Final Flashcards
1
Q
negligence
A
- legal duty to the patient.
- breach of duty.
- failure to act was the proximate cause of injury
- Malfeasance: direct action
- Misfeasance: action but inappropriate circumstances
- Nonfeasance: no action
- Duty- Prescribed by law; Do not further harm to the patient; Cannot abandon the patient once care begins; Must maintain licensure or certification and skills.
- Breach of Duty- Standard of care: what a reasonable paramedic would do in a similar situation
- There is no protection against gross negligence.
- Proximate cause- Improper action (commission) or failure (omission) to act caused harm to the patient.
- Harm- Usually physical injury, but may also include emotional distress, loss of income, loss of spousal consortium, etc.
2
Q
civil vs criminal law
A
CIVIL LAW
-patient can sue for perceived injury.
-Concerned with establishing liability.
-It has to be someone’s fault for the incident; someone has to pay.
-Civil suit is a legal action of this sort.
-Tort reform: limitations for what can be sued for in regards to specific cases $$
-Some people will go through arbitration
CRIMINAL LAW
-state can prosecute for breaking a statute/law/declaration.
-action taken by the GOVERNMENT against someone prosecutors believed violated the law.
-In the US you are innocent until proven guilty and you will be tried to the fullest extent of the law.
-Medicare, Medicaid, and Workman’s Compensation fraud are three things you never want to be accursed of
3
Q
5 stages of grief / dealing with a grieving child
A
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
- Dealing with a grieving child:
- Children up to 3 years of age will be aware.
- Children 3-6 years of age believe death is temporary.
- Children 6-9 years of age mask their feelings
- Children 9-12 years of age want to know the details (curious about death).
4
Q
adolescence
A
- 13-17
- in regards to CPR treat as adult
5
Q
pediatrics head / airway
A
- infants and young children’s heads are large relative to the rest of their bodies
- airway is more anterior to the neck
- cover head, feet, hands, torso (in that order) to prevent heat loss
- during infancy, the anterior and posterior fontanelles are open -> fuse when toddler
- short neck, smaller airway
- more prone to obstruction
- epiglottis is at the back of posterior oral pharynx
- epiglottis is long and floppy
- difficult to see vocal cords during intubation
- avoid hyperextension of neck
- lungs -> height
- medication -> weight
- airway-> age
6
Q
pediatrics respiratory vitals
A
- smaller tidal volume (height)
- double metabolic oxygen demand- younger the child -> higher heart rate
- smaller functional residual capacity
- neonate (0-1 month)- 30-60 respirations
- infant (1 month- 1 year)- 25-50
- toddler- (1-3 years)- 20-30 respirations
- preschool (3-5 years)- 20-25 respirations
- school age- (6-12 years)- 15-20
- adolescent (13-17)- 12-20
- adult (>18)- 12-2
7
Q
diaphractic breathers
A
- infants use diaphragm during inspiration
- belly breathers
- haven’t developed muscles of respiration yet
- diaphragm connects torso to abdomen
- experience muscle fatigue quicker
- highly susceptible to hypoxia
- can spiral into cardiovascular collapse
- bradycardic child is hypoxic until proven otherwise- administer oxygen
8
Q
pediatrics HR vitals
A
- blood pressure is meaningless number in initial assessment for children
- compensate for decreased oxygenation
- increase heart rate -> increase cardiac output
- if a child has a decreased heart rate -> failure/death -> past compensatory mechanism
- neonate (0-1 month) - 100-180
- infant (1 month -1 year)- 100-160
- toddler (1-3 years)- 90-150
- preschool age (3-5 years)- 80-140
- school age (6-12 years)- 70-120
- adolescent (13-17)- 60-100
- 18+ - 60-100
9
Q
leading causes of respiratory arrest in children
A
- respiration causes -> hypoxia -> cardiac collapse (disease, obstruction)
- trauma from bleeding
10
Q
pediatrics: the heart
A
- ECG: Large right-sided forces are normal in young infants (in adults its left sided)
- limited but vigorous cardiac reserves
- children can increase rate to compensate for conditions faster and more meaningful that adults but shorter
- injured children can be in shock and maintain blood pressure for long periods -> hypotension is an ominous/late sign- failure/death
- more blood loss before hypotension
- brain has twice the blood flow -> risk for hemorrhage
11
Q
pediatrics: spine, abdomen, pelvis
A
- spinal injury not common with safety mechanisms
- most common spinal injury where there is nothing to protect -> cervical and lumbar
- organs are situated more anteriorly and are relatively large
12
Q
appearance
A
- child with a grossly abnormal appearance requires immediate life-support interventions and transportation
- tone- does the child have good muscle tone? is the child limp, listless, or flaccid
- instructiveness- how alert is the child? distract the child or draw the childs attention?
- consolability
- look or gaze- fixed gaze on a face, or is there a nobody home glassy eyed stare (dolls eyes)
- speech or cry- is the cry strong, spontaneous, or weak or high pitched?
13
Q
work of breathing
A
- attempt to compensate for abnormalities in oxygenation (getting oxygen in), ventilation (Getting CO2 out)
- NOT RATE
- abnormal airway sounds- snoring, muddled or hoarse speech, stridor, grunting, or wheezing
- abnormal posturing- sniffing position, tripod position, refusing to lie down
- retraction- supraclavicular, intercostal or substernal retraction of the chest wall; head bobbing in infants
- flaring- flaring of the nares on inspiration
- wheezes- lower airway
- stridor- upper airway -> concerning because there is only one upper airway
14
Q
circulation to skin
A
- determine adequacy of cardiac output and core perfusion
- first thing you stop profusing when your sick is skin and then the GI track -> this is why you go pale and get nauseous
- pallor- white or pale skin or mucous membranes from inadequate blood flow
- mottling- patchy skin discolorations due to vasoconstriction or vasodilation
- cyanosis- bluish discoloration of skin and mucous membranes
15
Q
respiratory distress vs respiratory failure
A
- distress- increased work of breathing results in adequate gas exchange
- failure- no longer ability to compensate -> hypoxia and/or carbon dioxide retention occur
- arrest- pt is not breathing spontaneously
- adequacy of gas exchange is the difference between distress and failure
16
Q
anaphylaxis
A
- immediate symptoms
- respiratory or cardiovascular pathology/involvement*** -> anaphylaxis
- H1- presence in lungs- Benadryl-diphenhydramine*****
- H2- presence in GI tract - famotidine (pepsin)*
- histamine blockers - 24 hours
- give epinephrine for vasoconstriction and bronchodilation
17
Q
croup
A
- viral infection of the upper airway*******
- PAT:
- audible stridor with activity or agitation
- barky cough
- some increased work of breathing
- normal skin color
- treatment:
- position of comfort
- avoid agitating child -> you can increase RR
- nebulized (racemic**) epinephrine
- assisted ventilation with bag mask ventilation may be necessary
18
Q
epiglottitis
A
- inflammation of the supraglottic structures
- epiglottis covers the larynx during ingestion
- rapidly onset
- intubating a child is a ONE shot thing -> swelling will make it worse
- ask about immunizations, and get the child to an appropriate hospital
- be prepared with a bag mask device and an ET tube
- classic presentation:
- sick
- anxious
- sitting in sniffing position
- caused by H flu (vaccinated against)
- drooling***
- inability to swallow**
- increased work of breathing
- pallor or cyanosis
19
Q
asthma
A
- disease of the small airways
- reversible
- bronchospasms
- mucus production
- airway inflammation
- results of hypoxia
- anticholinergic- dry out the lungs
- dilators- bronchodilation
- position of comfort
- supplemental oxygen
- epinephrine for severe respiratory distress -> quick to use bc children mostly dont have heart issues
20
Q
bronchiolitis
A
- leading cause is RSV- respiratory syncytial virus**
- more common in premature or low birth weight*
- inflammation or swelling of small airways in lower respiratory tract due to VIRAL infection
- highly contagious
- mild to moderate retractions
- tachypnea
- diffuse wheezing and crackles
- mild hypoxia
- severe:
- sleepy; obtunded
- severe retractions
- diminished breath sounds (especially lower-> alveoli)
- moderate to severe hypoxia
- first month of life, prematurity, congenital heart disease, immunodeficiency -> greatest risk
- support care and time***
- inhaled albuterol or nebulized racemic epinephrine may be given for moderate to severe respiratory distress
21
Q
complications and indications for ET tube
A
- complications:
- bradycardia due to hypoxia -> taking to long or too many attempts
- increased ICP- blade stimulating vagal stimulants
- incorrect placement
- gagging if the person is awake or not fully sedated -> increases ICP
- indications:
- cardiopulmonary arrest
- traumatic brain injury
- inability to maintain a patent airway
- need for prolonged ventilation
22
Q
ET tube sizing
A
-younger than 1 year -> length-based resuscitation tape measure
-older than 1 year: uncuffed formula:
[Age (in years) + 16] ÷ 4 = Size of tube (in mm)
-> For cuffed tube, go down half a size (preferred for peds)
-2 years old -> 4.5 - and 4 for a cuffed
23
Q
orogastric and nasogastric tubes
A
- invasive gastric decompression: placement of a nasogastric (NG) tube or orogastric (OG) tube to decompress the stomach
- removes the contents with suction
- makes assisting ventilation easier
- contraindicated in unresponsive children
24
Q
aortic sclerosis
A
- aortic valve thickens from fibrosis and calcification
- obstructs blood flow from left ventricle
- leads to aortic stenosis
- peripheral vessel walls lose elasticity
- leads to higher blood pressure, other risks
- heart needs to beat harder to overcome stiffness
- treatment- TAVR- trans aortic valve replacement
25
Q
vision disorders
A
- cataracts- hardening of lenses over time
- glaucoma- optic nerve damaged due to intraocular pressure
- macular degeneration- more common and challenging diagnosis ->blurred or reduced central vision, due to thinning of the macula
26
Q
pneumonia
A
- biggest impact on very young and elderly
- consolidation- sputum production -> coughing -> degraded respiratory system -> only way to get over it
- considered at risk :
- the elderly
- those with underlying health problems
- depressed immune system
- those who are generally immobile, confined to bed or have conditions that limit deep breathing
27
Q
COPD
A
- Chronic Obstructive Pulmonary Disease
- degenerative process
- permanent
- set of diseases characterized by bronchial obstruction and airway inflammation:
- chronic bronchitis
- emphysema
- prevention:
- Cessation of smoking
- Avoidance of certain environmental pollutants
- Immunization for influenza and pneumococcal pneumonia
28
Q
stroke
A
- leading cause of long term disability
- risk double each decade after 35
- family members/caregivers give information about:
- baseline cognitive status and physical status
- personality
- ADL- daily living
- LKW- last known well** -> most important
- evaluation patients ability to perform basic cognitive functions
29
Q
dementia
A
- produces irreversible brain failure
- short term memory loss, short attention span
- jargon aphasia
- confusion and disorientation
- difficulty retaining new information
- personality changes
- two most common degenerative dementias:**
- Alzheimer disease
- multi-infarct or vascular dementia- caused by stroke
30
Q
diagnosing dementia
A
- diagnosed when two or more cognitive or psychomotor brain functions are impaired:
- language- aphasia
- memory- short and long term
- visual perception
- emotional behavior/personality
- cognitive skills
31
Q
UTI
A
- most common hospital associated infection causing sepsis (HAI)
- usually develop in lower urinary tract where normal flora grow in the urethra
- more common in women
- indwelling device- highest risk (folley catheter)
- regular straight catheter next highest risk
- external urinary assistance- next highest risk
32
Q
polypharmacy
A
- polypharmacy becomes problematic when medications interact:
- dosages not adjusted for multiple medications
- multiple organs affected increased likelihood of adverse reactions
- chances of being hospitalized increases with number of medications
- best dosage- lowest drug that achieves therapeutic effect
- medications may not be received because of caregiver theft
33
Q
cellulitis
A
- acute inflammation in skin caused by bacterial infection ***
- usually affects lower extremities
- third spacing of fluid
- capillary failing process
- venous return failing process
- bacteria likes warm and dark
- cooling of fluid in the peripheral
- venous system wont work efficiently
34
Q
pressure ulcers
A
- occur from pressure applied to body tissue, result in lack of perfusion and necrosis
- possible risk factors:
- brain or spinal cord injury
- neuromuscular disorders- Guillain-Barre
- nutritional problems
35
Q
arthritis
A
- progressive joint disease
- formation of bone spurs in joints -> leading to stiffness
- though to result from:
- joint wear and tear
- repetitive joint trauma
- time heals everything
36
Q
behavioral emergency
A
- some disorder of mood, thought, or behavior that interferes with activities of daily living (ADLs)
- physiological response of emergent
- emergent nature to you and your lifestyle -> not necessarily emergency care
- ex. OCD
- BH- behavioral health
37
Q
psychiatric emergencies
A
- behavior that threatens a persons health or safety and the health and safety of another person
- danger to self and others
- ex. someone threatening to stab someone else and themselves
38
Q
warning signs of abuse
A
- posture- sitting tensely
- speech- load, critical, threatening
- motor activity- unable to sit still, easily startled
- clenched fists, avoidance of eye contact
- your own feelings
39
Q
manic behavior
A
- patients typically have abnormally exaggerated happiness with hyperactivity and insomnia **
- insomnia is used to diagnose mania**
- pressured and rapid speech
- tangential thinking
- grandiose and unrealistic ideas
- be calm, firm, and patient
- minimize external stimulation
40
Q
GASPIPES
A
- Guilt
- Appetite
- Sleep disturbance
- Paying attention
- (decreased) Interest
- Psychomotor abnormalities
- (decreased) energy
- suicidal thoughts
41
Q
schizophrenia
A
- typical onset occurs during early adulthood
- experience may include:
- delusions
- hallucinations
- a flat affect- no emotion in speech, neutral
- erratic speech
42
Q
antipsychotics
A
- know as atypical antipsychotic (AAP) drugs
- relieve delusions and hallucinations
- improve symptoms of anxiety and depression
- may cause metabolic side effects
- cardiovascular effects depends on medication
- erectile dysfunction in men
- bipolar and schizophrenia -> leading
43
Q
child abuse
A
- from infancy to 18 and can be inflicted by any number of caregivers.
- A child’s behavior is one of the most important indicators of abuse.
- Soft tissue injuries are common indicators of abuse, especially multiple bruises in different places on the body, in different stages of healing, and/or with distinctive shapes.
- Majority of states require healthcare workers to report suspicions of child abuse
- malnutrition
- severe diaper rash
- diarrhea or dehydration
- hair loss
- untreated medical conditions
- inappropriate, dirty, or torn clothing
- tired or listless attitudes
- nearly constant demands for physical contact or attention
44
Q
ketamine
A
- ketalar
- used as an anesthetic
- 10 times more potent than valium
- hallucinogenic effects last 45-90 minutes
- duration up to 24 hours
- widely used in veterinary practice
- used in human anesthesia
- characteristics:
- potent anesthetic agent with dissociative effects
- colorless, odorless liquid
- white
- off-white powder
- effects:
- hallucinations
- delirium
- amnesia
- dissociation
- respiratory depression
- seizures
- arrhythmias
- cardiac arrest
- hypertension
45
Q
ketamine street names
A
- K
- special K
- vitamin K
- jet
- green
- kay
- mauve
- special LA
- super acid
46
Q
MDMA
A
- one of the most abused amphetamines by teenagers/college students
- large dose = same effects as amphetamines
- onset within 20-60 minutes
- 2-3 hour duration
- characteristics:
- 10% the stimulant effect of amphetamines
- potent serotonin release
- mood alteration, sleep, anxiety
- poor memory, poor impulse control
- use of other drugs
- tolerance
- MI, dysrhythmias, CVA
- seizures
- serotonin syndrome
- permanent damage to serotonin neurons
- hyperthermia 109*
47
Q
MDMA street names
A
- ecstasy
- E
- adam
- XTC
- M&M
- eve
- love drug
- M
- beans
- roll
48
Q
placenta
A
- attaches to the inner lining of the wall of the uterus and connects to the fetus by the umbilical cord (life line)
- the placental barrier consists of two layers of cells
- very vascular
- the umbilical vein (1) carries oxygenated blood from the women to the fetus**
- the umbilical arteries (2) carry deoxygenated blood from the fetus to the woman**
49
Q
amniotic sac
A
- the fetus develops inside a fluid filled baglike membrane called the amniotic sac, or bag of waters
- 500-1,000mL (ccs) of amniotic fluid
- fluid helps insulate and protect the fetus in development
- fluid increases as you get further along
- fluid is released in a gush (sometimes) when the sac ruptures, usually at the beginning of labor
- you can break the water manually
- you can remove the baby with the sac present if premature
