Paramedic National Test Medical Flashcards
Normal lung sounds
Bronchial- loud, high pitch, hollow. Heard over upper sternum
Bronchovesicular- soft, lower pitch. Heard over scapula and 2,3 intercostal space lateral to sternum
Vesicular- soft, low pitch. Heard in lung periphery.
Apneustic breathing pattern
Long, deep breaths that are stopped during inspirations then periods of apnea. (CNS injury or stroke)
Biot’s (ataxic)
Irregular periods of breathing or gasping with apnea
Usually due to increased ICP
Cheyne-Stokes
Increasing in rate and depth, decreasing in rate and depth with period of apnea
Neurological condition
Kussmaul’s
Rapid and deep
DKA
Right Upper Quadrant
Liver
Gall bladder
Stomach
Left upper quadrant
Spleen
Liver
Stomach
Pancreas
Right lower quadrant
Appendix
Right ovary and tube
Bladder in distended
Left lower quadrant
Left ovary and tube
Bladder if distended
Types of pain
Visceral
Somatic
Referred
Visceral
Internal organs damaged or injured
Vague, lull, aching, pressure
Somatic
Irritation of peritoneal lining.
Sharp, localized, throbbing, deep breath increases pain
Referred
Discomfort perceived in other parts of body, such as cardiac pain referred to jaw or arm.
Cullens sign
Ecchymosis around umbilicus
Bleeding in abdominal cavity
Grey turner’s
Ecchymosis in flank
Bleeding from kidneys
Hemorrhagic pancreatitis
Kehr’s sign
Referred pain to shoulder
Ectopic or spleen injury
Blood under diaphragm
Murphys sign
Right upper quadrant pain
Cholecystitis
Brudzinski’s sign
Hip sleeves when neck is flexed
Meninges irritation, meningitis
Hammans Sign
Crunching, rasping sound that correlates with heartbeat.
Heard over mediastinum
Spontaneous mediastinal emphysema, tracheobronchial trauma
Homan’s sign
Pain in calf on dorsiflexing foot while leg is straight
DVT
Kernig’s sign
Inability to straighted leg when hip is flexed 90 degrees
Meninges irritation, meningitis
Blood pressure, what is it? (Formula)
B/P= Cardiac output X Systemic vascular resistance
B/P= CO X SVR
Pulse pressure
Difference between systolic and diastolic pressure (narrows in shock and widens in increasing ICP)
Map (mean arterial pressure)
Average pressure in arteries during one cardiac cycle, good indicator of perfusion
Normal between 70-110 mmHg
Add diastolic + 1/3 of pulse pressure
HR, respiratory rate, and systolic BP for infants
100-160 bpm at birth
120 bpm after birth
Resp: 40-60 initially
20-30 by one year
BP: 70 mmHg at birth
90 mmHg at 1 year
Hr, respiration rate and systolic BP for toddlers
80-130 bpm
24-40 respiratory rate
70-100 mmHg
HR, Respiratory rate, and systolic BP for preschool
80-120 bpm
22-34 respiration rate
80-110 mmHg
HR, Respiratory Rate, and systolic BP for school age
70-110 bpm
18-30 respiratory rate
80-120 mmHg
HR, Respiratory rate, and systolic BP for adolescents
55-105 bpm
12-16 respiratory rate
11-120 mmhg
Infant ages
Birth to 1 year of age
Toddler
1-3 years of age
Preschool
3-5 years of age
School age
6-12 years of age
Adolescent
13-18 years of age
Pediatric triangle
Appearance
Work of breathing
Circulation to skin
Normal BGL
70-140 mg/dL
Troponin
Found in cardiac muscle
Most specific to cardiac muscle injury
Myoglobin
Found in striated muscle
Damaged to cardiac or skeletal muscle
Methemoglobin
Hemoglobin that is oxidized. Oxygen cannot attach
What causes methemoglobin?
Drugs such as: Amyl nitrate Benzocaine Nitrates Nitroglycerin Nitroprusside Exposure to cyanide
Symptoms of methemoglobinemia
Color change from gray to cyanosis
CNS changes
Delirium
Death
When do we use blood as a choice of fluid replacement?
Hemorrhage
Colloid
Does not leak out of blood vessel quickly
Has large particles or proteins
Examples of colloid solutions
Albumin
Hespan
Dextran
Blood plasma
Crystalloid solutions
Normal saline
Lactated ringers
5% D/W
Osmosis
Fluid movement from an area of less particle concentration to an area of greater concentration
Isotonic
Stays in blood vessels longer, field fluid replacement (NS, LR)
Hypertonic
Mor particles, fluid moves into vascular space while solution moves into cells
Example of hypertonic solution
D10
Hypotonic
Fluid moves out of vascular space into cells
5% dextrose in water, when to give it
MI
CHF
Giving drugs
KVO
Cations
Positive charged ions
Anions
Negative charged ions
Erythrocyte
Red blood cell
Hemoglobin
Red blood cells carry oxygen on hemoglobin molecule
Hematocrit
Percentage of red blood cells in whole blood, approx. 45%
Leukocytes
White blood cells
Types of white blood cells
Eosinophils (fight parasites and other infections) Neutrophils Basophils Lymptcytes Monocytes
Thrombocytes
Platelets
What do platelets do?
Promotes clotting
Type 0- blood
Can give blood to any blood type
AB+
Can receive blood from any type
Fluid replacement dosing for adult and child
20 mL/kg
Fluid replacement for a newborn
10 mL/kg
Max for fluid replacement
60 mL/kg
Complication of IV, local
Infiltration, cellulitis, phlebitis, and thrombophlebitis
Systemic complications of an IV
Air or pulmonary embolus
Catheter shear
Sepsis
PICC
Peripherally inserted central catheters
Usually in arm, but long enough to go into central circulation
What is HCO3 and what’s the normal ranges
Bicarb, 22-26
Above 26= alkalosis
Types of shock
Hypovolemic Cardiogenic Anaphylactic Neurogenic (spinal)(distributive shock) Septic (distributive shock) Obstructive
Hypovolemic shock causes and findings
Loss of volume
Increased heart rate Increased respirations Eventually decreased BP Pale/cyanotic Flat neck veins
Cardiogenic shock causes
MI
Heart failure
Etc
Cardiogenic shock findings
Increased or decreased heart rate
Possible pulmonary edema
Pale or cyanotic skin
Anaphylactic shock causes
Severe allergic reaction
Anaphylactic shock assessment findings
Increased heart rate Decreased BP Severe respiratory difficulty Wheezing Stridor Hives Vasodilation Capillary permeability Angioedema
Neurogenic shock causes
Spinal injury
Sympathetic nerve conduction interrupted
Neurogenic shock assessment findings
Decreased BP HR normal or decreased Skin dry and normal below injury (possible pale and clammy above) Vasodilation Hypothermia
Septic shock causes
Overwhelming infection, sepsis
Septic shock findings
Decreased BP Possible increased or decreased temp Pale Cyanotic or red Vasodilation Capillary permeability
Obstructive shock causes
Pulmonary embolus
Cardiac tampanode
Tension pneumothorax
Obstructive shock assessment findings
Obstruction that does not allow blood to circulate through the heart.
Chemical and physical responses to shock
- ) Baroreceptors in aortic arch and carotid sinuses sense change in BP and send message to cardiovascular centers in medulla
- antidiuetic hormone (ADH) from pituitary, increases PVR, retains water in kidneys
- Renin release by kidney to convert angiotensin 1 into angiotensin 2
(Angiotensin 2 is a potent vasoconstrictor) - Epinephrine and norepinephrine released secreted from adrenal glands
- increases systemic vascular resistance (maintains BP), stimulates aldosterone which retain sodium and water in kidneys
Pharmacodynamics
Study of biochemical and physiological effects of drugs on the body
Pharmacokinetics
What body does to drug after administered
Controlled substance act (1970)
Places drugs that are addictive into 5 schedules
Schedule 1
Abuse potential high
No recognized medical indication
Ex: heroin, LSD, mescaline, crack cocaine
Schedule 2 drugs
Cocaine, morphine, fentanyl, methadone, etc. small medical indications
Autonomic nervous system is made up of what?
Sympathetic and parasympathetic nervous system
Parasympathetic nervous system
Feed or breed
Sympathetic nervous system
Fight or flight q
Parasympathetic nervous system chemical control
Acetylcholine found in nerve synapses
Sympathetic nervous system control and chemical control
Nerve roots in lower thoracic and upper lumbar area of spine
Norepinephrine
Inotropic
Contraction
Chronotropic
Rate
Dromotropic
Velocity of conduction through electrical system of heart
Catecholamines
Dopamine
Epinephrine
Norepinephrine
Sympathomimetic or adrenergic
Stimulates the SNS (such as epi)
Enteral
Drugs given via GI tract such as orally, SL, nasogastric tube, rectally
Parenteral
All other routes besides enteral
IV bolus calculation formula
Total volume X Order dose
————————————
Total medication in vial
Grand mal seizure
Generalized seizure
Status epilepticus
Prolonged seizure over 5 min or 2 or more seizures without consciousness
Febrile seizure
Most common cause of seizures in young children, rapid spike in temp
Petit mal seizure
Occur in children, no loss of consciousness, many a day
Stare into space