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935 Cards in this Set
- Front
- Back
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Duty to perform,damages (harm), and proximate cause are all elements needed to be found
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guilty of neglect. The final element needed is: Breech of duty
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Negligence
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breech of duty/duty to act/proximate cause, damages or harm; INTENT not needed
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Legal document that indicates end of life request regarding resuscitation
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DNR
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Greatest threat for false imprisonment
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psychiatric patients
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Emergency with a minor without parents the medic should
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assume implied consent and begin care
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Granting of PRIVELEDGES (sp?) by doctor's to medics to perform skills
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delegation of authority
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Malpractice term where caused direct injury to pt
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proximate cause
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health care decisions designeated to another
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durable power of attorney
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Labor and negligence law
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tort law
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Malicious writing
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libel
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malicious spoken terms
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slander
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Standards governing group of people or profession
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ethics
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Reciprocity
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recognizing comparable standards set forth from another agency
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Who are ethical standards developed for
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The PATIENT
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indirect medical control
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standing ordersTrauma with multiple GSW, unconscious=implied consent
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Legal refusal must be
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refusal that is INFORMED refusal
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OSHA
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MSDS must be ON-SITE where hazardous materials STORED
safety and occupational standards |
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If medic charged w/ negligence
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defendant
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Directly causes harm or injury
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proximate cause in negligence case
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Error; forgot drug dose AFTER COMPLETING PCR
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add a dated and signed addendum=already handed to ER
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Error, wrote wrong dose, non-completed PCR
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cross out with one line, initial,date incorrect info and add correct info at bottom of report=not already handed to ER
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Best protection for paramedic
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thorough documentation
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Assessment of call begins at
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dispatch
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Ambulance crashes, court will try to prove
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lack of due regard
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Scenario: rescuer found negligent
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do not have to prove it happened away from medical facility
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Organization that est. the qualifications for EMS personnel on a Nat'l basis
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National Registry of EMT's.
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Dyspnea
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difficult or painful breathing
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The Hering-breur reflex
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prevents overexpansion of the lungs
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Hypoxia
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decreased Oxygen in the lungs
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Hypoxemia
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decreased partial pressure of O2 in the blood
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Normal stimulus to breath
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increased PACO2, ARTERIAL
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Hypoxic drive or pt's with COPD, stimulus to breathe
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decreased 02 levels
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COPD
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Aminophylline/albuterol/bronkosol NOT BENADRYL-COPD not an allergic reaction
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Skin pallor
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vasoconstriction causes this condition
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Upper a/w sound with inspiratory difficulty
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stridor
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Wheezing
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whistle sound on inspiratiom (lower a/w)
constriction |
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Whistling sound during exhalation
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consider asthmatic broncholitis
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Rhonchi
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Fluid/mucous in LARGE a/w
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Croup
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stridor at night w/ seal bark
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Rales
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usually heard in lower airway (alveoli) fluid
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Most common a/w obstruction
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tongue (Generally snorous)
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Poor airway compliance is seen in
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sucking chest wounds/ tension pneumothorax/flail chest NOT Pleurisy or pleuritis
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Tension pneumthorax treatment
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02, decompress,transport, IV enroute
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One of the major purposes of pulmonary VENTILATION
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ability to retain or eliminate CO2
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One of the major advantages of RESP
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to increase absorption of 02 by the cells
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Pulmonary Emboli s/s
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Dyspnea/SOB/pleuritic pain/Tachycardia
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Pulmonary emboli
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NO JVD
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Anaphylaxis
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Classis sign is HYPOTENSION
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Anaphylaxis
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Uticaria/SOB/facial swelling/tachypnea and HYPOTENSION hallmark of anaphylaxis
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Tx anaphylactic shock
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Epinephrine 1mg in 1:10,000 IV and Benadryl 25-50 mg
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Bee/ hornet/wasp stings/PCN injection
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fastest and most frequent cause anaphylasix
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Chronic Bronchitis, an acute exacerbation
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Respiratory acidosis &Tachycardia
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Pneumonia
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Fever/rhonchi/hot and dry skin NO PEDAL EDEMA
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20 yr. old asthmatic has not R to normal Tx.
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Use:Aminophyline
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Epi dose for asthma
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=.3-.5 mg SQ 1:1000
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Chronic bronchitis
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blue bloater, fat, increased mucous production, chronic cough & NOT a PINK PUFFER
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Emphysema
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SOB, barrel chest /thin and pursed lip breathing to create back pressure to open alveoli, cough=generally only in morning with increased mucous=pink puffer
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Cough up blood
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hemoptysis
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Cough up pink tinged sputum
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hemoptsis and s/s Left sided heart failure/Pulmonary edema
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CHF
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Left sided ventricular damage
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Overhydration in elderly listen
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lungs and for rales to confirm overhydration
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Anaphylactic shock pharmocological tx
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epi & benadryl
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Deep regular respirations
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not a s/s shock
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Pink puffers (emphysema) and Blue Bloaters (Chronic bronchitis)
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COPD
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COPD Tx
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02 & Albuterol
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IV COPD
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KVO 55 dextrose in sterile water (?)
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Emphysema
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use NC or Venturi mask
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Hyperventilation helps to correct
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respitory acidosis
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Pneumothorax
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air trapped in pleural space
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Asthmatic
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Relieve Bronchspasms/Bronchonstriction
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Anaphylaxis
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Increased HR,HYPOTENSION, itching, flushing, uticaria
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Upper a/w sound produced with inspiration difficulty
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stridor
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Sound assoc. w/ lower a/w obstruction
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wheezing
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LS due to bronchoconstriction
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wheezing
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Neurogenic/anaphylactic & septic shock cause
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HYPOtension due to-vasodilation
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Neurogenic/anaphylactic & septic shock
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distributive shock
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Hemoglobin
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responsible for transport & delivery of 02
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Smaller a/w sound w/ fine crackling
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Rales
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Rumbling sound/fever/no edema
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pneumonia
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Carpal pedal spasms
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are side effect of hyperventilation
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Pneumonia is not associated with
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COPD
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Cor pulmonade
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underlying cause of Right-sided heart failure
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Hypertension and JVD
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emphysema
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JVD, Hypertension, Dyspnea on exertion
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emphysema (remember..form of COPD)
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Pulmonary edema s/s
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rales/dypnea/no pedal edema
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Treatment Pulmonary edema
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LMNO
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Treatment CHF
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LMNO
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LMNO
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O2, Lasix (40 mg) slow IVP, Morphine sulfate (2 mg) slow IVP and Nitro ( 0.4 mg ) sublingual
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Pt. s/s PE, 2 IV's in, 02 on next
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Nitro .4 mg
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Primary concern near drowning
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hypoxia and acidosis
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Salt water drowning
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respitory alkalosis=C02 retention and pulmonary edema
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Fresh water drowing
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Hemodilution or hemolysis
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Asthma s/s
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agitation, anxiousness, hypoxia and wheezing ( Silent chest is ominous)=prepare for intubation and/or cardiac arrest.
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Pleural effusion
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escape of fluid from vascular space into pleural space=pleural friction rub lung sounds
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21 yo w/ chest pn after coughing
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Spontaneous Pneumothorax
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remember
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20-30 y.o., thin, smokers and males more prone to spontaneous pneumothorax
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DVT (thrombi)=
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Right Pulmonary Artery= will travel and lodge (embolus)
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SC/SQ Emphysemia
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crackling sensation in the neck due to air under the skin
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Orthopnea
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difficulty breathing while lying down
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Pt. 70 yo w/ SOB and orthopnea, can't lie flat, DRIED BLOOD on LIPS
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Pulmonary edema
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Orthopnea s/s
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Pulmonary edema and suggests either right-sided heart failure or CHF
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Bright red frothy blood at mouth w/ each exhalation
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lung damage
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Long bone fx at risk of
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Fat embolism
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Minute volume
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RR x Tidal volume in one minute
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Bronchiolitis
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Inflammation oof bronchioles with expiratory wheezing
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Sudden onset wheezing in ONE LUNG/Lobe
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Foreign body aspiration (esp. if have just finished eating)Inhalation=decrease in intrathoratic pressure relative to environment (ACTIVE)
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As volume in thoratic cavity increases
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pressure decreases =exhalation (PASSIVE)
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Tidal volume
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Amount of air inhaled and exhaled during one respiratory cycle
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Minute volume regarding respirations
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Tidal volume x resp. rate
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Average Tidal volume
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500 cc in ONE respiration
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Irregular breathing pattern with periods of apnea gradually increasing and decreasing
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Biots
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Aminophylline AKA Theophylline dose
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5-6 mg/kg
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Aminophylline
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smooth muscle relaxant used with bronchial asthma
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21 yo w/ asthma
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tx via ALBUTEROL 2.5 mg nebulized/02 @ 6 lpm
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Pulmonary Edema
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in order=02, monitor and IV and NTG @ .4mg
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Spontaneous pneumo
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description=knife-like pain
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Collapsed alveoli with decreased ventilation
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ATELECTASIS
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ATELECTASIS
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Pink puffers=emphysema
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Atelectasis
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Pa02 will fall
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Alveoli
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surfacant keeps open
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Lack of surfacant
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ATELECTASIS
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Remember
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emphysema=destruction alveoli. Chronic bronchitis is increased mucous production hence why they are blue bloater's (cyanotic) because of mucous and lack of 02 exchange.******************************
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COPD
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Respitory drive =hypoxic drive AKA back-up drive
stimulus to breathe=Decreased Oxygen |
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Collapse of alveoli
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decreases ventilatory effectiveness
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Respirations
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exchhange of gases between internal/external environment
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Ventilation
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mechanics (body parts) responsible for respiration
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Ventilation/perfussion mismatch
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ARDS
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Pulmonary ventilation important in maintaining acid-base balance
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the ability to retain or eliminate CO2
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Hemoglobin
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transports 02 (iron containg component of RBC)
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Ventilation problem
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=throratic injury which leads to resp. pattern=Ataxic respirations
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Emphysema
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pursed lips( to open alveoli ), thin and barrel-chest
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Pink-puffer
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increase RBC production to increase hemoglobin capacity to breathe
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Asthmatic patient's
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main tx is to relieve bronchospasms
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S/S respiratory distress
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nasal flaring, tracheal tugging, sternomastoid muscle use, intercostal retractions
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Pulmonary edema can be caused by
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overhydrating your patient
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Pulse oximetry
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02 saturation in periphreal tissue
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JVD caused by tension pneumothorax, Rt. sided heart failure, cardiac tamponade, traumatic axphysia from=
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Increase in portal pressure(LIVER) in venous side or cor pulmonade
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JVD best evaluated in
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semi-fowler position @ 45 degrees
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Asthma
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Albuterol 2.5 mg, Epi .3-.5ml 1:1000 solution SQ, Bronkosol..NO BENADRYL (adult doses)
Asthma is not an=Allergic reaction |
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Hard to bag w/ decreased compliance
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pheumothorax
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Due to bronchiolar spasm a pt. w/ asthmatic bronchiolitis will show
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expiratory wheezing
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Hypoxemia
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reduction of partial pressure of 02 in blood
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Rescue breathing pushes diaphram
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increasing ventricular rate
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Compliance
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acceptable rate of ventilation (lk. @ other definitions too!)
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Pulmonary embolus
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thrombus formation in deep veins of legs that travels to Pulmonary artery ( one cause)
Recent delivery of child immobilization recent surgery Presentation=Chest pain and dypnea |
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As approach any scene
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make sure scene is safe
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Repeater
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increases transmission range by changing to a higher or different frequency
name of the tower that increase transmission range of portable or mobile radio |
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Best tool for exposing a car's locking mechanism
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air chisel
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Repeater in a TELEMETRY sytem
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increases transmitting and receiving range
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Telemetry sytem in which voice and ekg can be transmitted at same time
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multiplex system
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Radio to physician
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Events surrounding initial incident+history and physical findings and treatment given
DO NOT use name of patient |
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Radio frequencies are measured
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Hertz or megahertz
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Holding the radio horizontal does NOT
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REDUCE radio transmission
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Radio transmission reduced
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Holding radio vertically/no repeater/weak battery
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Listen and speak at same time
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duplex
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Group of frequencies close together
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band
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VHF/UHF
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used for medical communications
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UHF band used
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Biotelemetry
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EKG
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send via radio =BIOTELEMTRY
Transmitted and decoded=Oscilloscope |
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Agency for licensing and monitoring radio frequencies
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FCC
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Proper radio procedure
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speak clearly and keep messgae brief
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device that transfers electrical energy into sound waves
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transmitter
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First phase EMS
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public access to 911
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Implied consent
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would not receive care if severe asthmatic and refuse transport
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Less a medic uses skill
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review should be more frequent on down time
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Libel
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malicious writing
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Best way to avoid anaphylactic reaction
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ask allergy Hx.
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Unable to defib, failed to replace battery is
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negligence
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Established policies and proceddures of EMS system
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protocols
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Standard(ing) orders
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written medical orders via EMS physician (Off-line or indirect medical control)
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Ststem used to ensure that needed resources are available in neighboring areas in time of MCI
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MUTUAL AID
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Most fatalities of RESCUERS
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Confined space rescue
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Recommended access in order at MVA
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Doors then windows then body of vehicle
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Proper procedure for disabling battery
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Disconnect negative side first
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First step of extrication
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gaining access to patient
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One man carry, not used often due to pt.s entire weight on rescuer
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Fireman's Carry
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Removing pt's from heights or over rough terrain or rubble
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Stokes basket
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technique used w/ spine board in narrow spaces as alternative to four man roll
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four-man-straddle slide
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A rescue vehicle parks
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no closer than 100 ft from a burning vehicle
no closer than 50 ft from a non-burning vehicle |
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Landing zone
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100 x 100
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Rotors can dip
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4 feet from ground
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Only approach helicoptor
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when tlod it is safe
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MVA
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AMBER LIGHTS ON
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Most accidents
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intersections, clear day, and dry roads
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Intervener physician
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doctor at scene who is not patient's doctor..if problem call medical control and then intervener physician can transport pt. with you to hospital if he want's to keep primary care at scene
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Safest way to enter car involved in MVC
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door
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Front windshield
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Laminated Safety Glass
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Explosion
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Airway/ ventilate and 02/stop bleeding/tx fx's
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Flashlight
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sealed no risk fire=point down at ground and keep at side
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Cribbing
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stabilizes a vehicle
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Most injuries to medics
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at MVC's and lifting
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Build trust/rapport
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look at pt, use professional but compassionate tone
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UHF/VHF and FM fequencies
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medical communications
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KEY to effective management in disaster situations
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Communication system
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Lights siren on four lane highway
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drive in Left lane so traffic can move to right
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Flashing lights attract
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intoxicated and sleepy drivers
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Partner w/ normal stress reaction at MCI
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Give specific task to complete
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MCI
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Incident Commander in charge andd transfer of command is face to face
• Triage=sort |
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Last (Black) priority in MCI
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Cardiac arrest
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START
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Triage=simple triage and rapid transport
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Seperate the walking wounded
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in MCI
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MCI
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Can you walk, breathing, pulse, circulation
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Remeber
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• In any MCI scenario you treat airway, bleeding, AMS, and then fx's. Immediate life threats are first except cardiac arrest/major burn patient (tagged dead/black) then potential life threats...BLS before ALS..
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First medic on scene w MCI
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Triage
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Potential life threats
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most challenging call for medic
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Decontaminate in
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yellow or warm zone
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Placard
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read from distance=call haz mat=do not enter
Placard=only if carry 5000+ pounds |
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MVC w truck carrying Hazardous material
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Size up scene and THEN notify hazmat
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Red pacard
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fire danger
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When responding to a call most important
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using seat belts
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FLorida
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Chapter 401
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"Emergency Medical Services Act"
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ethics for allied health professionals
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64E
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EMS Administrative Code for Florida
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60 cylcle interference
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disconnect any electrical appliances in area
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Fire and partner falls
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clothes drag
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Critical stress debriefing within
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72 hours
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Due regard does not mean
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can pass school bus with arm down or speed in school zone/violate RR Crossing
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Highest level of driving
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due regard for others
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On way to stressful situation you become tachycardic and clammy
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Epinephrine released from ADRENAL glands/catecholamine dump
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MVA w/ airbag that did not deploy
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disconnect both battery cables
consult owners manual |
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Vehicle extrication when airbags do not deploy
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do nothing @ first
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Extrication
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is the removal of entrapments from victims, enabling a safe controlled rescue
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4 man roll used when moving a pt., the first step the medic should do is
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Stabilize C-Spine
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The less you use a skill
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the more frequent it should be reviewed
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Having essential supplies/equiptment at scene insured by
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developing an inventory & replenish truck supply after every run
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A sealed flashlight is not
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an ignition source
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Rule of thumb w/ Hazmat
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keep safe distance
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MCI- most critical pt
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person walking around aimlessly repeating things over & over w/ AMS
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MCI START System
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RR greater than 30,Cap refill less than 2 seconds-R to painful Stimulus/unconsious/alert & disoriented are all=Critical, immediate patients (*****Key is any altered mental status)
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Bus load kids crashes into hazmat ruck
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Scene survey(always first @ Hazmat situation)
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Technical rescue
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decided upon arrival
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After stabilizing car,next
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patient assessment
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Triage officer
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does not run rescue tools
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Do not do when triaging
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primary and secondary survey's
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Primary survey
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check ABC
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Secondary survey
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do not determine life-threatening injuries
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When using stair chair to carry pt down stairs, or anywhere, you must
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test chair first to make sure it is strong
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2 rescue carry that can be used to carry pt. through a narrow space
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Extremity carry/extremity lift
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If you lose contact w/ hospital
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follow local protocols or standard orders
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Break a windsheild via
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fire ax
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safest way enter a vehicle
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door
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Gaining access to a rear TEMPERED window of car
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spring loaded center punch to corner
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A pry bar is
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NOT used to pull or roll a dashboard
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Cannot transmit or receive data at same time
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Simplex System
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Telemetry system where voice and EKG can be transmitted from field to hospital @ same time
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Multiplex System
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When surveying the scene initially, you do not have to report
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life-threatening injuries
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Best tool for exposing a car door lock
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air chisel
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One of first signs hypovolemic shock
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Tachycardia
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Earliest sign of any shock
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AMS
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Small Length, Large gauge
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IV
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Jaw thrust or Modified jaw thrust
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trauma pt. to open airway
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Factor common to all forms of shock
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inadequate tissue perfusion
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Most reliable indicator of severity of injury in Trauma is
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MOI
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Damage to tissues due to high speed bullet
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cavitation
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Traumatic asphyxia
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swollen/protruding tongue/bulging eyeballs/cyanosis NOT flat Neck Veins
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Trauma
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Give 3 times estimated blood loss of LR
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Trauma in field fluid of choice
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Lactated Ringers
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Traumatic asphyxia most commonly caused
|
crush injury to chest or abdomen
|
|
|
Abdominal evisceration tx
|
tx. for shock/ oxygen/cover organs w/moist and stable saline soaked dressing/LR.. DO NOT REPLACE BACK INTO ABD. AND COVER
|
|
|
Tension pneumothorax s/s
|
dypnea/mediastinal shift away from affected area/JVD
|
|
|
Explosion tx
|
Assess a/w, ventilate and oxygenate,stop arterial bleeding, tx. closed femur fx.
|
|
|
Blast injury
|
primary phase is rupture of large intestines/hollow organs
|
|
|
S/S Neurogenic shock
|
hypotension/bradycardic/warm/dry skin BELOW level of injury following trauma
|
|
|
ICP
|
Bradycardic/irregular respirations/ increased BP=CUSHINGS TRIAD
bradycardia/vomiting/irregular or unequal pupils NOT HYPOTENSION |
|
|
Trauma victim pulse 40 & BP 200/120
|
increased ICP Cushing's triad
|
|
|
High cervical fx
|
impairs respirations
|
|
|
Fx hand
|
splint in position of function
|
|
|
Stab wound to neck at jugular vein, suspected air embolism
|
apply pressure to wound and position on left side (rationale:air rises away from left and toward right)
|
|
|
"Battle sign"
|
eccyhmosis behind ear or mastiod process=Basilar skull fx
|
|
|
Periorbital bruising ("racoon eyes")
|
Basilar skull fx
|
|
|
Clear fluid leaking from ears/nose
|
Basilar skull fx
|
|
|
Allow CSF/blood to drain from ears/nose w/ head trauma because
|
the bleeding relieves pressure and will decrease chance of ICP
|
|
|
Burns
|
Signif. damage to underlying soft tissue, 2nd degree (partial thickness) have blisters, swelling can be generalized, greater than 10% third degree burns is a major burn
|
|
|
Burns
|
2nd degree 30% significant burn
|
|
|
60 yo male, twisted ankle, stable VS, tx
|
Splint & Transport
|
|
|
Electrical burns cause
|
both superficial and deep burns
|
|
|
Route of passage for electrical burns is determined by
|
entrance and exit wounds
|
|
|
Pt. fell through glass door, glass stuck in neck
|
stabilize glass and transport
|
|
|
Maximum amount of Crystalloid fluid given to adult trauma victim
|
2000-3000 mL
|
|
|
Hypovolemic shock prehospital fluid
|
2000-3000 mL
|
|
|
Abdominal bleed takes
|
2-3 hours to occur
|
|
|
Unconscious, no response to verbal/painful stimulus
|
Glascow Coma Scale(GCS)=3
|
|
|
GCS
|
Motor(6), Verbal (5)eye opening(4)=
|
|
|
Electrical burns
|
entrance and exit wounds/ current follows nerve pathways/ may cause V-Fib, & more internal than external damage
|
|
|
MAST/PASG INFLATION
|
Left leg, right leg, abdomen
|
|
|
MAST/PASG DEFLATION
|
Abdomen, right leg, left leg
|
|
|
Major indication for PASG suit
|
pelvis fracture
|
|
|
Clinical signs of shock do not include
|
constricted pupils
|
|
|
Scenario Burn to Anterior chest and abdomen and anterior upper extremities(2)=
|
rule of nines=27
|
|
|
Pneumothorax
|
does not cause stridor ( upper airway, inspiratory resp. sound)
|
|
|
Place for decompression
|
2nd or third intercostal space(midclavicular line) OR 4th or 5th intercostal space (midaxillary line)
|
|
|
Sequence pleural decompression
|
02, decompess, Transport, IV enroute
|
|
|
Scenario=MVA pt. w/ HR 120, BP 40 palp, pt
|
Hypovolemic shock
|
|
|
Wadell's traid
|
Left femur, spleen or chest injury and right-sided head injury
|
|
|
Most chemicals are rinsed w/copious amounts water
|
dry lime must be brushed off first
|
|
|
Traumatic thoratic injury w/ puncture to chest wall and air exchange between pleural area and outside environment
|
sucking chest wound
|
|
|
FBO in globe of eye
|
protective cone over eye and bandage botheyes
|
|
|
a severly angulated fx
|
pinching or cutting of nerves and blood vessles
|
|
|
Fx clavicle
|
patient presents w/ shoulder on injured side bent forward
|
|
|
Unconscious at scene of fire
|
suspect respitory burns
|
|
|
Spinal injury w/ intercostal retractions
|
suspect CERVICAL SPINE
|
|
|
MVC w/ decreased BP and Tachycardia suspect
|
hypovolemic shock
|
|
|
15 foot fall. pt flat neck veins/chest DULL TO PERCUSSION
|
HEMOTHORAX
|
|
|
Initial survey
|
tx. exsanguinating hemorrhage (not lac to abdomen)
|
|
|
Beck's triad:
|
Muffled/distant heart sounds, narrowing pulse pressure, decreased BP (NOT FLAT NECK VEINS)
|
|
|
Beck's triad indicates
|
cardiac tamponade
|
|
|
Flat neck veins seen with
|
dehydration, hypovolemia, hemothorax..NOT CARDIAC TAMPONADE
|
|
|
Alkali (strong base) burns
|
strongest and most severe=Drano or oven cleaner
|
|
|
A pt. w/ major burns has hypovolemic shock
|
due to plasma loss
|
|
|
Paradoxical respirations
|
flail chest (3+ ribs in 2+ places)
|
|
|
COLLAPSED STEERING WHEEL
|
look for flail chest
|
|
|
Thin,male, smokker,coughed
|
chest pain, some SOB=spont. pneumothorax
|
|
|
Female in gym with weights
|
spont. pneumothorax
|
|
|
Flail chest
|
paradoxical chest wall movement that decreases RESP. insufficiency
|
|
|
Flail chest
|
3+ ribs broken in 2+ places..significant MOI
|
|
|
Most serious complication of Joint injury
|
nerve damage
|
|
|
Fx straight across shaft of bone
|
transverse Fx
|
|
|
Most common fx
|
clavicle
|
|
|
Child most common fx
|
Greenstick
|
|
|
Spiral fx in child
|
suspect abuse
|
|
|
Fx at elbow
|
immobilize in position found ALWAYS
|
|
|
Fx Elbow
|
splint upper arm to wrist (proximal to distal), use a swathe with the splint, check radial pulses frequently (DO NOT ATTEMPT TO STRAIGHTEN)
|
|
|
Conscious w/femur fx
|
apply traction w/ traction splint until=pt.feels relief
|
|
|
Compound femur Fx actively bleeding
|
Control bleeding/bandage & splint
|
|
|
Ligaments torn, from motion forced beyond normal range of joint
|
sprain
|
|
|
Sprain
|
Torn/ Strain=stretched..."STRETCH....STTTTRAIN"
|
|
|
Affective nerve pathways
|
send sensory messages to the brain..(affective=ascending)
|
|
|
Effector nerve pathways
|
send motor messages from brain to body (descending sends down)
|
|
|
Most commoonly injured abdominal organ from blunt trauma
|
liver in RUQ
|
|
|
23 yo, sharp chest pn & increeasing SOB
|
spontaneous pneumothorax
|
|
|
Trauma w/ fascia seperation
|
avulsion
|
|
|
Usually massive bleeding with
|
avulsion
|
|
|
Most common type MVA rural area
|
Frontal or head-on collision
|
|
|
The kidney's rely on what for perfussion?
|
stroke volume (not systolic/diastolic or RR)
|
|
|
S/S shock
|
Increased pulse/cool skin/sweating NOT constricted pupils
|
|
|
Exsanguinate
|
loss of blood to point where life cannot be sustained/bleeding out
|
|
|
Cold/windy night, alcoholic unarousable, V-Fib, no respirations treatment
|
Airway, defib x3,CPR and transport.
|
|
|
Closed head injury
|
= NO D5W. NS and/or LR ONLY
|
|
|
GCS
|
verbal/ motor movement & eye opening Not pupil Response
|
|
|
Scenario
|
One car MVC, one dead other ejected, badly lacerated scalp and unconscious=open airway AND stabilize C-spine
|
|
|
Pupil Response
|
Cranial Nerve III
|
|
|
Pitocin for postpartum hemorrhage
|
also massage fundus/IV fluid and put baby to breast...Massaging fundus, after placental delivery=controls bleeding
|
|
|
Fundus
|
upper area of uterus
|
|
|
Cervix
|
neck
|
|
|
Pitocin to tx
|
=.post-partum hemorrhage=increases uterine contractions
|
|
|
Delivery of placenta
|
end of third stage of labor
|
|
|
Pregnancy blood volume increases by
|
40% w/ relative anemia ( most blood increase is plasma )
|
|
|
BP decreases, HR increases, cardiac ouput increases, respiration rate increase
|
stroke volume remains the same
|
|
|
Oxytocin
|
released by Pituatary gland
|
|
|
Acetylcholine also released by
|
released by Pituatary gland
|
|
|
Parathyroid glands are
|
small pea shaped glands
|
|
|
Emergency delivery and must seperate baby from mom
|
tie cord 8" from baby and a couple of inches from first tie and cut
|
|
|
Clamped and cut cord that continues to bleed
|
clamp again
|
|
|
Normal pregnancy length=
|
280 days, 9 months, 10 lunar months and 40 weeks
|
|
|
Gravida
|
=# of pregnancies
|
|
|
Prima gravida
|
First Pregnancy
|
|
|
Primapara
|
women who has delivered first child
|
|
|
Para
|
=# of deliveries
|
|
|
Ectopic
|
fertilization of ovum outside uterus..may stay in tube
|
|
|
Most common fallopian tube
|
ectopic pregnancy
|
|
|
Fallopian tubes
|
usual place of fertilization
|
|
|
Cord
|
2 arteries and ONE vein (LARGER OPENING)=umbilical cannulation via vein
|
|
|
Heimlich in pregnancy
|
chest compressions
|
|
|
MVA
|
save mom or child?=mom
|
|
|
Mom gave birth 24 hours ago, now sudden onset SOB/dypnea and chest pain
|
Pulmonary embolism
|
|
|
26 yo multi garvida w/ prior c-sections, C/C
|
full term w contractions 3-4 minutes apart/ TEARING pain,"",no s/s bleeding= abruptio placenta
|
|
|
Abruptio placenta
|
DARK red blood and Pain= classic differentiation
|
|
|
Abruptio placenta
|
premature seperation of placenta from wall of uterus
|
|
|
Apruptio placenta
|
minimal dark red bleeding, rigid uterus & shock/ can also be described as tearing pain
|
|
|
Placenta previa
|
placenta covers cervial opening
|
|
|
Placenta previa
|
BRIGHT red blood and Painless=classic differentiation
|
|
|
Placenta previa
|
placenta covers cervical opening
|
|
|
Prolapsed cord
|
Oxygen, elevate hips, insert gloved hand in vagina to relieve pressure on cord, keep cord moist w/ saline DO NOT PUSH CORD back in canal
|
|
|
Primary concern with prolapsed cord
|
Compromised blood supply.
|
|
|
APGAR
|
0-2 scale for appearance,pulse, grimace,activity, resp. rate( under 6 intervention required)
|
|
|
APGAR
|
1 and 5 minutes
|
|
|
False labor
|
Braxton-Hicks=false labor can't be determined in field
|
|
|
OB pt. over three months transport
|
On left at least 15 degrees to avoid SUPINE HYOTENSIVE SYNDROME or pressure on inferior vena cava from uterus
|
|
|
40 yo female w/ loss of appetite/RUQ tenderness. Urine is TEA (COLA) color
|
HEPATITIS
|
|
|
Early sign pregnancy-amennorhea=
|
lack of menses
|
|
|
Deliver in bag of waters
|
pinch bag open and remove from near infant's airway
|
|
|
Rape victim
|
DO NOT ALLOW TO CLEAN PERINEUM..you shouls tx all major trauma/emotionally support and allow a family member to be present...female medic is best.
|
|
|
22 yo female w/ severe pn LRQ, no appetite with constipation
|
appendicitis
|
|
|
Seizures from TOXEMIA( ECLAMPSIA)=ninth month (can occur all of third trimester!)Tx: 5-10 mg valium or Mag Sulfate(first choice)..Mag Sulfate
|
Toxemia of pregnancy usually in ninth month pregnancy but again, can occur any time in third trimester
|
|
|
Preeclamsia presentation
|
Hypertension, edema, proteinuria NOT SEIZURES
|
|
|
SEIZURES main characteristic of
|
ECLAMPSIA
|
|
|
Primary cause transmission AIDS
|
unprotected sex
|
|
|
Complication of HIV=
|
Karposi's Sarcoma (purple/blue lesions in the mouth and other areas of the body)
|
|
|
32 yo w/ excrutiating headache while working out and lost consciousness..unresponsive w bilateral dilated pupils
|
Cerebral Anuerysm
|
|
|
Common cause uterine bleeding first trimester
|
Threatened abortion/incomplete abortion/ruptured etopic pregnancy...NOT PLACENTA PREVIA
|
|
|
Ectopic pregnancy are
|
amenorrhea of less than 12 weeks/sharp,sudden, unilateral lower abdominal pn/severe shock NOT 3rd trimester bleeding
|
|
|
22 yo RLQ pain radiating to Rt. shoulder/ no menses w/ spotting today
|
ectopic pregnancy
|
|
|
BP decreases during
|
third month of pregnancy
|
|
|
Time from conception to delivery
|
Prenal period
|
|
|
Antepartum
|
before birth AKA same as Prenatal period
|
|
|
Newborn
|
newly born=first few hours
|
|
|
Neonate
|
birth through one month
|
|
|
Neonates loss body heat mostly via
|
evaporation
|
|
|
First Stage
|
contractions to dilation
|
|
|
Second Stage
|
dilation to crowning full dilation/delivery
|
|
|
Third stage
|
delivery to placenta delivery
|
|
|
If suspect Abruptio Placenta
|
High 02, LR (Ringers) and check VS every five miinutes
|
|
|
Serous membrane covering abdominal organs
|
Visceral
|
|
|
Delivery for sure
|
Urge to push, crowning contraction1-2 minutes apart
|
|
|
Third trimester pt. Transport LLR elevated 10-15degrees...
|
done after 12th week of pregnancy and forward
|
|
|
32 weeks pregnant
|
labor pains=can't distinguish in field
|
|
|
Arm &leg presentation
|
Transport immediatly PERIOD
|
|
|
Brethine
|
stops uterine contracions
|
|
|
Pitocin
|
encourages uterine contraction to decrease bleeding
|
|
|
UTI
|
most common is Cystitis
|
|
|
Hyperglycemia in pregnancy
|
gestational diabetes
|
|
|
PPE delivery
|
gloves/mask/gown/protective eyewear
|
|
|
PID
|
most common cause =Gonorrhea
|
|
|
All s/s kidney stones except
|
frequent urination
|
|
|
Frequent urination s/s
|
UTI
|
|
|
Kidneys
|
retroperitoneal
|
|
|
AMS
|
AEIOU-TIPS
ALWAYS Do glucose check even if under ETOH influence |
|
|
NORMAL "FIGHT FLIGHT RESPONSE"..ALPHA & BETA STIMULATION=
|
SYMPATHETIC NERVOUS SYSTEM ....CLAMMY SKIN,TACHYCARDIA, PERIPHREALVASOCONSTRICTION, DILATED PUPILS,SLOWED DIGESTION/CONSTRICTION OF SHINCTER MUSCLES..SYMPATHOMIMETIC
|
|
|
Bilateral dilated pupils usually
|
cerebral hypoxia
|
|
|
Lower extremity check for paralysis
|
ask pt. to wiggle toes
|
|
|
Decerabrate posturing
|
damage in brainstem
|
|
|
Decorticate posturing
|
damage can be ABOVE brainstemDecorticate ( body extremities upper come to core=corticate) posturing=indicates CEREBRAL injury
|
|
|
Neurological status
|
least important=does pt. have deep tendon reflexes. Responding to voice/Pupil response and hand grip strength IS IMPORTANT re: Neuro status
|
|
|
23 yo working out in gym w/ explosive headache
|
subarachnoid aneurysm
|
|
|
Eyes don't move in unison
|
dysconjugate gaze
|
|
|
dysconjugate gaze
|
failure of the eyes to move in unison, failure of eyes to rotate simultaneously (conjugate) in the same direction, or the eyes gazing in different directions
|
|
|
Decerabrate posturing
|
extended extremities
|
|
|
Epidural hematoma
|
FAST AND ARTERIAL BLEED
|
|
|
SUBDURAL
|
SLOW VENOUS BLEED ( problems can occur days/hours later)
|
|
|
Concussion
|
brief period unconsciousness followed by return to complete function
|
|
|
Part of brain that controls posture
|
cerebellum
|
|
|
Severed C4
|
total paralysis motor and resp. paralysis=can't breathe on own=quadIncreased ICP should be hyperventilated=20-24=Mannitol for ICP
|
|
|
Series increased and decreased RESP, then apnea
|
Cheyne-stokes
|
|
|
Rapid, irregular in rate and volume, with periods of apnea
|
Cheyne-stokes
|
|
|
Scenario:Pt fell from 3rd floor, Right LS absent, fx'd leg, after opening a/w=
|
BVM 02/decompress r side, PASG, transport with 2 large bore IV's
|
|
|
Contercoup
|
injury to opposite side of the head/ or opposite side of impact
|
|
|
Cerebellum
|
balance, coordination, motor control
|
|
|
ICP
|
Mannitol
|
|
|
Halo test
|
checks for CSF
|
|
|
21 yo male with C/C-severe headache
|
Aneurysm
|
|
|
Unequal pupils suggests
|
CNS injury or a neurological crisis
|
|
|
T4 injury
|
paralysis below nipple line
|
|
|
T10 injury
|
paralysis below the umbilicusPt loss of feeling below nipple line=T-4 spinal injury
|
|
|
Cerabellum
|
balance, coordination and fine motor control
|
|
|
Cerebrum
|
thought, intelligence, higher brain function
|
|
|
Slow venous bleed
|
subdural
|
|
|
Fast arterial bleed
|
epidural
|
|
|
Syncope
|
DO NOT place in Fowler's position. DO ECG/IV KVO and Accucheck
|
|
|
CVA or Seizures
|
DO NOT IV w/ 5% D5W wide open
O2/Airway/EKG |
|
|
Seizures w/out regaining consciousness in between 2+ seizures=
|
status epilepticus
|
|
|
CLASSIC s/s stroke
|
aphasia/loss memory/hemiplegia
|
|
|
Increased carbon dioxide in blood
|
hypercarbia
|
|
|
One pupil slow and nonreactive, other slow to respond
|
Neurological crisis
|
|
|
Transport stroke pt in
|
LLR ( as EMT we are taught affected side down, Brady book says LLR)
|
|
|
Blood under dura
|
subdural
|
|
|
Outside to brain
|
dura, arachnoid, pia (in to out =pia, arachnoid, dura)
|
|
|
Part of the brain which effects vision
|
Occipital/ injury=vision affected
|
|
|
If old, PMHX: diabetic, stroke, aphasic, syncopal episode, dementia, recent surgery, immobilized in warm comfortable environment= cool/pale diaphoretic w/ no apparent or obvious chest pn. Accucheck WNL
|
consider silent MI=monitor for ekg changes ( long scenario)
|
|
|
Vagalvalsa manuever
|
passed out while on toilet
|
|
|
Seizures
|
valium/diazapam=5-10 mg
|
|
|
Status epilepticus=
|
Insert NPA/O2/ IV NS/ keep safe..Do not intubate=medical emergency and priority pt.
|
|
|
Seizure pt. a priority=
|
if no respond between seizures or in status state
|
|
|
Seizure common in children
|
Febrile
|
|
|
Seizure mistaken for daydreaming
|
absence
|
|
|
Seizure found in children of short duration w/ no loss consciousness can occur 100
|
times per day=Focal Motor
|
|
|
Focal motor
|
clonic movements of one hand,one arm, one leg or one side of face
|
|
|
Syncope is associated
|
Heart block
|
|
|
Syncope associated with
|
Bradycardia
|
|
|
Syncope associated with
|
hypoglycemia
|
|
|
Syncope
|
cardiogenic, non-cardiogenic or idiosyncratic
|
|
|
Syncope associated with
|
psychoneurogenic shock
|
|
|
Syncope associated with
|
stroke/ishemia/hypoxia
|
|
|
Syncope associated with=
|
vasovalsa manuever
|
|
|
Scenario=Syncopal pt. Do all except
|
Lift patient in sitting positio
|
|
|
Major contradiction Thrombolytic tx
|
Bleeding out
|
|
|
Major complication Thrombolytic therapy
|
recent surgery
|
|
|
EKG-No P waves
|
SA NODE is NOT pacemaker; unless a strip is shown DO NOT ASSUME A-Fib
|
|
|
Stimulation of Sympathetic NS
|
Increased HR (+chronotrope) and blood vessel constriction ( INCREASES PVR Periphreal vascular resistance)........Remember: fills the tank......=BETA RECEPTOR STIMULATION
|
|
|
Pt. family with DNR, can't find it
|
Start CPR
|
|
|
Cardiac Tamponade
|
JVD, narrowing pulse pressure ( systolic closer to diastolic), clear lungs, muffled distant heart sounds
|
|
|
Tracheal deviation
|
late sign tension pneumo/cardiac tamponade
|
|
|
Most unstable or lethal ectopic beats originate
|
ventricles
|
|
|
Most deaths after MI within
|
2 hours
|
|
|
OD tricyclic
|
EKG= all irregularities except inverted T waves
|
|
|
Part heart most commonly damaged
|
left ventricle
|
|
|
Pain in chest that is searing and tearing with radiation to neck and No pedal pulses
|
Aortic Aneurysm
|
|
|
Stable angina responds
|
to rest and NTG
|
|
|
Stable Angina occurs
|
During exercise or stress
|
|
|
Nitro
|
reduces preload in pulmonary edema and subsides w/ rest and NTG
|
|
|
Initial NTG dose
|
=.4mg sublingual
|
|
|
Unstable Angina
|
may not subside w/ rest consider=AMI
|
|
|
Thrombi in deep part of legs(DVT) migrates
|
RIGHT VENTRICAL (venous side)
|
|
|
Pulmonary Edema
|
Pink frothy sputum/cyanosis/rales/tachycardia
|
|
|
Pulmonary artery carries deoxygenated blood to the lungs
|
right atrium has lowest amount oxygen
|
|
|
Pulmonary vein carries oxygenated blood to the heart
|
left atrium has highest amount oxygen
|
|
|
Arteries carry bloood
|
away from heart
|
|
|
Veins carry blood
|
to the heart
|
|
|
PEA
|
not pneumonia
|
|
|
Systolic BP
|
pressure of blood agst. ARTERIAL wall during heart beats
|
|
|
Diastolic BP
|
pressure of blood agst. arterial walls between heart beats
|
|
|
Adrenal glands secrete
|
Epinephrine
|
|
|
Stroke volume
|
amount of blood EJECTED from the heart DURING EACH CONTRACTION(Systole)
|
|
|
If stroke volume does not change, but HR decreases
|
Cardiac output decreases
|
|
|
Cardiac output decreases
|
perfuse the heart
empty via =coronary sinus |
|
|
Coronary Occlusion
|
thrombosis
|
|
|
Periphreal vasoconstriction
|
pallor
|
|
|
Wide bizarre look in monitor
|
V-Tach
|
|
|
Highest 02 concentration
|
left atrium
|
|
|
Lowest 02 concentration
|
right atrium
|
|
|
EKG paper large block
|
.20 seconds
|
|
|
EKG paper small block
|
.04 seconds
|
|
|
P-R Interval greater than
|
.20 seconds diagnostic for heart block
|
|
|
P-R Interval is measured from
|
beginning of P wave
|
|
|
P-R Interval=
|
normal .12-.20 seconds
|
|
|
P waves get wider till QRS drops
|
Wenkebach Mobitz II
|
|
|
Re-entry may cause
|
premature beats=tachydysryhthmias (ex. PAC)
|
|
|
Wide QRS rhtthm w/ no p-waves
|
idiovoventricular (look at strip if provided; this is assumed from other tests)
|
|
|
Routes of Epi=
|
IV (1:10000), ET Doubled ( 2-2.5 mg cardiac arrest), SC (1:1000 .3-.5 mg)
|
|
|
V-Fib will occur if
|
cardiovert on=T wave
|
|
|
Isoproterenal=
|
increases myocardial oxygen demand
|
|
|
ALPHA
|
CONSTRICTION ( Normal)=periphreal
|
|
|
BETA
|
DILATION (normal)
|
|
|
Blockers
|
ALPHA NON CONSTRICTION OR DECREASED VASCULAR RESISTANCE (Hypertension meds)
BETA INCREASES CONSTRICTION OR INCREASED VASCULAR RESISTANCE and can decrease HR ( many are selective) |
|
|
Calcium Channel Blockers
|
Decrease HR
|
|
|
Chemoreceptors
|
Medulla, pons, aortic arch..
|
|
|
Regulates BP/RR/PULSE
|
MEDULLA OBLONGOTA
|
|
|
Neurotransmitte
|
Parasympathetic is acetylcholine
|
|
|
Stimulation of vagal nerve
|
production of acetylcholine
|
|
|
Neurotransmitter of vagus nerve
|
acetylcholine
|
|
|
Chest pain after 02
|
morphine sulfate 3 1 pain relief
|
|
|
Side effect of Bretylium
|
Postural/orthostatic hypotension
|
|
|
Two-sided heart failure
|
Pulmonary edema
|
|
|
Inotropic
|
contractility...Positive increases..negative inoptrope decraeses contractility
|
|
|
85 yo w/ severe headache, NV, dizzy , BP 210/120=
|
Hypertensive crisis
|
|
|
Epinepherine causes all of the following:
|
Increased automaticity/HR/BP NOT DECREASED SYSTEMIC RESISTANCE
|
|
|
Automaticity
|
ability of heart to generate own electrical impulses
|
|
|
Post arrest pt:
|
: pH=7.00/Pco2=35/Po2=95/HCO3=12 =Give sodium bicarb in metabolic acidosis
|
|
|
Hypotensive pt=
|
dopamine/fluid bolus/epi drip/trendelenburg NOT FOWLER's
|
|
|
60 yo patient weights 110 lbs., heart palpitations, AP=145, BP=110/60, RR=24: EKG Wide complex Tachycardia Treatment
|
Lidocaine 1-1.5 mg/kg or 50 mg IVP
|
|
|
Pulmonary edema w/ cardiac symptoms
|
IV KVO
|
|
|
Epi=
|
stimulates heart in Aysystole
|
|
|
Norepi
|
causes vasoconstriction ( alpha 1 property )
|
|
|
CHF
|
decreased workload and a decreased preload
|
|
|
Cardiovascular assessment includes determining pulse and BP, in SECONDARY survey it also involves assessing venous pressure
|
JVD
|
|
|
JVD
|
Increased venous pressure
Right heart failure ( man sitting @ 45 degrees) |
|
|
Adult female tachycardic, VS are WNL
|
does not meet cardioversion criteria-try to calm her
|
|
|
Central venous pressure AKA
|
Right arterial pressure
|
|
|
Procainamide
|
Antiarhythmic
|
|
|
Procainamide
|
used for PVC, V-Tach, Maintnance of NSR after conversion from A-fib/A-flutter
|
|
|
Procainamide
|
STOP IF (one of four happens)= arrhythmia resolved/ QRS widens by 50%, P-R Interval is prolonged, or BP drops greater than 15mm/Hg...in additioon any toxic side effects occur=stop procainamide
|
|
|
Adrenal gland releases
|
epinephrine and norepinephrine(sympathetic NS=Fight or flight")
|
|
|
P for every QRS, P-R interval is .16. Pt. cold/clammy w/ BP 70/50.Pulse is 50. Rhythm and treatment
|
sinus brady and give atropine .5 mg
|
|
|
Norepipinephrine
|
Alpha and Beta Stimulator
|
|
|
Atropine given too slow causes
|
Parodoxical Bradycardia
|
|
|
Atropine
|
Parasympathetic blocker
|
|
|
C/C midsternal Chx pn: sinus brady w/ PVC's on monitor..P=40,BP+ 90/60, R=22
|
drug to give first is ATROPINE
|
|
|
Atropine side effects
|
Tachycardia/blurred vision/dry mouth NOT Sweating
|
|
|
Atropine causes
|
blurred vision
|
|
|
Atropine
|
Blocks effects of vagus nerve
|
|
|
Atropine is used to treat
|
Aysystole/Bradycardia/SECOND DEGREE HEART BLOCK NOT PSVT
|
|
|
Alpha one Stimulation causes
|
Increased HR/skeletal muscle contraction and arteriole constriction NOT Bronchodilation
|
|
|
V-tach, unconscious, no VS
|
Defib at 200j/300j/360j
|
|
|
Lidocaine
|
increases V-fib threshold/ used for PVC's/can cause seizures it does NOT DEPRESS CARDIAC FUNCTION
|
|
|
Do not give LIDOCAINE
|
PVC'S and BRADYCARDIA
|
|
|
Early s/s Lidocaine toxicity
|
muscle twitching or tremors/parasthesia (numbness and tingling)
|
|
|
Lidocaine OD
|
HYPOTENSION & seizures
|
|
|
If question says toxicity or OD
|
seizures ,Hypotension, tremors(twitching of muscles)
|
|
|
Lidocaine side effect
|
Hypotension and Bradycardia
|
|
|
During Cardiac arrest
|
build up of lactic acid causes=Metabolic acidosis
|
|
|
Lidocaine dose pulseless V-Tach
|
1 mg/kg then 1.5 mg/kg
|
|
|
Lidocaine administered
|
ET/IV/IO NOT rectal
|
|
|
Dead man dose lidocaine
|
1.5 mg/kg then 1.5 mg/kg
|
|
|
Next drug after Lidocaine for mulifocal PVC's
|
Procainimide
|
|
|
Lidocaine drip using 60 gtts/min at 20 gtts/min will deliver what amount in 30 minute trip to hospital
|
10 mL
|
|
|
Lidocaine drip
|
2 gm in 250 bag D5W=15 drops
2 gm in 500 bag D5W=30 drops 2 gm in 1000 bag D5W=60 drops |
|
|
Lidocaine dose 110 llbs
|
50 mg then 2-4 mg/min
|
|
|
Lidocaine dose w/ 80 kg pt. w/ PVC's
|
100 mg lidocaine
|
|
|
Never do a
|
slow code
|
|
|
Gel
|
decreases D-fib/paddle resistance= decreases resistance to increase conduction
|
|
|
Irregularly-irregular rhythm
|
A-FIB
|
|
|
Intubate a cardiac arrest pt
|
immediately
|
|
|
Synchronized cardioversion
|
occurs on R-wave
|
|
|
R on T phenomena can cause
|
VTACH?VFIB
|
|
|
Gallop Heart sound classified as S3 is s/s
|
CHF
|
|
|
scenario w/ LBP ( 51 yo w/ Pulse 110, BP 112/92, R-18)
|
do not administer norepi by titrated IV infusion
|
|
|
Pt. w/ pacer
|
shock at 200j but not over pacer
|
|
|
Rhythm strip shows some kind of indiscerable block
|
02/monitor and transport
|
|
|
Morphine
|
vasodilator
|
|
|
Major side effect of certain diuretic tx example: lasix
|
Hypokalemia
|
|
|
Pt. needs lidocaine for PVC's. 110 lbs needs bolus and drip
|
50 mg bolus and 2-4mg/min drip
|
|
|
Ascites
|
fluid in abdomen usually a result of CHF or Liver dysfunction
|
|
|
Verapamil side effects
|
hypotension/coronary artery dilation/bradycardia NOT TACHYCARDIA
|
|
|
Other names Verapamil
|
soptin/Calan...calcium channel blockers or CCB's
|
|
|
Pulmonary edema tx use
|
Lasix/morphine/nitro/O2 NOT SOLUMEDROL (Same as CHF treatment)
|
|
|
CHF
|
left-ventricular failure
|
|
|
ALL are vasopressors except
|
Atropine (Levephed/norepi and Intropin are vasopressors)
|
|
|
Beta blockers are used to treat
|
cardiac dysrythmias, Hypertension
|
|
|
When Beta blockers are stimulated
|
heart rate is increased+vasodilation+increased myocardial 02 demand Again NO BRONCHOCONSTRICTION
|
|
|
Beta Agonist (natural.normal response)=
|
Increased HR=+ chronotrope
|
|
|
Verapamil
|
contraindicated in WPW
|
|
|
Verapamil
|
Rapid a-fib/ A-flutter & SVT
|
|
|
Verapramil CONTRAINDICATION
|
Pulomary Edema & Cardiogenic shock
|
|
|
Side effects Verapramil
|
Tachcardia (WPW Problems)
|
|
|
Verapramil side effects
|
Decreased vasoconstriction(hypotension) and decreased conductivity
|
|
|
Wolfe-Parkinson-White with no s/s (hemodynamically stable in PSVT=
|
adenosine 6mg if no change/12 mg/12 mg fast IV push
|
|
|
Adenosine
|
slows conduction through AV node..slows all cations
|
|
|
Pulseless V-Tach
|
Defib 200j/300j and 360j
|
|
|
Symptoms due to tachycardia are related to
|
decreaded ventricular filling time and stroke volume
|
|
|
Quickest way to check for circulation
|
check pulse!!
|
|
|
Drug with posistive inotrope will cause(contractility)=
|
increased force of contraction
|
|
|
Epi given IV during Cardiac arrest does all of the following:
|
Increases myocardial blood flow/increases force of contraction/dilates bronchioles/increases periphreal resistance DOES NOT DECREASE PERIPHREAL VASCULAR RESISTANCE
|
|
|
Epi
|
DOES INCREASE MYOCARDIAL DEMAND
|
|
|
Side effects epi SC or IV
|
palpitations and HYPERTENSION
|
|
|
Pt. w/ MI
|
dr. needs present compliants and history
|
|
|
Not true regading Lasix
|
can not be given ET
|
|
|
Lasix
|
vasodilator, diuretic, causes dehydration and can cause Hypokalemia or decreased potasium
|
|
|
HYPERkalemia
|
elevated T waves
|
|
|
Lasix must be given slowly
|
can cause dehydration and can cause fetal problems if given to pregnant pt. Lasix dose=start at 40 mg
|
|
|
Lasix
|
works in loop of henle, is a loop diuretic, DECREASES preload, prevents reabsorption of sodium, causes venodilation within 5 minutes. NO INCREASE preload.
|
|
|
Lasix (Furosemide) side effects
|
HYPOKALEMIA, venodilation, reduce preload, and increase urine output...
|
|
|
ANY DIURETIC TX
|
can cause HYPOKALEMIA
|
|
|
AMI
|
ASA/NTG/Morphine NOT lidocaine
|
|
|
You draw up 800 mg of dopamine which comes 25 mg/cc. How many cc's will you put in the IV bag:
|
32 cc's
|
|
|
Medication first given for SVT=
|
Adenosine
|
|
|
Adenosine side effects
|
SOB/Chest Pn/dizziness...TACHYCARDIA is NOT SIDE EFFECT
|
|
|
Adenosine
|
PSVT assoc. w/ WPW syndrome refractory to vagal maneuvers
|
|
|
Beta stimulation
|
vasodilation/bronchodilatiopn/tachycardia NOT Vasoconstriction
|
|
|
Isoproterenol=
|
2-20 mcg/min
|
|
|
Digitalis
|
Causes blurred vision/dizziness/decreased HR/positive chronotropic
|
|
|
Digitalis is contraindicated
|
in HEART BLOCKS
|
|
|
Digitalis toxicity
|
A-fib...also used to treat a-fib=DO NOT SHOCK
|
|
|
Don't shock
|
digoxin/digitalis pt.
|
|
|
Pt. takes digitalis is weak/dizzy,VS WNL
|
= monitor,IV and transport
|
|
|
Stroke volume
|
amount of blood ejected in one contraction (500 ml)
|
|
|
Cardiac Output
|
Heart rate x stroke volume
|
|
|
BP
|
Cardiac output x PVR
|
|
|
BP varies by age and sex. Normal SYSTOLIC males=
|
100+age
|
|
|
Chest pn
|
questions should also include=GI problems and musclular skeletal issues
|
|
|
BBB
|
transport=cannot rule out Cardiac event
|
|
|
Cardiac output
|
amount of blood ejected in one minute= Stroke volume x Heart rate
|
|
|
Normal Cardiac output
|
500 ml per heart beat
|
|
|
Normal pulse rate adults
|
60-100 bpm
|
|
|
Pulse pressure
|
systolic pressure minus diastolic pressure or difference between systolic and diastolic
|
|
|
Palp BP
|
Systolic measure only
|
|
|
Heat stroke
|
Aggressive cooling methods then 2 IV's wide open
|
|
|
Heat stroke
|
Failure of heat-regulating mechanisms
|
|
|
TB s/s
|
Weaknesss and weight loss, night sweats and fever,hemoptsis and SOB
|
|
|
TB
|
NO substernal Chx PN w/ radiation to arms
|
|
|
Contamination vai dirty linen
|
indirect contamination
|
|
|
Fresh water drowning
|
hemodilution, electrolyte imbalance and hypoxia w/ resp. acidosis
|
|
|
Scenario: Fresh water drowning
|
NOT RESP. ALKALOSIS
|
|
|
Primary concern in treating a near-drowning victim
|
mgmt of HYPOXIA and ACIDOSIS
|
|
|
Fast ascents from dives=joint pain, tingling in legs, and abdominal pain
|
decompression sickness
|
|
|
Farmer
|
Organophosphate poisoning
|
|
|
Organophosphate
|
SLUDGE ( pulse also slow and pupils constricted) NO Dry mouth***** Think Parasympathetic OD of Acetacholine
|
|
|
Hot,dry skin, summer, temperature of pt 106 degrees and unconscious
|
heat stroke
|
|
|
Profuse sweating
|
heat exhaustion
|
|
|
Heat exhaustion
|
salt and water loss via sweating/evaporation
|
|
|
Heat cramps
|
leg cramps from lactic acid accumulation
|
|
|
Coral snake
|
most neurotoxic of snake bites
|
|
|
INHALATION
|
POISON ABSORPTION=most frequent
|
|
|
INJECTION
|
Hymenoptera/ PCN= deadly
|
|
|
INGESTION
|
TOXIC ROUTE=most frequent
|
|
|
Burns cause massive generalized swelling
|
due to plasma movement into interstitial tissues
|
|
|
Electrical burns always check for
|
exit & entrance wounds
|
|
|
Blast injusries
|
compression of hollow organs particularly small intestine/bowel & eardrum problems
|
|
|
Blast injuries
|
lungs least likely to collapse
|
|
|
Near drown tx
|
hypoxia and acidosis
|
|
|
DT's
|
48-72 hours after decrease of ETOH consumption or NO ETOH in chronic ETOH abuse
|
|
|
Green tongue
|
chronic alcoholic
|
|
|
Chronic ETOH and Vitamin deficiency (Thiamine and B vitamines)
|
Wernicke's syndrome
|
|
|
CAGE questionaire-
|
ETOH evaluation
|
|
|
Fever prehospital
|
remove clothing
|
|
|
Best method on LSD pt
|
talk down/reorient
|
|
|
Pt. tachy and talking very fast
|
consider amphetamine use (pinpoint pupils?)
|
|
|
Transport SCUBA diver
|
LLR
|
|
|
If flying w/ SCUBA diver
|
fly as low as posible
|
|
|
Caissons disease
|
the bends=diving illness=ascention to fast
|
|
|
Most common route of POISONING
|
INGESTION
|
|
|
Absorption of toxins occurs in within
|
the small intestines
|
|
|
Most common route for toxins/hazmat
|
Resp & absorption via skin
|
|
|
30 year heroin addict with OD
|
complication of narcan withdrawal reactions
|
|
|
TCI
|
Sodium bicarb and CRUCIAL EKG monitoring Torsades commonly seen
|
|
|
TCI & LITHIUM & Saicylates
|
Sodium Bicarb to alkalinize urine and hasten elimination process
|
|
|
CYANIDE
|
Amyl nitrate+sodium Nitrate solution+ Sodium Thiosulfate Solution
|
|
|
BENODIAZEPINES
|
Flumazenil
|
|
|
OPIATES
|
Narcan
|
|
|
ACETAMINOPHEN
|
Mucomyst
|
|
|
NITRATES
|
Methylene Blue
|
|
|
ATROPINE
|
Physostigmine
|
|
|
Black widow
|
NO ANTIDOTE (cytotoxin)
|
|
|
Sick for days/450 blood glucose
|
pt. needs insulin/we don't give INSULIN
|
|
|
PT w/ IDDM
|
Insulin on daily basis to control illness
|
|
|
Hypoglycemia s/s
|
weak and rapid pulse,weakness and incoordination, seizures,cool and clammy NOT POLYURIA
|
|
|
Obvious diabetic ketoacidosis
|
WARM & DRY SKIN
|
|
|
Kussmauls
|
deep and gasping respirations seen in DKA/Hyperglycemia
|
|
|
Hypoglycemia
|
stupor, stumbles, slurred speech, bizarre Bx, cool/clammy skin (D50W=25 g dexrose) Child dose=12.5 g dextrose also termed D25W
|
|
|
Normal
|
80-120
|
|
|
Measured glucose
|
mL/dL
|
|
|
Body cannot use glucose over
|
180 mL/dL
|
|
|
All s/s of DKS ecxept no kussmaul respirations and no fruity breath
|
HHNK
|
|
|
HHNK
|
=Osmotic diuresis with no ketones being used/burned for energy
|
|
|
Scenario; diabetic pt w/ headache=most important ?:
|
how long have you had headache
|
|
|
Administering glucose
|
stimulates the release of glucagon
|
|
|
Before giving dextrose
|
always check glucose
|
|
|
Never give insulin in field to
|
IDDM
|
|
|
DKA
|
Kussmaul respirations=deep, rapid,gasping
|
|
|
DKA can be casued by pt
|
not taking insulin
|
|
|
Glucagon
|
causes a breakdown of stored glycogen to glucose or releases glycogen from liver
|
|
|
Glucagon
|
releases glygogen from liver
|
|
|
Pychiatric condition w/ wide mood swings
|
Manic-depression
|
|
|
Mood swings from euphoria to depression
|
Manic-depression
|
|
|
Lithium
|
drug for bipolar aka Manic Depression
|
|
|
Disoriented pt
|
Try to focus pt. on time,place,person and situation
|
|
|
Thorazine/Mellaril/ Haldol used for
|
Psychiatric patients particularly Schizophrenia
|
|
|
Haldol and thorazine
|
antipsychotics/tranqualizers
|
|
|
Tricyclic OD=
|
Sodium Bicarb
|
|
|
Psychotic vs. Neurotic patient main difference
|
Psychotic pt. not in touch w/ reality
|
|
|
Most likely to restrain
|
raged/angered pt.
|
|
|
Non-combativve but emotionally disturbed
|
be calm, identify self, be supportive
|
|
|
Behavioral emergency
|
person in danger to self or others ( think BA52-Baker Act)
|
|
|
Extrapyramidal reaction from
|
antipsychotic meds
|
|
|
Extrapyramidal reaction
|
tx. is Benadryl 25-50 mg
|
|
|
Elderly
|
diminished vision inherent with aging
dementia=deterioration of mental status with neuro disease= ALZHEIMER's common cause injury=falls |
|
|
Dementia
|
increases falls in eldderly
|
|
|
Decreased pain perception
|
particularly if old-old (+85) or DIABETIC=Silent AMI
|
|
|
Most common elder abuse
|
Neglect
|
|
|
Most common child abuse
|
Physical
|
|
|
Infant with rib fractures
|
suspect abuse
|
|
|
Do not rule out Shaken Baby Syndrome
|
lethargic and no other s/s
|
|
|
Sons most likely
|
Abuse parents (elderly)
|
|
|
Caregiver's
|
most likely to abuse children
|
|
|
Special needs children, wrong sex, disabled
|
suspect abuse (all ages)
|
|
|
Story does not match injury
|
suspect abuse (all Ages)
|
|
|
Healing in various stages
|
suspect abuse (all ages)
|
|
|
Scalding circumferential with no splash marks-
|
suspect abuse (all ages)
|
|
|
Deaf
|
look directly at pt, do not yell, speak slow
|
|
|
Hard of hearing
|
lower tones better heard= best to use a male medic
|
|
|
Two common TCA's=
|
Elavil and Trofanil= OD Soduim Bicarb
|
|
|
Let the psych pt
|
cry if ipt. is crying and listen to them cry!
|
|
|
No discriminate agst. AIDS/Communicable disease pt
|
violation of American's with Disabilities Act
|
|
|
If use fireman's drag
|
sit patient up DO NOT TIE HANDS TOGETHER (as on other Rambling Thought's; this is incorrect)
|
|
|
Elderly abuse
|
unreasonable confinement
|
|
|
Tolerance
|
need more and more of drug to reach desired effect
|
|
|
Restraining in behavioral emergency
|
One arm over head, other arm behind pt's side, lying prone (face down) w/ feet tied together @ end of stretcher
|
|
|
Behavioral emergency
|
Can not be tolerated by pt. or members of society
|
|
|
False beliefs
|
delusions
|
|
|
Any hostile, angry, or paranoid pt=
|
meet w/ non-aggressive bx
|
|
|
Crying spells, anorexia, unkempt, lethargic. PE (physical exam)=
|
no abnormalties=depression
|
|
|
28 yo w/ depression hx, unconscious, sweating, pinpoint pupils, skin and fine motor fasciculations and tearing excessively=
|
Lithium OD
|
|
|
Mgmt. of suicide crisis
|
every attempt needs to be evaluated by physician
|
|
|
Flase re: treating a paranoid pt
|
Don't take pt. aside to talk
|
|
|
If psychiatric pt. violent
|
wait for assistance if pt. violent=call law enforcement
|
|
|
"experience of sense of dread or fear, distress over real or imagined threat to one's own mental or physical well-being
|
anxiety
|
|
|
Valium routes of administration
|
RECTAL, IV & IM
|
|
|
Old lady thinking neighbors are out to get her
|
remove her from situation and keep her talking
|
|
|
Person witnesses murder. He ppears paralyzed while PE reveals no injury/abnormalty
|
conversion hysteria
|
|
|
Women threatened to kill self w/ barbituates. She is willing to talk, but not open door
|
contact interview from outside door and call police
|
|
|
Person frightened of heights/can't ride elevator
|
phobia
|
|
|
Crisis intervention
|
is that it is suitable for application iin many situations faced by medic
|
|
|
How to deal w/ the effects of a pt's bx re: physical exxam (PE)=
|
modify the exam if necessary
|
|
|
Pt. exhibiting hostile, aggressive bx
|
contact police and remove bystanders from scene
|
|
|
Dealing w/ hostile pt. you and your partner
|
stand apart from each other @ equal distances from each other
|
|
|
DO NOT EVER LET PT
|
BLOCK EXIT
|
|
|
Distraught elderly person urinates while upon stretcher & does not inform you until she/he is finished=
|
bx is example of Regression
|
|
|
False beliefs
|
delusions
|
|
|
Delusional geriatric
|
remove from situation
|
|
|
Restrain
|
prone, 1 arm @ side, other above head, ankles together
|
|
|
Spleen, LUQ
|
part of lymphatic system
|
|
|
Choleosystitis
|
Vomiting green/yellow bile...FATTY MEALS will cause also
|
|
|
Bile
|
enzyme produced in liver and stored in gall bladder
|
|
|
Pouch
|
like herniations through muscular layer of colon=diverticulosis found usually in LLQ
|
|
|
Colored portion eyeball that surrounds pupil
|
iris
|
|
|
Sclera white of eye that yellows with
|
jaundice
|
|
|
Optic nerve
|
transmits sight to back of the eye for brain interpretation
|
|
|
Occipital lobe
|
vision
|
|
|
Neurological findings during or after dialysis as result of imbalance of intracellular and extracellular fluids in brain
|
disequilibrium syndrome
|
|
|
Hyperthyroidism which increases thyroid hormone circulating in bloodstream AKA
|
Grave's disease
|
|
|
Pituatary gland
|
Master gland=secretes oxytocin and ACTH
|
|
|
Endocrine
|
ductless and release directly to bloodstream, hormones are what they release
|
|
|
Exocrine Glands
|
duct glands excrete directly through ducts to epithelial cells (sweat/salivary
|
|
|
Endocrine system
|
lymphatic
|
|
|
Endocrine acts by
|
hormone release
|
|
|
Spleen
|
=lymphatic organ
|
|
|
Major extracellular cation=
|
Sodium (***sweat tastes extra salty on skin)
|
|
|
Major intracellular cation
|
potasium (***In my pot )
|
|
|
Cations=
|
=++=potasium( helps with electrical/nerve conduction), magnesium, calcium ( helps w/ nerve/electrical conduction) and sodium ( helps with fluid regulation)
|
|
|
Head Trauma pt. with s/s shock, then find no head trauma but still s/s of AMS
|
Look elsewhere/change differential diagnosis
|
|
|
Dialysis
|
removal of toxins from blood through a semi-permeable membrane
|
|
|
Hemotoxin
|
toxins in blood
|
|
|
Insulin
|
hormone released by =beta cells in pancreas=@ Isles of Lagerhans
|
|
|
Orthopnea
|
place pt. in sitting position
|
|
|
When evaluating s/s of CC: last appt w/ Dr. not as important as
|
time and rapidity of onset/duration/location of pain
|
|
|
Uticaria
|
Hives
|
|
|
Orthostatic
|
take BP lying down, sit and stand @ 2 min intervals measures dehydration or hypovolemia-fuid lossor blood loss
|
|
|
Dehydrated pt.=
|
will not see decreased HR
|
|
|
Activated charcoal
|
1 Gm/kg
|
|
|
OPQRST
|
OPQRST
|
|
|
Heimlich hands placed on
|
abdomen
|
|
|
Not a sign dehydration
|
polyuria
|
|
|
Pryrogenic reaction
|
fever, chills,nausea, vomiting ( common in blood transfusions)
|
|
|
Pryrogenic =
|
natural compensatory mechanism for increased body temperature and infection
|
|
|
Cholecystitis
|
female, fat, forties, and after eating fatty foods=RUQ PN
|
|
|
Droplets
|
Measles, mumps chicken pox
|
|
|
Think that all childhood diseases are spread via
|
droplets that is why we are vacinated
|
|
|
TB
|
spread by droplets=HEPA
|
|
|
If patient coughing
|
mask them and/or self
|
|
|
Best defense
|
handwashing
|
|
|
Hep A
|
Fecal/oral route
|
|
|
Hep B
|
very virtulant and can stay on surfaces for days
|
|
|
Microorganisms
|
fungus/bacteria/viurus NOT erythrocyte (RBC)
|
|
|
Handwashing
|
best defense agnst. disease
|
|
|
UNIVERSAL PRECAUTIONS
|
gloves/mask/gloves/gown and eyewear
|
|
|
Menningitis
|
stiff neck,high fever, headache/backache
|
|
|
Always discrad in sharps container
|
marked container/puncure-proof
|
|
|
Keep up w/ vacinations
|
if never had varicella(chicken pox)=mask/gloves
|
|
|
If never had varicella(chicken pox)=
|
and partner has had it=have partner attend to patient
|
|
|
AIDS
|
oppurtunistic infections are Thrush or monilia.TB. and CMV and Pneumonia
Kaposi's sarcoma=purple/blue lesions=UNIVERSAL PRECAUTIONS |
|
|
High risk AIDS
|
increased exposure to blood/body fluids & unprotected sex (Most common cause)
|
|
|
Fever/chills/night sweats and blood in cough
|
TB without hemotypsis=HIV
|
|
|
How do you know if someone has AIDS
|
you don't=You ask but they may not tell you truth
|
|
|
Shingles is
|
NOT contagious
|
|
|
Gonorrhea
|
highest transmitted STD
|
|
|
48 hours to begin
|
prophylactic HIV Treatment
|
|
|
Hypovolemic mom due to blood loss and newborn is delivered=newborn fluid replacement
|
10cc/kg (newborn and infant to one year) mom-20 cc/kg
|
|
|
Children (1-8) fluid replacement
|
20cc/kg (one year and up as 20cc/kg = adult fluid bolus dosage)
|
|
|
Treating a child and mother is hysterical
|
assign a crew member to calm mom
|
|
|
Croup aka LARYNGOTRACHEOBRONCHITIS
|
occurs at night, seal bark, stridor..Do not lay flat and keep calm. Do not examine throat or laryngospasm can occur. Use humidified oxygen. THE MOST DANGEROUS DISORDER CAUSING UPPER AIRWAY STRIDOR=CROUP
|
|
|
Newborn
|
ekg not vital to perform
|
|
|
Life threatening infection..bacterial that causes upper airway obstruction with reluctance to swallow due to pain and high fever=
|
Epiglotitis (DROOLING)..Do not lay flat. Keep calm. do not exam throat or laryngospasm can occur. O2 humidified.
|
|
|
Epiglotitis scenario will say
|
sitting upright/fever/drooling
|
|
|
When opening airway of infant
|
do not exagerate head tilt it may obstruct breathing passages.
|
|
|
Suction then
|
mouth then nose
|
|
|
Obligatory nose breathers
|
newborns
|
|
|
4-6 months children should
|
double birth weight
|
|
|
by age one
|
21 pounds
|
|
|
Average weight at birth
|
7 pounds
|
|
|
Pediatric dose atropine
|
.02 mg/kg
|
|
|
Child CPR Compression depth
|
1-1.5" ( ages 1-8 )
|
|
|
NO atropine
|
infant v-fib
|
|
|
Number 1 cause of death
|
trauma
|
|
|
SIDS=
|
4-6 months of age highest death rate=1 week to one year= (answer) tricky one.
|
|
|
Assess child
|
toe to head
|
|
|
3-5 years
|
magical thinking
|
|
|
Adolescents
|
seperate from parents when questioning and honor modesty
|
|
|
Febrile seizures
|
caused by SUDDEN temperature changes, are usually self-limiting and require minimum treatment, treatment should include gentle cooling measures such as removing clothing/blankets and tepid water used...They SHOULD be transported to hospital.
|
|
|
Meconium staining
|
fetal distress
|
|
|
Meconium staining
|
First Intubate and suction prior to first breath
|
|
|
Broslow Tape
|
weight based tape
|
|
|
CPR on infant
|
fingertip pressure, faster compression(1:3) rate than adult
|
|
|
Encircle infants body
|
proper CPR=thumbs (NEW AHA CRITERIA)
|
|
|
CPR Infant if can't encircle
|
big baby=2 fingers one finger width below nipple line
|
|
|
Innitial Joules
|
under 8=Initially 2j/kg then 4j/kg
|
|
|
Infant=uncuffed due to till 8 years old=
|
narrowest area of airway crichoid
|
|
|
Seizures
|
convulsions=most common in children 6 months to 6 years due to febrile illness
|
|
|
Child Bells ringing in my head and hyperventilating (respitory ALKALOSIS)=
|
ASA OD
|
|
|
ASA OD
|
Vomiting/diarhea/dehydration/diaphoresis/clammy can lead to =Metabolic ALKALOSIS
|
|
|
Single indicator of neonatal distress
|
BRADYCARDIA
|
|
|
Pediatric Lidocaine dose
|
1 mg/kg of body weight
|
|
|
Pedi dose lidocaine for 20 pound child
|
9 mg
|
|
|
Pedi can use
|
miller or macintosh blade and a stylet
|
|
|
2 yr. old w/ fever
|
cover in tepid towels
|
|
|
Bolus
|
10 mg/kg=INFANT/NEONATE
|
|
|
Child playing w/dry ice
|
immerse warm water
|
|
|
Pediatric dose SC Epi for allergic reaction
|
=.0l mg/kg
|
|
|
Pediatric pt weights 67lbs. needs SC epi what is dose
|
=.3mg
|
|
|
Child 18 or under C/C headache, stiff neck, vomiting
|
menningitis
|
|
|
Asthma attack=primary problem=
|
Bronchoconstriction w/ bronchospasms
|
|
|
Pedi=Bradycardic
|
first drug line=02
|
|
|
#1 cause pediatric arrest
|
respitory arresst
|
|
|
Larngotracheobronchitis
|
croup=night=stridor=do not lay flat=barking seal-like cough
|
|
|
Unilateral chest wheeze-6 yo child consider
|
FBO
|
|
|
Pediatric pt=altered bx, has flu, nausea, vomiting
|
consider Reye's syndrome
|
|
|
Unexplained viral infection in children
|
consider Reye's syndrome
|
|
|
Not a S/S Reye's syndrome
|
dehydration
|
|
|
S/S resp. distress=nasal flaring, tracheal tugging, pursed lips=
|
particulary seen with infants/pedi population
|
|
|
Neonate
|
position, suction, stimulation
|
|
|
Compressions on infants
|
start if HR less than 60 bpm
|
|
|
Positive pressure ventilations are given to infants
|
HR less than 100 bpm
|
|
|
Epiglotitis
|
rapid ONSET fever higher than 101 degrees usually
|
|
|
Croup
|
Slow onset fever usually between 100-104 degrees
|
|
|
Pediatric Atropine dose
|
0.02 mg/kg
|
|
|
Scenario:Ominous sign of resp. FAILURE in 6 yo
|
Hypothermic breathing 6x/minute
|
|
|
Stylet
|
makes intubation easier and CAN be used with infants
|
|
|
A single important indication in neonatal distress is
|
Bradycardia
|
|
|
IV drugs administered to a premature infant in the field should be administered ONLY IF
|
the HR remains less than 60 bpm. Tracheal route is the most rapidly accessible route for drug administration; umbilical vein is fastest VENOUS route.
|
|
|
Best way of delivering 02 to an asthmatic child in acute distress
|
humidified 02
|
|
|
Unresponsive baby w/ frantic mom
|
never restrain mom
|
|
|
IO
|
Placement proximal tibia
|
|
|
Infant not breathing for 1-2 minutes, then suddenly begins spontaneous resps
|
assist ventilations
|
|
|
Anterior fontanelle
|
bones not yet fused, slightly sunken, and may pulsate=normal
|
|
|
Sunken fontonelle=
|
possible dehydration
|
|
|
Bulging fontenelle
|
NOT linear skull Fx
|
|
|
Bulging fontonelle
|
ICP,overhydration, traumatic injury coup-countercoup,shaken-baby syndrome
|
|
|
Pediatric ingested lye
|
give milk
|
|
|
Dehydration in child from
|
vomiting, diarrhea, fever, burns
|
|
|
Location for IO
|
Below tibial tuberosity
|
|
|
Location IO
|
Two fingers below tibial tuberosity, on medial surface of tibia
|
|
|
Common fx pediatric long bone
|
greenstick fx
|
|
|
Child inhales freon
|
PVC's/VTACH,VFIB
|
|
|
Initial survey does not include=
|
vital signs..Airway/pulse/ access any hemorrhage(ABC's=BLS)
|
|
|
A
|
Alert in AVPU
|
|
|
Tissue anoxia from decreased blood flow that leads to narrowing or occlusion of the artery TO THE TISSUE
|
Ischemia
|
|
|
Ischemia leads
|
leads to injury which leads to infarct AKA necrosis or death of tissue to death of organ
|
|
|
Why should you palpate painful quadrant last?
|
because palpation may lead to entire abdominal area to have pain.
|
|
|
End of femur towards foot
|
distal end
|
|
|
Visceral pleura
|
covering of lungs..visceral covers organs parietal covers abdominal cavity/thoratic cavity etc.
|
|
|
Smooth/Skeletal/cardiac
|
types of muscle
|
|
|
Effusion
|
the escape of fluid into a cavity
|
|
|
Connects bone to muscle
|
tendon
|
|
|
Bone to bone
|
ligament
|
|
|
Use dressing first and then
|
bandage
|
|
|
A bandage
|
holds dressing
|
|
|
Open fx Tx
|
dress wound then bandage
|
|
|
Down and under injuries
|
ankle/femur fx
|
|
|
Voluntary muscles
|
move bones
|
|
|
Secondary assessment does not include determining
|
Life threatening injuries
|
|
|
Immobilize shoulder injury
|
sling & swath
|
|
|
Ligamentum Arteriosum
|
connects descending aorta to spine
|
|
|
Dislocation of a Joint
|
subluxation
|
|
|
Partial dislocation of a joint that remains in place but is deformed
|
subluxation
|
|
|
Iron conaining pigment in RBC
|
Hemoglobin
|
|
|
# 1 vertabrae
|
atlas
|
|
|
% of RBC in whole blood
|
hemocrit and should be approximately 45%
|
|
|
Liver produces
|
bile
|
|
|
Gallbladder stores
|
bile
|
|
|
Involuntary is NOT a type of
|
muscle
|
|
|
Process in which cell size decreases
|
atrophy
|
|
|
Remove foreign object if
|
interferes w/ breathing or CPR
|
|
|
Guarding
|
voluntary or involuntary contractions of the abd. muscles in response to severe abdominal pain
|
|
|
Abdominal muscle flexion on palpation
|
guarding
|
|
|
Exchanging various biochemical substances across semipermeable membranes to remove toxic substances=
|
dialysis
|
|
|
JVD not a s/s of
|
dehydrations
|
|
|
Polyuria not s/s
|
dehydration
|
|
|
Thrombolytic therapy disadvantages
|
costly & may cause excessive bleeding
|
