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
2
Q
What is Cushing’s Triad?
A
Three medical signs that are indicative of ICP:
- Bradycardia
- Irregular respirations
- Widened pulse pressure
3
Q
What do Chronotropes, Inotropes, and Dromotropes do?
A
Chronotropes - HR (Metropolol)
Inotropes - Myocardial Contractility (Epinephrine)
Dromotropes - Electrical Conductivity (Digoxin)
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
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.
6
Q
What does the Blood Brain Barrier allow to pass?
A
Water, oxygen, carbon dioxide, and general anesthetics
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”
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
9
Q
What serves as a relay station for incoming sensory impulses?
A
Thalamus
10
Q
What is responsible for maintaining:
- Homeostasis in the body?
- Regulation of body temperature?
- Regulation of libido?
A
Hypothalamus
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
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
13
Q
Where does the spinal start and end?
A
Starts at Medulla Oblongata, ends at 1st Lumbar Vertebra
14
Q
Spinal Cord Breakdown?
A
Cervical: C1 -C7
Thoracic: T1-T12
Lumbar: L1-L5
Sacral: - S1-S5
Coccyx: 4
15
Q
The pressure inside of the cranium is a result of?
A
Brain tissues, blood, CSF
16
Q
What is the regular ICP pressure?
A
5-15 mmHg (15 upper limit of normal)
17
Q
What is Cerebral Perfusion Pressure (CPP)?
A
Pressure gradient that causes cerebral blood flow to the brain.
18
Q
What level should CPP be?
A
70-80 mmHg. NO LESS THAN 60; doubles patient’s chances of death)
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.
20
Q
How do you calculate CPP?
A
MAP - ICP = CPP
*When ICP = MAP, BLOOD FLOW STOPS
21
Q
If suspected ICP continues to build up, what should you look for right away?
A
Cushing’s Triad
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
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.
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
25
How does Glucagon increase blood sugar levels?
1) Glycogenolysis - conversion of glycogen into glucose from stores in liver
2) Glucogenesis - conversion of nutrients into glucose molecules
26
What are the main hormones that the Islet of Langherhans secretes?
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.
27
What are some examples of Beta Blockers?
Metoprolol, Atenolol, Propanolol
28
What are some examples of Calcium Channel Blockers?
Amlodipine, Diltiazem, Felodipine
29
What are some examples of ACE inhibitors?
Benazepril, Lisinopril, Captopril
30
What are some examples of Potassium Sparing Diuretics?
Amiloride (Midamor)
Spironolactone (Aldactone, Carospir)
Triamterene (Dyrenium)
Eplerenone (Inspra)
31
What is the Left Coronary Artery? (LCA)
Artery that supplies blood ot left side of heart muscle (LV and LA)
32
What is the Left Anterior Descending Artery (LAD)?
Branches off the Left Coronary Artery and supplies blood to the front of the left side of the heart
33
What is the Left Circumflex Artery (LCA)?
Branches off the Left Coronary Artery and encircles the heart muscle. Supplies blood to lateral side and back of the heart.
34
What is the Right Coronary Artery (RCA)?
Supplies blood to the RV, RA, SA node and AV node
35
What can prolonged SVT lead to?
- 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
36
Prolonged hypertension can cause?
- 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
37
What is the reason for paradoxical chest movement on INSPIRATION?
Decreased intrathoracic pressure
38
Signs and symptoms of Right Sided Heart Failure?
Peripheral edema, tachycardia, chest pain, JVD
39
Signs and symptoms of Left Sided Heart Failure?
SOB, coughing, pulmonary edema
40
Signs and symptoms of hypoglycemic attack?
Diaphoresis, irritability/anxiety, hunger tachycardia
41
What is Placenta Accreta?
When the placenta grows too deeply into the uterine wall. This can cause severe blood after delivery.
42
What is Placenta Previa?
When the placenta completely or partially covers opening of uterus.
43
What is Placenta Abruptio?
When placenta partly or completely separates from inner wall of uterus before delivery.
44
What is Afterload?
The pressure that the heart must work against to eject blood during systole.
45
What is Preload?
The force that stretches the cardiac muscle prior to contraction;
The "force" is composed of the volume that fills the heart from venous return.
46
LAMS scale grade?
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
47
APGAR scale?
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
48
What is the Bohr Effect?
Shift RIGHT
- Increase H+
- Increased CO2
- Increased 2,3 BPG
- Increased Temp
- Decreased Affinity of O2 (Hb)
Net result? HIGHER O2 DISSOCIATION
49
What is the Haldane Effect?
Shift LEFT
- Decreased H+
- Decreased CO2
- Decreased 2,3 BPG
- Decreased Temp
- Increased Affinity of O2 (Hb)
Net result? LOWER O2 DISSOCIATION
50
What is Tidal Volume?
Normal inhalation. Avg tidal volume is 500 ml.
51
What is Inspiratory Reserve Volume?
Amount of extra air inhaled AFTER a normal/tidal inspiration. Can be as high as 3000 ml.
52
What is Expiratory Reserve Volume?
Amount of extra air exhaled AFTER a normal/tidal expiration.
53
What is Vital Capacity?
The most air you can exhale after taking the deepest inhalation possible.
54
What is Total Lung Capacity?
The total amount of air the lungs can hold; includes everything. Average TLC is 6000 ml.
55
What are the primary bronchi known as?
Right and left mainstem bronchi (bronchus for singular)
56
Of the primary bronchi, which one is longer and is at an angle of 45 degrees?
Left bronchus
57
Of the primary bronchi, which is shorter and is at an angle of 25 degrees?
Right bronchus
58
Where do most foreign bodies that pass the carina end up in?
The right mainstem bronchus; due to the 25 degree angle, it's almost in a straight line with the distal end of the trachea
59
What major illnesses are common to diabetic patients secondary to their diabetes?
Arteriosclerotic heart disease, stroke, renal disease
60
How long should a PR interval be?
0.12 - 0.20 seconds (or 3-5 small squares)
61
How long should a QRS interval be?
0.08 - 0.12 seconds (or 2-3 small squares)
62
How long should a QT interval be?
0.35 - 0.44 seconds (men)
0.35 - 0.46 seconds (women)
63
Indications for STEMI Bypass Protocol?
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
Contraindications for STEMI Bypass Protocol?
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
For NEMS, where is the headquarters?
NOTL
66
What does the Welland Canal not cross?
Fort Erie
67
Who is the Interim Chief, Deputy Chief, and Interim Deputy Chief of NEMS?
Interim Chief - Rick Farron
Deputy Chief - Karen Lutz-Graul
Interim Deputy Chief - Michael Franklin
Regional Chair - Jim Bradley
Commander - Lesley Donaldson
68
With a COPD patient, what should your target ETCO2 values be?
50-60 mmHg
69
What is the Pediatric Triangle?
Appearance, Work of Breathing, Circulation
70
Which bridge do you cross for Erie County Medical Center?
Peace Bridge
71
How many communities are in the Niagara Region?
12
72
Doffing Order?
Mask
Gown
Gloves
Eye protection
Hand hygiene
73
Where do hemostatic dressings go?
Groin, axilla, abdomen, extremities
74
When the coronary arteries receive blood, this is known as?
Ventricular Systole
75
Where is compartment syndrome most severe?
Abdomen, most common in arm
76
Ventricular relaxation is known as?
Diastole
77
What is croup called?
Laryngeotracheobronchitis
78
Where are chemoreceptors located in?
Carotid and aortic bodies
79
What are the KED weight restrictions?
227 kg or 500 pounds
80
Examples of retroperitoneal organs?
kidneys, esophagus, pancreas, rectum, ureters
81
Tonic-clonic seizure phases?
- 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
What does diphenhydramine block the production of?
Leukotriene prostaglandins
83
What do mast cells secrete?
HIstamine
84
When does glucagon not work?
When there's no more glycogen stores
85
How long do you rinse alkali burns for?
20 minutes
86
Which hospitals have CT scans in the NIagara Region?
Welland, SCGH, GNGH
87
List some barriers you'd encounter in Niagara
Niagara Escarpment
Niagara River
Welland Canal
Train tracks in Grimsby
88
What lakes surround Niagara?
Lake Erie, Lake Ontario
89
International Bridges?
Peace
Queenston
Whirpool
Rainbow,
Lewiston
90
What are the CITIES in Niagara Region?
Niagara Falls
Port Colborne,
Catharines
Thorold
Welland
91
What are the TOWNS in Niagara Region?
Fort Erie
Lincoln
NOTL
Grimsby
Pelham
92
What are the TOWNSHIPS in Niagara Region?
Wainfleet, West Lincoln
93
What impedes radio transmission in Grimsby?
Escarpment
94
What is a popular example of a Cardiac Glycoside?
Digoxin
95
Intrinsic rate values for nodes of the heart?
SA: 60 - 100 BPM
AV: 40 - 60 BPM
Bundle of His/Purkinje Fibers: 20 - 40 BPM
96
What does aphasia mean?
Can not speak
97
3 P's of diabetes?
Polyuria (excessive urination)
Polydipsia (excessive thirst)
Polyphagia (excessive amount of food)
98
What effects does Epi have on ALPHA and BETA cells?
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
Maximum CPAP volume?
15cm H2O
- Starts off at 5 cm H2O, increasing by 2.5 cm q 5
100
How does Januvia work?
Increases insulin production by the pancreas
101
How many mls can an adult BVM hold?
1500 ml
102
How many mls can a pediatric BVM hold?
450 ml
103
How many mls of oxygen does a BVM with 2 hands deliver?
2 hands = 1100 ml
1 hand = 800 ml
104
What would overdosing on ASA cause?
Metabolic acidosis
105
When the V/Q is > 0.8, what does this mean?
Ventilation EXCEEDS perfusion.
Common causes: Emphysema, blood clot, heart failure
106
When the V/Q is < 0.8, what does this mean?
Perfusion EXCEEDS ventilation.
Common causes: Aspiration, FBO, pulmonary edema
107
Targeted Pre-Ductal SPO2 after birth?
1 min - 60% - 65%
2 min - 65% - 70%
3 min - 70% - 75%
and so forth until....
10 min - 85% - 95%
108
What is Kernig's Sign?
Pain in neck when extending the knee
109
What is Brudzinski's Sign?
Flexion of knees when neck is flexed
110
ACR Code 71?
Patient not found
111
Epinephrine is rapidly metabolized by enzymes in which part of the body?
Liver and excreted in the urine or lungs by being exhaled
112
Tank Constants
D=0.16
E=0.28
M=1.56
113
Which coronary arteries supply the POSTERIOR and INFERIOR portion of the heart?
RCA, Circumflex
114
Which coronary arteries supply the ANTERIOR portion of the heart?
LAD
115
Which coronary arteries supply the ANTEROLATERAL portion of the heart?
LAD, Circumflex
116
Which coronary arteries supply the ANTEROSEPTAL portion of the heart?
LAD
117
Ontario Street crosses the QEW how many times?
3 times:
Beamsville, St. Catharines, Grimsby
118
What streets make up the 4 corners in the falls?
Drummond, Portage, Thorold, Stone
119
Shock therapy aims to restore two processes at a cellular level. What are they?
Oxygenation and perfusion
120
What is the relationship b/w oxygenation and perfusion?
Oxygenation is dependent upon delivery of oxygen to blood via respiratory system
AND
Ability of hemoglobin to transport it to cells.
121
Three causes of shock related to PUMP?
- MI
- Dysrhythmia
- Myocardial Contusion
122
Three causes of shock related to VESSEL?
- Sepsis
- C-Spine injury
- Anaphylaxis
123
Three causes of shock related to VOLUME?
- GI losses
- Hemorrhaging
- Renal losses
124
The cell prefers to use ______ and ________ to make _________?
O2, Glucose, ATP/energy
125
Why does someone in shock have metabolic acidosis?
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
Slight tachycardia and mild anxiety may be your only clues to early detection of an occult bleed. Why?
Neurogenic (SNS) compensation or the “fight or flight” response is responsible for the vasoconstriction, tachycardia and anxiety.
127
The patient's ability to to compensate for shock is influenced by?
- Duration of shock
- Severity of shock
- Age
- Concurrent illnesses
128
What are some factors that determine the quantity of oxygen being delivered to the tissues?
- Blood flow
- Concentration of hemoglobin
- Affinity of oxygen for hemoglobin
129
Oxygen moves out of the alveoli into the circulation by process of?
Diffusion
130
Oxygen is transported in the circulation primarily by _____ and minimally by ______?
Combining with hemoglobin, dissolving in plasma
131
Oxygen release to the tissues occurs when
Oxygen concentration in tissues is lower than in the blood
132
What are some factors that affect oxygen release to the tissues?
pH, temperature, CO2
133
List - from largest to smallest - the means by which carbon dioxide is transported into the body.
- Bicarbonate
- Combined with hemoglobin (carbaminohemoglobin)
- Dissolved in plasma (smallest)
134
Major types of hypoxia?
Hypoxemia and tissue hypoxia
135
Difference between intracellular fluid (ICF) and extracellular fluid (ECF)
ICF - Fluid that circulates inside body's cells
ECF - Fluid that circulates outside body's cells
136
Difference between intravascular fluid (IVF) and interstitial fluid (ISF)
IVF - Extracellular fluid located within blood vessels
ISF - Extracellular fluid located between cells and blood vessels
137
What are the two main hormones that act on the kidney to regulate fluid and electrolyte balance?
Antidiuretic hormone (ADH) and aldosterone
138
Which hormone is produced by the adenohypophysis?
Growth hormone
139
What chemical substances are released by the adrenal medulla?
Epi and norepi
140
Where are the parathyroid glands found?
One pair on posterior aspect of each lobes of the thyroid gland
141
What is the anatomical location of the thyroid gland?
Below larynx, anterior upper end of trachea
142
What is a mixed gland?
Gland with both endocrine and exocrine function (pancreas)
143
What is a double gland?
Gland with two major components which differ in their hormone production (pituitary gland)
144
Four muscles that comprise the anterior abdominal wall?
Rectus abdominis
External oblique
Internal oblique
Transversus abdominis
145
What organs come into contact with the spleen?
Pancreas
Left kidney
Colon
Stomach
