NREMT Flashcards
Alpha -1 has what effect?
Vasoconstriction of arteries and veins
Alpha - 2 effect ?
Inhibits norepinephrine release, Inhibits insulin release, stimulates glucagon secretions, and inhibits my lipolysis
Beta one effect?
Increases heart rate – positive call real trophy, increase his cardiac contractility, increases myocardial conduction, and increases renin production to retain your
Beta 2 effect?
Smooth muscle relaxer that causes bronchodilation and stimulates glycogenolysis insulin secretion
Lemon pneumonic
L Look externally E Evaluate 3-3-2 M MALLAMPATI O Obstructions N Neck mobility
Normal RR
Adult
Child
Infant
12 - 20
15-30
25-30
Cheyenne stokes respirations
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
KUSSMAUL respirations
Continuous deep sign breast with a rapid rate usually greater than 40 when the body is responding to metabolicAcidosis
Normal ETC02 values range between one what and what?
35 and 45
Loud high-pitched crackling
Rails
Low pitched crackles found in the lower airway is made clear with a cough
RONCHI
Pericardium
Fibrous sac that protects the heart from other structures of the chest and contains lubricating fluid to reduce friction
Three layers of the muscular walls of the heart
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
Stroke volume range
60 to 100
Frank’s darling principal
A property of cardiac muscle; as it gets stretched more, it contracts with greater force
Atherosclerosis
Narrowing of aorta cerebral and coronary blood vesselsBy way of fatty material deposited along the inner walls of the arteries
Axis deviation can be determined
BY looking at lead one and lead
aVF
Normal
Left axis
Right axis
Extreme right
Up and Up
Up and Down
Down and Up
Down and Down
Left bundle branch block and what leads
Leads one leaves AVF and lead V6
Right by the branch block
One, a avl , V5, and v6
TRhombus
Blood clot already formed in the near artery
Embolus
Blood clot formed elsewhere in the body can travel to Coronary artery
Natural effects in the respect to myocardial infarction
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
Vasopressor of choice during acute coronary syndrome
Dopamine we use dopamine because it maintains a renal bloodflow low doses while increasing myocardial contractility
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
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
Beck triad
JVD hypotension and muffled heart tones
Biot’s respirations
Biot respirations can be described as a regular rate and depth of reading with periodic apnea
Shush Cheyenne stokes respirations
A gradual increase in respiration followed by a gradual decrease with apnea that the last of the 60 seconds
Cushing’s Triad
Ataxic respirations Low heart rate high blood pressure brainstem injury
Synchronize cardioversion for SVT in a flutter
50 to 100 J
Synchronize cardioversion for a fib
120 to 200 J
Synchronize cardioversion for unstable ventricular tachycardia with pulses
100 to 150 Jules
One cardiac cycle occurs every how many seconds
0.8
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.
Prior to puberty the hypothalamus restricts the production of this hormone
GRh
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
The follicle stimulating hormone and luteinizing hormone secrete what hormones
Estrogen
The corpus luteum is secretes what
Progesterone
Four phases of the metro cycle
follicular phase,Ovulation, the luteal phase, Menstruation
Hypermenorrhea also known as menorrhagia is what
Abnormally or excessive heavy bleeding during a period
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
Dysmenorrhea
Painful Menzies that can be so badass to interfere with their daily life
Metrorhagia
Spotting that occurs in between periods
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%
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
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
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
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
Trousseau sign
which is a carpopedal spasm induced by ischaemia through inflation of a sphygmomanometer cuff to a suprasystolic blood pressure
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.
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.
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.
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.
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.
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.
Somatic Pain
Somatic pain is similar to pleuritic pain and is described as sharp and originating from the skin, muscles, or bones.
Referred Pain
Referred pain is when the discomfort is perceived in other parts of the body.
Ascites
Excessive Swelling of the abdomen with fluid
Related to liver disease
OPQST
Onset, Provocation, Quality, Region-Radiation, Severity, and Time
SAMPLE
Signs/Symptoms, Allergies, Medications, Past Medical History, Last oral Intake, and Events leading up to the occurence.
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)
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
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
Order of Trauma Assessment
IPAP
Inspect, Palpate, Auscultate, Percuss
.Glascow Coma Scale
Highest is 15
Eyes - 4
Verbal - 5
Motor - 6
Decorticate
elbows, wrists, and fingers, flexed, stiffened legs, and feet. OUTWARDLY
Decerebrate (worse)
stiffened and INTERNALLY rotated elbows, and legs, teeth clenched, legs stiff and feet extended.
Babinski Response
Big toe moves upward and other toes fan out when stroking bottom of foot, mean CNS Problem.
Term for Dialated Pupils
and Occurrences
Mydriasis
Cardiac Arrest, shock, cerebral hypoxia, cocaine, epi, amphetamines.
Term for Constricted Pupils
and Occurrences
Miosis
Narcotics, central nervous system disorder, glaucoma meds, bright light
Term for Unequal Pupils
and Occurrences
Brain injury, brain tumor, stroke, artificial eye, eye meds, or can be normal (called anisocoria)
Rapid eye movement term
Nystagmus
Rales/Crackles
Fluid in small airways-alveoli
Found in CHF, Pulmonary edema, drowning, pneumonia, COPD
Rhonchi
Mucus or fluid in the larger airways - Bronchioles
Found in Bronchitis, COPD, pnuemonia
Wheezing
Whistling sound due bronchoconstriction or marrowing of the terminal bronchioles due to edema ( swelling)
Vesicular
Soft, low pitch
heard in lung periphery
Apneustic Breathing
Long, deep breathes that are stopped during inspirations then periods of apnea.
found in CNS injury or stroke
Biots (ataxic)
Irregular periods of breathing or gasping with apnea
Usually due to increased ICP
Cheyne-Stokes
Increasing in rate and depth, decreasingg, in rate and depth with period of apnea
Neurological condition
Hyperressonant Percussion
Air - snare drum Hollow
tension pneumothorax, emphysema, asthma
Hyporessonant Percussion
Dull - Watery
Abdominal Quadrant Right Upper Quadrant (RUQ)
Liver
Gall Bladder
Stomach
Abdominal Quadrant Left Upper Quadrant (LUQ)
Liver
Spleen
Stomach
Pancreas
Abdominal Quadrant Right Lower Quadrant (RLQ)
Appendix
Right Ovary and FallTube
Bladder
Abdominal Quadrant Left Lower Quadrant (LLQ)
Left Ovary and Tube
Bladder
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
Somatic Pain
irritation, of peritoneal lining, sharp, localized, throbbing, deep breathe increases pain
Referred Pain
discomfort perceived in other parts of the body such as cardiac pain referred to jaw or arm
Cullens Sign
Ecchymosis (bruising) around umbilicus
Bleeding in the abdominal cavity
Grey Turner Sign
Ecchymosis (bruising) in the flank
Bleeding from kidneys, hemorrhagic pancreatitis
Kehrs Sign
Referred pain to shoulder
Ectopic or spleen injury, blood under diaphragm
Murphys Sign
Right Upper quadrant pain
Cholecystitis (inflammation of the gall bladder gal stones)
Brudzinkis Sign
Hip flexes when neck is flexed
Meningeal irritation, meningitis
Hamman’s Sign
Crunching, rasping sound that correlates with heart beat. heard over mediastinum.
spontaneous mediastinal emphysema
tracheobronchial trauma
Hormans Sign
pain incalf on dorsiflexing foot while leg is straight
meningeal irritation, meningitis
Clubbing of the fingers sign
flattening of the nail angle; Sign of chronic hypoxia - COPD
Measure Blood Pressure Formula
Cardiac Output X Systemic Vascular Resistance
Pulse PRessure
Difference between systolic and diastolic
NARROWS in shock
WIDENS in increased ICP
Orthostatic Vital Signs
positive Tilt
Decrease in Systolic BP 20mm
Increase Diastolic BP 10mm
Increase Heart Rate HR of 200
suggests Hypovolemia - Dehyadration
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)
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
Pediatric Assessment Triangle
APPEARANCE - muscle tone, speech/cry, eye contact
WORK OF BREATHING - airway sounds, positions
CIRCULATION OF SKIN - pallor, mottling, cyanosis
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
Cerebral Palsy
group of chronic disorders, damage motor centers in brain in children; abnormal muscle spasms, hearing and vision problems, seizures
BGL normal measures
70 - 140mg/dl
Why is it difficult to judge Sp02 with sickle sell PTS
Anemia/blood disorders have inherent hemogloban issues.
Osmosis
Fluid movement from an area of less concentration to an area of greater concentration
Isotonic
stays in hlood vessels longer, field fluid replacement
Normal Saline and Lactated Ringers
Hypertonic
more particles, fluid moves in vascular space,
10% Dextrose
Hypotonic
1/2 NS
5% Dextrose in Water
Not used for fluid replacement
MI, CHF, giving drugs, KVO
Calcium chloride magnesium potassium sodium
calcemia chloremia magnesemia kalemia natremia
Hematocrit
%of red blood cells in the whole body - approx 45%
White blood cells - Leukocytes
fight infection
Platelets/Thrombocytes
promote clotting
ABO bloodtyping
O negative Universal Donor
AB+ Universal Recipient
GTTS Formula
C
Fluid Challenge
Infusion Rate Over Time
T
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
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.
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.
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
RE: Shock…Adrenal glands secrete what?
Epinepherine and norepiniephrine to increase SVR (maintains BP) and stimulates aldosterone which retains sodium and water in kidneys
Hypovolemia
Causes and Assessment Findings
Cause
Loss of blood or fluids
Findings Increased HR Increased Resp Low BP Pale or Cyanotic Flat veins
Cardiogenic
Cause Myocardial Infarctions (paricularly Left Ventricular HF or other cardiac issue)
Findings
Increased or Decresead HR
Pulmonary edema
Pale or Cyanotic
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)
Neurogenic Shock
Causes
Spinal Injury - Sympathetic Nerve conduction interrupted
Findings Decreased BP Normal or Decreased HR Vasodilation hypothermia
Septic Shock
Overwhelming Infection
Decreased BP
High Temp/Fever
Vasodilation
Treatment
Airway, O2, fluids,
Dopamine - 5 - 20mcg/kg/min for hypotension or shock
Obstructive Shock
Causes
Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax