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368 Cards in this Set
- Front
- Back
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Identify Componets of the Central Nervous System
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CNS- Brain & Spinal Cord
Peripheral Nervous System (PNS)- The nerves connecting the brain and spinal cord to other parts of the body. |
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Describe the fight-flight system.
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Body prepares for a threat. Hormones are released by the SNS controled by the hypothalamus, Epi and Norepi from the medulla increase heart rate, blood pressure, dilate pupils, increase blood sugar, slow digestion, dialate bronchial tree.
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Define somatic nervous system
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Controls functions that are under conscious, voluntary control suck as skeletal muscles and sensorey neurons of the skin
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Define Autonomic nervous system
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Mostly motor nerves, controls functions of involunatry smooth muscles, cardiac muscle
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Afferent Divison
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Nerve fibers that send impulses from the periphery to the central nerveous system
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Efferent Division
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Nerve fibers that send impulses from the CNS to the periphery
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Another name for the sympathetic nervous system
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Adrenergic
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Sympathetic nervous system
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A division of the autonomic nervous system that usually is involved in preparing the body for physical activity
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Parasympathetic nervous system
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The subdivison of the autonomic nervous system usually involved in activating vegetative functions such as digestion, defecation, urination
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Another name for the Parasympathetic nervous system
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Cholinergic
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Preganglionic Fibers
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Are cholinergic, secreting acetylcholine, whihc stimulates nicotinic receptors in the postgaglionicneuron
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Postganglionic Fibers
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Are adrenergic secreting norepinephrine, thus timulating alpha or beta adrenergic receptors
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Acetylcholine
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A neurotransmitter, widely distributed in body tissues, with the primary function of mediating the synaptic activity of the nervous system.
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4 terms that indicate Stimulation in the Sympathetic Divison
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Sympathomimetic
Sympathetic agonist Adrenergic Adrenergic agonist |
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4 terms that indicate Stimulation in the Parasympathetic Divison
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Parasympathomimetic
Parasympathetic agonist Cholinergic Cholinergic agonist |
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5 terms that indicate Inhibition in the Sympathetic Divison
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Sympatholytic
Adrenergic blocker Sympathetic blocker Antiadrenergic Sympathetic antagonist |
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6 terms that indicate inhibition in the Parasympathetic Divison
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Parasympatholytic
Cholinergic blocker Parasympathetic blocker Anticholinergic Parasympathetic antagonist Vagolytic |
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Chronotrope positive and negative effects refer to a...
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A subsatnce that affects the heart rate.
Positive Chronotrope increase heart rate Negative Chronotrope decrease heart rate |
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Inotrope positive and negative effects refer to a...
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A substance that affects myocardial contractility
Positive Inotrope increase force of contraction Negative Inotrope decrease force of contraction |
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Agonist
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A drug or substance that produces a predicatable response(stimulates action)
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Antagonist
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An agent that exerts an action opposite to another potential(blocks action)
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Muscarinic receptors are primarily responsible for promoting what type of response
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Parasympathetic response
Slow onset and long duration and may be excitatory or inhibitory. |
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Because both nicotinic and muscarnic receptors are specific for acetylcholine they are collectiviely referred to as...
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Cholinergic receptors
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Nicotinic receptors are located in the_____ and they are responsible for what.
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Autonomic ganglia
Initiate muscle contraction as part of somatic nervous system. The responses are of fast onset and short duration |
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Cholinergic Drugs mimic what actions
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The parasympathetic nervous system
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Cholinergic Blocking Drugs mimic what actions
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Which block the action of the parasympathetic nervous system
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Adrenergic drugs mimic what actions
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The sympathetic nervous system or the adrenal medulla
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Adrenergic blocking Drugs mimic what actions
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Which block the action of the sympathetic nervous system
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Anatomical and functional terms for the Autonomic nervous system what are the Anatomical name, Functional Term, Primary Neurotransmitter
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Sympathetic
Adrenergic Norepinephrine Parasympathetic Cholinergic Acetylcholine |
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Adrenergic drugs are designed to produce activities like a _______?
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Neurotrsnamiter
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Neurotrsnamiter
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Chemical compound released by one neuron to affect the membrane potential of another
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Affinity
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The property of a drug to bind or attach itself to a given receptor site
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Effiacy
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the ability of a drug to initiate biological activity as a result of binding to a receptor site
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Pharmacodynamics
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The study of how drugs act on living organism
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The primary organ for excreation of a drug
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Kidney
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Define chemical name for a drug
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It describes the chemical composition of a drug
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Define generic name for a drug
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This is the offical name given by the US Food and Drug Administration
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Define Trade name for a drug
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Is a trademark name designated by the drug company that sells the medication. The first letter of the name is capital.
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Define ofical name for a drug
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Name of the drug followed by the initials USP (United Staes Pharmacopeia)
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Mimetic is rfered to as what type of action.
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mimic's the actions
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Olytic is rfered to as what type of action.
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Block the actions
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Most drugs cross the cell membrane by means of;
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Diffusion- The process in whihc solid, particulate matter in a fluid moves from an area of high concentration to an area of low concentration, resulting in an even distribution of the particles in the fluid.
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Rug absorbition refers to the movement of the drug from the:
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Entry site to the genral circulation
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A subcutaneous injection is introduced into the:
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Fat and connective tissue
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The body has two general types of drug reservoirs they are:
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Plasma protien binding and tissue binding
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Diffusion results from____movements of particles in solution.
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Random
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You have a 100mL of a 30% solution. How many grams are in the solution.
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Step 1: Convert 30% to .30 by moving the decimal to the left 2 spaces.
Step 2: Multiply 100 X .30 Step 3: 30 grams |
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Remember the following when you are considering ratio measures:
Prescription 5:1,000 |
HAVE 5:1,000 solution
KNOW 5 parts drugs 1,000 parts solution WANT Ratio Solution |
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When setting up the ratio proportion, you must ask yourself the following:
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What do I HAVE? (strength/volume of drug on hand)
What do I WANT? (prescribed dosage of drug) |
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How do you change grams to milligrams; change 0.5 g to milligrams
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By moving the decimal point three places to the right
0.5 = 500 |
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1 gram is equal to how many milligrams?
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1000 milligrams
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Q: Ch17 - Move the decimal to the right when you want to ___. Move the decimal to the left when you want to ____.
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Multiply
Dividing |
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Ch7 What is the name of the water that lies outside the vascular bed and lies between the tissue cells.
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Extrcellular Fluid
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Ch7 The fluid found inside all body cells.
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Intracellualr Fluid. It accounts for 40% of tghe bodies weight.
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The extracellular fluid between the cells, and outside the vascular bed is know as.
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Inerstitial Fluid ( connective tissue, cartilage, and bone)
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C7 The diffusion of solvent through a membrane from a less concentration solution to a more concentrated solution.
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Osmosis
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C7 What is the result of constant motion of all the atoms, molecules, or ions in a solution. A passive process in whihc molecules or ions move from and area of high concentration to an area of low concentration
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Diffusion
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C7 A term used to describe a solution that causes cells neither to shrink nor to swell
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Isotonic
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C7 What hormone regulates water balance
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Antidiuretic Hormone (ADH)
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C7 ADH casues Pt. with shock to have a desire for thirst. What is a reason?
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A decreas in circulating blood volume and decline in artiral pressure will release ADH in the body. In response to ADH water is reabsorbed into the plasma.
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C7 renin-angiotensin-aldosterone system
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a hormone system that helps regulate long-term blood pressure and extracellular volume in the body. The system can be activated when there is a loss of blood volume or a drop in blood pressure
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C7 What is call when there is equal loss of water and sodium in the body.
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Isotonic Dhydration
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C7 Signa and symptoms of Isotonic Dhydration
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Dry skin mucous mebrane, Poor skin turgor, decrease urine output, Acute weight loss
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Isotonic Dhydration treatment
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IV infusion of sodium chloride or normal saline)
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C7 What is a continued intake of sodium in the absence of water called.
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Hypernatremic Dehydration
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C7 Osmotic pressure
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The pressure exerted on a semipermeable membrane that separates two solutions and the particles they contain.
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C7 Hypertonic
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One solution having a greater amount of solute (dissolved substance in a solution) than another solution, thus it exerts more osmotic pressure than the second solution and the body will attempt to equalize pressure by passing fluid through the cell membranes.
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C7 One solution having a lesser amount of solute than another solution, thus it exerts less osmotic pressure than the second solution.
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Hypotonic
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C7 Signa and symptoms of Hypernatremic Dehydration
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Dry and sticky mucous membrane, Flushed dry skin, Intense thirst, Increased body temp, Altered mental status
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C7 Hypernatremic Dehydration treatment
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Volume replacement with isotonic solution.
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C7 Hyponatremic Dehydartion
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Continued intake of of water in the absence of sodium
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C7 Hyponatremic Dehydartion signs and symptoms
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Muscle cramps, seizures, Rapid thready pulse, profuse sweating, cyanosis
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C7 Hyponatremic Dehydartion traetment
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IV fluid replacement
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Ch.7 Potassium
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Potassium is important in nerve function and in influencing osmotic balance between cells and the interstitiual fluid.[1]
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C7 A shortage of potassium in body fluids may cause
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A potentially fatal condition known as hypokalemia, typically resulting from diarrhea, increased diuresis and vomiting. Deficiency symptoms include muscle weakness, paralytic ileus, ECG abnormalities, decreased reflex response and (in severe cases) respiratory paralysis, alkalosis and arrhythmia.
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C7 Hyperkalaemia
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Is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium.
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C7 Hypokalemia
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is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. The condition is also known as potassium deficiency.
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C7 Hyperkalaemia Cause
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Renal failure, burns, crush injuries, severe infection
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C7 Calcium
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Is important for nuromuscular transmission, call membrane permeability, hormone secretion, growth and ossification of bane
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C7 What is an abnormally low level of calcium in the bllod called?
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hypocalcemia
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C7 Hypercalcaemia
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is an elevated calcium level in the blood.
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C7 Hypermagnesemia
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Is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood.
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C7 Respiratory acidosis
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is acidosis (abnormal acidity of the blood) due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide concentration (PaCO2).
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C7 Metabolic Acidosis
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is a state in which the blood pH is low (less than 7.35) due to increased production of H+ by the body or the inability of the body to form bicarbonate (HCO3-) in the kidney
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C7 Signs and symptoms of Metabolic Acidosis
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Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis
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Diabetic ketoacidosis (DKA)
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is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia).
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Signas and symptoms of DKA
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Sluggish, extreme tiredness.
Fruity smell to breath/compare to nail polish remover, similar to peardrops. Extreme thirst, despite large fluid intake. Constant urination Extreme weight-loss. |
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C7 Treatment for DKA
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Administration of normal saline for volume repletion
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C7 Respiratory alkalosis
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results from increased alveolar respiration (hyperventilation) leading to decreased plasma carbon dioxide concentration.
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C7 Respiratory alkalosis treated in filed by:
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Low concentration of O2, Calming measures to slow and control breathing
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C7 Metabolic alkalosis
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is a metabolic condition in which the pH of the blood is elevated beyond the normal range. Ingetion of large amounts of tums, other antacids
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C7 Metabolic alkalosis treated
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Voume replacement with isotonic solution
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What type of solution is body fluid?
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Isotonic Solution
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What name is given to solutes that generate an electrical charge when dissolved in water?
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Electrolytes
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What are the major intracellular cation and the major extracellular cation?
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Potassium is the major intracellular cation; Sodium is the major extracellular cation
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Whihc hormone influences the amount of urine produced by the kidney?
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The amount of urine produced each day by the kidneys is influenced by Aldosterone and ADH levels.
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What are two major functions of K?
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Maintining cell electroneytrality and cell osmolality, directly affecting cardiac muscle contraction & electrical conductivity, aiding neuromuscular transmission of nerve impulses, and playing a major role in acid-base balance
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What organs are the first line of protection in acid-base regulation and are capable of responding to changes in minutes?
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The lungs are the first line of protection in acid-base regulation.
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How does the body attempt to compensate for metabolic acidosis?
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The lungs compensate by increasing the rate and depth of respirations and greater elimination of C02
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What are 4 assessments findings in an ECF volume excess?
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Weight gain, distended neck vein, elevated blood pressure, full bounding pulse, crackles, dyspnea
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What are 3 cause of ICF Volume excess?
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IV administration, hypotonic solution, tap water enemas
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What effects does hyperkalemia have on the heart?
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Excess K acts as a myocardial depressantt, resulting in a decreased heart rate, decreased cardiac output, and possible cardiac arrest
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How does the body compensate for metabolic acidosis?
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Through hyperventilation
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When are Colloids administered
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During acute situation to expand intravascular volume and maintain blood pressure.
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When are Crystalloid administered
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Provide hydration and calories, replace ECF loss
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What is the most common Acid-Base imbalance for the Pt. with respiratory insufficiency
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Respiratory acidosis
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Which acid base imbalcne would be seen with vomiting?
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Metabolic Acidosis
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Which imbalce is most commonly seen in diuretic use
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Hypokalemia is the most common imbalnce associated with diuretic use.
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1-8-08 What breathing pattern is characterized by long, deep breaths that are stopped during inspiratory phase and seperated by periods of apnea?
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Apneustic respirations (seen in stroke or severe central nervous system disease
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Ataxic respirations are characterized by:
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repeated episodes of gasping ventilations seperated by periods of apnea. This pattern is seen in Pt. w/ increased intracranial pressure.
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Deep, rapid respirations that are caused by strokes or injury to the brainsteam. In this case, there is a loss of normal regulation of ventilatory controls and respiratory alkalosis is often seen is known as?
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Central neurogenic hyperventialtion
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Characteristics of Kussmauls respirations.
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Deep, rapid breaths that result as a corrective measure against consitions such as diabetic ketoacidosis that produce metabolic acidosis
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Ventilatory pattern with progressively increasing tidal volume, followed by declining voulme, seperated ny periods of apnea at the end of expiration.
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Cheyne-Stokes Seen in older Pt. with terminal illness or brain injury.
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What are six classsic signs of respiratory distress:
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Nasal Flaring: Widening of the nares W/ respiration
Tracheal tugging: Retraction of tissue of the neck. Intercostal muscle retraction Accessory respiratory muscles cyanosis, pursed lips |
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Life threatening respiratory problems in adult. In order of most ominous to least severe:
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Altered mental status
Severe central cyanosis Absent brath sounds Audible stridor 1-2 word dyspnea (with breath after each word) Tachycardia > 130 beats a minute Pallor & diaphoresis Intercostal retraction Accessory muscle use |
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Define:
Dyspnea Orthopnea pleuritic |
Difficult or labored breathing a sensation of SOB
Dyspnea while lying supine Sharp or tearing, a pain description |
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Sputum Color:
Thick green or brown Thin yellow pale-gray Pink frothy Bloody sputum |
Lung infection
Allergic Severe pulmonary edema cancer,TB and Bronchial infection |
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Vibration of respiratory structures and the resulting sound, due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant
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Snoring
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A high pitched sound resulting from turbulent gas flow in the upper airway. associated with laryngeal constrictiobn or edema
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Stridor
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A continuous, coarse, whistling sound produced in the respiratory airways during breathing
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Wheeze, wheezes to occur, some part of the respiratory tree must be narrowed or obstructed
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The "coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways".
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Rhonchi
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What are the clicking, rattling, or crackling noises heard on auscultation of (listening to) the lung with a stethoscope during inhalation.
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Rales, crackles or crepitations,
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Sounds, like dried pieces of leather rubbing together; occurs when the pleura become inflamed, as in pleurisy
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Pleural Friction Rub
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The disposable device that records the level of CO2 exhaled using PH senssitive chemically impregnated paper is a:
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Colormetric device
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The airway technique preferred for use with the Pt. who is Unconscious is:
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endtracheal intubation
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Describe how the pilot ballon should be on an ET Tube
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Partially inflated but soft to avid over inflation.
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Why is a stylet used in a ET Tube
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Maintain a preset curve in the tube
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ET Tube Indicators:
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1.Respiratory / cardiac Arrest
2.Unconsciousness w/ no gag reflex 3.Risk of aspiration 4.Obstruction due to foreign bodies,trauma,burns or anaphlaxis 5.Respiratory extremis due to disease 6.Pneumothorax,hemothorax, hemopneumothorax w/ respiratoory difficulty |
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ET Tube Complication include:
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1.Equipment malfunction
2.Teeth breakage & soft tissue laceration 3.Hypoxia 4.Esophageal intubation 5.Endobronchial intubation 6.tension pneumothorax |
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When using an ET Tube what is likley to occur:
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Complete airway control
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To avoid hypoxia tube attempts should be limited to under how many seconds/
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30
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Name indictions of esophagel intubation
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1.absent chest rise & fall & breath sounds
2.Gurgling sound over the epigastrium w/ breaths 3.Abdomen distention 4.Absence of breath condensation in tube 5. Air leak despite inflation of cuff 6.Cyanosis and worsening Pt. condition 7.Phonation(nosie made by the vocal cords) 8.No color change w/ colorinetric ETC2 detector 9.Falling pulse oximetry reading |
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Digital intubation may be indicated in what situations:
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1.An unconscious trauma Pt. with cspine injury
2.A Pt with facial injury that distort the anatomy 3.An entrapped Pt. who cannot be positioned 4.Pt. with copious amounts of fluids in the airway |
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Indication of rapid-sequence intubation.
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1.Impending respiratory failure
2.Acute disorder that threats airway 4.Altered mental status w/ risk of aspiration 5.Glasgow coma scale of 8 or less |
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Name 4 common paralytic agents
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1.Succinylcholine
2.Vecuronium 3.Atracurium 4.Pancuronium |
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Succinylcholine guidelines
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Dose 1.5mg/kg IV bolus in adults
Onset 60-90 seconds Duration 3-5 minutes Contraindication: Penetrating eye injuries, Pt with burns greater than 8 hours, duration, massice crush injuries and neuro injury greater than 1 week. |
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In the Tubeing of children under 8, it is recommended that the P use:
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An uncuffed E Tube & straight blade
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Indications of nasotrachel intubation
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1.Spinla injury
2.Clenched teeth 3.Fractured jaw, oral injuries 4. Significant angioedema (facial/airway swelling) 5.Obesity 6.Arthritis, preventing placement in the sniffing position |
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Contarindication of nasotrachel intubation
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1.Suspected nasal fracture
2.Suspected basilar skull fracture 3.Significant deviated nasal septum or other nasal obstruction 4.cardia and respiratory arrest 5.Unresponsive Pt. |
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The primary risk of field extubation:
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Laryngospasm, involuntary closure of the glottis.
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What are the features of the PtL
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1.It can be inserted blindly
2.It can seal off the nasal and oral cavity 3.The Pt. can be ventilated reagrdless if tube is in Trac or Esoph 4.No cervical spine movement |
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A cric should not be perforemd on a Pt. 12 years of age or younger becasue:
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The cricothyroid membrane is small and underdeveloped
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Nasogastric tube placement is indication in a Pt. with:
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1.Facial fracture
2.Possible skull fracture 3.who is awake 4.when a large gastric tube is indicated |
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BVM delivers what percentage of air when it is connected to 15 L per minute:
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60-70% To get 90 to 95% you must connect a oxygen reservoir adjunct
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1 rescu BVM is difficult because:
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1.Can't maintain a good airway position
2.Hard to keep mask seal 3.Hard to squeeze bag |
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What is the youngest age a auto vetilator can be used:
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Children under 5 years of age
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The most common cause of children's pneumonia is:
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Influenza A
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A reactive airway disease that is stimulated by both intrinsic and extrinsic factors is known as:
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Asthma
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One factor that may help differentiate pneumonia from COPD is the presence of:
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fever
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A condition that exists when the capillaries in the lung have greater permeability, which leads to rales and stiff alveoli, is known as:
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ARDS
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The air inhaled and exhaled during normal respiratory cycle
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Tidal volume
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Quantity of air moved on deepest inspiration and expiration
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Vital capacity
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Air remaining in the respiratory passage after exhalation
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residual volume
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Amount of air that can be exhaled forcefully after normal breath is exhaled
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Expiratory reserve voulme
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List three physilogical factors that can increase the work of breathing.
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1.Pulmonary surfactant - reduce surface tension to allow gas exchange
2.Increase in airway resistance 3.Decrease in pulmonary compliance |
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The amount of CO2 in the blood is influenced by rate and type of:
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Metabolism
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With a high suspect of spinal injury what airway should be used on a Pt.
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Nasal intubation
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The difference between oral endotracheal intubation and oral intubation
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OEI is used for cervical spine injury.
OI is used for unconscious Pt. with no C Spine injury |
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What airway adjunct provides the best protection aginst aspiration>
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ETT - Oral endotracheal tube
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1. Mouth to mouth
2. Mouth to mask 3. BVM |
1 A: easy,no equipment
D: Infection,No 02 supplement 2 A: Easy, Supplemental 02 D: Can't give 100% 02 3 A:100% 02, vary volume D: Difficult for maske seal, Requires two people |
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Define external respiration
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The transfer of 02 and C02 between the inspired air and pulmonary capillaries.
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Define Pulmonary Respiration
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movement of air into and out of the lungs
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Respiration is defined
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The exchange of 02 and CO2 between an organisim and the environment
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In what structure must continues negative pressure be maintain lung expansion
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Pleural space
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If you have a PT. with PO2 of 70 mm Hg. What does that mean.
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Less than 3 mL of 02 is disolved in 1L of blood. 80-100 is the normal value for PO2
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When a Pt. Pulse Ox is 100% that means what in the Pt.
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The hemoglobin is converted to oxyhemoglobin
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Respiratory chemoreceptors are found in what parts of the body?
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Medulla, aortic bodies, carotid bodies
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Respiratory chemoreceptors are stimulated by:
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C02, Oxygen and PH
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Laryngeal fracture can occur following:
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direct trauma to the neck region and may lead to life-threatening airway obstruction. For this reason, a patient suspected of having a fractured larynx should be treated in an emergent manner.
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The Pt. on a nasal cannula at 5L/min. is receiving approxinately how much 02:
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50%
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2/4
The series of events between the end of a cardiac contraction to the end of the next |
Cardiac Cycle
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The phase of cardiac cycle during whcih the heart muscle is relaxed
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Diastolic
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The phase of the cardiac cycle during whihc the heart contracts
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Systole
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The ratio of blood pumped from the ventricle coampared w/ the amount at the end of diastole
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Ejection fraction
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The end-diastolic volume of ventricles
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preload
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The resistence against whihc the heart pumps
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afterload
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The amount of blood pumped by the ventricles during one minute
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cardiac Output
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Innate rate of Purkinje fibers
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15-40
|
|
|
Innate rate of the SA Node
|
60-100
|
|
|
Innate rate of the av node
|
40-60
|
|
|
Atropine, lidocaine, adenosine are in whihc group of drugs
|
antidysrhythmics
|
|
|
Dopamine dobutamine and epi are whihc class of drugs
|
Parasympathomimetics
|
|
|
Nitrous oxide, nitro, fentynal and morphine are whihc group of drugs
|
Antiatherosclerotics ischemia and it's pain
|
|
|
Digitalis has the following effects
|
increase cardiac contraction
increase cardiac output decrease ventricular response decrease condution through the aV NODE |
|
|
Medication for Asytole
|
Epi and atropine and maybe sodium bicarbonate
|
|
|
Indication for synchronized cardioversion
|
Rapid atrial fib
Paroxysmal super v-tach Perfusing v tach 2:1 atrial flutter |
|
|
urgent noncardiac causes of chest pain include
|
peptic ulcer disease
pneumathorax pulmonary embolism esophagel disease |
|
|
Define a transmural infarction
|
Myocardial infarction where the injury affects the full thinkness of the myocardium
|
|
|
Cardiogenic shock can come from
|
Subendocardial MI
Tension pneumo Pulmonary embolism Diffuse myocardial ischemia |
|
|
Criteria for termination of resucatation
|
Successful and maintained E-T
PT remains assytole after 4 rounds of drugs ACLS standards have been applied throughout arrest |
|
|
Signa or symptoms of abdominal aortic aneurysm
|
Hypotention
Back pain Urge to defecate abdominal pain |
|
|
ECG Findings
Pathological Q wave ST segment elevation T wave inversion St segment depression |
Infarcted tissue or transient ischemia
Myocardial injury Myocardial ischemia Myocardial ischemia |
|
|
name diagnoises
30 minutes of acute chest pain not relieved by nitro |
Acute MI
|
|
|
Diagnosis
progressive fluid accumulation in lungs |
left ventricular failure
|
|
|
heart pumping ability does not meet body need
|
heart failure
|
|
|
Unresponsivenss with apnea and pulselessness
|
Cardia arrest
|
|
|
Jugular vein distention, edema and tachycardia
|
Reight ventricular failure
|
|
|
Pulsus paradoxus and electrical alternana
|
Pulmonary edema
|
|
|
Dyspnea, orthopenia, decreased systolic BP narrowing pulse pressure
|
cardiac tamponade
|
|
|
Severa headache, visula disturbance, seizures, stupor,diagnostic vital signs
|
hypertesnive encephalopathy
|
|
|
Orthopenea
|
Relief of dyspnea when sitting up
|
|
|
Pulsus paradoxus
|
drop of more than 10 mmHg in systolic BP w/ inspiration
|
|
|
Risk factors for heart disease
|
obesity, contraceptive use, cocains use, family history
|
|
|
Blood supply to L ventricle, septum, part of R ventricle and hearts conduction system comes from the 2 brnaches of the l coronary artery are:
|
Anterior deceding arterey and circumfle artery
|
|
|
Tunica advnticia is whihc layer of the artery
|
Muscular middle layer
|
|
|
Stimulation of the heart by the SNS results in
|
+ intopic and chronotropic effects
|
|
|
Cardiac cells have whihc properties
|
excitability, conductivity, automticity, contractility
|
|
|
Electrode location for bipolar leads
|
L eg, R arm, L arm
|
|
|
As single monitoribng lead cannot identtify
|
Prsence of infarct, location of infarct, axis deviation information, quality of pumping action
|
|
|
Single monitoring lead can provide:
|
heart rate, regularity, time it takes to conduct an impulse through the parts of the heart
|
|
|
Causes of dysrhythmias include
|
Myocardia iscemia, PH imbalnce, CNS & sutonomic nerveous damage and drug effects
|
|
|
Which atrial dysrhythmi is a seroious undelying disease
|
Mutifocal atrial contraction
|
|
|
What dysrhthimi has chartieristic sawtooth shaped p waves
|
Atrial flutter
|
|
|
Whihc dysrhthimi is irregular irregular
|
Atrial fibrilation
|
|
|
The diagnositic finding of 1st degree AV block on ECG
|
A PR interval longer than 0.20 seconds
|
|
|
The cheif difference between type 1 and type 2 av block is
|
lengthening P-R intravla before blocked impulse in type 1 second degree heart block
|
|
|
What medication should never be used for 3rd degree blocks
|
lidocaine
|
|
|
Name findigs in the ECG for dysrhthmias originating in the AV junctionm
|
PR intravl less than 0.12, P waves are inverted in lead 2, QRS complex normal in duration, P waves can be masked if atrial depolerization occurs during ventricular depolarization
|
|
|
Caffine, tobaco, alchol and sympathomimetic drugs are common casue of:
|
Premature junctional contraction
|
|
|
What can casue paroxysmal junctional tach:
|
smoking, caffine, stress, overexertion
|
|
|
The treatment of choice for ventricular escape with no symptoms:
|
No treatment if no history or symptoms
|
|
|
Possible cause of PEA
|
Hypovolemia, tension pneumo, pulmonary emboli, cardiac tamponade
|
|
|
Hypothermia may prsent what on an ECG
|
J or osborn wave, T wave inversion, Pr intrval longation, atrial flutter
|
|
|
The acronym "PATCH(4) MDs" provides a guide to:
|
Pulmonary Embolism, Acidosis
(preexisting), Tension pneumothorax, Cardiac Tamponade, Hyperkalemia, (preexisting),Hypokalemia Hypovolemia, Hypoxia, Myocardial infarct,Drugs, Shivering |
|
|
Pulmonary Embolism
|
No pulse w/ CPR, JVD Thrombolytics, surgery
|
|
|
Acidosis
(preexisting) |
Diabetic/renal patient, ABGs Sodium bicarbonate,
hyperventilation |
|
|
Tension pneumothorax
|
No pulse w/ CPR, JVD, tracheal deviation Needle thoracostomy
|
|
|
Cardiac
Tamponade |
No pulse w/ CPR, JVD, narrow pulse pressure prior to arrest Pericardiocentesis
|
|
|
Hyperkalemia
(preexisting) |
Renal patient, EKG, serum K level Sodium bicarbonate, calcium chloride, albuterol nebulizer, insulin/glucose, dialysis, diuresis, Kayexalate
|
|
|
Hypokalemia
|
EKG, serum K level Treat with great prudence after careful assessment of the cause. K can kill.
|
|
|
Hypovolemia
|
Collapsed vasculature Fluids
|
|
|
Hypoxia
|
Airway, cyanosis, ABGs Oxygen, ventilation
|
|
|
Myocardial
|
infarct History, EKG Acute Coronary Syndrome algorithm
|
|
|
Drugs
|
Medications, illicit drug use, toxins Treat accordingly
|
|
|
Shivering
|
Core temperature Hypothermia Algorithm
|
|
|
Adult ACLS Secondary Survey ABCDs
|
A Airway: *Establish appropriate airway management.
B Breathing: Ventilate with O2. Assess adequacy of ventilation, e.g., by exam, chest rise, SaO2 monitor, CO2 detector, esophageal detector, as indicated. C Circulation: IV/IO. Attach monitor leads. Follow appropriate ACLS algorithm. Give rhythm-appropriate medications. Get vital signs/EKG/labs. Continue effective **CPR as indicated. Minimize chest compression interruptions to <10 seconds. D Differential Diagnosis: Attempt to identify and treat reversible causes |
|
|
P E A Algorthym
|
P Problem search Treat accordingly.
E Epinephrine 1 mg IV/IO q3-5 min. Or vasopressin 40 U IV/IO, in place of the 1st or 2nd dose of epi. A Atropine 1 mg IV/IO q3-5 min. (3mg max.) Consider termination of efforts if asystole persists despite appropriate interventions. |
|
|
Mnemonic directs AHA accepted actions after absolute (<60bpm) or relative (slower rate than expected) bradycardia:
Pacing Always Ends Danger |
Prepare TCP w/ serious cir. compromise due to bradycardia (especially high-degree blocks)if atopine failed to increase rate.
Ready RX: Atropine 1st-line drug, 0.5 mg IV/IO q3-5 min. (max. 3mg) Epi. 2-10 µg/min 2nd-line drugs to consider if atropine and/or TCP are not working Dopamine 2-10 µg/kg/min |
|
|
Circulatory Compromise Scale
|
Symptoms: shortness of breath, chest pain, altered level/loss of consciousness
Signs: mild hypotension, pulmonary congestion, CHF, hypotensive shock Mild (Severity) Critical Click Here to Close Window Copyright 2006, ACLS.net. All rights reserved. |
|
|
Mnemonic directs preparations for synchronized electrical cardioversion of unstable tachycardia with circulatory compromise due to the fast rate (do not delay shocking if seriously unstable):
|
Oh Say It Isn't So
|
|
|
Oh Say It Isn't So
|
Oh = O2 Saturation monitor
Say = Suctioning equipment It = IV line Isn't = Intubation equipment So = Sedation and possibly analgesics |
|
|
pulselessness with an organized cardiac rhythm. Provide 2 minute cycles of CPR-rhythm/pulse checks and think:
|
P = Problem searchTreat accordingly.
E = Epinephrine 1 mg IV/IO q3-5 min. Or vasopressin 40 U IV/IO, once, in place of the 1st or 2nd dose of epi. A = Atropine, with a slow heart rate, 1 mg IV/IO q3-5 min. (3mg max.) |
|
|
Tachycardia with symptoms due to the fast rate is discovered: Start the Secondary ABCDs with emphasis on oxygenation, IV, VS, and EKG, and consider the following questions:
|
Stable, Narrow, Regualr
think SVT, then V-A-C ↓ Vagal maneuvers, if this fails.. ↓ Adenosine 6mg rapid IV push repeat x2, q1-2min. at 12mg) ↓ Cardizem (diltiazem) managed by an expert if stable, narrow, regular tachyarrhythmia continues |
|
|
When due you consult an expert
|
Tachycardia with symptoms due to the fast rate. That have QRS that are Narrow and Regular
|
|
|
When due you not consult a expert on tachycardia with symptoms due to the fast rate.
|
Unstable person you electrical cardiovert
|
|
|
Synchronized Electrical Cardioversion = mnemonic
|
Oh Say It Isn't So
|
|
|
Bradycardia Algorithm mnemonic
|
Pacing Always Ends Danger
|
|
|
Ventricular Fibrillation (VF)/
Pulseless Ventricular Tachycardia (PVT) Algorithm mnemonic |
SCREAM
|
|
|
SCREAM mnemonic stands for
|
Shock 360J mono, 1st + sub. shocks.
CPR 30:2 ratio for 2 min. No check rhythm or pulse) Rhythm check shock Epi 1mgIV/IO q3-5 min. Or vasopressin 40UIV/IO, 1x in place of 1st or 2nd dose of epi. Antiarrhythmic Medications Antiarrhythmics. Amiodarone 300mg IV/IO, Lidocaine 1.0-1.5 mg/kg Magnesium Sulfate 1-2gIV/IO |
|
|
Appropriate for acute MI treatment: Along with Mnomic
|
Morphine
Oxygen Nitroglycerin Aspirin MONA |
|
|
Contraindications for thrombolytic therapy include
|
Active internal bleeding.
Recent head trauma. Traumatic CPR. Suspected aortic dissection |
|
|
stroke is suspected the single most important test for a stable patient presenting to the emergency department is:
|
Computed tomography (CT) of the head
|
|
|
A head Ct can diferinate what:
|
A hemoragic stroke from a ischemic stroke
|
|
|
Ischemic stroke is when:
|
Blood vessels supplying the brain is blocked
|
|
|
Hemorrhagic Stroke is when:
|
When a cerebral artery bursts
|
|
|
Thrombotic stroke charcteristics
|
Most common, due to narrowing of brain vessels, occurs due to lack of 02
|
|
|
Embolic Stroke charcteristics
|
Material from outside brain becomes lodged in brain, may be fat,air, plaque, lodged were arteries branch
|
|
|
2 types of heemorrhagic stroke
|
Subarachnoid hemorrhage and Intracerebral hemorrhage
|
|
|
Subarachnoid hemorrhage
|
rupture of an artery w/ bleeding onto the surface of the brain
|
|
|
Intracerebral Hemorrhage
|
Bleeding into the brain caused by hypertension ruptures small blood vesels in brain
|
|
|
Hemorrhage or no hemorrhage TX:
|
Yes: Pt is not a candidate for fibrinolytic surgerey
NO: Pt may be a cadidate for fibrinolytic |
|
|
guidelines accepted by the American Heart Association indicate thrombolytics should be given within how many hours of the onset of acute ischemic stroke symptoms?
|
3 hours
|
|
|
Indications for cardiac pacing include
|
Hemodynamically unstable bradycardia.
Bradycardia with ventricular escape beats. Some cases of asystole. |
|
|
Tachycardia with symptoms due to the fast rate is discovered: Start the Secondary ABCDs with emphasis on oxygenation, IV, VS, and EKG, and consider the following questions:
|
Stable, Narrow, Regualr
think SVT, then V-A-C ↓ Vagal maneuvers, if this fails.. ↓ Adenosine 6mg rapid IV push repeat x2, q1-2min. at 12mg) ↓ Cardizem (diltiazem) managed by an expert if stable, narrow, regular tachyarrhythmia continues |
|
|
When due you consult an expert
|
Tachycardia with symptoms due to the fast rate. That have QRS that are Narrow and Regular
|
|
|
When due you not consult a expert on tachycardia with symptoms due to the fast rate.
|
Unstable person you electrical cardiovert
|
|
|
Synchronized Electrical Cardioversion = mnemonic
|
Oh Say It Isn't So
|
|
|
Bradycardia Algorithm mnemonic
|
Pacing Always Ends Danger
|
|
|
Ventricular Fibrillation (VF)/
Pulseless Ventricular Tachycardia (PVT) Algorithm mnemonic |
SCREAM
|
|
|
SCREAM mnemonic stands for
|
S Shock 360J* monophasic, 1st and subsequent shocks.
(Shock every 2 min.) C CPR After shock, chest compressions respirations (30:2 ratio) for 2 min. (Do not check rhythm or pulse) R Rhythm check after 2 min of CPR (and after every 2 min of CPR thereafter) shock again if indicated. Check pulse only if an organized or non-shockable rhythm is present. ment the Secondary ABCD Survey. Continue this algorithm if indicated. Give drugs during CPR before or after shocking. Minimize interruptions in chest compressions to <10 seconds. E Epinephrine 1 mg IV/IO q3-5 min. Or vasopressin 40 U IV/IO, once, in place of the 1st or 2nd dose of epi. A Antiarrhythmic M Medications Antiarrhythmics. Amiodarone 300mg IV/IO, may repeat 1 150mg in 3-5 min. if VF/PVT persists or Lidocaine 1.0-1.5 mg/kg IV/IO, may repeat X 2, q5-10 min. at 0.5-0.75 mg/kg, (3mg/kg max. loading dose) if VF/PVT persists,or Magnesium Sulfate1-2 g IV/IO diluted in 10mL D5W (5-20 min. push) for torsades |
|
|
With Automated External Defibrillation(AED):
|
Deliver no more than three shocks in a hypothermia patient.
|
|
|
If a patient develops V-fib during synchronized electrical cardioversion:
|
Switch off synchronization mode and defibrillate at 200J (or biphasic energy equivalent).
|
|
|
An oropharyngeal airway may:
|
Not be used in a conscious patient.
Cause airway obstruction. Prevent a patient from biting and occluding an ET tube. Be inserted "upside down" into the mouth opening and then rotated into |
|
|
Endotracheal intubation:
|
Reduces the risk of aspiration of gastric contents.
|
|
|
When giving bag-valve mask ventilation what will prvent gastric inflation:
|
Cricoid pressure may prevent gastric inflation during ventilations.
|
|
|
Tracheobronchial suctioning points
|
Can result in hypoxemia.
Can cause bradycardia or arrhythmias Should last no longer than 15 seconds. Should be preceded and followed by hyperventilation with 100% oxygen. |
|
|
An esophageal obturator airway (EOA):
|
Should not be used with a conscious person, pediatric patients, or patients who have swallowed caustic substances.
|
|
|
Mouth-to-mask ventilation has the following advantages:
|
It can be used with an oropharyngeal airway in place.
When correctly used it can effectively ventilate a patient. It can deliver greater tidal volumes than bag-valve mask. Supplemental oxygen can be administered during its use. |
|
|
Increase cardiac output you can:
|
Increase heart rate and stroke volume
|
|
|
Sodium-Potsaium pump functions to move:
|
Pumps sodium ions out of the cell and potasium ions into the cell. This returns the cell to its resting state.
|
|
|
Leads 2 and 3 are what type of leads
|
Inferior
|
|
|
Lead 1 looks at the heart from what view
|
Lateral
|
|
|
Leads V1 & V2 are:
|
Septal leads:
|
|
|
Deep and inverted T waves may be indicative of:
|
cardiac Ischemia
|
|
|
Sinus Tach
|
RR constant
Rate 100-160 P wave uniform in all QRS Pri .12-.20 QRS measure less .12 |
|
|
SVT rules
|
Rate 150-250
P buried Pri may be shortned Rhythm might be regualr except onset & termination |
|
|
Tachycardia Narrow QRS RX
|
Vagal maneuvers
Adenosine 6mg |
|
|
hallmark of atrial fib
|
irregular irregular
|
|
|
Atrail fib therapy is performed how:
|
synchronized countershock with 100 joules
|
|
|
Symptom matic PVC are treated with:
|
O2 antidysrhythmic drugs EG beat blocker
|
|
|
B blocker
|
class of drugs used for various indications, but particularly for the management of cardiac arrhythmias and cardioprotection after myocardial infarction. Block fight or flight
|
|
|
B blocker end in what
|
LOL but include lidocaine
|
|
|
Traetment of choice for ventricular escape is:
|
Pacing
|
|
|
PT w/ pulseless v-tach should be traeated as though they have
|
V-fib
|
|
|
V-Fib arrest rhythm
|
CPR
Epi 1mg Vasopressin 40 units Amiodarone 300 mg Mag 1-2g diluted IV |
|
|
Type 2 2nd degree heart block
|
Rr constant
rate 60-100 P wave upright and uniform more P waves then QRS PRI if seen is contant QRS less than .12 |
|
|
Type 2 heart block is considered
|
Serious regardless of signs and symptoms
|
|
|
TX for 2nd degree heart block include
|
pacing and possibly atropine
|
|
|
3rd degree heart block
|
regu: Both p&R are firing regular
Rate: p 60-100 20-60 ventr P more than QRS upright PRI: none QRI: -.12 |
|
|
How does atropin effect ventric rate in 3rd degree HB
|
Because it works on the VN and the VN works on the atria. 3rd degree is ventric focus so it would not work
|
|
|
The 3 charcteristics of Wolff-Parkinson-White Syndrome are
|
Short PR intravla, QRS widening and delta wave (abnormal notching of the QRS)
|
|
|
Drug therapy for cadiogenic shock include
|
Dopamine 1-5 mcg/kg/min
dobutamine 2-20 mcg/kg/min |
|
|
Signs of cardiac tamponade
|
Faint muffled heart sound
|
|
|
Cardiac tampnade Pt is treated how when hypotensive is showing
|
Fluid bolus
|
|
|
Aneurysms are caused by
|
atherosclerotic
|
|
|
The major neurostransmitter of Parasympathetic system is
|
Acetylcholine
|
|
|
Norepi major effect is
|
vasoconstriction
|
|
|
A depreesed ST segment suggests
|
Ischemia
|
|
|
Pt is asystolic cardiac arrest vasopressein should be given
|
Instead of 1st or 2nd dose of epi
|
|
|
Adenosine is treatment of
|
Narrow complex SVT
|
|
|
Adenosine typicla dose for an adult
|
6 mg rapid IV bolus followed by flush
|
|
|
Adverse effects of adenosine
|
Paresthesias (Numbess and tingling)
headache palpitation |
|
|
Treatment for v-fib
|
Amiodarone 300mg
|
|
|
Atenolo is classfied as a ____ when is it used and whais is the dose?
|
beta Blocker
PSVT, atrial flutter, atrial fib 5mg slow IV (over 5min) |
|
|
Dopamine is classfied as a ____ when is it used and what is the dose
|
Sympathomimitec
Hypotenstion 1-5 mcg/kg/min |
|
|
Atropine is classfied as a ____ when is it used and what is the dose?
|
Anticholinergic agent
Bracardic Pt 0.3 g 3-5 min Max 3mg |
|
|
Digoxin is classfied as a ____ when is it used and what is the dose?
|
Inhibits the sodium potasium pump made from foxglove.They have an antiarrhythmic effect by prolonging the refractory period of the AV node
|
|
|
Diltiazem is classfied as a ___ what is it used for and what is the dose?
|
Calcium channel blocker
A fib and flutter Bolus injection 0.25 mg/kg 15-20 mg on averegae |
|
|
What is the indication of dopamine
|
Hyptension with hypovolemia
|
|
|
Epi is best described as a
|
Endogenous catecholamine and is an alpha beta agonist
|
|
|
Epi is used in the management of what arythmia
|
vfib
|
|
|
Labetalol is classfied as a ____ used in the TX of ___ and the dose.
|
Alpha beta adrenergic blocker
hypertesnive emergencies 10 mg iv over 1-2 min |
|
|
Morphine sulfate is classfied as a ____ used in the TX of ___ and the dose.
|
Opioid analgetic
Chest apin for MI 2-4mg slow IV over 1-5 min |
|
|
Norepinephrine should be considered
|
the last line drug in heart disease and shock due to constriction of blood vessels
|
|
|
Procainmide is classfied as a ____ used in the TX of ___ and the dose.
|
Antidysrthmic
Stable VT and other dysrthmia 20 mg/min |
|
|
What is Immune system and two types of cells
|
The body system that combates infection through cellular immunity- Direct attack of forign substance by cells. Humoral immunity a chemical attacks on the invading susbatnce
|
|
|
Unique class of chemicals that are manufactured by specialized cells of the immune system to attack foreign protein:
|
Antibody
|
|
|
Any substance that can produce specfic immune response
|
antigen
|
|
|
The type of immunity at birth is called
|
natural
|
|
|
The type of immunity acquired over time is
|
acquired
|
|
|
What is the difference between allergic reaction and anaphylaxis
|
Allergic reaction is an exaggerated response whil anaphlxis is an unusual exgerated response to forign protein or substance
|
|
|
the antibody that is most commonly associated with hypersensitivity reaction is
|
IgE
|
|
|
The primary chemical mediator of an allergic reaction is:
|
Histamine
|
|
|
Physiolgicl effects with chemicl mediators:
|
Bronchconstriction prvents respiratory tract infection
Gastric production - destroys ingested antigen Intestinal motility - moves antigen out of body Vasodialition - removes antigen from circulation |
|
|
Urticaria, a wheal and flare reaction charcterised by red raised bumps that appear on the skin, is due to
|
Vasodilation and fluid leaking from capillaries
|
|
|
The first priorty when responding to a PT with anaphylactic reaction is?
|
ensure scen safety
|
|
|
Hypotention in anaplyxis is due to
|
vasodialation
|
|
|
Major cause of upper GI hemorrahge include
|
Gastritis
Espphageal varix peptic uclers- Mallory-white syndrome -esopagel laceration dur to Vomiting |
|
|
Melna
|
dark tarry foul smelling stool indicating the presence of partially digested blood.
|
|
|
A common diffrerenc between acute gastroenteritis and gastroenteritis is:
|
Acute: sudden onset of inflamation of stomach
Chronic: Due to microbial infection |
|
|
The differnce between gastric ulcer and duodenal ulcer
|
Ga: Pain + after eating no pain at night
Du: pain when the stomach is empty |
|
|
The most common cause of bowel obstruction include:
|
Hernias - protrusion of organ in protective sheath
volvulus- twisting of intestin adhesions - union of two seperate tissue with new tissue |
|
|
Acute pancreatitis is caused by:
|
gallstones and excesive use of alchoal
|
|
|
Pain originating in the walls of hollow organs produced by inflamation, distension, ischemia
|
Visceral
|
|
|
Pain frequently charcterised by the Pt as sharp and well localized travels along neural route to spinal cord
|
somatic
|
|
|
pain eased by knee-chest position caused by blood or Gi contents in the abd. cavity
|
peritonitis
|
|
|
The abdomen can hold how many liters of fluid before change
|
4-6 liters
|
|
|
Persistenat abdominal pain lasting how many hours can be classfied as surgicl emergencey
|
6
|
|
|
The most common casue of lower GI hemorrhage is
|
diverticulosis
|
|
|
The most common surgical emergencey in the field is:
|
appendicitis
|
|
|
Upper right quadrant pain is caused by
|
gallbladder
|
|
|
Felling detached from onself
|
Depersonalization
|
|
|
Condition charctericsed by relatively rapid onset of widespread disorginized thought
|
Delirium
|
|
|
Fixed false beliefs
|
Delusion
|
|
|
Condition that results in persistently maladaptive behaivor
|
Personality disorder
|
|
|
Sensory perception with no base of reality
|
hallucination
|
|
|
Condition charctericsed by 1 or more manic episodes, with or without subsequent or alternating periods of depression
|
bipolar disorder
|
|
|
Condition charctericsed by immobility, rigidity and stupor
|
catatonia
|
|
|
Common disorder involving significant behavioural chnages and disorginized thought
|
schizophrenia
|
|
|
Preoccupation with feelings of persecution
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paranoid
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Condition involving gradual development of memory impairment and cognitive disturbance
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Dementia
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The genral cause of behavioral emergencies include:
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social, biological, psychosocial
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What is the name is used to describe a persons behaviorial disorder relating to society actions and interaction
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socialcultural
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Visible indicators of a persons mood describes
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affect
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Observing hygiene, clothing and overall apperance describes whihc companet of the MSE?
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general apperance
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Psychiatric disorders with organic causes such as brain injury or disease are known as_____ diorders
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cognitive
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Failure to recgonise objects or stimuli despiote intact sensory functions describe
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agnosia
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Feeling detached from onself defines
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depersonalization
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