EMT 224 (3) Flashcards
(148 cards)
1
Q
Emphysema
A
pathological changes to the lungs, happens over time, permeant enlargement of the air spaces & collapse of the alveoli
reduces the number of alveoli for gas exchange
reduces the elasticity of the remaining alveoli
2
Q
Chronic Bronchitis
A
condition involving inflammatory changes and excessive mucus production
increase in the number and size of mucus producing glands
3
Q
Chronic bronchitis is clinically diagnosed by:
A
the presence of cough with sputum production that is present half of time for at least 2 years
4
Q
Emphysema signs and symptoms:
A
Thin Barrel chest appearance Non productive cough Wheezing and rhonchi Pink appearance (Pink puffers)
5
Q
Chronic Bronchitis:
A
Typically overweight
Productive cough w/ sputum
Coarse rhonchi
Chronic cyanosis
6
Q
Upper Airway includes:
A
Naso
Oro
Laryngopharynx
Larynx
7
Q
Lower Airway includes:
A
Trachea
Bronchial tree
Alveoli
Lungs
8
Q
Capnography waveform Phases:
A
1: exhaled air from conducting airways
2. mix of anatomical dead space & alveolar gas (CO2 starts to rise)
3. alveolar gas is exhaled
4. inspiration
9
Q
Peak Flow Meter:
A
is a measurement of how fast a person can exhale air
10
Q
Increased hypoxemia and hybercarbia may be indicated by:
A
tachypnea, diaphoresis, cyanosis, confusion, irritability and drowsiness
11
Q
COPD Pt’s may present with what on ECG’s:
A
Cardiac dysrhythmias or signs of Rt atrial enlargement; tall, peaked T-waves in leads II, III and aVF
12
Q
Medications for prehospital to relieve bronchospasm and reduced constricted airways are:
A
Beta agonists (levalbuterol, albuterol)
13
Q
Pulsus paradoxus:
A
abnormal decrease in systolic pressure, drops 10-15 mm Hg during inspiration
14
Q
Well-known neurotransmitters:
A
Acetylcholine:
Norepinephrine:
Epinephrine:
Dopamine:
15
Q
Arterial blood supply to the brain comes from the:
A
vertebral arteries and the internal carotid arteries
16
Q
What vessels feed the frontal lobes of the brain:
A
anterior cerebral arteries
17
Q
The circle of Willis does what:
A
provides an important safeguard, helps to ensure blood flow to all parts of the brain, in the event of a blockage
18
Q
Veins that drain blood from the head:
A
venous sinuses
19
Q
Brain Stem:
A
Medulla
Pons
Midbrain
Site of reticular formation
20
Q
Cerebrum:
A
Largest part, controls conscious thought
21
Q
Oxygen and glucose delivery to the brain are controlled by:
A
Cerebral blood flow
22
Q
Cerebral blood flow is a function of:
A
the cerebral perfusion pressure (CPP) and the resistance of the cerebral vascular bed
23
Q
How to measure CPP:
A
Inter cranial pressure is subtracted from the Mean arterial pressure (MAP)
MAP = diastolic blood pressure + 1/3 PP (Systolic - Diastolic)
24
Q
ICP range:
A
10-15 mmHg or
25
MAP range:
70-95 mmHg
26
CPP range:
60-80 mmHg
27
Vascular tone of the brain is regulated by the:
partial pressure of arterial carbon dioxide (PCO2)
28
Cushing reflex is what:
Caused ICP and presents with, progressive hypertension increase of Systolic, Bradycardia, diminished respiratory effort, body is attempting to compensate for decreased cerebral perfusion
29
If both pupils are dilated and do not react to light, what may be affected:
Brain stem, may also occur from severe cerebral anoxia (absence of oxygen)
30
Kussmaul respiations:
abnormally deep and rapid
31
Cheyenne Stokes respirations:
regular period of breathing, followed with equal length of apnea
32
Late signs of increased ICP:
Increased systolic pressure
Widen pulse pressure
decrease in pulse
decrease in respiration
33
Compression of Cranial Nerve III:
Interrupts parasympathetic nerve actions
34
Coma is:
a deep state of unconsciousness, Pt can not be aroused by external stimuli
35
Two types of comas:
structural lesions: destroying the reticular activating system (usually effect one side of the body)
Toxic/metabolic: involve the presence of toxins/ lack of oxygen
36
AEIOU - TIPS
```
A - acidosis or alcohol
E - Epilepsy
I - Infection
O - Overdose
U - Uremia (Raised level of urea in blood)
```
T - trauma
I - Insulin
P - Psychosis
S - Stroke
37
Cerebral aneurysm:
is a weak or thin spot on a blood vessels in the brain that balloons and fills with blood
38
Eight D's of Stroke:
Detection (Public & EMS)
Dispatch (Public & EMS)
Delivery (Public & EMS)
```
Door (EMS)
Data
Decision
Drug
Disposition
```
39
Cincinnati Stroke
facial drop, arm drift and speech
40
Stroke Times:
41
Most important care for stroke Pt:
besides life support, identify stroke and rapid transport to appropriate facility
42
Tonic-clonic seizures:
Involve whole body (grand mal seizure)
43
What can cause death following grand mal seizure:
Hypoxia
44
The tonic phase is:
marked by a sequence of extensor muscle tone activity and apnea, last only a few seconds
45
The Clonic phase:
a massive autonomic discharge occurs, resulting in hyperventilation, salivation and tachycardia
46
Status Epilepticus
Aspiration, brain damage and fracture of long bones or spine
47
Brain abscess:
Accumulation of purulent material (pus) surrounded by a capsule within the brain
48
Confabulation is:
inventing stories to fill voids in memory
49
Alzheimers:
nerve cells in cerebral cortex die and the brain substance shrinks
50
Multiple sclerosis:
progressive disease where patches of myelin in the brain are destroyed
51
Peripheral Neuropathy:
refers to diseases that affect the PNS
52
Types of Spina Bifida:
occulta, meningocele, myelomeningocele, encephalocele
53
Bells Palsy effects which nerve:
VII
54
Islets of Langerhans
made up of Alpha, Beta and Delta which secrete hormones
55
Beta cells produce
insulin, a small protein released when blood glucose levels rise
56
Alpha Cells produce
glucagon, protein released when the blood glucose level falls
57
Delta Cells produce
somatostatin, inhibits the secretion of growth hormone TSH
58
Normal FSBS range:
60-120
59
Carbohydrates metabolism acts as
fast energy
60
Brain is not able to store:
Glucose
61
Hypoglycemia S&S:
```
Progressive irritability
Altered Mental Status
Fainting
Convulsions
Coma
```
62
hypoglycemia
insulin shock
63
hyperglycemia
diabetic ketoacidosis
64
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
acute diabetic decompensation
65
Hyperthyroidism is an:
excess of thyroid hormones in the blood, which may result in thyrotoxicosis
66
Most cases of hyperthyroidism occur as a consequence of:
toxic diffuse goiter (Graves disease)
67
Hyperthyroid S&S and common medications:
warm, flushed skin, fever, agitation, hyperactivity, weight loss
MED's: lodine, Methimazole (Tapazole), Propylthiouracil (Propacil)
68
Hypothyroid S&S and common medications:
Facial edema, JVD, cool skin, hypothermia, coma, weakness, weight gain
MED's: Levothyroxine (Synthroid), Liothyronine (Cytomel), Liotrix (Euthroid)
69
Graves disease is:
hyperthyroid issue, generalized by generalized enlargement of the Goiter gland
70
Genitourinary system refers to two different body systems, they are:
Genito refers to genital organs and the reproductive system
Urinary refers to the system responsible for the removal of concentrated urine, and conservation of water
71
Genitourinary system plays a role in:
```
Regulation of water and electrolytes
Regulation of the acid-base balance
Excretion of waste products and foreign chemicals
Production of red blood cells
Stimulation of glucose production
```
72
Kidneys are located:
on the posterior abdominal wall behind the peritoneum
superior border reaches the 12 thoracic vertebra
inferior border just above the horizontal plane of the umbilicus
73
Causes of renal failure are classified as:
prerenal, intrarenal, and postrenal
74
Prerenal disease occurs:
before the kidneys are reached, results from inadequate perfusion of the kidneys
75
Intrarenal disease occurs:
results from conditions that damage both kidneys
76
Postrenal disease occurs:
blocks the system that collects urine, obstruction to urine flow from both kidneys
77
Acute Renal Failure (ARF) is a clinical syndrome that results from a:
sudden, significant decrease in the filtration through the glomeruli
78
ARF leads to a build up of:
high levels uremic toxins in the blood
79
ARF occurs when the kidneys are:
unable to excrete the daily load of toxins in the urine
80
Pt's with ARF are divided into two groups based on:
the amount of urine excreted in 24 hrs
81
Oliguric
Pt's that excrete less than 500 ml/per day
82
Nonoliguric
Pt's that excrete more than 500 ml/per day
83
Conditions that can cause ARF:
Trauma, Shock, Infection, Urinary obstruction and multi-system diseases
84
When kidney function deteriorates, urine output:
frequently decreases (oliguria) or completely stops (anuria)
85
Uremia is:
and generally results from:
an excess of urea and other nitrogenous wastes in the blood
kidney malfunction
86
Uremia must be recognized and treated early and appropriately, if not it renal dysfunction leads to:
Heart failure, volume overload, hyperkalemia, and metabolic acidosis
87
Damaged kidneys are unable to rid the blood of waste products such as:
and may be caused by:
urea and creatine
hypovolemia or impaired cardiac output
88
Obstruction of the renal arteries results in:
and causes:
decreased blood flow to the kidneys
an increase in renal vascular resistance that effectively shunts blood away from the kidneys
89
A major cause of prerenal ARF in Pt's with Heart Failure is:
dehydration caused by use of diuretics
90
ARF S&S:
```
Dizziness
Dry Mouth
Thirst
Hypotension
Tachycardia
Weight Loss
```
91
ARF treatment goal is to:
improve the kidney perfusion and function by treating g the underlying causes
92
Acute Tubular necrosis:
death of tubular cells
93
Ischemic causes of Intrarenal ARF are associated with:
and most often the result of:
hypo perfusion
hemorrhage, trauma, sepsis and Pt's undergoing cardiovascular surgery
94
Drugs that can trigger Intrarenal ARF include:
Antibiotics, non steroidal anti-inflammatory drugs (NSAIDs), anticancer drugs, radio contrast dyes, alcohol
95
Intrarenal ARF S&S:
```
Fever
Flank Pain
Joint Pain
Headache
Hypertension
Confusion
Seizure
Oliguria
```
96
Treatment goal of Intrarenal ARF:
restore adequate renal blood flow by resolving the underlying cause and its complication
97
Postrenal ARF S&S:
urine retention
distended bladder
gross hematuria
peripheral edema
```
pain:
lower back
Abdomen
groin
genitalia
```
98
Chronic renal failure (CRF) is a:
progressive, irreversible systemic disease, that develops over months to years as internal structures of the kidneys are slowly damaged
99
CRF leads to:
and requires:
end-stage renal failure
dialysis or kidney transplant
100
In industrialized world, CRF results most often from:
systemic diseases (diabetes, hypertension) and autoimmune diseases
101
CRF results in the build up of:
fluid and waste products in the body
102
Azotemia is associated with CRF and is:
retention of excessive amounts of nitrogenous compounds in the blood
103
CRF may show the following 6 systemic magnifications:
```
Gastrointestinal
Cardiopulmonary
Nervous system
Metabolic or Endocrine
Personality changes
Signs of uremia
```
104
Dialysis is:
Usually performed:
used to normalize blood chemistry and remove excess fluid in Pt's with acute chronic renal failure
3x a week, each session may last 4 to 5 hours
105
Two types of dialysis:
hemodialysis and peritoneal dialysis
106
Hemodialysis:
blood is pumped through a surgically constructed arteriovenous fistula
107
Arteriovenous fistula is an:
and is located:
internal anastomosis between an artery and a vein
in the inner aspect of the Pt's forearm
LESS often may be located in the upper arm or medial aspect the lower extremity
108
Peritoneal dialysis is a:
dialysis membrane is the Pt's own peritoneum
works much slower than hemodialysis
109
A major complication of peritoneal dialysis is:
which usually results when:
peritonitis
the proper aseptic technique is not used
110
Problems associated with vascular access of dialysis Pt's:
bleeding from the site of puncture for dialysis, thrombosis, and infection
111
Bleeding from the fistula or graft can be controlled:
Complication:
with direct pressure at the site
excessive pressure can cause thrombosis
112
Pseudoaneurysm is a:
Paramedic treatment:
dilation resembling an aneurysm that occurs at the site of the graft, can rupture and may cause a large hematoma and hypovolemia
direct pressure on the hematoma and treat for blood loss, rapid transport
113
Pt's with a surgical anastomosis are instructed to:
check periodically for a bruit or "thrill", which verifies unobstructed circulation
114
Pt has a thrombosis during dialysis:
stop dialysis, fluids should be given at alternate site
115
Decreased blood flow is a common trigger for:
and the reason the blood pressure should:
thrombosis
not be taken on the arm with vascular access
116
The paramedic should consider what for a dialysis Pt with unexplained fever, malaise
vascular access infection
117
Pt's on dialysis are at risk of hemorrhage due to:
regular exposure to anti-coagulants and their decrease in platelet function
118
Most dialysis Pt's have anemia related to:
which lowers their ability to:
decrease in the production of erythropoietin
compensate for blood loss when they have acute hemorrhage
119
How should a paramedic manage a Pt has hemorrhage at the fistula or graft:
Special care should be taken:
control the bleeding and immobilize the extremity
to not obstruct the circulation of anastomosis
120
Hypotensive dialysis Pt's should be managed:
Most respond to what amount of fluid challenge:
carefully, so not to cause fluid overload
200 to 300 mL, if no response consider more serious causes
121
Dialysis may cause myocardial ischemia and chest pain, from:
episodes of hypotension and mild hypoxemia
122
Most common ischemia rhythm disturbances related to dialysis:
What should the paramedic do if the Pt's is in the middle of treatment
PVC's
stop procedure and contact medical control
123
Severe hyperkalemia often results from:
poor diet regulation and missed dialysis treatments
124
Severe hyperkalemia often presents how:
weakness but often are asymptomatic
125
As potassium levels rise, the conduction slows resulting in what on ECG's:
prolonged P-R interval, depressed ST segments and sometimes loss o P-waves
126
Pt in cardiac arrest with renal failure should be suspected of:
Based on the Pt's Hx, medical direction may recommend:
severe hyperkalemia
separate administration of calcium and sodium bicarb during resuscitation
High dose albuterol to reduce the plasma potassium concentration
127
Disequilibrium Syndrome refers to a group of neurological findings that sometimes occur:
during or immediately after dialysis
128
Disequilibrium S&S:
```
are mild
headache
restlessness
nausea
fatigue
```
129
Disequilibrium syndrome creates an osmotic gradient between the brain and the blood, which causes:
water to move into the brain, resulting in cerebral edema and increased intracranial pressure
130
Pt with air embolism should be treated with:
High flow O2 and rapid transport, placed on left side in an effort to trap the embolism where it will least likely obstruct blood flow
131
Pre hospital management for Chronic or Acute renal failure:
Airway
Vascular access for fluid replacement, medication therapy (diuretics, anti-dysrhythmics, vasopressors)
Meticulous aseptic technique
ECG
Rapid transport to appropriate facility
132
Urinary retention is the:
Caused by:
inability to urinate
enlarged prostate, CNS dysfunction, foreign body obstruction
133
Urinary retention can be caused by which drugs:
parasympatholytic or anticholinergic agents
134
S&S of Urinary retention:
severe abdominal pain associated with urgent need to urinate and a distended bladder
135
Nocturia is:
excessive urination at night
136
overflow incontinence is:
an overflow of urine from the bladder
137
Prostatic hypertrophy in can cause delirium, especially in:
elderly Pt's
138
UTI's usually develop first in the:
lower urinary tract (urethra or bladder)
139
Upper tract infections often are associated with:
kidney infection or abscesses that form in the kidney tissue
140
Lower UTI of the urethra and bladder occurs when:
enteric flora (particularly Esherichia coli, normally found in the bowel) enter the opening of the urethra
141
S&S of UTI:
painful or difficult urination (dysuria)
urinary frequency
hematuria
cloudy or rust colored urine
flank or suprapubic abdominal pain
fever, chills and malaise (may be present)
142
Pyelonephritis is:
Most often occurs as result:
inflammation of the kidney parenchyma (upper urinary tract)
of lower UTI
143
Pyelonephritis is most common in:
adult women
144
S&S of Pyelonephritis:
usually abrupt
mistaken for lower back strain
flank pain
fever
chills
145
Therapeutic intervention for pyelonephritis consist of:
antibiotics, fluid replacement, and sometimes hospitalization
146
Urinary calculi (kidney stones) are:
and are more common in:
pathological concretions that originate in the renal pelvis
men than women; most often occur in men between 20-50's
147
Kidney stones result from:
supersaturation of urine with insoluble salts
148
when the level of insoluble salts or uric in the urine is high, the urine lacks:
citrate (a chemically that normally inhibits the formation of stones)
