Ch 15, 16, 17, 18, 19, & 20 Flashcards
——- is the emergency care process that attempts to restore lost vital functions, focuses on managing the airway, oxygenation, ventilation, and circulation.
Resuscitation
—— is a critical condition that results in the inadequate perfusion of cells, tissue, and organs, leading to cellular and organ dysfunction, carries high morbidity and mortality if it is allowed to progress.
Shock
Shock is also referred to as:
Hypoperfusion
What are the three basic etiologies of shock?
- inadequate volume
-inadequate pump function - inadequate vessel tone
What is the formula for cardiac output?
Cardiac output= heart rate x stroke volume
A decrease in —— causes a drop in the systolic blood pressure.
Cardiac output
A decrease in systolic blood pressure can result in ——
Inadequate tissue perfusion
The —- is related to the size of the vessel and the resistance created within it and is referred to as the systemic vascular resistance or peripheral vascular resistance.
Tone
What are the 4 major categories of shock?
- hypovolemic
- cardiogenic
-distributive - obstructive
The term —— means shock that is caused from a low blood volume
Hypovolemic shock
What is the most common cause of hypovolemic shock?
Hemorrhage
——- shock is associated with a decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability.
Distributive
—— shock is caused by an ineffective pump function of the heart
Cardiogenic shock
When more than —% of the left ventricle tissue has been deadened from a myocardial infarction, the patient is prone to cardiogenic shock
40%
—— shock results from a condition that obstructs forward blood flow.
Obstructive shock
What are 3 causes of obstructive shock?
-pulmonary embolism
-tension pneumothorax
-pericardial tamponade
—— shock is described as a dysfunction in the ability of oxygen to diffuse into the blood, be carried by hemoglobin, offload at the cell, or be used effectively by the cell for metabolism.
Metabolic or respiratory shock
—— shock results from the loss of whole blood from the intravascular space.
Hemorrhagic shock
—— shock is caused by the shift of fluid out of the intravascular space; however, red blood cells and hemoglobin remain within the vessels
Nonhemorrhagic hypovolemic shock
—- shock is a specific form of nonhemorrhagic shock resulting from a burn injury.
Burn shock
The key emergency care in a burn patient is to establish and maintain:
-an adequate airway
-ventilation
-oxygenation
—- shock is a type of distributive shock usually treated with epinephrine
Anaphylactic shock
—- shock is another type of distributive shock, it results from sepsis, which is an exaggerated inflammatory response to an infection that causes the vessels throughout the body to dilate and become permeable
Septic shock
——, is the body’s exaggerated inflammatory response to an infection, typically fungal, viral, or bacterial, that overwhelms the body’s normal defense and regulatory systems causing a disruption in cell and organ function
Sepsis
What are the key physical exam findings of sepsis?
-tachycardia
-tachypnea
-hyperthermia and hypothermia
-hypotension
—- shock is another type of distributive shock, is usually caused by spinal cord injury.
Neurogenic or vasogenic shock
What is hypovolemic shock caused by?
Hemorrhage, fluid loss, burns
What is cardiogenic shock caused by ?
CHF, abnormal rhythm, beta blocker, pneumothorax
What is distributive shock caused by?
Sepsis, anaphylaxis, CNS injury
What is metabolic shock caused by?
Decreased oxygen delivery
When the body compensates for a decrease in pressure, maintains a normal to near normal blood pressure and perfusion of the vital organs, this is known as:
Compensatory shock
—— shock is an advanced stage of shock in which the body’s compensatory mechanisms are no longer able to maintain a blood pressure and perfusion of the vital organs
Decompensatory or progressive shock
—— (MODS) is the stage in which multiple organs begin to fail throughout the body from extreme and prolonged hypoxia, altered metabolism, and elevated carbon dioxide and acid levels
Multiple organ dysfunction syndrome or multiple organ failure
What are some signs of poor perfusion?
-altered mental status
-pale, cool, clammy, skin
-delayed capillary refill
-decreased urine output
-weak or absent peripheral pulses
—— occurs when the ventricles of the heart, for any of a variety of reasons, are not contracting or when the cardiac output is completely ineffective and no pulses can be felt.
Cardiac arrest
Cardiac arrest patients are often described as having suffered from ——, which occurs when the patient dies within 1 hour of the onset of the signs and symptoms
Sudden death
—— is a chaotic and disorganized cardiac rhythm that causes the ventricles to quiver and does not produce ventricular contraction.
Ventricular fibrillation
What are the 3 phases a patient goes through following cardiac arrest that lead to death?
- electrical phase
-circulatory phase
-metabolic phase
The —- phase begins immediately upon cardiac arrest and ends 5 minutes afterward.
Electrical phase
If CPR is started within — minutes during the electrical phase it gives a further chance of resuscitation.
4 minutes
The —- phase begins at 5 minutes following the cardiac arrest and lasts through 10 minutes following the cardiac arrest.
Circulatory phase
The —— phase begins 10 minutes after cardiac arrest, the chances of survival drop dramatically during this phase
Metabolic phase
What terms are related specifically to resuscitation of a cardiac arrest patient?
-downtime
-total downtime
-return of spontaneous circulation
-survival
-witnessed cardiac arrest
-unwitnessed cardiac arrest
This time starts when the patient goes into cardiac arrest until CPR is effectively being performed:
Downtime
This is the total time from when the patient goes into cardiac arrest until you deliver the patient to the emergency room or there is a return of spontaneous circulation:
Total downtime
This is when the patient regains a spontaneous pulse during the resuscitation effort:
Return of spontaneous circulation
In cardiac arrest, this is defined as a patient who survives to be discharged from the hospital:
Survival
This is when the EMT witnesses the patient become unresponsive, apneic, and pulse less:
Witnessed cardiac arrest
This is when the EMT arrives on the scene and the patient is already unresponsive, apneic, and pulse less:
Unwitnessed cardiac arrest
When resuscitating a cardiac arrest patient, success depends on a sequence of events that the AHA has termed the ———.
Chain of survival
—- is the procedure of sending an electrical current through the chest, is necessary to convert an abnormal and lethal non perfusion rhythm with no pulse to an organized rhythm capable of producing a pulse.
Defibrillation
What components make up the AHA adult chain of survival?
-activation of emergency response
-high quality CPR
- defibrillation
-advanced resuscitation
- post cardiac care
-recovery
What components make up the AHA pediatric chain of survival?
-prevention
-activation of emergency response
-high quality CPR
-advanced resuscitation
-post cardiac care
-recovery
When performing chest compressions, deliver compressions at —— per minute to maximize the pressures needed for blood circulation.
100 to 120 per minute
Deliver compressions at a rate of — compressions to — ventilations to minimize the interruption of chest compressions.
30:2
Following defibrillation, immediately resume —-.
CPR
Deliver the —- rate and volume of artificial ventilation.
Minimum
What are the two basic categories of external defibrillators?
-manual
-automated
What are some advantages of the AED?
-speed of operation
-safer, more effective delivery
-more efficient monitoring
What are the two types of AED’s?
-semi automated
-fully automated
Most current AED’s use what type of wave form?
Biphasic waveform
—— is a very fast heart rhythm that is generated in the ventricle instead of the sinoatrial node in the atrium.
Ventricular tachycardia
—- is the absence of electrical activity and pumping action in the heart.
Asystole
In cases of —— (PEA), the heart has an organized rhythm, but either the heart muscle is so weakened that it fails to pump or the heart muscle does not respond to electrical activity, or the circulatory system has lost so much blood that there is nothing to pump.
Pulseless electrical activity
What are the signs and symptoms of cardiac arrest?
- unresponsive
-no breathing
-no pulse
-no other signs of life
What are some signs of cardiac arrest in a child?
-unresponsive
-gasping or no respiratory sounds
-no heart sounds
-cyanosis
What are the key components of management for cardiac arrest?
-provide positive pressure ventilation
-perform CPR
-defibrillate
-call for ALS backup
-transport rapidly to appropriate facility
——- (SIDS), commonly known as “crib death”, is defined as the sudden and unexpected death of an infant under 1 year of age in which an autopsy fails to identify the cause of death.
Sudden infant death syndrome
—— is a high pitched, musical, whistling sound that is best heard initially on exhalation but can also be heard during inhalation in more severe, it is an indication of swelling and constriction of the inner lining of the lower airways, primarily the bronchioles.
Wheezing
—-, which can also be referred to as coarse crackles, are snoring, or rattling noises heard on auscultation, indicate obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucous.
Rhonchi
—- also known as rales, are bubbly or crackling sounds heard during inhalation, these sounds are associated with fluid that has surrounded or filled the alveoli or small bronchioles.
Crackles
Failing to breathe adequately, even for short periods of time, can result in —- (decreased oxygen in the bloodstream) and —- (increased carbon dioxide in the blood stream)
-Hypoxemia
-Hypercarbia
Respiratory emergencies can range from “shortness of breath” or —-, to complete respiratory arrest, or —-.
-dyspnea
-apnea
What is it termed when a patient is found leaning forward, braced with arms and elbows locked and hands on a hard surface?
Tripod position
Many complaints of breathing difficulty result from significant narrowing of the lower airways, which include the bronchi and bronchioles, from inflammation, swelling, or constriction of the muscle layer, a condition known as ——.
Bronchoconstriction
A beta 2 agonist, or a ——, is designed to help relax the bronchi and bronchiole smooth muscle, causing dilation, which results in a decrease in airway resistance and an increase in the effectiveness of moving air in and out of the alveoli, better gas exchange, and a relief from the signs and symptoms.
Bronchodilator
A breathing disturbance in a patient can be categorized in one of 3 ways:
-respiratory distress
-respiratory failure
-respiratory arrest
A patient who is having difficulty breathing but has an adequate tidal volume and respiratory rate is said to be in ——.
Respiratory distress
The patient is said to be in —— when the tidal volume or respiratory rate is inadequate and no longer can provide an adequate oxygenation of the cells.
Respiratory failure
—— is a complete cessation of breathing effort or the patient experiences agonal breathing.
Respiratory arrest
An —— causes an obstruction of airflow through the respiratory tract, leading to a reduction in gas exchange.
Obstructive pulmonary (lung) disease
What is the most severe consequence of reduced airflow?
Hypoxia
What are the 3 most commonly encountered obstructive Pulmonary diseases?
-emphysema
-chronic bronchitis
-asthma
—- is considered to result primarily from inflammation of the lower airways, which can lead to airway hyperactivity, resulting in bronchospasm.
Asthma
—— is a permanent disease process distal to the terminal bronchioles that is characterized by the destruction of the alveolar walls and the distention of the alveolar sacs and a gradual destruction of the pulmonary capillary beds with a severe reduction in the alveolar/capillary area in which gas exchange can occur.
Emphysema
—— is a disease process that affects primarily the bronchi and bronchioles., is characterized by a productive cough that persists for at least three consecutive months a year for at least 2 consecutive years.
Chronic bronchitis
A prolonged life threatening attack that produces inadequate breathing and severe signs and symptoms is called—-.
Acute severe asthma
What is it termed when there is a drop in systolic blood pressure of 10mmHg or more on inhalation?
Pulsus paradoxus
—- is primarily an acute infectious disease caused by bacterium or a virus that affects the lower respiratory tract and causes lung inflammation and fluid or pus filled alveoli.
Pneumonia
—— is a sudden blockage of blood flow through a pulmonary artery or one of its branches.
Pulmonary embolism
——, usually caused by a cardiogenic etiology, occurs when an excessive amount of fluid collects in the spaces between the alveoli and the capillaries.
Acute pulmonary edema
