pm 60 final review

volumes and capacities of the respiratory system cont'd:

Inspiratory reserve volume (IRV). The inspiratory reserve volume is the amount of air that can be maximally inhaled after a normal inspiration. Expiratory reserve volume (ERV). The expiratory reserve volume is the amount of air that can be maximally exhaled after a normal expiration. Residual volume (RV). The residual volume is the amount of air remaining in the lungs at the end of maximal expiration. Functional residual capacity (FRC). The functional residual capacity is the volume of gas that remains in the lungs at the end of normal expiration: Forced expiratory volume (FEV). The forced expiratory olume is the amount of air that can be maximally expired after maximum inspiration.

significance of rapid and deep respirations in a diabetic patient

Kussmauls respirations; means pt is probably going into DKA if they aren't already

NAEMT vs NREMT

NAEMT: the only national association representing the professional interests of paramedics, advanced emergency medical technicians, emergency medical technicians, emergency medical responders and other professionals providing prehospital and out-of-hospital emergent, urgent or preventive medical care;serves its members by advocating on issues that impact their ability to provide quality patient care, providing high quality education that improves the knowledge and skills of practitioners, and supporting EMS research and innovation NREMT: the goal of the National Registry of Emergency Medical Technicians (NREMT) is to offer assurance that EMS personnel providing treatment to patients—at their highest moment of need—are competent.They are responsible for implementing a process that involves meeting specific educational requirements, developing legally defensible and psychometrically sound exams to measure entry-level competency, implementation of a criminal conviction policy and more.

#9: where is body thermoregulatory center located?

The thermoregulatory center of the human body is Hypothalamus. Hypothalamus is a part of the forebrain and contains a thermoregulatory center within them.

volumes and capacities of the respiratory system

Total lung capacity (TLC). Total lung capacity is the maximum lung capacity—the total amount of air contained in the lung at the end of maximal inspiration. In the average adult male, this volume is approximately 6 liters. Tidal volume (VT). The tidal volume is the average volume of gas inhaled or exhaled in one respiratory cycle. In the adult male this is approximately 500 mL (5 to 7 mL/kg). Dead space volume (VD). The dead space volume is the amount of gas in the tidal volume that remains in air passageways unavailable for gas exchange. It is approximately 150 mL in the adult male. Anatomic dead space includes the trachea and bronchi. Obstructions or diseases such as chronic obstructive pulmonary disease or atelectasis can cause physiologic dead space. Alveolar volume (VA). The alveolar volume is the amount of gas in the tidal volume that reaches the alveoli for gas exchange. It is the difference between tidal volume and dead-space volume (approximately 350 mL in the adult male): Minute volume (Vmin). The minute volume is the amount of gas moved in and out of the respiratory tract in 1 minute: Vmin=tidal volume-dead space volume Alveolar minute volume (VA-min). The alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in 1 minute:

elements of implied consent for an adult and a minor

adult: automatically assumed if a patient is unresponsive or unable to make a rational decision (e.g. altered mental status)-that is, if the pt was conscious and awake, they would want you to treat them minors: treatment is invoked when a child's parent or legal guardian is not available to give consent, especially if the child has life-threatening injuries. In that situation, the law presumes consent would be granted by the parent or legal guardian. Some examples of this include: The minor is unconscious and needs immediate attention. A sick child is brought to an emergency room by a neighbor. The child's condition is serious, but doctors cannot tell how serious without running tests. The parents are unavailable.

differentiate between assault and battery

assault: defined as unlawfully placing a person in apprehension of immediate bodily harm without his consent battery: the unlawful touching of another individual without his consent

tort law

branch of civil law, deals with civil wrongs committed by one individual against another (rather than against society). Tort law claims include negligence, medical malpractice, assault, battery, and slander.

phases of a typical generalized seizure and describe tonic clonic seizures

include: tonic-clonic, absence: -tonic-clonic aka grand mal: characterized by rapid LOC and motor coordination, muscle spasms and jerking motions --typically have a tonic (increased tone) phase characterized by tensed contracted muscles and a clonic phase, characterized by rhythmic jerking of the extremities --diaphragm becomes temp. paralyzed, interrupting resps -aura: subjective sensation that may precede a seizure-may be olfactory, visual, auditory or taste hallucinations -LOC: pt becomes unconscious at some point after aura if any -tonic phase: continuous muscle tension -hypertonic phase: extreme muscle rigidity w/ hyperextension of the back -clonic phase: muscle spasms marked by rhythmic mvmts -postictal: pt may awaken confused and tired; may have a HA -absence seizure aka petit mal: brief, generalized seizure that usually presents w/ a 10-3- sec LOC/awareness, eye or muscle fluttering and occasional loss of muscle tone

differentiate between libel and slander

libel: the act of injuring a person's character, name, or reputation by false statements made in writing or through the mass media with malicious intent or reckless disregard for the falsity of those statements slander: the act of injuring a person's character, name, or reputation by false or malicious statements spoken with malicious intent or reckless disregard for the falsity of those statements

15 components of the ems systems act of 1973

manpower, training, communications, transportation, emergency facilities, critical care units, public safety agencies, consumer participation, access to care, patient transfer, standardized record keeping, public information and education, system review and evaluation, disaster management plans, and mutual aid

online vs offline med control

online: occurs when a qualified physician gives direct orders to a prehospital care provider by either radio or telephone. Medical direction may be delegated to a mobile intensive care nurse (MICN), advanced practice practitioner, or paramedic. In all circumstances, ultimate on-line responsibility remains with the medical director. off-line: Off-line medical oversight refers to medical policies, procedures, and practices that a system medical director has established in advance of a call. It includes prospective medical oversight such as guidelines on the selection of personnel and supplies, training and education, and protocol development. An important part of medical oversight is participation in the selection of medical equipment. Off-line medical oversight also includes retrospective medical oversight, such as auditing, peer review, conflict resolution, and other quality assurance processes.

2 groups of patients who may be unresponsive to glucagon therapy?

people who are malnourished, who have an adrenal insufficiency, or w/ longstanding hypoglycemia people w/ a tumor in their pancreas or adrenal gland (ex: pheochromocytoma)

describe preload and afterload

preload: the amount of blood delivered to the heart during diastole (when the heart fills with blood between contractions). Preload depends on venous return. The venous system is a capacitance, or storage, system afterload:the resistance against which the ventricle must contract. This resistance must be overcome before ventricular contraction can result in ejection of blood. Afterload is determined by the degree of peripheral vascular resistance (defined later). This, in effect, is due to the amount of vasoconstriction present

compare/contrast standards of care, protocols and scope of practice

standards of care: the degree of care, skill, and judgement that would be expected under like/similar circumstances by similarly trained, reasonable paramedic in the same community protocols: are the recognized operating procedures that all emergency medical service professionals, such as paramedics and emergency medical technicians (EMTs) must follow for patient assessment, treatment, transportation and delivery to definitive care scope of practice: the range of duties and skills medics and other levels of EMS certs are allowed and expected to perform

define abandonment

the termination of the paramedic-patient relationship without providing for the appropriate continuation of care while it is still needed and desired by the patient. You cannot initiate patient care and then discontinue it without sufficient reason. You cannot turn the care of a patient over to personnel who have less training than you without creating potential liability for an abandonment action Physically leaving a patient unattended, even for a short time, may also be grounds for a charge of abandonment. If, for example, you leave a patient at a hospital without properly turning over his care to a physician or nurse, you may be liable for abandonment

what type of seizure is usually preceded by an aura

tonic clonic seizures

potential causes for: wheezing rhonchi crackles

wheezing: Respiratory infections (croup, laryngitis, bronchiolitis),Obstructive airway diseases (asthma)chronic obstructive pulmonary disease(COPD),Anaphylaxis, Pulmonary peribronchial edema (congestive heart failure), Vocal cord dysfunction (paradoxical vocal fold motion [PVFM], vocal cord paralysis), Postnasal drip, Airway compression: Intrinsic or extrinsic (squamous cell carcinomas, goiter), Hyperdynamic airway collapse (tracheobronchomalacia), Carcinoid tumors Foreign body inhalation, Forced exhalation by normal individuals Rhonchi: Rhonchi are low pitched, continuous sounds that sound similar to snoring. They occur due to blockages in the large airways of the lungs.Rhonchi can occur during exhalation or exhalation and inhalation, but not inhalation alone. They happen due to the movement of fluid and other secretions in the large airways. can result from: pneumonia, chronic bronchitis, COPD, and cystic fibrosis crackles(rales): Crackles occur as a result of small airways suddenly snapping open. causes include: pneumonia, COPD, pulmonary edema, which refers to fluid in the lungs, interstitial lung disease, a group of diseases that cause scarring of the lungs, heart failure, chronic bronchitis

#6: what is the mammalian diving reflex? why is it important in the mgmt of cold water drowning victims

when a human holds their breath and submerges in cold water, the face and nose become wet, signaling the trigeminal nerve in your face-signaling the vagus nerve and the ANS- which in turn causes bradycardia, apnea, increased PVR -increased PVR is thought to redistribute blood to vital organs while limiting O2 consumption by non essentials -bradycardia decreases work of heart and further limit unnecessary O2 consumption *in cold water, the bodies vital fxns slow down and shunt blood to the core-preserving vital functions. "they aren't dead until they're warm and dead"

renal failure

-CKD: permanently inadequate renal fxn due to nephron loss; aka CRF -usually at least 70% of the nephrons must be lost b4 significant clinical s/s appear --metabolic instability=80%+ destroyed ---when this point is reached: pt has developed end stage renal failure (ESRF aka ESKD): an extreme failure of kidney fxn due to nephron loss -more than 250k have ESRF and 50k die yearly -pathophysiology: 3 processes initiate nephron damage: microangiopathy/ glomerular capillary injury, tubular cell injury and inflammation/infection of interstitial tissue -fxn-al nephrons adapt to damage by increasing globular filtration (by decreasing vascular resistance) and increasing tubular reabsorption and secretion --time/stress compensatory changes lead to nephron damage and destruction -depending on the degree of failure, each of the 4 main kidney fxns may be disturbed/absent: --maintenance of blood volume w/ proper balance of water, electrolytes and pH: ---electrolyte and acid base imbalances --retention of key compounds such as glucose w/ excretion of wastes such as urea: urea and creatinine accumulate in blood in direct proportion w/ # of nephrons lost --control of arterial BP: RAAS loop disturbed; small amounts of renin can cause severe HTN -regulation of RBC development: erythropoietin no longer produced in norm. amounts so chronic anemia developes -HX: pale, moist skin, scratches and ecchymosis are common skin changes, jaundice may be present, hyper/hypotension depending on fluid retention, hyperk, --uremic frost: excessive amounts of urea are eliminated through sweat; as it dries, a white "frosty" dust of urea may appear -mgmt: fluids if hypotensive, pressers for hypotension and bicarb for acidosis, rapid transport.

MOA and sites of production on insulin and glucagon

-Insulin:MADE BY BETA CELLS IN THE PANCREAS. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells *Bind insulin receptors on cells of adipose tissue and skeletal muscles → stimulates glucose uptake from the blood into these cells. Stimulate glycogenesis, lipogenesis, amino acids uptake and protein synthesis Stimulate Na+/K+ pump → potassium uptake into cells Glucagon: MADE BY ALPHA CELLS IN THE PANCREAS; *MOA: Glucagon triggers your liver to convert stored glucose (glycogen) into a usable form and then release it into your bloodstream. This process is called glycogenolysis. Glucagon can also prevent your liver from taking in and storing glucose so that more glucose stays in your blood. Glucagon helps your body make glucose from other sources, such as amino acids.

differentiate between muscarinic and nicotinic acetylcholine receptors. which are affected by organophosphates? neuromuscular blockers? atropine?

-M: found in organs throughout the body and primarily responsible for parasympathetic response -N: neuron; found in ALL autonomic ganglia where AcH is presynaptic neurotransmitter for SNS and PNS -Atropine: prototype for muscarinic cholinergic antagonists; blocks AcH almost exclusively at muscarinic receptors -neuromuscular blocking agents: produces neuromuscular blockage by binding w/ nicotinic M receptor sites w/o causing depolarization -organophosphates: muscarinic effects' SLUDGE and DUMBELS

Salicylate OD

-OTC meds like ASA that decrease pain, fever and inflammation can cause resp. alkalosis bye stimulating resp. centers in the brain followed by metabolic acidosis by uncoupling oxidative phosphorylation (halts electron transport chain in mitochondria causing an increase in lactic acid production leading to metabolic acidosis) -s/s: may take up to 6-12 hrs to develop; N/V, tinnitus, hearing loss, vertigo, changes in BG, increased temp, hypokalemia, resp. alkalosis, increased anion gap and tachypnea -150mg or less: minimal symptoms -150-300mg: mild-moderate s/s; hyperopnea (increased depth of breathing), tinnitus and N/V -300mg+: severe; metabolic acidosis, AMS ans seizures -500mg+: potentially lethal >pts are usually volume depleted due to hyperventilation, fever and increased metabolic activity -TX: D5 w/ 3 amps Bicarb; D5 for CNS hypoglycemia and bicard for metabolic acidosis

acid base and electrolyte abnormalities in renal failure pts

-Retention of K+ can lead to dangerous hyperkalemia, and retention of H+ can lead to equally dangerous metabolic acidosis. -Hypocalcemia is also common. It results from several causes, including renal retention of phosphate ions (with higher levels of serum phosphate facilitating -Ca++ absorption into bone) and lack of renal production of vitamin D

severe allergic reaction:

-SEVERE upper and lower airway edema, GI s/s (increased motility), cardiovascular collapse (loss of radial pulses) -mgmt: high flow O2 first 1. epi 1:10,000 0.2 mg over 5 min IV/IO 2. fluids (isotonic crystalloids)-NS/LR 20 ml/kg 3. antihistamines: 50 mg Benadryl-prevent further histamine response 3.5. if bronchospasm exists: albuterol 4. consider corticosteroids (Solu-Medrol/Decadron) or hydrocortisone 5. reevaluate pt 6. if hypotension persists: epi drip 1-4mcg/min and consider glucagon 1-2mg q 5 min for pts unresponsive to epi 6.5. if pt is bradycardia: consider atropine

what critters carry Lyme disease

-SPREAD MAINLY BY: backlegged (deer) tick

what is a neonates primary response to hypoxemia? how is it different than that of an adult:

-Unlike adults and older children, neonates respond to hypoxia and hypercarbia with a brief increase in respiratory rate followed by respiratory depression and apnea

when can a DNR be honored and when can it be revoked?

-Valid DNR orders should be honored as your protocols allow. Note, however, that if there is any doubt as to the patient's wishes, resuscitation should be initiated. When you honor a DNR order, do not simply pack up your equipment and leave the scene. You still may have the patient's family and loved ones to attend to. Provide emotional support as appropriate. -DNR can be revoked at any time by the patient or the person who acted on behalf of the agent. -Revocation can be in the form of communication to responding health care professionals, destruction of the form, or removal of devices. -Health professionals can refuse to honor a DNR if they think: The patient is pregnant There are unnatural or suspicious circumstances surrounding the death. The form is not signed twice by all who need to sign it or is filled out incorrectly.

ectopic pregnancy

-abnormal implantation of the fertilized egg outside of the uterus -occurs in 1 in every 44 live births -most detected between 2nd and 12th week -predisposing factors: scarring of fallopian tubes from PID, previous ectopic pregnancy, or previous pelvic/tubal surgery (tubal ligation) -assessment: presents as abd pain, initially diffuse tenderness then localizes as a sharp pain in the lower abd quadrant on the affected side ---pain due to rupture of fallopian tube when fetus outgrows the available space ---pt often reports that she missed a period or LMP was 4-6 weeks ago -mgmt: rapid transport, O2 as needed and IV TKO

placenta previa

-abnormal implantation of the placenta on the lower half of the uterine wall, resulting in partial or complete coverage of the cervical opening -vag bleeding: can be intermittent, and occurs after the 7th month of pregnancy as lower uterus begins to contract and dilate for labor --this process pulls placenta away from uterine wall, causing bright red vaginal bleeding -occurs in 1 in 250 live births -predisposing factors: hx of placenta prevue, multiparty, increased maternal age -assessment: TYPICAL PT: multigravida in 3rd trimester w/ a hx of placenta previa or bleeding early in current pregnany --may report recent episode of sex/vaginal exam just b4 bleeding begins -PAINLESS BRIGHT RED BLEEDING -mgmt: treat for shock, O2, rapid transport

ethylene glycol OD

-accidental ingestion common in kids b/c of its coloration and "sweet taste" - as little as 60 mL can kill an adult -toxicity caused by build of glycolic and oxalic acids in liver and kidneys after metabolism and can cause hypocalemia -main s/s come in 3 stages-but in ems we usually only see stage 1; --stage 1: CNS effects usually within 12 hrs of ingestion: Slurred speech Ataxia, Somnolence N/V, Focal/general convulsions Hallucinations Stupor, Coma --stage 2: cardio/pulm effects usually occur 12-36 hrs after ingestion: Rapidly progressing tachypnea, Cyanosis Pulmonary edema Heart Failure --renal effects usually occur 24-72 hrs after ingestion: Flank pain, Oliguria Hematuria, Uremia -TX: ensure ABCs, gastric lavage, fluids to maintain urine output, give ethanol via OG tube *special consideration: Thiamine to degrade glycolic acid to a nontoxic metabolite, Calcium Gluconate or Calcium Chloride to manage possible hypocalcemia Diazepam or Lorazepam to control active seizure

MOA of histamine

-acts on local hormones by activating specialized histamine receptors present throughout the body w/ the goal of minimizing the body's exposure to the antigen -4 classes of receptor: --H1: located in smooth muscle and endothelial cells; major effects are acute allergic rxn --H2: located in gastric parietal cells and w/ the major effects of secreting gastric acid --H3: located in the CNS w/ the effect of modulating neurotransmission --H4: located in mast and T cells, as well as eosinophils w/ the effects of regulating the immune response

hypoglycemia

-aka insulin shock -pathophysiology: reflects high insulin and low blood glucose *insulin causes remaining blood glucose to be taken up by cells *b/c of high levels of glucagon may not be able to raise blood glucose levels -s/s: AMS, diaphoresis, tachycardia, possible seizures and coma -assessment and mgmt: determine BG levels early, if pt can swallow give oral glucose, if IV access established, if you suspect hypoglycemia secondary to alcoholism, give 100mg Thiamine

#4. describe the pathophysiology, precipitating factors, presentation and mgmt for the following:

-arterial gas embolism: pressure buildup in the lungs can damage and rupture the alveoli, allowing air in the form of a large bubble to leave the lungs and enter circulation. *signs and symptoms: include onset within 2-10 mins of rapid ascent; rapid and dramatic onset of sharp and tearing pain, confusion, vertigo, visual disturbances, LOC, bloody froth from mouth/nose, hemiplegia or unilateral weakness ~TX: Check for, and treat, pneumothorax. Administer oxygen by nonrebreather mask at 100 percent (consider CPAP, if no pneumothorax). Consider contacting DAN.Place the patient in a supine position. Administer a corticosteroid agent, if ordered by medical direction.Transport to a recompression chamber as rapidly as possible. If air transport is used, it is very important to use a pressurized aircraft or to fly at a low altitude.

methanol OD

-as it is absorbed, it is converted to formaldehyde in the liver causing MASSIVE metabolic acidosis -s/s: CNS depression (Lethargy Confusion, Coma, Seizures), abd pain, N/V, photophobia, blurred vision, dilated/sluggish pupils, blindness, metabolic acidosis, SOB (tachypnea), shock, MODS, death -TX: ensure ABCs, gastric lavage, correcting acidosis, hemodialysis

describe the appearance of black widow and brown recluse spiders

-black widow: typically black with two reddish triangular markings going together to form the characteristic hourglass shape on the underside of their abdomen -brown recluse: light brown, except for a darker violin shaped marking on the back, immediately behind its eyes

why does diabetes increase the risk for renal failure

-causes injury to the small blood vessels in your kidneys, preventing them from properly filtering blood --causes body to retain more water and salt than it should

presentation and management of coelenterate envenomation

-coelenterate: jellyfish,, sea anemones and corals -the species involved in injures have stinging cells called nematocysts (enclosed venom sacs and are found in tentacles) -presentation: range from mild dermatitis to cardiovascular and pulmonary collapse ---mild: usually cause self limited inflammatory response w/ burning and limited areas of contact ---moderate-severe: produce spectrum of near, cardio, resp and GI s/s and cause severe and acute anaphylactoid rxns and drowning

calcium Chanel blocker OD

-common Ca2+ CB: amlodipine, diltiazem, nicardipine, nifedipine, verapamil -s/s: agitation (hyperactivity), delirium (AMS/hallucinations) SOB, lightheadness/dizziness, increased BG, irregular and decreased HR, N/V, hypotension, ARDS, MI --verapamil OD: decreased heart contractility, SA node automaticity and AV conduction and causes vasodilation --diltiazem OD; less vasodilation, more chronotropic effects ----BOTH cause: decrease in HR and BP, an escape rhythms --Nifedipine (procardia) OD: hypotension and reflex sinus tach -onset within 2-3 hours and symptoms after 6 hrs -TX: early intubation (if unstable/deteriorating), atropine (offset vagal stim. from ett), fluids CALCIUM GLUCONATE AND CHLORIDE (mostly gluconate in EMS), and consider INSULIN OR GLUCAGON

urinary calculi

-crystal aggregation in kidneys collection system -affect about 50,000 ppl/year -stones form from metabolic disorders like gout and primary hyperparathyrpidism --too misc insoluble stuff and the urine is too concentrated -presentation: first notes vague discomfort and visceral pain unilaterally; within 30-60 mins, pain progresses to sharp and may stay in that flank or migrate down and anterior to the groin, --stones that become lodged in the lowest part of the ureter within the bladder can produce classic s/s like frequent urination , urgency and painful urination -TX: ABCs, transport. POC, analgesics, zofran

#4 continued:

-decompression sickness: aka dysbarism; developed in divers who are subjected to rapid reduction of air pressure after ascending to the surface. >results from: nitrogen bubbles coming out of the solution in the blood and tissues, causing increased pressure in body stxs and occluding small blood vessels +symptoms develop after: diver ascends rapidly after being at a depth of 33 ft of more =risk factors: cold water dives, strenuous diving conditions, hx of decompression sickness, overstaying time at a given depth, dives at 80ft +, rapid ascent or panic, flying after diving, driving to high altitudes, alcohol consumption #s/s: joint pain (myalgias), rash, swollen/painful lymph nodes, numbness, AMS, tinnitus, vertigo, N/V, Cp w/ inspiration, pulmonary congestion ^^TX: usually seek tx within 12 hrs of ascent; early O2 via NRB, IV TKO w/ LR, tx to hospital w/ hyperbaric chamber

what is cushings disease? what metabolic abnormalities are present in patients with this disease

-def of cushings syndrome: hyperadrenalism ;adrenal disorder; caused by high levels of cortisol in the blood -caused by: meds (glucocorticoids, prednisone) or by pituitary tumors -cushings disease: 70% of cases; caused by a tumor of the pituitary (adenoma) that causes excess production adrenocorticotropic hormone (ACTH) that elevates cortisol production from adrenals -classic moon face and buffalo hump, fragile skin, thinning hair -causes hypokalemia

gastritis:

-def: inflammation of the soft mucous lining your stomach -Can be either visceral or parietal pain, depending on the causative agent; RUQ and/or LUQ, typically referring to the back -can be : --actue: sudden, severe inflammation --chronic: long term inflammation that can last for years if left untx --erosive: can lead to bleeding and ulcers in the lining of the stomach -s/s: Stomach upset or pain Belching and hiccups, Belly (abdominal) bleeding Nausea and vomiting, Feeling of fullness or burning in your stomach Loss of appetite Blood in your vomit or stool. This is a sign that your stomach lining may be bleeding -TX: antacids, proton pump inhibitor if caused by H. pylori, meds to block acid production (protonix), Pepcid

what is an extrapyramidal rxn? what groups of drugs tend to be associated w/ them and how can they be managed

-def: involuntary movements you cannot control --EX:akathisia, dystonia, Parkinsonism, tar dive dyskinesia, dystonia -commonly found in people who take: antipsychotic meds -managed by: benzos for dystonia and traduce dyskinesia, propranolol and clonidine for akathisia

heat exhaustion:

-definition: a mild heat illness; an acute reaction to heat exposure -MOST COMMON HEAT RELATED ILLNESS SEEN BY EMS -resulting loss of water and sodium from sweat combined with general vasodilation, leads to a decreased circulating blood volume, venous pooling, and reduced cardiac output -s/s: increased body temp (over 100F or 37.8C), cool clammy skin w/ heavy perspiration, tachypnea and a weak pulse, CNS sympt. like HA, anxiety, impaired judgment -TX: remove pt from environment, place pt supine w/ knees bent and elevated, administer water or a sports drink or antiemetics, remove some clothing and fan pt, tx for shock if needed

heat stroke:

-definition: acute, dangerous rxn to heat exposure, characterized by a temp usually above 105F (40.6C) and CNS disturbances, sweating usually stops -causes death and damage to brain, liver and kidneys -s/s: Cessation of sweating, Hot skin that is dry or moist Very high core temperature, Deep respirations that become shallow; rapid at first but may later slow, Rapid, full pulse; may slow later, Hypotension with low or absent diastolic reading Confusion or disorientation or unconsciousness, CNS symptoms such as headache, anxiety, paresthesia, impaired judgment, or psychosis, Possible seizures -classic heatstroke: common in those w/ chronic illnesses, w/ increased core temp caused by thermoregulatory fxn-including age, DM; common s/s include hot red dry skin -exertional heatstroke: common in those in good health, w/ increased temp cause by overwhelming heat stress. although sweating has stopped, moisture from prior sweat may still be present; metabolic acidosis may be present as well as hyperkalemia -TX: remove pt from environment, initiate rapid active cooling by removing pts clothing and covering to w/ sheets soaked in tepid water, fanning and misting pt, give O2 if needed, start oral or IV fluids, monitor EKG for changes, AVOID vasopressors/anticholinergic meds, monitor temp

heat cramps

-definition: acute, painful spasms of voluntary muscle following strenuous activity in a hot environment w/o adequate fluid/salt intake -s/s: pt will present w/ cramps in fingers, arms, legs and abd muscles. pt may feel weak or dizzy, VS stable, temp norm to slightly elevated, skin moist and warm -TX: remove to from environment, give sports drinks PO, educate pt on proper prevention

DKA:

-definition: complication of DM1 due to decreased insulin intake. marked by high blood glucose, metabolic acidosis, and in advanced stages coma -common causes: noncompliance w/ insulin injections, physiologic stress (infection/surgery), causing release of catecholamines, potentiating glucagon effects and blocking insulins -pathophysiology: in early phases, hyperglycemia exists b/c of lack of insulin. loss of glucose via urine along w/ loss of water through osmotic diuresis produce dehydration, as body moves to fat based metabolism, blood ketone levels rise and pH drops -s/s: slow onset usually over 12-24 hrs, polyphagia,dypsia and uria, warm dry skin and mucous membranes, Kussmauls respirations-help expel excess CO2, fruity odor from breath assessment and mgmt: check BG and ensure ABCs, not uncommon for a BG above 500 mg/dL, -TX: 1-2 L of NS for fluid rehydration and to lower BG and rapid transp.

Hyperosmolar Hyperglycemic State (HHS) or Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK):

-definition: complication of DM2 due to inadequate insulin activity. marked by high BG, dehydration, decreased mental fxn -developes when 2 conditions occur: sustained hyperglycemia causes osmotic diuresis enough to produce dehydration and water intake isn't enough to replace lost fluids -pathophysiology: sustained hyperglycemia causes glucose to spill into urine and cause osmotic diuresis and dehydration; BG usually much higher (up to 1,000 mg/dL+), though insulin activity prevents formation of ketone bodies, higher mortality rate than DKA (40-70%) -s/s: slower onset than DKA (usually over several days), early signs are increased urination and thirst, NO KUSSMAULS!!!!, lethargy, confusion, coma -assessment and mgmt: tx the same prehospital as DKA

frostbite

-definition: environmentally induced freezing of body tissues, causing destruction of cells -As the tissues freeze, ice crystals form within and water is drawn out of the cells into the extracellular space. Damage to blood vessels from ice crystal formation causes loss of vascular integrity, resulting in tissue swelling and loss of distal nutritional flow. -superficial frostbite (aka frostnip): involving only epidermal tissues causing redness followed by blanching and diminished sensation -deep frostbite: involving epidermal and subq tissues, resulting in white appearance, hard, frozen feeling on palpation and loss of sensation -TX: Do not massage the frozen area or rub with snow. Rubbing the affected area may cause ice crystals within the tissues to damage the already injured tissues more seriously. Administer analgesia prior to thawing. If transport will be delayed, thaw the frozen part by immersion in a 102°F to 104°F (39°C to 40°C) water bath

hypothermia

-definition: state of low body temp-specifically low core temps *when the core temp drops below 95 (35 C) pt is considered hypothermic -predisposing factors: age (the really young and the really old), health of the pt (hypothyroidism suppresses metabolism, preventing appropriate response to cold stress, malnutrition, DM, Parkinson's) meds (can interfere w/ heat generation-narcs, ETOH, bars, anti seizure meds, allergy meds, antipsychotics, sedatives, antidepressants, NSAIDS) length of exposure -mild hypothermia-core temp btwn 90-95 (32-35C) w/ s/s of hypothermia: tachycardia, shivering, vasoconstriction, tachypnea, impaired judgement -moderate hypothermia: core temp btwn 82-90 (28-32C) w/ s/s of hypothermia: cold induced arrhythmia (Brady, Osborn waves), hypotension, resp depression, AMS, LOSS OF SHIVERING -severe hypothermia: core temp below 82 (28C) w/ s/s of hypothermia: coma, apnea, no palpable BP, ventricular arrhythmia/asystole -TX: Remove wet garments. Protect against further heat loss and wind chill. Use passive external warming methods such as application of blankets, insulating materials, and moisture barriers. Maintain the patient in a horizontal position. Avoid rough handling, which can trigger arrhythmias. Monitor the core temperature. Monitor the cardiac rhythm.

hyperthermia:

-definition: state of unusually high core body temp. -usually caused by heat transfer from the external environment for which the body cannot compensate or by excessive generation of heat within the body -external signs of thermolysis: caused by chief method of heat dissipation-sweating (leads to evaporation) and vasodilation (allows the blood to carry heat to the periphery for dissipation through the skin); include: Diaphoresis, increased skin temperature and Flushing; as it progresses: s/s of thermolytic inadequacy present in the form of AMS and altered LOC -predisposing factors: age (very old and very young), health of pt (dm can cause hyperthermia more easily b/c they can develop autonomic neuropathy, interfering w/ thermoregulatory input), meds (diuretics, beta blockers and allergy meds predispose and worsen hyperthermia), level if acclimatization, length and intensity of exposure -remove pt from environment and begin cooling pt

what is a tilt test? how is it performed? what changes do you expect to see if your pt is hypovolemic?

-definition: usually following a syncopal episode; orthostatic vital signs involves measuring pulse and blood pressure while the patient is lying down and then again after standing up (at intervals of one and three minutes). Some clinicians may elect to measure heart rate and blood pressure when the patient is seated, between the lying and standing measurements -If one or more of the following is true, the test is indicative of a loss of blood volume: *Decrease of systolic blood pressure of 20 mm Hg or more *Decrease of diastolic blood pressure of 10 mm Hg or more *Increase in heart rate of 20 beats per minute or more

What is Mallory-Weiss syndrome?

-esophageal laceration, usually secondary to vomiting, w/ resultant bleeding

esophageal varices

-esophageal varies: swollen vein of esophagus; if ruptured, 35% mortality rate -cause: usually increase in portal HTN (pertaining to flow of blood into liver) --damage to the organ impairs blood return and causes backup into left gastric vein causing the bulging of the veins -PRIMARY CAUSES: consumption of alcohol and ingestion of caustic substances -presentation: painless bleeding and s/s of hemodynamic instability; complain of hematemesis, dysphagia (diff. swallowing), and a burning/tearing sensation as they continue to bleed and irritate lining of esophagus -TX: aggressive airway mgmt, fluid replacement, tx for shock as needed

use of analgesics should be done sparingly or w/ caution due to:

-fear of masking any abd pain -exceptions: mesenteric ischemia-pre hospital tx is hydration, pain control and antiemetics -cholecystitis: tx usually involves fentanyl and dilaudid

relationship between fundal height and fetal development

-fundal height: distance from pubic symphysis to top of uterine fundus -each cm of fundal height: roughly corresponds to a week of gestation --palpable above pubic symphysis: 12-16 weeks --fundus reaches belly button: 20 weeks --if fetal mvmt felt w/ abdominal palpation: at least 20 weeks --fundus palpable near xiphoid process: reaching full term

what would happen if a patient who is on chronic corticosteroid therapy suddenly discontinues their meds

-fxn of corticosteroids: stimulate cortisol (a naturally occurring anti-inflammatory hormone) -if you use them for a long time, your body stops making enough of its own steroids to maintain important fxns -s/s of steroid withdrawals: Severe fatigue, Weakness, Body aches, Nausea Joint pain, Loss of appetite, Lightheadedness Irritability or mood swings

what does gravida and para mean

-gravida: how many times a woman has been pregnant -para: how many live births she has had

sine-waves on an egg

-indication of severe and profound hyperkalemia -K+ usually at: 8 mEq/L+ causing the QRS to blend into the ST segment and the T wave -short and almost indiscernible P waves -if not fixed, QRS will continue to widen and flatten and blend w/ t waves -means VF/asystole are imminate -TX: calcium gluconate-10mL of 10% solution over 2-3 mins and HAUL ASS TO THE ER

Diverticulitis

-inflammation of the diverticula; and a common complication of diverticulosis [presence of diverticula(small pouches in the mucosal lining of the GI tract) w/ or w/o bleeding] -common complaint of: LLQ pain -pouches may collect food, poop particles and potential sources of infection -complications secondary to diverticulitis: hemorrhage or large perks though colon allowing fecal matter to spill into peritoneal cavity causing peritonitis -presentation: colicky abd pain, N/V, fever and tenderness w/ palpation of abd -TX; supportive; O2 as needed, consider fluids and zofran

cholecystitis

-inflammation of the gallbladder -5 Fs: fair, female, fat, fertile and 40. -cholelithiasis: (gall stone formation); causes 90% of cases -gallbladder stores bile-which can become supersaturated and calculi (stone like masses based on bilirubin, cholesterol or both) and commonly lodge in common bile duct --bile flow becomes obstructed ---bile irritates mucosal membrane and prostaglandins are released, further irritating wall -can be caused by calculus cholecystitis: cholecyistiis w/o stones resulting from burns, sepsis,DM or MODS -presentation: RUQ pain, irritation of diaphragm causing R shoulder pain, colicky abd pain (especially after meals high in fat), sympathetic stim may cause pale cool skin, N/V -murphys sign: pain w/ palpation by pressing under R costal margin -TX: palliative; maintain ABCs, fentanyl or dilaudid NOT morphine

pancreatitis

-inflammation of the pancreas -4 main categories: --metabolic: specifically alcoholism-80% of all cases --mechanical: gallstones or increase in serum lipid levels-9% --vascular and infections: thromboembolism, shock and infection; remaining 11% -pancreatic tissue arranged in granular stxs called acini --produce digestive enzymes and also have small endocrine fxns like secreting insulin an glucagon -gallstones can obstruct pancreatic duct causing a backup of digestive enzymes --inflammation/irritation of pancreas by enzymes causes edema and decreased blood flow-ischemia and acinar destruction (acute pancreatitis) ---acinar destruction: commonly caused by chronic alcohol abuse, drug tax, ischemia and infection -presentation: acute LUQ pain radiating to back and epigastric region, N/V, poss. bruising/LUQ swelling, diaphoresis and tachycardia -TX: supportive; maintain ABCs, high flow O2, fluids TKO

explain the processes involved in inspiration, expiration and respiration

-inspiration: phrenic nerve signals for diaphragm to contract, thorax size increases and pressure inside thorax decreases-negative pressure created draws air into lungs -expiration: at the end of inspiration, respiratory muscles relax, decreasing size of chest cavity and increasing intrathoracic pressure until it equals atmosphere again, forcing air out of airway -respiration: the exchange of gases between a living organism and its environment. Pulmonary (external) respiration occurs in the lungs when the respiratory gases are exchanged between the alveoli and the red blood cells in the pulmonary capillaries through the capillary membranes; Cellular (internal) respiration, occurs in the peripheral capillaries. It is the exchange of the respiratory gases between the red blood cells and the various body tissues. Cellular respiration in the peripheral tissue produces carbon dioxide

describe the distribution of fluids in the body-intra and extracellular, intravascular, and interstitial fluids and % of total body water compromised by each

-intracellular fluid: fluid found inside body cells, 70% of all body water -extracellular fluid: fluid outside of body cells composed of intravascular fluid and interstitial fluid; remaining 30% of total body water -intravascular fluid: division of extracellular compartment; fluid within circulatory system-essentially the same as blood plasma; 5% of total body water -interstitial fluid: division of extracellular compartment; all fluid found outside of cell membranes yet not in circulatory system; 25% of body water -At birth, an infant's TBW is about 75 to 80 percent of its body weight, compared to the 65 percent TBW of the average adult

preferred medication route for pts suffering from sever allergic reaction. why?

-intramuscular is the best route for epinephrine administration-more commonly available to the public (epi pen) and easier to train on??? *not really sure on this one, Dr.Google wasn't specific-ask caldwell?*

why does diabetes increase the risk for AMI

-long term high blood sugar levels can cause the excess sugar to attach itself to RBCs and build up in your hart

what are mast cells and their function

-mast cells: specialized cells of the immune system that contains chemicals that assist in the immune response -when IgE attached to the basophils along w/ mast cells bind to an allergen, they release histamine, heparin and other substances to surrounding tissues --histamine and other substances are stored in granules found within the basophils and mast cells ---b/v of this, basophils and mast cells are also known as granulocytes ----process of releasing these cells is called degranulation

how does pulse ox work? strengths and weaknesses

-measures hemoglobin oxygen saturation in peripheral tissues -strengths: detects probs w/ oxygenation faster than assessments of BP, HR and RR -weaknesses: in cases of CO poisoning, pulse ox can read normal;

TCA OD

-meds usually end in -line and -mine (amitriptyline, clomipramine, nortriptylinem imipramine) -block many receptors: alpha andrenergic, histaminic, muscarnic and central serotonin --alpha adrenergic: decrease BP --musicarnic: s/s of anticholinergic too ( increase HR, fever, dry mouth and skin, decreased bowel sounds and AMS) --histaminic: AMS -produce a WIDE, PROLONGED QRS: blockage of fast sodium channels slows action potential -symptoms start in 30-40 mins and s/s of toxicity start within 2 hrs -s/s: resp depression, sinus tach common (be on the lookout for other dysrhythmias), decrease in HR, anticholinergic effects, AMS, agitation, sz, prolonged QRS -TX: BICARB!!!!!!, airway mgmt, admin of activated charcoal up to 2 hrs post ingestion

primary functions of medulla, cerebrum and cerebellum

-medulla oblongata: lower portion of the brainstem, connecting the pons and spinal cord. contains major centers for control of respiratory, cardia and vasomotor activity -cerebrum: largest part of brain; consists of 2 hemispheres; seat of consciousness and the center of higher mental fxns like memory, learning, reasoning, judgement, intelligence and emotions as well as the involuntary regulation of somatic patterns -cerebellum: located dorsally to the pons and medulla; plays important role in the fine motor movement, posture, equilibrium and muscle tone, involuntary control of complex somatic motor patterns, memory storage of learned motor patterns and adjusts output of other somatic motor centers in the brain and spinal cord

common sources for methanol and ethylene glycol

-methanol: Antifreeze, Canned heating sources, Copy machine fluids De-icing fluid, Fuel additives (octane boosters), Paint remover or thinner Shellac, Varnish Windshield wiper fluid and some fresh fruits and vegetables -ethylene glycol: antifreeze, hydraulic brake fluids, some stamp pad inks, ballpoint pens, solvents, paints, plastics, films, and cosmetics

brown recluse spider bite

-mild s/s of bite: Pain, Ache at the site., Pain surrounding muscles near the bite. Pain in your abdomen, back, chest and legs. Blister at the site. Swelling. Bruising. -severe s/s of bite: Rash., Fever, Dizziness. Vomiting., Chills. Restlessness or difficulty sleeping. -stages of bites: --hours after a bite: The area of the bite becomes sensitive and red about three to eight hours after the bite. The bite site feels like it is burning.The bite site changes color. It can have a bullseye look or can bruise and have a blueish color. --3-5 days after bite: If the spider injected a small amount of venom, immediate discomfort should disappear. If the venom spread beyond the bite area, discomfort could continue for several days and an ulcer would appear on the bite site. -7-14 days after bite: In severe cases, the skin around the ulcer breaks down and becomes a wound that could take several months to heal completely. -3 weeks after bite: The majority of bites will heal after three weeks.A thick, black scab will cover the wound. -TX: pain meds (Tylenol and NSAIDS), antihistamines, don't pick at scabs, ice packs for swelling

appwndicitis

-most often due to obstruction of appendices human by fecal matter- inflames/irritates lymphoid tissue often causing bacterial/viral infection --inflammation can cause internal diameter to increase, blocking appendicular artery and cause thrombosis --w/ artery blocked, appendix becomes ischemic and necrotic, wearing vessels leading to rupture -mild/early s/s: diffuse, colicky abd pain, N/V, decreased appetite --as it continues to dilate, pain will localize to RLQ -McBurneys point: common pain point for appendix, 1-2 inches above the anterior iliac crest in line w/ the belly button -Markles sign: heel-drop jarring test; variation of rebound tenderness elicited by having pt stand on their toes for a few seconds then putting their full body weight down on their heels-if pain, + Markle sign -TX: place pt in POC, ensuring airway, establish iv

#4 continued:

-nitrogen narcosis: developed during deep dives and contributes to dive emergencies at the bottom. Results in intoxication and AMS due to similar effects of higher nitrogen levels in brain mimicking the effects of alcohol. ^between 70-100ft: effects apparent in most divers ^at 200 ft: most divers are so impaired, the cannot do useful work ^at 300-350 ft: unconsciousness occurs +s/s: AMS and impaired judgement ~tx: returning to a shallow depth- condition is self resolving =tx is preventable by using O2 mixed w/ helium (no anesthetic effects like nitro)

pneumonia

-one of the leading causes of death in the elderly and HIV+ -pathophysiology: bacterial, viral or fungal, begins in 1 part of the lung and spreads to nearby alveoli, and as it progresses, fluid and inflammatory cells collect in alveoli possibly causing collapse -PRIMAIRLY A VENTILATION DISORDER -risk factors: kids under 2 and adults over 65, smoking, heavy drinking, being in the hospital on a vent, having a lung disease or weak immune system or probs w/ coughing or swallowing -assessment: recent hx of fever/chills. generalized weakness and malaise, deep productive cough w/ yellow or brown septum, pleuritic CP (sharp/tearing) -s/s: tachypnea, tachycardia, cough, rales/decreased lung sounds, egophony (dullness over areas) -mgmt: transport POC, fluids, neb

when and how should a new born be suctioned

-only indicated in babies who have an obstruction to spontaneous breathing or who require PPV -suction steps: mouth then nose

define osmosis, diffusion, facilitated diffusion and active transport

-osmosis: the movement of water molecules from an area of high water (low solute) concentration to an area of low water concentration (high solute concentration) -diffusion: random mvmt from region of high concentration to area of low concentration -facilitated diffusion: mvmt from area of high concentration to low concentration w/ help of carrier or channel protein -active transport: mvmt from a region of high-low concentration w/ help of a carrier or channel protein and energy-usually from ATP

asthma

-pathophysiology: involves the following components-airway inflammation, intermittent airflow obstruction bronchial hyperresponsiveness --smooth muscles in the bronchioles conducting air to alveoli are stimulated by external factors leading to bronchospasm and increased resistance to airflow -risk factors: parental hx of asthma, having a severe respiratory infection as a kid, exposure to certain elements, smoking, pollution and obesity -presentation: within mins of exposure-2 phase rxn occurs --phase 1: release of chem. mediators like histamine causing contraction of bronchial smooth muscle and leakage of peribronchial cavities-causing bronchial constriction and edema ---can reduce expiratory air flow and usually resolve within 1-2 hrs or sooner w/ meds --phase 2: 6-8 hours after exposure, inflammation of bronchioles and immune cells invading resp. mucosa causing edema ---wot respond to albuterol but will to corticosteroids -s/s: dyspnea, wheezing, cough (initial), but as severity increases, hyperinflation of chest due to air trapping in alveoli, tachypnea, accessory muscle use, pulsus paradoxes and tachycardia -mgmt: correct hypoxia, reverse bronchospasm, tx inflammation albuterol/atrovent/solu-medrol O2 and mag

identifying characteristics of pit vipers and coral snakes

-pit vipers: Arrowhead-shaped (triangular) heads Elliptical pupils Heat-sensing pits between the eyes and nose, Retractable fangs, A single row of subcaudal plates extending from the anal plate on the underside of the tail --THICK BODY SKINNY TAIL -coral snakes: RED AND YELLOW KILL A FELLOW;

common organic sources of cyanide

-produced by certain bacteria, fungi and algea -can also be found in foods like: spinach, bamboo shoots, ALMONDS, lima beans, fruit pits, tapioca

functions of the liver

-producing albumin: protein that keeps fluids in bloodstream from leaking into surrounding tissues and carrying hormones, vitamins and enzymes -producing bile: critical for digesting and absorbing fats in small intestine -filtering blood: blood leaving stomach and intestines passes through liver, which removes toxins, byproducts and harmful substances -regulates blood clotting: coagulants including vitamin K (can only be absorbed w/ the help of bile) -processes glucose: removes excess glucose from bloodstream and stores it as glycogen, and can be converted into glucose if needed

cyanide OD:

-product of combustion-common at house fires -combines and reacts w/ ions to inhibit cellular oxygenation -managing cyanide poisoning: remove pt from hazardous environment if possible, ensure ABCs (provide vent. support as needed), give high flow O2, administer cyanokit, IV/IO w/ fluids TKO

mild allergic reaction

-s/s: Stuffy nose, sneezing, itching around the eyes or skin, rash, urticaria (hives) -mgmt: O2, cardiac monitor, 0.3-0.5mg epi 1:1000 IM q 15-20 min (vasoconstrictor and bronchodilates), Benadryl 25-50mg, Solu-Medrol 125mg -if pt wheezy: give albuterol via ned (2.5 mg in 3mL) -if pt experiences decompensation/crdiovascular deterioration: process to 0.1 mg epi 1:10,000 and follow down that pathway

Benzo OD

-s/s: resp. depression, confusion, dizzy/drowsy, blurred vision, unresponsiveness, anxiety, agitation, ataxia, slurred speech, hypotension and AMS -TX: flumazenil

#5: pathologies of salt water and fresh water drownings:

-saltwater: when saltwater enters the lungs, the high salt content prevents it from crossing the membranes of the capillaries. instead, it causes blood and water from the bloodstream to cross over the membranes of the capillary walls and into the lungs - not only preventing O2 from entering bloodstream, but causes victim to basically drown in their own fluids: -Freshwater: when freshwater enters the lungs, the low salt content allows water to cross over the membrane of capillary walls and be absorbed into bloodstream- causing damage to blood and causes cardiac arrest

status asthmaticus

-severe, prolonged asthma attack unresponsive to bronchodilators

why does diabetes increase the risk for blindness

-short term effects of high BG: blurry vision for days or weeks; vision will blur when sugar is high but return to normal when sugar lowers -long term effects: damage to blood vessels in the back of the eye causing fluid to leak and swell leading to scarring and increased intraoccular pressures -diabetic retinopathy: blood vessels weaken, bulge or leak into retina-or worse close off-leading to vision problems

why does diabetes increase the risk for stroke

-stroke: The pancreas is responsible for producing this insulin in the right amounts. In people who have Type 1 diabetes, the pancreas does not make insulin. In people who have Type 2 diabetes, the pancreas makes too little insulin, or muscles, the liver and fat do not use insulin in the right way. As a result, people with untreated diabetes accumulate too much glucose in their blood, and their cells don't receive enough energy. Over time, excessive blood glucose can result in increased fatty deposits or clots in blood vessels.

cerebrovascular accident (CVA)

-strokes: 3 most common COD, and in the middle aged and older patients, aa frequent cause of disability -occlusive: cerebral artery is blocked by a clot or other foreign matter causing ischemia that progresses into infarction --if tissue infarcts, the dead tissues swells-pushing on nearby tissues causing further damage and reducing blood flow --if swelling severe enough, can cause herniation -embolic stroke: embolus=solid, liquid or gas carried to a blood vessel from a remote site --most common emboli: clots (thromboemboli) ---usually arise from diseased blood vessels in the neck (carotid) or from abnorm. contracting chambers of the heart (a-fib) ---OCCUR SUDDENLY AND MAY BE CHARACTERIZED BY SEVERE HA -thrombotic strokes: cerebral thrombus=blood clot that gradually develops in and obstructs a cerebral artery-buildup of plaque causes narrowing of artery walls (atherosclerosis) until they are finally so plaque-filled they close --s/s: develop gradually; often occurs at night and characterized by pt waking up altered w/ AMS, aphasia etc -hemorrhagic stroke: either intracerebral (within the brain) or subarachnoid (in the space around the outer surface of the brain) --onset: sudden severe HA, "worst HA of my life. thunderclap HA" --most occur in: pts w/ HTN when a small vessel deep in the brain ruptures --subarachnoid: commonly result from congenital abnormalities (aneurysm, AVM) or head trauma -assessment/tx: remember be FAST: Facial droop, Aphasia, Speech, and Time (LKN)

black widow spider bite

-symptoms: --After 15 minutes to 1 hour, a dull muscle pain spreads from the bite area to the whole body. If the bite is on the upper body, you will usually feel most of the pain in your chest. If the bite is on your lower body, you will usually feel most of the pain in your abdomen. --other symptoms can also occur: Anxiety, SOB, HA HTN, Increased salivation and sweating, photophobia, Muscle weakness, N/V, Numbness and tingling around the bite site, then sometimes spreading out from the bite Restlessness Seizures (usually seen just before death in children who are bitten) Very painful muscle cramps or spasms Facial swelling in the hours after the bite (This pattern of swelling is sometimes confused with an allergy to the drug used in treatment.) -TX: muscle relaxers/sedatives/analgesics, antivenom

another name for a temporal lobe seizure and how does it present

-temporal lobe seizures=focal seizures; most common type of epilepsy -presentation: can be preceded by an aura; --usually last 30 sec-2 min --s/s: Not being aware of the people and things around you. Staring. Lip smacking. Repeated swallowing or chewing. Finger movements, such as picking motions.

Transient Ischemic Attack (TIA)

-temporary interruption of blood supply to the brain that has symptoms that can mimic a stroke -s/s can last for a few mins to several hours, but usually pt is back to baseline within 24 hrs -1/3 out of all TIA pts suffer a stroke soon after their TIA -most common cause: carotid artery disease --other causes: small embolus, decreased CO, hypotension and cerebrospinal vasospasm -management: supportive measures, rapid transport, ensuring airway protection, monitor O2, BG and LOC

difference between type 1 and type 2 diabetes

-type 1: the pancreas does not make insulin, because the body's immune system attacks the islet cells in the pancreas that make insulin. -type 2: the pancreas makes less insulin than used to, and your body becomes resistant to insulin. This means your body has insulin, but stops being able to use it.

Beta Blocker OD

-used in tx of : angina, hear failure, a fib, HTN, and hyperthyroid-blocks effects of adrenaline on heart (decreased HR and contractile force) -common beta blockers: end in -lol; atenolol, carvedilol, labetalol, metoprolol, sotalol and propranolol -s/s: SOB/gasping, wheezing, blurry vision, irregular and slow HR, lightheadedness/dizziness, hypotension, AMS, diaphoresis and low BG -TX: GLUCAGON 1MG!!!!!!!; activated charcoal, laxatives, prompt airway mgmt, bicarb (if wide QRS), or mag sulfate (if prolonged QT)

why is epi useful in the management of moderate and severe allergic reactions

-vasoconstriction effects: prevents/decreases upper airway mucosal edema, hypotension and shock -also has: bronchodilator effects as well as inotropic and chronotropic effects

how many months/weeks is a term pregnancy

-weeks: 39 weeks days-40 weeks 6 days -months: a little more than 9 months

why is Benadryl useful in the management of allergic reactions

-works by blocking histamine that your body makes during an allergic reaction, and by drying secretions related to symptoms like watery eyes and runny nose.

persons who may consent to the care of a minor

Any time an EMS crew encounters a minor who has a life-threatening illness or injury, they should initiate care under the principle of implied consent. Generally, consent of a parent or legal guardian is required to begin medical care for a minor, Some states have statutes allowing persons to act "in loco parentis" — in place of a parent — under given situations. This is usually called for in the school setting: If a child becomes ill at school, they will generally be cared for under this principle.

differentiate between certification, licensure and registration

C-the process by which an agency or association grants recognition to an individual who has met its qualifications. L-a process of occupational regulation. Through licensure, a governmental agency (usually a state agency) grants permission to engage in a given trade or profession to an applicant who has attained the degree of competency required to ensure the public's protection. R-accomplished by entering one's name and essential information within a particular record.