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Medicine (Expanded) | Paramedic School Study Aid
Cardiac Cycle - Diastole
- Characteristics
- Aortic Valve Closes
- Pulmonary Valve Closes
- Ventricles Relax
- Mitral Valve Opens
- Tricuspid Valve Opens
- Ventricles Fill
- Sinoatrial (SA) Node Fires
- Atrial Contraction
3 mins
Cardiac Cycle - Systole
- Characteristics
- AV Node
- AV Node Conducts Signal to Bundle of His
- Bundle of His Signals Purkinje Fibers to Contract Ventricles
- Tricuspid Valve Closes
- Pulmonary Valve Opens
- Mitral Valve Closes
- Aortic Valve Opens
2 mins
Blood Pressure Classification (JNC 7)
- Classifications
- Normal
- Systolic (<120)
- Diastolic (< 80)
- Prehypertension
- Systolic +20 (120-139)
- Diastolic +10 (80-89)
- Stage 1 Hypertension
- Systolic +20 (140-159)
- Diastolic +10 (90-99)
- Stage 2 Hypertension
- Systolic + > 20 (160)
- Diastolic + > 10 (100)
- Hypertensive Crisis
- Systolic > 180
- Diastolic > 110
4 mins
Blood Pressure Classification (ACC/AHA 2017)
- Classifications
- Normal
- Systolic Less than 120
- Diastolic Less than 80
- Elevated
- Systolic +10 (120-129)
- Diastolic Less than 80
- Stage 1 Hypertension
- Systolic +10 (130-139)
- Diastolic +10 (80-89)
- Stage 2 Hypertension
- Systolic +40 (140-179)
- Diastolic +30 (90-119)
- Hypertensive Crisis
- Systolic greater than or equal to 180
- Diastolic greater than or equal to 120
5 mins
Hypertension Intervention
- Lifestyle Modifications
- Weight Reduction and Exercise
- Diet Changes
- Relaxation Techniques
- Smoking Cessation
- Medications
- Encourage Self Monitoring
1 min
Hypertension Management (JNC-8)
- Goal of Treatment
- Age Over 60 years (and Healthy)
- 150/90
- Age Under 60 years (and Healthy)
- Any Age with Diabetes or CKD
- 140/90
- Treatment
- ARB/ACE-I/Thiazide/CCB (Primary or Combo)
- CKD (w/wo Diabetes)
- ARB or ACE-I Primary
- African American
- Thiazide or CCB Primary
3 mins
High Blood Pressure Response
- Characteristics
- Atria Release Atrial Natriuretic Peptide
- Vasodilation
- Antagonizes Aldosterone
- Na+ and Water Excreted
1 min
Primary Hypertension Risk Factors
- Excessive Alcohol Consumption
- High Sodium Diet
- Dyslipidemia
- Obesity
- People of African Descent
- Advanced Age
- Vitamin D Deficiency
- Reduced Nephron Number
- Diabetes
- Lack of Physical Activity
2 mins
Hypertension Assessment
- Mechanism
- Essential Hypertension
- Secondary Hypertension
- Assessment
- Headache
- Vision Changes
- Nosebleed (Epistaxis)
- Chest Pain
- Syncope (Fainting)
- Diagnosis
- Average 2 Sets, 2 Minutes Apart
- After 2 or More Visits (within 1-4 weeks)
- Nursing Considerations
- Take BP Both Arms
- Common in African Americans
2 mins
Chronic Venous Insufficiency (Venous Stasis Ulcer) Assessment
- Venous Stasis Ulcer
- Uneven Edges
- Dull Persistent Pain
- Medial Malleolus
- Necrotic
- Normal Pulses
- Lower Leg Edema
- Bronze-Brown Pigmentation
- Warm
- Pruritus
2 mins
Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions
- Frequently Elevate Legs
- Avoid Standing/Sitting for Long Periods of Time
- Elastic Compression Stockings
- Bilayer Artificial Skin
- Daflon
- Wound Dressings
- Proper Foot and Leg Care
2 mins
Peripheral Artery Disease (PAD)
- Mechanism
- Atherosclerosis
- Assessment
- Intermittent Claudication
- Pain with Exercise
- Paresthesias
- Arterial Ulcers
- Critical Limb Ischemia
- Amputation
- Consideration
- Ankle-Brachial Index (ABI)
2 mins
Varicose Veins Assessment
- Cause
- Increased Venous Pressure
- Incompetent Valves
- Assessment
- Telangiectasias
- Small Reticular Veins
- Dilated and Tortuous Veins
1 min
Varicose Veins Interventions
- Laser Therapy
- Sclerotherapy
- Removal of Saphenous Vein
- Considerations
- Avoid Prolonged Standing
- Elastic Compression Stockings
2 mins
Superficial Thrombophlebitis
- Cause/Mechanism
- IV Catheter Irritation
- Assessment
- Erythema
- Cord-like Vein
- Edema
- Interventions
- Remove IV Catheter
- Elevate
- Warm Compress
- Considerations
- Rotate Sites Q3 Days
- Aseptic Technique
2 mins
Venous Thromboembolism (DVT) Assessment
- Mechanism
- Venous Wall Inflammation caused by Thrombus
- Assessment
- Tenderness
- Edema
- Warmth
- Asymmetry
- Considerations
- Could be Asymptomatic
- Monitor for Pulmonary Embolism
58 secs
Venous Thromboembolism (DVT) Interventions
- Anticoagulants
- Prevention Education
- Frequent Ambulation
- Leg Exercises
- Compression Stockings or SCD's
- Avoid Nicotine and Oral Contraceptives
- Surgery
1 min
Deep Vein Thrombosis (DVT) Characteristics
- Mechanism
- Virchow's Triad
- Venous Stasis
- Endothelial Damage
- Hypercoagulability
- Symptoms
- Tenderness
- Homan's Sign
- Warmth
- Redness
- Swelling
- Asymptomatic
1 min
Pulmonary Embolism Causes
- Causes
- FAT BAT Mnemonic
- Fat
- Air
- Deep Vein Thrombosis (DVT)
- Bacteria
- Amniotic Fluid
- Tumor
- Risk Factors
- Hypercoagulable
- Central Venous Lines
- Immobilized
1 min
Pulmonary Embolism Presentation and Diagnosis
- Presentation
- Sudden onset Shortness of Breath (S.O.B.)
- Tachypnea
- Pleuritic Chest Pain
- Hemoptysis
- Hypoxemia
- Sudden Death
- Diagnosis
- Gold Standard: CT Pulmonary Angiography
- X-Ray
- D-Dimer
- V/Q Scan
1 min
Wells' Criteria for Pulmonary Embolism
- Scoring
- Clinical Symptoms of DVT (+3)
- Pulmonary Embolism Most Likely Diagnosis (+3)
- Tachycardia (+1.5)
- Immobilization > 3 Days (+1.5)
- Previous DVT or PE (+1.5)
- Hemoptysis (+1)
- Malignancy (+1)
- Probability
- > 6 = High
- 2-6 = Moderate
- < 2 = Low
3 mins
Pulmonary Embolism Assessment
- Assessment
- Shortness of Breath (SOB)
- Pleuritic Chest Pain
- Tachypnea
- Hemoptysis
- Hypoxemia
- Considerations
- Sudden Death
52 secs
Abdominal Aortic Aneurysm
- Screening
- Screen Males 65-75 Who've Ever Smoked
- Diagnosis
- Ultrasound
- Treatment
- Observation
- Asymptomatic and < 5 cm in Size
- Surgical Repair
- > 5.5 cm in Abdomen
- Emergent Surgery
- Ruptured or Symptomatic
2 mins
Abdominal Aortic Aneurysm (AAA) Assessment
- Mechanism
- Atherosclerosis
- Assessment
- Bruit
- Pulsation in Abdomen
- Abdominal or Lower Back Pain
- Tearing Pain
- Diagnosis
- Ultrasound
- Considerations
- Rupture
- Shock
- Surgical Repair
1 min
Hypercholesterolemia Disease
- Risk Factors
- Diabetes
- Smoking
- Family History
- Hypertension
- HDL < 40
- Men Older than 45 Years of Age
- Women Older than 55 Years of Age
- Signs and Symptoms
- Atheromas
- Plaques in Blood Vessel Walls
- Tissue Ischemia
- Xanthomas
- Lipemia Retinalis
2 mins
Hypercholesterolemia Risk Stratification
- 0 - 1 Risk Factors
- < 160 mg/dl LDL goal
- greater or equal to 2 Risk Factors and 10-year Risk ≤ 20%
- < 130 mg/dL LDL Goal
- Coronary Heart Disease OR >/= to 2 Risk Factors AND 10-Year Risk > 20%
- < 100 mg/dL LDL Goal
2 mins
Cholesterol Lab Values
- LDL (Low Density Cholesterol)
- < 100 mg/dL
- HDL (High Density Cholesterol)
- > 40 mg/dL Males
- > 50 mg/dL Females
- Total Cholesterol
- < 200 mg/dL
1 min
Hypercholesterolemia Treatment
- Lifestyle Modifications (Diet, Exercise, Smoking Cessation)
- Statins
- Niacin
- Ezetimibe
- Fibrates
- Bile Acid Resins
- PCSK9 Inhibitors
- Omega 3 Fatty Acids
- Screening
- Pooled Cohort Test
2 mins
Stable Angina
- Assessment
- Chest Pain with Exertion
- Relieved within 15 Minutes
- ST Depression
- Interventions
- Nitroglycerin
- Up to 3 Doses q 5 Minutes
- Rest
- Antiplatelet Medication
- CABG
- Angioplasty
2 mins
Unstable Angina
- Assessment
- Chest Pain with Rest or Exertion
- Limits ADLs
- > 15 Minutes
- Less Likely Relieved by Nitroglycerin
- ST Depression
- Fatigue
- Considerations
- Acute Coronary Syndrome (ACS) Treatment
- Emergency Treatment
2 mins
Myocardial Infarction Assessment
- Assessment
- Substernal Chest Pain
- Crushing or Dull Sensation
- Arm, Jaw, and Neck
- > 20 Minutes
- Unrelieved by Nitro
- Palpitations
- Diaphoresis
- Fear of Impending Doom
- Nausea and Vomiting
- Shortness of Breath
- Considerations
- Monitor for Arrhythmias
2 mins
Left Heart Failure Assessment
- Pulmonary Assessment
- Pulmonary Congestion
- Pink Frothy Sputum
- Wheezing or Crackles
- Dyspnea with Exertion
- Cough
- Systemic Assessment
- Fatigue
- Tachycardia
- Weak Peripheral Pulse
- S3, S4 Heart Sounds
1 min
Right Heart Failure Assessment
- Jugular Venous Distention (JVD)
- Peripheral Edema
- Hepatosplenomegaly
- Nocturia
- Weight Gain
- Ascites
- Fatigue
1 min
Myocardial Infarction Diagnosis
- Diagnosis
- 12 Lead ECG
- ST Elevation
- Q Wave
- T Wave Inversion
- Troponin T and I
- CK-MB
- Considerations
- Early ECG
- Cardiac Stress Test
2 mins
Cardiac Enzyme Evaluation: Troponin
- Measures
- Cardiac Muscle Injury
- Time Ranges
- Detection in Blood: 4 Hours
- Peak: 24 - 36 Hours
- Return to Normal: 5 - 14 Days
- Considerations
- Most Specific for Cardiac Muscle
- Treat Aggressively
2 mins
Cardiac Enzyme Evaluation: Myoglobin
- Measures
- Skeletal or Cardiac Muscle Injury
- Time Ranges
- Onset: 1 - 4 Hours
- Peak: 12 Hours
- Return to Normal: 24 Hours
- Considerations
- Elevation After 24 Hours: Reinfarction
2 mins
Cardiac Enzyme Evaluation: Creatine Kinase CK-MB
- Measures
- Skeletal or Cardiac Muscle Injury
- Time Ranges
- Onset: 4-8 Hours
- Peak: 12-24 Hours
- Return to Normal: 2-3 Days
1 min
Myocardial Infarction Interventions
- MONA
- Morphine
- Oxygen
- Nitrates
- Aspirin
- Thrombolytics (tPA)
- Invasive Procedures
- Cardiac Catheterization
- Stent Placement
- Angioplasty
- Coronary Artery Bypass Grafting (CABG)
- Considerations
- Decrease Modifiable Risk Factors
- Resuming Activity (Physical, Sexual)
2 mins
Cardiac Catheterization
- Considerations
- Fluttering Sensation
- Contrast Media
- NPO 6-12 Hours
- After Procedure
- Bed Rest
- Assess Circulation
- Assess for Bleeding
- Monitor Vital Signs
2 mins
Coronary Artery Bypass Grafting (CABG)
- Indications
- ST-Segment Elevation Myocardial Infarction (STEMI)
- Cardiovascular Disease (CAD)
- Uncontrolled Angina
- Considerations
- Internal Mammary Artery
- Saphenous (Leg) Vein
- Transient Limb Edema
- Closely Monitor Patients
- Venous Thromboembolism (VTE) Prophylaxis
- Incentive Spirometer
2 mins
Heart Failure Interventions
- Diagnostic Tests
- Echocardiogram
- Invasive Hemodynamic Monitoring
- Improve Gas Exchange
- High Fowler's Position
- Oxygen
- Advanced Airway
- Drugs and Devices
- Diuretics
- Beta Blockers
- Angiotensin II Receptor Blockers (ARBs)
- ACE Inhibitors
- Digoxin (Lanoxin)
- Pacemaker
2 mins
Acute Pericarditis Assessment
- Pericardial Sac Inflammation
- Assessment
- Sharp Chest Pain
- Increased with Inspiration
- Pain Decreased by Leaning Forward
- Pericardial Friction Rub
- Diffuse ST-Elevation
- T Wave Inversion
- Fever
- Considerations
- May Be Asymptomatic
- Cardiac Tamponade
2 mins
Acute Pericarditis Causes
- Idiopathic
- Infection
- Trauma
- Cardiac
- Myocardial Infarction
- Autoimmune Diseases
- Uremia
- Tumor
- Radiation
2 mins
Acute Pericarditis Interventions
- Interventions
- Treat Underlying Disorder
- Antibiotics
- Colchicine + NSAIDs
- Corticosteroids
- Place Patient Upright with Head of Bed at 45°
- Pericardiocentesis
- Pericardial Window
2 mins
Cardiac Tamponade
- Mechanism
- Fluid in the Pericardial Sac
- Pericarditis
- Decreased Cardiac Output
- Signs/Symptoms
- Beck's Triad
- Hypotension
- Jugular Venous Distention (JVD)
- Distant Heart Sounds
- Pulsus Paradoxus
- Electrical Alternans
- Treatment
- Pericardiocentesis
1 min
Bacterial Endocarditis
- Signs and Symptoms
- Fever
- New murmur
- Janeway Lesions
- Splinter Hemorrhages
- Roth spots/round white spots on retina
- Osler nodes/tender lesions on finger or toe pads
- Anemia
2 mins
Endocarditis Assessment
- Infection of Inner Layer and Valves
- Assessment
- Fever
- Fatigue
- New or Changed Murmurs
- Roth's Spots
- Splinter Hemorrhages
- Janeway Lesions
- Osler's Nodes
- Considerations
- Heart Failure
- Embolization
2 mins
Endocarditis Interventions
- Interventions
- IV Antibiotics
- 4-6 Weeks
- Anticoagulants
- Good Hygiene
- Considerations
- Closely Monitor
- Antibiotic Prophylaxis
- Dental Procedures
- Invasive Procedures
1 min
Hypertrophic Cardiomyopathy Mechanisms
- Pathophysiology
- 2/3 Autosomal-Dominant
- 1/3 Sporadic Type
- Mutation in Gene for Sarcomere Protein
- Cardiac Myosin Binding Protein C
- Asymmetric Septal Hypertrophy
- Outflow Tract Obstruction
- Diastolic Dysfunction
2 mins
Hypertrophic Cardiomyopathy Signs, Symptoms and Treatment
- Signs and Symptoms
- Sudden Death Of Young Athlete
- Heart Failure
- Angina
- Arrhythmias
- Syncope
- Harsh Systolic Ejection Murmur
- S4 Heart Sound
- Treatment
- Beta Blocker
- Non-dihydropyridine Calcium Channel Blocker
2 mins
Restrictive Cardiomyopathy
- Sarcoidosis
- Amyloidosis
- Post-radiation Fibrosis
- Endocardial Fibroelastosis
- Löffler's or Loeffler's Syndrome with Eosinophilia
- Hemochromatosis
2 mins
Dilated Cardiomyopathy
- Chronic Alcohol Abuse
- Doxorubicin Toxicity
- Cocaine Use
- Wet Beriberi
- Hemochromatosis
- Coxsackie B
- Chagas Disease
- Peripartum
- S3
- Eccentric Hypertrophy
2 mins
Aortic Regurgitation
- Auscultation
- Diastolic Murmur
- Immediate High-pitched
- Blowing Murmur
- Clinical Findings
- Wide Pulse Pressure
- Water Hammer Pulse
- Head Bobbing
- Pulsating Nail Bed
- Considerations
- Can Cause Austin Flint Murmur
1 min
Aortic Stenosis
- Characteristics
- Age-related Calcifications
- Bicuspid Aortic Valve
- Crescendo-decrescendo Murmur
- Systolic Murmur
- Ejection Murmur
- Ejection Click
- Radiates to Carotids and Apex
- Pulsus Parvus et Tardus
- Syncope
- Helmet Cells
2 mins
Tricuspid Regurgitation
- Holosystolic
- Blowing Murmur
- Radiates to Right Sternal Border
- Enhanced by Inspiration
1 min
Pregnant Cardiac Patient Assessment
- Mechanism
- Cardiac Decompensation
- Signs and Symptoms
- Frequent Cough
- Dyspnea
- Palpitations
- Excessive Fatigue
- Pulse > 100 bpm
- Crackles
2 mins
Pregnant Cardiac Patient Interventions
- Prenatal
- Monitor for Cardiac Decompensation
- Stool Softener
- Calcium Channel Blockers
- Labor
- ECG Monitor
- Open Glottis Pushing
- Pulmonary Artery Catheter
- No Beta-Adrenergic Medications
- Penicillin Prophylaxis
- Postpartum
- Stress on Heart
2 mins
Hyperkalemia
- Assessment
- > 5.0 mEq/L K+
- Abdominal Cramps
- Muscle Weakness
- Diarrhea
- Arrhythmia
- Tall, Peaked T Waves
- Interventions
- IV Calcium
- Infusion of Glucose and Insulin
- Loop or Thiazide Diuretics
- Kayexalate
- Dialysis
- Prevention Education
2 mins
Hypokalemia
- Assessment
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- Interventions
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Nursing Considerations
- Monitor Respiratory Status
3 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypermagnesemia
- Assessment
- Flushing
- Lethargy
- Muscle Weakness
- Decreased Deep Tendon Reflexes (DTRs)
- Decreased Respirations
- Bradycardia
- Hypotension
- Interventions
- Dialysis
- IV Calcium Gluconate
- Diuretics
- Avoid Antacids and Laxatives containing Mg2+
2 mins
Hypomagnesemia
- Assessment
- Confusion
- Increased Deep Tendon Reflexes (DTRs)
- Neuromuscular Irritability
- Seizures
- Muscle Cramps
- Tremors
- Insomnia
- Tachycardia
- Interventions
- Magnesium Sulfate
- Foods High in Magnesium
1 min
INR Lab Value
- 0.8-1.2 Normal Range
- Warfarin
- 2.0-3.0
1 min
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