What are the 3 signs of cushings triad?
1) Widening Pulse Pressure (or hypotension) 2) Bradycardia 3) Irregular Breathing Patterns
What is the 2 most concerning causes of a widening pulse pressure?
1) Aortic Aneurysm 2) Aortic Dissection
Which peripheral nervous system increases heart rate?
Sympathetic
Which peripheral nervous system decreases heart rate?
Parasympathetic
What is the frank-sterling law?
Too little stretch doesn't give a good contraction, too much stretch also effects the contraction ability, need just the right amount of stretch for optimal contraction.
How do you calculate MAP?
2x diastolic plus systolic divided by 3.
Where do Chronotropic drugs bind to the heart?
At the SA node
What effect do inotropic drugs have on the heart?
Increases force of contraction... (I KNOW!!!)
What medication affects the heart rate by changing the generation of electrical impulse?
Chronotropic
What medication affects the contractility of the the heart by increasing the force of contraction?
Inotropic
What medication affects the automaticity of the heart by changing electrical impulse velocity?
Dromotropic
What does stimulation of ALPHA receptors cause?
Peripheral vascular Contraction (AbCd)
What does stimulation of BETA receptors cause?
Bronchial smooth Dilation (aBcD)
What medication ends in -pril?
ACE inhibitors
If a patient doesn't tolerate ACE inhibitors well, what medication is next in line?
Angiotension receptor blockers (ARBs)
What 4 adverse effects should you monitor for when administering an ACE inhibitor?
1) Rash 2) Renal Impairment 3) Angioedema 4) Dry cough (ACE is RRAD)
ACE inhibitors are catagory D in pregnant women, which means what?
Avoid during pregnancy
What does ACE inhibitors do?
Decrease BP and afterload (means less filling of ventricles often helping those in heart failure)
What medication ends in -sartan?
Angiotension receptor blockers (ARBs)
What 2 conditions would you administer an ARB?
1) hypertension 2) Heart Failure
In Addison's Crisis, what do you expect the sodium, potassium, and blood pressure to be?
1) Hyponatremia 2) Hyperkalemia 3) Hypotension
In Addison's Crisis, what organ is having the problem and what is the problem?
Adrenal glands are not sufficiently producing or releasing cortisone or aldosterone
In DIC, what diagnostic lab do you test for diagnosis?
D-Dimer (positive is elevated D-Dimer)
When do you use unsynchronized cardioversion (defibrillation) vs synchronized cardioversion?
PULSELESS V-Tach or PULSELES V-Fib is Unsynchronized, everything with a pulse is syncronized.
What medication do you give to someone with myasthenia gravis?
edrophonium (Tensilon)
What medication do you give to someone with gout?
allopurinol (Zyloprim)
When is a patient likely to experience a gout pain attack?
At night b/c low body temp, decreased O2 (especially if they have sleep apnea), and nighttime dip in cortosol
What is a medical emergency, strangulated or incarcerated hernia?
Strangulated
After delivery, what should the uterus feel like?
Firm
What is the treatment of an aortic aneurysm if it is stable?
BP control with beta blockers or calcium channel blockers
What medication can sometimes cause Second-Degree AV block Type I (Wenckenback)?
Digoxin
What are 3 things treat Second-Degree AV block Type II (Mobitz)?
1) Temporary Pacemaker 2) Supplemental Oxygen 3) IV Atropine
What is happening during Complete Heart Block?
No atrial impulses to the ventricles, so the SA node impulses are not reaching the AV node
What is the treatment of complete heart block?
Cardiac Pacing
How long can life be sustained while in Ventricular Fibrillation?
6 minutes, afterwards death occurs
What 3 medications do you give for a patient in V-Tach?
Lidocaine, Magnesium Sulfate, and Amiodarone
How do you treat V-Fib?
100% O2, Epinephrine, and defibrillation (Unsynchronized Cardioversion)
What are Osler's Nodes? What to they indicate?
Red, tender spots seen under the skin of fingers. Indicates Endocarditis.
What is the definition of Hypertensive Crisis?
Dialstolic BP greater than 120 mmHg.
How do you treat Cardiac Tamponade?
Pericardiocentesis or Thoracotomy, Oxygen, IV fluids, and medications to raise the BP
If your patient has pericarditis, which leads do you expect to have ST elevation in?
All leads except aVR and V1
How should you auscultate heart sounds for a patient who has pericarditis?
Sitting forward and upright while exhaling
What is intermittent claudication?
pain in legs with exertion, relieved by rest
What medication ends in -dipine?
Calcium Channel Blockers
What medication ends in -olol?
Beta blockers
What potential adverse effect does ARBs have on potassium?
Hyperkalemia
If someone has right sided heart failure, what non-invasive way can you look for this?
JVD
If someone has left sided heart failure, what non-invasive way can you look for this?
Lung sounds
If someone has right sided heart failure, what invasive way do you measure this?
Central Venous Pressure CVP
If someone has left sided heart failure, what invasive way do you measure this?
Pulmonary wedge pressure PWP
Chronotropic medications effect what?
Heart rate at the SA node
Dromotropic medications effect what?
Heart rate via automaticity (speed at which electricity moves through the heart)
What is automaticity?
The speed at which electricity moves from the heart?
What two treatment are used for symptomatic bradycardia?
Atropine and transcutaneous pacing
What do you give if you want to increase preload and afterload?
Vasoconstrictors
What do you give if you want to decrease preload and afterload?
Vasodilators
What does a positive dromotrope medication do to the heart?
Increases the speed at which electricity moves through the heart
What does a negative dromotrope medication do to the heart?
Decreases the speed at which electricity moves through the heart
What does a positive chromotrope medication do to the heart?
Makes the SA node fire faster
What does a negative chromotrope medication do to the heart?
Makes the SA node fire slower
What does a positive inotrope medication do to the heart?
Increases contractility
What does a negative inotrope medication do to the heart?
Decreases contractility
If a patient has a stable wide QRS complex, where is the problem coming from?
Below the AV node
When synchronizing the defibrillator, which wave are you syncing to?
R wave
How do you treat stable bradycardia vs unstable bradycardia?
Stable: atropine and fluids; unstable: epi/dopamine infusion
What measurement is also the hearts afterload?
MAP
When performing transcutaneous pacing, how far away do the pads need to be from an ICD and why?
10 cm because the ICD will absorb the electricity and it won't go to the heart
What two medications do you give to a patient in a hypertensive emergency?
Beta blockers and calcium channel Blockers
What is the goal for the first hour of someone in a hypertensive emergency?
Decrease systolic and diastolic BP by ONLY 15%-20% to reduce the risk of organ dysfunction
What difference in BP should you be concerned for an aortic Aneurysm?
More than 20 mmHg between the right arm and the left arm
Ascending aortic aneurysms need what treatment?
Emergent Surgery- Get them to OR immediately
If your patients IV extravasates and is running a vasoconstrictor medication, what medication do you need to give?
Phentolamine (Regitine) into the IV, then give it SubQ.
Right Ventricle MI can irritate what cranial nerve?
Vagus Nerve, causing parasympathetic s/sx
What is the classic triad of endocarditis?
Fever, anemia, and heart murmur (FAM-Hold your FAM closest to your heart, the endothelium)
If you see electrical alternans (different QRS everytime), what is this associated with?
Pericarial Tamponade
What are the 3 sings of Becks Triad and what is Becks Triad a sign of?
Hypotension, Distendid Neck Veins, Muffled Heart Sounds. Is a sign of Pericardial Tamponade
Which EKG finding would make you question the administration of Procainamide?
Prolonged QT interval
What do tall R waves on V1 and V2 potentially indicate?
Posterior MI-Do a Posterior EKG
A patient who has had a cardiac transplant is unlikely to have a response to which medication used for bradycardia?
Atropine
Heart block is most closely associated with what kind of MI?
Inferior MI
What is a sign that is only present with fat emboli?
Red petechiael rash to the chest
What does the heart sound like with an air emboli?
Drum-like Mill Wheel mumur
What oxygen saturation do you want a patient to have with COPD? Asthma?
COPD: 90% Asthma-Normal range
What BP would you expect for someone with a PE?
Hypotension
What positiion do you put a patient with an air emboli?
Left lateral decubitus position
When sputum is pink and frothy, what should you suspect?
Pulmonary Edema
Which virus is small enough to make it to the lower lungs to cause bronchiolitis?
RSV
What is infected with pneumonia?
The parenchyma (not the airways)
What is a good indicator that an infection is bacterial rather than viral?
Temps over 101F are more likely bacterial
Why is a penetrating thorasic trauma almost always on the left and not the right?
Because the liver protects the right.
What are the most concerning rib fractures and why?
1-3 because they protect the subclavicular vessels and have a high mortality rate
What fluid causes a pleural effusion?
Serous, AKA pale yellow transparent fluid that fills body cavities.
What is the difference in pain for a fluid pneumothroax vs an air pneumothorax?
Fluid: Dull ache on the affected side; Air: Sharp pain that radiates to the shoulder on the affected side
What would you expect to find for RBCs on a patient with chronic bronchitis?
Polycythemia thus increased risk of PE, DVT, MI
What time period after a long bone fracture can a fat emboli occur?
24-48 hours
If the trachea is pushed to the side of the neck, what does this indicate?
Tension Pneumothorax-Deviates AWAY from the tension pneumothorax bc pressure
How do you treat a tension pneumothorax?
Rapid chest decompression with needle thoracotomy or chest tube placement
What two blood gas disorders are similar in s/sx and what are the s/sx?
Alkolotic (both respiratory and metabolic) and they are the same s/sx of hypocalcemia
What is the normal range for bicarb (HCO3)?
22-26
What is the normal range for CO2?
35-45
What is a normal pH range?
7.35-7.45
What side effect can Etomidate have?
Myoclonic activity (twitching)
What condition is ketamine contraindicated with?
Asthma
What medication do you want to give when intubating a patient with increased ICP?
Lidocaine
When intubating, what color do you want the capnometer to turn if it is in the coorect place?
Gold is good
How many breaths at most should you wait for the capnometer to read?
6 breaths
If a patient with Emphysema has their negative pressure reverse and their airways close, what two treatments should you do?
PEEP and blowing against pursed lips to pop open the airways
In an asthma patient how do you want their legs to be positioned?
Dangling
If a patient has an air embous, what s/sx will you see?
Right sided heart failure s/sx
What is the treatment for a pneumothorax?
3 sided tape down dressing to allow air to escape but not enter
When monitoring a chest tube, what drainage amount is concerning?
>1,000mL initially or more than 200mLs over 2-4 hours
What is Kehrs sign and what is it associated with?
Sharp pain to the left shoulder and difficulty breathing, it is associated with diaphragmatic rupture and is due to abdominal contents entering the left side of the thorax, smooshing the trachea.
How many mmHg is considered increased in any body cavity? (ICP, orbital, etc)
20 mmHg and above because at this pressure the capillaries begin to crush
When ICP is increasing (but not herniated), what order do you lose your orientation?
Time-Place-Person
When a patient has had a cranial herniation (brain squeezed out of the orafices), what vital signs do you expect?
Cushings triad: Bradycardia, irregular respirations, widening pulse pressure
If a pediatric patient has sunsetting eyes, what are you worried about?
Increased ICP
In a patient with increased ICP, how do you "get rid of brain"?
Diuretics
What is the fastest acting diuretic?
Mannitol
What are biots respirations and what are they a sign of?
Respirations that are short and shallow followed by periods of apnea. Sign of increased ICP in peds!
What position should a patients head be in if they have increased ICP?
Elevated
What 3 signs should you teach your patients upon discharge about subdural hematoma?
Vomiting, Change in pupils, AMS
What kind of bleed is a subdural bleed?
Slow because it is venous
What is the subarachnoid bleed usually?
An aneurysm
If a patient says, "This is the worst headache of my life." What are you concerned about?
Subarachnoid bleed
What is nuchal rigidity?
Impaired neck flexion from muscle spasm and usually because of menengial irritation
If a patient has battles sign, what are you worried about?
A posterior fossa fracture
What is battles sign?
Bruising behind the ears from a posterior fossa fracture
What is the halo test for CSF?
To check if there is CSF in blood, drop it on an absorbant cloth and the CSF is oily and will absorb outside the blood, causing a halo
The posterior spinal cord controls what? Anterior cord?
Posterior: Sensory (Chills down my back), Anterior: Motor (you wave to people in front of you)
What does the center of the spinal cord innervate? Outside of the spinal cord?
Center: arms, Outside: legs (You can walk INTO a bar but you cannot have a drink)
What is brown-sequard spinal cord injury?
The side you are injured on, you lose motor function but still have sensation, on the opposite side you can't feel anything but you can move it.
If you want to test for lateral spinal cord injury, what should you use?
Sharp item, can they feel pain?
If you want to test for posterior spinal cord injury, what should you use?
Tunning fork and cotton q-tip for sensory functions
If a patient has an injury above C3, what will the patient need?
To be intubated because paralysis of all breathing muscles with respiratory arrest at that level
When you have a spinal cord injury, which autonomic nervous system is impaired?
Sympathetic, bc the parasympathetic runs through the vagal nerve.
If a patient is in neurogenic shock, what s/sx would you expect?
The parasympathetic system is stimulated (Cholinergic AKA rest and digest) plus dudes get priapism
What is poikelothermy?
assuming room temperature, thus a patient is cold
If a patient is receiving cancer treatments, immunosupressants, or has HIV, and presents with a new onset headache, what should you be worried about?
Meningitis
If an entire family presents with headaches, what should you be thinking?
Carbon monoxide poisoning
How do you treat a temporal arteritis head ache?
Steroids
How do you treat a cluster headache?
high flow 100% O2
Where is a cluster headache normally located?
Around the eye
What does cloudy CSF indicate?
Bacterial meningitis
What does a non-blanching rash indicate in a patient with meningitis s/sx?
Meningococcal meningitis WORRY ABOUT THIS
How do you test for nuchal rigidity?
Have the patient touch their chin to their chest
What is Kurnig's Sign and why would you test this?
If you lay a patient flat, and bend one of their legs, if they have pain in their hamstrings, they may have meningitis
What is Brudzinski's sign and why would you test this?
If you lay a patient flat and bend their neck forward, their legs will automatically bend up if they have meningitis
What precautions do you need to place a patient if they have bacterial meningitis?
Droplet
How do you treat viral meningitis?
Supportive care: fluids, rest, pain and fever control
What is the difference between a focal seizure and a generalized seizure?
Focal: a specific part of the brain; Generalized: the whole brain
What is Todd's paralysis?
Where s/p a sz the patient has one area that is non-responsive, numb, or stiff and can last for up to 24 hours
What are the 3 side effects of giving dilantin too fast?
Hypotension, bradycardia and heart block
What neurotransmitter is disrupted when a patient has myesthenia gravis?
Acetylcholine
What is the key issue with myesthenia gravis?
Muscle Weakness that gets worse as the day goes on
What is a myesthenia crisis?
When the patients respiratory muscles are so weak they go into respiratory distress or arrest
If a patient has an anterior fossa fracture, where would bleeding/CSF leak?
Through the nose
If a patient has a middle fossa fracture, where would bleeding/CSF leak?
Through the ear
What kind of fracture do you want to avoid giving someone NC O2?
Basilar skull fracture b/c it can blow air embolisms into the brain (pneumocephalus)
What is the treatment for Lithium toxicity?
Dialysis
What two medications do you give for Mania?
Lithium and Carbamazepine
What two classes of drugs do you give a patient with schizophrenia?
Antipsychotics and benzodiazepines
What is Blepharospasm?
Eyelid spasm causing forced eyelid closure
What is Torticollis?
Neck muscle spasms causing the head to twist to one side
What medications do you give for a patient with extrapyramidal symptoms?
Benadryl, propranolol, Antiparkinsonian drugs
Lithium toxicity is associated with which electrolyte imbalance?
Hyponatremia
What shape bruising indicates pinching?
Crescent shaped
What medication class do you give to increase preload and afterload? Decrease?
Increase: Vasoconstrictor - Decrease: Vasodilator
What are the two settings you set when performing transcutaneous pacing?
Rate and output.
When transcutaneously pacing, what should you initially set the rate to?
70 bpm
When transcutaneously pacing, what should you initially set the output to?
Unitl you get Capture (puts the pacing spikes on the R waves) then turn it up 10% above capture
How far away should you place a transcutaneous pad away from an ICD?
10 cm
What is the lowest dose of atropine? Why?
0.5mg/dose because it will cause paradoxical bradycardia (or just bradycardia)
What does the EKG wave look like in super late hyperkalemia?
Sine wave
What does the EKG wave look like in the very earliest of hyperkalemia?
Peaked T-wave
What symptoms will you see for early vs late hyperkalemia?
Early: so excited I'm going to puke, Late: so weak I can't breath
What EKG changes will you see with hypokalemia?
ST depression (below isoelectric line) and a U wave (looks like a camel hump)
If a patient is hypokalemic, what other electrolyte abnormality accompanies this?
Hypomagnesemia
What does a positive Chvostek and Trousseau's sign indicate?
Hypomagnesemia
What is the treatment for hypermagnesemia?
If no EKG changes: loop diuretics and fluids, if EKG changes then dialysis
Calcium and phosphate have what kind of relationship?
INVERSE, opposite
After transfusing 10 units of blood, what electrolyte imbalance are you worried about?
Hypocalcemia and hyperphosphatemia (inverse relationship!)
If a patient is hypoalbuminemic what electrolyte are you worried about?
Hypocalcemia bc albumin carries calcium (also hyperphosphatemia=inverse relationship!)
What oral medication do you give someone with hyperphosphatemia?
Antacids (aluminum hydroxid) it absorbs phosphate
What happens if you give IV hypertonic saline solution too fast?
Central Pontine Myelinolysis (Flaccid paralysis, dysarthria, dysphasia, hypotension)
What is Central Pontine Myelinolysis and how do you get it?
Flaccid paralysis, dysarthria, dysphasia, hypotension from administering hypertonic saline solutions too fast
How slowly should you administer IV hypertonic saline solution?
over 48-72 hours
What are the two types of renal failure?
oliguric and non-oliguric
What two electrolytes do you expect to be increased in renal failure? Decreased?
Increased: potassium & phosphate; Decreased: sodium & magnesium
What medication should you NOT give a patient in Thyroid Storm?
ASA because it can release more TSH, give Acetaminophen (Tylenol) instead for fever
What 3 medications do you give a patient in Thyroid Storm in order?
Prop or methamazole then ONE HOUR LATER Iodine
When giving IV dextrose to a patient in hypoglycemia, what percentage should you be giving an adult vs child vs infant?
Adult: 50%, Child: 25%, Infant: 10-12.5%
What kind of respirations would you expect for a patient in DKA?
Kussmauls
Why do you give a patient in HHS of DKA IV insulin?
Because they will be dehydrated and cannot absorb as effectively SQ
What is the difference between HHS and DKA?
HHS=No Acidosis and DKA=Acidosis
If a patient is taking prednisone long term, what are you concerned about?
Cushings syndrome
What medication usually causes cushings syndrome?
Prednisone
What does cortisol regulate?
Blood sugars
What does aldosterone regulate?
re-absorption of sodium and water (indirectly excretion of potassium)
What makes cortisol and aldosterone?
Adrenal glands
What medications do you give a patient in addisions crises?
IV solumedrol and IV decadron
What medical condition makes IM shots contraindicated?
Hemophillia
Which factor do you give to a patient with hemophilia A? B? C?
A=8, B=9, C=11, if you wanna eat again you better call 911
In DIC, what do you expect the platelets to be?
Low because they have already been used to clot
In DIC, what do you expect the PT/PTT to be?
Elevated because they are bleeding out
In DIC, what do you expect the Fibrinogen to be?
Low because they have already been used to form clots
In DIC, what do you expect the D-Dimer to be?
High because there are a lot of clots that are releasing this to break theirselves down
In DIC, what do you expect the HGB/HCT to be?
Low because they are bleeding out
What do you give a hemophiliac with a nose bleed?
Topical thrombin
An infant with a fever is life-threatening under what amount of days from birth?
28 days or less
What age does a child start to have an immune system that can handle a fever well?
6 months or older
Febrile seizures are most common in children between which age range?
6 months and 5 years of age
What degree of fever can cause irreparable damage to the brain?
41C/105.8F
What is SIRs?
When an infection goes systemic and the infammatory response follows leading to sepsis, unless they have massive tissue damage, it can be SIRs w/o bacteria
What does the inflammatory respose do to our capillaries?
Vasodilates them (thus when infection goes systemic is causes hypotension)
What defines septic shock?
When a patient with sepsis is hypotensive and they do not respond to fluid resuscitation
What is the goal MAP for a patient in septic shock?
65 mmHg or above
What does calcitonin do to serum calcium levels?
Decreases them
What kind of rash would you see with chicken pox?
Vessicular
What kind of rash would you see with measles?
Maculopapular
What kind of rash would you see with pertussis?
Peticheal
What does the eyelid do in bells palsy?
It doesn't close bc it has paralysis of the eye lid and the eye ball will roll back into the head called bells sign
What happens to a patient who has a needle cricothyroidotomy?
They can only get O2, no CO2 can escape so you are concerned about hypercapnea
What is a rust ring?
When a metal object that was in the eye leaves behind some rust aound the hole and it is painful
If a patient has a foreign body in their eye that penetrates, what will their pupil look like?
Tear drop with the point of the tear pointing at the location of the penetration
How do you reduce vitrious fluid in the eye?
Give IV mannitol
When teaching about glaucoma, how is the weight limit that a patient can lift?
5 pounds or less
What is a corneal ulceration?
An abrasion that has become infected and destroyed the corneal layer, will lose sight if not treated within 24-48 hours
What is the main complaint of a patient with a retinal artery occlusion?
Sudden painless loss of vision
What 3 quick options do you have to treat a patient with a retinal artery occlusion?
Goal: dilate artery get clot out of eye. Breath in CO2 via breathing into a brown paper bag, breath in carbogen, S/L nitro
What causes ludwig's angina and where does it affect the body?
Starts as a molar infection that moves down the throat and causes significant neck swelling
What is treching?
having a patient rinse their mouth with 1/2 strength paroxide or saline rinses to keep the mouth from getting re-infected
Where is vincent's angina located and what is it?
The mouth, an infected film that coveres the mouth lining (mouth breathers, poor oral hygeine, etc)
Whats the main difference between croup and epiglotitis?
Croup=viral with cough and epiglotitis=bacterial w/o cough
When administering ear drops, what should you do and why?
warm the ear drops in your hand b/c cold drops cause dizziness
If a patients ear wick falls out, what should you do?
Keep it out, the ear no longer needs it
What is Epleys manuever and what do you do it for?
Move the head from left to right quickly like a metronom, used in meniere's disease to release crystals in the labrynth and decrease dizziness
What do you have a patient do if they have labrynthitis or menieres disease and they are having a dizzy spell?
Have them sit upright, place their shoulders and their head on the same surace, push back and close their eyes
What is the difference between -paresis and -plegia?
Paresis is weakness, plegia is paralysis
What is the one thing that happens in late signs of increased ICP rather than in the early stage?
In the late stage, you are herniating the brain through the foramen magnum
If someone has increased ICP on one side of their brain, which pupil will be effected?
The ispilateral pupil (SAME side becomes dilated, oval, and sluggish in early and Fixed in late)
What triad indicates late signs of ICP (post herniation)?
Cushings triad: Bradycardia, irregular respirations, widening pulse pressure
A patient with a complete spinal cord injury has what autonomic nervous system still in tact?
Parasympathetic because it runs through the vagus nerve. So they have low bp, hr, rr, temperature.
If a patient has meningitis, what accompanying sign is particularily worrisome?
Non-blanchable rash, it means it is a fast moving meningitis
What kind of precautions should a patient with meningititis be put on?
Droplet
Where do you pinch in the hand to test for radial, ulnar and median nerve function?
Radial: thumb web; Ulnar: pinky; median: pointer
How to do remember the leg/foot nerves?
Top: Peronial goes uP (P). Bottom: TiBial (B)
At what second interval does a Q wave become concerning?
0.04 or bigger is concerning of a myocardial infarction
A widening pulse pressure is associated with vaso constriction or dilataion?
Constriction
What two EKG changes are associated with pericarditis?
ST-segment elevation and PR depressions in the majority of the leads
Stable angina responds best to which medication?
Nitroglycerin
How do you test motor function of the radial nerve?
Have the patient give a thumbs up
How do you test motor function of the ulnar nerve?
Have the patient fan their fingers apart
What type of wound is the only wound you soak?
Puncture wounds
What part of the body is at risk for developing pseudomonas aeruginosa?
Bottom of the foot from puncture wounds
Where do you give TIG?
Close to the wound
If you gave TIG, where do you give TDAP?
As far away from the wound as you can
What bone is broken in a nightstick fracture?
Ulna (not radius) from blocking a blow
Which bone is fractured and which bone is dislocated with a monteggia's fracture?
Fracture of the ulnar and dislocation of the radial head
Which bone is dislocated in a nursemaid's elbow?
Just the radial head
If a patient has a fractured elbow, what nerve should you assess?
Median nerve (look for volkmanns contracture)
Where is a smith's and colles fracture? And what is thee difference?
In the wrist and smith=garden hoe (farmer smith had a hoe down) and colles=fork (eat collard green with a fork)
If you press on the snuff box and it hurts, what bone are you concerned might be fractured?
Scaphoid in the wrist
What is coopernail sign?
bruising and swelling in the scrotum or labial folds from a pelvic fracture
What group of antibiotics weaken tendons?
Floroquinolones (Levoquin, cirpo, avelox)
At what level do you elevate extremities?
At the level of the heart if compartment syndrome, above the heart if no compartment syndrome
What is contraindicated for treatment in compartment syndrome?
Ice
Who is most likely to get septic arthritis?
Children bc their bones are very porous
What should a patient with gout avoid?
Thiazide diuretics, alcohol, aspirin and foods with purine.
What should a patient with gout have more of?
Vitamin C, coffee, dairy products, physical fitness.
What foods have purine in them?
Seafood, organ meats, bacon, and yeast
What is the pH of tears?
7.4-7.6 (This is what you want the eye pH to be!)
If someone has a radiation exposure, what temperature of the water should you use to cleanse their skin?
Tepid AKA Luke warm
What determines if you can stop showering a radiation exposure patient?
Their radiation meter thing has to read 2x less on their skin than the surrounding air
In the Cold zone, when does a rescuer need to wear PPE and when do they not need to?
If radiation exposure, keep wearing PPE if other exposure no need for PPE
What should you be concerned about for a patient who has radiation sickness, days or weeks after the exposure?
Hematopoietic Syndrome (low blood counts) leading to increased risk of infection and bleeding and anemia
What is released if plastic and paper materials are burned?
Cyanide
What happens on a cellular level with cyanide poisoning?
The cyanide offloads into the cells and wont obsorb oxygen=hypoxia but the O2 can still bind to the RBCs and circulate it just isn't moving into our bodys cells
How do you treat carbon monoxide poisoning?
100% O2, monitor cardiac rhythm, possibly hyperbaric chamber
If you give 100% O2 to a patient with carbon monoxide poisoning, what is the half life of the carbon monoxide? What is the half life without the 100% oxygen?
with O2 it is an hour (half of the carbon monoxide will be out of the system) without the O2 it is 6 hours
How do you treat cyanide poisoning?
Amyl nitrite pearls, crush them under the patients nose and have them breath it in, changing them every 3 minutes, until IV hydroxocobalamin is available. Afterwards administer Sodium Nitrite then Sodium Thiosulfate IV
What happens inside the body when you give hydroxocobalamin?
It turns cyanide into vitamin B12 which will be a lot of B12 causing toxicity-The skin and urine will turn reddish brown
What do you need to know about giving hydroxocobalamin?
It does not play well with others so give it in its own IV line.
In cyanide toxicity, what two sodium drugs do you give at the end and in what order?
Sodium nitrate first then sodium thiosulfate
What percentage of TBSA burned causes systemic inflammatory response?
over 20% leading to hypovolemic shock, less than 20% is local inflammatory response
For the rule of Nines, what body parts are 18 and what parts are 9 (also which part is 1)?
18=chest abdomen back and each leg, 9=head and arms, 1=genitalia
At what age does the rule of nines switch from peds to adult?
Age 9
What is different from peds to adult on the rule of nines?
the head is 18 and the legs are 14 each
If a patient is burned in a weird shape, what do you use to estimate the TBSA?
Their hand is 1%
What degree burns do you use the rule of nines?
2nd and 3rd degree burns, not 1st
For fluid resuscitation in the burn patient, how do you decide how many mLs to administer?
2 for adults, 3 for peds, and 4 for electrical burns
When fluid resuscitating a burn patient, using the parkland burn formula, how much time do you have to infuse the amount of fluids?
24 hours, with 1/2 the fluid given in the first 8 hours
What fluid should you use to fluid resuscitate a burn patient?
LR or D5LR
When do you give a burn patient an NG tube?
When their burns are greater than 20%
For an electrical burn, how do you manage their fluid resuscitation?
Start at 20mL/kg and adjust until the patient has 1mL/kg/hr of urinary output
What is the earliest sign that someone has moved from heat exhaustion to heat stroke?
Altered Mental Status
What is the treatment for heat EXHAUTION?
IV fluids, move to a cool place, stay out of the heat for 1-2 days after
What is the treatment for heat STROKE?
Immediate AGGRESSIVE cooling, wet the skin, IV fluids, ice packs
What do you give to a heat stroke patient to control their shivering?
Chlorpromazine (Thorazine) or benzodiazapines
How do you treat frostbite?
Immerse the tissue in water that is 98,6F-104F, pretreat for pain!
What temperature is considered hypothermic?
95F (bc the heart becomes irritable)
What 5 cardiac dyrhythmias can occur from hypothermia?
1) Asystole 2) Afib 3) V-fib 4) QT prolongation 5) Osborn or J waves
What happens to a patient who has V-Fib from hypothermia?
the V-Fib doesn't respond to defibrillation, medication, or pacing.
Why can't you give LR in hypothermia?
Bc the liver doesn't work when its cold so it wont process it, give NS. Also check BG cause the liver isn't working
If the patient isn't responding to medications in hypothermia, when do you give IV meds?
When the patient has been re-warmed to 98F
What is re-warming shock?
When the limbs become re-warmed before the core and all the metabolic waste from the hypoxia circulates to the core putting the patient in shock. Warm the core first!
When re-warming a patient what should you focus on?
The core! Limbs warm faster than the core and you risk rewarming shock.
How do you treat a submission survivor?
BiPAP, bicarb, inotropic medications.
What metabolic state with a submerssion survivor be in?
Acidosis-Give bicarb and treat dysrhythmias
How do you deactivate sealion, sting ray, sea urchin venom? (sea animals with barbs)
Warm water from 110F-115F
How do you treat Jellyfish. fire coral, or man of war venom?
SALT water (DO NOT rub) and apply proteolytic (vinegar, isopropyl alcohol) and tetanus
How do you deactivate jellyfish, fire coral, or man of war venom? (sea animals with tenticals with nematocysts on the tenticles)
Proteolytic like vinegar or isopropyl alcohol
What snakes are in the Pit Viper (crotalidae) family?
Rattle snakes, copperheads, cotton mouths/water moccasins
Where do you want to position the affected limb if bitten by a pit viper snake?
At the level of the heart or lower
What medications do you give to someone who has been bitten by a pit viper snake?
antivenom and tetanus
What will a patient complain of tasting if bitten by a pit viper snake?
metallic taste
How can you tell if a snake bite has venom or not?
If no venom it wont get red and swollen right away.
What vital sign will be abnormal if bitten by a pit viper snake?
BP=Hypotension (cardiovascular collapse! give IV boluses)
What is the difference in coral snake venom and pit viper venom?
Coral venom is neurotoxic so blurred vision, difficulty swallowing, respiratory distress, hypersalivation
How will a bite from a brown recluse spider differ in s/sx from a black widow spider?
Brown=painless itching, Black=painful with halo around it and muscle cramping
What medications do you give for a brown recluse spider bite?
dapsone (Avlosulfon)-Watch out for blood dyscrasias!
What medications do you give for a black widow spider bite?
benzodiazepines
If you administer dapsone (Avlosulfon), what do you need to monitor?
CBC bc it causes blood dyscrasias.
How do you treat lyme disease?
ABX
What does the rash look like and how does it move for rocky mountain spotted fever?
small, flat, pink, non-itchy macules that start on the hands and feet then move towards the trunk
How do you treat rocky mountain spotted fever initially if it is only on the hands and feet?
Doxycycline
For RMSP what s/sx indicates coagulopathies have started?
When the rash becomes non-blanching
How do you administer rabies vaccine and diploid?
rabies as much into the site and in the muscle, and diploid needs to be distal bc it will cancel out the rabies vaccine
What days do you give diploid (booster vaccine for rabies)?
0-3-7-14
How long should a patient have their bedding and clothing in plastic bags if they have scabies?
72 hours
What medication do you give to someone with Giardia?
Tinidazole or mitronidazole (flagyl)
What kind of infection is ringworm?
Fungal infection
What GI s/sx do you get with Giardia?
Steatorrhea, Nausea, excess gas
How do you remember airborne precautions? (This bird isn't airborne cause it doesn't fly)
My Chicken Hez TB (Measles, chicken pox, herpes zoster, TB)
How do you remember droplet precautions? (Who doesn't drop to the ground when swinging from buildings on his webs?)
SPIDERMAN (scarlet fever,streptococcal pharyngitis, Pertussis, Influenza, Diptheria, Epiglottitis, Rubella, RSV, Mumps, Meningitis, Mycoplasma, Adenovirus.
What happens when TB is active?
it is a skin toxin, so if it is in the skin, it will ulcerate the skin
How do you know if someone with TB is active or latent?
if active they will have nightsweats, fever, chills, hemoptysis, and cough. Also unexplained weight loss. Diagnosed with a culture of the area.
What drugs treat TB? (There are 5 RIPES)
Rifampin, INH, Pyrazunamide, Ethambutol, Streptomycin
What 3 organs are enlarged with Mono?
Liver, Spleen and Lymphnodes
What meds should you not give with mono?
ASA or NSAIDs bc liver isn't working so increased risk of bleeding
If a patient has Mono, how long do they have to wait until they can donate blood?
6 months
What are the s/sx of measles?
Rash and the 3 Cs= Conjunctivitis, Cold symptoms and cough
What does mumps present as?
swelling of glands
What cream should you apply to pt with shingles?
capsaisin cream
How do you remember anticholinergic toxidrome?
Blind as a bat, red as a beet, bry as a bone, mad as a hatter, hotter than hades
When treating a cholinergic overdose, you give an anticholinergic...which one? and how?
Atropine in LArge doses, keep giving it till the patients heart rate is normal.
What is the half life of narcan?
30-60 minutes
What are you worried about when giving flumazenil?
If the patient is addicted, you are worried about them going into withdrawal seizures.
Why can a small amount of alcohol kill a 2 year old?
because of the profound amounts of hypoglycemia associated with alcohol consumption.
What vitamin is the most deficient in alcoholics?
Thiamin
What are you low in if you have Weirnicke-Korsakoff Syndrome?
Thiamin
What do you have to worry about in a methanol overdose?
Optic nerve damage=Irreversable Blindness and acidosis
What do you need to worry about with Ethylene Glycol overdose?
Renal Failure and acidosis
What medication can you give someone who has overdosed on Methanol and ethylene glycol?
Fomepizole (antizol)
What sign that you wouldn't normally think of happens with overdose of calcium channel blockers? Beta blockers?
Hyperglycemia-Calcium and hypoglycemia-beta
What is the antidote for calcium channel blockers?
Calcium chloride
What is the antidote for beta blockers?
Glucagon
What is the visual disturbance with digoxin overdose?
The halo
What is the antidote for digoxin overdose?
Digibond
What is the antidote for heavy metal overdose (lead, gold, arenic)?
Dimercapol
What is the antidote for iron overdose?
Deferoxamine-makes your pee pink/orange
How many stages are there in iron overdose and what are they?
1) N/V/bloody stools, abdominal pain and HYPOTENSION. 2) latent stage 3)Metabolic acidosis, coagulopathies, hemorrhage/shock, liver and kidney failure
What is the side effect of metformin overdose?
Severe lactic acidosis
What is the antidote for hypoglycemic overdose?
Octreotide
What is the antidote for warfarin?
Vitamin K
What is the antidote for Heparin?
Protamine Sulfate
What is the antidote for tricyclic antidepressants overdose?
Sodium bicarb
What happens to the heart in a tricyclic antidepressant overdose?
Slows everything down (prolonged QT, widened QRS, Prolonged PR, heart blocks and asystole)
What is the target temperature when cooling a patient with heat stroke?
102F
What is Mallory-Weiss Syndrome?
Small tears in the esophagus from vomiting that cause blood streaks in the vomit.
What is Boerhaave's Syndrome?
Ruptured esophagus from heavy vomiting...needs surgery
Where do you get ulcers in the GI tract and why?
Stomach and duodenum b/c the pancreas neutralizes that acid after the duo.
What is another way you can test for high ammonia levels besides blood?
Liver flop, have the patient hold up their hand and they can't keep it up, it will flop over
If a patient has hepatitis of any letter, what two medications do they need to avoid?
Acetaminophen and steroids.
Where do you feel appedicitis pain?
Early= umbilicus; late=RLQ (Appendix and belly button share T10 nerve)