Secondmidquaterstudy Flashcards
What is the optimal Spo2 saturation? What do you do if it is low?
Spo2 should be 94% or greater. (I’m thinking 94-99). If its too low, give oxygen
How many cranial nerves run directly from the brain to the head?
Cranial nerves are the 12 pairs of nerves that emerge from the brainstem and transmit information directly to or from the brain. For the most part, they perform special functions in the head and face, including sight, smell, taste, hearing, and facial expressions
What are the types of stroke?
The two main types of stroke are ischemic and hemorrhagic. Transient ischemic attack
What are the symptoms of a stroke, and which are most common?
The general signs and symptoms of stroke include the following:
• Facial drooping
• Sudden weakness or numbness in the face, arm, leg, or one side of the body
• Decreased or absent movement and sensation on one side of the body
• Lack of muscle coordination (ataxia) or loss of balance
• Sudden vision loss in one eye; blurred or double vision or abnormal eye movements
• Difficulty swallowing (a primary reason for good airway management in a patient with a stroke)
• Decreased level of responsiveness
• Speech disorders
• Aphasia; difficulty expressing thoughts or inability to use the right words (expressive aphasia) or difficulty understanding spoken words (receptive aphasia)
• Slurred speech (dysarthria)
• Sudden and severe headache
• Confusion
• Dizziness
• Weakness
• Combativeness
• Restlessness
• Tongue deviation
• Coma
What is the treatment for strokes and what is the time frame for treatment?
Supporting XABCs, rapid transport to a stroke center. Fibrinolytic therapy(blood clot-dissolving drugs) and methods to mechanically remove the blood clot may reverse stroke symptoms or even stop the stroke if implemented within 3 hours (drugs) or 6 hours (mechanical method) of the onset of symptoms. The ED needs to determine if there’s bleeding in the brain because the medication will increase the bleeding which isn’t good. They will use a CT scan of the head to see
What are the types of seizures? Symptoms of a seizure.
Generalized seizure- abnormal electrical discharges from large areas of the brain, involving both hemispheres. Unconsciousness and a generalized severe twitching of the body’s muscles that lasts several minutes or longer
Focal seizure- begins in one part of the brain. Are classified as either aware or impaired-awareness, and either type can be motor or nonmotor(absence)
Febrile seizures-sudden high fevers, primarily in children.
In a focal-onset aware seizure, no change occurs in the patient’s level of consciousness. Patients may report numbness, weakness, or dizziness. The senses may also be involved; the patient may report visual changes and unusual smells or tastes. A focal-onset aware (motor) seizure may also cause twitching of the muscles and the extremities that may spread slowly from one part of the body to another, but it is not characterized by the dramatic severe twitching and muscle movements seen in a generalized seizure. The patient may also experience brief paralysis.
In a focal-onset, impaired-awareness seizure, the patient has an altered mental status and does not interact normally with his or her environment. This type of seizure results from abnormal discharges from the temporal lobe of the brain. Other signs may include lip smacking, eye blinking, and isolated convulsions or jerking of the body or one part of the body such as an arm. The patient may experience unpleasant smells and visual hallucinations, exhibit uncontrollable fear, or exhibit repetitive physical behavior such as constant sitting and standing. In impaired-awareness seizures, the patient usually does not remember events occurring during the seizure.
Some focal-onset seizures remain on only one side of the body. Others begin on one side and gradually progress to the entire body. In focal-onset aware seizures, the patient may have no loss of consciousness but still experience body shaking or muscle tremors. Most people with lifelong or chronic seizures tolerate these events reasonably well without complications, but in some patients, seizures may signal life-threatening conditions.
Often, a patient may experience a warning sign prior to the event. This is referred to as an aura. An aura can include visual changes (flashing lights or blind spots in the field of vision) or hallucinations (seeing, hearing, or smelling things that are not actually present). People with a history of seizures recognize their auras and usually take steps to minimize injury, such as sitting or lying down, knowing what is about to happen. However, be aware that auras do not occur prior to every seizure, and not all patients with a seizure disorder experience an aura. A generalized motor seizure may be characterized by sudden loss of consciousness followed by chaotic muscle movement and tone. The patient may experience a tonic phase, usually lasting only seconds, in which there is a period of extreme muscular rigidity. This period is usually followed immediately by a clonic phase, lasting much longer, of constant muscle contraction and trembling, tongue biting, bladder incontinence, or bowel incontinence, During a generalized seizure. the patient typically may exhibit bilateral movement characterized by a cycle of muscle rigidity and relaxation. Throughout a generalized seizure, the patient exhibits tachycardia, hyperventilation, sweating, and intense salivation; however, other responses are also possible.
Generalized motor seizures typically last less than 5 minutes and are followed by a lengthy period (5 to 30 minutes or more) called a postictal state, in which a patient is unresponsive at first and gradually regains consciousness. The postictal state is over when the patient regains a complete return of his or her normal level of consciousness. In most cases, the patient will gradually begin to recover and awaken but appear dazed, confused, and fatigued. In contrast, a generalized nonmotor or absence seizure may last for just seconds, after which the patient fully recovers with only a brief lapse of memory of the event.
Seizures lasting more than 5 minutes are at risk for progressing to status epilepticus, which describes seizures that
continue every few minutes without the person regaining consciousness or that last longer than 30 minutes.
Recurring or prolonged seizures should be considered immediately life-threatening situations in which patients need emergency medical care. If the patient does not regain consciousness or the seizure continues, protect the patient from self-harm, and call for advanced life support (ALS) backup. These patients need advanced airway management and medication to stop the seizure.
Epileptic - congenital origin
Structural - tumor (benign or cancerous),infection, scar tissue from injury (within the skull ), head trauma, stroke
Metabolic - hypoxia, abnormal blood chemical values, hypoglycemia, poisoning, drug overdose, sudden withdrawal from alcohol or medications
How long can it take oral medications to cause an adverse reaction?
As long as 1 hour
Why is treating anaphylaxis rapidly so important?
Is an extreme allergic reaction that is life threatening and involves multiple organ systems. Can rapidly result in shock and death. If untreated, an anaphylactic reaction can proceed rapidly to death. More than two-thirds of patients who die of anaphylaxis do so within the first 30 minutes, so rapid treatment and transport is essential
What treatments are required to treat a patient having an anaphylaxis reaction?
Immediate transport after epinephrine is given.
What are the doses for each age group? (I’m assuming for epi)
Adult EpiPen 0.3mg
Children EpiPen 0.15mg
What are the side effects of epinephrine?
Hypertension
Tachycardia
Anxiety
Restlessness
The air sacs of the lungs in which the exchange of oxygen and carbon dioxide takes place
Alveoli
The walls of the ___ contain a network of tiny blood vessels (pulmonary capillaries) that carry carbon dioxide from the body to the lungs(for removal through exhalation) and oxygen from the lungs to the body
Alveoli
Each time you take a breath, the__ receive a supply of oxygen-rich air. Recall that the oxygen then passes into a network of pulmonary capillaries, which are located in the walls of the__. The walls of the capillaries and the__ are extremely thin. Thus, air in the___ and blood in the capillaries are only separated by two thin layers of tissue.
Oxygen and carbon dioxide pass rapidly across these thin tissue layers by diffusion. Diffusion is a passive process in which molecules move from an area with a higher concentration of molecules (oxygen in the air) to an area of lower concentration (oxygen in the bloodstream). There are more oxygen molecules in the__ than in the blood.
Therefore, the oxygen molecules move from the___ into the blood. Because there are more carbon dioxide molecules in the blood than in the inhaled air, carbon dioxide moves from the blood into the__. This process is completely passive-nature does all the work.
The blood does not use all the inhaled oxygen as it passes through the body. Exhaled air contains 16% oxygen and
3% to 5% carbon dioxide; the rest is nitrogen
alveoli
Cardiac muscle cells have a special characteristic called___ that is not found in any other type of muscle cells.
___allows a cardiac muscle cell to contract spontaneously without a stimulus from a nerve source. Normal impulses in the heart start at the SA node. As long as impulses come from the SA node, the other myocardial cells will contract when the impulse reaches them. However, if no impulse arrives, the other myocardial cells are capable of creating their own impulses and stimulating a contraction of the heart, although at a generally slower rate.
automaticity
The contraction, or period of contraction, of the heart, especially that of the ventricles
Systole
Blood pressure (BP) is the force of circulating blood against the walls of the arteries. This pressure wave keeps the blood moving through the body. When the left ventricle of the heart contracts, it pumps blood into the aorta. This phase in the cardiac cycle is called__. The pressure inside the arteries during this time is referred to as the systolic blood pressure.
The time between contractions when the ventricle is relaxed and refilling with blood is called diastole. The resting pressure in the arteries during this phase is the diastolic blood pressure. The values of the systolic and diastolic pressures are measured with a sphygmomanometer (blood pressure cuff) and are expressed numerically in millimeters of mercury mm Hg). Blood pressure is displayed as the systolic number over the diastolic number.
systole
The time between contractions when the ventricle is relaxed and refilling with blood is called_. The resting pressure in the arteries during this phase is the__ blood pressure. The values of the systolic and__ pressures are measured with a sphygmomanometer (blood pressure cuff) and are expressed numerically in millimeters of mercury (mm Hg). Blood pressure is displayed as the systolic number over the diastolic number.
diastolic
Pressure within the arteries when the heart is at rest. Indicates adequate cardiac relaxation and pressure in the arteries between heartbeats. Indicates amount of blood within blood vessels
Diastolic blood pressure
Pressure within the arteries when the heart is contracting; left ventricular force. Indicates heart pumping effectiveness. Indicates blood available to the heart
Systolic blood pressure
Define hypertensive
An emergency situation created by excessively high blood pressure, which can lead to serious complications such as stroke or aneurysm. Hypertension is defined as any systolic blood pressure greater than 130 mm Hg or a diastolic blood pressure greater than 80 mm Hg. A hypertensive emergency is defined as a systolic pressure greater than 180 mm Hg in the presence of impending or progressive organ damage
Define hypotensive
Low blood pressure
Define LVADs
Left ventricular assist devices (LADs) are used to enhance the pumping function of the left ventricle in patients with severe heart failure or in patients who need a temporary boost due to a myocardial infarction (FIGURE 17-14). There are several types of LVADs; the most common ones have an internal pump unit and an external battery pack. These pumps are almost all continuous, so most of these patients will not have any palpable pulses. If you encounter a patient with an LVAD, he or she (or his or her family members) may be able to tell you about the unit. Unless it malfunctions, you should not need to dea with it. If you are unsure of what to do, contact medical control for assistance. Also, LVADs provide a number to call for assistance. Transport all LVAD supplies and battery packs to the hospital with the patient.
Define atherosclerosis
As with coronary artery disease, atherosclerosis in the blood vessels is often the cause of ischemic stroke.
Atherosclerosis is a disorder in which calcium and cholesterol build up, forming plaque inside the walls of the blood vessels.
This plaque may obstruct blood flow and interfere with the vessels’ ability to dilate. Eventually, atherosclerosis may cause complete occlusion of an artery (FIGURE 18-3). In other cases, an atherosclerotic plaque in the carotid artery in the neck ruptures. A blood clot forms over the crack in the plaque. Sometimes, it grows large enough to completely block all blood flow through that artery. The parts of the brain supplied by the artery are deprived of oxygen and stop functioning. A disorder in which cholesterol and calcium build up inside the walls of the blood vessels, forming plaque, which eventually leads to a partial or complete blockage of blood flow
Define ventricular tachycardia
Rapid heart rhythm, usually at a rate of 150 to 200 beats/min. The electrical activity starts in the ventricle instead of the atrium. This rhythm usually does not allow adequate time between beats for the left ventricle to fill with blood. Therefore, the heart pumps less volume and the patient’s blood pressure may fall, or the pulse may be lost altogether. The patient may also feel weak or lightheaded or may even become unresponsive. In some cases, existing chest pain may worsen or chest pain that was not there before onset of the dyshythmia may develop. Most cases of ventricular tachycardia (VT) will be sustained but may deteriorate into VF. A rapid heart rhythm in which the electrical impulse begins in the ventricle (instead of the atria), which may result in inadequate blood flow and eventually deteriorate into cardiac arrest
Define ventricular fibrillation
Disorganized, ineffective quivering of the ventricles. No blood is pumped through the body, and the patient becomes unconscious within seconds. The only way to convert this dyshythmia is to defibrillate the heart. To defibrillate means to shock the heart with a specialized electric current in an attempt to stop the chaotic, disorganized contraction of the myocardial cells and allow them to start again in a synchronized manner to restore a normal rhythmic beat. Defibrillation is most likely to be successful in terms of saving a life if delivered within the first few minutes of sudden death. If a defibrillator is not immediately available, CPR must be initiated until the defibrillator arrives. Even if CPR is begun at the time of collapse, chances of survival diminish approximately 7% to 10% each minute until defibrillation is accomplished
Signs and symptoms of hypoxia
Hypoxia is an extremely dangerous condition in which the tissues and cells of the body do not get enough oxygen. Patients who are breathing inadequately will show varying signs and symptoms of hypoxia. The onset and degree of tissue damage caused by hypoxia often depend on the quality of ventilations. Early signs of hypoxia include restlessness, irritability, apprehension, fast heart rate (tachycardia), and anxiety. Late signs of hypoxia include mental status changes, a weak (thready) pulse, and cyanosis. Conscious patients will complain of shortness of breath (dyspnea) and may not be able to talk in complete sentences. The best time to give a patient oxygen is before signs and symptoms of hypoxia appear.
Signs and symptoms of pertussis
Pertussis (whooping cough) is an airborne bacterial infection that primarily affects children younger than 6 years. It is highly contagious and is passed through droplet infection.
A patient with pertussis will be feverish and exhibit a “whoop” sound on inspiration after a coughing attack.
Symptoms are generally similar to colds, but coughing spells can last for more than 1 minute, during which the child may turn red or purple. This may frighten the parents or caregivers into calling 9-1-1.
Some infants and younger children with pertussis should be treated in a hospital because they are at greater risk for complications such as pneumonia, which occurs mostly in children younger than 1 year. In infants younger than 6 months, pertussis can be life threatening.
Children with pertussis may vomit or not want to eat or drink. Watch for signs of dehydration. You may have to
suction thick secretions to clear the airway. Give oxygen by the most appropriate means.
Pertussis can also occur in adults either because they were not vaccinated as children, or more commonly because the vaccine did not confer lifelong immunity. When it does occur, it can cause a severe upper respiratory infection, which can lead to pneumonia in geriatric patients or people with compromised immune systems. The infection can cause coughing spells that last for weeks and can be so severe that patients find it hard to breathe, eat, or sleep. In the worst cases of infection, particularly in geriatric patients, coughing can lead to cracked ribs. For patients who are already weak from other chronic conditions, pertussis can lead to hospitalization. According to the CDC, the disease has become a serious issue and physicians are becoming more aggressive about immunizing adults with the pertussis vaccine
Signs and symptoms of asthma
Produces wheezing. In severe cases, the actual work of exhaling is tiring and cyanosis or respiratory arrest may quickly develop. Asthma is an inflammation of the lungs associated with excessive mucus production and swelling of the bronchioles
___stroke occurs as a result of bleeding inside the brain. According to the American Stroke Association__ account for 13% of all strokes. In hemorrhagic stroke, a blood vessel ruptures and the accumulated blood then forms a blood clot, which compresses the brain tissue next to it. The compression prevents oxygenated blood from getting into the area, and the brain cells begin to die. Cerebral hemorrhages are often massive and rapidly fatal.
__commonly occurs in people experiencing stress or exertion. The people at highest risk for ___are those with extremely high blood pressure or long-term untreated elevated blood pressure. Many years of high blood pressure weaken the blood vessels in the brain. If a vessel ruptures, the bleeding in the brain will increase the pressure inside the cranium. Proper treatment of high blood pressure can help prevent this long-term damage to the blood vessels, decreasing the risk of this devastating complication.
Some people are born with a weakness in the walls of an artery. An aneurysm, a swelling or enlargement of the wall of an artery resulting from a defect or weakening of the arterial wall, may then develop. FIGURE 18-5 is an angiogram showing a cerebral aneurysm. The most notable symptom of a ruptured aneurysm is often a sudden-onset, severe headache, typically described by the patient as the worst headache he or she has ever had. The headache is caused by the irritation of blood on the brain tissue after the artery swells and ruptures. A___ in an otherwise healthy young person is often caused by a weakness in a blood vessel called a berry aneurysm. This type of aneurysm resembles a tiny balloon (or berry) that juts out from the artery. When the aneurysm is overstretched and ruptures, blood spurts into an area between two of the coverings of the brain called the subarachnoid space. These types of strokes are called subarachnoid hemorrhages. If the patient gets to the hospital quickly, surgical repair of the aneurysm may be possible. However, like other brain bleeding and cerebral hemorrhage, this condition is often fatal.
Hemorrhagic stroke
According to the American Stroke Association, ___is the most common type of stroke, accounting for 87% of all strokes. When blood flow to a specific part of the brain is stopped by a blockage (blood clot) inside a blood vessel, the result is an__. Patients who experience an___ may have dramatic symptoms, including loss of movement on the side of the body opposite the side where the occlusion has occurred
This blockage may be due to thrombosis, where a clot forms at the site of blockage, or an embolus, where the blood clot forms in a remote area (such as a diseased heart) and then travels to the site of the blockage. Patients with atrial fibrillation (a heart rhythm where the atria shake rather than squeeze) are prone to___ caused by an embolus and often take blood thinners to reduce the risk of these events.
As with coronary artery disease, atherosclerosis in the blood vessels is often the cause of__.
Atherosclerosis is a disorder in which calcium and cholesterol build up, forming plaque inside the walls of the blood vessels.
This plaque may obstruct blood flow and interfere with the vessels’ ability to dilate. Eventually, atherosclerosis may cause complete occlusion of an artery (FIGURE 18-3). In other cases, an atherosclerotic plaque in the carotid artery in the neck ruptures. A blood clot forms over the crack in the plaque. Sometimes, it grows large enough to completely block all blood flow through that artery. The parts of the brain supplied by the artery are deprived of oxygen and stop functioning.
ischemic stroke
___is a common cause of illness in young children. It causes an infection in the lungs and breathing passages, and can lead to other serious illnesses such as bronchiolitis and pneumonia, as well as serious heart and lung problems in premature infants and in children who have depressed immune systems.
___is highly contagious and can be spread through droplets when the patient coughs or sneezes. The virus can also survive on surfaces, including hands and clothing. Therefore, the infection tends to spread rapidly through schools and child care centers.
When you assess a child with suspected__, look for signs of dehydration. Infants with___ often refuse liquids.
Treat airway and breathing problems as appropriate. Humidified oxygen is helpful if available. Is more common in premature infants and results in copious secretions that may require suctioning of the nose
Respiratory syncytial virus (RSV)
___is a condition that is characterized by sudden respiratory distress that awakens the person at night when the patient is in a reclining position. The respiratory distress is caused by fluid accumulation in the lungs. Patients report coughing, feeling suffocated, and cold sweats, and you will notice tachycardia. The term for not being able to breathe while lying down is orthopnea. One indication that your patient may be experiencing heart failure is that he or she sleeps sitting up
Treatment should consist of airway, ventilatory, and circulatory support.
Paroxysmal nocturnal dyspnea
A buildup of fluid in the lungs, often as a result of chf
