State Review Flashcards
Binds to narcotic receptor sites in the brain to reverse narcotic - opiate OD
Narcan
Narcan to an addict =
Withdrawal reaction
Narcan Adult dose
0.4 - 2mg
Narcan pedi dose
0.1 mg/kg
Fastest administration route =
Sublingual
Intradermal injections are done at what degree?
10-15 degrees
What are the Central lines in the body?
Internal jugular, femoral, subclavian, GO FOR EXTERNAL JUGULAR
IV therapy complications are?
Hematoma, infiltration, cellulitis, air embolism, thrombus formation/infection and phlebitis ( which is infection ) NOT SEPSIS.
Destruction of RBC during venipuncture is?
Hemolysis
Elevating an arm will not?
Distend vein for venipuncture
Medications combined with fat and oils is what?
Emulsion
Mini drip is used for what?
Med-line IV’s
KVO = what drip rate?
10 gtts/min
1 pint of blood = how many CC’s?
500
1 oz = how many CC’s?
30
60mg = how many grain?
1
Med-I =?
463,000
Time required for 1/2 of radio active substance to lose activity =
1/2 life
1/2 life =
Radio active decay
Routes of medication from slowest to fastest absorption
PO, SQ, IM, ET, IV
Parenteral routes of drug administration are?
SQ, IM, IV, ET, IO
SQ injections are contraindicated with a pt in what?
Hypovolemic shock
Parenteral routes =
SQ, IM, IV not oral (Enteral)
5% dextrose in H2O should not be given to a pt with what?
Pulmonary edema
5% dextrose and H2O is used for what conditions?
Dehydration, Med infusion, and AMI
Never give D5w to a pt with what?
Head injury or normal glucose levels
IV set with 15 gtts/ml to administer 50ml an hr =
13 drops per min
Order 25G dextrose from 100cc amp of 50% dextrose, how many CC’s will be given?
50 CC’s
20 drop set in 30 min running at 50 gtts =
75 ml
60 drop set in 30 min running at 20 gtts=
10 ml
Colloids increase intravascular space the most but take longer to get in due to protein size and molecular weight is what?
Hespan/dextran
Homeostasis AKA?
Dynamic steady state
IV solution closest to plasma is?
Lactated Ringers
Reduces the portability of blood transfusion reaction
Fresh frozen plasma can be used and does not have to be cross matched
Hemorrhagic shock best fluid =
Blood ( definitive ) Lactated ringers in the field 3x blood loss
Universal blood donor
O neg
O Negative =
Negative AB antigens
Universal blood recipient is?
AB
Schedule 1 drugs
Heroin, Mescaline, LSD - NOT Cocaine
Increased amount of a drug to reach a desired effect =
Tolerance
Tricyclic Overdose =
Sodium Bicarbonate
Drug of choice for hyperkalemia (increase potassium) is?
Calcium chloride
Benzo overdose (Valium) reversal is?
Romazicon/ flumazanil
Morphine is given by what routes?
IV and IM
Morphine OD causes what symptoms?
Hypotension and Resp depression ( same for all opiates, benzo/barbiturates)
Clinical signs of shock do not give?
SQ injection
Major problems with catheter thru the needle system is?
Catheter embolus
Bretylium dose
5mg/kg
Benadryl dose
25-50 mg (IVP)
First compensatory mechanism to maintain homeostasis is?
Bicarbonate buffer then Resp and renal
Hydrogen protons that make pH balance is located where?
Kidneys
Hydrogen Ions are eliminated by what?
Kidneys
Decreased O2 in blood
Hypoxemia
Decreased O2 in the lungs
Hypoxia
Hyperventilation syndrome in a pt is what state?
Resp Alkalosis
The use of energy to move particles across a membrane
Active transport
Major extra cellular cation
Sodium
Major intracellular cation is
Potassium
Magnesium , calcium help with
Electrical and nerve conduction
Sodium helps with
Fluid regulation
Excretory function of blood is to remove
Urea, creatine, lactic acid and waste ; primarily lactic acid from cells
Normal stimulus to breath is
Increased PACO2, Arterial
pH less than 7.35 and pCO2 greater than 40 is
Resp acidosis
pH less than 7.35, pCO2 greater than 40 and HC03 or PO2 less than 24
Metabolic acidosis
pH greater than 7.45 and pCO2 less than 40
Resp Alkalosis
Need blood gases for anion gap; should not see as an answer
Metabolic Acidosis
Primary treatment of a near drowning victim
Management of Hypoxia and Acidosis
Battle signs and raccoon eyes are a contraindication for what airway?
NPA
Pulmonary ventilation =
Remove excess CO2 (normal balance)
One of the major purposes of pulmonary ventilation is
The ability to retain or eliminate CO2
Intubation of a child under 8 =
Uncuffed
Macintosh blade is inserted
Between epiglottis (vallecula) and base of tongue
Miller blade lifts
Epiglottis
(Mean) =
15-17 Resp per min adult RR
Is not an airway sound?
Cough
Crichothyroid performance =
Laryngeal edema and facial trauma
The EGTA is used on a
Comatose adult
Complications of a BVM
Abd distention, pushes diaphragm down and leads to vomiting
Air in the stomach makes intubation difficult because of
Vomiting and also aspiration risk
O2 delivered via NC =
22-44%
Narrowest part of adult airway is
Glottic opening
Contraindication for EOA (combitube) is
Less than 16 y/o , esophageal varices, ingestion of caustic substances, positive gag reflex, less than 5’ or over 6’8”
Civil wrong doing such as medical negligence
Tort law
If your dispatched to a scene, you have a ?
Duty to act
Comparing your actions under same/similar circumstances with that of other similar trained medics.
Standard of Care
All refusals must be what type of consent?
Informed consent
Physicians with the most authority on scene
On line physician
Negligence =
Breech of duty
Duty to act
Proximate cause, damages or harm
* intent not needed
The greatest threat for false imprisonment is
Psychiatric pt’s
Granting privileges by Dr’s to medics to perform skills is called
Delegation of authority
Malpractice term where cause direct injury to a pt is called
Proximate cause
Labor and negligence law is
Tort law
Standards governing a group of people or profession is called
Ethics
Who are ethical standards developed for?
Pt’s
Indirect medical control is called
Standing orders
If a medic is charged with negligence they are the
Defendant
Directly caused harm or injury in a negligence case is what?
Proximate cause
Assessment of calls begin when?
When the call is dispatched
Ambulance crashes, court will try to prove?
Lack of due regard
Difficult or painful breathing
Dyspnea
Prevents over expansion of the lungs
Hearing-Breuer reflex
Decrease oxygen in the lungs
Hypoxia
Decrease partial pressure of O2 in the blood
Hypoxemia
Increased PACO2 ,Aterial
Normal stimulus to breath
Hypoxic drive or a pt with COPD’s stimulus to breath is
Decreased O2 levels
Medications for COPD pt is
Aminophylline, albuterol, bronkosol
Vasoconstriction causes this condition
Skin pallor
Whistling sound during exhalation consider
Asthmatic bronchiolitis
Fluid/ mucous in LARGE airway will have what sound?
Rhonchi
Stridor at night with seal type bark is what condition
Croup
Poor airway compliance seen in
Sucking chest wounds / tension pneumothorax / flail chest NOT pleurisy or pleuritis
One of the major purposes of pulmonary VENTILATION
Ability to retain or eliminate CO2
One of the major advantages of RESPIRATION is
To increase absorption of O2 by the cells
Classic sign of Anaphylaxis is
Hypotension
Chronic bronchitis, an acute exacerbation =
Resp acidosis and tachycardia
Fever , rhonchi, hot and dry skin NO PEDAL EDEMA
Pneumonia
20 yr old asthmatic pt has not reacted to normal treatment, use what?
Aminophyline
Blue bloater, fat, increased mucous production, chronic cough, NOT A PINK PUFFER
Chronic bronchitis
Pink puffer, Barrel chest, thin, pursed lip breathing to create back pressure to open alveoli, SOB, cough generally in the morning with increased mucous
Emphysema
Coughing up blood
Hemoptysis
Cough up pink tinged sputum is
Hemoptysis and s/s of Left sided HF / pulmonary edema
Left sided ventricular damage is
CHF
IV for COPD pt is
KVO 55 dextrose in Sterile water
Use N/C or Venturi mask in a pt with?
Emphysema
Air trapped in the pleural space
Pneumothorax
Neurogenic/ anaphylactic and septic shock cause what due to VASODILATION?
Hypotension
Neurogenic, anaphylactic and septic shock are all what type of shock?
Distributive shock
Responsible for the transport and delivery of O2
Hemoglobin
Rumbling sound, fever, no edema is what condition?
Pneumonia
What is a side effect of hyperventilation
Carpal pedal spasms
Underlying cause of R sided heart failure
Cor pulmonade
Hypertension and JVD
Emphysema
Treatment for pulmonary edema / CHF =
LMNO
Lasix (40mg) slow IVP
Morphine sulfate (2mg) slow IVP
Nitro (0.4mg) sublingual
O2
Salt water drowning =
Respiratory alkalosis, CO2 retention and pulmonary edema
Fresh water drowning =
Hemodilution or hemolysis
Escape of fluid from vascular space into pleural space = pleural friction rub lung sounds
Pleural effusion
20 to 30 y/o thin smokers and males more prone to
Spontaneous pneumothorax
Pt 70 y/o with SOB and Orthopnea can’t lie flat DRIED BLOOD on LIPS is
Pulmonary edema
Bright red frothy blood at mouth w/ each exhalation =
Lung damage
Long bone fx at risk of what?
Fat embolism
RR x tidal volume in one minute is
Minute volume
Inflammation of the bronchioles with expiratory wheezing.
Bronchiolitis
Sudden onset of wheezing in ONE LUNG / Lobe is
Foreign body aspiration ( especially if just finished eating)
Decrease in intrathoratic pressure relative to environment (Active) CONTRACTION OF MUSCLES.
Inhalation
As volume in the thoracic cavity increases = pressure decreases
Exhalation (passive)
Amount of air inhaled and exhaled during one respiratory cycle
Tidal volume
Irregular breathing pattern with periods of apnea gradually increasing and decreasing
Biots breathing
Aminophylline aka Theophylline dose
5-6 mg/kg
Average tidal volume in one respiration is
500cc
Smooth muscle relaxant used with bronchial asthma is what?
Aminophylline
Knife like pain describes what condition
Spontaneous pneumo
Treatment in order for pulmonary edema is
- O2
- Monitor
- IV
- Nitro .4 mg
Collapsed alveoli with decreased ventilation =
Atelectasis
Respiratory drive- hypoxic drive aka back up drive is what type of disease
COPD
Decreases ventilatory effectiveness
Collapse of alveoli
Exchange of gasses between internal and external environment
Respirations
Ventilation / perfusion mismatch is called what
ARDS
Transports O2 ( iron containing component of RBC)
Hemoglobin
Ventilation problem , thoracic injury which leads to Resp pattern
Ataxic respirations
Asthmatics pt’s main treatment is to what?
Relieve bronchospasms
Signs and symptoms of respiratory distress is
Nasal flaring, tracheal tugging, sternomastoid muscle use, intercostal retractions
Tension pneumothorax treatment is?
O2, decompress, transport, IV en route
Pulmonary Emboli S/S is?
Dyspnea, SOB, pleuritic pn, tachycardia
No JVD with ?
Pulmonary embolism
Tx for anaphylactic shock is ?
Epi 1 mg 1:10,000 IV and Benadryl 25-50mg
Bee,hornet, wasp stings / PCN injection are the fastest and most frequent cause of?
Anaphylaxis
Left sided ventricular damage is called ?
CHF
Use a NC or Venturi mask in pt’s with
Emphysema
Hyperventilation helps to correct
Respiratory acidosis
Air trapped in the pleural space is called?
Pneumothorax
Neurogenic/ Anaphylactic & septic shock cause hypotension due to?
Vasodilation
Underlying cause of Right sided HF
Cor pulmonade
Carpal pedal spasms are a side effect of?
Hyperventilation
Hypertension and JVD are S/S of ?
Emphysema
Primary concern for a near drowning is?
Hypoxia and acidosis
Difficulty breathing while lying down is
Orthopnea
70 y/o pt. with SOB and Orthopnea, can’t lie flat with dried blood on his lips
Pulmonary edema
Bright red frothy blood at mouth with each exhalation =
Lung damage
Orthopnea S/S =
Pulmonary edema and suggests right sided HF or CHF
Long bone fx at risk of?
Fat embolism
RR x tidal volume in one minute =
Minute volume
Inflammation of bronchioles with expiratory wheezing is ?
Bronchiolitis
Sudden onset of wheezing in one lung / lobe is ?
Foreign body aspiration ( especially if just finished eating )
Salt water drowning S/S
Respiratory alkalosis, CO2 retention and pulmonary edema
Average tidal volume in one respiration is?
500cc
Irregular breathing pattern with periods of apnea gradually increasing and decreasing is what kind of breathing pattern?
Biots
Atelectasis means ?
Lack of surfactant
Transports O2 ( iron containing component of RBC )
Hemoglobin
Pulmonary edema can be caused by what?
Over Hydrating your pt
O2 saturation in peripheral tissue
Pulse Oximetry
Aminophylline aka Theophylline dose=
5-6 mg/kg
Smooth muscle relaxant used for bronchial asthma
Aminophylline
Spontaneous pneumothorax description =
Knife like pain
Collapsed alveoli with decreased ventilation =
Atelectasis
Complete or partial collapse of a lung or lobe is called ?
Atelectasis
Exchange of gases between internal and external environment is called?
Respiration
Thrombus formation in deep veins of legs that travel to pulmonary artery are called ?
Pulmonary embolus
Recent delivery of a child can cause a?
Pulmonary embolus
Best tool for exposing a cars locking mechanism
Air chisel
Repeater in a Telemetry system increases?
Transmitting and receiving range
Telemetry system in which voice and ekg can be transmitted at the same time is called?
Multiplex system
Radio transmissions can be reduced due to?
Holding the radio vertically , no repeater, weak battery
The ability to listen and speak at the same time is what type of telemetry system?
Duplex
Group of frequencies close together are called a
Band
VHF and UHF are bands used for?
Medical communications
EKG’s transmitted and decoded is called ?
Oscilloscope
Malicious writing is called
Libel
Malicious words spoken is called
Slander
Established policies and procedures of EMS system is called?
Protocol
Most fatalities of rescuers happen in ?
Confined space rescues
First step of extrication is?
Gaining access to pt
Cannot transmit or receive data at the same time is what type of telemetry system?
Simplex
One of the first signs of hypovolemic shock is?
Tachycardia
Earliest sign of any type of shock is?
AMS ( Altered Mental Status )
Factor common to all forms of shock?
In adequate tissue perfusion
Most reliable indicator of severity of injury in Trauma is
MOI ( Mechanism of Injury )
Damage to tissue due to high speed bullet
Cavitation
Swollen/ protruding / bulging tongue would indicate what?
Traumatic asphyxia
Traumatic asphyxia is most commonly caused by what?
Crush injury to chest or abdomen
When surveying the scene initially of an MCI you do not have to report ?
Life threatening injuries
For trauma in the field give 3 times estimated blood loss of ?
Lactated ringers
Abdominal evisceration tx consist of what?
Treat for shock, O2, cover organs with a moist stable saline soaked dressing. DO NOT PUT ORGANS BACK
Tension pneumothorax S/S
Dyspnea, mediastinal shift away from affected area / JVD
Explosion tx consist of?
Asses airway, ventilate, oxygenate, stop arterial bleeding and treat closed femur fx
Blast injury primary phase is?
Rupture of large intestines / hollow organs
S/S of Neurogenic shock
Hypotension, bradycardia, warm/dry skin below level of injury following trauma
ICP, bradycardia, irregular Resp, elevated BP are S/S of what?
Cushings triad
S/S of ICP include?
Bradycardia, vomiting, irregular or unequal pupils ( NOT HYPOTENSION )
Trauma victim w pulse of 40, BP 200/120 and increased ICP S/S of what condition?
Cushings triad
High cervical fracture impairs what?
Respirations
Anaerobic metabolism means?
Without O2
Atropine pediatric dose?
0.02 mg/kg
Atropine adult dose
.5-1.0 mg
Pediatric sodium bicarbonate dose?
1 meq/kg
Adult sodium bicarbonate dose?
1 meq/kg
Bretylium pedi dose?
5 mg/kg
Bretylium adult dose?
5 mg/kg
Epi 1:1000 pedi dose?
.01 mg/kg
Epi pedi dose for a CODE?
0.1 mg/kg
Epi 1:10,000 adult dose?
.3-.5 mg
Epi pediatric dose 1:10,000 CODE only
.01 mg/kg
Haldol adult dose
2-5 mg
Lidocaine pedi dose?
1.0 mg/kg
Lidocaine adult dose?
1.0-1.5 mg/kg
Mag Sulfate adult dose?
1-2 g over 1-2 min
Morphine adult dose?
2-5 mg
Narcan pedi dose?
0.1 mg/kg
Narcan Adult dose?
0.4-2 mg
Oxytocin adult dose?
10-20 units
Valium adult dose?
2-10 mg
In an adult with a partial FBAO what would be your first intervention?
Encourage or to cough
Thin shaped valve covering the trachea?
Epiglottis
Landmark for a cricoid stick is?
Cricoid cartilage or depression inferior to Adam’s apple
Contraindication for crichothyrotomy is?
Crush injury to the larynx
Sellicks maneuver/ cricoid pressure is used for what purpose?
Displaces esophagus posterior and increases vocal chord visualization.
Narrowest part of an adult airway?
Glottic opening
Good Samaritan act offers protection when?
While off duty
The FDA governs what?
The safety of drugs
Granting privileges by Dr’s to paramedics to perform skills is called what?
Delegation of authority
Malpractice term where direct injury has been caused to a pt is called ?
Proximate cause
JVD beat evaluated in what position?
Semi fowlers @ 45 degrees
Device that transfers electrical energy into sound waves is called?
Transmitter
Proper radio procedure?
Speak clearly and keep message brief
First phase of EMS is?
Public access to 911
Best way to avoid anaphylactic reaction is to?
Ask allergy hx
One man carry that’s not used often due to pt’s weight on rescuer is called what?
Firemans carry
Technique used with a LSB in narrow spaces as an alternative to the four man roll is called what?
Four man straddle slide
What is the maximum amount of a crystalloid fluid given to an adult trauma victim?
2000-3000 mL
How long do abdominal bleeds take to occur?
2-3 hours
In a stab wound to the neck at the jugular vein, what should you expect and what would your treatment be?
Suspect an air embolism and apply pressure to the wound and position on left side.
Ecchymosis behind the ear or mastoid process is called what from what type of injury?
Battle signs form basilar skull fx
Electrical burns cause what type of of burns?
Superficial and deep burns
Route of passage for electrical burns is determined by ?
Entrance and exit wounds
In electrical burns entrance and exit wounds, the current follows?
Nerve pathways and may cause V-Fib and more internal than external damage
MAST/PASG inflation order?
L leg, R leg then abd
MAST/PASG deflation order?
Abd, R leg then L leg
AAA stands for what?
Abdominal Aortic Aneurysm, femoral pulses in scenario “ do not give nor Epi “
For needle decompression place needle where?
2nd or 3rd intercostal space mid clavicular or 4th or 5th intercostal space midaxillary
Sequence pleural decompression order is?
O2, decompress, transport and IV in route
MVA pt with HR 120, BP 40 palp what condition is pt in?
Hypovolemic shock
Left femur, spleen or chest injury and right sides head injury is what condition?
Wadell’s triad
Pinching or cutting of nerves and blood vessels is cause by what type of fracture?
Severely angulated fx
Spinal injury with intercostal retractions suspect?
Cervical spine
15ft fall, pt with flat neck veins /chest Dull to percussion is ?
Hemothorax
