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Drug Card - Epinephrine
- Classification: Sympathomimetic; Endogenous Catecholamine
- Action: Alpha 1: Vasoconstriction Beta 1: Increased rate, conduction, contraction, workload, v-fib threshold, irritability. Beta 2: Stimulate respiration, bronchodilator
- Indications: Anaphylaxis, asthma
- Contraindications: None when used in life threatening condition
- Side effects: Tachycardia, palpitations, head ache, nausea, vomiting, anxiety, tremors
- Dose: 0.3-0.5 mg adult, 0.15 mg child
- How supplied: 1 epinephrine pen (adult or child)
- Route: Intramuscular, intravenously
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Drug Card - Nebulized Inhaler
- Classification - Beta 2 agonist - Synthetic Sympathomimetic
- Action: Broncodilation, relaxation of bronchiole smooth muscle, reduce airway resistance
- Indication: Relief of bronchospasm (asthma, anaphylaxis, COPD)
- Contraindications: Not patient's inhaler, excessive tachycardia, already used maximum amount
- Side effects: Shakiness, headache, tachycardia, anxiety
- Dose: 90-100 micrograms
- How supplied: 1 puff of meter dosed inhaler; number of inhalations based on medical direction
- Route: Inhalation
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Drug Card - Glucose
- Classification: Carbohydrate
- Actions: Essential for normal metabolism, increases the amount of sugar available for use in the body.
- Indications: Hypoglycemia
- Contraindications: Decreased LOC
- Side Effects: May be aspirated if no gag reflex
- Dose: One tube
- How supplied: 15 - 24 grams / tube
- Route: Buccal
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Define palpitations
Awareness of one's own heartbeat
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What are the three kinds of shock?
- Compensating
- Decompensating
- Irreversible
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What happens during compensating shock?
- Blood returns to the five major organs for survival.
- -Heart
- -Brain
- -Lungs
- -Liver
- -Kidneys
- Tachycardia - 120
- Increased respirations
- Pallor
- Diaphoresis
- Slow CR
- Altered LOC
- General Weakness
- Poor Peripheral Pulses
- Cool extremities
- Dilated Pupils
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What happens during decompensating shock?
- The blood is removed from the kidneys, liver, and brain
- Mentations decreased
- Hypotension
- Tachycardia - 130-140
- Decreased urine output
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What happens during Irreversible shock?
- Bradycardia
- Systole under 60
- Death
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Define ergophobia
The fear of work
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Define poison
Any substance that is taken into the body that interferes with normal body function
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Define substance abuse
The deliberate, persistent, and excessive self-administration of a substance in a way that is socially or medically not approved
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Define phobia
An irrational and constant fear of a specific activity, object, or situation
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Define Obsessive Compulsive Disorder (OCD)
Recurring thoughts, impulses, or images that causes the person anxiety or rituals or behavior
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Define sympathomimetic
A toxidrome that mimics the sympathetic nervous system
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What is narcan?
A narcotic agonist
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Define opiate
A substance derived from the opium plant
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Define depression
A state of mind characterized by feelings of sadness, worthlessness, and discouragement
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Define hemaphobia
The fear of blood
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Define behavior
The way in which a person acts or performs
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Define paranoia
A mental disorder characterized by excessive suspicion or delusions
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Define Withdrawl
The condition produced when an individual stops using or abusing a drug to which she is physically or psychologically addicted
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Define bipolar
A condition characterized by extreme changes in mood, energy, thinking and behavior. Patients cycle through periods of high energy (manic) and major lows (depression)
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Define hallucations
Patient sees, hears, or feels things others cannot; can be disproved
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Define enetophobia
The fear of needles
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Define tolerance
When an individual requires progressively larger doses of a drug to achieve the desired effect
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Define iatrophobia
The fear of doctors
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Define toxidrome
Signs, symptoms, and characteristics that often occur together in toxic exposures
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Define panic attack
An intense fear that occurs for no apparent reason
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Define delusions
False beliefs in spite of evidence to the contraty noited in schizophrenia
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Define schizophrenia
Schizophrenia is a mental disorder that makes it difficult to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses, and to behave normally in social situations.
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Define claustrophobia
The fear of enclosed spaces
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Define socialphobia
The fear of people
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Define anxiety
State of worry or agitation
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Define agoraphobia
The fear of open spaces
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Define overdose
An intentional or unintentional overmedication or ingestion of a toxic substance
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Define hallucinogen
A group of agents that alter a person's perception of reality
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Define addiction
A psychological and physical dependence on a substance that has gone beyond voluntary control
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Define antidote
A substance that is given to a patient that has to ability to counter the effects of a toxin
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Define prolapsed cord
A presentation of the umbilical cord prior to delivery
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Define APGAR
A scale to determine the wellness of a newborn instant at 1 and 5 minutes
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Define perineum
The area between the vagina and anus
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Define crowning
Bulging or the baby's head beginning to emerge from the birth canal
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Define breeched birth
When the baby's butt or feet come out of the uterus first
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Define gravida
The number of pregnancies a woman has gone through
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Define para
The number of successful pregnancies (live births) a woman has gone through (20+ weeks)
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Define abruptio placenta
Occurs when a normally implanted placenta separates prematurely from the wall of the uterus prior to delivery
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Define menstruation
The periodic discharge of blood and tissue from the uterus
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Define meconium
The baby's first stool while in utero
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Define placenta previa
The partial or complete covering of the cervix by the placenta
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Define ectopic pregnancy
Pregnancy occurring when a fertilized egg implants outside the uterus
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Define eclampsia
Seizure phase of preeclampsia
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Define acrocyanosis
Cyanosis noted on the extremities of a newborn
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Define fallopian tubes
Either a pair of tubes that receives and transports the egg from the ovary to the uteus, where an ectopic pregnancy may occur
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Define delivery
Birth of the baby at the end of the second stage of labor
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Define preeclampsia
Condition of high blood pressure and swelling during pregnancy
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Define abortion
Termination of pregnancy before the fetus is able to live on its own outside the uterus
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Define vagina
The birth canal
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List 4 routes of exposure for a poison.
- Ingestion
- Inhalation
- Absorption
- Injection
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List 5 sources of common poisonings.
- Ethanol
- Acetaminophen
- Carbon monoxide
- Acetylsalicylic acid
- Household products;
- Drugs of abuse
- Bites
- Stings
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List six signs and symptoms of a patient experiencing an exposure to carbon monoxide.
- Headache
- Confusion
- Nausea
- Vomiting
- Irritability
- Loss of coordination
- Cardiac disturbances
- Seizures
- Coma
- Death
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List 5 signs and symptoms of a patient who has taken an overdose of aspirin
- Abdominal pain
- Nausea
- Tinnitus
- Hyperventilation
- Hyperpnea
- Altered mental status
- Pulmonary edema
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List two types of stimulants a person would take
- Cocaine
- Amphetamine
- Methamphetamines
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List eight signs and symptoms of a patient with a stimulant toxicity
- Hypertension
- Diaphoresis
- Restlessness
- Dilated pupils
- Seizures
- Arrhythmias
- Hyperthermia
- Euphoria
- Anxiety
- Paranoia
- Agitation
- Delirium
- Tachycardia
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List 4 types of opiates a patient may take
- Heroin
- Morphine
- Codeine
- Hydrocodone
- Oxycodone
- Fentanyl
- Meperidine
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List six signs and symptoms of a patient who has an opiate toxicity
- Sleepiness
- Respiratory depression
- Constricted pupils
- Vomiting
- Coma
- Respiratory arrest
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List six common clinical effects of poisons
- Coma
- Seizure
- Agitation
- Hypoglycemia
- Hypotension
- Hypertension
- Bradycardia
- Tachycardia
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List five questions to ask for a suspected overdose or poisoning
- Chief complaint?
- Substance?
- How long ago was the exposure?
- How much did you ingest?
- How long were you in environment?
- How long was contact with skin?
- What have you done so far to treat poisoning?
- Have you called poison control center?
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List 3 physiologic changes that occur in a pregnant patient
- Increased HR
- Increased RR
- Increased blood volume
- Decreased BP (2nd trimester)
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List 3 signs and symptoms of a patient having a miscarriage
- Cramping
- Vaginal bleeding
- Passage of tissue
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List 3 interventions for a patient who has had a miscarriage
- Oxygen
- Trendelenburg position
- Keep warm
- Transport tissue
- Consider ALS
- Rapid transport
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List 4 signs and symptoms of a patient with pregnancy induced hypertension
- HA
- Peripheral edema
- Abdominal pain
- Nausea
- Vomiting
- Visual changes
- Hypertension
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Briefly describe the three stages of labor
- Stage 1 – from contractions to full dilation
- Stage 2 – from full dilation to delivery of fetus
- Stage 3 – from delivery of fetus to delivery of placenta
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List 5 questions to ask a pregnant patient who is in labor
- Have your waters broken
- Is this your first pregnancy
- How frequent are your contractions
- How long are your contractions lasting
- Have you had prenatal care
- Do you feel the need to push
- What is your due date
- Could you be having multiple births
- Are you bleeding or do you have discharge
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List 5 items you need in an OB kit.
- Towels
- Blankets
- Bulb syringe
- Cord clamps
- Gauze sponges
- Scissors
- Container for placenta
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List the first six steps of care you would provide for a newborn
- Dry
- Warm
- Position
- Suction
- Stimulate
- Oxygen
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List what is noted in the APGAR score, when it is taken and what the scoring system is.
- Check at 1 and 5 minutes
- Appearance – 2 all pink, 1 pink core blue extremities, 0 all blue
- Pulse - 2 > 100, 1 < 100, 0 absent
- Grimace - 2 strong cry and cough, 1 weak cry and cough, 0 no response
- Activity - 2 Active, 1 some flexion, 0 limp
- Respirations - 2 good no effort, 1 slow increased effort, 0 absent
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List 4 ways heat is lost.
- Convection
- Conduction
- Radiation
- Evaporation
- Respiration
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List 4 signs and symptoms of a patient exhibiting hypothermia
- Core temperature: 89.6° to 95°F, Shivering, cold skin, poor judgment, difficulty speaking, difficulty walking, apathy
- Core temperature: 78.8° to 89.6°F, Shivering stops, ↓ LOC, ↓ HR, irregular rhythm (A fib), ↓ respirations, ↓ pupillary response, rough handling, including bumping & jarring can lead to V fib
- Core temperature: <78.8°F, Reflexes absent, no response to pain, nonreactive pupils, bradycardia progresses to asystole, tissues stiff & cold, pulse & respirations may be undetectable
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List 5 treatments for a patient with hypothermia
- Airway
- Breathing
- Circulation
- Remove from environment
- Prevent further heat loss
- Warmed, humidified oxygen
- Warm packs
- Verify pulselessness for 1 minute
- Limit defibrillation
- Hypothermic patients are not dead until they are warm & dead!
- Handle very gently to avoid V fib
- Warm packs can be applied to the armpits and groin
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List 6 signs and symptoms of a patient with heat exhaustion
- Skin pale
- Cool
- Clammy
- Goose bumps
- Dizziness
- Headache
- Syncope
- Nausea
- Fatigue
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List four signs and symptoms of a patient with heat stroke
- Disorientation
- Incoherence
- Confusion
- Red, hot, dry skin
- ↑ Respirations
- ↑ HR
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List 5 treatment s for a patient with a heat emergency
- Remove from source
- Remove clothes
- Cover with cool moist sheet
- Oxygen
- Small sips of water
- ALS rendezvous
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List 4 problems that may be included in mental illness.
- Changes in sensory perception
- Thought disturbances
- Paranoia
- Depression
- Psychosis
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List 4 causes that may lead to behavioral emergencies
- Psychological
- Medical
- Intracranial
- Infectious
- Metabolic
- Psychosocial
- Situational
- Alcohol & drug abuse
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List 6 points to consider when assessing a patient with a behavioral problem
- Observe patient from door
- Note – Posture – Speech -Possession or access to weapons
- Any object can become a weapon if patient feels threatened
- Watch patient for changes as you approach
- Some patients want and will accept help; others may feel threatened by your approach
- Use a slow, calculated approach
- Always have path to exit
- Introduce yourself and other responders
- Establish rapport
- Treat any medical condition
- List 4 calming or crisis management techniques to use with a patient having an emergency
- Anticipate changes in scene safety
- Enlist law enforcement as needed
- Designate 1 person to have patient contact
- Speak in slow, relaxed tone
- Do not insult or antagonize
- Do not go along with hallucinations or delusions
- Use restraints only as last resort
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List 6 signs and symptoms of a patient experiencing severe depression
- Depressed mood
- Loss of interest in activities
- Weight loss/gain
- Sleep disturbances
- Agitation
- Fatigue
- Feelings of worthlessness
- Inability to concentrate
- Recurrent thoughts of death
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List 6 general treatments for a patient with a behavioral emergency
- Scene safety
- Be calm and reassuring
- No sudden movements
- Communicate clearly
- Introduce yourself
- Talk to the patient not family members or bystanders
- Don’t play into delusions or hallucinations
- Assess VS
- O2 as needed
- Transport
- Restrain as needed
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List ten causes of AMS
- Cerebrovascular accident (CVA)
- Hypoglycemia
- Hyperglycemia
- Transient ischemic attack (TIA)
- Seizure
- Hypoxia
- Drugs
- ETOH
- Environment
- Uremia
- Trauma
- Tension pneumothorax
- Tumor
- Infection
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List five actions that should be done all patients with AMS
- Position
- Airway
- Oxygen
- Keep warm
- Rapid transport
- Consider ALS
- Blood glucose
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Differentiate between altered and Decreased LOC
- Altered is a pt is conscious, however disoriented
- Decreased patient drops to the AVPU scale
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List the three components of the GCS and break down the score for each part
- Eyes : A-4 V-3 P-2 U-1
- Verbal: oriented – 5 disoriented – 4 inappropriate – 3 incomprehensible – 2 none - 1
- Motor: obey – 6 localizes pain – 5 withdraw – 4 decorticate – 3 decerebrate – 2 none - 1
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List the three types of diabetic emergencies you may see and a brief description of each
- Hypoglycemia – Low blood sugar, need glucose
- Diabetic Keto Acidosis (DKA) – Excessive sugar in the blood, inability to move into cells due to lack of insulin, ketones
- Hyperglycemic hyperosmolar nonketotic coma (HHNC) – Excessive sugar in blood with minimal movement of sugar in cells, no ketones
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List five signs and symptoms for a pt with hypoglycemia and DKA.
- Hypoglycemia – Pale; diaphoretic; low glucose; altered LOC; seizures; incontinence; normal pulse; normotensive; sudden onset; may be confused with
- DKA – poyuria; polyphagia; polydipsia; kussmauls; acetone breath; altered or decreased LOC; hypotension; abd pain; nausea; vomiting; tachycardia
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List three types of seizure a pt may develop and a brief description of each.
- Absence – A loss of awareness, may not lose consciousness
- Focal – One part of the body is seizing IE- arm-leg-eye
- Generalized – Full clonic tonic activity, total body activity
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Differentiate between the two types of CVA
- Ischemic – Blockage of artery from a blood clot or clot other than blood
- Hemorrhagic – A blood vessel in the brain ruptures
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List ten signs and symptoms noted in a pt experiencing a CVA
- Hemiparesis
- Hemiplegia
- Hypertension
- Headache
- Weakness
- Dizziness
- Pupil changes
- Incontinence
- Seizures
- Parasthesia
- Facial droop
- Dysphasia
- Aphasia
- Positive stroke scale
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List 5 specific interventions for a pt exhibiting signs and symptoms of a critical hemorrhagic CVA
- High fowlers position
- Maintain airway
- High flow oxygen
- Rapid transport
- ALS rendezvous;
- Assessment and reassessment
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Briefly describe the difference between resistance and compliance issues.
- Resistance is a situation that inhibits airflow : IE – obstruction; anaphylaxis; croup
- Compliance is a situation that inhibits exchange of gases at the alveoli: IE: asthma; pulmonary edema; pneumonia
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List ten signs and symptoms of a patient in respiratory distress or failure.
- Restlesness
- Anxiety
- Altered or decreased LOC
- Tachycardia
- Bradycardia(late sign)
- Tachypnea
- Bradypnea
- Skin color changes
- Abnormal BS
- Poor phonation
- Accessory muscle use
- Position
- Pursed lips
- The “O” sign
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List five respiratory problems a patient may present with.
Obstruction; asthma; emphysema; chronic bronchitis; pulmonary edema; pulmonary embolism; pneumonia; hyperventilation; anaphylaxis; spontaneous pneumothorax
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Briefly describe asthma and five specific triggers.
- Hyper-reactive airway disease that leads to bronchoconstriction
- Increased edema
- Excessive mucous plugging
- Anxiety
- Stress
- Exercise
- Aerosols
- Smoke
- Temperature
- Dander
- Dust
- Pollen
- Medications
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Briefly describe emphysema and four signs and symptoms noted with a patient.
- Damage to the alveoli causing a loss of elasticity(atelectasis) leading to decrease in gas exchange
- Pursed lip breathing (building PEEP)
- Barrel chest
- Thin
- Shallow rapid resp
- Poor color
- Low oxygen saturation
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Briefly describe chronic bronchitis and four signs and symptoms noted with a patient.
- An excessive secretion of mucous that leads to poor exchange and a chronic cough;
- Cyanotic
- Right heart failure
- Chronic cough
- Low oxygen saturation
- Dyspnea
- Tachypnea
- Hypopnea
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Briefly describe pulmonary edema and four specific signs and symptoms to pulmonary edema
- A build up of fluid in the alveoli due to left heart failure causing a decrease in exchange of gases
- Frothy sputum(hemoptysis)
- Pallor
- Cyanosis
- Tachypnea
- Wet lung sounds
- Orthopnea
- Paroxsysmal nocturnal dyspnea
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Briefly describe anaphylaxis and four specific treatments for the patient.
- A situation where an antigen (invader in the body) leads to a build up of antibodies to identify it. If and when it happens again it triggers a response that causes increased edema and bronchoconstriction in the airway. Leads to circulatory collapse and death if not relieved
- BVM
- Assist with an epi-pen
- Call for ALS transport
- Rapid transport
- High flow oxygen
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Define antigen.
Substance that immune system recognizes as foreign and induces sensitivity and the immune response system
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Define antibody
A substance that initiates sensitization and then detects, locates and destroys antigens with chemical mediators
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Define allergic reaction
- An initiation of the immune system that leads to specific signs and symptoms due to chemical mediator release
- List 4 differences between allergic reaction and anaphylaxis
- Allergic reaction - hives; itching; edema; redness; lacrimation; S.O.B.
- Anaphylaxis - altered or decreased L.O.C.; hypotension; angioedema; stridor; wheezes; tachycardia; respiratory distress or failure
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List four specific treatments for a patient experiencing an asthma event.
- High flow oxygen
- Vital signs
- Rapid transport
- Assist with inhaler
- Assessment
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Define poyuria
The excessive passage of urine
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Define polyphagia
Excessive eating or desire for food
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Define polydipsia
Excessive thirst
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Define kussmauls respirations
Deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also renal failure. It is a form of hyperventilation, breathing which is increased above the normal rate.
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