1
Q
Medications on a BLS ambulance
A
aspirin
Oral glucose
Oxygen
Activated charcoal
Naloxone
2
Q
Aspirin
A
administered to patients with chest pain of a suspected cardiac origin
3
Q
Oral glucose
A
may help patients with diabetes, specifically hypoglycemia
4
Q
oxygen
A
commonly used, but powerful, medication
5
Q
activated charcoal
A
occasionally used in poison cases
6
Q
naloxone
A
antidote for patient who is unconscious and in respiratory failure after taking a narcotic (Opioids)
7
Q
Bronchodilator inhaler
A
Enlarges constricted bronchial tubes to make breathing easier
8
Q
Bronchodilator inhaler side effects
A
increased heart rate
Patient jitteriness
9
Q
Nitroglycerin is prescribed
A
prescribed for chest pain or history of chest pain with a cardiac origin
10
Q
Nitroglycerin contradictions
A
low blood pressure
Medications for erectile dysfunction
11
Q
Nitroglycerin side effects
A
dropping blood pressure
12
Q
Epinephrine
A
Reverse severe allergic reactions
13
Q
Epinephrine side effects
A
increased heart rate and blood pressure
14
Q
autropine
A
Auto-injector to treat responders in the event of a chemical attack
15
Q
3 types of drug names
A
chemical, generic and trade
16
Q
5 things to know when giving medication
A
indications
Contradictions
Side effects
Untoward events
Form of medication
17
Q
Forms of medication
A
tablets
Liquids
Suspensions
Fine powder
Gases
Sublingual sprays
18
Q
5 rights of medication
A
Right person
Right time
Right medication
Right dose
Right route
19
Q
routes of administration : oral
A
swallowed
20
Q
routes of administration: sublingual
A
dissolved under tongue
21
Q
routes of administration: inhaled
A
breathed into lungs, usually tiny aerosol particles, such as inhaler
22
Q
routes of administration: intranasal
A
sprayed into nostrils
23
Q
routes of administration: intravenous
A
injected into veins
24
Q
routes of administration: intramuscular
A
injected into muscles
25
routes of administration: subcutaneous
injected under the skin
26
routes of administration: intraosseous
injected into bone marrow
27
routed of administration: endotracheal
sprayed directly into a tube inserted into the trachea
28
pharmacodynamic considerations
what effect will the medication have on the body
How will this medication affect my patient specifically
Patient-specific factors change how medication works
29
advair
daily management of a respiratory disease, not used for emergency treatment of an acute attack or breathing difficulty
30
Analgesics
drugs prescribed for pain relief
31
antidysrthymics
drugs prescribed for heart rhythm disorders
32
anticonvulsants
drugs prescribed for prevention and control of seizures
33
When should I NOT give aspirin
If the patient has certain allergies or gastrointestinal bleeding
34
When used in high or large concentrations narcotics can cause
slow respiratory drive and respiratory arrest
35
Patients with what diseases may carry a bronchodilator
asthma, emphysema, or chronic bronchitis
36
What does nitroglycerin do
helps dilate coronary arteries that supply the heart with blood
37
Indications
specific signs or circumstances under which it is appropriate to administer a drug to a patient
38
contraindictions
specific signs or circumstances under which it is NOT appropriate to administer a drug as it may be harmful to the patient
39
untoward effects
effects that occurred in addition to the specific reason the drug was administered. Unexpected and potentially harmful
40
enteral route
route of medicine that uses GI tract, such as swallowing a pill
41
what ensures the proper and safe treatment of medication
focus, clear thinking, and good judgement
42
sublingual medication absorption may be more difficult in cases of
poor circulation such as shock
43
Two ways fluids and medications may be administered into the vein
heparin/saline lock
Traditional IV bag
44
KVO
keep vein open
45
typical KVO rate for micro drip
30 drops per minute
46
typical KVO rate for macro drip
10 drips per minute
47
flow rate of an IV that is too fast
runaway IV
48
infiltrated IV
the needle has punctured the vein and exited the other side or pulled out of the vein. Fluid is flowing into the surrounding tissue instead of the vein
49
What kind of pressure moves air into the chest
Negative pressure
50
What kind of pressure moves airout
Positive pressure
51
Rate of adequate breathing in adults
12-20 bpm
52
. Respiration rate for school age child
18-30 bpm
53
Respirations for infants
30-60 bpm
54
Control of breathing occurs in
The brain, medulla oblongata
55
Assessment of breathing includes
Rate, rhythm, quality
56
Why is the brain one of the first organs affected by inadequate respirations
The brain has no capacity to store oxygen or nutrient which is why altered mental status is one of thefirst charges
57
Somnolence
Sleepiness
58
Inadequate breathing decision points
Is patient breathing? Is patient breathing adequately? Do I have intervention to help this patient? Will this patient benefit from ALS?
59
Early signs of respiratory distress specific to infants +children
Nasal flaring, retractions, strider,grunting,decreased muscle tore, decreased mental status,poor peripheral perfusion and decreased heart rate
60
CPAP
Continuous positive airway pressure
61
CPAP (definition)
Form of noninvasive positive pressure ventilationand means blowing of oxygen or air into mask to prevent airway collapse or alleviate difficulty breathing
62
CPAP flow generation
Air flow can be as high as 70 liters per minute. Think gentle breeze
63
Peep
Positive end and expiratory pressure
64
What is peep?
The pressure within the respiratory system at the end of exhalation.
65
How much peep are most CPAP systems designed to provide
7-15 centimeters of water peep
66
Common indications of CPAP
Pulmonary edema + drowning,asthma and cold, respirators failure
67
How does CPAP aid pulmonary edema and drowning
Prevents movement of fluid and pneumatically splints the small airways open
68
Contraindications of CPAP:2 classes
Anatomic - physiologic and pathologic
69
Anatomic -physiologic contraindications of CPAP include
Mental status impaired enough that patient cannot protect their airway) lack of normal,spontaneous respiratory rate, inability to sit-ups, hypotension,
70
Pathologic contraindications of CPAP
Nausea, vomiting, chest trauma (pneumothorax)shock, upper G.I. Bleeding, recent gastric surgery
71
CPAP side effects
Less blood returning to the heart/ cardiac output decreases, drop in blood pressure
72
In order to consider CPAP patient must have a systolic blood pressure of at least
90mmhg
73
What level of peep do most systems start
5-7 cm of water
74
At what level of peep do patients with pulmonary edema achieve benefit
At or around 10 cm of water
75
COPD stands for
Chronic obstructive pulmonary disease
76
Pulmonary edema
Abnormal accumulation of fluid in or around the alveoli
77
Pneumonia
Infection caused by bacteria, viruses, or fungi
78
Common signs+symptoms of pneumonia
Coughing, mucus that is green, yellow or occasionally bloody. Fever, chestpain, and severe chills
79
Spontaneous pneumothorax
Lung collapses without injury resulting from a rupture of a bleb. Do not use CPAP
80
Pulmonary embolism
Blood clot, air or fat that travels to the lungs
81
DVT
Deep vein thrombosis, blood clot most commonly starting in the leg
82
Epiglottis
Infection inflames area around+ above epiglottis
83
Symptoms of epiglottitis
Sorethroat, drooling, fever, difficulty swallowing, strider
84
Croup
Group of viral illnesses that result in inflammation of the larynx +trackea and bronchi
85
Croup signs+symptoms
Loud barking cough hoarse voice, typically follows a cold or respiratory infection
86
Bronchiolitis
Condition in which small airways became inflamed because of viral infection. Most common is respiratory syncytial virus (RSV)
87
Cystic fibrosis
Genetic disease,causes thick, sticky mucous that accumulates in the lungs and digestive system
88
Signs+ symptoms of cystic fibrosis
Coughing w/ large amounts of mucus,fatigue, frequent pneumonia,abdominal pain and destination, coughing up blood, nausea, weight loss
89
Influenza symptoms
Fever, bodyaches, headaches
90
Metered dose inhaler
Each dose is exactly measured,medications administered by metered-dose inhaler can also be administered by small-volume nebulizer
91
3 types of medications administered through small volume nebuizer
Albuterol, ipratropium bromide, dvo new
92
Pulmonary embolism signs and symptoms
Think P.E. =PAIN
P- pleuritic chest pain
A- acute shortness of breath
I- increased heart rate
N- not enough oxygen
93
Cardiovascular systems job
Perfusing the cells of the body, pumping blood
94
Components of blood
Red+ white blood cells, plasma, platelets
95
First organ perused by oxygenated blood
The heart
96
Acute coronary syndrome
Blanket term used to represent any symptoms related to lack of oxygen in the heart muscle
97
Ischemia
Cells of the heart go without adequate oxygenated blood
98
Syncope
Temporary loss of consciousness
99
Syncope
Fainting or near fainting
100
ACS pattern of symptoms
Discomfort, aching,pressure in the chest, can radiate to jaw, neck, arm. Dyspnea, syncope, sudden onset of sweating, abnormal pulse/bp
101
What do 12-lead ECG do
Speed up the process ofrecognizing electrocardial findings associated with acute myocardial infarction
102
Lead VI is placed
At the level of the 4th intercoastal space,just to the right of the sternum
103
Lead V2 is placed
Same intercostal level as VI, but to the left of the sternum
104
Placement of lead V4
5th intercostal space at the-
mid-clavicular line, next to the right nipple
105
Placement of lead V3
Halfway between V2+V4
106
Placement of lead v5
5th intercostal space, anterior axillary line,
107
Placement of lead V6
5th intercostal space axillary line
108
Emergency care of a patient with suspected ACS
Position of comfort, determine if oxygen should be administered, 12-lead ECG, up to 325mg of aspirin, nitroglycerin
109
The majority of cardiovascular emergencies are caused by
(Indirectly or directly) by changes in the inner walls of arteries. Can be systemic, pulmonary, or coronary
110
Risks of coronary artery disease
Hypertension, obesity, lack of exercise, elevated blood levels of cholesterol and cigarette smoking
111
Angina pectoris
Pain in the chest, occurring when blood supply to Th heart is reduced and the heart is not receiving enough oxygen (portion of (the myocardium)
112
When do signs and symptoms of angina pectoris come on
With increased exercise or exertion
112
Signs + symptoms of angina pectoris
. Pain/discomfort, shortness of breath, nausea, sweating, syncope
112
Myocardial infarction
Heart attack, blocking of a coronary artery by formation of a thrombus or embolism
112
Occlusion
Blockage of an artery by fatty deposits
113
Thrombus
A clot formed of blood+ plaque attached to the inner wal of an artery or vein
113
Embolism
Blockage of a vessel by a clot or foreign material brought to the site by the blood current
114
2 categories of problems with acute myocardial infarction
Ischemia +dysrhythmia
115
Ischemia as it relates to AMI
Leads to injury of cells +cell death which can disturb the electrical function of the heart
116
Dysrhythmia
Occurs when electricity is disturbed abnormally through the heart, causing harmful changes to the rate, rhythm and pumping
117
Fibrinolytics
Medications used to dissolve clots that block coronary arteries
118
Cardiogenic shock
When the heart can't pump enough blood to meet body needs, even though there is plenty of fluid to pump
118
Beta blocker
Group of medications that slow the heart and make it beat less strongly. Decreases the work heart has to do
119
Most important treatment for myocardial infarction
Transport
120
Congestive heart failure (CHF)
The failure of the heart to pump blood with normal efficiency. One or both ventricles can no longer fill properly or pump an adequate amount blood
121
Signs+symptoms of heart failure
JVD, pedal edema. Pulmonary edema
122
Right side heart failure
Blood backs up into the body
123
Left-side heart failure
Fluid backs up in the lungs
124
Pulmonary edema
Accumulation of fluid in the lungs
125
In what assessment is heart failure identified
Secondary assessment
126
Pedal edema
Fluid buildup in feet and ankles
127
Aneurysm
The dilation or ballooning of a weakened section of the wall of an artery
128
2 common sites of aneurysm
Aorta + brain
129
Cardiac arrest
A state in which the heart is no longer pumping blood
130
Chain of survival
Recognition, high quality CPR, rapid defibrillation, bls+als, advanced life support and post arrest care
131
Defibrillation
Delivery of an electrical shock to stop the fibrillation of heart muscles and restore A normal heart rhythm
132
Chronic hypertension
Causes heart muscle to become abnormally thick, reducing pumping efficiency
133
Coronary artery disease
Conditions that narrow or block the arteries of the heart often the result of the buildup of fatty deposits on the inner-middle walls of arteries (plaque)
134
Profound mechanical dysfunction
Can result from loss of normal heart function
135
Pericardial tamponade
Blood or other fluids occupy the space between the heart and the pericardial sac
136
Pulseless electrical activity(PEA)
The heart's electrical rhythm remains relatively normal, yet mechanical pumping activity fails to follow the electrical activity causing cardiac arrest
137
Sodium potassium pump
Generates electrical impulses, helps maintain normal rhythm
138
Asystole
The heart has ceased generating electrical impulses. Commonly called flatline
139
Ventricular tachycardia.
Heartbeat is rapid, both ventricles are pumping and do not allow for the hearts chambers to fill with enough blood between beats to produce blood flow sufficient to meet body's needs
140
Ventricular fibrillation
Hearts electrical impulses are disorganized, preventing the heart muscle from contracting normally
141
Sudden cardiac arrest
Abrupt onset of a dysthymia like v-fib or v-tach. Account for 85% of all arrests. Other causes include congenital heart conditions, illness, toxins, sudden blunt trauma
142
Commotio cordis
Cardiac arrest caused by acute blunt force trauma to anterior chest
143
Asphyxial cardiac arrest
Cardiac arrest caused by systemic hypoxia, typically due to a respiratory disorder or shock
144
agonal respirations
Irregular, gasping breaths that precede apnea+ death- primal reflex
145
Perceptual narrowing
Tunnel vision
146
3 key features of cardiac arrest patients
1. Unresponsiveness
2. Apnea
3. Absence of pulse
147
When should you perform compressions on an infant
An infant with a heart rate less than 60 beats per minute
148
SUIDS
Sudden unexpected infant death syndrome
149
3 commonly reported types of SUIDS
SIDS
UNKNOWN
Accidental suffocation and strangulation in bed
150
What percent of cardiovascular function can quality compressions replace
Roughly 20-25%
151
Key elements of high-quality CPR
Hand placement, compression depth, compression rate, minimizing pause in compression, rescue breathing
152
Compression depth
Adults: at least 2 inches
Infants-children: 1/3 the anterior-posterior diameter of chest, about 1.5 to 2 inches
153
Compression rate
100 -120 compressions per minute
154
Compression fraction
The amount of time chest compressions are being performed compared with total time patient contact, aim for above 90%
155
Rescue breathing ratio
2 ventilations to every 30 compressions(adults)
2:15 for children/infants
156
Triangle of life
P1: initiates chest compressions;rightside
P2:operates AED; patients left
P3: at patients head, open, clears airway BVM
157
Return of spontaneous circulation ( ROSC)
Heart beats again after successful resuscitation
158
Reticular activating system (RAS)
A series of neuralgic circuits in the brain that are responsible for staying awake, paying attention, and sleeping
159
What does oxygen do for brain tissue
Perfusion
160
What does the brain tissue need glucose for
To nourish
161
Why does brain issue need water
Hydration
162
Most common causes of altered mental status
Hypoxia and retention of Carbon dioxide due to inadequate resp iratory efforts
163
Diabetes mellitus
The body's inability to maintain balance or the interaction between glucose and insulin
164
Glucose
A form of sugar and the body's basic source of energy
165
Why cant a glucose molecule pass into a cell without insulin
Glucose is a big molecule
166
What organ secretes insulin
Pancreas
167
When does the body secrete insulin
When blood glucose rises above 90mg/dL
168
Relationship described as a "lock and key"
Insulin_glucose, insulin is the key, glucoseis the lock
169
Islets of langerhans
Secrete insulin
170
Type 1 diabetes
Pancreatic cells fail to function properly and insulin is not secreted normally
171
Type 2 diabetes
Body's cells fail to use insulin properly
172
Most common medical emergency for diabeticS
Hypoglycemia
173
Signs + symptoms hypoglycemia
Altered mental status, drunken stupor, confusion, unconsciousness, seizures, pale, sweaty skin
173
Hypoglycemia
Low blood sugar
174
What causes hypoglycemia
Takes too much insulin _ causing rapid depletion of available sugar
Reduces sugar intake by not eating
Over-exercises -over exertion
Vomiting a meal
Increased metabolic rate during shivering or fever
175
How does the body respond to hypoglycemia
Fight or flight, sympathetic nervous system signals the liver to release glucagon to raise blood sugar
176
Signs that glucagon has been discharged
Pale,sweaty skin, tachycardia, rapid breathing
177
Hyperglycemia
High blood sugar
178
What causes hyperglycemia
Lack of sufficient insulin, leaving sugar in the blood stream rather than helping it into the cells. Due to body's inability to produce insulin, or insulin injections were forgotten. Infection, stress
179
Signs and symptoms of hyperglycemia
Hunger, thirst, warm dry red skin, acetone breath, dry mouth, abdominal pain, vomiting
180
Diabetics who do not manage their diabetes will routinely have
Hyperglycemia, with blood glucose at 200-300mg/dl
181
Diabetic ketoacidosis
Condition resulting from high blood sugar as waste products build up and combine with dehydration
body using fat for fuel
Most common in type-1
182
Hyperglycemic hyperosmolar nonketotic syndrome
High blood glucose leading to severe dehydration and increased blood osmolarity. Without significant ketone production. No unusual breath Ordor. Typically found in type 2 diabetics who are undiagnosed
183
Diabetes-related complications
Heart disease, blindness, kidney failure
184
Hypoglycemia in a systematic diabetic
Blood glucose lower than 60mg/dl
185
What level of low blood glucose is associated with signitant alterations in mental status
Lower than 50mg/dl
186
187
Criteria for administering oral glucose
Altered mental status
History of diabetes
Alert enough to shallow
188
Glycogen
Naturally stored sugar in liver and muscles.
189
Glucagon
A hormone that tells the liver to release glycogen
190
Causes of altered mental status (not diabetes)
Hypoxia, sepsis, drug+ alcohol use, brain injuries, seizures stroke, dizziness' syncope
191
2 types of seizure
Partial + generalized
192
Seizure
Sudden change in sensation, behavior, or movement. Electrical change in the brain become irregular
193
Partial seizures
Affect only one side or one part of the brain. Patient usually does not lose consciousness
194
Generalized seizure
A seizure affecting both sides of the brain, resulting in lose of consciousness of the patient
195
Tonic-clonic seizures
Generalized seizure, in which patient loses consciousness and has jerking movements of paired muscle groups
196
3 phases of tonic-clonic seizure
1. Tonic phase - body becomes rigid/stiff, breathing may stop
2. Clonic phase- body jerks violently, 1-2 minutes
3. Postictal phase - convulsions stop, patient regainsciousness
197
Causes of seizures
Hypoxia, stroke, traumatic brain injury, toxins, hyperglycemia, brain tumor, congenital brain defects, infection, metabolic, idiopathic
Epilepsy, measles, eclampsia, heat stroke
198
If you are present for a convulsive seizure you should :
Place patient on floor, position on their side, loosen restrictive clothing, remove objects, protect from injury
199
Status epilepticus
A prolonged seizure when a person suffers 2 or more convulsions without regaining full consciousness
200
Complex partial seizure
Psychomotor,temporal lobe seizure. Characterized by abnormal behavior varying person to person. May involve glassy stare, lip smacking, chewing, fidgeting
201
Absence seizure
Petit mal seizure, less than 10 seconds. Temporary loss of concentration or awareness
202
Stroke
Death or injury of brain tissue that is deprived of oxygen. Can be caused by a blocked or ruptured blood vessel)
203
Ischemic stroke
Stroke caused by a blockage, (clot,embolism) occluding artery
204
Hemorrhagic stroke
Stroke caused by bleeding into the brain
205
Hemiparesis
One-sided weakness, one of the most common signs of stroke
206
Left-side of the brain controls
Movement on the right side the body,
207
Expressive aphasia
Difficulty using words
208
Receptive aphasia
Patient can speak clearly but cannot understand you
209
Transient ischemic attack
Ministroke, complete resolution of stroke symptoms without treatment in 24 hoursl
210
Cincinnati prehospital scale
- Facial drop
- arm drift
- speech
211
Syncope
Fainting, brief loss of consciousness with spontaneous recovery
212
Pallor
Loss of normal skin color
213
Causes of dizziness and syncope
Cardiovascular (dysrhythmias)
Hypovolemic causes
Structural/metabolic causes
Environmental/toxicological
214
Vasovagal syncope
Fainting from emotion such as being frightened or emotional stress
215
Causes of hypovolemia
Dehydration, internal bleeding, trauma
216
Medication used in some fast-acting emergency inhalers
Ipratropium
217
Sound created by the presence of fluid in the alveoli or by the opening of closed alveoli
Crackles
218
Hypoperfusion refers to
Shock
219
Idiopathic stroke
Stroke with no known cause
220
Condition that leaves sugar in the bloodstream rather than helping it into the cells
Hyperglycemia
221
Why does diabetic ketoacidosis cause dehydration
In attempt to rid the blood of excess sugar, the body will increase urination
222
Patient has been actively seizing for over 5 minutes, jaw clenched and she is cyanotic around her lips. You should next…
Maintain airway and administer oxygen as appropriate
FWFD Class 100/1 - EMT
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