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What do you do in case of a suspected emergency? (5)
- 1. Stop tx
- 2. Position pt
- - usually - trendelenburg position (feet up, head down)
- - chest pain/resp prob - semisupine
- 3. start O2
- 4. get vitals
- - BP, Pulse, resp rate
- 5. call for help
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Predisposing factors of syncopy (3)
- 1. young adult males
- 2. Psychogenic factors
- 3. Nonpsychogenic factors
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Psychogenic factors of syncope (6)
- 1. Fright
- 2. anxiety
- 3. emotional stress
- 4. unwelcom news
- 5. pain
- 6. sight of blood
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Nonpsychogenic factors of syncope (5)
- 1. sitting upright/standing
- 2. hunger
- 3. exhaustion
- 4. poor physical condition
- 5. heat and humidity
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How do you prevent syncope? (2)
- 1. eliminate nonpsychogenic factors
- 2. relieve anxiety
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Manifestations of presyncope (4)
later...(4)
- Now
- 1. warmth
- 2. pallor
- 3. sweating
- 4. nausea
- Later
- 1. deep breathing
- 2. hypotension
- 3. bradycardia
- 4. pupillary dilation
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Manifestations of syncope (5)
- 1. loss of consciousness
- 2. irreg, shallow/absent breathing
- 3. convulsive movements/twitching
- 4. extreme hypotension and bradycardia
- 5. weak thready pulse
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postsyncope (5)
- 1. pallor
- 2. nausea
- 3. weakness
- 4. sweating
- 5. return of vital sign toward normal
- 6. tendency to faint may persist for several hours.
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Pathophysiology of syncope (4)
- 1. catecholamine secretion
- 2. peripheral pooling of blood
- 3. vagal activation
- 4 cerebral ischemia
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how to manage syncope (6)
- 1. stop procedure
- 2. place in trendelenburg position
- 3. admin O2 - establish airway
- 4. ammonia ampule of complete loss of consiousness
- 5. muscle movement
- 6. check vitals
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Predisposing factors of Hyperventilation (2)
- 1. predominantly young women
- 2. anxiety
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prevention of hyperventilation (2)
- 1. education
- 2. control anxiety
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manifestations of hyperventilation (6)
- 1. complaints of chest tightness
- 2. obvious overbreathing
- 3. dizzienss
- 4. paresthesias
- 5. muscle tetany
- 6. loss of consiousness
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pathophysiology of hyperventilation (3)
- 1. increased RR --> decreased CO2-->increased pH
- 2. increased pH -->decreased Ca ions -->neuromuscular irritation
- 3. increased catecholamines -->palpitation, sweating, chest pains
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Mgt of hyperventilation (5)
- 1. anxiety reduction
- 2. terminate procedure
- 3. position upright
- 4. rebreath exhaled air (paper bag/hands)
- 5. educate
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common allergens (4)
- 1. Penicillin - 5-10% - rsh to anaphylaxis (10% die)
- 2. ASA - .2-.9% - rash-anaphylaxis
- 3 LA - dermatitis-anaphylaxis
- 4. latex
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how to prevent allergy (3)
- 1. obtain accurate health hx
- 2. allergy testing (for L/A)
- 3. avoid allergens and allergy prone meds
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manifestations of allergy (5)
- 1. immediate vs. delayed rxn occur
- 2. range from mild skin rxn to severe urticaria
- 3. asthma
- 4. angioedema
- 5. anaphylaxis (urticaria, angioedema, CV collapse)
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Mgt of allergic rxn (delayed skin rxn)
antihistamine (benadryl 50mg Q 6h PO)
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Mgt of allergic rxn (immediate skin rxn) (2)
- 1. Epi (.3-.5 mL 1:1000)
- 2. antihistamine (benadryl 50 mg Q 6h PO or 25 mg IV/IM)
- Observe for more than 1hr
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Mgt of respiratory allergic rxn (8)
- 1. position semi upright
- 2. assess vitals
- 3. basic life support if necessary
- 4. administer O2
- 5. brochodilator (epi 0.3mL 1:1000)
- 6. Observe
- 7. Antihistamine
- 8. medical consult
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Mgt of allergic laryngeal edema/anaphylaxis (8)
- 1. Position pt
- 2. basic life support
- 3. epi .5mg SQ/IM/IV
- 4. maintain airway
- 5. summon assistance
- 6. antihistamine
- 7. steroids
- 8. cricothyroidotomy
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Predisposing factors of Angina (7)
- 1. CAD
- 2. Male
- 3. increased age
- 4. Smoking
- 5. HTn
- 6. DM
- 7. Hypercholesterolemia
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Prevention of angina (4)
- 1. control risk factors
- 2. stress reduction
- 3. O2
- 4. NG
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Manifestations of Stable angina (4)
- 1. substernal chest pain or dull aching discomfort
- 2. exercise or stress induced (identifiable cause)
- 3. Relieved by rest or NG
- 4. Consistent with prior chest pain over last 2 months
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Manifestationsof unstable (transitional) angina (4)
- 1. may occur at rest
- 2. no identifiable cause
- 3. not relieved by rest or NG
- 4. variable presentation
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Mgt of Angina (5)
- 1. stop tx
- 2. position upright
- 3. sublingual NG (repeat 3x over 10 mins)
- 4. give O2
- 4 if not improved get help
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Predisposing factor of Acute MI (7)
- 1. CAD
- 2. Male
- 3. increased age
- 4. smoking
- 5. HTN
- 6. DM
- 7 Hypercolesterolemia
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Prevention of Acute MI (4)
- 1. control risk factors
- 2. stress reduction
- 3. O2
- 4. NG
- Post MI - avoid elective care for 6 mos
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Manifestations of AMI (7)
- 1. sudden onset of severe pain
- 2. crushing chest pain
- 3. not relieved by rest or NG
- 4. Sweating, weakness, restlesness
- 5. sense of impending doom
- 6. dyspnea
- 7. abdominal bloating
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Mgt of AMI (8)
- 1. Stop tx
- 2. BLS
- 3. chew one aspirin
- 4. get help
- 5. admin O2, monitor vitals
- 6. relieve pain (morphine, N2O)
- 7 manage complications (arrhythmias, HF)
- 8. transport
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Predisposing factors of extrinsic asthma (2)
- 1. exposure to allergens
- 2. decrease with age (tend to become mild, disappear in adulthood)
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predisposing factors of intrinsic asthma (2)
- 1. more common >35
- 2. precipitated by:
- - URI
- - irritation inhalents
- - smoke
- - cold air
- - exercise
- - emotional stress
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predisposing factors of Status Asthmaticus (2)
- 1. true medical emergency
- 2. does not respond to usualy therapy
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prevention of asthmatic attacs (4)
- 1. assure adequate med mgt
- 2. relieve anxiety
- 3. avoid allergens
- 4. use inhaler prior to appt
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manifestations of asthma (6)
- 1. wheezing
- 2. SOB
- 3. cough
- 4. chest tightness
- 5. anxiety
- 6. orhtopnea
- 7. cyanosis
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pathophys of asthma (4)
- 1. bronchial hyperactivity --> bronchospasm
- 2. bronchial edema and hypersecretion
- 3. increased airway resistance-->hyperinflation
- 4. Tachypnea -->fatigue, hypercardia, hypoxia
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Mgt of asthma (7)
- 1. stop tx
- 2. position upright
- 3. use bronchodilator
- 4. admin O2
- 5. admin epi 1:1000 IM, .3 mL if needed
- 6. give aminophylline, hydrocortisone
- 7. get assistance
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Precipitation factors of Hypoglycemia (5)
- 1. weight loss
- 2. increased exercise
- 3. recovery from infxn and fever
- 4. omission/delay in meals
- 5. insulin overdose
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manifestations of hypoglycemia (4)
- 1. rapid onset
- 2. decreased ventilation, may progress to rapid LOC, seizures
- 3. hunger, nausea, increased GI
- 4. sweating, tachycardia, anxiety
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Tx of conscious hyperglycemic pt (2)
- 1. give Carbohydrates (OJ)
- 2. assess vital signs and assure recovery
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Tx of unconscious pt (3)
- 1. assess ABC's - provide BLS if needed
- 2. parenteral carbohydrate (50 mL of 50%dextrose)
- 3. summon assistance
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predisposing factors of seizures (7)
- 1. hypoxia
- 2. hypoglycemia
- 3. hypocalcemia
- 4. flickering lights
- 5. fatigue
- 6. poor health
- 7. phsycial/ emotional stress
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prevention of seizures (4)
- 1. avoid IV L/A injection
- 2. Manage Hyoglycemia
- 3. consider psychosedation/ manage anxiety
- 4. be prep'd to prev injury
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Stages of seizures (3)
- 1. Prodromal stage
- - subtle changes in emotional reactivity
- 2. Convulsive stage
- - LOC, tonic contration, clonic movement 2-5 mins
- 3. Postictal stage
- - gradual return of consciousness, disorientation
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Status epilepticus (4)
- 1. continuation of tonic-clonic seizures
- 2. Hyperthermia
- 3. Hypertension
- 4. Hypoventilation
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Mgt of seizures (6)
- 1. position supine
- 2. prev injury (restrain w/o force)
- 3. BLS (open airway, suction in vestibule, O2)
- 4. Monitor vitals
- 5. if continuous- valium 2mg/minute up to 10 mg
- 6. summon assistance
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