Exam #4

If we suspect a patient has a life-threatening opiate overdose, what intervention should we be performing first?

, prepare to give Nasal airway and BVM

At what stage in the patient assessment is the priority transport decision made

ABCs

What physical signs indicate a patient is in severe respiratory distress?

Accessory muscle and JVD

What is "AMI" and how does it differ from ACS?

Acute myocardial infarction, needs cath lab and is life threatening.

Describe the mechanism of aspirin and how it helps patients in a heart attack.

Antiplatelet medicine - Vasodilator and brings more blood back to the heart

What is the purpose of defibrillation?

Convert deadly rhythm to a non-deadly rhythm

What is the most common reason people with AMI (a heart attack) do not seek medical attention?

DENIAL

In patients with a history of heavy alcohol use or abuse, what life-threatening condition can occur if suddenly attempting to quit drinking?

DT/delirium tremens- sizieurs, tremors, hallucinations, tachy, irritability

What are the dangers in administering naloxone? Why must we titrate the administration to effect?

Dont want it to drip, takes off high and makes people mad their high was destroyed

Describe the difference between early and late signs of hepatitis. Why do some of the early signs make hepatitis so difficult to notice or detect? Which late and highly visible sign is unique to hepatitis and ailments of the liver?

Early- loss appetite, weakness/fatigue, fever, itching, sore throat, cough, vomiting, could be anything and is too vague Late- jaundice, RUQ pain

In patients who have signs and symptoms of anaphylaxis (remember - multisystemic), which drug should ALWAYS be given first/is most important? Why?

Epinephrine. Bronchodilator = histamine antidote It counteracts the vasodilation effect of anaphylaxis; decreases swelling

What is one of the most high-risk locations for acquiring MRSA?

Healthcare setting, sicker the unit the sicker the pt will be

Why might patients who hyperventilate experience pain or numbness and tingling in their hands and feet? What is the treatment for these patients?

Hyperventilation decreases CO2, which leads to vasoconstriction of extremities → less blood flow = numbness / tingling Coach down to get CO2 levels back up

Why might you have increased concern about internal bleeding in a trauma patient with a history of prolonged alcohol abuse?

Inability to clout if alcohol abuse because of clotting cascade

What makes opiate overdoses lethal? What is the only appropriate indication that naloxone should be given in a suspected overdose?

Irritable, any signs and symptoms with withdrawal

When an AED states "no shock advised" when analyzing a patient during a pause in CPR, what does this mean?

It means they are not in a deadly rhythm and dont need to have their rhythm adjusted Rules out V-fib

Describe unique medical emergencies which require transport to specialized resource hospitals.

MI, stroke, trauma

What is "ACS" (acute coronary syndrome) used to describe? Is a heart attack included in this

Main causes of cardiac-related chest pain; ACS includes unstable angina and acute myocardial infarction (AMI). Two types of AMI are STEMI (most severe & is seen on EKG), and non-STEMI (not seen on EKG; is detected by Troponin levels via blood test).

How should you administer intranasal naloxone (between nostrils?) Is it administered by mL or mg? What is the maximum amount of fluid per nostril?

Mg, 1 mL per nostril initial max (can repeat after 5 minutes, total max 2mL)

What is a MAD device

Mucosal atomization device - Turns to mist to reach CSF

Which type of airway adjunct should you place (OPA/NPA) if managing an airway in a narcotic overdose? Why?

NPA, can become conscious and then no puke on OPA

What is "pleuritic chest pain?" What can this often indicate in patients with coughing and unilateral decreases in breath sounds if they have a history of lung disease?

Non-cardiac (pleuritic relates to lungs); worsens with deep breaths One sided coughing, changes in lung sounds on one side Sign of spontaneous pneumothorax

Is chest pain in AMI reproducible or easily provoked? Describe common signs and symptoms of AMI.

Not changeable Short of breath, nausea/vomiting for women, gas pressure, change in color, and diaphoresis

Know what types of drugs hydrocodone, oxycodone, codeine, and methadone are, and what effects they would have on an overdose.

Opioids. Methadone and hydrocodone, oxycodone, codeine. OD → respiratory arrest

What must you do after administering any medication in terms of evaluation

Recheck vitals and secondary and primary

What are the three leading chief complaints of a pulmonary embolism? What are some of the main risk factors?

Shortness of breath, chest pain, fatigue Blood clot in the lungs Risk factors: prolonged bed rest, smoking, and sometimes certain contraceptives

Know the differences between common illicit and prescription drugs and which ones have a stimulant effect vs a depressant or narcotic effect.

Stimulant (sympathomimetics) - or amphetamine, MDMA, or coke Depressant-alcohol, opiates Sedative-Hypnotic - barbiturates, benzodiazepines

What is a difference between the pain present in angina vs the chest pain in AMI? (hint: think "P" in OPQRST!)

The difference is that AMI-constant pain whereas Angina-can get better with rest / nitroglycerin (NTG)

We frequently see repeat patients in EMS. Why must we avoid making assumptions about, or downplaying the nature of a patient complaints, even if their history is familiar?

This time could be different, could have underlying issues

Define "infectious disease."

Within the body, disease is the more important part, organism within the body

What effect do Tylenol (acetaminophen) overdoses have on the body that makes them so deadly?

acute liver failure

Describe signs and symptoms associated with delirium tremens. What causes this condition

alcohol wtihdrawl

he slideshow from Toxicology notes a drug called "Calcium Channel Blockers," the most common of which is amlodipine, which can treat high blood pressure and other issues. This, in addition to "-statin" drugs (prescribed for high cholesterol) suggest your patient has medical history impacting which major organ or body system?

amidipile=most common Ca2+ blocker, for higher BP statin=high cholesterol drug Pt with cardiac history

What is the first step you should take when decontaminating a patient with a dry chemical or dry powder exposure?

brush off before getting wet

Unlike traumatic injuries, which can be highly visible, what is the danger of many medical injuries or complaints in terms of their severity?

cant see them

During assessment, what is the best way to determine the nature of a patient's illness

chief complaint

How do you medically manage a patient who is tachycardic, hypertensive, and agitated or anxious with rapid respirations?

coach them down

If you need to administer a medication but are unable to reach medical control, and the patient is in severe distress, what should you do?

give it anyway

What scene safety/personal safety measures must you take in a patient who has been poisoned via the absorption route?

keep off self

Is epinephrine an artificial or natural substance in the body? What two lifesaving effects does it have on thebody in anaphylaxis? How will it impact vital signs?

natural, vasoconstriction, increase BP and open airway=bronchodilator

If concerned about loss of motor function or changes in pupillary response, what body system is most likely affected?

nero

In patients who have an LVAD, what clinical findings may be absent upon assessment? Why?

no pulse or BP

hy does learning a patient's medical history often help reveal the underlying problem

not breathing, only give narcan if having severe respiratory distress

Through which route do most poisonings occur?

oral or ingested

What is the leading cause of death from AMI

v-fib

What is the mechanism of nitroglycerin in patients with cardiac chest pain? In other words, if it helps reduce their pain, what action is the nitro taking on the body to help relieve it?

vasodilator, relaxes coronary arteries

Describe signs or symptoms which make airborne or droplet diseases likely to spread (e.g. produce the smallest or farthest-traveling contagious particles)

wheezing or coughing