Chapters 14-23: Test Question Guide

What are the side effects of epinephrine?

What are the side effects of epinephrine?

Hypertension, nausea, chest pain, cardiac arrhythmia, anxiety, tremors, nervousness

How long can a bee stinger keep pumping venom inside you?

20 minutes

Try to take out the stinger with another object

What are the symptoms of a heart attack?

Crushing pain in the chest

Weakness

The pain will travel to the left side

What are the signs of hypoglycemia?

Possibly seizures in diabetic patients

Normal or shallow to rapid respirations

Moist and pale skin, pale and clammy

Low blood pressure

Rapid, weak pulse

Altered mental status, steadily deteriorating

Taken insulin but not eaten

What are the signs of hyperglycemia?

Hyperventilating, rapid, deep breathing

Kussmaul respirations

Dry and warm skin

Normal blood pressure

Rapid, weak, thready pulse

A fruity odor on their breath: acetone/ketone odor

Altered mental status, steadily deteriorating

Eaten but not taken insulin

What would tell you that a patient has pulmonary edema?

Cannot be supine, cannot breathe if supine

Labored breathing, respiratory distress

Crackles/Rhonchi

History of heart failure

History of high blood pressure

Treat them by putting them on CPAP

What are normal blood glucose levels?

80-120 in adults

70 in neonates

Steps of the primary patient assessment:

General impression

AVPU

Chief complaint

ABCs

Transport decision

What is the dose of epinephrine for children and adults? What are the age ranges for each?

Child: under 4: 0.15

Adult: over 4: 0.30

You have put an AED on a patient. It advises a shock. What should you do?

Say CLEAR and administer the shock

You have given all the doses you can of medication, but the patient is in distress and the transport time is long. Who do you call?

Call medical control

How do we position a stroke patient while transporting?

On the affected side

What do you do if a scene is unsafe?

Make it safe if you can

Call for appropriate resources

What is the big problem with narcotics in terms of a patient taking them?

The lowered respiratory rate for OPIOIDS especially

Ventilate with a BVM, optimally at 100% O2 with 15 L/min

What are the symptoms of an overdose of benzedrine?

1. An amphetamine, not a benzodiazepine/barbiturate

2. A Sympathomimetic stimulant, not a Sedative-Hypnotic

   1. An agent that produces an excited state

   2. Ex: amphetamine, methamphetamine

3. Usually taken to make the user feel good

   1. Improve task performance

   2. Suppress appetite

   3. Prevent sleepiness

4. May produce irritability, anxiety, fear, lack of concentration, seizures

5. Paranoia and delusions are common signs of abuse

What are the symptoms of an overdose of ecstasy?

A Sympathomimetic stimulant, not a Sedative-Hypnotic

Agitation and restlessness

Panic attacks or severe anxiety

Severe confusion or disorientation

Hallucinations or delirium

Rapid heartbeat (tachycardia) or irregular heartbeat (arrhythmia)

High blood pressure

Nausea and vomiting

Blurred vision

Fainting or loss of consciousness

Hyperthermia (dangerously high body temperature)

Seizures

What are the symptoms of an overdose of cocaine?

1. A Sympathomimetic stimulant, not a Sedative-Hypnotic

2. Classically inhaled into the nose and absorbed by the nasal mucosa

   1. Damaging tissue, causing nosebleeds (epistaxis), and eventually destroying the nasal septum

   2. In any form the immediate effects of a given dose, including excitement and euphoria, last an hour

3. Intense agitation or anxiety

4. Severe paranoia or hallucinations

5. Aggressive or violent behavior

6. Tremors or muscle twitches

7. Increased heart rate and blood pressure

8. Irregular heart rhythm

9. Chest pain or discomfort

10. Difficulty breathing

11. Nausea and vomiting

12. Seizures

13. Stroke

14. Coma

What are the symptoms of an overdose of oxycodone?

1. CNS depressants

2. Can cause respiratory depression

   1. Decreased volume of inspired air

   2. Decreased rate of respirations (below 10)

   3. This can lead to respiratory and cardiac arrest

3. Produce a high/kick when administered intravenously

4. Overdose can result in rare seizures, comatose condition

5. Patients appear sedated or unconscious

6. Exhibit cyanosis with pinpoint pupils (most specific sign)

Contraindications for administering oral glucose:

1. The patient is unable to swallow

2. The patient has a severely altered mental status

   1. Very confused, cannot follow commands, etc.

3. The patient is unconscious

4. The glucose is expired

How does anaphylaxis kill people?

Airway swelling

Respiratory distress/arrest

Overdilation of blood vessels → shock

Symptoms of an acute myocardial infarction?

1. AMI pain differs from angina pain

   1. Once dead, cells cannot be revived.

   2. “Clot-busting” (thrombolytic) drugs or angioplasty within the first few hours prevent damage.

   3. Immediate transport is essential

2. Not always due to exertion

3. Lasts 30 minutes to several hours

4. Not always relieved by rest or nitroglycerin

5. AMI and cardiac compromise physical findings

6. Movement or palpation should not alter pain

7. Chest discomfort: Pressure, squeezing, fullness, pain, burning, or heaviness

8. Upper body discomfort: Neck, jaw, shoulder, arms, back

9. Shortness of breath: Shortness of breath, feeling light-headed, or unusually tired

10. Diaphoresis: Sweating

11. Nausea: Feeling nauseous

12. Peripheral cyanosis: Peripheral cyanosis, edema, pallor, diminished pulse volume, delayed rise, and delayed capillary refill

13. Pulse and neck-vein patterns: Pulse and neck-vein patterns may reveal other associated abnormalities

14. Cardiac bulge: Rarely, a cardiac bulge with a pace different from the pulse rhythm can be felt on precordial examination

How do you care for a sexual assault victim?

Move them to a private area

Be respectful, supportive, and a good listener

Get some evidence, clothing, hair, nails, etc.

Wrap evidence materials in a paper bag, plastic degrades DNA

What is a TIA?

A transient ischemic attack

Stroke symptoms that resolve within 24 hours on their own with no deficit in function

You are doing CPR and have the return of spontaneous circulation. What should you do?

Check the pulse

Check the airway

Check the breathing

Give ventilation if needed (NRB at 12-15 L/Min)

In the JB LEARNING world, ALWAYS VENTILATE for shallow respirations

How do we treat a patient with dyspnea?

Oxygen and position of comfort

Sitting up: Fowler’s or Semi-Fowler’s

AEIOU TIPS:

1. A: Alcohol or drug abuse

2. E: Epilepsy, electrolyte imbalances, and endocrine problems

3. I: Insulin, inborn errors of metabolism, and overdose of oxygen

4. O: Overdose

5. U:  Underdose, uremia

6. T: Trauma

7. I: Infection, psychiatric, or poisoning

8. P: Psychosis

9. S: Stroke or subarachnoid hemorrhage (SAH)

What do you do for a patient with good breathing with a lot of oral secretions that they cannot clear on their own?

Suction their airway

What would happen if a solid organ is ruptured?

Severe internal bleeding

What would happen if a hollow organ is ruptured?

Its contents would spill out

This would lead to sepsis, bacterial infection

What are the signs of adequate air exchange?

Chest rise

Skin is pink, warm, and dry

LOC is alert and oriented

Respirations between 12-20 for an adult, etc.

For a patient with a narcotic overdose, what type of airway would you use?

An oral airway until naloxone/Narcan is administered

Have to use an oral until Narcan is administered in two nostrils

Only suction if the person has vomitus or something in the mouth

How does nitroglycerin work?

Dilates the coronary arteries

Causes blood pressure to drop

What are the signs and symptoms of acute hyperventilation?

• Over breathing to the point that arterial carbon dioxide falls below normal

  • May be an indicator of life-threatening illness

  • The body may be trying to compensate for acidosis

  • A buildup of excess acid in blood or body tissues

• This can result in alkalosis

  • The buildup of an excess base in body fluids

• Can cause symptoms of a panic attack:

  • Anxiety

  • Dizziness

  • Numbness

  • Tingling or painful spasms of the hands/feet

When calling medical control, I want the correct course of treatment for a narcotic/poisoning patient. They have to know:

Size of the patient (weight)

What they took

When they took it

How much they took

What do you have to watch for when giving activated charcoal?

Vomiting

First two steps of assessing any patient:

PPE

Scene Safety

How long should a generalized seizure last?

3-5 minutes

What happens after the generalized seizure?

The patient is in a postictal state

How long is the postictal period?

5-30 minutes, depending on the initial seizure

Have a patient with surface contact poisoning, have poison on their body. What is the main concern with this?

That it does not get on the EMS provider

My patient has polypharmacy. They took multiple drugs and one of the drugs is an opiate. The person’s breathing is bad. What are the two steps for treatment?

Ventilate with a BVM and give Narcan/naloxone

How to treat a vomiting patient experiencing a tonic-clonic seizure?

Turn them to their side

Move them out of the way of objects

Suction them

Give them a nasal airway

NEVER put anything into their mouths

How do you treat shock?

Nonrebreather at 15 L/min

Trendelenberg/shock position

Keep them warm with a blanket

Rapid transport, if possible beat the cause of shock

Ex: if bleeding, stop the bleeding

Ex: if anaphylactic, give an EpiPen

What do I do after treating a patient?

Reassess every 5 minutes if unstable

Reassess every 15 minutes if stable

Have a patient who is yelling, cursing, calling people names, etc. Would you say that is a behavioral crisis? When does it become a psychological emergency?

When the patient becomes a threat to themselves or others

What is the difference between allergies and anaphylaxis?

Anaphylaxis deals with multiple body systems

At least one system has to be under a life threat

Anaphylaxis is life-threatening

Allergies are merely annoying

What tells you that a person might become violent?

Changes in body language

Fists clenched, jaw clenched

Holding a bat and smashing windows

A person has shortness of breath. Their pulse ox reads at 92%. What should you do right away for them?

Give them a nasal cannula at 4-6 L/min

Whatever is appropriate

A person has shortness of breath. Their pulse ox reads at 88%. They are slightly cyanotic, maybe hypoxic. What should you do right away for them?

Give them a nonrebreather mask at 10-15 L/min

Whatever is appropriate

A person has shortness of breath. They are in severe respiratory distress and are very hypoxic. What should you do right away for them?

Give them a BVM mask at 15 L/min

Whatever is appropriate

In the primary assessment, ABCs C stands for circulation. What are the three things to check for?

Bleeding

Capillary refill/radial pulse

Skin tone, temperature

Common signs of severe/symptomatic hypoglycemia:

Sudden altered mental status

Severe hypoglycemia

Needs glucose immediately

This will result in loss of consciousness, brain damage, and death

More critical than hyperglycemia or diabetic ketoacidosis

Common signs of severe/symptomatic hyperglycemia:

Acidosis

Dehydration: needs IV fluid therapy

Severe hyperglycemia

Needs insulin immediately