1
Q
What are some reasons to patch?
A
- Mandatory
- Outside directive but in scope
- Consultation situations
2
Q
What should a BH patch look like for a TOR?
A
Hi, my name is [Your Name].
Include what you are, where you are, what you’re patching for, patient age, patient sex, confirm contraindications and conditions, provide past medical history and incident history, ask if they need more info, confirm orders, confirm doctor name, ask for patch number.
3
Q
What’s the formula for a kid’s weight?
A
(age x 2) + 10
4
Q
What’s the normotension formula?
A
90 + (2 x age in years)
5
Q
What’s the hypotension formula?
A
70 + (2 x age in years)
6
Q
What’s the hypoglycemia value for someone less than 2?
A
3
7
Q
What’s the hypoglycemia value for someone over 2 or 2?
A
4
8
Q
What does PCP IV assist mean?
A
PCP can start peripheral IV at request and under direct supervision of ACP; can’t give meds, can only start.
9
Q
What does PCP autonomous IV mean?
A
PCP can independently start IV without ACP; can also give IV meds.
10
Q
How much of our body is water?
A
60%
11
Q
How much of our body is extracellular fluid?
A
33%
12
Q
How much of our body is intracellular fluid?
A
66%
13
Q
How much of our body is interstitial fluid?
A
25%
14
Q
How much of our body is blood plasma?
A
8%
15
Q
What are the 5 objectives of IV therapy?
A
- Restore and maintain fluid balance
- Restore and maintain electrolyte balance
- Provide medications and route for them
- Transfuse blood and blood products
- Deliver parenteral nutrients and nutritional supplements
16
Q
What does dehydration mean?
A
Loss of total body water
17
Q
What does edema mean?
A
Accumulation of fluid in interstitial space
18
Q
What does volume depletion mean?
A
Loss of isotonic solution
19
Q
What’s fluid excess?
A
Extra water or fluid in specific compartment
20
Q
What is an electrolyte?
A
Substance that when dissolved in water or another body fluid, breaks apart into charged ions
21
Q
What are the 4 cations?
A
- Na
- K
- Ca
- Mg
22
Q
What are the 2 negative anions?
A
- Cl
- PO4
23
Q
What does sodium do in the body?
A
Fluid balance and BP regulation
24
Q
What does potassium do in the body?
A
Cardiac rhythm stability
25
What does calcium do in the body?
Muscle contraction and clotting
26
What does magnesium do in the body?
Neuromuscular function
27
What does chloride do in the body?
Acid-base balance
28
What's simple diffusion?
Movement of water from high to low concentration across membrane
29
What's osmosis?
Diffusion of water to a place with more solutes to even out balance
30
What's facilitated diffusion?
Water moved freely but some molecules need channels and helpers to move (protein channels) or glucose needs help
31
What's active transport and an example of it?
Requires ATP to move ions, moves them against a gradient; like Na/K pump
32
What happens with hypotonic fluids and what are examples?
Cells swell and can rupture; examples include 0.45 saline, 0.225 saline, 0.33 saline, 5% dextrose in water
33
What's an isotonic solution and some examples?
Water is equal in and out of cell; helps expand intravascular space; examples include 0.9% saline, lactated ringers
34
Explain a hypertonic solution and examples.
Water moves out of cell; examples include 3% saline, Dex 10 in normal saline, dex 5 in 0.45% normal saline
35
What are colloids and some examples?
Pull water through oncotic pressure from interstitial space into intravascular; examples include albumin, blood, dextran
36
What are some types of IV infusion?
Continuous, intermittent, bolus
37
According to BLS, what's the flow rate TKVO for patients <12?
15 mL/hr of any isotonic crystalloid solution
38
According to BLS, what's the flow rate for someone >12 y/o TKVO?
30-60 mL/hr of any crystalloid solution
39
According to ALS PCS, what's the maximum ml/hr and minimum ml/hr for IV fluid replacement?
- 2 mL/hr/kg minimum
- 200 mL/hr maximum
40
According to ALS, can PCP AIV or when being watched by ACP monitor a bag with thiamine or multivitamin preparations?
Yes
41
According to ALS, can PMDs monitor bags with KCl for patients >=18 years old to a maximum of 10 mEq in a 250 bag?
True
42
According to ALS PCS, can PMDs request escorts for IV for blood products, KCl for patients >18 years old, meds out of directive, pressure pumps, central venous line, or kids <2 years old?
True
43
What should PMD check before transport for an IV?
- Doctor's orders
- Solution, flow rate, catheter gauge, length and cannulation site
- Condition of IV site
- Confirm fluid in bag
- Determine amount of fluid needed
- Document pre-transport IV info in ACR
44
According to ALS PCS, should PMD monitor bag during transport, discontinue fluid if it becomes dislodged and confirm condition of catheter if removed?
Yes
45
What are macrodrip values?
10, 15, 20
46
What's a microdrip value?
60
47
What are some things that affect flow rates?
- Patient position
- Veins
- Phlebitis
- Amount of fluid
- Height of IV bag
- Catheter size
- Catheter position
- Amount of fluid in bag
48
What is phlebitis?
Infection at catheter site
49
If you need to troubleshoot an IV, where do you start?
At hand/catheter and work your way back to the bag
50
What is a hematoma?
Perforation of vein wall; lack of adequate pressure following unsuccessful attempt
51
What's an interstitial IV and how can it happen?
Perforation of vein wall; cannulation site moves; catheter in position of flexion; catheter not properly secured
52
What does sepsis cause?
- Widespread inflammation
- Tissue damage
- Organ dysfunction
53
Why does sepsis happen with IVs?
- Poor aseptic technique
- Contaminated IV, fluids, or meds
- Prolonged use of IV site without proper care
54
What is pulmonary edema a sign of and what is it secondary to?
- Fluid overload
- Fluid bolus
55
What's the mandatory patch point for IV?
Kids less than 12 who are hypotensive and suspected of being in ketoacidosis to prevent cerebral edema
56
How does titrate to effect work?
Begin with lowest dose and increase until desired effect
57
What are the 5 principles of titration?
- Know the therapeutic goal
- Use incremental dosing
- Monitor closely
- Document
- Stop immediately if making worse
58
What meds that we use get reconstituted?
- Dimenhydrinate
- Diphenhydramine
- TXA
59
What nervous system has only acetylcholine?
Parasympathetic
60
What nervous system has both acetylcholine and epi and norepi?
Sympathetic
61
What division are the sympathetic and parasympathetic under?
Autonomic
62
What's an agonist?
Binds to receptor to activate it
63
What's an antagonist?
Binds to receptor to block it
64
What are some examples of sympathomimetics?
- Epi (alpha and beta agonist)
- Ventolin (beta 2 agonist)
65
What are sympathomimetics?
Adrenergic agonists; mimic sympathetic fight or flight
66
What are sympatholytics?
Adrenergic antagonists; block sympathetic effects
67
What are some examples of sympatholytics?
- Beta-blockers
68
What are parasympathomimetics and examples?
Cholinergic agonists; activate muscarinic receptors; example: pilocarpine used for glaucoma to stimulate pupil constriction
69
What are parasympatholytics and examples?
Cholinergic antagonists; prevent acetylcholine from binding to muscarinic receptors; example: atropine
70
Explain overview of asthma.
Trigger - allergen exposure; IgE = histamine release; vasodilation = increased permeability and bronchospasm; s/s = hypotension, airway swelling, wheezing, stridor, urticaria
71
What is an allergic reaction?
Rapid, whole body immune response triggered by an allergen that causes mast cells and basophils to release chemical mediators like histamine
72
Where is EPi produced and what is it?
Naturally occurring catecholamine; made in adrenal medulla
73
What is norepi?
Naturally occurring catecholamine; acts as a neurotransmitter in sympathetic nervous system; helps maintain BP and vascular tone
74
What is the half-life of epi?
5-15 mins
75
What are adverse reactions of epi?
- Jitters
- Anxiety
- Hypertension
- Angina
- Nausea
- Vomiting
76
What is diphenhydramine?
Antihistamine; H1 receptor antagonist; blocks histamine; adjunct after EPI because it doesn't reduce airway issues; half-life = 4-8 hrs, longer in elderly
77
What's a biphasic/rebound allergic reaction?
You get better then worse again
78
What's the max volume of adults for deltoids and vastus lateralis?
2.5 mL for deltoids and 5 mL for vastus lateralis
79
What's the max volume for kids for deltoids and vastus lateralis?
1 mL for deltoids and 1 mL for vastus lateralis
80
What is bronchoconstriction?
Narrowing of airways due to contraction of smooth muscle in bronchioles
81
What's the triple problem of bronchoconstriction?
1. Smooth muscle contraction
2. Swelling (edema)
3. Mucus production
82
What are some causes of bronchospasm?
- Asthma
- Allergic reactions
- COPD
- Infections
- Cold air
- Irritants
- Medications
83
How does asthma cause bronchoconstriction?
Triggered by allergens; immune reaction releases histamines, leukotrienes and prostaglandins; smooth muscle contraction + swelling + mucus
84
How do allergic reactions cause anaphylaxis?
Histamine release from mast cells cause smooth muscle contraction and mucosal edema; also see swelling, stridor, hypotension
85
How does COPD cause bronchoconstriction?
Chronic inflammation; mucus production; airway narrowing
86
What's the patho of bronchoconstriction?
Smooth muscle contracts around bronchi/bronchioles; mucosal edema (swelling in airway); mucus hypersecretion blocks airflow; narrow airway lumen = increased resistance to airflow = wheeze = hypoxia
87
What are s/s of bronchoconstriction?
- Wheezing
- SOB
- Tightness in chest
- Coughing
- Prolonged expiratory phase
- Tachypnea
- Cyanosis
- Fatigue or altered LOA
88
What is a silent chest?
No air movement heard on auscultation; happens when airways become critically obstructed and patient is running out of air
89
Explain what salbutamol is and what happens at the receptor level.
Short-acting beta 2 adrenergic agonist; binds to B-2 receptors in smooth muscle of bronchi and bronchioles; salbutamol binds to B-2 receptors; increases cAMP inside cell (cyclic adenosine monophosphate); cAMP activates protein kinase A (PKA); PKA inhibits phosphorylation of myosin = relax smooth muscle
90
What is the onset, peak effect, and duration time of salbutamol?
- Onset: 5 mins
- Peak effect: 30-60 mins
- Duration: 3-6 hours
91
How do MDIs work and what are the pros and cons?
Delivers measured puff of med; best for patients who can follow commands; pro: fast, portable, few side effects; con: requires coordination, less effective if patient is SOB
92
Explain how a nebulizer works.
Turns liquid meds into a mist; best for severe respiratory distress; pro: allows for continuous delivery of meds; con: takes longer (5-15 mins), less portable, higher systemic side effects
93
Know broncoconstriction medical directive.
N/A
94
What is dexamethasone and how does it work?
Steroid; reduces swelling in airways; calms inflammation (stops histamine release); helps ventolin work better
95
What's the onset and duration of dexamethasone?
- Onset: takes 2-4 hrs to kick in
- Duration: long lasting, works for 1-3 days
96
What are some causes of hypoglycemia?
- Missed meals
- Excess insulin
- Alcohol
- Sepsis or shock
- Liver disease
97
What are the early symptoms of hypoglycemia?
Caused by adrenaline release as body tries to raise blood sugar; symptoms include shakiness, sweating, palpitations, anxiety, hunger
98
What are some later signs of hypoglycemia?
Caused by not enough glucose to brain; symptoms include confusion, slurred speech, weakness, headache, seizures, decreased LOC
99
What's the difference between strokes and hypoglycemia?
Strokes don't sweat
100
How many minutes behind are Dexcoms?
15 mins
101
What's the treatment flow of hypoglycemia?
Reassess BGL and LOC; if alert and able to swallow: oral glucose; if IV/IO access: dextrose; if no IV/IO: glucagon IM
102
Explain oral glucose.
First line if they can swallow; absorbed via GI-tract; slower onset than IV; examples: tablets, gels, juice
103
Know dextrose directive.
N/A
104
What's the mechanism of action of dextrose?
Provides immediate glucose to cells; reverses hypoglycemia rapidly; onset = 1-3 min IV; duration: variable
105
What's the difference between D10 and D50?
D10 = safer for veins, smaller dose, 0.1g/ml; D50 = rapid effect, risk of necrosis, 0.5g/ml
106
What's the MOA of glucagon?
Stimulates liver-glycogenesis; raises blood glucose; promotes gluconeogenesis (make sugar from fat/protein); relaxes smooth muscle in GI tract
107
What's the onset, peak, and duration of glucagon?
- Onset: 5-15 min
- Peak: 30 mins
- Duration: 10-30 mins
108
What are some side effects of glucagon?
- Nausea and vomiting
- Dizziness
- Headache
Sem 3
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