National Registry TQ Flashcards
What’s the most abundant cation associated with cardiac contractility?
a. Sodium
b. Chloride
c. Calcium
d. Potassium
c. Calcium
What causes fluid shift in pulmonary edema secondary to CHF?
a. Increased hydrostatic pressure
b. Increased capillary permeability
a. Increased hydrostatic pressure
What is the most common EKG finding with Tricyclic Antidepressant OD?
a. Inverted T wave
b. Bradycardia with heart blocks
c. R on T phenomenon
d. Widened QRS
c. R on T phenomenon
What is the medication treatment for cocaine use?
Benzodiazepines
Male complaining of chest pain and dyspnea after cocaine use. What can you give him?
a. Nitroglycerin
b. Aspirin
c. Valium
d. Naloxone
c. Valium
67yo male complaining of retrosternal chest pain, BP 90/50, HR 79, RR 24. (shows elevation in III, aVF and reciprocal changes in I, aVL, V5 and V6) what is your next action?
a. Posterior 12 lead ECG
b. NS fluid bolus of 500mL
c. Administer Dopamine
d. Administer Nitroglycerin
b. NS fluid bolus of 500mL
4yo presents with bounding pulses in upper extremities but cool, cyanotic faint pulses in the lower extremities. What is likely occurring?
a. Coarctation of the aorta
b. Atrial septal defect
c. Total anomalous venous return
d. Tetralogy of Fallot
a. Coarctation of the aorta
27yo female was cleaning her shower with ammonia and bleach, she has coughing and dyspnea. As soon as you load her into the Ambulance she has stridor and diffuse wheezing throughout. What do you do next?
a. Administer Racemic Epi via nebulizer
b. Administer Amyl Nitrate
c. Intubate immediately
d Perform cricothyrotomy
a. Administer Racemic Epi via nebulizer
A 27yo female is in active labor and feels sharp, sudden shearing pain and her contractions stop. BP 70/40, HR 112. What could possibly be happening?
a. Abuptio placenta
b. Uterine rupture
c. Placenta previa
d. Ectopic preganance
a. Abuptio placenta
What is the name for regurgitation of the uterine lining into the fallopian tubes?
a. Ectopic pregnancy
b. Abruptio placenta
c. Endometriosis
d. something else
c. Endometriosis
What is Lou Gehring’s disease termed?
Amyotrophic Lateral Sclerosis (ALS)
Elderly male with COPD, diffuse rales throughout. BP98/60, P88, spo2 <90’s%. What treatment would be appropriate?
a. Albuterol
b. CPAP
b. CPAP
Which of the 4 relate to Negligence?
a. Probable cause
b. Quid Pro Quo
c. etc.
d. etc.
a. Probable cause
Gestational Diabetes
hyperglycemia in mom results in hypoglycemia in baby (<40mgDl) leads to c section and big baby.
Newborn Resucitation
HR <60
Cystitis
bladder infection
Pelvic Inflammatory Disease
Infection of the female reproductive organs.
- Pain in lower abdomen - Pain or bleeding with sex - Bleeding between periods. - Burning - Odor - Discharge
Untreated STI
cloudy urine
Spontaneous Abortion
up to 20 weeks.
Placenta Previa
non-painful vaginal bleeding, after 20 weeks.
Amenorrhea
absence of menstruation caused by pregnancy.
Hypermenorrhea
abnormally heavy bleeding during menstruation.
Breech delivery position
Knees to chest
Placentia Abruptio
-placenta separates from the inner wall of the uterus before birth.
-Deprives the baby of oxygen and nutrients and cause heavy bleeding in the mother.
-Trauma caused.
-pain, discomfort, tenderness and abdominal back pain.
Ovarian cyst
pelvic pain, sex pain, urinary pain.
Therapeutic abortion
abortion to save mom.
Ectopic pregnancy
-stay in the fallopian tube and doesn’t move to uterus.
-light vaginal bleeding, pelvic pain, shoulder pain
Stages of delivery
1st: labor until dilation
2nd: dilation until birth
3rd: birth until placenta delivery
Fetal circulation
-foramen ovale and ductus arteriosus close after birth.
-Unoxygenated blood through (2) two umbilical arteries to placenta
-Oxygenated blood through (1) one umbilical vein to right side of heart.
Foramen Ovale
hole between right and left atria
-moves blood to left side and left ventricle contracts to send oxygenated blood to system
Fetal systemic blood
returns to the right side of heart
Ductus Arteriosus
ejects blood to lower extremities which leaves through umbilical arteries to placenta to re-oxygenate.
Hyperemesis Gravidarum
excessive nausea and vomiting during pregnancy
-can result in Mallory Weiss syndrome.
Mallory Weiss Syndrome
a tear or laceration of the mucous membrane, most commonly at the point where the esophagus and the stomach meet (gastroesophageal junction).
-Such a tear may result in severe bleeding from the gastrointestinal tract.
-The immediate cause of the lesion is usually a protracted period of vomiting.
Braxton Hicks
Pre-labor contractions, irregular, change with position. Do not get closer together.
Newborn Responsiveness
warm, dry, stimulate
-flick soles of their feet.
Postpartum hemorrhage control
fundal massage
Apneic Neonate
stimulate THEN ventilate
Prolapsed cord
Place the mother in the knee-chest position,
Elevate Mother’s hips,
If possible, place stretcher in Trendelenburg position.
Oxytocin
post delivery of placenta (3rd stage of birth)
-IV: 10gtts/mL in 1000mL lactated ringer
Preeclampsia
hypertension, blurred vision, ALOC, SOB, nausea.
Chest compressions on pregnant female
displace fetus to left to relieve pressure on vena cava
Supine Hypertension Syndrome
inferior vena cava compression due to prego laying supine
Shoulder dystocia
when a baby’s shoulder gets caught above the mother’s public bone during birth.
-baby’s head emerges and then pulls back in against the area between vagina and rectum.
Tension Pneumothorax
JVD
-tracheal deviation
-ventricular dysrhythmias
Hemopneumothorax
caused by a trauma (blunt/penetrating) injury to the chest.
-blood, air, or both can enter the thin fluid-filled space surrounding the lungs, which is called the pleural space.
Hemothorax
blunt trauma injuries.
-flat neck veins
-hyporesonance
-rapid transport due to uncontrolled bleed
Simple Pneumothorax
penetrating trauma to the chest.
-hyperresonance
Spontaneous pneumothorax
the sudden onset of a collapsed lung without any apparent cause, such as a traumatic injury to the chest or a known lung disease.
-A collapsed lung is caused by the collection of air in the space around the lungs
Pelvic Inflammatory Disease
occurs when a sexually transmitted bacteria spreads from the vagina to the womb (uterus), fallopian tubes, or ovaries.
S/S:
-pelvic pain (lower abdomen)
-fever
-bleeding between periods and after sex
-pain during sex
-unusual vaginal discharge, especially if it’s yellow, green or smelly.
Peritonitis
Life threatening infection
inflammation of the lining of your belly/abdomen
tenderness, fever and reduced urine.
don’t like to sit up due to too much pain.
ACS - Aspirin dosage
160 - 325mg
Zofran contraindication
prolonged QT intervals
-less than 1 month old.
-pregnant patients, may cause damage to fetus.
Murphy’s Sign
Gall Bladder (RUQ) pain (Cholecystitis)
pain upon inspiration during palpation of the border of the liver directly below the rib cage.
cholecystitis radiating right shoulder pain
Kehr’s sign
Steve Kerr from the left.
radiating left shoulder pain.
ruptured spleen
Positive Dunphy’s sign
bowel rupture, appendicitis
sharp pain in the RLQ elicited by a voluntary cough
diverticulum, pain with coughing to RLQ
McBurney’s sign
RLQ pain in cases of acute APPENDICITIS.
Assessing for the McBurney’s sign involves palpation of the point that is one-third the distance from the anterior superior iliac spine to the umbilicus. Tenderness at this point is a positive sign of appendicitis
Acute appendicitis is characterized by the inflammation, infection, or swelling of the appendix.
Ascities
excessive abdominal fluid
cirrosis
liver
Huntington’s disease
a rare, inherited disease that causes the progressive breakdown (degeneration) of nerve cells in the brain.
Huntington’s disease has a wide impact on a person’s functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders
Subdural hematoma
5% of all head injuries, increased ICP
venous bleeding
fluctuating consciousness
hemiparesis
slurred speech
Epidural hematoma
1-5% of all head injuries
unequal pupils
Cushing’s triad
ICP - WIRB
signs that are indicative of increased cranial pressure (ICP)
Widening pulse pressure (hypertension)
IRregular respirations
Bradycardia
Subarachnoid hemorrhage/hematoma
sudden severe headache, decreased LOC
Brown-Sequard syndrome (BSS)
a rare neurological condition characterized by a lesion in the spinal cord which results in:
-weakness or paralysis on one side of the body
-loss of sensation on the opposite side.
Complete spinal cord injury
Incomplete spinal cord injury
Cauda Equina Syndrome
Anterior cord syndrome
Posterior cord syndrome
extension injuries, very rare
Central cord syndrome
greater loss of function in upper extremities than lower extremities
Addison’s Disease
LOW cortisol and LOW aldosterone
bronze color, HYPOtensive, fatigue, dehydration, peaked T-waves,
HYPOglycemia, salt cravings.
Cushing’s disease
HIGH cortisol and HIGH aldosterone
Increased ADH, increased sugar
- s/s: moonface, overweight, humpback.
Grave’s disease
HIGH Thyroid, autoimmune disorder
Addisonian Crisis
a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium.
treatment = corticosteroids
Hashimoto’s disease
Autoimmune disorder that causes your thyroid to not make enough thyroid hormone.
LOW thyroid
- bradycardia, brittle nails, enlarged
tongue, flushed puffy face (Moonface)
Histamine release
vasodilator, causes capillary permeability and constricts muscles in the lungs, making it hard to breath.
-produces antibodies that “attack” the allergen which can cause wheezing, itching, runny nose, watery or itchy eyes, and other symptoms.
Cheyne-stokes
a rare abnormal breathing pattern. View Source that can occur while awake but usually occurs during sleep.
The pattern involves a period of fast, shallow breathing followed by slow, heavier (deep) breathing and moments without any breath at all, called apneas.
-patients with trauma, tumors, heart failure or sunstable central respiratory control.
Ataxic respirations
an irregular breathing pattern w/irregular pauses and increasing periods of apnea.
trauma, stroke
damage to the medulla oblongata
As the breathing pattern deteriorates, it merges with agonal respiration.
Tachypnea
above 20 respirations/min
pain, anxiety
PE, pneumothorax (start)
Bradypnea
less than 12 respirations
respiratory depression
Agonal respirations
gasping, pt in arrest.
Kussmaul respirations
an abnormal breathing pattern characterized by deep, rapid breathing at a consistent pace.
-DKA
Beck’s triad
JMN
- JVD - Muffled/Distant Heart Tones - Narrowed Pulse Pressure (Hypotension) - tension pneumothorax
Other s/s: Cold, pale, mottled, cyanotic skin
Tachycardia, weak or absent peripheral pulses
Pulses paradoxus (change in pulses with deep respirations)
ECG may show Electrical Alternans
1st line medication for wide complex tachycardia.
Procainamide
Sodium Channel Blocker
Class 1A
CHF with the presence of pulmonary edema
Furosemide - 40mg
Cullen’s sign
Belly button bruising, pain.
acute hemorrhagic PANNICULITIS.
Periumbilical bluish discoloration that is not related to cyanosis is a positive sign of retroperitoneal hemorrhage.
Grey-Turner sign
Flank bruising, pain.
discoloration of the left flank associated with acute hemorrhagic PANCREATITIS.
A bluish discoloration to the unilateral flanks that is not related to cyanosis is likely to indicate the presence of intra-abdominal hemorrhage.
Wernicke’s encephalopathy
a degenerative brain disorder caused by the lack of vitamin B1. It may result from: Alcohol abuse. Dietary deficiencies. Prolonged vomiting.
Confusion and loss of mental activity that can progress to coma and death.
Loss of muscle coordination (ataxia) that can cause leg tremor.
Vision changes such as abnormal eye movements (back and forth movements called nystagmus), double vision, eyelid drooping.
Hering-Breuer
is what keeps the lungs from over-inflating with inspired air.
The neural circuit that controls the Hering–Breuer inflation reflex involves several regions of the central nervous system, and both sensory and motor components of the vagus nerve.
Myxedema Coma
severe HYPOthyroidism and a general slowing of the metabolism.
-weakness or lethargy, low body temperature, swelling of the body (especially the face, tongue, and lower legs)
-WEIGHT GAIN, HYPOthermia and cold intolerance.
What EKG waveform is affected by right ventricular hypertrophy?
QRS complex
Examples of nerve agents that cause immediate onset of symptoms when exposed? (4)
Tabun, Sarin, VX and Soman are nerve agents.
START triage
a 60 second Simple Triage and Rapid Transport method with 4 assessment parameters.
- ability to walk
- respiratory effort
- perfusion status
- mental status
GREEN (Minor) - pts able to walk to a collection area on their own.
YELLOW (Delayed) - pts unable to walk but have normal respirations (10 - 30 breaths/min), cap refill < 2 secs/pulse < 100) and can follow simple commands.
RED (Immediate) - If any category falls outside these parameters.
BLACK (deceased/unsalvageable) pts that have no pulse, not breathing and unresponsive.
What are the categories of blast injuries?
Primary injuries result from the pressure wave of the blast wave, ruptures hollow organs and tympanic membranes.
Secondary injuries result from two sources: fragmentation and shrapnel.
Tertiary injuries result from the objects the patient is thrown into by the blast wave.
Quaternary injuries result from the inhalation of superheated gasses from the detonation.
Quinary injuries result from long-term damage from biologic or radiologic materials involved in a blast such as that from a dirty bomb.
4 types of fire extinguishers
Type A - ordinary combustibles only
Type B - effective for flammable liquids, such as gasoline, and would likely extinguish the ordinary combustible material.
Type C - best suited for energized electrical equipment fires
ABC All Purpose - effective for suppressing ordinary combustibles, flammable liquids, and energized electrical components.
Hyponatremia
the sodium level in the blood is below normal. (135-145mEq/L).
Addision’s disease
Renal disease
SIADH
Pediatric dose for amiodarone
5mg/kg
Hemoperitoneum
collection of blood in the abdominal cavity from a solid organ or vascular injury.
-could lead to traumatic shock
Contracoup
-a brain injury
a contusion resulting from the brain contacting the skull on the side opposite from where impact occurs.
french term meaning counterblow
A 14yo with normal vitals with a HR of 150, what is the concern?
a. addisonian crisis
b. brain injury
c. cocaine toxicity
Coup
refers to the brain damage that occurs directly under the point of impact.
Biot respirations
an irregular breathing pattern with sudden periods of apnea.
ataxic respirations
commonly with ICP
closed trauma or hemorrhagic stroke
Sympathomimetic drugs
increase heart rate and myocardial oxygen demand and consumption.
epinephrine, norepinephrine
pts with hypoxemia/ACS = could result in cardiac dysrhythmias.
Thrombocytopenia
a condition in which you have a low blood platelet count.
platelets (thrombocytes) are colorless blood cells that help clot blood to stop bleeding
Nitroglycerin
relaxes the blood vessels by increasing the supply of blood and oxygen to the heart while reducing its work load.
-VASODILATOR
-REDUCES Preload and Afterload
WILL LOWER BLOOD PRESSURE
- By 20 - 30pts -
By diminishing preload, nitroglycerin decreases left ventricular end diastolic volume and pressure and myocardial wall tension, thus reducing myocardial oxygen consumption. These changes favor redistribution of coronary blood flow to the subendocardium, which is more vulnerable to ischemia.
Multiple Sclerosis
an autoimmune disorder in which the immune system recognizes the protein that makes up the myelin sheath-the protective insulation that coats the axons of most nerve cells (neurons) -as being foreign and creates antibodies, that destroy it.
-This leads to areas of scarring that produce
symptoms such as:
- muscle weakness
- impairment of pain
- temperature
- and touch senses, pain (moderate-
severe)
- ataxia
- tremors
- speech disturbances
Fibrinolytic Agents
alteplase (activase),
streptokinase (streptase)
tenecteplase (TNKase)
Beta Blockers
suppress the sympathetic nervous system which reduces the heart rate and myocardial contractility.
Propranolol (Inderal)
Metoprolol (Lopressor)
Atenolol (Tenormin)
Labetalol (Normodyne)
Laryngeal spasm
the spasmodic closure of the vocal cords
- often caused by an overly aggressive
intubation technique.
Brown-Séquard syndrome
caused by partial transection (hemitransection) of the spinal cord,
typically from intervertebral disk rupture or an unstable vertebral fragment that puts pressure on the spinal cord.
- weakness of the upper and lower extremities on the ipsilateral side - loss of pain and temperature sensation on the contralateral side.
treatment for Dystonia
Benadryl - Diphenhydramine
Dystonia
Involuntary muscle contractions that cause repetitive or twisting movements.
Dystonia may affect one or more parts of the body, and sometimes the entire body.
The main symptom is involuntary muscle contractions that result in slow repetitive movements, cramps, or abnormal posture.
Cystic Fibrosis
An inherited life-threatening disorder that damages the lungs and digestive system.
it affects the cells that produce mucus, sweat, and digestive juices which causes fluids to become thick and sticky. They then plug up tubes, ducts, and passageways.
S/S:
- cough, repeated lung infections, inability
to gain weight, and fatty stool
Boyle’s Law
the volume of gas increases as the pressure decreases.
Volume/Pressure
Charles Law
the volume of gas increases as the temperature increases.
Volume/Temperature
RCA
Posterior wall of LV
II, III, aVF
LCx
Lateral wall of the LV
I, aVL, V5, V6
LAD
Septum
V1, V2
LAD (b)
Anterior wall of the LV
How to determine axis deviation?
leads I and aVF
Calcium Channel Blockers
RELAXES smooth muscles to provide VASODILATION as well as reducing heart rate (⬇️HR) and stroke volume (⬇️SV) of the heart.
DILTIAZAM (or Cardizem)
VERAPAMIL
NICARDIPINE
Sodium Channel Blockers
IMPAIRS CONDUCTION of sodium ions through sodium channels used in the treatment of cardiac dysrhythmias.
They do not effectively block the sympathetic stimulation of the beta-cells that work on the SA node
An example of this type of agent is LIDOCAINE.
Andenocard - pediatric dosage
01mg/kg rapid IV/IO
pediatric weight measurement
(age x 2) + 8 = approx weight in kg.
A febrile seizure would MOST likely occur in a child:
a. Who is less than 8 yrs of age
b. With a fever that acutely spikes
c. With nuchal rigidity and a headache.
d. With a temperature of 101 degrees, F
b. With a fever that acutely spikes.
A febrile seizure would MOST likely occur in a child:
A) who is less than 8 years of age.
B) with a fever that acutely spikes.
C) with nuchal rigidity and a headache.
D) with a temperature greater than 101° F.
B) with a fever that acutely spikes.
You would expect to encounter trismus with which of the following conditions?
A) Tetanus
B) Rabies
C) Mumps
D) Meningitis
A) Tetanus
What are the components of the “trauma lethal triad”?
Select the three answer options which are correct.
a. Coagulopathy
b. Hypothermia
c. Acidosis
d. Hypoxia
a. Coagulopathy
b. Hypothermia
c. Acidosis
Muscle contracts with more force when stretched. This is most commonly associated with what law?
A. Biot’s law
B. Fudd’s First Law of Oppostion
C. Murphy’s law
D. Starling’s law
D. Starling’s law
Bronchiolitis?
A viral infection caused by RSV that affects children between 6 and 18 months old
Bronchiolitis is a viral infection of the lower airways that occurs primarily in infants under the age of 18 months. It is characterized by expiratory wheezing, respiratory distress, inflammation, and obstruction at the level of the bronchioles.
Hemoptysis
coughing up blood
You have just received a subpoena for a patient that you treated 2 years ago. You documented “the patient was obviously drunk on arrival.” Subsequently the patient was diagnosed with hypoglycemia. Your documentation should be considered which of the following?
a. Assault
b. Libel
c. Slander
d. Negligent
B. Libel (written statement)
During which phase of the cardiac cycle do the coronary arteries receive blood flow?
a. Systole
b. Diastole
c. Repolarization
d. Depolarization
b. Diastole
Which of the following beta blockers would be most appropriate for the treatment of paroxysmal supraventricular tachycardia?
a. Propranolol
b. Metoprolol
c. Adenosine
d. Verapamil
b. Metoprolol
Which of the following is true regarding atrial flutter?
a. The atrial rate will be between 250 and 360
b. P waves are still present
c. PR intervals are shorter
d. The ventricular rate will be between 100-200
a. The atrial rate will be between 250 and 360
Which of the following conditions is most likely to cause a decrease in spontaneous respiration?
a. Aspirin poisoning
b. Metabolic acidosis
c. Metabolic alkalosis
d. Hypoxemia
c. Metabolic alkalosis
-Metabolic alkalosis results in a decrease in the rate and depth of a patient's spontaneous respiration. -The body decreases respiration in an attempt to correct the carbon dioxide levels and pH of the patient's blood.
Your 22-year-old patient is suspected of experiencing tricyclic antidepressant toxicity after beginning a new prescription ordered by her physician. Her current GCS is 8, and she is experiencing hypotension with tachycardia. Her heart rate is 138, showing a widened ORS complex.
Per MCP, which of the following may be effective in helping this patient reverse the toxic cardiac effects she is experiencing?
a. Calcium chloride
b. Sodium bicarbonate
c. Potassium
d. Sodium
b. Sodium bicarbonate
Orthopnea
is the sensation of breathlessness in the recumbent position, relieved by sitting or standing.
PND
Paroxysmal nocturnal dyspnea - is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.
- caused by the failure of the left ventricle. - it is unable to pump as much blood as the right ventricle, which is functioning normally. - As a result, you experience pulmonary congestion, fluid fills the lungs.
Pancreatitis
when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.
The most common causes are alcohol abuse and lumps of solid material (gallstones) in the gallbladder.
Diverticultis
when small, bulging pouches (diverticula) develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.
Diverticula are small, bulging pouches that can form in the lining of your digestive system.
Pain, which may be constant and persist for several days.
S/S:
- The lower left side of the abdomen is
the usual site of the pain.
- Nausea and vomiting. - Fever. - Abdominal tenderness. - Constipation or, less commonly, diarrhea.
Cerebral Contusions
are scattered areas of bleeding on the surface of the brain, most commonly along the undersurface and poles of the frontal and temporal lobes.
They occur when the brain strikes a ridge on the skull or a fold in the dura mater, the brain’s tough outer covering.
Cerebral Concussion
is a traumatic brain injury that affects your brain function. Usually caused by a blow to the head.
- headaches - problems with concentration, memory balance and coordination. - Nausea or vomiting. - Balance problems or dizziness - double or blurry vision. - Bothered by light or noise.
Subdural Hematoma
Concave/Crescent-shaped
bridging veins
elderly/alcoholics
suB = Banana (shaped)
Epidural Hematoma
Convex/Lens shaped
middle meningeal artery
lucid interval (AMS)
Epi = Pie = Lemon (shaped)
Determining the electrical axis on a 12-lead
ECG can be accomplished using the ORS direction of which two leads?
Select the two answer options which are correct.
a. V1
b. aVL
c. aVF
d. Lead I
c. aVF
d. Lead I
A fast and easy way to determine the electrical axis is to use the direction of the QRS complex in leads I and aVF.
These two leads are used because they are the only perfectly horizontal and vertical leads, respectively.
Pulmonary Embolus
A condition in which one or more arteries in the lungs become blocked by a blood clot.
Most times, a pulmonary embolism is caused by blood clots that travel from the legs or, rarely, other parts of the body (deep vein thrombosis) DVT
S/S: dyspnea, cough, hemoptysis, pain, hypotension, diaphoresis, tachypnea, tachycardia, fever, and JVD, as well as many other signs and symptoms depending on the area and size of the pulmonary embolus.
Pts with a history of a recent pelvic/lower limb fracture or surgery, recent prolonged travel or immobility, as well as other conditions point to the probability of an embolus.
Which of the following conditions is most likely to prevent the sinoatrial node from initiating an electrical impulse needed to begin myocardial depolarization?
a. Hypovolemia
b. Hypercapnia
c. Hypoxia
d. Hyperthyroidism
c. Hypoxia
Which type of cardiac cells sends electrical impulses from the atria to the AV node?
a. Internodal tracts
b. Interatrial tracts
c. Bundle of His
d. Purkinje fibers
a. Internodal tracts
Electrical impulse through the heart, start to finish.
SA node
InterATRIAL tracts (SA node through the atria).
InterNODAL tracts (Atrial tissue to the AV node).
AV node
Bundle of His
Purkinje fibers innervate the ventricular walls.
Which of the following rhythms requires cardioversion for treatment?
a. Junctional rhythm
b. Junctional bradycardia
c. Junctional tachycardia
d. Accelerated junctional rhythm
c. Junctional tachycardia
Which of the following rhythms requires pacing for treatment?
a Junctional rhythm
b. Junctional bradycardia
c. Junctional tachycardia
d. Accelerated junctional rhythm
b. Junctional bradycardia
Your adult chronic hypertension patient calls for help after developing a sudden-onset headache that he describes as “the worst headache he has ever experienced.” You note nausea, vomiting, and a steady decrease in mental status when he begins to experience a tonic-clonic seizure.
Which of the following should you suspect until proven otherwise?
a. Drug overdose
b. Hemorrhagic stroke
c. Ischemic stroke
d. Transient ischemic attack
b. Hemorrhagic stroke
Hemorrhagic stroke
present with sudden-onset symptoms that include a crushing headache often described as the worst they have ever experienced.
As the intracranial pressure begins to increase, the patient often experiences rapid-onset nausea, vomiting, and decreases in mental status.
As the pressure increases, the patient may experience seizure activity before becoming comatose, increasingly hypertensive despite the blood loss, bradycardia, and diminished respiratory effort.
Ischemic stroke
Present with one-sided weakness and paralysis first.
The key finding in ischemic stroke is unilateral symptoms with weakness and facial droop.
Lower GI bleeding
bright red blood bleeding from large intestine (Colon)
constipation, hemorrhoids, cancer
Esophageal Varices
abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus).
bleeding esophageal varices include vomiting blood, tar-like or bloody stools, and, in severe cases, shock.
Pancreatitis
when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.
causes:
- gallstones
- chronic, heavy alcohol use.
Crohn’s disease
a type of inflammatory bowel disease (IBD).
It causes swelling of the tissues (inflammation) in your digestive tract
- can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.
Thoracentesis
removal of fluid in the space outside of the lungs (pleura space) and the wall of the chest.
Thoracic Decompression
Needle decompression
Child’s weight to kg measurement
age x 2 + 8
ex) 4yr old = 4 x 2 = 8 + 8 = 16kg
Adenosine pediatric dosage for SVT
0.1mg/kg - max initial dose = 6mg
0.2mg/kg - max 2nd dose = 12mg
What does a high level of TSH in the blood indicate?
a. Graves disease
b. Cushing’s syndrome
c. elevated T3/T4 levels
d. Hypothyroidism
d. Hypothyroidism
high TSH = Low thyroid
What does a low level of TSH in the blood indicate?
Hyperthyroidism
Low TSH = High thyroid
By which of the following mechanisms does atropine sulfate exerts its therapeutic effect?
A) Opposes the vagus nerve
B) Stimulates alpha receptors
C) Blocks sympathetic activity
D) Increases cardiac contractility
A) Opposes the vagus nerve
- Atropine sulfate is a parasympathetic blocker (parasympatholytic, vagolytic). - It’s used to increase HR by opposing the vagus nerve when excessive parasympathetic (vagal) tone causes symptomatic bradycardia.
Crackles
(formerly called rales), which are fine, moist, thin sounds that are difficult to auscultate, represent FLUID IN SMALL LOWER AIRWAYS.
- indicative of early pulmonary edema (ie, heart failure).
Rhonchi
Loud rattling sounds that can often be heard without a stethoscope and are indicative of FLUID IN THE LARGER AIRWAYS (ie, severe pulmonary edema).
Aspirin Dosage
ACS/Chest Pain
81mg/tablet (Oral) chew up
proper dosage = 324mg (3pills)
Nitroglycerin Dosage
0.4mg
Sublingual (SL) every 3-5min
Check EKG, BP & no ED meds in last 48ghrs
IV route (Drip)
= 2 large bore IV’s
- 10mcg/min - 50mcg/min
Epinephrine
VASOCONSTRICTOR
1:10,000 Cardiac Epi
- 1mg IV/IO every 3-5min
1:1,000 IM Epi
- 0.3mg IM
Pediatric Dosage
- 0.01mg/kg
NorEpinephrine
Indicated for Septic Shock, Hypotension and post-Resus (ROSC)
Contraindications:
- Allergy and do not give if Tachy or
HIGH BP - hypertension
Vasopressor Agonist - Alpha 1 and Beta 1
Last line defense drug
- 1 to 30mcg/min via Pump
Levophed
- Leave em fed or leave them dead…
VASOCONSTRICTOR, strongest drug in box
Dopamine
INTROPIN - brand name
Sympathetic Agonist, Chatecholamine
- acts on Alpha 1/Beta 1 and Dopamine 1
(D1) and Dopamine 2 (D2)
Not a pushed drug but a drip drug
Indicated for severe HYPOtension due to Cardiogenic Shock.
3 dosages (Low, Medium and High)
a. High Dose = Vasoconstriction
- Alpha 1 and increased BP
b. Medium Dose = Increased HR, Beta 1
c. Low Dose = D1 or D2 receptor
- increased blood flow to the kidneys and
intestines.
Bradycardia - if Atropine doesn’t work USE
Dopamine
DO NOT USE for HYPOVOLEMIC Shock
- WIll not solve a Volume issue
Dopamine dosage
Low: (D1/D2) = 2-5mcg/kg/min
Medium: (Beta 1) = 5-10mcg/kg/min
High: (Alpha 1) = 10-20mcg/kg/min
Pediatric dosage: 2-20mcg/kg/min
Amiodarone
Cordarone
Anti-Dysrhythmic drug
- Sodium, Potassium and Calcium channel
blocker.
- Decrease HR
Indications:
- V-Tach, V-Fib
- Wide Complex Rapid Tachycardia
Fibrinogen
forms a substance that holds a clot together and helps achieve hemostasis.
Hypoxia
Cyanosis
Pallor
primary skin sign of shock
Grey/Mottled skin
poor cardiac function
Internal respiration
the exchange of O2 and CO2 (Gases) with the cells and blood.
External Respiration
the exchange of gases between the alveoli of the lungs and the blood.
the transfer of O2 and carbon dioxide between the inspired air and the pulmonary capillaries.
Respiration
the process of gas exchange of O2 and CO2 in the lungs.
Ventilation
the mechanical moving of air in and out of the lungs.
Lidocaine
Xylocaine
ANTI-ARRYTHMIC
- stop ventricular ectopy
- Sodium Channel Blocker
- slow impulse of electrical conduction
Indications:
- V-Tach and V-Fib
Dosage: 1mg/kg IV/IO
Atropine
Anti-Cholinergic drug
- Blocks Acetylcholine (Parasympathetic)
= Sympathetic response
Indications: Bradycardia, Nerve agent
exposure and
organophosphate poisoning
Dosage: Bradycardia
- 0.5-1mg/kg. IV/IO every 3-5min
Nerve Agent/Organophosphate
poisoning
- 2mg, 4mg, 8mg
every 5min until desired effect
Adenosine
Adenocard - a chemical cardioversion
MOA: Acts on SA node/AV node
reduces electrical conduction
“Re-Sets the Heart”
Indications: SVT/Rapid Tachycardias
Causes faint, dizziness, anxiety and impending doom
Dosage:
- 6mg IV/IO
12mg IV/IO
Pediatric Dose:
- 0.1mg/kg (max 6mg)
- 0.2mg/kg (max 12mg)
Metoprolol
Lopressor
BetaBlocker,
- blocks beta receptors in body
- decrease HR
Indications:
- Rapid Tachycardias
- A-Fib, A-Flutter
- SVT
Dosage:
- 5mg IV/IO every 5min
- (up to 15mg until effect)
Diltiazem
Cardizem
Calcium Channel Blocker
Lowers BP & Lowers HR
Indications:
- Rapid Tachycardias
- A-Fib/A-Flutter
Dosage:
- 0.25mg/kg IV/IO
- max of 15mg IV/IO
Nitroglycerin
Vasodilator - reduces preload and afterload
to improve cardiac output.
relaxes the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen.
Which of the following conditions can cause crackles in lung sounds but should not be given a diuretic?
Select the two answer options which are correct.
a. Asthma
b. Pneumonia
c. Left ventricular failure
d. Acute renal failure
a. Ashthma
b. Pneumonia
-Giving diuretics to patients with pneumonia or asthma may worsen their overall condition by dehydrating them.
What are some complications of CPAP administration?
Select the three answer options which are correct.
a. Claustrophobia
b. Hypotension
c. Bradycardia
d. Gastric distension
a. Claustrophobia
b. Hypotension
d. Gastric Distension
-CPAP may also increase intrathoracic pressure which reduces preload available to the heart, resulting in Hypotension.
Myocardial Contusions
Blunt trauma
-causes Auscultation of crackles in
lungs.
-ECG changes
Cardiac Tamponade
Penetrating Trauma, causes:
-Muffled Heart tones
- Electrical Alternans
All of the following are recommended treatments for atrial flutter except:
a. Adenosine
b. Carotid Massage
c. Defibrillation
d. Cardioversion
c. Defibrillation
Cardioversion, adenosine, and carotid massage are all treatments for atrial flutter. Defibrillation is a treatment for ventricular fibrillation or ventricular tachycardia.
All of the following are recommended treatments for atrial flutter except:
a. Adenosine
b. Carotid Massage
c. Defibrillation
d. Cardioversion
c. Defibrillation
Cardioversion, adenosine, and carotid massage are all treatments for atrial flutter. Defibrillation is a treatment for ventricular fibrillation or ventricular tachycardia.
You are ordered to administer 3 mg/min of lidocaine via intravenous infusion to your cardiac patient who presents with symptomatic tachycardia and multifocal PVCs.
Which of the following drip rates would effectively deliver the ordered dose of lidocaine using micro drip tubing and a pre-mixed bag with a drug concentration of 4 mg per mL?
a. 45 gtts/min
b. 60 gtts/min
c. 30 gtts/min
d. 15 gtts/min
a 45 gtts/min
Normal pediatric respiratory rates:
Neonates
Infants
Toddler
Preschooler
School-aged
Adolescent
Neonates (first 28 days of life): 30–60
Infant (one month to 1 year): 30–53
Toddler (1 to 2 years): 22–37
Preschooler (3 to 5 years): 20–28
School-aged child (6 to 12 years): 18–20
Adolescent (12 to 15 years): 1–20
Inferior MI
occlusion of the RCA
Posterior MI
occlusion of the Circumflex
Anterior MI
occlusion of the LAD
