CARE AMBULANCE Flashcards
4 steps of negligence
- duty to act
- breech of duty
- damage
- proximate cause
emt had an obligation to respond and provide care
duty to act
emt failed to assess, treat, or transport patient according to the standard of care
breech of duty
the plaintiff experienced damage or injury recognized by the legal system as worthy of compensation
damage
the injury due to the plaintiff was, at least in part, directly due to the emts breech of duty
proximate cause
4 things patients need to know to be fully competent
- person
- place
- time
- event
4 obvious signs of death
- decapitation
- rigor mortis
- decomposition
- dependent lividity
stiffening of the body after death
rigor mortis
the settling of blood within the body
dependent lividity
physical decay of the body’s components
decomposition
flower position
seated with head elevated
recovery position
lying on the left or right side
what does the thoracic cavity contain?
heart, lungs, trachea, esophagus, and great vessels
what is in the upper airway?
nose/mouth nasopharynx oropharynx larynx epiglottis
what is in the lower airway?
trachea
left/right mainstream bronchi
bronchioles
alveoli
two thin, smooth layers of tissue with thin film of fluid in between to allow frictionless movement across one another
pleura
lines the outer surface of the lungs
visceral pleura
lines the inside surface of the chest cavity
parietal pleura
the amount of air inhaled or exhaled in one breath
tidal volume
normal breathing rates for adult, pediatric, and infants
adult: 12 to 20 bpm
pediatrics: 15 to 30 bpm
infants: 25 to 50 bpm
tripod position
seated, leaning forward, and using the arms t help breath
dying gasps; slow and shallow; will not move air into alveoli
atonal breaths
fibrous sac surrounding the heart
pericardium
Sinoatrial (SA) node
generates impulses between 60 to 100 times per minute
atrioventricular (AV) node
backup pacemaker and generates electrical impulses at about 40 to 60 per minute
Purjunkie fibers (bundle of his)
final pacemaker and generates impulses only at about 20 to 40 per minute
the flow of blood throughout the body
perfusion
coordinates voluntary movement, fine motor function and balance
cerebellum
a clear fluid in and around brain and spinal cord
cerebrospinal fluid
pancreas, liver, spleen, and kidneys are all what?
solid organs
stomach, gall bladder, small/large intestine, and appendix are all what?
hollow organs
what organs are in the LUQ?
stomach, spleen
what organs are in the RUQ?
liver, gall bladder
what organs are in the LLQ?
small/large intestines
what organs are in the RLQ?
appendix, and small/large intestines
what do depressed fontanelles indicate?
hypovolemia
hypoxia
inadequate delivery of oxygen to the cells
early indications of hypoxia?
restlessness, anxiety, irritability, dyspnea, tachycardia
late signs of hypoxia?
ALOC, severe dyspnea, cyanosis, bradycardia
what does the hypoxic drive monitor?
oxygen levels in the plasma
indications of inadequate breathing?
nasal flaring, paradoxical motion, cyanosis, unequal rise and fall of the chest, dyspnea, accessory muscle use, retractions, agonal breaths
high pitched sound usually heard during exhalation
wheezing
“wet” or “crackling” sounds
rales
a high pitched sound indicating partial upper airway obstruction
stridor
indications for head tilt-chin lift
patients with ALOC
patients with suspected airway obstruction
patients requiring suctioning
contraindications for head tilt-chin lift
suspected c-spine injury
indications of jaw thrust maneuver
ALOC patients
suspected c-spine patients
contraindications for jaw thrust maneuver
conscious patients
indications for an OPA
unresponsive patients without a gag reflex
contraindications for an OPA
conscious patient or any patient with an intact gag reflex
Sizing of the OPA?
measure from the corner of the mouth to the earlobe
indications of the NPA
unresponsive patient without a gag reflex
ALOC patients with an intact gag reflex
contraindications of an NPA
conscious patients with an intact gag reflex
severe head injury
patients under 1 year
sizing of the NPA
measure from the tip of the nose to the earlobe
entry of matter into the lungs
aspiration
suction time for adults, pediatrics, and infants
adults: 15 seconds
pediatrics: 10 seconds
infants: 5 seconds
ALL ON THE WAY OUT!
When should you put a person in the recovery position?
unresponsive patient with adequate breathing and no c-spine injury
indications for supplemental oxygen
any patient with:
- cardiac arrest
- receiving artificial ventilations
- suspected hypoxia
- signs of shock
- ALOC
contraindication of supplemental oxygen
unsafe environment
flow rate for a nonrebreather mask
10 to 15 lpm
indications for a nasal cannula
patient will not tolerate a NRB
flow rate for a nasal cannula
1 to 6 lpm
when are artificial ventilations indicated?
any patient with inadequate spontaneous breathing
atonal breaths
shallow, ineffective breaths
correct rates for rescue breathing for adults, pediatrics/infants, and newborns
adult: 1 breath every 5-6 seconds
pediatrics/infants: 1 breath 3-5 seconds
newborns: 1 breath every 1-1 1/2 seconds
compression/ventilation rate for single rescue CPR on any patient and for adults
30 compressions: 2 breaths
compression/ventilation rate for two rescuer CPR on children/infants
15 compressions: 2 breaths
compression/ventilation rate for newborns
3 compressions: 1 breath
indications for CPAP
conscious patient in moderate to severe respiratory distress
tachypnic patients with reduced respiratory efficiency
pulse ox is below 90%
contraindications for CPAP
apnea patients or patients unable to follow commands
chest trauma
hypotension
vomiting or suspected GI bleeding
what is CPAP used for?
to improve ventilatory efficiency in spontaneously breathing patients in respiratory distress
signs of respiratory failure in pediatrics
ALOC
seesaw breathing
head bobbing
bradycardia
What is SAMPLE?
S: signs/sypmtoms A: allergies M: medications P: past pertinent medical history L: last oral intake E: events leading up to illness
what is OPQRST?
O: Onset P: provocation Q: quality R: region, radiation, reoccurrence S: severity T: time
normal pulse rates for adults, pediatrics, and infants
adult: 60 to 100 bpm
pediatric: 80 to 120 bpm
infants: over 100 bpm
what are the standard vital signs?
respirations, pulse ox, pulser, pupils, skin, blood pressure
the difference between the systolic and diastolic pressures
pulse pressure
what does an widened pulse pressure indicate?
possible head injury
what does a narrow pulse pressure indicate?
possible hypoperfusion, tension pneumothorax, pericardial tamponade
what is fixed and dilated pupils refer to?
pupils are large and nonreactive to light
what is PERRL?
pupils equal, round, reactive to light
4 possible assessments for skin?
color, temperature, condition, and cap refill
abnormal skin color findings?
pale: lack of blood due to hypovolemia or vasoconstriction
cyanotic: lack of oxygenated blood
flush: excessive heat, high temperature, exertion, vasodilation
jaundice: liver problems
temperature skin findings?
warm: normal
cold: abnormal
hot: abnormal
skin condition findings?
dry: normal
wet: abnormal
diaphoretic: abnormal
clammy: abnormal
what is a glucometer?
identifies the amount of glucose in the blood
what are the blood glucose levels?
normal: 80 to 120 mg/dL
hypoglycemia: 60 mg/dl or below
hyperglycemia: over about 140 mg/dL
indications for a glucometer
any patient with ALOC known/suspected diabetic history
contraindications for glucometer
not permitted per local protocol
medications that stimulate an effect
agonists
medications that inhibit an effect
antagonists
class, mechanism of action, dose/route, and special considerations of activated charcoal?
class: adsorbent
mechanism of action: binds many drugs and chemicals preventing their absorption from GI tract
dose/route: adult 25 to 50 g, pediatric 12.5 to 25 g orally
special considerations: shake before administering
indication for activated charcoal
recently ingested poison
contraindication for activated charcoal
ALOC, inability to swallow, ingested acids, alkalis, or hydrocarbon
class, mechanism of action, route for aspirin?
class: anti-platelet aggregate
mechanism of action: reduces inflammation, decreases platelet aggregation , reduces fever
route: orally
indications for aspirin
acute chest pain
contraindication for aspirin
allergy to medication, ALOC, recent bleeding
class, mechanism of action, dose/route for albuterol?
class: bronchodilator
mechanism of action: relaxes bronchial smooth muscles
dose/route: 1-2 inhalations, orally
indications for albuterol
asthma, dyspnea
contraindications for albuterol
unable to follow commands
class, mechanism of action, route and special considerations for epi auto-injector?
class: sympathomimetic, bronchodilator
mechanism of action: peripheral vasoconstriction, increased hear rate, bronchodilation
route: administered IM, laterally mid-thigh
special considerations: must hold in place for several seconds
indications of epinephrine
anaphylaxis
contraindications of epinephrine
export medication
class, mechanism of action, dose/route of naloxone?
class: narcotics antagonist
mechanism of action: reverse effects of opioid medications
dose/route: adult dose 1 mg each nostril with spray using MAD, administer intranasally
indications for naloxone
suspected opioid overdose
contraindications for naloxone
expired medication
class, mechanism of action, route, side effects for nitroglycerin
class: vasodilator
mechanism of action: vasodilation, deceased myocardial oxygen demand
route: spray or tablet sublingual
side effects: headache, burning under the tongue
indications for nitroglycerine
acute chest pain
contraindications for nitroglycerine
53 BASH taken dose less than 5 minutes ago taken 3 doses prior per episode systolic bp is less than 100 mg ALOC taken sexually enhancement drug with 48-72 hours head injury
class, mechanism off action, route of oral glucose?
class: oral hyperglycemic
mechanism of action: increases blood glucose level
route: orally
indication for oral glucose
hypoglycemic
contraindication of oral glucose
ALOC
inability to swallow
what is the purpose of the primary assessment?
to identify and treat immediate life-threatening conditions
how to manage a flail chest?
initiate artificial ventilations
how to manage a sucking chest wound?
apply an occlusive dressing
head to toe assessment should be performed when?
when a patient is unresponsive or unable to provide feedback
when should you consider doing a focused physical exam?
when an alert patient has an isolated injury or has a specific medical complaint
adequate circulation of oxygenated blood through the body
perfusion
widespread inadequate tissue perfusion
shock or hypoperfusion
early stage of shock, the body is still able to compensate for the hypovolemic state through defense mechanisms such as increased heart rate and peripheral vasoconstriction
compensated shock
late stage of shock, the body can no longer compensate for the hypovolemic state and BP starts to fall
decompensated shock
caused by low cardiac output due to reduced preload, high afterload, or poor myocardial contractility; a pump problem
cardiogenic shock
accumulation of fluid in the lungs
pulmonary edema
s/s of cariogenic shock
hypotension, chest pain, respiratory distress, pulmonary edema, ALOC
the type of shock is a pump problem caused by mechanical obstruction of the heart muscle
obstructive shock
fluid accumulates within the pericardial sac and compresses the heart
cardiac tamponade
s/s of cardiac tamponade
JVD, narrow pulse pressure, hypotension
air enters the chest cavity due to lung injury or sucking chest wound
tension pneumothorax
s/s of tension pneumothorax
JVD, respiratory distress, diminished or absent lung sounds, tracheal deviation
what is distributive shock?
a pipe (blood vessel) problem, it occurs due to widespread vasodilation
a life threatening form of severe allergic reaction due to massive vasodilation, widespread vessel permeability, and brochoconstriction
anaphylactic shock
s/s of anaphylactic shock
hives, flushed askin, wheezing, weak pulses
caused by spinal damage, interrupts the normal coounication pathways between the central n nervous system and the peripheral nerves system
neurogenic shock
s/s of neuronic shock
hypotension, warm skin, normal color, and mechanism of injury indicative of c-spiune injury, paralysis, priapism
caused by a severe infection
septic shock
s/s of septic shock
fever, infection, chills, weakness
a pseudo-shock caused by a sudden temporarily vasodilation that leads to syncope
phylogenic shock
sudden vasodilation interrupts blood flow to the brain leading to what?
syncopal episode
a fluid problem, dehydration due to vomiting, diarrhea, or burns
hypovolemic shock
s/s of hypovolemic shock
ALOC, tachycardia, pale, cool skin, weak peripheral pulses, delayed cap refill
what is the management of shock?
control bleeding
prevent heat loss
place patient supine when possible
what is asynchronous CPR?
1 breath every 6 seconds
continuous compressions
used on a patient with an advanced airway
indications for an AED
pulseless/apneic adult, pediatric, or infant
contraindications for an AED
unsafe environment
any patient with circulation
