NREMT Paramedic Exam

NREMT Paramedic Exam stridor Harsh or high-pitched respiratory sound, swelling, fb in upper airway. Croup is an example Snoring The sound of the soft tissue of the upper airway creating a partial obstruction of air flow. The tongue blocking the airway is an example. gurgling indicates presence of fluid in the upper airway, need for suctioning Decorticate elbows and hands flexed, and legs flexed. They are internally rotated (the lets look bowlegged) (make an O with their arms: corticate) Decerebrate (worse) Stiffened and internally rotated elbows and legs, teeth clenched, legs stiff and feet extended. Babinski's response dorsiflexion (splaying) of toes -abnormal plantae reflex response if over 18 months mydriasis dilation of the pupil. Appears in cardiac arrest, shock, cerebral hypoxia, cocaine, epinephrine, and amphetamines. Miosis Constricted pupils. Narcotics, CNS disorder, glaucoma medication, bright light anisocoria unequal pupil size that may indicate serious neurologic dysfunction nystagmus involuntary rapid eye movements - often reported as horizontal, vertical, or rotary subcutaneous emphysema Air under the skin; crepitus sound rales (crackles) Fluid in small airways (aveoli). Common in CHF, pulonary edema, drowning, pneumonia, and COPD Rhonchi Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways. Found in Bronchitus, COPD, and pneumonia. Wheezing The production of whistling sounds during expiration such as occurs in asthma and bronchiolitis. Bronchial lung sounds heard over trachea/upper sternum; expiratory sound predominates; is higher pitched and louder; if heard in other locations it indicates consolidation -- a space that usually contains air now has fluid Bronchovesicular Heard over scapula and 2/3rd intercostal space lateral to sternum. Apneustic breathing Characterized by prolonged inspirations unrelieved by attempts to exhale, which indicates trauma to the pons. AKA long, deep breaths that are stopped during inspirations then periods of apnea. Biot's (Ataxic) Respirations Shallow, deep respirations with periods of apnea Irregular pattern Precipitating factors: respiratory depression, brain damage Cheyne-Stokes respiration pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea Hyperventilation rapid, shallow breathing Kussmaul respirations very deep and rapid respirations. Example: DKA Hyperresonant tension pneumothorax, emphysema, asthma resonant echoing normal sound right upper quadrant Liver, gallbladder, and stomach Right Lower Quadrant Appendix, right ovary, and tube. Bladder if distended Left Upper Quadrant Spleen, stomach, liver, and pancreas left lower quadrant Left ovary and tube. Bladder if distended Visceral Pain Internal organs damaged or injured. Vague, not well organized, pressure like, or dull aching, can't point to pain with one finger. Hollow organs stretches, ischemia, inflammation. somatic pain Pain that originates from skeletal muscles, ligaments, or joints. Peritoneal linining sharp, localized, throbbing, deep breath increases pain Cullen's sign ecchymosis in umbilical area, seen with pancreatitis. aka bleeding in abdominal cavity Grey Turner's Sign (ecchymosis in flank area) Chronic hemorrhagic from kidneys and pancreatitis Kehr's sign Referred pain down the left shoulder; indicative of a ruptured spleen. Murphy's sign Pain with palplation of gall bladder (seen with cholecystitis) Brudzinski's sign pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine. Seen in meingitis Hamman's sign Cruching shound on auscultation Emphysematous mediastinum Seen with Boerhaave's syndrome, pneumomediastinum, etc. Homan's sign DVT Kernig's sign Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. Clubbing of fingers Caused by chronic hypoxia. Presence of this is suggestive of pulmonary disease. Orthostatic tilt test Supine, Sitting, and standing. BP raising 20 systolic, increase in heart rate by 20, and decrease in diastolic by 10 MAP (mean arterial pressure) The average pressure for the entire cardiac cycle MAP=Diastolic Pressure + 1/3 of the Pulse Pressure Pediatric Assessment Triangle (PAT) A structured assessment tool that allows you to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin. Drip calculations gtts/min gtts/min= ml*drip size/time in minutes drip calculation ml/hr ml/hr= (gtts/min) * time in minutes(/)drip size weight based dosing Desired DoseWeight (in KG)GTT(drop set) (/) concentration*Time Dosage calculation formula Example:Atropine 0.02mg/kg. (Atropine comes 1mg/5ml)Patient weighs 55lbs(55/2.2) becomes 25kg. 0.02mg25kg= 0.5 mg. 0.5mg5ml= 2.5 ml Alkalosis pH above 7.45 Acidosis pH below 7.35 pC02 35-45 Hypercabia excessive levels of carbon dioxide in the blood hypocarbia insufficient carbon dioxide, hyperventilation syndrome. Kussmaul's breathing HC03 (bicarbonate) 22-26. above 26 (metabolic alkalosis), below 22 (metabolic acidosis) examples include shock, dka, aspirin overdose, cardiac arrest, lactic acid (waste product). hypovolemic shock shock resulting from blood or fluid loss (burns or dehydration). High heart rate, high respiration, eventually low BP, pale or cyanotic, flat neck veins. Pale skin. Management- Airway, O2, BVM, if needed, control bleeding, position flat, isotonic crystalloid, keep warm cardiogenic shock Shock caused by inadequate function of the heart, or pump failure. High or low heart rate, may have pulmonary edema, pale, or cyanotic. Management- Airway, O2, BVM, restrict fluids, and dopamine (vasopressor/inotropic agent Adult dose- 5-20 mcg/kg per minute. Pediatric- 5-20 mcg/kg per minute) anaphylactic shock (distributive shock) A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Characterized by bronchoconstriction, labored breathing, widespread vasodilation, circulatory shock, and sometimes sudden death. Angioedema, hives, stridor, wheezing, vasodilation. Management- Airway, O2, BVM, beta 2 agonist, epi (adults 0.3-0.5 mg, peds-0.01mg/kg) or benadryl (adults 25-50 mg, peds-1 to 2mg/kg) neurogenic shock (distributive shock) a state of shock (hypo-perfusion) caused by nerve paralysis that sometimes develops from spinal cord injuries. Management- Airway, O2, dopamine (vasopressor/intropic 5-20 mcg/kg). Flat position, spinal precautions if needed. septic shock a serious condition that occurs when an overwhelming bacterial infection affects the body. Low BP, temp may be high, low or normal skin- pale, cyanotic or red, vasodilation. Rhonci obstructive shock Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues. Causes- Pulmonary embolus, cardiac tamponade, tension pneumothorax. Management- Rapid transport, airway, O2, pleural decompression for tension. antagonist drugs drugs that block or change the effects of an addictive drug agonist drug mimics and enhances a neurotransmitter's effect Schedule 1 drugs Highest potential for abuse, no therapeutic use, (Heroin, marijuana, LSD, crack cocaine) Schedule II drugs - Drugs have high potential for abuse - Drugs have currently accepted medical uses, although there may be serious restrictions. (Fentanyl, cocaine, morphine, methadone) Pediatric Drugs Weight based due to being absorbed more cumulative increasing, building upon itself