1
Q
What is hematopoiesis?
A
Process of the creation of blood cells
2
Q
What percentage of plasma (55% of blood) is proteins?
A
6-7%
2
Q
What percentage of plasma (55% of blood) is water ?
A
90-92%
3
Q
What percentage of plasma (55% of blood) is other solutions such as fats, carbs, electrolytes, gases, and chemical messengers?
A
2-3%
4
Q
What is males % of hematocrit ?
A
45%
5
Q
Female percentage of hematocrit?
A
36-48%
6
Q
What is the principle component of blood?
A
Red blood cells (erythrocytes)
7
Q
What does Red blood cells do?
A
Carry hemoglobin
Iron containing protein and each protein can carry one oxygen.
8
Q
Your pt is alkalotic, what is the CO2 doing?
A
Decreasing
9
Q
Your pt is acidotic, what is CO2 doing?
A
Increasing
10
Q
What is it called when referring to CO2’s relationship with PH?
A
Bohr effect
11
Q
What is red blood cell production called?
A
Erythropoiesis
12
Q
Destroys more blood cells than one can produce
A
Hemolysis
13
Q
LABS of red blood cells?
A
Red blood count (RBC)
Hematocrit
Hemoglobin
14
Q
What are white blood cells called and what is their function?
A
Leukocytes, identify and destroy foreign substances in blood.
15
Q
What cells are in the subpopulation of immunity?
A
T cells and B cells
16
Q
What do T cells develop?
A
Cellular immunity
17
Q
What do B cells produce?
A
Humoral immunity
18
Q
What are platelets called and what do they do?
A
Thrombocytes, initial clotting process.
19
Q
What is hemostasis?
A
Controlling of blood loss through vascular spasms, platelet plugs, stable fibrin blood clots
20
Q
What medications effects clot formation?
A
Thrombolytics
21
Q
Universal blood donor
A
O-
22
Q
Universal blood recipient ?
A
AB
23
Q
Type of transfusion that contains red blood cells and some plasma. Used to treat anemic pts
A
Packed RBCs
24
Type of transfusion that includes all cells, platelets, clotting factors, and plasma. Used for hemorrhage
Whole blood
25
Type of transfusion that contains thrombocytes and some plasma
Platelets
26
Type of transfusion that contains plasma, a combo if fluids, clotting factors, and proteins
Used in burn pt or hypovolemia due to low oncotic pressure
Fresh frozen plasma (FFP)
27
Type of transfusion that contains specific clotting factors needed for coagulation.
Used in hemophilia
Clotting factors
28
What type of reaction has headache, fever, and chills?
What is the treatment ?
Febrile nonhemolytic reaction
Stop transfusion, change all IV tubing,
Initiate Crystalloid IV therapy
Consider diphenhydramine and antipyretic
Observe closely for hemolytic reaction.
29
What type of reaction has
- facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosis?
What is the treatment?
Hemolytic reaction to blood transfusion
Stop transfusion, change all IV tubing, initiate Crystalloid IV therapy.
Consider furosemide, dopamine, and diphenhydramine
30
What will iron deficiency anemia have?
Pagophagia (pica for ice)
31
Pernicious anemia, what is it?
Inability of stomach to absorb vitamin b12
Present mostly in 40-80 y/o Northern Europeans
Results in enlarged/ misshapen red blood cells
32
What are the effects of sickle cell crises?
Red blood cells start normal and become O2 depleted, cells take sickle shape and are unable to carry O2.
Vaso-occlusive
Hematological
Infectious
33
What are the S/S of sickle cell crises?
Pain in bones of back, long bones, chest, and abdomen for hours to days
Fatigue, paleness, tachycardia, respiratory distress, jaundice, priapism, strokes, infection
34
What does hemolytic mean?
Body destroys blood cells faster than they are produced
35
What is polycythemia and what are the results of it?
Overproduction of erythrocytes
-usually in its over 50 y/o or secondary to dehydration
Results in bleeding abnormalities such as epistaxis, spontaneous bruising, GI bleeds
36
Leukopenia/ neutropenia
Too few white blood cells or neutrophils
37
What is leukocytosis?
Increase in number of circulating white blood cells, often due to infection.
38
What are lymphomas?
Cancers of the lymphatic system
Abnormal B or T lymphocytes that divide farther than normal.
39
What is leukemia?
Cancer of hematopoietic cells
Initial presentation is acutely fatigued, febrile, weak, anemic
Often have secondary infections
Cancer that makes it unable to produce more WBC
40
What is Hodgkin’s lymphoma ?
Pathological marker is reed-sternberg cell
Presents with enlarged lymph nodes in neck, head, and armpits
Good prognosis
41
Non-Hodgkin’s lymphoma
More common, no specific
2x more common in men
Immuno-suppressive medications increase risk 100x
Swelling of lymph nodes, fever, night sweats, anorexia, weight loss, fatigue, and puritis
42
Thrombocytosis
Abnormal increase in thrombocytes
Secondary causes include: inflammation, spleen surgery/disorders, iron deficiency anemia, hemorrhage
43
Thrombocytopenia
Decrease in thrombocytes (not enough platelets)
44
Thrombotic thrombocytopenia pupura
Rare disorder of extensive microclots
Damage many organs(kidneys, heart, brain)
45
Idiopathic thrombocytopenia purpura
Lowe platelets count with normal bone marrow
Characteristic purpuric rash
Increased bleeding
46
What is hemophilia?
Deficiency or absence of blood clotting factor
Sex-linked, inherited disorder that is carried on X chromosome
47
S/S of hemophilia ?
Numerous bruises
Deep muscle bleeding
Joint bleeding
48
The proliferation of neoplastic cells leads to the development of what?
Tumors
49
What is the uncontrolled growth of cells whose proliferation cannot be adequately controlled by normal regulatory mechanisms operating in normal tissues
Neoplasia
50
What is the movement of cells from one site of the body to another? Often in cancers
Metastasis
51
What is the metastatic cascade?
1.developement of primary tumor
2.metastatic clone evolves
3.profileration of clone and invasion of vessel
4.transport by circulation
5.embolization
6.invasion through embolis into surrounding tissue
7.formation of new tumor
52
Early warming sign pneumonic for cancer
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening of lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
53
What is thermoregulation controlled by?
Hypothalamus
54
What does the body do for heat elimination?
Vasodilation
Perspiration
Increased cardiac output
Increased respirations
55
What does the body do for heat preservation ?
Vasoconstriction
Shivering
Piloerection
Decreased respirations
Increased BMR
56
Radiation heat lost to what?
Air
57
Convection, heat is lost to what?
Air with wind
58
Conduction, heat is lost to what?
Lost to an object
59
Evaporation, heat is lost to what?
To air through water
60
Hyperthermia body temp starting level?
101 F
61
Heat stroke and seizures temp?
104 F
62
Hypothermia temp?
95 F
63
Shivering stops and moderate hypothermia begins temp?
92 F
64
Severe hypothermia with high risk for LOC and VFIB temp?
86 F
65
Asystole from hypothermia temp?
71 F
66
What is an electrolyte imbalance caused by salt and water loss, replacing only water. S/S of:
-painful cramps to fingers, arms, legs, and abdominal muscles
-alert
-tachycardia and normal BP
- normal core temp
- hot sweaty skin
Called?
Heat cramps
67
What is dehydration with or without electrolyte imbalance with S/S of :
History of working in heat
Decreased urine output
Positive tilt test
Tachycardia
Nausea and vomiting
Cool to warm, wet skin, pale tissues
Dizziness and syncope
Headache
Muscle cramps
Normal to low BP
Usually normal core temp ?
Heat exhaustion
68
Heat exhaustion treatment?
Remove pt from environment
Administration of O2 prn
Begin IV infusion of LR or NS to BP
Do not cool unless core temp is elevated
69
What are metabolic (hypothalamic) disorders that occur from 2 paths
1. Progression from heat exhaustion
2. Isolated activity without exertion
May be seen in lower temps when pt has used methamphetamines or GHB
Heat stroke
70
S/S and management of heat stroke
S/S elevated core temp usually above 105 F
Tachycardia early, bradycardia late
Hypotension
Rapid, shallow respirations
Confusion/ disorientation
Seizures/ coma
Management
-Aggressive pt cooling (ice packs groin, axilla, and neck) misted ice water with fans
-Administration of O2 PRN
-IV with LR to BP, no pressers
-monitor vitals and for seizures
-benzodiazepines as needed for excited delirium from stimulant use
71
What is the condition with nausea, vomiting, abd distress, vision disturbances, decreased urine output, poor skin turgor and hypovolemic shock
Dehydration
Treat with oral fluids if A&O
use IV fluids if AMS or nausea
72
How is fever (pyrexia) different from a heatstroke and what is the treatment ?
Fevers are caused by pyrogens. The mechanism is the most important.
Usually form infection
Slower development of symptoms
Cool the pt with an antipyretic med such as APAP or ibuprofen
Avoid sponge baths
73
Hypothermia by increased heat loss examples ?
Removal of clothing
Wet clothing
Wind
Cold water
74
Decreased heat production hypothermia examples?
Shock
AMI
Hypothyroidism
Diabetic coma
Drugs
Sepsis
75
Mild hypothermia body temp
94-97 f, 34-36 c
76
Moderate hypothermia temp
86-94 f, 30-34 c
77
Severe hypothermia temp
Less than 80 f, less than 30 c
78
S/S of mild to moderate hypothermia
Shivering
Lethargy
Loss of coordination
79
S/S of severe hypothermia
Confusion
Coma
Loss of shivering
Stiff muscles
ECG changes and cardiac arrhythmias
80
ECG changes in hypothermia
J wave (OSBORN)
AFIB- early on
Bradycardia
VFIB (from rough handling and gag reflex stimulation)
81
Management of hypothermia ?
-remove all wet clothing
-protect against further heat loss
-avoid rough movement
- gentle rewarming
- administer warm oxygen/ warm air
82
What changes about cardiac arrest management with hypothermia?
- start CPR with active rewarming
-if VFIB shock x1 and resume CPR
-intubate
-ventilate with warm O2 or mouth to mask
- start IV of warm fluids
CORE TEMP above 30 C
-defib as normal and give meds as indicated with longer intervals
CORE Temp below 30C
-Give no meds until temp is elevated
-do not give additional defibs
83
What is frostbite ?
Intracellular water expands, forming ice crystals, destroying cell walls
84
Assessment finding with frostbite
-cold, then pins and needles, then pain, then numb
- appears irritated, then white or blue gray, then blue/black
-feels doughy, then hard
85
Superficial frostbite
-freezing of epidermal tissue
-redness followed by blanching and diminished sensation
86
Deep frostbite
Freezing of epidermal and subcutaneous layer
-white frozen appearance
87
Management of frostbite
-do not allow to thaw, if refreezing is possible
-do not massage or rub
-begin IV
-give morphine 1-3mg/min, titrated to pain
-thaw by immersion in warm water 100-106F
-cover with loose dry dressing
- do not puncture or drain blisters
-do not rewarm feet if walking will be required
88
What presents with symptoms similar to frostbite. May present with pain, blisters may form with spontaneous rewarming.
What is the treatment?
Trench Foot
Treatment is warm, dry, aerate foot
-prevention is best treatment
89
Drowning vs near-drowning
Drowning is death within 24 hours of suffocation in water
Near-drowning is suffocation in water which does not result in death in first 24 hours
90
Laryngospasm in drowning
-water enters larynx and causes spasms to occur
-prevents water from entering lungs (dry drowning)
-in absence of laryngospasm, water enters lungs
-called “wet drowning”
91
Factors that affect survival in drownings
-cleanliness of water
- length of time submerged
- victims age and general health
-water temp:
Cold water- mammalian diving reflex
*cold water drowning pt is not dead until warm and dead*
92
What is the clinical syndrome that can develop near drowning, accompanied by: increasing SOB, pulmonary edema
-occurs within 24 hours of immersion
-mechanical ventilation may be required
Post-immersion syndrome, secondary drowning
93
Volume of gas is inversely proportional to to pressure if temperature is kept constant
Boyles law
94
Total pressure of mixture of gases is equal to sum of partial pressures of individual gases
Dalton’s law
95
Amount of gas dissolved in given volume of liquid is proportional to pressure of gas above it
Henry’s law
96
At what depth in water is equal to adding 1ATM
Surface 1ATM, every 33 ft add 1ATM
Ex 33ft 2ATM, 66ft 3ATM
97
Diving injury on decent, caused by increasing pressure and inability to equalize
Ruptured ear drums, sinus squeeze
98
SCUBA injury at the bottom (usually depth 100ft or deeper, nitrogen becomes narcotic )
Effect is reversed with ascent
Nitrogen narcosis
99
SCUBA injuries on ascent
From too rapid ascent:
-Arterial Gas Embolism (AGE)
- pneumothorax
-mediastinal emphysema
From improper decompression
-decompression sickness
100
Nitrogen bubbles trapped in tissues
Improper decompression on ascent
-muscle/ joint pain
-rash
-pitting edema
Decompression sickness type 1
101
Nitrogen bubbles trapped in tissues
Improper decompression on ascent
-paresthesia
- paralysis
- chokes (CP, dyspnea)
- CNS disturbances
Type 2 decompression sickness
102
During immersion, blood is shunted from the periphery to the core resulting in increased pressures in pulmonary vasculature
S/S (not depth dependent)
-substernal chest pain with associated respiratory distress
-coughing up blood (hemoptysis)
-rales
-fatigue
Immersion pulmonary edema
103
S/S
-onset is within 2-10 minutes of ascent
-there is a dramatic onset of sharp, tearing pain
-common presentation mimics stroke
Suspect AGE in any pt with neurological deficits immediately after ascent
Arterial gas embolism
104
S/S substernal chest pain
- irregular pulse
- abnormal heart sounds
-hypotension with a narrow pulse pressure
-change in voice
Mediastinal emphysema
105
Treatment for SCUBA injuries
Supportive
-definitive care requires recompression
-left side trendelenberg (maybe)
- aspirin
-diazapem for seizures
-fluid therapy
-call DAN
106
-altitudes above 8,000ft
Prevention
-ascend gradually
-limit exception
- descend for sleep
-eat a high-carbohydrate diet
What is it and what is the treatment ?
High altitude illness
Treatment:
Acetazolamide, nifedipine
107
Mild case: lightheaded, breathlessness, weakness, headache, nausea, vomiting
Severe cases: weakness, severe vomiting, decreased urine output, shortness of breath, and an altered level of consciousness
What is this and the treatment ?
Acute mountain sickness
Halting of ascent or decent, use of acetazolamide and anti-nausea drugs and supplemental oxygen
108
Mild symptoms: dry cough, shortness of breath, slight crackles in lungs
Severe cases: cyanosis, dyspnea, frothy sputum, weakness, and possibly coma or death
What is this and what is the treatment ?
High-altitude pulmonary edema
Treatment:
Descent and supplemental oxygen or portable hyperbaric bag
Medications such as acetazolamide, nifedipine, furosemide may be useful also
109
Usually occurs as progression of AMS or HAPE
Symptoms: AMS, ataxia, decreased level of consciousness and coma
What is this and what is the treatment?
Decent and supplemental oxygen or portable hyperbaric bag
110
Slow moving, low energy
Minor external hazard
Can be taken serious if taken internally
What particles is this ?
Alpha
111
Highly energized and penetrating
Extremely dangerous
Causes damage by emitting alpha and beta particles internally
What particles is this ?
Gamma
112
Small particles, high energy
Causes less local damage then alpha
Harmful if inhaled or ingested
What particle is this?
Beta
113
Most penetrating
Usually only present near reactor core
Causes direct tissue damage
What particles is this ?
Neutron
114
General rules of radiation accidents
Time
Distance
Shielding
115
An object at twice the distance from source receives what percentage of exposure?
One-fourth, 1/4, 25%
116
Management for radiation exposure ?
-Park upwind
-Look for signs of radioactive exposure
-Use portable instruments to detect radioactivity
-Normal emergency care principles should be applied
-externally radiated and internally contaminated pts pose little danger
-externally contaminated pts require decontamination
Paramedic Class Ashift
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