Zach EMT-B Exam 4

• 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

• 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

• 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

Awareness of one's own heartbeat

• Compensating
• Decompensating
• Irreversible

• 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

• The blood is removed from the kidneys, liver, and brain
• Mentations decreased
• Hypotension
• Tachycardia - 130-140
• Decreased urine output

• Bradycardia
• Systole under 60
• Death

The fear of work

Any substance that is taken into the body that interferes with normal body function

The deliberate, persistent, and excessive self-administration of a substance in a way that is socially or medically not approved

An irrational and constant fear of a specific activity, object, or situation

Recurring thoughts, impulses, or images that causes the person anxiety or rituals or behavior

A toxidrome that mimics the sympathetic nervous system

A narcotic agonist

A substance derived from the opium plant

A state of mind characterized by feelings of sadness, worthlessness, and discouragement

The fear of blood

The way in which a person acts or performs

A mental disorder characterized by excessive suspicion or delusions

The condition produced when an individual stops using or abusing a drug to which she is physically or psychologically addicted

A condition characterized by extreme changes in mood, energy, thinking and behavior. Patients cycle through periods of high energy (manic) and major lows (depression)

Patient sees, hears, or feels things others cannot; can be disproved

The fear of needles

When an individual requires progressively larger doses of a drug to achieve the desired effect

The fear of doctors

Signs, symptoms, and characteristics that often occur together in toxic exposures

An intense fear that occurs for no apparent reason

False beliefs in spite of evidence to the contraty noited in 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.

The fear of enclosed spaces

The fear of people

State of worry or agitation

The fear of open spaces

An intentional or unintentional overmedication or ingestion of a toxic substance

A group of agents that alter a person's perception of reality

A psychological and physical dependence on a substance that has gone beyond voluntary control

A substance that is given to a patient that has to ability to counter the effects of a toxin

A presentation of the umbilical cord prior to delivery

A scale to determine the wellness of a newborn instant at 1 and 5 minutes

The area between the vagina and anus

Bulging or the baby's head beginning to emerge from the birth canal

When the baby's butt or feet come out of the uterus first

The number of pregnancies a woman has gone through

The number of successful pregnancies (live births) a woman has gone through (20+ weeks)

Occurs when a normally implanted placenta separates prematurely from the wall of the uterus prior to delivery

The periodic discharge of blood and tissue from the uterus

The baby's first stool while in utero

The partial or complete covering of the cervix by the placenta

Pregnancy occurring when a fertilized egg implants outside the uterus

Seizure phase of preeclampsia

Cyanosis noted on the extremities of a newborn

Either a pair of tubes that receives and transports the egg from the ovary to the uteus, where an ectopic pregnancy may occur

Birth of the baby at the end of the second stage of labor

Condition of high blood pressure and swelling during pregnancy

Termination of pregnancy before the fetus is able to live on its own outside the uterus

The birth canal

• Ingestion
• Inhalation
• Absorption
• Injection

• Ethanol
• Acetaminophen
• Carbon monoxide
• Acetylsalicylic acid
• Household products;
• Drugs of abuse
• Bites
• Stings

• Headache
• Confusion
• Nausea
• Vomiting
• Irritability
• Loss of coordination
• Cardiac disturbances
• Seizures
• Coma
• Death

• Abdominal pain
• Nausea
• Tinnitus
• Hyperventilation
• Hyperpnea
• Altered mental status
• Pulmonary edema

• Cocaine
• Amphetamine
• Methamphetamines

• Hypertension
• Diaphoresis
• Restlessness
• Dilated pupils
• Seizures
• Arrhythmias
• Hyperthermia
• Euphoria
• Anxiety
• Paranoia
• Agitation
• Delirium
• Tachycardia

• Heroin
• Morphine
• Codeine
• Hydrocodone
• Oxycodone
• Fentanyl
• Meperidine

• Sleepiness
• Respiratory depression
• Constricted pupils
• Vomiting
• Coma
• Respiratory arrest

• Coma
• Seizure
• Agitation
• Hypoglycemia
• Hypotension
• Hypertension
• Bradycardia
• Tachycardia

• 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?

• Increased HR
• Increased RR
• Increased blood volume
• Decreased BP (2nd trimester)

• Cramping
• Vaginal bleeding
• Passage of tissue

• Oxygen
• Trendelenburg position
• Keep warm
• Transport tissue
• Consider ALS
• Rapid transport

• HA
• Peripheral edema
• Abdominal pain
• Nausea
• Vomiting
• Visual changes
• Hypertension

• 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

• 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

• Towels
• Blankets
• Bulb syringe
• Cord clamps
• Gauze sponges
• Scissors
• Container for placenta

• Dry
• Warm
• Position
• Suction
• Stimulate
• Oxygen

• 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

• Convection
• Conduction
• Radiation
• Evaporation
• Respiration

• 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

• 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

• Skin pale
• Cool
• Clammy
• Goose bumps
• Dizziness
• Headache
• Syncope
• Nausea
• Fatigue

• Disorientation
• Incoherence
• Confusion
• Red, hot, dry skin
• ↑ Respirations
• ↑ HR

• Remove from source
• Remove clothes
• Cover with cool moist sheet
• Oxygen
• Small sips of water
• ALS rendezvous

• Changes in sensory perception
• Thought disturbances
• Paranoia
• Depression
• Psychosis

• Psychological
• Medical
• Intracranial
• Infectious
• Metabolic
• Psychosocial
• Situational
• Alcohol & drug abuse

• 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

• Depressed mood
• Loss of interest in activities
• Weight loss/gain
• Sleep disturbances
• Agitation
• Fatigue
• Feelings of worthlessness
• Inability to concentrate
• Recurrent thoughts of death

• 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

• Cerebrovascular accident (CVA)
• Hypoglycemia
• Hyperglycemia
• Transient ischemic attack (TIA)
• Seizure
• Hypoxia
• Drugs
• ETOH
• Environment
• Uremia
• Trauma
• Tension pneumothorax
• Tumor
• Infection

• Position
• Airway
• Oxygen
• Keep warm
• Rapid transport
• Consider ALS
• Blood glucose

• Altered is a pt is conscious, however disoriented
• Decreased patient drops to the AVPU scale

• 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

• 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

• 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

• 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

• Ischemic – Blockage of artery from a blood clot or clot other than blood
• Hemorrhagic – A blood vessel in the brain ruptures

• Hemiparesis
• Hemiplegia
• Hypertension
• Headache
• Weakness
• Dizziness
• Pupil changes
• Incontinence
• Seizures
• Parasthesia
• Facial droop
• Dysphasia
• Aphasia
• Positive stroke scale

• High fowlers position
• Maintain airway
• High flow oxygen
• Rapid transport
• ALS rendezvous;
• Assessment and reassessment

• 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

• 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

Obstruction; asthma; emphysema; chronic bronchitis; pulmonary edema; pulmonary embolism; pneumonia; hyperventilation; anaphylaxis; spontaneous pneumothorax

• Hyper-reactive airway disease that leads to bronchoconstriction
• Increased edema
• Excessive mucous plugging
• Anxiety
• Stress
• Exercise
• Aerosols
• Smoke
• Temperature
• Dander
• Dust
• Pollen
• Medications

• 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

• 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

• 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

• 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

Substance that immune system recognizes as foreign and induces sensitivity and the immune response system

A substance that initiates sensitization and then detects, locates and destroys antigens with chemical mediators

• 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

• High flow oxygen
• Vital signs
• Rapid transport
• Assist with inhaler
• Assessment

The excessive passage of urine

Excessive eating or desire for food

Excessive thirst

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.