Paramedic

Becks Triad

It’s the 3 symptoms for Pericardial Tamponade

1. JVD

2. Narrowing pulse pressures

3. Muffled heart sounds

Benadryl Dosage

25mg - 50mg via IM/IV/IO

How does ketamine work?

Ketamine blocks pain receptors in the brain AND affects pathways of the brain between the thalamus and the limbic system

Which capnography waveform would you see with status asthmaticus?

A shark fin wave form

When suctioning an adult patients stoma, what is the max depth the catheter can be inserted?

12cm

When is giving Thiamine indicated?

It should be administered before giving dextrose or glucagon for a patient with alcoholism or malnourishment

Lasix Dosage

0.5 - 1.0mg/kg via IV/IO

If the patient has no response, double the dosage

What ribs are the most commonly fractured ones?

Ribs 4 through 9 because they are less protected by other bony and muscular structures

How would you treat organophosphate poisoning?

With a dose of Atropine ranging from 1mg-5mg via IV/IO/IM.

If the signs and symptoms are moderate, start initial dose at 2mg and double the dose every 5 minutes until symptoms are gone

What are the layers of the heart?

1. Epicardium (outermost)

2. Myocardium

3. Endocardium (inner most)

What is the Atropine symptomatic bradycardia dose?

0.5mg - 1mg IV push, with a total dose of 3mg

When is Albuterol indicated for a patient?

Bronchospasm or hyperkalemia

When is Lasix indicated for a patient?

1. Pulmonary edema

2. Hypertensive crisis

3. Heart failure

How does Narcan work?

Narcan blocks narcotic receptors in the brain AND it reverses respiratory depression from opiates

What does Off-label mean?

When a doctor uses a drug for another reason which it is not usually used for

How does Dopamine work?

Dopamine promotes ionotropic and chronotropic effects AND causes vasoconstriction which increases preload and blood pressure

Hypoxia due to emphysema is caused by a loss of what?

Hypoxia due to emphysema is caused by a loss of alveoli/capillary interface due to alveolar hyperinflation

How does Lidocaine work on the heart?

Lidocaine decreases automaticity by slowing the rate of spontaneous phase 4 depolarization

What glands secrete lubricant into the vagina during intercourse?

The Bartholin Glands

What is a sterile solution or drug administered into the body by injection, bypassing the gastrointestinal tract called?

A parenteral solution

How does Morphine work on the body?

Morphine decreases pain while suppressing fear and anxiety in the brain. Morphine also depresses respiratory drive AND decreases preload/afterload which ultimately decreases the hearts oxygen demand

What causes bronchiectasis?

Any damage to the bronchi. This increases thickness of the airway walls and increases mucus production. This can lead to increased infections. For example, bronchitis.

What are the 3 distinct names every medication is given?

1. Chemical name

2. Generic name

3. Brand name

What is the Epinephrine bradycardia dose?

The dose is 2-10mcg/min via IV/IO.

You mix 1mg in a 250mL bag of normal saline

What is the Nitroglycerin tablet dose?

0.3-0.4mg SL

What are routes that bypass first pass metabolism when giving drugs?

Buccal, sublingual, IV, and IM

What is First Pass Metabolism?

This is when a drug goes through the mouth and gets absorbed by the liver lowering its bioavailability

What is Tachyohylaxis?

It’s when someone gets repeated doses of medication within a short period of time rapidly causing tolerance, making the drug ineffective

What do all benzo drug names have in common?

They all end in “am”

What is a pneumothorax?

It is an accumulation of air or gas in the pleural cavity

What do all ACE inhibitor drug names have in common?

they all end in “pril”

What physical characteristic is most commonly seen in patients who suffer from emphysema?

They have a barrel shaped chest

Nitroglycerin IV dose

10mcg/min, you can increase it by 10 every 4 minutes. Total max dose for a patient is 200mcg/min

How is ipratropium able to relax smooth muscle of the lower airways?

Ipratropium blocks muscarinic acetylcholine receptors in smooth muscles

What is pulsus paradoxus?

When the patients BP drops upon inhalation

What is the drug Tamiflu used to treat?

Influenza

How does Aspirin work on the body?

Aspirin prevents formation of thromboxane A2. Aspirin also has analgesic and antipyretic (fever) properties

Aspirin Dose

160-325mg PO 2-4 tablets

What does Nitroglycerin do?

It relaxes the smooth muscle and dilates arteries and veins in the periphery. It also decreases preload and afterload which makes the heart demand less oxygen

What is the brand name for Metoprolol?

lopressor (lowers BP)

Morphine NSTEMI dose

1-5mg via IV/IM/IO, you can repeat every 5 minutes with a total max dose of 10mg

How does Albuterol work?

Albuterol is a selective beta-2 agonist that stimulates adrenergic receptors of the sympathomimetic nervous system. It also relaxes the smooth muscle in the bronchial tree and peripheral vasculature

How does Epinephrine work?

It is an alpha and beta agonist and blocks histamine receptors

What is laryngotracheobronchitis also called?

Croup

How does Amiodarone work?

Amiodarone blocks potassium, sodium and calcium channels. It also prolongs action potential and repolarization and decreases AV conduction and SA node function

What is a dystonic reaction?

It is an involuntary and sustained muscle contraction that causes abnormal postures and movements (extrapyramidal symptoms)

What type of patient is Wernicke’s encephalopathy most commonly found in?

Alcoholics (vitamin B1 deficiency)

What type of reaction causes anaphylaxis symptoms but does not involve the lgE antibody?

Anaphylactoid reaction

Epigastric pain caused by cholecystitis is often relieved when the patient does what?

When the patient vomits

How many half lives does it take to get a drug completely out of the body?

it takes 5 half lives

What drug can you use for status epilepticus?

Diazepam

What are the 2 most common causes of pancreatitis?

Gallstones and alcoholism

What is the Morphine STEMI dose?

2-4mg via IV/IO/IM slow IV push over 1-5min

Epidural hematomas are often associated with skull fractures that tear what artery?

The middle meningeal artery

What is the Lidocaine Stable VT dose?

1-4mg/min after the loading dose (1mg in 250mL D5W)

What is the Lidocaine PVC dose?

0.5 - 0.75mg/kg IV

What coronary artery is associated with V1-V4?

LAD

What are the 3 doses for Dopamine?

1. Renal: 2-5mcg/kg/min

2. Cardiac: 5-10mcg/kg/min

3. Vasopressor: 10-20mcg/kg/min

How does Atropine work?

Atropine inhibits the action of acetylcholine (ACh) at the parasympathetic neuroeffector sites which increases HR for symptomatic bradycardia

How does Adenosine work?

Adenosine slows the conduction through the AV node and can interrupt AV nodal pathways

Ketamine anesthesia dose?

1-2mg/kg IV slow push

OR

10mg/kg IM

what is at risk on a patient overdoses on acetaminophen?

Their liver

what do all ACE inhibitors end with?

They all end in “pril”

When looking at a 12 lead, what artery is associated with V5, V6, 1 and aVL?

Circumflex

how does the drug furosemide work?

furosemide blocks absorption of sodium and chloride at the distal and proximal tubes and loop of Henley, increasing urine output

How do ACE inhibitors work?

ACE inhibitors work by blocking conversion of angiotensin one to angiotensin two, which then creates less vasoconstriction making blood pressure lower

how does diphenhydramine or Benadryl work?

it blocks H1 histamine receptors, it also decreases motion sickness and reverses extrapyramidal reactions

what artery supplies 2, 3, and aVF on a 12 lead?

RCA

what is Addison’s disease?

Addison’s disease is an adrenal insufficiency. Not enough cortisol

what are some signs and symptoms of Addison’s disease?

Weight loss, fatigue, hypotension, hyperpigmentation

what does idiosyncratic?

it is an unusual or uncommon side effect from a drug

when would a paramedic give ketamine?

for excited delirium, pain or sedation

what are catecholamines?

catecholamines are naturally occurring chemicals that stimulate receptor sites in the sympathetic nervous system

what is Cushing syndrome?

it is an overproduction of the adrenal glands. Too much cortisol

what are signs and symptoms of Cushing’s syndrome?

Moon face, buffalo hump, obesity, hypertension, hyperglycemia

What do we want our end tidal CO2 to be during CPR?

Above 10

What causes prinzmetals angina?

vasospasms of the coronary arteries

What is the recommended dose of joules of energy to deliver to a child in cardiac arrest?

2 to 4 joules per kilogram

The most common origin of bacterial peritonitis in a patient is caused by bacteria present where?

In the colon

What is the most common symptom of peritonitis?

Pain with movement of the abdominal wall