CERTIFIED EMERGENCY MANAGER -
WEEK 1 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS!!
hypovolemic shock
decreased cellular perfusion due to lack of circulating volume
cardiogenic shock
decreased cellular perfusion secondary to failure of the central pump
distributive shock
decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery
obstructive shock
decreased cellular perfusion secondary to obstruction of blood into or out of the ventricles
(pulmonary embolism, pericardial tamponade, tension pneumothorax)
sympathetic nervous system
fight or flight
adrenergic system
s/s: vasoconstriction, glycogenolysis, diaphoresis, increased HR, increased RR, increased water
and sodium reabsorption, bronchodilation
parasympathetic nervous system
rest and digest
cholinergic system
s/s: vasodilation, glucogenesis, dry skin, decreased HR, decreased respiratory rate,
bronchoconstriction
beta one receptors
,-one heart, beta one affects the heart (contractility, automaticity, heart rate)
beta two receptors
-two lungs, beta two mainly affects the lungs (bronchodilation, respiratory rate)
agonist
stimulates a system
antagonist
diminishes system response
hyponatremia
(over hydration)
-s/s: symptoms of water retention, swelling, confusion, apathy, sense of impending doom,
muscle cramps
-treatment: water restriction, oral sodium replacement, slow replacement with hypertonic saline
(3-5% saline solution)
-correcting too rapidly can cause central pontine myelinolysis (flaccid paralysis, dysarthria,
dysphagia, hypotension)
hypernatremia
(dehydration)
-s/s: altered mental status, fatigue, lethargy, confusion, coma, weakness, diarrhea
-treatment: correct hypovolemia, treat underlying cause (fever, vomiting, diabetes insipidus,
lower serum sodium levels (slowly replace total body water deficit)
-sodium and chloride tend to elevate and decrease together
hyperkalemia
,-s/s:
early: muscular excitability, irritability, nausea, vomiting, diarrhea
late: muscular weakness, fatigue, generalized weakness, distal limb paresthesia, tetany,
respiratory depression, ascending paralysis
cardiovascular: peaked t wave, elongated PR interval, absent p wave, enlarging QRS complex
treatment:
-stabilize cardiac membrane: calcium chloride or calcium gluconate
-shift potassium into the cells: albuterol, insulin, dextrose
-remove potassium from the cells: hemodialysis, NS and furosemide, ion exchange resin
(kayexalate)
-common causes: rental failure, cellular death (rhabdomyelosis, tumor lysis syndrome, crush
injury, burns), acidosis
hypokalemia
s/s: frequently asymptomatic, weakness, hyporeflexia, tetany, paralysis to lower extremities,
respiratory failure, prominent U wave on EKG causing a camel hump appearance to the t wave,
st depression
treatment: oral or IV potassium
-hypokalemia and hypomagnesemia often co-exist so correct magnesium with potassium
hypermagnesemia
, s/s: neuromuscular depression, decreased deep tendon reflex, constipation, anorexia, nausea,
vomiting, fatigue, diffuse body aches, bradycardia, hypotension, tall t waves, depressed ST
segments
-treatment: reduce serum magnesium (fluids, loop diuretics) reduce ingestion of magnesium,
dialysis
what foods contain magnesium
dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit,
dark chocolate
hypomagnesemia
s/s: mild to moderate elevations (asymptomatic)
-severe elevations cause neuromuscular excitability (muscular cramping, tetanic contractions,
hyperreflexia, perioral or finger paresthesia, positive chovsteks sign, positive trousseau's sign,
seizures, prolonged PR interval, widened QRS complex
-treatment: mild: oral magnesium supplements
severe: IV magnesium
chvosteks sign
twitch in the facial muscles that occurs when tapping an individuals cheek in front of the ear by
the facial nerve
-hypocalcemia
-hypomagnesemia
trousseau's sign
carpal spasm when BP cuff is inflated 20 mm Hg above systolic blood pressure for 3 minutes
WEEK 1 EXAM QUESTIONS WITH 100%
CORRECT ANSWERS!!
hypovolemic shock
decreased cellular perfusion due to lack of circulating volume
cardiogenic shock
decreased cellular perfusion secondary to failure of the central pump
distributive shock
decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery
obstructive shock
decreased cellular perfusion secondary to obstruction of blood into or out of the ventricles
(pulmonary embolism, pericardial tamponade, tension pneumothorax)
sympathetic nervous system
fight or flight
adrenergic system
s/s: vasoconstriction, glycogenolysis, diaphoresis, increased HR, increased RR, increased water
and sodium reabsorption, bronchodilation
parasympathetic nervous system
rest and digest
cholinergic system
s/s: vasodilation, glucogenesis, dry skin, decreased HR, decreased respiratory rate,
bronchoconstriction
beta one receptors
,-one heart, beta one affects the heart (contractility, automaticity, heart rate)
beta two receptors
-two lungs, beta two mainly affects the lungs (bronchodilation, respiratory rate)
agonist
stimulates a system
antagonist
diminishes system response
hyponatremia
(over hydration)
-s/s: symptoms of water retention, swelling, confusion, apathy, sense of impending doom,
muscle cramps
-treatment: water restriction, oral sodium replacement, slow replacement with hypertonic saline
(3-5% saline solution)
-correcting too rapidly can cause central pontine myelinolysis (flaccid paralysis, dysarthria,
dysphagia, hypotension)
hypernatremia
(dehydration)
-s/s: altered mental status, fatigue, lethargy, confusion, coma, weakness, diarrhea
-treatment: correct hypovolemia, treat underlying cause (fever, vomiting, diabetes insipidus,
lower serum sodium levels (slowly replace total body water deficit)
-sodium and chloride tend to elevate and decrease together
hyperkalemia
,-s/s:
early: muscular excitability, irritability, nausea, vomiting, diarrhea
late: muscular weakness, fatigue, generalized weakness, distal limb paresthesia, tetany,
respiratory depression, ascending paralysis
cardiovascular: peaked t wave, elongated PR interval, absent p wave, enlarging QRS complex
treatment:
-stabilize cardiac membrane: calcium chloride or calcium gluconate
-shift potassium into the cells: albuterol, insulin, dextrose
-remove potassium from the cells: hemodialysis, NS and furosemide, ion exchange resin
(kayexalate)
-common causes: rental failure, cellular death (rhabdomyelosis, tumor lysis syndrome, crush
injury, burns), acidosis
hypokalemia
s/s: frequently asymptomatic, weakness, hyporeflexia, tetany, paralysis to lower extremities,
respiratory failure, prominent U wave on EKG causing a camel hump appearance to the t wave,
st depression
treatment: oral or IV potassium
-hypokalemia and hypomagnesemia often co-exist so correct magnesium with potassium
hypermagnesemia
, s/s: neuromuscular depression, decreased deep tendon reflex, constipation, anorexia, nausea,
vomiting, fatigue, diffuse body aches, bradycardia, hypotension, tall t waves, depressed ST
segments
-treatment: reduce serum magnesium (fluids, loop diuretics) reduce ingestion of magnesium,
dialysis
what foods contain magnesium
dark leafy greens, nuts, seeds, fish, beans, whole grains, avocados, yogurt, bananas, dried fruit,
dark chocolate
hypomagnesemia
s/s: mild to moderate elevations (asymptomatic)
-severe elevations cause neuromuscular excitability (muscular cramping, tetanic contractions,
hyperreflexia, perioral or finger paresthesia, positive chovsteks sign, positive trousseau's sign,
seizures, prolonged PR interval, widened QRS complex
-treatment: mild: oral magnesium supplements
severe: IV magnesium
chvosteks sign
twitch in the facial muscles that occurs when tapping an individuals cheek in front of the ear by
the facial nerve
-hypocalcemia
-hypomagnesemia
trousseau's sign
carpal spasm when BP cuff is inflated 20 mm Hg above systolic blood pressure for 3 minutes
