general2.txt

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dodgybarnet
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96335
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general2.txt
Updated:
2011-08-07 18:36:14
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EMR
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General 2
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  1. Hypothermia temp?
    <35°
  2. Severe Hypothermia temp?
    <32°
  3. s/s of Severe Hypothermia <32°?
    • Muscle activity decreases
    • Shivering stops
    • Coordinated finger movement stops
  4. s/s of Severe Hypothermia <29°?
    • Lose interest in keeping warm
    • Removal of clothes
    • LOC drops
    • Rigid limbs
  5. s/s of Severe Hypothermia ~27°?
    • Vitals drop
    • Pulse drops
    • Arrhythmia
    • BP drops
  6. s/s of Severe Hypothermia <27°?
    • Cardiorespiratory activity ceases
    • NOT dead!
  7. If hypothermia suspected, how long to check for pulse?
    30-45 seconds
  8. Hypothermia pt. precautions?
    • Be gentle!
    • Don’t over stimulate the heart!
  9. Management of cold pt.?
    • Remove pt. from cold enviro
    • Remove wet clothes
    • Prevent conductive heat loss (cold floors etc)
    • Prevent convective heat loss (wind)
    • Insulate cold bits of body
    • Handle gently
    • Provide O2
  10. Gangrene vs infarction?
    • Gangrene: death of the tissue in considerable mass, usually associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction.
    • Infarction: development or presence of an infarct (a localized area of ischemic necrosis produced by occlusion of the arterial supply or venous drainage of the part)
  11. Frostbite Tx (vs frostnip)
    • DO NOT: Rub
    • DO NOT: apply heat
    • DO NOT: allow them to walk on frostbitten feet.
    • Splint
    • Cover with sterile dressing
    • Remove jewelry
  12. Def of Hyperthermia?
    >38.3°
  13. Heat cramps?
    muscle spasms => loss of large amount of salt and water through exercise. Heat cramps are associated with cramping in the abdomen, arms and calves
  14. Heat Cramp Tx?
    • Remove pt. from enviro
    • Rest muscles
    • Provide fluids (50/50 water & Gatorade would be good)
  15. Tx for heat exhaustion?
    • Remove excess clothes
    • Remove pt. from enviro
    • O2
    • Pt. lies down
    • Iff pt. alert: drink water
    • If N/V: no water + LLR or RLR
    • Cover with wet sheets
    • Fan the pt.
  16. Def of Heat Stroke?
    body temperature of greater than 41 °C
  17. Reverse triage?
    In lightning strikes: treat those whom appear dead 1st
  18. Rattle snake Tx?
    • Reassure Pt.
    • Supine position
    • Clean bite area (no ice): treat as puncture wound
    • Splint if limb
    • Watch for N/V
    • Nil by mouth
    • Monitor Vx
    • Mark swelling with a pen to assess spread
    • Tx for shock
    • Bring dead snake
  19. Jellyfish Tx
    • Dose in vinegar/isopro alcohol
    • Scrape with CCard
    • Soak in hot water
  20. Def and s/s of Heat exhaustion?
    • Hypovolemic shock => of dehydration
    • Cold clammy skin
    • Weakness
    • Confusion
    • Headache
    • Rapid pulse
  21. Diving reflex?
    Pulse drops => of submersion in cold water
  22. Good question for suicidal pt.?
    • Do they have any vacation plans? Suicidal pt.s don’t look to the future.
    • Also, ask to borrow some money.
  23. Biggest factor behind attempted suicide?
    Depression
  24. Positioning for drowned pt.
    LLR: helps to drain upper airway
  25. Average fetal gestation?
    36-40 wks
  26. Gravida vs Para?
    • Gravida: Total # of pregnancies
    • Para: Total # of live births
  27. Braxton-Hicks contractions vs real? 5 things
    • BHC: irregular with no increase of frequency or intensity
    • REAL: regular + ^ of freq & intensity
    • ---
    • BHC: Pain in lower abdomen & contractions stay there
    • REAL: Pain in lower back that wraps around to lower abdomen
    • ---
    • BHC: if bloody show; brown
    • REAL: if bloody show; pink/red
    • ---
    • BHC: Moving Pt. position helps
    • REAL: Moving Pt. position doesn’t help
    • ---
    • BHC: If fluids, usually urine
    • REAL: If fluids, usually sweet smell + continuous
  28. Preeclampsia?
    Pregnancy induced hypertension
  29. Eclampsia?
    Seizures => of Pregnancy induced hypertension
  30. Eclampsia Tx?
    LLR
  31. Supine Hypotensive Syndrome?
    • Foetus compresses inferior Vena Cava
    • Tx: LLR
    • Iff supine on back board: Towels under right side of board
  32. Childbirth transport decision?
    Load ‘n’ go, unless baby crowning and coming out, or ass-out breech
  33. Neonatal Apgar score?
    • Appearance: pink not cyanotic
    • Pulse: has one
    • Grimacing: Grumpy is good
    • Activity or Muscle Tone: not floppy
    • Respirations: regular & Rapid
    • ---
    • Scoring: 2 for perfect, 1 for medium, 0 for absent
  34. PCR?
    Pt. Care report
  35. Clinical vs Biological death?
    • Clinical: Absence of respiratory or circulatory function in unresponsive pt.
    • Biological: Absence of brain activity
  36. DRIED definitive signs of death?
    • Decapitation
    • Rigor Mortis
    • Icinerated
    • Eviserated (of Heart/Brain etc)
    • Decomposing
  37. 5 steps of grieving?
    • DABDA
    • Denial
    • Anger
    • Bargaining
    • Depression
    • Acceptance
  38. 3 variations btwn child/adult?
    • Airway size
    • Blood loss coping
    • Kids more prone to head injuries
  39. Bodies reaction to stress?
    • Alarm response
    • Reaction & Resistance
    • Recovery OR Exhaustion
  40. CISM?
    Critical Incident Stress Management
  41. Deadly bleeding acronym?
    • RED
    • Rest
    • Elevate
    • Direct Pressure
  42. Depth or CPR compressions @ age?
    • Adult: 4-5 cm
    • Child/Infant: 1/2 to 1/3 chest
  43. Infant CPR landmarking
    2 fingers place 1 finger below nipple line
  44. Tx for mild choking
    • Encourage coughing
    • NRB @15 Lpm
    • Transport
  45. Tx for severe conscious choking (normal person)?
    • 5 J-Thrusts
    • Ensure proper landmarking
    • Repeat another set of 5 J-Thrusts
    • GOTO 1
  46. Tx for severe conscious choking (fatty or pregnant)?
    Chest thrusts until object free or Pt. collapses
  47. Tx for severe unconscious choking?
    • 30 Compressions: as per CPR
    • Check airway for obstruction: and remove with cross finger technique or sweeps (no blind finger sweeps)
    • Ventilate: 2 PPVs. If 1st unsuccessful, reposition head.
    • Repeat CPR prn
  48. Tx for severe unconscious choking - INFANT?
    • Hold sandwiched face down
    • 5 back blows
    • Switch infant face up resting on your thigh
    • 5 CPR compressions
    • Repeat prn
  49. Pertinent Positive vs Pertinent Negative?
    • PP: A finding (sign or symptom) that you would expect to find in a patient with this condition
    • Example: substernal crushing chest pain in a patient suspected of having a heart attack
    • PN: A finding (sign or symptom) that you would expect to find in a patient with a condition that is not present
    • Example: no half-paralysis of a patient suspected of having a stroke
  50. Weird breath sounds aka?
    Adventitious Breath Sounds
  51. Auscultation landmarks?
    • Apices: one inch below the mid-clavicle
    • Bases: at the mid-axillary line lateral to the xiphoid process
  52. Mask used if resps >30 or <10?
    • >30: BVM if tolerated.
    • If not tolerated: NRB & coached down
    • <10: BVM if tolerated.
    • If not tolerated: NRB & NO coaching
  53. TIC of pelvis?
    Inward NOT down
  54. Stopwatch of O2 deprivation?
    • 0-1 min: cardiac irritability
    • 0-4 min: brain damage not likely
    • 4-6 min: brain damage possible
    • 6-10 min: brain damage very likely
    • 10+ min: brain damage irrepressible
  55. Simple face mask details?
    • Not used much anymore
    • 6-10 Lpm
    • 35-60% inspired O2
  56. O2 cylinder PSIs?
    • 200 PSI: empty
    • <500 PSI: not suitable in ambulance
  57. O2 cylinder types & factors?
    • D: 350L – factor 0.16
    • E: 635L – factor 0.28
    • M: 3000L – factor 1.56
  58. How to calculate Tank Life?
    (Tank Pressure – 200)(factor/flow rate)
  59. Different flavours of Fowlers position?
    • pt’s head is elevated...
    • Low: 15-30 degrees
    • Semi: 30-45 degrees
    • Standard: 45-60 degrees.
    • High: 80-90 degrees
  60. Integumentary system?
    Skin
  61. 3 layers of the skin?
    • Epidermis
    • Dermis
    • Subcutaneous
  62. 2 sections of the skeletal system?
    • Axial: Cranium, spine ribs
    • Appendicular: everything else
  63. Bones of the spinal sysyem?
    • Total: 33
    • Cervical: 7
    • Thoracic: 12
    • Lumbar: 5
    • Sacrum: 5 fused
    • Coccyx: 4 fused
  64. Area just above angle of Louis?
    Jugular notch
  65. Line formed by ribs below xiphoid?
    Costal arch
  66. 3 parts of ankle/foot?
    • Tarsals
    • Metatarsals
    • Phalanges
  67. 3 parts of wrist/hand?
    • Carpals
    • Metacarpals
    • Phalanges
  68. 5 specialised assessments?
    • Medication Assessment
    • Neurologic Assessment
    • GI/GU Assessment
    • Poisoning / OD Assessment
    • OB/GYN Assessment
  69. Divisions of nervous system?
    • Central NS: Brain & Spinal cord
    • Peripheral NS: Somatic & Autonomic
    • Somatic: voluntary
    • Autonomic: involuntary
    • Autonomic: Sympathetic & Parasympathetic
    • Sympathetic: Adrenogenic (Alpha & Beta receptors)
    • Parasympathetic: Cholinergic
  70. Function of SNS
    • Sympathetic Nervous System
    • Prepares your body for stressful events
    • --- ^HR
    • --- ^Resps
    • --- Dilates pupils
    • --- Constricts peripheral blood vessels
    • --- Dilates coronary and skeletal muscle blood vessels
    • --- ileus
  71. Function of PNS?
    • Parasympathetic Nervous System
    • Returns the body to normal (or the reverse of above effects if over-stimulated)
  72. Anatomy of Meninges?
    • Dura Mater
    • Arachnoid Layer
    • Pia Mater
  73. Pituitary?
    Produces numerous hormones to control and regulate other glands
  74. Thyroid?
    • Produces thyroxin
    • Regulates growth and metabolism
  75. Parathyroid?
    Produces parathormone which regulates serum calcium
  76. Pancreas?
    • Located in the abdominal cavity and retroperitoneal cavity
    • Produces insulin (via beta cells) and glucagon (alpha cells)
    • Regulates blood sugar levels
  77. Adrenal glands?
    • Top of the kidneys
    • Produce adrenalin which regulates the stimulation of the SNS
  78. +ve vs –ve Feedback Loop?
    • +ve is least common type: causes itself to produce more and more of the effect until the stimulus is stopped
    • Examples: clotting, childbirth (uterine contractions)
    • -ve is the most common type: loop continues to produce the hormone until the stimulus is gone (fear factor return to zero)
    • Examples: “adrenalin rush”
  79. Electrical parts of heart?
    • SA: SinoAtrial Node
    • AV: AtroVentricular Node
    • Purkinje fibres: nice
  80. Erythrocyte vs leukocyte?
    RBC vs white BC
  81. RBC vs white BC?
    Erythrocyte vs leukocyte
  82. Enteral vs Parenteral?
    • Enteral: via intestines
    • Parenteral: any other way
  83. Instillation?
    Eye drops
  84. OR/NG enteral administration?
    • OR: Orogastic
    • NG: Nasogastic
    • Both: not in EMR scope
  85. Define the lobes of the lungs
    • Right: 3 lobes
    • Left: 2 lobes
  86. Thrombus vs Embolus?
    • Thrombus: clot which has formed at a specific location
    • Embolus: A thrombus that has broken loose and is travelling through the vascular system
  87. Atelectasis?
    • the lack of gas exchange within alveoli, due to alveolar collapse or fluid consolidation. It may affect part or all of one lung.
    • It is a condition where the alveoli are deflated.
  88. ARDS?
    • Acute respiratory distress syndrome: life-threatening lung condition that prevents enough oxygen from getting into the blood.
    • Severe lung disease caused by a variety of direct and indirect issues.
    • Very similar to pulmonary edema
  89. Pink Puffer vs Blue Bloater?
    • Pink: Emphysema => more RBCs as compensation
    • Blue: Cyanosis + barrel chestedness
  90. RSV?
    • Respiratory Syncytial Virus: A virus which causes lower airway illnesses like bronchiolitis or
    • pneumonia and possibly respiratory failure
    • Highly contagious!
  91. ASR?
    Acute Stress reaction: hyperventilation freak out
  92. Hemiparesis vs Hemiplegia
    • Hemiparesis: Weakness on one side
    • Hemiplegia: Paralysis on one side
  93. Tonic vs Clonic?
    • Tonic: Sustained muscle contractions
    • Clonic: Jerky violent movement
  94. Jacksonian / Focal Motor seizures?
    • Jacksonian: involve a progression of the location of the seizure in the brain, which leads to a "march" of the motor presentation of symptoms often beginning in the fingers moving proximally
    • Focal Motor: seizure of hands and face
  95. ICP / Cushings triad Tx?
    • BVM 15 Lpm 1:3
    • Head raised 15°-20°
  96. Emesis?
    Vomit
  97. Hematemesis?
    Blood in vomit
  98. Hematemesis vs hemoptysis?
    • Hematemesis: Blood in vomit
    • Hemoptysis: coughing up blood
  99. Hematuria?
    Blood in urine
  100. Melena?
    • Black tarry stool
    • Blood has run most of GI tract
  101. Hematochezia
    Red runny stool
  102. AAA?
    • Abdominal Aortic Aneurysm
    • Pathophysiology: The descending aorta ruptures due to a weakening in the aortic wall, usually due to atherosclerosis or congenital precondition
    • Blood leaking from the aorta pools around the peritoneum
  103. 2 chemicals released in allergic reactions?
    • Histamines: trigger the inflammatory response & increas the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens
    • Leukotrienes: sustain inflammatory reactions & trigger contractions in the smooth muscles lining the trachea
  104. 5 classes of allergen?
    • Insect stings, bites & animals
    • Meds
    • Plants
    • Food
    • Chemicals
  105. Codeine?
    • Opiate
    • Analgesic - mild to moderate pain
    • Relieves coughs
    • Antidiarrheal
  106. Fentanyl?
    • “China White”
    • Opioid
    • Analgesic - for chronic pain
    • 100 times more potent than morphine
    • rapid onset and short duration of action
  107. opiate versus opioid?
    • Opiate: derived from poppy
    • Opioid: synthetic & binds to opiod receptors
  108. Narcotic?
    Opiate
  109. Heroin?
    • “Smack”
    • semi-synthetic opioid drug synthesized from morphine
  110. MS Contin?
    brand of a time-released formulation of morphine sulfate
  111. Morphine?
    • Analgesic - for acute & chronic pain
    • Opiate
  112. Oxycodone?
    • opioid analgesic medication
    • Analgesic - moderate to moderately severe acute or chronic pain
  113. OxyContin?
    brand name of a time-release formula of oxycodone
  114. s/s of Cholinergic agents?
    • e.g.: Organophosphates
    • SLUDGE
    • Salivation
    • Lacrimation (tears)
    • Urination
    • Defecation
    • GI irritant
    • Emesis
  115. Delirium vs Dementia?
    • Delirium: rapid onset, temp change of cog status => of an outside factor (eg booze)
    • Dementia: progressive change in Mental Status over years
  116. What’s the MHA form 10 about?
    Mental Health Act: laws relating to consent from a crazy person
  117. AED for moderate/severe Hypothermia?
    Only zap once!
  118. Abruptio Placenta?
    • Premature separation of placenta from uterine wall
    • s/s: bleeding & Pain
  119. Placenta Previa?
    • Placenta partially or fully covers the cervix
    • s/s: bleeding & NO Pain
  120. 3 stages of childbirth?
    • 1st: Dilation of cervix
    • 2nd: Baby coming out
    • 3rd: Delivery of placenta
  121. Height of a “significant” fall?
    • 15 foot
    • 3x body height
  122. Max weight 2 EMS can lift?
    250lbs
  123. New term for “Spinal Immobilization”?
    Spinal motion restriction
  124. Everytime you move a Pt (eg onto backboard)?
    • ABCS
    • CMS
  125. Neurogenic shock?
    • Spinal shock
    • Damage to nerves affects control of muscle tone & therefore blood vessels too
  126. Spinal shock?
    • Neurogenic shock
    • Damage to nerves affects control of muscle tone & therefore blood vessels too
  127. Respiratory shock?
    • Severe chest injury / airway obstruction
    • => Hypoxia
  128. Psychogenic shock
    • Pt. freaks out causing generalized vascular dilation
    • => Syncope
  129. Metabolic shock
    Electrolyte imbalance causes arrhythmia & neuro disfunction
  130. 3 stages of shock?
    • Compensated
    • Decompensated
    • Irreversible
  131. 4 fracture classifications?
    • Greenstick: fracture in a young, soft bone in which the bone bends and partially breaks.
    • Comminuted: broken into 2 or more pieces
    • Pathological: => of weakened / diseased bone (eg: osteoporosis)
    • Epiphysial: occurs during bone growth in a child
  132. Compartment syndrome?
    • compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body.
    • leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure within the compartment.
    • Because the connective tissue that defines the compartment does not stretch, a small amount of bleeding into the compartment, or swelling of the muscles within the compartment, can cause the pressure to rise greatly.
  133. Ecchymosis?
    purple discoloration of the skin => of a bruise
  134. Procedure for splinting (mnemonic)?
    • RICE
    • Rest
    • Immobilize
    • Cold
    • Elevate
  135. Sinusitis?
    • Inflammation of paranasal sinuses (above & around ears & nose)
    • s/s: Headache / tenderness of upper jaw & teeth / Ear ache
  136. Epistaxis?
    Nose bleed
  137. Avulsion?
    Separating various layers of soft tissue
  138. Hematoma?
    • Pool of blood under damaged tissue
    • Big ass bruise
  139. 6 burn related injuries?
    • Superficial: (1st) only epidermis
    • Partial thickness: (2nd) epidermis & Dermis. Super ouchy.
    • Full thickness: (3rd) no pain @ 3rd, plenty @ 2nd
    • Chemical: wet / dry
    • Electrical: bzzzt
  140. Definition of “Critical” Burns?
    • FT: to hands
    • FT: to feet
    • FT: to face
    • FT: to airway
    • FT: to genitals
    • FT: >10% of body area
    • PT: >30% of body area
    • Burns: with respiratory emergencies
  141. Definition of “Moderate” Burns?
    • FT: >2% of body area
    • PT: 15% to 30% of body area
    • SF: >50% of body area
  142. Definition of “Minor” Burns?
    • FT: <2% of body area
    • PT: <15% of body area
  143. Tx for burns?
    • Immerse or run under cool sterile water / saline
    • <20% BSA = Wet Dressing
    • >20% BSA = Dry Dressing
    • Blanket
    • Shock Tx
  144. Retrograde vs Anterograde memory loss?
    • Anterograde amnesia: loss of the ability to create new memories after the event
    • Retrograde amnesia: loss of memories created prior to the event
  145. Hyphema?
    Bleeding in anterior chamber of the eye
  146. Blowout fracture?
    fracture of the walls or floor of the eye orbit: Intraorbital material may be pushed out into one of the paranasal sinuses.
  147. Tension pneumothorax?
    One lung collapses & compresses heart and other lung
  148. Paper bag syndrome?
    • Traumatic Asphyxia: sudden, severe compression of the chest causing a massive increase in intrathoracic pressure resulting in a reversal of blood flow through the circulatory system (possibly damaging heart valves)
    • Often caused by holding your breath before impact
  149. Becks triad?
    • Pericardial Tamponade
    • -> JVD
    • -> Narrowing pulse pressures
    • -> Muffled heart sounds
  150. Mesentery?
    Membranous folds attaching intestines to the body cavity
  151. RSV?
    Respiratory Syncytial Virus: lower airway illness
  152. Meningitis s/s?
    • Rash
    • Stiff neck
  153. Effects of hypo- & hyperventilation?
    • Hypoventilation: respiratory acidosis & < hemoglobin affinity to O2
    • Hyperventilation: respiratory alkalosis & ^ hemoglobin affinity to O2
  154. Hypercarbia?
    Excess CO2 in blood
  155. OPA & NPA measurement?
    • OPA: corner of mouth to earlobe
    • NPA: tip of nose to tragus, diameter bit smaller than pinky finger of pt, right nostril
  156. Most common cause of airway obstruction?
    Tongue
  157. Normal SPO2?
    >95%
  158. SPO2 & bag choice?
    • >95%: OK
    • 91%-94%: NC
    • 86%-91%: NRB
    • <85%: BVM
  159. To reduce the risk of gastric inflation that might lead to regurgitation and aspiration of stomach contents?
    recommend reductions in both volume and speed at which rescuers provide ventilations, but only if supplemental oxygen is provided.
  160. Compliance of lung tissue?
    It’s stiffness or flexibility
  161. Hemodynamic instability?
    Low blood pressure & poor perfusion

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