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DAACE ALL MODULES EXAM ACTUAL QUESTIONS
AND CORRECT ANSWERS ALREADY GRADED A+
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Amiodarone would be given in which emergency? V. Tach What medications can be given for a sever case of hyperventilation? Versed, Valium, or Propofol Secretes epinephrine, norepinephrine, and corticosteroids. Ectopic focus Displaced central point of origin for cardiac dysrhythmias. Inferior alveolar artery Supplies blood to teeth, mandible, lower lip, and chin. Inferior vena cava Drains lower extremities and abdominal viscera into right atrium. Brachial artery Supplies blood to shoulder, arm, forearm, and hand. Facial artery Supplies blood to face, tonsil, palate, and submandibular gland. T's of pulseleas electrical activity PVC's are treated with which medicine? Lidocaine Epi is given in which two emergencies? V. Fib and asystole
Max dose of epi for cardiovascular disease pt .04mg A beta blocker would be given in which emergency? Hypertension A fluid bolus of NS and ephedrine can be given with what emergency? Hypotension What medications are used to treat malignant hypothermia? Dantrolene, IV cold saline (not Ringer's) Nasopharyngeal airway When tongue is obstructing airway. Tube is lubricated and passed through the nose into nasal cavity. Sits in oropharynx behind tongue. Well tolerated and can be used on awake pts. Oropharyngeal airway Also placed to position tongue in more anterior position. Often interfere with intra oral procedures. Not tolerated well with awake pts. Laryngeal mask airway (LMA) Device that sits over top of larynx. Can be placed blindly. Does not protect against aspiration. Inflated with 30cc to create seal. Endotracheal intubation End of tube passes through vocal cords and terminates half way between vocal cords and bifurcation of trachea. Important to listen to both lungs after placement. May or May not be cuffed. Combitube Generally used for specific emergencies. Both cuffs inflated. Pts predisposed to bronchospasm Allergies, asthma, copd, bronchitis Bronchospasm
Optic nerve 2nd cranial nerve that controls sight Internal jugular vein Drains much of blood from head and neck Purkinje fiber system Causes muscles of heart to contract. Spreads impulse rapidly along heart muscle. Brachiocephalic artery Branches into right common carotid in neck and right subclavian artery in arm. Hematocrit % blood volume made up of red blood cells. Men: 42-52% women: 37-48%. Anything below 35% considered anemic. Mental artery Supplies blood to chin. Ischemia Reduced blood flow in coronary arteries. Lack of oxygen to heart cells weakens, but does not kill them. Maxillary artery Supplies blood to maxilla, teeth, sinuses, and portion of nose. Medulla oblongata Coordinating region for impulses. The seat of many autonomic centers. Normal levels of hemoglobin Males: 13-18 mg/dL Females: 14-16 mg/dL Oropharynx Located between soft palate and epiglottis. Facial nerve
7th cranial nerve. Supplies motor fibers to muscles of facial expression. Trigeminal nerve 5th cranial nerve. Supplies sensation to teeth and jaws. Vagus nerve 10th cranial nerve. Supplies fibers to many parts of body. (Ears, tongue, pharynx, larynx, thoracic/abdominal viscera). Pulmonary veins Return oxygenated blood to left atrium from lungs. Only veins that carry oxygenated blood. Superior vena cava Drains head, neck, and upper extremities into right atrium. Adrenal glad Toxins, trauma, thrombosis, tension pneumothorax, tamponade H's of pulseless electrical activity Hydrogen ion, hypoxia, hypovolemia, hypoglycemia, hypo/hyperkalemia, hypothermia. Pulseless electrical activity (PEA) Normal appearing tracing, but patient has no pulse. Asystole Cessation of all contractions. "Flat line" usually follows v. fib or v. tach. Treated with CPR. Ventricular fibrillation v. fib Course v. fib with prominent, erratic baseline or fine v. fib with far less pronounced vacillations. No p, qrs, or t. Often precedes asystole. Class III Pt has severe systemic disturbance or disease. Class IV
Social history review of systems Patients smoking and alcohol history/current use should be noted along with illegal drug use. Ventricular foci Located in ventricles Supraventricular foci Located above level of ventricles in atria. Antibiotic prophylaxis for total joint replacement patients Previous joint infection, 2 yrs following joint replacement, malnourishment, hemophilia, diabetes type I, immunosuppressed or immunocompromised patients. AV blocks PR length is prolonged or varies in length due to impulse being partially or completely blocked as it attempts to travel from atria to ventricles via AV node. Patients who need antibiotic prophylaxis Previous infective endocarditis, prosthetic valves, cardiac transplant patients who develop valvulopathy, congenital heart disease. Congestive heart failure Condition caused by the heart is unable to handle blood volume coming back to it from either the lungs or peripheral circulation. 3 characteristics of normal heart rhythms Rate, regularity, and rhythm. MVP (mitral valve prolapse) One or more of valve flaps don't close completely allowing redundancy of valve leaflets into left atrium. Rheumatic heart diseases Condition caused secondary to rheumatic fever (beta hemolytic streptococci) which damages the heart valves, primarily the mitral valve, and causes heart murmur.
MI (myocardial infarction) Heart attack. Six should be performed on patient until 6 months after. Right sided heart failure Increased pressure of fluid in blood vessels causes fluid to leak into body's tissues causing peripheral edema and ascites Left sided heart failure Increased pressure of fluid in blood vessels causes fluid to leak into lungs. Patients often present with shortness of breath. Review of systems musculoskeletal Weakness of extremities, atrophy of muscles, frequent cramping of muscles. Review of systems neurologic Weakness of extremities, hx of projectile vomiting, headaches, visual disturbances, any unexplained pain or numbness in body. Review of systems pulmonary Shortness of breath, dizziness, chronic cough, wheezing, productive cough. Review of systems genitourinary Painful urination, blood in urine, frequent urination, incontinence, discharge in urine. Review of systems gastrointestinal Loss of appetite, swallowing, change in taste, nausea, vomiting, diarrhea, constipation. Review of systems skin Bruising, bleeding, discoloration. Review of systems cardiovascular Headaches, dizziness, nosebleeds, shortness of breath, chest or arm pain, edema. Review of systems general Weight loss, loss of appetite, weakness, fatigue.
Predisposes patients to laryngospasm and bronchospasm. Upper respiratory infection (URI) Common cold or cough which produces increased secretions in airway. Best to delay surgery. Involves sinuses, nasal passages, pharynx, and larynx. Diabetes mellitus Metabolic impairment where the body is unable to metabolize glucose properly causing increased blood glucose levels. This prevents the body from metabolizing carbs properly. Type I Insulin dependent diabetes. Type II diabetes Non insulin dependent Considerations for diabetic patients Patients with diabetes do not heal as quickly and are more prone to infection. Often placed on antibiotics. Fasting blood sugar (FBS) 125 mg/dL normal or in control Insulin overdose Give patient sugar, candy, or sugar containing beverage. Glucose IV or glucagon IM if patient is sedated. Emphysema Enlargement of alveolar sac in lungs along with destruction and scarring of alveoli which makes less surface area available for exchange of O2 and CO2. Smokers. Risks of kidney disease Patients with kidney disease may have difficulty eliminating medications from their body. Sx should not be scheduled on same day as dialysis. Epilepsy Seizures. If an incident occurs during anesthesia Valium IV can be given.
TIA (transient ischemic attack) Mini stoke. Sudden neurological loss of function with full recovery in 24 hrs. Cerebrovascular accidents (CVA/stroke) Neurological impairment caused by disruption of blood supply to area of brain. Ischemic stroke 85% caused by occluded blood vessel. Hemorrhagic stroke 15% caused by ruptured artery (aneurysm) Trimester to best perform surgery 2nd trimester. Most risk to fetus in 1st trimester. Obesity 20 % above ideal body weight [(wt in lbs/height in inches)2] x 703 Modifiable risk factors of stroke High blood pressure, diabetes, heart disease, smoking, TIA, increased red blood cells, sickle cell disorder. Unmodifiable risk factors for stroke Male, age 55 or older, two times African American, previous stroke, heredity. Considerations for obese patients Use of a large blood pressure cuff, difficult venous access, patients should be treated in upright or semi fowler position. Protease inhibitors Patients with HIV take this medications. It prolongs effects of benzodiapam derivatives. INR Pulmonary artery
Upper airway Nasal passages, sinuses, pharynx, and larynx. Max O2 hemoglobin 1.34 mL Anemia Decreased amount of hemoglobin concentration. Below 35% Diaphragm Dome shaped muscle that separates the chest cavity from abdominal cavity. Most important muscle of inspiration. Cerebellum Main motor coordinating area. Stroke volume Total amount of blood pumped out of left ventricle in one beat. 60 mL. Left atrium Receives oxygenated blood from lungs via pulmonary vein. Tidal volume Normal breathing 500 cc of air is inhaled and exhaled. Basilic veins Located on inner (medial) aspect of forearm. Dead space No gases are exchanged. 150 cc. Extends from pharynx to bronchioles. Allows CPR to take place. O2 capacity Blood has a certain amount of O2 it can carry depending on hemoglobin available. Nasopharynx Located above back of soft palate.
External respiration O2 is inspired and enters the body by coming in contact with blood and alveoli. Pharynx Located between nose and trachea. 3 parts nasopharynx, oropharynx, laryngopharynx Synapse A junction between two neurons. Hypoxia Lack of O Automaticity Ability of heart muscle to contract on it's own without nerve stimulation. Best places to check for patients pulse Carotid arteries and radial arteries. Trachea Wind pipe. Neurons Nerve cells Tachycardia HR above 100 bpm Sensory nerves Receive messages from environment and and conduct messages back to CNS. CAC (cardioacceleratory center) Located within medulla. Sympathetic fibers travel down spinal cord to SA node. When stimulated release norepinephrine with increases HR and strength of contractions. Cardiac output
Sends deoxygenated blood to lungs via pulmonary artery. Respiration rate 12 - 16 per minute QRS complex Ventricular depolarization Left ventricle Pumps oxygenated blood to peripheral circulation via aorta. Cricothyrotomy/coniotomy The passage of a large needle through the cricothyroid ligament. Used in upper airway obstruction. T wave Ventricular repolarization Angina pectoris Chest pain. Caused by ischemia. Can be treated with nitroglycerin. Robinul or atropine Inhibits parasympathetic stimulation of increased saliva. Decreases secretions. Erythrocytes Red blood cells Dorsal venous plexus Back of hand. Normal HR 60 - 100 bpm Bradycardia HR of less than 60 bpm Blood pressure Systolic/diastolic. Normal BP 120/80.
Flow of blood through the heart Inferior/superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary valve, pulmonary artery, lungs, pulmonary vein, left atria, mitral valve,eft ventricle, aortic valve, aorta, peripheral circulation. Antecubital space Anterior surface of elbow located between arm and forearm. SA node Located in right atrium. Acts as pacemaker. Produces sinus rhythms. Systolic phase Both ventricles contracting simultaneously. P wave Atrial depolarization Phlebitis Inflammation of vein Capillaries Smallest arteries where the exchange of O2, CO2, cell by products, and nutrients are exchanged between blood and cells of body. Diastolic phase Both atria contracting simultaneously. Autonomic nervous system Sympathetic and parasympathetic nervous system Motor nerves Carry out responses from CNS. Cardiac cycle One alternate contraction and relaxation of atria and ventricles followed by a short pause. Cerebrum
Treatment for seizures IV access, Valium 5mg IV or medazolam 3mg, continue to monitor vitals, activate EMS Treatment of syncope (fainting) Tredelenburg position, ABC's, head tilt chin lift, 100% O2, monitor vitals, relax/reassure patient Treatment of acute adrenal deficiency Terminate procedure, monitor vitals, tredelenburg position if hypotensive, activate EMS,IV access, steroid administration, fluid bolus, transport to hospital Treatment of hypoglycemia Activate EMS, IV access, measure blood sugar with glucometer, 1 amp of glucose, IV infusion of dextrose or glucogan IM if no IV Treatment of intra arterial injection Activate EMS, secure catheter DO NOT REMOVE, 10 cc lidocaine w/o epinephrine, ice pack to limb Propofol Mimics barbiturates. Rapidly redistributed and metabolized due to being highly bound to fat.Does not tend to predispose to laryngospasm and has antiemetic properties. Discard after 12 hrs. Treatment for high blood pressure 200/ Terminate procedure, check monitor function, attempt to determine cause, record vitals every 5 min, consider EMS, IV access, beta blockers (labetalol, esmolol, atenolol) Treatment for asystole/PEA CPR, epinephrine IV may repeat every 3-5 min, one dose of vasopressin may be given to replace 1st and 2nd dose of epi Treatment of ventricular fibrillation Activate EMS, CPR/AED, cont CPR and establish IV, give epinephrine 1 mg every 3-5 min, CPR/repeat shocks as above, may give single dose vasopressin to
replace 1st and 2nd dose epi, amiodarone, lidocaine, and magnesium considered as well. Treatment of ventricular tachycardia 100% O2, amiodarone 150mg IV over 10 min, prepare for synchronous cardio version Treatment for premature ventricular contractions (PVC) Try to determine cause (ie hypoxia) and correct, lidocaine IV repeat every 5- 10 min until 3mg/kg administered Treatment of supraventricular tachycardia Place patient in supine position, adenosine 6mg, after 1-2 min adenosine 12mg, 3rd dose given in 1-2 min as needed. MONA Morphine, oxygen, nitroglycerin, aspirin Treatment for symptomatic bradycardia Terminate procedure, 100% O2, establish IV, atropine, may need ER for transcutaneous pacing. Treatment for heart attack Activate EMS, closely observe vitals, 100% O2 via mask, make pt comfortable/reassure, attach AED/defibrillator, aspirin 325mg, establish IV with normal saline slow drip, morphine 2-4 mg every 5-10 min Symptoms of heart attack Chest pain, anxiety, weakness, sweating, cardiac dysrhythmias, drop in blood pressure. Black Nitrogen Yellow Compressed air Topical anesthetics
