UF EMR EXAM 1 – Flashcards

C: chief complain H: history A: assessment R (x): treatment/medication T: transport. ETA where you dropped off and to whom

Alert and orientated x 3 (person, place, time)

loss of consciousness or level of consciousness

pupils equal and round, reactive to light

Denial Anger Bargain Depression Acceptance

Most contagious and contracted among health care workers NO VACCINE OR CURE JAUNDICE

vaccine preventable. B is more lethal and contagious than HIV

WEAR HIPPA MASK! S&S: hemoptysis (coughing up blood), night sweats, coughing, weight loss PDD: shows if you were exposed but DOES NOT MEAN YOU HAVE IT! Will need to go get chest x-ray to confirm

CANT GET FLU FROM SHOT! It is specific to respiratory epithelium!! Live attenuated given though nasal is best: given to immune compromised young and elderly. It comes with IgA

Vancomycin-Resistant Enterococci -develops in septic patients who become resistant to antibiotics -hard to treat bc small amount of antibiotics that are stronger than it -High mortality -Wear mask and gloves when treating

Clostridium difficile bacteria -opportunistic infection -small among normal found in colon -kills normal flora that keeps it under control if -CAN SURVIVE STANDARD CLEANING METHODS!! -*NOSOCOMIAL infection!* originates in hospital and spreads -Awful smelling and causes severe diarrhea -Megacolon (surgical emergency) -often comes back after treatment

Creutzfeldt-Jacob & Kuru -survives *autoclave process* : high temperature used to kill bacteria & viruses

Can only be considered "implied" if life threatening situation

-Decapitation -Rigor Mortis -Tissue decomposition -Dependent lividity

When a patient sustains further injury or harm bc the care administered did not meet standards These conditions must be present: -duty to act -breach of duty -resulting injuries -proximate cause

protects citizen if gave care in good faith emergency care if you WERE NOT ON DUTY and stopped to help -doesnt apply if you were on duty :(

tenting -pinch skin and it should rebound to normal position

blue lips or around the mouth; indicated hypoxia

Systolic >190 or Diastolic >90

DKA

CVA, brain tumor

Medulla oblongata Head injury

Dead

Used for breathing patients -Patient lyes on side but not completely face first onto ground -protects airways and prevents aspirations -DOES NOT protect C-spine!

patient sitting up at an angle -used with head bleed or CVA

patient sitting up straight up in a chair like form -used with CHF, COPD, and other respiratory emergencies to help with breathing

Lifts the feet about 10-15 degrees above head -USED FOR SHOCK AND HYPOTENSION!! -displaces blood to the core?

Patient lays on side (left more common) -Used in OB patients to keep fetus from compressing the inferior great arteries or veins

white = right arm black = left Red= left leg green = right leg sometimes people move them up (so on shoulders and pelvis area) to avoid artifact from patient moving *SALT PEPPER KETCHUP PICKLE*

Vagus nerve controls heart beats 1) SA note (master packemaker) 2) AV node (takes over if SA node broken) 3) Right and Left bundle branches 4) PF fibers running up left and right ventricles

on EKG, should be at same level as baseline. It is when ventricles are beginning to depolarize after a contraction If above or below this = signs of mardicardial infarction!

not getting any input from SA/AV nodes -ventricles don't get good filling -stop pushing blood out *you shock this rhythm!* -If don't shock, will go into V-FIB (ventricles seizing without moving blood) Stable = have pulse but will soon become Unstable= no pulse/ not conscious

head injury/ facial fractures affect this plate. Don't put anything up nose if dealing with these injuries bc could damage plate more!!

1. Cervical (7) 2. Thorastic (12) 3. Lumbar (5) back pain from lifting 4. Sacrum (5) 5. coccyx (4)

10th cranial nerve (vagus nerve)

solid organ -in retroperiotneal space and not abdominal cavity

primary mechanism of respiratory control (pH & pO2 secondary)... CO2 is like an acid in our body

Primary: diaphragm Secondary: intercostals and neck

primary /central respiratory control centers!! In brain stem (increase CO2 and pH)

Peripheral chemoreceptors (decrease in O2 or an increase in CO2/pH)

voluntary

Hemoglobins ability to cary and release oxygen Vertical: % oxyhemoglobin saturation AND oxygen content Horizontal: amount of oxygen stored within body

Reduced affinity for oxygen= unloads oxygen faster -increased temp -increased 2-3 DPG (enzymes help hemoglobin hang onto oxygen) -increased [H+] -"Bohrr effect" when working out will cause shift to right to unload oxygen to tissues!!

Increased affinity for oxygen= unloads oxygen slower -decreased temp -decreased 2-3 DPG (enzymes help hemoglobin hang onto oxygen) -decreased [H+] or increase pH -CO!!

less oxygen, ANEMIA

increase # RBC, makes someones endurance increase!!

At pO2 of 60, the SaO2 (oxyhemoglobin saturation) is 90. *If pO2 falls below 60 the SaO2 will fall dramatically and will be difficult to get back up to where they need

paramedic skill -last resort for airway -hole on cricothyroid membrane (middle of neck)

DKA, anxiety, shock, sympathetic response

heady injury, narcotic/opiate drug use

pneumothroax, heady injury

head injury, DKA

Sign of respiratory distress via accessory muscles! -huge in PEDS -Dip in sternum bc not enough air

Sign of respiratory distress via accessory muscles! -A lot of accessory muscles used to breathe

respiratory distress via accessory muscles! How kids "autoPEEP" -sounds like "uh, uh, uh"

bluing on nail bed (most common) and around mouth sign of respiratory distress

Respiratory distress

Hole in neck -Place O2 delivery device over it -DO NOT MOUTH BAD THEM

delivers 90-100% O2 with reservoir -Can use with mask or connect to King airway or ET tube (100% O2) -15 LPM of oxygen -Bag slow and deliberate! Use "C/E method" when holding mask around their mouth

delivers 70-90% O2 -10 to 15 LPM

Can deliver more specific percentage of O2 -2 to 15 LPM flow

Delivers 30-40% O2 -normally give 2-4 LPM

NO!! If pulses is carotid and radial artery is uneven= internal bleeding

systolic BP at least 60 mm Hg -CHECK ONE SIDE AT A TIME -pushing on the carotid can stimulate vagal response -be careful of BRUITS (plaque) in patients with atherosclerosis

1) Decreased LOC 2) 2 long bone fractures (tib/fib and ulna/radius counts as ONE! if just on one side) 3) Penetrating head, chest, abdominal injury 4) Burns >10% 5) Unstable pelvis 6) Rigid abdomen (bleeding) 7) Assisting airway

DO NOT FLUSH WITH H2O WHEN ON SKIN! -brush off the skin with a brush then flush -neutralize with vinegar

Ventiliate structure before you go in and then remove patient! -Cherry red lips are a late sign

can irritate skin and cause respiratory distress -wash off with soap and water -cut off clothing with gasoline exposure -motorcycle accidents common

Weak acid but can cause damage to skin -Treat with CaCl2 gel

How many patients? MOI (mechanism of injury) Patient position/location Is the patient awake, moving, talking? Obvious injuries? Skin colors?!

Head injury

Possible facial and c-spine injury -it emits a powder that can be a respiratory irritation

Chest trauma! -Cardiac contusion -Pericardial tamponade (fluid build up around heart) -Pneumothorax (collapsed lung)

Worst! Can cause serious or fatal injury *Aortic dissection*

Suspect c-spine injury! *Coup-contra coup:* jolt of head moving forward than another when brain moves back

establishing airway control bleeding flail chest sucking chest wound NEEDS TO BE DONE IN LESS THAN TWO MINUTES

Deformities Contusions Abrasion Penetrations Burns Tenderness Laceration Swelling

Take a 4x4 gauze and dip it in blood coming from ear -There will be a yellow ring around the spot of blood -Indication for basilar skull fracture -Tells if blood from head contains cerebrospinal fluid

Racoon eyes (contusions around eyes) Battle sign (contusion around ears)

*JVD* -seen in 30 degree fowler. Don't put them in this just to see it! *Tracheal deviation* -tension pneumothorax possible (same for JVD) **PUT ON C-COLLAR AFTER THIS**

Paradoxyl movement (in one complete breath) -two or more ribs break in two or more different places and DETACHES from chest wall -part of chest wall moves independently. So one side of chest will go in while other goes out -Due to Blunt chest trauma -HIGH suspicion of underlying injury Treatment: stabilize, endotracheal intubation

trauma alert! possible tension pneumothorax

trauma alert soft, non-tender, non-rebounding

bleeding

stimulate sole of foot Positive: toes extend up and spread out = SPINAL CHORD INJURY Negative: toes curl and flex down *reflex opposite in pediatric patients who do not walk yet!

Eye opening (4 best = spontaneous; 1= none) Verbal response (5 best= normal convo) Motor response (6= normal, 5 moves hand to touch pains when pinch)

Decorticate posture --- TRAUMA -Arms flex towards core and feet flexed up with internal rotation -high brain injury!

Decerebrate posture --- TRAUMA -Arms extend out and wrists flexed down/out -Feet flexed toes down LOW BRAIN INJURY

Patient bent over to catch breath *Respiratory distress!*

abdominal pain

Clutching the chest -sign of chest pain

blood thinner

antibiotic

Blood pressure medication

Non-insulin dependent diabetes mellitus

end with " -ase" -Keep blood pressure down!

end with "-ol" -keep blood pressure down

Sedative, for anxiety -ends with "-pam"

BP and cardiac

quality -stabbing, sharp, burning, etc.

In bronchi -build up of mucous -hear breathe "uh"... breathe "uh" -Ammonia or respiratory infection

Constriction of bronchioles -sounds like puppy whimpering on EXPIRATORY -Asthma, COPD, Anaphylaxis (severe allergic reaction)

Build up of fluid in lungs!! -sounds like slurping drink -don't lay them down bc hard to breathe -CHF, which can cause pulmonary edema

upper air obstruction -sounds like wind on INSPIRATORY

Build up of metabolic acid in body -Trying to blow out a lot of CO2 -FAST AND DEEP (more than hyperventilation/hypernea)

CVA, brain tumor (neurological) -small, shallow breaths, then deeper/big breaths, then apnea (no breath), then repeats

*FOR AMI TREATMENT* Potent vasodilator -protect form light -can't give if SBP <100 bc this drug lowers blood pressure -1 stray/pill under tongue -Don't give with viagra, lavitra (erectile)

Embolus: clot travels to site Thrombus: clot forms at the site

Venous Looks like quarter moon can develop slowly *most common!*

Arterial Looks like a football Lucid interval (moment of unconsciousness and wakes up fine but really isn't) High mortality

Arterial Bleeds all around brain and compresses the brain on all sides

Bleeding INSIDE THE BRAIN

Area of brain that is affected from interstitial hemorrhage, can be saved if acts fast!

Used for Anaphylactic Reaction -Sympathomimetic (mimics sympathetic NS) -Catecholamine

bronchodilator used in asthma patients inhaler -also called CombiVent -Beta 2 sympathomimetic

Common in pesticides -Acts on somatic NS -Acetylcholinesterase inhibitor (blocks the enzyme that breaks down acetylcholine so it can be reabsorbed) *first decontaminate then give high dose of ATROPINE SULFATE

S: salivation L: lacrimation (tears) U: urination D: defecation G: gastroenteritis (abdominal pain) E: emesis

No accepted medical use High potential for addiction Most dangerous of all drugs *Heroin, LSD, weed, MDMA

Sympathetic nervous system

Class Two Drug Amphetamine (SNS) Paranoid, anxious Increase HR, so increased chance of heart attack, increased stroke chance

Cheap form of cocaine that is smoked (harder to overdose) -increased body temp = increased metabolism -increased HR, paranoid, itching skin, increased BP (bv constriction) -dry mouth/chapped lips

Amphetamine -Paranoid, talks a lot, can be aggressive -Stimulates aging process, destroys teeth, sores on body, sunken in face (weight loss and poor nutrition) -smoked or injected (overdose)

Opiate *Injected* Class 1 - very addicting -first high is best then keep trying to get it so report -become biologically addicted S/S -respiratory depression -Slow breathing -lethargy *-high chance for aspiration* -"Track marks" on skin of chronic users -veins eventually scar -deterioration of physical appearance

Heroin derivative -used to treat heroin addictions but just as addicting! -overdose common -same S&S

AKA acid -class one drug -hallucinogenic -pill, paper tab, liquid "sublingual admin" -BAD TRIP!!: users become very disassociated from reality and very dangerous/violent bc can't feel pain -SYMPATHETIC ACTIVATION: pupils dilate, increase body temp, profuse sweating, high BP, muscle weakness, numbness & tremor

"special K" -hallucinogenic -dissociate from reality -violence common

"X" or "E" -DEADLY! -Can cause dehydration and hyperthermia -TEETH CLENCHING! -Touching/feeling people

Acid used to victimize females -"Spike drink" -Gives it a salty taste -Effects 10-15 mins -Produces relaxation and euphoria to vomiting and seizures at high dosage

"Date rape drug" -"Roofies" -Effects 20-30 mins -tasteless and dissolves quickly -can be abused VIA pill -used as a sleep aid in some countries but US bands it -Extreme drowsiness, lowered BP, visual disturbance, loss of memory *APPEARANCE OF EXTREME INTOXICATION WITH VERY LITTLE TO DRINK

Opiate -strongest prescribed opiate -Time release tablet but abusers crush tablet and snort/IV it -OD COMMON -Resp depression, decreased in BP, pupil constriction, seizures, confusion, constipation

Amphetamine -Too high of a dosage can negatively affect the heart (irregular heart beat, high BP) -shortness of breath, headaches, change in mood, tremors in body, numbness in body

Arrow shaped head Tail with rattle or scales in a single row Slit eyes like a cat -Dizziness, blurred vision, increase HR, nausea, fever, difficulty breathing

Snake venom Kills tissues and cells Coral snake Timber snakes sometimes

Keep patient calm Place patient supine Loosely wrap the bite and transport them to facility that contains anti-venom -DON'T PLACE ICE ON THE WOUND OF LET PATIENT WALK!

Hot water & soap Scrape stinger cells with flat surface (like a credit card) Don't pee on patient!

Venom causes pain that lasts for several hours -Remove barb -Soak bite in hot water for several hours

2 1 per cycle 32-33 ATP

Lactic acid

Anxiety Decreased LOC Thirst Impending doom Trachycardia Tachypnea Pale, cool, diaphoretic NOT HYPOTENSION

Keep BP high in brain but low elsewhere. Decomensated: 60-100 systolic. Bad! means compensatory is failing Irreversible shock: <60. Not perfusing brain at all so brain dead :(

High flow O2 Keep patient warm Trendelenberg position Treat underlying cause (anaphylactic shock = eli pen)

1. Pump (obstructive): heart 2. Pipes (distributive): vessels 3. Volume (hypovolemia) blood plasma

-Control bleeding if possible (internal or external) -IV fluids: 0.9% normal saline or lactated ringers (LR) -Packed red blood cells (PRBC -Will need trauma surgeon

O-

AB+

Heart failure, AMI

1. Tension pneumothorax 2. Pericardial tamponade

Cardiogenic shock! -Air in pleural space compresses heart and causes a mediastinal shift -S&S: JVD, tachycardia, *absent lung sounds* on effected side -Treatment: needle decompression -EMR CAN ONLY TAKE TO HOSPITAL

Cardiogenic shock or chest trauma -fluid build up around heart and compresses the heart -Beck's triad

-JVD -Muffled heart sounds -Pulsus Paradoxus: SBP and DBP narrow and close together (110/98)

Pipe problem! *NO sympathetic response!* Don't get cool, pale, diaphoretic, or rapid heart beat, but BP GOES DOWN! (systemic vasodilation) -WARM SHOCK -Occurs from an injury above T10 Treatment: fluid resuscitation (paramedic)

Pipe problem -Systemic vasodilation (drop in BP) -Capillaries permeable -Caused by SYSTEMIC INFECTION!! -Urine can be TEA COLORED -Core body temp can be high or low -High WBC -Common in *nursing homes* -Treatment: Antibiotics, Fluids, Norepinephrine

Hypoglycemia Bg: <60 If give Oj with sugar packets, make sure pt eats solid food after!!

Caused by large MAST CELL and HISTAMINE release Lung sounds: wheezes Sx&Sx: uticartia, swelling, itching causes vasodilation of BV!

1. Apply direct pressure 2. Elevate the extremity 3. Quick clot (powder) 4. Put pressure on pulse points to stop blood flow there 5. Tourniquet (wrap that decreases blood circulation) *once applied, do not loosen or remove! Document the time it is applied

Usually trauma to SIDE OF HEAD -decreased LOC -Blood from ears (halo test) -Late signs: Racoon eyes & battle signs

Compound is more open!

common in infants and neonates -Like ping pong ball pressed into skull

Suspect cribiform fracture!! NO nose airway should be put in

Nose bleed -Pinch nose, head forward -Tamponade devices used to stop bled (doctor does this)

Stabilize penetrating object with gauze and a cup!! -COVER BOTH EYES

The higher the cervical vertebrae injured, the more divesting the injury -FRACTURE DOES NOT MEAN NEUROLOGICAL DAMAGE -Subluxation: incomplete or partial dislocation of a vertebrae *PRIAPISM:* erection of penis due to sc injury (painful)

Separation or "kink" of the trachea -airway emergency Treatment: surgical cricothyrotomy or endotracheal intubation

Pockets of air under the subcutaneous layer of the skin -Causes: penetrating trauma, tracheal disruption, necrotizing fascititis -when palpated, the skin "pops" like rice krispies

spinal chord injury without radiological abnormality -neurologic findings in a patient with cervical spine trauma -no fractures of dislocations seen in lateral neck X-ray or in an MRI -Prognosis of this is actually better than a patient with sc injury and radiologic evidence of the injury

accumulation of blood in the pleural space -same signs as tension pneumorthorax except: flat jugular veins, some lung sounds, no medistinal shift

penetrating injury to the chest wall that goes into the pleural space -air takes the path of least resistant -if the dressing does NOT vent the air, a tension pneumothorax can occur -BURP the dressing (let air out but not in)

For clavicular fractures -2 triangular bandages -one forms sling to hold arm in position -second will tie around the patient to stabilize

Intestines protrude through abdominal cavity -usually little to no bleeding -put moist gauze ontop and cover to keep warmed

circular contusion by belly button -Causes: 1. acute pancreatitis 2. bleeding from blunt abdominal trauma 3. Bleeding from ruptured AAA 4. bleeding from ruptured topic pregnancy

Contusion on side of abdomen! Take 24-48 hours -Acute pancreatitis -Retroperitoneal hemorrhage -Blunt trauma -AAA (aortic abdominal aneurysm)

acute pain in the tip of the *shoulder* due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down with feet elevated *RUPTURED SPLEEN*

Pelvis rarely fractures at just one site! -Can lose up to 500 cc blood per fracture site Open book pelvic fracture: most devastating. Treatment: triangular bandages, sheets, KED (upside down), prevent further blood loss by tamponade

used ONLY for isolated mid shaft femur fracture -DO NOT put straps over knee or site of fracture -Can't fit into helicopter

Same concept as hare traction -this one CAN fit into helicopter but it is not as easy to apply

-Soft and flexible -Can cut with trauma shears Used mainly for ams and lower leg fractures Can form to position

Tib fib fractures -a piece of wood with a thing pad and plastic cover

wrap a pillow around the ankle/foot and secure with tape

*check PMS BEFORE AND AFTER splinting* -only manipulate the fractured extremity ONCE to attempt to regain PMS -always splint above and below the fracture site

Painful!! -CAN be reset in the field by applying traction -If done, then splint the leg and transport

Tearing away skin -control bleeding -clean injury with saline -bandage and splint *DEGLOVING INJURY: skin comes off, bring it with you!

Epidermis and Dermis -fluid blisters that should not be punctured! -Life threatening if >20% BSA

Burned through the epidermis, dermis, and into the subcutaneous tissue -NO PAIN (burnt off pain receptors) -nerve endings burnt off -high chance for infection -burns >5% considered life threatening

Down to bone and tendons -common in long exposure to heat source or electrical burns -life threatening

Outside burns do not look serious, the internal organs can become burned and rhabdomylosis occurs (broken down muscles released into bloodstream) -Entrance and exit wound

#1 cause of respiratory arrest -paralyzes diaphragm -Airway and breathing top priority

Head is 9% (front and back) -Palm of hand is 1% -CHEST AND ABDOMEN = 18%

Stop burn! cool off with tepid(lukewarm) sterile saline -bandage with dry, sterile gauze *NO ICE, BUTTER, or LOTIONS!!* Parkland Formula: 4mL x % burns x weight in Kg = amount given in 16 hours! DIVIDE BY TWO IF WANT 8 hours!