Exam 2 study guide

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What are the components of an ECG waveform?

• P wave: atrial depolarization

• QRS complex: ventricular depolarization

• T wave: ventricular repolarization

• PR interval: atrioventricular conduction delay

• ST segment: early ventricular repolarization

What are key signs and symptoms of acute coronary syndrome (ACS)?

• Chest pain/pressure (may radiate to jaw, shoulder, or arm)

• Dyspnea

• Diaphoresis

• Nausea or vomiting

• Anxiety or sense of doom

• ECG changes: ST elevation/depression, T wave inversion

What is the prehospital management for a patient with suspected ACS?

• Administer oxygen if SpO₂ < 94%

• 12-lead ECG and cardiac monitoring

• IV access

• Position of comfort

• Rapid transport with early hospital notification

List common cardiac medications and their effects.

• ASA: antiplatelet, prevents further clot formation

• Nitroglycerin: vasodilation, reduces preload and myocardial workload

• Beta blockers: slow HR, lower BP, reduce myocardial oxygen demand

• ACE inhibitors: reduce afterload, improve cardiac output

• Anticoagulants (e.g., heparin): prevent clot propagation

What are early signs of heart failure in a prehospital assessment?

• Dyspnea (especially on exertion or lying flat)

• Crackles on lung auscultation

• Jugular venous distension (JVD)

• Peripheral edema

• Tachycardia

• Fatigue or weakness

• Pink frothy sputum (in severe pulmonary edema)

What complications should you anticipate in acute coronary syndrome?

• Arrhythmias (V-fib, V-tach, bradycardias)

• Cardiogenic shock

• Cardiac arrest

• Pulmonary edema

• Re-infarction

• Sudden death

What are the signs of respiratory distress and impending failure?

• Increased respiratory rate (tachypnea)

• Use of accessory muscles (neck, intercostals)

• Tripod positioning

• Nasal flaring (especially in pediatrics)

• Cyanosis (late sign)

• Inability to speak full sentences

• Altered LOC or agitation

• Silent chest (ominous sign of no air movement)

How does COPD present and how is it managed?

• Chronic airflow limitation, typically from emphysema or chronic bronchitis

• Pursed-lip breathing, barrel chest, productive cough, wheezing, cyanosis
  Treatment:

• Controlled O2 (88–92% target sat) to avoid CO2 retention

• Salbutamol and Ipratropium

• Monitor for fatigue and CO2 narcosis

• Transport in position of comfort

Pink puffers versus blue bloaters 

Pink puffer is for emphysema and that relates to barrel chest whereas blue bloater is chronic bronchitis 

What is pneumonia and how does it present?

• Infection of alveoli or interstitial tissue

• Fever, chills, productive cough, pleuritic chest pain, crackles/rales, dyspnea
  Prehospital care:

• O2, supportive care, monitor vitals

• Treat as sepsis if systemic signs are present

What is a pulmonary embolism (PE) and its classic presentation?

• Blockage of pulmonary artery by thrombus (often from DVT)

• Sudden unexplained dyspnea

• Pleuritic chest pain

• Cough with hemoptysis

• Tachycardia

• Clear lungs on auscultation

• May lead to hypotension, shock, or cardiac arrest
  Care:

• High-flow O2, cardiac monitoring, rapid transport

Abnormal (Adventitious) Lung Sounds

Crackles (Rales):
These are discontinuous, popping or clicking sounds, often described as like velcro being pulled apart. They are typically heard during inhalation and can be fine or coarse, moist or dry. They indicate air passing through secretions or the opening of collapsed airways. Crackles are most often heard in the bases of the lungs.

Rhonchi:
These are low-pitched, continuous, snoring-like sounds, caused by airflow obstruction in the larger airways, often due to mucus or other secretions. They can be heard during exhalation or both inhalation and exhalation, but not just during inhalation. Rhonchi are typically heard over the central airways, such as in the bronchi, especially in the chest’s anterior and posterior regions.

Wheezing:
These are high-pitched, whistling sounds, usually heard during exhalation, caused by narrowed airways. They are common in conditions like asthma and COPD. Wheezing is often heard throughout the lung fields but is typically louder in the upper lobes or over areas of narrowed airways.

Stridor:
This is a high-pitched, wheezing sound, usually heard during inhalation, caused by a severe narrowing of the upper airway (trachea or larynx). It is a serious sign and requires immediate attention. Stridor is best heard over the neck and upper chest area.

Pleural friction rub:
This is a creaking or grating sound, caused by the inflamed pleura (lining of the lungs and chest wall) rubbing together. It can be painful and is often heard during both inhalation and exhalation. Pleural friction rub is usually heard in the lower anterolateral chest wall, where the pleural surfaces are in closest contact.

What is a pneumothorax and how can it escalate to a tension pneumothorax?

• Air in pleural space collapses lung

• Decreased breath sounds on affected side, dyspnea, chest pain

• Tension pneumothorax adds: tracheal deviation, JVD, hypotension, cyanosis
  Treatment:

• O2, needle decompression (if trained and authorized), rapid transport

What is the pathophysiology of sepsis?

• Systemic inflammatory response to infection → vasodilation, capillary leak, clotting dysregulation → poor perfusion → organ failure

• Often triggered by pneumonia, UTI, skin infections, or catheter infections

What are the early signs of sepsis?

• Fever or hypothermia

• Tachycardia

• Tachypnea

• Hypotension

• Altered mental status

• Mottled or flushed skin

• Decreased urine output

How should you manage sepsis prehospital?

• Administer high-flow oxygen

• Establish IV access, give fluid bolus (NS)

• Monitor LOC, respiratory rate, BP

• Notify receiving hospital (Sepsis Alert)

• Keep patient warm

• Avoid unnecessary delays — rapid transport

What are the components of a neurological assessment?

Fast Van

What is the difference between a CVA (stroke) and a TIA?

• CVA: Permanent neurological damage due to ischemia or hemorrhage

• TIA: Temporary interruption of blood flow, symptoms resolve in <24 hours
  Symptoms: Facial droop, arm drift, speech difficulty, visual loss, weakness/numbness

has it been more or less than 6 hours? if they woke up like this it counts as less

What are the signs of increased intracranial pressure (ICP)

• Headache

• Vomiting (often without nausea)

• Altered LOC

• Unequal pupils

• Bradycardia, irregular respirations, widened pulse pressure (Cushing’s triad)

• Seizures

: What is SIRS and how is it defined?

SIRS (Systemic Inflammatory Response Syndrome) is a widespread inflammatory reaction to a variety of clinical insults (infection, trauma, burns, etc.).
SIRS criteria (≥2 of the following):

• Temperature >38°C or <36°C

• Heart rate >90 bpm

• Respiratory rate >20 breaths/min or PaCO₂ <32 mmHg

• WBC >12,000 or <4,000 or >10% bands

What is sepsis, and how is it related to SIRS?

Sepsis = SIRS + suspected or confirmed infection.
It is a dysregulated immune response to infection, leading to tissue damage and potential organ failure.
Progression:

• Sepsis → Severe Sepsis (with organ dysfunction) → Septic Shock (with persistent hypotension despite fluids)

What organ systems are affected by sepsis, and how?
A:

• Respiratory: Hypoxia, ARDS

• Cardiovascular: Vasodilation → hypotension → shock

• Renal: Decreased perfusion → acute kidney injury → low urine output

• Hepatic: Coagulopathies, jaundice

• Neurological: Altered LOC, confusion

• GI: Poor perfusion → ileus or gut ischemia

What are early and late signs of sepsis in the field?
A:

Early: Fever or hypothermia, tachycardia, tachypnea, flushed or warm skin, anxiety or confusion
Late: Hypotension, mottled/cool skin, altered LOC, decreased urine output, cyanosis

What is the pathophysiology of Parkinson’s disease?

Degeneration of dopamine-producing neurons in the substantia nigra of the brain.
Dopamine is critical for smooth, coordinated muscle movements. Its depletion causes resting tremor, rigidity, and bradykinesia.

What is the pathophysiology of Multiple Sclerosis (MS)?

Autoimmune attack on the myelin sheath of CNS neurons → demyelination and plaque formation → disrupted nerve conduction.
Leads to motor weakness, vision issues, fatigue, and sensory disturbances.

What is the pathophysiology of Amyotrophic Lateral Sclerosis (ALS)?

Progressive degeneration of upper and lower motor neurons → muscle atrophy and paralysis.
Cognitive function usually preserved, but death typically results from respiratory failure.

What is the pathophysiology of Muscular Dystrophy?

Genetic defect in dystrophin (a muscle-supporting protein) → progressive muscle fiber breakdown and weakness.
Begins in childhood, especially affecting pelvic and shoulder muscles.

What is the pathophysiology of appendicitis and how does it present?

Obstruction of the appendix (often by fecalith) → inflammation, ischemia, and possible rupture.
Presentation: RLQ pain (McBurney's point), rebound tenderness, fever, nausea, vomiting, guarding.
Treatment: Pain management, antiemetics, IV fluids, NPO, transport to surgical facility.

What is the pathophysiology and field management of bowel obstruction?

Mechanical blockage (tumor, hernia, adhesions) or functional paralysis → backup of contents.
Presentation: Abdominal distension, cramping pain, vomiting (possibly fecal-smelling), no bowel movement or gas.
Treatment: Monitor airway, IV fluids, antiemetics, NPO, rapid transport.

What is peritonitis and how does it present?

Inflammation of the peritoneum, often due to perforation of a hollow organ.
Presentation: Severe abdominal pain, rebound tenderness, rigid abdomen, fever, nausea, tachycardia, signs of shock.
Treatment: O2, fluids, NPO, monitor vitals, rapid transport.

How does pancreatitis present and what causes it?

Caused by gallstones, alcohol use, or high triglycerides.
Presentation: Epigastric or LUQ pain radiating to the back, nausea, vomiting, fever, abdominal guarding.
Treatment: Supportive care, pain control, fluid resuscitation, monitor for shock.

What are key signs and concerns in gastrointestinal bleeding (GI bleed)?

Upper GI bleed: Hematemesis (vomiting blood), melena (black stools)
Lower GI bleed: Bright red blood per rectum
Concerns: Hypovolemic shock, anemia
Treatment: O2, IV fluids, monitor for hypotension and tachycardia, NPO, transport upright unless hypotensive

What is the pathophysiology and presentation of a urinary tract infection (UTI)?

Bacterial infection (usually E. coli) ascends from the urethra into the bladder.
Symptoms: Dysuria, urgency, frequency, suprapubic pain, foul-smelling or cloudy urine
Treatment: Supportive care, monitor for signs of sepsis if fever/LOA present, transport

What is pyelonephritis and how does it differ from a UTI?

Infection spreads to the kidneys → systemic symptoms
Presentation: Flank pain, fever, chills, nausea/vomiting, CVA tenderness
Treatment: Monitor for sepsis, IV fluids, pain control, transport

What are renal colic and kidney stones, and how do they present?

Calculi form in the kidney and obstruct ureter
Symptoms: Sudden severe flank pain radiating to groin, hematuria, restlessness, nausea/vomiting
Treatment: Pain management, antiemetics, fluids, position of comfort, rapid transport

What is urinary retention and how might it present?

Inability to void despite full bladder — common in males with BPH
Symptoms: Suprapubic pain/distension, urgency, no urine output, restlessness
Treatment: Monitor vitals, support ABCs, transport

What are red flags in GI/GU emergencies that suggest critical illness?

• Absent bowel sounds with distension

• Rigid abdomen

• Vomiting fecal matter

• Tachycardia with hypotension

• Rectal bleeding or hematemesis

• Severe dehydration or altered LOC

Where do you put the three lead ECG 

On the shoulders or wrists and calves

12 lead ECG placement

Name the steps for IM injection 

Hopefully you didn't forget aspiration

What age-related changes affect pharmacology in geriatric patients?

• Decreased renal and liver function slows drug metabolism/excretion

• Altered body composition (↑ fat, ↓ muscle) affects distribution

• Increased sensitivity to CNS depressants and anticoagulants

• Polypharmacy increases risk of adverse effects and interactions

What are common geriatric presentations that differ from younger patients?
A:

• Silent MIs (no chest pain)

• Infections without fever (e.g., UTI → delirium)

• Falls with fractures or head injury without major mechanism

• Hypoglycemia with confusion instead of diaphoresis

• Pneumonia without cough or sputum

What is the difference between delirium and dementia?

• Delirium: acute onset, fluctuating consciousness, often reversible (infection, medication, metabolic)

• Dementia: chronic, progressive cognitive decline (e.g., Alzheimer’s), usually irreversible