Paramedic

Step 1: Physiological

GCS Less than 13 or equal to

Systolic less then 90

RR less than 10 or greater than 29 (less than 20 under 1 year of age)

Assisted ventilation

Step 2: Anatomic

Penetrate Head, Neck, Torso, Extremities

Proximal to elbow or knee

Flail chest

Amputation proximal to wrist or ankle

Pelvic Fractur

Open skull fractur

paralysis

If yes to above, then go to level one trauma center if possible

Step 3: Mechanism

Adult fall 20ft or more

Pedi fall form 10ft or more

Intrusion of roof of car

More than 12 inches on occupant side

Greater than 18 inches on passenger side

Ejection from vehicle

Death in same compartment

Auto vs pedestrian, Ped ran over

Motorcycle greater than 20mph

Step 4: Special Conditions

Age greater than 55

Systolic less than 100 in greater than 65yo

Pedi trauma

Anti-coagulants

Burns (consider burn center)

Pregnancy over 20weeks (about 4 and a half months)

Judgment of EMS professional

PUPILS

Dilated (Mydriasis)

Cardiac Arrest

Shock

cerebral hypoxia

Cocaine

Epi

Amphetamines

Constricted (Miosis)

Narcotics

CNS Disorder

Glaucoma medication

Unequal

Brain injury

Brain Tumor

Stroke

Fake eye

Eye medication

Eye Injury

Anisocoria (Normal state due to multiple reasons)

Nystagmus: Rapid involuntary movement of the eyes; CNS disorder, some drugs PCP, Ketamine, LSD, Lithium, anticonvulsants

JVD: Seen at 45-degree angle

Tension pneumothorax

Cardiac Tamponade

Right sided heart failure

Traumatic asphyxia

Pulmonary embolism

Emphysema

Chronic Bronchitis

Rupture diaphragm

Flat neck vein seen when supine

Hemothorax

Dehydration

Shock

Biot: Irregular period of breathing or gasping; usually due to increase ICP

Cheyne stokes: Increase or decrease in rate and depth; Neurological condition

Kussmauls: Rapid and deep breathes; DKA

Visceral: Vague; Dull; aching

Somatic: Sharp localized; deep breathe increases pain

Referred: Discomfort perceived in other part of body

Presbycusis: Age related hearing loss

Osteoporosis: Degenerative bone loss

Fontanel: Anterior closes 12-18 Months

Posterior closes 3 months

Cerebral Palsy: Does not get worse. a group of disorders that affect a person’s ability to move and maintain balance and posture

Muscle Spasm, hearing and visual issues, seizures, verbal difficulties

Troponin: Cardiac Muscle; first to elevate in myocardial infarction most specific to cardiac injury.

Methemoglobinemia: Monitors methemoglobins which inhibits O2 binding to cells

Colloid is the choice of fluid replacement due to hemorrhage: Albumin, Hespen, Dextran, Blood plasma

Crystalloids 5% D/W all other IV solutions

Osmosis: Fluid moves from less particular to more

Tonicity

Isotonic: NS and LR stays in blood longer

Hypertonic: More Particles, Fluid moves into vascular space 10% dextrose

Hypotonic: Fluid moves out of vascular space into cells

Cations: Postive charged ions

Anions: Negative charged ions

Calcium: CA++

Chloride: CL- (most common extracellularr anion)

Magnesium: MG++

Potassium: K+ (most common intracellular cation)

Sodium: Na+ (most common extracellular cation)

RBC: Erythrocyte

Hematocrit: % of RBC in blood (aprox 45%)

Thrombocytes: Promote clotting

Complications of IV

Infiltration, cellulitis, phlebitis and thrombolites

Systemic: Air or pulmonary embolus, catheter sheer

Pharmacodynamic: Study of drug on the body

Pharmacokinetics: Study of what the body does after the drug is administered.

Antagonist: Put simply, when the antagonists bind to a receptor, that receptor loses the ability to receive sensory signals and information. Antagonists want to cause problems by not allowing or blocking receptors

Agonist: The good guy binds to a receptor and promotes the interaction inside the body. They allow stuff to happen, opposite from the Antagonist

Elderly have depressed livers and renal function which can affect the drugs action or elimination

Parasympatholytic or anticholinergics block the PNS such as atropine. Which would mean they tend to not allow the rest and digest to happen.

Inotropic- Contraction

Chronotropic- Rate

Dromotropic- Velocity of conduction

Catecholamines- Dopamine, Epi, Norepinephrine

Sympathomimetic or adrenergic- Stimulate the SNS (Sympathetic system) Such as EPI

Sympatholytic or adrenergic blocker- Blocks SNS such as drugs to lower B/P (Labetalol)

Calculate Drip Rate.

Children face score for pain level, adults 1-10

Status epilepticus- Prolonged seizure over 5 mins or 2 or more seizures without consciousness

Petit mal- Absent or generalized seizure, happens in children a lot. No loss of consciousness, stare into space.

Focal motor seizures or partial seizures- Jacksonian from electrical disruption on part of the brain. Does not lose consciousness and only effects an area or part of the body.

Subarachnoid bleed- Sudden onset of severe headache, neruo symptoms. Common in young females or someone lifting heavy objects. Very serious and usually fatal.

Cephalgia (Headache)

Migraine- more common in women (vascular)

Cluster headache (vascular) more common in men

Tension- throbbing, squeezing, may wake up with headache

Bell’s palsy- sudden weakness in facial muscles on one side of face, one-sided smile, eye resists closing, involves cranial nerve 7, trigeminal neuralgia pain in areas supplied by the trigeminal nerve cranial nerve 5 including cheek, teeth, gum, lips

Meningitis- Inflammation of meninges (the meninges are the three membranes that envelop the brain and spinal cord.)

Viral meningitis: Most common less severe

Bacterial meningitis- Most lethal usually present with one- or two-day fever.

Brudzinski sign- hips and knees flex when neck is flexed and Kernig's sign- unable to straighten leg when hip flexed, rash, irritability

Spreads through droplets, saliva mucus. Surgical mask on you and PT

Hydrocephalus- Buildup of fluid in ventricles of brain. Brain infection, obstruction of drain tube can cause high B/P, peritonitis, seizures.

Ileostomy- Diverts from ileum, contents don’t pass through large intestine, liquid stools, may be green

Colostomy- Diverts stool away from colon or large intestine, has bag on abdomen, usually has soft stool in bag.

GERD- Gastroesophageal reflux disease- stomach contents refluxes into esophagus – may take ranitidine (Zantac)

Appendicitis: RLQ (Mcburney's point) may have LLQ pain.

Cholecystitis: RUQ pain (Murphy's sign) Pain on deep breath. Yellow or green bile emesis after fatty meal, more common in women.

Cholestasis- Flow of bile from liver stops

Cholelithiasis- Gall stones

Crohn’s disease: RLQ pain, Bowel problems, rectal bleeding

Upper GI Bleed: Black tarry stools (Melena) vomiting coffee grounds (Hematemesis)

Lower GI Bleed: Bright red or wine color stool (hematochezia)

Pancreatitis: LUQ and may radiate to back. Grey turner signs, Techy sepsis or shock

Ulcerative colitis: LLQ usually. Loose and or bloody stools with constipation or weight loss

Renal problems

Prerenal- Low blood flow to kidneys – hemorrhage heart failure, shock, sepsis

Intrarenal- disease or damage within the kidneys- glomerular blood vessels – diabetes

Postrenal- Blockage to urine collecting system

Oliguria- decrease urine output

Anuria- No urine output

Chronic kidney failure – long and slow process of kidneys function

Most likely need dialysis for the rest of life

Hemodialysis- Shunt connects artery to vein, fistula is under skin. Uses machine

During or before or after dialysis small U waves can be seen

Peritoneal dialysis- tube inserted into abdominal cavity, uses PT peritoneal membrane to exchange fluids and removes toxins/waste products which draws out of blood and into dialysis fluid through process of diffusion

Renal calculus (kidney stone)

Unilateral flank pain, hematuria, pale, sweating, renal colic waves of pain due to peristalsis.

Cystitis- Inflammation of uniary bladder.

Endocrine system: purpose is to produce hormones which affect endocrine glands body systems

Hypothalamus- Located in lower part of brain above brain stem, stimulates pituitary gland, sleep, temp, hunger, thirst, B/P balance

Pituitary glands- Located in brain called master gland.

Thyroid gland- In neck below thyroid cartilage, affects metabolism and decrease calcium levels

Graves' disease: Heat intolerance. Weight loss, goiter (enlarged thyroid) exophthalmos (protrusion of eyeballs) Can use beta blocks to treat

Thyroid storm: Fever, sweating, seizures. Treatment: cooldown beta blocker glucose if indicated

Myxedema: Fatigue lethargy, cold intolerance, brady, weight gain. Common meds, levothyroxine thyroxine

Myxedema coma: treat with rewarming ALS procedure

Hashimoto disease: Thyroiditis enlargement symptomatic treatment.

Adrenal glands located on top of each kidney, produce epinephrine and norepinephrine, aldosterone which increases reabsorption of sodium, cortisol which increases energy.

Addison’s disease: Adrenal insufficiency, steroids like prednisone

Pancreas: Upper abdomen behind stomach

Islets of Langerhans is where insulin is produced when blood sugar levels drop

Glucagon- Produced in alpha cells increases blood glucose by stimulating liver which breaks down glycogen into glucose

Type 1 Diabetes: Does not produce insulin, juvenile diabetic, IDDM- insulin dependent diabetes

Insulin serves as carrier for glucose to enter cells

If there are not enough insulin fats are broken down for fuel, ketones are produced which causes met acidosis

Type 2 diabetes- Insufficient insulin production or has insulin resistance, can control with diet, or take pills, and/or insulin. Non-insulin dependent diabetes

Common oral hypoglycemic drugs- metformin, chlorpropamide, Glyburide

Hyperglycemia DKA: Kussmauls breathing, polyuria (thirst) Polydipsia (hunger or eating) Polyphagia (always hungry)

TREATMENT: Glucose- oral or 50% Dextrose (.5-1.0 G/KG) IV slowly or glucagon (1MG) IM; Thiamine if alcoholic and giving dextrose

HHNK- Hyperosmolar, hyperglycemic, nonketotic coma (HHNC) also called hyperosmolar nonketotic coma (HONK) no ketones but S&S of DKA but no fruity odor breath or Kussmauls breathing, type 2 diabetes.

Allergic reaction- antigen-antibody reaction (exposure to antigen stimulates IgE- immunoglobulins)

Mast cells stimulate H1 histamine receptors- vasodilates, increase cap permeability, bronchoconstriction and laryngospasm; eosinophils (type of WBC) are elevated

Urticaria- Hives

Angioedema- itching tongue and lips with swollen eyes

Wheals- raised itchy area

0.3mg of 1:1000 Epi with fluids, steroids and Mag

Anaphylactoid reaction- like anaphylaxis but not caused by IgE reaction, produced by injection of serum or protein- is symptomatic after first exposure

Systemic lupus erythematosus – Auto immune disease – swelling of joints, damage to skin, kidney heart and lungs

ATROPINE will not work on heart transplant patients due to vagus nerve being severed.

HIV/AIDS- Kaposi’s Sarcoma (type of cancer with blue/red lesions called purpura

Hep A is fecal – oral contamination, not bloodborne – contaminated food or water

Hep B and C are bloodborne, fluid borne

Scabies- (mites under skin) severe itching mainly at night, rash, sores from scathing, thick crusts on skin, very contagious.

Septic shock – Temp can be high or low, tachycardia, tachypnea, AMS, Hypotension, OLIGURIA (decreased urine output)

Nosocomial infection – hospital acquired

Clean equipment with chlorine-based cleaning solution- bleach 1:10

Rabies- bite from infected animal fever chills seizures paralysis or coma. Clean the wound dress bandage.

Agitated delirium- can be from use of stimulants- MDMA, Bath salts, Flakka, synthetic THC, cocaine, PCP Meth

5 people preferred for applying restraints, one at each limb and one to apply restraints

Heavy metal- lead or mercury exposure: Headache irritability tremors confusion. No activate charcoal, chelating agents (Convert metals to safe form) can be used as BAL)

Atropine for Organophosphate poisoning.

Alcoholism is common in elderly – portal hypertension which is elevated pressure in portal venous system

Tylenol/acetaminophen- OD can cause liver damage – antidote used in hospital with N-acetylcyeine, mucomyst

Cocaine stimulates the sympathetic nervous system – so dilated pupils, raised heart rate and RR rate along with higher B/P

HEMATOLOGY

Hemophilia- genetic disease, blood clotting disorder

Smallest cut can cause uncontrolled bleeding

Most often affects males, hereditary

Sickle cell anemia – genetic disease

Pain and swelling in joints, pain in chest, back or flank pain, priapism, infection, stroke or MI symptoms usually due to Vaso-occlusive episode spleen involvement

DIC- Disseminated intravascular coagulopathy – Blood clots (thrombi) form throughout body due to activation of coagulation due to fibrinogen drop

Purple rash and bleeding from any orifice

Caused by sepsis, ob complication, cancer, transfusion reaction

Polycythemia – increase in RBC, high hematocrit (high RBC)

GYN EMERGENCIES

Endometriosis- Endometrial tissue grows outside uterus, abdominal pain

Endometritis- Inflammation of lining of uterus, can occur post delivery

Menarche- Onset of menses, first period

Menopause- Ending of menses, irregular bleeding

Mittelschmerz- Unilateral lower abdominal pain during ovulation.

Amenorrhea- Without a period

Gravida – Number of times pregnant including current

Para- Number of deliveries (Primipara- first delivery)

9 months = 40 weeks

Abruptio placenta- Placenta tears away from uterus- Dark red or no visible bleeding, abdominal pain, pain in lower back. Transport on left side

Placenta previa- Placenta implanted partially or completely over cervical os- Bright red bleeding, no pain. Treatment is the same as abruptio.

Supine hypotensive syndrome- put on left side even if on backboard

Hyperemesis gravidarum- excessive vomiting of pregnancy, usually 1st and early 2nd tri

Preterm labor (before 38 weeks) sop contractions with terbutaline/Berthine- tocolytic

Hypertensive syndrome of pregnancy- 3rd tri; can occur 1-2 days after delivery and possibly longer

BREECH- Butt first head is stuck – Supine head down position with pelvis elevated gloved hand into vagina with palm towards baby face make V to provide airway

Prolapsed cord- cord presenting through opening- Place mother in knee-chest position (or Trendelenburg) sterile gloved hand into vagina and raise presenting part off cord moist Wrap in sterile moist towel.

Shoulder dystocia- Shoulder passes beyond symphysis; turtle sign- head delivers but retracts because shoulders trapped- McRoberts maneuver- buttocks off end of bed with things flexed upward, apply pressure above symphysis.

Acrocyanosis- Body pink, extremities blue

Choanal atresia – Nasal passage blocked, causes difficulty breathing.

Pierre Robin syndrome – Smaller than normal jaw, tongue falls back in throat, difficulty breathing.

Spinal bifida – Spinal cord and meninges are external, one type – meningomyelocele

Pyloric stenosis (3-5 weeks old) Narrowing of the pyloric valve between stomach and small intestine – forceful vomiting, dehydration, wt. Loss.

TRAUMA

Blast injury

Primary phase – Pressure waves, hollow and air – filled organs affected like bowel, lungs. Most common tympanic membrane

Secondary phase – Struck by shrapnel

Tertiary phase – Injuries due to patient being thrown into air and hit another object such as a wall

Quaternary injuries – Crush, asphyxia, burns, toxic exposure, radiation sickness.

Stages of hypovolemic shock

Compensatory- Able to maintain perfusion, blood shunted to brain, heart, lungs, one of the first signs is tachycardia B/P normal

Decompensated – Lower B/P Lower LOC, unable feel peripheral pulses, mottled skin color, MAP less than 65

Irreversible – Irreparable damage to vital organs, unconscious, cyanotic, bradycardia

Hypotension means not enough fluid circulating and there is lower systemic vascular resistance also called peripheral vascular resistance.

BLOOD LOSS

Stage 1 – up to 15% (750ml loss)

Stage 2 – up to 30% (1500ml) Tachycardia, anxiety, narrow pulse pressure.

Stage 3 – 40% loss (1500-200ml) Hypotensive, tachycardia, confusion

Stage 4 – 40% or greater Usually irreversible.

14g-16g 20ml/kg rapid transport to trauma center

Rhabdomyolysis – Myoglobin released into bloodstream due to muscle breakdown in burns and crush injuries can cause acute kidney failure.

PARKLAND FORMULA

First 24hrs after burn – 4ml x KG x BSA%

Give half this in first 8 hours

For first hour take that 8-hour number and divide by 8

Lightning strikes if a person is in cardiac arrest they are treated first. May be in v-fib automaticity of heart may cause heart to respond

Chemical

Alkali (worse) Liquefaction necrosis – little pain but deep penetrating injury.

Adduction towards core

Abduction away

Spain is injury to ligament

Strain is injury to muscle STrain T= tendons

Types of fractures

Comminuted – More than 2 pieces; broken in several places

Green stick – Incomplete fracture; more often in children

Open or compound – Bone ends protruded through skin

Spiral – Around the bone; twisting motion

Olecranon process – Proximal ulna (can feel at elbow)

Blood loss for broken bones

Radius or ulna- 250ml – 500ml

Humerus- 500ml – 750ml

Tibia or fibula – 500ml – 1000ml

Femur – 1000ml – 2000ml

Pelvis – 1000ml – 2000ml

Traction splints – should use 10% of PT weight in pounds but no more than 15lbs of pressure

Compartment syndrome

Increased pressure compromises circulation and neuromuscular function; can occur up to 48 hours after injury

Loss of sensation, tension of skin, severe pain, color changes of extremity- pale or cyanotic, late sign – loss of pulse

Thee compartments in forearm; 4 compartments in lower leg

Le Fort fractures

Le fort l- maxilla

Le Fort ll- Nasal bridge through maxilla

Le Fort lll- Includes zygomatic arch

EYES

Teardrop shape after injury usually foreign body that punctured or ruptured globe fluids may leak out, may threaten eyesight

BRAIN INJURY

Traumatic brain injury (TBI) can have stroke S&S lower LOC speech problems vomiting headache blurred vision diplopia (double vision) nausea dizzy photopia numbness noise sensitivity fatigue

Levels of TBI – GCS 13-15 is minor GCS 9-12 is moderate and 3-8 is severe

Epidural hematoma – bleeding between dura and skull

Unconscious then conscious then unconscious

Cerebral conclusion occurs in brain stem

Cerebral contusion occurs in cerebrum

Intracranial pressure usually less than 15

Cushing's response- increase in B/P lower Pulse irregular respiration

Reverse Trenden burg- so elevate head higher than feet/body

C-1 to C-4 control the diaphragm

C-5 to C-7 Quadriplegia but can usually breath but may have difficulties

Brown Sequard syndrome – Penetrating Injury to one side of cord

Kyphosis (abnormal curvature of spine)

Aorta torn from ligamentum arteriosum

Flail cheat – secure chest and use PPV

JVD in tension pneumothorax…. flat in hemothorax

Pulsus paradoxus – Decrease in systolic B/P during inspiration narrow pulse pressures

Commotio cordis – Disruption of rhythm of heart usually due to direct blow to chest in children and teenagers because chest wall is still pliable

HYPOTHERMIA

Mild hypothermia – core temp 89.9 to 95 (32C-35C)

Moderate 82.5 - 89.7 may have Osborn wave (J wave) camel humps sign, positive deflection @ junction between QRS and ST, best seen in v2 and v5

Heat cramps – cramping and sweating, move to cool area and give sports drink

Heat exhaustion – increase HR sweating pale and dizzy, cool down give IV of normal saline

Heat stroke- Lower LOC hot dry skin and red 105 body temp or higher, rapid cooling protect airway give o2 if needed.

NEAR DROWNING

Salt water – pulmonary edema, draws water into alveoli

Fresh water – Hemodilution. Electrolyte imbalance- hyperkalemia, V-fib, washed surfactant away

Cold water may have better survival, salt water has better survival rates than fresh water

Boyles law – as pressure on a gas increases, the volume decreases and vice versa (gas under pressure takes less space)

High altitude pulmonary edema (HAPE) Dyspnea, cough, chest tightness, wheezing or rales, cyanosis, increase HR and RR, can use Furosemide, nifedipine (Procardia) Morphine cautiously because PT may be dehydrated

General treatment for all high-altitude troubles is lower altitude and give O2

Crotalidae antivenin – CroFab – snake antivenom

Marine animal stings – No cold water or ice, can use salt or hot water, vinegar solution.

RESPIRATION/ VENTUILATION

Upper airway – nasopharynx, oropharynx, laryngopharynx, larynx

Lower airway- Trache, Bronchi, alveoli, lung tissue

Glottic opening at vocal cords- smallest area of adult opening

Alveolar ventilation – Amt. Of air that moves in and out of the alveoli per min. (Tidal volume – dead space) x resp rate in one min. Va = (Vt-Vd) *RR

Hering- breuer – Reflex that prevents overxpansion of the lungs

Orthopnea – Difficulty breathing in a flat postion

Pulmonary shunting – Blood supply from lung to circulation lower O2 lower co2 higher, right to left pulmonary embolus, pneumonia, bronchitis, pul edema; hypoxia but adequate ventilation

Surfactant – Chemicals in alveoli which keeps them from collapsing

Diffusiion – Gas movement from area of greater to an area of lesser concentration

INspiration – Diaphragm contracts, moves downward, intercostal muscles contract, chest wall gets larger, pressure inside less than outsied and air moves in

Expiration is passive – Diaphragm relaxes and moves upwards, intercostal muscles relax, chest wall gets smaller, pressure inside greater and air moves out

Foreighn body airway obstruction – 2020 AHA guidelines will be used for test questions

Suction for 15 seconds in adults then ventilate or oxygenate for 2 mins then repeat, 10 sec children, and 5 sec infants

If blood or secretions in mouth after maximum seconds, continue suctioning

Always look for “suction when necessary” as an option in the answers, gurgling sounds indicates need to suction

Verify tube placement – gold standard is ETCO2

CATNOGRAPHY

Phase l – Baseline, no CO2 end of inhalation and beginning of exhalation, no CO2 exchanged, air from trachea, posterior pharynx, nose and mouth (dead space

Phase ll Ascending phase – Beginning of exhalation, CO2 goes from alveoli through anatomical dead space

Phase lll alveolar plateau – Sensor is reciving CO2 rich gas which was in alveoli, at the end of phase is where the ETCO2 is measured

Phase 0 (or 4) decending phase – inspiratory phase, CO2 drops to zero

Shark fin – asthma, reverse shark fin – emphysema

Cricothyrotomy

Indications – Upper airway obstruction,trismus (clenched teeth) Laryngospasm, facial trauma including burns to face and respiratory

Rate adult – 12 to 20

Child aprox 20-30

Infant aprox 25-50

Effect of ventilation on venous return and cardiac output – negativer pressure that causes inhalation facilities venous return necessary for adequate CO and perfusion

CPAP- Setting 5cm H2o Bronchospasm 10cm pulmonary edema pneumonia, max for peds 5cm

Nasal canula – 1L/M 21+3=24% o2

2L/M 21+6=27%

6 L/m= 44%-55%

COPD

Emphysema= Pink piuffer- pursed lips/puffing, barrel chest, expiration is active, JVD, any lung sounds, hyperresonance, right heart failure

Chronic bornchitis= Blue bloater – Overweight, cyanotic, cough, mucus(green), rhonchi, JVD, right heart failure

Ashma = Expiratory wheezing first, then inspiratory and expiratory

Pulmonary embolus= sudden onset, pleuritic pain – more on inspiration, JVD, cyanotic from nipple line up, shock, respiratory distress

EKG changes – S wave in lead 1, Q wave in lll, 20% of PEs have inverted T in lead lll

UNilateraly wheezing could be obstruction in lower airway

Pedi tidal volume 6-8ml/kg

Cuffed tubes all ages

Racemic epi- bronchodilator (inhaled bronchodilator)

Epiglotitis

RApid onset 4-6year old

Bacteria, high fever, tripod postion, drooling, sore throat, odynophagia- painful swallowing

Hib vaccination is infants has made this condition rare

Lower airway = wheezing

Pertusis (Whooping Cough) bacterial infection highly contagious (there is a vaccine) whooping sound when coughing; PPE- mask on you and PT

HEART layers

Endocardium

Myocardium

Epicardium

Left anterior descending – Interventricular septum, anterior surface of L and R ventricle

Circumflex L atrium, Lateral and posterior L ventricle

Right coronary artery – R atrium (SA and AV nodes) R ventricle, posterior septum

Heart sounds

S1 closure of cuspid valves

S2 closure of semilunar valves

Preload- blood pumped with each contraction of ventricle

Subendocardial infarction – Affects inner layer of heart (Inner ½ of myocardium)

Transmural infarction – Extends through entire wall of ventricle (Endocardium to epicardium)

Movement of Na+, K+, Ca++

Phase 0 is depolarization of the cell, Na+ channels open and Na+ goes into cells, K+ goes out of cell, Ca++ goes into cell late

Phase 2 is plateau phase, both Ca++ and K+ channels are open (Halfway through phase 2 is when actual myocardium contracts)

Bipolar leads are l,ll,lll

Absolute refractory period- Onset of QRS to peak of T wave- Cardiac cells cannot be stimulated to conduct an impulse

Relative refectory period – Distal or downslope of T wave cardiac cells can be stimulated

H’s & T’s

Hydrogen ion (acidosis)

Hyper, hypo kalemia

Hypothermia

Hypovolemia

Hypoxia, hypoventilation

Tension pneumothorax

Cardiac tamponade

Thrombus, cardiac

Thrombus pulmonary

Toxins

Best treatment of asystole and PEA – Epinephrine ASAP, High quality CPR, IV preferred over IO

Necrosis – Death of cells/tissue

Prisma's angina – Vasospasm – treat with nitro or ca channel blocker

Cardiogenic shock might be treated with dopamine, limit IV fluids

Left sided heart failure

Paroxysmal nocturnal dyspnea (intermittent SOB at night)

Orthopnea (Difficulty breathing when in flat position

Treatment – Furosemide recommended, nitro CPAP suction

Right sided heart failure

JVD; Sacral edema if supine in bed

Enlarged liver (Hepatomegaly) or spleen (Splenomegaly)

Can be caused by pulmonary hypertension

NON traumatic cardiac tamponade

Sharp substernal or left precordial chest pain – more intense lying flat.

Best type of study is prospective, randomized, double-blind

Stress

Alarm

Resistance

Exhaustion

Malfeasence – Performing an act which is illegal or completely wrongful

Misfeasance – An act which is legal but performing improperly

Nonfeasance – Failure to perform an act that is required

EMTALA – Emergency Medical Treatment and Active Labor Act – Have to provide care regardless of ability to pay

Aplastic anemia can be complication of radiation exposure