NREMT Flashcards
1
Q
Alpha -1 has what effect?
A
Vasoconstriction of arteries and veins
2
Q
Alpha - 2 effect ?
A
Inhibits norepinephrine release, Inhibits insulin release, stimulates glucagon secretions, and inhibits my lipolysis
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
4
Q
Beta 2 effect?
A
Smooth muscle relaxer that causes bronchodilation and stimulates glycogenolysis insulin secretion
5
Q
Lemon pneumonic
A
L Look externally E Evaluate 3-3-2 M MALLAMPATI O Obstructions N Neck mobility
6
Q
Normal RR
Adult
Child
Infant
A
12 - 20
15-30
25-30
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
8
Q
KUSSMAUL respirations
A
Continuous deep sign breast with a rapid rate usually greater than 40 when the body is responding to metabolicAcidosis
9
Q
Normal ETC02 values range between one what and what?
A
35 and 45
10
Q
Loud high-pitched crackling
A
Rails
11
Q
Low pitched crackles found in the lower airway is made clear with a cough
A
RONCHI
12
Q
Pericardium
A
Fibrous sac that protects the heart from other structures of the chest and contains lubricating fluid to reduce friction
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
14
Q
Stroke volume range
A
60 to 100
15
Q
Frank’s darling principal
A
A property of cardiac muscle; as it gets stretched more, it contracts with greater force
16
Q
Atherosclerosis
A
Narrowing of aorta cerebral and coronary blood vesselsBy way of fatty material deposited along the inner walls of the arteries
17
Q
Axis deviation can be determined
A
BY looking at lead one and lead
aVF
18
Q
Normal
Left axis
Right axis
Extreme right
A
Up and Up
Up and Down
Down and Up
Down and Down
19
Q
Left bundle branch block and what leads
A
Leads one leaves AVF and lead V6
20
Q
Right by the branch block
A
One, a avl , V5, and v6
21
Q
TRhombus
A
Blood clot already formed in the near artery
22
Q
Embolus
A
Blood clot formed elsewhere in the body can travel to Coronary artery
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
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
25
Chest pain abdominal pain and back pain or off in the chief complaint for what aneurysm
Abdominal aortic aneurysm
| Pulsating masses can also be found it
26
Drug of choice for hypertension
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
27
Beck triad
JVD hypotension and muffled heart tones
28
Biot’s respirations
Biot respirations can be described as a regular rate and depth of reading with periodic apnea
29
Shush Cheyenne stokes respirations
A gradual increase in respiration followed by a gradual decrease with apnea that the last of the 60 seconds
30
Cushing’s Triad
Ataxic respirations Low heart rate high blood pressure brainstem injury
31
Synchronize cardioversion for SVT in a flutter
50 to 100 J
32
Synchronize cardioversion for a fib
120 to 200 J
33
Synchronize cardioversion for unstable ventricular tachycardia with pulses
100 to 150 Jules
34
One cardiac cycle occurs every how many seconds
0.8
35
Stick fibrosis
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.
36
Prior to puberty the hypothalamus restricts the production of this hormone
GRh
37
At the start of puberty the hypothalamus releases pulses of GRH which trigger the
Follicle-stimulating hormone and luteinizing hormone. These hormones trigger the production of other sex hormones that develop and maintain the reproductive system
38
The follicle stimulating hormone and luteinizing hormone secrete what hormones
Estrogen
39
The corpus luteum is secretes what
Progesterone
40
Four phases of the metro cycle
follicular phase,Ovulation, the luteal phase, Menstruation
41
Hypermenorrhea also known as menorrhagia is what
Abnormally or excessive heavy bleeding during a period
42
Polymenorrhea
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
43
Dysmenorrhea
Painful Menzies that can be so badass to interfere with their daily life
44
Metrorhagia
Spotting that occurs in between periods
45
Physiological changes in pregnant.
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%
46
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
Narcan
47
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.
CAT SCAN
48
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
ULCER
49
The history of abdominal pain after eating (when stomach acid is high), dark tarry stools, and recent diagnosis of anemia is a sign of
gastric ulcer
50
Trousseau sign
which is a carpopedal spasm induced by ischaemia through inflation of a sphygmomanometer cuff to a suprasystolic blood pressure
51
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
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.
52
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
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.
53
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
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.
54
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
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.
55
Visceral pain
Visceral pain originates in the body's organs. Often this pain is described very generally as dull, heavy, oppressive, or as pressure or ache.
56
Pleuritic Pain
Pleuritic pain is caused by inflammation of parietal pleura of the chest that is described as sharp, stabbing, or burning. The pain often radiates.
57
Somatic Pain
Somatic pain is similar to pleuritic pain and is described as sharp and originating from the skin, muscles, or bones.
58
Referred Pain
Referred pain is when the discomfort is perceived in other parts of the body.
59
Ascites
Excessive Swelling of the abdomen with fluid
| Related to liver disease
60
OPQST
Onset, Provocation, Quality, Region-Radiation, Severity, and Time
61
SAMPLE
Signs/Symptoms, Allergies, Medications, Past Medical History, Last oral Intake, and Events leading up to the occurence.
62
```
Trauma Criterion Step One
Physiological Criterion
Glascow
Systolic
Resp Rate
Vent Assistance
```
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)
63
Trauma Criterion
| Anatomic Criteria
- 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
64
Trauma MOI Criteria
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
65
Order of Trauma Assessment
| IPAP
Inspect, Palpate, Auscultate, Percuss
66
.Glascow Coma Scale
Highest is 15
Eyes - 4
Verbal - 5
Motor - 6
67
Decorticate
elbows, wrists, and fingers, flexed, stiffened legs, and feet. OUTWARDLY
68
Decerebrate (worse)
stiffened and INTERNALLY rotated elbows, and legs, teeth clenched, legs stiff and feet extended.
69
Babinski Response
Big toe moves upward and other toes fan out when stroking bottom of foot, mean CNS Problem.
70
Term for Dialated Pupils
| and Occurrences
Mydriasis
Cardiac Arrest, shock, cerebral hypoxia, cocaine, epi, amphetamines.
71
Term for Constricted Pupils
| and Occurrences
Miosis
Narcotics, central nervous system disorder, glaucoma meds, bright light
72
Term for Unequal Pupils
| and Occurrences
Brain injury, brain tumor, stroke, artificial eye, eye meds, or can be normal (called anisocoria)
73
Rapid eye movement term
Nystagmus
74
Rales/Crackles
Fluid in small airways-alveoli
Found in CHF, Pulmonary edema, drowning, pneumonia, COPD
75
Rhonchi
Mucus or fluid in the larger airways - Bronchioles
Found in Bronchitis, COPD, pnuemonia
76
Wheezing
Whistling sound due bronchoconstriction or marrowing of the terminal bronchioles due to edema ( swelling)
77
Vesicular
Soft, low pitch
heard in lung periphery
78
Apneustic Breathing
Long, deep breathes that are stopped during inspirations then periods of apnea.
found in CNS injury or stroke
79
Biots (ataxic)
Irregular periods of breathing or gasping with apnea
Usually due to increased ICP
80
Cheyne-Stokes
Increasing in rate and depth, decreasingg, in rate and depth with period of apnea
Neurological condition
81
Hyperressonant Percussion
Air - snare drum Hollow
tension pneumothorax, emphysema, asthma
82
Hyporessonant Percussion
Dull - Watery
83
Abdominal Quadrant Right Upper Quadrant (RUQ)
Liver
Gall Bladder
Stomach
84
Abdominal Quadrant Left Upper Quadrant (LUQ)
Liver
Spleen
Stomach
Pancreas
85
Abdominal Quadrant Right Lower Quadrant (RLQ)
Appendix
Right Ovary and FallTube
Bladder
86
Abdominal Quadrant Left Lower Quadrant (LLQ)
Left Ovary and Tube
| Bladder
87
Visceral Pn
Internal organs damaged or injured
-vague not well organized, pressure-like, dull, aching, cant point to pAin, with one finger, stretches, ischemia, inflammation
88
Somatic Pain
irritation, of peritoneal lining, sharp, localized, throbbing, deep breathe increases pain
89
Referred Pain
discomfort perceived in other parts of the body such as cardiac pain referred to jaw or arm
90
Cullens Sign
Ecchymosis (bruising) around umbilicus
Bleeding in the abdominal cavity
91
Grey Turner Sign
Ecchymosis (bruising) in the flank
Bleeding from kidneys, hemorrhagic pancreatitis
92
Kehrs Sign
Referred pain to shoulder
Ectopic or spleen injury, blood under diaphragm
93
Murphys Sign
Right Upper quadrant pain
Cholecystitis (inflammation of the gall bladder gal stones)
94
Brudzinkis Sign
Hip flexes when neck is flexed
Meningeal irritation, meningitis
95
Hamman's Sign
Crunching, rasping sound that correlates with heart beat. heard over mediastinum.
spontaneous mediastinal emphysema
tracheobronchial trauma
96
Hormans Sign
pain incalf on dorsiflexing foot while leg is straight
meningeal irritation, meningitis
97
Clubbing of the fingers sign
flattening of the nail angle; Sign of chronic hypoxia - COPD
98
Measure Blood Pressure Formula
Cardiac Output X Systemic Vascular Resistance
99
Pulse PRessure
Difference between systolic and diastolic
NARROWS in shock
WIDENS in increased ICP
100
Orthostatic Vital Signs
| positive Tilt
Decrease in Systolic BP 20mm
Increase Diastolic BP 10mm
Increase Heart Rate HR of 200
suggests Hypovolemia - Dehyadration
101
MAP
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)
102
Heart Rates for Peds
```
Adolescent (13-18)
School-Age (6-12)
Preschool (3-5)
Toddler (12-36 months)
Infant ( Birth to 1 year)
```
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
103
Pediatric Assessment Triangle
APPEARANCE - muscle tone, speech/cry, eye contact
WORK OF BREATHING - airway sounds, positions
CIRCULATION OF SKIN - pallor, mottling, cyanosis
104
Fontanel
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
105
Cerebral Palsy
group of chronic disorders, damage motor centers in brain in children; abnormal muscle spasms, hearing and vision problems, seizures
106
BGL normal measures
70 - 140mg/dl
107
Why is it difficult to judge Sp02 with sickle sell PTS
Anemia/blood disorders have inherent hemogloban issues.
108
Osmosis
Fluid movement from an area of less concentration to an area of greater concentration
109
Isotonic
stays in hlood vessels longer, field fluid replacement
Normal Saline and Lactated Ringers
110
Hypertonic
more particles, fluid moves in vascular space,
10% Dextrose
111
Hypotonic
1/2 NS
112
5% Dextrose in Water
Not used for fluid replacement
MI, CHF, giving drugs, KVO
113
```
Calcium
chloride
magnesium
potassium
sodium
```
```
calcemia
chloremia
magnesemia
kalemia
natremia
```
114
Hematocrit
%of red blood cells in the whole body - approx 45%
115
White blood cells - Leukocytes
fight infection
116
Platelets/Thrombocytes
promote clotting
117
ABO bloodtyping
O negative Universal Donor
| AB+ Universal Recipient
118
GTTS Formula
V x SS x DD
-----------------
C
119
Fluid Challenge
| Infusion Rate Over Time
V x SS
----------
T
120
Blood Gases
```
pH
PCO2
PO2
BiCard
HCO3
```
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
121
What receptors located in this arch and this sinus sense changes in BP? once sensed what happens?
Baroreceptors located in the aortic arch and carotid sinus sense changes in BP send messages to cardio centers in medulla.
122
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?
Antidiuretic hormone from the pituitary - Increases Peripheral Vascular Resistance, retains water in kidneys.
123
RE: Shock... What is released by this organ to convert Angiotension 1 to angiotension 2?
What does AG2 do?
Renin is secreted by the kidneys
| AG2 is a potent Vasoconstrictor
124
RE: Shock...Adrenal glands secrete what?
Epinepherine and norepiniephrine to increase SVR (maintains BP) and stimulates aldosterone which retains sodium and water in kidneys
125
Hypovolemia
Causes and Assessment Findings
Cause
Loss of blood or fluids
```
Findings
Increased HR
Increased Resp
Low BP
Pale or Cyanotic
Flat veins
```
126
Cardiogenic
```
Cause
Myocardial Infarctions (paricularly Left Ventricular HF or other cardiac issue)
```
Findings
Increased or Decresead HR
Pulmonary edema
Pale or Cyanotic
127
Anaphylactic Shock
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)
```
128
Neurogenic Shock
Causes
Spinal Injury - Sympathetic Nerve conduction interrupted
```
Findings
Decreased BP
Normal or Decreased HR
Vasodilation
hypothermia
```
129
Septic Shock
Overwhelming Infection
Decreased BP
High Temp/Fever
Vasodilation
Treatment
Airway, O2, fluids,
Dopamine - 5 - 20mcg/kg/min for hypotension or shock
130
Obstructive Shock
Causes
Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax
131
Controlled Substance Act
Schedule 1 no medicinal use
Heroin, Weed, LSD, Mescaline, Crack
Schedule 2 easily abusable
Cocaine, Morphine, Fentanyl, Methadone
132
Things to remember with geriatrics per drog ingestion
Decreased liver/kidney/renal function can affect drug action/elimination.
Levels can be toxic
133
Parasympathetic ANS
```
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
Sympathetic ANS
Chemical control
Norepinipherine then later epi
Nervous Control
nerve roots in thoracic and upper lumbar area of spine
135
Alpha Responses
Heart
Blood vESSELS
Bronchioles
Heart - No effect
Blood vESSELS - Constricts, Increased BP
Bronchioles - No response or slight bronchoconstriction
136
Beta Responses
Heart
Blood vESSELS
Bronchioles
```
Heart (B1)
Increased HR (chronotropic)
Increased Contractility (Inotropic)
Increased Conductivity (Dromotropic)
```
Blood Vessels
Dilate, Decreased BP
Bronchioles (B2)
bRONCODILATION
137
Drugs given IN (MAD)
Midazolam (Ativan), Naloxone (Narcan), Fentanyl, Lorazepam (Versed), Glucagon, max 1ml in each nostril
138
Enteral
Drugs given via GI tract(orally, SL, NG tube, rectally;
139
Parenteral
IV, IM, IN, SQ
140
Adenosine/Adenocard
Class - Antidysrhythmic
MOA - slows conduction to the AV
Indications - SVT
141
Albuterol
Class - Sympathomimetic, bronchodilator
MOA - Beta 2 agonist
Indications - Bronchospasms, COPD
142
Amioderone (Cordarone)
```
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
Amyl Nitrate
Class - Antidote
| Indications - Cyanide Poisoning
144
Aspirin
Class - Platelete Inhibitor, anti-inflammatory
Indications - Acute Chest Pn suggestive of AMI
Contradictions - acute ulcer or asthma
145
Atropine
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
Diazepam (Valium)
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
Diltiazem
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
Diphenhydramine (Benadryl)
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
Dopamine
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
Calcium Chloride
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
Epinephrine
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
Fentanyl
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
Flumazenil
Class Benzodiazepine antagonist, antidote.
Mechanism of action Antagonizes the action of benzodiazepines
on the central nervous system, reversing the sedative effects
154
Furosemide (Lasix)
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
Glucagon
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
Ipratropium (Atrovent)
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
Lorazepam (Ativan)
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
Magnesium Sulfate
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
Midazolam Hydrochloride (Versed)
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
Morphine Sulfate
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
Naloxone Hydrochloride (Narcan)
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
Nitroglycerin
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
Ondansetron (Zofran)
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
Promethazine Hydrochloride (Phenergan)
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
Hypertonic
| solutions
```
- 5% Dextrose in 0.9% Sodium
Chloride
- 5% Dextrose in 0.9% Sodium
Chloride
- 10% Dextrose in Water (D 10 W)
```
166
Isotonic
| solutions
- Lactated Ringer’s (Hartmann’s Solution)
-0.9% Sodium Chloride (normal saline)
-
167
Hypotonic
| solutions
-0.45% Sodium Chloride (½ normal saline)
- 5% Dextrose in Water (D 5
W)
168
Strokes are caused by?
caused by blood clot (thrombus) or intravascular particle or clot that moves (embolus) cerebral bleed can also cause stroke
169
Window for fibrolynics in stroke?
3 hrs
170
Hemiparesis
numbness on one side of the body
171
hemplegia
paralysis on one side of the body, dizzy, drooping of mouth
172
aphasia
inability to understand or express speech
173
dysarthria
difficulty speeking, speech slurred
174
How do we transport stroke patient?
supine with head elevated 15-30 degrees or on side, (affected side down), IV KVO (no fluid bolus). oxygen only in indicated.
175
Difference between stroke and TIA?
TIA resolves within hours
176
Stages of Seizures
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
absence seizures (pet mal)
little to no movement; typically children
178
drugs for seizures
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
status elepticus
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
sudden onset of severe headache, neuro symptoms, unconscious.
"worst headache ever"
usually presents in young female
subarachnoid bleed
181
medical term for headache
cephalgia
182
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
CNS neoplasm
183
sudden/acute state of confusion which is reversible
| elderly may experience at night
delerium
184
chronic deterioration of memory, reasoning, judgement, usually progressive deterioration
dementia
185
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.
bacterial meningitis
viral meningitis also presents with fever but not as severe.
PPE droplet precautions - mask for us and PT
186
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
Alzheimers
187
Neurological Disorder
causes
infection usually due to eating contaminated beef
(fatal af)
signs
ataxia, jerking, visual impairment, mental disorientation
Creutzfeldt-Jakob disease
188
Neurological Disorder
Causes
genetic disorder with loss of neurons in brain
signs
restless, abnormal eye movements, irritability, ataxia, difficulty standing, memory loss.
Huntington disease
189
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.
Guillain-Barre syndrome
190
Neurological Disorder
Cause
inflammation of nerve cells, loss of myelin sheathm inhibits nerve impulses, autoimmune
Signs
Diplopia, nystagmus, speech diff, weakness, impaired coordination, progressive
Multiple Sclerosis
191
Neurological Disorder
Cause
unknown cause, loss of dopamine producing brain cells
signs
impaired voluntary movements and coordination, tremors, rigidity, chronic and progressive
Parkinsons
192
Neurological Disorder
Cause
obsessive behavior, socially inappropriate, mental highs of depression, tremors, incontinence
```
signs
genetic disease (cause unknown), damage to neurons
```
Pick Disease
193
Neurological Disorder
Cause
Thiamine deficiency usually in chronic alcoholics
signs
mental confusion, abnormal eye movements, ataxia
Wernicke
| ecephalopathy
194
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
Myasthenia Gravis
195
Organs in the RUQ
LLGPSK
```
Large Liver
Gallbladder
Pancreas (tail)
Stomach (small)
Kidney (right)
```
196
Organs in the LUQ
SSPK
Stomach
Spleen
Pancreas
Kidney (left)
197
Organs in the RLQ
AIO
Appendix,
reproductive organs, (ovary fallopian tube, spermatic cord)
right ureter
198
Organs in the LLQ
Left ureter
| reproductive organs
199
Order for ABD Assessment
Inspect
Auscultate
Percuss
Palpate
200
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.
Appendicitis
201
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
cholecystitis (inflammation of the gallbladder)
202
pain in RUQ
Ass findings
jaundice, nausea, and vomiting, weight loss, fatigue, bruising easily
cirrhosis of the liver
203
Pain in LLQ
Ass findings
fever, nausea/vomiting, diarrhea or constipation
Diverticulitis
204
Absent ABD pn
Ass findings
bleeding in GI tract - vomiting blood (name for that?), shock
Esophageal varices
205
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
GI hemorrhage-upper (ulcers)
206
ABD disorder; Pn in lower abdomen, rectal, or no pain
Ass findings
bright red or wine-colored stool (name for this?)
GI hemorrhage- lower
| hemorrhoids, anal fissures
207
ABD disorder; Absent pain
Assessment finding
hematemesis, melena
Patient been vomiting
Mallory-Weiss Tear
transport in reverse trendelenburg position
208
ABD issue: Pain can be anwhere, usually entire abd
Ass findings
rigid abdomen, fever, vomiting
Peritonoitis
| inflammation of abdominal lining
209
ABD issue: Pn in LUQ and may radiate to back or epigastric area
Findings
Diaphoresis, tachycardia, appears ill, sepsis, shock
Pancreatitis
210
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
Abdominal Aortic Aneurysm
transport rapidly and carefully
could rupture in route
211
Tearing pain in upper chest and between shoulder blades
Unequal pulses in upper extremities,
Thoracic aortic aneurysm
transport rapidly and carefully
could rupture in route
212
Acute Kidney Renal Failure
S&S
-sudden onset (days), oligaria (decrease in urine), anuria (no output), fatigue, weight loss, trauma to flank, AMS, hyperkalemia, heart dysrhythmia
213
Chronic Kidney Failure
long and slow process
diabetes/hypertension
slower onset than AKF, may have some urine output, anemia
needs dialysis for the rest of life
214
What happens if PT misses dialysis?
Fluid overload, pulmonary edema, hyperkalemia, with tall peaked T waves, prominent U waves (found after T waves)
215
This syndrome can occur during or right after hemodialysis treatments due to decrease in blood urea which can cause cerebral edema and increased ICP
disequilibrium syndrome
216
this type of dialysis is conducted by inserting tube into abdominal cavity. uses peritoneal membrane to exchange fluids and remove toxins/waste products
peritoneal dialysis
217
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.
Kidney Stone
218
back or flank pain, hematuria, cloudy and foul smelling urine, high fever
pyelonephritis
219
lower mid abdominal pain/tenderness, frequent urination with burning, hematuria, cloudy, foul smelling urine
Cystitis
220
pain in groin, foul smelling urine
epididymitis
221
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
Hypothalamus
222
Located in brain, called the master gland
Pituitary gland
223
```
ACTH
ADH
FSH
GH
Oxytocin
TSH
```
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
Thyroid condition assessment findings: agitation and nervousness, heat intolerance, weight loss, tachycardia, hot and flushed skin, goiter (which is?), exophthalmos (which is?)
Graves’ disease Hashimoto
Protrusion of eyeballs
225
Thyroid condition: acute fever, sweating, diarrhea, altered mental status, hypoglycemia, seizures
Thyrotoxicosis, thyroid storm
Management includes cool down, beta blocker, glucose is indicated, benzo’s for seizures
226
Thyroid issue: assessment findings fatigue and lethargy, cold intolerance, bradycardia, weight gain, dry, cold skin, constipated
Myxedema: management includes common thyroid med Synthroid/levothyroxine
227
Thyroid issue, assessment findings altered middle status, coma, hypothermic
Slow to develop but can decline rapidly, usually triggered by sepsis, surgery, trauma
Myxedema coma
Management includes active rewarming, ALS procedures in aCLS if need
228
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
Thymus
229
These are located on the top of each kidney, produce epinephrine and norepinephrine, Aldosterone (which raises reabsorption of sodium/cortisol which raises energy)
Adrenal glands
230
Adrenal insufficiency’s; signs and symptoms include fatigue, loss of appetite, vomiting, diarrhea, weight loss
Addison’s disease
231
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
Addisonian crisis
232
This diabetic disorder has signs and symptoms of DKA, but no fruity order/breath or Kuszmaul respirations, typical and type two diabetics
Hyperosmolar non ketotic coma
| Or HHNK,HONK
233
Demonology of an allergic reaction
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
HIV complication type of cancer with blue/red colored lesions, Pneumocystis pneumonia, TB.
Kaposis Sarcoma
235
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
Hepatitis viral infection in the liver
236
Shortness of breath, night sweats, cough, weight loss, fever, hemoptysis, Chills… Spreads by droplet must wear HEPA or N 95 mask
TB
237
Drug abuse: assessment findings respiratory in central nervous system depression, decreased respirations and level of consciousness, small pupils
Possibly narcotic, opium heroin, fennel, morphine, codeine management includes protecting the airway suction as needed, BVM if respirations are too low, Narcan
238
Drug abuse assessment findings: dilated pupils, increased heart rate and respiratory rate and blood pressure, agitated/restless, seizures, V fib
Stimulants Dash cocaine, methamphetamine… Management includes seizure treatment as needed, benzodiazepine, EKG, IV
239
Assessment findings: salivation lacrimation, urination, diarrhea, G.I. symptoms, emesis, constricted pupils open quotation (meiosis), Bradycardia
Organophosphate poisoning treat was heavy doses of atropine
240
Assessment findings metabolic acidosis, respiratory alkalosis, hyper ventilation, tachycardia, fever, sweating, ringing in the ears (tinnitus)
Salicylate - aspirin
| Acetylsalicylic acid
241
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
Try cyclic antidepressant overdose
Treat with sodium bicarb
242
Treatment for a cyanide overdose/exposure
Amyl nitrate
243
Treatment for extrapyramidal symptoms (dystonic) From psych drugs such as Haldol Thorazine
Treat with Benadryl
Prolixin
244
Drug use for a beta blocker overdose
Glucagon
245
Phases of the female menstrual cycle
MFOL
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
Pain in both lower quadrants, fever, foul smelling discharge, fever
Most common causes gonorrhea/chlamydia
Pelvic inflammatory disease
247
Early pregnancy emergencies comma:Signs and symptoms include bilateral lower of Domino pain, bleeding, passing clots a tissue, cramping
Abortion
248
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
Ectopic pregnancy
249
Late pregnancy emergencies: silence and include dark red or no visible leading, tearing up Domino pain, shock. Can be trauma induced N deceleration injury
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
Late pregnancy emergencies: sign the sellers include bright red vagina bleeding, but no pain
Placenta previa - placenta implanted partially or completely over cervical os
251
Late stage pregnancy emergency: in labor, painful contractions and then pain-free, labor stops, peace and
Ruptured uterus
252
Stages of labor
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
Indication of imminent delivery
Contractions less than two minutes apart lasting 60 to 90 seconds
254
Apgar
Appearance presentation grimace activity respirations. Should be checked at the one in five-minute mark
255
Pediatric Triangle
W-hat? O-h?
BICH DRUGS
```
Warm, Position, Dry, Clear Airway
O2
BVM
INTUBATE
Chess Compressions
Medications
```
256
What do we use to combat bradycardia during signs of hypoxia in newborn
Oxygen not atropine
257
Compensatory stage of shock
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
Decompensated stage of shock
Low blood pressure (late sign), decreased LOC, unable to feel peripheral pulses, modeled skin, mean arterial pressure less than 65 MMHG
259
Blood loss/hemorrhage classes one through four
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
Treatment for have a hypovolemic shock
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
Myoglobin released into bloodstream due to muscle break now and burns in crush injuries, can cause acute kidney failure
Rhabdomyolsis
262
Parkland formula
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
Why do we Reverse triage if the mask has to be involved in lightning strike
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
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Head injury or trauma which presents with bleeding between the durra in the school, patient can be unconscious and conscious and then unconscious again
Suspect epidural hematoma
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What is the difference between a cerebral concussion and a cerebral contusion
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
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Cushing’s response
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
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During hypovolemic shock heart rate does what BP does what respirations to work
Heart rate increases BP eventually decreases respirations increase
268
During neurogenic shock heart rate does what BP does work respirations do what
Neurogenic shock presents with decreased heart rate or normal, decreased blood pressure, and the respiration aren’t affected
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During moments of increased intracranial pressure heart rate does what BP does what respiration’s present how?
I see people presents with decreased heart rate, Increased blood pressure, irregular fast or slow respirations
270
C1-C5 are responsible for what?
| Injury to this area can present with what?
Responsible for control of diaphragm, injury to this area can cause respiratory paralysis
271
C-6 and C-seven can yield what sign and symptom when injured
Quadruple easier but can breathe, diaphragm working but may have difficulty breathing
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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?
Ligamentum arteriosum
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Fuck difference between simple pneumo, tension pneumo-and hemothorax?
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
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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
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
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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
Commotion cordis
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Cullen Signs
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
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Gray Turner
Kidney injury hematoma in the flank may also present with hematuria, could be pancreas too
278
Pregnant female may suffer up to how much blood loss before hypotension sets in
30 to 35%
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What will you notice in a hypo dermic patient on their EKG and where were you notice it
Osborne Wave, V2 through V5
280
Dangers of fresh water drowning
Hemodilution, electrolyte imbalance, washed away surfactant which leads to atelectasis -collapse of alveoli
281
Dangers of saltwater drowning
Pulmonary edema, salt draws water into alveolar
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Shark fin on capno
| Reverse shark fin on capno
Shark fin - asthma
| Reverse - emphysema
283
What marking on ET tube does intubated male and female PT at Lip read?
23cm for male
| 22cm for female
284
Thyroid, CTM, cricoid cartilage
CTM location for thyrotomy
285
Adequate respiration rates
Adult
Child
Infant
Adult 12-20
Child 15-30
Infant 25-50
286
Equation for propose Et tube
Age plus 16 then divide by 4
287
Sudden onset, pleuristic chest pn, more on Inspiration, JVD, may be cyanotic from nipple line down, shock, resp distress
Most commonly caused by DVT
Pulmonary Embolism
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Slow onset (several nights in a row)
Viral, not high fever, “seal” like barking cough
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Croup
289
Lower airway wheezes
| Whooping cough
Pertussis
290
Genetic ailment, thick mucus which can cause life threatening infection
Cystic fibrosis
291
Layers of the heart
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
LAD sever which walls of heart?
Circumflex
Then RAD
LAD
SEPTAL, ANTERIOR
Circ
LATERAL
RAD
INFERIOR
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cardiac issue
| SOB, crackles, orthopnea or paroxysmal nocturnal Dyspnea
Left Ventricular Heart failure
Management
02, lasix, nitro, morphine, CPAP, suction if needed, advanced airway if needed
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Cardiac issue
No trauma
JVD, pedal or sacral edema
Hx of high blood pressure
Right side heart failure
| Or cor pulmonale
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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.
Non traumatic cardiac tamponade
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Types of Responses
```
Facilitation
Reflection
Clarification
Silence
Empathy
Confrontation
Interpretation
Summary
```
...
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Landing zone by day and night
By day, Varies
| By night 100x100
298
Cheyenne stokes
Biots
Apneustic
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
disease is a common inflammatory bowel disorder characterized by occult bleeding and frequent intestinal obstructions.
Chrons disease
300
This period is the time between infection and the ability of the infection to be transmitted to another.
Latent period
301
This period is the length of time the pathogen can be spread from one person to another.
communicable period
302
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
15-30 percent
4500-5500 mL
303
Heart Sounds
S1
S2
S3 gallop
S-gallop before S-1
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
U waves present when?
| Delta waves present when?
Hypokalemia
| Wolf Parkinson’s
305
Pediatric Joule recommendation for cardioversion
2joules/kg then 4joules/kg
Max is 10ug/kg
306
Cardioversion
Vfib/Vtach without pulse
Afib-cardioversion
A flutter and SVT
VTACH WITH PULSE
120-200 biphasic
120-200
50-100
100
307
Which heart failure categorized as SOB, crackles, S-3 gallop, blood-tinged white foam from mouth/nose, orthopnea
Pulmonary edema
LV failure
308
Right sided heart failure
JVD, pedal edema
Enlarged liver
Loss of appetite
309
Sharp substernal or left precordial chest pain, more intense when lying flat, may radiate to neck arms or jaw
Non traumatic cardiac tamponade/pericarditis
Excessive fluid inside pericardial sac
310
Heart defect where blood passes directly from LA to RA
| May be asymptomatic
Foramen Ovale
| Atrial Septal Defect
311
Heart defect
| Narrow Aorta, reduces flow of blood to body; hypertension
Coarctation of Aorta (COA)
312
Heart defect where blood flows continuously from sorts through ductus into pulmonary artery, shunts blood away from lungs
Patent ductus arteriosus
| Ductus fails to close at birth
313
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
Pulmonary stenosis
314
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
Tetralogy of Fallot
315
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
Transposition of the great vessels TGA
316
Heart defect where there is no tricuspid valve, small or no right ventricle
Tricuspid atresia
317
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
Ventricular septal defect VSD
318
SIDS happens between these months
4-6months
319
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
Vasopressin
320
Calcium channel blockers are those that end in?
Beta blockers end in?
Nitrates end in?
Pine
Olol
Trate
321
hypoglycemic pediatric patient should be treated with what?
| And what dose?
25% dextrose
| 2-4ml/kg
322
refers to a small margin between an effective dose and a harmful dose.
Narrow therapeutic index
323
Drug most effective in acute congestive heart failure (CHF) because it helps to excrete the excess fluid
Furosemide
324
Size needle most appropriate for IM injections
For most IM injections on nonobese patients, a
| 21-gauge 1 to 1 1/2-inch needle is appropriate.
325
DOPE Mnemonic for intubated peds
Displacement
Obstruction
Pneumo
Equipment
