Pregnancy/Gyno
Pregnant pt's need to lose more blood than a non-pregnant patient before showing signs of shock due to...
20-50% Increased blood volume with pregnancy
Why are peds called belly breathers?
Underdeveloped Diaphragm & Intercostal Muscles
What pathology is associated with Right Lower Quadrant abdominal pain with rebound tenderness? What is the most important treatment?
Appendicitis
Rapid transport
What is a normal blood glucose level?
What is hypoglycemic crisis:
What level is DKA, HHNS, or symptomatic hyperglycemia?
80-120 normal
under 60 = low (can occur rapidly)
400+ = very high DKA symptoms
600+ = very high HHNS symptoms (slower onset, takes a while to get this high
What is a generalized seizure and what are S/Sx of it ? EMT treatment?
Chaotic electrical firing in the brain leads to a total loss of consciousness, tonic clonic rigid and clenching/muscular movement, Rapid eye movement
Lasts 5 minutes or less
Followed by postictal state of 5 to 30 min
Irregular breathing, incontinence
Consider c-spine if unwitnessed and patient's found on the ground or signs of trauma precede seizure
If cyanotic or seizure goes past 5min: oxygenate patient high flow o2 15lpm, position away from objects that can harm the patient, if unable to maintain airway place on side, be prepared to suction
List 3 things that should be done IMMEDIATELY following birth...
Dry/stimulate, place head lower than body, keep neck in neutral position/suction mouth then nose, baby to breast/chest
List the components of the pediatric triangle and explain how it is used.
Appearance, work of breathing, skin circulation. Used to get a general impression pediatric patient in first 30 seconds.
Appearance: TICLS (Tone, Interactiveness, Consolability, Look, Speech)
Work of Breathing: Snoring, stridor, grunting, wheezing, retractions, nasal flaring, tripoding
Circulation: Pallor, Mottling, Cyanosis
Stroke S/Sx and Treatment
S/Sx: BEFAST
Rx: rapid transport lateral recumbent position paralyzed side down, O2, suction if necessary
What is the difference between Type 1 and Type 2 Diabetes
Type 1: Insulin dependent diabetes resulting from some idiopathic origin, Onset in early childhood/early adulthood
Type 2: Insulin resistant diabetes, can be improved by healthy diet, exercise, oral medications
Narcotic Overdose S/Sx, and Rx
Pt took: heroin, fentanyl, morphine, oxy...etc
Pt Appears: Unresponsive or Semi-conscious with no gag reflex or potential intact gag reflex --> OPA or NPA
Pale, cool, diaphoretic skins --> supine, high flow O2, maintain body temp
Slow, shallow respirations --> use BVM ventilate
Administer Narcan after 2 minutes of PPV
What is the difference between Abruptio Placenta and Placenta Previa what are the S/Sx?
Generally in the third trimester
In Abruptio Placenta: Placenta prematurely separates from the uterine wall, 3rd trimester, PAIN, bright red blood (not always a lot), typically due to trauma or HTN or drug usage
In Placenta Previa: placenta covers the opening of the cervix and it tears during cervix dilation--> lots of bright red blood, but not pain, can occur with normal labor progression if the placenta is too low
Bacterial infection that may cause obstruction of the upper airway in a child
Epiglottitis
S/Sx: drooling, unable to swallow, high fever,
What organs are retroperitoneal?
Kidneys, Ovaries, and Pancreas
What are symptoms a patient with new onset of Type 1 diabetes may show:
possibly have recent stressors or illnesses
typically show symptoms of Hyperglycemia:
3 Ps: polyuria, polyphagia, polydipsia
Recent Weight loss
Warm, dry skins, fast HR, acetone breath
Even pts experiencing minor head trauma from a fall, expect brain injury if
ALOC
Very young (neonate/infant) or Elderly and taking Blood thinners
What's the APGAR score (limp baby, strong cry, completely cyanotic, HR 70, RR fast)?
Limp = 0, Strong cry = 2, completely cyanotic = 0, HR less than 100 = 1, RR fast = 2
total = 5
Most reliable indicator of decompensated shock in pediatrics is....
Blood Pressure: 90 SBP for adult for decompensated shock
To calculate minimum systolic bp for a ped: 70+2(Pt age) up to 10 years of age
(last thing to fall with peds)
What acute abdominal condition results in: Burning or gnawing pain in the stomach that subsides or diminishes after eating then reemerges two to three hours after eating, hematemesis, melena, n/v
Peptic Ulcer Disease
What is a blood clot? What is the danger with blood clots? Who is at risk? What is the Rx?
Thrombus forms from platelet and attaches to blood vessel wall
Embolism: air, water, blood clot, plaque, any substance that travels in blood stream from one location to another
Danger is a blood clot can lodge and become DVT, PE, can lead to MI in coronary arteries, Ischemic CVA in cerebral arteries... lead to death
Pregnant women, women who just gave birth, Elderly, People who take Birth control, People who Smoke, have sedentary lifestyle, recent bedrest, recent long travel, recent surgery, recent injury, have CHF, have respiratory failure, obesity, over 40
High flow O2 10-15LPM via NRB, Rapid transport
Elderly people respond to changes in blood pressure differently.. how and why
Due to aging elderly people experience a decline in function of baroreceptors, less elasticity in the blood vessels (arteriosclerosis) and thickening of the left ventricle --> less able to respond to orthostatic changes in blood pressure
Potentially life threatening consequences of PID and 2 things that can cause it...
Ovarian abscess and ectopic pregnancy,
Can be caused by: gonorrhea, bacterial vaginosis, chlamydia
Triaging a child at MCI and determine they are apneic/unresponsive, next 2 steps (Jump START Triage)
Re-position airway, check pulse
Acute Renal Failure vs Chronic Renal Failure
Acute: results from some other recent condition like trauma, sepsis, Rhabdomyolysis reversible with rapid Rx
Chronic: develops over time, often caused by HTN and DM over lifetime, requires dialysis for life, irreversible
Compare and Contrast Hypoglycemia vs Hyperglycemia (s/sx- think skin signs and respiratory rate)
Hypoglycemia: rapid onset, cool, pale, clammy skins, normal to shallow/slow respirations, normal breath odor, normal to low bp, rapid and weak HR, irritability, confusion, seizure, coma, potential stroke like symptoms (unsteady gait, facial droop, arm/leg drift), can result from excess insulin, excess exercise, Rx: O2, glucose tabs/gel, IV dextrose
Hyperglycemia: gradual onset, warm and dry skins, intense thirst and hunger, rapid and deep respirations, fruity breath, normal to low Bp, rapid, weak, thready pluse, restlessness, slurred speech, gait, common vomiting and abd pain, can result from infection/stress, can lead to a diabetic coma. Rx: fluids, insulin drip (in ICU), O2
What causes polyuria in uncontrolled diabetes?
Excess sugar in blood is excreted by kidneys which draws H2O out of the body.