Sac State Paramedic 22-1 missed mod questions

Electrical Pathway Through the Heart and the different HR

SA Node(60-100)--AV node(40-60) conducts impulses to bundle of his(20-40)---bundle of his carries impulses to R & L branches----impulses travel to Purkinjie fibers

Spermatogenesis

production of sperm

dopamine response

may cause renal vasoconstriction. Increases cardiac output, increases blood flow, and improved renal blood flow

layers of central nervous system

3 protective layers around the brain and spinal chord.

Dura Mater: Outer Most

Arachnoid

Pia Mater: Inner Most

Pancreas Functions

exocrine secretes hormones into small intestine; endocrine secretes hormones into bloodstream; Insulin stimulates muscles to remove glucose from the blood when glucose levels are high (like after a meal); Islets of Langerhans secrete glucagon that respond to low levels of blood glucose

Olifactory Nerve #/Function

1 Smell

Optic Nerve

2 Vision/sight

Occulomotor Nerve

3 Eye Movement

Upper eye lid/pupilary muscle

Trochlear Nerve

4 eye movement

Trigeminal Nerve

5 Facial sensation

Abducens Nerve

6. eye movement

Facial Nerve

7 Facial expression

Vestibulocochlear Nerve

8, hearing and balance

Glossopharyngeal Nerve

9 Taste

Vagus Nerve

10 swallowing/speech

Acessory Nerve

11 Tilt head/ Shrug Shoulders

Hypoglossal Nerve

12 Tongue Movement

Pulmonary Blood Flow

Pulmonary Artery: deoxygenated blood away from the heart

Pulmonary Vein: Oxygenated blood to the heart

Systemic Circulation

Artery: Oxygenated blood away from the heart (only difference is Pulmonary artery)

Vein: Deoxygenated blood to the heart

Process of Digestion

1.Ingestion

2.Mechanical Process

3.Digestion

4.Secretion (acid, water, enzyme release)

5.Absorption

6.Excretion

White Blood Cell types

Stored in Lymph + Blood

- Move through Capillary Wall into Tissue

- Elevated during Immune/inflammatory response

Neutrophils

- Finds and Destroys Bacteria(Unibomber)

- First responders to inflammation

- Backstage pass to all tissue/cells/organs

- produced in Bone Marrow

Eosinophils

- Memory Cells in the immune system

- Kill + Record

Basophils

Allergy +Inflammatory Response

- Release Histamine and Heparin

(Found in Blood Stream, create Mast Cells)

Monocytes

- Healers, ingest broken down tissue

- produced in Bone Marrow

Inner workings of the Kidney (Nephrons)

Glomerulus: Blood vessel inside Bowmans Capsule

Bowmans capsule: Collects fluid from the Glomerulus

Proximal Convoluted Tubule: Absorbs: salt, water, glucose, amino acids, potassium, urea, phosphate, and citrate

Loop of Henle: reabsorption of water and sodium chloride (Urine formation)

Distal Convoluted Tubule: regulate pH of blood by regulating H+ ion

Spleen

Largest Lymphatic organ. Breaks down old RBC/ Filters

Helps produce Lymphocytes

How much ATP is created after Glycolysis

2 Net ATP (2 spent, 4 produced)

2 Pyruvates

2NADH

How much ATP is created after Krebs

2 more ATP

How much ATP is created after Electron Transport Chain

34 from ETC with a total of 38 after everything

Mast Cells

Release Histamine and Heparin

- Histamine triggers Allergic response

- Heparin prevents clotting

Where does fertilization occur?

fallopian tubes

renin-angiotensin-aldosterone system pathway Diagram

renin-angiotensin-aldosterone system

a hormone cascade pathway that helps regulate blood pressure and blood volume

Neuron Action potential Threshold

-55

4 Steps of Action Potential

1. Depolarization- Sodium Channels open and sodium leaves making room for potassium on outside

2.Action potential- "Message sent" Sodium ion chanells close

3. Repolarization- sodium Ions pushed out (K inside. NA Outside)

4.Hyperpolarization- NA closed off, K being pulled inside the cell

Hypoxic Drive

Backup system for body where the body switches to breathing being controlled by amount of O2

Upper and Lower airway separation

The airways are separated at the Larynx

Upper Airway and Lower Airway

Upper:

Nasopharynx, pharynx, laryngopharynx. larynx

Lower:

Bronchiole, Bronchiole Branches, Alveoli

How to increase pressure in vascular system

Increase volume via fluid

Beta 1 Receptors

Beta-1 = Heart (Beta 1, One Heart)

Increased Heart Rate

(Positive chronotropic Effect)

Increase Force of Contraction

(Positive inotropic effect)

Increased conduction velocity

(Positive dromotropic effect)

Beta 2 Receptors

Beta-2 (Beta-2, Two lungs)

Bronchodilation and Vasodilation in muscle/liver

Alpha 1 Receptors

Vasoconstriction of peripheral vasculature

Alpha 2 Receptors

Decrease in Sympathetic Nervous System (Brain)

Alpha Adrenergic Receptor Antagonist

- Prevent endogenous catecholamines from reaching alpha receptors

(lowers BP and decreases systemic vascular resistance)

-Prescribed for patients with hypertension, enlarged prostate, glaucoma

Needle Cric. Contraindication

Any other Airway

VAD's

Ventricular Assist Device

A-Fib can lead to

Stoke, PE, and MI

Aortic disection

Injury of the inner most layer of the Aorta, causing blood to flow between the layers of the aortic wall

First thing to do on scene

BSI/ Scene Safe

Stable vs Unstable V-Tac

Unstable v-tac can result in ALOC or a Loss of Consciousness

Functions of the skin

Thermo Regulation, protection, water retention, sensation, secretion, absorption

Treatment for Aortic Disection

Manage PT stress and administer Analgesiscs to bring PT Heart rate and Blood pressure down to prevent further damage

How does septic Shock Cause Hypotension

Sepsis causes Vasodilation and third spacing throughout the body resulting in hypotension

Intervention for a patient with shallow ineffective respirations?

BVM

Treatment for acute limb Ischemia

−If limb ischemia affects a lower extremity, sit the patient up, with feet lower than chest.

−Keep the ambulance warm to avoid vasoconstriction of the skin.

•Do not apply heat or cold to affected limb.

What limb leads have what polar charge

L Arm (+/-)

R Arm (-/-)

L Leg (+/+)

Electrons

Negatively charged particles

Protons

Positively charged particles

Neurons

Individual cells in the nervous system that receive, integrate, and transmit information.

Stable Angina

−Follows a predictable, recurrent pattern

1) Pain occurs after a predictable amount of exertion, with a predictable location, intensity, and duration.

(2) Patients often take some form of NTG.

(3) ST-segment depression or inverted T waves show on ECG.

(4) ECG changes resolve when the heart's oxygen demand is met.

Unstable Angina

−More serious, higher level of obstruction

−Changes in frequency, severity, and duration

−May begin during sleep or at rest

−Warning of impending MI

Where are 12 lead electrodes placed

Distributive Shock Types

neurogenic, anaphylactic, septic

Glasgow Coma Scale (GCS)

Oogenesis

Central Nervous System (CNS)

brain and spinal cord

Peripheral Nervous System (PNS)

the sensory and motor neurons that connect the central nervous system (CNS) to the rest of the body.

Hypoventilation leads to

Respiratory Acidosis

H's and T's

5 H's

H ypoxia

H ypovolemia

H ydrogen Ion (acidosis)

H ypo / Hyper kalemia

H ypothermia

H ypogylcemia

5 T's

T ension pneumothorax

T amponade

T oxins

T hrombosis (pulmonary)

T hrombosis (coronary)

covalent bond

A chemical bond that involves sharing a pair of electrons between atoms in a molecule

ionic bond

Formed when one or more electrons are transferred from one atom to another

hydrogen bond

weak attraction between a hydrogen atom and another atom

The bodys response to a drop in Blood Pressure

peripheral Vasoconstriction, shunting blood to the core and increasing heartrate

CPAP contraindications

respiratory arrest, pneumothorax or chest trauma, tracheostomy, GI bleeding or vomiting, unable to follow verbal commands, Low Blood Pressure

organo phosphate poisoning

SLUDGEM

Treatment: Atropine 2-4mg

Beta Blockers and Calcium Channel Blocker OD Treatment

Atropine

1mg with a max of 3mg

Beta Blockers OD S/S

Irregular/slow HR

lightheadedness

Low BP

Signs of shock

Cushings Triad (ICP)

HTN (Widened pulse pressure)

Bradycardia

Irregular respirations

Becks Triad

Muffled heart sounds

JVD

Narrowing pulse pressure (Hypotension)

Upper GI Bleed S/S

Bright red bloody emesis

Dark tarry/coffee ground stools

(Not a disease it is a symptom)

Tx: Fluid, zofran if needed, O2, etc

Lower GI Bleed

Coffee ground emesis

Bright red hematochezia

Tx: Fluid, zofran if needed, O2, etc

Hyperosmolar Hyperglycemic Syndrome (HHS)

Type 2 diabetes

From hyperglycemia and no ketones being metabolized

ALOC

Lethargic

Dehydration

Partial paralysis/muscle weakness

If sugar does not raise high enough overtime from dextrose we should...

Repeat dose as needed

What does EMS need to worry about with toxic/hazmat environments?

There could be multiple patients

If a patient is hypotensive and tachycardic we should...

Give fluid boluses at minimum

In regards to ABC's

Do not advance to the next step until airway is secured

Pt is getting adequate oxygenation (if it is from themselves or a BVM etc)

Pt bleeding is controlled

(For trauma we go in order of C.A.B. if needed)

s/s of hemorroids

Itching or irritation around the anus

pain or discomfort

Swelling of the anus

Hematochezia

S/S of gastroenteritis

Inflammation of the stomach and intestines

nausea, vomiting, abdominal cramping, diarrhea

be cautious, could go into hypovolemic or septic shock

Cholecystitis

inflammation of the gallbladder

5 F's (Fat, Fair, Fertile, 40-50, Female)

Severe RUQ pain

appendicitis

inflammation of the appendix

3 phases

-Early: Gradual onset of pain

-Ripe: Extreme pain (RLQ could be referred to McBurneys point)

-Rupture: Burst of appendix, no pain, stool released in abdomen could cause peritonitis and sepsis

Diverticulitis

inflammation/weak area of the diverticula

Low fiber diet

LLQ pain

pacreatitis

sudden severe LUQ epigastric pain -steady boring through to the back

usually with a history of chronic alcohol abuse

may have abdominal tenderness and or distention

Grey Turners sign and or Cullen Sign

ulcerative colitis

a chronic condition of unknown cause in which repeated episodes of inflammation in the rectum and large intestine cause ulcers and irritation

AGES 15-25 and 55-65

Be cautious the ones above could be abdominal scenarios in the final skills

TCA Overdose S/S and Treatment

(Could be a scenario after Mod 3...)

Red as a beat, Dry as a bone, mad as a hatter, blind as a bat, hot as a hare, Widening QRS, Dilated pupils

Tx: Sodium bicarb

Examples: Amyltriptaline/nortryptaline

Describe status epilepticus

Seizures that last 4-5 minutes or multiple seizures with little to breaks in between

prehospital treatment for a stroke

Vitals

Oxygen

Monitor

IV

Transport

Prehospital care for a pt with increase ICP?

Recognize

Vitals

Oxygen

Monitor

Iv

Transport

-Remember to elevate the pt 30* and hyperventilate to vasoconstrict for the brain (no more than 5 minutes)

Phases of Renal Problems

Acute Kidney Injury

Chronic Kidney Disease

Renal Failure/End Stage Renal Disease