Semester 2 Final

In which of the following stroke screening methods is arm drift one of the screening criteria?

- Both the Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen

It is the middle of winter and you are called to a scene for a "sick family." The husband meets you at the road complaining of a severe headache. He returned home from work this morning and found his wife and two children drowsy and lying on the coach complaining of nausea/vomiting and headaches. He developed his headache only after entering the residence. What would you suspect in this case?

- Carbon monoxide poisoning

Which of the following is one of the listed considerations on the Los Angeles Prehospital Stroke Screen?

- Duration of signs and symptoms less than 24 hours

Which of the following stroke screening methods relies on speech as one of the screening criteria?

- The Cincinnati Prehospital Stroke Scale

You are evaluating a 52-year-old male complaining of facial drooping on his right side upon awakening this morning. You have established that he has no prior medical history vital signs were all within normal ranges and his blood glucose level was 98 mg/dL. You have determined that he has right-sided facial droop equal grip and equal arm drift. What screening result would you determine according to the Los Angeles Prehospital Stroke Screen (LAPSS) assessment?

- The screening criteria were not met

You are evaluating a 52-year-old male complaining of facial drooping on his left side upon awakening this morning. You have established that he has no prior medical history vital signs were all within normal ranges and his blood glucose level was 98. You have determined that he has left-sided facial droop is slurring his words slightly has equal grip and has equal arm drift. What screening result would you determine according to the Cincinnati Prehospital Stroke Scale?

- There is a 72 percent or higher probability of an ischemic stroke.

Which type of stroke often occurs at night and is characterized by a patient awakening with altered mental status and/or loss of speech sensory or motor function?

- Thrombotic stroke

Migraine headaches fall into which of the following categories?

- Vascular

A brain abscess can be described as:

-a localized collection of pus in the brain

carbon monoxide poisoning

-carbon monoxide binds with hemoglobin and reduces oxygen supply to tissues -cannot be seen. smelled, or tasted -s/s include: nausea, vomiting, headache, weakness, and unconsciousness -death may occur with prolonged exposure -prevention by ensuring proper ventilation when using fuel-burning devices -gas-burning devices should be inspected annually -flues and chimneys should be unobstructed -carbon monoxide detectors should be installed and inspected regularly

Deficient adrenocortical activity results in which of the following?

Addison's disease

Syncope causes

Cardiovascular conditions, such as arrhythmias or mechanical problems—A heart rate that is too fast or too slow, or an abnormally functioning heart valve, may trigger hypoxia in the brain and subsequent fainting. Hypovolemia, a decrease in total body fluid volume—This can cause syncope, especially when the patient moves from a seated or supine position to a standing position (orthostatic or positional syncope). Noncardiovascular disease, such as metabolic, neurologic, or psychiatric conditions—Hypoglycemia, a transient ischemic attack, or an anxiety attack can cause syncope. Idiopathic, or unknown, cause—Often, the cause of a patient's syncope remains unknown despite careful assessment and diagnostic tests.

Bell's Palsy

Caused by infection (possibly herpes simplex virus) and effects seventh cranial "facial nerve"

Leukotrienes

Chemical substances that contribute to anaphylaxis; released by the immune system in allergic reactions.

Addison's cardiac response

Can cause electrolyte imbalance and low blood volume causing arrhythmias

You have a patient that was rescued from a​ burning, smoke-filled home and shows a SpCO reading of 28 percent. He is unconscious and you have to make a transport decision. Which of the following facilities is the most​ appropriate?

Closest hospital with a hyperbaric chamber

Which statement is accurate concerning a patient involved in a rollover​ accident? A. Secondary collisions are unlikely. B. Patient survival is higher if they are thrown clear of the vehicle. C. Injuries from rollover crashes are more easily predictable than other impact types. D. Multisystem trauma is common in rollover​ crashes, even if the patient is restrained.

D. Multisystem trauma is common in rollover​ crashes, even if the patient is restrained.

What is the first sign that can reliably be attributed to a state of hypovolemic​ shock? A. Pale skin B. Increasing pulse rate C. Thirst D. Narrowing pulse pressure

D. Narrowing pulse pressure

Which of the following can result in hemorrhagic​ shock? A. Plasma loss from significant burns B. Diarrhea C. Fluid and electrolyte loss due to protracted vomiting D. Significant blood loss

D. Significant blood loss

What is the neurologic condition characterized by a​ sudden, temporary loss of consciousness that can be caused by​ hypovolemia, hypoglycemia, a heart​ arrhythmia, and/or​ TIA? A. Neuralgia B. Neoplasm C. Uremia D. Syncope

D. Syncope

What is a zone of​ injury? A. The area of swelling surrounding a compartment injury B. Physical contact with the bullet and its movement that creates a temporary cavity that​ crushes, stretches, and tears the affected tissues C. The area of laceration associated with a puncture wound D. The area of​ crushed, torn, and contused tissue that does not function​ normally, which surrounds a projectile wound

D. The area of​ crushed, torn, and contused tissue that does not function​ normally, which surrounds a projectile wound

As you question a patient who has recovered from a complex partial​ seizure, which of the following is he likely to​ mention? A. His jaw aches quite a bit due to uncontrollable clenching. B. He changed his shorts prior to your arrival because he wet himself. C. All of a​ sudden, just his right leg started to jerk violently. D. The patient has a very bad metallic taste in his mouth.

D. The patient has a very bad metallic taste in his mouth.

What is the unsteady wobble that a bullet develops when​ deflected? A. Cavitation B. Rotation C. Rifling D. Yaw

D. Yaw

Inhalation of a toxic substance deliberately distributed by an explosion would be​ considered: A. a tertiary blast injury. B. an unrelated blast injury. C. a terrorism injury. D. a quarternary blast injury.

D. a quarternary blast injury.

The use of a properly adjusted headrest during a rear​ collision: A. allows slow deceleration of the head. B. minimizes the need to use a cervical collar. C. keeps the head from moving and promotes rotation. D. accelerates the head at the same speed as the body.

D. accelerates the head at the same speed as the body.

A shallow diving accident may result in compression force on the cervical spine known​ as: A. a pressure wave. B. epistaxis. C. blast overpressure. D. axial loading.

D. axial loading.

Two specific injury mechanisms can cause energy transfer to the pulmonary tissue and result in pulmonary​ contusions, of which the more common​ is: A. puncture of the chest wall. B. the pressure wave from a​ high-velocity bullet. C. the pressure wave from an explosion. D. deceleration.

D. deceleration.

Your auto accident victim is alert and​ oriented, has no obvious injuries other than a tender​ abdomen, and displays vital signs of pulse​ 100, respirations​ 24/deep, and blood pressure​ 110/84; her skin is​ cool, slightly​ pale, and clammy. She appears anxious and​ restless, and she complains of being thirsty. You​ suspect: A. digestive system injury. B. prolonged epistaxis. C. lower respiratory injuries. D. internal bleeding.

D. internal bleeding.

The most common and serious explosion injuries​ are: A. severe lacerations. B. oxidation. C. head injuries. D. pulmonary injuries.

D. pulmonary injuries.

Supplemental restraint systems​ (SRS) produce a cushion to absorb the energy exchange​ of: A. the force of the impact. B. kinetic energy. C. rapid acceleration. D. rapid deceleration.

D. rapid deceleration.

In a motor vehicle​ collision, the impacts on victims from other objects within the passenger compartment are​ called: A. additional impacts. B. body collisions. C. deceleration impacts. D. secondary collisions.

D. secondary collisions.

The term​ "force" as it relates to penetrating injuries can be practically defined​ as: A. ​Newton's first law of motion. B. the change in mass of a penetrating object on impact. C. the mass transferred to the​ "target" on impact. D. the rate of deceleration of a penetrating object on impact.

D. the rate of deceleration of a penetrating object on impact.

Fluid overload in the geriatric patient is a risk of treating shock​ because: A. their spleen is likely removed. B. they have reduced interstitial flexibility. C. their kidneys store additional fluids. D. their system cannot accommodate large fluctuations in fluid reserves.

D. their system cannot accommodate large fluctuations in fluid reserves

Which of the following nonstroke disorders could result in a​ "probability of ischemic​ stroke" according to the Cincinnati Prehospital Stroke​ Scale? A. amyotrophic lateral sclerosis​ (ALS) B. ​Guillain-Barré syndrome C. Myoclonus D. ​Bell's palsy

D. ​Bell's palsy

While monitoring the victim of a brain injury during the secondary​ assessment, you should be especially watchful​ for: A. narrowing pulse pressure. B. a rising GCS. C. tachycardia. D. ​Cushing's triad.

D. ​Cushing's triad.

Because of pressure that builds within the tissue or fascia during internal​ hemorrhage, most internal bleeding is said to​ be: A. always critical. B. unimportant. C. almost always fatal. D. ​self-limiting.

D. ​self-limiting.

What disorder is caused by inadequate ADH secretion relative to blood volume?

Diabetes insipidus

What is the autoimmune disease process that is due to an excessive amount of circulating thyroid hormone and is six times more common in women?

Graves' disease

Graves' disease

Graves' disease has an autoimmune origin. Autoantibodies are generated that stimulate thyroid tissue to produce excessive amounts of thyroid hormones. The resultant changes in organ function are either responses to excess thyroid hormones or responses to the autoantibodies themselves.

During your primary assessment of a patient, you note that the patient has "bulging" eyes and a large tumor looking structure on the anterior neck. The most likely diagnosis would include:

Graves' disease.

Alzheimer's Disease

Most common cause of dementia. Results from death and disappearance of nerve cells in the cerebral cortex. This causes marked atrophy of the brain.

Amyoptrophic Lateral Sclerosis (ALS)

Lou Gehrig's disease, is a progressive degeneration of specific nerve cells that control voluntary movement. Characterized by weakness, loss of motor control, difficulty speaking, and cramping, the disease eventually weakens the diaphragm, which leads to breathing problems. ALS belongs to a class of disorders known as motor neuron diseases. It affects 20,000 Americans, with 5,000 new cases being reported each year.

dehydration

Mild volume depletion (dehydration) can cause both weakness and dizziness

Multiple Sclerosis (MS)

disease of the central nervous system characterized by the demyelination (deterioration of the myelin sheath) of nerve fibers, with episodes of neurologic dysfunction (exacerbation) followed by recovery (remission)

TMJ syndrome

dysfunction of the temporomandibular joint

Which chemical mediates the autonomic nervous system?

epinephrine and norepinephrine (adrenal gland)

muscular dystrophy (MD)

group of hereditary diseases characterized by degeneration of muscle and weakness

Diabetic neuropathy

happens when high levels of sugar in the blood damage the nerves in the body.

Thymus

in the mediastinum just behind the sternum. Although the thymus is usually considered a lymphatic organ on the basis of its anatomy, its most important function is as an endocrine gland.

parathyroid hormone (PTH)

increases blood calcium levels

hyperglycemia

Similarly, a blood glucose level higher than that expected shortly after a meal (often defined as greater than 140 mg/dL when drawn in a setting other than directly following a meal) reflects hyperglycemia, or high blood sugar. Signs and Symptoms of Hypersmolar Hyperglycemic state: Polyuria, polydipsia, polyphasia, Warm and dry skin, Orthostatic hypotension, Tachycardia, AMS or coma

You are managing a patient with suspected CO poisoning from using a kerosene heater in his home during a cold winter night. What is the lowest SpCO reading considered to be objective for initiating treatment for the​ exposure?

SpCO​ >10 percent

GCS Eye Opening Response

Spontaneously 4 To speech 3 To pain 2 No response 1

What is the mechanism of glucagon?

Stimulates breakdown of glycogen

hyperglycemia and kidney function

Sustained hyperglycemia causes osmotic diuresis sufficient to produce marked dehydration, and water intake is inadequate to replace lost fluids.

Cerebellum

The cerebellum is located in the posterior fossa of the cranial cavity. It consists of two hemispheres closely related to the brainstem and higher centers. The cerebellum coordinates fine motor movement, posture, equilibrium, and muscle tone.

Cerebrum

The cerebrum is in the anterior and middle area of the cranium. Containing two hemispheres, it is joined by a structure called the corpus callosum. The cerebrum governs all sensory and motor actions. It is the seat of intelligence, learning, analysis, memory, and language. The cerebral cortex is the outermost layer of the cerebrum.

peripheral vascular resistance

The force exerted against the blood flow and is determined by the diameter of the vessel. The lower the vascular resistance the less force is needed to eject the blood out of the heart during systole.

poliomyelitis

inflammation of the gray matter of the spinal cord caused by a virus, commonly resulting in spinal and muscle deformity and paralysis

Kussmaul's respirations

rapid deep respirations caused by severe metabolic and CNS problems.

Afterload

resistance against which the ventricle must contract

Guillain-Barre syndrome

autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness

cauda equina syndrome

condition caused by significant narrowing of the spinal canal that compresses the nerve roots below the level of the spinal cord, causing back pain, leg pain, numbness in the groin or perineal region, and bowel and bladder disturbances, as well as diminished reflexes, muscle weakness, and loss of sensation in the lower extremities.

hemoptysis

cough up bright red blood

peripheral neuropathy

damage to nerves in lower legs and hands as result of diabetes mellitus; symptoms include either extreme sensitivity or numbness and tingling

partial seizures

seizures that remain confined to a limited portion of the brain, causing localized malfunction. Partial seizures may spread and become generalized.

The two requirements for insulin effectiveness include:

sufficient insulin circulating in the bloodstream and able to bind to body cells.

diving injuries

when the patient's head strikes a lake or pool bottom, the rest of the body compresses the cervical spine between the head and shoulders. This axial loading can crush the vertebral bodies, injure the spinal cord, and paralyze the patient

parasympathetic nervous system

"feed-or-breed" system, is responsible for controlling vegetative functions, such as normal heart rate and blood pressure. Associated with the cranial nerves and the sacral plexus, it is mediated by the neurotransmitter acetylcholine. When stimulated, it causes a decrease in heart rate, an increase in digestive activity, pupillary constriction, and a reduction in blood glucose.

sympathetic nervous system

"fight-or-flight" system, prepares the body for stressful situations. It is located near the thoracic and lumbar parts of the spinal cord. Stimulation causes increased heart rate and blood pressure, pupillary dilation, a rise in the blood sugar, as well as bronchodilation.

Aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure

What percentage of the body's total blood flow per minute does the brain receive?

-20%

What is a brief generalized seizure that usually presents with a 10-30 second loss of consciousness eye fluttering and an occasional loss of muscle tone?

-Absence seizure

Cauda equina syndrome has been shown to be caused by:

-All of the above are potential causes.

What is the abnormal breathing pattern characterized by prolonged inspiration unrelieved by expiration attempts?

-Apneustic respirations

What is a common etiology underlying abnormal breathing patterns such as Cheyne-Stokes or central neurogenic hyperventilation?

-CNS illness or Injury

If there is no indication of injury how should you position your patient after the tonic-clonic phase of a seizure?

-On her left side

All of the following are predisposing factors to stroke EXCEPT:

-Parkinson's disease

You are called to a church where an elderly female was reported to have a sudden temporary loss of consciousness. While en route to the scene dispatch advises the patient is now awake and talking. Bystanders at the scene described a return of consciousness almost immediately after laying patient supine on the floor. Which of the following are you most likely suspecting?

-Syncope

GCS mild

13-15

GCS motor response

6-Obeys commands 5-Localizes 4-Withdraws 3-Abnormal flexion (decorticate) 2-Extension response (decerebrate) 1-None

GCS severe brain injury

8 or less

The connective strength and elasticity of tissue influence how much tissue damage occurs with kinetic energy​ transfer; this strength and elasticity is​ called: A. memory. B. recovery. C. resiliency. D. healing.

C. resiliency.

GCS moderate

9-12

You are called to the scene of a​ 68-year-old female patient. The family told your dispatcher that she was​ "breathing but​ wouldn't wake​ up." On your arrival you find the patient lying in bed with sonorous respirations and decorticate posturing. What is your initial​ concern? A. Airway maintenance B. Blood glucose reading C. Patient history D. Rapid transport

A Airway Maintenance

Which of the following is the third most common cause of death​ and, in​ middle-aged and older​ patients, is a frequent cause of disability each year in the​ U.S.? A. Stroke B. Neoplasm C. Seizures D. ​Parkinson's

A Stroke

hypoglycemia

A blood glucose level lower than baseline (often defined as less than 80 mg/dL) reflects hypoglycemia, or low blood sugar Signs and symptoms: Weak and rapid pulse, cold and clammy skin, weakness, headache, irritability, agitated behavior, decreased mental function, bizarre behavior, coma

Thrombotic strokes (Type of Ischemic)

A cerebral thrombus is a blood clot that gradually develops in and obstructs a cerebral artery. As a person ages, atheromatous plaque deposits can form on the inner walls of arteries. The buildup causes a narrowing of the arteries and reduces the amount of blood that can flow through them. This process is known as atherosclerosis. Once the arteries are narrowed, platelets adhere to the roughened surface and can create a blood clot that blocks the blood flow through the cerebral artery. This ultimately results in brain tissue death. Unlike the embolic stroke, the signs and symptoms of thrombotic stroke develop gradually. This type of stroke often occurs at night and is characterized by a patient awakening with altered mental status and/or loss of speech, sensory, or motor function.

Norepinephrine

A neurotransmitter involved in arousal, as well as in learning and mood regulation

How is the consumption of alcohol most likely to affect the​ body's compensation mechanisms for shock due to​ hemorrhage? A. Alcohol depresses the central nervous system and dilates peripheral vessels. B. Alcohol slows cellular metabolism and increases the ATP available for anaerobic metabolism. C. Alcohol can increase the likelihood of injury. D. Alcohol decreases the pain response from injury.

A. Alcohol depresses the central nervous system and dilates peripheral vessels.

What does the increasing heart rate mean for the patient who has entered into the phase of decompensated​ shock? A. Clinically nothing B. A reflex increase in the level of consciousness C. Continued maintenance of blood pressure D. Continued perfusion of only the most critical organs

A. Clinically nothing

What does​ Newton's second law of motion​ quantify? A. Deceleration B. Inertia C. Volume D. Energy conservation

A. Deceleration

Which of the following is a complication of type 2 diabetes due to sustained hyperglycemia and water intake that is inadequate to replace lost​ fluids? A. HHS B. TSH C. DKA D. PRL

A. HHS

You respond to the scene of an explosion to treat a victim with a penetrating injury to the occipital area from shrapnel. For which additional injury should you have a high level of​ suspicion? A. Hyperflexion of the cervical spine B. Axial stress on the cervical spine C. Hyperextension of the cervical spine D. Distraction of the cervical spine

A. Hyperflexion of the cervical spine

What best describes how​ Newton's first law of motion applies to penetrating​ trauma? A. It explains both how a projectile delivers its energy to an object and how that object reacts to being impacted. B. It explains how a projectile delivers​ it's mass to an object. C. It explains kinetic energy. D. It explains the trajectory at work during a collision.

A. It explains both how a projectile delivers its energy to an object and how that object reacts to being impacted.

The law of inertia and the law of energy conservation are the two basic principles of what​ concept? A. Kinetics B. Force C. Mass D. Velocity

A. Kinetics

You are called to examine a​ middle-aged female patient. She is not responsive to verbal​ commands, but tries to withdraw from and brush away painful stimulus. As you perform a physical​ exam, you find an insulin pump attached to her. Among the following possible​ causes, which one would be least​ likely? A. Metabolic alkalosis B. Hyperglycemia C. Metabolic acidosis D. Hypoglycemia

A. Metabolic alkalosis

Which type of shock results from spinal cord​ damage? A. Neurogenic B. Cardiogenic C. Anaphylactic D. Septic

A. Neurogenic

In which type of collision does the occupant contact the​ vehicle's interior​ and/or restraints and slow or​ stop? A. Organ collision B. Body collision C. Secondary collision D. Additional collisions

A. Organ collision

Injuries received by being struck with projectiles in an explosion are​ considered: A. Secondary injuries B. Primary injuries C. Tertiary injuries D. Quaternary injuries

A. Secondary injuries

What could be an early indicator of internal bleeding requiring intervention as part of your treatment​ plan? A. Signs of poor peripheral perfusion B. ​Cheyne-Stokes respirations C. Dropping blood pressure D. Sluggish pupils

A. Signs of poor peripheral perfusion

Which definition best defines kinetic​ energy? A. The energy of an object in motion B. Inertia of energy C. Force of motion D. The energy delivered during deceleration

A. The energy of an object in motion

Which of the following is true regarding fragmenting ballistic​ rounds? A. They increase in profile and damage potential. B. They carry more kinetic energy than​ non-fragmenting rounds of similar mass and speed. C. They decrease in profile and damage potential. D. They decrease in profile but increase in damage potential.

A. They increase in profile and damage potential.

What affects the amount of energy delivered by a projectile to the tissue it​ impacts? A. Trajectory B. Centrifugal force C. Compounding D. Acceleration

A. Trajectory

​Hematemesis, an indicator of internal​ bleeding, may present with the appearance​ of: A. coffee grounds. B. hematochezia. C. epistaxis. D. black tarry stool.

A. coffee grounds.

In​ trauma, the loss of enough blood volume that it causes death is known​ as: A. exsanguination. B. hypovolemia. C. circulatory collapse. D. hemorrhagic shock.

A. exsanguination.

When differentiating hyperglycemia from​ hypoglycemia, a notable difference when gathering history​ is: A. hypoglycemia can develop within minutes to an​ hour, while hyperglycemia may take hours to a day to manifest. B. hypoglycemia and hyperglycemia can both develop within minutes to an hour. C. hyperglycemia can develop within minutes to an​ hour, while hypoglycemia may take hours to a day to manifest. D. hyperglycemia is the result of​ ketosis, while hypoglycemia is a result of gluconeogenesis.

A. hypoglycemia can develop within minutes to an​ hour, while hyperglycemia may take hours to a day to manifest.

You respond to a shooting at a high​ school; the shooter has been​ apprehended, and law enforcement has certified the scene as safe. A​ 16-year-old patient presents with a​ small-caliber gunshot wound in the lower middle abdomen. The gunshot wound is small and not bleeding​ much, and there is no exit wound. This presentation suggests​ that: A. internal bleeding and possible organ damage should be suspected. B. the patient should receive a full physical exam. C. there is little to no internal bleeding. D. the​ patient's injury is minor and​ self-contained.

A. internal bleeding and possible organ damage should be suspected.

Characteristics that distinguish whether a patient is suffering from hyperosmolar hyperglycemic state​ (HHS) and diabetic ketoacidosis​ (DKA) are: A. often difficult to distinguish in the prehospital context and should be treated the same. B. slow to develop and therefore serial blood glucose monitoring will reveal the underlying condition. C. subtle and require extensive​ on-scene assessment and treatments prior to transport. D. the result of too much insulin and can be resolved with administration of 50 percent dextrose.

A. often difficult to distinguish in the prehospital context and should be treated the same.

Immobilization of a closed long bone fracture​ may: A. reduce the volume of internal bleeding. B. increase the need for fluid administration. C. cause additional​ soft-tissue injury. D. result in nervous system damage.

A. reduce the volume of internal bleeding.

The two functional divisions of the autonomic nervous system are​ the: A. sympathetic and the parasympathetic. B. sensory and motor. C. central and peripheral. D. visceral and somatic

A. sympathetic and the parasympathetic.

Pressure waves from an explosion may concentrate energy and cause areas of increased mortality at a further distance than expected from the​ epicenter: A. when the explosion occurs in a confined space. B. when the blast occurs in an open area. C. when the explosion is in a populated area. D. if the blast is caused by a​ low-velocity explosive.

A. when the explosion occurs in a confined space.

How much blood loss can femur fractures account​ for? A. ​1,500 mL B. 500 mL C. 3 L D. 750 mL

A. ​1,500 mL

Radiation

Alpha radiation. The unstable atomic nucleus releases alpha radiation in the form of a small helium nucleus. Alpha radiation is a very weak energy source and can travel only inches through air. Paper or clothing can easily stop alpha radiation. This radiation also cannot penetrate the epidermis. On the subatomic scale, however, alpha particles are massive and can cause great damage over the short distance they travel. Alpha radiation is a significant hazard only if the patient inhales or ingests contaminated material, thus bringing the source in proximity to sensitive respiratory and digestive tract tissue. Beta radiation. A second type of radiologic process produces beta radiation. Its energy is greater than that of alpha radiation. However, the beta particle is relatively lightweight, with the mass of an electron. Beta radiation can travel 6 to 10 feet through air and can penetrate a few layers of clothing. Beta particles can invade the first few millimeters of skin and thus have the potential for causing external as well as internal injury. Gamma radiation. Gamma radiation, also known as X-rays, is the most powerful type of ionizing (atom-changing) radiation. It can travel through the entire body or ionize any atom within. Its lack of mass or charge (it is pure electromagnetic energy, or photons) helps give it great penetrating power. Gamma radiation evokes the greatest concern for external exposure. It is the most dangerous and most feared type of radiation because it is difficult to protect against. Many feet of concrete or many inches of lead are needed to shield against the highest-energy gamma rays. Fortunately, exposure to high-energy gamma rays occurs only in individuals who are exposed to nuclear blasts, are near nuclear reactor cores, or are very close to highly radioactive materials. More modest amounts of concrete, steel, or lead can provide shielding from the more common and lower energy X-rays and gamma rays encountered in medicine and industry. Neutron radiation. Neutrons are small, yet moderately massive subatomic particles with no charge. Their small size and lack of charge account for their great penetrating power. Fortunately, strong neutron radiation is uncommon outside of nuclear reactors and bombs.

Embolic strokes (Type of Ischemic)

An embolus is a solid, liquid, or gaseous mass carried to a blood vessel from a remote site. The most common emboli are clots (thromboemboli) that usually arise from diseased blood vessels in the neck (carotid) or from abnormally contracting chambers in the heart. Atrial fibrillation often results in atrial dilation, a precursor to the formation of clots. Other types of emboli that may cause occlusion in cerebral blood vessels are air, tumor tissue, and fat. Embolic strokes occur suddenly and may be characterized by severe headaches.

Newton's First Law

An object at rest stays at rest and an object in motion stays in motion with the same speed and in the same direction unless acted upon by an unbalanced force.

The hormone that opposes the effects of the antidiuretic hormone (ADH) is:

Atrial natriuretic hormone (ANH).

Phases grand mal of seizure

Aura. An aura is a subjective sensation preceding seizure activity. The aura may precede the attack by several hours or by only a few seconds. An aura may be of a psychic or a sensory nature, with olfactory, visual, auditory, or taste hallucinations. Some common types include hearing noise or music, seeing floating lights, smelling unpleasant odors, feeling an unpleasant sensation in the stomach, or experiencing tingling or twitching in a specific body area. Not all seizures are preceded by an aura. Loss of consciousness. The patient will become unconscious at some point after the aura sensations, if any. Tonic phase. This is a phase of continuous muscle tension, characterized by contraction of the patient's muscles. Hypertonic phase. The patient experiences extreme muscular rigidity, including hyperextension of the back. Clonic phase. The patient experiences muscle spasms marked by rhythmic movements. The patient's jaw usually remains clenched, making airway management difficult. Post-seizure. The patient remains in a coma. Postictal. The patient may awaken confused and fatigued. He may complain of a headache and may experience some neurologic deficit. In many cases, patients will be in this postictal state when paramedic crews arrive. There may be evidence of incontinence, which supports the likelihood that seizure activity has taken place.

Your patient is postictal from a seizure. He opens his eyes to painful​ stimulation, makes incomprehensible​ sounds, and reaches away from the midline when a sternal rub is applied. What is his Glasgow Coma Scale​ value? A. 9 B. 5 C. 8 D. 7

B. 5

What is the study of projectiles in motion and their effects on objects they impact​ called? A. Trajectory B. Ballistics C. Biomechanics D. Penetrating trauma

B. Ballistics

During penetrating​ trauma, what causes damage to the object being penetrated​ (the target)? A. The need by the penetrating object to retain kinetic energy B. Conversion and absorption of the penetrating​ object's kinetic energy by the target C. The loss of friction D. A lack of opposing energy from the target

B. Conversion and absorption of the penetrating​ object's kinetic energy by the target

What is the stage of shock in which compensatory mechanisms begin to​ fail? A. Compensated B. Decompensated C. Hypovolemic D. Irreversible

B. Decompensated

What type of shock in the pediatric patient occurs when there is a marked decrease in peripheral vascular​ resistance? A. Hypovolemic B. Distributive C. Obstructive D. Cardiogenic

B. Distributive

Which of the following does not result in hypovolemic​ shock? A. Fluid and electrolyte loss due to protracted vomiting B. Introduction of a foregin substance into the body that causes a massive histamine release C. Plasma loss from significant burns D. Significant blood loss

B. Introduction of a foregin substance into the body that causes a massive histamine release

What condition exists when aggressive resuscitation restores blood pressure and pulse but organ failure continues​ unabated? A. Disseminated intravascular coagulation B. Irreversible shock C. Terminal hypoxia D. Compensatory failure

B. Irreversible shock

The energy of a body in constant motion is​ called: A. Impact B. Kinetic C. Potential D. Deceleration

B. Kinetic

The portion of the brainstem that is located between the diencephalon​ (interbrain) and the pons that is responsible for motor coordination and control of eye movement is which of the​ following? A. Pons B. Mesencephalon​ (midbrain) C. Cerebellum D. Medulla oblongata

B. Mesencephalon​ (midbrain)

A patient you are transporting because of a fall exhibits vital signs consistent with hypovolemic shock but also has​ warm, dry skin and is unable to move his extremities. Which of the following types of shock is he likely​ exhibiting? A. Cardiogenic B. Neurogenic C. Obstructive D. Anaphylactic

B. Neurogenic

What approximate portion of patients who experience a TIA is likely to soon after experience a​ stroke? A. ​Two-thirds B. ​One-quarter C. ​One-third D. ​One-half

C. ​One-third

Approximately​ 50,000 people are newly diagnosed in the United States each year with what nervous system​ disorder? A. Epilepsy B. Multiple sclerosis C. ​Parkinson's disease D. Stroke

C. ​Parkinson's disease

You are called to a residence for a 7yearold male subject not acting appropriately. On scene the patient appears to be unaware of your arrival and responsive to verbal stimuli from his mother.​ ABC's appear to be intact and no life threats are immediately present. The mother reports that the child was watching television and noticed the​ child's fingers began to twitch. As she continues to describe the course of events leading up to calling for​ EMS, the patient becomes unresponsive and exhibits hyperextension of the back. Which of the following describes the evolution of the​ patient's current​ condition? A. Pseudoseizure to post seizure B. Simple partial to​ tonic-clonic C. Grand mal to tonic D. Absence to complex partial

B. Simple partial to​ tonic-clonic

An explosion collapses a parking​ garage, crushing the legs of a​ bystander; what type of injury would this​ be? A. Quaternary B. Tertiary C. Primary D. Secondary

B. Tertiary

Which statement correctly applies to an underwater​ blast? A. The lack of free oxygen limits the lethal range of an underwater detonation. B. The density of water extends the lethal range of an explosion threefold. C. Injuries in underwater detonations are less serious because the density of water is similar to a person. D. The density of the water limits the lethal range of an underwater detonation.

B. The density of water extends the lethal range of an explosion threefold.

When a bullet comes to rest inside an​ organ, then: A. all the kinetic energy has been converted to mass. B. all the kinetic energy has been converted to other energy forms. C. gravity has overcome the inertia. D. the trajectory of the round was inadequate.

B. all the kinetic energy has been converted to other energy forms.

The most common form of shock associated with trauma is hemorrhagic​ shock, which occurs​ from: A. internal blood loss. B. blood loss from the vascular container. C. exsanguination. D. external blood loss.

B. blood loss from the vascular container.

High-energy penetrating wounds create a wound track much larger than the projectile size due to a phenomenon known​ as: A. compression. B. cavitation. C. deceleration. D. crepitus.

B. cavitation.

After securing the scene of a​ shooting, law enforcement instructs you to approach the scene. The male victim received a single penetrating gunshot to the head and is unconscious. You expect that the cavitational energy of the bullet has resulted​ in: A. a persistent vegetative state. B. extreme pressures within the skull. C. excessive blood loss. D. axial loading injury.

B. extreme pressures within the skull.

The formation of a hematoma is indicative​ of: A. external bleeding. B. internal bleeding. C. vascular insufficiency. D. edema.

B. internal bleeding.

Burn injuries associated with an explosion are​ typically: A. secondary to structural collapse. B. partial thickness. C. third degree. D. scalds.

B. partial thickness.

Cool and pale skin in the victim of hypovolemic shock is the result​ of: A. the release of angiotensin II. B. peripheral vasoconstriction. C. progressive shock. D. peripheral venous constriction.

B. peripheral vasoconstriction.

Cavitation is a term typically associated with which type of​ trauma? A. ​Low-velocity blunt trauma B. ​High-velocity penetrating trauma C. ​High-velocity blunt trauma D. ​Low-velocity penetrating trauma

B. ​High-velocity penetrating trauma

Pons

Between the midbrain and the medulla oblongata, the pons contains connections between the brain and the spinal cord.

melena

Black tarry stool

You are caring for a patient with penetrating abdominal trauma secondary to an industrial explosion. The patient has an altered mental status and is found to be​ hypotensive, tachycardic, and tachypneic. During your fluid​ administration, what minimum systolic blood pressure do you wish to​ maintain? A. 70 mmHg B. 60 mmHg C. 80 mmHg D. 90 mmHg

C. 80 mmHg

What is the shock wave and temporary cavity created by medium or​ high-velocity projectiles, such as handgun or rifle​ bullets, when they set a portion of the semifluid body tissue in​ motion? A. Rifling B. Yaw C. Cavitation D. Rotation

C. Cavitation

As blood loss continues for the patient in compensated​ shock, what is the clinical result of blood being redirected to critical organs from the peripheral​ circulation? A. Reddened skin B. Warm and pale skin C. Cool and pale skin D. Cool and red skin

C. Cool and pale skin

Which of the injury types is most likely to be complicated by​ entrapment? A. ATV collisions B. Blast injuries C. Crush injuries D. Falls

C. Crush injuries Mark sucks dong for McDonald's

The​ "blown outward" appearance of a bullet exit wound is the result of which of the​ following? A. The bullet and hot gases B. Damage by the bullet forcing debris and bodily contents out of the wound C. Damage by the bullet and the cavitational wave D. The bullet and displaced bone fragments

C. Damage by the bullet and the cavitational wave

A patient is stimulated by a vigorous sternal rub​ and, in response to such​ stimuli, he flexes his arms and extends his legs. What is this​ called? A. Dystonias B. Decerebrate posturing C. Decorticate posturing D. Flaccid paralysis

C. Decorticate posturing

Identify the correct statement regarding a stroke. A. It is a state of unconsciousness characterized by a patient who is not able to be aroused by any type of voice or painful stimulus. B. It is due to uncontrolled discharge of multiple neurons within the cerebral​ cortex, resulting in interference with normal function. C. It occurs when the normal blood flow to an area of the brain is compromised due to partial or total blockage of a cerebral artery. D. It is a cerebral ischemic event that lasts less than 24 hours and leaves no permanent neurological deficit after its resolution.

C. It occurs when the normal blood flow to an area of the brain is compromised due to partial or total blockage of a cerebral artery.

What impact type would most likely be associated with acceleration damage to the cervical​ spine? A. Frontal oblique impact B. Rollover C. Rear impact D. Front impact

C. Rear impact

A properly restrained driver is found unconscious in a utility van with moderate damage to the front of the​ vehicle, after being involved in a frontal collision. The steering wheel is not​ deformed, nor does the windshield show signs of impact in front of the​ driver; however, the passenger side of the windshield is damaged. The​ driver's headrest appears to be at an appropriate height. Equipment and debris from the van is scattered in the roadway. What is the most likely cause of his decreased level of​ consciousness? A. Whiplash B. Additional impacts C. Secondary collisions D. Stress

C. Secondary collisions

When dealing with the victim of a​ stroke, why is it imperative to establish the exact time of onset while rapidly delivering the patient to the​ ED? A. To prevent the onset of disseminated intravascular coagulation​ (DIC) B. To minimize the time to conduct a CT scan C. To determine the​ patient's fibrinolytic candidacy D. To prevent muscle atrophy

C. To determine the​ patient's fibrinolytic candidacy

You arrive at the scene of an altercation after the scene has been cleared by law enforcement. There you are faced with a​ 22-year-old female, unconscious on the​ sidewalk, with a bat nearby. The victim is without response to pain and has a large contusion in the area of the left zygomatic arch.​ Additionally, you note that her radial pulse is 68 and​ thready, her skin is warm and​ dry, and her right pupil is dilated. Based on her​ findings, do you believe there is significant internal​ bleeding? A. Absolutely B. There is no internal bleeding. C. Unlikely D. ​Yes, but no more than​ 1,000 mL.

C. Unlikely

If a patient were to suffer a hemorrhagic stroke in the occipital cortex of the​ cerebrum, what would the patient complain about​ most? A. Motor disturbances B. Speech disturbances C. Vision disturbances D. Balance disturbances

C. Vision disturbances

A​ patient's jugular veins are​ flat, suggesting hypovolemic​ shock, and you can see signs of hemorrhaging. Serious hemorrhaging from the neck should be addressed aggressively​ because, in addition to​ exsanguination, the victim of a neck injury may be subject​ to: A. hemothorax. B. spinal injury. C. an air emboli. D. cerebral hypothermia.

C. an air emboli.

As a burn destroys dermal​ cells, they become hard and​ leathery, producing what is known​ as: A. a thermal burn. B. compartment syndrome. C. an eschar. D. shielding.

C. an eschar.

shock

Compensated Shock Initial stage of shock in which the body progressively compensates for continuing blood loss. Pulse rate increases. Pulse strength decreases. Skin becomes cool and clammy. Progressing anxiety, restlessness, combativeness. Thirst, weakness, eventual air hunger. Decompensated Shock Begins when the body's compensatory mechanisms can no longer maintain preload. Pulse becomes unpalpable. Blood pressure drops precipitously. Patient becomes unconscious. Respirations slow or cease. Irreversible Shock Shortly after the patient enters decompensated shock, the lack of circulation begins to have profound effects on body cells. As they are irreversibly damaged, the cells die, tissues dysfunction, organs dysfunction, and the patient dies.

The pathophysiological process that underlies Addison's disease is characterized by the diminished activity of what hormone?

Corticosteroid

The most important of the glucocorticoids is:

Cortisol. increase the blood glucose level by promoting gluconeogenesis and decreasing glucose utilization as an energy source.

You are dispatched to the scene of a shallow water diving accident. While en​ route, what would you consider to be the most likely result of this method of​ injury? A. Excessive rotation of the cervical spine B. Hyperextension of the cervical spine C. Hyperflexion of the cervical spine D. Axial loading of the cervical spine

D. Axial loading of the cervical spine

Why is collection of a thorough history important when building a differential diagnosis on the victim of a severe​ headache? A. To determine if you will transport the patient B. To determine a position of comfort and what actions help relieve the pain C. To determine if the patient is contagious D. A​ severe, acute onset headache or a change in headache pattern indicates the need for immediate attention

D. A​ severe, acute onset headache or a change in headache pattern indicates the need for immediate attention

Which of the following categories of pediatric shock is NOT considered a type of distributive​ shock? A. Neurogenic B. Anaphylactic C. Septic D. Hypovolemic

D. Hypovolemic

What do the signs and symptoms of​ Cushing's triad​ include? A. Decreasing systolic blood​ pressure, decreasing heart​ rate, and agonal respirations B. ​Confusion, amnesia, and nausea C. Increasing diastolic blood pressure and pulse with a decreased level of consciousness D. Increasing systolic blood​ pressure, slowing​ pulse, and irregular respirations

D. Increasing systolic blood​ pressure, slowing​ pulse, and irregular respirations

Which type of blood loss is most likely to continue unabated until it is halted by the normal clotting​ process, a significant drop in blood​ pressure, exsanguination, or surgical​ intervention? A. External blood loss resulting from an amputation of the leg proximal to the knee B. External blood loss from a longitudinal laceration of the wrist C. Internal blood loss resulting from a femur fracture D. Internal blood loss into the abdomen

D. Internal blood loss into the abdomen

A blunt impact begins to cause injury when what​ increase? A. Acceleration and inertia B. Mass and deceleration C. Force and mass D. Kinetic energy and rate of velocity

D. Kinetic energy and rate of velocity

Diabetic ketoacidosis

Diabetic ketoacidosis is a serious, potentially life-threatening complication associated with type 1 diabetes. It occurs when there is profound insulin deficiency coupled with increased glucagon activity. It may occur as the initial presentation of severe diabetes, as a result of patient noncompliance with insulin injections, or as the result of physiologic stress such as surgery or serious infection Signs and symptoms: Polyuria, polydipsia, polyphasia, Warm, dry skin, Nausea/vomiting, Abdominal Pain, Tachycardia, Deep, rapid (kussmaul) respirations, fruity breath, fever, AMS or coma

Addison's disease

Due to cortical destruction. Occurs when the adrenal glands fail to produce adequate amounts of the steroid hormones

Newton's Third Law

For every action force there is an equal and opposite reaction force

Newton's Second Law

Force equals mass times acceleration

ketones

Fragments formed by the tissues during incomplete use of fat for energy, and released into the blood.

Hemorrhagic strokes

Hemorrhagic strokes are usually categorized as being within the brain (intracerebral) (Figure 3-21) or in the space around the outer surface of the brain (subarachnoid) (Figure 3-22). Onset is often sudden and marked by a severe headache. Most intracranial hemorrhages occur in the hypertensive patient when a small vessel deep within the brain tissue ruptures. Subarachnoid hemorrhages most often result from congenital blood vessel abnormalities or from head trauma. Congenital abnormalities include aneurysms (weakened vessels) and arteriovenous malformations (collections of abnormal blood vessels). Aneurysms tend to be on the surface and may hemorrhage into the brain tissue or the subarachnoid space. Arteriovenous malformations may be within the brain, in the subarachnoid space, or both. Hemorrhage inside the brain often tears and separates normal brain tissue. The release of blood into the cavities within the brain that contain cerebrospinal fluid may paralyze vital centers. If blood in the subarachnoid space impairs drainage of cerebrospinal fluid, it may cause a rise in the intracranial pressure. Herniation of brain tissue may then occur.

Which of the following conditions is characterized by profound hyperglycemia, but without formation of ketones?

Hyperosmolar hyperglycemic state

What gland of the body connects the endocrine system with the nervous system?

Hypothalamus

Which of the following is most likely caused by permanent loss or atrophy of functional thyroid tissue or insufficient stimulation of a normal thyroid gland as a result of hypothalamic or pituitary disease?

Hypothyroidism

Yaw

If a spinning bullet is slightly deflected, it wobbles, or yaws, then slowly returns to straight flight.

thermal burns of airway

If damaged, this tissue swells rapidly, seriously reducing the size of the airway lumen. The patient presents with minor hoarseness, followed precipitously by dyspnea. Stridor or high-pitched "crowing" sounds on inspiration are ominous signs of impending airway obstruction. Other clues leading you to suspect potential airway burns include singed facial and nasal hair, black-tinged (carbonaceous) sputum, and facial burns. The airway injury may be so extensive that it induces complete respiratory obstruction and arrest. Accurate assessment is important because 20 to 35 percent of patients admitted to burn centers, and some 60 to 80 percent of burn patients who die, have an associated inhalation injury.

How glucose is synthesized

If glucose is high, insulin helps move glucose into the cells for energy and glucose is converted to glycogen for storage in the liver. If glucose is low glycogen is released and converted to glucose for use by the cells

The process in which ketone bodies accumulate to biologically significant levels in the bloodstream is known as:

Ketosis

hemorrhage control

Least Invasive Place bandage and dressing Elevation Place direct pressure to bandage Place direct pressure on wound itself Tourniquet

epinephrine

Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.

Occlusive Stroke (Ischemic)

Occlusive strokes. An occlusive stroke occurs when a cerebral artery is blocked by a clot or other foreign matter. This results in ischemia, an inadequate blood supply to the brain tissue, and progresses to infarction, the death of tissues as a result of cessation of blood supply. In infarction, the tissue that has died will swell, causing further damage to nearby tissues, which have only a marginal blood supply. If swelling is severe, herniation (protrusion of brain tissue from the skull through the foramen magnum, the narrow opening at the base of the skull) may result. Occlusive strokes are classified as either embolic or thrombotic, depending on the cause.

GCS verbal response

Oriented=5; confused conversation=4; inappropriate words=3; incomprehensible words=2; no response=1

Parkinson's Disease

Parkinson's is a chronic and progressive disorder. It has four main characteristics: Tremor. Sometimes called "pill rolling," the typical tremor is a rhythmic back-and-forth motion of the thumb and forefinger. It usually begins in the hand and may progress to an arm, a foot, or the jaw. Rigidity. Most Parkinson's patients suffer rigidity, or resistance to movement. All muscles have an opposing muscle. In the healthy adult, one muscle contracts while the opposing muscle relaxes. In Parkinson's, the balance of this opposition is disturbed, leading to rigidity. Bradykinesia. Normal, spontaneous, and autonomic movement is slowed and sometimes lost. Such loss of movement is unpredictable. One moment the patient can move easily, and the next moment he cannot. Postural instability. Impaired balance and coordination cause patients to develop a forward or backward lean, stooped posture, and the tendency to fall easily.

Blast injury types

Primary—caused by heat of explosion and overpressure wave Secondary—caused by blast projectiles Tertiary—caused by personnel displacement and structural collapse Quarternary—other injuries associated with or exacerbated by a blast

meninges

Protective membranes called the meninges cover the entire central nervous system. There are three layers of meninges that pad, or cushion, the brain and spinal cord (Figure 3-6). The durable, outermost layer is referred to as the dura mater. The middle layer is a weblike structure known as the arachnoid membrane. The innermost layer, directly overlying the central nervous system, is called the pia mater.

Dose (of radiation)

RADS 5-25 Asymptomatic. Blood studies are normal. 50-75 Asymptomatic. Minor depressions of white blood cells and platelets in a few patients. 75-125 May produce anorexia, nausea, vomiting, and fatigue in approximately 10-20 percent of patients within two days. 125-200 Possible nausea and vomiting. Diarrhea, anxiety, tachycardia. Fatal to less than 5 percent of patients. 200-600 Nausea and vomiting. Diarrhea in the first several hours. Weakness, fatigue. Fatal to approximately 50 percent of patients within 6 weeks without prompt medical attention. 600-1,000 "Burning sensation" within minutes. Nausea and vomiting within 10 minutes. Confusion, ataxia, and collapse within 1 hour. Watery diarrhea within 1 to 2 hours. Fatal to 100 percent within short time without prompt medical attention.

paper bag syndrome

Rupture of the lungs that occurs as the chest meets with blunt trauma after taking a deep breath, usually during a motor vehicle crash, similar to rupture of an air-filled paper bag.

Testosterone

The hormone testosterone promotes the development and maintenance of secondary male sexual characteristics and plays a role in development of sperm.

Medulla oblongata

The medulla oblongata is located between the pons and the spinal cord. It marks the division between the spinal cord and the brain. Located here are major centers for controlling respiration, cardiac activity, and vasomotor activity.

brainstem

The mesencephalon (midbrain), pons, and the medulla oblongata collectively form the brainstem.

Mesencephalon, or midbrain

The mesencephalon, located between the diencephalon and the pons, is responsible for certain aspects of motor coordination. The mesencephalon is the major region controlling eye movement.

Preload

The precontraction pressure in the heart as the volume of blood builds up.

Which of the following endocrine glands is larger and more active in the child as compared to the adult?

Thymus

Which of the following is generally caused by Graves' disease?

Thyrotoxicosis

rotation

To prevent tumbling, bullets are sent spinning through air by gun barrel rifling. This rotation gives a bullet gyroscopic stability like a spinning top.

Trigeminal neuralgia

Trigeminal neuralgia, also called tic doloureux, is an extremely painful disorder that affects the fifth cranial nerve (trigeminal nerve). The trigeminal nerve is responsible for sensation in the face. Although primarily a sensory nerve, it also has some motor functions (e.g., biting and chewing). The trigeminal nerve has three branches: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve.

Headache

Vascular. Vascular headaches include migraines and cluster headaches. Migraines can last from several minutes to several days. They can be characterized by an intense or throbbing pain, photosensitivity (sensitivity to light), nausea, vomiting, and sweats. Migraines are frequently unilateral (on one side of the head) and may be preceded by an aura. Cluster headaches usually occur as a series of one-sided headaches that are sudden and intense, and may continue for 15 minutes to 4 hours. Symptoms may include nasal congestion, drooping eyelid, and an irritated or watery eye. Migraines occur more commonly in women, whereas cluster headaches generally occur in men. Tension. A significant percentage of headaches are tension headaches. Most personnel in the emergency medical field have, at one time or another, suffered from a tension headache. Sometimes such headaches occur on a daily basis. Sufferers often awake in the morning with a mild headache that gets worse during the course of the day. The tension headache produces a dull, achy pain that feels like a forceful pressure is being applied to the neck and/or head. Organic. A third, less common, category includes organically caused headaches. They occur in individuals suffering from tumors, infections (especially sinus infections), or other diseases of the brain, eye, or other body system.

Stages of impact

Vehicle collision. Vehicle collision begins when a vehicle strikes an object (or an object strikes the vehicle). The vehicle's kinetic energy causes damage as it is converted to mechanical and heat energy as the vehicle comes to a stop. Mechanical energy is the energy that is possessed by an object because of its motion or its position. Heat energy is the movement of molecules and atoms within an object. Forces developed in the collision depend on the initial velocity (kinetic energy) and stopping distance (rate of deceleration). If an auto slides into a snowbank and slows gradually, damage is usually limited. If an auto strikes a concrete retaining wall and stops abruptly, however, the deceleration rate and vehicle damage are typically much greater. The degree of auto deformity is often an indicator of the strength and direction of forces experienced by its occupants. Body collision. An auto collision slows or stops a vehicle, but not necessarily the occupants. Body collision occurs when an occupant remains in motion and subsequently strikes the vehicle's interior. The vehicle and its interior have slowed dramatically during the collision, but an unrestrained occupant remains at or close to the speed at the time the collision occurred. As the occupant impacts the interior, his kinetic energy is transformed into initial tissue deformity (mechanical injury). If the vehicle collision causes intrusion into the passenger compartment, this displacement may further subject occupants to impact forces. Restraints (seat belts and supplemental restraint systems) slow and cushion occupants along with the slowing of the vehicle during the collision, thereby decreasing the occupant's rate of deceleration, impact force strength, and seriousness of expected injuries. Organ collisions. Organ collision results as an occupant contacts the vehicle's interior and/or restraints and slows or stops. Tissues behind the contacting surface of the occupant's body collide, one into another, as the body comes to a stop. This can cause compression, stretch, and shear injuries as tissues and organs press violently against each other. In this process, organs may also twist or decelerate, tearing at their attachments or at blood vessels. The result is blunt trauma. Secondary collisions. Secondary collisions occur when the occupant is struck by loose objects within the vehicle. During the collision, objects within the vehicle, including unrestrained passengers, continue to travel at the vehicle's initial speed. They can then strike the occupant, who has come to rest (or whose speed is slowing) within the auto. It is important to consider the possibility of any secondary collisions and their effects on occupants when developing an index of suspicion for injuries.5 Additional impacts. Additional impacts may occur when a vehicle undergoes a second impact, such as striking another vehicle or a light pole. This second impact may cause additional injuries or increase the seriousness of those already received. For example, consider someone who has sustained a femur fracture. It initially takes a great deal of energy to break the bone. However, once the bone is broken, the energy needed to move those bone ends and cause additional injury to adjoining nerves and blood vessels is much less. It is important to always consider what effect any additional impacts may have on the initial injuries and overall patient condition.

Cheyne-Stokes respirations

a breathing pattern characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations.

myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles

dystonias

a group of disorders characterized by muscle contractions that cause twisting and repetitive movements, abnormal postures, or freezing in the middle of an action. Can manifest in deterioration in writing, foot cramps, or a tendency to drag one foot

myexedema

a skin and tissue disorder caused by hypothyroidism, difficult to treat

Neurotransmitters

a substance that is released from the axon terminal of a presynaptic neuron on excitation and that travels across the synaptic cleft to either excite or inhibit the target cell. Examples include acetylcholine, norepinephrine, and dopamine.

renin

an enzyme produced by kidney cells that plays a key role in controlling arterial blood pressure.

Question about volleyball

answer is hypoglycemia

hematemesis

blood in vomit

hemorhage

blood loss STAGE 1—blood loss of up to 15 percent; patient may display some nervousness and marginally cool skin with slight pallor STAGE 2—blood loss of 15 to 25 percent; patient displays thirst; anxiety; restlessness; cool, clammy skin; increased respiratory rate STAGE 3—blood loss between 25 and 35 percent; patient experiences air hunger, dyspnea, severe thirst, anxiety, restlessness; survival unlikely without rapid intervention STAGE 4—blood loss greater than 35 percent; pulse barely palpable; respirations ineffective; patient lethargic, confused, moving toward unresponsiveness; survival unlikely

apneustic respiration

breathing characterized by a prolonged inspiration unrelieved by expiration attempts, seen in patients with damage to the upper part of the pons.

Common Causes of TIA and Stroke

carotid artery disease, embolus, decreased cardiac output, hypotension, cerebrovascular spasm

Antidiuretic hormone (ADH

causes retention of body water

hormone

chemical substance released by a gland that controls or affects processes in other glands or body systems.

hematochezia

passage of fresh, bright red blood from the rectum

Symptoms of untreated type 1 diabetes

polyuria (urine), polyphagia (hunger), polydopsia (thirst) poly=excessive