Medical Emergencies

Question 1

1. (Lou Gehrig’s Disease) a muscular dystrophy caused by degeneration of motor neurons of the spinal cord
2. Management - support ventilations; assure airway and oxygenation; remain aware of patient’s LOC (compassion is essential)

Answer 1

Amyotrophic lateral sclerosis (ALS)

Question 2

1. A disease characterized by muscular weakness and fatigue improved by rest
2. Management - support ventilations; assure airway and oxygenation; remain aware of patient’s LOC (compassion is essential)

Answer 2

Myasthenia gravis

Question 3

1. A disease of unknown etiology, characterized by pain and weakness beginning in the distal extremities and progressing to involve entire limbs and possibly the trunk
2. Management - support ventilations; assure airway and oxygenation; remain aware of patient’s LOC (compassion is essential)

Answer 3

Guillain-Barre’s syndrome

Question 4

1. A severe, prolonged attack that cannot be broken by beta bronchodilators (albuterol, levalbuterol, metaproterenol, epinephrine, terbutaline)
2. Greatly diminished breath sounds
3. Respiratory arrest imminent - aggressively manage airway and breathing; transport immediately
4. Pharmacologic interventions
   a. Oxygen - moderate to high flow
   b. Beta sympathomimetics - albuterol, levalbuterol, metaproterenol, epinephrine, terbutaline
   c. Anticholinergics - ipratropium
   d. Anti-inflammatory - methylprednisolone
   e. Bronchodilators - magnesium sulfate
5. Physical interventions
   a. CPAP
   b. Intubation - as needed to improve ventilation; pharmacologically assisted/rapid sequence
   c. Instill saline down endotracheal tube or use albuterol bullets
   d. Chest percussion

Answer 4

Status asthmaticus

Question 5

1. A wasting disease of the muscles
2. Management - support ventilations; assure airway and oxygenation; remain aware of patient’s LOC (compassion is essential)

Answer 5

Muscular dystrophy

Question 6

1. Causes - acidosis, beta-adrenergic agonist, bronchial asthma, cardiovascular disorder, CNS infection, CHF, drugs, fever, hepatic failure, high altitude, hypotension, hypoxia, interstitial pneumonitis, metabolic disorders, methyxanthine derivatives, pain, pneumonia, pregnancy, progesterone, psychogenic or anxiety, pulmonary disease, pulmonary emboli, salicylates
2. Assessment
   a. Focused history and physical exam - SAMPLE and OPQRST
   b. Fatigue, nervousness, dizziness, dyspnea, chest pain; numbness and tingling in hands, mouth, and feet
   c. Presence of tachypnea and tachycardia
   d. Spasms of the fingers and feet
   e. Dyspnea, chest pain, other symptoms based on etiology, carpopedal spasm, rapid breath with high minute volume, varying depending on cause of syndrome
3. Management
   a. Depends on cause
   b. Airway and ventilation
   c. Oxygen - based on symptoms and pulse oximetry
   d. If anxiety hyperventilation - coached ventilation/rebreathing technique

Answer 6

Hyperventilation syndrome

Question 7

1. Chronic infection
   a. Clinically, productive cough - three months/year for two or more consecutive years
2. Increased number of goblet cells
   a. Over production of mucus
3. Usually the result of heavy smoking history
4. Pathophysiology
   a. Results from increase in mucus-secreting cells in respiratory tree
   b. Alveoli relatively unaffected
   c. Decreased alveolar ventilation
5. Assessment
   a. History - frequent respiratory infections; productive cough
   b. Develop pulmonary hypertension causing RHF (cor pulmonale)
   c. Gas exchange decreased from lower alveolar ventilation (hypoxia and hypercarbia)
6. Physical exam
   a. Often overweight, rhonchi present on auscultation, jugular vein distention, ankle edema, hepatic congestion, “blue bloaters”

Answer 7

Chronic bronchitis

Question 8

1. Common causes - tongue, foreign matter, trauma, burns, allergic reaction, infection
2. Assessment - differentiate cause
3. Management
   a. Conscious patient - if the patient is able to speak, encourage coughing; if the patient is unable to speak, perform abdominal thrusts
   b. Unconscious patient - full CPR (inspect mouth before ventilation); visualize the airway with the laryngoscope (remove foreign body with Magil forceps)

Answer 8

Upper airway obstruction

Question 9

1. Headache, congestion, tenderness over the sinuses, worsening of pain with leaning forward, yellow nasal discharge, pressure behind the nose
2. Management
   a. Typically no intervention required
   b. Oxygen administration
   c. Supportive care - antipyretics, analgesics
   d. Remain cautious when symptoms seem extremely severe (meningitis)
   e. Avoid evaluating the airway in a patient with epiglottis
   f. Remain alert for complications in patients with asthma or COPD (prepare to use bronchodilators and corticosteroids)

Answer 9

Sinusitis

Question 10

1. Infection of the lungs (immune-suppressed patients)
2. Pathophysiology
   a. Bacterial and viral infections - hospital-acquired vs. community-acquired
   b. Infection can spread throughout lungs
   c. Alveoli may collapse, resulting in a ventilation disorder
3. Risk factors - cigarette smoking, alcoholism, exposure to cold, extremes of age (old or young)
4. Assessment
   a. Focused history and physical exam - SAMPLE and OPQRST (recent fever, chills, weakness, and malaise; deep, productive cough with associated pain)
   b. Tachypnea and tachycardia may be present
   c. Breath sounds: presence of rales/crackles in affected lung segments; decreased air movement in affected lung
5. Management
   a. Maintain the airway
   b. Support breathing - high flow O2 or assisted ventilation as indicated
   c. Monitor vital signs; establish IV access (avoid fluid overload)
   d. Medications - antibiotics, antipyretics, beta-agonists

Answer 10

Pneumonia

Question 11

1. Not a disease but a pathophysiological condition
   a. High pressure (cardiogenic) - acute MI, chronic HTN, myocarditis
   b. High permeability (non-cardiogenic) - acute hypoxemia, near-drowning, post-cardiac arrest, post shock, high altitude exposure, inhalation of pulmonary irritants, ARDS
2. Assessment
   a. Hypoxic episode - shock (hypovolemic, septic, or neurogenic) dyspnea, orthopnea, fatigue, cough, frothy sputum, pulmonary rales
3. Management
   a. Airway and ventilation - intubation as necessary; assisted ventilation (PEEP), high flow O2
   b. Avoid fluid excess; diuretics - not usually appropriate in high permeability edema; corticosteroid

Answer 11

Pulmonary edema

Question 12

1. Odorless, colorless gas
   a. Results from combustion of carbon-containing compounds
   b. Often builds up to dangerous levels in confined spaces such as mines, autos, and poorly ventilated homes
2. Pathophysiology
   a. Binds to hemoglobin; prevents oxygen from binding and creates hypoxia at cellular level
3. Assessment
   a. Determine source and length of exposure
   b. Symptoms: headache, confusion, agitation, lack of coordination, loss of consciousness, seizures
4. Management
   a. Ensure scene safety - remove the patient from the toxic environment
   b. Maintain the airway
   c. Support breathing - high flow O2 or assisted ventilations as indicated
   d. Establish IV access; transport to hyperbaric therapy

Answer 12

CO inhalation

Question 13

1. Pathophysiology
   a. A variety of bacteria and virus; 20-30% are group A streptococci; 50% of pharyngitis have no demonstrated bacterial or viral cause; most are self-limiting diseases
2. Assessment findings
   a. Chief complaints - sore throat, fever, chills, headache
   b. Physical findings - erythematous pharynx, positive throat culture
3. Management
   a. Typically no intervention required
   b. Oxygen administration
   c. Supportive care - antipyretics, analgesics
   d. Remain cautious when symptoms seem extremely severe (meningitis)
   e. Avoid evaluating the airway in a patient with epiglottis
   f. Remain alert for complications in patients with asthma or COPD (prepare to use bronchodilators and corticosteroids)

Answer 13

Upper respiratory infection

Question 14

1. Pathophysiology
   a. Includes inhalation of heated air, chemical irritants, steam
   b. Airway obstruction due to edema and laryngospasm due to thermal/chemical burns
2. Assessment
   a. Determine nature of substance; length of exposure/loss of consciousness
3. Management
   a. Consider Haz-Mat
   b. Maintain airway - early, aggressive management may be indicated
   c. Support breathing; establish IV access; transport promptly to appropriate facility

Answer 14

Toxic inhalation

Question 15

1. Pathophysiology
   a. Obstruction of a pulmonary artery - may be of air, fat, amniotic fluid, foreign bodies
2. Risk factors - recent surgery, long-bone fractures, pregnancy or postpartum, atrial fibrillation, oral contraceptive use, tobacco use, long term immobilization
3. Assessment - presence of risk factors, sudden onset of severe dyspnea and pain, cough (often blood-tinged)
4. Physical Exam - signs of heart failure including JVD and hypotension; warm, swollen extremities
5. Management
   a. Maintain airway
   b. Support breathing - high flow O2 or assisted ventilations as indicated; intubation may be indicated
   c. Establish IV access; monitor closely; transport to appropriate facility

Answer 15

Pulmonary embolism

Question 16

1. Pathophysiology
   a. Significant variety in cell types/growth rates
   b. Signs and symptoms vary according to location of tumor
   c. Signs of severe distress - altered mentation, 1-2 syllable dyspnea, severe or uncontrollable hemoptysis, dysphagia
2. Management - supportive care
   a. Airway and ventilation; intubation if required; assisted ventilation if necessary; oxygen (flow rate based on symptoms and pulse ox); honor scope of DNR (palliative care may be indicated)

Answer 16

Pulmonary neoplasms

Question 17

1. Pathophysiology - chronic inflammatory disorder
   a. Results in widespread but variable air flow obstruction
   b. The airway becomes hyperresponsive
   c. Induced by a trigger, which can vary by individual
   d. Trigger causes release of histamine, causing bronchoconstriction and bronchial edema
   e. 6-8 hours later, immune system cells invade the bronchial muscosa and cause additional edema
2. Initial presenting signs on physical exam
   a. Dyspnea, wheezing (not present in all asthmatics), cough
3. Secondary (worsening) symptoms on physical exam
   a. 1-2 word dyspnea, lengthened expiratory periods,
   hyperinflation of the chest, accessory muscle use, tachycardia, pulsus paradoxus
4. Management
   a. Treatment goals - correct hypoxia, reverse bronchospasm, reduce inflammation
   b. Maintain the airway
   c. Support breathing - High flow O2 or assisted ventilations as indicated
5. Pharmacologic interventions
   a. Oxygen - moderate to high flow
   b. Beta sympathomimetics - albuterol, levalbuterol, metaproterenol, epinephrine, terbutaline
   c. Anticholinergics - ipratropium
   d. Anti-inflammatory - methylprednisolone
   e. Bronchodilators - magnesium sulfate
6. Physical interventions
   a. CPAP
   b. Intubation - as needed to improve ventilation; pharmacologically assisted/rapid sequence
   c. Instill saline down endotracheal tube or use albuterol bullets
   d. Chest percussion

Answer 17

Asthma

Question 18

1. Pathophysiology - exposure to noxious substances
   a. Exposure results in destruction of walls of alveoli
   b. Weakens walls of small bronchioles/results in increase residual volume
2. Often develop pulmonary hypertension, leading to right heart failure (cor pulmonale); polycythemia causing elevated hematocrit; increased risk of infection and dysrhythmia
3. Live with condition every day (compensated); when infection sets in, or stress in present (decompensated)
4. Assessment
   a. History: recent weight loss, dyspnea with exertion; cigarette and tobacco usage; diseases usually start after 20 pack/years
   b. Lack of cough
5. Physical exam
   a. Barrel chest, prolonged expiration/rapid rest phase, thin, pink skin due to extra red cell production, hypertrophy of accessory muscles, pursed lips - “pink puffers”

Answer 18

Pulmonary emphysema

Question 19

1. Respiratory syndrome characterized by respiratory insufficiency and hypoxia
2. Pathophysiology
   a. High mortality, multiple organ failure, affects interstitial fluid (disrupts diffusion and perfusion)
3. Causes - sepsis, aspiration, pneumonia, pulmonary injury, burns/inhalation injury, oxygen toxicity, drugs, high altitude, hypothermia, near-drowning syndrome, head injury, pulmonary emboli, tumor destruction, pancreatitis, invasive procedures (bypass, hemodialysis), hypoxia, hypotension, cardiac arrest
4. Findings - SOB, rapid breathing, inadequate oxygenation, decreased lung compliance
5. Management
   a. Provide supplemental oxygen
   b. Support respiratory effort - provide positive pressure ventilation if respiratory failure is imminent
   c. PEEP; suction
   d. Manage the underlying condition
   e. Consider medications - beta adrenergic, corticosteroids

Answer 19

Adult respiratory distress syndrome (ARDS)

Question 20

1. Rhinorrhea, nasal congestion, sneezing
2. Management
   a. Typically no intervention required
   b. Oxygen administration
   c. Supportive care - antipyretics, analgesics
   d. Remain cautious when symptoms seem extremely severe (meningitis)
   e. Avoid evaluating the airway in a patient with epiglottis
   f. Remain alert for complications in patients with asthma or COPD (prepare to use bronchodilators and corticosteroids)

Answer 20

Rhinitis

Question 21

1. Sore throat, difficulty swallowing, erythmatous pharynx, tonsil enlargement, pus on tonsils, cervical lymph node enlargement
2. Management
   a. Typically no intervention required
   b. Oxygen administration
   c. Supportive care - antipyretics, analgesics
   d. Remain cautious when symptoms seem extremely severe (meningitis)
   e. Avoid evaluating the airway in a patient with epiglottis
   f. Remain alert for complications in patients with asthma or COPD (prepare to use bronchodilators and corticosteroids)

Answer 21

Pharyngitis

Question 22

1. Sore throat, drooling, ill appearing, upright position
2. Avoid evaluating the airway

Answer 22

Epiglottitis

Question 23

1. Sore throat, hoarseness, pain on speaking, red pharynx, hoarse quality to voice, cervical lymph node enlargement
2. Management
   a. Typically no intervention required
   b. Oxygen administration
   c. Supportive care - antipyretics, analgesics
   d. Remain cautious when symptoms seem extremely severe (meningitis)
   e. Avoid evaluating the airway in a patient with epiglottis
   f. Remain alert for complications in patients with asthma or COPD (prepare to use bronchodilators and corticosteroids)

Answer 23

Laryngitis

Question 24

1. Sudden pneumothorax without trauma
2. Risk factors - males, younger age, smokers, thin body mass, hx of COPD
3. Assessment
   a. SOB, chest pain (sudden onset), pallor, diaphoresis, tachypnea
   b. Severe - altered mentation, cyanosis, tachycardia, decreased breath sounds, local hyperresonance to percussion, subcutaneous emphysema
4. Management - supportive
   a. Airway and ventilation - intubation as required; assisted ventilation if necessary; oxygen - administration levels based on symptoms and pulse ox
5. Tension pneumothorax? - needle decompression

Answer 24

Spontaneous pneumothorax

Question 25

Inflammation of the lining of shealth that surround a tendon

Answer 25

Tenosynovitis

Question 26

One of the big 5 higher-order personality traits that causes the pt to be prone to moodiness. The pt will respond worse to stressors and experiences; anxiety, fear, frustration, anger, envy, depression.

Answer 26

Neuroticism

Question 27

unusual and stressful situation that is encountered in every call. This is the paramedic's most challenging role.

Answer 27

Emotional crisis

Question 28

The origin of abnormal behaviors caused/ related by structural changes or disease processes. Eg metabolic disease, infection, head trauma

Answer 28

Biological/ organic

Question 29

The origin of abnormal behaviors caused/ related to the pt's personality style, unresolved conflict, or crisis management methods

Answer 29

Psychosocial

Question 30

The origin of abnormal behaviors caused by the pt's actions and interactions with society such as environmental violence/ cultural norms.

Answer 30

Sociocultural

Question 31

General management of behavioral emergencies pt

Answer 31

-SS/BSI - supportive + calm environment - treat any existing medical conditions - do not allow SI pt to be alone -do not confront/ argue with pt - provide realistic reassurance - IDENTITY cause (medical or psychological) - if psychological build trust, use interviewing skills, and talk down pt -inquire mental warrant if applicable

Question 32

Chemical restraint medication options

Answer 32

- benzodiazepines - haloperidol - droperedol -ziprasidone - paralytics (RARE)

Question 33

Produces a rapid onset of unconsciousness, seizures, and widening of the QRS complexes. This is a type of overdose

Answer 33

Tricyclic Antidepressants (TCA)

Question 34

what drug should TCA overdoses be treated with?

Answer 34

1 mEq/kg Sodium Bicarbonate

Question 35

the eating disorder when the pt consumes non-food items

Answer 35

pica

Question 36

The lack of maintenance of a healthy body weight and obsessive fear of gaining weight. The pt may refuse to gain weight. The unrealistic perception or non-recognition of the seriousness of weight

Answer 36

Anorexia nervosa

Question 37

Recurrent binge eating, followed by compensatory behaviors such as purging. Pt presents with - self induced vomiting - eating to the point of vomiting -excessive use of laxatives/ diuretics excessive exercise

Answer 37

Bulimia nervosa

Question 38

neutralization

Answer 38

disarms

Question 39

- contagious respiratory infection - three types (A,B,C) - constant change or antigenic drift - mild to severe illness, frequently fatal - spread through airborne secretions - sudden onset of : fever, headache, fatigue, dry cough, sore throat, runny nose, muscle aches, GI complications

Answer 39

Influenza

Question 40

general signs and symptoms for hepatitis

Answer 40

-fever and weakness being first to appear - anorexia, nausea, and abdominal pain - guarding to upper right quadrant - jaundice, with dark yellow urine - light stool

Question 41

- inflammation of the lining of brain and spinal cord - viral, bacterial, or fungal - often follows trauma or sinus infectious - airborne or direct contact with respiratory secretions - S/S include irregular fever, headache, nausea, STIFF NECK - presents with brudzinskis neck sign ( with supine pt, lift head. Knees should rise) - eventually vomiting, rash, anorexia, constipation, noise, light intolerance, and decreased mentation will occur - treatment includes supportive, control seizures, maintain airway and ventilations, IV fluids

Answer 41

Meningitis

Question 42

Syndrome, not disease - developed from HIV - began in homosexual men and IV drug abusers- since spread to general population - spread through direct contact with human fluid - S/S include fever, cough, reddish lesions (kaposi's sarcoma), night sweats, and weight loss - may develop encephalopathy - pneumonia from pneumocystis carinii parasite cause of death: pneumonia and suicide

Answer 42

AIDS

Question 43

Gram positive spore-forming bacterium - normal flora of colon - remains/ flourishes after antibiotic treatment - outbreaks follow accidental ingestion of spores - releases toxins that cause: bloating, diarrhea, abd pain, causes psuedomebranous colitis, may be life threatening to manage: - maintain hydration - antibiotics - control nausea/ emesis - stool transplant Latent bacteria can be killed by bleach solutions

Answer 43

Clostridium Difficile (C-Diff)

Question 44

Conjunctival condition - raised, wedge shaped growth of conjunctiva - non-cancerous - common in people who have increased outdoor exposure to sun, wind , and dust.

Answer 44

Pterygium

Question 45

Clouding of lens of eye -associated with; aging, breakdown of proteins within lens risk factors: diabetes, eye injury, radiation exposure, smoking, exposure to ultraviolet light Presents with: decreased vision, cloudy / fuzzy vision, light sensitivity, diplopia, loss of color intensity, halos around lights treatment is prevention and surgical removal

Answer 45

Cataract

Question 46

Separation of retina from supporting structures: causes: trauma, diabetes, unknown presents as: bright flashes in peripheral vision, floaters in eye, shadow/ blindness in part of visual field

Answer 46

Retinal detachment

Question 47

Infection/ inflammation of sinuses - bacterial, viral, allergies symptoms: facial pressure, headaches, sore throat, posterior nasal drip, cough, bad breath, loss of smell, malaise, fever treatment -antibiotics, decongestants, antihistamines, corticosteroids

Answer 47

Sinusitis

Question 48

Viral infection/ drainage from upper airway/sinus infection - causes; allergies, bacterial infections, injury, chemical exposures, germ, pneumonia S/S include: fever, hoarseness, loss of voice

Answer 48

Laryngitis

Question 49

Chronic autoimmune disease that affects skin, joints, kidneys, and other organs - runs in families but common in women - joint pain/ swelling with some developing arthritis - fingers, wrists, knees are affected S/S include: chest pain, fatigue, fever, malaise, skin rash, swollen Lymph nodes - diagnosed through laboratory testing/ physical exam - treatment is symptomatic

Answer 49

Systemic lupus erythematous (SLE)

Question 50

Pediatric condition of painful swelling of the anterior tibial tubercle - bump on upper tibia below knee - repetitive injuries before growth complete -treatment is rest, ice, NSAID medications

Answer 50

Osgood-schlatter disease

Question 51

The informal term that refers to a pattern of antisocial behavior and attitudes. This is most closely represented by antisocial personality disorder. Lack empathy but HAS conscience.

Answer 51

Sociopathy

Question 52

Categorized under antisocial personality disorder. Lacks empathy but DOES NOT have a conscience

Answer 52

Psychopath

Question 53

Functional mental disorders that involve chronic distress but is absent of delusion/ hallucinations. This term is no longer used by the psychiatric community. Pt still has a touch of reality and is not a fundamental personality trait.

Answer 53

Neurosis

Question 54

RAPID ONSET of widepread, disorganized thought. - inattention - memory impairment - disorientation - clouding of consciousness - vivid visual hallucinations

Answer 54

Delirium

Question 55

GRADUAL development of memory impairment and cognitive disturbances. -aphasia, apraxia, agnosia - abstract thinking/ judgment

Answer 55

Dementia

Question 56

The behavioral disorder that presents with gross distortions of reality - withdrawal from social interaction - disorganized thought, perception and emotion assessment will present with -delusions -hallucinations - disorganized speech - high risk SI/ HI

Answer 56

Schizophrenia

Question 57

the worry of future events

Answer 57

Anxiety

Question 58

the fear of CURRENT events regarding behavioral disorders

Answer 58

fear

Question 59

Recurrent attacks of sudden anxiety. May present with 4 symptoms peaking within 10 minutes, including but not limited to - palpitations - sweating - SOB -trembling -CP -nausea - parethesia - dizziness

Answer 59

Panic disorders

Question 60

Exaggerated, sometimes disabling, frequently inexplicable fear. May be unreasonable for the average person.

Answer 60

Phobias

Question 61

Anxiety reaction to a severe psychosocial event. Usually from a life threatening event. There will be repetition of intrusive memories. Findings will include: - depression/ nightmares - survivor guilt - frequent and complicated substance abuse

Answer 61

PTSD

Question 62

One of the most prevalent major psychiatric conditions. Affects 10-15% of population. This condition is episodic with periods of remission. There may be gradual or rapid onset with clusters of episodes. This is a major cause of suicide.

Answer 62

Depression

Question 63

Depressed mood lasting all day, nearly every day - diminished interest in pleasure and dainty activities - significant weight change - insomnia or hypersomnia - psychomotor agitation - recurrent thoughts of death

Answer 63

Major depressive episodes

Question 64

Requires 5 or more symptoms during the same 14 day period and depression cannot be accounted for by other events. ( ISAD CAGES) -interest - sleep -appetite - depressed mood - concentration - activity -guilt - energy - suicide

Answer 64

Major depressive disorder (MDD)

Question 65

What should be noted during documentation of a suicidal pt?

Answer 65

-Document observations about the scene that may be valuable to mental health professionals - notes, plans, or statements from pt - treat trauma/ medical complaints

Question 66

described as alternating periods of depression with manic behavior. Depressive periods are greater than manic episodes. Irritation, gregarious, and quickly becomes argumentative and hostile if thwarted

Answer 66

Bipolar

Question 67

OD of this drug produces extrapyramidal reactions (shakes, dyskinesia)

Answer 67

Phenathiazines

Question 68

what drug should be used in treatment of an OD of phenathiazines?

Answer 68

25 mg of Diphenhydramine

Question 69

The feigning of the symptoms of a disease or injury in order to undergo diagnostic tests, hospitalization, or medical/ surgical treatment.

Answer 69

Munchausen's syndrome

Question 70

The eating disorder involving the regurgitation of food

Answer 70

rumination disorder

Question 71

Eating disorder presenting with the lack of interest of food

Answer 71

Avoidant/ restrictive food intake disorder

Question 72

Preoccupation that one's own body is too small, too skinny, insufficiently muscular or lean. Eats to bulk up and build muscle. Mostly affects males

Answer 72

muscle dysmorphia

Question 73

Grazing on large quantities of food rather than binging

Answer 73

Compulsive overeating

Question 74

Aberrant eating disorders of children in foster care

Answer 74

Food maintenance

Question 75

obsession with pure diet

Answer 75

orthorexia nervosa

Question 76

restricting food to save food calories for alcohol calories

Answer 76

drunkorexia

Question 77

Obsessive focus on fine foods, following frontal lobe injury

Answer 77

Gourmand syndrome

Question 78

Odd/eccentric cluster of personality disorders includes: -paranoia - schiziod - schizotypical common features include social awkwardness, social withdrawal, and dominated by distorted thinking

Answer 78

Cluster A

Question 79

Pervasive social detachment/ restricted range of emotional expression. "Loners"

Answer 79

Schiziod personality disorder

Question 80

Pervasive pattern of social/ interpersonal limitations. - experience acute discomfort in social settting - reduced capacity for close relationships - notices flashes of light no one else can see - think they can read thoughts/ others steeling theirs

Answer 80

schizotypal personality disorder

Question 81

Cluster of personality disorders that share problems with impulse control, emotion, and regulation. - borderline personality disorder - narcissistic personality disorder - histrionic personality disorder - antisocial personality disorder

Answer 81

Cluster B

Question 82

Pervasive pattern of disregard for the rights of others. Often manifesting as hostility or aggression - may first appear in childhood - do not experience genuine guilt - take little to no responsibility for their actions

Answer 82

antisocial personality disorder

Question 83

pattern of excessive emotionality and attention seeking - drama queens - emotional expression is vague/ shallow but has manners that draw attention to oneself

Answer 83

Histrionic personality disorder

Question 84

Significant problems with the sense of self worth stemming from a powerful sense of entitlement. - they believe they deserve special treatment, assume the are uniquely talented - can fundamentally disregard/ disrespect worth of those around them

Answer 84

narcissistic personality disorder

Question 85

Most widely studied personality disorder that is characterized by intense/ unstable emotions/ moods that can shift fairly - generally have a hard time calming down once upset. - angry outbursts - engage in impulsive behaviors - see world as black and white - unstable sense of self

Answer 85

borderline personality disorder

Question 86

Cluster of personality disorders that share a high level of anxiety - avoidant personality disorder - dependent personality disorder - OCD

Answer 86

Cluster C

Question 87

Characterized by - pervasive pattern of social inhibition - feelings of inadequacy - hypersensitivity to negative evaluation people with this disorder are afraid others will ridicule, reject, and criticize them.

Answer 87

Avoidant personality disorder

Question 88

Characterized by: - strong need to be cared for - fear of losing support of others - fear of losing relationship makes them vulnerable to manipulation/ abuse

Answer 88

dependent personality disorder

Question 89

Characterized by: -preoccupied with rules, regulations, orderliness - great makers of list/ schedules - devoted to work- often neglect social relationships - unable to delegate bc " it wont be done right"

Answer 89

obsessive compulsive personality disorder

Question 90

Development disorder characterized by troubles with social interaction/ communication - restricted/ repetitive behavior - usually seen within first 2-3 years of life

Answer 90

Autism

Question 91

- Unicellular, microorganism - visible under light microscopy - plant-like without photosynthetic capabilities - reproduce through binary fission - treated with antibiotics

Answer 91

Bacteria

Question 92

- Extremely small, non-living, microorganism - not visible under light microscopy - obligate, intercellular - depend on host for nutrition

Answer 92

Virus

Question 93

- unicellular organism - motile - lack cell walls - capture food through phagocytosis -malaria, giardiasis, amebic dysentery

Answer 93

Protozoa/ protozoan diseases

Question 94

- cellular organisms which live off of organic matter - size varies - found in decaying tissues, and damp, warm environments - athletes foot, yeast infections

Answer 94

fungi/ fungal infection

Question 95

- recently recognized infections agent - normal protein, mutated - smaller than viruses - kuru, creutzfeld-Jakob disease, bovine spongiform encephalitis

Answer 95

prions/ prion diseases

Question 96

A foreign substance, usually protein, may be anything (dust, pollen, drug, food)

Answer 96

Antigens

Question 97

-immunoglobulin proteins - each specific antibody is developed in response to specific antigen

Answer 97

Antibodies

Question 98

What is the most short lived immunoglobulin protein that is formed in almost every immune response following contact of B-lymphocyte with its specific antigen.

Answer 98

IgM (gamma M)

Question 99

The most abundant immunoglobulin protein that compromises 75 % of normal persons antibodies. Important in producing immunity in fetus prior to birth

Answer 99

IgG (gamma G)

Question 100

Principle immunoglobulin protein in exocrine secretions that PROTECTS MUCOUS MEMBRANES

Answer 100

IgA (gamma A)

Question 101

antibody responsible for allergic effects. Allergies can be from the overproduction of this

Answer 101

IgE (gamma E)

Question 102

Present in very small amounts in human serum. Kickstarts immune system, least abundant immunoglobulin protein.

Answer 102

IgD (gamma D)

Question 103

Agglutination

Answer 103

grab+ clump, bear hug cells

Question 104

Precipitation

Answer 104

makes liquid to solid

Question 105

Lysis

Answer 105

destruction of antigen

Question 106

- white blood cells - travels circulatory system - Destroy invading substances - 7000 per milliliter

Answer 106

Leukocytes

Question 107

- another circulatory system - contains lymph nodes, lymphocytes - spleen is key factor

Answer 107

lymphatic system

Question 108

Staph that is resistant to beta-lactum antibiotics such as penicillins, and cephalosporins (CEF drugs) - presents with skin infection such as pimple or boil - can lead to more serious infections such as pneumonia, sepsis, surgical wound infections.

Answer 108

methicillin-resistant staphylococcus aureus (MRSA)

Question 109

- airborne or direct contact disease - infectious for 4 days before and 5 days following a rash - S/S include: fever, cough, conjunctivitis, photosensitivity, rash to face, neck, and may spread to entire trunk/ extremities - treatment is supportive but look out for complications such as Ottis media, bronchopneumonia, and encephalitis

Answer 109

measles (rubeola)

Question 110

- viral infection - transmitted through salvia - infectious 2 days before swelling of parotid gland until symptoms subside - S/S include fever, fatigue, sore throat, dysphasia, testicular swelling - treatment is supportive, apply ice to swollen areas, look for complications such as orchitis, pancreatitis, and meningoencephalitis.

Answer 110

Mumps (epidemic parotitis)

Question 111

- "general measles" - transmitted through airborne droplet, urine/ feces on skin - virus teratogenic/ crosses placenta - stops cells from developing- destroys the fetus - S/S include rash (face, spread to trunk/ limbs) that fades in THREE DAYS, low grade fever, swollen lymph nodes, joint pain, headache, conjunctivitis

Answer 111

Rubella

Question 112

- herpes varicella zoster virus - airborne/ direct contact with respiratory secretions - infectious 1 days before swelling before symptoms until all lesions have scabbed over - S/S fever + vomiting early, headache and chills, general fatigue, itchy skin eruptions begin on chest and may cover the entire body. - treatment is supportive, lotions and cream may ease itching, virus may become active in later years as shingles

Answer 112

Chicken pox

Question 113

-from bacterium clostridium tetani - infection puncture or deep wound - muscle spams development in jaw "lock jaw" - S/S include spasms in jaw, chest, neck, and abd - back muscle spasms can cause arching (opisthotonos) - spasms may affect intercostal muscles - drooling, sweating, fever, irritability, uncontrolled urination/ defecation may be present as well.

Answer 113

Tetanus

Question 114

- caused by bacteria bordetella pertussis - spread by coughing or sneezing while in close contact with others - infants contract from parents, older siblings, or other caregivers - S/S include starting like a common cold (runny nose/ congestion, sneezing, mild cough, fever) - after 1-2 weeks severe coughing begins - violent and rapid cough until air is gone from lungs, forcing and inhale - infants can have a minimal/ absent cough but may present with a life threatening apnea.

Answer 114

Pertussus (whooping cough)

Question 115

- bacterial infection - usually involves the lungs - can spread to kidneys, pericardium, bone and meninges - airborne; contact with respiratory secretions - S/S include fever, productive cough (hemoptysis), night sweats, weight loss, fatigue

Answer 115

tuberculosis

Question 116

Infection of the liver that is the most common form. - formally called infectious hepatitis - fecal-oral transmission - approximately 30 day incubation period - once infected- immune for life

Answer 116

Hepatitis A

Question 117

Infection of liver that is commonly called serum hepatitis - serious risk to healthcare workers - transmitted through body fluids, primarily blood - approximately 50-day incubation period - carrier state possible

Answer 117

Hepatitis B

Question 118

Infection of the liver that is bloodborne and is a major cause of post-transfusion hepatitis - incidences declining - approximately 50-day incubation period - carrier state exists

Answer 118

hepatitis C

Question 119

Infection of the liver that is called delta hepatitis - a defective virus ( must have another virus to exist) - exaggerated symptoms with Co-infection - can lead to fatal cirrhosis

Answer 119

hepatitis D

Question 120

Infection of the liver with a fecal-oral transmission - rare in the US - approximately 40 day incubation period - chronic states do not appear to exist

Answer 120

Hepatitis E

Question 121

disease from palladium bacteria - transmitted through direct sexual contact - infectious during active periods - several stages, may be dormant for long periods -Primary stage: 2-4 weeks after exposure, chancre (painless genital ulcer) that will disappear untreated and pt becomes asymptomatic - Stage 2: 6-8 weeks post chancre, headache, malaise, anorexia, fever, sore throat, reddish rash on palms and soles but may cover whole body, will end untreated - Tertiary stage: months to years later, bacteria invades vessels and CNS, tabes dorsalis (wide gait, slapping feet, ataxia), psychosis, potentially fatal (usually from ruptured aorta)

Answer 121

syphilis

Question 122

Bacterial disease from direct sexual contact - females remain asymptomatic for extended periods while transmitting disease - may be symptomless in oropharynx and rectums - painful and frequent urination, constant purulent discharge from urethra/ vagina. - lower abd pain in women

Answer 122

Gonorrhea

Question 123

Bacterial disease transmitted from vaginal, anal, or oral sex - can pass from infected mother to baby during vaginal childbirth - S/S in women asymptomatic in 50-70% of women, unusual vaginal bleeding/ discharge, abd pain, painful intercourse, fever, urinary complications - S/S in men, urethritis, painful/ burning urination, purulent discharge from penis (lighter color than gonorrhea), swollen/ tender testicles, fever

Answer 123

chlamydia

Question 124

Chronic viral infection - infectious anytime lesions are present - can reoccur anytime - S/S include fever, swollen lymph nodes, ulcerated lesions, thin white discharge from ulcer until encrusted

Answer 124

Herpes

Question 125

Itch mite infestation through direct contact s/s include red/ elevated skin lesions, itching, dermatitis

Answer 125

scabies

Question 126

Ectoparasite - small sting insect - transmitters of epidemic typhus and other diseases - transmitted through direct contact -S/S include itching, small white speck resembling dandruff, secondary injury is burns

Answer 126

Lice

Question 127

bacterial infection disease from the borrelia family, tick borne from infected ticks belong to species genus Ixodes. S/S include early fever, headache, fatigue, depression, character circular skin rash, erythema migrans (EM). Later symptoms involve joints, heart, and CNS

Answer 127

Lyme disease

Question 128

warm blooded animals - zoonotic (can be transmitted from one species to another) - early S/S include malaise, headache, fever - progression to acute pain, violent movements/ uncontrolled excitement, depression, hydrophobia - finally, mania and lethargy, coma - death is usually in 2-10 days mostly from respiratory insufficiency

Answer 128

Rabies

Question 129

Viral infection that affects the respiratory system coronavirus is a cause for infection - first reported in Asia in 2003 - spread through airborne droplets or by touching contaminated surface S/S include: high fever, headache, body aches/chills, malaise, dry cough, pneumonia, diarrhea. Good prognosis if caught early

Answer 129

Sudden Acute Respiratory Syndrome (SARS)

Question 130

Viral infection from central and west Africa, coming to the US in 2003 - transmitted by respiratory droplets or contact with bodily fluids - S/S include fever, headache, muscle aches, backache, lymph nodes swell, fatigue, rash for 1-3 days after fever. - rash develops into raised bumps, fluid starting on face, spreads to other parts of the body, bumps go through several stages before they get crusty, scab over, and fall off - illness usually lasts for 2-4 weeks

Answer 130

Monkey pox

Question 131

Variola virus that is extremely contagious and fatal - no cure - vaccine has been extremely successful - S/S include fever malaise, headache and body ache, emesis, fever, prodrome phase lasting 2-4 days. - rash emerges as small red spots on tongue/ mouth - spots develop into sores and break open, spreading large mounts of virus into mouth/ throat. - rash appears on skin (face, arms, legs, body, over 24 hours) - fever usually falls and the person may start to feel better - by 4th day, bumps fill with thick/ opaque fluid, often have depression in the center that looks like a bellybutton - fever will often rise again and remain high until scabs form over the bumps - remained contagious until scabs fall off

Answer 131

Small pox

Question 132

Viral infection spread by mosquitoes feeding on infected birds - only 20% of those infected will develop symptoms - S/S include fever, headache, body aches, skin rash on trunk, swollen lymph glands. - severe S/S include neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, paralysis

Answer 132

West Nile virus

Question 133

Bacterial infection, yersinia pestis, spread by fleas on rats and other vectors - responsible for millions of deaths from multiple epidemics in china, Europe, and africa - currently still present in many countries There are 3 types with 3 different sets of symptoms - bubonic: swollen lymph nodes, fever, chills, weakness - septicemic: fever, chills, weakness, septic shock, DIC - pneumonic: dyspnea, hemoptysis, cheat pain, weakness, fever, headache

Answer 133

Plague

Question 134

Virus spread by rodent urine, feces, and saliva - symptoms, following 1-5 week incubation early: fatigue, fever, muscle aches, headaches, dizziness, chills, abd problems late: cough, chest pain, dyspnea, pulmonary edema

Answer 134

Hantavirus

Question 135

Viral hemorrhagic fever - death rate of up to 90% - symptoms are flu like: fever, intensive weakness, muscle pain, headache, sore throat, vomiting, diarrhea, rash, impaired kidney/liver function, internal/ external bleeding - symptoms appear from 2-21 days after exposure

Answer 135

Ebola

Question 136

What alert should be called based on the following criteria ? Suspected infection + 2 (or more) of the following: - AMS - RR >/= 20 - HR > 90 - SBP 100.4/38 or <95/35

Answer 136

Sepsis

Question 137

Infection of the eyelid- external hordeolum - blockage of oil glands associated with eyelash - located at lash line with a small pustule/lump - resolves when gland blockage is relieved

Answer 137

Stye

Question 138

Internal hordeolum - inflammation/infection - blockage of the meibomian glands (produces the fluid tha lubirvstes the eyes) - red, tender lump in eyelid/ margin

Answer 138

chalazion

Question 139

Infection/inflammation of the conjunctiva Bacterial cause: -pinkeye - cornea is clear - redness/ itching - more tears than normal -topical antibiotics can be used for treatment viral cause: -similar to bacterial but cause is viral - treatment is symptomatic Allergic cause: -redness, watery discharge, itching, swelling - tends to be seasonal - oral/ topical ocular antihistamines for treatment

Answer 139

Conjunctivitis

Question 140

Swelling/ irritation in the middle layer of the eye - common in pt with autoimmune diseases - anterior is the inflammation in the front of the eye - posterior is the back part (choroiditis) - can effect one or both eyes causes: blurred vision, eye pain, erythema, photosensitivity, floaters treatment: protection from light, analgesia, corticosteroid eye drops

Answer 140

Iritis / Uveitis

Question 141

Infection/ inflammation of the cornea - frequent cause of corneal transplantation - pain -photophobia - blurry vision - tearing - erythema

Answer 141

Herpes simplex virus (HSV) keratitis

Question 142

Shingles that affects eye - virus spreads along first division of trigeminal nerve - damage can result to eye itself - ulcer/ similar lesion on cornea

Answer 142

Herpes Zoster Ophthalmicus

Question 143

Infection of cornea that breaks through the epithelial of cornea - serious/ sight-threatening infection - painful red eye, tearing, photophobia - Evaluation by ophthalmologist essential

Answer 143

Corneal ulcers

Question 144

Soft tissues surrounding eye infected - sight-threatening/ life threatening condition - edematous, erythematous, warm eyelids/ surrounding tissues - eye itself not involved

Answer 144

Cellulitis

Question 145

Type of cellulitis that is usually bacterial - risk for children - presents w/ pain, conjunctivitis, blurred vision, increased tear production - treated with potent antibiotics + hospital admission

Answer 145

Periorbital cellulitis (preseptal)

Question 146

ype of cellulitis that infects the structures behind the orbital septum - common in winter -S/S include fever, headache, malaise, eyelid edema, runny nose, protrusion of eye, inability to move eye, decreased vision - true emergency

Answer 146

orbital cellulitis (postseptal)

Question 147

Collection of blood in the anterior chamber of eye From - trauma - sickle cell disease -diabetes - tumors of eyes sight threatening

Answer 147

Hyphema

Question 148

Group of eye sight threatening eye conditions - increased pressure with eye IOP - damages optic nerve - blockage of flow of aqueous humor from anterior chamber

Answer 148

Glaucoma

Question 149

Most common type of glaucoma -IOP increases slowly over time - no symptoms other than begin to lose vision - places pressure on optic nerve/ retina

Answer 149

open-angle glaucoma

Question 150

Type of glaucoma that is an outflow of aqueous humor suddenly blocked - rapid and severe increased on IOP - severe eye pain - decreased, cloudy vision - red/ swollen - rainbow/ halo like effects around lights treatment is to reduce IOP, medicate, and perform surgery

Answer 150

Angle closure glaucoma

Question 151

Inflammation of the optic nerve result of: autoimmune diseases, infections, drug toxicity, multiple sclerosis -presents as loss of vision in single eye in hour, loss of color vision, changes in pupillary reaction to light, pain with eye movement vision returns to normal within 2-3 weeks without treatment -corticosteroids used - ophthalmology evaluation essential

Answer 151

Optic neuritis

Question 152

Swelling of optic disc secondary to increased intracranial pressure caused by: trauma, infections within the brain, stroke, tumors, hydrocephalus can be a retinal artery or vein occlusion

Answer 152

papilledema

Question 153

Ear disease that has: -earache -ear plugging - tinnitus - hearing loss Plug may be removed by mineral/ baby oil, drops, detergents, hydrogen peroxide

Answer 153

Impacted cerumen

Question 154

Inflammation of the external auditory canal - S/S include pain, drainage, itching ear/ canal, hearing loss, - treatment is analgesia, topical otic antibiotics, anti inflammatory drugs

Answer 154

Otitis external

Question 155

Ear infection that spreads to bones/ cartilage at the base of the skull - caused by difficult to treat bacterial infections - difficult swallowing, loss of voice, facial weakness - treatment includes hospitalization and antibiotic therapy

Answer 155

malignant otitis external

Question 156

Blockage of eustachian - increased fluid pressure within middle ear - bacterial/ viral infection - S/S include earache, fullness, pressure, general malaise, hearing loss, fever, vomiting/ diarrhea - chronic middle ear infection management includes antibiotics, placement of tympanostomy tubes to decompress the middle ear

Answer 156

otitis media

Question 157

Delicate structure that separates the external ear from the middle ear - membrane is easily ruptured/ perforated - trauma - foreign objects - infections symptoms begin acutely and include: decreased hearing, earache, drainage of blood/ pus, noise/ buzzing

Answer 157

perforated tympanic membrane

Question 158

Infection that spreads from the middle ear to the mastoid - primarily affects children - symptoms include ear pain, drainage, hearing loss, erythema/ tenderness over mastoid bone, headache, fever management includes antibiotics, surgery

Answer 158

Mastoiditis

Question 159

Swelling/ irritation of the inner ear - occurs following a middle ear infection/ upper respiratory infection symptoms: vertigo, involuntary eye movement, dizziness, loss of balance, nausea/ vomiting, hearing loss, tinnitus treatment is supportive

Answer 159

labrynthitis

Question 160

Labyrinths within inner ear are swollen S/S include begin acutely, vertigo/ dizziness, severe nausea. Hearing loss unilateral no known cure

Answer 160

meniere disease

Question 161

Nosebleed

Answer 161

Epistaxis

Question 162

inflammation of the nose - upper respiratory infection - allergies - similar condition in infants: treat with humidification of air, saline nose drops, and bulb suctioning in adults: treat with decongestants, antihistamines, nasal corticosteroids

Answer 162

rhinitis

Question 163

- red/ swollen throat - pus - enlargement/ tenderness of anterior nodes - head/neck pain - nausea/ vomiting viral- symptomatic treatment bacterial- antibiotics

Answer 163

pharyngitis/ tonsillitis

Question 164

Fungal (yeast) infection of the mouth - found in infants, diabetics with poor BGL control, AIDS pts, side effect to antibiotics. - presents with white/ cream colored deposits inside mouth - oral mucosa red/swollen treatment is to correct cause, anti-fungal agents

Answer 164

oral candidiasis (thrush)

Question 165

Collection of pus around the tonsils - complication of tonsillitis - swollen tissues block airway - life threatening symptoms include: flu like, difficulty opening mouth, swallowing, drooling, facial swelling, muffled voice, tender glands of jaw/ throat.

Answer 165

Peritonsillar Abscess

Question 166

Lack of preventive dental care, restorative care, and trauma can be causes - non-life-threatening - S/S include: dental pain, exterior of tooth broken down, allowing sensitive interior structures (nerve) to be exposed to Manage: alleviate pain, treat infection, dental care

Answer 166

dentalgia/ dental abscess

Question 167

Oral bacterial cellulitis (floor of mouth, under tongue) -occurs after infection of dental abscess, mouth injury - develops quickly swelling can occlude airway, can be life threatening S/S include difficulty breathing, confusion/ AMS, fever, neck pain, redness/ swelling of neck, weakness, fatigue, excess tiredness, difficulty swallowing, drooling, earache, speech that sounds like person has "hot potato" in mouth. -Management: in severe cases, cricothyrotomy, cured with proper protection of airways + appropriate antibiotics

Answer 167

Ludwig's angina

Question 168

Inflammation/ infection of the epiglottis - can be life threatening emergency - S/S include fever, sore throat, drooling, stridor, hoarseness, difficulty breathing, cyanosis -Management is to protect airway, antibiotics

Answer 168

epiglottis

Question 169

Bacterial infection in the airway/ respiratory system component - S/S include: deep cough, dyspnea, fever, stridor, pt may be hypoxic - management is to prevent airway obstruction, ventilate the pt

Answer 169

Tracheitis

Question 170

Problems with the joint between temporal bone/ mandible - malocclusion of teeth - orthodontic appliances - difficulty/ pain in biting/ chewing/ clicking/ popping, of joint, dull facial pain, earache, jaw pain, headache

Answer 170

Temporomandibular Joint (TMJ)

Question 171

Central herniated disc, compressing nerve roots - pain radiating down one/ both legs - weakness of legs - lack of feeling in genitalia - bladder/ bowel disturbance/ no urge/ inconsistency treatment is supportive/ symptomatic, pain management, application of cold/ heat packs

Answer 171

cauda equina syndrome

Question 172

Inflammation of tendon - tennis elbow: inflammation of the extensor tendon on the lateral aspect of the elbow - golfer's elbow: inflammation of the tendinous sheath that inserts into the medial epicondyle

Answer 172

tendinitis

Question 173

Inflammation of the bursae in elbow, knee, and hip

Answer 173

bursitis

Question 174

Painful condition of various/ unknown causes during lifting moving turning

Answer 174

chronic myalgia

Question 175

Caused by pressure on median nerve in wrist - S/S include tingling, numbness, weakness, pain felt in fingers/ hand

Answer 175

carpal tunnel syndrome

Question 176

Disturbance in normal functioning of affected tissues/ organs systems due to age/ wear/ tear can affect virtually any body system what type of condition ?

Answer 176

Degenerative conditions

Question 177

Degenerative joint disease - wear/ tear on joints associated with aging- runs in families exacerbated by obesity can result from medical disorders (hemophilia, avascular necrosis, arthritic disorder) S/S pain/ stiffness on arising in morning, becomes worse over time, may be swelling/ crackling of joints routine movement/ activities painful -chronic condition but improves with medications/ physical therapy

Answer 177

Osteoarthritis (OA)

Question 178

Common form of bone disease thinning of bone tissue loss of bone density occurs over time - body fails to produce enough new bone to replace bone being reobsorbed/ used - calcium/ phosphate substances essential for normal bone formation - primary causes is loss of estrogen in women during menopause - drop in testosterone levels in men - Increased risk groups: women over 50, men over 70, chronic arthritis, pts taking corticosteroids, hyperparathyriodism, vitamin D deficiency, bedridden pts AS condition progresses, pts may present with: - bone pain, tenderness, fx with little/ no trauma - pt may lose body height - prone to low back pain/ neck pain - women tend to develop increased kyphosis of spine Treatment Includes pain control, medications/therapies, to reduce bone loss/ promote bone development, preventive strategies to minimize falls/ injuries. Calcium replacement, hormonal therapy, and exercise is often used

Answer 178

osteoporosis

Question 179

Age- related changes in spinal discs - discs dehydrate/ become stiff - function less effectively as shock absorbers - outer layer cracks causing disc to bulge/ rupture - herniated portion of disc places pressure on spinal nerves, causing pain/ weakness - does not have blood supply - pain often worsened with movement

Answer 179

degenerative disc disease

Question 180

Chronic disease that leads to the inflammation/ injury to joints/ surrounding tissues - autoimmune disease - women more often affected S/S include: painful/ swollen joints, fatigue, low-grade fever, malaise, weakness - chronic condition that has no cure although surgery can restore damaged joints to fairly normal level

Answer 180

rheumatoid arthritis (RA)

Question 181

Inflammatory arthritis of the spine - extremely fragile and subject to fx with spinal cord injury - important to pad underneath the head, neck, upper back, with sheets/ pillows. - manage airway with techniques that do not extend neck

Answer 181

ankylosing spondylitis (AS)

Question 182

inflammatory arthritis with uric acid accumulation in joints - although not every pt with elevated uric acid will develop - tends to occur in families - symptoms include: severe pain, swelling, erythema - treatment is medication for pain/ inflammation, dietary restrictions to help keep uric acid levels at a minimum.

Answer 182

Gout

Question 183

Flesh eating disease - bacterial infection that rapidly destroys skin, muscles, surrounding tissues - causes widespread tissue damage - bacteria resistant to potent antibiotics - critically ill

Answer 183

Necrotizing fasciitis (NF)

Question 184

Death of a tissue in part of body - blood supply in affected tissue interrupted - from: peripheral vascular diseases, diabetes, immunosuppressed, post-surgical procedures

Answer 184

gangrene

Question 185

Widespread cause of pain in the body with an unknown cause

Answer 185

fibromyalgia

Question 186

- wear/ tear on joints associated with aging- runs in families exacerbated by obesity can result from medical disorders (hemophilia, avascular necrosis, arthritic disorder) S/S pain/ stiffness on arising in morning, becomes worse over time, may be swelling/ crackling of joints routine movement/ activities painful -chronic condition but improves with medications/ physical therapy

Answer 186

Degenerative joint disease

Question 187

1. Not a medical condition; symptom of ALL conditions gone bad; requires in-depth assessment to find cause A. Alcohol, epilepsy, infection, overdose, uremia, trauma, insulin, pregnancy, poisoning, stroke, shock 2. Assessment A. Perform detailed history (pt, family, and by-standers); perform detailed physical exam; attempt to determine cause 3. Management A. Treat specific cause if known; manage airway, breathing, and circulation; transport in lateral recumbent position if no trauma B. Appropriate use of pharmacology - Do not give blindly - Thiamine: for most patients is acceptable - Naloxone: for suspected narcotic overdose - Dextrose: for low blood sugar 4. Concerns: Wernicke’s syndrome and Korsakoff’s psychosis

Answer 187

Altered mental status

Question 188

1. Reversible 2. Loss of memory and orientation 3. Associated with chronic alcohol intake and diet deficient in thiamine 4. Symptoms: ataxia, nystagmus, diplopia, neuropsychiatric disorders

Answer 188

Wernicke’s syndrome

Question 189

1. Potentially permanent psychosis 2. Characterized by disorientation, muttering delirium, insomnia, delusions, and hallucinations 3. Symptoms: painful extremities, bilateral foot drop, bilateral wrist drop (rare), and pain on pressure over the long nerves

Answer 189

Korsakoff’s psychosis

Question 190

1. “Brain attack” 2. Injury or death of brain tissue due to interruption of cerebral blood flow 3. Atherosclerotic heart disease (and all cardiac risk factors) are associated with the onset 4. Long-term use of birth control pills increases risk 5. Predisposing factors: hypertension, diabetes, high blood lipids, sickle cell disease, atrial fibrillation 6. Examples: TIA, occlusive, hemorrhagic, cerebellar infarct 7. Assessment A. Perform complete detailed exam (Cincinnati, NIHSS, LAMS) B. Assure assessment of blood glucose level C. Monitor ECG, 12-lead if possible (12-lead abnormalities may mimic myocardial ischemia or injury) 8. Signs: facial drooping, headache, aphasia/dysphasia, hemiparesis, hemiplegia, paresthesia, gait disturbances, incontinence 9. Symptoms: confusion, agitation, dizziness, vision problems 10. Management A. Assure airway, breathing, and circulation B. Oxygen to maintain SpO2 above 94% C. Ventilate carefully based on PetCO2 and SpO2 D. Patient in position of comfort or lateral recumbent E. Begin IV of normal saline TKO F. Protect paralyzed or weakened extremities G. Transport to hospital with specific capabilities (draw blood samples; comprehensive vs. primary)

Answer 190

Stroke

Question 191

1. Temporary interruption of blood supply to the brain 2. Resembles strokes in every way except that the patient recovers fully without interventions (within 24 hours)

Answer 191

Transient Ischemic Attack

Question 192

1. Caused by the occlusion of the cerebral artery, denying the flow of blood to parts of the brain 2. Embolic and thrombotic strokes

Answer 192

Occlusive stroke

Question 193

A solid, liquid, or gaseous mass carried to the brain from another part of the body

Answer 193

Embolic stroke

Question 194

1. Blood clot carried to the brain, usually from pulmonary tissues or the heart 2. Atrial fibrillation is often a cause

Answer 194

Thrombotic stroke

Question 195

1. Rupture of blood vessels in the brain; in some cases, in the areas around the brain (subarachnoid) 2. May present with sudden onset, severe headache (immediate thunderclap)

Answer 195

Hemorrhagic stroke

Question 196

1. Usually seen in patients under 50 years of age 2. Dizziness (walk as if drunk), ataxia, can’t touch nose with fingers, vertical nystagmus, CT scans can’t pick up (requires MRI)

Answer 196

Cerebellar infarct

Question 197

What is the criteria to transport to a comprehensive stroke center?

Answer 197

1. Onset > 3 hours 2. Surgery in last 14 days 3. MI/previous stroke in last 3 months 4. Hemorrhage in last 21 days 5. Age < 18 6. NIHSS > 8 7. Posterior fossa infarct assessment failure (cerebellar infarct) A. Finger to nose test - right hand (normal/missed); left hand (normal/missed); vertical nystagmus (positive/negative)

Question 198

1. A temporary alteration in behavior due to the massive electrical discharge of one or more groups of neurons in the brain 2. “Cerebral fibrillation” 3. Epidemiology: alcohol, epilepsy, infection, overdose, uremia, trauma, insulin, pregnancy, poisoning, stroke, shock 4. Generalized, partial, status epilepticus 5. Assessment A. Obtain detailed history including: history; recent history of head trauma (subdural hematoma); alcohol or drug use; history of fever, headache, or stiff neck (meningitis); history of diabetes, heart disease, or stroke B. Check current medications - common anticonvulsants include: phenytoin (Dilantin), phenobarbital, carbamazepine (Tegretol), valproic acid (Depakote) 6. Physical exam A. Assess for signs of head trauma, tongue injuries, evidence of alcohol or drug use, blood sugar, cardiac monitoring 7. Signs and symptoms: convulsing activity; postictal may be: unconscious, bizarre behavior, tongue lacerations, incontinent 8. Management A. Protect patient during active convulsing; assure airway; suction as needed; DO NOT force object between clinched teeth; administer O2, 15 L/min by NRB; establish IV, normal saline TKO B. If blood sugar was low, administer dextrose (give 100 mg thiamine with dextrose) C. Position patient in recovery position 9. Treatment A. Diazepam up to 10 mg (0.2 mg/kg) - short duration (15-20 min) B. Midazolam 5-10 mg (0.1 mg/kg) - short duration (15-20 min) C. Lorazepam 4-10 mg (0.05-0.1 mg/kg) - long duration (45 min) D. Sodium bicarbonate 1 med/kg IV push - TCA overdose E. Magnesium sulfate 4 g over 5-10 min - pregnancy F. Naloxone up to 10 mg - narcotic overdose

Answer 198

Seizure

Question 199

1. Initial, localized electrical discharge of the brain, spreading to entire cortex 2. Grand Mal (tonic-clonic) - generalized motor seizure (airway!) A. Aura - subjective sensation preceding the seizure B. Tonic phase - muscle rigidity and contraction C. Clonic phase - muscle spasms and rhythmic jerking D. Postictal - awakening phase, seen as slow improvement in mental status 3. Petit Mal (absence seizure) - brief loss of awareness and pauses of activity 4. Pseudoseizures (hysterical seizures) - psychological disorders, usually seen as an outburst

Answer 199

Generalized seizures

Question 200

1. Usually remain confined, but may march 2. Simple (focal motor, Jacksonian, Jacksonian March) A. Chaotic movement localized to one area of the body; can march through body, ending with a focal motor seizure in a different site than that of origin 3. Complex (psychomotor) B. Loss of contact with surroundings and unusual behavior or personality

Answer 200

Partial seizures

Question 201

1. Recurrent seizures, unbroken by a lucid interval 2. Also consider continuous seizures and several recurrent seizures 3. Management A. Diazepam up to 10 mg (0.2mg/kg) - short duration (15-20 min) B. Midazolam 5-10 mg (0.1mg/kg) - short duration (15-20 min) C. Lorazepam 4-10 mg (0.05-0.1mg/kg) - long duration (45 min)

Answer 201

Status epilepticus

Question 202

1. A transient loss of consciousness due to inadequate flow of blood to the brain with rapid recovery of consciousness upon becoming supine (commonly known as fainting) 2. Cardiovascular causes: dysrhythmias, bradycardia, or tachycardia 3. Non-cardiovascular causes: hypoglycemia, TIA, metabolic disorders, anxiety attack 4. Management A. Differentiate possible cause B. Assure airway management C. Administer oxygen as needed D. Reassure E. Treat underlying cause

Answer 202

Syncope

Question 203

1. Vascular headaches - migraine, cluster 2. Non-vascular - tension, organic 3. Assessment A. Perform history - general health, previous medical conditions, medications, previous experience with complaint, time of onset B. Physical exam - evaluate neurological status and indications of recent injury 4. Management A. Mostly supportive; consider rehydration and anti-emetics; narcotics can be used for severe headaches; patients may know what is needed

Answer 203

Headache

Question 204

1. Disabling pain lasting minutes to days 2. Characterized by intense or throbbing pain, photosensitivity, nausea, vomiting, and diaphoresis 3. Frequently unilateral in presentation and may be preceded by an aura or warning 4. More common in women than men 5. Vascular headache

Answer 204

Migraine

Question 205

1. Occur as a series of one-sided headaches that are sudden and intense 2. Symptoms may include: nasal congestion, drooping eyelid, and irritated watery eye 3. More common in men than women 4. Vascular headache

Answer 205

Cluster

Question 206

1. Brought about by stress and emotional tension 2. Often begins as a mild headache in the morning, worsening throughout the day 3. Non-vascular headache

Answer 206

Tension

Question 207

1. Caused by tumors, infections, or other diseases of the brain, eye, or other body system 2. Non-vascular headache

Answer 207

Organic

Question 208

1. Assessment A. Symptomatic of many illnesses B. Focused assessment - Include a detailed neurological exam - Specific signs and symptoms: nystagmus, nausea and vomiting, dizziness 2. Management A. Maintain airway and administer high-flow oxygen; position of comfort; IV access; determine blood glucose level; consider antiemetics

Answer 208

“Weak and dizzy”

Question 209

1. Tumor to the brain and spinal cord 2. Benign and malignant; brain abscess 3. Assessment A. Perform history - general health, previous medical conditions, medications, previous experience with complaint, time of onset, seizure activity, headache, nosebleed; type and timing of prior treatment (chemotherapy, radiation therapy, holistic and other nontraditional approaches, experimental treatment) 4. Management B. Mostly supportive; consider pain management; maintain compassion

Answer 209

Neoplasms

Question 210

1. Grow similarly to normal cells 2. Grow relatively slow 3. Confined by a membrane 4. Pose a greater threat in the brain and spinal cord because of limited room for growth 5. Can cause impaired function relatively easily, and death if untreated

Answer 210

Benign neoplasms

Question 211

1. Cancerous tumors 2. Can quickly metastasize (frequently the result of cancer elsewhere in the body) 3. Risk factors - genetics, exposure to radiation, tobacco, occupational, pollution, medications, diet, viruses

Answer 211

Malignant neoplasms

Question 212

1. A collection of pus localized in an area of the brain 2. Will present much like a neoplasm 3. Management is supportive

Answer 212

Brain abscess

Question 213

1. Alzheimer’s disease, muscular dystrophy, multiple sclerosis, dystonias, Parkinson’s disease, central pain syndrome, Bell’s palsy, amyotrophic lateral sclerosis, myoclonus, spina bifida, poliomyelitis 2. Management A. Supportive; assure adequate ventilations; prepare for communication difficulties

Answer 213

Degenerative neurological disorders

Question 214

1. Devastating neurologic disorder effecting elderly individuals 2. Most common cause of dementia in the elderly 3. Results from the death and disappearance of nerve cells in the cerebral cortex 4. Causes marked atrophy of the brain 5. Initially patients will have problems with short-term memory 6. Progression A. Problems with thought and intellect; shuffling gait; stiffness of the body muscles 7. Eventually aphasia and psychiatric disturbances

Answer 214

Alzheimer’s disease

Question 215

1. A group of genetic diseases (Duchenne is the most common form) 2. Characterized by progressive muscle weakness and degeneration of the skeletal muscle fibers 3. May affect heart and other involuntary muscles 4. May develop at any age 5. Prognosis varies depending on the type

Answer 215

Muscular dystrophy

Question 216

1. An unpredictable disease of the central nervous system 2. Involves inflammation of the certain nerve cells and followed by the demyelination of the nerve sheath 3. Signs and symptoms include: A. Weakness of one or more limbs, sensory loss, paresthesia, changes in vision; come and go over the years and range from mild to severe

Answer 216

Multiple sclerosis

Question 217

1. A group of disorders characterized by muscle contractions that cause twitching and repetitive movements, abnormal postures, and freezing in the middle of an action 2. Early symptoms include: deterioration in handwriting, foot cramps or a tendency of one foot to drag after walking; initial symptoms can be mild and may be noticeable only after prolonged exertion, stress, or fatigue

Answer 217

Dystonias

Question 218

1. A chronic and progressive motor system disorder characterized by tremor, rigidity, bradykinesia, and postural instability 2. Caused by a limited amount of dopamine available to the brain 3. Patients with this disease may exhibit dementia or depression

Answer 218

Parkinson’s disease

Question 219

A condition resulting from the damage or injury to the brain, brainstem or spinal cord characterized by intense, steady pain described as burning, aching, tingling, or a “pins-and-needles” sensation

Answer 219

Central pain syndrome

Question 220

1. The most common form of facial paralysis 2. Involves inflammation of the facial nerve 3. Characterized by one-sided facial paralysis, inability to close the affected eye, pain, lacrimation, drooling, hypersensitivity to sound and impaired taste

Answer 220

Bell’s palsy

Question 221

-endocrine disease -inadequate insulin production - affects body’s ability to metabolize glucose

Answer 221

diabetes mellitus

Question 222

Temporary, involuntary twitching or spasms of muscle or group of muscles

Answer 222

Myoclonus

Question 223

1. A neural defect that results from the failure of one or more of the fetal vertebrae to close properly during the first month of pregnancy 2. Leaves a portion of the spinal cord unprotected 3. Can usually be repaired after birth, but any nerve damage already done will be permanent 4. Three most common forms A. Myelomeningocele - most severe form; the spinal cord and meninges protrude through the opening in the spine B. Meningocele - normal development of the spinal cord; meninges protrude through the opening C. Occulta - most mild form; skin covering the opening in the malformed vertebrae

Answer 223

Spina bifida

Question 224

1. An infectious, inflammation viral diseases of the central nervous system 2. Sometimes results in permanent paralysis 3. It is characterized by fatigue, headache, fever, vomiting, stiffness of the neck, and pain to the hands and feet 4. Because of available vaccines, polio is nearly eradicated from the western hemisphere

Answer 224

Poliomyelitis

Question 225

1. Low back pain 2. Causes - disc injury, vertebral injury, cysts and tumors, other causes 3. Assessment A. Evaluate history - speed of onset; risk factors such as vibration or repeated lifting; determine if pain is related to a life-threatening problem 4. Management A. Consider c-spine (immobilize if in doubt); consider analgesics

Answer 225

Back pain/spinal disorders

Question 226

An exaggerated response by the immune system to a foreign substance

Answer 226

Allergic reaction

Question 227

1. An unusual or exaggerated (systemic) allergic reaction 2. A life-threatening emergency causing nearly 1000 deaths each year (most from PCN injections and Hymenoptera stings)

Answer 227

Anaphylaxis

Question 228

1. Immune response A. Isolates and destroys invading antigens in the body B. Cell-mediated immunity - phagocytosis of invading antigen C. Humoral immunity - releases antibodies to neutralize antigen 2. Antibodies (Immunoglobulins) A. IgM - first produced antibody; largest immunoglobulin B. IgG - most prevalent antibody; has a memory to recognize repeat invasions C. IgE - least concentrated; it is the antibody of allergic and anaphylactic reactions D. IgA - present in mucous membranes E. IgD - present in very low concentrations

Answer 228

The immune system

Question 229

1. Genetically predetermined immunity that is present at birth 2. Inflammatory system A. Complement cascade and leukocytes

Answer 229

Innate immunity

Question 230

1. Immune system A. Antibodies and activated T-cells

Answer 230

Adaptive immunity

Question 231

1. Type of immunity that begins to develop after birth and is continually enhanced by exposure to new pathogens and antigens throughout life 2. Contact with disease causing agent (catching chickenpox)

Answer 231

Natural acquired immunity

Question 232

Deliberate contact with disease causing agent (vaccination)

Answer 232

Artificial acquired immunity

Question 233

1. Maternal passage of antibodies (MatAb) 2. Nursing (IgA in breast milk)

Answer 233

Natural passive immunity

Question 234

Exposure to live pathogen (development of memory B-cells and T-cells)

Answer 234

Natural active immunity

Question 235

1. Short-term immunity (temporarily-induced immunity) A. Transfer of antibodies (transfusion)

Answer 235

Artificial passive immunity

Question 236

Vaccination - stimulates immune response without causing disease; creates antibodies

Answer 236

Artificial active immunity

Question 237

Protection from infection or disease that is 1) developed by the body over time after exposure to an antigen (active acquired immunity) or 2) transferred to the person from an outside source such as from the mother through the placenta or as a serum (passive acquired immunity)

Answer 237

Acquired immunity

Question 238

1. Initial entry of antigen 2. Body responds by creating antibody 3. After initial response, antibody attaches to basophil and mast cells to await repeat contact 4. On second exposure, antibodies are released from basophil and mast cells; cells release histamine, heparin, leukotriene (slow reacting substance of anaphylaxis) 5. Result is bronchoconstriction, vasodilation, capillary permeability, angioedema (ACE inhibitors)

Answer 238

Sensitization

Question 239

1. Mild allergic reaction A. Gradual onset, mild flushing, rash, urticaria, mild bronchoconstriction (mild wheezing), mild cramps, diarrhea 2. Severe allergic reaction A. Sudden onset, severe flushing, rash, urticaria, severe bronchoconstriction and laryngospasm, severe cramps, altered vital signs, altered mentation

Answer 239

Allergies

Question 240

1. Causes: antibiotics, drugs, foreign proteins, foods, Hymenoptera stings, hormones, blood products 2. Signs and symptoms A. Skin - flushing, itching, hives (urticaria), edema B. GI - nausea/vomiting, cramps, diarrhea C. Nervous - dizziness, headache, convulsions D. Respiratory - dyspnea, sneezing, coughing, wheezing, stridor, laryngeal edema and spasm E. Cardiovascular - vasodilation, tachycardia, hypotension 3. Management A. Scene safety - consider source of problem B. Assure airway, ventilation, and oxygenation - Supraglottic airways contraindicated - Cricothyrotomy may be indicated C. Begin IV of normal saline D. Pharmacological - Albuterol 2.5-5 mg every 20 min for max of 3 doses - Diphenhydramine (mild, moderate, severe) 25-50 mg IM, IV, or IO - Epinephrine (moderate and severe) 0.3-0.5 mg (1:1000 & 1:10,000 : allergic reactions & anaphylaxis) - Sodium methylprednisolone (severe, consider in moderate) 125mg IV or IO

Answer 240

Anaphylaxis

Question 241

what is the role of insulin?

Answer 241

It increases glucose for the cells of the general body. It increases the production of glycogen, protein, and fat in the liver. It is released when blood glucose levels are high

Question 242

what is the role of glucagon ?

Answer 242

In the liver, glucagon promotes the breaking of glycogen back into glucose (glycogenolysis) Additionally, it promotes gluconeogenesis, or the converting of protein and fats into glucose.

Question 243

Can glucose be used as energy when insulin is not available?

Answer 243

No, the body turns to fat for fuel. The fat is broken down to fatty acids and waste products are collectively called ketones. BGL continues to rise

Question 244

Where is glucose filtered?

Answer 244

The kidneys

Question 245

What is an important test for diabetes, consisting of the average blood sugar over the past 2-3 months?

Answer 245

A1c, glycated hemoglobin. The higher the greater risk for diabetes

Question 246

what type is insulin dependent DM?

Answer 246

type 1

Question 247

What type of DM is non-insulin dependent and is rather controlled by hypoglycemic agents, diet, and exercise?

Answer 247

type 2 DM

Question 248

what medical emergency is caused by missed insulin injections, stress/ catecholamine release, or binge eating leading to hyperglycemia with a BGL of approximately 400 mg/dL ?

Answer 248

Diabetic ketoacidosis ( DKA)

Question 249

signs and symptoms of DKA

Answer 249

- polyuria, polydipsia, polyphagia - warm, dry skin - nausea vomiting, abdominal pain - tachycardia -hypotension -kussmauls respirations - fruity odor on breath - slow decline in LOC.

Question 250

1. “Master Endocrine Gland” 2. Divided into anterior and posterior lobes 3. Posterior responds to nervous signals from hypothalamus 4. Anterior responds to hormone signals from hypothalamus 5. Anterior hormones A. Growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, lutenizing hormone, prolactin 6. Posterior hormones A. Antidiuretic hormone, oxytocin

Answer 250

Pituitary gland

Question 251

1. “Third eye”; responds to light by releasing melatonin 2. May have role in daily and lunar cycles, reproductive cycles, seasonal affective disorder

Answer 251

Pineal gland

Question 252

1. Responsible for body’s metabolic rate 2. Principle hormones: thyroxine, triiodothyronine, calcitonin

Answer 252

Thyroid gland

Question 253

1. Located on posterior, lateral surfaces of thyroid 2. Regulates blood calcium levels 3. Principle hormone: parathyroid hormone

Answer 253

Parathyroid gland

Question 254

1. In children, large gland responsible for cell-mediated immunity 2. In adults, degenerates into non-distinct mass of fat and fibrous tissues 3. Principle hormone: thymosin - matures T lymphocytes

Answer 254

Thymus

Question 255

1. Adrenal medulla A. Inner segment of adrenal gland; closely tied to autonomic nervous system 2. Adrenal cortex A. Outer layers of endocrine tissue, which secrete steroidal hormones 3. Adrenal medulla hormones A. Epinephrine and norepinephrine 4. Adrenal cortex hormones A. Glucocorticoids (cortisol), mineralocorticoids (aldosterone), androgenic hormones (estrogen, progesterone, testosterone)

Answer 255

Adrenal gland

Question 256

1. Combination organ A. Exocrine tissues called acini - secrete digestive enzymes into small intestine B. Endocrine tissues secrete hormones from islets of Langerhans C. Responsible for maintenance of blood sugar through glycogenolysis and gluconeogenesis 3. Principle hormones A. Glucagon - released from alpha cells when blood sugar level drops B. Insulin - released from beta cells when blood sugar rises C. Somatostatin - released from delta cells; tells all to slow down

Answer 256

Pancreas

Question 257

1. Produce hormones responsible for sexual maturity, gamete production, and pregnancy 2. Principle hormones: estrogen and progesterone

Answer 257

Ovaries

Question 258

1. Produce hormones responsible for sexual maturity and gamete development 2. Principle hormone: testosterone

Answer 258

Testes

Question 259

What hormone does the placenta secrete?

Answer 259

Human chorionic gonadotropin

Question 260

What hormone does the kidneys secrete?

Answer 260

Renin

Question 261

What hormones does the digestive tract secrete?

Answer 261

Gastrin and secretin

Question 262

What hormone does the heart secrete?

Answer 262

Atrial natriuretic hormone

Question 263

1. Disease of inadequate insulin production 2. Affects body’s ability to metabolize glucose (glucose is essential in energy production)

Answer 263

Diabetes mellitus

Question 264

What is the normal blood sugar range?

Answer 264

80-100 mg/dL fasting 120-140 mg/dL following meal

Question 265

At what blood sugar level is a patient considered hypoglycemic?

Answer 265

< 80 mg/dL

Question 266

At what blood glucose level is a patient considered hyperglycemic?

Answer 266

> 140 mg/dL

Question 267

1. Insulin dependent diabetes mellitus (IDDM) 2. Very low level of, or no, insulin production 3. Often begins early in life (juvenile onset) 4. Hereditary is the greatest risk factor A. Other causes: viral infections, autoimmune disorders 5. Leads to heart disease, strokes, blindness, kidney failure, distal tissue necrosis

Answer 267

Type I diabetes mellitus

Question 268

1. Non-insulin dependent diabetes mellitus (NIDDM) - controlled by hypoglycemic agents, diet, and exercise 2. Decline in production of insulin and receptor site response 3. Most common form of diabetes (approx. 90%) 4. Hereditary and obesity are greatest risk factors

Answer 268

Type II diabetes mellitus

Question 269

1. Hyperglycemia; blood sugar may exceed 400 mg/dL 2. Causes: missed insulin injections, stress (catecholamine release), binge eating 3. Signs and symptoms A. Polyuria, polydipsia, polyphagia; warm, dry skin; nausea/vomiting; abdominal pain; tachycardia; low blood pressure; deep, rapid respirations; fruity breath odor; slow decline in level of consciousness 4. Management A. Treat dehydration - normal saline titrated to blood pressure B. Field administration of insulin not advised - not harmful, but ineffective; insulin does not correct emergent problem C. Correction of acidosis should occur in hospital

Answer 269

Diabetic ketoacidosis (DKA)

Question 270

1. Pathophysiology A. Found in type II diabetics; results in blood glucose levels up to 1000 mg/dL B. Insulin activity prevents buildup of ketones C. Sustained hyperglycemia results in marked dehydration - often related to dialysis, infection, and medications D. Very high mortality rate 2. Causes - physiological stress 3. Signs and symptoms A. Polyuria, polydipsia, polyphagia; warm, dry skin; orthostatic hypotension; tachycardia; gradual mental impairment (may take days) 4. Management A. Treat dehydration - normal saline titrated to blood pressure B. Field administration of insulin not advised - not harmful, but ineffective; insulin does not correct emergent problem

Answer 270

Hyperglycemic hyperosmolar nonketotic coma (HHNK)

Question 271

1. Hypoglycemia 2. Causes - excessive administration of insulin, excess insulin for dietary intake, overexertion resulting in lowered BGL 3. Signs and symptoms A. Weak, rapid pulse; normal blood pressure; cool, clammy skin; weakness, incoordination; headache; irritable, agitated behavior; decreased mental function or bizarre; rapid onset unconsciousness 4. Management A. Aimed at correcting blood sugar B. Pharmacological - D10, glucagon

Answer 271

Insulin shock

Question 272

1. A thyroid disorder 2. Pathophysiology - probably hereditary in nature A. Autoantibodies are generated that stimulate thyroid tissue to produce excessive hormone 3. Signs and symptoms A. Agitation, emotional changeability, insomnia, poor heat tolerance, weight loss, weakness, dyspnea, tachycardia, new onset atrial fibrillation, protrusion of eyeballs or goiters 4. Management - supportive

Answer 272

Grave’s disease

Question 273

1. A thyroid disorder 2. Pathophysiology A. Worst case scenario of hyperthyroidism B. Life-threatening emergency, usually associated with severe physiologic stress or overdose of thyroid hormone C. Results when thyroid hormone moves bound state to free state within the blood 3. Signs and symptoms A. High fever (106F or higher) B. Reflected in increased activity of sympathetic nervous system - Irritability, delirium, or coma; tachycardia and hypotension; vomiting and diarrhea 4. Assessment and management A. Support airway, breathing, and circulation B. Monitor closely and expedite transport

Answer 273

Thyrotoxic crisis (thyroid storm)

Question 274

1. A thyroid disorder 2. Pathophysiology A. Can be inherited or acquired B. Chronic untreated hypothyroidism creates myxedema - Thickening of connective tissue in skin/other tissues - Infection, trauma, CNS depressants, or cold environment can trigger progression to myxedemic coma 3. Signs and symptoms A. Fatigue, slowed mental function; cold intolerance, constipation, lethargy; absence of emotion, thinning hair, enlarged tongue; cool, pale dough-like skin; coma, hypothermia, and bradycardia 4. Management - supportive

Answer 274

Hypothyroidism and myxedema

Question 275

1. An adrenal disorder; hyperadrenalism 2. Pathophysiology A. Often due to abnormalities in anterior pituitary or adrenal cortex B. May also be due to steroid therapy for non-endocrine conditions such as COPD or asthma C. Long-term cortisol elevation causes many changes - Atherosclerosis, diabetes, hypertension; increased response to catecholamines; hypokalemia and susceptibility to infection 3. Signs and symptoms A. Weight gain; “moon-faced” appearance; fat accumulation on upper back; skin changes and delayed healing of wounds; mood swings; impaired memory or concentration 4. Management - supportive

Answer 275

Cushing’s syndrome

Question 276

1. An adrenal disorder; adrenal insufficiency 2. Pathophysiology A. Due to destruction of adrenal cortex; often related to heredity; stress may trigger crisis B. May be related to steroid therapy - sudden withdrawal can trigger crisis 3. Signs and symptoms A. Progressive weakness, fatigue, decreased appetite; unintentional weight loss; hyperpigmentation of skin and mucous membranes; vomiting or diarrhea; hyperkalemia and other electrolyte disturbances; unexplained cardiovascular collapse; salt craving 4. Management - supportive

Answer 276

Addison’s disease

Question 277

1. An adrenal disorder 2. Genetic defect of adrenal glands A. Cannot produce vital corticosteroids; treated with hormone replacement; requires extra attention to common illnesses and stress inducing situations (injury, exercise, etc) 3. In emergencies, fever, vomiting, cardiorespiratory depression; needs solu-cortef IM; may be off protocol 4. Off-protocol care A. Confronted with need for “patient provided” medication - contact medical control; assist patient, parent, caregiver; listen to caregiver

Answer 277

Congenital adrenal hyperplasia

Question 278

What are respiratory causes of dyspnea?

Answer 278

Aspiration, asthma, COPD (chronic bronchitis and emphysema), pneumonia, pleuritis, non-cardiac pulmonary edema, pleural effusion, pulmonary embolism, toxic inhalation

Question 279

What are upper airway causes of dyspnea?

Answer 279

Foreign body Infections: croup, epiglottitis, Ludwig’s angina

Question 280

What are neuromuscular causes of dyspnea?

Answer 280

Muscular dystrophy, Guillain-Barre’s syndrome, myasthenia gravis, amyotrophic lateral sclerosis

Question 281

What are miscellaneous causes of dyspnea?

Answer 281

Anemia, hyperthyroid disease, metabolic acidosis, psychogenic hyperventilation

Question 282

What are intrinsic factors that would exacerbate underlying respiratory conditions?

Answer 282

Genetics, stress, upper respiratory infection, exercise

Question 283

What are extrinsic factors that would exacerbate underlying respiratory conditions?

Answer 283

Tobacco smoke, allergens, drugs, occupational hazards

Question 284

What are the functions of the upper airway?

Answer 284

Warm, filter, humidify, conduct

Question 285

What is the pathway of air, starting from the nares/mouth?

Answer 285

Nares/mouth, turbinates/oral cavity, nasopharynx/oropharynx, laryngopharynx, larynx, trachea, primary bronchi, secondary (lobar) bronchi, tertiary (segmental) bronchi, quaternary (subsegmental) bronchi, bronchioles, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveoli

Question 286

What makes up the nasal cavity?

Answer 286

Nares and turbinates

Question 287

1. Parallel to nasal floor 2. Provide increased surface area A. Filtration, humidifying, warming

Answer 287

Turbinates

Question 288

1. Cavities formed by cranial bones 2. Appear to further trap bacteria, and act as tributaries for fluid to/from Eustachian tubes/tear ducts 3. Commonly become infected 4. Fracture may cause CSF leak 5. Extremely delicate and vascular tissues A. Improper or overly aggressive placements of tubes or airways will cause significant bleeding which may not be controlled by direct pressure

Answer 288

Sinuses

Question 289

1. Large muscle attached at the mandible and hyoid bones 2. Most common airway obstruction

Answer 289

Tongue

Question 290

1. Lined with mucous membranes and cilia 2. Nasopharynx - from the nasocavity to the soft-palette 3. Oropharynx - soft palate to the hyoid bone 4. Hypopharynx (laryngopharynx) - from the hyoid bone to the larynx

Answer 290

Pharynx

Question 291

1. Lymph tissue - filters bacteria 2. Frequently infected and swollen 3. Posterior tongue

Answer 291

Tonsils/adenoids

Question 292

1. Attached to hyoid bone - “horseshoe-shaped” bone between the chin and mandibular angle 2. Supports trachea 3. Made of 9 cartilages

Answer 292

Larynx

Question 293

1. First tracheal cartilage; “shield-shaped”; cartilage anterior; smooth muscle posterior 2. Laryngeal prominence - “Adam’s apple” anterior prominence of thyroid cartilage 3. Glottic opening directly behind

Answer 293

Thyroid cartilage

Question 294

1. “Drops” to protect airway 2. Leaf-like structure

Answer 294

Epiglottis

Question 295

1. Narrowest part of adult trachea 2. Patency heavily dependent on muscle tone 3. Contain vocal bands 4. White bands of cartilage 5. Produce voice

Answer 295

Glottic opening

Question 296

1. “Pyramid-like” posterior attachment of vocal bands 2. Important landmark for endotracheal intubation

Answer 296

Arytenoid cartilage

Question 297

“Hollow pockets” along the lateral borders of the larynx

Answer 297

Pyriform fossae

Question 298

1. First tracheal ring 2. Completely cartilaginous 3. Compression occludes esophagus (Sellick maneuver)

Answer 298

Cricoid ring

Question 299

1. Fibrous membrane between cricoid and thyroid cartilage 2. Site for surgical and alternative airway placement

Answer 299

Cricothyroid membrane

Question 300

1. Located below cricoid cartilage 2. Lies across trachea and up both sides

Answer 300

Thyroid gland

Question 301

Oxygenated vessels that branch across and lie closely alongside trachea

Answer 301

Carotid arteries

Question 302

Deoxygenated vessels that branch across and lie closely to the trachea

Answer 302

Jugular veins

Question 303

What is the function of the lower airway?

Answer 303

Exchange of O2 and CO2

Question 304

What is the location of the lower airway?

Answer 304

From the fourth cervical vertebrae to xiphoid process; from glottic opening to pulmonary capillary membrane

Question 305

1. A cartilaginous structure; 4-5” long 2. Uniformly stacked “C” shaped cartilaginous rings 3. Smooth muscle and a ciliated columnar epithelium compose the internal lining 4. Posterior wall separates the trachea from the esophagus

Answer 305

Trachea

Question 306

1. Cartilaginous structures 2. Composed of incomplete, randomly arranged, cartilaginous rings 3. Covered with smooth muscle, elastic bands, and ciliated columnar epithelium 4. Primary, lobar, segmental, and subsegmental

Answer 306

Bronchi

Question 307

Which primary main stem bronchi is angled at 30 degrees and results in more FBAO and ETT failures?

Answer 307

Right main stem bronchi

Question 308

How many lobar bronchi are on the left side? The right side?

Answer 308

2 on left, 3 on right

Question 309

1. Conducting ducts 2. Lost of the cartilaginous rings 3. Smooth muscle and columnar epithelium (mostly without cilia) remain

Answer 309

Bronchioles

Question 310

1. Last of the bronchiole structures which SOLELY conduct air 2. Remaining bronchioles are small enough in size and close enough to the alveolar capillaries that gas exchange begins to occur

Answer 310

Terminal bronchioles

Question 311

1. Bronchioles where gas exchange is able to take place 2. Start of the respiratory unit - also composed of alveolar ducts and alveoli

Answer 311

Respiratory bronchioles

Question 312

What alveolar cells are involved in gas exchange?

Answer 312

Type I cells

Question 313

What alveolar cells secrete surfactant?

Answer 313

Type II cells

Question 314

What structures make up the conducting system?

Answer 314

Nares/mouth, turbinates/oral cavity, nasopharynx/oropharynx, laryngopharynx, larynx, trachea, primary bronchi, lobar bronchi, segmental bronchi, subsegmental bronchi, bronchioles, terminal bronchioles

Question 315

What structures make up the respiratory unit?

Answer 315

Respiratory bronchioles, alveolar ducts, alveoli

Question 316

The process of air movement

Answer 316

Ventilation

Question 317

The process of diffusion and movement of gases

Answer 317

Respiration

Question 318

1. An active process 2. Diaphragm contracts and moves down and outward, intercostal muscles contract and pull ribs up and outward, lungs expands, negative pressure in the lung cavity, positive pressure in the atmosphere, air flows in

Answer 318

Inspiration

Question 319

1. A passive process 2. Diaphragm relaxes and moves upward, intercostal muscles relax and ribs go back to normal position, lungs recoil, positive pressure in the lung cavity, negative pressure in the atmosphere, air flows out

Answer 319

Exhalation

Question 320

1. Located in carotid bodies, arch of the aorta, and medulla 2. Stimulated by decreased PaO2, increased PaCO2, and decreased pH 3. Cerebrospinal fluid (CSF) pH is primary control of respiratory center

Answer 320

Chemoreceptors

Question 321

What nervous system control is the main respiratory center that initiates impulses to produce respiration?

Answer 321

Medulla oblongata

Question 322

Which center is located in the lower pons and assumes respiratory control if the medulla fails to initiate impulses?

Answer 322

Apneustic center

Question 323

Which center is located in the upper pons and controls breathing rates and patterns?

Answer 323

Pneumotaxic center

Question 324

1. Hypoxemia is a profound stimulus of respiration in a normal individual 2. Hypoxic drive increases respiratory stimulation in people with chronic respiratory disease

Answer 324

Hypoxic drive

Question 325

What is the stretch receptor that is the back up structure located in the pleural apices and is responsible for the prevention of over expansion of the lungs?

Answer 325

Hering-Breuer reflex

Question 326

What are the requirements for pulmonary perfusion?

Answer 326

Adequate blood volume (hemoglobin), intact pulmonary capillaries, efficient pumping action by the heart

Question 327

Respectively, what are volumes of total lung capacity? Vital capacity? Inspiratory reserve? Tidal volume? Expiratory volume? Residual volume?

Answer 327

6000mL, 4800mL, 3000mL, 500mL, 1200mL, 1200mL

Question 328

What are the regulatory structures/functions of ventilation?

Answer 328

Medulla oblongata, stretch receptors, changes in PCO2, COPD patients

Question 329

What are some upper airway obstructions that cause problems with ventilation?

Answer 329

Trauma, epiglottis, FBAO, inflammation of the tonsils

Question 330

What are some lower airway obstructions that cause problems with ventilation?

Answer 330

Trauma, obstructive lung disease, mucous accumulation, smooth muscle spasms, airway edema

Question 331

What are chest wall impairments that cause problems with ventilation?

Answer 331

Trauma, hemothorax, pneumothorax, emphysema, pleural inflammation, neuromuscular diseases (such as multiple sclerosis or muscular dystrophy)

Question 332

What are neurological control issues that cause problems with ventilation?

Answer 332

Brainstem malfunction (CNS depressant drugs, CVA or other medical neurologic conditions, trauma), phrenic/spinal nerve dysfunction (trauma, neuromuscular diseases)

Question 333

What are some alveolar pathologies that cause problems with diffusion?

Answer 333

Asbestosis and other environmental lung diseases; blebs/bullaes associated with COPD; capillary bed pathology (severe atherosclerosis)

Question 334

What are some inhalation injuries/interstitial space pathologies that cause problems with diffusion?

Answer 334

1. Pulmonary edema A. High pressure (aka cardiogenic) - left heart failure; idiopathic pulmonary hypertension B. High permeability (aka non-cardiogenic) - ARDS, asbestosis, environmental lung disease, near-drowning, post-hypoxia, inhalation injuries

Question 335

What are some problems of perfusion?

Answer 335

1. Inadequate blood volume/hemoglobin levels A. Hypovolemia and anemia 2. Impaired circulatory blood flow A. Pulmonary embolus 3. Capillary wall pathology A. Trauma

Question 336

1. Altered but effective difficulty breathing with increase work effort and sustained air movement 2. Indicators: A. Normal mental status with mild anxiety, minimal or mild cyanosis, altered breath sounds, chest tightness, slight tachycardia, decreased SpO2 that improves with oxygen, altered high or low EtCO2 3. Management A. Supplemental oxygen, inhaled bronchodilators, anti-inflammatory medications B. Assisted ventilations and intubation NOT INDICATED

Answer 336

Respiratory distress

Question 337

1. Ineffective difficulty breathing with maximum work effort and minimal air movement 2. Indicators A. Alterations in mental status, severe cyanosis, pallor and diaphoresis, absent breath sounds, audible stridor, 1-2 syllable dyspnea, fatigue, tachycardia > 130 bpm, the presence of retractions/use of accessory muscles, decreased SpO2 with supplemental oxygen, altered (almost always low) EtCO2 3. Management A. Start with basics - supplemental oxygen, inhaled bronchodilators, anti-inflammatory medications B. Assess effectiveness C. Consider aggressive action - assisted ventilations, intubation (PA), IV access, IV bronchodilators, IV steroids, chest percussion

Answer 337

Respiratory failure

Question 338

1. Bronchial - loud, high pitched; expiratory phase usually longer 2. Bronchovesicular - softer, medium pitched; equal phases 3. Vesicular - soft, low pitched

Answer 338

Normal breath sounds

Question 339

1. Snoring - partial upper airway obstruction (tongue) 2. Stridor - harsh, high pitched inspiratory sound; edema to trachea and upper airway 3. Wheezing - partial obstruction of bronchi or bronchioles; from edema, bronchoconstriction, foreign objects 4. Rhonchi (low wheezes) - rattling sounds in larger airways (fluid, mucus) 5. Rales (crackles) - fine crackling sounds in smaller airways 6. Pleural friction rub - rubbing sound; breakdown of pleural fluid (pleurisy)

Answer 339

Abnormal breath sounds

Question 340

1. High pitched, heard at end of inspiration 2. Discontinuous 3. Not cleared by cough 4. Caused by fluid in lower airways

Answer 340

Fine crackles (fine rales)

Question 341

Type of abdominal pain that originates in the walls of the abdominal cavity - described as sharp and localized - usually seen in bacterial and chemical irritations

Answer 341

Somatic pain

Question 342

1. Lower, more moist sound heard during the mid-inspiration 2. Not cleared by cough 3. Caused by fluid in lower airways

Answer 342

Medium crackles (rales)

Question 343

Type of abdominal pain that: - originates in the walls of hollow organs - described as dull, poorly localized - usually seen with bacterial infections - ex: appendicitis, pancreatitis, cholecystitis

Answer 343

Visceral Pain

Question 344

Type of abdominal pain that originates in an area other than where felt - caused by an embryonic origin of nerves -ex: diaphragmatic injury, AAA, appendicitis

Answer 344

Referred pain

Question 345

Ecchymosis in periumbilical region only

Answer 345

Cullen’s sign

Question 346

Ecchymosis in the flank and periumbilical region, often associated with a pancreatic injury

Answer 346

Grey-Turner’s sign

Question 347

The term for hemorrhaging of the proximal esophagus, stomach, and duodenum Causes: - peptic ulcer disease - gastritis - varix rupture - Mallory-Weiss tear - esophagitis - duodenitis S/S: -general abdominal discomfort - hematemesis - melena - classic signs and symptoms of shock - changes in orthostatic vital signs

Answer 347

Upper Gastrointestinal Bleeding

Question 348

An Upper GI disease involving portal hypertension caused by liver cirrhosis from alcoholism/ ingestion of caustic substances. S/S - hematemesis - dysphagia - painless bleeding - hemodynamic instability - classic signs of shock

Answer 348

Esophageal Varices

Question 349

GI disease where damage to the mucosal GI surfaces occurs - there is pathological inflammation causing hemorrhage and erosion of the mucosal and submucosal layers of the GI tract S/S: - rapid onset of severe vomiting/ diarrhea - hematemesis, hematochezia, melena - diffuse abdominal pain -classic signs of shock

Answer 349

Acute gastroenteritis

Question 350

GI disease that stems from LONG term mucosal changes/ permanent damage

Answer 350

Chronic gastroenteritis

Question 351

GI disease caused by erosions caused by gastric acid. Terminology is based on the portion of the tract that is affected. - S/S: -abdominal pain - observe for signs and symptoms of hemorrhagic rupture

Answer 351

Peptic ulcer

Question 352

Bleeding distal to the ligament of Treitz - diverticulitis - colon lesions - rectal lesions - inflammatory bowel disorder S/S: - determine acute vs chronic - quantity/ color of blood in stool - abdominal pain - signs of shock

Answer 352

Lower Gastrointestinal bleeding

Question 353

A lower GI disease with an unknown cause. S/S include abdominal cramping, nausea, vomiting, diarrhea, fever, weight loss

Answer 353

Ulcerative colitis

Question 354

Lower GI disease that occurs with pathologic inflammation that can affect the entire GI tract. - The mucosa may be damaged. -hypertrophy and fibrosis of underlying muscle may also be damaged

Answer 354

Crohn’s disease

Question 355

The lower GI disease that includes the inflammation of small out-pockets in the mucosal lining of the intestinal tract S/S: - abdominal pain/ tenderness -LLQ sharp/ rapid onset - fever, nausea, vomiting - signs of lower GI bleeding

Answer 355

Diverticulitis

Question 356

lower GI complication that includes a mass of swollen veins in the anus or rectum - idiopathic - may present with with limited bright red bleeding and painful stools

Answer 356

Hemorrhoids

Question 357

Blockage of the hollow space of the small or large intestine

Answer 357

Bowel obstruction

Question 358

Inflammation of the appendix, lack of treatment can cause rupture and subsequent peritonitis S/S: - nausea, vomiting, low grade fever - pains localized to RLQ (McBurney’s point) - radiates to umbilicus

Answer 358

Appendicitis

Question 359

Inflammation of the gallbladder S/S: - URQ abdominal pain (Murphy’s sign) - nausea, vomiting - pain occurs after a meal high in fats - pain radiates to right shoulder

Answer 359

Cholecystitis

Question 360

Gall stone “ fat, forty, fertile, fair skinned, flatulent, female”

Answer 360

Cholelithiasis

Question 361

Inflammation of the pancreas - can be from alcohol abuse, gallstones, elevated serum lipids, or drugs S/S for mild: -epigastric pain -abdominal distention - nausea/ vomiting - elevated amylase and lipase levels S/S for severe: - refractory hypotensive shock and blood loss - respiratory failure

Answer 361

Pancreatitis

Question 362

Inflammation or infection of the liver that causes injury to liver cells S/S include: - URQ abdominal tenderness - loss of appetite, weight loss, malaise - clay- colored stool, jaundice, scleral icterus - photophobia, nausea, vomiting

Answer 362

Hepatitis

Question 363

Dysfunction BEFORE level of the kidneys - most common and easiest to reverse - caused by hypovolemia, cardiac failure, cardiovascular collapse, renal vascular anomalies

Answer 363

Pre-renal acute renal failure

Question 364

Dysfunction within the kidneys themselves - caused by a small vessel/ glomerular damage - tubular cell damage (ischemic or toxic) - interstitial damage ( acute pyelonephritis, allergic reactions)

Answer 364

Renal Acute Renal Failure

Question 365

Dysfunction distal to the kidneys Causes: - abrupt obstruction to both ureters - abrupt obstruction to the prostate - abrupt obstruction to the urethra

Answer 365

Post-Renal Acute Renal failure

Question 366

What medications are used to treat hyperkalemia and acidosis?

Answer 366

Sodium bicarbonate 1 mEq/ kg + calcium chloride 1g

Question 367

Causes similar to Renal Acute Renal Failure – Microangiopathy, glomerular injury – Tubular cell injury – Insterstitial injury • Congential causes – Polycystic diseases – Renal hypoplasia • May impair other essential functions of the kidney – Maintenance of blood volume with proper balance of water, electrolytes, and pH • Increased sodium, water, and potassium retention – Retention of key compounds such as glucose with excretion of wastes such as urea • Loss of glucose and buildup of urea within the blood – Control of arterial blood pressure • Disruption of the renin-angiotensin loop resulting in HTN – Regulation of erythrocyte development • Development of chronic anemia

Answer 367

Chronic renal failure

Question 368

Renal complication when “ too much insoluble stuff accumulates in the kidneys Findings include: – Severe pain in one flank that increases in intensity and migrates from the flank to the groin – Painful, frequent urination with visible hematuria – Prior history • Physical Exam – Difficult due to patient discomfort – Often fell need to walk, usually in slumped position – Tachycardia with pale, cool, and moist skin

Answer 368

Renal Calculi / kidney stones

Question 369

Infection of this tract that presents with: – Abdominal pain – Frequent, painful urination – A “burning sensation” associated with urination – Difficulty beginning and continuing to void – Strong or foul-smelling urine – Similar past episodes And this is found upon examination: – Restless, uncomfortable appearance – Presence of a fever – Vital signs vary with degree of pain

Answer 369

Urinary Tract Infection

Question 370

Twisting of spermatic cord – Disrupts blood supply to the testicle – Results in severe pain – A significant EMERGENCY because the testicle will die after a few hours

Answer 370

Testicular Torsion

Question 371

Antidote for acetaminophen OD

Answer 371

N-acetylcysteine, 140 mg/kg

Question 372

Antidote for atropine OD

Answer 372

Physostigmine, 0.5 to 2 mg IV

Question 373

Antidote for benzodiazepine OD

Answer 373

Flumazenil, 0.2 mg q 1 min to total of 1 to 3 mg

Question 374

Antidote for cyanide poisoning

Answer 374

– Amyl nitrite, inhaled 20 to 30 seconds each minute – Hydroxocobalamine (cyano-kit)

Question 375

Antidote for Ethylene glycol / Methyl Alcohol

Answer 375

Ethyl alcohol, 1 mL/kg of 80 to 100 proof

Question 376

Antidote for nitrates

Answer 376

Methylene blue, 0.2 mL/kg of 1% solution over 5 min

Question 377

Antidote for Opiate OD

Answer 377

Naloxone, 0.4 to 2.0 mg IV

Question 378

Antidote for Organophosphates / Nerve Agent exposure

Answer 378

– Atropine, 2 to 5 mg – Pralidoxime, 1 g

Question 380

1. Loud, course sounds; most often continuous 2. Coughing may clear sounds 3. Caused by mucus accumulation in larger airways

Answer 380

Rhonchi

Question 381

1. Musical noise; heard continuously during inspiration or expiration 2. Caused by partial airway obstruction

Answer 381

Wheeze

Question 382

1. Dry, rubbing or grating sound 2. May be localized or over lateral anterior surface 3. Caused by pleurisy

Answer 382

Pleural friction rub

Question 383

“Eupnea”

Answer 383

Normal breathing pattern

Question 384

1. Cyclic wax and wane 2. Usually involves periods of apnea 3. Seen in stroke, head injury, CHF

Answer 384

Cheyne-stokes respirations

Question 385

1. Deep, rapid respirations 2. Seen in metabolic disease

Answer 385

Kussmaul’s respirations

Question 386

1. Rapid respirations 2. Seen in cerebral injury and increased ICP

Answer 386

Central neurogenic hyperventilation

Question 387

1. Irregular rate and depth 2. Seen in CNS dysfunction and increased ICP

Answer 387

Ataxic (Biot’s) respirations

Question 388

1. Deep, gasping inhalation with long slow exhalation 2. Brief periods of apnea 3. Seen in pons damage and brain stem stroke

Answer 388

Apneustic respirations

Question 389

What does the pulse oximetry percentage reflect?

Answer 389

The amount of saturated hemoglobin

Question 390

What causes the oxygen dissociation curve to go left?

Answer 390

Decreased temperature, alkalosis (increased pH), decreased CO2

Question 391

What causes the oxygen dissociation curve to go right?

Answer 391

Increased temperature, acidosis (decreased pH), increased CO2

Question 392

What does end-tidal CO2 measure and correlate to?

Answer 392

Measures carbon dioxide in expired air and correlates to carbon dioxide in arterial blood

Question 393

What is the normal range for EtCO2? What are the waveform phases?

Answer 393

Range: 35-45 mmHg Phase I - baseline, initial exhalation (dead air) Phase II - expiratory upstroke Phase III - alveolar plateau, extended expiration Phase IV - end of expiration, onset of inspiration

Question 394

What causes elevated EtCO2?

Answer 394

1. Respiratory - respiratory depression, COPD, hypoventilation, partial blocked airway 2. Circulatory - increased cardiac output, ROSC 3. Metabolic - pain, hyperthermia, malignant hyperthermia, shivering, muscle exertion, acids/acidosis, bicarbonate admin, seizure

Question 395

What causes decreased EtCO2?

Answer 395

1. Respiratory - hyperventilation, bronchospasm, mucus plugging, shunting, COPD 2. Circulatory - cardiac arrest, pulmonary embolism (dead air space), hypovolemia, hypotension 3. Metabolic - hypothermia, sedation/anesthesia 4. Circuit problems - airway disconnection, deflated ET cuff, dislodged tube, kinked/obstructed tube

Question 396

What causes a sudden drop in EtCO2 to zero?

Answer 396

Esophageal intubation, ventilator disconnection or defect in ventilator, defect in CO2 analyzer, kinked endotracheal tube

Question 397

What causes a sudden decrease in EtCO2?

Answer 397

Leak in ventilatory system, obstruction in ventilation system, partial disconnection of ventilator system, partial airway obstruction (secretions or mucus)

Question 398

What causes an exponential decrease in EtCO2?

Answer 398

Pulmonary embolism, cardiac arrest, hypotension (sudden), severe hyperventilation

Question 399

What causes a gradual lowering over time of EtCO2?

Answer 399

Hypovolemia, decreasing cardiac output, decreasing body temperature, hypothermia, drop in metabolism

Question 400

What causes a sudden increase in EtCO2?

Answer 400

Accessing an area of lung previously obstructed, release of tourniquet (arterial), sudden increase in blood pressure

Question 401

What causes a gradual increase over time of EtCO2?

Answer 401

Rising body temperature, hypoventilation, partial airway obstruction (foreign body), reactive airway disease

Question 402

What would cause a flat EtCO2 waveform?

Answer 402

Hypopharyngeal intubation; a missed or dislodged intubation

Question 403

What causes a shark fin EtCO2 waveform?

Answer 403

Asthma

Question 404

What causes a declining alveolar plateau EtCO2 waveform?

Answer 404

Emphysema - ineffective exhalation

Question 405

What happens to the EtCO2 waveform when ROSC occurs?

Answer 405

Causes “jump” in carbon dioxide release which causes an increase in EtCO2; sudden rise indicates improvement in circulation

Question 406

What should the EtCO2 waveform look like in order to consider the termination of effort?

Answer 406

Carbon dioxide levels consistently less than 10 mmHg for over 20 minutes Non-statistical ability to survive

Question 407

1. Don’t just measure EtCO2, we drive it 2. PaCO2 35-39 mmHg optimizes cerebral blood flow 3. Correlates to an EtCO2 of 32 A. Typically accomplished with 10-12 VPM B. Hypoventilation (VR < 10) - hypercapnea and engorgement of blood C. Hyperventilation (VR of 18-20) - hypocapnea and profound vasoconstriction; is beneficial with increased ICP by restricting blood flow; use only with s/s of increased ICP or herniation (Cushing’s triad, pupillary abnormalities, posturing)

Answer 407

Traumatic brain injury

Question 408

1. Helps to keep airway open during and after inhalation 2. Eases/assists patient’s own breathing 3. Used in the treatment of CHF, COPD, asthma

Answer 408

CPAP

Question 409

1. Augments patient’s own breathing 2. Uses two levels of positive pressure A. Exhalation - variably positive or near ambient B. Inspiration - variably positive, and is always higher than the expiratory pressure 3. Intended to be used with room air (can have oxygen supplement)

Answer 409

Bi-PAP

Question 410

What part of the nervous system contains the brain and spinal cord?

Answer 410

Central nervous system

Question 411

What part of the nervous system innervates the body?

Answer 411

Peripheral nervous system

Question 412

Which part of the nervous system controls sensory and motor neurons?

Answer 412

Somatic nervous system

Question 413

Which part of the nervous system controls regulatory nerves?

Answer 413

Autonomic nervous system

Question 414

What is the basic unit of the nervous system that operates through the same system as the cardiac conduction system?

Answer 414

Neuron

Question 415

Which type of neuron is the efferent nerve?

Answer 415

Motor neuron

Question 416

Which type of neuron is the afferent nerve?

Answer 416

Sensory neuron

Question 417

What cranial nerve provides sensory input for the ophthalmic (forehead), maxillary (cheek), and mandible (chin) regions, as well as the motor input for the chewing muscles?

Answer 417

Trigeminal CN V

Question 418

What cranial nerve provides motor input to the lateral rectus muscle of the eye?

Answer 418

Abducens CN VI

Question 419

What cranial nerve provides sensory input to the tongue and motor input to the facial muscles?

Answer 419

Facial CN VII

Question 420

What cranial nerve provides sensory input for hearing and balance?

Answer 420

Acoustic CN VIII

Question 421

What cranial nerve provides sensory input for the posterior pharynx and taste of the anterior tongue, as well as motor input for the facial muscles?

Answer 421

Glossopharyngeal CN IX

Question 422

What cranial nerve provides sensory input for the taste to posterior tongue, as well as motor input to the posterior palate and pharynx?

Answer 422

Vagus CN X

Question 423

What cranial nerve provides motor input to the trapezius and sternocleidomastoid muscles?

Answer 423

Accessory CN XI

Question 424

What cranial nerve provides motor input to the tongue?

Answer 424

Hypoglossal CN XII

Question 425

What structure exits the skull through the foramen magnum and carries impulses down to the body and up to the brain?

Answer 425

Spinal cord

Question 426

Which route has efferent (motor) fibers?

Answer 426

Ventral route

Question 427

Which route has afferent (sensory) fibers?

Answer 427

Dorsal route

Question 428

What set of nerves leave the spinal cord in 31 pairs between the vertebral discs?

Answer 428

Peripheral nerves

Question 429

What nervous system contains somatic (voluntary) and visceral (autonomic) innervations?

Answer 429

Peripheral nervous system

Question 430

Which part of the PNS contains somatic sensory (afferent) nerves that transmit sensations of touch, pressure, pain, temperature, and position?

Answer 430

Somatic sensory

Question 431

Which part of the PNS contains somatic motor (efferent) nerves that carry impulses to skeletal muscles?

Answer 431

Somatic motor

Question 432

Which part of the nervous system contain the visceral innervations, the sympathetic nervous system, and the parasympathetic nervous system?

Answer 432

Autonomic nervous system

Question 433

Which part of the ANS has afferent tracts that sense when the bladder is full and signal the need to defecate?

Answer 433

Visceral sensory

Question 434

Which part of the ANS has efferent tracts that innervate the involuntary cardiac and smooth muscles?

Answer 434

Visceral motor

Question 435

Which part of the ANS is the “fight-or-flight” mechanism that branches from thoracic and lumbar nerves that increases heart rate and blood pressure, pupillary dilation, increased blood sugar, and bronchodilation?

Answer 435

Sympathetic nervous system

Question 436

Which part of the ANS branches from the cranial and sacral nerves that decreases heart rate, causes bronchoconstriction, pupillary constriction, and increases digestive activity?

Answer 436

Parasympathetic nervous system

Question 437

What is decorticate posturing?

Answer 437

Arms are flexed, legs are extended; lesion at or above upper brain stem

Question 438

What is decerebrate posturing?

Answer 438

Stiff and extended extremities; retracted head; brainstem lesion

Question 439

What is a carotid bruit?

Answer 439

Carotid arteriosclerosis decreases cerebral blood flow

Question 440

What are 12-lead changes associated with increased ICP?

Answer 440

Wide ST segments, broad T waves Deep S waves in V1-V3

Question 441

What is the myelinated sheath that wraps around the axon and acts as an insulator?

Answer 441

Schwann cell

Question 442

What is at the end of an axon terminal that releases neurotransmitters that are received by the next neuron’s dendrite or by the site of action?

Answer 442

Synapse

Question 443

What part of the brain is responsible for conscious thought and sensory interpretation, has two hemispheres separated by the central sulcus, and is connected by the corpus callosum?

Answer 443

Cerebrum

Question 444

Which part of the brain is responsible for coordination and balance, fine motor movement, equilibrium, posture, and muscle tone?

Answer 444

Cerebellum

Question 445

Which part of the brain is located along the walls of the third ventricle; is the site of the thalamus, hypothalamus, and the limbic system; and regulates temperature, water balance, sleep, stress, and emotions?

Answer 445

Diencephalon

Question 446

Which part of the brain contains the mesencephalon (mid-brain) that controls some motor coordination and eye movement; the pons that acts as the connection pathway and controls the respiratory and cardiac rates; and the medulla oblongata that controls respiratory and cardiac regulation?

Answer 446

Brain stem

Question 447

What part of the mid-brain is the connection center and controls respiratory and cardiac rates? What centers are found in the structure?

Answer 447

Pons; Apneustic and pneumotaxic center

Question 448

What part of the mid-brain controls respiratory and cardiac regulation, and contains the cardioinhibitory center, cardioacceleratory center, and vasomotor center?

Answer 448

Medulla oblongata

Question 449

What sensory and motor interpretations is controlled by the frontal lobe?

Answer 449

Personality, association, speech, smell, taste, and motor interpretations in the leg, trunk, arm, hand, and face

Question 450

What sensory and motor interpretations are controlled by the parietal lobe?

Answer 450

Visual association area, and sensory interpretations in the leg, trunk, arm, hand, and face

Question 451

What sensory and motor interpretations are controlled by the temporal lobe?

Answer 451

Hearing and speech

Question 452

What sensory and motor interpretations are controlled by the occipital lobe?

Answer 452

Vision and primary visual area

Question 453

What system is located along the brainstem and maintains consciousness and response to stimuli?

Answer 453

Reticular Activating System (RAS)

Question 454

What arteries and structure assures cerebral perfusion?

Answer 454

Carotid and vertebral arteries; Circle of Willis

Question 455

What cranial nerve is provides sensory input for smell?

Answer 455

Olfactory CN I

Question 456

What cranial nerve provides sensory input for sight?

Answer 456

Optic CN II

Question 457

What cranial nerve provides motor input for pupil constriction and innervates the rectus and oblique muscles of the eye?

Answer 457

Oculomotor CN III

Question 458

What cranial nerve provides motor input for the superior oblique muscles of the eye?

Answer 458

Trochlear CN IV

Question 459

What questions do you want to ask someone who is processing toxins/ foreign substances through gastric absorbtion?

Answer 459

- ask patient: – What, when and how much, was ingested? – Did you drink any alcohol? – Have you attempted to treat yourself? – Have you been under psychiatric care? Why? – What is your weight?

Question 460

S/S + management for an anticholinergic OD. Ex: incidental anticholinergic such as antihistamines, phenothiazines, TCA, cold medicines

Answer 460

Signs and Symptoms – Dry skin and membranes – Thirst – Dysphagia – Blurred near vision – Fixed, dilated pupils – Hypertension, tachycardia – Hyperthermia – Seizures – Respiratory failure • Management – Supportive care – Benzodiazepines as needed for seizures – Physostigmine (not generally used prehospital)

Question 461

S/S and management of phenathiazines. These medications are used to treat serious mental and emotional issues but may be for other purposes such as antiemetics. Ex: haloperidol, promethazine, thioridazine

Answer 461

Signs and Symptoms – Parkinsonian appearance – Dystonia – Dysphagia – Eye muscle spasm – Rigidity / Tremors – Neck spasms – Shrieking – Jaw spasm – Laryngospasm • Management – Supportive care – Diphenhydramine, 25 to 50 mg IV bolus

Question 462

S/S and management for a sympathomimetic OD Ex: amphetamines, cocaine, aminophylline

Answer 462

Signs and Symptoms – CNS excitation • Excited delirium – Seizures – Extreme hypertension – Hypotension with caffeine – Tachycardia – Hyperthermia • Management – Maintain airway and ventilation – Begin IV access – Administer diazepam for excited states – Consider use of chemical restraint (PAI / RSI) – If hyperthermic, begin external cooling

Question 463

Management for ingestion/ surface absorption of caustic substances

Answer 463

– Acids • Cause significant damage at sites of exposure • Are rapidly absorbed into the bloodstream – Alkalis • Slower onset of symptoms allows for longer contact and more – Perform standard toxicologic emergency procedures – Maintain an adequate airway • Esophageal airways are contraindicated Rinse external contact with copious amounts of water • 5 minutes minimum for acid • 15 minutes minimum for alkali

Question 464

S/S and management for a TCA overdose

Answer 464

Signs & Symptoms of Severe Toxicity – Confusion, hallucinations, hyperthermia – Respiratory depression, seizures – Tachycardia, hypotension, cardiac dysrhythmias, widening of QRS complex • Management – Bicarbonate may be indicated for seizures – Monitor and treat cardiac dysrhythmias – Avoid use of flumazenil, which may precipitate seizures

Question 465

Serotonin syndrome

Answer 465

Triggered by increasing the dose or by adding selected drugs, typically in newer antidepressants such as trazodone, bupropion, and SSRIs • Marked by agitation, anxiety, confusion, insomnia, headache, coma, salivation, diarrhea, abdominal cramps, cutaneous piloerection, flushed skin, hyperthermia, rigidity, shivering, incoordination, and myoclonic jerks.

Question 466

S/S for lithium OD

Answer 466

Prescribed to treat bipolar disorder. – Narrow therapeutic index • Signs & Symptoms – Thirst, dry mouth, tremors, muscle twitching, and increased reflexes – Confusion, stupor, seizures, coma, nausea, vomiting, diarrhea, bradycardia, and dysrhythmias • Treatment – Activated charcoal is not effective with lithium

Question 467

S/S and management for salicylates

Answer 467

Common Overdose Drug – Includes aspirin, oil of wintergreen. • Signs & Symptoms – Tachypnea, hyperthermia, confusion, lethargy, coma, cardiac failure, and dysrhythmias – Abdominal pain, vomiting, pulmonary edema, ARDS • Treatment – Standard toxicologic emergency procedures • Activated charcoal is indicated.

Question 468

S/S for an NSAID OD

Answer 468

Includes – Ibuprofen, keterolac, naproxen sodium. • Signs & Symptoms – Headache, tinnitus, nausea, vomiting, abdominal pain, drowsiness – Dyspnea, wheezing, pulmonary edema, swelling of extremities, rash, itching

Question 469

Problems with inhaled toxins

Answer 469

Displace oxygen – Atmospherically – Hematologically • Pulmonary tissue burns – Gas reacts with water to form acid/alkali • Absorbed as systemic toxins – Immediate effects – Long-term effects

Question 470

S/S and management of inhaled toxins

Answer 470

History and physical exam – Central nervous system effects: • Dizziness, headache, confusion, seizure, hallucinations, coma – Respiratory effects: • Cough, hoarseness, stridor, dyspnea, retractions, wheezing, chest pain / tightness, pulmonary edema, rales, rhonchi, apnea – Cardiac effects • Dysrhythmias Management Initiate supportive measures – Oxygenation – Ventilation • Poison Control may recommend specific treatment if HazMat is not indicated • Transport considerations – Hyperbaric therapy

Question 471

S/S of hemoglobinopathies such as carbon monoxide and methemoglobin

Answer 471

Signs and Symptoms – Headache, nausea, vomiting, dizziness, dyspnea, seizures, coma, death – Cutaneous blisters, gastroenteritis – Epidemic occurrences with carbon monoxide – Cyanosis, chocolate blood, with non- functional hemoglobin

Question 472

S/S of cyanide poisoning with treatments

Answer 472

Signs & Symptoms – Odor of almonds – Burning sensation in the mouth and throat – Headache, confusion, and combativeness – Hypertension and tachycardia – Seizures and coma – Pulmonary edema Management – Ensure rescuer safety – Initiate supportive care – Administer antidote: • Amyl nitrite – 20 to 30 seconds per minute, inhaled • Sodium nitrite • Sodium thiosulfate Hydroxocobalamine • Vitamin B-12 • Converts cyanide to be excreted in urine • 5g over 15 minutes (repeated once as if needed)

Question 473

S/S and management of Carbon Monoxide inhalation

Answer 473

Signs & Symptoms – Headache – Nausea and vomiting – Confusion or other altered mental status – Tachypnea – 100% oxygen saturation (saturated with CO) Management – Ensure rescuer safety – Remove the patient from the contaminated area – Initiate supportive measures • High-flow oxygen • Monitor SpO2 – Low saturation is cause for concern – Hyperbaric therapy

Question 474

S/S for Acetylcholinesterase Inhibition - organophosphates such as parathion, malathion, diazanon, and trithion - nerve agents such as sarin (GB), so an (GD), tabun (GA), GF, and VX

Answer 474

SLUDGE and DUMBBELLS Salivation, Lacrimation, Urination, Diarrhea, Gastritis, Emesis • (Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm, Emesis, Lacrimation, Lethargy and Salivation / seizures) – Bradycardia or tachycardia – Hypotension or hypertension – Muscle cramps and weakness – CNS Alterations – Respiratory and cardiovascular depression

Question 475

S/S and treatment for scorpion stings

Answer 475

Signs & Symptoms • Localized burning and tingling sensation • Slurred speech, restlessness, muscle twitching, salivation, nausea, vomiting, and seizures – Treatment • Supportive

Question 476

Snakebite treatment

Answer 476

Keep the patient supine and calm • Wash site • Immobilize limb, neutral or below level of heart • Apply high-flow oxygen • Establish IV access • Controversial – Constricting bands or tourniquets – Ice, cold packs • DO NOT apply electrical stimulation

Question 477

Treatment for marine animal injuries

Answer 477

Treatment – Wash area with Sea Water – Old treatments (no longer recommended) • Flush with: – Vinegar – 1/4 strength ammonia – Baking soda solution – Alcohol – Urine – Apply meat tenderizer paste

Question 478

Treatment for marine animals that puncture such as spine fish and animals. -Usually stepped on by a victim

Answer 478

Treatment – Supportive care, assure ventilation and circulation – Place injured area in HOT water, 105-115 degrees (avoid pain medications initially) – If patient has severe spasms: • Administer Calcuim Gluconate, 10mL of 10% solution, IV push

Question 479

Treatment for marine animals that bite and cause envenomation • Most cause respiratory paralysis • Some can be deadly in less than five minutes • Includes: – Blue-ringed octopus, sea snakes, cone shells

Answer 479

Treatment – Supportive – Assure ventilations and circulation • May have to continue resuscitation for hours – Pressure immobilization technique still recommended

Question 480

S/S and management for contact dermatitis - poison oak - poison ivy - poison sumac

Answer 480

Signs & Symptoms – Itching – Rash – Vesicles Treatment – Supportive – Topical cortisone cream

Question 481

Management for insect bites and stings Most from hymenoptera – Wasps, bees, fire ants – Venom causes pain, edema, and local irritation – Systemic problems are anaphylactic

Answer 481

Management – Wash the area – Remove stingers, if present • Use care not to disturb the venom sac – Apply cool compresses to the injection site – Observe for and treat allergic reactions and/or anaphylaxis

Question 482

S/S and symptoms for Black Widow Spider – Dime sized, shiny black – Red, reddish orange hourglass shaped mark on ventral abdomen – May have stripes or spots matching spot – Neurotoxin

Answer 482

Signs & Symptoms of Bite – Immediate pain, redness, and swelling – Progressive muscle spasms of all large muscle groups – Nausea, vomiting, sweating, seizures, paralysis, and altered level of consciousness Treatment – Follow general treatment guidelines – Provide supportive care – Consider using muscle relaxants to relieve severe muscle spasms • Diazepam 2.5–10mg IV • 0.1–0.2 mg/kg of a 10% calcium gluconate solution IV

Question 483

S/S and management for Brown Recluse Spider – Found primarily in the South and Midwest – Small, brown, spindly spider with dark brown fiddle shape on the back or thorax – Necrotoxin

Answer 483

Signs & Symptoms of Bite – Localized, white-ringed maculae – Progresses to localized pain, redness, and swelling over next 8 hours – Chills, fever, nausea, vomiting, and joint pain may develop – Tissue necrosis develops over subsequent days and weeks Treatment – Supportive – Transport for excision of necrotic area

Question 484

What is the three most common addictions?

Answer 484

Tobacco, alcohol, marijuana

Question 485

1. Effects A. Known carcinogen, COPD, testosterone reduction, breast enlargement in men, cognitive dysfunction 2. Signs and symptoms A. Euphoria, dry mouth, green and/or brown residue on back of tongue, dilated pupils, body tremors, altered sensation 3. Management A. Supportive, speak quietly, oxygen if respiratory impairment is noted

Answer 485

Marijuana

Question 486

1. Effects A. Brain dysfunction, cardiac myopathy, cognitive functioning reduction 2. Signs and symptoms A. CNS depression, slurred speech, disordered thought, impaired judgement, nystagmus, diuresis, stumbling gait, stupor, coma 3. Management A. ABCs, respiratory support, oxygen, IV access, Thiamine 100 mg IV, D10W if low blood sugar

Answer 486

Alcohol

Question 487

1. Effects A. Apathy, organ damage, tolerance, habituation 2. Signs and symptoms B. AMS and coordination, nystagmus, hypotension, respiratory depression 3. Management A. Support respirations, oxygen, IV access 4. Examples: thiopental, phenobarbital, primidone

Answer 487

Barbiturates

Question 488

What is an involuntary jerking of the eyes, whether stationary or moving?

Answer 488

Nystagmus

Question 489

1. Effects A. Tolerance, habituations, liver complications 2. Signs and symptoms A. AMS, hypotension, slurred speech, respiratory depression, bradycardia, seizures 3. Management A. Protect the airway, support respirations, oxygen, IV access, benzodiazepines as needed for seizure activity 4. Examples: secobarbital (Seconal), diazepam (Valium), chlordiazepoxide hydrochloride (Librium), triazolam (Halcion), phenobarbital, alprazolam (Xanax)

Answer 489

Sedatives

Question 490

1. Effects A. Tolerance, habituations, bone pain, generalized weakness, jaundice 2. Signs and symptoms A. Respiratory insufficiency, AMS, slurred speech, dysrhythmias, decrease/loss of reflexes, decreased body temp, nystagmus 3. Management A. Require large overdosage before serious toxicity occurs, support respirations, consider Flumazenil (1-10mg) 4. Examples: diazepam (Valium), chlordiazepoxide hydrochloride (Librium), alprazolam (Xanax), triazolam (Halcion), lorazepam (Ativan), flunitrazepam (Rohypnol)

Answer 490

Benzodiazepines

Question 491

1. Effects A. Apathy, organ damage, respiratory arrest, brain damage 2. Signs and symptoms A. Severe respiratory depression, aphasia, loss of muscle tone/paralysis, hypothermia, seizures, death 3. Management A. Aggressive airway intervention (intubate), 100% oxygen (support ventilations), IV access, transport

Answer 491

GammaHydroxyButarate (GHB)

Question 492

1. Effects A. Apathy, end organ damage, infectious diseases, death 2. Signs and symptoms A. CNS depression, pupil constriction, respiratory depression, hypotension, bradycardia, hypothermia 3. Management A. Support respirations (do not intubate until Naloxone has been given), establish IV access, consider Naloxone (0.4-2.0 mg) 4. Examples: heroin, codeine, propoxyphene (Darvon), meperidine (Demoral), morphine, methadone

Answer 492

Narcotics

Question 493

1. “Starter heroin” - combination of heroin and ground up cold medicine (Tylenol PM; acetaminophen and diphenhydramine) 2. Effects A. Euphoria, disorientation, lethargy, sleepiness, hunger 3. Withdrawal A. Begins within twelve hours, headache, chills, muscle pains, muscle spasms, anxiety, agitation, disorientation, disassociation

Answer 493

Cheese

Question 494

1. Powdered form 2. Effects A. Structural degradation of the upper airway, cardiac myopathy, infectious diseases, psychosis, end organ damage, death 3. Signs and symptoms A. Euphoria, hyperactivity, dilated pupils, psychosis, HTN, tachycardia, chest pain, hyperthermia, vasoconstriction 4. Management A. ABCs, support respirations, oxygen, IV access, violent patients can have heart attacks during struggle, cardiac arrest likely (monitor ECG carefully)

Answer 494

Cocaine hydrochloride

Question 495

1. Crack 2. Effects A. Excitability, aggressiveness, scarring of mid-to-lower airways, organ damage, cardiopulmonary arrest 3. Signs and symptoms A. Euphoria, hyperactivity, dilated pupils, psychosis, HTN, tachycardia, chest pain, callouses or burn marks on dominant thumb and forefinger 4. Management A. ABCs, support respirations, oxygen, IV access, violent patients can have heart attacks during struggle, cardiac arrest likely (monitor ECG closely)

Answer 495

Cocaine free-base

Question 496

1. Effects A. Psychosis, infectious diseases, cardiac myopathy, end organ damage, death 2. Signs and symptoms A. Exhalation, hyperactivity, dilated pupils (dark glasses), hyperthermia, HTN, tachycardia, psychosis, seizures 3. Management A. Supportive, patient may “crash”, treat threats to life, consider benzodiazepines for excited delirium and hyperthermia

Answer 496

Methamphetamine

Question 497

1. Effects A. Hypovolemia, dehydration, hyperthermia, psychosis, stroke, organ damage, death 2. Signs and symptoms A. Dilated pupils, bruxism, cracked teeth, hyperthermia, HTN, tachycardia, psychosis, dysrhythmias, death 3. Management A. Remove external stimuli, initiate controlled cooling (consider benzodiazepines), oxygen via NRB (12-15 liters), initiate IV access, transport

Answer 497

3,4 - Methylinedioxymethamphetamine (Ecstasy)

Question 498

1. Effects A. Excitability, aggressiveness, organ damage, hyperthermia, delusional or hallucinatory behavior 2. Signs and symptoms A. Psychosis, nausea, dilated pupils, rambling sounds, headache, dizziness, hallucinations, distorted senses 3. Management A. Safety first (patients can be violent), reassure the patient, provide dark and quiet transport 4. Examples: LSD, PCP, mescaline, mushrooms, ketamine

Answer 498

Hallucinogens

Question 499

1. Effects A. Excitability, aggressiveness, organ damage, hypothermia, ventricular irritability, CPR 2. Classes A. Volatile solvents - model glue, cleaning fluids, fuels B. Aerosols - freons, lubricants, hydrocarbons C. Anesthetics - amyl nitrate, nitrous oxide (N2O)

Answer 499

Inhalants