Stroke/ams/shock/Headache Flashcards
(118 cards)
1
Q
What is the definition of shock?
A
Inadequate tissue perfusion where oxygen delivery is not sufficient for demand
Requires a functioning pump (heart), adequate volume (blood), and intact pipes (vessels)
2
Q
What are the types of shock?
A
- Distributive Shock
- Cardiogenic Shock
- Obstructive Shock
- Hypovolemic Shock
Each type has specific causes and mechanisms
3
Q
What causes Distributive Shock?
A
- Septic Shock (infection)
- Anaphylactic Shock (allergic reaction)
- Neurogenic Shock (spinal injury)
Characterized by vasodilation and blood pooling
4
Q
What are the causes of Cardiogenic Shock?
A
- Myocardial infarction
- Heart failure
This type results from heart pump failure
5
Q
What causes Obstructive Shock?
A
- Pulmonary embolism
- Cardiac tamponade
Resulting from physical obstruction
6
Q
What are the causes of Hypovolemic Shock?
A
- Trauma
- Dehydration
- Severe burns
Involves fluid loss
7
Q
What are the early signs and symptoms of shock?
A
- Tachycardia
- Narrowed pulse pressure
- Cool, pale skin
- Restlessness, confusion
Known as compensated shock
8
Q
What are the late signs and symptoms of shock?
A
- Hypotension
- Weak or absent pulse
- Decreased urine output
- Loss of consciousness
Known as decompensated shock
9
Q
What are the main treatment steps for shock?
A
- Airway management & oxygen therapy (SpO2 > 93%)
- Control external bleeding
- IV fluid resuscitation (Normal Saline/Lactated Ringers)
- Vasopressors (Dopamine, Norepinephrine)
Specific treatments vary by type of shock
10
Q
What specific treatments are used for Cardiogenic Shock?
A
- Dobutamine
- NTG
These medications are aimed at improving heart function
11
Q
What specific treatments are used for Septic Shock?
A
- IV fluids
- Antibiotics
Immediate intervention is critical for survival
12
Q
What specific treatments are used for Anaphylactic Shock?
A
- Epinephrine
- Antihistamines
- Steroids
Rapid treatment is essential to counteract allergic reactions
13
Q
What is the definition of behavioral emergencies?
A
Out-of-control behaviors posing a danger to self or others
Includes various mental health crises
14
Q
What are common causes of behavioral emergencies?
A
- Mental illness (e.g., schizophrenia, bipolar disorder, PTSD)
- Substance abuse
- Medical conditions (e.g., hypoxia, TBI, infections, hypoglycemia)
These factors can exacerbate or trigger dangerous behaviors
15
Q
What are the signs and symptoms of behavioral emergencies?
A
- Extreme agitation
- Threats of harm (self or others)
- Yelling, irrational thoughts
- Violence, unpredictability
Recognizing these symptoms is crucial for intervention
16
Q
What are the symptoms of anxiety and panic attacks?
A
- Tachycardia
- Palpitations
- Dizziness
- Shortness of breath
These can severely impact daily functioning
17
Q
What is the treatment for anxiety and panic attacks?
A
- Verbal de-escalation
- Breathing techniques
Focus on calming the individual
18
Q
What are the symptoms of depression?
A
- Loss of interest
- Fatigue
- Suicidal ideations
Understanding these symptoms is important for support
19
Q
What is the treatment for depression?
A
- Supportive care
- Psychiatric referral
Professional intervention is often necessary
20
Q
What characterizes the manic phase of bipolar disorder?
A
- Rapid speech
- Impulsivity
- Insomnia
These can lead to risky behaviors
21
Q
What characterizes the depressive phase of bipolar disorder?
A
- Guilt
- Hopelessness
- Isolation
Recognizing these symptoms is crucial for treatment
22
Q
What are the symptoms of schizophrenia?
A
- Hallucinations
- Paranoia
- Delusions
Early intervention can improve outcomes
23
Q
What is the treatment for schizophrenia?
A
- Ensure safety
- Verbal de-escalation
- Antipsychotics (if prescribed)
Managing symptoms effectively requires medical oversight
24
Q
What are the risk factors for suicidal ideation?
A
- Mental illness
- Crisis
- Substance abuse
Identifying these factors can help in prevention
25
What is the treatment approach for suicidal ideation?
* Remove means
* Peer support
* Psychiatric evaluation
## Footnote
Immediate action can save lives
26
What is the first step in prehospital management of emergencies?
Scene safety first
## Footnote
Ensuring safety is crucial before intervention
27
What techniques are used for behavioral emergencies?
* Verbal de-escalation techniques
* Physical restraints (last resort)
* Chemical restraints if required (under medical direction)
## Footnote
Careful management can prevent escalation
28
When should law enforcement be involved in behavioral emergencies?
When needed
## Footnote
Their presence can assist in managing dangerous situations
29
Why is early recognition and intervention important in shock and behavioral emergencies?
Critical for patient outcomes
## Footnote
Proper assessment and treatment can prevent complications and improve survival rates
30
What is a seizure?
Sudden, usually brief, usually temporary neurologic dysfunction caused by an abnormal electrical spark in one or more groups of neurons or areas of the brain.
## Footnote
The abnormal spark spreads throughout the brain.
31
What are the two main types of seizures?
Generalized and Partial
## Footnote
Pseudoseizures are also noted as a type.
32
Define Simple Partial Seizures.
No loss of consciousness, localized, focal tonic clonic activity, may progress to Todd’s Paralysis.
33
Define Complex Partial Seizures.
Temporal or psychomotor, wandering, repetitive motions like lip smacking or swallowing, no memory.
34
What is the Aura phase in generalized seizures?
A warning sign that animals may be able to sense.
35
What is characterized by loss of consciousness and sudden body rigidity?
Tonus.
36
What occurs during the Clonus phase of generalized seizures?
Jerking that is symmetric and rhythmic with no purposeful movements.
37
What is a Tonic Clonic Seizure also known as?
Grand Mal.
38
What is a Petit Mal Seizure?
Subtle with loss of consciousness, mimics inattention, no loss of posture.
39
List common causes of seizures.
* Idiopathic
* Secondary
* Structural
* Metabolic
* Pregnancy
* Tumors.
40
What is the annual incidence of new seizures?
300,000 new incidents of seizures/year.
41
What is the definition of Status Epilepticus?
2 or more seizures without regaining consciousness or continuous seizures for more than 5 minutes.
42
What is the mortality rate associated with Status Epilepticus?
10%.
43
What are some pharmacological management options for active seizures?
* Valium: 5-10 mg IV/IO or rectal
* Versed: 2-5 mg IV/IO, IN, IM
* Ativan: 2-5 mg IV/IO, IM
* Magnesium: 4 g for OB seizures.
44
What should be done to protect a patient during a seizure?
* Remove objects that may injure the patient
* Pad under the patient's head
* Use loose restrictive clothing.
45
What are the signs of chronic phenytoin therapy?
Gingival hypertrophy and swelling of the gums.
46
What is a classic sign of Pseudoseizures?
Capable of purposeful activity during the seizure.
47
What is the CABCDE approach in the diagnostic and therapeutic approach to seizures?
CABCDE refers to a systematic assessment and management protocol.
48
True or False: A vagus nerve stimulator can be used for frequent partial seizures unresponsive to medications.
True.
49
What is the role of the vagus nerve stimulator?
Stimulates the vagus nerve and causes widespread release of GABA and Glycine.
50
What should be assessed in a physical exam for seizures?
* Look for injuries
* Head
* Tongue
* Stiff Neck?
* Fever?
* Incontinence.
51
Fill in the blank: The _______ phase of generalized seizures involves confusion or unresponsiveness that gradually improves.
Postictal.
52
What is the first step in initial treatment during a seizure?
Protect the patient during the seizure.
53
What is the initial management step for a patient in septic shock?
Manage airway and breathing
## Footnote
May need airway support
54
What is the recommended IV fluid for septic shock treatment?
Normal Saline
## Footnote
Administer in 500-1000 ml increments
55
What is the dosage of Dopamine for septic shock treatment?
10 mcg/kg/min IV drip
56
What is the dosage of Norepinephrine for septic shock treatment?
10 mcg/kg/min bolus then 2 mcg/min drip
57
What is the goal of septic shock treatment?
Restore perfusion, decrease heart rate, increase blood pressure, decrease respiratory distress
58
What is one of the most reliable early signs of shock?
Increased pulse rate
59
What is a more sensitive indicator of shock than pulse rate?
Narrowed Pulse Pressure
60
True or False: No single vital sign or value is diagnostic of shock.
True
61
What are common signs of compensated shock?
* Epinephrine release maintains perfusion
* Normal to slightly elevated BP
* Cool skin
* Tachycardia
* Decreased capillary refill
62
What are signs of decompensated shock?
* Decreased BP
* Decreased urine output
63
What is the initial fluid resuscitation amount for shock management?
20 ml/kg over 10 minutes
64
What types of fluids can be used for fluid resuscitation?
* Normal Saline
* Lactated Ringers
65
Name the specific kinds of shock.
* Distributive
* Cardiogenic
* Obstructive
* Hypovolemic
66
What is the most common cause of cardiogenic shock?
Myocardial Infarction (MI)
67
What is the goal for reperfusion therapy in cardiogenic shock?
Within 90 minutes
68
What are risk factors for cardiogenic shock?
* Female
* Advanced Age
* Large Anterior MI
* History of CHF
* Diabetes
69
What are clinical features of cardiogenic shock?
* Narrow Pulse Pressure
* Altered level of consciousness
* Left CHF or Right CHF
* Abnormal 12 lead showing ST elevation associated with a STEMI
70
What is the treatment for mild to moderate cardiogenic shock?
Dobutamine 10 mcg/kg/min
71
What are common signs and symptoms of shock?
* Warm and flushed skin (distributive shock only)
* Strong bounding pulse (distributive shock only)
* Thirsty
* Narrowing pulse pressure
* Confusion
* Decreased urine output
* Listlessness or lethargy
* Weak or dizzy
72
What are the obvious risk factors for shock?
* Pain – Chest, Abdominal, or Back
* Bleeding
* Trauma
* Pregnancy
* Elderly/Infant
* Immunocompromised patients
* Sepsis
* Bee Sting
* Food Allergies
* Altered Level of Consciousness
73
What is inadequate perfusion?
Inadequate oxygen delivery for oxygen demand
74
What does the body's response to inadequate perfusion aim to maintain?
Perfusion to the most vital organs - heart & brain
75
What happens to blood during inadequate perfusion?
Shunted away from less vital organs
76
What occurs at the cellular level during inadequate perfusion?
* Mitochondria can't produce adequate ATP without adequate O2
* Burns fats, carbs, and ketones instead
* Less ATP produced
* Lactic Acid produced
77
What is the consequence of not enough ATP in cells?
Break down of cell walls
78
What is obstructive shock?
Obstructs blood flow
79
List causes of obstructive shock.
* Pulmonary Embolus
* Cardiac Tamponade
* Trauma
* Infections
* Inflammatory disorders like Lupus
80
Who is most at risk for septic shock?
* Elderly
* Alcoholics
* Neonates
* Immunocompromised patients
81
What is the mortality rate without treatment for septic shock?
20-80%
82
What are the primary causes of septic shock?
Gram negative organisms
83
What defines sepsis?
Whole body inflammatory response with a confirmed infection
84
What are the criteria for diagnosing sepsis?
* Temperature greater than 100.4 or less than 96.8
* Heart rate greater than 90
* Respiratory rate greater than 20 or PaCO2 less than 32
* White blood cell count greater than 12,000 or less than 4000 or greater than 10% immature forms
85
What triggers anaphylaxis?
Antibody/antigen reaction
86
What happens during anaphylaxis?
* Releases histamine, eosinophils, heparin, and leukotrienes
* Loss of peripheral vascular resistance
* Airway edema
87
What are the common causes of anaphylactic shock?
* Penicillin
* Bee stings
88
What are the signs and symptoms of anaphylaxis?
* Restlessness, agitation, and anxiety
* Warm and flushed skin
* Hives/Itching
* Rapid pulse
* Thirst
* Confusion
* Low BP
* Facial swelling
* Coughing, wheezing, and dyspnea
89
What is the treatment for anaphylaxis?
* Airway and Oxygen
* IV
* Monitor
* Epinephrine 1:1000 IM: 0.3-0.5 mg
* Albuterol: 2.5 mg HHN
* Diphenhydramine: 25-50 mg IM or IV
90
What are clinical features of septic shock?
* Increased heart rate
* Confusion
* Temperature over 100.4 or less than 96.8
* Wide Pulse Pressure
* Warm extremities
* Hyperglycemia
* Minimal response to fluid challenges
* Lactate levels greater than 4mmol/L
91
What is the Miami Sepsis Score used for?
To identify risk for sepsis
92
What points are assigned in the Miami Sepsis Score?
* Body temperature greater than 100.4 F (38C): 1 point
* Respiratory Rate greater than 22 bpm: 1 point
* Shock index greater than 0.7: 2 points
93
What is the sense of urgency in treating anaphylactic shock?
Initial assessment and intervention are critical
94
What is the purpose of the Wake EMS Sepsis Screening Tool?
To identify signs of sepsis
95
What are the vital signs included in the Wake EMS Sepsis Screening Tool?
* SBP < 90
* HR > 90
* RR > 20
* GCS < 15
* Temp > 100.4 or < 96.0
* Obvious or suspected infection
96
What are the two main types of headaches?
Primary and Secondary
## Footnote
Primary headaches are not caused by underlying diseases, while secondary headaches are due to structural problems or diseases.
97
What is the pathophysiology of headaches?
Brain does not have pain receptors; pain receptors are found in various areas including:
* Extracranial arteries
* Cranial and spinal nerves
* Head and neck muscles
* Meninges
* Parts of the brainstem
98
What are common causes of headaches seen in the ED?
Common causes include:
* Migraine
* Tension
* Cluster
* Hypertension
* Sinusitis
99
What characterizes tension headaches?
Caused by activation of peripheral nerves in head and neck muscles, characterized by:
* Band-like pressure on both sides
* Non-pulsing, dull or achy
* Lasts 30 minutes to several hours
100
What are the characteristics of migraines?
Characteristics include:
* Unilateral head pain
* Pulsing pain
* Nausea
* Photophobia
* Phonophobia
* Auras (30-60 minutes)
101
What defines cluster headaches?
Characteristics include:
* Rare and short duration
* Sudden onset
* Occur at the same time every day
* Severe, sharp, or stabbing pain affecting one eye or temple
102
What are sinus headaches caused by?
Caused by inflammation of the sinuses leading to:
* Blocked drainage
* Pressure build-up
103
What are some other causes of headaches?
Other causes include:
* Fatigue
* Sleep deprivation
* Stress
* Medications
* Viral infections
* Loud noises
* Head injury
* Dental issues
104
What are potentially life-threatening causes of headaches?
Potentially life-threatening causes include:
* Subarachnoid Hemorrhage
* CVA (stroke)
* Meningitis
* Hypertensive encephalopathy
105
What critical questions should be asked during headache assessment?
Critical questions include:
* Has there been trauma?
* Has there been seizure?
* Has there been fever?
* Are there any focal or neurological deficits?
106
What are red flags in headache history?
Red flags include:
* First or worst headache ever
* Getting worse
* Neurological findings
* Sudden onset after age 40
107
What are the vital signs to monitor in headache patients?
Vital signs to monitor include:
* Blood Pressure
* Pulse
* Respirations
108
What are CNS neoplasms?
CNS neoplasms include:
* Gliomas
* Meningiomas
* Medulloblastomas
* Gangliogliomas
* Schwannomas
* Craniopharyngiomas
109
What is Multiple Sclerosis (MS)?
Most common autoimmune disorder characterized by:
* Progressive or relapsing course
* Onset typically between 20-50 years
* Unknown cause
* Damages CNS
110
What are the signs and symptoms of Guillain-Barré Syndrome?
Signs/symptoms include:
* Changes in sensation and pain
* Muscle weakness
* Diminished or absent reflexes
111
What characterizes Parkinson's Disease?
Characteristics include:
* Tremors
* Rigidity
* Slow movement
* Trouble walking
* Mask-like facial expression
112
What is Trigeminal Neuralgia?
Chronic pain of the trigeminal nerve characterized by:
* Severe, sudden one-sided pain
* Atypical form presents as constant burning
113
What are the symptoms of Acoustic Neuroma?
Symptoms include:
* Hearing loss
* Tinnitus
* Balance problems
* Vertigo
114
What is Bell’s Palsy?
Most common cause of facial paralysis associated with an infection, characterized by:
* Facial weakness
* Recovery in 6-9 months for most
115
What causes spinal cord compression?
Causes include:
* Bone fragments
* Tumor
* Abscess
* Ruptured disc
116
What is Wernicke’s Encephalopathy caused by?
Caused by low thiamine (Vitamin B1) with risk factors including:
* Malnourishment
* Alcohol abuse
* Post-bariatric surgery
117
Fill in the blank: The classic presentation of Wernicke’s Encephalopathy includes _______.
Ophthalmoplegia, ataxia, and confusion
118
True or False: Headaches are a common complaint in the emergency department.
True
