Which critters have neurotoxins?
Pit Vipers (Coral Snakes)
How do you treat a 1 year old in SVT?
Ice to the face
What do you use to treat a Beta Blocker OD?
Glucagon
More then .04 mg/kg of Atropine can cause what?
Reflex Bradycardia
Which disease has an increased risk to a baby/fetus/neonate
Rhubella
If a patient is in shock long enough, what will the develop?
Renal Failure
What do adrenergic drugs do?
Increase Afterload
How do you stimulate a neonate to breathe?
Rub back, message back
What is the neurotransmitter for the sympathetic nervous system?
Norepinephrine
What is the first question you should ask a pregnant woman with abdominal pain?
Do you have an urge to push?
What is reflex guarding from?
Pain to parietal peritoneum (also known as somatic pain)
If you have abnormal movement from chest wall, what is your first action?
High flow O2
Paediatric patient fell down the stairs c/o leg pain; and is now altered. What is the main concern?
Head Injury
What does the vertical axis on the ECG reading represent?
Voltage
More then .04 mg/kg of Atropine can cause what?
Reflex Bradycardia
Which disease has an increased risk to a baby/fetus/neonate
Rhubella
If a patient is in shock long enough, what will the develop?
Renal Failure
What do adrenergic drugs do?
Increase Afterload
How do you stimulate a neonate to breathe?
Rub back, message back
What is the neurotransmitter for the sympathetic nervous system?
Norepinephrine
What is the first question you should ask a pregnant woman with abdominal pain?
Do you have an urge to push?
What is reflex guarding from?
Pain to parietal peritoneum (also known as somatic pain)
If you have abnormal movement from chest wall, what is your first action?
High flow O2
What does the vertical axis on the ECG represent?
Voltage
What is an example of a mobile data terminal?
Vehicle Mounted Computer
What are your best methods of checking tube placement?
Visualize, bilateral chest rise, no epigastric sounds, L-Lung, then R-Lung
Where is the femoral vein in relation to the femoral artery or nerve?
Medial
You have a Pt. with 4mm ST elevation in II, III and AVF c/o chest pain with a BP of 86 what is your treatment?
Fluid Bolus
84 yr old with full thickness burn to mouth, chest and abdomen- What is the biggest concern?
BSA of the burns
What is your joule setting for an unstable pt in A-Fib with RVR
100 Joules
Your patient presents with audible wheezes as you prepare an SVN of Albuterol when your patient stops wheezing what do you do?
Prepare to intubate
What is the most plentiful ion in the body?
Calcium
On scene of a bus crash what do you do first?
Additional Resources
What is your pediatric dose for Lidocaine
1 mg/kg
What is your pediatric dose for Epinephrine
0.01 mg/kg Max 1 mg
What is your pediatric dose for Atropine
0.02 mg/kg IV or 0.03 mg/kg ET Max 0.5 mg
What is your pediatric dose for Adenosine
0.1-0.2 mg/kg Max 12 mg
What is your pediatric dose for Naloxone (Narcan)
0.1 - 0.2 mg/kg
What is your pediatric dose for Sodium Bicarbonate
1 mEq/kg slow push IV (same as adult)
What is your pediatric dose for Amiodarone
5 mg/kg repeat up to 15 mg/kg Max 300 mg
What is your pediatric dose of Calcium Chloride
20 mg/kg
What is your pediatric dose for Magnesium Sulfate
20-50 mg/kg
What is a mobile device that can transmit and receive?
Mobil or Portable Radio
What does Atropine do?
Competitive agonist to acetylcholine at muscarinic receptor sites. Blocks parasympathetic response and lets sympathetic response take over. Increases heart rate, conduction velocity, and contraction; bronchodilation;
Initial joule setting for pediatric pt?
SVT- 0.5-1.0 Joule/KG, repeat at 2 J/KGV-Fib/ Pulseless Tach- 2J, then 4J
What is Diltiazam?
Calcium Channel Blocker
Pt. has JVD and clear and equal lung sounds. What is most likely the cause of this?
Pericardial Tamponade
Pt. is cool, clammy skin. Fever of 101. Low BP, high pulse, high respirations; recently hospitalized. What do you suspect?
Septic Shock
Laryngeotracheobronchiolitis
Croup
Kid has a fever and cold symptoms for 5 days. Wakes up with DB and cough; what do you suspect?
Croup
You're called to a mall with 20 people with watery eyes and coughing; what is your BSI?
Respirator
You have a neonate that is flaccid and blue, what is your first action?
Dry/Warm
MVA involving a motorcycle on a dry road. Pt. has a R leg injury and states R foot feels wet. What is your next action?
Cut boot and assess ankle
ST depression is an indication of what?
Ischemia
ST elevation is a sign of what?
Injury
What is crush Injury?
Crush injury results from a compressive force that causes cellular disruption with immediate cell lysis. Crush syndrome can lead to tissue death or pt. death.
What is compartment syndrome?
Culmination of crush injury and crush syndrome worsening, but can also be caused by burns and electrical injuries. Results in compressive forces inside a closed space. Crush injuries cause edema to the initial area and also to the underlying structures that may be contained in nonexpansile compartments that cannot accommodate dramatic changes in their size.
If a patient has high levels of CO2 they are said to?
Hypercapnia - Too much CO2 in the blood
A pt had recent surgery for abdominal obstruction. Pt presents pale and diaphoretic. What type of shock is he in?
Obstructive Shock
What part of the body does Crones disease affect?
Small Intestine
Female patients has history of abdominal pain every month, but this time it is more intense. V/S stable- Normotensive, tachycardia, tachypnea
Endometriosis
Normotensive means
Having a normal Blood Pressure
You have a neonate with a blood glucose level of 20. What concentration of glucose will you deliver?
D10
What is the Parkland formula used for?
Fluid resuscitation in burns
What is the Parkland formula?
4 mL of Ringer's Lactate (NS) x % BSA x kg4 x % burned x weight in kg
You have a pt that had a gas can explode 2 hours ago and he now presents with burns about the face, stridor and DB. What is your first action?
Assess level of consciousness
You have an infant with normal tidal volume that requires O2 therapy. What will deliver the highest quality of oxygen?
Non-Rebreather Mask
Your patient has burns to the head/neck, anterior chest. What drives your decision to intubate this patient?
Mechanism of Injury
Who has the most potential for suicide?
Recent divorce
What is the most common antipyretic used for kids?
Acetaminophen (Tylenol)
Your patient has a pulse of 190 and is hypotensive. What is the reason that this patient is hypotensive?
Decreased diastolic fill time
Your patient has CHF, what is your primary medication?
Nitroglycerine
How do you manage inter-cranial pressure?
Hyperventilate
You have a hyperthermic patient that presents initially with Sinus Brady which changes to V Fib. What is your initial action?
Defibrillation
You have a patient who was jogging and now has a flutter in his chest. He has a history of flutter in his chest. He has a history of Wolff Parkinson White. What is the pathophysiology associated with this condition?
Ventricular Irritability
Why would you not give medication IM to a patient in shock?
Poor Perfusion
What is a common symptom of schizophrenia?
Hallucinations
During childbirth how would you determine the position of the fetus?
Leopold Maneuver
What is the appropriate treatment for a prolapsed chord?
Insert 2 fingers to relieve pressure from the chord
What is a complication of a precipitous delivery (fast labor)?
Maternal lacerations
Following delivery of the head you clear the airway and noticed you have a nucal cord, what is the appropriate action to take?
Gently remove the cord from the neck
You are on scene of an MVA with a 30 y/o female sitting in the front seat. Pt presents as cool, wet, and pale with low back pain and tingling in the legs. What is your next appropriate action?
C-Collar and KED's board
Which of the following is an example of involuntary consent?
Psych patient in mental institution
You have a patient that drove his car into a pool; steering wheel of car is bent. Patient presents with hypotension, warm flush skin. What type of shock is this?
Neurogenic shock
When placing an IO, how do you know if you are in the correct location?
Bone marrow can aspirate, flush with NS
You patient has no eye opening , makes incomprehensible sounds, and moves her right hand to push you away when you pinch her left arm. what is your patients GCS score?
8
What is a tort?
Breach of duty, injured party has a right to file a suit
What are the categories of the GCS scale?
Eye openingBest Verbal ResponseBest Motor
What is the reasoning for fluid therapy in trauma?
Correct hypovolemia
Your patient is a 23 y/o female in her 3rd trimester, sitting on the couch rubbing her belly. What is your first appropriate action?
Ask for patient history
How would you determine who is incident command on a large scale emergency?
Guy with the vest on
What is the most common type of Hepatitis?
A
How is Hep C is transmitted?
Blood
What is the most detrimental to the unborn fetus?
Rubella
What is the pathophysiology of Parkinson's disease?
Insufficient formation and action of dopamine, impairs motor skills, speech, and other functions.
You have a 20 y/o male hit 2 hours ago, and called 911 20 mins ago. Presents with a flail segment and coughing blood what do you suspect?
Pulmonary contusion
You have a patient with pulse of 220 and BP 70/P
Sync cardiovert/ consider Adenosine
How would you determine the tube size for an infant?
(Age/4)+4
Partner refuses to respond to call because location in known for its violence.
Breech of Duty
Which meds are prescribed for SVT?
Atenolol/Adenosine
59 y/o female, husband did Heimlich. Pt sill c/o rapid heart rate. Pt has increased BP, ST @ 110, RR 24. What is your next appropriate action?
Nothing
Mobile Radios
Radios mounted in the vehicle, more power and larger antenna
Hand Held
Portable radios that are light weight, but have a decreased range and power
Simplex Radio System
Single channel, one way communication mechanism one frequency to both transmit and recieve radio traffic. Allows only one person to speak at a time. Requires 2 frequencies, one to recieve and one to transmit.
Multiplex System
Allows simultaneous transmission of multiple, different radio transmissions over one radio frequency.
What is the primary immunoglobulin in an anaphylactic reaction?
IgE
The umbilical cord consists of_ arteries, and _ vein(s)?
2 Arteries and 1 Vein
Peaked T waves on the ECG is indicative of what?
Hyperkalemia
What is the drug of choice for seizures in the eclamptic patient?
Magnesium Sulfate
How should you stage your emergency vehicle when responding to an MVA?
Well before or beyond the wreckage. Avoid parking in a location that will hamper your exit from the scene or impede the arrival of other emergency units.
What term best describes the codition of being woken up in the night by diffuculty breathing?
Paroxysmal Nocturnal Dypsnea
What is a static cardiac rhythm
Third degree block
What is a static cardiac rhythm
SVT
Most severe systemic and life threatening reactions to allergens.
Anaphylaxis
You have a 3 y/o male, weighing 35 lbs., what would your epi (1:10,000) dose be for a cardiac emergency?
.15mg
What is the leading cause of bradycardia in the pediatric patient?
Hypoxia
A mom presents you with a child and says he is not breathing what should your first action be?
Check for responsiveness
Tinnitus and hyperacusis are signs of what type of OD?
Acetylsalicylic Acid (ASA, Aspirin)
What do the terms G3, P2 describe?
Gravida- # of times pregnant- 3Para- # of deliveries- 2
You are called to the scene of an unconsious person. Witnesses state the pt was riding her bike when she crashed and had a brief LOC; she regained consiousness stareted to walk away and then collapsed. What type of bleed is this?
Epidural
What two values does the pulse oximeter measure?
Oxygen saturation and pulse rate
ICP =
Head Injury
What is the standard treatment for CHF
Nitro, Lasix and Magnesium Sulfate
You are called to the scene of an assult. You have a female patient that was stabbed in the back. Where would you expect to have Hyper-resonance sounds?
On the opposite side
Where would you expect to hear bowel sounds with a diaphragm rupture?
In the chest/thoracic cavity
You are called to the scene of an injured person. Friends say the pt. dove head first into shallow water. Pt is unresponsive with no motor sensory function c/o neck pain. What would you expect the vital signs to be?
Hypotensive, bradycardic
What is the standard pharmacological tx. for CHF?
NTG, Lasix, MS
You are called to the scene of an assault. You have a female patient that was stabbed in the back. Where would you expect to have Hyper-resonance sounds?
On the opposite side
Where would you expect to hear bowel sounds with a diaphragm rupture?
In the chest/thoracic cavity
Pt. with DB, tears off the NRB.. how do you deliver O2?
Nasal Cannula
You have a 26 y/o c/o DB, has a history of asthma.... initial eval has expiratory wheezes... SVN cocktail... wheezing stops, lung sounds are not present. What is your next action?
Intubate the patient
What type of virus is Croup?
Viral
What type of virus is Epiglottis
Bacterial
A nasal cannula at 6lpm delivers how much O2?
44%
What is Cushings Reflex? (Signs & what is it indicative of?)
Increased BP, temp, decrease in HR and Resp erratic
You have an adult female pt with c/o heavy chest pain. History reveals recent surgery and hospitalization. What disease process is most likely?
Pulmonary embolism
How will a pt with digitalis toxicity present?
Vomiting, visual disturbances (colors), bradycardia, heart block, dysrhythmias, and hyperkalemia.
What is the third process of the clotting process?
Coagulation
At how many weeks gestation is the funds barely palpable above symphysis pubis?
12-16 weeks
When evaluating respirations, rate and quality quantify what?
Tidal volume and minute volume
A pt with paralysis from the waist down has a spinal injury at what level?
L3
What type of lung sounds indicate the most serious condition?
Audible wheezing from across the room
You are O/S of a 962 and have a pt c/o paralysis; how would you extricate the pt?
Use of a KEDS board and minimize movement
Cricoid pressure stops vomiting for a short period of time because...
Puts pressure on the esophagus
Of trauma patients, who is worse?
Sub Q emphysema- pneumothorax
Signs and symptoms of Hypoglycemia
Sweating, tremors, anxiety, hunger, dizzy, headache, impaired vision, confusion/altered mental status, abnormal behavior, seizure, loc, slurred speech, tingling sensation around mouth, cool/pale, diaphoresis, tacky/brady, and hypotension.
Pt. had argument with her husband; c/o headache, nuchal tightness, dizziness; pt has no change with rest
Adult Meningitis
Pt. stabbed in the back with right sided paralysis
Brown-Sequard's syndrome
Male pt is unconscious, sever respiratory distress, rales/rhonchi. Family states he almost drowned yesterday, refused to go to the hospital. What is the appropriate treatment?
Intubate and assist ventilations
Pneumonia R side lower lobe will present with lung sounds where?
R posterior, below scapula
Mom presents with baby, says baby is not breathing. What is your first action?
Check level of responsiveness
What is considered hypertension in pregnant females
140/90
Most critical information (V/S) in CHF patient- what needs rapid intervention?
86/40 BP
Appropriate treatment for CHF patient that presents hypotensive?
Dopamine Drip @ 5-15 mpg/kg/min
What is the most communicable disease?
Hepatitis B
Pt. with procainamide drip becomes hypotensive
Discontinue drip and reassess
First stage in the clotting process?
Vascular
Child with bark-like cough, runny nose
Laryngotracheobronchitis (Croup)
Why do you hyperventilate?
Decrease CO2 levels
Child with croup has low o2 stats., what is the appropriate treatment? (Look at all doses given)
Racemic Epi 2.5-5.0 mg SVN
FF is pulled out of a burning bldg- pt is unconscious with hot, dry skin. V/S- 80 sys pulse 120 s/r, 36 rapid.What condition does FF have?
Heat stroke
Reflex hypothermia
Rapid overcooling
Motorcycle rider in MVA with 2" crack in helmet with visor. What is the initial action?
Hold and maintain C-Spine
Child with parent c/o respiratory distress. How do you approach pt for eval?
Nose to Toes
Child with respiratory distress how do you give O2 therapy?
5 LPM blow by