Medical Exam 4 Review
Side effect is lowering of blood pressure (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
List 6 stages that may occur in a generalized tonic-clonic seizure.
1. Aura 2. LOC (level of consciousness) 3. Tonic Phase (muscle rigidity) 4. Hypertonic Phase (back extensions) 5. Clonic Phase (convulsion) 6. Postictal State
For any patient whose mentation is altered, you should:
1. Manage any Life-threats or conditions 2. Recognize the mental status change 3. Document the altered mentation 4. Continue to monitor for further deterioration
Inspiration
Active part of respiratory cycle, requires energy
Sudden onset CP/diaphoresis, sense impending doom
Acute Coronary Syndrome (ACS)
SQ (subcutaneous) Emphysema
Air trapped under skin, may result from CPAP with pneumothorax
Must be shaken vigorously for 30 seconds before use (EMT MEDICATIONS)
Albuterol via MDI
2.5 mg per dose (EMT MEDICATIONS)
Albuterol via SVN
Administered with oxygen at 8-10 liters per minute (EMT MEDICATIONS)
Albuterol via SVN
Indicated for wheezing/bronchoconstriction caused by asthma
Albuterol via SVN & Albuterol via MDI
May be contraindicated if patient is unconscious or unable to protect airway (EMT MEDICATIONS)
Albuterol via SVN & MDI Aspirin Nitroglycerin Tablet Oral Glucose
Causes bronchodilation (EMT MEDICATIONS)
Albuterol via SVN & MDI and Epinephrine
May cause increased HR (EMT MEDICATIONS)
Albuterol via SVN & MDI and Epinephrine
Side effects include anxious/jittery feeling (EMT MEDICATIONS)
Albuterol via SVN & MDI and Epinephrine
Chest pain described as tearing, unequal right/left BPs
Aortic Dissection
162 to 324 mg per dose (EMT MEDICATIONS)
Aspirin
Contraindicated if patient has bleeding stomach ulcers (EMT MEDICATIONS)
Aspirin
Decreases adhesion of platelets (EMT MEDICATIONS)
Aspirin
Should be chewed before it is swallowed (EMT MEDICATIONS)
Aspirin
Respiratory distress with wheezing, no rash/itching
Asthma
Is an asthmatic patient getting better or worse when their breathing becomes less labored and their wheezing is louder after an albuterol treatment?
Better
Absence Seizure
Blank stare, lasts few seconds, chewing/blinking, mostly children
Type 1 DM
Body does not make insulin, must inject insulin daily
Syncope
Brief LOC with immediate return to baseline when supine "fainting"
Rales or Crackles
Bubbling/crackling lung sounds caused by fluid in alveoli
S/S of Acute Coronary Syndrome? (ACS)
Chest Discomfort, SOB, N/V, Skin pale/cool/diaphoretic, anxiety, feeling of impending doom, high/low/ BP
Physical Causes of Altered Mental Status
CVA, Seizures, Overdose, Blood Sugar, Trauma
Febrile Seizure
Caused by rapid spike in fever, children 6 months to 6 years
Type 2 DM
Cells resist insulin, treated with oral meds/exercise/diet
Stable Angina
Chest discomfort increases with exertion, no death of tissue
Myocardial Infarction
Chest discomfort not relieved by rest, causes death of tissue
Rhonchi
Coarse rattling lung sounds caused by thick secretions
Chest pain with pulmonary/pedal edema, crackles, JVD
Congestive Heart Failure
Grand Mal Seizures
Convulsions, whole body, symmetric, followed by postictal period
Fruity breath, deep regular Kussmaul respirations
Diabetic Ketoacidosis
List 3 classes of people who often have "atypical" presentations of ACS (acute coronary syndrome):
Diabetics, women, and elderly
Cystic Fibrosis
Disease that causes thick sticky mucus in air passages/GI tract
Barrel chest, chronic dyspnea, long smoking history
Emphysema
Administered via intramuscular route (EMT MEDICATIONS)
Epinephrine
Constricts blood vessels (EMT MEDICATIONS)
Epinephrine
Indicated for anaphylactic shock (EMT MEDICATIONS)
Epinephrine
Requires sharps container for disposal after use (EMT MEDICATIONS)
Epinephrine
Stimulates four receptors: alpha 1, alpha 2, beta 1, beta 2 (EMT MEDICATIONS)
Epinephrine
0.3 mg per dose (EMT MEDICATIONS)
Epinephrine (adult dose)
Name the 3 parts to the Cincinnati Pre-hospital Stroke Scale (CPSS), and describe how you would test each part:
Facial Droop, Arm Drift, & Impaired Speech
(True/False) If a patient only demonstrates one of the three elements of the Cincinnati Pre-Hospital Stroke Scale, then the stroke scale is negative and that patient is not at risk for stroke.
False (one or more positive findings is a good indicator of a stroke)
(True/False) If your patient is suffering from status epilepticus, you should wait on scene for all seizure activity to stop before transporting.
False (you need to rapid transport and early ALS intercept)
How can an EMT field test for Arm Drift?
Have pt close eyes and hold hands directly in front of them for 10 seconds and watch for single arm drifting
How can an EMT field test for impaired speech?
Have pt repeat familiar sayings (ei. "you can't teach an old dog new tricks") and listen for wrong, slurred, or missing words.
How can an EMT field test for facial droop?
Have pt smile and/or show teeth
Sudden onset AMS, severe headache, N/V, rapid decline
Hemorrhagic Stroke
Wheezes
High-pitched whistling lung sounds due to bronchoconstriction
Insulin
Hormone that enables glucose to enter the cell
Polyuria, polydipsia, polyphagia, weak, dizzy
Hyperglycemia
Rapid onset confusion, skin cool/moist, type 1 diabetic
Hypoglycemia
Sudden onset slurred speech, confusion, arm drift
Ischemic Stroke
List two types of CVA (stroke):
Ischemic and Hemorrhagic
Chest pain, crackles, no JVD or pedal edema
Left-sided heart failure
Hypoglycemia
Low blood sugar
Indicated sublingually for cardiac chest pain/discomfort
Nitroglycerin Tablet/Spray
Maximum is 3 doses without online medical direction (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Often causes headache as side effect (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Severe localized headache, photosensitivity, nausea
Migraine Head Ache
Also comes in spray application administered SL (EMT MEDICATIONS)
Nitroglycerin Spray
0.4 mg per dose (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Contraindicated if ED medication taken in previous 48 hours (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Contraindicated with systolic blood pressure below 90 mmHg (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Dilates blood vessels which decrease workload on the heart (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
Indicated for cardiac chest pain or discomfort (EMT MEDICATIONS)
Nitroglycerin Tablet/Spray
What are the general steps for any med administration?
Obtain order from medical control If needed (when in doubt call medical control, describe what you want and why) ● Repeat the order back/verify ● Select proper drug, check label ● Explain to the Pt what you are doing and why (consent) ●Question the Pt about allergies (again) and prior use of the drug ●Check the medication for impurities (floaties, leaks, discoloration) ●Recheck the medication label and date ●Prep the drug for admin. (explain to your Pt what you will do, demonstrate on yourself) ●Recheck label and date for 3rd time ●Administer ●Dispose equipment ●Monitor Pt for changes
What is the difference between an Ischemic Stroke and a Hemorrhagic Stroke?
One is an obstructed blood vessel and the other occurs when a weakened blood vessel ruptures.
Glucose
Only energy source the brain can use
What do Beta 2 Medications do?
Opens/dilates the small airways (bronchioles)
15 grams per tube (EMT MEDICATIONS)
Oral Glucose
Indicated for low blood sugar (EMT MEDICATIONS)
Oral Glucose
Expiration
Passive part of respiratory cycle, requires little or no energy
Complex Partial Seizure
Patient awake but not aware, chewing/lip smacking, 1-2 min
Slow onset of cough, green sputum, localized chest pain
Pneumonia
Sharp chest pain with decreased lung sounds same side
Pneumothorax
Sudden SOB, CP varies with inspiration, recent surgery
Pulmonary Embolism
Postictal State
Recovery period after convulsions, disoriented/lethargic
CPAP
Reduces work of breathing by pushing fluid out of alveoli
CP with pedal edema and JVD but no crackles
Right-sided heart failure
Status Epilepticus
SZ lasts > 5 minutes, or 2 or more SZs in a row w/o return of consciousness
Bitten tongue, convulsions, incontinence
Seizure
Simple Partial Seizure
Single body part and one side of brain involved, no AMS/LOC
Seizure lasting longer than 5 minutes
Status Epilepticus
What does acronym CVA indicate?
Stroke
(True/False) Hyperglycemia from HHNS does not cause fruity acetone breath or deep Kussmaul respirations because there is minimal lactic acid build up. The main problem is dehydration.
True
(True/False) If a patient takes their insulin and does not eat, you would expect their blood sugar to be low.
True
(True/False) If your ACS patient has chest discomfort but no SOB and an SpO2 of 94%, you should not administer O2.
True (free radicals from over oxygenation may explode cells in the brain.... not good)
Onset of chest pain while at rest, gone in 10 minutes
Unstable Angina
Two Forms of Acute Coronary Syndrome
Unstable Angina and Acute Myocardial Infarction
Aura
Unusual vision/smell/taste/feeling, signals upcoming seizure
Transient LOC while straining on toilet
Vasovagal Faint
Is an asthmatic patient getting better or worse when their breathing becomes more labored and their lung sounds decrease after an albuterol treatment?
Worse
Treatment for chest discomfort from ACS?
calm/reassure O2 Aspirin 324mg chewed Nitroglycerin 0.4 mg SL spray/pill ALS intercept Rapid Transport
treatment for altered mental status
calm/reassure establish rapport address physical causes O2 PRN VS PRN Transport: Lack of decisional capacity or suicidal ideation.
What is the most common cause of Hemorrhagic Stroke?
uncontrolled hypertension (high blood pressure)
How do you assess chest discomfort
visualize the chest: pacemaker, scars, etc. auscultate BBS Palpate chest wall: reproducible pain Assess JVD Assess pedal edema