Exam 2: 7,9, and 10 Flashcards
What is pathophysiology?
study of how disease processes affect the function of the body
What is the sodium potassium pump?
responsible for moving ions back and forth across cell membrane using ATp and this movement of ions leads to the generation of an electrical charge leading to depolarization stimulating muscle contraction.
What is metabolism?
the cellular function of converting nutrients into energy by water, glucose and oxygen
What is electrolyte?
a substance that, when dissolved in water, separates into charged particles with their movement enabling electrical functions of cells such as nerve transmisisona nd cardiac muscle depolarization including potassium, sodium, and magnesium
What is aerobic metabolism?
the cellular process in which oxygen is used to metabolize glucose. energy is produced in an efficient manner with minial waste products
What is anaerobic metabolism?
the cellular process in which glucose is metabolized into energy without oxygen. energy is produced in an inefficient manner with many more waste products (which affect hemoglobin binding
What is FiO2?
fraction of inspired oxygen, concentraton of oxygen in the air we breathe
What is perfusion?
delivering oxygenated blood to body cells
What is patent?
open and clear airway; free from obstruction above trachea most common obstructions occur
What is tidal volume?
the volume of air moved in one cycle of breathing
amount of air moved in one breath ex. less than 94% oxygen is bad
What is minute volume?
the amount of air breathed in during each respiration multiplied by the number of breaths per minute problems with this elad to respiratory dysfunction
ex. average adult breathes 12-20 breaths per minute with under 8 is concerning and over 30. it is about depth, how they look.
What is dead air space?
air that occupies the space between the mouth and alveoli but that does not actually reach the area of gas exchange
150 mL not available at alveolar ventile keeping bronchiole and pharynx open, alveolar volume is tidal volume minus dead space volume
What is medulla oblongata?
part of brain controlling repiration can be affected by stroke, infection, narcotics,
What is inhalation?
active process, diaphragm contracts, muscles of chest expand and negative pressure is created in the chest cavity and lungs and this negative pressure pulls air in through trachea
What is exhalation?
muscles relax passive process creating positive pressure pushing air out relying on contact with the chest compartment. bleeding In pleural space between chest walls and lungs can cause them to collapse
What is heart failure and sepsis?
changes ability of alveloli to transfer gases across membranes. permeability of thin walla that separates form capillary changes impairing diffusion causing hypoxia and hypercapnia (high carbon dioxide)
What is chemoreceptors?
chemical sensors in the brain and blood vessels that identify changing levels of oxygen and carbon dioxide by increasing or decreasing breathing based on concentration in blood
What is dyspnea?
shortness of breath resuls form need for gas exchange that cannot be met by current breathing levels (minute ventialiation
What is blood plasma?
liquid portion of blood, dissolving oxygen and carbon dioxide, contains large proteins attract water from area around cells into bloodstream
What is plasma osmotic pressure?
the pull exerted by large proteins in the plasma portion of blood that tends to pull water form the body into the bloodstream.
What is hydrostatic pressure?
the pressure within a blod vessel that tends to push water out of the vessel when the heart contracts
What is liver failure?
swelling in patient as fluid accumulates outside bloodstream and dehydration of blood because liver doenst produce enough albumin which would pull water into blood stream so water leaves bloodstream accumulates around body cells and cavities.
What is anemia?
decrease in the number of red blood cells and loosing oxygen in blood changing amount delivered
What is sympathetic nervous system (SNS)?
in its fight or flight response stimulates blood vessels to constrict and the parasympathetic nervous system stimulates blood vessels to relax.
What is sepsis?
causes uncontrolled dilation of the body vessels increases in capillary permeability leading to volume loss form blood stream restricting airflow
What is stretch receptors?
sensors in blood vessels that identify internal pressure
What is systemic vascular resistance?
(SVR) the pressure in the peripheral blood vessels that the heart must overcome to pump blood into the system
What is stroke volume?
the amount of blood ejected form the heart in one contraction average 70 mL =per contraction with more forceful contractions increasing stroke volume, greater the pressure in the systemic system lower stroke volume pumping blood fast decreases stroke volume as not enough blood gets back to heart.
What is cardiac output?
the amount of blood ejected form the heart in one minute (heart rate x stroke volume)
What is V/Q match?
ventilation perfusion match. implies that alveoli are supplied with enough air that the air in alveoli is matched with suffi]cient blood in the pulmonary capillaries to permit optimum exchange of oxygen and carbon dioxide
What is perfusion?
supply of oxygen to and removal of wastes form cells and tissues of body as a result of flow of blood through capillaries
regular delivery of oxygen and nutrient to cells and removal of waste products
What is hypoperfusion?
inability of the body to adequately circulate blood to the body’s cells to supply them with oxygen and nutrietns a life threateneing condition called shock. oerfusion is inadequate and leads to acidosis of blood as the cells relay only on anaerobic respiration. heart rate increases, blood vessels constrict breathing increases, compensated shock. ex. slightly changed mental status anxiety and feeling impending doom, delayed capillary refill time, pale skin diaphoresis, sweating leads to decompensated shock (altered mental status and decreased blood pressure) to irreversible shock (organs die)
pediatric patient can compensate until they absolutely cant anymore so it is important to treat it right away for worst possible outcome because adult usually has a progression that you can see. Na+/K+ when messed with it leads to misfiring
What is hypovolemic shock?
low blood volume blood is lost (blleding) or volume portion lost (dehydration), too little volume mean reduced pressure, heart difficulty with cells hypoperfused loosing oxygen-carrying capacity creating oxygen deficit in cells
breach in vessel you are leaking out with lacceration in internal or external, it can also be due to loosing vascular tone (distributive shock) cant costrict like they should and cant dilate (neurogenic shock)
What is distributive shock?
blood vessel tone lost, losing ability to maintain normal diameter (anaphylaxis or sepsis) normally constricted vessels to dilate reducing pressure in system diminishing blood flow
What is cardiogenic shock?
heart fails to pump (myocardial infarction or trauma), lead to electrical or mechanical problem damage to heart itself. pump fails and cardiac output suffers, heart can no longer maintain pressure in cardiovascular system and blood fails to be pumped to cells, may not allow heart rate to increase
What is obstructive shock?
blood physically prevented from flowing, large amounts of blood prevented from reaching essential organs and vital areas organs go without blood.
What is diaphoresis?
cool pale and moist/sweaty skin; sweating symptoms in shock
What is dehydration?
an abnormally low amount of water in the body
How much water is in the body?
60% of body made up of water. 70% is intracellular water inside cells, 5% is intravascular water in bloodstream, interstitial fluid 25% water found between cells and blood vessels.
What is trauma to the brain and what does it lead to?
blood or edema takes up space where brain tissue would otherwise be and presses on brain increasing intracranial pressure damaging things
What are strokes?
from clots in or dbleeding from arteries that perfuse the brain depriving these cells of oxygen and die
What are signs of neurological impairment?
altered mental status, seizures, inability to speak or difficulty speaking, visual or hearing disturbance, inability to walk or difficulty walking, paralysis or weakness (sometimes limited to one side), loss of sensation and pupil changes.
What is gastrointestinal bleeding?
hypovolemic shock from acute massive bleeding in form of rectal bleeding or vomiting blood. nausea dn vomiting can be a sign of acute myocardial infarciton and even strokes and brain injuries
What is hypersensitivity?
an exaggerated response by the immune system to a particular substance. rapid drop in blood pressure, distributive shock, dilation of blood pressure, blood vessel permability,
What is diffusion?
moves oxygen across thin membrane form alveoli to capllaires and within capilarries oxygen is loaded onto hemoglobin and transported to cells
how gases exchange from an area of high concentration to an area of low concentration
What is edema?
swelling associated with the movement of water into the interstitial space, when pressure is high fluid is moved out
fluid part pulled out of vascular systems and the volume is pushed into the interstitial space
What is airway?
the passageway by which air enters and leaves the body. the structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi and lungs
What is trachea?
16 rings of cartilage preveting collapse top ring cricoid ringbranches at carina into bronchi
What is sniffling position?
when swelling obstructs upper airway patients sit bolt upright with head ptched forward but if they can talk they are not obstructed different sounds may
What happens to children with inadequate airway?
pulling in of muscles above clavicles and between and below ribs, nasal flaring widening of nostrils with respiration in infant and children
What happens in partially obstructed airways?
makes sounds of stridor (high pitched) severly narrowed passage, hoarseness- swelling is building, snoring- upper airway soft tissue creating impedance (partial obstruction), and gurgling (fluid obstruction of vomit or blood)
What is a patent airway?
an airway (passage form nore or mouth to lungs) that is open and clear and will remain open and clear without interference to the passage of air into and out fo the body
what is the best way to look at an airway?
on their back
What is bronchioconstriction?
he contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resitance to airflow
what is stridor?
a high-pitched sound generated from partially obstructed airflow in the upper airway.
What is the head-tilt, chin-lift maneuver?
a means of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin used when no trauma or injury is suspected until lower teeth touching upper teeth by moving the bone and lower lip but don’t put thumb in mouth. maintain even when having a device in.
What is the jaw thrust maneuver?
a means of correcting blockage of the airway by moving the jaw forward without tilting the head or neck. used when trauma, or injury, is suspected to open the airway without causing further injury to the spinal cord move jaw but steady rest of head retracting lower lip maintain even when having a device in
What are airway adjuncts?
oral- keep head-tilt, chin-lift when putting in and take out when person regains consciousness. to determine correct size measure device form cornor of patient’s mouth to tip of earlobe on same side of patient’s face if to large will put air into stomach. use tongue repressor to keep tongue down as you insert it along top of mouth and down their throat separate teeth on outside of mouth and rotate so tip is pointing down. or start with it pointed down and suction especially in children
What is a nasopharyngeal airway?
use when teeth clenched, intact gag reflex, or oral injuries soft flexible nasal airway, measure from nose to earlobe, lubricate non-water based, tube usually right nostril and points towards septum, do not use if clear fluid is coming from nose or ears (cerebrospinal fluid suggesting damage to skull)
a flexible breathing tube inserted through the patine’ts nostril into the pharynx to help maintain an open airway
What is an oropharyngeal airway?
curved device inserted through the patients mouth into the pharynx to help maintain an open airway only used on patients without a gag reflex such as when deeply unconscious but when regaining consciousness take it out
What is a gag reflex?
vomiting or retching that results when something is placed in the back of the pharynx this is tied ot the swallow reflex
What is suctioning?
use of a vacuum device to remove blood, vomitus, and other secretions or foreign materials from the airway. consists of suction source, continer material, tubing, suction tips or catheters. tubing- thick-walled nonkinking, wide-bore tubing don’t suction more than a ten seconds at a time if possible and if oxygen needed do it for a few second then switchand don’t lose the tip Yankaeur. Wear gloves, protective eyewear, and mask lay patient on side.
What is ventilation/
breathing in or out (inhalation and exhalation), or artificial provision of breaths
What is inhalation?
muscles of chest, intercostal muscles between ribs expanding at same time diaphragm contracts in a downward motion creating negative pressure
What is alveolar ventilation?
the amount of air that reaches the alveoli
What is diffusion?
a process by which molecules move from an area of high concentration to an area of low concentration
What is pulmonary respiration?
the exchange of oxygen and carbon dioxide between alveoli and circulating blood in the pulmonary capillaries
What is a stab wound?
when diaphragm moves down air is pulled into chest cavity through stab wound as well as normal drawing in of air through glottis opening, because of air rushing into chest through stab wound the negative pressure not created efficiently to pull into lungs
What happens when you lose nervous control in respiration?
cant transmit message through nerve tissue to innervate muscles of respiration from diseases such as multiple sclerosis
What is chest wall injuries/
pain and physical damage limiting chest wall movment
What are some airway problems?
air cannot move, no breathing astma and COPD decreasing in diameter with low oxygen levels in outside air in confined space with not enough oxygen to breath
What happens with diffusion problems in respiration?
congestive heart failure and COPD limit ability of alveoli to exchange oxygen and CO2 alveoli are not working.
What happens when there is not enough blood?
lost significant amounts of blood not enough circulating in alveoli
What are hemoglobin problems?
anemia with low hemoglobin or acidic body making hemoglobin difficiult to hold oxygen
What is cellular respiration?
exchange of oxygen and carbon dioxide between cells and circulating blood.
What is respiration?
the diffusion of oxygen and carbon dioxide between the alveoli and blood (pulmonary respiration) and between the blood and the cells (cellular respiration). also used to mean simply breathing when trying to make up for it if mental status and skin color is normal it is working
exchange of gases, o2 and co2, internal- at a cellular level, external- is in the lungs with the environment at the alveolus
What is hypoxia?
an insufficiency of oxygen in the body’s tissues cant tolerate for very long cause by fire, emphysema, overdose, heart attack, stroke, and shock
smoke inhalation, anaphylaxis, overdoses, emphysema, heart attack, stroke, trauma, seizure.
use positive pressure ventilation (positive pressure ventilation bag mask rest across chin and over nose, BiPAP (going with their respiration) , CPAP (continuous pressure)
Bad: gastric distention- (can decrease cardiac output, increase heart rate, cerebral pressure) air going into stomach don’t push on belly
know doing right- see chest rise and fall, for an adult every six seconds, 6
What is hypercapnia?
high levels of carbon dioxide the body can tolerate it for longer periods of time
What is respiratory distress?
increased work of breathing; a sensation of shortness of breath increasing heart rate to move more blood transporting more oxyen and CO2 constrict blood vessels
What is respiratory failure?
the reduction of breathing to the point where oxygen intake is not sufficient to support life
What is respiratory arrest?
when breathing completely stops. no breating/chest rise/ no air moved form mouth or nose/breath sounds/oxygen saturdation very low use use aritifical ventilation (pocket fask mask PFM, bag-valve mask (BVM), or flow-restricted, oxyen-powered ventilation device FROPVD) assiting ventlations at 10-12/minute for an adult or 20/ minute for a child or infant
What is inadequate breathing?
(respiratory failure)- rate of breathing or depth of breathing is outside normal ranges if the patient continues in this way they will undergo respiratory arrest and death. patient is moveing some air in and out, slow and shallow and not enough to leive, rate and/or depth outside normal, shallow ventilations, diminished or absent breath sounds, noises like crowing, stridor, snoring, gurgling or gasping, blue or gray skin color, decreased minute volume, oxygen saturation low so use assisted ventilation (air forced into lungs under pressure) with pocket face mask, bag-valve mask oR FROPVD
What do you do to some patient conditions?
to check look to see if chest is rising, listen for breath sounds or air leaving nose or mouth, feel for air moving out of nose or mouth
What is adequate breathing
speaking full sentences, alert and calm, rate and depth are adequate, no abnormal breath sounds, air moves freely in and out of chest, skin color normal, oxygen saturation normal but needs supplemental oxygen to a medical or traumatic condition use non breather mask or nasal cannula. adults- 12-20 per minute, childe 15-30 per minute, infant 25-50 per minute
What is inadequate breathing?
(respiratory failure)- rate of breathing or depth of breathing is outside normal ranges if the patient continues in this way they will undergo respiratory arrest and death. patient is moveing some air in and out, slow and shallow and not enough to leive, rate and/or depth outside normal, shallow ventilations, diminished or absent breath sounds, noises like crowing, stridor, snoring, gurgling or gasping, blue or gray skin color, decreased minute volume, oxygen saturation low so use assisted ventilation (air forced into lungs under pressure) with pocket face mask, bag-valve mask oR FROPVD
What is increasing respiratory distress?
visibly short of breath, speaking 3-4 word sentences, increasing anxiety use non breather mask or nasal cannula
What is severe respiratory distress?
speaking only 1-2 word sentences; very diaphoretic (sweaty); severe anxiety use assisted ventilations (pocket fask mask PFM, bag-valve mask (BVM), or flow-restricted, oxyen-powered ventilation device FROPVD) by assisting the patient’s own ventilations adjusting the rate for rapid or slow breathing continuing to deteriorate by sleeping with head-bobbing and becomes unarousable
What is cyanosis?
a blue or gray color resulting from lack of oxygen in body
What is artificial ventilation?
forcing air or oxygen into lungs when a patient has stopped breathing or has inadequate breathing, positive pressure ventilation.
What are negative side effects?
decreasing cardiac output/dropping blood pressure (use just enough volume to raise the chest), gastric distention- filling of stomach with air leading to vomiting, restriction of movement of diaphragm so use airway adjuncts maintain proper ventilation so body doestn vasoconstrictor
What are techniques of artificial ventilation?
(high concentration supplmenetal oxygen 15 liters/minute): mouth to make, two-rescuer bag valave mask BVM, flow restricted oxygen powered ventilation device, one=rescuer bag valve mask suction if vomited. do every 5 seconds for adult and every 3 for a child
What is noninvasive passive pressure ventilation (NPPV)?
(NPPV) in form of CPAP (continuous positive airway pressure and BiPAP (biphasic continuous)- NPPV assure that each breath maintains adequate pressure within respiratory tract improving alveolar ventilation and gas exchange preventing hypoxia and carbon dioxide accumulation.
What is a pocket face mask?
a device, usually with a one-way valve to aid in artificial ventilation. A rescuer breathes through the valve when the mask is placed over the patient’s face. Acting as a barrier to prvenet contact with a patient’s breath or body fluid. it can be used with supplemental oxygen when fitted with an oxygen inlet.
What is a bag valve mask?
(BVM)- a handheld device with a face mask and self-refilling bag that can be squeezed to provide artificial ventilations to a patient. it can deliver air form the atmosphere or oxygen form a s upllemental oxygen supply system. use 2 rescuers
What is stoma?
a permanent surgical opening in the neck thorugh which the patient breathes suction stoma before ventilating use pediatric sized masc to seal around stoma
What is FROPVD?
flow-restricted, oxygen-powered ventilation device- a device that uses oxygen under pressure to deliver aritifical ventilation. its trigger is paced so the rescuer can operate it while still using both hands to maintain a seal on the fac mask. it has automatic flow restriction to prvenet overdeliver of oxygen to the patient.
What is ATV?
automatic transport ventilator a device that provides positive pressure ventilations. it includes settings designed to adjust ventilation rate and volume, is portable, and is easily carried on an ambulance use for patients in respiratory arrest
What does oxygen do?
oxygen can cause harm in reperfusion situations with cells surrounding heart attack killed but oxygen must be given to anyone with a sitatution of saturation below 94 percent or in respiratory distress ventilate instead of oxygenate patients. can lead to patient lung collapse if too much oxygen, if given to infant for days causes eye damge, COPD towards end use low concentration
What is oxygen cylinder?
what are the different kind of oxygen cylinders?
a cylinder filled with oxygen under pressure. always use pressure gauges, regulators, and tubing, nonferrous (plasmtic or noniron) oxygen renched for chaning gauges and regulators, every five years kept in cold room, no fire oil or dropping. when connecting pressure regulator stand to the side and let out slightly to clear out dust. if punctured can become a missle, fire hazard, explosion around oil
o D cylinder- 350 liters of oxygen, E cylinder0 625 liters of oxygen, M cylinder 3000 liters of oxygen, G cylinder 5300 liters of oxygen, and H cylinder- 6900 liters of oxygen
What is a pressure regulator?
a device connected to an oxygen cylinder to reduce cylinder pressure so it is safe for delivery of oxygen to patient
What is a flowmeter?
a valve that indicates the flow of oxygen in liters per minute
What is a low-pressure flowmeter?
pressure compensated flometer selector valve common 15-25 liters per minute
What is pressure-compensated flowmeter?
gravity-dependent in upright position to deliver accurate raeding, ball floats indicating flow at times not portable
What is constant flow sector valve?
no gauge adjust flow in liters per minute incremently nasal cannula or nonrebreather mask and any size oxygen cylinder
What is a high-pressure flowmeter?
thumper CPR device and ventilators CPAP and BiPAP green tubing
What is a humidifier?
a device connected to the flowmeter to add moisture ot the dry oxygen coming from an oxygen cylinder can dry out mucous membranes do in COPD and children use fresh water for each shift used in long transports
What is a non-rebreather mask?
(NRB) a face mask and reservoir bag device that delivers high concentrations of oxygen. the patient’s exhaled air escapes thorugh a valve and is not rebreathed used in patients with signs of hypoxia, short of breath, or displaying an altered mental status
What is nasal cannula?
a device that delivers low concentration of oxygen through two prongs that rest in the patien’s nostrils those with signs of shock, hypoxia and those who cannot handle a mask delivering 4-6 liters per minute
What is partial rebreather mask?
a face mask and reservoir oxygen bag with no one-way valve to the resrouver bag to some exhaled air mixes with oxygen; used in some patients to help preserve carbon dioxide levels in the blood to stimulate breathing. rebreathe 1/3 of exhaled air in order to preserve carbon dioxide levels in blood to stimulate breathing 9-10 liters per minute, 40-60% O2 used at homes
What is a venture mask?
a face mask and reservoir bag that delivers specific concetrations of oxygen by mixing oxygen with inhaled air used on patients with COPD, can change tip based on flow rate
What is tracheostomy mask?
a device designed ot be placed over a sotma or tracheostomy tube to provide supllemental oxygen 8-10 liters per minute
What is a BURP maneuver?
bringing up and to the right position of vocal cords for when the paramedic is placing an endotracheal tube can be easily dislodged with movement
What is acute coronary syndrome?
(ACS)-a blanket term used to represent any symptoms related to lack of oxygen (ischemia) in the heart muscle, cardiac compromise. associated with chest pain such as crushing, dull, heavy or squeezing and radiation to the arms. anxiety/irritability and short temper, nausea, pain, discomfort in upper abdomen, cvomit, sweating, abnormal pulse or blood pressure, palpitations or abnormal pulse.
What is chest pain?
give oxygen only if less than 94% and bring it up to that, give nitroglycerin if prescribed right patient, time, drug, dose, and route check expiration. transport quickly is has no history of cardiac problem, doesn’t have nitroglycerin systole of 90 or below or if medical director says you can but don’t give if took Viagra give after 5 minutes if no bettering of symptoms and u have permission. be careful of driving ambulance and going fast with hear problems
When do you give aspirin?
chest pain, no history of asthma, no conflicting medications, able to swallow, medical direction authorization
What is percutaneous coronary internet?
PCI use a tube to open up artery causing obstruction
What is OPQRST?
ask a paitent about the onset, provocation, quality, radiation , severity and time
What is acute myocardial infarction?
(AMI- the condition in which a portion of the myocardium dies as a result of oxygen starvation; often called a heart attack by layspersons rought on by narrowing or occlusion of coronary artery supplying region with blood. unusual exertion, severe emotional stress or chronic respiratory problems may cause and are treated with fibrinolytic dissolveing clot early on, or balloon angioplasty or chatheterization afterwards given beta blocker to slow heart and beat less strongly
What is agonal breathing?
irregular, gasping breaths that precede apnea and death
What is aneurysm?
dilation or ballooning, of a weakened sextion of the wall of an artery. caused by internal bleeding, in aorta or in brain causing severe stroke
What is angina pectoris?
pain the chest occurring when blood supply to the heart is reduced because of narrowed arteries, CAS, and a portion of the heart muscle is not receiving enough oxygen.
What is apnea?
· apnea- no breathing
What is asystole?
a condition in which the heart has ceased generating electrical impulses, flatline from untreated ventribular fibrillation and ventricular tachycardia
What is cardiac compromise?
acute coronary syndrome
What is cardiac arrest?
most often caused by ventricular fibrillation and/or ventricular tachycardia
What is cardiopulmonary resuscitation?
CPR · cardiopulmonary resuscitation (CPR)- actions taken to revive a person by keeping the person’s heart and lungs working start CPR when coming upon patient then use AEd when available.
What is the cardiovascular system?
heart and blood vessels
What is congestive heart failure ?
(CHF) failure of heart to pump efficiently, leading to excessive blood or fluids in the lungs, body or both cuasing swelling clogging the organs or from AMI area in left ventricle dies backing up blood into lungs causing pulmonary edema causing poor gas exchange causing right side to not work as well and lead to fluid accumulation in lower extremiites, liver and abdomen. symptoms include tachycardia, dyspnea, normal or elecvated blood pressure, cyanosis, pulmonary edema coughing up frothy white or pink sputum, anxiety or confusion, pedal edema, engorged pulsating neck veings (late), enlarged liver and spleen (late sign)
What is hypoxia?
lack of oxygen causes death of portion of myocardium, no longer contracting and pumping leading to arrest, shock and edema or congestive heart failure
What is coronary disease?
(CAD disease that affect the arteries of the heart buildup of fat deposits on inner wall of arteries narrowing them with plague and restricting flow caused by hypertension, lack of exercise, high cholesterol and triglcerides, cigareetes, and obesity
What is defibrillation?
delivery of an electrical shock to stop the fibrillation of heart muscles and restore a normal heart rhythm
What is dyspnea?
shortness of breath; labored or difficult breathing
What is dysrhythmia?
disturbance in heart rate and rhythm
What is edema?
swelling resulting from a buildup of fluid in the tissues
What is embolism?
blockage of a vessel by a clot or foreign material brought to the site by the blood current
What is nitroglycerin?
medication that dilates blood vessels more blood stayin gin veins of body, so less coming to heart and heart not working as hard
What is occlusion?
blockage, as of an artery by fatty deposits
What is pedal edema?
accumulation of fluid in the feet or ankles
What is pulmonary edema?
accumulation of fluid in the lungs
What is pulseless electrical activity?
(PEA a condition in which the heart’s electrical rhytm remains relatively normal, yet the mechanisl pumping activity fails to follow the electrical activity causing cardiac arrest not shockable, such as no fluid in the system
What is sudden death?
a cardiac arrest that occurs within two hours of the onset of sympotoms. the patient may have no prior symptoms of coronary artery disease
What is tachycardia?
when the heart rate is fast more than 100 beats per minute
What is thrombus?
a clot formed of blood and plaque attached to the inner wall of an artery or vein
What is ventricular fibrillation?
(VF) a condition in which the ehart’s electrical impulses are disorganized, preventing the heart muscle from contracting normally a shockable rhythm if awake don’t shock
What is ventricular tachycardia?
(V-tach) a condition in which the heartbeat is quite rapid; if rapid enough, ventricular tachycardia will not allow the heart’s cahambers to fill with enough blood between beats to produce blood flow sufficient to meet the body’s needs
What is automatic external defribillator?
only use for shcockable conditions like ventricular fibrillation nd tachycardia, don’t use for Pea and asystole, monophasic units use 360 joules, and biphasic electrocuting twice120-200 joules. if child get child size one or use adult with pads on front and back. white to right and red to ribs. ½ of all cases have unshockable rhythms. begin CPR after delivering shock. ROSC_ return of spontaneous circulation. don’t defibrillate soaking wet person, or touching anything metallic and remove nitroglycerin patch. just move pads down if someone has pacemaker.
What is high-performance CPR?
compressing chest 2 inches in adults, allow for full relaxation on upstroke of compressions, half of compression on downstroke and half on upstroke, correct hands, 100 times per minute, 1 second each ventilation, interupptions not for more than 10 seconds. apply ice packs to carotid artery and other major arteries. 2 minutes or 5 cycles of CPR then reassess. call ALS to meet you somewhere
What happens if patient has signs of life?
use head-tilt jaw-thrust maneuever check for respiration (breathing) and pulse circulation ABC
What happens if the patient is lifeless?
unconscious, not moving, not breathing, gasping breathing, pulseless chest compressions then open airway CAB
What is agonal respirations?
gasping breaths as heart stops but blood still moving through system with enough oxygen in medulla
What is VAD?
ventricular assist device, no pulse but is pumping do not use CPR as it will break it and vessels so just transport
What is ALS?
advanced life support intravenous or intraosseous to emergency medication and can pass advanced airway, change pressure to asynchronous 30:2 when advanced airway placed
What is post-resuscitation?
make sure to keep airway, reassess every 5 minutes once stabilized adjust amount of oxygen to 94% and is highly likely to go back into cardiac arrest, if unconscious check pulse ever 30 seconds. if en route stop the vehicle, have someone start CPR and sed up AED use two shocks separated by 2 minutes of CPR
What happens if it faces a lot of trauma?
if facing a lot of trauma take to emergency care center fast, so don’t necessarily do defibrillation because of injury, hypothermia do once then wait till 86 degrees, and transport immediately
What happens if alone?
if alone defibrillate immediately, then begin chest compressions and ventilation
What is pediatric arrest like?
most often cardiac arrest caused by airway obstruction,
What is terminating resuscitation?
when too exhausted, turned over, no resuscitation order from physician or other authority arrest not witnessed by EMS personnel or first responders, no spontaneous circulation after 3 rounds of CPr and rhythm checks with AED, AED did not detect shockable rhythm and didn’t deliver shocks.
What is clinical death?
patient’s breathing and heartbeat stop
What is biological death?
brain cells die after 10 minutes of clinical death and is irreversible beginning to die after 4-6 minutes
When does CPR being?
when found unresponsive, breathlessness, and pulselessness. (ABC-airway, breathing, and circulation. unless you definetily feel a pulse in adult patient start CPR
When you found an unresponsive adult what do you do?
do CPR more likely heart
What do you do when people are drowing?
children and people drowning do a little CPR then defibrillation more likely the problem
What do you do for an infant?
don’t do abdominal compressions- do 5 back blows and five chest compressions, alternating back blows and chest compressioin. if unresponsive after 30 compressions or if 5 back blows and 5 chest compressions not cleared look for foreign body, 2 breaths and continue alternating.
When do you do CPR?
obvious wounds so it cannot be effectively performed, rigor mortis (4-10 hours), decomposition, lividity (15 minutes),
What is emphysema?
causes alveolus breaking down the surface with less area to perfuse decreasing the exchange of O2 and CO2 must breathe fast or with pressure, whistler especially smokers with heated air hurting tissue as well as the toxins
What is sacral edema?
candles too much water
What happens with dehydration?
and what causes it?
dehydration- less vascular volume caused by:
edema- fluid part pulled out of vascular systems and the volume is pushed into the interstitial space.
burns- lose plasma 50-60% most drawing blood to system changing the permeability
What is pericarditis?
fluid around heart and cant stretch for cardiac amount
What is neurogenic shock?
causes for a loss of tone with no constriction so there is not enough fluid in the veins
What is anaphylaxis?
bronchial tree closes, with a loss of vascular tone
What is FBAO?
foreign body airway obstruction
What is pneumothorax?
decreased respiratory rate and volume with visceral (lines long) and pariteal pelvic lining the thoracic cavity. as EMT use needle decompression to close hole
What is respiratory control?
medulla oblongata in brain
What is pneumonia?
fluid in alveoli people make crackle hard to get air through the phlegm around the lungs
What is asthma?
explitory wheezing with inpitory is worse with smoke, inhlaition and irritation similar to anaphylaxis
What is venture to internally split?
paradoxical breathing as the sternum breaks body wants to increase repiratory but you want to save as sternum goes in heart goes out
What happens when there is a life threatening situation?
if in situation chose life over limb- you are going to break ribs in normal CPR or hurt rib, liver, lung, and spleen
What is cardiopulmonary system?
pulmonary artieries have low pressure, systemic has high pressure with oxygenated blood.
What are the valves in the heart?
the tricuspid valve is in the right side of the heart and the bicuspid/mitral valve is in the left sides
What is respiratory dysfunction?
respiratory dysfunction nerves? blocked airway
respiratory control- nerves
airway patency- blocked airway
bronchial patency
intra-thoracic pressure open pnumonal throax causing complex
lung tissue- burn emphysema chronic bronchitis compensation
badly attempts to compensate for gas exchange benefits adjusting rate and volume
chemoreceptors= detect changing oxygen and carbon dioxide levels
brain stimulates respiration system to increase rate and/or tidal volme
What is cardiovascular dysfunction?
cardiovascular dysfunction- blood vessels hear compensation body will attempt to compensate for perfusion rate vessel diameter changes changes in heart rate amount of blood being delivered breakdown impact life-threateneing must balance between ventilation and perfusion V/Q match with 1 L blood and having 200 ml oxygen
What are the four types of shock?
hypovolemic hemmorhagic- bleeding out non-hemmorhagic- burn and vascular tone distributive vessel tone- vasodilation, sepsis, anaphalaxis cardiogenic- happens to heart electrical mechanical obstructive-FBAO
What is airway physiology?
starts at nares and mouth with nasopharynx and oropharynx. the laryngopharinx passed epiglottis cartilage covering tracheae attached to base of tonuge with eth trachea biforcating by carina
What is a paramedic?
can run a code wihtout a dcotor, give meds, do a trache, fix collapsed lung
What is the lower airway
begins below larynx mode of trachea bronchial tree with crchoid ring not continous pushes membrane in parting airway reducing air
What is alveoli?
tiny airway sacs with lots of surface area and muecle around bronhial surrounded by pulmonary capillaries wnat bilateral chest rise test mix=axilalry to isee if get to alveoli mid=clavicular.
What are the kinds of obstructions?
variety of obstructions interfere with ari flow can be acute or chronic (sleep apnea, edema from burns or infection
foreign bodies- food small toys, liquids, blood, vomit so you suction and remove them
obstruction may also result from poor muscle tone caused by altered mental staus.
How do you test for patency?
Response: inspect, oscallate- listen, and feel-palpate
is airway patent? will it stay that way so inspect is there dentures or tongue in the way
oscallate- listen to airway is there gurgling or blood if so suction and look for stridor obsrtruction raspy burns and unable to speek
palpate- feel for air
What are the signs of inadequate airway?
signs of inadequate airway: vomit or obstruction, abdominal breathing, diminshed or absent breath sounds, aboormal oises: wheezing, crowning, stridor, snoring, gurgling, gasping. in
children and infants with nasal flaring tetraction above clavicle grunting and tirppodings. with accessory muscle using neck muscles and abdominal retractions in between ribs when working hard to breath. sniffling, head forward alignign the airway.
What is an oropharyngeal airway?
(OPA) cant maintain own airways unresponsive (if guy try other)- better because it is stiffer holding tongue
What is NPA?
nasopharyngeal airway- can be compressed with swelling because flexing. piggy nose to put it in and has gag reflex, cant maintain airway, mouth damage, with severe facial or spinal fracutres dont use. measure it based on the patients pinky diameter wise choose larger one if possible.
What do u do for pediatric breathing problems?
dont want to hit top of palette can cause bradycardia with larger, softer palete use tongue depresser or sideways
What are the measurements you use for suction?
30L/min and 300mmHg vacuum
How much do you suction adults, kids, and/or infants?
adult suction for 15 seconds, kids for ten seconds, infant 5 seconds if there is a lot of stuff in a suction put it on the side to flow out into the sterile water
What is a yanker?
(for vomit)- rigid only go in as far as you can see with a finger on the suction and do on way out.
How do you check for cerebrospinal fluid?
do test on gauze and see if yellow from clear fluid
What is a french tip?
use french tip for clean fluid or nose
What are some disruptions with mechanics of breathing?
any time disruption with mechanics of breathing, ex. chest wall integrity, airway going to have a shock state leading to ineffective ventilation, respiration and perfusion
What do you look for when you are looking for patient patency?
Look (chest rise? equal- flail injury causing paridoxical motion? chest injury? , listen and feel is it adequate?)
pediatric- nasal flaring, tripoding, intercostal contractions, sniff position, head bobbing, grunting,
adult- different coloring, cyanosis
What do you look for when you are listening for patient patency?
Listen:
wheezing
sucking or gurgling
grinding of the pericardial axis
What do you look for when you are hearing for patient patency?
snoring (upper airway and so much reposition)
What do you have to do to illustrate that an EMT was negligent?
prove that there was a duty to act, that damage occurred (physical, money, emotional and social), there was a breach of duty, proximate cause (misfeasance, malfeasance, nonfeasance)
What do you do in neonatal care?
dry, warm them, blow by oxygen, and bag valve mask if heartbeat under 100. heart rate less than 60 should be doing CPR for 10 cycles 3:1.
ALS: Intubate, and then meds given
How many patients can EMTs take care of at once?
if critical must be one emt per patient. EMT can have two patients though and can fit two into ambulance
What is heart and where is it located?
heart- fully contained system, about size of fist located behind the sternum 2/3rds of heart behind sternum and last ⅓ sticks out to left near sternum in fifith intercostal space tilting forward
media estina space, trachea, esophagus heart and pericardium
outside is epicardium adhered to visceral pericardium, myocardium- muscle, endocardium- inside. parietal percardium adheres to inside of sternum, diaphragm, mediasonym chamber to help keep heart in location
self-conduct its own actional potential, squeezes and excitability
What are the seminar valves?
pulmonic (pumonary trunk) aortic valve
What receives the first blood and from where?
heart receives first blood coming from heart left coronary articles- left atria both ventricles and septil wall.
What happens in a heart attack?
blood not going to ventricle wall causes ischemia- pain leading to infarct and injury
How long can tissue live without oxygen?
tissue without oxygen- can live without for 7 minutes. heart can develop own collateral circulation growing extra vessels another vessel extends to feed that part missing it
What does the superior vena cava get blood from?
superior vena cava gets lungs from clavicular up.
What are the muscles like in the ventricle versus other parts of the body?
muscles themselves tighter wound in ventricle for stronger contraction
What are nodal cells?
SA node primary pacemaker setting intrinsic rate for hwole heat firing at 60-100 beats per minute originating in atra and fired by SA node between 60 and 100. if doesnt work AV node 60-80 beats per minute with bundle of his 20-40 beats per minute and from there on out
When do you use AED for electrical activity?
use AED if irregular beats to allow SA or AV node to pick back up or if no conduction at all
What are the central arteries?
coronary, pulmonary, aortic, carotid, femoral, and brachial
What are the peripheral arteries/
: radial, popliteal (behind knee), dorsalis pedis (top of foot) , posterior tibialis (behind ankle bone) good at looking for perfusions
What are the blood contents?
plasma (55% of blood), red blood cells (ex. erythrocytes red corpuscles), white blood cells (leukocytes, white corpuscles fights infection) , plateleys (thrombocytes, or yellow blood cells)
What is hypo perfusion like form the heart perspective?
hypoperfusion squeeze everything into core shunting away blood from skin looking pale and cool and diapharetic. when inside changes respiration, persipration and releases fluid
What do we do for the acute coronary syndrome?
chest pain (aquuezing, stabbing, ache in different aresradiation (jaw, neck, arm), dypsnea, nausea, epigastric pain, diaphoresis, pulse changes (increas)e, bp changes, anxiety, feeling impending doom, post menopausal women (flu-like) over 40 fat weak and dizzy but if history, cholesterol, hypertension blood pressure
What are the medications you can give ACS?
oxygen, aspirin, and nitroglycerin
What is oxygen used for?
nonrebreater 15 liters, or nasal canula if nasal O2 95+. revereses hypoxia less than 94, increases arterial oxygen, increases hemoglobin saturation, and increases tissue oxygenation with indicaitons of hypoxia or you suspect hypoxia
What is aspirin used for?
inhibits the production of certain prostaglandins, which acccounts for its aniplately, anti-inflammatory, antipyretic and analgesic actions, and inhibits platelet aggregation for life of platelelt dont want to continue causing clot (7-10 days stops clotting) use for acute coronary syndrome such as chest painmdont give to kids dont give if active GI bleed or suspected aortic dissection and increases bleeding time.
What is nitroglycerin?
tab or spray delivered underneath tongue dilates corony vesicles. dilates coronary vessels decreasing workload of heart and demand of oxygne on heart making it work less use for chest pain cardiac in origin must have prescription to assist with so make sure no viagra drugs always ask twice 5 minutes to maximum of 3 doses if over 120 systole give again. spray kept in ambulance.
side effects- should bd bruning udnerneath tongue, should have headache if working, nausea.
What are some other cardiac conditions?
coronary artery disease, aneurysm, dysrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure, cardiac arrest
What is coronary artery disease?
plague broken off with fat
artheriosclerosis- any vessel in body
What is an aneurysm?
weakness in vessel wall with hypertension, cholesterol, smokers, males, patients with genetic can be from inside and trapped inside tunica layer instead of staying in vascular circulation filling up losing circulation and weakening vessel wall. with pulsating mass dont push on, if ruptures will blead out fast.
What is dysrhythmias?
part of heart muscle is ischemic
What is angina pectoris?
part of heart muscle is ischemic
What is congestive heart failure?
congestive heart failure (CHF)- sided. right side is rarer to have- pendent edema with cankles . left side is weak with left side filled by lungs meaning fillup of lungs fluid because not as good getting rials with CPAP forcing fluid out of lungs. tired difficulty breathing, hard time breathing at night sitting up to sleep
