Term
Medication Assessment
List the Six Rights |
|
Definition
| Medication, dose, route, time, patient and documentation |
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Term
Medication Assessment
List the 3 C’s and an E |
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Definition
| Color, clarity, concentration and expiry date |
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Term
| Medication Assessment - what is the full procedure before you administer a drug? |
|
Definition
1. List the 6 Rights - Medication, dose, route, time, patient and documentation
2. List the 3 C’s and an E – Color, clarity, concentration and expiry date
3. Confirm indications
4. Verify no contraindications (list them all)
5. List side effects (all of them)
6. Verbalize that Vitals are done before administration and within 5 minutes after administration |
|
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Term
Neurological Assessment
When to use |
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Definition
Whenever your patient has an altered level of consciousness or memory loss
You should check the:
- LOC
- CMS X in all 4 extremities
- Pupils
- Consider AEIOU and TIPS |
|
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Term
Neurological Assessment
AEIOU
TIPS |
|
Definition
A Alcohol, Apnea, Anaphylaxis
E Epilepsy, Environmental
I Insulin
O Overdose
U Underdose
T Trauma
I Infection
P Psychiatric, Poisoning
S Stroke, Shock |
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Term
Where does gas exchange occur in lungs?
What gases? |
|
Definition
Alveoli
Oxygen in and Carbon dioxide out |
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Term
| What are the time-scales and effects of lack of oxygen? |
|
Definition
0 - 1 minutes: cardiac irritability
0 - 4 minutes: brain damage unlikely
4 - 6 minutes: brain damage possible
6 - 10 minutes: brain damage very likely
> 10 minutes: irreversible brain damage |
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Term
| What is the Primary breathing stimulus? |
|
Definition
Raised CO2 levels - brain stem senses level of carbon dioxide in blood, stimulating breathing
We blow off more CO2 than we inhale
If CO2 levels increase - breathing rate will increase and breaths become deeper
If CO2 levels decrease - Breathing rate decreases and breaths become shallow |
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Term
What is the secondary breathing stimulus?
In what group of patients does it become more important than the Primary breathing stimulus? |
|
Definition
Hypoxic drive is the secondary breathing stimulus based on a lack of oxygen in the blood
Over time COPD patients often develop a higher level of CO2 in their blood and the primary stimulus to breath (CO2 levels) fails.
These patients will often end up being stimulated to breath primarily through their hypoxic drive. |
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Term
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Definition
| Myocardial infarction, Pulmonary edema, Stroke, Chest injury, Shock, Acute narcotic overdose (Pinpoint pupils/respiratory depression), Smoke inhalation, Lung disease, Asthma |
|
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Term
| Signs and symptoms of hypoxia |
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Definition
- Nervousness irritability and fear
- Tachycardia – HR over 100 BPM
- Mental status changes
- Use of accessory muscles for breathing
- Difficulty breathing, possible chest pain |
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Term
| What are the normal respiration rates for adults, children and infants? |
|
Definition
Adults: 12 to 20 breaths/min
Children: 15 to 30 breaths/min
Infants: 25 to 40 breaths/min |
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Term
| What does "adventitious sounds" mean? |
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Definition
| Any abnormal sounds heard on auscultation (listening) with a stethoscope e.g. crepitations (crackling), rhonchi (wheezing) |
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Term
| What are the signs of inadequate breathing? |
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Definition
Labored breathing (using more energy then usual)
Use of accessory muscles
Pale or blue skin
Cool, clammy skin
Irregular respiration pattern
Adventitious lung sounds |
|
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Term
| How do you position an unconscious patient? |
|
Definition
Kneel beside the patient
Straighten the patient’s legs and move nearer arm across the chest
Turn patient by pulling the distant hip and shoulder
Control the head and neck so they move as a unit with the torso
Roll onto backboard if available
Open patient’s airway and assess breathing |
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Term
| What is the maximum time allowed for continuous suction? |
|
Definition
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|
Term
| List the causes of airways obstruction |
|
Definition
Relaxation of the tongue (most common in a supine patient)
Vomited stomach contents
Blood clots, bone fragments, damaged tissue
Swelling caused by allergic reactions
Foreign objects |
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Term
| What are the two types of flow meters used with oxygen supplies? |
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Definition
1. Pressure-compensated flowmeter - Affected by gravity; must be kept upright, usually found on the wall of an ambulance of hospital
2. Bourdon-gauge flowmeter - Not affected by gravity; can be used in any position |
|
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Term
| What types of oxygen delivery devices are there? |
|
Definition
- Nasal Cannula
- Simple Face Mask
- Non-Rebreather Mask (NRB)
- Venturi Mask
- Bag-Valve Mask (BVM) |
|
|
Term
| When is a nasal cannula contraindicated? |
|
Definition
- Severe hypoxia
- Apnea
- Mouth breather
- Severe distress |
|
|
Term
| What is the limit to how fully inflated a nonrebreather mask bag should be? |
|
Definition
|
|
Term
| What is the oxygen concentration and flow rate for nasal cannula? |
|
Definition
24%-44% oxygen
Flow rate: 1-6 L/min |
|
|
Term
| What is the oxygen concentration and flow rate for simple face mask? |
|
Definition
35%-60% oxygen
Flow rate: 6-10 L/min
Carbon dioxide collects in mask if rate <6 L/min |
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|
Term
| What is the oxygen concentration and flow rate for non-rebreather mask? |
|
Definition
Up to 90-95% oxygen
Flow rate: 10-15 L/min
Fit firmly on face and make sure the reservoir bag is never less than 2/3 full |
|
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Term
| What is the oxygen concentration and flow rate for a Venturi mask? |
|
Definition
24% - 50% Oxygen
Flow rate dependant on colored insert
- Able to deliver precise amount of oxygen
- Used with some COPD patients (Dr. ordered) |
|
|
Term
| What is the oxygen concentration and flow rate for a Venturi mask? |
|
Definition
24% - 50% Oxygen
Flow rate dependant on colored insert
- Able to deliver precise amount of oxygen
- Used with some COPD patients (Dr. ordered) |
|
|
Term
| What is the rate of artificial ventilation for adults, children and infants? (...without need for cardiac compression) |
|
Definition
Adult 1:5 sec i.e. 12/min
Child 1:3 sec i.e. 20/min
Infant 1:3 sec i.e. 20/min
(all 1 second ventilation) |
|
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Term
| What percentage of oxygen can a bag-valve mask deliver with and without a reservoir? |
|
Definition
Can deliver nearly 100% oxygen when used at 15 L/min and a reservoir
Provides 40 to 60% with oxygen and without a reservoir |
|
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Term
| What are the signs of adequate ventilation? |
|
Definition
- Equal chest rise and fall
- Ventilating at appropriate rate
- Heart rate returns to normal
- Cyanosis disappears |
|
|
Term
| What are the signs of inadequate ventilation? |
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Definition
- Minimal or no chest rise and fall
- Ventilations too fast or slow
- Heart rate does not return to normal |
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Term
| What is the pressure of a full tank of oxygen and when should it be considered 1. empty and 2. not suitable to be kept in an ambulance? |
|
Definition
Pressure is 2000psi when full
A tank is considered “empty” when there is 200psi left and if <500psi it is not suitable to be kept in service |
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Term
| What are the different oxygen tank sizes and factors used to calculate time remaining? |
|
Definition
- D cylinder 350L factor 0.16
- E cylinder 625L factor 0.28
- M cylinder 3000L factor 1.56 |
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|
Term
| How do you calculate oxygen tank life? |
|
Definition
Tank Pressure (psi) – 200 x factor / flow rate (litres per minute)
e.g. 2000psi – 200 x 0.16 / 10 L per min = 28.8 minutes of O2 delivery time |
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Term
| What are the midaxillary and midclavicular lines? |
|
Definition
Midclavicular is the plane straight down from the middle of the collar bone
Midaxillary line is the plane straight down from the middle of the armpit |
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Term
| What are the terms for 1. closer and further away from centre of the body and 2. front and back of the body? |
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Definition
1. Proximal and distal
2. Ventral and dorsal |
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Term
| What are the terms for 1. lying on your front and 2. lying on your back? |
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Definition
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Term
| What is the Trendelenburg position and when is it used? |
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Definition
Lying tilted with head down
Can be used to help cerebral blood flow if hypotensive (low BP) |
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|
Term
| What is Fowler's position and what variations are there? |
|
Definition
Sitting up 45 to 60 degrees
Low Fowler's 15 to 30 degrees
High Fowler's 80 to 90 degrees |
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Term
| What is the dorsal body cavity and what does it contain? |
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Definition
Cranial cavity contains the brain
Vertebral / spinal cavity contains the spinal cord
(each connects with the other) |
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Term
| What is the Ventral body cavity and what does it contain? |
|
Definition
Thoracic cavity - pleural contains the lungs and mediastinum contains heart, oesophagus, trachea and blood vessels
Abdominopelvic cavity - liver, spleen, kidneys, stomach, intestines, bladder, etc |
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Term
| What are the main organs in 1. the right upper quadrant and 2. left upper quadrant? |
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Definition
RUQ - liver and gall bladder
LUQ - spleen |
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Term
| What are the four types of tissue and what do they do? |
|
Definition
- Epithelial: covers body surface and lines cavities
- Muscle: provides movement
- Connective: supports and protects organs
- Nervous: rapid internal communication via electrical impulses |
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Term
| What does the endocrine system do? |
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Definition
| Glands secrete hormones that regulate processes such as growth, reproduction and metabolism by body cells |
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Term
| What does the integumentary system do? |
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Definition
- forms the external body covering
- protects deeper tissues from injury
- synthesizes vitamin D
- site of cutaneous receptors and sweat and oil glands |
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Term
| What does the lymphatic / immune system do? |
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Definition
- picks up fluid leaked from blood vessels and returns it to blood
- disposes of debris in the
lymphatic stream
- houses white blood cells (lymphocytes) involved in immunity
- immune response mounts the attack against foreign substances within the body |
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Term
| What are the three layers and the function of skin? |
|
Definition
1 Epidermis & Germinal Layer
2 Dermis
3 Subcutaneous tissue
Functions:
- Protects body from the environment
- Regulates body temperature
- Transmits information from environment to brain |
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Term
| What are the two main sections of the skeleton and how many bones are there? |
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Definition
1. Axial (cranium, spine and ribs)
2. Appendicular (everything else)
There are 206 bones and over 600 muscles |
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Term
| Where is the zygomatic bone? |
|
Definition
| The cheek bone under the eye socket and extending back towards the ear |
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Term
| Where are the sphenoid and ethmoid bones? |
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Definition
Sphenoid is lateral (outer) part inside the eye socket
Ethmoid is medial (inner) part inside the eye socket |
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Term
| Where is the cricothyroid membrane and why is it important? |
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Definition
The membrane between the thyroid and cricoid (lower just above start of trachea) cartilages in the throat
It is where you can surgically insert an airway in an emergency (not EMR) |
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Term
| How many vertebrae in each of the 5 sections? |
|
Definition
- 7 Cervical
- 12 Thoracic
- 5 Lumbar
- 5 Sacrum (fused)
- 4 Coccyx (fused) |
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Term
| Is the femoral vein lateral or medial to the artery |
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Definition
Lateral
- for groups of vessels around joints, think "VAN" - vein, artery, nerve with the Nerve on the iNside) |
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Term
| Is the fibula or tibia the medial bone of the lower leg? |
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Definition
| The tibia is medial - the fibula lies on the outside of the lower leg. |
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Term
| What are the three types of muscle? |
|
Definition
- Skeletal (voluntary, striated)
- Smooth (involuntary, automatic processes)
- Cardiac (involuntary, blood supply critical) |
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Term
| What protects the nervous system? Name the layers. |
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Definition
Meninges (Dura Mater - outer layer, Arachnoid Layer, Pia Mater)
Covers skull and spinal cord |
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Term
| Where is the pituitary gland and what does it do? |
|
Definition
Dangles from base of the brainstem just behind the eyes
Produces numerous hormones to
control and regulate other glands |
|
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Term
| Describe the two types of feedback loop. |
|
Definition
Positive Feedback Loop (less common) e.g. clotting, childbirth (uterine contractions)
- positive loop causes itself to produce more and more of the effect until the stimulus is stopped
Negative Feedback Loop (more common) e.g. “adrenalin rush”
- continues to produce the hormone until stimulus is gone |
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Term
| What coronary artery does the circumflex branch come off? |
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Definition
| The left coronary artery divides into the circumflex branch which supplies the lateral part of the heart and the anterior descending which supplies the front of the heart |
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Term
| What are the three sources of pacemaker signal in the heart? |
|
Definition
SA node - main pacemaker
AV node - next best…
Purkinje fibers - the best of what is left… |
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Term
| What are the four main components of blood? |
|
Definition
Plasma 55% (water 95%)
Red cells (erythrocytes) 45% (transports oxygen)
White cells (leucocytes) <1% (fights infection)
Platelets <1% (clotting mechanism) |
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Term
| What is interstitial fluid? |
|
Definition
| Lymph fluid lying in between cells in the tissues |
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|
Term
| Does the diaphragm contract or relax during inhalation? |
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Definition
| Diaphragm contracts when you breath in |
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Term
| What part of the brain controls breathing and how? |
|
Definition
Brain stem (medulla oblongata) controls breathing
- increases breathing rate if carbon dioxide level rises to get rid of CO2
- hypoxic drive (driven by low oxygen level) kicks in if that fails |
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Term
| Where is the fallopian tube, how many are there and what does it do? |
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Definition
One fallopian tube on each side of the uterus extending out towards the two ovaries
- collects the eggs released by the ovaries during each menstrual cycle |
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Term
| What are the risks of giving medication? |
|
Definition
- Potential side effects (no drug exerts a single desired effect)
- Potential allergic/anaphylactic reactions (even if you ask all the right questions)
- Potential for overdosing the patient (even if you give the proper amount)
- NO DRUG IS BENIGN |
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Term
|
Definition
| Over The Counter medicines are available from a pharmacist or other retailer without a prescription |
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Term
| How many micrograms are in 1mg? |
|
Definition
1000 micrograms (mcg) = 1 milligram (mg)
....and there are 1000 mg in 1 gram |
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Term
| What are Schedule H drugs? |
|
Definition
Hallucinogens such as LSD and mescaline
- they have no medicinal uses |
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Term
| What are Schedule G drugs? |
|
Definition
Controlled drugs with potential of abuse such as amphetamine and milder narcotics
- opiates and derivatives come under the Narcotics Schedule
- Schedule F is for other prescription drugs |
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|
Term
| What does parenteral administration of a drug mean? |
|
Definition
| Any means of administration other than via the GI (gastrointestinal) tract which is called enteral administration |
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Term
| Is sublingual administration fast, slow or moderate speed of absorption and is it enteral or parenteral? |
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Definition
| Sublingual (under the tongue) is enteral and has a moderate rate of absorption |
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Term
| Can an EMR draw up a medication from a vial or from an ampule? |
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Definition
| No - an EMR can only administer some tablets, inhalers, oral gels and auto-injectors |
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Term
| What are the three phases of pharmacology? |
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Definition
1 Pharmaceutic Phase - dispensing and how it dissolves
2 Pharmacokinetic Phase - how the body handles a drug over time (absorption, distribution, biotransformation, excretion)
3 Pharmacodynamic Phase - how the drug works |
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Term
| What is the half-life of a drug? |
|
Definition
Time required for total amount of drug diminish by one-half
i.e. If patient received a single dose with a half-life of 5 hours, the patient would have half of that dose left 5 hours later, one quarter of the original dose after 10 hours…
- In effect eliminated after 5 half-lives (only 3% left) |
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Term
| Is a Category D drug safe to use in pregnancy? (FDA classification) |
|
Definition
No - studies show a risk to the fetus
Category X - worse - a definite risk
A - no risk
B - animal studies no risk
C - animal studies show there may be a risk |
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|
Term
| What do affinity and efficay of a drug mean? |
|
Definition
Affinity is force of attraction between drug and its receptor site - greater the affinity, stronger the bond
Efficacy is the ability to cause expected response |
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Term
| What is the difference between the sympathetic and parasympathetic nervous systems? |
|
Definition
Sympathetic Nervous System
- prepares for stressful events
- ↑ HR
- ↑ Respirations
- dilates pupils
- constricts peripheral blood vessels
- dilates coronary & skeletal muscle blood vessels
- ↓ digestion
Parasympathetic Nervous System
- returns body to normal (or reverses above effects if over-stimulated)
Sympathetic and parasympathetic work opposite of each other |
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Term
| What are the autonomic neurotransmitter receptors and their effects? |
|
Definition
Alpha-1 - peripheral vasoconstriction
Beta-1 - increased heart rate, force, and automaticity
Beta-2 - bronchodilation
(Beta receptor memory hint – you have 1 heart and 2 lungs…)
Dopaminergic - renal and mesenteric vasodilation |
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|
Term
| What does epinephrine do? |
|
Definition
Binds to the Alpha-1 (α1) and Beta-1 (β1) and Beta-2 (β2) receptors of
the sympathetic system, causing bronchodilation, drying of bronchial mucus membranes. Activation of both alpha and beta receptors explains associated increased pulse and BP |
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|
Term
|
Definition
| Binds to Beta-2 (β2) receptor sites and causing bronchodilation. Also activates cardiac receptors, (Beta-1 (β1), which explains increase in pulse and BP |
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|
Term
| What does acetylsalicylic acid do? |
|
Definition
| At low doses, appears to impede clotting by blocking prostaglandin synthesis, which prevents formation of platelet aggregating substance (this is irreversible) called thromboxane A2 |
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Term
| What does ipratropium bromide do? |
|
Definition
| Ipratropium bromide: inhibits parasympathetic bronchoconstriction, opening lower airways and bronchodilation (especially used in COPD rather than asthma) |
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Term
| What is the difference between a generic and proprietary drug name? |
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Definition
| The generic (non-proprietary) name is usually an abbreviation of the chemical name. The proprietary name is the trade or brand name copyrighted by the drug company. |
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Term
| What are the six Rights of medication? |
|
Definition
RIGHT patient? - ensure you receive orders
RIGHT drug? - read the label 3 times
RIGHT time? - time of day and dose interval
RIGHT dose? - know dosages for your scope of practice and get partner to double-check dose if possible
RIGHT route? - possible fatal complications or not absorbed at proper rate
RIGHT documentation? - drug, time, route, concentration, dose, person who administered and patient’s response. Medication errors must be documented and reported |
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|
Term
| What are the three Cs and E of administering medication? |
|
Definition
Color - Ensure medication is appropriate color
Clarity - they should be clear, with no precipitate (floaties)
Concentration - ensure the right
one is being used e.g. epinephrine comes in 1:1,000 and 1:10,000
Expiry Date - don't use if it’s expired |
|
|
Term
| What is the dose of acetylsalicylic acid (ASA) and when is it used? |
|
Definition
Adult dose: 160 to 325 mg chewed as soon as possible for ischemic chest pain (angina or myocardial infarction (MI)
Contraindications: hypersensitivity, bleeding disorders (e.g. hemophilia), unconscious patient
Note that effects of aspirin persists
for the life of the platelet (about 8 days) |
|
|
Term
| What are the side-effects of and precautions needed when using acetylsalicylic acid (ASA)? |
|
Definition
Heartburn, GI upset, nausea and vomiting
- Asthma - may produce bronchoconstriction
- Active ulcer disease
- Impaired renal and hepatic function
- Children and adolescents with
influenza or chickenpox infections (may increase risk of Reye’s syndrome, a rare but serious illness with mortality of 20-30% - encephalopathy and liver damage) |
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Term
| What is the trade name for epinephrine and what is it used for? |
|
Definition
Adrenalin / Epi-pen
Used for anaphylaxis
Adult – 0.3 mg Epi-Pen IM repeat 15-20 minutes prn
Pediatric – 0.15 mg Epi-Pen Jr (do not exceed 0.3 mg) - for patients between 16 and 30 kg |
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|
Term
| What are the side-effects of epinephrine? |
|
Definition
- anxiety
- headache
- heart palpitations
- angina
- cardiac arrhythmias
- acute hyper tension (HTN)
- pallor
- breathlessnesness (SOB)
- nausea and vomiting |
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|
Term
| What is the Trade name and action of salbutamol? |
|
Definition
Ventolin
Bronchodilator, β2-selective adrenergic agonist (sympathomimetic - i.e. acts positively on the sympathetic autonomic nervous system) |
|
|
Term
| What is the dose and when do you use salbutamol? |
|
Definition
Severe bronchospasm due to
chronic bronchitis, shortness of
breath due to asthma
Adult dosage: 6-20 puffs, each puff being 100mcg/spray or 2.5 to 5.0 mg nebule, repeat 10 mins prn
Child dosage: 2 - 10 puffs MDI or 0.15 mg/kg diluted to 2.5 ml saline
via nebulizer |
|
|
Term
|
Definition
As required
from Latin "pro re nata" - as the need arises |
|
|
Term
| What are the side-effects of salbutamol? |
|
Definition
- nervousness
- muscle tremors
- headache
- tachycardia
- heart palpitations
- transient muscle cramps
- nausea and vomiting
- weakness |
|
|
Term
| When do you use iptratropium bromide and how does it work? |
|
Definition
For severe bronchospasm due to
chronic bronchitis, shortness of
breath due to asthma
It inhibits cholinergic (parasympathetic) receptors to relax bronchial smooth muscle and dries
secretions |
|
|
Term
| What is the dose of ipratropium bromide? |
|
Definition
Adult Dosage: 1-4 puffs PRN to a max of 10 puffs, each puff being 20 mcg/spray or 250-500 mcg via neb with
salbutamol ×3
Pediatric Dosage: MDI: 2 puff prn; max ×4 or 25-250 mcg via neb with salbutamol ×3 (ages 5-11) |
|
|
Term
| What are the contraindications and precautions for the use of ipratropium bromide? |
|
Definition
- allergy to Ipratropium bromide or to
atropine
- allergy to soy lethicin or related food products (soybeans, peanuts)
- Children under 5 years old
Precautions: narrow angle glaucoma so use mouth piece nebulizer if possible to stop it getting in eyes |
|
|
Term
| What are the side-effects of ipratropium bromide? |
|
Definition
- nervousness
- muscle tremors
- headache
- tachycardia
- heart palpitations
- transient muscle cramps
- nausea and vomiting
- weakness |
|
|
Term
|
Definition
| Shortness of breath - breathlessness, dyspnea, difficulty breathing |
|
|
Term
|
Definition
| A high pitched, “crowing” adventitious sound usually on inspiration indicating upper airway restriction e.g. foreign body airway obstruction |
|
|
Term
| What is the difference between a thrombus and an embolus? |
|
Definition
Thrombus is a blood clot which has formed at a specific location
Embolus is a thrombus that has broken loose and is traveling through the vascular system e.g. most venous emboli end up in the lung, arterial ones can go to the brain, gut or limbs |
|
|
Term
| How many lobes does the right lung have? |
|
Definition
Three - upper, middle and lower
Left lung only has two - upper and lower because the heart takes up space |
|
|
Term
| What are alveoli and what are they attached to? |
|
Definition
They are tiny air sacs where gas transfer happens
Attached to bronchioles - the smallest airways which have smooth muscle but no cartilege in the walls |
|
|
Term
| What are the causes of respiratory distress? |
|
Definition
- pulmonary vessels become obstructed
- alveoli are damaged
- air passages are obstructed
- blood flow to the lungs is obstructed
- pleural space is filled e.g.with blood or air |
|
|
Term
| What are the signs of asthma? |
|
Definition
Hallmark - tripod positioning due to accessory muscle use, audible wheezing (usually on exhalation) heard with or without stethoscope
Other - speaking in 1 or 2 word sentences, cyanosis/ pallor, diaphoresis (sweating), wheezing or absent breath sounds on auscultation, retractions & indrawing, tachycardia, anxiety, confusion |
|
|
Term
| What part of an MDI (metered dose inhaler) do you check for dosage? |
|
Definition
| The metal canister - because the packaging and plastic part could have been changed. |
|
|
Term
| What is the difference between and "pink puffer" and "blue bloater"? |
|
Definition
Pink puffer has severe emphysema (abnormal ballooning and destruction of alveoli) with hyperventilation
Blue bloater has severe airways obstruction with right heart failure and cyanosis |
|
|
Term
| What are the signs of tuberculosis? |
|
Definition
Hallmark - haemoptysis (coughing up blood)
Other - cough, fever, night sweats, weight loss, fatigue
Use a N95 mask yourself or both patient and EMR use oxygen masks |
|
|
Term
| What are the signs of pneumonia? |
|
Definition
Hallmark - High or low-grade fever with or without a productive cough
Other - Tachypnea (fast breathing), crackles on auscultation, RUQ or LUQ abdo pain, history of fever x multiple days |
|
|
Term
| What are the signs and cause of croup? |
|
Definition
Hallmark - barking cough or seal-like
cough
Other - low-grade fever, audible wheezing & stridor
Caused by viral inflammation and
swelling of the lining of larynx narrowing the airway
Typically in children 6 months to 3 years |
|
|
Term
| What are the signs of epiglottitis? |
|
Definition
Hallmark - drooling due to reluctance to swallow saliva
Other - high-grade fever, sore throat, stridor
Typically seen in children 3 to 6 yrs - DO NOT insert any type of airway |
|
|
Term
|
Definition
| Respiratory syncitial virus which causes lower airway illnesses like bronchiolitis or pneumonia and possibly respiratory failure in children aged 2 to 6 months (highly contagious) |
|
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Term
| What are the signs of pulmonary aspiration? |
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Definition
Hallmark - “Where did the vomit go?”
Other - chest pain, burning in the mediastinum, cough, wheezes or
crackles on auscultation, cyanosis
....usually has problem maintaining airway so have suction ready |
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Term
| What are the signs of pulmonary embolism? |
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Definition
Hallmark - Sharp stabbing pain, possible history of surgery or prolonged inactivity
Other - dyspnea, pain diminishes after lung tissue death (tricky!), hemoptysis (usually pink frothy), cyanosis, tachypnea, hypoxia, maybe preceded by DVT (pain and swelling) in calf (deep venous thrombosis) |
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Term
What are the signs of pulmonary edema?
What does edema mean? |
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Definition
Hallmark - coughing up pink, frothy fluid
Other - tachypnea (fast respiration rate), shallow respirations
- May be due to left heart failure, abnormal heart rhythms, lung irritants, recent MI
Edema means swelling due to fluid |
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Term
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Definition
Destruction and collapse of alveoli due to COPD or pulmonary edema
May result in pursed lip breathing which helps by creating Positive End Expiratory Pressure (PEEP) forcing oxygen into the blood |
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Term
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Definition
Acute respiratory distress syndrome usually a complication of illness or injury (pulmonary aspiration, toxic inhalation, pneumonia…)
Additional fluid volume between alveoli and pulmonary vessels causes tachypnea, cyanosis, possible pulmonary edema |
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Term
| What are the signs of pneumothorax (air in pleural cavity)? |
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Definition
Hallmark - sharp/burning/tearing pain in chest with no obvious cause
Other - Dyspnea, absent or decreased breath sounds on one side
Often recurrent in young, tall, skinny males, commonly caused by stifling a sneeze |
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Term
| What are the signs of hyperventilation? |
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Definition
Overbreathing to a point where CO2
levels fall - may be due to acidosis (e.g. diabetic ketoacidosis - raised sugar) or psychological stress
Hallmark - Rapid breathing in the absence of other medical or traumatic problems
Other - no adventitious sounds, deep or shallow breathing, numbness / tingling, dyspnea despite rapid breathing, dizziness, hands and feet cramps |
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Term
| What is standard management of all respiratory emergencies? |
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Definition
- high-flow oxygen appropriately (after determining rate of respirations)
- position patient appropriately (sitting if lungs are “wet”, position of comfort (POC) usually Fowlers or High Fowlers)
- consider salbutamol and/or
ipratroprium bromide
- request ALS for breathing problems
- if severe dyspnea, prioritize questions
- if patient has been intubated
previously, you need ALS backup |
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Term
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Definition
| Myo- (muscle) cardial (heart) infarction (localised necrosis due to loss of blood supply) |
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Term
| What is the lumen of a blood vessel? |
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Definition
| The inside diameter of a vessel |
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Term
| What is the difference between bradycardia and tachycardia? |
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Definition
Bradycardia - heart rate is slower than 60 bpm
Tachycardia - heart rate is faster than 100 bpm
...think tachy - fast as in tachometer another name for speedometer |
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Term
| Describe the flow of blood through the heart. |
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Definition
| Venous (deoxygenated) blood arrives at the right atrium then flows through the tricuspid valve to the right ventricle, out the piulmonary valve to the lungs to get oxygenated, then returns to the left atrium, through the mitral valve to the left ventricle and finally out the aortic valve to the body |
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Term
| What are the risk factors for arteriosclerosis? |
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Definition
- diet
- exercise
- obesity
- smoking
- age
- gender
- genetics
- race
- alcohol
- diabetes
- stress
- high BP
- raised blood lipids |
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Term
| What are the signs of angina/ myocardial ischemia? |
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Definition
Hallmark - substernal crushing/ squeezing tight pain, may radiate to back, neck or arms, usually relieved with rest (within 15 minutes)
Other - pain usually lasts 3 to 8 minutes, rarely longer than 15 minutes, breathlessness, nausea and vomiting, diaphoresis (sweating), pallor |
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Term
| How do you tell the difference between myocardial ischemia and myocardial infarction? |
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Definition
| Ischemia is lack of blood and infarction is cell death due to lack of blood. Symptoms and signs are the same - but ischemia usually lasts 3 to 8 (maybe 15) minutes |
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Term
| What are the three rhythms of cardiac arrest? |
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Definition
1. asystole (no beats at all - flat lining)
2. ventricular tachycardia (fast ventricular beating with no output)
3. ventricular fibrillation (ventricles quivering muscular activity with no organised contractions) |
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Term
| What do you do in a cardiac arrest? |
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Definition
Automated electrical defibrillator (AED) on scene (per protocols) max 3 shocks on scene or 3 no shock advised, high O2 and transport, CPR
Immediate ALS intervention is required |
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Term
| What volume of blood is usually pumped at each pulse? |
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Definition
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Term
| What is cardiogenic shock? |
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Definition
| When the heart cannot pump effectively. |
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Term
| What is the difference between right and left heart failure? |
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Definition
Right usually due to COPD, pulmonary embolism - lungs clear, with peripheral edema and jugular venous distension (JVD)
Left usually due to MI - crackles in lower lung at back, no JVD, edema less likely |
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Term
| What position is best for a cardiac patient? |
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Definition
| High Fowlers (sitting upright) - never Trendelenburg (head down) |
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Term
| What is 1. angioplasty 2. CABG 3. stent? |
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Definition
1. Angioplasty - artery (e.g. coronary) is dilated perhaps by balloon passed into artery from wrist or groin
2. Coronary artery bypass graft - new vessel grafted onto artery to bypass blockage
3. Stent - basket like device placed inside an artery to keep it open |
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Term
| Where is a cardiac pacemaker usually sited? |
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Definition
| Just below the left clavicle, just under the skin |
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Term
| What does an automatic implantable cardiac defibrillator do? |
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Definition
| Monitors heart rhythm and delivers shocks as needed |
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Term
| What heart rhythms need to be defibrillated quickly? |
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Definition
| Ventricular fibrillation or ventricular tachycardia needs to be defibrillated as soon as possible for optimal survivability |
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Term
| How quickly should you use an AED in cardiac arrest? |
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Definition
| CPR should be performed while AED preparation occurs, complete 2 minutes of CPR then follow the AED prompts in a unwitnessed patient, however in a witnessed cardiac arrest go straight to defibrillation |
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Term
| When do you transfer a cardiac arrest patient? |
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Definition
- when patient regains pulse
- after delivering 3 shocks
- after receiving one “no shock advised” message
(finish packing patient during following 2 minutes of CPR)
stop ambulance to use AED because it interferes with the monitor |
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Term
| What is the difference between hemiparesis and hemiplegia? |
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Definition
Hemiparesis means weakness and hemiplegia means paralysis down one side of the body - most commonly caused by a stroke (cerebrovascular accident CVA -blockage of blood supply to one side of brain)
It can be congenital due to birth damage |
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Term
| What do 1. aura and 2. post-ictal mean? |
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Definition
1. an aura is hallucination of smell, taste, hearing, sight, touch
that may warn of an impending seizure
2. post-ictal is a sleepy, lethargic state after a seizure |
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Term
| Name three different types of seizure disorder. |
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Definition
- grand mal / tonic-clonic
- petit mal / absence
- Jacksonian / focal motor
(- postictal state and status epilepticus) |
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Term
| What are the signs of haemorrhagic stroke or ruptured aneurysm? |
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Definition
Hallmark - sudden severe headache (as if hit on head)
Other - changes in sensations (vision/ hearing/ taste/ smell/ feeling), unequal pupils, coordination/ balance changes, facial droop/unequal smile, drooling, memory disturbances…long or short term, behavioral disturbances, incontinence |
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Term
| Which has higher mortality - ischemic or haemorrhagic strokes? |
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Definition
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Term
| How do you tell the difference between ischemic and haemorrhagic stroke? |
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Definition
Ischemic Stroke (1) vs Hemorrhagic Stroke (2)
- (1) more common
- cause: (1) atherosclerosis or tumor (2) cerebral aneurysms, arteriovenous (AV) malformations, hypertension
- onset: (1) slow (2) abrupt
- (1) long history of vessel disease (2) stress or exertion
- (1) valvular heart disease and atrial fibrillation (2) cocaine and other sympathomimetics
- (1) previous angina or strokes (2) aneurysm may be asymptomatic before rupture |
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Term
| What are the signs of a TIA (transient ischemic attack)? |
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Definition
Hallmark: sudden severe head-ache, hemiparesis and hemiplegia, goes away within 24 hours
Other: denial, changes in sensations (vision/ hearing/ taste/ smell/ feeling), pupils unequal, coordination/ balance changes, facial droop/ unequal smile, drooling, memory disturbances…long or short term, behavioral disturbances, incontinence, altered LOC |
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Term
| What else do you consider in a patient with a suspected stroke? |
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Definition
- hypoglycemia
- postictal state
- drug/ alcohol use
- subdural or epidural bleeding (head trauma)
- traumatic brain injury (TBI)
Always consider other problems when dealing with a suspected stroke |
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Term
| What is Cushing's triad and what does it tell you might be happening? |
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Definition
Associated with raised intracranial pressure
1. hypertension, a blood pressure that is increasing from normal, often over 180 systolic and with relatively low diastolic
2. bradycardia, pulse rate decreasing from normal, often <60
3. Cheyne-Stokes breathing (deep/ irregular breathing pattern) |
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Term
| What do you do if you suspect raised intracranial pressure (ICP)? |
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Definition
If signs of ICP/Cushing’s triad present (unconscious, irregular
breathing, slowing down of the pulse and unequal pupils) hyper-oxygenate using a BVM with a O2 flow rate of 15 L/min making sure reservoir bag is never less than 2/3 full ventilating 1 breath every 3 seconds or 20/min. Elevate head of stretcher/ back-board by 15-20 degrees |
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Term
| Do you give acetylsaliclylic acid (ASA) to stroke patients to treat a clot? |
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Definition
| No, never - because it may well be haemorrhagic so you would make it worse. |
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Term
| How quickly does proper treatment have to start in a case of stroke? |
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Definition
| Treatment needs to start within 3 to 6 hours of onset, pending protocols |
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Term
| What are the acronyms (letters in code form) for neurological assessment? |
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Definition
AEIOU
A Alcohol, Apnea, Anaphylaxis
E Epilepsy, Environmental
I Insulin
O Overdose
U Underdose
TIPS
T Trauma
I Infection
P Psychiatric, Poisoning
S Stroke, Shock |
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Term
| What are the three physical findings in the Cincinnati Stroke Scale? |
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Definition
1 facial droop
2 arm drift
3 speech |
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Term
| What are the signs of a grand mal, generalized tonic-clonic seizure? |
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Definition
Hallmark: unconscious patient, severe, jerky muscle twitching and clenching
Other: cyanosis, abnormal or noisy breathing, absence of respirations, possible head injury, loss of bowel and bladder control, severe muscle twitching, post seizure state of unresponsiveness with deep and
labored respirations |
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Term
| What are the signs of petit mal/ absence seizure? |
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Definition
Hallmark: staring episodes, sudden halt in conscious activity
Other: no movement, hand fumbling, fluttering eyelids, lip smacking, chewing, lack of awareness of surroundings, may be provoked by hyperventilation or flashing lights, in some cases, abrupt beginning of seizure, each seizure lasts no more than a few seconds, full recovery of consciousness, no confusion, no memory of seizure
May occur hundreds of times a day |
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Term
| What are the signs of a Jacksonian/ focal motor seizure? |
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Definition
Hallmark: one limb or portion of limb shaking uncontrollably (e.g. hand)
Other: memory impairment, usually fully conscious, may spread to a generalized seizure so transport required |
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Term
| What is the usual progression of a seizure? |
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Definition
Aura - happens to some, usually
30 seconds to 2 minutes beforehand, varies between patients, smelling or tasting something odd like burnt toast is common
Seizure - uncontrolled electrical activity in brain causes convulsion
Postictal State: period after convulsions patient is physically exhausted, may have a decreased LOC, may last a few seconds to many hours |
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Term
| What is status epilepticus? |
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Definition
| Any seizure activity that lasts more than 5 minutes without return of consciousness, repetitive seizure activity with no regaining of consciousness |
|
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Term
| How would you classify the 8 major causes of illness? |
|
Definition
1. Congenital
2. Infection
3. Cancer
4. Immunological
5. Trauma
6. Vascular
7. Environmental
8. Metabolic / endocrine |
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Term
| What is Sellick's manoeuvre? |
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Definition
Cricoid pressure
Use on unconscious patients to prevent passive regurgitation (EMT’s and Paramedics)
EMRs should ensure the airway is open and ventilate over 1-2 seconds to prevent gastric distention |
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