Midterm Flashcards
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
cellulitis
- 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
risk factors for pressure ulcers
- brain or spinal cord injury
- neuromuscular disorders- Guillain-Barre
- nutritional problems
27
LES
locally employed staff
- provide care to Americans in other countries
- EFM- eligible family members
28
impact on health funding
- 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
emergency medicine maturation
- 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
bureau of medical services (MED)
- 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
non governmental organizations
- 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
travel insurance vs medical evacuation costs
- 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
Saudi arabia
- saudi red crescent authority
| - national network
34
Australia
- 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
Canada
- socialized medicine paid by the government (taxes)
| - early adopters of community paramedicine
36
stages of the grieving process
- denial
- anger
- bargaining
- depression
- acceptance
37
dealing with a grieving child
- 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
reactions to stress can be
- acute
- delayed
- cumulative
39
oath of geneva
–Drafted by the World Medical Association in 1948
| –Taken by medical students after completion of their studies
40
intentional tort claims
- assault
- battery
- libel or slander
- false imprisonment
41
health care providers must answer to
- medical directors- credentialing employers
- licensing agency- state level
- employer- rare employer is separate from medical director
- despite overlap, distinctions are important
42
medical practice act
- 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
information can be released for
- treatment
- payment
- with consent
- subpoenas
- research with consent -> if no consent it is deidentified
- reporting abuse
44
EMTALA
- 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
3 types of negligence
- Malfeasance- did the wrong action
- Misfeasance- right action, wrong circumstances
- Nonfeasance- lack of action
46
types of advance directives
- 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
durable power of attorney
- only certain specific certain circumstances
| - ex. only if they are intubated
48
MOLST
- 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
DOA / DOS
- dead on arrival
| - dead on scene
50
defenses to litigation
- statute of limitations
| - contributory negligence- pt is injured due to their own actions
51
title 7 of civil rights act
-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
OSHA
occupational safety health administration
53
Laws regarding discrimination
- Pregnancy Discrimination Act- cannot discriminate
- Equal Pay Act of 1963- gender gap, race gap
- Age Discrimination in Employment Act of 1967
54
FMLA
- 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
ryan white act
- 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
Wagner Act
- 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
assault vs battery
- assault- pt is in fear of immediate physical harm ex. restraint
- battery- unlawfully putting your hands on the pt ex. no consent
58
comission vs omission
- comission- something you shouldnt have done
| - omission- something you should have done
59
1485
- first use of an amblulance
| - transport only
60
1800s
-first use of an ambulance/attendant to care for injured on site
61
1926
-service started similar to present day
62
1940
- EMS turned over to fire and police department
- no set standard of care
- police and fire dept were well established and funded
63
20th century and modern technology
- mad major strides after WW2
| - bringing hospital to field have patients a better chance for survival
64
Korean war
- first use of helicopter for transport (not care)
- helicopter evacuation (MEDVAC)
- helicopters flew to the MASH units were they would give care
- M*A*S*H units
- mobile army surgical hospital -> MASH
65
1956
-mouth to mouth resuscitation developed
66
late 1950s/early 1960s
- focused shifted to bring hospitals to patients
| - mobile ICU developed
67
1966
- 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
white paper finding outlined 10 critical points for EMS system
- 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
1968
- training standards implemented
| - 911 created
70
1969
- 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
1970s
- 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
1970
- NREMT began- National Registry of Emergency Medical Technicians
- emergency physicians are still not recognized at this time
73
1980s/1990s
- 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
2009
national EMD education standard -> NREMT provides a national standard for testing and certification
75
paramedic
- 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
CQI
continuous quality improvement
77
1996
- 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
WW2
ambulance corps were developed
79
1973
- emergency medical service act
| - says that states regulate EMS not federal gov -> some state gave money to counties making it more separated
