction of capillary bed = fluid leakage
- Pneumonia, aspiration, drowning, OD, etc

59
Q

Wheezing

A

PP:
- High pitched, musical whistling sound
- Bronchoconstriction
- Mostly heard on exhalation

DISEASES:
- Asthma, Emphysema, Chronic Bronchitis, Pneumonia

60
Q

Rhonchi

A

PP:
- Snoring, rattling noise
- Thick mucous
- Obstruction in larger airways

DISEASES:
- Pneumonia, Chronic Bronchitis, Emphysema

61
Q

Rales (Crackles)

A

PP:
- Bubbling, crackling heard on inspiration
- Fluid build in alveoli

DISEASES:
- CHF and Pulmonary Edema

62
Q

Types of Respiratory Distress

A

DISTRESS: Adequate tidal volume and rate; maintain SpO2 94% or greater

FAILURE: Inadequate volume and or rate; PPV

ARREST: No tidal volume/ rate; PPV

63
Q

Multi- Dose Inhaler

A

Actions:
- Relaxes the bronchiole smooth muscle and dilates lower airways (improves airflow in alveoli)

Side Affects:
- Tachycardia
- Tremors, shakiness
- Nervousness
- Dry mouth
- Nausea, vomiting

64
Q

Silent MI

A
  • MI with no chest pain/ vague symptoms
  • common in the elderly, women, and diabetic
65
Q

Nitroglycerin (NTG)

A

Indications:
- SS of chest pain or discomfort, consistent with acute coronary syndrome
- Prescription
- Approval to administer

Contradictions:
- Viagra in the past 24 h (can cause DEATH)
- HR less than 50 bpm or more than 100 bpm
- 3 doses have been taken

Action:
- Relieves chest pain
- Dilates coronary arteries/ increased blood flow
- Reduces workload of the heart
-Decreases cardiac oxygen demand

Side effects:
- Headache
- BP drop
- Change in pulse rate

Dosage:
- .4mg x3

66
Q

Aspirin (ASA)

A

Indications:
- Chest pain/ discomfort that is suggestive of acute coronary syndrome
- Medical direction to give

Contradictions:
- Not given to patient who are known to be allergic (hypersensitive to drug)

Actions:
- Does not allow platelets to stick together = prevents vessel blockage

Side effects:
– Overall a very good drug
- Stomach irritation

Dosage:
- 160-325mg

67
Q

AEIOUTIPS

A

Alcohol
Epilepsy
Insulin
Overdose
Uremia
Trauma
Infection
Psychological
Shock

68
Q

Cincinnati Prehospital Stroke Scale

A
  • Facial droop: have patient smile
  • Arm drift: have patient hold arms out for 10 seconds
  • Speech: have patient speak a simple sentence
69
Q

Seizure Treatment

A
  • Ensure airway
  • Let them have the seizure
  • Prevent injury
  • Nothing in the mouth
  • Status epilepticus: NPA- BVM
70
Q

Seizure

A

Sudden and temporary altercation in brain function caused by massive, continuing electrical discharges in the brain

71
Q

Cerebrovascular Accident (CVA)/ Stroke

A
  • Inadequate amount of blood being delievered to a portion of the brain (Blood clot or Hemorrhage)
72
Q

Poison

A

Any substance that impairs health or causes death by its chemical action when it enters the body or comes in contact with skin

73
Q

Toxicology

A

Study of toxins, antidotes, and the effects of toxins on the body

74
Q

Antidotes

A

Substance that will neutralize or counteract the effects of a poison

75
Q

Spontaneous Abortion

A
  • Miscarriage
  • Passage of tissue before the 20th week or gestation
  • USUALLY in the first trimester, between 8-12 weeks gestation
76
Q

Ectopic Pregnancy

A
  • First trimester
  • Fertilized egg implants anywhere but the uterus
  • Usually in fallopian tubes
  • Egg starts to grow and develop, rupturing the fallopian tubes

SXSX:
- Intense lower quadrant abd pain described as dull, then sharp, and knife like
- Can lead to internal bleeding and signs of shock possible

77
Q

Placenta Previa

A
  • 3rd trimester emergency
  • Placenta implants itself over the cervix

SXSX:
- LOTS of vaginal bleeding
- NO pain

78
Q

Abruptio Placenta

A
  • Common in 1st pregnancy
  • 3rd trimester emergency
  • Placenta prematurely tears away from the uterine wall
  • High mortality rate for mom and baby
  • Many causes, from hypertension to trauma

SXSX:
- LOTS of pain
- LITTLE/ NO bleeding (infants head is covering the cervix)

79
Q

Ruptures Uterus

A
  • 3rd trimester
  • Spontaneous or traumatic rupture of the uterine wall
  • Release fetus into abdominal cavity

Special question:
- Has the patient has a c- section before?

80
Q

Preeclampsia/ Eclampsia

A
  • 3rd trimester
  • Characterized by hypertension and swelling of the extremities
  • Preeclampsia turns into Eclampsia when the mother has seizures
  • Pregnancy related seizures have high mortality rate for mother and baby
81
Q

Supine Hypotensive Syndrome

A
  • 2nd and 3rd trimester
  • Uterus and growing fetus compress the inferior vena cava when the mom lays flat on her back
  • Leads to hypotension when laying down
  • Prop a pillow or similar under the patients right side to ensure the fetus does not compress the inferior vena cava
82
Q

Prolapsed Cord

A
  • Umbilical cord presents before the head
  • TRUE EMERGENCY
  • Baby can compress the cord, cutting off blood supply
  • Can insert gloved hand into birth canal to lift presenting part of the baby off of the cord
83
Q

Breech Birth

A
  • Butt or legs present first
  • Allow deliver to happen
  • If head gets stuck, after 2 minutes, may insert gloved hand into birth canal to make an airway for the baby
84
Q

Limb Presentation

A
  • Single arm or leg is presenting
  • TRUE EMERGENCY, cannot deliver in the field
  • Patient will need c section
85
Q

Meconium Staining

A
  • Baby had a bowel movement in the amniotic sac
  • When water breaks, fluid is greenish or brown
  • Tells you that the baby was in distress at one time
86
Q

Postpartum Hemorrhage

A
  • Any bleeding over 500cc after baby is born
  • Place mom on high flow O2
  • Massage fundus
  • Baby to breast
87
Q

Epipen

A

Indications:
- Allergic reaction/ anaphylaxis
- Mucosal signs
- Angioedema/ respiratory symptoms
- Poor perfusion

Contradictions:
- None is administered for life threatening anaphylactic emergencies

Actions:
- Reverses reaction by mimicking sympathetic response (turns off histamine/ does nothing to pre existing histamine)
- Bronchodilation
- Vasoconstriction
- Reverses capillary permeability

Side affects:
- Tachycardia
- Dizzy/ excitability
- Chest pain
- Nausea/ vomiting

Dosage:
- Adults- .3mg
- Children- .15mg

88
Q

Oral Glucose

A
89
Q

Naloxone/ Narcan

A

Indications:
- suspected opioid intoxication with respiratory depression

Contradictions:
- known hypersensitivity

Actions:
- Opioid antagonist
- Binds to opioid receptors to reverse respiratory depression

Side affects:
- Acute withdrawal

Dosage:
- Intranasal
1 mg per nostril = 2 mg

90
Q

Hypoxia Signs

A

EARLY:
- Tachypnea, dyspnea, anxiety, apprehension, pale skins

LATE:
- ALOC, Cyanosis, dyspnea

91
Q

Birth Stages

A

STAGE ONE:
- Dilation phase
- Beginning of true labor until full dilation of the cervix
- Braxton hicks contractions: False labor

STAGE TWO:
- Expulsion phase
- Full dilation of the cervix until the baby is born
- Look for Nuchal Cord: cord wrapped around babys neck

SXSX:
- Contractions 2-3 minutes apart and lasting 60-90 seconds
- Urge to bear down
- Crowing

STAGE THREE:
- Placenta phase
- Delivery of the baby until delivery of the placenta
- 5-20 minutes after

92
Q

APGAR out of 10

A

APPEARANCE: 0-2
PULSE: 0-2
- 1: <100
- 2: >100
GRIMACE: 0-2
ACTIVITY: 0-2
RESPIRATIONS: 0-2

93
Q

APGAR Scoring

A
  • 7-10: only routine care
  • 4-6: Simulate baby, O2
  • 0-3: BVM, CPR as needed
94
Q

5 Patient Rights

A
  • Right patient
  • Right drug
  • Right dose
  • Right route
  • Right time
95
Q

Normal blood sugar

A

70-140 mg/dl

96
Q

Glycogen

A
  • Stores unused glucose
  • Stores many simple glucose molecules together in the liver
97
Q

Insulin

A
  • Moves glucose into cells
  • Secreted when glucose levels are high
  • Produced in pancreas
98
Q

Glucagon

A

Converts glycogen into glucose
- Produced in pancreas

99
Q

Nasal Canula

A
  • 2-6 lpm
  • Low flow
100
Q

Non rebreather mask

A
  • 10-15 lpm
  • High flow
101
Q

Bag valve

A
  • 10-25 lpm
  • assisting in ventilation
102
Q

RUQ

A

Liver S
Right Kidney S
Colon H
Gallbladder H

103
Q

RLQ

A

Colon H
Small intestine H
Major Artery/ vein to the right leg
Ureter
Appendix H

104
Q

LLQ

A

Colon H
Small intestine H
Major artery/ vein to the left leg
Ureter

105
Q

LUQ

A

Liver S
Spleen S
Left Kidney H
Stomach H
Pancreas S