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205 Cards in this Set

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What are the physiologic actions within the heart during the QRS complex?

A. Ventricular repolarization
B. Movement of sodium into the cell
C. Atrial depolarization
D. Movement of potassium into the cell
B. Movement of sodium into the cell

Rationale
The QRS complex is indicative of ventricular depolarization. To depolarize, sodium rushes into the cell while potassium leaves, causing the originally negatively charged inner cell environment to become positive. Depolarization is followed by contraction of the myocardial cells and is responsible for the physical pumping of blood into the circulatory system. Ventricular repolarization describes the return of potassium to the inside of the cells and removal of sodium to the outside of the cell. Ventricular repolarization is evident on the ECG as the �T� wave and results in the inside of the cell regaining its negative charge and the outside its positive charge. Atrial depolarization occurs during the �P� wave of the ECG tracing. As stated, potassium leaves the cell during ventricular depolarization and does not enter it.
The presence of S2 in the heart indicates:
Closing of the aortic and pulmonic valves: Heart sounds are related to closure of the different heart valves. S1 occurs as the bicuspid and tricuspid valves (separating the atria and ventricles) close at the beginning of ventricular systole. S2 represents the closing of the pulmonary and aortic valves at the end of ventricular systole. Ventricular diastole would not produce any sounds since the mitral valves are open and the pulmonic and aortic valves are closed. A pericardial friction rub is a �grating� noise associated with inflammation or infection of the pericardial sac, not closure of the pulmonic and aortic valves.
What is the normal respiratory rate for 4 month old infant?
Normal respiratory rates for a 4-month old infant range from 25-50 breaths per minute. In general, the first manifestation of respiratory distress in infants and young children is tachypnea. Bradypnea would then indicate a pateint who's respiratory system is failing and who is becoming critically hypoxic and acidotic.
What is "N.R." correct infusion of fluid for a patient in hypovolemic shock?
Fluids should be infused at 20cc/kg to maintain a blood pressure of at least 90-100mmHg. Too much crystalloid will promote increased blood pressures and increased bleeding.
What abnormalities in the red blood cells occur to promote vascular occlusion at the capillary bed during times of serious trauma and irreversible shock?
Creation of rouleaux formations

Lack of oxygen causes blood to become acidotic. Acidotic blood then causes the red blood cells to stack-up into misshaped chains resulting in rouleaux formation causing the red cells to become inflexible, promoting vessel occlusion. When the post capillary sphincters open during the final stage of the shock syndrome, the rouleaux formations can cause microemboli to occur in various regions of the body.
What makes a crush injury life threatening?
The term crush injury describes a collection of traumatic insults that includes both crush injury itself and crush syndrome. In crush injury, a body part that is compressed, possibly by a heavy object, sustains deep injury to the muscles, blood vessels, bones, and other internal structures. Damage can be massive, despite minimal signs displayed on the skin itself. Crush syndrome is the term used to describe the systemic effects of a large crush injury. If the pressure that causes a crush injury remains in place for several hours, the resulting destruction of skeletal muscle cells leads to the accumulation of large quantities of myoglobin (a cell protein), potassium, lactic acid, uric acid, and other toxins. When the pressure is released, these products enter the bloodstream. They circulate, causing a severe metabolic acidosis. These materials are also toxic to the kidneys and heart. Crush syndrome is thus a potentially life-threatening trauma event.
What are the two most important catecholamines?
Epinephrine and norepinephrine
What is Addison's Disease?
Chronic adrenal insufficiency; a rare endocrine disorder wherein the adrenal glands produce insufficient steroid hormones glucocorticoids and often mineralocorticoids.
Always check the (blank) level of any patient with adrenal insufficiency such as Addison's Disease.
blood glucose level
Typical "fight or flight" responses (sympathetic nervous system) are:
Our senses sharpening. Pupils dilate (open out) so we can see more clearly, even in darkness. Our hairs stand on end, making us more sensitive to our environment (and also making us appear larger, hopefully intimidating our opponent).
The cardio-vascular system leaping into action, with the heart pump rate going from one up to five gallons per minutes and our arteries constricting to maximize pressure around the system whilst the veins open out to ease return of blood to the heart.
The respiratory system joining in as the lungs, throat and nostrils open up and breathing speeding up to get more air in the system so the increased blood flow can be re-oxygenated. The blood carries oxygen to the muscles, allowing them to work harder. Deeper breathing also helps us to scream more loudly!
Fat from fatty cells and glucose from the liver being metabolized to create instant energy.
Blood vessels to the kidney and digestive system being constricted, effectively shutting down systems that are not essential. A part of this effect is reduction of saliva in the mouth. The bowels and bladder may also open out to reduce the need for other internal actions (this might also dissuade our attackers!).
Blood vessels to the skin being constricted reducing any potential blood loss. Sweat glands also open, providing an external cooling liquid to our over-worked system. (this makes the skin look pale and clammy).
Endorphins, which are the body's natural pain killers, are released (when you are fighting, you do not want be bothered with pain–-that can be put off until later.)
The natural judgment system is also turned down and more primitive responses take over–this is a time for action rather than deep thought.
When questions concerning the non-traumatic "LLQ" pain on a NR test, (blank) should be highly considered if it's in the answer options.
Diverticulitis
Hemorrhage associated with a (blank) is typically dark colored since the blood is partially digested within the GI tract.
peptic ulcer
Gallstones do not cause rectal bleeding. (true or false)
True
The transmission of rubella to the non-immunized pregnant female has a high probability of causing (blank) to the baby.
congenital birth defects
A (blank) seizure results when the electrical discharge form one cerebral hemisphere causes repetitive clonic movement to the opposite side of the body.
simple partial motor
A (blank) seizure occurs when both cerebral hemispheres are involved and results in clonic movements to the entire body, as well as a loss of consciousness and post ictal phase.
generalized or grand mal
An (blank) seizure is caused by uncontrolled electrical discharge from both hemispheres and is evidenced by a brief loss of consciousness. It is sometimes accompanied by fluttering of the eyelids and/or brief loss of motor tone, but not global clonic movement.
absence (petit mal)
(Blank) are related to psychological disorders and describe sharp bizarre movements of the body and can often be interrupted by commands such as �stop it!�
Pseudo-seizures
Why would it be important to transport a conscious, alert patient with a brain tumor in a semi-fowlers position instead of supine?
vomiting often accompanies brain tumors.
Because the kidney is responsible for the regulation of electrolyte balances, acute renal failure can result in electrolytic imbalances, the most dangerous being (blank) because it can precipitate a variety of lethal cardiac dysrhythmias, up to and including asystole.
hyperkalemia
Name the three stages of stress.
Alarm, Resistance, Exhaustion.
Morphine sulfate is supplied in a prefilled syringe with 10mg/2ml. What is the concentration equivalent to?

5mg/2cc
5mg/cc
5ml/cc
5ml/2cc
5mg/cc is exactly equal to 10mg/2cc or 10mg/ml. CC's are the same thing as ml's.
What is the preferred method for the administration of epinephrine for the anaphylactic patient who presents with a moderate reaction?

Subcutaneous
Percutaneous
Transdermal
Intramuscular
IM injections is the preferred injection method. The subcutaneous route provides slow uptake, especially in the patient who has already begun to display poor peripheral perfusion. If the peripheral perfusion is significantly diminished or absent, the drug should be administered via the intravenous route for immediate absorption and distribution.
What respiratory problem is often associated with Marfan's syndrome?
Spontaneous pneumothorax
The clinical signs of a rapid loss of consciousness and motor coordination, coupled with violent muscle spasms, and uncontrolled jerking is hallmark to a (Blank).
tonic-clonic seizure.
What is the healthy heart rate for a newborn?
Typically between 120 and 160 beats per minute. Anytime the heart rate falls below 100 beats per minute, the newborn is distressed
What does "natremia" mean?
Presence of sodium in the blood.
What is the average amount of blood loss that could be expected during the monthly menstrual cycle, ?
The average woman bleeds out a total of approximately 50 cc during her monthly flow
In a field delivery, where should the umbilical cord be cut?
Approximately 10-15 cm from the baby
What is the proper sequence of events immediately following delivery, as advocated by the American Academy of Pediatrics?
Dry, warm, position, suction, and then stimulate the infant.
you and your partner are using the "contact and cover" procedure for a psychiatric patient, of which you will assume the "cover" role. What is your responsibility as "Cover"?
Observation of the scene for danger.
What must occur in order to be found guilty of negligence?
To be found guilty of negligence, the patient must suffer some sort of harm or damage, either physically or emotionally. If harm does not occur, negligence cannot be proven. Regardless of whether the dosage of the drug administered was incorrect or the paramedic himself attached the cardiac monitor, the issue at hand is the administration of a medication that was not indicated. In this case, the expiration date of the medication has no bearing in determining whether or not the paramedic is negligent
Is an "off duty" paramedic required to assist a patient who collapses in front of him?
Healthcare ethics dictate that healthcare professionals help others and not do any harm. Morals describe personal beliefs, and may not always be in accordance with the ethical dictates of the profession to which an individual belongs. Since the paramedic is unsure of whether or not to intervene, a moral dilemma exists (should he render care or not help another in need). There is no duty to act, given that the paramedic is off duty, so breach of duty and negligence cannot be demonstrated. Since the paramedic has not provided care, abandonment does not exist either.
What does it mean when a medication is susceptible to the phenomena of first pass metabolism.
First pass metabolism refers to the deactivation of a medication as it passes through the liver.
(Blank) is the passage of maroon colored stool [1]. It is distinguished from melena, which is stool with blood that has been altered by the gut flora and appears black/"tarry".
Hematochezia
What is "conversion disorder"?
Conversion disorder is a rare psychological disorder brought on by intense stress. The patient manifests physical symptoms with no underlying physical cause, literally converting a psychological issue into a physical problem.
What are the ss of cholecystitis?
Acute cholecystitis is a sudden inflammation of the gallbladder that causes severe abdominal pain that is located on the upper right side or upper middle of the abdomen. The pain may:

Be sharp, cramping, or dull
Come and go
Spread to the back or below the right shoulder blade
Be worse after eating fatty or greasy foods
Occur within minutes of a meal
What is the normal average temperature for humans?
37 Celsius, 98.6 F
What is tactile fremitus?
Fremitus is a palpable vibration on the human body.
What is hyperpryxia?
hyperpyrexia
[hī′pərpīrek′sē·ə]
Etymology: Gk, hyper + pyressein, to be feverish
an extremely elevated temperature that sometimes occurs in acute infectious diseases, especially in young children. Malignant hyperpyrexia, characterized by a rapid rise in temperature, tachycardia, tachypnea, sweating, rigidity, and blotchy cyanosis, occasionally occurs in patients undergoing general anesthesia. A high temperature may be reduced by sponging the body with tepid water, by giving a tepid tub bath, or by administering antipyretic medication, such as aspirin or acetaminophen.
When taking the NR test, it often refers to patients who are breathing within the normal range but "shallow". This indicates that the patient needs (blank) assistance.
BVM
What is the purpose of oxygen in the blood?
Oxygen is the final electron acceptor in the electron transport chain during the production of ATP during fat and sugar catabolism. Without oxygen present, anaerobic respiration would occur producing far less energy than aerobic respiration. The difference is about 2 ATP molecules per glucose (pyruvate) molecule to 36 ATP molecules per glucose (pyruvate) in the presence of oxygen in the electron transport chain.
Which of the following correctly describes what will occur with an esophageal detection device (EDD) after it is applied to the endotracheal tube that is properly positioned in the trachea?
It will quickly inflate due to the residual air in the trachea
Classic sign of bronchitis?
Chronic Bronchitis is characterized by frequent outbreaks of bronchitis over several years. The patient is classically overweight and cyanotic becomes dyspneic with very little movement.
What is Lupus?
Lupus is a chronic inflammatory disease that occurs when the body's immune system attacks its own tissues and organs.
Which of the following assessment findings would indicate that the pericardial tamponade is severe?

*Hypotension
*Loud heart sounds
*Abdominal pain
*Flat jugular veins
Pericardial tamponade describes a condition in which fluid, blood, or pus (depending on the casual condition) accumulates between the heart and pericardial sac. Since the pericardial sac is very fibrous and has difficulty expanding, the heart is compressed and cardiac output falls. This results in hypotension and is an ominous sign in a critical patient. Flat jugular veins are indicative of hypovolemia, not pericardial tamponade. In severe cases, jugular venous distention is seen in conjunction with tamponade since the heart is so compressed by fluid that it cannot accept returning blood. The blood then backs up into the jugular veins. Heart tones in tamponade are muffled and difficult to hear secondary to the increased volume of fluid between the pericardial sac and myocardium. There is no direct correlation between abdominal pain and pericardial tamponade. Additionally, abdominal pain is nonspecific and could indicate any of a number of conditions.
A person who has the complaint of chest pain, for two days that has been intermittent, but never completely resolved with hypotension is probably in which of the following:
*Cardiogenic shock
*Right sided heart failure
*Left sided heart failure
cardiogenic shock
The presence of an S3 heart sound is suggestive of.....
The presence of an S3 heart sound is suggestive of ventricular dysfunction, most commonly as the result of too much pressure in the left ventricle.
A cardiac arrest patient received 150 mg of Lidocaine IVP for his ventricular dysrhythmia. Since he has not converted, what would the next dose of Lidocaine be?
Repeat 150 mg
Note: Here's a NR tricky-dickie heads up.

An intravenous line at 30 cc/hour is a N.R. "tricky-dickie" way of saying (blank).
TKO or KVO (To Keep Open or Keep Vein Open) and.... N.R. likes to use this term when they are offering treatment options for patients with pulmonary edema whom you think not to give fluids to but at 30 cc per hour... you're just keeping the vein open with the option of giving meds.
What are the signs associated with compensated shock?
Compensated shock is often associated with early shock. The patient will develop pallor, thirst, anxiety, and increased heart rate. Often times hypotension and dropping heart rate are associated with decompensated shock. Once the patient has begun to decompensate, death is quickly approaching.
Decreased (blank) output is an early sign of shock.
Urinary Output: As perfusion decreases one of the first signs of shock is decreased urinary output. The average adult should create about 30 cc per hour of urine. A Foley catheter should quickly be inserted in the patient to judge their distal perfusion status. If the patient is producing adequate urine output, his distal circulation is adequate. Vasodilation, decreased heart rate, and enhanced peristaltic activity are not correlated with hypoperfusion syndromes.
The most appropriate care for the patient's burns with less than 25% BSA of second degree burns is...
wetting the area with tepid water and then cover the burns with sterile dressings.
When a fractured bone is exposed, care must be taken to prevent further injury and infection. A good rule of thumb for the use of moist, sterile dressings is as follow:
If the protruding part is normally on the inside of the body, cover it with a moist sterile dressing. Do not attempt to reinsert or reduce the exposed bone back into the body.
What is the appropriate manner in which you should splint a dislocated knee?
It should be splinted in the position in which it was discovered.
Epidural hematoma usually involve (blank) causing symptoms to develop very rapidly.
arterial vessels
(Blank) usually develops more slowly and does not cause herniation and compression of brain tissue.
Subarachnoid Hemorrhage
(Blank) typically presents much like a stroke due to blood's direct irritation of the brain tissue.
Intercerebral Hemorrhage
(Blank) typically involves veins that hemorrhage at a lower pressure and are therefore associated with a slower onset.
Subdural hematoma
The greater trochanter is the most proximal bony process of the (Blank).
femur
The tragus is the cartilaginous triangular structure anterior to the external (Blank).
ear canal
The hyoid bone is embedded in the (Blank) and supports the epiglottis and swallowing.
neck
What blood type is considered to be the "universal donor"?
O negative is considered to be the universal donor because it does not contain the A, B, or Rh antigens. If blood containing a different type of antigen were administered, it would cause a hemolytic (blood cell destroying) reaction and the patient could die if the error were not caught in time.
What is vasogenic shock?
Vasogenic (aka neurogenic and spinal shock) is characterized by spinal injury. The spinal injury that usually results is vasodilatation, which produces shock. The skin will often remain warm and pink during vasogenic shock. All of the other signs and symptoms will be present or develop other than the cool, pale, moist skin.
What type of CVA does not result in ischemia?
An aneurysm: It is a form of a CVA, but it does not result in ischemia. It is a form of a hemorrhagic stroke. An embolism and thrombus produces a direct ischemic stroke by occluding blood flow, and a tumor can press against a cerebral artery and occlude the blood flow producing ischemia.
In the back of the ambulance unit, a (blank) may be used to protect the crew from secondary contamination during transport by isolating potentially contaminated body fluids.
decon pool
What types of cells are neutrophils, eosinophils, and basophils?
Leukocytes
The concept of (blank) refers to attempts made by the body to maintain itself in a steady state. (Blank) is the body's ability to stop bleeding. (Blank) is a state in which a solution has a lower solute concentration than a comparable fluid. (Blank) is part of the process related to differentiation of various types of blood cells within the body.
The concept of homeostasis refers to attempts made by the body to maintain itself in a steady state. Hemostasis is the body's ability to stop bleeding. Hypotonicity is a state in which a solution has a lower solute concentration than a comparable fluid. Hematopoiesis is part of the process related to differentiation of various types of blood cells within the body.
One of the precipitating causes of disseminated intravascular coagulation (DIC)would be:
depletion of clotting factors within the capillaries.
What is disseminated intravascular coagulation (DIC)?
Normally, when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active.

Small blood clots form within the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs such as the liver or kidney. These organs will then stop functioning. Over time, the clotting proteins become "used up." When this happens, the person is then at risk for serious bleeding from even a minor injury.

This disorder can result in clots or, more often, in bleeding. The bleeding can be severe.
A patient with a hx of asthma, hypertension hands you a list of his medications. On the list are Acetaminophen, Labetalol, Nitroglycerin and MDI inhaler. Which is contraindicated due to his medical history of Asthma? (according to NR testing)
Labetalol. Beta blockers properties should be avoided in patients with asthma (according to NR testing).
You have just delivered a baby to a herion addict mother who has shot up just prior to delivery. The baby is born and is breathing 20 breaths per minute. Along with ventilatory support, do you administer Narcan?
No. The baby is probably addicted also and the reversal at this time would not be best. Provide ABC's.
Since an infant's heart is not developed fully, Starling's law doesn't apply. So what is the best way to increase an infant's cardiac output?
Increase the rate.
Of the following choices, which is the most important to relay to the physician in your report.

Patient age
Vital signs
Past Medical History
Patient's allergies
Vital signs
What is a CISD?
Critical Incident Stress Debriefing is a formal, structured discussion including responders from all involved agencies.
In triage of a mass casualty incident, what constitutes a "red" label?
Respiratory rates greater than 30 breaths per minute are tagged as immediate, or red. Additionally, if further assessment reveals that the patient is experiencing delayed capillary refill, greater than two seconds, or if radial pulse is absent, the patient again gets placed into the immediate category.
What is Prinzmetal's angina?
Prinzmetal's angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. It is caused by vasospasm, a narrowing of the coronary arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis (buildup of fatty plaque and hardening of the arteries).
What is electrical alternans?
Electrical alternans is an electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats. Also a wandering baseline may be seen. It is seen in cardiac tamponade and is thought to be related to changes in the ventricular electrical axis due to fluid in the pericardium.
What is Hyperpyrexia?
hyperpyrexia is an excessive and unusual elevation of set body temperature greater than or equal to 41 °C (105.8 °F). It is an extremely high fever. Such a high temperature is considered a medical emergency as it may indicate a serious underlying condition such as sepsis or Kawasaki syndrome.[1]
What hormone causes Cushings Syndrome?
Cushing's syndrome, a disorder resulting from prolonged exposure of the body's tissues to high levels of the hormone cortisol.
What are Biots Respirations?
Biot's respiration, sometimes also called cluster respiration,[citation needed] is an abnormal pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea
what is Cheyne-Stokes Respirations?
Cheyne-Stokes respiration (pronounced /ˈtʃeɪnˈstoʊks/), also known as periodic breathing is an abnormal pattern of breathing characterized by oscillation of ventilation between apnea and tachypnea with a crescendo-decrescendo pattern in the depth of respirations, to compensate for changing serum partial pressures of oxygen and carbon dioxide.
What is the primary difference between Biots and Cheyne-Stokes respirations?
Cheyne-stokes is cyclic and Biot's is irregular and chaotic.
What is Proventil?
Albuterol
What's an "osborn wave"?
An extra notch after the QRS and before the T wave seen often on hypothermic patients.
Define visceral pain.
Source - internal organs of the main body cavities. There are three main cavities - thorax (heart and lungs), abdomen (liver, kidneys, spleen and bowels), pelvis (bladder, womb, and ovaries).
Receptors activated - specific receptors (nociceptors) for stretch, inflammation, and oxygen starvation (ischaemia).
Characteristics - often poorly localised, and may feel like a vague deep ache, sometimes being cramping or colicky in nature. It frequently produces referred pain to the back, with pelvic pain referring pain to the lower back, abdominal pain referring pain to the mid-back, and thoracic pain referring pain to the upper back.
Define Somatic Pain.
Somatic Pain
Source - tissues such as skin, muscle, joints, bones, and ligaments - often known as musculo-skeletal pain.
Receptors activated - specific receptors (nociceptors) for heat, cold, vibration, stretch (muscles), inflammation (e.g. cuts and sprains which cause tissue disruption), and oxygen starvation (ischaemic muscle cramps).
Characteristics - often sharp and well localised, and can often be reproduced by touching or moving the area or tissue involved.
What is Trismus?
Trismus is the inability to normally open the mouth.
What is the current American Heart Association standards for compression/ventilation ratio for one person CPR?
The current American Heart Association standards for compression/ventilation ratio for one person CPR is 30:2 for adults and children. If two rescuers are present to provide care, the rate can be 15:2. Adults and children are the same.
What is the current American Heart Association standards for compression/ventilation ratio for two person CPR?
If two rescuers are present to provide care, the rate can be 15:2. Adults and children are the same. The current American Heart Association standards for compression/ventilation ratio for one person CPR is 30:2 for adults and children.
What should the vacuum be set at when suctioning the oropharynx using a rigid catheter?
Greater than -120 mmHg. The soft tipped catheter used for nasal and tracheal suctioning only requires vacuum levels between -80 mmHg and -120 mmHg. With either catheter, suctioning should be performed for less than 15 seconds in the adult prior to reoxygenation.
A patient with emphysema has weakened lung parenchyma from the disease process, and has increased susceptibility to a rupture of an emphysemic bleb causing a (blank).
pneumothorax

They would present with unilateral breath sound diminishment, respiratory distress, and equal resonance if it were only a simple pneumothorax.
What is Pleurisy?
Inflamation of the lining of the lung. Pleurisy may develop when you have lung inflammation due to infections such as pneumonia or tuberculosis. It may also occur with: Asbestos-related disease, Certain cancers, Chest trauma, Pulmonary embolus, Rheumatic diseases.
Where do you place a needle cricothyrotomy. Where will you perform this procedure?
In the cricothyroid membrane located on the anterior aspect of the neck immediately inferior to the thyroid cartilage and immediately superior to the cricoid ring. There is a slight depression of the membrane between the cartilage boarders on either side.
What size ET tube should be used to perform a cricothyrotomy?
Either a size 6.0 or 7.0 mm cuffed endotracheal tube or a size 6 or 8 Shiley tracheostomy tube should be utilized. The initial incision is typically a 1 to 2 cm vertical incision immediately over the cricothyroid membrane.
Cricothyrotomy should not be performed on patients under the age of (blank).
Cricothyrotomy should not be performed on patients under the age of 12 because the cricothyroid membrane is small and underdeveloped in children.
Which bundle branch is most likely involved when conduction defects occur to the heart's electrical system as a result of myocardial ischemia?
The right bundle branch of the ventricular conduction system is most commonly the bundle branch affected by periods of ventricular ischemia because the right bundle branch is smaller in diameter and longer in length as compared to the left (thus making it more susceptible to injury), and the right ventricle is not as well perfused as the larger, thicker left wall.
Nitro is contraindicated (by N.R. standards) when the systolic BP is below (blank).
100
Electrical alternans is a finding seen on the ECG machine of a patient who has significant (blank).
pericardial tamponade
The combination of sudden dyspnea, deteriorating pulse oximetry reading, sharp and localized chest pain, and expiratory wheezing in the immediate area of chest pain are all consistent with a (blank).
pulmonary embolism
Compensated or Decompensated shock? Stap victim's skin is pale, cool, and clammy, airway is open and patent, breath sounds are clear and equal bilaterally, respiratory rate is 36 with adequate tidal volume, radial pulse is thready at a rate of 114, and blood pressure is 96/70 mmHg.
Compensated Shock: A patient who is displaying the primary signs and symptoms of shock but has not yet become hypotensive is typically described as suffering from compensated shock. These patients will typically present with tachycardia, tachypnea, and skin that is pale, cool, and clammy. Only when presenting with *significant* hypotension would we consider a patient to be in decompensated shock. Irreversible shock is very difficult to discern in the field setting, but closely mimics the presentation of decompensated
What is the appropriate fluid bolus for a nine-year old, 77 pound patient suffering from hypovolemic shock?
An appropriate fluid bolus for children experiencing hypovolemic shock is 20 ml/kg of a crystalloid intravenous solution. The patient weight of approximately 77 pounds converts to 35 kg. Multiplying 35 kg by a dose of 20 ml/kg yields a bolus dose of 700 ml of an appropriate crystalloid solution such as 0.9 % sodium chloride or lactated ringers solution
How would you describe a "Grade II sprain"?
A sprain is defined as a tearing of a ligament. Grades I and II sprains refer to partial ligament tear, while Grade III refers to a complete tear.
Injuries to tendons and muscles are referred to as (blanks).
Injuries to tendons and muscles are actually referred to as strains.
What is a "subluxation?
A partial dislocation of a bone end is referred to as a subluxation.
Physical assessment of a patient found lying on the floor reveals that the patient's right leg is outwardly rotated with a large palpable mass found in the right inguinal area. No pelvic instability is noted. Pedal pulses, sensation, and motor response are all present in the affected limb. The patient complains of extreme pain in the right hip and an inability to move his right leg. Based upon your physical exam findings, what condition is the patient most likely to be experiencing?

Anterior hip dislocation
Anterior hip dislocation.
Note: The "large palpable mass in the inguinal area" is the head of the femur. You cannot palpate the head of the femur on a posterior hip dislocation.
How do you splint a hip dislocation for transport?
In any type of hip dislocation that is not complicated with neurovascular deficits distal to the injury, the best treatment strategy is to apply appropriate padding and splint in the position found to a long backboard. Re-alignment into a normal anatomical position may, in fact, cause neurovascular compromise. Attempts at reduction should only be attempted in posterior hip dislocations, and only if the patient does not have intact pulse, motor function, or sensation distal to the injury. Traction splints should never be applied in situations that involve pelvic or hip injury, even if accompanied by obvious mid-shaft femur fracture.
What is the major cause of a pericardial tamponade?
The major cause of a pericardial tamponade is blunt force trauma of the chest that results in narrowing pulse pressure, positive jugular vein distention, and muffled heart tones.
What is the normal size of the pupil?
The normal size of the pupil, is usually between 3 to 5 millimeters in diameter. If a patient displays bilateral papillary constriction (miosis), that is unresponsive to light, the paramedic should consider a pathology that is causing CNS depression, the kind consistent with a narcotic overdose. Oculomotor nerve damage results typically in unilateral dilation, and excessive sympathetic stimulation results in pupillary dilation (mydriasis).
What is miosis?
Constriction of the pupils.
High PaCo2 levels capillary (blank).
capillary vasodilation
High levels of PaCo2 causes (increased/decreased) intracranial pressure.
increased due to increased blood flow as a result of capillary vasodilation caused by the higher level of Co2.
Ventilating a patient with suspected ICP should be slightly hyperventilated at a rate of no greater than 20 breaths per minute. Why?
To vent off excess Co2 to releave ICP.
The neurological disorder characterized by progressive muscle weakness and degeneration of the voluntary muscle fibers is called?
MD Muscular Dystrophy
Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone (blank). Symptoms vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs.
Cortisol
An inflamed (blank) usually starts with the general findings of abdominal pain ("dull and crampy"), fever, and vomiting. The abdominal pain usually begins in the center of the abdomen, around the area of the umbilicus, and later, the pain radiates downward and to the right - to an area called McBurney's point.
appendix
Explain the difference between the following types of poisonings:
Cyanide
Chlorine
Ammonia
Organophosphate pesticide
The effects of chlorine and ammonia exposure typically revolve around the respiratory system, and are both likely to cause pulmonary edema. Neither of these substances is likely to produce seizures. Organophosphate pesticides have a direct effect on the central nervous system and can cause seizures. They would also produce SLUDGE type symptoms, including salivation, tearing, incontinence, gastric upset, vomiting, as well as constricted pupils. Cyanide poisoning can cause seizure and coma, but will not have an effect on pupil constriction or yield SLUDGE symptoms.
You arrive to a residence and find a patient in stage three of delivery. Examination of the perineum reveals limb presentation. What do you do next?
When examination of the perineum reveals limb presentation, a cesarean section is necessary and field delivery should not be attempted. Treatment for limb presentation includes application of oxygen, placing the patient into a knee-chest or Trendelenburg position, and immediately initiating transport. Under no circumstances should attempts be made to re-insert the extremity into the vagina. In fact, the paramedic should even avoid simply touching the exposed extremity, as doing so may stimulate the infant to gasp and aspirate amniotic fluid. If the umbilical cord were visible instead of an extremity, then insertion of two fingers into the vagina in order to raise the presenting part of the fetus off of the cord would be appropriate.
What is Renal calculi?
Renal calculi: Kidney stones
What is the most common method of transmission route for hepatitis A?
Hepatitis A is most commonly transmitted by the fecal-oral route via contaminated food or drinking water.
How do you ventilate a patient with a stoma?
The use of a pediatric mask and an adult bag valve mask can effectively maintain an airtight seal over a stoma. If a seal can't be maintained, an endotracheal tube can be inserted into the stoma to create an airtight seal.
Here's another NR "tricky-dickie" that I've seen a couple of times on practice tests:
What should be done first for an unresponsive patient with a possible airway obstruction after you have opened the airway with a head-tilt, chin-lift and the airway is not yet patent?
The correct answer is:
Reposition the airway with a head-tilt, chin-lift. (in other words...do it again)
What color sputum is often associated with pneumonia?

Clear
Green
Brown
White
Brown
When should you perform a laryngoscopy on a suspected chocking patient?
If the airway is still occluded after two manual attempts to open it, initiate 30 chest compressions and then reassess the airway. If this is not effective, you should perform a laryngoscopy to attempt to visualize the obstruction and remove it with Magill forceps.
Before perfroming a tracheobronchial suctioning, how should you measure the suction cathater?
The suction catheter should be measured from the mouth to the ear and then to the xiphoid process. Inserting the catheter until the patient's heart rate slows or until resistance is met may indicate that you have actually hit the carina.
What does hyporesonance and hyperesonance upon percussion in the lung fields indicate?
Hyporesonance on the affected side is indicative of a hemothorax. Air accumulation would result in hyperresonace with percussion.
What would a paricardial tamponade produce upon percussion?
A pericardial tamponade is not assessed through the technique of percussion but it would produce a muffled heart tone upon auscultation.
You are called to the local grocery store for an unresponsive patient. Upon arrival, you find an elderly male patient lying supine on the floor. A certified First Responder is performing one person CPR, and has been doing so for 3 minutes now. Upon initial assessment, you determine that the patient�s airway is clear and you confirm chest rise and fall with the First Responder's ventilations. You are unable to palpate a carotid pulse. What would be your next immediate action?
Determine cardiac rhythm via "Quick Look".
Since a *certified* EMS provider was on scene to provide at least two minutes of high quality CPR prior to your arrival, you may then begin assessment of the cardiac rhythm to determine if defibrillation is warranted.
You are called to a local shopping mall for a patient experiencing chest pain. Upon arrival you find a 52-year-old male patient seated on a bench. The patient is complaining of severe substernal chest pain that radiates into his lower back. Skin is pale and diaphoretic, lungs are clear and equal, respirations are nonlabored at a rate of 26 per minute with adequate tidal volume, radial pulse is 50 beats per minute, and blood pressure is 86/58 mmHg. The cardiac monitor shows sinus bradycardia with 2nd degree type II heart block: You place the patient on oxygen via nonrebreather mask at 15 liters per minute and initiate an intravenous line of 0.9% sodium chloride at a keep vein open rate. What is your next immediate action?

A. Administer atropine sulfate 0.5 to 1.0 mg intravenously.
B. Administer nitroglycerin 0.4 mg sublingually.
C. Begin transcutaneous pacing
D. Administer chewable aspirin 160 to 325 mg.
It's interesting to note that in this case, the bradycardic rhythm "trumps" the "chest pain" protocol.
Although this patient is experiencing acute substernal chest pain, the bradycardic cardiac rhythm causes standard chest pain treatments to be replaced with therapy aimed at increasing heart rate. Given the infranodal rhythm, atropine is not warranted so TCP should be initiated. If the TCP fails to work, the next consideration should be a dopamine infusion. Nitroglycerin and morphine sulfate are both contraindicated in this patient due to hypotension.
Your patient is bradycardic with a second degree block. What treatment sequence do you follow?
Transcutaneous pacing is a Class I intervention for the infranodal rhythm. Following this a dopamine infusion should be administered. Should the dopamine also prove unsuccessful in increasing the rate, the next infusion should be epinephrine.
What is isoproterenol?
This drug has popped up in a couple of practice tests and it is never the correct answer. According to AHA 2005 standards, the use of isoproterenol for bradycardia is no longer warranted.
What is the order of the meningi layers?
The outermost layer is the Dura mater, the middle layer is the arachnoid and the inner-most layer is the pia mater.
When blood gathers between the skull and the dura mater it is considered a (blank).
epidural hemorrhage
Bleeding between the dura mater and arachnoid leads to (blank).
subdural hemorrhage
Bleeding between the arachnoid and pia mater leads to a (blank).
subarachnoid hemorrhage
Can a tension pneumothorax cause right sided heart failure?
Yes. Due to the pressure caused by the free air in the thoracic cavity, the heart cannot pump efficiently thus causing the failure.
What is the most common cause of paricardial tamponade?
Blunt force trauma to the chest.
Bowel sounds in the chest cavity would be a good indication of (blank).
diaphragmatic tear
What is the prefered device to use to splint an ankle fracture?
pillow splint
Here's another trickie-dickie question dealing with termanology:

You are called for a motor vehicle collision. When you arrive on scene, you find a 36-year-old male lying supine on the ground beside the vehicle. Bystanders pulled him from the car because they thought it was on fire. What is the first phase of assessment you must complete after finishing your scene size-up?

Initial assessment
Rapid trauma assessment
Sample history
Detailed assessment
Initial assessment (da)
The patient is complaining of sharp pain in the upper abdominal quadrants that radiates to her back. On palpation of the abdomen, you find that it is extremely rigid, with no signs of external injury. The patient has a blood pressure of 118/100 mmHg, a heart rate of 126, and a respiratory rate of 18. What type of abdominal injury is this patient probably suffering from?
pancreatic injury
What are the differences in skin assessment between compensated spinal shock and compensated hypovolemic shock?
The skin in hypovolemic shock will be flush because of the body's mechanism of peripheral vasoconstriction, shunting blood away from the extremeties and to the organs. In spinal shock, the skin will look normal due to the innability to vasoconstrict.
Patient was struck by a forklift at work. His blood pressure is 92/80 mmHg, heart rate is 136, and she is being ventilated at 12 per minute. Your partner advises you that he is hearing a fluctuation in the systolic pressure when you ventilate the patient. The patient still has clear and equal breath sounds and his neck veins are now elevated. What type of injury do you think the patient is most likely suffering from?
Cardiac tamponade as evidenced by the narrowing pulse pressure and the presence of pulsus paradoxus.
The "universal blood type" is (blank).
O-
AB- can only receive A+, B+, 0+, and AB. (true or false)
False. AB- can only receive A-, B-, 0- and AB-.
A+ can receive what blood types?
0-, 0+, A-. and A+.
B- blood type can receive what types of blood?
0-, B-
B+ blood type can receive what types of blood?
0-, 0+, B- and B+
O+ blood type can receive what types of blood?
O- and 0+
0- blood type can receive what types of blood?
0- (only)
(Blanks) are easy to spot by name because they almost always end in (blank) such as diazapam or lorazapam. A couple end in "lam"; they are Midazolam and Triazolam.
Benzodiazepines
(BLANK), (also known as Briquet's syndrome) is a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause.
Somatoform disorder
(BLANK) dissorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception.
Dissociative disorders
Here's another tricky one:

Confidential information may be released to the county coroner after a motor vehicle accident with a fatality. (True or False)


Confidential information can only be released for the following reasons: to physicians or nurses involved in the continuation of patient care, after a legal subpoena is issued, and to third party insurance companies for the purposes of medical billing.
False: Confidential information can only be released for the following reasons: to physicians or nurses involved in the continuation of patient care.
After a legal subpoena is issued.
To third party insurance companies for the purposes of medical billing.
Atavan is the same thing as (blank).
Lorazepam. It is a benzodiazepine drug with short to medium duration of action. It has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant. It is a powerful anxiolytic, and, since its introduction in 1977, lorazepam's principal use has been in treating the symptom of anxiety. Among benzodiazepines, lorazepam has a relatively high addictive potential. It is also used to treat active seizures.
What is the correct dose for Lorazapam when using to treat for seizures.
2 mg IV push
In managing the airway of a patient with known esophageal varices and unresponsive with respirations of 6, what technique should be avoided?
Esophageal varices are diseased blood vessels that line the esophagus. A nasogastric tube should not be inserted in a patient with this condition. It could cause a rupture and severe bleeding if the nasogastric tube were to lacerate one of the varices.
Rationale
The primary intracellular ion is (blank) and the primary extracellular ion is (blank).
potassium

sodium
A hypoglycemic patient typically presents with (blank) skin. Diabetic ketoacidosis, and anaphylaxis would present with warm, (blank) skin.
diaphoretic

dry
What is the correct way to treat heat stroke?
While air conditioning is a good start, the patient should be covered with sheets soaked in tepid water. Ice packs and refrigerated IV fluids will cause peripheral vasoconstriction and shivering which may actually increase the core temperature.
Of all the potential abnormal delivery situations listed below, which is the most commonly encountered, and the only one in which field delivery may be attempted?

A. Face or brow presentation
B. Breech presentation
C. Limb presentation
D. Prolapsed cord
Breech presentation occurs in approximately four percent of all live births. Although cesarean is sometimes necessary with breech presentation, field delivery is occasionally unavoidable. Prolapsed cord occurs once in every two hundred and fifty deliveries, and limb presentation in less than one percent of all births. Face and/or brow presentation occurs in less than one in every five hundred deliveries. Cesarean section is almost invariably necessary for delivery of the fetus when presented with prolapsed cord, limb, face or brow presentation.
Positive pressure ventilation should be utilized whenever the newborn's heart rate is less than (blank) beats per minute.
100 beats per minute. When administered, chest compressions are performed at a rate of 120 per minute and a depth of 1.5 to 2.0 cm (1/2 to 1/3 inches).
Chest compressions should be immediately administered if the heart rate of a newborn drops below (blank) beats per minute, or when the heart rate has not risen above 100 beats per minute following 30 seconds of bag-valve ventilation with supplemental oxygen.
60
You respond to a 2 year old patient choking. Pt is still conscious. What is your first response?
For a child older than the age of one, you should administer abdominal thrusts if the patient is still responsive. If the child goes unresponsive you should proceed to the use of McGill forceps and a laryngoscope after chest compressions have failed. If the child would have been under the age of one, the method of choice for relieving an airway obstruction initially is back blows and chest thrusts.
(Blank) is defined as threatening to touch, or creating an air of apprehension regarding touching a patient, without his consent.
Assault
(Blank) is the process of physically touching a patient without his consent.
Battery
The administration of succinylcholine will aid in tracheal tube placement by:

A. abolishing the patient�s gag reflex.
B. relaxing the central nervous system.
C. sedating the patient so that she cannot move.
D. binding to the receptors of the muscle cells.
D. binding to the receptors of the muscle cells.

Succinylcholine is used for muscular paralysis and classified as a depolarizing agent. As such, succinylcholine binds with receptors on the muscle cells, causing them to depolarize. Since the succinylcholine is not released from the receptors for 3 to 5 minutes, the muscles cannot move and paralysis is achieved. Paralysis facilitates tracheal tube placement in the conscious patient. However, the diaphragm is also paralyzed, meaning that the patient has lost their means to breathe on their own. As a muscular paralytic, succinylcholine does not relax the central nervous system nor abolish the patient�s gag reflex. Paralytic agents do not produce sedation. Rather, medications like midazalom (Versed) are used for this purpose.
Name varietions, stages or degrees of high blood pressure.
"Hypertensive Crisis" is divided into two catagories: "Hypertensive Urgency" is with high blood pressure with diastolic pressure below 130.
"Hypertensive emergency" occurs when the diastolic blood pressure exceeds 130 mmHg.
"Hypertensive encephalopathy" describes a state of extreme hypertension accompanied by neurologic signs and symptoms like slurred speech, headache, or visual disturbances.
You are carring for a patient with leg pain. You're enroute to the hospital when she suddenly develops difficulty breathing and chest pain on the left side. What is the most appropriate next step (according to NR test questions)?
Because her when into a life threatening status, you should contact medical control to notify them so they can prepare for the treatment of the patient when she arrives at the hospital.
You are carring for a patient with leg pain. You're enroute to the hospital when she suddenly develops difficulty breathing and chest pain on the left side. What is the most appropriate next step (according to NR test questions)?
Because her when into a life threatening status, you should contact medical control to notify them so they can prepare for the treatment of the patient when she arrives at the hospital.
You are carring for a patient with leg pain. You're enroute to the hospital when she suddenly develops difficulty breathing and chest pain on the left side. What is the most appropriate next step (according to NR test questions)?
Because her when into a life threatening status, you should contact medical control to notify them so they can prepare for the treatment of the patient when she arrives at the hospital.
What drug could be used to block the parasympathetic nervous system when intubating a child?
Atropine: When the vagus nerve is stimulated, as can occur with hypoxia and laryngoscopy, it excites the parasympathetic nervous system. Atropine is a parasympatholytic, which means that it blocks the parasympathetic nervous system and can help prevent the drop in heart rate with pediatric intubation.
What heart sound would you most likely hear in the beginning stages of heart failure?
The presence of an S3 heart sound is suggestive of ventricular dysfunction, most commonly as the result of too much pressure in the left ventricle. Although an S4 may be suggestive of left ventricular dysfunction, it is most commonly associated with ischemia and left ventricular dysfunction simultaneously.
What is "HAPE"?
High-altitude pulmonary edema (HAPE) usually occurs in an unacclimatized individual who rapidly ascends to an altitude that exceeds 8,000 feet. HAPE develops as a result of increased pulmonary pressure and hypertension caused by changes in blood flow at high altitudes.
What does it mean when a person tests positive for tuberculosis by PPD reading?
The person has developed antibodies from TB exposure.
In a frontal impact MVA involving a restrained driver, lower extremity and pelvis injuries are expected. (true or false)
True

In a frontal impact MVA involving a restrained driver, lower extremity and pelvis injuries are expected. Head, chest, and pelvis injuries are most often associated with unrestrained patients, as they tend to go up and over the dash. The injury pattern expected with a restrained patient can be classified as down and under the dash.
Diabetic Ketoacidosis is a state in which the body starts producing ketone bodies such as acetone. A blood sugar level between (blank and blank) mg/dl characterizes DKA. A fruity smell on the patient's breath is produced as the body tries to remove excess ketones through the respiratory system. The ketone acid is created by the body when it converts non-carbohydrates into glucose.
300 and 600
(Blank) is an inflamed gall bladder that produces pain in the right upper quadrant, nausea, vomiting, and sometimes, right shoulder pain called Kerr's sign. It classically flares up after the ingestion of a meal high in fat content. Care should be supportive.
Cholecystitis
Labetalol is a beta-blocking agent, which will diminish the degree of bronchial dilation from beta 2 stimulation. As such, the use of beta blockers in patients with reactive airway diseases (such as asthma), should be avoided. (true or false)
True
A normal body temperature in Celsius is (blank) degrees (98.6 degrees F). A Celsius reading of 41.1 is about (blank) degrees higher than normal (and corresponds to about 106 degrees F).
37
4
What are the rules or standards that govern the conduct of EMS professionals?

Morals
Ethics
Standards
Codes
Ethics
(Blank) is the act of injuring a person's character, name, or reputation by making a false or malicious statement with malicious intent or reckless disregard for the falsity of the statement.
Slander
If you "slander" a person and put the statement into writing, that would constitute possible (blank). Negligence is a deviation from accepted standards of care. Malfeasance is a form of negligence involving the performance of a wrongful or unlawful act.
Libel
(Blank) is a form of negligence involving the performance of a wrongful or unlawful act.
Malfeasance
(Blank) is a deviation from accepted standards of care.
Negligence
What happens to the vital signs when entering decompensated shock?
Decompensated shock physiologically occurs as the precapillary sphincters that guard the peripheral capillary beds relax secondary to local blood chemistry changes due to shock. The opening of these sphincters allows blood to flow back into the stagnant capillary beds which decreases the available blood volume for core perfusion, and, results in a significant drop in systemic vascular resistance. Thus the clinical finding consistent with decompensated drop is a sudden decrease in blood pressure, tachypnea, and continued elevation of the heart rate.
What happens to the vital signs when entering decompensated shock?
Decompensated shock physiologically occurs as the precapillary sphincters that guard the peripheral capillary beds relax secondary to local blood chemistry changes due to shock. The opening of these sphincters allows blood to flow back into the stagnant capillary beds which decreases the available blood volume for core perfusion, and, results in a significant drop in systemic vascular resistance. Thus the clinical finding consistent with decompensated drop is a sudden decrease in blood pressure, tachypnea, and continued elevation of the heart rate.
Describe typical symptoms of Hemorrhagic stroke.
A hemorrhagic stroke typically starts as a bad headache, and as blood accumulates outside the vascular system, it compresses the normal brain tissue and can cause herniation of the brain stem through the foramen magnum (causing the Cushing's triad findings).
Describe typical symptoms of an inflamed appendix.
An inflamed appendix usually starts with the general findings of abdominal pain, fever, and vomiting. The abdominal pain usually begins in the center of the abdomen, around the area of the umbilicus, and later, the pain radiates downward and to the right - to an area called McBurney's point. This roughly corresponds to the location of the appendix in the lower right portion of the abdomen.
Describe "Cushings *Reflex*"
The Cushing reflex is usually seen in the terminal stages of acute head injury. Cushing's reflex is a reaction of the hypothalamus to ischemia in the brain. The ischemia activates the heart to speed up and vessels to constrict in order to increase BP and deliver more oxygen to the brain. The high BP then activates baroreceptors and causes the heart to slow down resulting in high BP and bradycardia.
Describe "Cushing's *Triad*".
Cushing's triad (not to be confused with the Cushing reflex) is a sign of increased intracranial pressure. It is the triad of:

1. Hypertension (progressively increasing systolic blood pressure)

2. Bradycardia

3. Widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time)

Cushing's triad suggests a cerebral hemorrhage in the setting of trauma or an space occupying lesion (e.g. brain tumor) that is growing and a possible impending fatal herniation of the brain.
Describe the effects of cyanide poisoning.
Cyanide poisoning can cause seizure and coma, but will not have an effect on pupil constriction or yield SLUDGE symptoms.
What would you do if a patient has a blood-spurting injury to the femur that does not stop bleeding with the use of pressure bandage and elevation?
Hemorrhage control should follow a progression which begins with the application of direct pressure and a pressure dressing, often combined with elevation. When these techniques do not prove adequate at stopping the hemorrhage, application of pressure to a proximal pressure point should be attempted. In this case, the femoral artery would be the appropriate proximal pressure point, as the popliteal artery is distal to the injury site. Typically, removal of an existing pressure dressing is not recommended, as it is likely to disrupt to clotting process and prolong the hemorrhage. Application of a tourniquet is considered only as a last resort, after all other attempts to control hemorrhage have failed.
How do you determine if a patient has suffered a TIA?
Symptoms will resolve within 24 hours.
Describe Biots Respirations, Cheyne-stokes Respirations and Kussmaul's respirations.
Cheyne-Stokes breathing is characterized by periods of hyperventilation followed by periods of apnea in a crescendo/ decrescendo pattern. Kussmaul's respirations refers to rapid, deep breathing typically associated with metabolic acidosis. Central neurogenic hyperventilation produce rapid and deep respirations and are typically associated with strokes or brainstem injury. Biot's breathing is characterized by episodes of gasping interspersed with periods of apnea in an irregular pattern.
26 y.o.f. complains of diffuse, severe, lower abdominal pain that increases wtih sexual activity. Pt. has chills, nausea, vomiting, and pain increases before and/or after menstrual periods.
Pelvic inflammatory disease Cystitis is an infection of the urinary bladder, causing pain immediately superior to the symphysis pubis.
(Blank) is an infection of the urinary bladder, causing pain immediately superior to the symphysis pubis.
Cystitis
(Blank) is a condition in which endometrial tissue grows outside the uterus causing inflammation and bleeding.
Endometriosis
(Blank) is typically characterized by cramping abdominal pain and vaginal bleeding, often accompanied by passage of clots and tissue.
Spontaneous abortion (miscarriage)
Your patient is a 29-year-old woman complaining of severe, diffuse, lower abdominal pain. The patient states that her menstrual periods have been occurring at normal intervals. Additionally, she states that pain increases during sexual activity and following her menstrual period, and that she has recently experienced a yellow, vaginal discharge. Her skin is warm and slightly diaphoretic, respiratory rate is 14 breaths per minute with adequate tidal volume, radial pulse is 112 beats per minute, and blood pressure is 110/90 mmHg. What is the most likely cause of this patient's symptoms?
Pelvic Inflamitory Disease (PID)
What is the correct dose of subcutaneous epinephrine for a child suffering anaphylaxis?
0.15mg
You are called to a private residence for a 22-year-old female patient with severe abdominal pain. Upon arrival, you find your patient in a left lateral recumbent position on the bedroom floor. A family member tells you that she fainted approximately 5 minute prior to your arrival. The patient is conscious and alert, and is complaining of sharp abdominal pain in her lower left quadrant. The patient denies pregnancy and states that her last menstrual period was 6 weeks ago, however her menstrual flow was brownish in color and her menstrual period was short in duration. Patient is gravida 1, para 1. Assessment reveals a rigid abdomen, and the patient also complains of pain to the left shoulder. Respiratory rate is 26 breaths per minute with adequate tidal volume, radial pulse is 126 beats per minute, and blood pressure is 84/62 mmHg. What condition is the patient likely experiencing?
Ruptured ectopic pregnancy
Name the correct landmark for performing a surgical cricothyrotomy.
The cricothyroid membrane, also known as the cricothyroid ligament, located immediately inferior to the larynx and immediately superior to the cricoid ring of the trachea.
What is the correct size ET tube or "Shiley tracheostomy tube to use for a cricothyrotomy?
Either a size 6.0 or 7.0 mm cuffed endotracheal tube or a size 6 or 8 Shiley tracheostomy tube should be utilized.
How old does a patient have to be in order to qualify for a cricothyrotomy?
The procedure should not be performed on patients under the age of 12 because the cricothyroid membrane is small and underdeveloped in children. The initial incision is typically a 1 to 2 cm vertical incision immediately over the cricothyroid membrane