Pharmacology
What is the "factor" for a 60 drop per cc micro drip set?
1
Define:
1) Hypovolemic shock
2) Cardiogenic shock
1) Inadequate perfusion caused by inadequate blood volume
2) Pump failure causing inadequate perfusion to tissues
List types of conduction system defects.
BBB, AVB, Accessory Pathway
What is:
1) BAAM Whistle
2) Endotrol tube
1) Device at end of ETT that allows you to hear patient's breathing by amplifying sound
2) Tube designed for nasal intubation; has a "trigger" like device that allows tip to be angled during placement
Length of QRS
wider than 200ms
There are three basic drip rates for the standard IV of NS in EMS- ______, ________, and _______.
tko
wide-open
30 drops/minute
Describe the placement of EKG chest leads on a patient's chest
V1: 4th intercostal space, right sternal border
V2: 4th intercostal space, left sternal border
V3: Between V2 and V4
V4: 5th intercostal space, mid-clavicular
V5: 5th intercostal space, between V4 and V6
V6: 5th intercostal space, mid-axillary
Sinus "pause," or "SA Block" or "Sinus Arrest" are all variations of mostly the same thing. Describe, in general, these rhythms.
A rhythm with dropped P-waves
-normal otherwise
-rare
-no backup pacer kicks in
List steps in nasal intubation
Same prep
Use BAAM Whistle on Endotrol, lube and numb nostril, advance tube into the posterior pharynx (time with inhalation), insert all the way to the nostril
Confirm as usual
How many micrograms is 2.7 mg?
2700mcg
2.7*1000=2700
List steps in IO insertion in order
Find it, clean it, mark it, don't touch it anymore, poke to bone, drill it, hold it, remove drill, unscrew inner trochar, attach holder, attach extension, aspirate it, flush it, attach IV, secure it.
What can a medic do to:
1) improve slow HR
2) improve fast HR
3) affect SV
1) Pacing or meds
2) Synchronized cardioversion or meds
3) inotropic meds
What rhythms appear as a wide-complex tachycardia?
V-Tach
BBB
AP (ST, SVT, Afib, Aflutter, MAT, JT)
Describe the technique for external laryngeal manipulation and explain its importance to the airway operator.
Airway operator's right-hand moves Adam's Apple laterally or posteriorly to gain the best view of the glottic opening.
How would you make a 60% solution of Dextrose into a much safer concentration of 10%?
Dilute 5 times so 5 parts saline to every 1 part Dextrose
60-10=50; need to dilute by 5 times
Describe how to find the two primary IO sites:
1) Proximal tibia landmark
2) Humeral head landmark
1) locate tibial tuberosity, move fingers medially and slightly distally to locate flat spot
2) pronate arm (across chest, down the side with thumb out), locate humeral head (two-handed "karate chop" method)
Describe assessment for shock:
signs for AMS, tachycardia, tacypnea, skin changes, hypotension, along with reason for shock (bleeding out, MI, etc.)
Describe the AV Blocks:
1) 1st Degree
2) 2nd Degree Type 1
3) 2nd Degree Type 2
4) 3rd Degree
1) Long pause in impulse; PRI longer than 200ms; nodal
2) AV Node holds impulse for a progressively longer period until next impulse overtakes it; lengthening PRI before dropped P-wave; nodal
3) AV Node delays some impulses so long, the impulse following it overtakes it; consistently prolonged PRI; infranodal
4) Regular atrial and regular ventricular rates, though both of these rates are different; technically no PRI; no pattern; could be either nodal or infranodal
You have intubated your cardiac arrest patient and visualized the ETT passing the vocal cords. You placed the ETT just past the cords and held it firmly and it has not moved nor has the patient's head flexed, extended, or rotated since. You see chest rise and fall although with difficulty. You see no waveform on the EtCO2 with a reading of 0. Your patient is an adult male who is approximately six feet tall and weighs about 220lbs. The ETT is at 21 cm at the teeth. What should you do next about your ETT?
6*3=18, so 21cm is a good length (at teeth is also a good sign)
Check laryngoscope to see if tube is between cords.
-yes, leave it
-no, take it out
Troubleshoot EtCO2 next
If you are running an IV on a 15 drop macro drip set at one drop every other second, how many drops per hour is that?
15*4=60 : factor is 4
60 sec = min. / 2 ("every other second)
60/2=30
30*4=120 drops per hour
Explain why you may choose one of the two primary IO sites over the other.
Humeral head allows for large volume flow in almost every case - tibial lines may not flow fast
What is SVR and why does it matter?
Systemic Vascular Resistance; an element of BP that can be manipulated for patients
How do you differentiate between 2nd Degree AV Block and non-conducted PAC?
March out P-waves:
2nd Degree: dropped, extended PRI
PAC: early, look funky
List how to manage an airway from "Prep"
Prep Yourself: plans A,B, and C; need to oxygenate and ventilate
Prep Patient: Max O2, sniffing position
Prep Team: 1 on mask and 1 on bag; clear, concise orders)
Prep Equipment:
-2 to visualize: Laryngoscope, suction
-2 to place: test tube and lube, bougie
-2 to confirm: capnography, stethoscope
-2 to secure: tube holder, C-collar
Your medical control physician tells you to run IV on dehydrated patient wide open until you have given a fluid bolus of 500cc, and then set the IV at 100 cc/hr. Your service uses 15 drop sets. How many drops per minute will give you 100 cc/hr?
15*4=60 : factor is 4
100 cc/hr / factor of 4 = 25
25 drops per minute