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A-Para 2 Final > NREMT > Flashcards

NREMT Flashcards

1
Q

Alpha -1 has what effect?

A

Vasoconstriction of arteries and veins

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2
Q

Alpha - 2 effect ?

A

Inhibits norepinephrine release, Inhibits insulin release, stimulates glucagon secretions, and inhibits my lipolysis

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3
Q

Beta one effect?

A

Increases heart rate – positive call real trophy, increase his cardiac contractility, increases myocardial conduction, and increases renin production to retain your

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4
Q

Beta 2 effect?

A

Smooth muscle relaxer that causes bronchodilation and stimulates glycogenolysis insulin secretion

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5
Q

Lemon pneumonic

A 
L Look externally
E Evaluate 3-3-2
M MALLAMPATI
O Obstructions
N Neck mobility
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6
Q

Normal RR

Adult
Child
Infant

A

12 - 20
15-30
25-30

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7
Q

Cheyenne stokes respirations

A

Periodic breathing with cycles of increasing rate and depth of breathing followed by gradual decrease in depth and Rate breathing in between periods of apnea that can last up to 60 seconds

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8
Q

KUSSMAUL respirations

A

Continuous deep sign breast with a rapid rate usually greater than 40 when the body is responding to metabolicAcidosis

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9
Q

Normal ETC02 values range between one what and what?

A

35 and 45

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10
Q

Loud high-pitched crackling

A

Rails

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11
Q

Low pitched crackles found in the lower airway is made clear with a cough

A

RONCHI

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12
Q

Pericardium

A

Fibrous sac that protects the heart from other structures of the chest and contains lubricating fluid to reduce friction

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13
Q

Three layers of the muscular walls of the heart

A

Epicardium outer most layer
Myocardium contractile muscle
Endocardium layer that lines the inside of the heart and protect muscle tissue from the friction of the blood flowing

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14
Q

Stroke volume range

A

60 to 100

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15
Q

Frank’s darling principal

A

A property of cardiac muscle; as it gets stretched more, it contracts with greater force

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16
Q

Atherosclerosis

A

Narrowing of aorta cerebral and coronary blood vesselsBy way of fatty material deposited along the inner walls of the arteries

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17
Q

Axis deviation can be determined

A

BY looking at lead one and lead

aVF

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18
Q

Normal
Left axis
Right axis
Extreme right

A

Up and Up
Up and Down
Down and Up
Down and Down

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19
Q

Left bundle branch block and what leads

A

Leads one leaves AVF and lead V6

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20
Q

Right by the branch block

A

One, a avl , V5, and v6

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21
Q

TRhombus

A

Blood clot already formed in the near artery

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22
Q

Embolus

A

Blood clot formed elsewhere in the body can travel to Coronary artery

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23
Q

Natural effects in the respect to myocardial infarction

A

Natural dilates coronary arteries which in hopes will increase oxygen to ischemic areas… Will also significantly reduce preload because it dilates the Venus side of the vasculature

With all nitro in patient suspected of inferior myocardial infarction which includes leads two, three, and aVF

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24
Q

Vasopressor of choice during acute coronary syndrome

A

Dopamine we use dopamine because it maintains a renal bloodflow low doses while increasing myocardial contractility

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25
Q

Chest pain abdominal pain and back pain or off in the chief complaint for what aneurysm

A

Abdominal aortic aneurysm

Pulsating masses can also be found it

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26
Q

Drug of choice for hypertension

A

Labetalol because it has alpha and beta blocker effects. As an alpha blocker it relieves peripheral vasoconstriction, and it’s been a block in effect prevent the possibility of rebound tachycardia tell me a company or drop in blood pressure. The beta blockade also have negative inotropic affects

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27
Q

Beck triad

A

JVD hypotension and muffled heart tones

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28
Q

Biot’s respirations

A

Biot respirations can be described as a regular rate and depth of reading with periodic apnea

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29
Q

Shush Cheyenne stokes respirations

A

A gradual increase in respiration followed by a gradual decrease with apnea that the last of the 60 seconds

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30
Q

Cushing’s Triad

A

Ataxic respirations Low heart rate high blood pressure brainstem injury

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31
Q

Synchronize cardioversion for SVT in a flutter

A

50 to 100 J

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32
Q

Synchronize cardioversion for a fib

A

120 to 200 J

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33
Q

Synchronize cardioversion for unstable ventricular tachycardia with pulses

A

100 to 150 Jules

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34
Q

One cardiac cycle occurs every how many seconds

A

0.8

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35
Q

Stick fibrosis

A

Cystic fibrosis is a chronic disease primarily causing respiratory complications and deterioration. It predisposes patients to pneumonia and other components of respiratory failure as well.

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36
Q

Prior to puberty the hypothalamus restricts the production of this hormone

A

GRh

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37
Q

At the start of puberty the hypothalamus releases pulses of GRH which trigger the

A

Follicle-stimulating hormone and luteinizing hormone. These hormones trigger the production of other sex hormones that develop and maintain the reproductive system

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38
Q

The follicle stimulating hormone and luteinizing hormone secrete what hormones

A

Estrogen

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39
Q

The corpus luteum is secretes what

A

Progesterone

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40
Q

Four phases of the metro cycle

A

follicular phase,Ovulation, the luteal phase, Menstruation

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41
Q

Hypermenorrhea also known as menorrhagia is what

A

Abnormally or excessive heavy bleeding during a period

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42
Q

Polymenorrhea

A

Refers to a condition where a woman has a period more frequently than once every 24 days and is brought on by physical mental stress

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43
Q

Dysmenorrhea

A

Painful Menzies that can be so badass to interfere with their daily life

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44
Q

Metrorhagia

A

Spotting that occurs in between periods

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45
Q

Physiological changes in pregnant.

A

The heart increases in size to handle the polycythemia and increase circulating volume from 10% to 15%. Overall cardiac output increases by 40% kidneys increase in size but the 30%. Total volume and minute volume increase by as much as 50%. Blood volume increases by approximately 50%

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46
Q

A patient is suspected to be abusing recreational drugs. He currently presents with hypotension, cool and dry skin, respiratory depression, nausea, and diminishment in orientation. Vitals also are diminishing. What medication may be warranted?

Dextrose

Metoprolol

Narcan

Versed

A

Narcan

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47
Q

A 68-year-old male is displaying new onset, right-sided facial droop and an inability to move his left arm. When considering where to transport this patient, the most important factor to consider would be:

availability of a trauma surgeon.

closest location.

availability of a neurosurgeon.

availability of CAT scan.

A

CAT SCAN

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48
Q

You arrive on scene for a 70-year-old female sitting on the toilet. She has experienced pain in her upper abdomen for the past two hours. As you help her to the ambulance cot, you note dark, tarry stools in the toilet. She states her abdomen hurts worse right after eating. She was recently diagnosed as anemic by her primary care physician. What is your field impression at this time?

Diverticulitis

Constipation

Gastric ulcer

Hemorrhoids

A

ULCER

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49
Q

The history of abdominal pain after eating (when stomach acid is high), dark tarry stools, and recent diagnosis of anemia is a sign of

A

gastric ulcer

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50
Q

Trousseau sign

A

which is a carpopedal spasm induced by ischaemia through inflation of a sphygmomanometer cuff to a suprasystolic blood pressure

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51
Q

A patient is suspected of having cirrhosis of the liver. Which one of the following conditions would the paramedic expect to find in a patient with end-stage liver disease?

A severely enlarged liver on palpation

Encephalopathy

Seizures

Nausea and vomiting

A

Encephalopathy

Early on, the liver becomes enlarged and signs of inflammation such as itching, pain, nausea, vomiting, and anorexia occur. As the disease progresses, bleeding tendencies and esophageal varices develop. End-stage disease is typically characterized by a buildup of toxins that leads to altered levels of consciousness, or encephalopathy.

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52
Q

Which of the following is most likely to indicate appendicitis?

Umbilical pain migrating to the RLQ

Pain radiating to the back

Vomiting

Diffuse pain in both lower abdominal quadrants

A

Abdominal complaints are always challenging to diagnose. Pain beginning at the umbilicus which migrates to the RLQ is most indicative of appendicitis (approximately 66% of patients report this pain pattern).

The other signs and symptoms may appear in other abdominal conditions.

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53
Q

You arrive on scene for a 70-year-old female sitting on the toilet. She experienced pain in her upper abdomen for the past two hours. You note dark, tarry stools in the toilet. She states her abdomen hurts worse right after eating. What is your field impression at this time?

Hemorrhoids

Diverticulitis

Gastric ulcer

Constipation

A

Gastric ulcer

The history of abdominal pain after eating (when stomach acid is high), dark tarry stools, and recent diagnosis of anemia are all consistent with a gastric ulcer.

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54
Q

A 78 year old male had a sudden onset of a severe headache and associated neurological dysfunction, dysphasia, and motor ataxia. He tells you the headache is progressively worsening. Based on this information, what is the likely cause?

Hemorrhagic stroke

Embolic stroke

Thrombotic stroke

Intracerebral tumor

A

There are usually three mechanisms behind the precipitation of a stroke. A hemorrhagic stroke usually is abrupt at onset, and rapidly progresses as blood continues to spill into the cranial vault. An embolic stroke happens suddenly, with significant findings, but usually does not progress much further, because there is a specific amount of brain tissue affected by the cessation of blood flow. Thrombotic strokes and cerebral tumors have a slower onset (possibly over days, months, and even years) as the thrombus (tumor) continues to expand in the brain. Although all these conditions may present with a headache, the progression of the syndrome is key to forming an accurate diagnosis.

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55
Q

Visceral pain

A

Visceral pain originates in the body’s organs. Often this pain is described very generally as dull, heavy, oppressive, or as pressure or ache.

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56
Q

Pleuritic Pain

A

Pleuritic pain is caused by inflammation of parietal pleura of the chest that is described as sharp, stabbing, or burning. The pain often radiates.

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57
Q

Somatic Pain

A

Somatic pain is similar to pleuritic pain and is described as sharp and originating from the skin, muscles, or bones.

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58
Q

Referred Pain

A

Referred pain is when the discomfort is perceived in other parts of the body.

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59
Q

Ascites

A

Excessive Swelling of the abdomen with fluid

Related to liver disease

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60
Q

OPQST

A

Onset, Provocation, Quality, Region-Radiation, Severity, and Time

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61
Q

SAMPLE

A

Signs/Symptoms, Allergies, Medications, Past Medical History, Last oral Intake, and Events leading up to the occurence.

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62
Q 
Trauma Criterion Step One
Physiological Criterion
Glascow
Systolic
Resp Rate
Vent Assistance
A

GCS less than or equal to 13
Systolic less than 90mmhg
Resp Rate less than 10 or more than 29
(Less than 20 if under 1 year old)

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63
Q

Trauma Criterion

Anatomic Criteria

A
  • open or depressed skull fractures
  • Penetrating chest would to head, neck, torso, extremities proximal to elbow or knee.
  • chest wall instability or deformity
  • amputation to wrist or ankle
  • crushed, degloved, mangled, or pulseless extremity.
  • pelvic fractures

-paralysis

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64
Q

Trauma MOI Criteria

A

Adult: Falls > 20ft
Children: Falls > 10ft or 2/3 times the height of the child
Intrusion, including roof: greater than 12 on occupants side; 18 on any other side.
Ejection
Death in the compartment
Auto vs pedestrian, run over, thrown, or significant impact.
Motorcycle crash > 20mph

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65
Q

Order of Trauma Assessment

IPAP

A

Inspect, Palpate, Auscultate, Percuss

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66
Q

.Glascow Coma Scale

A

Highest is 15
Eyes - 4
Verbal - 5
Motor - 6

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67
Q

Decorticate

A

elbows, wrists, and fingers, flexed, stiffened legs, and feet. OUTWARDLY

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68
Q

Decerebrate (worse)

A

stiffened and INTERNALLY rotated elbows, and legs, teeth clenched, legs stiff and feet extended.

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69
Q

Babinski Response

A

Big toe moves upward and other toes fan out when stroking bottom of foot, mean CNS Problem.

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70
Q

Term for Dialated Pupils

and Occurrences

A

Mydriasis

Cardiac Arrest, shock, cerebral hypoxia, cocaine, epi, amphetamines.

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71
Q

Term for Constricted Pupils

and Occurrences

A

Miosis

Narcotics, central nervous system disorder, glaucoma meds, bright light

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72
Q

Term for Unequal Pupils

and Occurrences

A

Brain injury, brain tumor, stroke, artificial eye, eye meds, or can be normal (called anisocoria)

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73
Q

Rapid eye movement term

A

Nystagmus

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74
Q

Rales/Crackles

A

Fluid in small airways-alveoli

Found in CHF, Pulmonary edema, drowning, pneumonia, COPD

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75
Q

Rhonchi

A

Mucus or fluid in the larger airways - Bronchioles

Found in Bronchitis, COPD, pnuemonia

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76
Q

Wheezing

A

Whistling sound due bronchoconstriction or marrowing of the terminal bronchioles due to edema ( swelling)

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77
Q

Vesicular

A

Soft, low pitch

heard in lung periphery

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78
Q

Apneustic Breathing

A

Long, deep breathes that are stopped during inspirations then periods of apnea.

found in CNS injury or stroke

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79
Q

Biots (ataxic)

A

Irregular periods of breathing or gasping with apnea

Usually due to increased ICP

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80
Q

Cheyne-Stokes

A

Increasing in rate and depth, decreasingg, in rate and depth with period of apnea

Neurological condition

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81
Q

Hyperressonant Percussion

A

Air - snare drum Hollow

tension pneumothorax, emphysema, asthma

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82
Q

Hyporessonant Percussion

A

Dull - Watery

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83
Q

Abdominal Quadrant Right Upper Quadrant (RUQ)

A

Liver
Gall Bladder
Stomach

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84
Q

Abdominal Quadrant Left Upper Quadrant (LUQ)

A

Liver
Spleen
Stomach
Pancreas

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85
Q

Abdominal Quadrant Right Lower Quadrant (RLQ)

A

Appendix
Right Ovary and FallTube
Bladder

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86
Q

Abdominal Quadrant Left Lower Quadrant (LLQ)

A

Left Ovary and Tube

Bladder

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87
Q

Visceral Pn

A

Internal organs damaged or injured
-vague not well organized, pressure-like, dull, aching, cant point to pAin, with one finger, stretches, ischemia, inflammation

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88
Q

Somatic Pain

A

irritation, of peritoneal lining, sharp, localized, throbbing, deep breathe increases pain

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89
Q

Referred Pain

A

discomfort perceived in other parts of the body such as cardiac pain referred to jaw or arm

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90
Q

Cullens Sign

A

Ecchymosis (bruising) around umbilicus

Bleeding in the abdominal cavity

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91
Q

Grey Turner Sign

A

Ecchymosis (bruising) in the flank

Bleeding from kidneys, hemorrhagic pancreatitis

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92
Q

Kehrs Sign

A

Referred pain to shoulder

Ectopic or spleen injury, blood under diaphragm

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93
Q

Murphys Sign

A

Right Upper quadrant pain

Cholecystitis (inflammation of the gall bladder gal stones)

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94
Q

Brudzinkis Sign

A

Hip flexes when neck is flexed

Meningeal irritation, meningitis

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95
Q

Hamman’s Sign

A

Crunching, rasping sound that correlates with heart beat. heard over mediastinum.

spontaneous mediastinal emphysema
tracheobronchial trauma

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96
Q

Hormans Sign

A

pain incalf on dorsiflexing foot while leg is straight

meningeal irritation, meningitis

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97
Q

Clubbing of the fingers sign

A

flattening of the nail angle; Sign of chronic hypoxia - COPD

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98
Q

Measure Blood Pressure Formula

A

Cardiac Output X Systemic Vascular Resistance

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99
Q

Pulse PRessure

A

Difference between systolic and diastolic

NARROWS in shock
WIDENS in increased ICP

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100
Q

Orthostatic Vital Signs

positive Tilt

A

Decrease in Systolic BP 20mm
Increase Diastolic BP 10mm
Increase Heart Rate HR of 200

suggests Hypovolemia - Dehyadration

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101
Q

MAP

A

Mean Arterial Pressure - average pressure in arteries during one cardiac cycle, considered good indicator of perfusion

normal between 70-100mmhg
ADD DIASTOLIC + 1/3 of PULSE PRESSURE (Systolic minus Diastolic)

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102
Q

Heart Rates for Peds

Adolescent (13-18)
School-Age (6-12)
Preschool (3-5)
Toddler (12-36 months)
Infant ( Birth to 1 year)
A

Adolescent (13-18) ……………….. 55-105
School-Age (6-12) …………………70-110
Preschool (3-5)……………………..80-120
Toddler (12-36 months)………………..80-130
Infant ( Birth to 1 year)………..100-160

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103
Q

Pediatric Assessment Triangle

A

APPEARANCE - muscle tone, speech/cry, eye contact
WORK OF BREATHING - airway sounds, positions
CIRCULATION OF SKIN - pallor, mottling, cyanosis

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104
Q

Fontanel

A

Two Fontanels (Holes in Skull)

Anterior closes 12-18 months
Posterior closes by 3 months

If found SUNKEN - dehydrated or shock
if found BULGING - Increased ICP

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105
Q

Cerebral Palsy

A

group of chronic disorders, damage motor centers in brain in children; abnormal muscle spasms, hearing and vision problems, seizures

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106
Q

BGL normal measures

A

70 - 140mg/dl

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107
Q

Why is it difficult to judge Sp02 with sickle sell PTS

A

Anemia/blood disorders have inherent hemogloban issues.

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108
Q

Osmosis

A

Fluid movement from an area of less concentration to an area of greater concentration

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109
Q

Isotonic

A

stays in hlood vessels longer, field fluid replacement

Normal Saline and Lactated Ringers

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110
Q

Hypertonic

A

more particles, fluid moves in vascular space,

10% Dextrose

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111
Q

Hypotonic

A

1/2 NS

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112
Q

5% Dextrose in Water

A

Not used for fluid replacement

MI, CHF, giving drugs, KVO

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113
Q 
Calcium
chloride
magnesium
potassium
sodium
A 
calcemia
chloremia
magnesemia
kalemia
natremia
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114
Q

Hematocrit

A

%of red blood cells in the whole body - approx 45%

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115
Q

White blood cells - Leukocytes

A

fight infection

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116
Q

Platelets/Thrombocytes

A

promote clotting

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117
Q

ABO bloodtyping

A

O negative Universal Donor

AB+ Universal Recipient

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118
Q

GTTS Formula

A 
   C
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119
Q

Fluid Challenge

Infusion Rate Over Time

A 
T
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120
Q

Blood Gases

pH
PCO2
PO2
BiCard
HCO3
A

pH - 7.35 - 7.45 (If high, acidosis - if low, alkalosis)
PCO2 - 35-45 (If high, acidosis - if low, alkalosis)
PO2 - 80-100 (if under 80, hypoxic)
BiCarb - 22-26
HCO3 - 22-26

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121
Q

What receptors located in this arch and this sinus sense changes in BP? once sensed what happens?

A

Baroreceptors located in the aortic arch and carotid sinus sense changes in BP send messages to cardio centers in medulla.

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122
Q

RE: Shock, Once changes in BP are sensed, messages sent to cardio centers in medulla. What hormone is secreted and from what gland and what happens?

A

Antidiuretic hormone from the pituitary - Increases Peripheral Vascular Resistance, retains water in kidneys.

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123
Q

RE: Shock… What is released by this organ to convert Angiotension 1 to angiotension 2?
What does AG2 do?

A

Renin is secreted by the kidneys

AG2 is a potent Vasoconstrictor

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124
Q

RE: Shock…Adrenal glands secrete what?

A

Epinepherine and norepiniephrine to increase SVR (maintains BP) and stimulates aldosterone which retains sodium and water in kidneys

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125
Q

Hypovolemia

Causes and Assessment Findings

A

Cause
Loss of blood or fluids

Findings
Increased HR
Increased Resp
Low BP
Pale or Cyanotic
Flat veins
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126
Q

Cardiogenic

A 
Cause
Myocardial Infarctions (paricularly Left Ventricular HF or other cardiac issue)

Findings
Increased or Decresead HR
Pulmonary edema
Pale or Cyanotic

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127
Q

Anaphylactic Shock

A

Causes
Allergic Reaction

Findings
Increased HR
Decreased BP
Angioedema (fluid leaking out and appearing like swelling)
wheezing, stridor, utercaria (hives)
Treatment
Airway, O2, BVM if needed
Beta2 Agonist - Epi/Diphenhydramine
0.3 epi 1:1000 IM
1mg/kg (MAX 50)
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128
Q

Neurogenic Shock

A

Causes
Spinal Injury - Sympathetic Nerve conduction interrupted

Findings
Decreased BP
Normal or Decreased HR
Vasodilation
hypothermia
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129
Q

Septic Shock

A

Overwhelming Infection

Decreased BP
High Temp/Fever
Vasodilation

Treatment
Airway, O2, fluids,
Dopamine - 5 - 20mcg/kg/min for hypotension or shock

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130
Q

Obstructive Shock

A

Causes

Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax

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131
Q

Controlled Substance Act

A

Schedule 1 no medicinal use
Heroin, Weed, LSD, Mescaline, Crack

Schedule 2 easily abusable
Cocaine, Morphine, Fentanyl, Methadone

132
Q

Things to remember with geriatrics per drog ingestion

A

Decreased liver/kidney/renal function can affect drug action/elimination.
Levels can be toxic

133
Q

Parasympathetic ANS

A 
chemical control 
acetylcholine
nervous control
vagus nerve
Organophosphate like effects (SLUDGE)
Salivation, Lacrimation, Urination, Defacations, Gastrointestinal Distress and Emesis

At Rest
Constricted Pupils
Flushed Skin (Vasodilation)
Dry Skin
Decreased HR, Decreased BP

Treatment
Atropine - 0.5 mg/kg Bradycardia

134
Q

Sympathetic ANS

A

Chemical control
Norepinipherine then later epi

Nervous Control
nerve roots in thoracic and upper lumbar area of spine

135
Q

Alpha Responses

Heart
Blood vESSELS
Bronchioles

A

Heart - No effect
Blood vESSELS - Constricts, Increased BP
Bronchioles - No response or slight bronchoconstriction

136
Q

Beta Responses

Heart
Blood vESSELS
Bronchioles

A 
Heart (B1) 
Increased HR (chronotropic)
Increased Contractility (Inotropic)
Increased Conductivity (Dromotropic)

Blood Vessels
Dilate, Decreased BP

Bronchioles (B2)
bRONCODILATION

137
Q

Drugs given IN (MAD)

A

Midazolam (Ativan), Naloxone (Narcan), Fentanyl, Lorazepam (Versed), Glucagon, max 1ml in each nostril

138
Q

Enteral

A

Drugs given via GI tract(orally, SL, NG tube, rectally;

139
Q

Parenteral

A

IV, IM, IN, SQ

140
Q

Adenosine/Adenocard

A

Class - Antidysrhythmic
MOA - slows conduction to the AV
Indications - SVT

141
Q

Albuterol

A

Class - Sympathomimetic, bronchodilator
MOA - Beta 2 agonist
Indications - Bronchospasms, COPD

142
Q

Amioderone (Cordarone)

A 
Class - Antidysrhythmic 
MOA - blocks sodium/potassium channels, delaying repolarization and increasing the duration of action potential
Indications - VFib, PVT, Unst VTach
Contraindications 
2nd or 3rd degree Heart Blocks
Sinus Brady

Dose
300mg first dose/ 150mg second dose

143
Q

Amyl Nitrate

A

Class - Antidote

Indications - Cyanide Poisoning

144
Q

Aspirin

A

Class - Platelete Inhibitor, anti-inflammatory
Indications - Acute Chest Pn suggestive of AMI
Contradictions - acute ulcer or asthma

145
Q

Atropine

A

Class - Anticholinergic
MOA - Inhibits the action of acetylcholine, increases HR in life threatening bradycardia.
Indications - Unstable Bradycardia, Organophosphate poisoning, beta blocker/calcium channel blocker OD.
Dosage and administration Adult: Unstable bradycardia:
0.5 mg IV/IO every 3–5 minutes as needed. Not to exceed total dose of 0.04 mg/kg (maximum 3 mg total). Use shorter
dosing interval (3 minutes) and higher doses in severe clinical
conditions. Organophosphate poisoning: Extremely large doses
(2–4 mg or higher) may be needed. Pediatric: Unstable bradycardia: 0.02 mg/kg IV/IO (minimum dose: 0.1 mg). May repeat
once. Maximum single dose: Child: 0.5 mg. Adolescent: 1 mg.
Maximum total dose: Child: 1 mg. Adolescent: 3 mg. ET dose:
0.04–0.06 mg/kg. Rapid sequence intubation: 0.01–0.02 mg/kg
IV/IO (minimum: 0.1 mg, maximum: 0.5 mg).

146
Q

Diazepam (Valium)

A

Class - Benzo
MOA- Induces amnesia and sedation. rasies seizure threshold
Indications - Muscle relaxant, acute anxiety and agitation.
Dosage and administration Adult: Seizure activity: 5–10 mg
IV q 10–15 minutes PRN (5 mg over 5 minutes) (maximum
dose: 30 mg). Premedication for cardioversion: 5–15 mg IV over
5–10 minutes prior to cardioversion. Pediatric: Seizure activity: 0.2 mg/kg to 0.5 mg/kg slow IV q 2–5 minutes up to 5 mg
(maximum dose 10 mg/kg). Rectal diazepam: 0.5 mg/kg via 2”
rectal catheter and fl ush with 2–3 mL air after administration

147
Q

Diltiazem

A

Class - Calcium Channel Blocker
MOA - Slows calcium channel blocker that blocks calcium ion influx during depolarization of cardiac and vascular smooth muscle. reduces preload and afterload.
reduces myocardial oxygen demand.
Indications - Afib, Aflutter, SVT
Dosage and administration Adult: Initial dose: 0.25 mg/kg
(15–20 mg for the average patient) IV over 2 minutes. If inadequate response, may re-bolus in 15 minutes. Secondary dose:
0.35 mg/kg (20–25 mg for the average patient) IV over 2 minutes

148
Q

Diphenhydramine (Benadryl)

A

Class - Antihistamine, anticholinergic
MOA - blocks histamine receptors, decreases vasodilation, reverses extrapyramidal reactions.
Indications - Anaphylaxis, Extrapyramidal,
Dosage and administration Adult: 25–50 mg IM, IV, PO. Pediatric: 1–2 mg/kg IV, IO slowly, or IM. If PO: 5 mg/kg/24h.

149
Q

Dopamine

A

Class- Sympathomimetic, vasopressor, inotropic agent
MOA - produces positive chronotropic and inotropic effects. Constricts systemic vasculature, increasing BP, and preload. increases myocardial contractility and stroke volume.
Indications - Cardiogenic, distributive and septic shock, hypotension with low cardiac output states.
Dosage and administration Adult: IV/IO infusion at 2–20 µg/kg/
min, slowly titrated to patient response. Pediatric: IV/IO infusion
at 2–20 µg/kg/min, slowly titrated to patient response

150
Q

Calcium Chloride

A

Class Electrolyte (anion).
Mechanism of action Increases cardiac contractile
state (positive inotropic effect). May enhance ventricular
automaticity.
Indications Hypocalcemia, hyperkalemia, hypermagnesemia,
beta blocker and calcium channel blocker toxicity.
Contraindications Hypercalcemia, ventricular fi brillation, digitalis toxicity.
Adverse reactions/side effects Syncope, cardiac arrest,
dysrhythmia, bradycardia, hypotension, asystole, peripheral
vasodilation, nausea, vomiting, metallic taste, tissue necrosis at
injection site, coronary and cerebral artery spasm.
Drug interactions May worsen dysrhythmias secondary to
digitalis toxicity. May antagonize the effects of calcium channel blockers. Do not mix or infuse immediately before or after
sodium bicarbonate without intervening fl ush.
How supplied 10% solution in 10 mL (100 mg/mL) ampules,
vials, and prefi lled syringes.
Dosage and administration Adult: Calcium channel blocker
overdose and hyperkalemia: 500 mg to 1,000 mg (5–10 mL
of 10% solution) IV push. May repeat as needed. Pediatric:
Calcium channel blocker overdose and hyperkalemia: 20 mg/
kg (0.2 mL/kg) slow IV

151
Q

Epinephrine

A

Class Sympathomimetic.
Mechanism of action Direct-acting alpha and beta agonist.
Alpha: vasoconstriction. Beta-1: positive inotropic, chronotropic, and dromotropic effects. Beta-2: bronchial smooth
muscle relaxation and dilation of skeletal vasculature. Blocks
histamine receptors.
Indications Cardiac arrest (asystole, PEA, ventricular fi brillation
and pulseless ventricular tachycardia), symptomatic bradycardia
as an alternative infusion to dopamine, severe hypotension secondary to bradycardia when atropine and transcutaneous pacing
are unsuccessful, allergic reaction, anaphylaxis, asthma.
Contraindications Hypertension, hypothermia, pulmonary
edema, myocardial ischemia, hypovolemic shock.
Adverse reactions/side effects Nervousness, restlessness,
headache, tremor, pulmonary edema, dysrhythmias, chest pain,
hypertension, tachycardia, nausea, vomiting.
Drug interactions Potentiates other sympathomimetics.
Deactivated by alkaline solutions. MAOIs may potentiate effect.
Beta blockers may blunt effects.
How supplied 1:1,000 solution: Ampules and vials containing 1 mg/mL. 1:10,000 solution: Prefi lled syringes containing
0.1 mg/mL. Auto-injector (EpiPen): 0.5 mg/mL (1:2,000).
Dosage and administration Adult: Mild allergic reactions
and asthma: 0.3–0.5 mg (0.3–0.5 mL 1:1,000) SC. Anaphylaxis: 1 mg (10 mL of 1:10,000) IV, IO over 5 minutes. Cardiac
arrest: IV/IO dose: 1 mg (10 mL, 1:10,000 solution) 3–5
minutes during resuscitation. Follow each dose with a 20-mL
fl ush and elevate arm for 10–20 seconds after dose. Continuous infusion: Add 1 mg (1 mL of a 1:1,000 solution) to 250 mL
normal saline or D 5
W (4 µg/mL). Initial infusion rate of 1 µg/
min titrated to effect (typical dose: 2–10 µg/min). Endotracheal (ET) dose: 2–2.5 mg diluted in 10 mL normal saline.
Profound bradycardia or hypotension: 2–10 µg/min; titrate to
patient response. Higher dose: Higher doses (up to 0.2 mg/kg)
may be used for specifi c indications: (beta blocker or calcium
channel blocker overdose). Pediatric: Mild allergic reactions
and asthma: 0.01 mg/kg (0.01 mL/kg) of a 1:1,000 solution SC
(maximum of 0.3 mL). Anaphylaxis/severe status asthmaticus:
0.01 mg/kg (0.01 mL/kg) IM of a 1:1,000 solution (maximum
single dose: 0.3 mg). Cardiac arrest: IV/IO dose: 0.01 mg/kg
(0.1 mL/kg) of a 1:10,000 solution every 3–5 minutes during
arrest. All ET doses 0.1 mg/kg (0.1 mL/kg) of a 1:1,000 solution mixed in 3–5 mL of saline until IV/IO access is achieved.
Maximum single dose 1 mg. Symptomatic bradycardia: IV/IO
dose: 0.01 mg/kg (0.01 mL/kg) of a 1:10,000 solution. All ET
doses 0.1 mg/kg (0.1 mL/kg) of a 1:1,000 solution. Continuous IV/IO infusion: Begin with rapid infusion, and then titrate
to response. Typical initial infusion: 0.1–1 µg/min. Higher
doses may be effective.

152
Q

Fentanyl

A

Class Opioid analgesic, schedule II narcotic.
Mechanism of action Binds to opiate receptors, producing
analgesia and euphoria.
Indications Pain management, anesthesia adjunct.
Contraindications Known hypersensitivity. Use with caution
in traumatic brain injury.
Adverse reactions/side effects Confusion, paradoxical excitation, delirium, drowsiness, CNS depression, sedation, respiratory depression, apnea, dyspnea, dysrhythmias, bradycardia,
tachycardia, hypotension, syncope, nausea, vomiting, abdominal pain, dehydration, fatigue.
Drug interactions Increased respiratory effects when given
with other CNS depressants.
How supplied 50 µg/mL ampules and Tubex syringes.
Dosage and administration Adult: 50 to 100 µg (1µg/kg) IM
or IV, IO slow push (over 1–2 minutes) to maximum of 150 µg.
Pediatric: 1–2 µg/kg IM, IV, or IO slow push (over 1–2 minutes).
The safety and effi cacy in children younger than 2 years has not
been established.

153
Q

Flumazenil

A

Class Benzodiazepine antagonist, antidote.
Mechanism of action Antagonizes the action of benzodiazepines
on the central nervous system, reversing the sedative effects

154
Q

Furosemide (Lasix)

A

Class Loop diuretic.
Mechanism of action Blocks the absorption of sodium and
chloride at the distal and proximal tubules and the loop of
Henle, causing increased urine output.
Indications CHF, pulmonary edema, hypertensive crisis.
Contraindications Hypovolemia, anuria, hypotension (relative contraindication), hypersensitivity, hepatic coma, suspected
electrolyte imbalances.

155
Q

Glucagon

A

Class Hyperglycemic agent, pancreatic hormone, insulin antagonist.
Mechanism of action Increases blood glucose level by stimulating glycogenesis. Unknown mechanism of stabilizing cardiac
rhythm in beta blocker overdose. Minimal positive inotropic
and chronotropic response. Decreases gastrointestinal motility
and secretions.
Indications Altered level of consciousness when hypoglycemia
is suspected. May be used as a reversal agent in beta blocker and
calcium channel blocker overdoses

156
Q

Ipratropium (Atrovent)

A

Class Anticholinergic, bronchodilator.
Mechanism of action Inhibits interaction of acetylcholine at
receptor sites of bronchial smooth muscle, resulting in decreased
cyclic guanosine monophosphate and bronchodilation.
Indications Persistent bronchospasm, COPD exacerbation.
Contraindications Hypersensitivity to ipratropium, atropine,
alkaloids, peanuts.

157
Q

Lorazepam (Ativan)

A

Class Benzodiazepine, short/intermediate acting; sedative,
anticonvulsant, schedule IV drug.
Mechanism of action Anxiolytic, anticonvulsant, and sedative
effect; suppresses propagation of seizure activity produced by
foci in cortex, thalamus, and limbic areas.
Indications Initial control of status epilepticus or severe recurrent seizures, severe anxiety, sedation.
Contraindications Acute narrow-angle glaucoma, coma,
shock, suspected drug abuse.
Dosage and administration Note: When given IV/IO, must be
diluted with equal volume of sterile water or sterile saline. When
given IM, lorazepam is not diluted. Adult: 2–4 mg slow IM/IV at 2 mg/min; may be repeated in 15–20 minutes. Maximum dose of
8 mg. For sedation: 0.05 mg/kg up to 4 mg IM. Pediatric: 0.05–
0.20 mg/kg slow IV/IO/IM over 2 minutes. May be repeated
once in 5–20 minutes. Maximum dose of 0.2 mg/kg.

158
Q

Magnesium Sulfate

A

Class Electrolyte, anti-infl ammatory.
Mechanism of action Reduces striated muscle contractions
and blocks peripheral neuromuscular transmission by reducing
acetylcholine release at the myoneural junction. Manages seizures in toxemia of pregnancy. Induces uterine relaxation. Can
cause bronchodilation after beta-agonists and anti-cholinergics
have been administered.
Indications Seizures of eclampsia (toxemia of pregnancy), torsades de pointes, hypomagnesaemia, ventricular fi brillation/
pulseless ventricular tachycardia that is refractory to amiodarone, life-threatening dysrhythmias due to digitalis toxicity.
Contraindications Heart block, myocardial damage.
Dosage and administration Adult: Seizure activity associated
with pregnancy: 1–4 g of a 10% solution IV/IO over 3 minutes;
maximum dose of 30–40 g/day. Cardiac arrest due to hypomagnesaemia or torsades de pointes: 1–2 g of a 10% solution IV/IO
over 5–20 minutes. Torsades de pointes with a pulse: Loading
dose of 1–2 g in 50–100 mL of D 5
W over 5–60 minutes IV. Follow with 0.5–1 g/h IV (titrate dose to control torsades). Pediatric:
Pulseless ventricular tachycardias with torsades de pointes:
25–50 mg/kg IV/IO bolus of a 10% solution to a maximum dose
of 2 grams. Torsades de pointes with pulses/hypomagnesaemia:
25–50 mg/kg IV/IO of a 10% solution over 10–20 minutes to
maximum dose of 2 grams. Status asthmaticus: 25–50 mg/kg
IV/IO of a 10% so

159
Q

Midazolam Hydrochloride (Versed)

A

Class Benzodiazepine, short/intermediate acting; schedule
IV drug.
Mechanism of action Reversibly interacts with gamma-amino
butyric acid (GABA) receptors in the central nervous system
causing sedative, anxiolytic, amnesic, and hypnotic effects.
Indications Sedation for medical procedures (eg, intubation,
ventilated patients, cardioversion).
Contraindications Acute narrow-angle glaucoma, shock,
coma, alcohol intoxication, overdose, depressed vital signs.
Concomitant use with barbiturates, alcohol, narcotics, or other
central nervous system depressants.
Adverse reactions/side effects Headache, somnolence, respiratory depression, respiratory arrest, apnea, hypotension, cardiac arrest, nausea, vomiting, pain at the injection site.
Drug interactions Should not be used in patients who have
taken central nervous system depressants.
How supplied 1 mg/mL and 5 mg/mL vials and Tubex syringes.
Dosage and administration Adult: 2–2.5 mg slow IV (over
2–3 minutes). May be repeated to total maximum: 0.1 mg/
kg. Pediatric: 0.1–0.3 mg/kg IV/IO (maximum single dose:
10 mg).

160
Q

Morphine Sulfate

A

Class Opioid analgesic (schedule II narcotic).
Mechanism of action Alleviates pain through CNS action.
Suppresses fear and anxiety centers in the brain. Depresses
brainstem respiratory centers. Increases peripheral venous
capacitance and decreases venous return. Decreases preload and
afterload, which decreases myocardial oxygen demand.
Indications Severe CHF, acute cardiogenic pulmonary edema,
chest pain associated with acute myocardial infarction, analgesia
for moderate to severe acute and chronic pain.
Contraindications Head injury, exacerbated COPD, depressed
respiratory drive, hypotension, undiagnosed abdominal pain,
decreased level of consciousness, suspected hypovolemia,
patients who have taken MAOIs within 14 days.
Dosage and administration Adult: STEMI: Initial dose: 2–4 mg
slow IV (over 1–5 minutes). Repeat dose: 2–8 mg at 5–15 minute intervals. NSTEMI/Unstable angina. 1–5 mg IV push if
symptoms not relieved by nitrates, use with caution. Pediatric:
0.1–0.2 mg/kg/dose IV, IO, IM, SC. Maximum dose: 5 mg.

161
Q

Naloxone Hydrochloride (Narcan)

A

Class Opioid antagonist, antidote.
Mechanism of action Competitive inhibition at narcotic receptor sites. Reverses respiratory depression secondary to opiate
drugs. Completely inhibits the effect of morphine.
Indications Opiate overdose, complete or partial reversal of
central nervous system and respiratory depression induced by
opioids, decreased level of consciousness, coma of unknown
origin
Dosage and administration Adult: 0.4–2 mg IM/IV/IO/SQ/
ET/Intranasal (diluted); minimum single dose recommended:
2 mg. Repeat at 5-minute intervals to a maximum total dose of
10 mg (medical control may request higher amounts). Pediatric:
0.1 mg/kg/dose IV/IO/IM/SQ every 2 minutes as needed. Maximum total dose of 2 mg. If no response in 10 minutes, administer an additional 0.1 mg/kg/dose.

162
Q

Nitroglycerin

A

Class Vasodilator.
Mechanism of action Smooth muscle relaxant acting on vasculature, bronchial, uterine, intestinal smooth muscle. Dilation of
arterioles and veins in the periphery. Reduces preload and afterload, decreasing workload of the heart and thereby myocardial
oxygen demand.
Indications Acute angina pectoris, ischemic chest pain, hypertension, CHF, pulmonary edema.
Contraindications Hypotension, hypovolemia, intracranial
bleeding or head injury, pericardial tamponade, severe bradycardia or tachycardia, RV infarction, previous administration in
the last 24 hours: tadalafi l (Cialis) (48 hours), vardenafi l (Levitra), sildenafi l (Viagra).
Dosage and administration Adult: Tablet: 0.3–0.4 mg sublingually; may repeat in 5 minutes to maximum of 3 doses. NTG
spray: 1–2 sprays for 0.5–1 second at 5-minute intervals to a
maximum of 3 sprays in 15 minutes. NTG IV infusion: Begin
at 10 µg/min; increase by 10 µg/min every 3–5 minutes until
desired effect. To a maximum of 200 µg/min. Pediatric: Norecommended. IV infusion: 0.25–0.5 µg/kg/min IV, IO titrated
by 1 µg/kg/min (max dose: 5 µg/kg/min).

163
Q

Ondansetron (Zofran)

A

Class Serotonin receptor antagonist; antiemetic.
Mechanism of action Blocks action of serotonin, which is a
natural substance that causes nausea and vomiting.
Indications For the prevention and control of nausea or vomiting. Used in hospital for patients undergoing chemotherapy or
surgical procedures.
Dosage and administration Adult: 4 mg IV/IM may repeat in
10 minutes. Pediatric: 0.1 mg/kg IV/IM.

164
Q

Promethazine Hydrochloride (Phenergan)

A

Class Phenothiazine, antiemetic, antihistamine.
Mechanism of action H-1 receptor antagonist; blocks action of
histamine; possesses sedative, anti-motion, antiemetic, and anticholinergic activity; potentiates the effects of narcotics to induce
analgesia.
Indications Nausea/vomiting, motion sickness, sedation for
patients in labor, potentiates the analgesic effects of narcotics.
Contraindications Coma, central nervous system depression
from alcohol, barbiturates, or narcotics, Reye syndrome, lower
respiratory symptoms (eg, asthma).

Dosage and administration Adult: Dilute 1–3 mg in 10–30 mL
of D 5
W. Administer slowly IV at rate of 1 mg/min. Maximum:
5 mg. Pediatric: 0.01–0.05 mg/kg/dose slow IV over 10 minutes.
Maximum: 3 mg

165
Q

Hypertonic

solutions

A 
- 5% Dextrose in 0.9% Sodium
 Chloride
- 5% Dextrose in 0.9% Sodium
 Chloride
- 10% Dextrose in Water (D 10 W)
166
Q

Isotonic

solutions

A
  • Lactated Ringer’s (Hartmann’s Solution)
    -0.9% Sodium Chloride (normal saline)
    -
167
Q

Hypotonic

solutions

A

-0.45% Sodium Chloride (½ normal saline)
- 5% Dextrose in Water (D 5
W)

168
Q

Strokes are caused by?

A

caused by blood clot (thrombus) or intravascular particle or clot that moves (embolus) cerebral bleed can also cause stroke

169
Q

Window for fibrolynics in stroke?

170
Q

Hemiparesis

A

numbness on one side of the body

171
Q

hemplegia

A

paralysis on one side of the body, dizzy, drooping of mouth

172
Q

aphasia

A

inability to understand or express speech

173
Q

dysarthria

A

difficulty speeking, speech slurred

174
Q

How do we transport stroke patient?

A

supine with head elevated 15-30 degrees or on side, (affected side down), IV KVO (no fluid bolus). oxygen only in indicated.

175
Q

Difference between stroke and TIA?

A

TIA resolves within hours

176
Q

Stages of Seizures

A

Aura - sensation
loss of consciousness
tonic phase - systemic rigidity
hypertonic - arched back and rigid
clonic phase - rhythmic contraction of major muscle groups, lip smacking, biting, clenching teeth
post seizure - muscles relax nystagmus, eyes in back of head
postictal - rest period of the brain

177
Q

absence seizures (pet mal)

A

little to no movement; typically children

178
Q

drugs for seizures

A

Lorazepam (Ativan) and Midazelam ( versed) and Mag Sulfate
Ativan - 1-2 mg IV, IM, can be given IN (intranasal)
Peds dose- 0.1mg/kg
Versed
1-5 mg IV, IM, IO, IN (intra nasal)  Peds dose 0.1 mg/kg
Mag
2-4 gm IV for eclampsia

179
Q

status elepticus

A

prolonged general seizure over 5 minutes or 2 or more seizures without consciousness

aspiration, bone and spinal fractures, hypoxia, brain damage, hypoglycemia, dehydration, metabolic acidosis.

180
Q

sudden onset of severe headache, neuro symptoms, unconscious.
“worst headache ever”
usually presents in young female

A

subarachnoid bleed

181
Q

medical term for headache

182
Q

brain and spinal cord tumor

causes weakness or paralysis or change in sensation of one or more limbs or side of face, dizzy, diplopia (double vision), similar to stroke

A

CNS neoplasm

183
Q

sudden/acute state of confusion which is reversible

elderly may experience at night

184
Q

chronic deterioration of memory, reasoning, judgement, usually progressive deterioration

185
Q

Presents with fever, head and back ache, nuchal rigidity, altered, bulging fontanel
Brudzinski sign - hips and knees flex when neck flexed
Kernigs Sign - unable to straighten leg when hip flexed, rash, irritability.

A

bacterial meningitis

viral meningitis also presents with fever but not as severe.
PPE droplet precautions - mask for us and PT

186
Q

Neurological Disorder
Cause
neurons die, buildup of plaque in brain

signs
memory loss, confusion, can be agressive/violent, eventually cant talk and need constant care

A

Alzheimers

187
Q

Neurological Disorder
causes

infection usually due to eating contaminated beef
(fatal af)

signs

ataxia, jerking, visual impairment, mental disorientation

A

Creutzfeldt-Jakob disease

188
Q

Neurological Disorder
Causes
genetic disorder with loss of neurons in brain

signs
restless, abnormal eye movements, irritability, ataxia, difficulty standing, memory loss.

A

Huntington disease

189
Q

Neurological Disorder
Cause
autoimmune, usually viral, inflammation and destruction of myelin sheath

Signs
tingling in fingers and toes, progressive muscle weakness, trouble talkin and swallowing, difficulty breathing, paralysis.

A

Guillain-Barre syndrome

190
Q

Neurological Disorder

Cause
inflammation of nerve cells, loss of myelin sheathm inhibits nerve impulses, autoimmune

Signs
Diplopia, nystagmus, speech diff, weakness, impaired coordination, progressive

A

Multiple Sclerosis

191
Q

Neurological Disorder

Cause
unknown cause, loss of dopamine producing brain cells

signs
impaired voluntary movements and coordination, tremors, rigidity, chronic and progressive

A

Parkinsons

192
Q

Neurological Disorder

Cause
obsessive behavior, socially inappropriate, mental highs of depression, tremors, incontinence

signs
genetic disease (cause unknown), damage to neurons
A

Pick Disease

193
Q

Neurological Disorder

Cause
Thiamine deficiency usually in chronic alcoholics

signs
mental confusion, abnormal eye movements, ataxia

A

Wernicke

ecephalopathy

194
Q

Neurological Disorder

signs
weakness, rapid fatigue of muscles under voluntary control, breakdown in communication between nerves and muscles, trouble talking, swallowing

droopy eyelid and mouth

A

Myasthenia Gravis

195
Q

Organs in the RUQ

LLGPSK

A 
Large Liver
Gallbladder
Pancreas (tail)
Stomach (small)
Kidney (right)
196
Q

Organs in the LUQ

SSPK

A

Stomach
Spleen
Pancreas
Kidney (left)

197
Q

Organs in the RLQ

AIO

A

Appendix,
reproductive organs, (ovary fallopian tube, spermatic cord)
right ureter

198
Q

Organs in the LLQ

A

Left ureter

reproductive organs

199
Q

Order for ABD Assessment

A

Inspect
Auscultate
Percuss
Palpate

200
Q

ABD Pain in RLQ (McBurneys Point??), may have periumblical pain initially, may have rebound

Ass Finding
sick for several days, n/v, low grade temp (only high if ruptured), low appetite.

A

Appendicitis

201
Q

ABD Pain in RUQ (Murphys Sign??), pn on taking deep breathe when palpation of RUQ or epigastric pn)

Ass Finding
yellow or green bile emesis, usually after a fatty meal, more common in women

A

cholecystitis (inflammation of the gallbladder)

202
Q

pain in RUQ

Ass findings
jaundice, nausea, and vomiting, weight loss, fatigue, bruising easily

A

cirrhosis of the liver

203
Q

Pain in LLQ

Ass findings
fever, nausea/vomiting, diarrhea or constipation

A

Diverticulitis

204
Q

Absent ABD pn

Ass findings
bleeding in GI tract - vomiting blood (name for that?), shock

A

Esophageal varices

205
Q

ABD disorder; epigastric pain

Ass finding
black, tarry stools (name for this?), coffee ground emesis or blood (name for this), patients on anticoagulant more susceptible

A

GI hemorrhage-upper (ulcers)

206
Q

ABD disorder; Pn in lower abdomen, rectal, or no pain

Ass findings
bright red or wine-colored stool (name for this?)

A

GI hemorrhage- lower

hemorrhoids, anal fissures

207
Q

ABD disorder; Absent pain

Assessment finding
hematemesis, melena
Patient been vomiting

A

Mallory-Weiss Tear

transport in reverse trendelenburg position

208
Q

ABD issue: Pain can be anwhere, usually entire abd

Ass findings
rigid abdomen, fever, vomiting

A

Peritonoitis

inflammation of abdominal lining

209
Q

ABD issue: Pn in LUQ and may radiate to back or epigastric area

Findings
Diaphoresis, tachycardia, appears ill, sepsis, shock

A

Pancreatitis

210
Q

Tearing or shearing abdominal pain and possibly back pn

findings
unequal pulses in the lower extremities, urge to defecate due to blood in retroperitoneal space, many times Hypertensive history

A

Abdominal Aortic Aneurysm

transport rapidly and carefully
could rupture in route

211
Q

Tearing pain in upper chest and between shoulder blades

Unequal pulses in upper extremities,

A

Thoracic aortic aneurysm

transport rapidly and carefully
could rupture in route

212
Q

Acute Kidney Renal Failure

A

S&S
-sudden onset (days), oligaria (decrease in urine), anuria (no output), fatigue, weight loss, trauma to flank, AMS, hyperkalemia, heart dysrhythmia

213
Q

Chronic Kidney Failure

A

long and slow process
diabetes/hypertension
slower onset than AKF, may have some urine output, anemia
needs dialysis for the rest of life

214
Q

What happens if PT misses dialysis?

A

Fluid overload, pulmonary edema, hyperkalemia, with tall peaked T waves, prominent U waves (found after T waves)

215
Q

This syndrome can occur during or right after hemodialysis treatments due to decrease in blood urea which can cause cerebral edema and increased ICP

A

disequilibrium syndrome

216
Q

this type of dialysis is conducted by inserting tube into abdominal cavity. uses peritoneal membrane to exchange fluids and remove toxins/waste products

A

peritoneal dialysis

217
Q

unilateral severe flanks pain, may have flanks to groin pain, hematuria, pale, sweating, renal colic waves of pain due to peristalsis (contraction and relaxation) of ureter.

A

Kidney Stone

218
Q

back or flank pain, hematuria, cloudy and foul smelling urine, high fever

A

pyelonephritis

219
Q

lower mid abdominal pain/tenderness, frequent urination with burning, hematuria, cloudy, foul smelling urine

220
Q

pain in groin, foul smelling urine

A

epididymitis

221
Q

Located in the lower part of the brain above the brainstem, stimulates the pituitary gland, plays a role in sleep, temperature, hunger, thirst, blood pressure and water balance

A

Hypothalamus

222
Q

Located in brain, called the master gland

A

Pituitary gland

223
Q 
ACTH
ADH
FSH
GH
Oxytocin
TSH
A

Adrenocorticotropic hormone
Effects release of glucocorticoids found in adrenal glands

Anti-diuretic hormone made in hypothalamus and stored inPituitary

Follicle-stimulating hormone development of eggs and sperm

Growth hormone growth of muscle and bones

Oxytocin made and hypothalamus and stored in pituitary

Thyroid stimulating hormone affects release of thyroid hormones

224
Q

Thyroid condition assessment findings: agitation and nervousness, heat intolerance, weight loss, tachycardia, hot and flushed skin, goiter (which is?), exophthalmos (which is?)

A

Graves’ disease Hashimoto

Protrusion of eyeballs

225
Q

Thyroid condition: acute fever, sweating, diarrhea, altered mental status, hypoglycemia, seizures

A

Thyrotoxicosis, thyroid storm

Management includes cool down, beta blocker, glucose is indicated, benzo’s for seizures

226
Q

Thyroid issue: assessment findings fatigue and lethargy, cold intolerance, bradycardia, weight gain, dry, cold skin, constipated

A

Myxedema: management includes common thyroid med Synthroid/levothyroxine

227
Q

Thyroid issue, assessment findings altered middle status, coma, hypothermic

Slow to develop but can decline rapidly, usually triggered by sepsis, surgery, trauma

A

Myxedema coma

Management includes active rewarming, ALS procedures in aCLS if need

228
Q

This is located in the chest between a start them in heart, produces T lymphocytes to help fight infection; not present in adults, atrophies during adolescence

229
Q

These are located on the top of each kidney, produce epinephrine and norepinephrine, Aldosterone (which raises reabsorption of sodium/cortisol which raises energy)

A

Adrenal glands

230
Q

Adrenal insufficiency’s; signs and symptoms include fatigue, loss of appetite, vomiting, diarrhea, weight loss

A

Addison’s disease

231
Q

Adrenal insufficiency: signs and symptoms include severe vomiting and diarrhea, hypotension and even shock may be brought on by stress including trauma

Presents withLow blood sugar and low blood pressure

A

Addisonian crisis

232
Q

This diabetic disorder has signs and symptoms of DKA, but no fruity order/breath or Kuszmaul respirations, typical and type two diabetics

A

Hyperosmolar non ketotic coma

Or HHNK,HONK

233
Q

Demonology of an allergic reaction

A

Immuno globin/IGE
Mast cells stimulate each one histamine receptors, basil dilates, increases capillary permeability, Bronchoconstriction and laryngospasm

Wheezing urtiCaria itching tongue and lips and Eyes swollen

234
Q

HIV complication type of cancer with blue/red colored lesions, Pneumocystis pneumonia, TB.

A

Kaposis Sarcoma

235
Q

Slow onset, fever, right upper quadrant pain, nausea and vomiting, loss of appetite, jaundice, dark colored urine, light colored stools, whites of eyes are yellow

A

Hepatitis viral infection in the liver

236
Q

Shortness of breath, night sweats, cough, weight loss, fever, hemoptysis, Chills… Spreads by droplet must wear HEPA or N 95 mask

237
Q

Drug abuse: assessment findings respiratory in central nervous system depression, decreased respirations and level of consciousness, small pupils

A

Possibly narcotic, opium heroin, fennel, morphine, codeine management includes protecting the airway suction as needed, BVM if respirations are too low, Narcan

238
Q

Drug abuse assessment findings: dilated pupils, increased heart rate and respiratory rate and blood pressure, agitated/restless, seizures, V fib

A

Stimulants Dash cocaine, methamphetamine… Management includes seizure treatment as needed, benzodiazepine, EKG, IV

239
Q

Assessment findings: salivation lacrimation, urination, diarrhea, G.I. symptoms, emesis, constricted pupils open quotation (meiosis), Bradycardia

A

Organophosphate poisoning treat was heavy doses of atropine

240
Q

Assessment findings metabolic acidosis, respiratory alkalosis, hyper ventilation, tachycardia, fever, sweating, ringing in the ears (tinnitus)

A

Salicylate - aspirin

Acetylsalicylic acid

241
Q

assessment findings dry mouth, blurred vision, hypothermia, alter mental status, seizure, EKG changes due to blockage of sodium channels – wife QRS, heart block, torsades, VTAC

A

Try cyclic antidepressant overdose

Treat with sodium bicarb

242
Q

Treatment for a cyanide overdose/exposure

A

Amyl nitrate

243
Q

Treatment for extrapyramidal symptoms (dystonic) From psych drugs such as Haldol Thorazine

Treat with Benadryl

244
Q

Drug use for a beta blocker overdose

245
Q

Phases of the female menstrual cycle

MFOL

A

menstruation,
follicular phase,
ovulation
luteal phase.

Menstruation - bleeding
Follicle - eggs formed; one matures
Ovulation - release of a mature egg from the surface of the ovary
Luteal - progesterone, along with small amounts of oestrogen. This combination of hormones maintains the thickened lining of the uterus, waiting for a fertilised egg to stick (implant)
Nothing happens, hormones disappear and lining thins.. cycle repeats

246
Q

Pain in both lower quadrants, fever, foul smelling discharge, fever

Most common causes gonorrhea/chlamydia

A

Pelvic inflammatory disease

247
Q

Early pregnancy emergencies comma:Signs and symptoms include bilateral lower of Domino pain, bleeding, passing clots a tissue, cramping

248
Q

Early pregnancy emergencies up 20 weeks: signs and symptoms of cool unilateral lower of Domino pain, minimal bleeding, curse sign (referred pain to shoulder), syncope, shock if Russia

A

Ectopic pregnancy

249
Q

Late pregnancy emergencies: silence and include dark red or no visible leading, tearing up Domino pain, shock. Can be trauma induced N deceleration injury

A

Abruptio placenta en plus into tears away from the wall the uterus. Treat for shock fluids to keep systolic at least 100 MMHG, transport on the left side only

Abrupto placenta may also occur due to trauma moi usually fall a car crash

250
Q

Late pregnancy emergencies: sign the sellers include bright red vagina bleeding, but no pain

A

Placenta previa - placenta implanted partially or completely over cervical os

251
Q

Late stage pregnancy emergency: in labor, painful contractions and then pain-free, labor stops, peace and

A

Ruptured uterus

252
Q

Stages of labor

A

First stage begins with contractions ends with complete Dilation

Second stage begins with the delivery of the baby ends with expulsion of baby

Third stage begins with the explosion of baby ends with delivery of placenta

253
Q

Indication of imminent delivery

A

Contractions less than two minutes apart lasting 60 to 90 seconds

254
Q

Apgar

A

Appearance presentation grimace activity respirations. Should be checked at the one in five-minute mark

255
Q

Pediatric Triangle

W-hat? O-h?
BICH DRUGS

A 
Warm, Position, Dry, Clear Airway
O2
BVM
INTUBATE
Chess Compressions
Medications
256
Q

What do we use to combat bradycardia during signs of hypoxia in newborn

A

Oxygen not atropine

257
Q

Compensatory stage of shock

A

Perfusion: Able to maintain perfusion
HEART RATE: one of the first signs is tachycardia
BP: blood pressure is normal for patient
S/S: anxiety/restlessness, thirst, weakness, dilated pupils, nausea vomiting, tachypnea, pale and clammy skin

258
Q

Decompensated stage of shock

A

Low blood pressure (late sign), decreased LOC, unable to feel peripheral pulses, modeled skin, mean arterial pressure less than 65 MMHG

259
Q

Blood loss/hemorrhage classes one through four

A

Class one-up to 15%/750
Class two-up to 30%/1500
Class three–30 to 40%/1500-2000
Class four greater than 40% usually irreversible

260
Q

Treatment for have a hypovolemic shock

A

NPO, airway add junk/control as needed, 02, NRM or BBM, control bleeding, flat position, keep warm, isotonic Crystalloid solutions, adult 20 ML/KG, rapid transport

261
Q

Myoglobin released into bloodstream due to muscle break now and burns in crush injuries, can cause acute kidney failure

A

Rhabdomyolsis

262
Q

Parkland formula

A

Four times BSA percentage times body weight

This gives you the amount to be given over the 24 hours you divide this In half to determine was to be given within the first eight hours

263
Q

Why do we Reverse triage if the mask has to be involved in lightning strike

A

Lightning strikes often send people into lethal dysrhythmia… A patient who is in a lethal dysrhythmia can we quickly right back these patients would normally be tags black

264
Q

Head injury or trauma which presents with bleeding between the durra in the school, patient can be unconscious and conscious and then unconscious again

A

Suspect epidural hematoma

265
Q

What is the difference between a cerebral concussion and a cerebral contusion

A

Cerebral concussion occurs in the brain stem includes loss of consciousness then wakes up, no permanent damage, may have minor confusion headache nausea

Cerebral contusion occurs in cerebrum, structural damage to brain tissue, patient is awake with vocal signs such a difficulty talking diplopia personality changes

266
Q

Cushing’s response

A

Involved in increased ICP patient will present with elevated blood pressure decreased falls and irregular respirations. Early signs include vomiting without nausea, headache and altered mental status. Low sets due to vasodilation

267
Q

During hypovolemic shock heart rate does what BP does what respirations to work

A

Heart rate increases BP eventually decreases respirations increase

268
Q

During neurogenic shock heart rate does what BP does work respirations do what

A

Neurogenic shock presents with decreased heart rate or normal, decreased blood pressure, and the respiration aren’t affected

269
Q

During moments of increased intracranial pressure heart rate does what BP does what respiration’s present how?

A

I see people presents with decreased heart rate, Increased blood pressure, irregular fast or slow respirations

270
Q

C1-C5 are responsible for what?

Injury to this area can present with what?

A

Responsible for control of diaphragm, injury to this area can cause respiratory paralysis

271
Q

C-6 and C-seven can yield what sign and symptom when injured

A

Quadruple easier but can breathe, diaphragm working but may have difficulty breathing

272
Q

If patient assistance injury to chest BST and will airbag deceleration complains of upper anterior chest pain, tearing pain, or pain between the shoulder blades, and has an equal radial pulses, suspect what?

A

Ligamentum arteriosum

273
Q

Fuck difference between simple pneumo, tension pneumo-and hemothorax?

A

Tension pneumo-presents with JVD tracheal deviation away from tension side, every breath patient takes gets worse decrease in blood pressure.

Simple Neumos may be spontaneous usually presents and tall young males presents with chest pain and coughing no JVD

Hemothorax flatJugular veins
May go into hypovolemic shock

274
Q

Results as patient encounters a direct blow to chair such as the steering wheel or airbag canpresent With Bex triad open parentheses define)Also define pulses paradoxus

A

Cardiac Tamponade
Compression of the heart, can’t refill properly, decreased cardiac output.

presents with my full heart sounds JVD due to increased venous pressure and decreased blood pressure due to decreased in arterial pressure

Pulses paradoxes presents with a decrease in systolic BP during inspiration, narrow path pressure

275
Q

Disruption of rhythm of heart due to direct blow to the chest and children and teenagers because Chest is still pliable.
CPR and defibrillation may be necessary

A

Commotion cordis

276
Q

Cullen Signs

A

Presents and patience with abdominal trauma signs and symptoms include. Umbilical bruising and pain, gardening, distention, rigid abdomen most likely due to blood pooling from Solid organs

277
Q

Gray Turner

A

Kidney injury hematoma in the flank may also present with hematuria, could be pancreas too

278
Q

Pregnant female may suffer up to how much blood loss before hypotension sets in

279
Q

What will you notice in a hypo dermic patient on their EKG and where were you notice it

A

Osborne Wave, V2 through V5

280
Q

Dangers of fresh water drowning

A

Hemodilution, electrolyte imbalance, washed away surfactant which leads to atelectasis -collapse of alveoli

281
Q

Dangers of saltwater drowning

A

Pulmonary edema, salt draws water into alveolar

282
Q

Shark fin on capno

Reverse shark fin on capno

A

Shark fin - asthma

Reverse - emphysema

283
Q

What marking on ET tube does intubated male and female PT at Lip read?

A

23cm for male

22cm for female

284
Q

Thyroid, CTM, cricoid cartilage

A

CTM location for thyrotomy

285
Q

Adequate respiration rates

Adult
Child
Infant

A

Adult 12-20
Child 15-30
Infant 25-50

286
Q

Equation for propose Et tube

A

Age plus 16 then divide by 4

287
Q

Sudden onset, pleuristic chest pn, more on Inspiration, JVD, may be cyanotic from nipple line down, shock, resp distress

Most commonly caused by DVT

A

Pulmonary Embolism

288
Q 
Slow onset (several nights in a row)
Viral, not high fever, “seal” like barking cough
289
Q

Lower airway wheezes

Whooping cough

290
Q

Genetic ailment, thick mucus which can cause life threatening infection

A

Cystic fibrosis

291
Q

Layers of the heart

A

Endometrium - lines inside of the heart

Myocardium muscle layer-does the world

Epicardium-outer most layer protects muscle from friction during beats

Pericardium - fibrous sac that protects heart from structures in chest

292
Q

LAD sever which walls of heart?
Circumflex
Then RAD

A

LAD
SEPTAL, ANTERIOR

Circ
LATERAL

RAD
INFERIOR

293
Q

cardiac issue

SOB, crackles, orthopnea or paroxysmal nocturnal Dyspnea

A

Left Ventricular Heart failure

Management
02, lasix, nitro, morphine, CPAP, suction if needed, advanced airway if needed

294
Q

Cardiac issue
No trauma
JVD, pedal or sacral edema
Hx of high blood pressure

A

Right side heart failure

Or cor pulmonale

295
Q

Excessive fluid inside pericardial sac (due to infection), diffuse st elevation, down sloping PR, sharp substernal chest pn, may radiate to neck, arms or jaw, more intense WHEN LAYING Down
Low grade fever, swelling of legs and feet.

A

Non traumatic cardiac tamponade

296
Q

Types of Responses

Facilitation
Reflection
Clarification
Silence
Empathy
Confrontation
Interpretation 
Summary
297
Q

Landing zone by day and night

A

By day, Varies

By night 100x100

298
Q

Cheyenne stokes
Biots
Apneustic

A

Shane Stokes presents with periodic breathing with cycles of increasing rate and depth of breathing followed by gradual decrease in depth and rate periods of apnea that can last up to 60 seconds

Biot’s presents with in the regular rate rhythm and depth with intermittent apnea
ataxic respirations

Apneustic respirations are an ominous sign of a brainstem injury, prolong inhalation fall of a short and ineffective exhalation

299
Q

disease is a common inflammatory bowel disorder characterized by occult bleeding and frequent intestinal obstructions.

A

Chrons disease

300
Q

This period is the time between infection and the ability of the infection to be transmitted to another.

A

Latent period

301
Q

This period is the length of time the pathogen can be spread from one person to another.

A

communicable period

302
Q

clinical presentation (anxious, narrow pulse pressure, tachycardia, etc), this patient displays findings consistent with what percentage of blood loss.

How much blood is in the body typical adult

A

15-30 percent

4500-5500 mL

303
Q

Heart Sounds

S1
S2
S3 gallop
S-gallop before S-1

A

S1 (closure of cuspid valves)
S2 (closure of semilunar valves)
S3 deceleration of blood flow from LA to LV, CHF
S-gallop: LV failure; aortic stenosis

304
Q

U waves present when?

Delta waves present when?

A

Hypokalemia

Wolf Parkinson’s

305
Q

Pediatric Joule recommendation for cardioversion

A

2joules/kg then 4joules/kg

Max is 10ug/kg

306
Q

Cardioversion

Vfib/Vtach without pulse
Afib-cardioversion
A flutter and SVT
VTACH WITH PULSE

A

120-200 biphasic
120-200
50-100
100

307
Q

Which heart failure categorized as SOB, crackles, S-3 gallop, blood-tinged white foam from mouth/nose, orthopnea

Pulmonary edema

A

LV failure

308
Q

Right sided heart failure

A

JVD, pedal edema
Enlarged liver
Loss of appetite

309
Q

Sharp substernal or left precordial chest pain, more intense when lying flat, may radiate to neck arms or jaw

A

Non traumatic cardiac tamponade/pericarditis

Excessive fluid inside pericardial sac

310
Q

Heart defect where blood passes directly from LA to RA

May be asymptomatic

A

Foramen Ovale

Atrial Septal Defect

311
Q

Heart defect

Narrow Aorta, reduces flow of blood to body; hypertension

A

Coarctation of Aorta (COA)

312
Q

Heart defect where blood flows continuously from sorts through ductus into pulmonary artery, shunts blood away from lungs

A

Patent ductus arteriosus

Ductus fails to close at birth

313
Q

Heart defect Narrowing of pulmonary valve, increased right ventricular pressure, right vent hyper trophy decreased blood flow to Lungs

May present with JVD, cyanosis especially when feeding

A

Pulmonary stenosis

314
Q

Pulmonary stenosis, right ventricular hypertrophy, BSD, overriding aorta – connected to left and right ventricle instead of just left, a order will receive some blood with low oxygen from right ventricle

Patient is Cyanotic all the time but worse room crying, feeding, or active

A

Tetralogy of Fallot

315
Q

Pulmonary artery connected to the left ventricle and a order of connected to right ventricle, blood from body goes back to body without being oxygenated, blood from the lungs goes back to Long’s without going to body

Patient presents with shortness of breath, clubbing of fingers, cyanosis

A

Transposition of the great vessels TGA

316
Q

Heart defect where there is no tricuspid valve, small or no right ventricle

A

Tricuspid atresia

317
Q

Heart defect with blood passes directly from left ventricle into right ventricle

Patient may be in asymptomatic, may called pulmonary hypertension or heart failure, low blood pressure

A

Ventricular septal defect VSD

318
Q

SIDS happens between these months

319
Q

Drug known to cause vasoconstriction and may help in shock states. It has been approved for massive bleeding when few choices exist for management

peptide hormone formed in the hypothalamus

A

Vasopressin

320
Q

Calcium channel blockers are those that end in?
Beta blockers end in?
Nitrates end in?

A

Pine

Olol

Trate

321
Q

hypoglycemic pediatric patient should be treated with what?

And what dose?

A

25% dextrose

2-4ml/kg

322
Q

refers to a small margin between an effective dose and a harmful dose.

A

Narrow therapeutic index

323
Q

Drug most effective in acute congestive heart failure (CHF) because it helps to excrete the excess fluid

A

Furosemide

324
Q

Size needle most appropriate for IM injections

A

For most IM injections on nonobese patients, a

21-gauge 1 to 1 1/2-inch needle is appropriate.

325
Q

DOPE Mnemonic for intubated peds

A

Displacement
Obstruction
Pneumo
Equipment

A-Para 2 Final (6 decks)

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