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Shivering is a response by the body to generate heat. It does not occur below body temperature of 90 degrees F.

Stage 1

Apathy and decreased muscle function. First fine motor function is affected, then gross motor function.

Stage 2

Decreased level of responsiveness is accompanied by a glassy stare and possible freezing of the exteremities.

Stage 3

Decreased vital signs, including slow pulse and slow respiration rate.

Stage 4


Stage 5

?? is a combination of dehydration and ketoacidosis. It is seen in diabetics who are not under medial treatment, who take insufficient insulin, etc.

Diabetic Coma

With Diabetic Coma s/s include: Air hunger a.k.a _______,
Dehydration , sunken eyes
____ or ____ breath odor
A rapid, weak pulse.

"Kussmaul respirations"; Sweet or Fruity

What are the 3 "P's" of Diabetes?

Polyuria, Polydypsia, Polyphagia

What is HHNC?

Hyperglycemic Hyperosmolar nonketoic coma

Describe what HHNC is.

Is a diabetic emergency usually seen in elderly Type 2 diabetics. Thy develop hyperglycemia leading to polyuria and resultant dehydration but not s/s of acidosis.

If a patient is Diabetic and has eaten but not taken their insulin then the problem is probably that their developing what?

Diabetic Ketoacidosis

If a patient is Diabetic and took their insulin but forgot to eat, then the problem is probably what?

Insulin Shock

What is the 1st treatment you should do in Diabetic Emergencies?

Call 911

_____: is a rapidly developing life threatening diabetic emergency. It is seen in diabetics who have taken too much insulin, have forgotten to eat or thrown up their last meal.

Insulin Shock

15. What are the s/s of Insulin shock?

Normal or rapid respiration
Pale, moist, diaphoretic skin
Dizziness and intense headache
Full rapid pulse or normal BP
Aggressive or unusual behavior
Intense hunger, fainting, seizures, or coma

What are the s/s of Diabetic Coma?

Air hunger
Dehydration manifested by dry, warm skin, sunken eyes, and loss of turgor in the skin
A Sweet or Fruity (acetone) breath odor
A rapid, weak pulse
A normal or slightly low BP
Vary degrees of unresponsiveness

What are the 3 Phases of a Grand mal seizure?

1. Aura
2. Convulsion
3. Posticta

____ this is a sensation perceived by the patient. It is a prodromal warning that a seizure is about to happen. It takes on many forms: a sound, smell, twitch, feeling of anxiety or dizziness. This last a very short time and is immediately followed by convulsion.


_____: Sustained, tonic muscular contractions, which can cause odd posturing may last 1 to several minutes. Clonic muscular activity or spasms, may be superimposed on the tonic contractions. During this the jaw is clenched, breathing is compromised, the patient is often incontinent of bowel and bladder. They can become quite cyanotic.


_____: This is a phase of exhaustion and recovery. Lasting 10-30 minutes to hours. Patient is fatigued, w/ depressed LOC. Local transitory weakness or paralysis may be present.


_____ is a sudden decrease in consciousness, sensation, and motor function cause by rupture or obstruction of an artery in the brain.

Cerebrovascualr accident (CVA) (stroke)

_____: A clot in a cerebral vessel caused by arteriosclerosis and the progressive narrowing of the lumen of the arterial walls. This is the most common cause of stroke


S/S of a CVA?

one sided monoplegia or hemiplegia
Difficulty w/ speech
Visual disturbances

____ has the signs and symptoms of a stroke but lasting only a few minutes up to 24 hours

TIA (Transient Ischemic Attack)

With this the patient recovers completely without permanent disability, this can be a warning of an impending major stroke.


Person is choking what do u do?

check scene, check person, call 911, obtain consent
Lean person forward and give 5 back blows with heel of hand
Give 5 abdominal thrusts

When performing CPR give the following depths that need to be done.

Infant: ½ or 1 inch
Child: 1 inch
Adult: 2 inches

CPR compress chest ___ times at a rate of about ____ compressions per minute.


How long are you suppose to check for signs of life?

10 seconds

CVA vs. Bell's Palsy

CVA vs. Bell's Palsy

This is a peripheral lesion involving the VII CN.

Bells Palsy

With this one entire side of face will show weakness, including the forehead.

Bell's Palsy

With a CVA in the cortex the ___ is spared.


T/F: If the patient has paralysis of lateral eye movement with facial paralysis this is Bell's Palsy.

FALSE ( immediate referral)

What is the treatment of Inhaled Poisons?

Call 911, wait if scene is not safe
Get victim to fresh air
Give BLS
Watch for pulmonary edema
Give oxygen
Save containers, etc. clues about the poison

Never induce vomiting when:

pt is unconscious
Pt has swallowed a corrosive chemical
Pt has swallowed a petroleum product
Pt is pregnant
Pt has severe cardiac disease
Pt under 1 y/o
Pt is seizing

Would you use charcoal when dealing with a poison victim?

yes, helps bind to poisons and prevents absorption

This bite is usually no painful but produces a subcutaneous blood filled blister which later turns into a non-healing necrotic ulcer. Vast tissue destruction is a possibility. This bite should be surgically excised. What caused this bite?

Brown Recluse Spider

This bite usually cause sharp pinprick pain. This is a powerful neurotoxin which produces systemic s/s including: Sever cramps, boardlike rigidity of the abdomen, chest tightness, dyspnea over 24 hours. What caused this bite?

Black Widow Spider

How do you treat a Bee Sting?

Remove stinger, wash w/ soap & water
Apply ice
Watch for s/s of anaphylaxis (if developing: apply constriction bands
above and below)

_____: Failure of the heart occurs when the heart muscle is so damaged by infarction or other disease that it can no longer pump enough blood for the needs of the body. This can occur any time after an AMI but it usually happens between the first few hours and the first few days.

Congestive Heart Failure (CHF)

How would you treat a pt that has asthma

BLS, sit patient up, suction, oxygen transport to ER

How would you treat a pt for Hyperventilation?

Calm and reassure the patient, Monitor vitals.

The common sign of croup is ____, a high pitched, barking, rough sound heard on inspiration. This signifies narrowing of the air passage of the larynx, which may progress to significant obstruction


This is a potent vasodilator. It causes the coronary vessel to dilate, thus reliving hypoxia.


____: this is very similar to those of an AMI, but here are some differences: pain is usually related to stress or exertion, pain last 3-10 minutes, pain is relived by rest &/or nitroglycerin.

Angina Pectoris

___ is a heart attack; specifically, death of the heart muscle from obstruction of its
blood flow.

Acute Myocardial Infarction (AMI)

S/S of AMI?

Substernal, squeezing or heaving in nature, last longer than 30 mins.

_____: this is caused by a blockage of vessel, Thrombus or emboli, start out dry (Dry stroke)


___: this is caused by a rupture of a vessel or an aneurysm, in general- worse b/c blood in CNS is caustic & causes liquefaction of CNS, Blood is very Deadly to Nerve tissue!


What causes an acute abdomen?

sudden irritation of the peritoneum

What are the s/s of acute abdomen?

severe pain, tenderness and distension

Treatment for acute abdomen?

Call 911

____: Painful muscle cramps of the legs and abdomen following vigorous exercise. Thought to be caused by an electrolyte imbalance.

heat cramps

____: is a mild form of hypovolemia caused by excessive sweating, s/s cold and clammy skin, gray face, dizzy, weak, faint, nausea and headache. Treat for shock.

Heat Exhaustion

____: is considered a dire emergency. If left untreated pt will always die. S/S: early pt. will be hot and wet, later they will be hot and dry. Their skin will be very red. Treatment call 911

Heat stroke

___cold injury s/s blanching of skin, skin remains soft but cold to the touch. Numb to the touch,, Tingling during any re-warming.


___cold injury s/s White Waxy Skin, firm-to-frozen feeling when the skin is palpated, Swelling, Blisters.


_____ results from an increase in the body's heat loss, a decrease in the body's heat production or both. It is the most life-threatening cold injury because the severe generalized cooling affects the whole body.


The most commonly occluded vessel is the what?

Posterior inferior cerebellar artery (PICA)

What do you do if patient is having a stroke?

Call 911

A 22 year old female comes into your office following basketball practice (it was an exceptionally
difficult workout) . While waiting the patient begins to develop a headache . You notice that her skin
pale and moist . While you are attending to her she becomes irrational . The patient is a known diabet
Her most likely diagnosis is

insulin shock

A 22 year old female comes into your office following basketball practice (it was an exceptionally
difficult workout) . While waiting the patient begins to develop a headache . You notice that her skin
pale and moist . While you are attending to her she becomes irrational . The patient is a known diabetic
The patient in the last question has


A 22 year old female comes into your office following basketball practice (it was an exceptionally
difficult workout) . While waiting the patient begins to develop a headache . You notice that her skin
pale and moist . While you are attending to her she becomes irrational . The patient is a known diabet
For the patient in the last question you should :

give the patient a can of pop or some candy if they are conscious and able to swallow

Fruity breath in a diabetic emergency is associated with :


A 67-year-old male patient presents in your office complaining of cervicalgia . During your history the
patient states that he has a history of hypertension . He also describes an episode which happened one
week ago, in which he experienced right sided facial droopiness, slurred speech, and paralysis to the
right arm and leg . An ambulance was called by his wife . By the time the ambulance got the patient to
the hospital 30 minutes had passed . During this time his symptoms had rapidly improved and were
totally remmissed upon presentation at the ER . This episode was most likely a(n) :


A 57-year-old female suffered a stroke . The patient awoke in the middle of the night with altered
mental status, loss of speech, right sided hemiplegia . The patient did NOT have a headache or seizure
heir stroke was most likely due to a(n) :


When opening the airway of a patient who you suspect may have a cervical injury, the most appropri,
method is the

Jaw thrust maneuver

A "blind" finger sweep is performed on which of the following choking victims?

unconcious adult

You are eating at a restaurant with your family when a nearby commotion catches your attention . Yo
notice a conscious middle-aged man who is sitting in a chair and exhibiting the universal choking sign
He is cyanotic and quiet with a very distressed expression . You should immediately

ask, "Are you choking? Can you speak? May I help you?"

As you are working with the patient in the last question, he becomes unconscious and begins to slide
the floor. You support him to prevent trauma and guide him to the floor into a supine position . You should immediately

activate EMS (if this has not already been done) .
Steps A.E.D.B

You are eating with your family in a restaurant when you hear a commotion coming from the ladys' room. A women runs out, screaming, "She choked to death! She choked to death!" As you enter the bathroom, you see a very pregnant (third trimester) woman lying on the floor . There is no apparent trauma, but she is very cyanotic . You should immediately

check for unresponsiveness then call 911 .

Your first attempt to ventilate the patient in the last question is unsuccessful . You should immediately

reposition the airway and attempt to ventilate again .

Your second attempt to ventilate the patient in the last question is also unsuccessful . Using the following, indicate the correct sequence of activities you should perform until ventilation is achieved ,(Not all the activities must be used) .
1) Reposition the airway and attempt to ventilate again .
2) Check the patient's pulse .
3) Perform 5 abdominal thrusts .
4) Perform finger sweep .
5) Perform 6 to 10 chest thrusts .
6) Perform 4 back blows .
7) Open the airway and attempt to ventilate the patient .
8) perform 5 chest thrusts .

8,4,7,1 and repeat until ventilation is achieved .

45-year-old man has a sudden seizure and rapidly loses consciousness . On examination, you coi that he is unconscious . The pulse is grossly irregular at 68/min, but full and easily felt . In response your question concerning a scar on the left side of the chest, the patient's wife tells you that he had a heart valve, damaged by rheumatic fever, replaced 2 years ago . She further states that her husband is on medicine to "thin" his blood, but that he had stopped taking the medicine 2 months ago . The unconsciousness is most likely caused by a(n)


The phases in a Grand Mal seizure include (in the correct sequence)

aura, convulsion and postictal

TRUE or FALSE . To protect the patient from injurying themselves during a tonic-clonic seizure it important to aggressively restrain the patient


TRUE or FALSE . Patients suffering from pulmonary edema associated with CHF should be attend a sitting or semi-reclining position .


TRUE or FALSE . A bee sting kit contains an oral antihistamine and an "epipen" or a syringe of mephrine .


The most frequent cause of airway obstruction in the unconscious victim is

the tongue

How many breaths do you initially deliver to the patient in respiratory arrest?

A. One long, slow breath
B . Four quick breaths (without allowing passive exhalation between them, in order to achieve a "stairstep" effect and fully reinflate the patient's collapsed lungs) .
C . Three quick breaths (without allowing passive exhalation between them, in order to achieve a "stairstep" effect and fully reinflate the patient's collapsed lungs) .
D. Two quick breaths (without allowing passive exhalation between them, in order to achieve a "stairstep" effect and fully reinflate the patient's collapsed lungs) .
E. Two deep breaths, lasting 1 .5 to 2 seconds (allowing passive exhalation between them) .

For single-rescuer CPR on an adult, compress the sternum approximately

1 1/2 to 2 in

After beginning CPR, the rescuer should recheck for return of the patient's pulse

the patient's pulse after one minute, then every few minutes .

The ratio of chest compressions to ventilations for one-rescuer CPR on an infant is

5 compressions alternated with 1 ventilation

Vomiting should be induced when

under the direction of a poison control center

Identification of a black widow spider can be made from the patient's description of observing

a red hourglass shape, underneath its largest body segment

Identification of a brown recluse spider can be made from the patient's description of observing

a violin shape on the top of the spider, behind its eyes

Which of the following statements regarding treatment of bee stings is false?

If a credit card is not available, with gloved hands, gently squeeze the stinger and/or venom sac
from the site and wipe it away with a clean cloth or sterile 4 X 4 .

Venomous snake species commonly found in the United States include the

rattlesnake, cottonmouth, copperhead, and coral snak

substernal chest pain with radiation to the jaw, back, shoulders and/or arms may indicate

Acute myocardial infarction

Which of the following statements regarding nitroglycerin (NTG) is false?

Nitroglycerin may cause the patient's blood pressure to increase by dilating the coronary arteries
and providing better blood flow to the ventricles

Signs and symptoms of CVA include all of the following, except

numbness or paralysis of both arms and/or both legs

The patient with typically appears and functions normally in between attacks of shortness of


Which of the following statements regarding diabetes is false?

Insulin enables sugar to pass from the body cells to the blood stream for excretion

Recently excessive urination with increased thirst and fluid intake may indicate that a diabetic is


During: there are tonic and clonic convulsions, and the patient may be incontinent of urine and/or

Grand Mal Seizures

Which of the following statements regarding emergency treatment of seizures is true?

A. During a grand mal seizure, the patient will require physical restraints to prevent head or extremity
B. It is important to force a bite block between the patient's teeth (even when the jaws are clenched) t
prevent dental injuries or self-inflicted bites
C . After the seizure, it is important to pull the tongue forward with a gloved hand and hold it there, tc
prevent the patient from swallowing his tongue
***None of the above are true

Common causes of acute abdominal distress include all of the following, except


respiratory distress with low fever, stridor and a loud, barklike cough indicates a child suffering from

croup aka Stridor

At normal room temperature, without the presence of air currents, heat can be lost through exposed skin by


Cold air passing over the body causes heat loss by


What causes(s) brain cell injury, and the patient may die

A. Heat cramps
Heat exhaustion
***Heat stroke
Heat prostration

The patient with has hot, dry, red skin

heat stroke

S/S heat Exhaustion

excessive sweating-: hypovolemic shock s/s clammy cold grayish skin

The earliest signs and symptoms of hypothermia include all of the following, except

slow pulse and slow respiration rate

Which of the following statements regarding severe hypothermia patients is false?

CPR should be delayed until the patient is warm, to prevent ventricular fibrillation

Which vessel is often the first to be occluded in a vertebral artery dissection?

Posterior Inferior Cerebellar artery .

If a patient has suffered a possible stroke during manipulation, which of the following would be contraindicated?

administer another cervical adjustment .

A 52-year-old man enters your office complaining of left sided facial droop . The entire left side seems -,_
to be involved . Which of the following tests would confirm the need of an immediate referral ?

Cardinal planes of gaze .

Herpetic Whitlow is defined as?

a herpes infection of the finger .

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