3d • Paramedic Talk
Who else needs National help?!
Cranial Nerve for Tongue/Speech
CN XII (Hypoglossal Nerve) = motor control of the tongueAlso know:
- CN X (Vagus): speech/swallowing
- CN IX (Glossopharyngeal): gag reflex, taste
Patient Already Triaged “Red” Becomes Unresponsive
Answer:
Immediate BLS or ALS resuscitation→ Priority transport
🧠 Triage is dynamic. You always reassess. Don’t leave a red patient dying just because triage is "complete."
💔 Aortic Dissection
Clue: Unequal BP in arms + tearing chest/back pain
Other signs:
- Pulse deficits
- New murmur
- Neurologic symptoms
Transport to surgical center. Avoid excessive fluid bolus if hypertensive.
💢 Epidural vs Subdural Hematoma
Epidural:
- Arterial bleed
- Lucid interval
- Rapid decline
- Temporal fracture → middle meningeal artery
Subdural:
- Venous bleed
- Gradual onset
- Elderly, alcoholics, falls
🧠 Lucid interval = Epidural
📈 Inferior Wall of LV – Which Lead?
Correct: Lead II, III, and aVF
🧠 You chose aVF — that is correct. All three monitor inferior wall supplied by RCA.
🦠 What Kills C. difficile?
Correct: Chlorine-based disinfectantsAlcohol-based sanitizers do not kill spores.
Use:
- Bleach
- EPA-registered sporicidal agents
☠️ Cushing Reflex
Classic triad (↑ ICP):
- Hypertension
- Bradycardia
- Irregular respirations
🧠 This = brainstem herniation risk. Needs rapid airway, ventilation, and hospital intervention.
Left-Sided vs Right-Sided Heart Failure
Left-Sided Heart Failure
Failure of the left ventricle → blood backs up into lungs.
Signs/Symptoms
- Dyspnea
- Orthopnea
- Crackles
- Pulmonary edema
- Pink frothy sputum
Key Mechanism↓ Cardiac output → ↑ pulmonary pressure
Right-Sided Heart Failure
Failure of right ventricle → blood backs up into systemic circulation.
Signs/Symptoms
- JVD
- Peripheral edema
- Hepatomegaly
- Ascites
Often caused by:
- Left-sided failure
- Pulmonary hypertension
- COPD (cor pulmonale)
Pulse Pressure
Pulse pressure = Systolic − Diastolic
Example: 120/80 = 40
Widened Pulse Pressure
- Aortic regurgitation
- Hyperthyroidism
- Sepsis
- Increased stroke volume
Example: 180/60
Narrow Pulse Pressure
- Cardiogenic shock
- Tamponade
- Severe blood loss
- Aortic stenosis
Example: 90/80
Pericarditis
Inflammation of pericardium.
S/S
- Sharp chest pain
- Worse with inspiration
- Relieved by leaning forward
EKG
- Diffuse ST elevation
- PR depression
Differentiate from STEMI:STEMI = localized ST elevation.
J-Point
Where QRS ends and ST segment begins.
Elevation at J-point:
- Early repolarization (benign)
- Pericarditis
- STEMI
Delta Wave (WPW Syndrome)
- Slurred upstroke of QRS
- Short PR interval
- Accessory pathway (Bundle of Kent)
Risk:
- SVT
- Atrial fibrillation with rapid conduction
Avoid:
- AV node blockers in WPW + Afib
Guillain-Barré Syndrome (GBS)
Autoimmune demyelination.
S/S
- Ascending paralysis
- Weakness starting in legs
- Loss of reflexes
- Possible respiratory failure
Priority: Monitor airway closely.
Wernicke’s Encephalopathy
Caused by: Thiamine deficiency (alcoholics)
Triad:
- Confusion
- Ataxia
- Ophthalmoplegia
Treat with: Thiamine before glucose.
Thyroid Disorders
Hyperthyroidism (Graves)
- Tachycardia
- Weight loss
- Heat intolerance
- Exophthalmos
Hypothyroidism (Hashimoto)
- Bradycardia
- Weight gain
- Cold intolerance
- Dry skin
Addison’s Disease
Adrenal insufficiency.
- Hypotension
- Hyperkalemia
- Hyponatremia
- Weakness
Addisonian crisis: Shock.
Cushing’s Syndrome
Excess cortisol.
- Moon face
- Buffalo hump
- Hypertension
- Hyperglycemia
Metabolic Acidosis
Low pH, low HCO₃.
Compensation:↑ Respiratory rate (Kussmaul respirations).
Example:DKA → deep rapid breathing.
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Who else needs National help?!
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