EMT Exam 2 Flashcards
(387 cards)
1
Q
What to know when giving medication
A
- Indications
- Contraindications (when you should’t give it)
- Side effects
- Untoward/adverse effects (more harmful and unpredictable compared to side effects)
2
Q
The six rights with medication
A
(1) Right patient
(2) Right medication
(3) Right dose
(4) Right time
(5) Right route
(6) Right documentation
3
Q
TRAMP-ED
A
- Time
- Route
- Amount
- Medication
- Patient
- Expired
- Documentation
4
Q
Routes of administration
A
- Oral (PO)
- Sublingual (SL)
- Inhaled
- Intramuscular (IM)
- Intranasal (IN); Mucosal Atomization Device (MAD)
- Subcutaneous (SubQ)
- Endotracheal (ET)
- Intravenous (IV)
5
Q
Pharmacodynamics (PD)
A
Study of effects of meds on the body
6
Q
Pharmacokinetics (PK)
A
Study of absorption and elimination in the body; patient specific factors change how a medication is absorbed, works, and is eliminated
7
Q
Ways fluids/meds can be administered into the vein
A
- Saline lock (includes catheter and cap/lock that contains the port for administering meds)
- Drip set (includes drip chamber, flow regulator, and drug/needle port)
8
Q
Aspirin
A
- Dose: 81mg to 324 mg baby (chewable); 325 mg adult
- Route: Chewed/PO
- MoA: Prevents further aggregation of platelets
- Indications: Cardiac nature chest pain/discomfort
- Contra indications: Asthma (can induce heart attack), recent trauma, GI bleeding, use in children
- Side effects: GI upset, N/V, Heart burn
- Medical command: Not required
9
Q
Oral Glucose
A
- Dose: 15 grams (1 single dose tube or 1/3 of tipple dose tube)
- Route: Buccual
- MoA: Increases blood sugar level
- Indications: AMS with a history of DM, with suspected hypoglycemia
- Contra indications: Unable to follow simple commands, Unable to protect airway
- Side effects: Possible hyperglycemia
- Medical command: Not required
- Notes: Protect patient’s airway, may be possible to give to patient with severely AMS and lowered LOC; hypoglycemia is a stroke mimic
10
Q
Oxygen
A
- Dose: Nasal Cannula: 0-6lpm; Non-rebreather: 15lpm
- Route: Inhalation
- MoA: Provides increase % of O2 in inhaled air
- Indications: Any patient in respiratory distress or suspected shock
- Contra indications: None for emergency use
- Side effects: Long term. non-humidified use can cause dehydration and nose bleeds
- Medical command: Not required
11
Q
Activated Charcoal
A
- Dose: 12.5-25 grams for peds (1/2 to 1bottle); 25-50 grams for adults (1-2 bottles)
- Route: Oral (PO)
- MoA: Binds to ingested particulate
- Indications: Ingestion of poison/toxin with medical command order
- Contra indications: Unable to swallow/protect airway/follow simple commands, ingestion of caustic substance, exposure to toxin/poison via means other than ingestion
- Side effects: Vomiting, black/tar stool a few days after
- Medical command: Must contact prior to administration
- Notes: If vomiting occurs, must repeat dose once
12
Q
Bronchodilator Inhaler and Albuterol Treatment
A
- Dose: 1 Rx dose (usually 1 dose is 2 puffs) for inhaler; 2.5mg through handheld nebulizer for albuterol treatment
- Route: Inhalation
- MoA: Causes bronchodilation, allowing air to more easily pass through airway structures; B-2 agonist
- Indications: Respiratory distress with signs of bronchoconstriction, wheezing
- Contra indications: Broncho-constriction not the suspected cause of respiratory distress, patient not alert
- Side effects: Increased HR, anxiety, shaking, nervousness
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: You do not need full set of vitals sins or assessment; the albuterol treatment that is given in a nebulizer is an administered med
13
Q
Nitroglycerin
A
- Dose: 0.4 mg (1 spray ro tablet)
- Route: Sublingual
- MoA: Dilated coronary arteries, reducing workload of the heart, thereby reducing O2 command
- Indications: Patients have chest pain as suspect to cardiac issues
- Contraindications: Non-cardiac chest pain, ED drug use in last 24-48 hours, systolic BP <100, recent dosing
- Side Effects: Light headedness, fainting, drop in BP, anxiety, increased HR
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: Must ask all patients (including females) about ED use, must be careful handing drug bs it can be absorbed into skin
14
Q
Naloxone (Narcan)
A
- Dose: 2mg
- Route: Intranasal
- MoA: Reverses the effects of narcotics, including depressed level of consciousness and respiratory depression
- Indications: Suspected narcotic overdose, coma of unknown cause
- Contraindications: Patient breathing adequately and able to maintain own airway
- Side Effects: May precipitate withdrawal in patients dependent on narcotics
- Medical Command: Not required
- Notes: Only used to attain adequate respiratory effect
15
Q
Epinephrine Auto-Injectors
A
Dose: 0.3 mg for adults; 0.15 for peds
Route: Intramuscular
- MoA: Sympathetic activation, bronchodilation, vasoconstriction
- Indications: Severe allergic reactions with signs of AMS or respiratory compromise
- Contraindications: Mild allergic reaction, none in true emergency setting
- Side Effects: Increased HR, anxiety, shaking, nervousness, headache, numbness in extremities
- Medical Command: Must call after first administration for any subsequent administrations
- Notes: Don’t need full set of vitals/assessment
16
Q
How many meds interact poorly with grapefruit
A
85+
17
Q
Saline lock
A
Catheter is placed into the vein and lock is place over it; lock contain port for administering meds through IV if needed later
18
Q
IV Drip Set
A
Clear plastic tubing connecting fluid bag; three important parts are drip chamber, flow regulator. drug/needle port
19
Q
Right atrium
A
Receives blood from veins; pumps to right ventricle
20
Q
Right ventricle
A
Pumps blood to lungs
21
Q
Left Atrium
A
Receives blood from lungs; pumps to left ventricle
22
Q
Left Ventricle
A
Pumps blood through the aorta to the body
23
Q
Tricuspid
A
24
Q
Mitral (Bicuspid)
A
25
Pulmonary Valve
26
Aortic Valve
27
Circulation of blood in the heart
28
What is the only ARTERY that carries deoxygenated blood
Pulmonary arteries
29
What is the only VEIN that brings oxygenated blood to the lungs
Pulmonary veins
30
Cardiac conduction system
A system of specialized muscle tissue that conducts electrical impulses that stimulate the heart to beat; automatic/involuntary; regulated by cardiac control centers in the brain
31
Pulse
The outward expression of the heart beating
32
Blood Pressure
- Heart at work = systole = systolic pressure
- Heart at rest = diastole = diastolic pressure
33
RBCs
34
Plasma
35
WBCs
36
Platelets
Help with clotting
37
Acute Coronary Syndrome (ACS)
- AKA cardiac compromise
- Blanket term for any time the heart may not be getting enough oxygen
- Symptoms often mimic non-cardiac conditions
- Treat all patients with ACS-like signs and symptoms as though they are having a heart problem
38
Common ACS symptoms
- Chest pain is best-known symptom
- The chest pain can be described as crushing, dull, heavy, and squeezing or will be described as only pressure or discomfort; radiates to arms, upper abdomen, and jaw
- Shortness of breath
39
Associated signs and symptoms of ACS
- Anxiety and feeling of impending doom
- Nausea and pain/discomfort in upper abdomen
- Sweating
- Abnormal pulse
- Abnormal blood pressure
40
What are the three patient populations that have atypical presentation in ACS
- Women
- Diabetics
- Elderly
41
Secondary assessment AFTER doing normal primary assessment for cardiac
- Use OPQRST-ASPN to get HPI
- Obtain SAMPLE history
- Take baseline vitals
- ASPN
42
Focused physical assessment for cardiac
- Look for perfusion (pulse in all extremities, capillary refill) in all extremities
- Lung sounds
- Inspection of chest
- Palpation of chest (rule our pleuritic chest pain)
- JVD
43
12 Lead EKG
- If trained and authorized to do so, obtain a 12-lead EKG for chest pain
- An EKG is a paper print out that reflects the electrical activity of the heart
- 12-lead tells us about STEMI
44
What does STEMI (12-lead) stand for
- ST: Segment
- E: Elevation
- M: Myocardial
- I: Infarction
45
Treatment for true chest pain
- Position of comfort
- O2 if appropriate
- Aspirin
- Nitroglycerin
- Transport to a cardiac center (emergency cath lab)
46
Coronary Artery Disease
- Underlying condition for MI
- Conditions that narrow or block arteries of heart
- Often result from fatty deposit build-up on inner walls of arteries
- Build-up narrows inner vessel diameter, restricts flow of blood
47
Types of coronary artery disease
- Thrombus: Blood clot on the inner surface of an artery
- Embolus: Piece of blood clot breaks loose and flows to a smaller artery
- Occlusion: Blockage of a blood vessel; reduced blood supply to myocardium causes emergency in majority of cardiac-related medical emergencies
48
Aneurysm
Weakened sections of blood vessels begin to dilate (balloon); bursting (rupture) can cause rapid, life-threatening internal bleeding
48
Electrical Malfunction of the Heart
- Malfunction of heart's electrical system generally results in dysrhythmia (abnormal rhythm)
- Dysrhythmias include bradycardia, tachycardia, and rhythms that may present when there is no pulse
49
Mechanical malfunctions of the heart
- Angina pectoris
- Acute MI (AMI)
- Congestive Heart Failure (CHF)
50
Angina Pectoris
- Type of mechanical malfunction of the heart
- Chest pain caused by insufficient blood flow to the myocardium
- Typically due to narrowed arteries secondary to coronary artery disease
- Pain usually during times of increased myocardial oxygen demand, such as exertion or stress
51
AMI
- Type of mechanical malfunction of the heart
- Death of a portion of the myocardium due to lack of oxygen
- Coronary artery disease is usually the underlying reason
- Signs and symptoms: Typical ACS
52
CHF
- Type of mechanical malfunction of the heart
- Inadequate pumping of the heart
- Often leads to excessive fluid build-up in lungs and/or body
- May be brought on by diseased heart valves, hypertension, obstructive pulmonary disease
- Often a complication of AMI
53
Progression of CHF
- Patient sustains AMI
- Myocardium of left ventricle dies
- Because of damage to left ventricle, blood backs up into pulmonary circulation and lungs
- If untreated, left heart failure commonly causes right heart failure
54
Signs/symptoms of CHF
Signs:
- Tachycardia
- Dyspnea and cyanosis
- Normal/elevated blood pressure
- Diaphoresis
- Pulmonary edema
Symptoms:
- Anxiety/confusion due to hypoxia
- Pedal edema
- Engorged, pulsating neck veins (late sign)
55
Adequate Breathing
Breathing is sufficient to support life; signs include:
- No obvious distress
- Ability to speak in full sentences
- Normal color, mental status, and orientation
- Regular respirations/breathing sounds
56
Inadequate Breathing
Breathing is not sufficient to support life; signs include:
- Abnormal resp, diminished/absent lung sounds, poor tidal volume
57
What must happen for heart to function
Function of heart if to pump blood:
- Electrical function and mechanical functions must work together
- Electrical stimulation causes muscles to contract
- Pumping muscle requires oxygenated blood
- Without oxygenated blood, pumping fails
58
Mechanical Failure of the heart
- Loss of normal heart muscle structure
- MI
- Chronic hypertension
- Loss of normal heart valve function
- Direct trauma
- Pulseless electrical activity (PEA) indicates mechanical failure
59
Asystole
No electrical functional of the heart (flat line); not shockable
60
Ventricular Tachycardia
Too often; shockable because there is still activity
61
Ventricular Fibrillation
No pattern; shockable bc there is still activity
62
Electrical dysfunction of the heart
63
Sudden cardiac arrest
- Abrupt onset of dysrhythmia
- Acute blunt trauma to the chest causes commotio cordis (has to be very specific; low chance; Damar Hamlin)
- Oxygen levels are relatively normal at beginning
64
Asphyxial cardiac arrest
- Heart stops pumping due to systemic hypoxia
- Result of low oxygen levels in blood
- Appears with more warning than sudden cardiac arrest
- Quality ventilations are important during CPR; no point in respirations without oxygen
65
Agonal Respirations
- Occurs breathing occurs as a primal reflex during cardiac arrest
- Small amount of oxygen allows medulla to send impulses to respiratory muscles
- A downward spiral will end in death unless someone intervenes
66
Effects of cardiac arrest
- Heart fails to pump
- Blood stops moving
- Cells are robbed of essential oxygen and nutrients
- Organs are damaged and eventually fail
- Patient will die if uncorrected
- Goal is to intervene as early as possible
67
Pediatric cardiac arrest
- Cardiac arrests in children are generally asphyxia in nature
- Caused by choking, shock, or resp problem
- Cardiac arrest in children is usually a predictable outcome after steady and rapid decompensation
68
Three commonly reported types of Sudden Unexpected Infant Death Syndrome (SUIDS)
Three commonly reported types of SUID:
- Sudden infant death syndrome (SIDS)
- Unknown cause
- Accidental suffocation and strangulation in bed
69
Typical SUIDS patient
- Cardiac slowdown and sleep apnea
- Eventually will stop breathing and not start again
- Episode will be fatal if infant not reached in time
70
What to do with SUIDS patient
- Unless there is rigor mortis, provide resuscitation
- Provide emotional support to the parents
71
Chain of survival (adult/5 elements)
(1) Recognition and activation of the emergency response system
(2) Immediate high-quality CPR
(3) Rapid defibrillation
(4) Basic and advanced EMS
(5) Advanced life support and postarrest care
72
BLS Assessment
- Check responsiveness
- Call for additional resources
- Check breathing (agonal gasps)
- Check pulse for 5-10 seconds
73
What to do if patient wakes up/moves after CPR
- Manage airway; avoid hyperventilation
- Keep defibrillator on patient during transport in case patient goes back into arrest
- Reassess pulse every 30 seconds
- Reassess all vitals frequently (at least every 5 minutes)
- Transport
74
What to do if patient goes back into cardiac arrest
- Stop vehicle and resume CPR
- Analyze rhythm asap
- Deliver shock if indicated
75
How to treat submersion injury patient in cardiac arrest
- Treat them the same as any other cardiac arrest patient
- Be aggressive with airway management and rescue breathing
- Dry the patient
- Take precautions to make very defibrillation safe for you and your team in water environment
- May need to check pulse for longer for hypothermic patients (30 seconds)
- Only defibrillate one time
76
When can you terminate resuscitation
Must continue resuscitation once you start until circulation occurs, another rescuer takes over, or until cease resuscitation order from physician/authority is received
77
How to notify family of unsuccessful resuscitation
- Be straightforward
- Allow family time with deceased patient
- Don't say you know how they feel
78
Common poisons
- Meds (PORCH)
- Pesticides
- Plants
- Foods
79
What is the severity of poison based on
- Nature of poison
- Concentration
- Route of entry
- Duration of exposure
- Patient's age and health
80
Routes of entry for poison
- Ingested
- Inhaled
- Absorbed
- Injected
- Radiation (which could be classified as absorbed)
81
When do children vs adults ingest poison
A child may accidentally eat/drink toxin; an adult may purposefully and accidentally overdose from meds
82
Assessment for ingested poison
- What substance was involved (look for container; bring it with you)
- When did the exposure occur
- How much was ingested (estimate missing pills with dates)
- Over how long a time (med taken for first time vs chronically)
- What effects has patient experienced
- What interventions have been taken
- Patients weight
83
Symptoms of food poisoning
Nausea, vomiting, abdominal cramps, diarrhea, fever
84
Effects of acetaminophen poisoning
- 4-12 hours: Loss of appetite, nausea, vomiting
- 1-2 days: RUQ pain and jaundice
- Antidote should be given within first 12 hours
85
Signs and symptoms of inhaled poison
- Difficulty breathing
- Chest pain
- Coughing
- Hoarseness
- Headache, confusion, AMS
- Seizures
86
Assessment for inhaled poisons
- Substance involved
- When did exposure occur
- Over how long did exposure occur
- What inventions taken
- Was patient removed
- Was the area ventilated
- What effects is patient experiencing
87
Treatment for inhaled poison
- Move patient from unsafe environment
- Open the airway, provide high flow oxygen
- History, physical exam, vital exams
- Transport with all bottles
- Ongoing assessment en route
88
What is CO, how is CO poisoning caused
- CO is colorless, odorless, tasteless gas created by combustion
- Can be caused by improper venting of fireplaces, portable heaters, generators
89
Signs and symptoms of CO poisoning
- Headache (band around head)
- Dizziness/nausea
- Breathing difficulty
- Cyanosis
90
Treatment for CO poisoning
- High flow oxygen is appropriate, but since CO bonds to rbcs more strongly than oxygen, can take several hours/days to "wash" CO from bloodstream
91
Why is inhaling smoke dangerous
- Smoke from burning materials can contains toxins like CO, ammonia, etc and the substances can irritate skin and eyes, damage lungs, and can progress to respiratory/cardiac arrest
- Burned airway
92
Signs and symptoms of smoke inhalation
- Difficulty breathing
- Coughing
- Smoky breath smell
- Black (carbon) residue in mouth, nose, or sputum
- Singed nasal or facial hair
93
Treatment for smoke inhalation
- Move patient to safe area
- Maintain airway; provide high flow oxygen
- Monitor patient closely- airway burns may lead to swelling of airway
94
Treatment of absorbed poisons
- Assess for immediate life threats
- History, physical exam, vital signs
- Brush off powder, then irrigate
- Irrigate skin and eyes for at least 20 minutes and during transport
- Transport with all containers
- Ongoing assessment en route
95
What does alcohol abuse affect
Central nervous system
96
Assessment of alcohol abuse
All patients receive full assessment regardless of suspicion of intoxication
97
Signs and symptoms of alcohol abuse
- Alcohol on breath
- Unsteady on feet
- Slurred speech
- Flushed, warm
- Nausea/vomiting
- Poor coordination
- Blurred vision
- Confusion/AMS
98
Delirium Tremens (DTs)
- Abrupt cessation of drinking may cause DTs (alcohol withdrawal)
99
Signs and symptoms of DTs
- Confusion and restlessness
- Unusual behavior (insanity)
- Hallucinations, hand tremors, sweating
- Seizures
100
Patient care for alcohol abuse
- Keep suction ready for vomiting
- Stay alert for airway problems
- Monitor vitals signs
- Gather history from patient, bystanders
- Stay alert for seizures
101
What is substance abuse
- Any chemical substance taken for other than medical reasons
102
Uppers
Stimulants that affect the nervous system; may be snorted, smoked, or injected (examples are cocaine, amphetamines,etc)
103
Signs and symptoms of uppers
- Excitement, restlessness
- Increased pulse and respirations
- Sweating
- Hyperthermia
- No sleep for a long time
104
Downers
Central nervous system depressants (examples are barbiturates, rohypnol (roofies), GHB)
105
Signs and symptoms of downers
- Sluggishness
- Poor coordination
- Decreased pulse and respirations
106
What are narcotics
- Used to relieve pain or help with sleep
- Examples are opiates (heroin, codeine, morphine), oxycodone
107
Signs and symptoms of narcotics
- Lethargy
- Pinpoint pupils
- Cool skin
- Respiratory depression
- Coma
108
What are hallucinogens
- Create intense state of excitement and distorted perception
- Examples are LSD, PCP, ecstasy
109
Signs and symptoms for hallucinogens
- Rapid pulse
- Dilated pupils
- Flushed face
- Seeing/hearing things
110
What are volatile chemicals
- Produce vapors that are inhaled
- Initial "rush" then can act as central nervous system depressant
111
Signs and symptoms of volatile chemical inhalation
- Dazed/disoriented
- Swollen membranes in nose or mouth
- Numbness/tingling sensation inside head
- Changes in heart rhythm
- May be residue of chemical on face or in bag
112
Treatment for substance abuse
- Be aware of possible airway problems and respiratory distress
- Provide oxygen and assist respirations as needed
- Treat for shock
- Talk to patient to keep them calm and cooperative
- Perform physical exam
- Look for evidence of injection site (track marks)
113
How do infectious diseases spread
Via bacteria, viruses, other microbes
114
How do communicable diseases spread
- Direct contact
- Contact with secretions
115
Incubation period
The time from exposure to development of the first symptoms when an infection cases illness
116
Communicable period
The interval when the patient is shedding/releasing infectious material; when the microbe can be potentially transmitted
117
Factors causing infection and illness after exposure
- Virulence
- Dose
- Route
- Body's resistance
118
Sepsis
Life-threatening condition resulting from an abnormal and counterproductive response to infection by the body that causes damage to tissues and organs; the body overreacts and secretes substances that, instead of helping, hurts cells, tissues, and organs
119
When does septic shock occur
When changes from sepsis results in shock and hypotension that do not respond to intravenous fluids
120
Stages of sepsis
Infection (local), sepsis (systemic), septic shock (systemic with hypotension)
121
Infection (local) stage of sepsis
Microbes multiply; the body mounts a normal immune response, usually including increase in wbcs
122
Sepsis (systemic) stage of sepsis
Body produces lactic acid and other chemicals; the ability to produce wbcs may be limited/exhausted
123
Septic shock (systemic with hypotension)
Lactic acid and other chemicals accumulate in the bloodstream, causing vasodilation and increased capillary permeability; leads to hypotension
124
Common causes of sepsis (by location)
- Lungs: pneumonia
- GI Tract: Abdominal surgery, pancreatitis
- Genitourinary Tract: Kidney/prostate infections, urinary catheter
- Skin: Long-term intravenous catheter, tracheostomy, gastrostomy tube, pressure sores
125
Systemic Inflammatory response syndrome (SIRS) criteria
- Temp: <96.8 deg F, >101 def F
- Heart rate over 90
- Respiratory rate over 20
- Systolic BP lower than 90
- New-onset AMS
126
Quick sepsis-related organ failure assessment (qSOFA)
- Resembles SIRS criteria
- Doesn't predict whether someone is septic
- Predicts whether septic patient will have longer to stay in ICU or be more likely to die
- Factors: AMS, resp rate >22, systolic blood pressure <100mmhg
127
What is chicken pox caused by
Varicella-zoster virus (VZV)
128
Signs and symptoms of chickenpox
- Starts with vague symptoms resembling cold
- Followed by fever and itchy rash that looks like blisters
129
How does chickenpox spread
- Direct person-to-person contact
- Airborne from rash on skin or mucous membranes
- Dried scabs don't spread disease
130
Treatment and prevention of chickenpox
- Isolation of patients until lesions dry
- Antiviral meds to shorten course of disease and prevent complications
- Vaccination
131
Measles
Aka rubeola, a highly infectious viral disease
132
Signs and symptoms of measles
- Starts with fever, cough, eye irritation
- Small white spots on inside of cheek (koplik spots)
- Red-blotchy rash
133
How is measles spread
It is easily spread via inhaled droplets in air, contact with nose and throat secretions
134
Treatment for measles
No specific treatment
135
Measles prevention
Vaccination, quarantine, and hand hygiene
136
What is mumps caused by
Paramyxovirus
137
Signs and symptoms of mumps
- Starts with vague symptoms such as muscle aches, loss of appetite, headache
- Progresses to swelling and inflammation of one or both parotids
- Parotitis lasts 7 to 10 days
138
Transmission of mumps
- Droplets
- Direct contact with saliva
139
Prevention of mumps
- Vaccination
- Quarantine of patients for 5 days after swelling appears
140
Hepatitis
General term that means inflammation of liver
141
Signs and symptoms of hepatitis
- Fever
- Nausea
- Loss of appetite
- Malaise
- Abdominal pain
- Jaundice a few days later
- General worse in older patients
142
How is hepatitis A spread
- By fecal-oral route
143
Treatment for hepatitis A
No specific treatment
144
Prevention of hepatitis A
- Hand hygiene
- Proper food prep
- Vaccination
145
Treatment for Hepatitis B
No specific treatment
146
Prevention for hepatitis B
- Vaccination
- Proper decontamination of equipment after a call
147
Postexposure actions for hepatitis B
- Wash exposure site with soap and water
- See health care provider right away
- Vaccination
- Possible immune globulin injection
148
Signs and symptoms of hepatitis B
- Nausea
- Vomiting
- Loss of appetite
- Vague abdominal pain
- Progresses to jaundice
- Younger patients have fewer or no symptoms, but much more likely to develop chronic infection
149
Transmission of hepatitis B
- Blood and any fluid that contains blood
- Semen
- Cerebrospinal fluid
- Amniotic fluid
- Vaginal secretions
- A few other fluids
150
Signs and symptoms of hepatitis C
- Similar to hepatitis B in many ways
- Nausea
- Vomiting
- Loss of appetite
- Vague abdominal pain
151
Transmission of hepatitis C
- Bloodborne through shared needles
- Less commonly through sex or childbirth
152
Is there a hepatitis C vaccine
Several safe med regimens but no vaccine
153
Prevention of hepatitis C
- Standard precautions
- Proper use and disposal of sharps
154
Signs and symptoms of HIV/AIDS
- For some, flu-like symptoms within a few weeks of HIV infection
- Fever
- Sore throat
- Fatigue
155
What is AIDS characterized by
Opportunistic infections:
- Pneumocystis carinii
- Kaposi's sarcoma
- Tuberculosis
156
Routes of transmission for HIV/AIDS
- Shared needles
- Unprotected sex between men
- Any penetrative activity involving blood and semen
- During delivery or breastfeeding from mother to newborn
157
Treatment for HIV/AIDS
Antiviral medications reduce and suppress HIV viral load
158
Prevention of HIV/AIDS
- Standard precautions
- Public measures to reduce shared needle use and promote condom use
159
What to do after exposure to HIV/AIDS
- Wash area
- Consult health care provider
160
Influenza
Common contagious respiratory illness caused by influenza virus
161
Signs and symptoms of influenza
- Fever
- Nonproductive cough
- Severe muscle aches
- Sore throat
- Headache
- Severe weakness
162
How is influenza spread
By droplets or direct contact
163
Treatment for influenza
Antiviral meds lessen severity but must be taken within 48 hours of symptoms onset
164
Prevention of influenza
- Hand hygiene
- Surgical masks
- Vaccination
165
What is croup caused by
AKA laryngotracheobronchitis; caused by human parainfluenza virus (HPIV)
166
Signs and symptoms of croup
- Mild fever and soreness
- LOUD SEAL BARK COUGH
- Dyspnea especially when upright
- Restlessness
- Paleness with cyanosis
167
Who is most susceptible to croup, how do they present
Children between 6 months and 3 years are most susceptible
- They present with history of upper respiratory infection that later produces characteristic seal bark cough
- Symptoms often worse at night
168
How does croup spread
Transmission by droplets from cough or sneezes that survive on objects
169
Prevention for croup
- Hand hygiene
- Refrain from touching nose, eyes, and mouth
170
What is whooping cough caused by
- Aka pertussis
- Respiratory infection caused by bordetella pertussis bacteria
171
Signs and symptoms of whooping cough
- Begins like typical upper respiratory infection
- Worsens into fits of uninterrupted coughing followed by "whooping" sounds on inspiration
172
How is whooping cough spread
By large droplets in air
173
How is whooping cough treated
Treatment with antibiotics
174
Prevention for whooping cough
- Vaccine
- Hand hygiene
- Refrain from coughing nose, eyes, and mouth
175
Pneumonia
Infection that affects one or both lungs; causes alveoli to fill up with fluid and bacteria, viruses, or fungi may cause pneumonia
176
Signs and symptoms of pneumonia
- Fever
- Chills
- Shortness of breath
- Tachypnea
- Pleuritic pain
- Productive cough
- Inflammation consolidated in part of lung on x-ray
- Potential febrile seizures in young children and infants
- AMS common in elderly patients
177
How is pneumonia spread
By droplets but requires close contact of several days
178
How is pneumonia treated
Antibiotics
179
Prevention of pneumonia
- Vaccination
- Hand hygiene
- Cough etiquette
180
Tuberculosis
Infection disease that affects lungs and it caused by mycobacterium tuberculosis
181
Signs and symptoms of tuberculosis
- Cough (initially dry, later productive)
- Fever
- Night sweats
- Weight loss
182
How is tuberculosis spread
By coughing, singing, or sneezing
183
How is tuberculosis treated
Treatment with antibiotics
184
How is tuberculosis prevented
- Vaccination
- Airborne disease precautions including N-95 respirator
185
Meningitis
Inflammation of meninges caused by bacteria neisseria meningitidis
186
Signs and symptoms of meningitis
- Abrupt onset of fever
- Nausea/vomiting
- Severe headache
- Nuchal rigidity
- Photophobia
- Possible petechiae
187
How is meningitis treated
Treatment with antibiotics for meningococcal meningitis
187
How is meningitis spread
By direct contact
188
How is meningitis prevented
By vaccination
189
Viral STIs
- HIV
- Hep A, B, C
- Genital herpes
- HPV
190
Bacterial STIs
- Chlamydia
- Gonorrhea
- Syphilis
191
How is lyme disease transmitted
Tick bites
192
What do patients with lyme disease display
Most patients display rash (erythema migrans) within a week that looks like a bull's-eye
193
How to treat lyme disease
Treatment with antibiotics
194
Requirements to maintain mental status
- Oxygen to perfuse brain tissue
- Glucose to nourish brain tissue
- Water to keep brain tissue hydrated
195
Sensory vs Motor (somatic division of peripheral nervous system)
- Sensory: Messages from body to brain; afferent
- Motor: Messages from brain to body; efferent
196
Causes of AMS 1
S: Stroke, seizure, sugar
N: Narcotics
O: Oxygen
T: Toxins, trauma, temperature
197
Causes of AMS 2
A: Alcohol
E: Epilepsy
I: Insulin
O: Overdose
U: Underdose
T: Trauma
I: Infection
P: Pyschosis
S: Stroke
198
What is one of the most common causes of AMS and how should it be treated
Hypoxia; consider oxygen administration and be alert for need of position and suctioning if required or if mental status worsens
199
Insulin
- Produce by pancreas
- Allows large glucose molecule to pass into cells
- Sugar intake-insulin production balance allows body to use glucose effectively as energy source
200
Type 1 vs Type 2 Diabetes Mellitus
Type 1: Underproduction of insulin by pancreas
Type 2: Inability of body's cells to use insulin properly
201
How is type 1 diabetes controlled
In type 1, there isn't enough to transfer circulating glucose into cells and so synthetic insulin is prescribed to supplement inadequate natural insulin
202
How is type 2 diabetes controlled
In type 2, pancreas is secreting insulin, but body is unable to use it to move glucose into cells; controlled through diet and/or oral antidiabetic meds
203
What causes hypoglycemia
The diabetic:
- Takes too much insulin
- Does not eat
- Over-exercises/overexerts
- Vomits
204
Signs of hypoglycemia
- Rapid onset
- Abnormal behavior
- Pale, clammy skin
- Tachycardia
- Seizures
205
Results of hypoglycemia
- Starvation of cells
- AMS
- Unconsciousness
- Permanent brain damage
206
Causes of hyperglycemia
- Decrease in insulin (may be doe to body's inability or because insulin injections not good enough quality)
- Infection
- Stress
- Increasing dietary intake
207
Signs of hyperglycemia
- Develops over days/weeks
- Chronic thirst and hunger
- Increased urination
- Nausea
208
Results of hyperglycemia
- Profound dehydration
- Excessive waste products released into system
- Diabetic ketoacidosis (DKA)
209
Signs and symptoms of DKA
- Profoundly AMS
- Shock (caused by dehydration)
- Rapid breathing
- Acetone odor on breath
210
What special things to look for in physical assessment for diabetic
- Calloused fingertips from needles
- Glucose monitor
- Contusions from insulin injection
211
Blood glucose measurements
- Less than 60-80 mg/dL in symptomatic diabetic: hypoglycemia
- Less than 50 mg/dL: significant alterations in mental status
- Over 140 mg/dL: Hyperglycemia
- Over 200-300 mg/dL for prolonged time: Dehydration, other more serious symptoms
212
Patient care for hypoglycemia
- Occasionally can treat person with mild hypoglycemia and minor AMS by giving something to eat; never give food/liquids at risk for aspiration
- Oral glucose if worse
213
Cerebral Vascular Accident
Aka stroke; death or injury of brain tissue from oxygen deprivation
214
What causes stroke (types)
Blockage of artery supplying blood to part of the brain (Ishemic) or bleeding from a ruptured blood vessel in the brain causing blood to leak into brain tissue (hemorrhagic)
215
Cincinnati Prehospital Stroke Scale (CPSS)
F: Facial droop (ask patient to smile)
A: Arms (Ask patient to close eyes and hold out arms for 10 seconds)
S: Slurred speech
T: Time
216
Signs and symptoms of stroke 2
- Confusion
- Dizziness
- Numbness, weakness, or paralysis (usually on one side of the body)
- Loss of bowel or bladder control
- Impaired vision
- High blood pressure
- Difficult/snoring respirations
- Nausea/vomiting
- Seizures
- Unequal pupils
- Headache
- Loss of vision in one eye
- Unconsciousness (uncommon)
216
Aphasia
Difficulty in communication
217
Transient Ischemic Attack (TIA)
- Small clots temporarily block circulation to part of the brain, causing stroke-like symptoms
- Symptoms resolve when clots break up, complete resolution of symptoms without treatment within 24 hours or sooner
218
Patient care for stroke
- Monitor airway
- Calm/reassure patient
- Consider oxygen
- Transport patient in semi-sitting position to hospital with capabilities for stroke patient (CT scan at least)
219
Seizure disorder
Sudden change in sensation, behavior, or movement; seizure is a sign of underlying defect, injury, or disease
220
How are seizures brought on
If normal brain function is upset by injury, infection, or disease, the brain's electrical activity can become irregular, bringing about a seizure
221
Causes of seizure
- Hypoxia
- Stroke
- Traumatic brain injury
- Toxins
- Hypoglycemia
- Brain tumor
- Congenital brain defects
- Infection
- Idiopathic
- Epilepsy
222
What is a major scene safety red flag when it comes to seizures
Multiple patients seizing at the same time
223
Tonic-clonic seizure
- Unconsciousness and major motor activity
- Tonic phase: Body rigid up to 30 seconds
- Clonic phase: Body jerks violently for 1-2 minutes
- Postictal phase: After convulsions stop; often slow period of regaining consciousness
224
Pre-seizure aura
- Some seizures preceded by sensation patient has just before it happens (aura)
- Patients may note smell, sound or just, a general feeling right before seizure
225
Partial Seizure
Uncontrolled muscle spasm/convulsion while patient is fully alert (different from generalized tonic-clonic)
226
Patient care for when seizure occurs
- Place patient on floor/ground
- Loosen restrictive clothing
- Remove objects that may harm patient
- Protect patient from injury, but don't hold patient still during convulsions
227
Patient care for after seizure convulsions end
- Protect airway
- If not possible spine injury, position patient on side
- If patient is cyanotic, ensure open airway and provide artificial ventilations with oxygen
- Treat injuries sustained during convulsions
- Transport
228
How long do seizures usually last
1-3 mins
229
Status Epilepticus
Two or more convulsive seizures lasting 5-10 mins or more without regaining full consciousness; high priority emergency requiring immediate transport and possible ALS intercept
230
Signs and symptoms of sepsis
- AMS
- Tachycardia
- Tachypnea
- Hypotension
- Hyperglycemia
- Fever
231
Treatment of sepsis
- Recognition
- Consider oxygen
- Consider ALS
232
Dizziness
Common term meaning different things
233
Vertigo
Sensation of surroundings spinning around you
234
Lightheadedness
Sensation you are about to pass out (pre-syncope)
235
Syncope
Brief loss of consciousness with spontaneous recovery; typically a few seconds to a few minutes; patients often have warning before syncopal episode
236
Causes of dizziness and syncope
- Hypovolemic
- Metabolic
- Environmental/toxicological (alcohol/drugs)
- Bradycardia/tachycardia
237
Assessment questions for dizziness and syncope
- On meds for this problems?
- Any other signs/symptoms?
- Experienced any unpleasant sight or experienced strong emotion before?
- Anyone witness involuntary movements of the extremities (like seizures)?
238
Patient care for dizziness and syncope
- High concentration oxygen
- Call for ALS
- Loosen clothing around neck
- Lay patient flat
- Treat associated injuries from fall
239
Allergic reaction
Immune system naturally responds to foreign substances in body; an allergic reaction is an exaggerated response to the foreign substance
240
Allergen
Substance causing exaggerated effect
241
Body's reaction to first exposure to allergen
- Immune system form antibodies
- Antibodies identify and attack particular foreign substance
- Antibodies combine only with allergen they were formed in response to
- No allergic reaction
242
Body's reaction to second (and subsequent) exposures to allergen
- Antibodies already exist
- Antibody combines with allergen, leading to release of histamine and other chemicals into bloodstream
- Chemicals cause harmful effects
243
Effects of histamine and other chemicals in allergic reaction
- Inflammation
- Bronchoconstriction
- Vasodilation
244
Anaphylaxis
Severe, life-threatening allergic reaction
245
What can anaphylaxis cause
- Dilation of blood vessels (hypotension)
- Airway swelling causing obstruction
- Bronchoconstriction (respiratory failure)
246
Signs and symptoms of allergic reaction: skin
- Swelling
- Flushing (red skin)
- Warm, tingling feeling in face, mouth, chest, feet, hands
- Urticaria (hives)
247
Angioedema
Facial swelling; can be caused by allergic reaction
248
Signs and symptoms of allergic reaction: respiratory
- TIghtness in throat or chest
- Cough
- Rapid, labored, noisy breathing
- Hoarseness, muffled, or lost voice
- Stridor
- Wheezing
249
Signs and symptoms of allergic reaction: cardiac
- Tachycardia
- Decreased blood pressure
250
General signs and symptoms
- Itchy, water eyes, runny nose
- Headache
- Feeling of impending doom
251
True or false: Info obtained in initial assessment may be enough to administer epinephrine
True; fix now; don't wait for medical direction, don't need full set of vitals, PE, Hx, etc
252
Signs and symptoms of anaphylactic shock
- AMS
- Flushed, dry skin or pale, cool, clammy skin
- Nausea, vomiting
- Changes in vital signs (increased pulse, increased respirations, decreased blood pressure)
253
Anaphylaxis vs mild allergic reaction
In anaphylaxis, patient has either respiratory distress or signs and symptoms of shock
254
Treatment for allergic reactions
- Manage patient's airway and breathing
- Apply high-concentration oxygen
- Provide artificial ventilations if patient not breathing adequately
- Consider assisting patient with epipen
255
When is use of epipen appropriate
- If patient has come in contact with substance that caused allergic reaction in the past
- If patient also has respiratory distress or exhibits signs and symptoms of shock (anaphylaxis)
256
Additional doses of epinephrine
- Additional doses may be needed if reassessment shows that condition is deteriorating
- Requires on-line med control
- Requires bringing patient's additional epipens in ambulance
257
What to do if no epipen available
- Treat for shock
- Request ALS intercept
257
What does anaphylaxis cause
Bronchoconstriction and vasodilation
258
Signs of inadequate breathing in infants and children
- Nasals flaring
- Grunting
- Seesaw breathing
- Retractions
259
Patient care for inadequate breathing
Assisted ventilation with supplemental oxygen
260
How to adequately artificially ventilation
- Chest rise and fall should be visible with each breath
- 12 breaths per minute for adults, 20 breaths per minute for infants and children
261
What can indicate inadequate artificial ventilation in adults
Increasing pulse rates
262
What can indicate inadequate artificial ventilation in peds
Decreasing pulse rates
263
True or false: Difficulty breathing is patient's subjective perception
True; amount of distress felt may or may not reflect actual severity of condition
264
Assessment for respiratory distress: observation
- AMS
- Unusual anatomy: Barrel chest, clubbed fingers
- Tripod position
- Work of breathing/use of accessory muscles
- Flared nostrils
- Pursed lips
- Numbers of words patients can be said without stopping
- Pale, cyanotic, flushed skin
- Pedal/sacral edema
- Coughing
- Noisy breathing
265
Assessment for respiratory distress: auscultation
Lung sounds on both sides during inspiration and expiration
266
Patient care options for respiratory distress
- Place patient in position of comfort
- Coach breathing
- Administer oxygen
- Artificial ventilation
- Assist with prescribed inhaler
- Administer continuous CPAP
267
Continuous Positive Air Pressure (CPAP)
- Blowing oxygen/air continuously at low pressure into airway
- Prevents alveoli from collapsing at end of exhalation
- Can prevent fluid shifting into alveoli from surrounding capillaries
- Measured in cm H2O
268
Common uses for CPAP
- CHF
- Pulmonary edema
- Drowning
- Asthma and COPD
- Respiratory failure in general
269
Indications for CPAP
AT LEAST TWO OF THE FOLLOWING:
- Pules oximetry of <90%
- Respiratory rate >25 bpm
- Use of accessory muscles during respiration
270
Side effects of CPAP
- Hypotension
- Pneumothorax
- Increased risk of aspiration
- Drying of corneas
271
Contraindications for CPAP
- Severe AMS
- Lack of normal, spontaneous respiratory rate
- Hypotension/shock
- Nausea/vomiting
- Penetrating chest trauma
- Upper GI bleeding
- Conditions preventing good mask seal
272
What to do if patient deteriorates using CPAP
Remove CPAP and ventilate with bag-mask
273
How to administer prescribed inhalor
Have patient exhale deeply, press inhaler to activate spray as patient inhales deeply, make sure patient holds breath as long as possible so medication can be absorbed
274
The small-volume nebulizer
- Meds in metered-dose inhalers can also be administered by small-volume nebulizer
- Nebulizing is running oxygen or air through liquid medication
- Patient breathes vapors created
- Gives patient greater exposure to medication
275
Chronic Obstructive Pulmonary Disease (COPD)
- Broad classification of chronic lung diseases
- Includes emphysema, chronic bronchitis, and black lung
276
What are the majority of COPD cases caused by
Cigarette smoking
277
Chronic Bronchitis
- Disease classified under COPD
- Bronchiole lining inflamed; excess mucus produced
- Cells in bronchioles that normally clear away mucus accumulations are unable to do so
278
Emphysema
- Disease classified under COPD
- Alveoli walls break down; surface area for respiratory exchange is greatly reduced
- Lungs lose elasticity; results in air being trapped in lungs, reducing effectiveness of normal breathing
279
Asthma
- Chronic disease with episodic exacerbations
- During attack, there is bronchoconstriction and mucus is overproduced
- Results in small airway passages closing down, severely restricting air flow
280
Treatment for COPD and Asthma
- Assess for and treat inadequate breathing
- Oxygen
- Coach breathing
- Sit patient up or in position of comfort
- Assist inhaler
- CPAP
281
Pulmonary Edema
- Abnormal accumulation of fluid in the alveoli
- CHF patients may experience difficulty breathing because of this
282
Congestive Heart Failure (CHF)
- Pressure builds up in pulmonary capillaries causing fluid crossing the thin barrier to accumulate in and around the alveoli
- Fluid occupying the lower airways makes it difficult for oxygen to reach blood; patient experiences dyspnea
283
Signs and symptoms of CHF
- Dyspnea
- Anxiety
- Pale/sweaty skin
- Tachycardia
- Hypertension
- Low oxygen saturation
- Crackles/wheezes when breathing
- Patients may cough up frothy white/pink sputum
- Pedal edema
284
Treatment for CHF
- Assess for and treat inadequate breathing
- Oxygen
- Coach breathing
- Sitting up
- CPAP
285
Spontaneous Pneumothorax
- Lung collapses without injury or other obvious cause
286
Who are at higher risk for spontaneous pneumothorax
- Tall, thin people
- Smokers
- Marfan syndrome
287
What is being contraindicated with spontaneous pneumothorax
CPAP
288
Signs and symptoms of pneumothorax
- Sharp, pleuritic chest pain
- Decreased or absent lung sounds on side with injured lung
- Shortness of breath/dyspnea on exertion
- Low oxygen saturation, cyanosis
- Tachycardia
289
Pulmonary Embolism
- Blockage in blood supply to lungs
- Commonly caused by DVT
- Increased risk from limb immobility, local trauma, abnormally fast blood clotting
290
Signs and symptoms of pulmonary embolism
- Chest pain
- Shortness of breath
- Low oxygen
- Tachycardia
- Wheezing
291
Which groups of people are at high risk for pulmonary embolism
Women on birth control, smokers, stagnation, and people who have recently had recent surgery
292
Epiglottitis
Infection causing swelling around glottic opening; in severe cases can cause airway obstruction through swelling
293
Signs and symptoms of epiglottitis
- Sore throat, DROOLING, difficulty swallowing
- Tripod position/upright preferred
- Sick appearance
- Muffled voice
- Fever
- Stridor, possibly seal-bark cough
294
Croup
Caused by croup of viral illnesses that result in inflammation of larynx, trachea, and bronchi
- Tissues in the airway (especially upper airway) become swollen and restrict the passage of air
295
Bronchiolitis
Small airways become inflamed become of viral infection
296
Most common cause of bronchiolitis
Respiratory syncytial virus (RSV)
297
Signs and symptoms of bronchiolitis
- Cold-like symptoms
- Symptoms progress over few days and worsen to include respiratory distress
- Can progress from there to inadequate breathing
298
Cystic Fibrosis
- Genetic disease typically appearing in childhood
- Causes thick, sticky mucus to accumulate in lungs and digestive system
- The mucus can cause life-threatening lung infections and digestion problems
299
Signs and symptoms of cystic fibrosis
- Coughing with large amounts of mucus
- Fatigue
- Frequent pneumonia
- Abdominal pain and distention
- Coughing up blood
- Nausea
- Weight loss
300
Abdomen
Region between the diaphragm and pelvis
301
Peritoneum
Thin membrane lining the abdominal cavity and covering each organ; two types are parietal and visceral peritoneum
302
Parietal vs Visceral Peritoneum
Parietal peritoneum lines the abdominal cavity, the visceral peritoneum covers each organ
303
What is the retroperitoneal space, which organs lie there
The space behind the peritoneum; kidneys, pancreas, part of aorta whereas the other organs are enclosed within the parietal peritoneum
304
What organs lie inferior to the peritoneum
The bladder and part of the rectum
305
Visceral pain
Originates from visceral peritoneum; fewer nerve endings allow for only diffuse sensations of pain
306
How is visceral pain described as
Dull or achy
307
Colic pain
INTERMITTENT intestinal pain; may result from distention and/or contraction of hollow organs
308
What does persistent or constant abdominal pain often originate from
Solid organs
309
Parietal Pain
Originates from the parietal peritoneum; many nerve endings allow for specific, efficient sensations of pain
310
How is parietal pain often described as
Sharp; the pain is often severe, constant, and localized to a specific area
311
Referred Pain
Perception of pain in skin or muscles at distant locations even though cause of pain is abdominal; caused because abdomen has many nerves from different parts of the nervous system and the overlap of these pathways as they return to the spinal cord causes pain to be transmitted from one system to another
312
Tearing pain
Originates in the aorta; separation of layers of the aorta caused by aneurysm causes referred pain to the back because of the retroperitoneal location of the aorta
313
What is appendicitis and what is usually indicated
Infection of appendix; appendectomy is usually indicated
314
Signs and symptoms of appendicitis
- Persistent RLQ pain
- Pain often initially referred to umbilical region
- Rupture of appendix (sudden, severe increase in pain, contents released into abdomen causes severe peritonitis)
315
Peritonitis
- Irritation of peritoneum, usually caused by foreign material in peritoneal space
- Parietal peritoneum is sensitive, especially to substances
- The irritation causes involuntary contraction of abdominal muscles
316
Signs and symptoms of peritonitis
Abdominal pain and rigidity
317
Peritoneal Dialysis
Dialysis using the lining of the abdomen to filter blood
318
Cholecystitis
- Inflammation of the gallbladder
- Often caused by blockage of its outlet by gall stones (cholecystolithiasis)
319
When do symptoms for cholecystitis worsen
By ingestion of fatty foods
320
Signs and symptoms of cholecystitis
- Sharp RUQ or epigastric pain
- Pain often referred to shoulder
321
Pancreatitis
- Inflammation of the pancreas
322
What is pancreatitis often associated with
Chronic alcohol abuse
323
Signs and symptoms of pancreatitis
- Epigastric pain
- Often referred to back or shoulder
324
Gastrointestinal (GI) Bleeding
- Hemorrhage within the lumen of the GI tract
- Can be minor to severe
- Blood eventually exits the mouth or rectum
- Often painless
- Gastric ulcers can cause severe pain and peritonitis
325
Signs and symptoms of GI bleeding
- Dark-colored stool (maroon to black, tarry)
- Frank blood from rectum (hemorrhoid)
- Vomiting coffee ground appearing blood
- Pain: absent to severe
326
Abdominal aortic aneurysm (AAA)
- Weakening of inner wall of the aorta
- Tears and separates from outer layers (dissection)
- Weakened vessel bulges, may continue to grow
- May eventually rupture
327
Hernia
- Hole in the abdominal wall, allowing tissue or parts of organs (commonly intestines) to protrude under skin
- May be precipitated by heavy lifting
- May cause strangulation of tissue or bowel obstruction
- May require surgical repair
328
Renal colic
Severe pain caused by kidney stones traveling down the ureter
329
Signs and symptoms of renal colic
- Severe, cramping, intermittent pain in flank or back
- Frequently referred to groin
- Nausea vomiting
330
Why should you consider the possibility of cardiac emergency as a cause of abdominal symptoms
Pain of MI can produce nausea or vomiting, epigastric pain, indigestion
331
Assessment and care of abdominal pain/discomfort
- Perform thorough history and physical exam
- Identify serious or life-threatening conditions
332
Behavioral emergency
Abnormal behavior (in a given situation) unacceptable or intolerable to patient, family, or community
333
Acute psychosis
Involves a severe break in patient's abilities to process information and interact with their environments
334
Symptoms of acute psychosis
- Hallucinations
- Delusions
- Catatonia
- Though disorder
335
Physical causes of behavioral emergencies
- Hyperthermia/hypothermia
- Substance abuse
- Head trauma
- Stroke
- Hypoxia
- Diabetic issues
- Hyperthermia
336
General rules for interactions with behavioral patients
- ID yourself and role
- Speak slowly and clearly
- Eye contact
- Don't judge
- Listen
- Open, positive body language
- Don't enter patient's space (3ft)
- Alert for behavior changes
337
Patient care for behavioral emergencies
- Treat life-threatening problems
- Consider medical/traumatic causes
- Follow rules for positive interactions
- Encourage patient to discuss feelings
- Never play along with hallucinations
- Consider involving friends/family
338
Possibilities for factors to suicide
- Depression
- High stress
- Recent emotional trauma
- Age
- Drug/alcohol abuse
- Threats of suicide
- Suicide plan
- Previous attempts/threats
- Sudden improvement
339
Age for highest risk for suicide
15-25, 40+
340
What to do with hostile patients
- Consider clues like dispatch information, information from bystanders, patient's stance
- Ensure escape route
- Don't threaten patient
- Stay alert for weapons
341
Reasonable Force
Force necessary to keep patient from injuring self or others
342
What is reasonable force determined by
- Patient's size and strength
- Type of behavior
- Mental status
- Available methods of restraint
343
Restraining a patient
- Have adequate help: one person at each limb and one EMT talking to and calming patient
- Plans actions
- Stay beyond patient's reach until prepared
- Act quick
- Restrain all limbs with approved leather restraints IN SUPINE POSITION ALWAYS
- EMT is responsible for patient's airway
- Apply surgical mask to spitting patients
- Reassess frequently, document thoroughly
344
Excited delirium
- Extremely agitated or psychotic behavior during struggle, followed by cessation of struggling, respiratory arrest, then death
- Patient is often hyperthermic and shouting incoherently
345
What is excited delirium usually preceded by
Cocaine use
346
What is excited delirium often linked to
Improper restraint in a position where patient can't expand chest to breath; positional asphyxia
347
When are providers allowed to treat and transport patients against their will in terms of behavior
If they are a danger to selves/others; local protocol may require med control/police
348
What are some ways to avoid false sexual misconduct accusations
- Have same-sex provider if possible
- Have third-party witness at all times
349
What is the body's most rapid and initial response to stopping bleeding
Aggregation of platelets
350
Clotting factors
Group of proteins produced in liver and released into bloodstream; once activated, clotting factors form cloths through clotting cascades
351
Coagulopathies
Abnormal clotting of blood; can occur when body forms clots too readily or patients clots too slowly
352
What diseases makes patients more prone to poor clotting
- Advanced liver disease
- Hemophilia
- Von Willebrand disease
353
Which patients are more prone to having life-threatening bleeding when injured (bleeding)
Patients prescribed blood thinners
354
Anemia
Lower-than-normal amount of RBCS
355
Acute Anemia
Sudden blood loss
356
What leads to chronic anemia
- Excessive menstrual periods
- Slow GI bleeding
- Diseases affecting bone marrow
357
Sickle Cell Anemia
Genetic disease causing RBCs to resemble a sickle shape; the RBCs have a short life span leading to anemia
358
In which ethnicities is sickle cell anemia most prevelant
- African Americans
- Indian/middle easterns
359
Complications of Sickle Cell Anemia
- Destruction of spleen
- Sickle pain crisis
- Acute chest syndrome
- Priapism
- Stroke
360
Treatment of Sickle Cell Anemia
- High flow supplemental oxygen
- Monitor for respiratory distress
- Monitor for signs of hypoperfusion
- Transport to stroke center if stroke is suspected
361
Components of the renal system
- Two kidneys
- Two ureters
- One urethra
362
Kidneys function
- Filters blood
- Remove certain waste products, excessive salts, and excessive fluids
- Maintains fluid balance
363
Urinary Tract Infection
- Most common disease that afflicts renal and urinary system
- Caused by bacteria
- Usually limited to bladder
- Can cause pain and frequent urination
- If left untreated, can result in pyelonephritis
364
Pyelonephritis
Inflammation of the kidneys caused by UTI ascending up the ureter into the kidney
365
Kidney stones
- Usually made up of calcium and formed within the kidney
- When in the kidney, they usually cause no symptoms but once dislodged, can cause severe unilateral flank pain
366
What may patients with kidney stones report
N/V
367
Why do patients need urinary catheters
- Obstruction of bladder outflow; used to drain urine
- Neurological disorder
368
Where are urinary catheters inserted
Usually in urethra, but sometimes through skin
369
What complications can arise at site of catheter insertion
UTIs and local trauma
370
When does renal failure occur
When kidneys lose ability to adequately filter and remove toxins
371
Acute vs chronic renal failure
- Acute failure typically results from shock or toxic ingestions
- Chronic may be inherited or secondary to damage from uncontrolled diabetes or hypertension
372
End-Stage Renal Disease (ESRD)
Irreversible renal failure that requires dialysis
373
Hemodialysis
Patient is connected to a machine that pumps blood through specialized membranes
374
How often are hemodialysis treatments, how long do they last
Most common is 3 days a week, 3 to 4 hours long
375
What are the two types of access to blood circulation for hemodialysis
- Two-port catheter
- A-V fistula
376
Peritoneal Dialysis
Uses the peritoneal cavity's large surface area; a special fluid is infused into the abdominal cavity and left for several hours to absorb waste and excess fluid; that fluid is removed and discarded
377
What are the two broad groups of complications of dialysis
- Loss of kidney function
- Complication of dialysis
378
What are complication of ESRD usually associated with
Patient missing dialysis
379
Signs and symptoms of ESRD complications
Similar to CHF symptoms
- Shortness of breath
- Edema
- Electrolyte disturbances
380
Specific complications of dialysis
- Bleeding from A-V fistula
- Clotting and loss of A-V fistula function
- Infection (peritonitis)
381
Treatment of dialysis complications
- Assess ABC's
- Control bleeding
- Administer oxygen
- Treat for shock (keep patient supine and warm)
- If peritonitis is suspected, transport dialysis fluid for confirmation
382
How many kidney transplants happen each year
21,000 (kidneys are the most transplanted organs)
383
What do the specialized medicines that kidney transplant patients take do
- Helps prevent organ rejection
- Prevents infection
