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395 Cards in this Set
- Front
- Back
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For a drug to reach its site of action and achieve its desired effect, it must first go through… (1)
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three steps
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What are the three components EMR's must know to understand Pharmacology? (3)
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- pharmaceutic phase
- pharmacokinetic phase - pharmacodynamic phase |
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Pharmaceutic phase (1)
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is the science of dispensing drugs
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Dissolution (2)
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- refers to the rate at chichi a solid drug goes into a solution after ingestion
- the more rapid the rate of dissolution, the more quickly the drug is absorbed |
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What are the 7 different types of liquid drugs? (7)
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- solutions
- tinctures - suspensions - spririts - emulsions - elixirs - syrups |
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solutions are…
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composed of one or more substances
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tinctures are ...
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alcoholic extract
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suspensions are ...
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liquide with fine solid particles
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emulsions are …
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mixture of two unblendable substance
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Elixirs are ...
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dissolved in ethyl alcohol
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Syrups are ...
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blended with a large amount of dissolved sugar
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What are 5 different drug forms for a solid drug? (5)
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- pills
- powders - tablets - suppositories - capsules |
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Liquid medications are already in …… , therefore they are absorbed much faster. (1)
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solution form
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Pharmacokinetic
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is the study of how the body handles a drug over a period of time.
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What does pharmacokinetics include? (4)
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- absorption
- distribution - biotransformation - excretion |
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What transformation must occur before the active drug ingredient reaches the systematic circulation? (1)
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the progression from a drugs pharmaceutical dosage form to a biologically available substance that can pass through or across tissues
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Absorption
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is the process of movement of a drug from site of application into the body and into the extracellular compartment (blood vessels and interstitial fluid)
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What factors affect a drugs absorption? (7)
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- solubility of the drug
- concentration of the drug - pH of the drug - sit of absorption - absorbing surface area - blood supply to the site of absorption - bioavailability |
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Solubility
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the tendency of a drug to dissolve
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To facilitate a drugs absorption, the solubility of the administered drug must match…. (1)
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the cellular constituents of the absorption site
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Drugs are administered in ….. contractions are absorbed much more rapidly than drugs administered in ….. concentrations
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- high
- low |
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Most drugs are weak…… or ……. (2)
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acides or bases
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Acidic drugs tend to be more rapidly absorbed when placed into an ……….
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acidic environment
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What is an example of an acidic environment?
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stomach
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Alkaline drugs are more rapidly absorbed in an …….. (1)
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alkaline environment
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What is an example of an alkaline environment?
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kidneys
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Once administered, drugs must pass through various biological membranes until they reach …. (1)
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circulation
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Drugs are absorbed quite rapidly from large ….
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surface areas (pulmonary capillaries - 85m2)
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Medications placed in areas of rich blood supply (sublingual) are absorbed ……
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- much faster than lower supplied areas (subcutaneous)
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Blood flow to a site can be affect by …. (2)
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- temperature
- shock …... |
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Bioavailability
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is the measure of the amount of a drug that is still active after it reaches its target tissue after considering all of the absorption factors
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Distribution
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is the process whereby a drug is transported from the site of absorption to the site of action
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What factors can influence drug distribution (4)
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- cardiovascular function
- regional blood flow - drug storage reservoirs - physiological barriers |
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After drug absorption, the drugs is initially distributed to which organs? (4)
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- brain
- heart - kidneys - liver |
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How could medical or traumatic emergencies influence the cardiac output and/ or circulation to non-vital organs?
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it could increase distribution times to these organs
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During which kinds of shock does blood flow to the kidneys diminish? (1)
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cardiogenic
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What is a drug reservoir? (1)
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various sites where a drug may be stored in the body
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What different types of drug reservoirs are there? (2)
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- plasma reservoir
- tissu reservoir |
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How do drug reservoirs work?
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they bind the drugs to proteins within specific tissues
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Drug reservoirs cause what… (2)
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- delays the onset
- prolongs the action of the drug |
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Physiological barriers
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inhibitors the movement of certain substances while permitting the passage of others
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What are two physiological barriers? (2)
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- blood barrier
- placental barrier |
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What are physiological barriers usually designed to to? (1)
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protect the organs
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Biotransformation
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process of drugs being broken down (metabolized) into different chemicals (metabolites)
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Biotransformation has what two effects on most drugs? (2)
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- transforms the drug into a more or less active metabolite
- make the drug more water soluble (for excretion) |
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Which locations is biotransformation located in? (5)
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- liver (primary)
- kidneys - lungs - intestines - plasma |
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Why does epinephrine require re-administration more often than other drugs? (1)
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it metabolizes much quicker than other drugs (3 to 5 minutes)
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Excretion of drugs (1)
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is the elimination of toxic or inactive metabolites from the bloodstream to organs of excretion
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Excretion is performed by which organs? (7)
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- kidneys (to urine)
- liver (to bile) - intestine (to feces) - lungs (exhaled) - sweat and salivary glands - mammary glands (breast milk) - artificial (dialysis) |
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Drug half life (1)
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is the time required for the total amount of a drug in the body to diminish by one-half
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Elimination can be affected by … (4)
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- drug half-life
-accumulation - clearance - onset, peak, duration |
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After how many half live are most drugs eliminated? (1)
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5 half lives
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The amount of drugs remaining after 5 half lives is only ….% of the original dose(1)
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3 %
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Drug clearance
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refers to the removal of a drug from the body
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High clearance rate drugs … (1)
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are removed rapidly from the body
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Low clearance rate drugs … (1)
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are removed slowly from the body
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A regularly administered drug reaches a constant total body amount (steady state) after about how many half lives?
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5 half lives
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Elimination: Onset (1)
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refers to the time when the drug is sufficiently absorbed to reach an effective blood level and sufficiently distributed to its site of action to elicit a therapeutic response
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Elimination: Peak (1)
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refers to when the concentration of drug in the blood rises and more drug reaches the site of action, the therapeutic response increases
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As soon as the drug begins to circulate in the blood stream, it also begins to …..
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be eliminated, and eventually the elimination will exceed absorption (drugs effect begin to decline)
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Elimination: Duration (1)
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is the length of time that drug concentration is sufficient in the blood to produce a therapeutic response
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List all factors that could influence the drug response. (9)
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- age
- body mass - gender - environment - time of administration - pathological state - genetic factors - pschychological factors -pregnancy |
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Drug response factors: Age (2)
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- kids' liver and kidney functions are not fully developed, so their response is slower
- older people's organs deteriorate with time |
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Drug response factors: Body Mass (2)
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- more a person has in mas, more they have fluid that is potentially available to dilute a drug
- most dosages are given in terms of body mass (mg/kg) |
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Drug response factors: Gender (2)
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- most differences result from the relative body masses
- different distribution and amounts of fat |
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Drug response factors: Environment (2)
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- surrounding conditions like heat and cold increase or decrease distribution and elimination
- unusually stressful situations can also affect distribution and elimination |
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Drug response factors: Time of Administration (1)
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- taking a drug immediately after eating vs taking a drug on an empty stomach
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Drug response factors: Pathologic State (2)
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- several disease states alter the drug response relationship (live and kidney failure)
- kidney failure results in the inability to eliminate a drug |
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Drug response factors: Genetic Factors (1)
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- genetic traits (such as lack of enzymes or a lower basal metabolic rate) alter the absorption or biotransformation
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Drug response factors: Pshychological Factors (1)
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- placebo effect (patient believes a drug will have a given effect, they will likely perceive that the effect has occurred)
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Pregnancy presents what two pharmacological problems? (2)
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- anatomical and physiological changes (increase some vitals)
- possibility of a drug passing to the fetus (may cross the placenta) |
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Anatomical and physiological changes (1)
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- increased cardiac output / heart rate / blood volume / hepatic metabolism & BP
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Using the FDA (USA) drug classification chart for pregnant woman, describe the 5 different categories (5)
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- category A (no risk to fetus)
- category B (animal studies show no risk to fetus) - category C (animal studies show there may be a fetal risk) - category D (studies show a risk to fetus) - category X (positive risk to fetus, do not use) |
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Pharmacodynamics
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is the study of the mechanism by which specific drug dosages act to produce biochemical r physiological changes in the body
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With regards to pharmacodynamics, drugs can act in what 4 different ways (4)
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- bind to a receptor site (most common in prehospital arena)
- change the physical properties of a cell - chemically combine with other chemicals - alter a normal metabolic pathway |
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Drugs that bind to a Receptor site (4)
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- most drugs operate by binding to a receptor site
- almost all receptors are protein molecules on the surfaces of cells - these receptors are part of the body's normal regulatory function and can be stimulated or inhibited by chemicals (metabolites) - when a drug binds to its receptor site, a chemical change occurs that leads to the body having its desired effect on the body |
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Affinity
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the force of attraction between a drug and its receptor site (the greater the affinity, the stronger the bond)
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Efficacy
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the ability to cause the expected response, different drugs may have different affinities and efficacies)
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Chemicals that stimulate a receptor site generally fall into two broad categories (2)
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- agonists
- antagonists |
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Agonists
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bind to the receptor and cause it to initiate the expected response
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Antagonists
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bind to the receptor site but DO NOT cause the receptor to initiate the expected response
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When drugs compete for a receptor site who usually wins? (1)
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the one with the stronger affinity
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Drugs directly and indirectly affect which part of the nervous system in particular? (2)
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- autonomic branch
- peripheral nervous system |
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What does the sympathetic nervous system do? (1)
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prepares your body for stressful events
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What does the parasympathetic nervous system do? (1)
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returns the body to normal (or reserve of sympathetic nervous system if over stimulated)
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In order to carry out all of the physiological changes, the CNS sends … to receptor sites to impact these actions (1)
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neurotransmitters
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Neurotransmitters used are (3)
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- Epinephrine
- Norepinephrine - Dopamine |
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What are the specific receptor sites for neurotransmitters? (4)
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- Alpha 1 (peripheral vasoconstriction)
- Beta 1 (increased heart rate, force, and automaticity) - Beta 2 (Bronchodilation) - Dopaminergic (renal and mesenteric vasodilation) |
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Mechanism of Action: Epinephrine (3)
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- binds to the Alpha-1 or Beta-1 and Beta-2 receptors of sympathetic system
- results in bronchodilation (drying of bronchial mucus membranes) - activation of both alpha and beta sites explains associated increased heart rate and blood pressure |
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Mechanism of Action: Salbutamol (2)
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- imparts its effect by binding to Beta-2 sites and promoting bronchodilation
- also activates cardiac receptors (Beta-1), which explains increase in heart rate and blood press effects of this drug |
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Mechanism of Action: Acetylsalicylic acid (2)
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- at low does, appears to impede clotting by blocking prostaglandin synthesis
- this prevents formation of platelet aggregating substance (irreversible) called thromboxane A2 |
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Mechanism of Action: Ipratropium bromide (1)
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- inhibits parasympathetic bronchoconstriction, resulting in more open lower airways and brochodilation
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Mechanism of Action: Oral glucose (1)
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- monosaccharide (sugar) that is given orally and is readily absorbed in the intestine
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Monosaccharide
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sugar
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CPS
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Compendium of Pharmaceuticals & Specialties
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PDR
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Physician's Desk Reference
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NDR
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Nursing Drug Reference
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The purple section of a CPS contains information on… (6)
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- controlled substances
- reporting adverse reactions - ACLS drugs and algorithms - Effects of surgery on drugs - Blood serum concentration monitors - drug-drug interaction charts |
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What are the different drug names you will need to know? (4)
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- chemical name
- generic name - trade name - official name |
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Chemical name (1)
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- a precise description of the drugs chemical composition and molecular structure (first name given to any drug)
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Generic name (2)
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- a markedly abbreviated form of the chemical name of the drug
- generic medications usually have the same therapeutic efficacy as the non-generic and are generally less expensive |
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Trade name (3)
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- brand or proprietary name
- a copyrighted name designated by the drug company that sells the medication - trade names are considered proper nouns (is Capitalized) |
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Official name (2)
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- followed by the initials USP or NF
- denotes its listing in one of the official publications and is usually the same as the generic name |
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What drug groups must EMR's be aware of their general characteristics? (6)
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- Opiates
- Hallucinogens - Stimulants - TCA antidepressants - SSRI antidepressants - Depressants |
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The steps to medication administration are… (5)
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- take universal precautions
- ensure indications/ contraindications for use of this drug & the route of administration are evaluated - determine that the patient is not allergic to the medication - explain the procedure to the patient (must be informed consent) - document dose, time, route, site, and response to drug |
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6 Rights of Medication (6)
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- RIGHT patient
- RIGHT drug - RIGHT time - RIGHT does - RIGHT route - RIGHT documentation |
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6 Rights of Medication: Right patient (2)
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- ensure you receive orders prior to giving medication
- right name on medication (if it's their own) |
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6 Rights of Medication: Right drug (1)
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- look and read label at least 3 times (when removed from sealed package, when preparing the drug, prior to administration)
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6 Right of Medication: Right time (1)
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- refers to time of day and timing of does intervals require to appropriately treat
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6 Rights of Medication: Right dose (3)
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- memorize the dosages for your scope of practice
- always calculate the dose prior to preparing - have partner double check the dose if possible |
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6 Right of Medication: Right route (1)
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- an incorrectly administered drug may cause fatal complications or not be absorbed at the proper rate
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6 Right of Medication: Right documentation (2)
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- document the drug, time, concentration, dosage, person who administered and the patients response
- medication errors must also be documented and reported to the receiving facility immediately |
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Three C's & E
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- colour
- clarity - concentration - expiry date |
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Three C's & E: Colour (1)
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ensure the medication is the appropriate colour (expired or bad medication will change colour)
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Three C's & E: Clarity (1)
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medications are supposed to be clear, with an absence of any precipitate (floaties)
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Three C's & E: Concentration (1)
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many medications come in different concentrations, ensure the right one is being used
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Three C's & E: Expiry Date (1)
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if it's expired, drug is bad, Do NOT use.
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List all medications EMR's will be administering. (6)
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- oxygen
- ASA - Oral glucose - Sabutamol - Ipratroprium Bromide - Epinephrine (auto injector) |
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As an EMR there are 4 methods required to administer medication. (4)
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- Oral
- Intramuscular Injection - Inhalation - Nebulized |
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Steps of administration: PO (6)
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- verify pt will be able to safely ingest oral medicines (intact gag reflex)
- measure correct volume/amount of medicine - position pt in semi or high Fowlers position - give medication to pt and instruct them to swallow all of it - Evaluate pt response to medicine - re-evaluate pt vital signs |
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Steps of administration: MDI (13)
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- snap off cap and turn mouthpiece sideways (attach spacer if available)
- insert bottle stem into the hole inside mouthpiece - shake MDI well - invert bottle and place mouthpiece near patients mouth - advise pt to exhale forcefully, pushing as much air from the lungs as possible - place mouthpiece in pt mouth - make sure tongue is under the mouthpiece - spray the medication while pt is inhaling - have them hold the breath as long as they can - evaluate pt response to medicine - re-evaluate breath sounds - re-evaluate pt vital signs - properly document drug, time, and pt responses, both expected/desired or unexpected/undesired |
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Steps of administration: IM injection (4)
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- insert at a 90 degree angle
- hold for 10 seconds - dispose of sharps in sharps container - massage injection site to speed up absorption |
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Oxygen: Pharmacodynamics (2)
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- transported from the lungs to the body's tissues attached to hemoglobin in the red blood cells
- inhalation/ administration will increase oxygen concentration |
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Oxygen medication overview (5)
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- generic name: medical oxygen
- trade name: - classification: medicinal gas - supplied: compressed gas cylinder - characteristics: colourless, odorless, tasteless gas essential t respiration |
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Oxygen: indications (3)
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- hypoxia from any cause
- chest pain due to cardiac ischemia - altered LOC |
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Oxygen: dosage (1)
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varies by mask
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Oxygen: route (1)
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inhalation
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Oxygen: contraindications (1)
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none for emergency use
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Oxygen: precautions (2)
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- in some cases of COPD, oxygen administration may reduce the pt's respiratory drive (this is NOT a reason to withhold oxygen, be prepared to assist)
- oxygen that is not humidified may dry out/ irritate mucous membranes |
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Glucose (Oral): pharmacodynamics
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- a monosaccharide that is given orally and is readily absorbed into the intestine
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Glucose (Oral): medication over view (4)
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- generic name: oral glucose
- trade name: insta-glucose, Monogel - classification: Glucose, Antihypoglycemic - supplied: 25g/tube of 15g/tablet |
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Glucose (Oral): Indications (1)
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- hypoglycemia (BGL less than 3.7 mmol/ L)
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Glucose (Oral): Dosage (2)
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- adult 25g PO (may repeat in 10 mins if necessary)
- administer the entire contents of the tube slowly and intermittently while pt swallows |
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Glucose (Oral): Route (1)
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- PO (must be swallowed)
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Glucose (Oral): Contraindications (3)
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- any patient who is not alert
- any patient unable to follow commands - any patient who lacks gag reflex Hyperglycemia |
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Glucose (Oral): Precautions (2)
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- may cause nausea or the pt may gag when administered
- oral glucose is not absorbed at the rate required sublingually or bucally |
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Nebulizer definition (1)
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a device for producing a fine spray of liquid, used for example for inhaling a medicinal drug.
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Nebulized (2)
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- nebulizer mask chamber holds 5ml of fluid (graduated at 2.5ml and 5ml)
- oxygen should be flowed at 5-8 l/m so the fluid is misted to appropriate size |
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ASA
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Acetylsalicylic Acid
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Acetylsalyclic Acid (ASA): Medication overview (4)
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- generic name: Acetylsalicylic Acid
- trade name: Novasen, aspirin, ASA, Bufferin - classification: salicylate, antiplatelet, antipyretic, anti-inflammatory, non-opiod analgesic - supplied: 80mg, 325 mg, or 650 mg tabs |
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Acetylsalyclic Acid (ASA): Pharacodynamics (3)
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- anticoagulant: at low doses, appears to impede clotting by blocking prostaglandin synthesis, which prevents formation of platelet aggregating substance (this is irreversible) called thromboxane A2
- Analgesia/ Anti-inflammatory: inhibits the synthesis of prostaglandin , preventing of reducing pain - Antipyretic: acts on the hypothalamus to produce peripheral vasodilation causing sweating which leads to heat loss and cooling by evaporation |
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Anticoagulation
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are a class of drugs that work to prevent the coagulation (clotting) of blood
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Analgesia
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the inability to feel pain
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Anti-inflammatory
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refers to the property of a substance or treatment that reduces inflammation
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Antipyretic (3)
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- drugs or herbs that reduce fever,
- cause the hypothalamus to override an interleukin-induced increase in temperature - the body then works to lower the temperature, resulting in a reduction in fever |
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Acetysalicylic Acid (ASA): indications (1)
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ischemia
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Acetysalicylic Acid (ASA): dosage (1)
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adult: 160 to 325 mg chewed ASAP
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Acetysalicylic Acid (ASA): contraindications (3)
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- hypersensitivity
- bleeding disorders (hemophilia…) - unconscious patient |
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Acetysalicylic Acide (ASA): precautions (5)
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- astham: may produce bronchioconstriction in asthmatics
- active ulcer disease - impaired renal and hepatic function - children and adolescents with influenza or chickenpox infections (may increase the risk of Reye's Syndrome) |
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Reye's Syndrome
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is a rare but serious illness in childhood that has a mortality rate of 20% - 30%. Symptoms are encephalopathy and fatty liver degeneration
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Encephalopathy
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- refers to permanent (or degenerative) brain injury, and in others it is reversible
- can be due to direct injury to the brain, or illness remote from the brain. |
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Acetysalicylic Acid (ASA): side effects (3)
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- heart burn
- GI upset - Nausea and vomiting |
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How long does a single dose of aspirin persist for in the body? (1)
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8 days, for the life of the platelet
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Epinephrine: medication overview (4)
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- generic name: epinephrine
- trade name: adrenaline - classification: adrenergic agonist (sympathomimetic) - supplied: Epi-Pen 0.3mg , Epi-Pen Jr. 0.15mg |
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Epinephrine: actions (3)
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- directly stimulates the alpha and beta adrenergic receptors in the sympathetic nervous system
- bronchodilation: relaxes bronchial smooth muscle (B2 receptors) inhibits histamine release - CV and vasopressor: produces positive chronotropic and inotropic effects (B1 receptors); increasing cardiac output, myocardial oxygen consumption and force of contraction. Vasodilation (B2 receptors) and vasoconstriction (A receptors) |
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Epinephrine: indications (1)
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anaphylaxis
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Epinephrine: dosage (3)
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- adult: 0.3mg Epi-pen IM repeat q 15 - 20 mins prn
- pediatric: 0.15 mg Epi-pen Jr (do not exceed 0.3mg) *The Epi-pen jr. is for patients weighing between 16 - 30 kg |
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prn
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as needed
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q
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each, every
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Epinephrine: route (1)
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SQ or IM (IM preferred)
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Epinephrine: contraindications (1)
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none in the emergent setting
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Epinephrine: precautions (4)
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- use with caution in elderly patients
- HTN - Cardiac Hx - Pulmonary edema |
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What can help speed up the absorption rate after administrating Epinephrine? (1)
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massaging the site after an IM injection
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Epinephrine: side effects (9)
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- anxiety
- headache - heart palpitations - angina - cardiac arrhythmias - acute hyper tension - pallor - SOB - N/V |
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HTN
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Acute hyper tension
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SOB
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shortness of breath, difficultly breathing
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N/V
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nausea/ vomiting
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Salbutamol: medication overview (4)
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- generic name: Salbutamol
- trade name: Ventolin - classification: bronchodilator, B2 - selective adrenergic agonist (sympathomimetic) - supplied: MDI 100 mcg/spray (200 dose MDI) , 2.5 ml nebule ( 1 mg/ml) |
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Sympathomimetic
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producing physiological effects resembling those caused by the activity or stimulation of the sympathetic nervous system
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Salbutamol: pharmacodynamics (1)
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Ventolin works on B2 receptors found in the smooth muscle layer of the bronchioles
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Salbutamol: indications (2)
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- severe bronchospasm due to chronic bronchitis
- shortness of breath due to asthma |
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Salbutamol: dosage (2)
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- adult:
6 - 20 puffs, each being 100 mcg/ spray 2.5 to 5.0 mg nebule, repeat q 10 mins prn - pediatric: 2 and 10 puffs of an MDI 0.15 mg/kg diluted to 2.5 ml saline via nebulizer |
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Salbutamol: side effects (8)
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- nervousness
- muscle tremors - headache - tachycardia - heart palpitations - transient muscle cramps - n/v - weakness |
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Ipratroprium Bromide: medication overview (4)
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- generic name: ipratroprium bromide
- trade name: atrovent - classification: ani-cholinergic, bronchodilator - supplied: MDI 20 mcg/spray (200 dose MDI) , combivent (Ventolin 2.5 mg / Atrovent 500 mcg) |
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Ipratroprium Bromide: pharmacodynamics (2)
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- inhibits cholinergic receptors in the bronchial smooth muscle
- inhibits cholinergic receptors to dry secretions |
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Ipratroprium Bromide: indications (2)
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- severe bronchospasm due to chronic bronchitis
- shortness of breath due to asthma |
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Ipratroprium Bromide: dosage (2)
|
- adult:
1- 4 pudds PRN to a max of 10 puffs, each puff being 20 mcg/spray 250 - 500 mcg via neb with salbutamol x3 - pediatric: MDI: 2 puff prn; max 4 25 - 250 mcg via neb with salbutamol x3 (ages 5-11) |
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Ipratroprium Bromide: contraindications (3)
|
- allergy to Ipratroprium bromide or to atropine
- allergy to soy lethicin or related food products (soybeans, peanuts) - children under 5 years old |
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Ipratroprium Bromide: precautions (1)
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patients with narrow angle glaucoma (Neb application) RE: Be careful to avoid accidental release into the eyes (use mouth piece neb if possible)
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Ipratroprium: side effects (8)
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- nervousness
- muscle tremors - headache - tachycardia - heart palpitations - transient muscle cramps - n/v - weakness |
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Dyspnea (2)
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- shortness of breath or difficulty breaking (SOB)
- patient may not be alert enough to complain of shortness of breath |
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Adventitious Breath Sounds
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- sounds other than "open and clear" when auscultating the lungs for breath sounds
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Auscultate
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to examine by ausculatation
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Wheezes (4)
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- "whistling"
- usually more pronounced on exhalation - generalized: narrowing, spasm of the smaller (lower) airways - asthma is a possible cause |
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Crackles (2)
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- air bubbling up through fluid in the smaller airways of the lungs - alveoli
- fine "crackling" can often be heard |
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Stridor (2)
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- high pitched "crowing"
- upper airway restriction ie. foreign body airway obstruction |
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Snoring respirations (1)
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- snoring sounds often made by the tongue being in the way when the patient breaths while supine
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Gurgling respirations (1)
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- air bubbling through fluid in the upper airway
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Thrombus (1)
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- a clot which has formed at a specific location
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Embolus (1)
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- a thrombus that has broken loose and is travelling through the vascular system
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How many lobes does each side of the lungs have? (2)
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- right lung has 3 lobes
- left lung has 2 lobes |
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Bronchioles (4)
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- smallest airways
- walls consist entirely of smooth muscle (no cartilage present) - constriction increases resistance to airflow - dilation reduces resistance to airflow |
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Alveoli (2)
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- air sacs
- site of oxygen and carbon dioxide exchange with blood |
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18 respiratory conditions (18)
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- upper airway obstruction (anatomical, foreign body)
- lower airway obstruction (asthma, chronic bronchitis, emphysema) - infectious agents (tuberculosis, pneumonia, croup, epiglottis, respiratory syncytial virus) - functional alterations (pulmonary aspiration, pulmonary embolism, pulmonary edema, atelectasis, ARDS, spontaneous pneumothorax, toxic inhalation, hyperventilation) |
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Causes of respiratory distress (5)
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- pulmonary vessels become obstructed
- alveoli are damaged - air passages are obstructed - blood flow to the lung is obstructed - pleural space if filled |
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Anatomical airway obstruction: pathophysiology (1)
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the tongue (most common is an unconscious supine patient) or other soft tissues in the upper airway occlude the flow of air
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Anatomical airway obstruction: signs/symptoms (3)
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- snoring (if only a partial obstruction)
- no air movement - inability to ventilate the patient |
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Anatomical airway obstruction: treatment (2)
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- abdominal thrusts/ chest thrusts
- high O2, AMPLE, OPQRSTA, vital signs and transport |
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Foreign body airway obstruction: pathophysiology (1)
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- some type of foreign object, usually food, becomes lodged in the upper airway of the patient either partially or completely preventing air exchange
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Foreign body airway obstruction: signs / symptoms (5)
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- universal sign of choking
- audible wheezes and stridor - panic -anxiety - respiratory arrest |
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Foreign body airway obstruction: treatment (6)
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- abdominal thrusts / chest thrusts / chest blows
- high O2 - AMPLE - OPQRSTA - vital signs - transport |
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What is something to consider when treating someone with a foreign body airway obstruction? (1)
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- consider the damage the foreign body may have done to the airway and any associated swelling or bleeding
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Asthma: pathophysiology (3)
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- asthma is an acute spasm of the bronchioles, associated with excessive mucous production and sometimes spasm within the bronchiolar muscles
- the decreased availability of systemic oxygen causes increased work of breathing, requiring additional oxygen for working muscles, creating a vicious circle - may be caused by exposure to an allergen, exercise, or have an unknown or other cause |
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Asthma: signs / symptoms (11)
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- tripod positioning
- accessory muscle use - audible wheezing heard with and possibly without a stethoscope - speaking in 1 - 2 word sentences - cyanosis to pallor - diaphoresis - wheezing to absent breath sounds on auscultation - retraction & indrawing - tachycardia - anxiety - confusion |
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Asthma: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - consider the use of salbutamol and/or ipratroprium bromide - transport |
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Kee p in mind that asthma and …. reactions look very similar
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anaphylactic
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COPD
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chronic obstructive pulmonary disease
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COPD patients rely on what to breath? (1)
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hypoxic drive
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COPD is classified in two categories. (2)
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- chronic bronchitis
- emphysema |
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COPD: Chronic Bronchitis - pathophysiology (2)
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- repeated infections or inhalation of toxic agents causes excessive mucous production obstructing small airways and alveoli
- this mucous production obstructs the flow of oxygen to the alveoli causing chronic oxygen deficits |
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COPD: Chronic Bronchitis - signs and symptoms (13)
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- "blue boater"
- oxygen cylinder - barrel chested - speaking 1-2 word sentences - diaphoresis - wheezing on auscultation - retraction & indrawing - tachycardia - anxiety - confusion - peripheral edema - productive cough - long expiratory phases |
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COPD: treatment (6)
|
- high O2
- AMPLE - OPQRSTA - vital signs - consider the use of salbutamol and/or ipratroprium bromide - transport |
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What is a blue bloater (1)
|
patients with COPD can develop chronically "inflated" chests and take on a cyanotic tinge due to oxygen deficits
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COPD: Emphysema - pathophysiology (2)
|
- chronic stretching of the alveoli due to obstruction of the bronchial passageways which prevents easy explosion of gases causing a decrease in alveolar elasticity
- when the alveoli are sufficiently stretched and no longer elastic, they are unable to force air out of the chest cavity, causing a "dead space" within the lung tissue |
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COPD: Emphysema - signs / symptoms
|
- "pink puffer"
- oxygen cylinder - barrel chested - speaking in 1 to 2 word sentences - diaphoresis - wheezing on auscultation - retraction & indrawing - tachycardia - anxiety - confusion - peripheral edema - productive cough - long expiratory phases |
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Diaphoresis
|
is the state of perspiring profusely, or something that has the power to cause increased perspiration
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COPD: emphysema - treatment (6)
|
- high O2
- AMPLE - OPQRSTA - vital signs - consider the use of salbutamol and/or ipratroprium bromide - monitor respirations closely (watch for respiratory arrest or depression, especially with O2 therapy) - transport |
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Patients with COPD are at higher risk of… (3)
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- right sided heart failure
- fluid retention - pneumonia |
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"Pink Puffer" is…
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when patients with COPD - emphysema adapt to their condition by increasing the quantity of RBCs, altering the pigmentation of their skin
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Tuberculosis: pathophysiology (2)
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- the mycobacterium tuberculosis cause inflammatory lesions through the body leading to the formation of necrotic inflammatory cells, causing lung disease
- the infection may remain dormant for an indefinite period of time (not causing disease) or may lead to active disease that is contagious |
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Tuberculosis: signs / symptoms (5)
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- coughing up blood
- fever - night sweats - weight loss - fatigue |
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Tuberculosis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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What could cause absent breath sounds on auscultation in a tuberculosis patient? (1)
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- the accumulation of fluid in the pleural space
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Who have a high incidence of recurring pneumonia? (1)
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patients who have already had it
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Croup: pathophysiology (1)
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- a virus causing inflammation and swelling of the lining of the larynx, causing a significant narrowing of the airway = leads air getting into the lungs
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Croup: signs / symptoms (3)
|
- barking cough or seal-like cough
- low grade fever - audible wheezing & stridor |
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Croup: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - humidify oxygen if available (cause less airway irritation & swelling) |
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Croup is typically seen in … (1)
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children 6 months to 3 years of age
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Epiglottitis: pathophysiology (2)
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- a bacterial infection of the epiglottis that produces sever swelling of the flap over the larynx
- the epiglottis may swell 3 to 4 times it's normal size, partially or completely blocking the airway, possibly quite suddenly |
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Epiglottitis: signs / symptoms (4)
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- drooling due to the reluctance to swallow the saliva because of discomfort
- high grade fever - sore throat - stridor |
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Epiglottitis: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Try to keep children who have epiglottitis from crying or screaming because…. (1)
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air turbulence can cause more swelling
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What should you not insert into a patient suspected of having epiglottitis and why? (2)
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an OPA because it could cause additional swelling and possible complete airway obstruction
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RSV
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respiratory syncytial virus
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Respiratory syncytial virus: pathophysiology (1)
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a virus which causes lower airway illnesses like bronchiolitis or pneumonia and possibly respiratory failure
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RSV: signs / symptoms (8)
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- fever
- severe cough - sore throat - wheezing - cyanosis - retractions and in drawing - accessory muscle use - possible dehydration |
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RSV: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - humidify oxygen if possible |
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RSV commonly occurs in …. (1)
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children aged 2 months to 6 months
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RSV is highly contagious. T/F
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True
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Pulmonary Aspiration: pathophysiology (2)
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- introduction of foreign matter, usually vomitus or a foreign body, into the lower airway (trachea or bronchi)
- this patient usually has an altered LOC and/or depressed gag reflex and/or ability to manage their own airway |
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Pulmonary Aspiration: signs/ symptoms (6)
|
- where did the vomit go… ?
- chest pain - burning in the mediastinum - cough - wheezes or crackles on auscultation - cyanosis |
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Pulmonary Aspiration: treatment (6)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport - have suction ready (ensure clear airway) |
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Complications from pulmonary aspiration include… (4)
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- pneumonia
- ARDS - pulmonary edema - death |
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PE
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pulmonary embolism
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Pulmonary Embolism: pathophysiology (1)
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- a stationary blood clot (thrombosis) that breaks off (embolus) and circulates through the venous system getting stuck in a pulmonary artery supplying a lung leading to death of lung tissue
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Pulmonary Embolism: signs / symptoms (9)
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- sharp stabbing pain (possibly Hx of surgery or prolonged inactivity - blood clots)
- dyspnea - pain diminished after lung tissue death (tricky) - hemoptysis (usually pink frothy) - cyanosis - tachypnea - varying degrees of hypoxia |
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Pulmonary Embolism: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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DVT
|
deep vein thrombosis
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Pulmonary embolism patients may get a sharp, burning pain in the lower legs, this is called… (1)
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deep vein thrombosis
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Pneumonia Edema: pathophysiology (2)
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- an accumulation of fluid in the lungs causing impairment of oxygen to effectively reach the alveoli
- there are numerous causes of pulmonary edema |
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Pulmonary Edema: signs / symptoms
|
- coughing up pink, frothy fluid
- tachypnea - shallow respirations |
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Pulmonary Edema: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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CHF
|
congested heart failure
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Pulmonary Edema may be caused by… (4)
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- left sided CHF
- abnormal heart rhythms - acute exposure to lung irritants - recent MI |
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Atelectasis: pathophysiology (2)
|
- the destruction and collapse of alveolar walls
- this causes a reduction in total area available for diffusion of gases across alveolar membranes |
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Atelectasis: signs / symptoms (2)
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- COPD
- pulmonary edema |
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Atelectasis: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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PEEP
|
positive end expiratory pressure
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What does PEEP do? (1)
|
keeps the alveoli inflated
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What creates PEEP? (1)
|
pursed lip breathing can create PEEP
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ARDS
|
acute respiratory distress syndrome
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Acute Respiratory Distress Syndrome: pathophysiology (3)
|
- an increase in the quantity of fluid between the alveolar membrane and surrounding pulmonary capillaries (interstitial fluid) causes a decrease in the amount of oxygen that is able to be absorbed by the RBCs
- usually caused as a complication of illness or injury (pulmonary aspiration, toxic inhalation, pneumonia..) - this additional fluid volume between alveoli and pulmonary vessels makes the lungs feel heavy, requiring additional pressure when ventilating the patient |
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Acute Respiratory Distress Syndrome: signs / symptoms (4)
|
- tachypnea
- cyanosis - possible pulmonary edema - history of illness or injury involving the lungs |
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Acute Respiratory Distress Syndrom: treatment (6)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport - encourage breathing through pursed lips (PEEP) |
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ARDS is more common in women or in men? (1)
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men
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Spontaneous Pneumothorax: pathophysiology (2)
|
- the surface of a lung in disrupted allowing air to escape into the pleural cavity and disabling the normal "vacuum pressure" or negative pressure required for inspiration, causing the lung to collapse fully or partially
- most often seen in young, tall, skinny males, commonly cause by stifling sneeze |
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Spontaneous Pneumothorax: signs / symptoms (4)
|
- sharp/burning/tearing pain in chest with no obvious cause
- dyspnea - sharp chest pain on one side - absent of deceased breath sounds on one side |
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Spontaneous Pneumothorax is most often seen in …. (1)
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young, tall, skinny males commonly caused by stifling sneeze
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Spontaneous Pneumothorax: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Patients who have had a case of spontaneous pneumothorax are more or less likely to have another recurrence?
|
more likely
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Toxic inhalation: pathophysiology (1)
|
inhalation of some form of irritant that damages the alveoli or bronchial passageways or elicits a protective response from the lung tissue
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Toxic inhalation: signs / symptoms (3)
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- environment is smoky
- HazMat incident - confined space - tachypnea - possible pulmonary edema |
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Toxic inhalation: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Hyperventilation: pathophysiology (2)
|
- over breathing to a point where the body's carbon dioxide / oxygen balance is upset so that CO2 levels fall to well below normal
- this over breathing may be an attempt to compensate for systematic acidosis or due to psychologically stressful situations |
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Hyperventilation: sign / symptoms (7)
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-rapid breathing in the absence of other medical or traumatic instigators
- absence of adventitious breath sounds - deep or shallow breathing - numbness / tingling - a sense of dyspnea despite rapid breathing - dizziness - cramping in hands and feet |
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Hyperventilation: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport never assume hyperventilation is not a true respiratory emergency |
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TLC
|
total lung capacity
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General Respiratory Emergency Assessment & Treatment Notes (6)
|
- initiate high flow oxygen appropriately (after determining rate of respirations)
- position patient appropriately (sitting if lungs are wet, position of comfort - fowlers or high fowlers) - consider administration of a salbutomal and/or ipratroprium bromide - request ALS backup early for breathing problems - if severe dyspnea, prioritize your questions appropriately (too much talking worsens condition) - determine if the patient has been intubated previously (if yes, the problem will probably deteriorate quickly, you need ALS) |
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POC
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position of comfort
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Aging alters respiratory system by… (3)
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- decreased chest cavity size
- decreased ability to expel pathogens - decreased elasticity of the alveoli |
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PPV (1)
|
positive pressure ventilation
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Cardiac Compromise (1)
|
chest pain results from ischemia
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Ischemia (2)
|
- lack of sufficient oxygen in the body organ
- schema heart disease involves decreased blood flow to the heart, commonly caused by atherosclerosis |
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Infarct (1)
|
- a localized area of necroses in a tissue, vessel or organ; resulting from an interruption of blood supply
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Myocardium (1)
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- heart muscle (myo = muscle , cardium = heart)
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Pulse (1)
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the pressure wave caused when the left ventricle contracts
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Lumen (1)
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inside diameter of a vessel
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Bradycardia (1)
|
heart rate is slower than 60bpm
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Tachycardia (1)
|
heart rate is faster than 100bpm
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7 circulatory conditions (7)
|
- artheriosclerosis
- acute coronary syndromes (angina pectoris, myocardial infarction) - cardiac arrest - cardiogenic shock - congestive heart failure (left sided, right sided) |
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Artheriosclerosis (2)
|
- a disorder in which calcium and cholesterol builds up and forms plaque inside walls of blood vessels
- this buildup obstructs blood flow and interferes with the vessel's ability to contract |
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Artheriosclerosis: common risk factors (12)
|
- diet
- exercise - obesity - smoking - alcohol - diabetes - stress - high BP - age - gender - genetics - race |
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Artheriosclerosis: signs / symptoms (1)
|
- elevated BP
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Artheriosclerosis: treatment (1)
|
none at a BLS level
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Artheriosclerosis is also known as… (1)
|
"root of all cardiac evil"
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Angina Pectoris / Myocardial Ischemia: pathophysiology (2)
|
- a spasm of a coronary artery, or a symptom of atherosclerotic coronary artery disease
- occurs when the myocardium's need for oxygen exceeds its supply, usually during periods of physical or emotional exertion |
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Angina Pectoris / Myocardium Ischemia: signs / symptoms (8)
|
- substemal crushing/ squeezing pain (may radiate and usually relieved with rest within 15 minutes)
- pain describe as tightness or pressure - pain radiates to the jaw, arms (usually left), back, epigastrium - pain usually lasts 3 to 8 minutes (rarely longer than 15) - SOB - N/V - diaphoresis / pallor |
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Angina Pectoris / Myocardium Ischemia: treatment (6)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport - consider the use of ASA |
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AMI
|
Acute Myocardium Infarction
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Acute Myocardium Infarction: pathophysiology (2)
|
- a crack/ fissure develops in the plaque surrounding the coronary blood vessel (atherosclerosis) which causes initiation of the clotting response
- resulting blood clot partially or completely occludes the lumen of the artery resulting in tissues downstream from the blockage infarcting |
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Acute Myocardium Infarction: signs / symptoms ()
|
- substernal crushings / squeezing pain
- may radiate - not usually relieved with rest - pain described as tightness or pressure - pain radiates to the jaw, arms (left), back, or epigastrium - N/V - SOB - diaphoresis / pallor / cyanosis - sudden fainting / dizziness - pulmonary edema - arrhythmias (irregular, weak, absent pulse) |
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Acute Myocardium Infarction: treatment (6)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport - consider the use of ASA * immediate ALS intervention is requires, and may or may not be caused by exertion |
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Cardiac Arrest / Sudden Death: pathophysiology (2)
|
- when the myocardium is no longer pumping effectively (such as to cause adequate perfusion)
- heart is in a non- perfusion rhythm: ventricular tachycardia (VT), ventricular fibrillation (VF) or Asystole (flatline) |
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VT
|
ventricular tachycardia
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VF
|
ventricular fibrillation
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Asystole
|
flatline
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Cardia Arrest / Sudden Death: signs / Symptoms (8)
|
- unconscious
- not breathing - no pulse - not moving - coughing - cyanosis - pallor - diaphoresis |
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Cardia Arrest / Sudden Death: treatment (5)
|
- AED on scene (max 3 shocks on scene) per protocols
or 3 no shock advised - high O2 - transport - CPR *immediate ALS intervention is required |
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Cardiogenic Shock: pathophysiology (4)
|
- when the myocardium is damaged and unable to pump blood effectively
- normal cardiac pumping moves about 75 mL of blood through each chamber (atria+ventricle) with each contraction - one, or both of the ventricles is unable to provide enough force to properly expel the full 75mL of blood, causing a backup of fluid with every cardiac cycle - anything that damages the myocardium may cause cardiogenic shock, from an MI to trauma to other medical conditions |
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Cardiogenic Shock: signs / symptoms (1)
|
varies depending on cause
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Cardiogenic Shock: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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|
"catch all"
|
term for cardiogenic shock condition where the heart is unable to pump effectively
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CHF
|
congestive heart failure
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|
Congestive Heart Failure: pathophysiology (1)
|
- heart failure is when the heart's mechanical performance is compromised so that cardiac output cannot meet the body's needs
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Congestive Heart Failure: left side (1)
|
pulmonary edema
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Congestive Heart Failure: right side (1)
|
- JVD and peripheral edema
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Congestive Heart Failure: signs / symptoms (3)
|
- SOB
- Diaphoresis - Pallor / Cyanosis |
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Congestive Heat Failure: treatment (5)
|
- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Generalized Circulatory Emergency Assessment & Treatment (5)
|
- initiate high flow oxygen appropriately (after determining rate of respiration)
- place the patient in a position of comfort, never Trendelenburg on a cardiac patient - consider administration of acetylsalicylic acid - transport promptly to ALS intercept or hospital - ensure a full set of vitals are checked q 5 mins |
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|
Name 4 Heart Operations (4)
|
- coronary artery bypass graft
- angioplasty - cardiac pacemaker - stent-expandable device inserted in occluded artery |
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|
CABG
|
Coronary Artery Bypass Graft
|
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Implantable Cardiac Pacemaker
|
- maintains a regular heart rhythm and rate
- usually under the left clavicle |
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|
When using an AED on a a patient with an implanted cardiac pacemaker, what must you remember? (1)
|
not to place the AED patches over the pacemaker (must be at least 2 inches away
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Automatic Implantable Cardiac Defibrillators (4)
|
- monitor heart rhythm and delivery shocks as needed
- low electricity will not affect rescuers - works in 20 second cycles - usually under the left clavicle |
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|
AED
|
Automated External Defibrillation
|
|
|
Automated External Defibrillation come in two different forms (2)
|
- automated
- semi automated (used by EMR's) |
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|
AED problems (4)
|
- battery is dead
- patient is being moved - ambulance is moving or the engine is running (must be stopped with the engine turned off) - poor pad/ patient connection |
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|
AED advantages (5)
|
- ALS providers do not need to be on scene
- remote, adhesive defibrillator pads are used - efficient transmission of electricity - simple step by step voice prompts - becoming more popular, in many public venues |
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|
What type of patients should be defibrillated as soon as possible for optimal survivability? (2)
|
- patient in ventricular fibrillation
- patient in ventricular tachycardia |
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|
Using an AED (9)
|
- assess responsiveness, airway, breathing and pulse
- deliver ventilations and begin CPR, while partner preps the AED - turn on AED - apply pads accordingly to pictures (while partner continues CPR) - allow partner to complete 2 minutes of CPR (1 cycle) - follow voice / screen prompts - press analyze button (shock advised or not advised) - clear patient (" I'm clear, everyone clear" ) - if no shock advised, follow the AED voice prompts (2 mins of CPR and then re-evaluate) |
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|
AED transport considerations
|
- keep AED attached
- check pulse frequently - transport (when pt regains pulse, after delivering 3 shocks, after receiving a no shock advised - stop ambulance movement to use and AED (moving will cause artifact) |
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|
AED considerations (8)
|
- make sure the electricity injures no one
- do not defibrillate a patient lying in pooled water - dry a soaking wet patient's chest first - do not defibrillate someone who is touching metal that others are also touching - remove nitroglycerin patches - shave the "Hairy Chest" patient (Never use the defibrillator pads) - remove bras if they are in the way - nipple rings can stay… |
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|
AED maintenance (5)
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- read operators manual
- check AED, battery and pad supply at beginning of each shift - get a checklist from the manufacturer and follow it - report any failures to your supervisor and dispatcher - AEDs should be supplied with a razor and cloth in the case at all times |
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The Cardiovascular system changes with Age… (5)
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- decreased pumping of the heart
- electrical system changes - artheriosclerosis - decreased peripheral circulation (diabetes) - AMI without pain (common) |
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CVA
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Cerebrovascular Accident
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Cerebrovascular accident (2)
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- stroke
- interruption of blood flow to the brain that results in the loss of brain function |
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Hemiparesis (1)
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weakness on one side of the body
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Hemiplegia (1)
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paralysis on one side of the body
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Congenital (1)
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since birth
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Chronic condition (1)
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a condition that develops over a period of time
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Acute condition (1)
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- a sudden onset of a condition
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Incontinence (1)
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- loss of control of bladder and/or bowel
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Aura (1)
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hallucinations of smell, taste, hearing, sight, touch that may warn of an impending seizure
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Tonic (1)
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sustained muscle contractions
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Clonic (1)
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jerky, violent movements
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Postictal (1)
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- sleepy, lethargic state after a seizure
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12 Neurological Conditions (9)
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- cerebrovascular accident (hemorrhagic, ischemia/occlusive, transient ischemic attack)
- cushing's triad - traumatic brain injury - grand mal/ tonic - clonic - petit mal/ absence - jacksonian/ focal motor - postictal state - status epilepticus - neurogenic shock |
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Hemorrhagic Stroke / Aneurysm: pathophysiology (2)
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- an artery in the brain ruptures causing blood to leak into the cranium, exerting pressure inside the cranium
- risk factors include elevated BP for a long period of time, preexisting or congenital weakened arterial wall |
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Hemorrhagic Stoke/ Aneurysm: signs / symptoms
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- sudden severe headache
- changes in senstations (vision/hearing/taste/feeling, unequal pupils, coordination/balance changes, facial droop/unequal smile, drooling) - memory disturbances (long or short term) - behavioural disturbances - incontinence - altered LOC |
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Hemorrhagic Stroke/ Aneurysm: treatment (5)
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- high O1
- AMPLE - OPQRSTA - vital signs - transport |
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Which stroke has a higher mortality rate? hemorrhagic or ischemia?
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hemorrhagic
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Ischemic / Occlusive stroke: pathophysiology (3)
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- when blood flow to part of the brain is cut off by a blockage inside the blood vessels
- blockage may be caused by an embolus or a thrombus and may form/travel deep into the brain - the location of the blockage determines the presence and severity of any associated sign/symptoms |
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Ischemic / Occlusive Stroke: signs / symptoms (9)
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- sudden severe headache
- hemiparesis and hemiplegia - changes in sensations (vision/hearing/taste/feeling, unequal pupils, coordination/balance changes, facial droop/unequal smile, drooling) - behavioural disturbances - incontinence - altered LOC - hemiparesis - hemiplegia - memory disturbances (long or short term) |
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Ischemic / Occlusive stoke: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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What are two common locations for emboli to break free from? (2)
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- carotid arteries
- aorta |
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TIA
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Transient Ischemic Attack
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Transient Ischemic Attakc: pathophysiology (1)
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- a partial or complete blockage in a cerebral artery that is effectively managed (broken down) by the body's natural defines mechanism
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Transient Ischemic Attack: signs / symptoms (9)
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- sudden severe head-ache
- hemiparesis and hemiplegia - goes away within 24 hours - denial - changes in sensations - memory disturbances (long or short term) - behavioural distrubances - incontinence - altered LOC |
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Transient Ischemic Attack: treatment (5)
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- high O2
- AMPLE - oPQRSTA - vital signs - transport |
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Patients will have a number of TIA's before having a full occlusive stroke. T/F
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False, some patients never have a TIA, others only have TIA's and never a full stroke
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CVA
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cerebrovascular accident
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CVA often appears as… (5)
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- hypoglycemia
- postictal state - drug / alcohol abuse - subdural or epidural bleeding (head trauma) - traumatic brain injury |
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TBJ
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Traumatic Brain Injury
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Always consider other problems when dealing with a suspected …… patient. (1)
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stroke
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ICP / Cushing's: pathophysiology (
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- dramatic increase of blood pressure in the skull compresses the brain, leading to brain hypoxia (low oxygen)
- body attempts to restore blood flow to brain by increasing systemic blood pressure - this increase intracranial pressure - changes in respiration rate, rhythm, and quality result from stimulation of the respiratory centre in the medulla oblongata (which is located in the brain stem) - decrease in heart rate is attributed to a vagal response - the Vagus nerve is responsible for "slowing down" the heart rate at the SA node |
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Crushing's triad is a triad of vital signs that are caused by the development of ICP in either a trauma or medical cause. The triad of vital signs are… (3)
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- hypertension, a blood pressure that is increasing from normal often over 180 systolic
- bradycardia, a heart rate that is decreasing from normal, often 60 BPM or lower - Cheyne strokes breathing (deep and irregular breathing pattern) |
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Other possible sings of ICP/ Cushing's are (5)
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- unequal pupils
- seizures - nausea / vomiting - unconscious - MOI of head injury, possibility of hemorrhagic stroke |
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ICP/ Cushing's: treatment (1)
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- if signs of ICP/ Cushing's are present, the critical intervention is to hyper-oxygenate the patient using a BVM with a O2 flow rate of 15 LPM making sure the reservoir bag never is less than 2/3 full
- ventilating 1 breath every 3 seconds or 20/min - if on a backboard, elevate the head end of the stretcher 15 - 20 degrees |
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ICP/ Cushing's *note
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patients will continue to deteriorate until the press increase is effectively manage in the hospital setting
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Generalized CVA Assessment & Treatment (5)
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- initiate high-flow oxygen appropriately (after determining rate of respirations)
- perform neurologic exam, use for any altered LOC - no ASA is to be given to a stroke patient - patients needs to be evaluated by computed topography - place the patient in a comfortable position (paralyzed side down) |
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CT
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computed topography
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CVA treatment needs to start within ….. to …. hours of onset, pending protocols
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3 to 6 hours
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Neurological Assessment abbreviations (2)
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A - alcohol, apnea, anaphylaxis
E - epilepsy, environmental I - insulin O - overdoes U - underdose T - trauma I - infection P - psychiatric, poisoning S - stroke, shock |
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Cincinnati Stroke Scale: three physical findings (3)
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- facial droop
- arm drift - speech |
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What are the three different type of causes for Grand Mal / Tonic- Clonic Seizures? (3)
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- structural causes (abnormality in the brain - benign or cancer tumours, brain infection or scar)
- metabolic causes (abnormally low level of blood chemicals (sodium, hypoglycemia, poisons, drug overdoses, withdrawal from alcohol or sedative drug use) - febrile causes (sudden high fever - common in infants and children - heat stroke) |
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Generalized / Grand Mal / Tonic - Clonic Seizures: signs & symptoms (8)
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- unconscious patient
- severe, jerky muscle twitching and clenching - cyanosis - abnormal or noisy breathing - absence of respirations - possible head injury - loss of bladder and bowel control - post seizure state of unresponsiveness with deep and laboured respirations |
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Generalized / Grand Mal / Tonic - Clonic Seizures: treatment (
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- high O2
- AMPLE - PQRSTA - vital signs - transport |
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What should you not do to an actively convulsing patient? (1)
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do not place anything in their mouth
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What may actively convulsing patients do? (1)
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bite their cheek or tongue
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Petit Mal / Absence: pathophysiology (1)
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- a petit mal seizure is a temporary disturbance of brain function caused by abnormal electrical activity in the brain
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Petit Mal / Absence: signs / symptoms (5 +)
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- staring episodes
- sudden halt in conscious activity - muscle activity changes (no movement, hand fumbling, fluttering eyelids, lip smacking, chewing) - consciousness changes (lack of awareness of surroundings, may be provoked by hyperventilation or flashing lights in some cases, abrupt beginning of seizure, each seizure lasts no more than a few secs, full recovery of consciousness no confusion) - no memory of seizures |
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Petit Mal / Absence: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Patients who have Petit Mals or absences are often young and accused of… (1)
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day dreaming
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Jacksonian / Focal Motor Seizures: pathophysiology (1)
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- a disruption in the electrical activity of the brain that is localized (focused) to one area of the brain
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Jacksonian / Focal Motor Seizures: signs / symptoms (4)
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- 1 limb or portion shaking uncontrollably (i.e. hand)
- memory impairment - may spread to a generalized seizure - patient is usually fully conscious |
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Jacksonian / Focal Motor Seizures: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport |
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Although Jacksonian / Focal Motor Seizures seem to appear minor, why is transport required for these patients? (1)
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they could progress to a generalized/ tonic-clonic seizure
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Progression of Seizures (3)
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- Aura (happens to some, not all, seizure patients have signs usually 30 seconds to 2 minutes before they start convulsing. smelling or tasting burnt toast is common)
- Seizure activity ( the uncontrolled electrical activity in the brain causes the convulsive activity) - postictal state (a period of time after the actual convulsions have finished where the patient is physically exhausted and may have a decreased LOC. this period last a few seconds to many hours) |
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Postictal State: signs / symptoms (4)
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- patient may have laboured breathing
- possible hemiparesis - lethargic, confused or combative - may appear/act intoxicated |
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Postictal State: treatment (5)
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- high O2
- AMPLE - OPQRSTA - vital signs - transport * ALS may be required to administer anti- convulsants |
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What are possible underlying conditions for postictal state? (2)
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- hypoglycemia
- infection |
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Seizures burn ….. / ….. hundreds of times more than during regular activities. (2)
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oxygen / glucose
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Status Epilepticus definition (2)
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- any seizure activity that lasts more than 5 minutes with out a return of consciousness
- repetitive seizure activity with no regaining of consciousness |
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Generalized Seizure Assessment & Treatment (5)
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- initiate high flow oxygen appropriately (after determining rate of respirations)
- expect rapid, deep respirations if the patient is postictal - consider AEIOR & TIPS - observe patient for recurrent seizures - attempt to lower body temperature if febrile seizure (tapid water - NOT Alcohol) |
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Geriatric notes - nervous system (3)
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- brain shrinks with age / lack of use
- always consider underlying conditions - elderly are at higher risk for central nervous system illness and injuries |
