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Questions and Answers

What primarily stimulates breathing in healthy individuals?

  • High pH levels
  • Stress and anxiety
  • Low oxygen levels
  • Increased carbon dioxide levels (correct)

    • Where are the chemoreceptors that monitor blood gases located?

  • In the liver
  • In the lungs
  • In the heart
  • In the carotid arteries and aortic arch (correct)

    • Which condition is characterized by inadequate amounts of oxygen reaching the cells?

  • Hypercapnia
  • Hypoxia (correct)
  • Hypotension
  • Hyperventilation

    • What is a sign of mild hypoxia?

    <p>Fast breathing and dyspnea</p> Signup and view all the answers

    Which of the following is NOT a sign of an inadequate airway?

    <p>Restlessness</p> Signup and view all the answers

    What specific airway sound indicates that the upper airway is partially obstructed?

    <p>Snoring</p> Signup and view all the answers

    Which maneuver is used for opening the airway of medical patients?

    <p>Head tilt – chin lift</p> Signup and view all the answers

    What sound indicates that liquid is blocking the airway and requires immediate suction?

    <p>Gurgling</p> Signup and view all the answers

    What is the primary purpose of maintaining an open airway in emergency medical care?

    <p>To ensure effective ventilation</p> Signup and view all the answers

    Which of the following structures is considered part of the upper airway?

    <p>Larynx</p> Signup and view all the answers

    What is the mechanism of inhalation during breathing?

    <p>Chest wall expands and diaphragm lowers</p> Signup and view all the answers

    Which of the following best describes respiration?

    <p>The exchange of O2 and CO2 between alveoli and blood</p> Signup and view all the answers

    What role do the intercostal muscles play in ventilation?

    <p>They assist in the expansion and contraction of the chest wall</p> Signup and view all the answers

    What does the term 'negative pressure' refer to during inhalation?

    <p>Less pressure inside the chest compared to outside</p> Signup and view all the answers

    What is the primary function of the diaphragm during breathing?

    <p>To assist in creating negative pressure for inhalation</p> Signup and view all the answers

    Which part of the airway is primarily responsible for obstructive issues such as snoring?

    <p>Tongue</p> Signup and view all the answers

    What is the correct method for suctioning?

    <p>Suctioning should not exceed 15 seconds for adults.</p> Signup and view all the answers

    Which type of suction catheter is suitable for children?

    <p>French</p> Signup and view all the answers

    What is a major risk associated with inserting a suction catheter too deep?

    <p>Potential damage to soft tissue</p> Signup and view all the answers

    Which airway adjunct is indicated for an unresponsive patient with no gag reflex?

    <p>Oropharyngeal Airway (OPA)</p> Signup and view all the answers

    What should be done immediately after suctioning?

    <p>Apply O2 for 2 minutes.</p> Signup and view all the answers

    What is the appropriate size measurement method for an OPA?

    <p>Corner of mouth to tragus or earlobe.</p> Signup and view all the answers

    What should be avoided to prevent causing bradycardia during suctioning?

    <p>Suctioning too long.</p> Signup and view all the answers

    When is the use of a nasopharyngeal airway (NPA) appropriate?

    <p>When the patient cannot maintain airway but is still responsive.</p> Signup and view all the answers

    What is the appropriate measurement for sizing a Nasopharyngeal Airway (NPA)?

    <p>Diameter of NPA should be slightly smaller than the nare</p> Signup and view all the answers

    Which of the following indicates inadequate breathing?

    <p>Irregular breathing patterns with decreased tidal volume</p> Signup and view all the answers

    What should be done if resistance is felt when inserting a NPA?

    <p>Remove the NPA and try inserting it into the other nare</p> Signup and view all the answers

    When is a Bag Valve Mask (BVM) necessary?

    <p>When the patient is breathing inadequately</p> Signup and view all the answers

    What is the primary mechanism by which normal ventilation assists blood flow into the right atria?

    <p>Creating negative pressure in the thoracic cavity</p> Signup and view all the answers

    What is the normal range for respiratory rate in adults?

    <p>8-24 breaths per minute</p> Signup and view all the answers

    Which of the following statements about positive pressure ventilation (PPV) is correct?

    <p>It can lead to decreased cardiac output</p> Signup and view all the answers

    What does positive pressure ventilation require that differentiates it from normal spontaneous ventilation?

    <p>An adequate seal to prevent air leaks</p> Signup and view all the answers

    What is a common respiratory pattern that indicates inadequate breathing?

    <p>Cheyne-Stokes breathing</p> Signup and view all the answers

    What is the capacity of a Bag Valve Mask (BVM)?

    <p>1600cc</p> Signup and view all the answers

    When assessing breathing adequacy, which factor does NOT contribute to determinations?

    <p>Patient's physical activity level</p> Signup and view all the answers

    What should be checked to confirm effective ventilation when using a BVM?

    <p>Adequate rise and fall of the chest</p> Signup and view all the answers

    When is it critical to use supplemental oxygen for patients?

    <p>With an oxygen saturation less than 94% or suspected hypoxia</p> Signup and view all the answers

    Which of the following is true about the Flow Restricted, Oxygen Powered Ventilation Device (FROPVD)?

    <p>Delivers 100% O2 at 40 liters per minute when the trigger is pressed</p> Signup and view all the answers

    What is a significant reason for performing a laryngectomy?

    <p>To facilitate insertion of an endotracheal tube</p> Signup and view all the answers

    What is an essential action before placing a Non-Rebreather Mask (NRB) on a patient?

    <p>Completely fill the oxygen reservoir</p> Signup and view all the answers

    What characteristic sound is typically associated with wheezing?

    <p>High pitched, musical sound</p> Signup and view all the answers

    Which condition is associated with the presence of rhonchi?

    <p>Chronic Bronchitis</p> Signup and view all the answers

    What indicates that a patient is experiencing respiratory distress?

    <p>Complaints of shortness of breath</p> Signup and view all the answers

    In which stage of respiratory failure is the respiratory rate less than 8 breaths per minute?

    <p>Respiratory Failure</p> Signup and view all the answers

    What is the definition of rales (crackles)?

    <p>Bubbling, crackling sounds on inspiration</p> Signup and view all the answers

    What is a common treatment for respiratory arrest?

    <p>Positive pressure ventilation</p> Signup and view all the answers

    Which breathing pattern characterizes inadequate breathing?

    <p>Rapid and shallow breaths</p> Signup and view all the answers

    What is the effect of bronchoconstriction on breath sounds?

    <p>High pitched wheezing sounds on exhalation</p> Signup and view all the answers

    What is the primary indication of wheezing during respiration?

    <p>Narrowing of the airways</p> Signup and view all the answers

    Which condition is primarily characterized by snoring or rattling noises during breathing?

    <p>Rhonchi</p> Signup and view all the answers

    What is a significant sign of respiratory distress?

    <p>Tripod positioning</p> Signup and view all the answers

    Which of the following conditions is commonly associated with the presence of rales (crackles)?

    <p>Pulmonary edema</p> Signup and view all the answers

    What characterizes respiratory failure in terms of respiratory rate?

    <p>Rate less than 8 or greater than 24 breaths per minute</p> Signup and view all the answers

    What does adequate breathing encompass?

    <p>Respiratory rate of 8-24 breaths per minute</p> Signup and view all the answers

    Which breathing sound is primarily heard on inspiration and associated with fluid in the alveoli?

    <p>Rales (Crackles)</p> Signup and view all the answers

    In the context of a metered dose inhaler, which medication is most commonly administered?

    <p>Albuterol</p> Signup and view all the answers

    What is the primary goal when managing a patient presenting with chest pain?

    <p>Identify life-threatening cardiac conditions and ensure proper care.</p> Signup and view all the answers

    Which structure is NOT part of the electrical impulse pathway in the heart?

    <p>Coronary artery</p> Signup and view all the answers

    In which condition is left-sided congestive heart failure most likely to lead to respiratory symptoms?

    <p>Right-sided congestive heart failure</p> Signup and view all the answers

    What is the primary action of Nitroglycerin when administered to a cardiac patient?

    <p>Dilate blood vessels to improve blood flow</p> Signup and view all the answers

    Which symptom is a characteristic of Acute Myocardial Infarction that differentiates it from Angina?

    <p>Severe and persistent chest pain</p> Signup and view all the answers

    What is the primary goal when managing a patient with chest pain?

    <p>To ensure they receive proper care and transport to an appropriate facility</p> Signup and view all the answers

    Which of the following correctly identifies components of the heart's conduction system responsible for electrical impulses?

    <p>SA node, AV node, Bundle of HIS, Purkinje fibers</p> Signup and view all the answers

    What differentiates angina from an acute myocardial infarction (AMI)?

    <p>Angina is usually temporary and relieved by rest or medication, while AMI is more severe and often long-lasting</p> Signup and view all the answers

    Which side of congestive heart failure primarily causes lung issues, such as crackles and difficulty breathing?

    <p>Left side</p> Signup and view all the answers

    What is a critical action of nitroglycerin in treating cardiac patients?

    <p>It dilates blood vessels to improve blood flow to the heart</p> Signup and view all the answers

    What differentiates an allergic reaction from anaphylaxis?

    <p>Anaphylaxis involves additional symptoms such as angioedema and bronchoconstriction.</p> Signup and view all the answers

    What role do histamines play in the body during allergic reactions?

    <p>Histamines increase capillary permeability and cause bronchoconstriction.</p> Signup and view all the answers

    Which statement best describes the process of sensitization in an allergic reaction?

    <p>Sensitization results from the first exposure to an allergen and leads to the production of specific antibodies.</p> Signup and view all the answers

    What does epinephrine do to counteract anaphylaxis?

    <p>It promotes bronchodilation and vasoconstriction.</p> Signup and view all the answers

    What is the normal range for blood glucose levels?

    <p>70-140 mg/dl</p> Signup and view all the answers

    Which hormone is responsible for allowing glucose to enter cells?

    <p>Insulin</p> Signup and view all the answers

    What characterizes hyperglycemia?

    <p>Blood sugar level greater than 200 mg/dl</p> Signup and view all the answers

    What are common signs of hypoglycemia?

    <p>ALOC and cool, pale skin</p> Signup and view all the answers

    Which of the following conditions is characterized by inflammation of the pancreas?

    <p>Pancreatitis</p> Signup and view all the answers

    What does rebound tenderness indicate in a patient experiencing abdominal pain?

    <p>Appendicitis</p> Signup and view all the answers

    Which group is known as the '7 F's' associated with cholecystitis?

    <p>Flatulant, Fat, Female, 40, Fertile, Fair Skinned, Freckled</p> Signup and view all the answers

    What is a common symptom of a ruptured abdominal aortic aneurysm?

    <p>Pulsating mass in the abdomen</p> Signup and view all the answers

    What type of bleeding is associated with esophageal varices?

    <p>Coffee ground vomit</p> Signup and view all the answers

    What is the difference between an antigen and an allergen?

    <p>Allergens are a type of antigen that specifically triggers allergic reactions.</p> Signup and view all the answers

    Which of the following is NOT a sign of anaphylaxis?

    <p>Localized hives</p> Signup and view all the answers

    What is the primary action of epinephrine in response to an allergic reaction?

    <p>Triggers bronchodilation</p> Signup and view all the answers

    Hypoglycemia is characterized by which of the following symptoms?

    <p>Cold/sweaty skin</p> Signup and view all the answers

    Which hormone allows glucose to enter cells?

    <p>Insulin</p> Signup and view all the answers

    What is hyperglycemia primarily defined as?

    <p>Blood sugar greater than 200 mg/dl</p> Signup and view all the answers

    Which symptom is most closely associated with anaphylactic shock?

    <p>Rapid heartbeat</p> Signup and view all the answers

    What affects does histamine have on the body during an allergic reaction?

    <p>Enhances capillary permeability</p> Signup and view all the answers

    Which of the following best differentiates an allergic reaction from anaphylaxis?

    <p>Anaphylaxis can include symptoms such as angioedema or bronchoconstriction.</p> Signup and view all the answers

    What immediate effect does histamine release have on the body?

    <p>Increased capillary permeability.</p> Signup and view all the answers

    What is the role of epinephrine during an anaphylactic reaction?

    <p>It facilitates bronchodilation.</p> Signup and view all the answers

    How does hypoglycemia differ from hyperglycemia in terms of onset?

    <p>Hypoglycemia usually has a rapid onset.</p> Signup and view all the answers

    What is the normal range for blood glucose levels in mg/dl?

    <p>70-140 mg/dl</p> Signup and view all the answers

    In which situation would glucagon be primarily used in glucose regulation?

    <p>To convert stored glycogen into glucose when needed.</p> Signup and view all the answers

    Which of the following symptoms is associated with hypoglycemia?

    <p>Cool, pale, and sweaty skin.</p> Signup and view all the answers

    Which statement best defines the action of antibodies in the immune response?

    <p>They recognize and bind to antigens to neutralize them.</p> Signup and view all the answers

    What does ALOC primarily indicate?

    <p>An issue with the central nervous system</p> Signup and view all the answers

    Which type of stroke is more common?

    <p>Ischemic</p> Signup and view all the answers

    What is the major precursor for a full blown stroke?

    <p>Transient Ischemic Attack (TIA)</p> Signup and view all the answers

    How long must stroke symptoms resolve for a TIA diagnosis?

    <p>24 hours</p> Signup and view all the answers

    Which of the following is NOT included in the AEIOUTIPS assessment?

    <p>Tremors</p> Signup and view all the answers

    What is the critical question to ask regarding stroke assessment?

    <p>When was the last time the patient was seen normal?</p> Signup and view all the answers

    Which condition is characterized by prolonged seizure activity?

    <p>Status Epilepticus</p> Signup and view all the answers

    Which assessment tool is used for stroke detection?

    <p>Cincinnati Stroke Scale</p> Signup and view all the answers

    What is the main purpose of performing a rapid physical exam on a patient with ALOC?

    <p>To identify the cause of altered consciousness</p> Signup and view all the answers

    Which condition is characterized by a burst of an artery in the brain?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    What is a significant symptom of a Transient Ischemic Attack (TIA)?

    <p>Symptoms that resolve within one hour</p> Signup and view all the answers

    Which aspect of a stroke assessment is considered the most critical?

    <p>Time last seen normal</p> Signup and view all the answers

    Which seizure type is characterized by a generalized seizure lasting longer than 5 minutes?

    <p>Status epilepticus</p> Signup and view all the answers

    What physical sign might indicate excessive insulin levels in a patient?

    <p>Cold clammy skin</p> Signup and view all the answers

    In the context of stroke, which of the following assessments includes facial droop?

    <p>Cincinnati Stroke Scale</p> Signup and view all the answers

    Which symptom is NOT typically associated with seizures?

    <p>Extreme persistent fatigue</p> Signup and view all the answers

    What is a common indication for administering Naloxone?

    <p>Respiratory depression with a rate less than 12</p> Signup and view all the answers

    What action does Naloxone perform in the body?

    <p>Binds to opioid receptor sites to reverse respiratory depression</p> Signup and view all the answers

    Which symptom is NOT associated with CNS stimulants?

    <p>Bradycardia</p> Signup and view all the answers

    Which of the following is a side effect of administering Naloxone?

    <p>Acute withdrawal symptoms</p> Signup and view all the answers

    Which symptoms would most likely indicate exposure to hallucinogens?

    <p>Anxiety, paranoia, and hallucinations</p> Signup and view all the answers

    What best describes a poison?

    <p>Any substance that impairs health or causes death through chemical action</p> Signup and view all the answers

    Which of the following is an example of an antidote?

    <p>Naloxone for opiate overdose</p> Signup and view all the answers

    What is the most common route of exposure in poisoning cases?

    <p>Ingestion</p> Signup and view all the answers

    Which symptom is NOT typically associated with ingestion poisoning?

    <p>Difficulty breathing</p> Signup and view all the answers

    Activated charcoal is contraindicated in which of the following scenarios?

    <p>Inability to swallow</p> Signup and view all the answers

    What is the primary action of activated charcoal in poisoning cases?

    <p>Prevents absorption of the poison into the bloodstream</p> Signup and view all the answers

    Which of the following signs indicates potential inhalation poisoning?

    <p>Chest pain and difficulty breathing</p> Signup and view all the answers

    When should activated charcoal be administered for it to be effective?

    <p>Within one hour of ingestion</p> Signup and view all the answers

    What is a common sign of carbon monoxide poisoning?

    <p>Cherry red lips/skin</p> Signup and view all the answers

    What stage of drug and alcohol withdrawal is characterized by hallucinations starting?

    <p>Stage two</p> Signup and view all the answers

    What is one of the symptoms associated with pesticide exposure categorized as SLUDGEM?

    <p>Urination</p> Signup and view all the answers

    Which of the following drugs is derived from opium?

    <p>Fentanyl</p> Signup and view all the answers

    Which of the following is NOT a skin-related symptom of poison absorption?

    <p>Euphoria</p> Signup and view all the answers

    What defines drug abuse?

    <p>Self-administering drugs in a non-approved manner</p> Signup and view all the answers

    What is considered a medical emergency during withdrawal from alcohol?

    <p>Delirium Tremens</p> Signup and view all the answers

    Which of the following describes the absorption of a poison through the skin?

    <p>Dermal contact</p> Signup and view all the answers

    What is the primary function of the placenta during pregnancy?

    <p>To provide oxygen and nutrients to the fetus</p> Signup and view all the answers

    Which of the following describes a characteristic of abruptio placenta?

    <p>Placenta prematurely detaches from the uterine wall</p> Signup and view all the answers

    What is one of the main risks associated with ectopic pregnancy?

    <p>Rupture of the fallopian tube</p> Signup and view all the answers

    Which structure serves as the birth canal?

    <p>Vagina</p> Signup and view all the answers

    What is a major symptom of placenta previa?

    <p>Vaginal bleeding without pain</p> Signup and view all the answers

    How many arteries are present in the umbilical cord to carry waste back to the placenta?

    <p>Two</p> Signup and view all the answers

    What characterizes preeclampsia during pregnancy?

    <p>Hypertension and swelling of extremities</p> Signup and view all the answers

    What is the amniotic sac primarily filled with?

    <p>Amniotic fluid</p> Signup and view all the answers

    What condition is characterized by the uterus and growing fetus compressing the inferior vena cava when the mother lays flat on her back?

    <p>Supine Hypertensive Syndrome</p> Signup and view all the answers

    What is the term used for the number of pregnancies a woman has had?

    <p>Gravida</p> Signup and view all the answers

    What phase of labor is characterized by the dilation of the cervix?

    <p>Stage one</p> Signup and view all the answers

    Which of the following presents a true emergency to the baby during delivery?

    <p>Prolapsed cord</p> Signup and view all the answers

    What should be done if a baby is found to have meconium-stained amniotic fluid?

    <p>Provide high-flow oxygen to the mother</p> Signup and view all the answers

    What is indicated when a baby is born foot first or buttocks first?

    <p>Breech birth</p> Signup and view all the answers

    What is defined as any bleeding over 500cc after delivery?

    <p>Postpartum Hemorrhage</p> Signup and view all the answers

    What emergency measure may be needed for a limb presentation during delivery?

    <p>Emergency C-section</p> Signup and view all the answers

    What is the first step in the scene sizeup process?

    <p>Ensuring personal safety</p> Signup and view all the answers

    Which of the following correctly defines advanced directives?

    <p>Written orders for resuscitation wishes</p> Signup and view all the answers

    What is the correct compression to ventilation ratio for adult, 2 person CPR?

    <p>30:2</p> Signup and view all the answers

    Which airway maneuver is appropriate for an unresponsive patient with no gag reflex?

    <p>Oropharyngeal airway insertion</p> Signup and view all the answers

    Which devices deliver supplemental oxygen at the highest flow rate?

    <p>Non-rebreather mask</p> Signup and view all the answers

    What legal term refers to evaluating a patient's ability to make informed decisions?

    <p>Capacity assessment</p> Signup and view all the answers

    Which stage of labor involves active contractions and dilation of the cervix?

    <p>First stage</p> Signup and view all the answers

    What is the primary purpose of the Apgar scoring system?

    <p>To evaluate newborn health immediately after birth</p> Signup and view all the answers

    Which of these diseases is characterized by inflammation of the airways, leading to difficulty breathing and wheezing?

    <p>Asthma</p> Signup and view all the answers

    What is a common treatment for Congestive Heart Failure (CHF)?

    <p>Diuretics</p> Signup and view all the answers

    Which assessment tool is used to evaluate neurological function in stroke patients?

    <p>Cincinnati Stroke Scale</p> Signup and view all the answers

    Which of the following conditions is most associated with shortness of breath and chest pain due to a blockage in blood flow to the lungs?

    <p>Pulmonary Embolism</p> Signup and view all the answers

    What is a key sign of Anaphylaxis?

    <p>Widespread hives</p> Signup and view all the answers

    Which medication is commonly used to manage symptoms of Angina?

    <p>Nitroglycerin</p> Signup and view all the answers

    Which condition typically presents with nausea, abdominal pain, and fever, often requiring surgical intervention?

    <p>Appendicitis</p> Signup and view all the answers

    In the case of a suspected stroke, which condition is characterized by temporary neurological symptoms lasting less than 24 hours?

    <p>Transient Ischemic Attack</p> Signup and view all the answers

    What is the primary purpose of SAMPLE history during a medical assessment?

    <p>To gather information about the patient's symptoms and medical history</p> Signup and view all the answers

    Which component does NOT belong to the Glasgow Coma Scale?

    <p>Cardiac response</p> Signup and view all the answers

    What does the abbreviation PRBELLS stand for in the context of assessments?

    <p>Pulse, Respirations, Blood Pressure, Eyes, Level of consciousness, Lung sounds, Skin</p> Signup and view all the answers

    What type of patients can be assisted with a metered-dose inhaler (MDI)?

    <p>Patients experiencing an acute asthma attack</p> Signup and view all the answers

    In assessing respiratory conditions, which symptom is experienced in chronic bronchitis?

    <p>Persistent productive cough and congestion</p> Signup and view all the answers

    What significant characteristic differentiates asthma from COPD?

    <p>Asthma can be fully reversed with appropriate treatment</p> Signup and view all the answers

    For which condition is the presence of rhonchi typically associated?

    <p>Pneumonia</p> Signup and view all the answers

    What oxygen delivery method provides the highest concentration of oxygen?

    <p>Non-rebreather mask</p> Signup and view all the answers

    What are the signs and symptoms of hyperglycemia?

    <p>Frequent urination, increased thirst, and fatigue</p> Signup and view all the answers

    What distinguishes a transient ischemic attack (TIA) from a stroke?

    <p>Symptoms of a TIA resolve within 24 hours</p> Signup and view all the answers

    What type of allergic reaction is characterized by symptoms such as hives, itching, and swelling?

    <p>Mild allergic reaction</p> Signup and view all the answers

    When do seizures typically occur in the stages of alcohol withdrawal?

    <p>After 48-72 hours</p> Signup and view all the answers

    Which of the following is a common sign displayed by a patient on stimulants?

    <p>Panic attacks and exaggerated reflexes</p> Signup and view all the answers

    What is indicated when a patient requires an epinephrine injection?

    <p>Severe allergic reaction/anaphylaxis</p> Signup and view all the answers

    What is the function of activated charcoal in poisoning cases?

    <p>To absorb toxins in the digestive tract</p> Signup and view all the answers

    What life-threatening condition is characterized by severely low blood pressure and difficulty breathing after an allergic reaction?

    <p>Anaphylactic shock</p> Signup and view all the answers

    Which stage of labor involves the delivery of the baby?

    <p>Second stage</p> Signup and view all the answers

    What is the purpose of the APGAR score?

    <p>To evaluate the baby's immediate health status</p> Signup and view all the answers

    What compression to ventilation ratio should be used for two rescuer CPR in a child?

    <p>15:2</p> Signup and view all the answers

    Which of the following best describes 'downtime' in relation to cardiac arrest?

    <p>The time from cardiac arrest until effective CPR is started</p> Signup and view all the answers

    Which signs signify imminent delivery?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended depth for compressions in adult CPR?

    <p>2-2.4 inches</p> Signup and view all the answers

    What differentiates a witnessed cardiac arrest from an unwitnessed one?

    <p>Witnessed events are seen by EMS, unwitnessed are not</p> Signup and view all the answers

    When should fingers be inserted into the birth canal?

    <p>When crowning is observed</p> Signup and view all the answers

    What outcomes are considered in total downtime during cardiac arrest?

    <p>ROSC and hospital discharge</p> Signup and view all the answers

    What is a key requirement when performing CPR to ensure effective compressions?

    <p>Allow for full chest recoil</p> Signup and view all the answers

    Which of the following accurately describes a characteristic feature of chronic bronchitis?

    <p>An increase in productive cough</p> Signup and view all the answers

    What clinical assessment tool is primarily used for stroke evaluation?

    <p>Cincinnati Stroke Scale</p> Signup and view all the answers

    What is a key treatment for anaphylaxis?

    <p>Injecting epinephrine</p> Signup and view all the answers

    Which of the following conditions can lead to hypoglycemia?

    <p>Insulin overdosing</p> Signup and view all the answers

    What action is essential when managing acute coronary syndrome?

    <p>Providing supplemental oxygen if hypoxia is present</p> Signup and view all the answers

    Which symptom is commonly associated with pneumonia?

    <p>Sharp pleuritic chest pain</p> Signup and view all the answers

    What is a notable contraindication for the use of nitroglycerin?

    <p>Systolic blood pressure less than 90 mmHg</p> Signup and view all the answers

    What is a common cause of spontaneous pneumothorax?

    <p>Tension on the lung tissue due to a ruptured bleb</p> Signup and view all the answers

    What is the correct compression to ventilation ratio for an adult during 2 person CPR?

    <p>30:2</p> Signup and view all the answers

    Which of the following airway adjuncts is specifically indicated for an unresponsive patient without a gag reflex?

    <p>Oropharyngeal airway (OPA)</p> Signup and view all the answers

    What is the liter flow range typically provided by a nasal cannula?

    <p>1 to 6 liters per minute</p> Signup and view all the answers

    What defines a 5150 hold under California law?

    <p>An individual posing a danger to themselves or others due to a mental disorder</p> Signup and view all the answers

    What should be done if you suspect child or elder abuse while on duty?

    <p>Notify Child Protective Services (CPS) or Adult Protective Services (APS) immediately</p> Signup and view all the answers

    Which of the following describes the definition of SAMPLE history?

    <p>Signs, Allergies, Medications, Past history, Last oral intake, Events leading to present illness</p> Signup and view all the answers

    What is the primary indication for administering nitroglycerin (NTG)?

    <p>To relieve angina pectoris</p> Signup and view all the answers

    What is the flow of oxygen through a non-rebreather mask in terms of liters per minute?

    <p>8-12 liters</p> Signup and view all the answers

    What does the Glasgow Coma Scale assess?

    <p>Patient's level of consciousness</p> Signup and view all the answers

    Which condition must be met for a patient to provide informed consent?

    <p>The patient must be of legal age and oriented</p> Signup and view all the answers

    What should the flow meter be set at for a demand valve (FROPVD)?

    <p>25 liters per minute</p> Signup and view all the answers

    What is the appropriate size measurement for a Nasopharyngeal Airway (NPA)?

    <p>From the tip of the nose to the earlobe</p> Signup and view all the answers

    What is the primary objective of an advanced directive?

    <p>To outline a patient's wishes regarding resuscitation measures</p> Signup and view all the answers

    Which condition is characterized by wheezing, pursed-lip breathing, and a barrel chest appearance?

    <p>Emphysema</p> Signup and view all the answers

    Which of the following is a symptom of hyperventilation syndrome?

    <p>Tingling in the hands and feet</p> Signup and view all the answers

    What is the first side of the heart that generally shows signs of congestive heart failure?

    <p>The left side</p> Signup and view all the answers

    What should be done immediately after a patient vomits?

    <p>Roll the patient on their side, clear the airway, and then roll back.</p> Signup and view all the answers

    When is it appropriate to use an AED?

    <p>When the patient is unresponsive, not breathing, and pulseless.</p> Signup and view all the answers

    What is the correct rescue breathing rate for adults?

    <p>1 breath every 5-6 seconds.</p> Signup and view all the answers

    What should you NOT do when using an AED?

    <p>Touch the patient during the analyzing phase.</p> Signup and view all the answers

    Which of the following is the correct action for a partially obstructed airway in a conscious patient?

    <p>Encourage them to cough and stay calm.</p> Signup and view all the answers

    What is the primary role of back blows for an infant who is choking?

    <p>To generate pressure and dislodge the object.</p> Signup and view all the answers

    What should you do if an unconscious patient's airway is obstructed?

    <p>Look in the mouth before giving breaths.</p> Signup and view all the answers

    When a patient is in need of rescue breathing, which rate should be applied for children and infants?

    <p>1 breath every 2-3 seconds.</p> Signup and view all the answers

    What defines the Return of Spontaneous Circulation (ROSC)?

    <p>The patient regains a pulse</p> Signup and view all the answers

    Which of the following is true regarding the compression to ventilation ratio for children during CPR?

    <p>30:2 for two rescuers</p> Signup and view all the answers

    What is the maximum duration allowed for checking breathing and pulse during a cardiac arrest assessment?

    <p>10 seconds</p> Signup and view all the answers

    What defines an unwitnessed cardiac arrest?

    <p>The EMT did not observe the event occur</p> Signup and view all the answers

    In adult CPR, what is the recommended depth of compressions?

    <p>2-2.4 inches</p> Signup and view all the answers

    Which of the following outcomes is considered a survival after cardiac arrest?

    <p>The patient regains ROSC and is discharged neurologically intact</p> Signup and view all the answers

    What is an appropriate action if a pulse is felt during CPR?

    <p>Reassess breathing and pulse</p> Signup and view all the answers

    What is the age range for identifying a patient as an infant?

    <p>Birth to 1 year</p> Signup and view all the answers

    What is considered 'downtime' in the context of cardiac arrest?

    <p>Time from cardiac arrest until CPR begins</p> Signup and view all the answers

    In CPR for infants, what is the recommended compression to ventilation ratio for two rescuers?

    <p>15:2</p> Signup and view all the answers

    Study Notes

    Airway Management

    • Maintaining an open airway is paramount in emergency medical care.
    • Airway patency is essential for breathing, ventilation, and oxygenation.

    Ventilation and Respiration

    • Ventilation refers to the movement of air in and out of the lungs, also known as breathing.
    • Respiration is the gas exchange process, where oxygen is transferred from the lungs to the capillaries and carbon dioxide is moved from the capillaries to the lungs.

    Anatomy

    • Upper airway: from nose/mouth to the larynx. Includes the nasal cavity, oropharynx, tongue, epiglottis, and larynx/vocal cords.
    • Lower airway: from the trachea to the lungs. Includes the trachea, carina, bronchi, bronchioles, and alveoli.
    • Musculature: diaphragm and intercostal muscles help with breathing.

    Mechanics of Ventilation

    • Inhalation: chest wall and diaphragm expand, creating negative pressure to draw air into the lungs, also assists with cardiac output.
    • Exhalation: chest wall relaxes, diaphragm returns to normal position, pressure equalizes, process is passive.

    Control of Respiration

    • Breathing stimulus: medulla oblongata in the brain stem monitors chemoreceptors and stimulates breathing.
    • Healthy individuals rely on hypercarbic drive (increased CO2 levels) for breathing stimulus.
    • Individuals with lung disease rely on hypoxic drive (low O2 levels) for breathing stimulus.
    • Chemoreceptors in the carotid arteries and aortic arch monitor oxygen, carbon dioxide, and blood pH.

    Hypoxia

    • Hypoxia: inadequate oxygen reaching cells.
    • Early signs of hypoxia: fast breathing, dyspnea, anxiety, apprehension, restlessness, and pale skin.
    • Late signs of hypoxia: altered level of consciousness, cyanosis, and dyspnea.

    Assessing the Airway

    • Signs of an adequate airway: air movement felt and heard at the nose and mouth, patient speaks in full sentences with ease, normal voice for the patient.
    • Signs of an inadequate airway: abnormal upper airway sounds, conscious patient unable to speak, foreign body airway obstruction, swelling of the mouth, tongue, or oropharynx.

    Abnormal Airway Sounds

    • Snoring: upper airway partially obstructed, typically due to the tongue. Relief with head tilt/chin lift.
    • Gurgling: liquid blocking the airway (blood, vomit, or secretions), immediate suction required.
    • Stridor: high-pitched sound on inspiration.

    Opening the Airway

    • Head tilt-chin lift: for medical patients.
    • Jaw thrust: for trauma patients or suspected spinal injury.
    • Reposition the airway if the first ventilation attempt is unsuccessful.

    Suctioning

    • Two types: mounted (on board) and portable (powered or manual).
    • Suction catheters: rigid (Yankauer, Tonsil Tip, adults, oral only) and soft (French, children, nasal, stoma, airway tubes).
    • Suction facts: always suction on the way out, 15 seconds maximum for adults, 5 seconds maximum for children, always measure the catheter before insertion (same measurements as airway adjuncts), apply oxygen after suctioning.
    • Suction precautions: do not insert too deep, do not suction for too long, apply oxygen for 2 minutes after suctioning.

    Airway Adjuncts

    • Used to maintain airway patency in unresponsive patients.
    • Keeps the tongue from obstructing the airway.
    • Oropharyngeal Airway (OPA): for unresponsive patients without a gag reflex. Sized using corner of mouth to tragus or earlobe, or middle of mouth to angle of jaw.
    • Nasopharyngeal Airway (NPA): for patients unable to maintain an airway with a gag reflex. Sized from tip of nose to tragus or earlobe, and diameter of NPA slightly smaller than nare. Insert bevel towards septum.

    Managing Breathing

    • Respiratory Rate and Tidal Volume: determine if breathing is adequate or inadequate by observing rate and depth.
    • Adequate Breathing: rate (8-24 breaths/min), rhythm (regular pattern), and quality (full, equal breath sounds, adequate tidal volume).
    • Inadequate Breathing: rate (outside adequate range), rhythm (irregular patterns), and quality (decreased breath sounds, decreased tidal volume).
    • Examples of inadequate breathing: apnea, agonal breathing, Cheyne-Stokes pattern, ataxia.

    Assisting Ventilations (Positive Pressure Ventilation)

    • Two types: Bag Valve Mask (BVM) and Flow-Restricted, Oxygen-Powered Ventilation Device (FROPVD, or Demand Valve).
    • Basics of Assisting Ventilation: adequate rate, adequate seal, do not over-ventilate.
    • Normal breathing creates negative pressure in the chest to draw air in, assisting with blood flow.
    • Positive pressure ventilation can impact cardiac output because it does not assist the vena cava with blood flow.
    • Bag Valve Mask (BVM): most common positive pressure ventilation device. Capacity of 1600cc, delivers 100% oxygen. Look for chest rise and fall.
    • Flow Restricted, Oxygen Powered Ventilation Device (FROPVD): can be used on spontaneously breathing patients, delivers 100% oxygen.

    Stoma/Tracheostomy

    • A hole cut into the trachea.
    • Used to relieve FBAO, insert ET tube, perform laryngectomy.
    • Tracheostomy opening size matches the port opening of a BVM.

    Oxygen Delivery (For Patients with Adequate Breathing)

    • Indications for oxygen: oxygen saturation less than 94% or suspected hypoxia, patient complaining of dyspnea, signs of poor perfusion, heart failure, shock.
    • Non-Rebreather Mask (NRB): high flow oxygen, delivers 90% oxygen. Use at 10-15 liters per minute. Fill oxygen reservoir before placing on patient.

    Normal Breathing

    • Open airway
    • Normal respiratory rate (8-24 breaths per minute)
    • Adequate tidal volume
    • Equal breath sounds

    Breath Sounds

    • Listening to breath sounds helps with field diagnosis
    • Listen over bare skin
    • Have patient breathe with their mouth open

    Wheezing

    • High-pitched, musical, whistling sound
    • Indicates narrowing of airways (bronchoconstriction)
    • Mostly heard on exhalation
    • Asthma, Emphysema, Chronic Bronchitis, Pneumonia can all have wheezing

    Rhonchi

    • Snoring, rattling noises
    • Thick mucous secretions
    • Obstruction of larger airways
    • Pneumonia, Chronic Bronchitis, Emphysema (if in the presence of pneumonia)

    Rales (Crackles)

    • Bubbling, crackling sounds on inspiration
    • Fluid build up in alveoli
    • Pulmonary edema, Congestive heart failure

    General Signs of Respiratory Distress

    • Shortness of breath
    • Hypoxia (mild or severe)
    • Wheezing, rhonchi, or crackles
    • Tripod positioning
    • Accessory muscle use (AMU)

    Stages of Respiratory Distress

    • Respiratory Distress
      • Subjective complaint of difficulty breathing
      • Respiratory rate and tidal volume are adequate
      • Treatment would be a non-rebreather
    • Respiratory Failure
      • Respiratory rate or tidal volume, or both, are inadequate
        • Rate less than 8 or greater than 24
        • Shallow and ineffective respirations
      • Treatment would be positive pressure ventilation
    • Respiratory Arrest
      • Apnea / not breathing
      • Treatment would be positive pressure ventilation

    Metered Dose Inhaler / Small Volume Nebulizers

    • EMT's can assist a patient with their metered dose inhaler
    • Medications commonly seen
      • Albuterol (Ventolin, Proventil)

    Normal Breathing

    • Open airway
    • Normal respiratory rate (8-24 breaths per minute)
    • Normal respiratory rhythm with adequate tidal volume
    • Equal breath sounds

    Breath Sounds

    • Assists with diagnosis
    • Listen over bare skin, not clothing
    • Have patient breathe with their mouth open

    Wheezing

    • High pitched, musical, whistling sound
    • Indicates airway narrowing (bronchoconstriction)
    • Mostly heard on exhalation
    • Associated with asthma, emphysema, chronic bronchitis, pneumonia

    Rhonchi

    • Snoring, rattling noises
    • Caused by thick mucous secretions
    • Obstruction of larger airways
    • Associated with pneumonia, chronic bronchitis, emphysema

    Rales

    • Bubbling, crackling sounds on inspiration
    • Fluid build-up in alveoli
    • Associated with pulmonary edema, congestive heart failure

    General Signs and Symptoms of Respiratory Distress

    • Complaint of shortness of breath
    • Signs of hypoxia (mild or severe)
    • Wheezing, rhonchi, or crackles
    • Tripod positioning
    • Accessory muscle use (AMU)

    Stages of Respiratory Distress

    • Respiratory Distress (subjective complaint of difficulty breathing, respiratory rate and tidal volume are adequate)
      • Treatment: non-rebreather
    • Respiratory Failure (respiratory rate or tidal volume, or both, are inadequate)
      • Rate less than 8 or greater than 24 breaths per minute
      • Shallow and ineffective respirations
      • Treatment: positive pressure ventilation
    • Respiratory Arrest (apnea/patient is not breathing)
      • Treatment: positive pressure ventilation

    Metered Dose Inhaler/Small Volume Nebulizers

    • EMTs can assist with medication
    • Common Medications: Albuterol (Ventolin, Proventil)

    Chest Pain Patient Management

    • Recognize potential cardiac emergencies and provide appropriate care.
    • Transport patient to the appropriate facility.

    Cardiac Conduction System

    • Understand the electrical impulse pathway:
      • Sinoatrial (SA) node
      • Atrioventricular (AV) node
      • Bundle of His
      • Purkinje fibers
    • Identify dysrhythmias that can lead to sudden cardiac arrest.

    Heart Blood Flow

    • Trace blood flow through the heart forwards, backwards, and in between.

    Coronary Arteries

    • Understand how coronary arteries become occluded.

    Pathophysiology, Signs/Symptoms, and Treatment

    • Angina
    • Acute Myocardial Infarction (MI)
      • Differentiate between angina and MI.
      • Identify individuals susceptible to silent MIs.
    • Aortic aneurysm and dissection
    • Congestive Heart Failure
      • Left-side heart failure:
        • Affects the lungs
        • Causes crackles/rales, chest pain, and difficulty breathing.
      • Right-side heart failure:
        • Affects the systemic circulation.
        • Causes ankle edema and jugular venous distention (JVD).

    Medications

    • Nitroglycerin (NTG) and Aspirin (ASA) :
      • Know trade and generic names.
      • Understand indications, contraindications, and potential side effects.
      • Be familiar with different medication forms:
        • NTG: spray, sublingual tablet, paste
        • ASA: tablet, chewable
      • Understand routes of administration:
        • NTG: sublingual
        • ASA: oral, chewable
      • Know the mechanism of action and how these medications benefit cardiac patients.

    Immune System

    • The immune system protects the body from disease and illness.
    • It recognizes harmful substances known as antigens.

    Antigens and Allergens

    • Antigens are substances that stimulate the immune system to produce antibodies.
    • Allergens are a type of antigen that cause an allergic reaction.

    Sensitization

    • Sensitization occurs when the immune system becomes hypersensitive to an allergen.
    • The body produces IgE antibodies, which bind to mast cells.
    • In an anaphylactoid reaction, sensitization involves a non-immunological reaction that mimics an allergic reaction, often triggered by medications, contrast dye, or venom.

    Antibodies

    • Antibodies are proteins produced by the immune system that specifically target and neutralize antigens.
    • In allergic reactions, IgE antibodies play a crucial role in releasing histamine and other inflammatory mediators.

    MAST Cells

    • Mast cells are specialized immune cells found in tissues throughout the body.
    • They contain granules filled with histamine and other chemical mediators responsible for allergic reactions.

    Histamine / Chemical Mediators

    • Histamine and other chemical mediators are released from mast cells when they are activated by allergens.
    • They cause the symptoms of an allergic reaction, including inflammation, itching, swelling, and bronchoconstriction.

    Allergic Reaction vs Anaphylaxis

    • Allergic reactions involve localized symptoms, such as hives, itching, and swelling.
    • Anaphylaxis is a severe, life-threatening allergic reaction that involves multiple systems.
    • Anaphylaxis is characterized by the rapid onset of symptoms including hives, angioedema, bronchoconstriction, and signs of shock.

    Angioedema

    • Angioedema is a swelling of the skin and underlying tissues, particularly in the face, lips, tongue, and throat.
    • It can lead to airway obstruction and difficulty breathing.

    Effects of Histamine on the Body

    • Bronchoconstriction: Narrowing of the airways, making it difficult to breathe
    • Vasodilation: Widening of blood vessels, leading to redness and swelling
    • Increased capillary permeability: Leaking of fluid from blood vessels into surrounding tissues, contributing to inflammation and swelling

    Effects of Epinephrine on the Body

    • Bronchodilation: Widening of the airways, relieving bronchoconstriction
    • Vasoconstriction: Narrowing of blood vessels, reducing swelling and fluid leakage
    • Reverses capillary permeability: Decreases the leakage of fluid from blood vessels, reducing inflammation and swelling

    Epi-Pen

    • Trade name: EpiPen
    • Generic name: epinephrine auto-injector
    • Indications: Used to treat acute, severe allergic reactions (anaphylaxis)
    • Contraindications: Hypersensitivity to ingredients
    • Dosage:
      • Adult: 0.3 mg
      • Pediatric: 0.15 mg
    • Actions: Administered intramuscularly, epinephrine works by constricting blood vessels, opening the airways, and reversing capillary permeability.
    • Side effects: Anxiety, nervousness, headache, tremor, sweating, nausea, vomiting, palpitations, and high blood pressure.

    Diabetes

    • A metabolic disorder that affects how the body regulates blood sugar (glucose).
    • Characterized by high blood glucose levels, due to either the body not producing enough insulin, or resistance to insulin.

    Normal Blood Sugar

    • 70-140 mg/dl

    Glucose Regulation Terms

    • Insulin: A hormone produced by the pancreas that allows glucose to enter cells for energy.
    • Glucose: The body's primary source of energy.
    • Glycogen: A form of stored glucose in the liver, readily available for when blood glucose levels drop.
    • Glucagon: A hormone produced by the pancreas that converts stored glycogen back to glucose when needed, raising blood glucose levels.

    Glucose Testing Procedures

    • A small blood sample is typically taken from the fingertip.
    • A lancet is used to puncture the skin and a drop of blood is collected onto a test strip.
    • The strip is then inserted into a blood glucose meter, which reads the blood glucose level and displays the results.

    Hypoglycemia

    • Blood sugar level less than 70 mg/dL.
    • Symptoms:
      • Altered level of consciousness (ALOC)
      • Pale, cool, and sweaty skin
      • May be combative

    Hyperglycemia

    • Blood sugar level greater than 200 mg/dL.
    • Symptoms:
      • Slow onset
      • Altered level of consciousness (ALOC)
      • Warm and dry skin
      • Kussmaul respirations (deep, rapid breathing)
      • Polydipsia (excessive thirst)
      • Polyuria (frequent urination)
      • Possible fruity odor on breath

    Type I vs Type II Diabetes

    • Type I Diabetes: An autoimmune condition in which the body's immune system attacks and destroys the cells in the pancreas that produce insulin.
    • Type II Diabetes: A condition in which the body does not use insulin properly, resulting in high blood sugar levels. (Insulin resistance)

    Abdominal Emergencies

    • Abdominal pain can be caused by a variety of conditions, including inflammation, infections, and bleeding.
    • Solid organs, when injured, bleed internally.
    • Hollow organs, when injured, can leak their contents, leading to infection.

    Causes of Abdominal Pain

    • Peritonitis: Inflammation of the abdominal wall.
    • Appendicitis: Inflammation of the appendix.
      • Pain generally starts around the belly button and radiates down the right side of the abdomen.
      • Rebound tenderness is common.
    • Cholecystitis: Inflammation of the gallbladder.
      • Referred pain to the shoulder is common.

    Cholecystitis Risk Factors

    • Often referred to as the "7 F's":
      • Flatulent
      • Fat
      • Female
      • Forty (years old)
      • Fertile
      • Fair skin
      • Freckled

    Pancreatitis

    • Inflammation of the pancreas.

    Gastroenteritis

    • Inflammation of the gastrointestinal tract.

    Hepatitis

    • Inflammation of the liver.

    Gastrointestinal Bleeding

    • Bleeding from any part of the gastrointestinal tract.
    • Note condition of blood:
      • Bright red
      • Dark
      • Coffee grounds
    • Determine the source of bleeding:
      • Mouth
      • Butt

    Esophageal Varices

    • Erosion of the esophageal tract.
    • Commonly due to alcoholism.
    • Bleeding can be severe.
    • Risk of airway and breathing issues due to potential blood flow into the airway.

    Abdominal Aortic Aneurysm

    • Similar to a thoracic aneurysm, but occurs in the abdomen.
    • Symptoms are similar to thoracic aneurysm, but located in the abdomen.
    • May palpate a pulsating mass in thin individuals.

    Primary Survey

    • General Impression:
      • Note patient positioning and level of pain.
      • Observe level of consciousness.
    • Chief Complaint:
      • Patients typically will describe their pain location before giving details using OPQRST.
    • Airway:
      • If patient is talking, the airway is patent.
    • Breathing:
      • Patient may be breathing shallowly due to pain.
    • Circulation:
      • Check for radial pulse and assess skin signs.

    SAMPLE History

    • Conduct a thorough OPQRST assessment.
    • Can be helpful for narrowing down a diagnosis.

    Vital Signs & Focused Secondary Survey

    • Note that pain stimulates the sympathetic nervous system.
    • This can lead to rapid breathing, pulse, and poor skin.
    • Differential diagnosis is important.

    Immune System

    • The immune system is a complex network of cells and organs that protects the body from disease.
    • Recognizes and fights off foreign invaders like bacteria, viruses, and allergens.

    Antigens and Allergens

    • Antigens are substances that trigger an immune response.
    • Allergens are a specific type of antigen that cause allergic reactions.

    Sensitization

    • The process of becoming sensitive to an allergen involves exposing the immune system to it.
    • Repeated exposure can lead to the development of allergies.

    Antibodies

    • Antibodies are proteins produced by the immune system to combat specific antigens.
    • They bind to allergens and trigger the release of histamine and other chemicals.

    MAST Cells

    • MAST cells are immune cells found in tissues that release histamine and other inflammatory mediators.
    • These mediators contribute to the symptoms of allergic reactions.

    Histamine

    • Histamine is a chemical mediator released by MAST cells during allergic reactions.
    • Causes a variety of symptoms, including:
      • Bronchoconstriction (narrowing of the airways);
      • Vasodilation (widening of blood vessels);
      • Increased capillary permeability (leakage of fluid from blood vessels).

    Allergic Reactions

    • Allergic reactions are immune responses to allergens.
    • They range in severity from mild (hives or skin rash) to severe (anaphylaxis).

    Anaphylaxis

    • Anaphylaxis is a severe, life-threatening allergic reaction.
    • Symptoms include:
      • Rapid onset;
      • Swelling of the lips, tongue, and face (angioedema);
      • Difficulty breathing (bronchoconstriction);
      • Low blood pressure (shock).

    Epinephrine

    • Epinephrine (adrenaline) is a medication used to treat anaphylaxis.
    • It reverses the effects of histamine by:
      • Relaxing airway muscles (bronchodilation);
      • Narrowing blood vessels (vasoconstriction);
      • Reducing capillary permeability.

    Epi-Pen

    • Trade name: Epi-Pen
    • Generic name: epinephrine
    • Indications: Used to treat anaphylaxis
    • Contraindications: None, except for known allergy to epinephrine
    • Dosage:
      • Adults: 0.3mg (Adult Auto-Injector)
      • Pediatric: 0.15mg (Junior Auto-Injector)
    • Actions: Reverses the effects of histamine, as described above.
    • Side effects: Tremors, anxiety, headache, tachycardia

    Diabetes

    • A chronic disease characterized by high blood sugar levels.
    • The body either does not produce enough (Type 1) or does not properly use (Type 2) insulin.

    Normal Blood Sugar

    • 70-140mg/dl

    Insulin

    • A hormone produced by the pancreas that enables glucose to enter cells.
    • It is essential for regulating blood sugar levels.

    Glucose

    • Body's primary source of energy.
    • It is absorbed into the bloodstream from food and used by cells for energy.

    Glycogen

    • The form in which excess glucose is stored in the liver.
    • When blood sugar levels are low, glycogen is converted back into glucose.

    Glucagon

    • A hormone produced by the pancreas that converts glycogen back into glucose when blood sugar levels are low.

    Glucose Regulation Cycle

    • The body constantly regulates blood sugar levels.
    • Insulin is released when levels are high, and glucagon is released when they are low.

    Glucose Testing

    • A common method for monitoring blood sugar levels.
    • Procedure:
      • Use a lancet to prick the finger.
      • Collect a blood sample.
      • Analyze the sample using a glucose meter.

    Hypoglycemia

    • Low blood sugar levels (< 70mg/dl)
    • Signs and symptoms:
      • Altered level of consciousness (ALOC);
      • Pale, cool, and sweaty skin;
      • Possible combativeness.

    Hyperglycemia

    • High blood sugar levels (> 200mg/dl)
    • Signs and symptoms:
      • Slow onset;
      • Altered level of consciousness (ALOC);
      • Warm, dry skin;
      • Kussmaul respirations (deep and rapid breathing)
      • Polydipsia (excessive thirst);
      • Polyuria (excessive urination)
      • Fruity odor on breath.

    Type 1 Diabetes

    • The body's immune system attacks and destroys insulin-producing cells in the pancreas.
    • Individuals with Type 1 diabetes require lifelong insulin injections.

    Type 2 Diabetes

    • The body does not produce enough or properly use insulin.
    • Usually develops over time due to lifestyle factors such as diet and lack of physical activity.

    Immune System

    • The immune system protects the body from foreign substances (antigens)
    • Recognizes antigens and produces antibodies to fight them

    Antigens vs Allergens

    • Antigens are any substance that causes the body to produce antibodies
    • Allergens are a specific type of antigen that causes an allergic reaction

    Sensitization

    • The process of the immune system becoming sensitive to a specific antigen
    • Repeated exposure to an allergen leads to sensitization
    • In anaphylactoid reactions, sensitization occurs without prior exposure to the allergen

    Antibodies

    • Proteins that bind to antigens and neutralize them
    • Produced by immune system cells (B-cells)
    • Trigger the release of histamine and other chemical mediators

    MAST Cells

    • Cells found in tissues that release histamine and other chemical mediators
    • Involved in allergic reactions and inflammation

    Histamine & Chemical Mediators

    • Chemicals released by MAST cells and other immune cells
    • Contribute to the symptoms of allergic reactions, including:
      • Vasodilation: widening of blood vessels
      • Bronchoconstriction: narrowing of airways
      • Increased capillary permeability: leakage of fluid from blood vessels

    Allergic Reaction vs Anaphylaxis

    • Allergic reactions involve localized symptoms
    • Common symptoms include hives and urticaria
    • Anaphylaxis is a severe, life-threatening allergic reaction
    • Differs from allergic reaction by presenting with systemic symptoms:
      • Angioedema: swelling of the face, lips, tongue, and throat
      • Bronchoconstriction: difficulty breathing
      • Shock: low blood pressure, rapid heart rate, and decreased consciousness

    Angioedema

    • Swelling of the face, lips, tongue, and throat
    • Can lead to airway obstruction and difficulty breathing

    Histamine's Effects on the Body

    • Causes vasodilation, bronchoconstriction, and increased capillary permeability
    • Contributes to the symptoms of allergic reactions

    Epinephrine's Effects on the Body

    • Reverses the effects of histamine
    • Bronchodilation: opens airways
    • Vasoconstriction: narrows blood vessels
    • Decreases capillary permeability: reduces fluid leakage

    Epi-Pen

    • Trade name: Epinephrine Auto-Injector
    • Generic name: Epinephrine
    • Indications: Treatment of anaphylaxis
    • Contraindications: Use in patients with known hypersensitivity to epinephrine
    • Dosage:
      • Adults: 0.3mg (0.3mL) via intramuscular injection
      • Pediatrics: 0.15mg (0.15mL) via intramuscular injection
    • Actions: Treats anaphylaxis by reversing the effects of histamine, resulting in bronchodilation, vasoconstriction, and decreased capillary permeability
    • Side effects: Anxiety, headache, restlessness, nausea, vomiting, dizziness, tremors, and palpitations

    Diabetes

    • Chronic disease characterized by high blood sugar levels
    • Body is unable to regulate blood sugar effectively

    Normal Blood Sugar

    • 70-140mg/dl

    Glucose Regulation Terms

    • Insulin: Hormone that allows glucose to enter cells
    • Glucose: The body’s usable form of energy
    • Glycogen: How extra glucose is stored in the liver
    • Glucagon: Converts released glycogen back into glucose when needed

    Glucose Testing

    • Procedure:
      • Prick finger with a lancet.
      • Apply a drop of blood to a test strip.
      • Insert the strip into a glucose meter.
    • Hypoglycemia: Blood sugar less than 70mg/dl with symptoms of altered level of consciousness (ALOC)
    • Hyperglycemia: Blood sugar greater than 200mg/dl

    Type I vs Type II Diabetes

    • Type I Diabetes:
      • Autoimmune disease that destroys insulin-producing cells in the pancreas.
      • Requires lifelong insulin injections.
    • Type II Diabetes:
      • Body does not use insulin properly (insulin resistance).
      • Often develops later in life.
      • May be managed with lifestyle changes, medication, and sometimes insulin.

    Hypoglycemia

    • Rapid onset
    • Altered level of consciousness (ALOC)
    • Pale, cool, sweaty skin
    • May be combative

    Hyperglycemia

    • Slow onset
    • Altered level of consciousness (ALOC)
    • Warm, dry skin
    • Kussmaul respirations: deep, rapid breathing
    • Polydipsia: excessive thirst
    • Polyuria: frequent urination
    • Fruity odor on breath possible

    ALOC (Altered Level of Consciousness)

    • Use AEIOUTIPS! to determine the cause.
    • Significant indication of injury or illness.

    AEIOUTIPS!

    • The "S" of SAMPLE for a patient with ALOC.
    • Alcohol (smell alcohol? Bottles lying around?)
    • Epilepsy (Bit tongue/bloody mouth, incontinence)
    • Insulin (check blood sugar).
    • Overdose/Underdose (pupil assessment, paraphernalia lying around?)
    • Uremia (recent infection).
    • Trauma (trauma).
    • Infection (recent infection, antibiotics).
    • Psychological (history, what was the onset of symptoms? Fast onset, look for other causes).
    • Stroke (Cincinnati stroke scale).

    Stroke

    • Formerly known as a Cerebral Vascular Accident (CVA).
    • Two Types:
      • Ischemic:
        • More common.
        • Similar to a myocardial infarction, but in a cerebral artery instead of a coronary artery.
      • Hemorrhagic:
        • Burst artery in the brain.
        • Aneurysm.
        • Patient often complains of "the worst headache of their life!"
    • Transient Ischemic Attack (TIA):
      • Mini stroke?
      • Stroke-like symptoms that resolve, usually within an hour or even 15 minutes.
      • Diagnosed as a TIA if the patient remains symptom-free for 24 hours.
      • Major precursor to a full-blown stroke.

    Stroke Assessment

    • When was the last time the patient was seen normal? This is the MOST IMPORTANT question.
    • Must deliver the patient to a stroke center hospital within:
      • 3 hours (per NR)
      • 6 hours (in SD County)
    • Cincinnati Stroke Scale:
      • Arm drift.
      • Facial droop.
      • Slurred speech.

    Seizures

    • Understand primary vs secondary seizures.

    Status Epilepticus

    • Generalized seizure lasting longer than 5 minutes, OR recurrent seizures without a lucid interval.

    Seizure Types

    • Generalized/Grand Mal:
      • Know the stages!
    • Absence/Petite Mal.
    • Febrile.

    Altered Level of Consciousness (ALOC)

    • ALOC indicates an injury or illness
    • Use AEIOUTIPS to determine the cause of ALOC
    • AEIOUTIPS stands for Alcohol, Epilepsy, Insulin, Overdose/Underdose, Uremia, Trauma, Infection, Psychological, Stroke

    AEIOUTIPS

    • Alcohol: Look for signs of alcohol consumption like smell or bottles
    • Epilepsy: Bitten tongue, bloody mouth, or incontinence
    • Insulin: Check blood sugar levels
    • Overdose/Underdose: Assess pupils and look for paraphernalia
    • Uremia: Recent infection
    • Trauma: Physical signs of trauma
    • Infection: Recent infection or use of antibiotics
    • Psychological: Consider patient history and onset of symptoms
    • Stroke: Use the Cincinnati Stroke Scale

    Stroke

    • Formerly known as a Cerebral Vascular Accident (CVA)
    • Two types: Ischemic and Hemorrhagic
      • Ischemic Stroke: Most common type, similar to a myocardial infarction but in a cerebral artery.
      • Hemorrhagic Stroke: Burst artery in the brain. Often related to aneurysms. Patients may experience the "worst headache of their life."
      • Transient Ischemic Attack (TIA): Mini-stroke with stroke-like symptoms that resolve.
        • Symptoms usually resolve within an hour (sometimes even 15 minutes).
        • Diagnosed as a TIA if the patient remains symptom-free for 24 hours.
        • A major precursor for a full-blown stroke in the future.

    Stroke Assessment

    • The most important question: When was the last time the patient was seen normal?
    • Patients must be transported to a stroke center hospital within:
      • 3 hours per national recommendations
      • 6 hours in San Diego County
    • Cincinnati Stroke Scale:
      • Arm drift
      • Facial droop
      • Slurred speech

    Seizures

    • A seizure is an uncontrolled electrical discharge in the brain.
    • Primary Seizure: Seizure that originates in the brain.
    • Secondary Seizure: Seizure that is the result of another condition.

    Status Epilepticus

    • A Generalized seizure lasting longer than 5 minutes or recurrent seizures without a lucid interval.

    Types of Seizures

    • Generalized/Grand Mal: Know the stages (Aura, Tonic, Clonic, Postictal)
    • Absence/Petite Mal: Short period of unconsciousness (usually only a few seconds).
    • Febrile: Seizures that occur in children as a result of high fever.

    Female Reproductive Anatomy

    • Ovaries: Produce estrogen and progesterone, and release eggs for reproduction.
    • Fallopian Tubes: Connect ovaries to the uterus.
    • Uterus: Pear-shaped organ that holds the fetus, composed of the fundus (top), body (middle), and cervix (bottom).
    • Placenta: Organ of pregnancy that provides oxygen and nutrients to the fetus.
    • Umbilical Cord: Connects the fetus to the placenta, containing one vein (oxygenated blood to fetus) and two arteries (waste back to placenta).
    • Amniotic Sac: Contains amniotic fluid that insulates and protects the fetus.
    • Vagina: The birth canal.

    Predelivery Emergencies

    • Spontaneous Abortion (Miscarriage): Passage of tissue before the 20th week of gestation, commonly occurring in the first trimester (8-12 weeks).
    • Ectopic Pregnancy: Fertilized egg implants outside the uterus, usually in the fallopian tubes. Can cause intense abdominal pain, internal bleeding, and shock.
    • Placenta Previa: Placenta implants over the cervix, often characterized by painless vaginal bleeding in the third trimester.
    • Abruptio Placenta: Premature detachment of the placenta from the uterine wall, causing intense pain and minimal external bleeding. Can be caused by factors like hypertension or trauma.
    • Ruptured Uterus: Spontaneous or traumatic rupture of the uterine wall, releasing the fetus into the abdominal cavity.
    • Preeclampsia/Eclampsia: Characterized by hypertension and swelling in the third trimester. Can progress to eclampsia with seizures, posing a high mortality risk to both mother and baby.
    • Supine Hypertensive Syndrome: Compression of the inferior vena cava by the uterus and fetus when the mother lies flat on her back. Leads to hypotension and can be avoided by propping up the patient's right side.

    Assessment of Predelivery Patients

    • Gravida: Number of pregnancies.
    • Para: Number of deliveries past 20 weeks gestation.

    Stages of Labor

    • Stage One (Dilation Phase): From the onset of true labor until full cervical dilation. Includes Braxton Hicks contractions (false labor).
    • Stage Two (Expulsion Phase): From full cervical dilation until the baby is born. Look for nuchal cord (umbilical cord wrapped around the baby's neck).
    • Stage Three (Placental Phase): Delivery of the placenta after the baby is born.

    Abnormal Deliveries

    • Prolapsed Cord: Umbilical cord presents before the baby's head. True emergency for the baby! Insert a gloved hand into the birth canal to lift the presenting part off the cord.
    • Breech Birth: Legs or buttocks present first. Allow delivery to happen naturally. If the head gets stuck after 2 minutes, insert a gloved hand into the birth canal to create an airway for the baby.
    • Limb Presentation: Single arm or leg is the presenting part. True emergency requiring a c-section.
    • Multiple Births: Proceed as normal, but suspect twins or more if:
      • Belly is still large after the baby is born.
      • Baby's size doesn't match the size of the abdomen.
      • Intense contractions start after the first baby's delivery.
    • Meconium: Baby has a bowel movement in the amniotic sac. Greenish or brown fluid upon water breaking indicates potential fetal distress.

    Postpartum Hemorrhage

    • Any bleeding exceeding 500cc after the baby is born.
    • Place the mother on high-flow oxygen.

    Cardiac Arrest

    • Cardiac arrest means the patient is unresponsive, not breathing, and has no pulse.
    • The most common reason for cardiac arrest in adults is cardiac problems and for children it is respiratory problems.

    Cardiac Arrest Terms

    • Downtime is from cardiac arrest until effective CPR is performed.
    • Total downtime is from cardiac arrest until the outcome.
    • Return of Spontaneous Circulation (ROSC) is when a patient regains their pulse.
    • Survival is when a cardiac arrest patient regains ROSC and is discharged from the hospital neurologically intact.

    Chain of Survival

    • The Chain of Survival is the sequence of events that need to be followed to increase the chance of survival after cardiac arrest.
    • It involves early recognition of cardiac arrest, early CPR, early defibrillation, early advanced life support, and post-cardiac arrest care.

    Recognizing Cardiac Arrest

    • Determine unresponsiveness by shaking and shouting or using painful stimuli.
    • Check breathing and pulse at the same time (maximum 10 seconds), checking the carotid pulse on your side.

    Starting CPR

    • For adults with one or two rescuers, compression to ventilation ratio is 30:2.

    • Compress at 100-120 compressions/minute with a depth of 2-2.4 inches.

    • Use two hands, center of chest, below sternal notch, above xyphoid process.

    • For children with one rescuer, compression to ventilation ratio is 30:2.

    • For children with two rescuers, compression to ventilation ratio is 15:2.

    • Compress at 100-120/minute with a depth of 1/3 diameter of chest (about 2 inches).

    • Use one or two hands, center of chest.

    • For infants with one rescuer, compression to ventilation ratio is 30:2.

    • For infants with two rescuers, compression to ventilation ratio is 15:2.

    • Compress at 100-120/minute with a depth of 1/3 diameter of chest (about 1.5 inches).

    • Use two hands, encircling thumb technique for both one and two rescuers.

    During CPR

    • Allow full chest recoil after compressions.
    • Minimize compression interruptions to 10 seconds or less.
    • You should be able to feel a pulse WITH compressions (carotid or femoral).

    ROSC and Following Actions

    • Recheck ABCs (airway, breathing, circulation) if ROSC is achieved.

    Age Categories

    • Infant: birth to 1 year of age, including neonates (birth to one month)
    • Child: 1 year until puberty (underarm hair for boys and breast tissue for girls)
    • Adult: Puberty and above

    Cardiac Arrest

    • Cardiac arrest simply means the patient is unresponsive, not breathing, and has no pulse
    • The most common reason for cardiac arrest is cardiac problems in adults and respiratory problems in children

    CPR

    • Adult CPR compression to ventilation ratio is 30:2
    • Child CPR compression to ventilation ratio is 30:2 for one rescuer and 15:2 for two rescuers
    • Infant CPR compression to ventilation ratio is 30:2 for one rescuer and 15:2 for two rescuers
    • The CPR rate for all ages is 100-120 compressions per minute
    • Adult CPR depth is 2-2.4"
    • Child CPR depth is about 2" (1/3 the diameter of the chest)
    • Infant CPR depth is about 1.5" (1/3 the diameter of the chest)
    • During CPR, allow full chest recoil with compressions and minimize interruptions to 10 seconds or less

    AED

    • AEDs are used on unresponsive patients who are not breathing and have no pulse
    • The AED will defibrillate the following rhythms: Ventricular Fibrillation (Vfib) and Ventricular Tachycardia (Vtach)
    • Remove medication patches, dry the patient if in water, avoid pacemakers, and remove all clothing before placing AED pads
    • Never touch the patient during the analyzing phase, clear the victim before pressing the shock button, and pull to the side of the road and stop to analyze every time while transporting in the ambulance

    Rescue Breathing

    • Rescue breathing is used when the patient is not breathing but has a pulse
    • Adults: 1 breath every 5-6 seconds (10-12/minute)
    • Children/Infants: 1 breath every 2-3 seconds (20-30/minute)
    • Do not use rescue breathing rate during CPR

    Obstructed Airway/Choking

    • Conscious Patient: perform abdominal thrusts (Heimlich maneuver) for an adult/child and 5 back blows and 5 chest thrusts for an infant
    • Unconscious Patient: perform CPR on an adult/child (check mouth before breaths) and 5 back blows, 5 chest thrusts, and attempt ventilations for an infant (check mouth before breaths)
    • For partially obstructed airways: encourage patient to stay calm and continue working to relieve obstruction but do not perform abdominal thrusts

    Stages of Labor

    • There are 3 stages of labor

    Return of Spontaneous Circulation (ROSC)

    • Recheck ABCs following ROSC

    Stages of Labor

    • Stage 1: Labor begins, cervix opens (dilation) and thins (effacement)
    • Stage 2: Baby is born
    • Stage 3: Placenta is delivered.

    Breech Birth

    • We treat a breech birth by placing the mother in a knee-chest position and elevating the hips with pillows

    Limb Presentation

    • Treat a limb presentation by placing the mother in a knee-chest position and elevating the hips with pillows

    Imminent Delivery

    • Signs of imminent delivery: the baby's head is crowning, the mother is pushing with strong contractions, and the woman has a strong urge to push.
    • When to insert fingers into the birth canal: (1) prior to delivery to assess cord prolapse and (2) once baby is born, to assess for further births
    • Never place your fingers into the vagina during labor

    Apgar Scoring

    • Apgar scoring is a quick assessment of a newborn baby's health at 1 and 5 minutes after birth.
    • It assesses: appearance, pulse, grimace, activity, and respiration.

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    Description

    This quiz focuses on the crucial aspects of airway management, ventilation, and respiration in emergency medical care. It covers the anatomy of the airways, the mechanics of breathing, and the processes involved in gas exchange. Test your knowledge on how these elements work together to ensure effective patient care.

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