Final Exam Review

Overview of Examination Structure

  • Exam consists of various question formats:

    • Fill in the Blank

    • Requires a few words or singular words.

    • Matching

    • Select All That Apply

  • Scenario-based questions with multiple diagnostic and treatment options.

    • Choose appropriate diagnoses and treatments from provided options.

Key Assessment Rules

  • Emphasis on ABCs (Airway, Breathing, Circulation) for patient assessment.

    • Prioritize airway management as the most critical action.

    • Assess the scene for safety as an initial step in assessments.

Exam Content Breakdown

  • Material is organized chronologically and thematically based on course modules:

    • Respiratory

    • Endocrine

    • Cardiac

    • Neurological

    • Gastrointestinal

    • Anaphylaxis

    • Toxicology

    • Environmental Factors

    • Trauma

  • Heaviest emphasis on Respiratory, Cardiac, and Trauma sections, although some topics may contain fewer questions.

Lung Sounds and Pathologies

  • Stridor

    • High-pitched inspiratory sound indicating upper airway obstruction.

    • Common causes: choking (in children), anaphylaxis, burns.

  • Rhonchi

    • Coarse, low-pitched sounds typically associated with pneumonia due to mucus clearance issues.

  • Wheezing

    • Sounds indicating narrowing of lower airways, typically associated with asthma and COPD.

    • Treatment options include albuterol and ipratropium (not recommended for children).

  • Rales (Crackles)

    • Indicative of fluid in the lungs, associated with CHF and pulmonary edema.

    • Treat with CPAP.

  • Diminished Lung Sounds

    • Best seen in conditions like pneumothorax, where breath sounds are weak.

  • Absent Lung Sounds

    • Identified in tension pneumothorax or severe airway obstruction.

Foreign Body Airway Obstruction

  • Identifying appropriate action based on whether the patient can cough:

    • If coughing, encourage to continue.

    • If unable to cough, perform Heimlich maneuver.

    • For unresponsive patients, administer CPR with back thrusts.

CPAP Contraindications

  • Indications: Used primarily for CHF but can also be applied to severe asthma/COPD.

  • Contraindications:

    • Unresponsive state, facial trauma, low blood pressure, GI bleeding, and vomiting.

Assessment Parameters

  • Cyanosis: Blue skin indicating severe hypoxia; late sign of respiratory issues.

  • Gas Exchange:

    • Normal aerobic metabolism produces CO2 as a waste product; anaerobic metabolism increases lactic acid.

  • End-tidal CO2 Range: Normal levels (35-45 mmHg) indicate adequate ventilation; abnormal levels may suggest medical issues.

pH and Breathing Mechanics

  • pH Scale:

    • Ranges from 0 (acidic) to 14 (basic).

    • Alterations in pH will influence breathing depth and rate to restore homeostasis.

Respiratory System Function

  • Minute Volume Defined:

    • Total air volume per minute; increased with rapid breathing.

Oxygenation Management

  • Administer oxygen based on saturation readings:

    • 89% saturation: Nasal cannula.

    • 70% saturation (conscious): Non-rebreather mask.

    • Unconscious: Begin bag-mask ventilation (BMV).

  • Airway Techniques:

    • Open airway using jaw thrust or head-tilt/chin-lift.

    • Recognize devices specific for oxygenation versus airway management (e.g., OPA, NPA).

Ventilation Complications

  • Risks of Rapid Ventilation:

    • Can lead to abdominal distension, lung over-inflation, and hypotension due to pressure on the heart.

Respiratory Disorders

  • Carbon Monoxide Exposure: Treatment involves removing from the area and providing high-flow oxygen.

Endocrine System Disorders

  • Emphasis on diabetes:

    • Hypoglycemia Symptoms: Altered mental status, diaphoresis, cool/clammy skin, hunger, confusion.

    • Kussmaul Respirations: Indicate DKA, rapid and deep breathing to offset metabolic acidosis.

Cardiac Assessment

  • Heart Anatomy & Electrical System:

    • SA node as the primary pacemaker (60-100 BPM), followed by AV node and Purkinje fibers.

  • Atherosclerosis: Plaque build-up increases risk for heart attack and stroke.

  • Angina vs. AMI:

    • Angina: Temporary chest pain, heart tissue remains viable.

    • AMI: Permanent tissue death due to prolonged oxygen deprivation.

Acute Coronary Syndrome (ACS)

  • Defined as symptom group for heart attack indicators: chest pain, shortness of breath, radiating pain.

Stroke Assessment

  • Use Cincinnati Stroke Scale (F.A.S.T.:

    • Face drooping, Arm weakness, Speech difficulties, Time last seen normal)

  • Document last seen normal time for treatment timelines.

Neurological Emergencies

  • Postictal State: Confusion after a seizure. Provide oxygen and monitor.

  • Cushing's Triad: Due to increased intracranial pressure leads to hypertension and bradycardia.

Anaphylaxis Management

  • Understand histamine mechanisms in systemic reactions, with airway constriction and vasodilation as key threats.

    • Treatment: Administer epinephrine.

Toxicology Emergencies

  • Opiate Overdose Treatment: Prioritize ventilation before administering Narcan for opioid effects.

Environmental Effects

  • Response to heat loss includes vasoconstriction to preserve core temperature, leading to cold extremities.

Trauma Considerations

  • Potential vs. Kinetic Energy: Recognize energy dynamics in injuries.

  • Hypoperfusion: Defined as inadequate delivery of oxygen to tissues, leading to shock.

  • Traumatic Injuries: Address hollow vs. solid organ damage and the impact of both on shock.

Special Cases with Burns

  • Rule of Nines: Memorize for calculating total body surface area burned in adults.

  • Burn Degrees:

    • Superficial: Surface level injuries such as sunburn.

    • Partial Thickness: Includes blisters and is painful.

    • Full Thickness: Destroys nerve endings, usually painless.

    • Treat with burn sheets, manage airway concerns immediately.

Pediatric Considerations

  • Normal vitals differ for newborns; special care for dehydration risks due to vomiting and diarrhea.

  • Know the implications of bruising and signs of potential abuse in pediatric patients.