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Bachelor of Paramedic Science > PME2 Signs, Symptoms and Treatments > Flashcards

PME2 Signs, Symptoms and Treatments Flashcards

1
Q

2 or more of the following dictates prehospital notification for meningococcal disease

A
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2
Q

3 physiologic types of somatic sensations

A

mechanoreceptive somatic senses

thermoreceptive senses
(heat and cold)

pain senses
(painful stimuli)

(tactile and mechanical displacement)

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3
Q

What are the AAA clinical features?

A

ALOC
shoulder tip pain
myocardial infarction
hypotension
asymmetrical/absent distal pulses
abdo pain
palpable mass
ecchymosis (bruising around flank)
limb ischaemia

shock
(hypovolaemic)

(quality and location varies)

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4
Q

Where does Abdominal Aortic Dissection Occur

A

in the suprarenal abdominal aorta or the infrarenal aorta

most common in the infrarenal aorta

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5
Q

Acute Lower GI Bleed Management

A

IV fluids challenge

Oxygen as a supportive measure

Treat symptomatically

Transport to hospital

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6
Q

Acute Lower GI Bleed Clinical Features

A

Lightheaded

Fatigue

Anaemia

Pain +-

Mild to moderate hypovolaemia

SOB on exertion

Haematochezia

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7
Q

Acute Pancreatitis Management

A

Pain management

Antiemetic
(ondansetron)

IV fluids
(could be shocked or dehydrated)

Oxygen?
(acute respiratory failure)

Treat symptomatically

Transport to hospital

(methoxy , morphine or if contraindicated use fentanyl)

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8
Q

Acute Pericarditis Clinical Features

A

fever

sharp chest pain worsened by lying down, expiration and cough

referred pain to trapezial ridge

dyspnoea

pericardial rub
(listen with stethoscope)

perciardial effusion

ECG changes
(global concave STE and PR depression, sinus tachy​)

cardiac tamponade
(sinus tachy, low QRS voltage, electrical alternatives)

(bacterial or viral)

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9
Q

Acute Pericarditis Management

A

pain management

treat symptomatically
(oxygen etc)

cardiac tamponade??

Transport to hospital

(2/10 - panadol, higher consider opiates)

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10
Q

What is Acute Pulmonary Embolism

A

obstruction within pulmonary artery from thrombus (venous thromboembolsm), air emboli or fat

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11
Q

Acute Pulmonary Embolism Locations

A

Saddle of pulmonary trunk bifurcation

Lobar artery

Segmental artery

Subsegmental

Clot “in-transit”

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12
Q

Addison Disease Management and Treatment

A

treat symptomatically

Consider IV fluids to assist with hypotension and/or shock

Consider hydrocortisone (provides endocrine hormonal requirements)

Glucagon/oral glucose/glucose 10%

Salbutamol

Calcium gluconate (CCP)

Sodium bicarbonate (CCP)

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13
Q

Addison Disease Signs and Symptons

A

Skin hyperpigmentation

Hypotension (postural initially)
– Weakness
– Worsening fatigue
– Dizziness
- Crave salts

ECG – tachycardia, peaked t-waves
(& broadening QRS and 1st degree block)

Hypoglycaemia

Nausea and vomiting

Diarrhoea

Sudden pain in lower back/abdo/legs

(knees, elbows, knuckles, joints)

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14
Q

Additional Appendicitis Clinical Features in Children

A

abdominal distension

diarrhoea

difficulty walking

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15
Q

Anaphylaxis Management

A

Remove allergen if present

DO NOT WALK Patient

Appropriate posturing
(supine, legs elevated or semi recumbent)

IM adrenaline ASAP

Hypotensive? 1-2L IV fluids - Sodium Chloride 0.9%
(if hypotension doesn’t respond promptly to adrenaline within minutes)

IV Access - bilateral 16 gauge

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16
Q

Aortic Dissection and Aneurysm Management

A

Pain Management
(not hypotensive - opiate - morphine/fentanyl)
(unstable - fentanyl max 25 microg IV or 50 microg IM)

Hypotensive and Shocked
(CCP backup ASAP, IV fluids to maintain BP)

Treat Symptomatically
(nausea - ondans)
(shock - high flow oxygen)

Transport as Appropriate

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17
Q

Aortic Dissection Clinical Triad

A

sudden onset of thoracic or abdominal pain

pulse variation
(absence of aproximal extremity or carotid and/or20mmHg difference in BP between Rand L arm)

mediastinal and/or aortic widening onchest radiograph

(sharp, tearing or ripping)

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18
Q

Aortic Dissection Clinical Features

A

ALOC

stroke

shoulder tip pain

chest or back pain (sharp/knife-likeor ripping/tearing)

ecg changes

hypotension/hypertension

pulse deficit

difference in bp

abdo, flank, back pain

limb paresthesia

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19
Q

Appendicitis Clinical Features

A

pain to periumbilical region followed by RLQ

rebound tenderness

positive rovsing sign

positive psoas sign

involuntary guarding

nausea/vomiting

anorexia

mild fever

tachycardia

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20
Q

Appendicitis Management

A

Pain management

Antiemetic

IV Fluids

Treat symptomatically

Transport

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21
Q

Are sepsis signs and symptoms the same as shock?

A

yes

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22
Q

Aspiration pneumonia Tx

A

Oxygenation

Paracetamol

Salbutamol if wheezes present

Antiemetic

Transport

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23
Q

Asthma Respiratory Assessment - Breath Sounds

A

Mild/Moderate - expiratory wheeze

Severe - expiratory wheeze, inspiratory wheeze

Life Threatening - expiratory wheeze, inspiratory wheeze

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24
Q

Asthma Respiratory Assessment - Conscious State

A

Mild/Moderate - alert

Severe - altered

Life Threatening - altered or unconscious

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25
Q

Asthma Respiratory Assessment - General Appearance

A

Mild/Moderate - mildly anxious

Severe - distressed, agitated

Life Threatening - exhausted, catatonic

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26
Q

Asthma Respiratory Assessment - O2 Saturation

A

Mild/Moderate - 90-94%

Severe - <90%

Life Threatening - <88%

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27
Q

Asthma Respiratory Assessment - Pulse Rate

A

Mild/Moderate - <110bpm

Severe - >110bpm

Life Threatening - hypotension/bradycardia, arrhythmia

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28
Q

Asthma Respiratory Assessment - Skin

A

Mild/Moderate - pale

Severe - pale, sweating

Life Threatening - pale, sweating, cyanosis

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29
Q

Asthma Respiratory Assessment - Speech

A

Mild/Moderate - sentances

Severe - words

Life Threatening - unable to speak

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30
Q

Asthma Respiratory Assessment - Ventilatory Effort

A

Mild/Moderate - accessory muscle use

Severe - accessory muscle use, intercostal retraction, tracheal tugging

Life Threatening - poor respiratory effort, respiratory exhaustion

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31
Q

Asthma Respiratory Assessment - Ventilatory Rate

A

Mild/Moderate - <25

Severe - pale, >25

Life Threatening - silent

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32
Q

Asthma Respiratory Assessment - Ventilatory Rhythm

A

Mild - slightly prolonged expiratory phase

Severe - marked prolonged expiratory phase

Life Threatening - marked prolonged expiratory phase, no expiratory pause

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33
Q

Asthmatic Arrest Management

A

standard cardiac arrest management:

CPR and defib as required

early back up notification

advanced airway (LMA/Igel) (adults: 6-8 vents/min) (paeds: 8-15 vents/min)

IV access and adrenaline every 3-5 mins

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34
Q

Autonomic Dysreflexia Description

A

massive stimulation of the sympathetic nervous sytem in Pts with cord lesion at T6 or above

50-70% of spinal cord injury Pts will develop symptoms of AD

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35
Q

Autonomic Dysreflexia Signs and Symptoms

A

headache (worsens as BP rises)

blurred vision

profuse sweating above the level of injury

flushing of skin above the level of injury

hypertension

bradycardia

if left untreated, intracranial haemorrhage is possible

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36
Q

Bacterial Pharyngitis and Tonsillitis Possible Complications

A

Acute rheumatic fever

Acute glumerulonephritis

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37
Q

Bacterial Pharyngitis and Tonsillitis Symptoms

A

Myalgia

fever and chills

headache

sudden onset of sore throat

painful swallowing

Obvious reddening of tonsils

Tonsillar exudate

Uvular oedema

Enlarged, painful anterior cervical lymph nodes

nausea/vomiting

Generally no rhinorrhea and cough

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38
Q

Bacterial Pharyngitis and Tonsillitis Tx

A

Treat symptomatically

fever & pain - paracetamol

dehydrated - 0.9% sodium chloride

nausea - ondansetron

Transport for further care or consider GPappointment

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39
Q

Blood Clot haematochezia origin

A

anywhere

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40
Q

What blood pressure characteristics define haemodynamically unstable acute pulmonary embolism?

A

SBP <90 mmHg or a drop of >40 mmHg over 15 minutes

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41
Q

Bowel Obstruction Management

A

IV fluids

antiemetic

antipyretic
(paracetamol - may do nothing due to malabsorption - probably shouldn’t be used as will likely be a complete obstruction, and associated with ischemia and necrosis)

transport

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42
Q

Bright red haematochezia origin

A

distal end of transverse colon and descending colon

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43
Q

Can HHS be the first presentation of type 2 diabetes?

A

yes

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44
Q

What is Cardiogenic Shock

A

intracardiac causes leading to decreased cardiac output and systemic hypoperfusion

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45
Q

Categories of lower GI bleed

A

Anatomic

Vascular
(ischaemic, enlargement of GI tract blood vessel, haemorrhoids)

Inflammatory
(ulcerative colitis, crohn’s disease)

Neoplastic
(abnormal cell growth, mole polyps, cancer)

Following interventions
(surgery)

(diverticulitis)

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46
Q

Cause of aspiration pneumonia

A

aspirated/loss of airway patency

something harmful to airways, eg gastric reflux or lower airway issues

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47
Q

Cause of Cardiac Syncope

A

cardiomyopathy

AMI

tachy/bradyarrhythias

PE

aortic dissection

(generally don’t have prodrome)

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48
Q

Cause of central vertigo

A

cerebellar haemorrhage

cerebellar infarct

multiple sclerosis

migraine related dizziness and vertigo

post-traumatic vertigo

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49
Q

Cause of Medication Syncope

A

Nitrates

alcohol
(vasodilator)

beta-blockers
(chronotropic effects - HR can’t compensate for BP change)

diuretics

(eg GTN)

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50
Q

Cause of Neurally Mediated Syncope

A

vasovagal

carotid sinus syndrome

coughing

omiting

defecation

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51
Q

Cause of Orthostatic Syncope

A

drop of 20 mmHG SBP or 10 mmHG DBP from:

dehydration

vasodilation

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52
Q

Cause of Peripheral Vertigo

A

benign paroxysmal positional vertigo (BPPV)

acute labyrinthitis

vestibular neuritis

8th nerve lesions

meniere disease

alcohol

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53
Q

Causes of Addison Disease

A

Adrenal haemorrhage

Autoimmune destruction of the adrenal cortex

Infection – tuberculosis/fungal/HIV

Infiltrative – Amyloidosis/metastatic carcinoma

Sudden reduction/ceasing steroid medication

Trauma/surgery

(secondary to warfarin or antiplatelet drugs)

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54
Q

Causes of DKA - the 6 I’s of DKA

A

infection

infarction

insulin

illegal drugs
(includes alcohol)

infant pregnancy

idiopathic

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55
Q

Causes of Hyperkalaemia

A

Acidosis

Diet

Dialysis

IV therapy

Lysis

Renal failure

(H outside goes inside cna displaces K)

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56
Q

Causes of Hypokalaemia

A

extreme sweating

diuretic use

low food intake (extreme fasting - anorexia/bulemia)

vomiting/diarrhoea

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57
Q

Causes of Hypoxia

A

FIO2
fractured inspired oxygen
(everest/house fire)

Hypoventilation

V/Q mismatch in the form of shunt
(portion of lung shut down)

VQ mismatch in the form of dead space
(muccous plug)

Diffusion
(pneumonia)

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58
Q

Causes of meningitis

A

viral

bacterial
(mongrel bacteria)

fungal
(rare - usually immunocompromised)

spinal
(rare - infection from spine)

(most common)

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59
Q

Causes of Pancreatitis

A

Alcohol

Gallstone

Idiopathic

Morbid obesity

Smoking

Type 2 diabetic

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60
Q

Causes of Pericardial Effusion

A

Aortic Dissection

Acute Pericarditis

Chest trauma
(sharp or blunt - MVA, horse kick to chest)

Post Cardiac Surgery
(small tear creating slow bleed)

Renal failure with uremia
(urea and protein not being filtered out and creating a cascade of issues)

(ascending aorta)

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61
Q

Causes of Pericarditis

A

dissecting aneurysm

idiopathic

infectious
(viral, bacterial, fungal etc)

myocardial infarction
(post recovery)

metabolic
(uraemia, myxoedema, cholesterol pericarditis)

malignancy

trauma
(coranary intervention)

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62
Q

Classifications of Pancreatitis

A

Mild acute pancreatitis - absence of organ failure - no cytokine storm or inflammation

Moderately acute Pancreatitis - transient organ failure for up to 48 hrs

Severe acute pancreatitis - persistant organ failure for longer than 48 hours, cytokine cascade and can lead to organ failure

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63
Q

Clinical features of mild to moderate hypovolaemia

A

15% blood loss - tachycardia, orthostatic hypotension, pale, diaphoretic

40% volume loss - hypertensive and tachy in supine position, pale, diaphoretic

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64
Q

Clinical features of nephrolithiasis

A

nausea and vomiting

flank pain (moving anteriorly to abdo or inginual region)

dysuria and urgency

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65
Q

Clinical features of ruptured varices

A

generally pain free

Hx liver disease

haematemesis

ascites

melena

haemotogesia (PR) beed

possible hypovolemia

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66
Q

Cluster Headache Symptoms

A

Severere unilateral orbital, supraorbital or temporal pain

Ipsilateral (same side as pain) signs of:

eye redness

drooping eyelid

lacrimation

blocked or runny nose

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67
Q

Cluster Type Headaches Description

A

disfunction of trigeminal nerve

Lasts 15-180 minutes

clusters on daily basis for several weeks

remission from weeks to years

triggered by vasodilators (eg alcohol)

men more frequently affected

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68
Q

Cluster Type Headaches Management

A

High flow oxygen (for up to 15 minutes) is effective in up to 70% of patients

Paracetamol and Narcotics

Tx based on individual presentation

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69
Q

Colours of haematochezia

A

bright red

maroon

blood clots

malaena - dark, tarry, sticky

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70
Q

Common Causes of Anaphylaxis

A

Food

Insect stings

Medications
(Antibiotics, anaesthetic drugs, NSAID’s, opiates)

(Peanuts, tree nuts, hen’s eggs, cow’s milk, wheat, seafood, seeds)

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71
Q

Common causes of upper GI bleed

A

Mass Lesions (polyps/cancer)

Oesophagealvarices

Peptic ulcers

Portal hypertension gastropathy

Severe gastritis

Severe oesophagitis

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72
Q

Common Cold and Influenza Tx

A

PPE

Treat symptomatically

Paracetamol?

IV fluids

SARS?????

Transport to hospital or refer to GP depending on Hx & Pt presentation

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73
Q

Common types of infection that cause sepsis

A

Respiratory

Abdo
(Pain, tenderness, nausea and vomiting eg pancreatitis, colicsystitis, colelithiasis)

UTI
(Frequency, Offensive odour, burning, FWT/white ccell test in hospital)

(Cough, Decreased AE, Course crackles,)

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74
Q

Complete Cord Injury

A

full disruption of spinal tracts

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75
Q

Cord Contusion

A

bruising of cord - leads to temoral loss of cord mediated functions

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76
Q

Cord Laceration

A

tearing of neural tissue

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77
Q

Cord Transection

A

severing of full cord - permanent loss

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78
Q

Deep Vein Thrombosis (DVT) of the Lower Limb

A

a blood lot (thrombus) develops in a deep vein in the leg

not all Pts symptomatic - will become symptomatic if it dislodges

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79
Q

Describe the Pericardium

A

fibrous

tough, dense connective tissue

protects heart and prevents overfilling

outer wall of heart

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80
Q

Diagnostic Criteria for Acute Pericarditis

A

must have 2 or more of:

pericarditic chest pain

pericardial rub

new widespread STE or PR Depression in ECG

pericardial effusion
(new or worsening)

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81
Q

Diagnostic criteria for anaphylaxis after exposure to a likely allergen

A

2 or more of:

sudden skin or mucosal symptoms
(generalised hives, itching, flushing, swollen lips/tongue/uvula)

sudden respiratory symptoms
(SOB, wheeze, cough, stridor, hypoxemia)

sudden hypotension or end-organ dysfunction symptoms
(hypotonia, incontinence)

sudden GI symptoms
(crampy abdo pain)

Or;

low SBP or >30% decrease in baseline BP

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82
Q

Diagnostic criteria for anaphylaxis when unknown

A

sudden onset of illness

involvement of skin, mucosal tissue or both
(generalised hives, itching, flushing, swollen lips/tongue/uvula)

and 1 of:

sudden respiratory symptoms
(SOB, wheeze, cough, stridor, hypoxemia)

sudden hypotension or end-organ dysfunction symptoms
(hypotonia, incontinence)

OR

reduced BP

(mins to hours)

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83
Q

DKA Management

A

large bore IV access

Sodium 0.9%

ECG pads

have adrenalin ready

CCP backup

transport

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84
Q

DKA vs HHS

A
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85
Q

Does Hyperosmolar Hyperglycaemic Syndrome (HHS) affect Type a or Type 2 diabetics?

A

Type 2

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86
Q

Does metabolic acidosis have an increased or decreased respiratory rate

A

increased

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87
Q

Does metabolic alkalosis have and increased or decreased respiratory rate

A

decreased

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88
Q

DVT Management

A

minimise movement

careful when palpating

pain management
(paracetamol)

transport for imaging

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89
Q

DVT Potential Differentials

A

Arthritis

Chronic Leg Oedema

Cellulitis

Postoperative swelling

Ruptured Baker Cyst

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90
Q

ECG Changes in DKA

A

prolonged PR interval

ectopic QRS

Prolonged QRS

peaked T wave

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91
Q

ECG Changes in Hyperkalaemia

A

wide, flat P wave

prolonged pr interval

decreased R wave amplitude

widened QRS

ST depression

tall, peaked T waves

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92
Q

ECG Changes in Hypokalaemia

A

formation of prominent U wave - usually bigger than T wave

T wave can flatten and become inverted
(normal biphasic T is up first - abnormal is down first)

prolonged QT interval

ectopics on back of T wave means more likely to go into VT

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93
Q

ECG Changes in Pulmonary Embolism

A

Sinus tachycardia (44% of Pts)

Complete or incomplete RBBB (18%)

Right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). Associated with high pulmonary artery pressures (34%)

Right axis deviation (16%). Extreme right axis deviation may occur, with axis between zero and -90 degrees, giving the appearance of left axis deviation (“pseudo left axis”)

Dominant R wave in V1 – a manifestation of acute right ventricular dilatation

Right atrial enlargement (P pulmonale) – peaked P wave in lead II > 2.5 mm in height (9%)

SI QIII TIII pattern – deep S wave in lead I, Q wave in III, inverted T wave in III (20%). This “classic” finding is neither sensitive nor specific for PE

Clockwise rotation – shift of the R/S transition point towards V6 with a persistent S wave in V6 (“pulmonary disease pattern”), implying rotation of the heart due to right ventricular dilatation

Atrial tachyarrhythmias – AF, flutter, atrial tachycardia (8%)

Non-specific ST segment and T wave changes, including ST elevation and depression (50%)

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94
Q

ECG Changes Stage 1 Pericarditis

A

global STE and PR depression with reciprocal changes in aVR (first two weeks)

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95
Q

ECG Changes Stage 2 Pericarditis

A

normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)

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96
Q

ECG Changes Stage 3 Pericarditis

A

flattened T waves become inverted (3 to several weeks)

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97
Q

ECG Changes Stage 4 Pericarditis

A

ECG returns to normal (several weeks onwards)

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98
Q

ECG Findings in Large Pericardial Effusion (by default cardiac tamponade)

A

Tachycardia

Low voltage in precordia leads - <5ml precordial leads and <10ml limb leads (low QRS voltage)

Electrical alternates - heart moves backwards and forwards - taller, smaller, taller, smaller QRS complexes

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99
Q

Function of Bile Salts

A

derivative of cholesterol - emulsifies fats (makes nice, smooth and more soluble) and dissolve in bile

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100
Q

Function of gall bladder

A

stores bile used for fat digestion, absorption of fatty acids, fat soluble vitamins and phospholipids

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101
Q

Grades of Pericardial Effusion

A

small = 50-100 mL

moderate = 100 - 500 mL

larger = >500 mL

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102
Q

Haematuria Management

A

Treat symptomatically

Transport to hospital

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103
Q

HHS Management

A

Sodium 0.9%

Manage airway
(Oxygen BVM)

Adrenalin

Treat symptomatically

Assess ECG for:

  • Hypokalaemia
  • Ectopics
  • R on T (big wobbly R that hits back of T)
  • Prearrest rhythms

Transport

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104
Q

HHS Patient Presentation

A

General appearance: generally ill-appearing with altered mental status

Cardiovascular: Tachycardia, orthostatic hypotension, weak and thready pulses

Respiratory Rate: Can be normal, tachypnoea might be present if acidosis is profound

Skin: Delayed capillary refill, poor skin turgor, skin tenting might not be present even in severe dehydration because of obesity

Genitourinary: Increased urine output

CNS: Focal neurological deficit, lethargy with low GCS may be comatose if severe

BGL: >33.3mmol

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105
Q

How do NSAIDs cause peptic ulcers?

A

inhibit prostaglandins

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106
Q

How does meningococcal disease spread?

A

respiratory and throat secretions

enter via upper airway

invade the meninges, blood or lungs (singularly or at same time)

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107
Q

How does Helicobacter pylori (H.pylori) cause peptic ulcers?

A

bacteria attaches to the gastric area causing release of uriase creating ammonia which releases phospholipase affecting surface tension, acid secretions then affect cells

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108
Q

How is pepsin formed

A

pepsinogen is converted to pesin by propeptide

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109
Q

How many mLs of urine are in the bladder when you need to urinate?

A

250-300mL

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110
Q

How much primary urine is produced per day?

A

170L

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111
Q

How much urine does the male bladder hold?

A

700mL

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112
Q

How much urine is produced per day?

A

1.7L

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113
Q

How much urine does the female bladder hold?

A

500mL

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114
Q

Hyperkalaemia Effect on Cardiovascular System

A

Peaked T wave

Ectopics

Heart block

Broad QRS

Bradycardia

Cardiac arrest

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115
Q

Hyperkalaemia Effect on Gastrointestinal System

A

Nausea & Vomiting

Colicky pain

Diarrhoea

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116
Q

Hyperkalaemia Effect on Kidneys

A

kidney damage

oliguria

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117
Q

Hyperkalaemia Effect on Nervous System

A

Anxiety

Numbness

Tingling

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118
Q

Hyperkalaemia Effect on Skeletal and Smooth Muscle

A

Early: hyperactive muscles

Late: weakness & flaccid paralysis

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119
Q

Hyperkalaemia Manifestations

A

Skeletal muscle cramping leading to weakness/paralysis

Smooth muscle weakness

Cardiac arrhythmias

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120
Q

Hypokalaemia Cardiovascular Clinical Manifestations

A

Arrhythmias

ECG changes (development of U wave)

Cardiac Arrest

Weak irregular pulse

Postural hypotension

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121
Q

Hypokalaemia Gastrointestinal Clinical Manifestations

A

Nausea & Vomiting

Decreased motility
(peristalsis/constipation)

Distension

Decreased bowel sounds

Ileus
(temporary lack of normal intestinal muscle contractions)

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122
Q

Hypokalaemia Renal (kidneys) Clinical Manifestations

A

Water loss

Thirst

Inability to concentrate urine

Kidney damage

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123
Q

Hypokalaemia Managment

A

Treat symptomatically

Transport

IV replacement

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124
Q

Hypokalaemia Nervous System Clinical Manifestations

A

Lethargy

Fatigue

Confusion

Depression/delium

Paraesthesia
(Tingling or prickling, “pins-and-needles” sensation in arms, hands, legs or feet)

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125
Q

Hypokalaemia Skeletal and Smooth Muscle Clinical Manifestations

A

Weakness

Flaccid paralysis
(weakness or paralysis and reduced muscle tone without other obvious cause)

Respiratory arrest

Constipation

Bladder dysfunction

Cramps

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126
Q

Incomplete Cord Injury

A

some tracts still in tact - may recover

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127
Q

Where does an infrarenal AAA originate?

A

distal to the renal arteries

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128
Q

Is ETC02 high or low in hyperventilation?

A

low as it is not being cleared

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129
Q

Is ETC02 high or low in hypoventilation?

A

high as it is not being cleared

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130
Q

Is MODS a process or event?

A

process

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131
Q

Where does a juxtarenal AAA originate?

A

just beyond the origins of the renal arteries

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132
Q

Large Bowel Obstruction Abdo Pain Clinical Features

A

waves of periumbilical cramping every 20 mins

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133
Q

What is the life-threatening asthma management?

A

oxygen (aim for 90%+)
IPPV with PEEP
salbutamol
ipratropium bromide
hydrocortisone
adrenaline
magnesium sulphate (CCP only)
CPAP (CPP only)
CCP backup ASAP
reassess
transport

(higher sats than normal)

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134
Q

Features of Gall Stone Pain

A

RUQ - tender on palpation

may radiate to back and right shoulder

intense pain lasting at least 30 minutes reaching plataeu within hour

resolve within 6 hours

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135
Q

Low aldosterone can lead to…

A

Hyperkalaemia

Hyponatremia

Decreased blood volume

Increased Protons/High H+ (Metabolic Acidosis)

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136
Q

Main Aetiologies of Autonomic Dysreflexia

A

Urological: distended bladder, UTI

Gastrointestinal: acute abdo, rectal distension

Musculoskeletal: fractures, dislocations

Others: pregnancy or skin problems such as infections, ulceration

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137
Q

Major causes of haematuria

A

Benign Prostatic Hyperplasia

Chronic Kidney Disease

Cystitis

Prostatitis

UTI’s

Renal Calculi

Trauma

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138
Q

Malaena haematochezia origin

A

more associated with upper GI bleed - can still happen sometimes with lower bleed

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139
Q

Management of Autonomic Dysreflexia

A

Management focuses on removal of the noxious stimuli. Check for kinked catheter for example

Sit patient upright with legs dependant where possible

Loosen clothing

Consider GTN if indicated

Consider Morphine or Fentanyl if indicated

Transport to hospital

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140
Q

Management of Cardiac Tamponade and Pericardial Effusion

A

Pain management

IV Fluids
(to maintain radial pulse - shock = tachy, hypotensive, poorly perfused, diaphoretic)

Treat symptomatically
(eg ondansetron for nausea etc)

Prepare for resus
(manage for cardiac arrest in PEA setting)

Transport to Hospital
(must be transported as will need pericardial centesis)

(be mindful of haemostability - morphine if stable, fentanyl if not)

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141
Q

Management of Cholelithiasis

A

Pain management

Antiemetic

IV Fluids
(250 - 500 mLs)

Antipyretic
(paracetamol, will also assist with pain)

Transport

(ibuprofen - 400mg - minimise morphine as opiates affect sphincter of oddi, increasing its pressure and worsening pain)

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142
Q

Management of Hyperkalaemia

A

IV access

Sodium chloride 0.9%

CCP backup for:
Calcium gluconate
Sodium bicarbonate 8.4%
Nebulised Salbutamol

Transport

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143
Q

Management of Meningococcal Disease

A

PPE

Consider Antiemetics

IV Fluids to Maintain a Radial Pulse
(meningococcal septicaemia pts will be severely hypotensive)

If Rash Present, Administer Ceftriaxone

Consider Analgesia/antipyretic

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144
Q

Management of Shock

A

depends on cause…

IV Fluids ???

Positioning
(lift feet, lower head)

Oxygen
(don’t rely on pulse oximeter as oxygen increases o2 in plasma and haemaglobin)

Treat the cause
(good Hx to ascertain type of shock and treat - particularly if anaphylactic)

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145
Q

Maroon haematochezia origin

A

proximal end of transverse colon or descending colon

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146
Q

Mean Arterial Pressure (MAP) Calculation

A

MAP = ((2 x DBP) + SBP) / 3

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147
Q

Mechanisms of Kidney Filtration

A

Intrinsic control (renalautoregulation)

Extrinsic control

148
Q

Meningism

A

headache

photophobia

neck stiffness

often with nausea and vomiting

149
Q

Meningococcal Septicaemia results in…

A

Intravascular Thrombosis

Increased Vascular Permeability

Vasoconstriction and Vasodilation

Myocardial Dysfunction

Other such as Renal Impairment

Pulmonary Issues

150
Q

Migraine Aura

A

Develops over minutes, lasts 1 hr or so, fully reversible

151
Q

Migraine Description

A

typically unilateral and pulsating headeach that worsens with physical activity

152
Q

Migraine Management

A

Consider analgesia (morphine/fentanyl)

Consider antiemetic (ondansetron)

Consider IV fluids (Sodium Chloride 0.9%)

Transport as appropriate

153
Q

4 phases of migraines

A

prodrome

aura

migraine

postdrome

154
Q

Migraine Postdrome

A

Feeling of being drained or energetic for up to 24hrs

155
Q

Migraine Prodrome

A

Warning symptoms up to 24 hrs prior to migraine

156
Q

Migraine prodrome symptoms

A

neuro changes (clumsy, lethargic, yawning, difficulty finding right words)

changes in behaviour (obsessional, hyperactive, lethargic)

changes in mood

gut symptoms

157
Q

Migraine Triggers

A

food - cheese, chocolate

blow to head

barometric pressure changes

hormones

158
Q

What is the moderate asthma management?

A

oxygen
salbutamol
ipratropium bromide (if unresponsive to first salbutamol neb)
hydrocortisone
reassess
transport

(aim for 92%+)

159
Q

What is the Modified Centor Criteria for Bacterial Pharyngitis

A

Helps predict the probability of streptococcal pharyngitis

160
Q

Near Syncope

A

light headedness and impending loss of consciousness

161
Q

Forms of Nephrolithiasis Formation

A

Calcium oxalate

Calcium phosphate

Cystine crystals

Magnesium ammonium phosphate crystals

Uric acid

162
Q

Nephrolithiasis Management

A

Pain management

Potential IV fluids

Transport to hospital

(paracetamol/ibuprofen/morphine/midaz etc)

163
Q

Obstructive Shock

A

extracardiac causes leading to a decrease in the left ventricular cardiac output

164
Q

Order of septicemia, sepsis and septic shock

A

septicemia

sepsis

septic shock

165
Q

Organ Systems Affected by Hyperkalaemia

A

skeletal and smooth muscles

nervous

cardiovascular

gastrointestinal

kidneys

166
Q

Where does the Pararenal AAA Originate?

A

the renal arteries

167
Q

Causes of Bowel Obstruction

A

Functional obstruction

Mechanical obstruction
(extrinsic or intrinsic or luminal defect)

Non-strangulating or strangulating
(strangling leads to poor perfusion ad necrosis)

(peristalsis/intestinal motility)

168
Q

Peptic Ulcer Management

A

pain management

IV fluids

antiemetic such as metoclopramide

oxygen as required

transport

169
Q

What is Percicardial Effusion

A

too much fluid in pericardial cavity

170
Q

Peritonsillar abscess signs and symptoms

A

Appearing ill

Fever

Drooling

Trismus

Sore throat
(generally unilateral)

Muffled voice
(hot potato)

Dysphagia

171
Q

Peritonsillar abscess Tx

A

Treat symptomatically

Transport to Hospital

172
Q

Peritonsillar abscess on examination of the oral cavity

A

Inferior and medial displacement of the affected tonsil

Contralateral deflection of the uvula

Swollen red tonsil

Cervical adenopathy

May or may not display purulent exudate

173
Q

Pneumonia Tx

A

Oxygenation

Paracetamol

Salbutamol if wheezes present

Antiemetic

Transport

174
Q

Pneumonia Tx if dysregulated with signs of sepesis

A

Oxygenation

Paracetamol

Salbutamol if wheezes present

Antiemetic

IV access

IV fluids

Hospital notification and transport

175
Q

Precipitating events for hyperosmolar hyperglycaemic syndrome (HHS)

A

Medications

Infection

Surgery

CVA

Cardiovascular condition
(Stroke, Angina, AMI)

(thiazides diuretics, beta blockers, glucocorticoids and some atypical antipsychotics)

176
Q

Primary Headaches

A

Migraines

Tension headaches

Cluster headaches

177
Q

Pulmonary Embolism Clinical Features

A

Dyspnoea

Chest Pain (pleuritic)

Cough

DVT symptoms

ECG Changes

Tachycardia

+- Hypotension

Rarely: syncope, shock, haemoptysis

178
Q

Pulmonary Embolism Management

A

Oxygen as required

Pain relief

IV fluids……careful
(no more than 1L as failing RV, and increasing preload adds stress to a failing pump)

Back up if haemodynamically unstable
(CCP as can provide vagal pressers)

Transport to Hospital
(for anticoagulants and antithrombolysis)

Prepare for resuscitation
(may deteriorate quickly)

(titrate as per sat levels)

179
Q

Pulmonary Embolism Risk Factors

A

Inherited
Prothrombin gene mutation

Factor V Leiden mutation
Sickle Cell Disease

Acquired
age

obese
smoking
surgery
trauma

180
Q

QAS Recognition of Sepsis

A

Requires 2 or more of:

Temp - < 35 or > 38.5⁰C

RR - >25

HR - <40 or > 110

SBP - _<_90

AVPU - new confusion

181
Q

Reftactory anaphylaxis management following 3 x IM adrenaline

A

Upper airway obstruction:
Nebulised adrenaline

For persistent wheezing:
Salbutamol and Hydrocortisone

For persistent hypotension/shock:
Continue IV fluids + Glucagon

182
Q

Risk Factors for Aortic Dissection

A

age

family history

hypertension

marfan syndrome, turner syndrome

pre-existing aortic aneurysm

trauma
(most common from deceleration)

183
Q

Risk Factors for Bowel Obstruction

A

Crohn’s disease

Hernia

Hx of foreign body ingestion

Hx of cancer

Prior abdominal surgery

184
Q

Risk factors for meningococcal disease

A

Infants ≤5 years old, late teens and ≥ 65 years old

Hx of preceding illness

Intimate kissing

Not vaccinated

185
Q

Risk Factors for Nephrolithiasis

A

Acidic urine

Diet
(low fluid, potasium and calcium intake, high animal protein intake)

Frequent UTI’s

Previous Hx or family Hx of renal stones

186
Q

Risk factors for peptic ulcers

A

Helicobacter pylori (H.pylori)

NSAIDs

Physiological stress

risks in conjuction with pepsin causes ulcers

187
Q

Risks of aspiration pneumonia

A

Dysphagia from neurologic deficits

Disorders of the upper gastrointestinal tract

Mechanical disruption of the glottic closure

Reduced consciousness

188
Q

Secondary Headaches

A

Subrachnoid haemorrhage (SAH)

189
Q

Sepsis Management

A

Position of patient

Oxygen

normothermia assistance where appropriate

analgesic - paracetamol

antipyretic - Paracetamol

IV access

BGL

12 lead

IV sodium chloride 0.9% in the setting of inadequate perfusion

Adrenaline
(CCP - if perfusion not maintained with fluid resuscitation)

Transport and pre-notify without delay

(auto infusion in the setting of low BP)

190
Q

Sepsis Signs and Symptoms

A

Lethargy/Weak/Look unwell

Red discoloration or small red dots that cover large portions of the body

Mottled skin

Fever or Low body Temperature

Rigors
(feeling cold & shivering)

Altered Mental State

Hypotension

Tachycardia

Tachypnoea

Nausea, vomiting and diarrhoea

Decreased Urine Output

Sluggish cap refill

Joint & Muscular pain

Cold hands and feet
(as BP drops)

191
Q

What is the severe asthma management?

A

oxygen
(aim for 92%+)
salbutamol
Ipratropium bromide
hydrocortisone
adrenaline
magnesium sulphate - CCP only
CPAP - CCP only
CCP backup ASAP
reassess
transport

192
Q

Shock Clinical Features

A

diaphoretic

poorly perfused

tachycardic

hypotensive

193
Q

Signs and Symptoms of Anaphylaxis

A

Gradual or rapid onset of localised or generalised symptoms of:

Cutaneous
angioedema (swelling)
urticaria (rash)
flushed skin
pruritus (itch)

Respiratory
rhinitis (runny nose)
wheeze
difficultly breathing
upper airway swelling

Cardiovascular
collapse

hypotension
dizziness
bradycardia/tachycardia

Abdominal
nausea and vomiting
abdominal pain
diarrhoea

194
Q

Signs and symptoms of diabetic ketoacidosis (DKA)

A

poor skin turgor

ALOC/unconsciousness

decreasing GCS

dizziness

irritability

poor cognition

acetone breath

kussmaul breathing

195
Q

Signs and Symptoms of Meningitis/Septicaemia in Older Children and Adults

A

General Malaise

Fever

ALOC/Moaning/Unintelligent Speech

Meningism
(headache, photophobia and neck stiffness)

Tachypnoea and Tachycardia

Vomiting

Aching/Sore muscles and Joint Pain

Cold Extremities

Petechial Rash or Purpuric Rash
(Advanced Sign)

196
Q

Signs and Symptoms of Meningitis/Septicaemia in Young Children

A

Fever

Irritability

ALOC

Photophobia

Food refusal

Grunting/Moaning

Vomiting

Petechial Rash or Purpuric Rash

Blotchy Skin

197
Q

Signs of Dehydration

A

dry mucous

tachycardia

orthostatic hypotension

decreased urine output

198
Q

Small Bowel Obstruction Abdo Pain Clinical Features

A

waves of periumbilical cramping every 4-5 mins

199
Q

Some Causes of Pneumonia

A

Bioterrorism

Emerging infections from animal sources
(Coronavirus, H5N1 avian influenza)

Haemophilus influenzae
(bacteria)

Influenza

Rhinovirus

Streptococcus pneumoniae

(inhalation anthrax)

200
Q

Stanford Aortic Thoracic Dissection Classification

A

Type A: any involvement of ascending aorta

Type B: involves the aorta distal to the origin of the left subclavian artery

201
Q

Subarachnoid Haemorrhage (SAH) Management

A

Consider analgesia

Consider antiemetic

Consider anticonvulsant if seizure present

Transport as appropriate

Prepare for resuscitation

202
Q

Subarachnoid Haemorrhage (SAH) Symptoms/Clinical Features

A

Thunderclap headache

ALOC
(2/3s Pts)

Seizures

photophobia

nuchal rigidity
(stiff neck)

nausea/vomiting
(blood toxic to brain when not in vessels)

(sudden, worst headache ever, peaks in minutes)

203
Q

Subarachnoid Haemorrhage Danger Signs and Considerations

A

Hx of intracranial bleed

Family Hx of intracranial bleed

Thunderclap headaches

Progressive headache worsening over weeks

Aura lasting longer than 60 minutes

Meningism

Anticoagulant or antiplatelet therapy

204
Q

Subarachnoid Haemorrhage (SAH) Description

A

leak of blood from rupture of intracranial vessel lasting a few seconds but can reoccur

blood released into intracranial fluid and increases ICP

life threatening

205
Q

Where does a suprarenal AAA originate?

A

one or more visceral arteries but does not extend into the chest

206
Q

Symptomology of Influenza

A

Myalgia

Weakness

Fever and chills

Headache

Nasal congestion

Sore throat

Cough (non-productive)

207
Q

Symptomology of the common cold

A

Malaise

Low-grade fever

Nasal Congestion

Rhinorrhea

Sore throat

Cough (within 24-48h)

208
Q

Syncope

A

brief loss ofconsciousness due to hopoperfusion of brain

209
Q

Syncope Management

A

Supine/legs elevated

determine type of dizziness, post-ictal phase?, prodrome? quick onset?

Pharmacology: Ondansetron? Sodium Chloride?
(dehydration, poor cardiac output - MAP should be > 60 mmHg)

Transport as appropriate

(increases perfusion to brain)

210
Q

What are the TAA and AAA Risk Factors?

A

age
family history
pre-existing cerebral aneurysm
previous hx of aortic dissection
hypertension
several syndromes (marfan or turner syndrome)
trauma (more commonly from deceleration)

211
Q

Tension Type Headache Description

A

bilateral

NOT pulsating

NOT worsend by exertion

NOT associated with nausea/vomiting

212
Q

Tension Type Headaches Management

A

Paracetamol

Severe tension-type – Same as migraines

213
Q

The 3 Causes of Venous Thrombosis

A

inherited hypercoagulable state
Factor V Leiden
prothrombin gene mutation

acquired hypercoagulable state
surgery
trauma
malignancy
haemoglisations
pregnancy
liver disease

combination of inherited and acquired

214
Q

The two types of DVT

A

Proximal - popliteal up

Distal - popliteal down

(greater risk of creating embolism)

215
Q

Thoracic Aneurism Locations

A

Ascending

Descending

Arch

Thoracoabdominal

216
Q

Three most common causes of portal hypertension

A

Cirrhosis of the liver

Hepatic schistosomiasis

Pre/post hepatic thrombosis

217
Q

To be classified as an aneurysm, the aorta must

A

increase in size by at least 50%

218
Q

Types of Pericarditis

A

acute - new onset

incessent group - > 4 wks but <3 mths

chronic >3 mths

recurrent - symptom free 4-6 wks but then comes back

219
Q

Typical symtpoms of complicated painful gall stones

A

Jaundice

Fever

Pain

Tachycardia

220
Q

Urinary Retention Management

A

abdo palption suprabubic area

ask about Hx prostate, bladder CA, infection, fever

Pain management as required
(panadol/maybe opiates)

Transport to hospital

221
Q

Variceal Haemorrhage Management

A

ascites

(ask about alcohol intake, emesis, melena)

IV fluids
(as required - titrate to maintain radial pulse)

antiemetic
(metoclopramide)

oxygen as required
(hi flow if shocked - titrate to maintain adequate sats)

transport
(pre-notify)

222
Q

Vertigo

A

perception of constant movment happening when not moving

subjective - I am spinning

objective - things are spinning

223
Q

Vertigo Management

A

determine type of dizziness and if peripheral or central and duration of symptoms

Pharmacology? Ondansetron? Sodium Chloride?
(Ondans treats brain disorders and MS)

Transport as appropriate

224
Q

Viral Pharyngitis and Tonsillitis Symptoms

A

Feeling unwell

Fever (either low or high-grade)

Headache

Rhinorrhea

Sore throat

Painful swallowing

Redness and/or drainage in throat

Vesicular/petechial pattern on soft palate and tonsils

Nausea/vomiting

225
Q

Viral Pharyngitis and Tonsillitis Tx

A

Treat symptomatically

fever & pain - paracetamol

dehydrated - 0.9% sodium chloride

nausea - ondansetron

Transport for further care or consider GPappointment

226
Q

What are peptic ulcers?

A

umbrella term for gastic and duodenal ulcers

227
Q

What are saccular aneurysms?

A

Wall extrusions of blood through the thin or absent tunica media

228
Q

What are the 2 types of pharyngitis and tonsillitis

A

viral

bacterial

229
Q

What are the categories of shock?

A

Cardiogenic

Hypovolemic

Relative Hypovolemic

Media/layman’s

230
Q

What are the components of intrinsic control of regnal autoregulation?

A

Myogenic mechanism

Tubuloglomerular feedback mechanism

231
Q

What are the conducting passagees in the upper respiratory tract?

A

nasal cavity

pharynx

larynx

232
Q

What are the four categories of relative hypovolaemic shock?

A

Anaphylactic

Burns

Neurogenic

Septic

233
Q

What are the stages of shock?

A

Compensation stage

Decompensation stage

Refractory

234
Q

What are the three steroid hormones produced by the adrenal cortex?

A

adrenal androgens

glucocorticoids

mineralocorticoids

235
Q

What are the viruses of the common cold?

A

Adenovirus

Coronavirus

Influenza

Rhinovirus (most common)

236
Q

What are the viruses of Influenza?

A

Avian Influenza A (H5N1)

Influenza A, B, C and D

Swine Flu Influenza A (H3N2)

Influenza A (H1N1) from the 2009 new outbreak

237
Q

What are varices?

A

enlarged swollen veins in the distal esophagus or proximal stomach caused by elevated pressure in the portal venous system, typically from cirrhosis

238
Q

What can cause urinary retention?

A

Medications

Trauma

Infection

Neurologic issues

Outflow obstruction

Inefficient detrusor muscle

239
Q

What clinical variables define systemic inflammatory response syndrome (SIRS)?

A

temperature <35 or >38

HR <90

RR >20

PCO2 <32 mmHg

WBC <4000 or >12000
(hospital test)

240
Q

What colour can haematuria be?

A

brown

red
​(macroscopic)

clots
​(macroscopic)

invisible
(microscopic)

(macroscopic)

241
Q

What comprises the respiratory conducting zone?

A

upper respiratory tract

242
Q

What comprises the respiratory end zone?

A

bronchioles

alveoli

243
Q

What do prostoglandins do?

A

prostoglandins inhibit acid secretions and stimulate mucous production and bicarbonate and protect against damaging compounds

244
Q

What does the conducting zone do?

A

cleanses air

removes dust and bacteria

humidifies air

warms air

245
Q

What factors does the modified centor criteria for bacterial pharyngitis take into consideration?

A

age

fever

tonsillar exudate

anterior cervical LAD
(lymph node swelling)

absent cough

246
Q

What happens during the compensation stage of shock?

A

BP drops so autonomic nervous system kicks in causing:

diaphoresis

vasoconstriction

tachypnoeic

Tachycardia

Renin angiotensin system also kicks in causing:

Vasoconstriction
Decrease urine output

247
Q

What happens during the decompensation stage of shock?

A

HR can’t keep up causing:

blood pressure decrease
(<100 mmHg)

organ perfusion decrease
(heart and brain prioritised for blood)

248
Q

What happens during the refractory stage of shock?

A

Low SBP causes:

Systemic Inflammatory Response Syndrome (SIRS)
(organs not getting perfused and can’t perform functions - cell rupture as sodium into cell)

Multiorgan Failure (MOF)
(from SIRS)

Death

249
Q

What is Anaphylactic Shock

A

cardiovascular collapse and respiratory distress due to bronchospasm

250
Q

What is a functional bowel obstruction?

A

peristalsis/intestinal motility

251
Q

What is a lumina defect bowel obstruction?

A

crohns disease, gall stones, foreign body, twisted bowel

252
Q

What is acute cholecystitis?

A

​inflammation of gall bladder secondary to gall stones

253
Q

What is Acute Perciditis

A

inflammation of the pericardium

254
Q

What is acute upper gastrointestinal bleeding?

A

uncontrolled haemorrhage in gastric region causing haemotemesis or melena

255
Q

What is addison disease (primary adrenal insufficiency)

A

adrenal glands fail to release adequate hormones to meet physiologic needs, despite release of ACTH from the pituitary

Note: ACTH = Adrenocorticotropic Hormone

256
Q

What is an acute lower gastrointestional (PR) bleed?

A

bleed that originates from the colon with an acute onset

257
Q

What is an aortic dissection

A

a tear in the inner layer (tunica intima) of the aorta allowing blood to flow into the intima-media space

258
Q

What is an extrinsic bowel obstruction?

A

from outside - adhesion, bulge

259
Q

What is an intrinsic bowel obstruction?

A

from within - disease, cancer

260
Q

What is anaphylactic relative hypovoleamic shock?

A

blood vessels vasodilate and capillary gets leaky and leaks out fluid from blood

261
Q

What is anaphylaxis?

A

a multi-system severe allergic reaction characterised by an acute onset of cardiovascular (eg hypotension) or respiratory (eg bronchospasm) symptoms

262
Q

What is appendicitis?

A

inflammation of the appendix

263
Q

What is bowel obstruction?

A

lumen gets obstructed

264
Q

What is burn relative hypovolaemic shock?

A

cell mediators cause vasodilation and capillary gets leaky and leaks out fluid from blood

265
Q

What is Cardiac Tamponade

A

increased pericardial pressure creates cardiac dysfunction (heart can’t stretch to pump properly)

266
Q

What is cardiogenic shock?

A

impaired cardiac output primarily caused by failure of the left ventricle

267
Q

What is cholangitis?

A

infection of the liver’s bile ducts - fever, jaundice and pain)

268
Q

What is cirrhosis of the liver

A

dead cells replaced by connective tissue, restricting blood flow

caused by hep B and C, alcoholics, non alcoholic fatty disease

269
Q

What is complicated gallstone disease?

A

biliary colic (pain) with the any of the following:

Acute cholecystitis

Cholangitis

Gallstone pancreatitis

270
Q

What is diabetic ketoacidosis (DKA)?

A

build up of ketones in the blood from breaking down fat for energy when the body doesn’t have enough insulin to process blood sugar into energy

271
Q

What is gall stone disease?

A

when gall stones cause symptoms

272
Q

What is gallstone pancreatitis?

A

affects pancreatic duct or obstructs hepatopancreatic ampula

273
Q

What is Haematuria

A

blood in urine - symptom not a condition

274
Q

What is hyperosmolar hyperglycaemic syndrome (HHS)?

also known as non-ketotic hyperglycaemic hyperosmolar syndrome (NKHS)

A

profound hyperglycaemia BGL >33.3 mmol/L where fluid is drawn into the blood vessels through osmotic pull causing severe dehydration from excessive urination

275
Q

What is hypokaleamia?

A

low potassium levels in the blood

276
Q

What is hypovolaemic shock?

A

decreased intravascular volume due to fluid loss from traumatic blood loss or;
internal fluid shifts (severe dehydration, edema, or ascites)

277
Q

What is Hypovolemic Shock

A

decreased intravascular volume and increased systemic venous assistance

278
Q

What is primary urine?

A

Filtrate - 1st pass

nutrients, iron, water

279
Q

What is media/layman’s shock?

A

term used by media to describe highly stressed state - catatonic, delirious etc

280
Q

What is meningococcal disease?

A

Illness caused by Neisseria meningitidis bacteria in the meninges, spinal cord (meningitis) and bloodstream.

281
Q

What is meningococcal septicaemia

A

infection in blood stream and going septic and affects integrity of blood vessels causing bleeding into organs

282
Q

What is Metabolic Acidosis?

A

low bicarbonate levels

283
Q

What is Multiple Organ Dysfunction Syndrome (MODS)

A

the development of a potentially reversible physiologic derangement involving two or more organ systems not involved in the initial cause of the physiological derangement (extension of SIRS)

284
Q

What is neurogenic relative hypovolaemic shock?

A

spinal injury causing vasodilation - particularly above T4 level

285
Q

What is normal blood pH?

A

7.35 - 7.45 pH

286
Q

What is pancreatitis?

A

inflammation of the pancreas from large pooling of pancreatic juices in the pancreas

287
Q

What is pneumonia?

A

acute infection of pulmonary paranchema (alveoli and bronchioles)

288
Q

What is portal hypertension?

A

portal system gets to pressure >10mmHg

289
Q

What is rabdomyolysis?

A

myoglobin protein in the blood caused by muscle breakdown and death due to overexertion trauma, toxins or disease

290
Q

What is refractory anaphylaxis?

A

symptoms continue post adrenaline x 3

291
Q

What is relative hypovolaemic shock?

A

third spacing of fluids eg bowel obstruction; ascites; loss of blood volume into a fracture site; burns

292
Q

What is Respiratory Acidosis?

A

ETCO2 levels over 45 mm

293
Q

What is Respiratory Alkalosis?

A

ETCO2 levels below 35mm

294
Q

What is Sepsis?

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

295
Q

What is septic relative hypovolaemic shock?

A

cell mediators cause vasodilation and capillary gets leaky and leaks out fluid from blood

296
Q

What is Septic Shock?

A

a subset of sepsis in where intense circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone

297
Q

What is Septicemia?

A

a serious bloodstream infection that occurs when a bacterial infection in another part of the body, such as the lungs or skin, enters the bloodstream

298
Q

What is shock?

A

the inadequate perfusion of tissues to meet the metabolic demands at that time and effectively remove the tissues metabolic wastes (heart not pumping enough blood to sustain life or perform functions)

299
Q

What is SIRS termed as when caused by infection?

A

sepsis

300
Q

What is splanchnic circulation?

A

splantnic circulation feeds abdomen

301
Q

What is Systemic Inflammatory Response Syndrme (SIRS)?

A

systemic inflammation and widespread tissue injury caused by trauma, thermal injury, pancreatitis, autoimmune disorders, and surgery

302
Q

How much blood passess the the kidneys per day?

A

1700L

303
Q

What is the main vehicle for excreting cholesterol?

A

bile

304
Q

What is the myogenic mechanism of Intrinsic control (renal autoregulation)?

A

Responds to BP - vasoconstricts to reduce flow if BP increases and dilates if BP drops to increase flow

305
Q

What is the neural control of extrinsic control in renal filtration?

A

SNS shunts blood to vital organs, adrenalin and noradrenalin to smooth muscles affecting efferent arterioles and causing vasoconstriction

306
Q

What is the normal ETCO2 range?

A

35 - 45 mm

respiratory rate increases with ETCO2 increase

307
Q

What is the role of the appendix?

A

immunity - has lymphoid tissue and stores bacteria to replenish the gut when required

308
Q

What is the role of the large intestine/bowel?

A

a little bit of digestion through good bacteria

absorption - water and electrolytes - sodium chloride and some vitamins

309
Q

What is the role of the small intestine/bowel?

A

digestion and absoprtion

310
Q

What is the Tubuloglomerular feedback mechanism of Intrinsic control (renal autoregulation)?

A

macular densa cells monitor flow and osmolarity

will promote vaso dilation to increase flow if too slow

will constrict if flow or osmomolarity is too high

311
Q

What is the vestibular Occular Reflex

A

connections between the brainstem, cerebellum and parietal lobes and occulomotor nuclei

312
Q

What is uncomplicated gallstone disease?

A

biliary colic - pain with no related complications

313
Q

What is V/Q Mismatch Dead Space?

A

the portion of the respiratory system where tidal volume doesn’t participate in gas exchange: it is ventilated but not perfused.

314
Q

What is variceal haemorrhage?

A

slow leak or full rupture of varices

mortality rate of up to 60%

ascites/alcholism can be an indicator

315
Q

What is Metabolic Alkalosis?

A

Increased bicarbonate levels

316
Q

What is Biphasic anaphylaxis?

A

less common

Has 2 phases:

spontaneously recover - asymptomatic in 1-24 hours

return of some symptoms approx 16-48 hours later
(may not be the same ones)

317
Q

What is choledocholithiasis?

A

gall stones within common bile duct

318
Q

What is Cholelithiasis?

A

gall stones in the gall bladder that causes pain when the gall bladder constricts

319
Q

What is Hepatic schistosomiasis?

A

group of 5 paracites creating immune response and irreversible fibrosis

320
Q

What is Nephrolithiasis?

A

kidney and ureteral stones - painful renal colic

321
Q

What is Protracted (persistent) anaphylaxis?

A

less common, lasts hours to days without completely self resolving

322
Q

What is Uniphasic anaphylaxis?

A

80-90% - peak within minutes to hours, may spontaneously self resolve within a few hours

323
Q

Who are high risk Pts for sepsis?

A

Underlying Malignancy/Chemotherapy/Radiation Therapy

Autoimmune

Elderly _>_65 yrs

Infants < 3 mths

Haemodialysis

Alcoholism

Diabetes

324
Q

Why does jaundice occur?

A

pooling of bile pigments (yellow) making way through blood and into the skin

325
Q

Why is glomerular filtration rate crucial?

A

too fast - nutrients and iron not reabsorbed

too slow - waste products reabsorbed with nurients

326
Q

What are ketones and ketoacids?

A

alternative fuels for the body that are made when glucose is in short supply

327
Q

Clinical features of peripheral vertigo

A

diaphoresis

spinning

nystagmus

nausea and vomiting

328
Q

Clinical features of central vertigo

A

incoordination

headache

diplopia

nystagmus - main objective sign

slurred speech

limb weakness

329
Q

Migraine aura signs and symptoms

A

generally visual

Less commonly affects speech or sensation

(dark spots, flashing lights)

330
Q

Migraine signs and symptoms

A

Scalp may or may not be tender

photophobia

phonophobia

nausea/vomiting

Symptoms not entirely sensitive
(can be bilateral for instance)

331
Q

TAA clinical features

A

pain

hoarseness of voice
(due to pressure on laryngeal nerve)

dysphagia
(compression of oesophagus)

wheezing
(compression of tracheal bronchial tree)

cough
(compression of tracheal bronchial tree)

haemoptysis
(compression of tracheal bronchial tree)

dyspnoea
(compression of tracheal bronchial tree)

(generally asymptomatic, pain will be in chest and back)

332
Q

Clinical features of DVT

A

Pain

leg swelling

warmth

erythema

(dull ache/tight feeling, generally in calves, can be across whole leg depending on thrombus location, felt on palpation)

333
Q

Clinical features of pericardial effusion and cardiac tamponade

A

Fatigue

fever
(pericarditis)

distended jugular veins
(increased pressure - poor ejection fraction backs up blood)

dyspnoea
(cardiac tamponade)

chest pain
(cardiac tamponade)

tachycardia

pulsus paradoxus
(BP drop of 10mmHg or more between expiration (highest) and inspiration)

hypotension
(late stage)

obstructive shock
(decompensating)

PEA cardiac arrest
(can’t physically pump anymore)

(poor ejection fraction as heart is restricted)

334
Q

Pneumonia clinical features

A

fever

ALOC

cough
(dry or productive)

SOB
(may have crackles, decreased breath sounds or other consolidated sounds)

pleuritic chest pain

nausea and/or vomiting

diarrhoea

(chills 40-50%, ribals 15%)

335
Q

Acute pancreatitis clinical features

A

fever

jaundice

ecchymotic discoloration

tachypnoea

tachycardia

hypotension

epigastric pain
(radiates to back 50%, may localise to RHS & eased when lean forward)

nausea and vomiting

336
Q

Bowel obstruction clinical features

A

Sudden onset of abdo pain

Nausea
(more common in small)

Vomiting
(more common in small)

Abdominal distention

Obstipation
(no movement of gas or stool)

Fever (with ischemic bowel or necrosis)

dehydration
(hallmark of small bowel obstruction)

(sm - periumbilical cramping waves every 4-5 mins, lg - periumbilical waves every 20 mins)

337
Q

Acute urinary retention clinical features

A

restless

acute change of mental status
(esp elderly pts with cognitive impairment)

abdominal pain

ack pain

nil/extremely decreased urine output

338
Q

Peptic ulcers clinical features

A

potential hypovolemia

hematemesis

heartburn

epigastric pain - may radiate to back

nausea

bloating/fullness

melena

339
Q

What simple procedure can you do to help someone having a panic attack?

A

5 senses

340
Q

De Bakey Aortic Thoracic Dissection Classification

A

Type I: ascending aorta; involves all portions of the thoracic aorta

Type II: ascending aorta only, stops before the innominate artery

Type III: almost always involves the descending thoracic aorta only, starting distal to the left subclavian artery; can propagate proximally into the arch

341
Q

Extent I Thoracoabdominal Aortic Aneurysm Classification

A

arises from above the sixth intercostal space near left subclavian artery

includes the origins of the celiac axis and superior mesenteric arteries

renal arteries can be involved

342
Q

Extent II Thoracoabdominal Aortic Aneurysm Classification

A

arises above the sixth intercostal space

may include ascending aorta

extends distal to include the infrarenal aortic segment often to the level of the aortic bifurcation.

343
Q

Extent III Thoracabdominal Aortic Aneurysm Classification

A

arises in the distal half of the descending thoracic aorta below the sixth intercostal space

extends into the abdominal aorta

344
Q

Extent IV Thoracoabdominal Aortic Aneurysm Classification

A

involves the entire abdominal aorta from the level of the diaphragm to the aortic bifurcation

345
Q

Extent V Thoracabdominal Aortic Aneurysm Classification

A

arises in the distal half of the descending thoracic aorta below the sixth intercostal space

extends into the abdominal aorta but limited to the visceral segment

346
Q

Key components of HHS

A

Gradual onset

BGL >33.3mmol

Coma

ALOC

Impaired cognitive state

Seizures (25%)

Severe dehydration

Cellular dehydration

Decreased cellular function

Polyuria

Postural Hypotension

Hypokalaemia
(also low magnesium and calcium)

347
Q

What is the AAA treatment?

A

Consider:
oxygen
IV access
analgesia
antiemetic
IV fluids
blood
transport
pre-notify as appropriate

348
Q

What is

A
349
Q

What is the Modified Wells Criteria:

A

A set of scored criteria which indicates the Pt’s likelihood to have a pulmonary embolism

350
Q

What is the Modified Wells criteria assessment score >4.0?

A

PE likely

351
Q

What is the Modified Wells criteria assessment score <4.0?

A

PE unlikely

352
Q

What is a transient ischaemic attack (TIA)?

A

short lived stroke, with signs and symptoms that spontaneously resolve within 24hrs

353
Q

What is a cerebrovascular accident (CVA)?

A

acute interruption to cerebral perfusion causing brain injury

354
Q

What are the two types of cerebrovascular accidents (CVAs)?

A
  • lschaemia (80°/o ): CVA due to a blockage or loss of cerebral perfusion
  • Haemorrhage (20°/o ): CVA due to a cerebral bleed
355
Q

What are the two types of cerebrovascular accidents (CVAs)?

A
  • lschaemia (80°/o ): CVA due to a blockage or loss of cerebral perfusion
  • Haemorrhage (20°/o ): CVA due to a cerebral bleed
356
Q

Can hyHypoperfusion and reduced CPP cause a CVA?

A

yes

357
Q

What can raised intracranial pressure may progress to?

A

brain/cerebral herniation

358
Q

What are the underlying causes of ischaemic stroke?

A
  • Arterial thromboembolism
  • Cardioembolism (clot from heart)
  • Carotid/vertebral artery/intracranial atheroma (build up of materials)
  • Gas embolism (from pneumothorax)
  • Hypercoagulopathy
  • Hypotension
  • Severe vascular stenosis (narrowing of blood vessels)
359
Q

What are the underlying causes of haemorrhagic stroke?

A
  • Amyloid angiopathy (protein build up in arteries)
  • Anticoagulant therapy or coagulopathy
  • Aneurysm
  • Arteriovenous malformations (AVM)
  • Hypertensive crisis (massive spike in BP)
  • Secondary haemorrhage from cerebral lesion (poorly formed blood vessels, tumour)
360
Q

What are some of the differential diagnoses for stroke?

A
  • Conversion disorder (results from psychological stress)
  • Electrolyte derangement
  • Encephalitis
  • Hypoglycaemia
  • Infection (particularly with fever in elderly) and sepsis
  • Migrainous aura and/or hemiplegia (with/without pain)
  • Space-occupying cerebral lesions
  • Seizures and post-ictal periods
361
Q

What are stroke (CVA including TIA) risk factors?

A
  • Age >60 years
  • Diabetes mellitus
  • Excess alcohol consumption
  • Heart disease
  • Hyperlipidaemia
  • Hypertension
  • Oral contraceptives
  • Previous vascular event, e.g. STEMI, DVT
  • Race: Afro-Caribbean > Asian > Caucasian
  • Smoking
362
Q

What assessment should you do to determine stroke?

A
  • Questioning of Pt and witness
  • National Institute of Health Stroke Scale (NIHSS-8)
  • 12-lead ECG (stroke can cause dysrhythmias)
  • Head-to-toe:
    • Motor and sensory function
    • Rashes, piloerection
    • Colour & temperature changes
    • Chest auscultation (listen for oedema)
    • Urinary retention (distended bladder)
    • Injuries sustained during collaps
363
Q

What is the National Institutes of Health Stroke Scale (NIHSS)?

A

a systematic, quantitative assessment tool to measure stroke-related neurological deficit

364
Q

What are the National Institute of Health Stroke Scale (NIHSS) components?

A
  • Level of consciousness
  • Questions (age, month)
  • Commands (eyes, grip)
  • Gaze tracking
  • Facial palsy
  • Speech (clear or slurred)
  • Motor arm (drift downwards)
  • Extinction and inattention (of affected side)
365
Q

What is the stroke (CVA) treatment plan?

A
  • Reassurance and non-pharmacological relief
  • Position patient with 45° head elevation
  • Life-threatening/haemodynamically unstable?
    • Seizures to be managed in the standard way
    • IV fluids (large-volume replacement or permissive hypotension?)
    • Consider oxygen, analgesia, anti-emetics
  • Repeat stroke assessments to trend condition
  • Rapid transport to appropriate receiving facility

Bachelor of Paramedic Science (19 decks)

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