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Flashcards in Midterm Deck (79)
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1
Q

delirium

A

a state of global cognitive impairment

  • increased vital signs
  • identify the stressor or metabolic problem in order to treat
2
Q

higher-risk suicide patients

A
  • pts who have attempted in the past
  • pts who have a family history
  • pts who have a detailed plan
3
Q

GAS PIPES

A
  • guilt
  • appetite
  • sleep disturbances
  • paying attention
  • interest
  • psychomotor abnormalities
  • energy
  • suicidal tendencies
  • manic behavior
4
Q

schizophrenia

A
  • typical onset occurs during early adulthood
  • experience may include:
  • delusions
  • hallucinations
  • a flat affect- no emotion in speech, neutral
  • erratic speech
5
Q

panic disorder

A
  • if allowed to continue, panic attacks can cause severe lifestyle restrictions
  • signs and symptoms usually peak in 10 minutes
6
Q

eating disorders

A
  • persons may experience severe electrolyte imbalances

- two thirds report anxiety, depression, and substance abuse disorders

7
Q

antipsychotics

A
  • newer medications have less risk of adverse effects and are more effective
  • know as atypical antipsychotic (AAP) drugs
  • relieve delusions and hallucinations
  • improve symptoms of anxiety and depression
  • may cause metabolic side effects
  • cardiovascular effects depends on medication
  • erectile dysfunction in men
  • bipolar and schizophrenia -> leading
8
Q

perpetrators of elderly abuse

A
  • adult children- 32.5%
  • grandchildren- 4.2%
  • spouse- 14.4%
  • sibling- 2.5%
  • other relatives- 12.5%
  • friend/neighbors- 7.5%
  • all others- 18.2%
  • unknown- 8.2%
9
Q

bruises

A
  • 0-2 days -> tender and swollen, red
  • 2-5 days -> blue, purple
  • 5-7- days -> green
  • 7-10 days -> yellow
  • 10 or more days -> brown
  • 2 or more weeks -> cleared
10
Q

rohypnol

A
  • flunitrazepam
  • a benzodiazepine marketed in mexico, south america
  • used for insomnia
  • 10 times more potent than valium
  • effects in 20 minutes
  • duration up to 8 hours
  • colorless, odorless, tasteless
  • can be dissolved in a drink without being detected
  • alcohol intensifies effects
  • roofies, mexican valium, roaches, ropes, forget pill, peanuts, trip and fall
  • effects:
  • CNS depression
  • amnesia
  • respiratory depression
  • muscle relaxation
11
Q

gamma-hydroxybutyrate (GHB)

A
  • like GABA or alcohol
  • effects in 15-30 minutes
  • duration 3 hours
  • used as an amino acid supplement by body builders
  • depressant with anesthetic type qualities
  • liquids, odorless, colorless
  • georgia home boy, grievous bodily harm, liquid ecstasy, soap, vita G, easy lay
  • effects:
  • relaxation
  • tranquility
  • sensuality
  • loss of inhibitions
12
Q

ketamine

A
  • ketalar
  • used as an anesthetic
  • 10 times more potent than valium
  • hallucinogenic effects last 45-90 minutes
  • duration up to 24 hours
  • dissociative effects
  • colorless, odorless liquid
  • off-white powder
  • K, special K, vitamin K, jet, green, kay, mauve, special LA, super acid
  • effects:
  • hallucinations
  • delirium
  • amnesia
  • dissociation
  • respiratory depression
  • seizures
  • arrhythmias
  • cardiac arrest
  • hypertension
13
Q

MDMA

A
  • one of the most abused amphetamines by teenagers/college students
  • large dose = same effects as amphetamines
  • onset within 20-60 minutes
  • 2-3 hour duration
  • 10% the stimulant effect of amphetamines
  • potent serotonin release
  • ecstasy, E, adam, XTC, M&M, eve, love drug, M, beans, roll
  • effects:
  • mood alteration, sleep, anxiety
  • poor memory, poor impulse control
  • use of other drugs
  • tolerance
  • MI, dysrhythmias, CVA
  • seizures
  • serotonin syndrome
  • permanent damage to serotonin neurons
  • hyperthermia 109
14
Q

hyperkalemia

A
  • 3.6-5.5 range for potassium
  • hyperkalemia- when you get to 7
  • a lot less wiggle room with potassium compared to sodium
15
Q

Dementia is diagnosed when two or more cognitive or psychomotor brain functions are impaired:

A
  • language- aphasia
  • memory- short and long term
  • visual perception
  • emotional behavior/personality
  • cognitive skills
16
Q

Parkinsons is diagnosed when two or more cognitive or psychomotor brain functions are impaired:

A
  • RESTING TREMOR (not active tremor) of extremity -> active tremor- you can do active activities without a tremor
  • slowness of movement
  • rigidity or stiffness of extremities or trunk
  • inaccurate motions
  • poor balance
17
Q

50% of elderly

A
  • are hypertensive
  • vision problems
  • decrease in renal blood flow
18
Q

two most common degenerative dementias

A
  • Alzheimer disease
  • multi-infarct or vascular dementia
  • 6-10% of elderly will eventually have dementia -> risk increases with age
19
Q

depression in elderly

A

6% of elderly

20
Q

organ and tissue aging may be accelerated by

A
  • genetics
  • preexisting disease
  • diet and activity levels
  • toxin exposure- second hand smoke, espestis
21
Q

aortic valves thicken from

A

fibrosis and calcification

22
Q

electrolyte and fluid imbalance

A
  • caused by increase in antidiuretics hormone (ADH)
  • decrease in kidney function
  • > pedal and peripheral edema
23
Q

prevention of COPD

A

−Cessation of smoking
−Avoidance of certain environmental pollutants
−Immunization for influenza and pneumococcal pneumonia

24
Q

strokes

A
  • LKW- last known well time
  • 80% of strokes are in people older than 65
  • chances of stroke double every decade after 35
  • 0 normal life 5 is death
  • ok/normal stroke outcome is 0-2
  • 2-> still bad but you can still do ADL
  • 3 -> barely can do ADLs
  • NIH stroke scale -> 0-42
25
Q

cellulitis

A
  • acute inflammation in skin caused by bacterial infection ***
  • usually affects lower extremities
  • third spacing of fluid
  • capillary failing process
  • venous return failing process
  • bacteria likes warm and dark
  • cooling of fluid in the peripheral
  • venous system wont work efficiently
26
Q

risk factors for pressure ulcers

A
  • brain or spinal cord injury
  • neuromuscular disorders- Guillain-Barre
  • nutritional problems
27
Q

LES

A

locally employed staff

  • provide care to Americans in other countries
  • EFM- eligible family members
28
Q

impact on health funding

A
  • 2.45 billion dollar reduction in Global health funding for state and USAID from FY 2017 to FY 2019 (30.8% decrease in funding)
  • funds used for HIV/AIDS, child and maternal deaths, infectious disease
  • 360 million dollar reduction in contributions to international organizations
  • US funding to WHO -> planned for 48% decrease
  • US funding to Pan American Health Organization ->planned for 49% decrease
  • international coffee organization -> 100% decrease*** -> important bc some people made all their money off this
29
Q

emergency medicine maturation

A
  • EM recognized in the US in 1973
  • national organization is recognized in 1968
  • academic society recognized in 1970
  • national certification in 1979
  • the rest of the world it happened a little later (1980s)
30
Q

bureau of medical services (MED)

A
  • mission is to safeguard and promote the health and well being of Americas diplomatic community
  • branch of the department of state
  • reports to the under secretary for management (vacant since Jan 2017)
  • has over 200 clinicians working in over 170 countries, supported by medical and administrative personnel in washington DC and abroad
  • provides healthcare to US government employees and their families who are assigned to our embassies and consulate’s worldwide -> not for everyone
  • we also advice our embassy and state department management about health issues throughout the world
  • although we cannot provide medical services to US citizens abroad who are not affiliated with the US government -> collaborate with the state departments bureau of consular affairs to ensure the assistance they render is medically appropriate for the situation and available resources
31
Q

non governmental organizations

A
  • usually nonprofit and humanity driven
  • public health programs- portable water, disease prevention, etc. -> necessary for healthcare
  • disaster assistance- not always cutting edge and chaos -> usually treating chronic disease that are disrupted by disaster*
  • infectious disease research and mitigation efforts
  • healthcare training
  • funding from mix of government and private donations -> what do you think happens with the government funding gets cut?
  • ex. doctors without borders
32
Q

travel insurance vs medical evacuation costs

A
  • travel insurance- transport to and treatment in nearest, and best medical facility -> don’t cover medical transport home
  • health insurance will cover some of your medical bills overseas, but wont transport you home
  • credit card medical insurance usually limited
  • medical evacuation costs start at $25K, go up very fast
  • medical evacuation- pay for membership service
  • membership from a week to a year. from $99
  • global rescue, medjet assist
33
Q

Saudi arabia

A
  • saudi red crescent authority

- national network

34
Q

Australia

A
  • vast majority is rural
  • royal flying doctor service (RFDS) - emergency and family medicine
  • all levels of care
  • in the cities -> ground ambulance and flight that is funded by the government * (socialized)
35
Q

Canada

A
  • socialized medicine paid by the government (taxes)

- early adopters of community paramedicine

36
Q

stages of the grieving process

A
  • denial
  • anger
  • bargaining
  • depression
  • acceptance
37
Q

dealing with a grieving child

A
  • children up to 3 years of age will be aware
  • 3 to 6 years of age believe death is temporary
  • 6 to 9 years of age may mask their feelings
  • 9 to 12 years of age may want to know details
38
Q

reactions to stress can be

A
  • acute
  • delayed
  • cumulative
39
Q

oath of geneva

A

–Drafted by the World Medical Association in 1948

–Taken by medical students after completion of their studies

40
Q

intentional tort claims

A
  • assault
  • battery
  • libel or slander
  • false imprisonment
41
Q

health care providers must answer to

A
  • medical directors- credentialing employers
  • licensing agency- state level
  • employer- rare employer is separate from medical director
  • despite overlap, distinctions are important
42
Q

medical practice act

A
  • defines minimum qualifications of health service providers
  • defines skills practitioners can use
  • establishes means of licensure/certification
  • may also include relicensure requirements
  • you dont want to practice outside of scope -> civil or criminal law
43
Q

information can be released for

A
  • treatment
  • payment
  • with consent
  • subpoenas
  • research with consent -> if no consent it is deidentified
  • reporting abuse
44
Q

EMTALA

A
  • emergency medical treatment and active labor act
  • establishes to combat “patient dumping”
  • never make decisions based on finances
  • know local transport selection protocols
  • guarantees medical screening exam and treatment
  • regulates patient transfers
  • unfunded mandate
  • cannot turn someone away or send them somewhere else to lesser care
45
Q

3 types of negligence

A
  • Malfeasance- did the wrong action
  • Misfeasance- right action, wrong circumstances
  • Nonfeasance- lack of action
46
Q

types of advance directives

A
  • related to end of life medical care
  • sometimes called durable powers of attorney
  • living will
  • Durable power of attorney for health care/Medical power of attorney
  • Do not resuscitate (DNR) orders
  • Organ and tissue donation
  • NOT MOLST*
  • NOT POLST (Physician Orders for Life-Sustaining Treatment)
47
Q

durable power of attorney

A
  • only certain specific certain circumstances

- ex. only if they are intubated

48
Q

MOLST

A
  • medical orders for life sustaining treatment
  • Similar to DNR, but more expansive
  • May apply with impending pulmonary failure
  • Guide use of CPR, intubation, feeding tubes antibiotics, palliative care
  • not an advance directive
49
Q

DOA / DOS

A
  • dead on arrival

- dead on scene

50
Q

defenses to litigation

A
  • statute of limitations

- contributory negligence- pt is injured due to their own actions

51
Q

title 7 of civil rights act

A

-Prohibits discrimination based on race, color,
religion, gender, national origin
-Also prohibits sexual harassment
-Applies to all aspects of employment
-Generally, a pattern over time, not single incident

52
Q

OSHA

A

occupational safety health administration

53
Q

Laws regarding discrimination

A
  • Pregnancy Discrimination Act- cannot discriminate
  • Equal Pay Act of 1963- gender gap, race gap
  • Age Discrimination in Employment Act of 1967
54
Q

FMLA

A
  • family medical leave act
  • 12 weeks unpaid per year
  • For eligible employees
  • Under certain circumstances
  • Some states have their own versions.
  • May provide more rights
55
Q

ryan white act

A
  • Provides safeguards and protections for health care workers exposed or potentially exposed to certain designated diseases
  • Notify your infection control officer if you believe you may have been exposed
  • assess to medical records even without consent
56
Q

Wagner Act

A
  • national labor relations act*
  • Rights of unions and union workers
  • Regulates unfair labor practices by employers
  • Become familiar with your rights and the union laws in your state
57
Q

assault vs battery

A
  • assault- pt is in fear of immediate physical harm ex. restraint
  • battery- unlawfully putting your hands on the pt ex. no consent
58
Q

comission vs omission

A
  • comission- something you shouldnt have done

- omission- something you should have done

59
Q

1485

A
  • first use of an amblulance

- transport only

60
Q

1800s

A

-first use of an ambulance/attendant to care for injured on site

61
Q

1926

A

-service started similar to present day

62
Q

1940

A
  • EMS turned over to fire and police department
  • no set standard of care
  • police and fire dept were well established and funded
63
Q

20th century and modern technology

A
  • mad major strides after WW2

- bringing hospital to field have patients a better chance for survival

64
Q

Korean war

A
  • first use of helicopter for transport (not care)
  • helicopter evacuation (MEDVAC)
  • helicopters flew to the MASH units were they would give care
  • MAS*H units
  • mobile army surgical hospital -> MASH
65
Q

1956

A

-mouth to mouth resuscitation developed

66
Q

late 1950s/early 1960s

A
  • focused shifted to bring hospitals to patients

- mobile ICU developed

67
Q

1966

A
  • national academy of sciences and the national research council released white paper
  • finding included:
  • lack of uniform laws and standards
  • sickest people were treated by the newest doctors
  • poor quality equipment
  • lack of communication -> no 911
  • lack of training -> therefore funding
68
Q

white paper finding outlined 10 critical points for EMS system

A
  • one of the points led to this
  • one of the leading causes of death and disability was traffic accidents -> this led to….
  • led to national highway safety act
  • created US department of transportation
69
Q

1968

A
  • training standards implemented

- 911 created

70
Q

1969

A
  • first true paramedic program
  • standards for ambulance design and equipment
  • cardiologist and trauma were the first bc cardiovascular disease and vehicle accidents were the leading causes of death
  • Pittsburgh, Florida, seatile, Washington
71
Q

1970s

A
  • 1971- emergency care and transportation of the sick and injured published by AAOS
  • 1973- emergency medical service act- says that states regulate EMS not federal gov -> some state gave money to counties making it more separated
  • this is how standard precautions become blurry
  • 1977- first national standard curriculum for paramedics developed by US DOT
72
Q

1970

A
  • NREMT began- National Registry of Emergency Medical Technicians
  • emergency physicians are still not recognized at this time
73
Q

1980s/1990s

A
  • number of trained personnel grew
  • NHTA developed 10 system elements to help sustain EMS system
  • responsibility for EMS to the states
  • major legislative initiatives
74
Q

2009

A

national EMD education standard -> NREMT provides a national standard for testing and certification

75
Q

paramedic

A
  • highest level to be nationally certified (outside of hospital)
  • 1999- major revision to curriculum to increase level of training and skill
  • 1,600-2000
  • even if independently licensed you must:
  • function under the guidance of a physician
  • be affiliated with a paramedic level service
76
Q

CQI

A

continuous quality improvement

77
Q

1996

A
  • Institute of Medicine (IOM)
  • launched efforts to improve patient safety and quality of care
  • at least 44,000 and may up to 100,000+people die in hospital each year as result of medical errors
  • better care or more money
78
Q

WW2

A

ambulance corps were developed

79
Q

1973

A
  • emergency medical service act

- says that states regulate EMS not federal gov -> some state gave money to counties making it more separated