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PCP Questions

Study questions for Primary Care Paramedic (Saskatchewan) to get you thinking

This type of pain originates when hollow organs are obstructed producing cramps and diffuse, wide spread pain Visceral
________ is a progressive, degenerative disease of the medium-sized and large arteries Atherosclerosis
In children younger than 18 months, their state of hydration, and possibly head trauma, can be assessed by evaluating their fontanelles. A “normal presentation” should be _________. Open and flat
What is the difference between stable and unstable angina? Stable occurs after a predictable amount of exertion and is similar to other ‘attacks’, unstable is characterized by noticeable changes in frequency, severity and duration of pain
A positive deflection on the ECG tracing paper indicates: The electrical impulse is moving toward the positive electrode
A run of ventricular tachycardia occurs if at least ____ PVCs occur in a row 3
Proper pad placement for defibrillation is: Right of the upper sternum and left in an anterior auxiliary line over the apex of the heart
What rhythms can PCP's defibrillate? Pulseless Vtach Vfib
Identify the contraindications of Nitroglycerine Systolic below 100mmHg Heart rate below 50BPm Viagra, Levitra, Cialis or similar in last 24hours
What SPO2 reading indicated possible respiratory compromise? 91%
What is the ideal blood pressure for an ICP patient? Why? Systolic of 110/120 ICP=MAP-CPP
What is Status Asthmatics? Prolonged asthma attack that does not respond to bronchodilator therapy
Numbness and tingling of the hands and feet, caused by hyperventilation syndrome, is due to: Respiratory alkalosis & decreased carbon dioxide levels
What is the primary antibody involved in an anaphylactic reaction? IgE
What is the safe residual (when an oxygen cylinder is considered empty)? 200 psi
Your patient is a 16 year old girl who has just been involved in an argument with her family. Examination reveals rapid, deep ventilations; dizziness; numbness around the mouth and tingling in the fingers. What condition is she suffering from? Hyperventilation syndrome
Flow rates for Nasal Cannula 1-6 lpm
What is digital clubbing MOST indicative of? Chronic Hypoxia
The OPA should be measured from Jaw line to corner of mouth
The NPA should be measured from Tip of the nose to earlobe
CPAP what does it do? Forces fluid from the alveoli, improve pulmonary gas exchange
Etc02 Volumes (ICP/Non-ICP) 30mmHg 35-45mmHg
What is Dysphagia? Difficulty Swallowing
You are on scene with a cardiac arrest patient and receive a copy of a valid DNR order after you have begun resuscitation attempts. You are ethically obligated to: Cease resuscitation efforts
DCAP BLS TIC DRT What do they stand for? Deformities, contusions, abrasions, penetrations (protruding viscera/paradoxical movement/pulsating masses) Burns, lacerations, swelling Tenderness, instability and crepitus Distension, rigidity, tenderness
Formula for IV flow rates? Volume(ml) x set(gtts/ml)=time (min) x drip rate (gtts/min)
What is orthostatic tilt testing? Taking blood pressures laying, sitting and standing
What should you do with a prolapsed cord? Transport quickly, gently push baby off cord if needed, have mom pant through contractions to avoid pushing.
Scenario: You arrive at the scene just as a 28-year-old has delivered her first child. Your initial assessment of the neonate revealed core and peripheral cyanosis, apnea, and a pulse of 74beats/min. Your initial treatment is: Warm, dry and stimulate for 30 seconds
A lethargic 5 year old child presents with diarrhea, dry mucous membranes, sunken eyes, oliguria and vomiting. Your treatment for fluid resusatation, as per protocol is: 20mls/kg
Meconium staining indicates Fetal distress in utero
Drug Calculation formula Desired dose x volume of container/pill = amount to give Dose on hand
At what point do you begin breathing for your patient? Absent breathing-vent twice and check pulse Less than 8-assist at 8-10/min Low tidal volume-assist at 8-10/min Labored-o2 by NRB
What are the three indicators that allow you to ‘hyperventilate’? GCS less than 8 with posturing GCS less than 8 with pupillary asymmetry or nonreactive GCS less than 8 with drop of two or more points
What are normal breathing rates for: Adults Small children Infants 10-20 15-30 25-50
What is Serum Lactate monitoring? A marker for tissue hypoxia. When the cells run out of oxygen and switch to anaerobic metabolism and start to produce lactic acid.
Formula for MAP Diastolic BP + 1/3 (systolic BP-Diastolic BP)
Rules for Refusal of Care LOC No signs of impairment (mental, drugs/alcohol, ect.) Vitals must be stable Pt must understand the risks of refusing Pt understands instructions given on how to call EMS back or seek medical eval
Indications for a BVM Apneic patients Patients whose respiratory rates are to slow or fast to provide adequate tidal volume.
What are the contraindications for inserting a combitube? Intact gag reflex Airway obstruction/actively vomiting Pt under 4 feet Known or suspected caustic ingestion Know esophageal disease
What are the contraindications for inserting a King air way? Intact gag reflex Airway obstruction/Actively vomiting Pt under 3 feet (3 kings) Known or suspected caustic ingestion Known esophageal disease
What are the three chambers in chest tube drainage unit or ‘helmlich valve’. Explain them. Suction-should be between 15-20 depending on doctors orders, rolling boil Water seal-should not be bubbling, rise in the middle tube is inspiration and expiration Drainage collection Make sure pt is hemodynamically stable and get rate of drainage
CPAP indications Hypoxemia secondary to CHF Acute cardio shock Pulmonary edema Asthma/COPD Resp rate less that 25, SP02 less 92% and accessory muscle use during inspiration
CPAP contraindications Pneumothorax/chest trauma or tracheotomy Hemodynamically unstable Altered LOC Actively vomiting Upper GI Bleed Under 12 or unable to fit mask
Acetaminophen Indications/Contra Dose Reduction of fever Hypersensitivity/actetam-induced liver disease ADULT: 325-650mg q 4-6 hrs not to exceed 4000mg/24hrs PEDS: 10-15mg/kg q 4-6hrs not to exceed
ASA Indications/Contra Dose Anti-platelet again to reduce non-fatal MI/stroke Prevent death in setting of STEMI and NSTEMI Hypersensitivity/Asthma (precaution) May cause stomach/prolonged bleeding ADULT: chew 160-325mg uncoated
Dextrose Indications/Contra Dose Hypoglycemia Side effects (fever, injection site infection) ADULT: Tablets or 50ml D50W PEDS: Tablets or 2-4ml/kg D25W
Epinephrine Indications/Contra Dose Anaphylaxis/severe bronchospasm Hypersensitivity/shock ADULT: 0.5mg may repeat after 5 min if necessary PEDS: 0.5mg/kg for Croup 0.01mg/kg to max of 0.5mg may repeat 5 min if necessary
Glucagen Indications/Contra Dose Treat hypoglycemia where a large vein cannot be established Hypersensitivity/pheochromacytoma ADULT: 1mg repeat q 15 min as needed PEDS: (under 12) 0.1mg/kg repeat q 15 min as needed
Atrovent Indications/Contra Dose Patient with bronchospasms unresponsive to salbutamol Hasn’t had in the last 4 hours Glaucoma/hypersensitivity ADULTS: (12 & older) 1.0-2.0 ml repeated as necessary PEDS: (5-12) 0.5ml repeated as necessary
Narcan Indications/Contra Dose Opiate induced depression/opiate overdose Hypersensitivity CAREFUL WITH WITHDRAWL SYMPTOMS/PAIN Dose: 0.4-2mg every 2-3 min PEDS: 0.01 mg/kg repeat once at 0.1mg/kg if needed
Nitroglycerine Indications/Contra Dose Chest pain cardiac origin/with pulmonary edema Systolic below 100mmHg Heart rate below 50BPm Viagra, Levitra, Cialis or similar in last 24hours ADULTS: tablet or spray q 3-5 min to max of 3
Nitrous Oxide Indications/Contra Dose Cardiac Chest pain Active labor Pain due to musculoskeletal trauma or amputation Burns Should not be admin without O2 Head injury/inebriation/drugs Facial injuries Inability to follow instructions Pneumothorax Decompression sickness
Salbutamol Indications/Contra Dose Exacerbation of asthma/chronic bronchitis Tachyarrhythmia ADULT: 2.5-5mg neb 6-8lpm PEDS: 1.25 mg in severe 2.5mg (both with 2-4ml NaCL)
Signs of Compensated Shock & Reasons Weakness/light headed (decreased blood volume) Pallor/pale (vasoconstriction) Tachycardia/tachypnea (release of catechomines) Diaphoresis (Catecholmines) Weakened peripheral pulses (shunting) Thirst (hypovolemia)
Signs of Decompensated Shock Hypotension (diminished cardiac output) Altered LOC (decreased cerebral profusion, acidosis, hypoxia) Cardiac Arrest (Organ failure 2ndary to blood loss, hypoxia and occasionally arrhythmia) Confusions, restlessness or combativeness
What is a Flail Chest and how do you treat it? (as PCP) Two or more adjacent ribs in or more places fractured Ventilation & pain management PEEP with ET tube for large, CPAP for small
Signs of a Hemothorax & how to treat it (as PCP) Neck veins are usually flat, shock may be present, decreased breath sounds and dullness to percussion on affected side. High flow O2-Load and Go-notify med control Treat for shock
Signs of Tension Pneumothorax & how to treat it. (as PCP) Dyspnea, anxiety, tachypnea, JVD & possible trach dev away from affected side. Diminished/absent breath sounds on affected side accompanied by hyperresponse. Shock with hypotension will follow. High flow O2 (Decompression)-load and go-notify med control
Signs of Cardiac Tamponade & how to treat it. (as PCP) Beck’s Triad, pulsus paradoxus. Shock High flow O2-load and go-ECG-treat for shock/dysrhythmias-watch to other complications.
Signs of Traumatic Asphyxia & how to treat it (as PCP) Results from a severe compression of the chest. Pts appear similar to those who have been strangulated. (cyanosis & swelling of neck and head) Conjunctival hemorrhage. Skin below injury appears normal. Airway-IV-treat other injuries-Rapid transport
In regards to a brain injury, what is Coup, Contracoup and Secondary brain injury? Coup: injury to the brain in area of original impact Contracoup: injury on the opposite side of original impact Secondary: hypoxia/decreased perfusion to the tissue of primary injury.
What is Cushing’s Reflex? The body responds to markedly elevated ICP by raising both diastolic and systolic BP, and reducing HR and RR.
What does APGAR stand for? Activity, Pulse, Grimace, Appearance & Respirations
Why is it so important to have IV started before relieve a crushed patient? The build-up of toxins due to lack of blood flow. Will all rush back into circulation and can cause major issues.
Baby has a HR of 90, is not crying, pale blue and hardly moving. What is baby’s APGAR? 2
Pt tracks you as you enter, uses inappropriate words but is able to localize pain. What is their GCS? 12
Pt opens eyes to pain, is confused and withdraws from pain. What is their GCS? 10
Baby’s HR is 110, is crying, pink with blueness in extremities and active. What is baby’s APGAR 7
What is the Parkland Formula? 4cc Ringers/NaCl x % of burn area x weight (Kg) Half given in the first 8hours and the remainder over the next 16 hours. Ringers preferred as NaCl can cause hyperchloremic acidosis in such large amounts
Pt has mottled red burns that are weeping, what degree of burn do they have? 2nd degree or Partial
Pt has very painful red burn covering both hands, what degree of burn and percentage is this? 1st degree or superficial
What is the treatment for burns? Why is ice not a good idea? Cool with room temp water. Remove clothing and jewelry around burn. Cover with dry sterile dressing unless small burn you are trying to keep cool. Watch for hypothermia! Manage pain. Causes vasoconstriction limiting blood supply to already damaged tissues
Your patient has burns to the entire left leg, groin area and front bottom half of the right leg. What is the percentage? 23.5%
What is FAST and what is it for? Focused assessment with sonography in trauma. Assesses 4 areas of the abdomen for free fluid.
Reason for metal state: AEIOU/TIPS What do they stand for? Alcohol, epilepsy, insulin, overdose, uremia Trauma, infection, psychiatric/poisons, stroke
A child has burns to their left leg, left arm and left side of the front of their chest. What percentage of burns do they have? 32%
Created by: Seenah1
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