| | hypovolemic shock | the circulating blood is unable to deliver adequate oxygen and nutrients to the body. | |
| | what are the 2 types of hypovolemic shock? | exogenous and endogenous | |
| | Exogenous Hypovolemic shock | THE MOST COMMON TYPE OF HYPOVOLEMIC SHOCK!! External Bleeding from an open wound, may also result in loss of plasma volume caused by diarrhea or vomitting | |
| | Endogenous Hypovolemic shock | fluid loss is contained within the body | |
| | Basophils | contain histamine granules and other substances that are released during inflammatory and allergic responses. | |
| | What % of leukocytes do basophils account for? | 1% but they are essential to the nonspecific immune response because the release histamine to dilate blood vessels | |
| | what is the life span of a basophil? | a few hours to a few days | |
| | what is the function of a basophil? | release histamine during inflammation | |
| | Mast Cells | resemble basophils but do not circulate in the blood, they are found in connective tissue beneath the skin in GI mucosa and in the mucosal membranes of the respiratory system. | |
| | what are the functions of mast cells? | allergic reaction, immunity and wound healing. They release histamine and seratonin and synthesize leukotrines. | |
| | what is the function of a neutrophil? | phagocytes bacteria | |
| | what is the function of esonophils? | phagocytizes antigen antibody complex and attacks parasites | |
| | what is the function of a lymphocyte? | immune protection, attacks cells directly or produces antibodies | |
| | hypoperfusion | occurs when the level of tissue perfusion decreases below normal | |
| | What does the body release in response to hypoperfusion? | catecholamines( epinephrine and norepinephrine) | |
| | What do the catecholamines cause? | vasoconstriction, increased systemic vascular resistance | |
| | what happens as hypoperfusion persists? | myocardial oxygen demand continues to increase, tissue perfusion decreases because of decreased cardiac output. blood pressure decreases, and often fluid will leak from blood vessels causing systemic and pulmonary edema | |
| | NSAID`s and Asprin | inhibit prostaglandin synthesis, leading to reduced inflammation and pain | |
| | Prostaglandin | synthesized by mast cells, found in vertebrate tissue and they act as messangers involved in reproduction and inflammatory response to infection | |
| | Acquired Immunity | also called adaptive immunity. highly specific, inducible, discriminatory and unforgetting method by which armies of cells respond to an immune stimulant. | |
| | when does acquired immunity take effect? | it arises when the body is exposed to a foreign substance or disease and produces antibodies to that invader. | |
| | passive acquired immunity | is the receipt of preformed antibodies to fight or prevent an infection | |
| | Which lasts longer between passive and active immunity? | Active Immunity | |
| | Examples of passive immunity | transmission of maternal antibodies and injection of immunoglobins( a concentrated form of antibodies obtained from donors) | |
| | Diabetes Mellitus | one of the most significant endocrine diseases, associated with either partial insulin secretion or lack of insulin secretion by the pancrease which then affects the patients ability to utilize glucose. | |
| | Type 1 diabetes | Ketoacidosis prone- insulin dependent diabetes, patients need exogenous insulin to survive | |
| | type 2 diabetes | non insulin dependent, even though most need insulin shots, both forms have a hereditary predisposition. | |
| | is there a cure for type 1 diabetes? | no cure, other than pancreas transplantation | |
| | treatment for type 2 diabetes? | can occasionally be brought under control by weight | |
| | diseases with obesity | diabetes, then kidney failure, then cardiac problems | |
| | Immune system development of a child? | Its not fully developed until the child is between 2 and 3 years of age, therfore investigation of a fever in a child should aggressive and thorough | |
| | when should a child be admitted into a hospital regarding a fever? | temperature greater then 100.4 in a child younger then 3 | |
| | 5 basic types of IV solutions | isotonic, hypotonic, hypertonic, crystalloid, and colloid | |
| | Isotonic solutions | normal saline(0.9% sodium chloride) all have the same osmalarity as serum and bodily fluids,Lactated Ringers, and D5W(5% dextrose in water) | |
| | D5W | as long as it stays in the bag its isotonic, once administered its hypotonic | |
| | Lactated Ringers | dont give to people with liver problems, they cant metabolize the lactate, it is normal saline with potassium, sodium and calcium | |
| | hypotonic solution | has an osmolarity of that less than serum. Water is pulled from the vascular compartment to the interstitial compartment causing the cell to swell | |
| | hypertonic solution | osmalrity of that higher then serum, pulls fluid and electrolytes from the intracellular and interstitial compartments to the intravascular compartment. Rarely if ever used in prehospital setting. High concentration of proteins | |
| | systolic blood pressure in compensated shock | systolic blood pressure is within normal range | |
| | systolic blood pressure in decompensated shock | the systolic blood pressure is less then the fifth percentile for the age | |
| | what causes syncope in most? | most patients are asymptomatic until they have an arrhythmia causing syncope or sudden death | |
| | should syncope be considered life threatening? | It is always life threatening until proven otherwise | |
| | what should you ask the patient in regards to his or her syncope? | was it exercised induced syncope? syncope associated with chest pain? History of syncope in the family? syncope associated with startle? | |
| | what causes respiratory acidosis to occur? | CO2 retention leads to increased Paco2 levels | |
| | What situations does respiratory acidosis occur? | Hypoventilation(HEROIN OVERDOSES!!!) or intrinsic lung diseases(asthma, COPD) | |
| | which plasma proteins assist with clotting? | Globulin, Fibrinogen, Prothrombin | |
| | fibrinolysis cascade | activated to disolve the fibrin and create fibrin split products( fragments of the disolved clot | |
| | hyperkalemia | elevated serum potassium level(greater then 6.5) | |
| | EKG changes associated with hyperkalemia | Peaked T Waves, widened of the QRS complex, and arrhythmias | |
| | Allergic Reaction | hypersensitivity reaction to the presence of an agent or allergen | |
| | Autoimmune Reaction | is the production of antibodies or T cells that work against the tissues of ones own body, producing hypersensitivity reactions or autoimmune disease(Systemic Lupus) | |
| | Mannitol | hypertonic solution, contains more solute than the interstitial or tissue fluid in the brain, it causes the fluid to be drawn into the blood decreasing swelling within the brain. | |
| | Higher osmalarity in a fluid(hypertonic solution) | pulls fluid and electrolytes from the intracellular and interstitial compartments into the intravascular compartment | |
| | dysplasia | is an alteration in the size, shape and organization of cells | |
| | The effects of Chronic Stress | Leads to a loss of normal control mechanisms, the adrenals continue to produce cortisol which leads to fatigue and depression. | |
| | High levels of cortisol lead to what? | suppression of the immune system through increased production of interluken-6, an immune system messanger. | |
| | Reduced Immunity | Body is more suceptible to disease, colds, flu, cancer! | |
| | scizophrenia | 1 in 100 people affected, occurs during early adulthood, | |
| | possitive symptoms | delusions and hallucinations | |
| | what does physical or mental stress do? | decreases white blood cell and lymphocyte function | |
| | sympathetic nervous system | fight or flight, dominant system during stress or activity | |
| | sympathetic nervous system chemical messangers | norepinephrine and epinephrine | |
| | parasympathetic nervous system | dominant during rest and relaxation | |
| | first group of drugs to treat HIV | nucleoside reverse transcriptase inhibitors( interupts the virus in the early stage | |
| | second group of HIV drugs | protease inhibitors( interupts the virus during replication) | |
| | Newest class of HIV drugs | fusion inhibitors | |
| | Enfuvirtide | Fuzeon or T-20 (HIV MED) | |
| | effects of tricyclite overdose | block norepinephrine and serotonin from being reabsorbed into the brain, block ACH from reaching its receptors leading to tachycardia, block alpha 1 receptors producing orthostatic hypotension | |
| | what do scizophrenia drugs cause | extrapyramidal symptoms, orthostatic hypotension or sedation | |
| | minimal # of animals for drug testing? | testing in at least 2 animal species required by law | |
| | hypothyroidism | drugs are used to replace missing thyroid hormones, Levothyroxine(SYNTHROID) | |
| | ACH(acetylcholine) | released by a cholinergic neuron, its the neurotransmitter of the parasympathetic nervous system. bradycardia, shortness of breath, pinpoint pupils, blurred vision, sweating bronchial secretions, wheezing, coughing, vomiting, urinary and fecal incontinece | |
| | affinity | attraction between a medication and its receptors. the stronger the affinity, the stronger the bond. If 2 medications have affinity for the same site, the one with the stronger bond will take precedence. | |
| | drug storage | each manufacturer must provide guidance on the proper storage of each medication that is approved by the FDA. | |
| | where can drug storage info be found? | USP or with the drug insert. | |
| | what temperature should medications be kept at? | out of direct sunlight, temp between 55-85 degrees Fahrenheit. | |
| | 2 divisions of the nervous system | central nervous system and the peripheral nervous system | |
| | CNS | brain and spinal cord | |
| | PNS | all nervous tissue outside the brain and spinal cord. | |
| | what are the 2 divisions of the peripheral nervous system? | the somatic nervous system and automatic nervous system | |
| | what are the 2 divisions of the automatic nervous system? | sympathetic and parasympathetic | |
| | TB medications | Isoniazid, Rifampicin, pyrazinamide, and ethambutol | |
| | chronotropic | medications that effect heart rate | |
| | inotropic | medications that effect contractility or force of contraction | |
| | dromotrope | medications that effect the conduction of electricity through the heart | |
| | ointment | semisolid preparation, for external application to the body, topical antibiotic.. | |
| | tincture | used as a skin antiseptic, dilute alcoholic extract of a drug such as iodine. | |
| | IV in a pediatric patient | 20, 22, 24, or 26 gauge catheter. scalp veins are best used in young infants | |
| | metacarpal veins of the hand | 18 or 20 g catheters | |
| | fluid replacement | 14 or 16 gauge AC or external jugular in the average adult. | |
| | pyrogens | foreign proteins capable of producing fever | |
| | pyrogenic reaction | can be caused by pyrogen presence in the infusion solution or administration set and its characterized by an abrupt temperature elevation(as high as 106 degrees Fahrenheit) with severe chills, backache, headache, weakness, nausea and vomiting. | |
| | how long til a pryrogenic reaction usually begins? | usually within 30 minutes after the IV infusion. | |
| | If you see signs of pyrogenic reaction | stop the infusion, start a new IV in the other arm with a fresh infusion solution and remove the first IV. | |
| | cation | electrolyte with a positive charge and they are sodium, potassium, calcium and magnesium. | |
| | anion | electrolyte with a negative charge and they are bicarbonate, chloride, and phosphorus | |
| | what is the most common fluid used in prehospital medicine? | normal saline(0.9% sodium chloride) | |
| | Why shouldn`t we give lactated ringers to patients with liver problems? | They cannot metabolize the lactate | |
| | patients with CHF or hypertension | are at great risk of fluid overloading, the fluid increases preload, which increases the workload of the heart, creating fluid backup in the lungs | |
| | when you replace lost volume through fluid replacement | 20 ml/kg should be given to maintain perfusion(radial pulses and adequate mental status)NOT TO RAISE BLOOD PRESSURE TO NORMAL LEVEL | |
| | what happens when we increase blood pressure to much with IV fluids? | dilutes remaining blood volume, thereby decreasing proportion of hemoglobin, but also may increase internal bleeding, it interferes with hemostasis. | |
| | hemostasis | the bodies internal blood clotting mechanism | |
| | how can narcan be given if IV can not be accessed? | Nasally | |
| | How should fluids be given? | 20ml/kg or maintain perfusion. If the 20ml/kg calculation is correct thats the right answer | |
| | sterile | refers to the destruction of all living organisms and is acheived by using heat, gas or chemicals. | |
| | medically clean | the site of a patients hand that has been cleaned with iodine and alcohol before starting an IV is said to be medically clean. | |
| | antiseptics | used to cleanse an area before performing invasive procedures, IV therapy or medication administration. they are capable of destroying pathogens but are NOT TOXIC TO LIVING TISSUE!(rubbing alcohol, iodine) | |
| | disinfectants | TOXIC TO LIVING TISSUES, never use them on a patient. Virex, Cidex and Microcide | |
| | autoclave | A pressurized, steam-heated vessel used for sterilization. | |
| | if the wrap is torn of an IV bag it is good for? | 24 hours, then it must be discarded | |
| | how many ports does an IV bag have and what are they? | 2 ports, an injection port for medication and an access port and a removable pigtail protects the access port. | |
| | transdermal medications | applied topically on the surface of the body. Intact skin absorbs the drugs. Nitroglycerin, estrogen, nicotine, and analgesic patches are attached to the skin and release meds over a specific period of time. | |
| | speeding up of transdermal meds | thin or non intact skin, to much medication | |
| | decreasing the absorption of transdermal meds | thick skin, scar tissue and peripheral vascular disease | |
| | children and airway obstructions | unless the kid has a fever its only a foreign body obstruction without distress | |
| | which type of intubation technique requires rigorous tube confirmation? | digital intubation, because it is truly a blind technique | |
| | how many people to bag with adequate tidal volume? | 2 people for adequate tidal volume | |
| | when using a combitube which syringe gets inflated first? | the pharyngeal cuff(THE LARGER ONE), 100ml of air then the distal cuff with 15ml of air | |
| | palate | forms the roof of the mouth and separates the oropharnyx and the nasopharynx. | |
| | hard palate | anterior portion, formed by the maxilla and palatine bones | |
| | soft palate | posterior to the hard palate. | |
| | recovery position | left lateral recumbent position, used in all non trauma patients with a decreased LOC whom are able to maintain there own airway spontaneously and breath adequately. | |
| | Inadequate breathing pattern | keep them out of recovery position and off back | |
| | why is sedation used in airway management? | to reduce the patients anxiety, induce amnesia, and to decrease there gag reflex. | |
| | complications typically associated with sedation | undersedation or oversedation | |
| | paralytics | neuromuscular blocking agents, with the patient chemically paralyzed and sedated, his or her airway reflexes are lost | |
| | depolarizing neuromuscular blocking agents | bind with ACH receptor sites, anectine, causes depolarization. | |
| | fasiculations | characterized by brief uncoordinated twitching of small muscle groups observd during the administration of succinocholine(anectine) | |
| | RSI Drugs | atomidate, fentanyl, succinocholine, norcuron | |
| | laryngospasm | spasmodic closure of the vocal cords, which seals off the airway | |
| | 2 functions of the lower airway | to exchange oxygen and CO2 | |
| | after suctioning a pt what is the next step? | Immedietely ventilate your patient | |
| | Metabolic rate during sleep | it will decrease, because respiratory rate drops | |
| | respiratory splinting | makes you suceptable to infection, gaurding means your protecting and the breathing will be inadequate | |
| | after dropping your tube what is the next step? | inflate your cuff | |
| | how many CC`s to inflate your ET tube cuff? | 10cc`s of air | |
| | 3 Parts of the pharynx in order? | 1 nasopharynx2 oropharynx3 LARYNGOPHARYNX | |
| | blind intubation tube size | select an ET tube that is one half to a full size smaller then that that would be used for laryngoscopy. | |
| | what should be used before inserting your fingers into a patients mouth? | insert a bite block or the flange of an oral airway turned sideways between the patients molars. | |
| | After removing the stylet and filling the cuff with air during blind intubation whats next? | attach a BVM with ETco2, ventilate the patient and look for rise and fall of the chest, auscultate over both lungs and over the epigastrum, monitor ETco2, and properly secure your tube. RIGOROUS TUBE CONFIRMATION!! | |
| | lateral collision(deformed side of car) | clavicle fracture, fractured humerous, multiple rib fractures | |
| | lateral collision(door smashed in) | fractured hip, fractured iliac wing, fractured clavicle or ribs | |
| | lateral collision("B" pillar deformed) | brain injury, cervical spine fracture | |
| | lateral collisions(broken door or window handle) | contusions | |
| | Lateral collisions(broken window glass) | multiple lacerations | |
| | Air Transport decision | Best to be made as soon as possible in the call | |
| | how many mechanisms incorporate blast injuries? | 4, primary, secondary, tertiary and miscellaneous | |
| | primary blast injuries | due to the blast itself, damage to the body is caused by the pressure wave itself | |
| | secondary blast injuries | damage results from being struck by flying debris, shrapnel, glass, or splinters set in motion by the expolsion. these objects can reach speeds of 3,000mph | |
| | tertiary blast injuries | occur when the patient is hurled against a stationary object by the blast. The blast wind causes the patient to be hurled or thrown and in some cases cause amputation | |
| | miscellaneous blast injuries | burns from hot gases or firest started by the blast, respiratory injury from inhaling toxic gas and crush injuries from colapse of buildings. | |
| | self splinting or respiratory splinting | may cause atelactasis, hypoxemia and pneumonia | |
| | kinetic energy(KE) of an object | energy associated with that object in motion | |
| | what factors effect kinetic energy? | mass or the weight of the object and velocity. | |
| | which has a greater effect on KE? | velocity has a much greater effect, speed kills | |
| | down and under pathway | unrestrained occupants slide under the steering column. | |
| | down and under injuries | look for femur fractures, pelvic fractures, dislocation of knees, lower leg fractures | |
| | up and over pathway | lead point is the head, torso moves in an upward and forward direction | |
| | up and over injuries | significant head and cervical spine trauma, laryngeal fractures, massive chest trauma | |
| | level 1 trauma criteria for fractures | 2 or more proximal long bone fractures | |
| | when responding to explosions | stage further from the blast area, be aware of secondary devices, less pressure wave!! | |
| | child in a car seat thats to small for him, what kind of injuries do we expect? | c-spine as a result of hyperextension of the neck, abdominal injuries | |
| | baroreceptors | are sensors located in the blood vessels,They are an example of a short-term blood pressure regulation mechanism. | |
| | weak radial, femoral, carotid | means dilation of the vasculature, decreased blood flow. BP<90 | |
| | distributive shock | widespread dilation of the resistance vessels, capacitance vessels or both leads | |
| | external bleeding control | 1)direct pressure which allows platelets to seal the vascular walls and 2)elevate!, 3)pressure dressing, 4) pressure point with direct pressure and 5) tourniquet | |
| | unexplained shock | hypovolemic shock #1 | |
| | where does assessment begin with the trauma patient? | with the scene size up and your general impression | |
| | relative hypovolemia | occurs when the vessels dilate. | |
| | the most reliable indicator for a shock patient | your patients signs and symptoms, how does the patient present or feel? | |
| | MODS | multiple organ dysfunction syndrome, progressive condition categorized by combined failure of several organs(lungs, liver, kidney, clotting mechanisms) | |
| | What is the major cause of death following septic, traumatic and burn injuries? | MODS, 60-90% mortality rate | |
| | primary MODS | direct result of an insult(pulmonary contusion from striking steering wheel) | |
| | secondary MODS | organ disfunction as an integral component to the hosts response( renal failure following trauma) | |
| | when does MODS occur? | when injury or infection trigger a massive systemic immune, inflammatory, and coagulation response resulting in the release of numerous inflammatory mediators | |
| | when does MODS develop | typically hours-days | |
| | inflammation | histamine gets released by mast cells which causes dilation of the blood vessels. leads to the removal of foreign material | |
| | whats the most immediate threat to a patient with a soft tissue injury? | hemorhage | |
| | pressure injuries | bed ridden patients or patients left on a backboard for significant periods of time. tissues are deprived of oxygen and localized hypoxemia ensues. | |
| | soft tissue injury severity | typically not life threatening, hemorhage the biggest threat. | |
| | pale or ashen skin | points to inadequate perfussion | |
| | trauma to the face, whats your first priority? | maintain the patients airway | |
| | considerations of splinting with bleeding | movement of an extremity will promote blood flow, which will disrupt the clotting process, move the extremity as little as possible and splint. | |
| | principal danger of avulsions | is the loss of blood supplied to the avulsed flap of skin. Significant bleeding(head avulsions are most significant) also be concerned of blood loss and contamination. | |
| | scald burns | produced by hot liquids, scald injuries cover large surface areas of the patient and spread quickly. MOST COMMONLY SEEN IN CHILDREN, often associated with child abuse, clothing must be removed | |
| | hypotensive patients get no what? | NO PAIN MEDICATION! | |
| | burn patients | a typically wont go into shock as a result of the burn, its from an underlying injury, don`t develop tunnel vision continue with your assessment. | |
| | 4 types of skull fractures | linear, depressed, basilar and open | |
| | linear skull fracture | 80% of all fractures to the skull are linear, often no gross physical signs(deformity, depression) therefore radiographic evaluation is required | |
| | depressed skull fracture | result from high energy direct trauma to a smal surface area of the head with a blunt object(baseball bat). Often present with neurological signs(loss of consciousness) skull fragments could be driven into brain | |
| | basilar skull fracture | extension of linear fracture to base of the skull, CSF draining from ears, raccoon eyes, battle signs | |
| | open skull fracture | often associated with multi-body system trauma, brain tissue may be exposed, high mortality rate. | |
| | intracranial hemorrhage caused by penetrating head injury? | Intracerebral hematoma | |
| | patients with maxillofacial trauma | protect C-spine, monitor patients neurological status | |
| | major threats of nasal fractures and facial trauma | anterior bleeding from the face as well as posterior epistaxis, blood drains into the stomach and the patient vomits. | |
| | oculomotor nerve | 3rd cranial nerve, innervates the muscles that cause motion of the eyeballs and upper eyelids also caries the nerve fibers that cause constriction and accommodation of the pupils. | |
| | optic nerve | 2nd cranial nerve, provides the sense of vision | |
| | sympathetic eye movement | when the eyes move together and in unison | |
| | conjugate gaze | eyes move in different direction | |
| | open neck wound management | because they can suck in air causing a fatal air embolism an occlusive dressing must be in place immediately. | |
| | what patients are at high risk of chronic subdural hematomas? | the elderly, patients with alcoholism, patients with bleeding diatheses(hemophilia), and patients taking anticoagulants | |
| | patients with fractured or avulsed teeth, who else is at risk? | the patient who hit him or her, they most likely have teeth in there hand. The human mouth is filled with bacteria and other microorganisms and those lacerations might get infected. | |
| | diffuse axonal injury presentation(mild) | loss of consciousness, confusion, disorientation, amnesia | |
| | diffuse axonal injury presentation(moderate) | immediate loss of consciousness, persistent confusion and disorientation, mood swings anxiety and motor defecits | |
| | diffuse axonal injury presentation(severe) | Immediate and prolonged loss of consciousness, posturing and other signs of increased ICP | |
| | movement of patients on a backboard | frequent reassessments are necessary to determine wether the patient is stabilizing, improving, or deteriorating. | |
| | What does a patient have to do to get a compression or burst fracture? | typically result from a direct blow to the crown or a rapid deceleration from a fall through the feet, legs and pelvis. Forces transmitted through the vertebral body cause fractures, producing a shatter or bursting fracture without Spinal Cord Injury. | |
| | upper thoracic spinal nerves, what is there function? | supply muscles of the chest that help with breathing and coughing | |
| | lower thoracic nerves, what is there function? | provide abdominal muscle control and contain nerves of the sympathetic nervous system | |
| | what helps stabalize the thoracic spine | The ribs, muscles and ligaments | |
| | Ideal log rolling manpower for long spine board? | 4 people | |
| | hemoptysis | coughing up blood | |
| | acute pulmonary contusion | hemoptysis, crepatis, paradoxical motion, wheezes, crackles, rales or diminished lung sounds | |
| | tracheobronchal injuries | high mortality rate, usually related to an airway obstruction, usually close to the carina | |
| | pulmonary contusion | injury to the underlying lung tissue that inhibits the normal diffusion of oxygen and carbon dioxide. | |
| | what three factors contribute to the formation of a pulmonary contusion | 1) the spalding effect, 2) inertial effects, 3) implosion | |
| | tension pneumox, normal vitals | there still compensating, pop the chest!, as venous return decreases the body attempts to compensate by increasing heart rate in an attempt to maintain heart rate. | |
| | the self splinting effect observed in patients with chest wall trauma? | may cause atelectasis, hypoxemia or pneumonia. | |
| | massive hemothorax | parietal and visceral pleura are violated and blood begins to accumulate within this space. 1500ml of blood within the pleural space, 25-30% of blood loss in the average adult. | |
| | ventilation perfusion mismatch | Collapse of the involved lung creates a mismatch between ventilation and perfussion. If you assume the pulmonary vasculature on the involved side remains intact, the heart will continue to perfuse the involved lung while the pneumothorax prevents adequate ventilation. Result is hypoxia and hypercarbia. | |
| | what is the largest cavity in the body? | abdominal cavity | |
| | Where does the abdominal cavity extend from? | the diaphragm to the pelvis | |
| | what is the abdominal cavity lined with? | a membrane called the peritoneum which is similar to the pleura of the thoracic cavity | |
| | why would bleeding in the abdomen and retroperitoneum produce few signs and symptoms? | they can both accommodate for large amounts of blood, the bleeding may produce few signs and symptoms of trauma, even the patients vitals may not indicate bleeding but there vitals will be your tell tale sign. | |
| | what lies in the retroperitoneal space? | aorta, vena cava, pancrease, kidneys, ureters, portions of the large intestines and duodenum. | |
| | How many phases of a MVC are there? | 5 phases tied to the effects of progressive deceleration. | |
| | first phase | deceleration of the vehicle, the vehicle strikes another vehicle and is brought to an abrupt stop | |
| | second phase | deceleration of the occupant, which starts during sudden braking and continues during impact and collision. results in compression, deceleration and shear trauma. | |
| | third phase | deceleration of the internal organs, involves the bodies supporting structures and the moveable organs | |
| | fourth phase | secondary collisions, occurs when the vehicles occupants are hit by moveable objects(packages, purses, etc..) within the vehicle. These objects are traveling at the automobiles speed at impact. | |
| | fifth phase | additional impacts, when the vehicle is struck by other vehicles after the crash or falling trees which may increase the seriousness of the other injuries. | |
| | kehr`s sign | when patients report pain in the left shoulder because of referred pain from diaphragmatic injury or ruptured spleen | |
| | primary blast injury | injury from the pressure wave | |
| | secondary blast injury | debris or fragments from the explosion | |
| | tertiary blast injury | from the victim being propelled | |
| | miscellaneous blast injury | from burns or scrapes as a result of the blast | |
| | MOI in MVC`s decribed as the 3rd collision? | organs that shear or tear(liver kidneys small intestines spleen)from there point of contact. | |
| | how many types of joints are there and what are they? | 3, fibrous, cartilaginous and synovial | |
| | fibrous joints | synarthroses or fused joints, dense fibrous tissue that does not allow movement | |
| | cartilaginous joints | amphiarthroses, allow for very minimal movement between bones | |
| | synovial joints | diarthroses, the most mobile joints of the body | |
| | joints | when 2 bones come together the articulate with one another to form a joint | |
| | what are the motions joints allow for? | flexion, extension, abduction, adduction, rotation, circumduction, pronation and supination | |
| | motorcycle rider, face down, helmet on. What do you do first? | stabilize his head, maintain his airway by yelling at the patient for a response. Its easier to take the helmet off when the patient is supine. | |
| | the key to prehospital pain management? | Make the patient comfortable and decrease pain to a tolerable level | |
| | what is the major concern with an open fracture? | control the patients bleeding, infection comes later. | |
| | what do you do if you feel crepitus in your initial assessment? | leave it alone, do not try to elicit this sign your efforts may result in further injuries to the bone and surrounding soft tissues and severe pain for the patient. | |
| | what is the best way to detect deformity or abnormality in an extremity? | compare it to the extremity on the other side. | |
| | patients with decreased sensation have what disease process? | diabetics, have swelling and decreased sensation so badly that they could have fractures without being aware of it. | |
| | linear fracture | parallel to the long axis of the bone | |
| | what causes linear fractures? | low energy stress injuries | |
| | transverse fractures | straight across the bone at right angles to each cortex | |
| | what causes transverse fractures? | direct, low energy blow | |
| | oblique fracture | at an angle, across the bone | |
| | what causes oblique fractures? | direct or twisting force | |
| | spiral fracture | encircles the bone | |
| | what causes a spiral fracture? | a twisting injury | |
| | impacted fracture | end of the bone becomes wedged in another bone | |
| | what causes an impacted fracture? | fall from a significant height | |
| | organic brain syndrome | patients presenting with psychiatric symptoms that are acutely suffering from physical symptoms. Look for evidence of poisoning, or fowl breath odor for organic causes to treat an acute emergency. | |
| | Bipolar Mood disorder | patients who alternate between mania and depression | |
| | Bipolar meds | Lithium and valproic will be used front line but some patients may develop toxicity and in this case valproic acid and trgetol(carbamazepine) are used | |
| | equipment placement | remember when walking into a psychiatric scene in which law enforcement has not yet arrived give yourself a good means of egress in case of emergency, keep the door open of any equipment that may prevent such egress. | |
| | depression | the leading cause of disability in people between 15-44 years of age. | |
| | who does depression affect more? | woman of any age | |
| | anxiolytic medications and examples? | benzodiazepines, drugs for a sedative effect for anxiety. xanax, valium, clonazepam(klonopin), lorazepam(ativan), and no benzo`s-Buspiarone(buSpar) | |
| | what % of the population will experience a mood disorder? | as much as 10% | |
| | psychotic episodes | Loss of reality, patient has his or her own rules or logic, and they are elicited by fear, hostility and suspicion.The patient is awake and alert and easily distracted, may be disorientated to time and place, accelerated activity, unusual words, memory can be entirely intact or relatively intact, euphoria to sadness, auditory hallucinations are common. | |
| | care plan for psych patients | always be open and talk to your psych patients, have a plan and explain everything your going to do to or with them to make them more comfortable and accepting of the situation. | |
| | DKA | Diabetic Keto-acidossis, blood sugar is through the roof! life threatening certain acids accumulate in the body because insulin is not available. Patient gives off a fruity odor to the breath | |
| | diagnostic evaluation of the psych patient and how it differs from that of a sick or trauma patient? | talk to your patient, pay attention to them, let them do all the talking if they`d like. It differs from normal diagnosis of patient because we are not using a stethoscope, or BP cuff. The paramedic is the diagnostic tool. Your voice manner will influence his or her condition. | |
| | why are mental problems in children difficult to diagnose? | the lines between normal and abnormal behavior are not clear | |
| | abnormal behavior when it comes to psychosocial idiology? | The answer is Kids! | |
| | Old men with difficulties urinating, whats the problem? | In men, ENLARGEMENT OF THE PROSTATE can place pressure on the urethra, making voiding difficult. bladder and UTI`s can also cause inflammation | |
| | interviewing the elderly patient | Be patient, attempt to get your history from the patient as opposed to the family | |
| | extrinsic cause of falls | ACCIDENTAL FALLS FROM AN OBVIOUS ENVIRONMENTAL HAZARD, uneven sidewalk, extension cords on the floor, poor lighting, scatter rugs, ice | |
| | intrinsic drop attacks | sudden fall, patient found on the ground, somewhat confused, temporarily paralyzed | |
| | what are the elderly more prone to? | dehydration,do not be afraid to give fluids unless a pr-existing condition should prevent you from doing so. | |
| | why are they more prone to dehydration? | the thirst mechanism which ordinarily protects a person from dehydration, becomes depressed in elderly patients. | |
| | can you give subcutaneous epinephrine to an older person if there in respiratory distress? | on rare occasions epinephrine might be indicated for life threatening asthma exacerbation, 1:1,000 0.3-0.5mg, | |
| | what changes in the elderly`s respiratory system with age? | decrease in elasticity of the lungs and in the decrease in the size and strength of the respiratory muscles and calcification of the cartilage makes the chest wall stiffer. VITAL CAPACITY DECREASES and residual volume increases. | |
| | trauma in the elderly | 1 of the top 10 causes of death in the elderly. 1/4th of the trauma deaths per year are people older than 65. | |
| | what makes the elderly more at risk of trauma? | slower reflexes, visual and hearing deficits, equilibrium disorders and overall reduction in agility. DEMINERALIZED BONE IS MORE VULNERABLE TO FRACTURE! | |
| | what is the number 1 cause of injury in the elderly? | Falls, the elderly account for more then 75% of fall related deaths. | |
| | what is the number 2 cause of injury in the elderly? | MVC, the elderly account for 10% of all traffic deaths | |
| | which orthopedic injury is the most common amongst the elderly? | Hip fracture, the most common risk factor is osteoporosis. They tend to only stay alive a year after fracturing their hips. | |
| | cervical spondylosis | degenerative changes in the cervical spine, cause athritic spurs and narrowing of the vertebral canal;the nerve roots existing from the cervical spine gradually become compressed, and pressure on the spinal cord increases. | |
| | patients wearing medical patches | if the patient is hypotensive wearing a nitro patch it must be removed. Fentanyl patches decrease respiratory rate. | |
| | What happens to an elderly persons brain? | decreases in terms of weight by 5-10%, it shrinks leaving space. | |
| | what is significant about the lederly brain shrinking? | it leads to increased subdural space, which if there was a bleed it would retain a larger amount of blood. | |
| | Whom does osteoporosis affect the most | the most rapid loss of bone occurs in women during the years following menopause, and many postmenopausal women use hormone therapy as a means to reduce the loss of bone. | |
