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368 Cards in this Set

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Identify Componets of the Central Nervous System
CNS- Brain & Spinal Cord

Peripheral Nervous System (PNS)- The nerves connecting the brain and spinal cord to other parts of the body.
Describe the fight-flight system.
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.
Define somatic nervous system
Controls functions that are under conscious, voluntary control suck as skeletal muscles and sensorey neurons of the skin
Define Autonomic nervous system
Mostly motor nerves, controls functions of involunatry smooth muscles, cardiac muscle
Afferent Divison
Nerve fibers that send impulses from the periphery to the central nerveous system
Efferent Division
Nerve fibers that send impulses from the CNS to the periphery
Another name for the sympathetic nervous system
Adrenergic
Sympathetic nervous system
A division of the autonomic nervous system that usually is involved in preparing the body for physical activity
Parasympathetic nervous system
The subdivison of the autonomic nervous system usually involved in activating vegetative functions such as digestion, defecation, urination
Another name for the Parasympathetic nervous system
Cholinergic
Preganglionic Fibers
Are cholinergic, secreting acetylcholine, whihc stimulates nicotinic receptors in the postgaglionicneuron
Postganglionic Fibers
Are adrenergic secreting norepinephrine, thus timulating alpha or beta adrenergic receptors
Acetylcholine
A neurotransmitter, widely distributed in body tissues, with the primary function of mediating the synaptic activity of the nervous system.
4 terms that indicate Stimulation in the Sympathetic Divison
Sympathomimetic
Sympathetic agonist
Adrenergic
Adrenergic agonist
4 terms that indicate Stimulation in the Parasympathetic Divison
Parasympathomimetic
Parasympathetic agonist
Cholinergic
Cholinergic agonist
5 terms that indicate Inhibition in the Sympathetic Divison
Sympatholytic
Adrenergic blocker
Sympathetic blocker
Antiadrenergic
Sympathetic antagonist
6 terms that indicate inhibition in the Parasympathetic Divison
Parasympatholytic
Cholinergic blocker
Parasympathetic blocker
Anticholinergic
Parasympathetic antagonist
Vagolytic
Chronotrope positive and negative effects refer to a...
A subsatnce that affects the heart rate.
Positive Chronotrope increase heart rate
Negative Chronotrope decrease heart rate
Inotrope positive and negative effects refer to a...
A substance that affects myocardial contractility
Positive Inotrope increase force of contraction
Negative Inotrope decrease force of contraction
Agonist
A drug or substance that produces a predicatable response(stimulates action)
Antagonist
An agent that exerts an action opposite to another potential(blocks action)
Muscarinic receptors are primarily responsible for promoting what type of response
Parasympathetic response

Slow onset and long duration and may be excitatory or inhibitory.
Because both nicotinic and muscarnic receptors are specific for acetylcholine they are collectiviely referred to as...
Cholinergic receptors
Nicotinic receptors are located in the_____ and they are responsible for what.
Autonomic ganglia

Initiate muscle contraction as part of somatic nervous system. The responses are of fast onset and short duration
Cholinergic Drugs mimic what actions
The parasympathetic nervous system
Cholinergic Blocking Drugs mimic what actions
Which block the action of the parasympathetic nervous system
Adrenergic drugs mimic what actions
The sympathetic nervous system or the adrenal medulla
Adrenergic blocking Drugs mimic what actions
Which block the action of the sympathetic nervous system
Anatomical and functional terms for the Autonomic nervous system what are the Anatomical name, Functional Term, Primary Neurotransmitter
Sympathetic
Adrenergic
Norepinephrine

Parasympathetic
Cholinergic
Acetylcholine
Adrenergic drugs are designed to produce activities like a _______?
Neurotrsnamiter
Neurotrsnamiter
Chemical compound released by one neuron to affect the membrane potential of another
Affinity
The property of a drug to bind or attach itself to a given receptor site
Effiacy
the ability of a drug to initiate biological activity as a result of binding to a receptor site
Pharmacodynamics
The study of how drugs act on living organism
The primary organ for excreation of a drug
Kidney
Define chemical name for a drug
It describes the chemical composition of a drug
Define generic name for a drug
This is the offical name given by the US Food and Drug Administration
Define Trade name for a drug
Is a trademark name designated by the drug company that sells the medication. The first letter of the name is capital.
Define ofical name for a drug
Name of the drug followed by the initials USP (United Staes Pharmacopeia)
Mimetic is rfered to as what type of action.
mimic's the actions
Olytic is rfered to as what type of action.
Block the actions
Most drugs cross the cell membrane by means of;
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.
Rug absorbition refers to the movement of the drug from the:
Entry site to the genral circulation
A subcutaneous injection is introduced into the:
Fat and connective tissue
The body has two general types of drug reservoirs they are:
Plasma protien binding and tissue binding
Diffusion results from____movements of particles in solution.
Random
You have a 100mL of a 30% solution. How many grams are in the solution.
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
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
When setting up the ratio proportion, you must ask yourself the following:
What do I HAVE? (strength/volume of drug on hand)

What do I WANT? (prescribed dosage of drug)
How do you change grams to milligrams; change 0.5 g to milligrams
By moving the decimal point three places to the right

0.5 = 500
1 gram is equal to how many milligrams?
1000 milligrams
Q: Ch17 - Move the decimal to the right when you want to ___. Move the decimal to the left when you want to ____.
Multiply

Dividing
Ch7 What is the name of the water that lies outside the vascular bed and lies between the tissue cells.
Extrcellular Fluid
Ch7 The fluid found inside all body cells.
Intracellualr Fluid. It accounts for 40% of tghe bodies weight.
The extracellular fluid between the cells, and outside the vascular bed is know as.
Inerstitial Fluid ( connective tissue, cartilage, and bone)
C7 The diffusion of solvent through a membrane from a less concentration solution to a more concentrated solution.
Osmosis
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
Diffusion
C7 A term used to describe a solution that causes cells neither to shrink nor to swell
Isotonic
C7 What hormone regulates water balance
Antidiuretic Hormone (ADH)
C7 ADH casues Pt. with shock to have a desire for thirst. What is a reason?
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.
C7 renin-angiotensin-aldosterone system
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
C7 What is call when there is equal loss of water and sodium in the body.
Isotonic Dhydration
C7 Signa and symptoms of Isotonic Dhydration
Dry skin mucous mebrane, Poor skin turgor, decrease urine output, Acute weight loss
Isotonic Dhydration treatment
IV infusion of sodium chloride or normal saline)
C7 What is a continued intake of sodium in the absence of water called.
Hypernatremic Dehydration
C7 Osmotic pressure
The pressure exerted on a semipermeable membrane that separates two solutions and the particles they contain.
C7 Hypertonic
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.
C7 One solution having a lesser amount of solute than another solution, thus it exerts less osmotic pressure than the second solution.
Hypotonic
C7 Signa and symptoms of Hypernatremic Dehydration
Dry and sticky mucous membrane, Flushed dry skin, Intense thirst, Increased body temp, Altered mental status
C7 Hypernatremic Dehydration treatment
Volume replacement with isotonic solution.
C7 Hyponatremic Dehydartion
Continued intake of of water in the absence of sodium
C7 Hyponatremic Dehydartion signs and symptoms
Muscle cramps, seizures, Rapid thready pulse, profuse sweating, cyanosis
C7 Hyponatremic Dehydartion traetment
IV fluid replacement
Ch.7 Potassium
Potassium is important in nerve function and in influencing osmotic balance between cells and the interstitiual fluid.[1]
C7 A shortage of potassium in body fluids may cause
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.
C7 Hyperkalaemia
Is an elevated blood level (above 5.0 mmol/L) of the electrolyte potassium.
C7 Hypokalemia
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.
C7 Hyperkalaemia Cause
Renal failure, burns, crush injuries, severe infection
C7 Calcium
Is important for nuromuscular transmission, call membrane permeability, hormone secretion, growth and ossification of bane
C7 What is an abnormally low level of calcium in the bllod called?
hypocalcemia
C7 Hypercalcaemia
is an elevated calcium level in the blood.
C7 Hypermagnesemia
Is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood.
C7 Respiratory acidosis
is acidosis (abnormal acidity of the blood) due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide concentration (PaCO2).
C7 Metabolic Acidosis
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
C7 Signs and symptoms of Metabolic Acidosis
Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis
Diabetic ketoacidosis (DKA)
is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia).
Signas and symptoms of DKA
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.
C7 Treatment for DKA
Administration of normal saline for volume repletion
C7 Respiratory alkalosis
results from increased alveolar respiration (hyperventilation) leading to decreased plasma carbon dioxide concentration.
C7 Respiratory alkalosis treated in filed by:
Low concentration of O2, Calming measures to slow and control breathing
C7 Metabolic alkalosis
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
C7 Metabolic alkalosis treated
Voume replacement with isotonic solution
What type of solution is body fluid?
Isotonic Solution
What name is given to solutes that generate an electrical charge when dissolved in water?
Electrolytes
What are the major intracellular cation and the major extracellular cation?
Potassium is the major intracellular cation; Sodium is the major extracellular cation
Whihc hormone influences the amount of urine produced by the kidney?
The amount of urine produced each day by the kidneys is influenced by Aldosterone and ADH levels.
What are two major functions of K?
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
What organs are the first line of protection in acid-base regulation and are capable of responding to changes in minutes?
The lungs are the first line of protection in acid-base regulation.
How does the body attempt to compensate for metabolic acidosis?
The lungs compensate by increasing the rate and depth of respirations and greater elimination of C02
What are 4 assessments findings in an ECF volume excess?
Weight gain, distended neck vein, elevated blood pressure, full bounding pulse, crackles, dyspnea
What are 3 cause of ICF Volume excess?
IV administration, hypotonic solution, tap water enemas
What effects does hyperkalemia have on the heart?
Excess K acts as a myocardial depressantt, resulting in a decreased heart rate, decreased cardiac output, and possible cardiac arrest
How does the body compensate for metabolic acidosis?
Through hyperventilation
When are Colloids administered
During acute situation to expand intravascular volume and maintain blood pressure.
When are Crystalloid administered
Provide hydration and calories, replace ECF loss
What is the most common Acid-Base imbalance for the Pt. with respiratory insufficiency
Respiratory acidosis
Which acid base imbalcne would be seen with vomiting?
Metabolic Acidosis
Which imbalce is most commonly seen in diuretic use
Hypokalemia is the most common imbalnce associated with diuretic use.
1-8-08 What breathing pattern is characterized by long, deep breaths that are stopped during inspiratory phase and seperated by periods of apnea?
Apneustic respirations (seen in stroke or severe central nervous system disease
Ataxic respirations are characterized by:
repeated episodes of gasping ventilations seperated by periods of apnea. This pattern is seen in Pt. w/ increased intracranial pressure.
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?
Central neurogenic hyperventialtion
Characteristics of Kussmauls respirations.
Deep, rapid breaths that result as a corrective measure against consitions such as diabetic ketoacidosis that produce metabolic acidosis
Ventilatory pattern with progressively increasing tidal volume, followed by declining voulme, seperated ny periods of apnea at the end of expiration.
Cheyne-Stokes Seen in older Pt. with terminal illness or brain injury.
What are six classsic signs of respiratory distress:
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
Life threatening respiratory problems in adult. In order of most ominous to least severe:
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
Define:
Dyspnea
Orthopnea
pleuritic
Difficult or labored breathing a sensation of SOB
Dyspnea while lying supine
Sharp or tearing, a pain description
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
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
Snoring
A high pitched sound resulting from turbulent gas flow in the upper airway. associated with laryngeal constrictiobn or edema
Stridor
A continuous, coarse, whistling sound produced in the respiratory airways during breathing
Wheeze, wheezes to occur, some part of the respiratory tree must be narrowed or obstructed
The "coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways".
Rhonchi
What are the clicking, rattling, or crackling noises heard on auscultation of (listening to) the lung with a stethoscope during inhalation.
Rales, crackles or crepitations,
Sounds, like dried pieces of leather rubbing together; occurs when the pleura become inflamed, as in pleurisy
Pleural Friction Rub
The disposable device that records the level of CO2 exhaled using PH senssitive chemically impregnated paper is a:
Colormetric device
The airway technique preferred for use with the Pt. who is Unconscious is:
endtracheal intubation
Describe how the pilot ballon should be on an ET Tube
Partially inflated but soft to avid over inflation.
Why is a stylet used in a ET Tube
Maintain a preset curve in the tube
ET Tube Indicators:
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
ET Tube Complication include:
1.Equipment malfunction
2.Teeth breakage & soft tissue laceration
3.Hypoxia
4.Esophageal intubation
5.Endobronchial intubation
6.tension pneumothorax
When using an ET Tube what is likley to occur:
Complete airway control
To avoid hypoxia tube attempts should be limited to under how many seconds/
30
Name indictions of esophagel intubation
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
Digital intubation may be indicated in what situations:
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
Indication of rapid-sequence intubation.
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
Name 4 common paralytic agents
1.Succinylcholine
2.Vecuronium
3.Atracurium
4.Pancuronium
Succinylcholine guidelines
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.
In the Tubeing of children under 8, it is recommended that the P use:
An uncuffed E Tube & straight blade
Indications of nasotrachel intubation
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
Contarindication of nasotrachel intubation
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.
The primary risk of field extubation:
Laryngospasm, involuntary closure of the glottis.
What are the features of the PtL
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
A cric should not be perforemd on a Pt. 12 years of age or younger becasue:
The cricothyroid membrane is small and underdeveloped
Nasogastric tube placement is indication in a Pt. with:
1.Facial fracture
2.Possible skull fracture
3.who is awake
4.when a large gastric tube is indicated
BVM delivers what percentage of air when it is connected to 15 L per minute:
60-70% To get 90 to 95% you must connect a oxygen reservoir adjunct
1 rescu BVM is difficult because:
1.Can't maintain a good airway position
2.Hard to keep mask seal
3.Hard to squeeze bag
What is the youngest age a auto vetilator can be used:
Children under 5 years of age
The most common cause of children's pneumonia is:
Influenza A
A reactive airway disease that is stimulated by both intrinsic and extrinsic factors is known as:
Asthma
One factor that may help differentiate pneumonia from COPD is the presence of:
fever
A condition that exists when the capillaries in the lung have greater permeability, which leads to rales and stiff alveoli, is known as:
ARDS
The air inhaled and exhaled during normal respiratory cycle
Tidal volume
Quantity of air moved on deepest inspiration and expiration
Vital capacity
Air remaining in the respiratory passage after exhalation
residual volume
Amount of air that can be exhaled forcefully after normal breath is exhaled
Expiratory reserve voulme
List three physilogical factors that can increase the work of breathing.
1.Pulmonary surfactant - reduce surface tension to allow gas exchange
2.Increase in airway resistance
3.Decrease in pulmonary compliance
The amount of CO2 in the blood is influenced by rate and type of:
Metabolism
With a high suspect of spinal injury what airway should be used on a Pt.
Nasal intubation
The difference between oral endotracheal intubation and oral intubation
OEI is used for cervical spine injury.
OI is used for unconscious Pt. with no C Spine injury
What airway adjunct provides the best protection aginst aspiration>
ETT - Oral endotracheal tube
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
Define external respiration
The transfer of 02 and C02 between the inspired air and pulmonary capillaries.
Define Pulmonary Respiration
movement of air into and out of the lungs
Respiration is defined
The exchange of 02 and CO2 between an organisim and the environment
In what structure must continues negative pressure be maintain lung expansion
Pleural space
If you have a PT. with PO2 of 70 mm Hg. What does that mean.
Less than 3 mL of 02 is disolved in 1L of blood. 80-100 is the normal value for PO2
When a Pt. Pulse Ox is 100% that means what in the Pt.
The hemoglobin is converted to oxyhemoglobin
Respiratory chemoreceptors are found in what parts of the body?
Medulla, aortic bodies, carotid bodies
Respiratory chemoreceptors are stimulated by:
C02, Oxygen and PH
Laryngeal fracture can occur following:
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.
The Pt. on a nasal cannula at 5L/min. is receiving approxinately how much 02:
50%
2/4
The series of events between the end of a cardiac contraction to the end of the next
Cardiac Cycle
The phase of cardiac cycle during whcih the heart muscle is relaxed
Diastolic
The phase of the cardiac cycle during whihc the heart contracts
Systole
The ratio of blood pumped from the ventricle coampared w/ the amount at the end of diastole
Ejection fraction
The end-diastolic volume of ventricles
preload
The resistence against whihc the heart pumps
afterload
The amount of blood pumped by the ventricles during one minute
cardiac Output
Innate rate of Purkinje fibers
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



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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
paranoid
Condition involving gradual development of memory impairment and cognitive disturbance
Dementia
The genral cause of behavioral emergencies include:
social, biological, psychosocial
What is the name is used to describe a persons behaviorial disorder relating to society actions and interaction
socialcultural
Visible indicators of a persons mood describes
affect
Observing hygiene, clothing and overall apperance describes whihc companet of the MSE?
general apperance
Psychiatric disorders with organic causes such as brain injury or disease are known as_____ diorders
cognitive
Failure to recgonise objects or stimuli despiote intact sensory functions describe
agnosia
Feeling detached from onself defines
depersonalization