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Service Hiring Deck Flashcards

1
Q

What is Beck’s Triad?

A

Three medical signs associated with ACUTE CARDIAC TAMPONADE:

  • Low BP
  • JVD
  • Muffled/diminished heart sounds
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2
Q

What is Cushing’s Triad?

A

Three medical signs that are indicative of ICP:

  • Bradycardia
  • Irregular respirations
  • Widened pulse pressure
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3
Q

What do Chronotropes, Inotropes, and Dromotropes do?

A

Chronotropes - HR (Metropolol)
Inotropes - Myocardial Contractility (Epinephrine)
Dromotropes - Electrical Conductivity (Digoxin)

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4
Q

H’s and T’s?

A

Hypovolemia Toxins
Hypoxia Tamponade
Hydrogen (Acidosis) Tension Pneumothorax
Hyper/Hypokalemia Thrombosis (Coronary)
Hypothermia Thromboembolism (Pulmonary)
Hypoglycemia Trauma

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5
Q

What is the Blood Brain Barrier?

A

Protective system in the brain via impermeable capillaries. Blocks harmful substances from entering such as bacteria and toxins.

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6
Q

What does the Blood Brain Barrier allow to pass?

A

Water, oxygen, carbon dioxide, and general anesthetics

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7
Q

What is Broca’s Area?

A
  • Motor or expressive speech area
  • Located at base of left frontal lobe

“Controls output of words - verbal and written. Ensures they are coordinated and appropriate”

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8
Q

What is Wernicke’s Area?

A
  • Center that comprehends language received - both written and spoken
  • Located in posterior temporal lobe
  • Has connective fibers to visual and auditory areas
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9
Q

What serves as a relay station for incoming sensory impulses?

A

Thalamus

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10
Q

What is responsible for maintaining:

  • Homeostasis in the body?
  • Regulation of body temperature?
  • Regulation of libido?
A

Hypothalamus

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11
Q

12 Cranial Nerves? (Oh oh oh, to touch and feel very good velvet ah heaven)

A

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Spinal Accessory
Hypoglossal

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12
Q

12 Cranial Nerves functions? (Some say money matters but my brother says big brains matter more)

A

Olfactory - Sensory
Optic - Sensory
Oculomotor - Motor
Trochlear - Motor
Trigeminal - Both
Abducens - Motor
Facial - Both
Vestibulocochlear - Sensory
Glossopharyngeal - Both
Vagus - Both
Spinal Accessory - Motor
Hypoglossal - Motor

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13
Q

Where does the spinal start and end?

A

Starts at Medulla Oblongata, ends at 1st Lumbar Vertebra

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14
Q

Spinal Cord Breakdown?

A

Cervical: C1 -C7
Thoracic: T1-T12
Lumbar: L1-L5
Sacral: - S1-S5
Coccyx: 4

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15
Q

The pressure inside of the cranium is a result of?

A

Brain tissues, blood, CSF

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16
Q

What is the regular ICP pressure?

A

5-15 mmHg (15 upper limit of normal)

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17
Q

What is Cerebral Perfusion Pressure (CPP)?

A

Pressure gradient that causes cerebral blood flow to the brain.

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18
Q

What level should CPP be?

A

70-80 mmHg. NO LESS THAN 60; doubles patient’s chances of death)

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19
Q

What is Mean Arterial Pressure?

A

The average arterial pressure throughout one cardiac cycle, systole, and diastole.

  • 70-100 mmHg. <60 can be deadly to organs.
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20
Q

How do you calculate CPP?

A

MAP - ICP = CPP

*When ICP = MAP, BLOOD FLOW STOPS

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21
Q

If suspected ICP continues to build up, what should you look for right away?

A

Cushing’s Triad

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22
Q

Indications for Acute Stroke Bypass Protocol?

A

1) Present with new onset of at least one of the following symptoms:
a: Unilateral arm/leg weakness or drift
b: Slurred speech or inappropriate words/mute
c: Unilateral facial droop

2) Can be transported to Designated Stroke Centre within 6 hours of symptom onset or last time patient was seen in state of health

3) Perform secondary screen for Large Vessel Occlusion (LVO) using LAMS, and inform CACC/ACS to aid in determination of most appropriate destination

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23
Q

Contraindications for Acute Stroke Protocol?

A
  • CTAS 1 and/or uncorrected airway, breathing or circulatory problem
  • Symptoms of stroke resolved prior to paramedic arrival**
  • Blood sugar <3 mmol/L ***
  • Seizure observed by paramedics
  • GCS <10
  • Terminally ill or palliative care patient
  • Duration of hospital transport exceeds two hours

**Patients whose symptoms improve significantly or resolve during transport will continue to be transported to a Designated Stroke Centre

*** If symptoms persist after correction of blood glucose level, the patient is not contraindicated.

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24
Q

How to calculate GCS?

A

Eye Opening:

4 - Spontaneous
3 - Verbal stimulus
2 - Pain stimulus
1 - No eye opening

Verbal:

5 - Oriented
4 - Confused
3 - Inappropriate words
2 - Incomprehensible sounds
1 - No verbal response

Motor:

6 - Obeys commands
5 - Localizes painful
4 - Withdraws from painful stimulus
3 - Abnormal flexion
2 - Abnormal extension
1 - No motor response

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25
Q

How does Glucagon increase blood sugar levels?

A

1) Glycogenolysis - conversion of glycogen into glucose from stores in liver

2) Glucogenesis - conversion of nutrients into glucose molecules

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26
Q

What are the main hormones that the Islet of Langherhans secretes?

A

1) Glucagon - produced by ALPHA cells. Secreted when blood glucose level falls. Stimulates liver to change glycogen into sugar

2) Insulin - produced by BETA CELLS. Enables cells to uptake glucose and allows of STORAGE OF GLYCOGEN for later use. Secreted when blood glucose levels are elevated.

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27
Q

What are some examples of Beta Blockers?

A

Metoprolol, Atenolol, Propanolol

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28
Q

What are some examples of Calcium Channel Blockers?

A

Amlodipine, Diltiazem, Felodipine

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29
Q

What are some examples of ACE inhibitors?

A

Benazepril, Lisinopril, Captopril

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30
Q

What are some examples of Potassium Sparing Diuretics?

A

Amiloride (Midamor)
Spironolactone (Aldactone, Carospir)
Triamterene (Dyrenium)
Eplerenone (Inspra)

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31
Q

What is the Left Coronary Artery? (LCA)

A

Artery that supplies blood ot left side of heart muscle (LV and LA)

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32
Q

What is the Left Anterior Descending Artery (LAD)?

A

Branches off the Left Coronary Artery and supplies blood to the front of the left side of the heart

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33
Q

What is the Left Circumflex Artery (LCA)?

A

Branches off the Left Coronary Artery and encircles the heart muscle. Supplies blood to lateral side and back of the heart.

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34
Q

What is the Right Coronary Artery (RCA)?

A

Supplies blood to the RV, RA, SA node and AV node

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35
Q

What can prolonged SVT lead to?

A
  • MI due to shortened chamber filling time, can lead to sudden chest pain/tightness
  • Loss of atrial kick leaving approx. 1/3 of blood volume remaining in atria. Leads to decreased cardiac output
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36
Q

Prolonged hypertension can cause?

A
  • Hypertrophy of LV; becomes enlarged and inefficient as a pump
  • Decline in coronary artery circulation to eventually occur if LV becomes inefficient at pumping the required cardiac output
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37
Q

What is the reason for paradoxical chest movement on INSPIRATION?

A

Decreased intrathoracic pressure

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38
Q

Signs and symptoms of Right Sided Heart Failure?

A

Peripheral edema, tachycardia, chest pain, JVD

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39
Q

Signs and symptoms of Left Sided Heart Failure?

A

SOB, coughing, pulmonary edema

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40
Q

Signs and symptoms of hypoglycemic attack?

A

Diaphoresis, irritability/anxiety, hunger tachycardia

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41
Q

What is Placenta Accreta?

A

When the placenta grows too deeply into the uterine wall. This can cause severe blood after delivery.

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42
Q

What is Placenta Previa?

A

When the placenta completely or partially covers opening of uterus.

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43
Q

What is Placenta Abruptio?

A

When placenta partly or completely separates from inner wall of uterus before delivery.

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44
Q

What is Afterload?

A

The pressure that the heart must work against to eject blood during systole.

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45
Q

What is Preload?

A

The force that stretches the cardiac muscle prior to contraction;

The “force” is composed of the volume that fills the heart from venous return.

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46
Q

LAMS scale grade?

A

Facial Droop:
Absent - 0
Present - 1

Arm Drift:
Absent - 0
Drifts Down - 1
Falls Rapidly - 2

Grip Strength:
Normal - 0
Weak - 1
No Grip - 2

Total: /5

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47
Q

APGAR scale?

A

Appearance:
Full body cyanosis - 0
Pink body, blue extremities - 1
Pink - 2

Pulse:
Absent - 0
<100 BPM - 1
>100 BPM - 2

Grimace:
Floppy - 0
Minimal stimulation - 1
Prompt response to stimulation - 2

Activity (Muscle Tone):
Absent - 0
Flexed Arms & Legs - 1
Active - 2

Respiration:
Absent - 0
Slow and Irregular - 1
Vigorous Cry - 2

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48
Q

What is the Bohr Effect?

A

Shift RIGHT

  • Increase H+
  • Increased CO2
  • Increased 2,3 BPG
  • Increased Temp
  • Decreased Affinity of O2 (Hb)

Net result? HIGHER O2 DISSOCIATION

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49
Q

What is the Haldane Effect?

A

Shift LEFT

  • Decreased H+
  • Decreased CO2
  • Decreased 2,3 BPG
  • Decreased Temp
  • Increased Affinity of O2 (Hb)

Net result? LOWER O2 DISSOCIATION

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50
Q

What is Tidal Volume?

A

Normal inhalation. Avg tidal volume is 500 ml.

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51
Q

What is Inspiratory Reserve Volume?

A

Amount of extra air inhaled AFTER a normal/tidal inspiration. Can be as high as 3000 ml.

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52
Q

What is Expiratory Reserve Volume?

A

Amount of extra air exhaled AFTER a normal/tidal expiration.

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53
Q

What is Vital Capacity?

A

The most air you can exhale after taking the deepest inhalation possible.

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54
Q

What is Total Lung Capacity?

A

The total amount of air the lungs can hold; includes everything. Average TLC is 6000 ml.

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55
Q

What are the primary bronchi known as?

A

Right and left mainstem bronchi (bronchus for singular)

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56
Q

Of the primary bronchi, which one is longer and is at an angle of 45 degrees?

A

Left bronchus

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57
Q

Of the primary bronchi, which is shorter and is at an angle of 25 degrees?

A

Right bronchus

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58
Q

Where do most foreign bodies that pass the carina end up in?

A

The right mainstem bronchus; due to the 25 degree angle, it’s almost in a straight line with the distal end of the trachea

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59
Q

What major illnesses are common to diabetic patients secondary to their diabetes?

A

Arteriosclerotic heart disease, stroke, renal disease

60
Q

How long should a PR interval be?

A

0.12 - 0.20 seconds (or 3-5 small squares)

61
Q

How long should a QRS interval be?

A

0.08 - 0.12 seconds (or 2-3 small squares)

62
Q

How long should a QT interval be?

A

0.35 - 0.44 seconds (men)
0.35 - 0.46 seconds (women)

63
Q

Indications for STEMI Bypass Protocol?

A

1) >18 yrs
2) Chest pain or equivalent with cardiac ischemia/MI
3) Time from onset of pain <12 hrs
4) 12-lead ECG indicates STEMI via:

a) 2mm ST-elevation in leads V1-V3 in at least two contiguous leads, AND/OR
b) 1mm ST-elevation in at least two other anatomically contiguous leads; OR
c) 12-lead ECG computer interpretation of STEMI and paramedic agrees

*Once activated, continue to follow STEMI Bypass Protocol even if ECG normalizes.

64
Q

Contraindications for STEMI Bypass Protocol?

A

1) CTAS 1 and unable to secure airway/ventilate
2) 12-Lead shows LBBB, ventricular paced rhythm, or any other STEMI imitator
3) Transport to PCI >60 mins from patient contact**
4) Pt is experiencing a complication requiring PCP diversion:

a) Moderate to severe respiratory distress of use of CPAP
b) Hemodynamic instability or symptomatic SBP <90mmHg at any point
c) VSA without ROSC

65
Q

For NEMS, where is the headquarters?

66
Q

What does the Welland Canal not cross?

67
Q

Who is the Interim Chief, Deputy Chief, and Interim Deputy Chief of NEMS?

A

Interim Chief - Rick Farron
Deputy Chief - Karen Lutz-Graul
Interim Deputy Chief - Michael Franklin
Regional Chair - Jim Bradley
Commander - Lesley Donaldson

68
Q

With a COPD patient, what should your target ETCO2 values be?

A

50-60 mmHg

69
Q

What is the Pediatric Triangle?

A

Appearance, Work of Breathing, Circulation

70
Q

Which bridge do you cross for Erie County Medical Center?

A

Peace Bridge

71
Q

How many communities are in the Niagara Region?

72
Q

Doffing Order?

A

Mask
Gown
Gloves
Eye protection
Hand hygiene

73
Q

Where do hemostatic dressings go?

A

Groin, axilla, abdomen, extremities

74
Q

When the coronary arteries receive blood, this is known as?

A

Ventricular Systole

75
Q

Where is compartment syndrome most severe?

A

Abdomen, most common in arm

76
Q

Ventricular relaxation is known as?

77
Q

What is croup called?

A

Laryngeotracheobronchitis

78
Q

Where are chemoreceptors located in?

A

Carotid and aortic bodies

79
Q

What are the KED weight restrictions?

A

227 kg or 500 pounds

80
Q

Examples of retroperitoneal organs?

A

kidneys, esophagus, pancreas, rectum, ureters

81
Q

Tonic-clonic seizure phases?

A
  • Tonic: All muscles stiffen, may hear cry/groan person losses consciousness and fall
  • Clonic: Arm/legs shake and jerk rapidly (convulsion stage)
  • Lasts 1-3 minutes, anything greater than 5 minutes needs medical attention
82
Q

What does diphenhydramine block the production of?

A

Leukotriene prostaglandins

83
Q

What do mast cells secrete?

84
Q

When does glucagon not work?

A

When there’s no more glycogen stores

85
Q

How long do you rinse alkali burns for?

A

20 minutes

86
Q

Which hospitals have CT scans in the NIagara Region?

A

Welland, SCGH, GNGH

87
Q

List some barriers you’d encounter in Niagara

A

Niagara Escarpment
Niagara River
Welland Canal
Train tracks in Grimsby

88
Q

What lakes surround Niagara?

A

Lake Erie, Lake Ontario

89
Q

International Bridges?

A

Peace
Queenston
Whirpool
Rainbow,
Lewiston

90
Q

What are the CITIES in Niagara Region?

A

Niagara Falls
Port Colborne,
Catharines
Thorold
Welland

91
Q

What are the TOWNS in Niagara Region?

A

Fort Erie
Lincoln
NOTL
Grimsby
Pelham

92
Q

What are the TOWNSHIPS in Niagara Region?

A

Wainfleet, West Lincoln

93
Q

What impedes radio transmission in Grimsby?

A

Escarpment

94
Q

What is a popular example of a Cardiac Glycoside?

95
Q

Intrinsic rate values for nodes of the heart?

A

SA: 60 - 100 BPM
AV: 40 - 60 BPM
Bundle of His/Purkinje Fibers: 20 - 40 BPM

96
Q

What does aphasia mean?

A

Can not speak

97
Q

3 P’s of diabetes?

A

Polyuria (excessive urination)
Polydipsia (excessive thirst)
Polyphagia (excessive amount of food)

98
Q

What effects does Epi have on ALPHA and BETA cells?

A

Alpha 1: Peripheral vasoconstriction (increased BP)
Alpha 2: Dilation of coronary arteries (increased HR)
Beta 1: Increased HR and contractility
Beta 2: Dilation of bronchi

99
Q

Maximum CPAP volume?

A

15cm H2O

  • Starts off at 5 cm H2O, increasing by 2.5 cm q 5
100
Q

How does Januvia work?

A

Increases insulin production by the pancreas

101
Q

How many mls can an adult BVM hold?

102
Q

How many mls can a pediatric BVM hold?

103
Q

How many mls of oxygen does a BVM with 2 hands deliver?

A

2 hands = 1100 ml
1 hand = 800 ml

104
Q

What would overdosing on ASA cause?

A

Metabolic acidosis

105
Q

When the V/Q is > 0.8, what does this mean?

A

Ventilation EXCEEDS perfusion.

Common causes: Emphysema, blood clot, heart failure

106
Q

When the V/Q is < 0.8, what does this mean?

A

Perfusion EXCEEDS ventilation.

Common causes: Aspiration, FBO, pulmonary edema

107
Q

Targeted Pre-Ductal SPO2 after birth?

A

1 min - 60% - 65%
2 min - 65% - 70%
3 min - 70% - 75%

and so forth until….

10 min - 85% - 95%

108
Q

What is Kernig’s Sign?

A

Pain in neck when extending the knee

109
Q

What is Brudzinski’s Sign?

A

Flexion of knees when neck is flexed

110
Q

ACR Code 71?

A

Patient not found

111
Q

Epinephrine is rapidly metabolized by enzymes in which part of the body?

A

Liver and excreted in the urine or lungs by being exhaled

112
Q

Tank Constants

A

D=0.16
E=0.28
M=1.56

113
Q

Which coronary arteries supply the POSTERIOR and INFERIOR portion of the heart?

A

RCA, Circumflex

114
Q

Which coronary arteries supply the ANTERIOR portion of the heart?

115
Q

Which coronary arteries supply the ANTEROLATERAL portion of the heart?

A

LAD, Circumflex

116
Q

Which coronary arteries supply the ANTEROSEPTAL portion of the heart?

117
Q

Ontario Street crosses the QEW how many times?

A

3 times:

Beamsville, St. Catharines, Grimsby

118
Q

What streets make up the 4 corners in the falls?

A

Drummond, Portage, Thorold, Stone

119
Q

Shock therapy aims to restore two processes at a cellular level. What are they?

A

Oxygenation and perfusion

120
Q

What is the relationship b/w oxygenation and perfusion?

A

Oxygenation is dependent upon delivery of oxygen to blood via respiratory system

AND

Ability of hemoglobin to transport it to cells.

121
Q

Three causes of shock related to PUMP?

A
  • MI
  • Dysrhythmia
  • Myocardial Contusion
122
Q

Three causes of shock related to VESSEL?

A
  • Sepsis
  • C-Spine injury
  • Anaphylaxis
123
Q

Three causes of shock related to VOLUME?

A
  • GI losses
  • Hemorrhaging
  • Renal losses
124
Q

The cell prefers to use ______ and ________ to make _________?

A

O2, Glucose, ATP/energy

125
Q

Why does someone in shock have metabolic acidosis?

A

Decreased oxygen delivery to cells makes the cell undergo anaerobic metabolism to generate energy. This leads to pyruvate production, which metabolizes to lactic acid

126
Q

Slight tachycardia and mild anxiety may be your only clues to early detection of an occult bleed. Why?

A

Neurogenic (SNS) compensation or the “fight or flight” response is responsible for the vasoconstriction, tachycardia and anxiety.

127
Q

The patient’s ability to to compensate for shock is influenced by?

A
  • Duration of shock
  • Severity of shock
  • Age
  • Concurrent illnesses
128
Q

What are some factors that determine the quantity of oxygen being delivered to the tissues?

A
  • Blood flow
  • Concentration of hemoglobin
  • Affinity of oxygen for hemoglobin
129
Q

Oxygen moves out of the alveoli into the circulation by process of?

130
Q

Oxygen is transported in the circulation primarily by _____ and minimally by ______?

A

Combining with hemoglobin, dissolving in plasma

131
Q

Oxygen release to the tissues occurs when

A

Oxygen concentration in tissues is lower than in the blood

132
Q

What are some factors that affect oxygen release to the tissues?

A

pH, temperature, CO2

133
Q

List - from largest to smallest - the means by which carbon dioxide is transported into the body.

A
  • Bicarbonate
  • Combined with hemoglobin (carbaminohemoglobin)
  • Dissolved in plasma (smallest)
134
Q

Major types of hypoxia?

A

Hypoxemia and tissue hypoxia

135
Q

Difference between intracellular fluid (ICF) and extracellular fluid (ECF)

A

ICF - Fluid that circulates inside body’s cells
ECF - Fluid that circulates outside body’s cells

136
Q

Difference between intravascular fluid (IVF) and interstitial fluid (ISF)

A

IVF - Extracellular fluid located within blood vessels
ISF - Extracellular fluid located between cells and blood vessels

137
Q

What are the two main hormones that act on the kidney to regulate fluid and electrolyte balance?

A

Antidiuretic hormone (ADH) and aldosterone

138
Q

Which hormone is produced by the adenohypophysis?

A

Growth hormone

139
Q

What chemical substances are released by the adrenal medulla?

A

Epi and norepi

140
Q

Where are the parathyroid glands found?

A

One pair on posterior aspect of each lobes of the thyroid gland

141
Q

What is the anatomical location of the thyroid gland?

A

Below larynx, anterior upper end of trachea

142
Q

What is a mixed gland?

A

Gland with both endocrine and exocrine function (pancreas)

143
Q

What is a double gland?

A

Gland with two major components which differ in their hormone production (pituitary gland)

144
Q

Four muscles that comprise the anterior abdominal wall?

A

Rectus abdominis
External oblique
Internal oblique
Transversus abdominis

145
Q

What organs come into contact with the spleen?

A

Pancreas
Left kidney
Colon
Stomach

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