final exam Flashcards
Pediatric hypotension
SBP <70 mmHg + (age x 2)
IV and fluid therapy medical directive- conditions
IV cannulation:
age- >2 years
LOA, HR, RR, SBP, other- N/A
0.9% NaCl fluid bolus:
LOA, HR, RR, other- N/A
SBP- normotension
Potassium-sparing diuretics
Increase diuresis without causing potassium to leave the body by stopping entry of aldosterone
into the nephron preventing sodium and water retention
Common hypothyroid meds
Levothyroxine (Synthroid)
Left sided heart failure
Left side is unable to pump blood from pulmonary vessels resulting in a backup of blood behind left ventricle causing increased pressure in the left atrium and pulmonary veins
As veins become enlarged with blood, serum is forced from pulmonary capillaries and into the alveoli (acute cardiogenic pulmonary edema)
Left ventricle is most commonly damaged during MI or chronic HTN
STEMI bypass contraindications- what complications require ACP diversion
Ventilation inadequate despite assistance, hemodynamic instability unresponsive/not amenable to CAP treatment/management, VSA without ROSC
Hypothyroid drugs
Stimulates release of TSH and mimic natural actions of the thyroid hormones replaced by the
body
Catheter sizes
Orange- 14g
Grey- 16g
Green- 18g
Pink- 20g
Blue- 22g
Yellow- 24g
Nitrates
Oldest class of drugs to treat angina
Dilates blood vessels and increase O2 supply to the heart by relaxing and dilating medium-large
coronary arteries and veins and reduces fluid backup in ventricles to reduce cardiac workload
What is the life saving measures that are classified in a DNR in the BLS
Chest compressions, defibrillation, artificial ventilation, insertion of oropharyngeal/supraglottic airway, endotracheal tube, transcutaneous pacing, advanced resuscitation drugs- vasopressors, antiarrhythmic agents, and opioid antagonists
ROSC summary
A- Advanced airway if needed
B- provide optimal ventilation with waveform capnography (ETCO2 35-40 mmhg and O2 sat 94-98%)
C- provide optimal perfusion what SBP >90 mmHg and treat hypotension with IV crystalloids, 12 with signs of ST elevation
D- consider raising the head of the bed by 30 degrees
Short acting beta agonist
Relievers/ rescue medications that provide short term rapid relief of asthma symptoms by
reversing bronchospasm and open the airways
Acts on B2 cells of the smooth muscle in the airways to relax bronchial smooth muscle
Hyperthyroid meds
Works by depleting excess thyroid hormones and measured by TSH
Common laxatives
Senna (senokot), Bisacodyl (Dulcolax), Docusate (Colace), PEG 3350 (Miralax)
Tachycardia
> 100 BPM
What is the suffix for cholesterol medication
“Statin”
Trauma TOR contraindications
Age <16, defibrillation delivered, signs of life at any time since fully extricated medical contact, rhythm PEA and closest ED <30min transport time, patients with penetrating trauma to the torso/neck/ and lead trauma hospital <30min transport time
What is the suffix of ACE inhibitors
“Pril”- can also be ezetimibe (vytorin)
What is a vector change
Pads change from the front of the chest to the back
COPD
Group of chronic respiratory disorders characterized by progressive tissue degeneration and obstruction of airways causing irreversible damage
Ex. emphysema, bronchitis, asthma
Local complication- Infiltration causes
Causes: dislodgement of the catheter from the vein, puncture of distal wall, leakage of solution/medications into surrounding tissue, poorly secured IV, poor vein/ site, irritating solution/med that inflames intimate of vein, improper cannula size, high delivery rate/ pressure of solution/meds
Benzodiazepines
Used to treat anxiety, slow brain activity by depressing limbic system and working on GABA
receptors in the brain to reduce neuronal excitement
Mechanical complications
changes in position of needle, height of solution, amount of solution, position of pt (kinked tubes), disconnected tubes, plugged air vents and/or plugged needles/ cannula
Joule settings
>24 hours to <8 years
Initial dose: 2J/kg
Subsequent doses: 4J/kg
Interval: 2 min
IV complication- Phlebitis
Inflammation of the vein caused by injury to the vessel wall
S&S: pain, swelling, redness, tenderness
Treatment: use of an appropriate size catheter to cannulate vein
Abnormal waveform- decreasing ETCO2
ET tube cuff leak
ET tube in hypopharynx
Partial obstruction
Angina
Caused by a deficiency of O2 for the heart and can occur when heart is working harder and needs more O2 or blood supply is impaired
Common benzodiazepines
Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Diazepam (valium), Midazolam (Versed), Oxazepam
After 20 mins what do ETCO2 levels indicate
ETCO2 levels <10mmHg are associated with futility (exceptions include hypothermia)
ETCO2 levels >25mmHg are associated with survival
Micro sets
Always 60 gtts/ml
Delivers meds over a long period of time
Assists in precise measurement of medications
Controls amount of fluid and fluid overload in certain patients
Abnormal waveforms- decreased ETCO2
Apnea, sedation
6-12 months HR and RR
RR: 25-45
HR: 80-140
What are the signs of an obviously dead patient
Decapitation, transection, visible decomposition, putrefaction, absence of vital signs and grossly charred body, an open head/torso wound with gross outpouring of cranial or visceral contents, gross rigor mortis, or dependent lividity
IV and fluid therapy med directive auxiliary treatment- NaCl 0.9% maintenance infusion
15ml/hr
> 12 years: 30-60ml/hr
IV and fluid therapy med directive auxiliary contraindications
fluid overload
Fluid bolus- >2 years old
Ensure chest is clear and BP is hypotensive, 10 ml/kg, max 1000ml, reassess every 100ml >2-<12 years and reassess every 250ml >12 years
Oxygenation- BVM ventilations are required, titrate SPO2 to 94-98%, avoid hyperventilation (ETCO2 40-40mmHg)
Hypotonic solution
Lower solute in the solution than the cell causing water to go into the cells (NS, LR)
Cytolysis
Abnormal waveform- sudden increase in ETCO2
ROSC
Tachypnea
> 28 breaths per minute
Pulse checks in cardiac arrest
Every 2 minutes and done in the last 15 seconds of the CPR cycle
Do not delay time off chest if unable to palpate pulse/ unsure of pulse presence
Also done if obvious signs of life is present
When do you insert an SGA
When BLS airways are ineffective or definitive need for a more advanced airway like prolonged extrication or ineffective management with other devices
ACR documentation
Time of insertion, number of attempts (individually documented), size/type of catheter, vein selected,
description of site and infusing abilities, medic info (number and initial), any type of reaction, if discontinued time and condition of catheter
What does a ETCO2 >45mmHg indicate
Hypoventilation/ hypercapnia
3-6 months HR and RR
RR: 30-60
HR: 80-160
How does ETCO2 and cardiac output relate
when cardiac output is normal ETCO2 measures ventilation, when cardiac output is decreased ETCO2 measures cardiac output
Termination of resuscitation
Must call BHP and continue running arrest until receiving TOR order, ensure you receive time of death from BHP
Monitoring CPR quality with ETCO2
Higher ETCO2: higher cardiac output (good CPR)
Lower ETCO2: change compressions or improve CPR quality
ETCO2 decreasing observe for chest compressor fatigue, hyperventilation, airway obstruction, or tracheal tube displacement
ETCO2 increasing: CPR is likely effective and ventilation appropriate; substantial rise can indicate ROSC
Crystalloids
Dissolved salts and sugars creates crystalloids.
Contains no proteins
Stays in intravascular space shortly before diffusing across capillary walls into tissue
What is PaCO2
Partial pressure of carbon dioxide in arterial blood gases that’s measured by drawing the ABGs (also measure arterial PH)
What is the second phase of the waveform
B-C: exhalation upstroke (dead space gas mixes with lung gas)
What do ETCO2 values indicate about a ROSC
ETCO2 values <10-15mmHG prompt close evaluation of CPR- if they remain low the prognosis of the ROSC is low
If the numbers rise into 20-30s the prognosis of the ROSC are high
If the numbers rise to extreme highs a ROSC is present so check rhythm and pulse at next rhythm check
Sizes of King LTs
Yellow- size 3, 4-5ft tall, cuff volume 60ml, cuff pressure 60cmH20
Red- size 4, 5-6ft tall, cuff volume 80ml, cuff pressure 60cmH20
Purple- size >6ft tall, cuff volume 90ml, cuff pressure 60cmH20
What is the suffix for proton pump inhibitors
“Zole”
Opioids
Opioids bind to receptors found at base of spinal cord, brainstem, thalamus, hypothalamus, and limbic system resulting in decreased painful sensations
Can be opioids agonists and antagonists
6 years HR and RR
RR: 16-24
HR: 70-110
Common antiplatelet medication
ASA (asaphen, Entrophen, novasen), Dipyridamole (Aggrenox), Clopidogrel (plavix), Trigrelor (Brilinta)
IV and fluid therapy medical directive- 0.9% fluid bolus
Age: >2- <12 years
Route: IV
Infusion: 20ml/kg
Reassess every: 100ml
Max volume: 2000ml
Age: >12 years
Route: IV
Infusion: 20ml/kg
Reassess every: 250ml
Max volume: 2000m
Unstable angina
Pain is more severe, feels different, and is not easily relieved by rest/meds
Greater degree of obstruction of coronary arteries with higher risk of imminent MI
Atherosclerosis
Thickening of artery wall from accumulation of fatty material that mostly affects coronary, renal, aortic, femoral, carotid, and cerebral arteries due to gradual narrowing of arteries and plaque rupture with thrombus formation
ACR documentation for a cardiac arrest
CPR, PPV (BVM/rate), OPA (size/toleration), suction (how much/response), rhythm interpretations, advanced airway if placed (size/ tolerated), BHP patch (orders received), extrication (what was used), delays to CPR, scene delays, anything of note on scene, pt movement
What are the most common errors in prehospital defibrillation
Improper pad placement and poor adhesive contact
Definition of ventilation
Pulmonary ventilation is the process by which oxygen enters, and carbon dioxide exits the alveoli ventilation is the process of inhaling and exhaling- “movement of air”
Insulin
Used for all types of diabetes but sole drug in type I and added to oral therapy in type II
Needs to be IM (protein) so PO would be absorbed by GI tract and stomach acid
Can be rapid-acting, short-acting, intermediate acting, and long-acting forms
What does hypothermia present as
Cold, waxy skin, blanching of skin, locked extremities, not shivering
Defibrillation in cardiac arrest
Heart is quivering but no blood is pumping so defib stuns heart muscles to allow the normal conduction to resume control
If not defibbed, VF/VT will deteriorate to asystole
Pt must be >24hrs
Stable angina
Insufficient blood supply- anaerobic metabolism and accumulation of lactic acid and CO2
At rest there is enough blood flow to meet sedentary needs
Contraindications for the King LT airway
Does not eliminate risk of vomiting and aspiration, high airway pressure can cause air to leak into stomach or out of mouth, do not use in patients with intact gag reflex, esophageal disease, or who have ingested caustic substance, airway obstructions
Common steroids
Fluticasone (Flovent), Budesonide (Plumicort), Advair, Symbicort
Epilepsy drugs
Reduce instances of seizures by suppressing seizure activity by controlling voltage-dependent
sodium channels
The drugs are aimed at delaying the movement of positive ions into the cells to stop the
abnormal firing and maintain homeostatic balance
DNR
Establish presence ASA, validity (if so, can be honoured without BHP call) if incomplete call BHP
Common antipsychotics
Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Aripiprazole (Abilify)
What is the suffix for beta blockers
“LOL”
SPO2 definition
Saturation of peripheral capillary oxygen- measures oxygen saturation levels
How to confirm cardiac arrest
Assess C-A-B to determine if pt is in cardiac arrest due to many presentations appearing initially as cardiac arrest
Check carotid/radial pulses and breathing in >10 seconds
Is suspected apply pads immediately over chest leads
SGA- King LT
Single lumen air device available in adult and peds sizes
Consists of a curved tube with ventilation ports between two inflatable cuffs
Air embolism S&S
hypotension, cyanosis, weak/ rapid pulse, loss of
STEMI bypass contraindications- what complications require PCP diversion
moderate to severe resp distress/ use of CPAP, hemodynamic instability or symptomatic SBP <90 mmHg, VSA without ROSC,
Why is capnography important
Verification of proper tube placement
No waveform= no tube
IV line maintenance standard BLS-guideline
the IV bag should be changed when approx. 150mls of solution remaining
Hypoglycemia
<2 years: BGL <3.0 mmol/L
>2 years: BGL <4.0 mmol/L
1-3 years HR and RR
RR: 20-30
HR: 75-130
Steroids
Anti-inflammatory drugs that reduce infiltration of mediators of the inflammatory response in
airway cells and reduce creation of proinflammatory substances (prostaglandins, leukotriene,
macrophages)
Definition of external respiration
Gas exchange across respiratory membrane in the lungs
Chronic bronchitis
Significant changes to bronchi from constant irritation from smoking or exposure to pollutants that are irreversible and progressive
Results in inflammation and obstruction to the bronchi, repeated infections and chronic coughing
Isotonic solution
Equal inside and outside the cell
Common antidepressants
Amitriptyline (Elavil), Nortriptyline, Trazodone, Mirtazapine (Remeron), Bupropion (Wellbutrin), Paxil (Paroxetine), Zoloft (sertraline), Effexor (Venlafaxine)
Right sided heart failure
Occurs as a result from left sided heart failure where blood backs up from left side of the heart and into lungs so right side has to work harder to pump blood but eventually can’t keep up to increased workload and fails
Can result from pulmonary HTN or pulmonary embolism
Air embolism (systemic complication)
during insertion, tubing is disconnected to replace solutions, or new extension tubing
Definition of respiration
Process of oxygen and carbon dioxide diffuse in and out of the blood
What is cardiac arrest
Occurs when the heart unexpectedly and suddenly stops pumping often from a irregular heart rhythm
Blood stops flowing to the brain and other vital organs
Common anticoagulants
Warfarin (Coumadin), Eliquis (Apixaban), Enoxaparin (Lovenox), Heparin
Antipsychotics
Blocks levels of dopamine being secreted and absorbed by the body at medulla, brainstem, and hypothalamus point
Cross blood brain barrier
Accompanied by sedative effects- confusion, decreased ability to regulate body temp, weight gain
What is the first phase of the wave form
A-B: inspiratory baseline (low CO2 as its inspired air)
B is the start of alveolar exhalation
IV and fluid therapy med directive auxiliary indications
actual or potential need for IV medication or fluid therapy
Abnormal waveform- CPR assessment
Attempt to maintain minimum of 10mmHg
NSAIDS
Anti-inflammatory, analgesic, antipyretic properties
Reduces production of prostaglandins
Cox-1 and COX-2 are main enzymes that create prostaglandins
What causes high CO2 levels (hypoventilation)
Retaining CO2 due to the slow rate of breathing
Caused by overdose, sedation, intoxication, postictal states, head trauma, stroke, tiring CHF, fever, sepsis, SOB
Pneumonia
Primary acute function in the lungs or secondary to another respiratory or systemic condition
Always a risk following aspiration or inflammation in the lungs when fluid pools and cilia are reduced
IV and fluid therapy medical directive- IV cannulation (0.9% IV maintenance)
Age: >2-<12 years
Route: IV
Infusion: 15ml/hr
Age: >12 years
Route: IV
Infusion: 30-60 ml/hr
Oral diabetic medication
Effective for type II diabetes by stimulating insulin release from pancreatic beta cells
Also decrease glycogenosis- process of converting glycogen to glucose
Pediatric normotension
SBP >90 mmHg + (age x 2)
Adult normotension
SBP >100 mmHg
Loop diuretics
Inhibit Na/K/Cl transport proteins in loop of Henle causing a reduction in reabsorption of sodium
increasing diuresis
May lose too much potassium so may be on supplements of K
Anticoagulants
Make the blood less viscous by increasing levels of antithrombin
Heparin works with antithrombin, and warfarin works to inhibit vitamin K effects on clotting
What is the difference between a SCA and a heart attack
Patients die from the rhythm/arrhythmia that is unsustainable for the electrophysiology of the heart not the STEMI
Common opioids
Morphine, Hydromorphone (Dilaudid), Oxycodone, Fentanyl, Hydrocodone (Vicodin), Codeine, Tramadol (Ultram), Percocet
What are the classes of antiarrhythmics
Sodium channel blockers, beta-blockers, potassium channel blocker, calcium channel blocker
What causes low CO2 levels (hyperventilation)
Blowing off large amounts of air from increased rate of breathing
Caused by anxiety, bronchospasm, pulmonary embolism, cardiac arrest, hypotension, decreased cardiac output, cold
Antinausea
Goal is to block nausea sensation in the brain or reduce the cause of the nausea
Nausea is often caused from serotonin (used to expel what is in the system- out)
Emphysema
Destruction of alveolar walls leading to large permanently damaged alveolar air spaces
Genetic deficiency of protein used to inhibit breakdown of elastase or smoking can cause emphysema
Where do you transport a cardiac arrest
Closest ER, CTAS 1 code 4
Joule settings
>8 years
Zoll: 120J, 150J, 200J
Lifepack: 200J, 300J, 360J
When does the capnogram start and end
Begins before exhalation and ends with inspiration
What do you do if you have a ROSC then a re-arrest enroute
Resume CPR immediately, pull over, initiate immediate rhythm interpretation, treat accordingly, continue transport to closest ER, ensure rhythm analyses/ defibrillation can be done safely while enroute
Air embolism management
close tubing, turn pt on left side with head down, check tubing for leaks, administer high concentration O2, notify medical direction
Common insulins
Insulin Aspart (Novolog), Insulin Lispro (Humalog), Humulin, Levemir, Insulin Glargine (Lantus)
How does a pt respiratory rate change in conjunction with CO2
A patient’s respiratory rate increases as CO2 rises and decrease as CO2 falls
Diuretics
Decrease BP by decreasing blood volume and sodium retention and increase elimination of
water, sodium and electrolytes
By decreasing blood volume, it reduces BP by reducing peripheral resistance and cardiac output
Types of diuretics
Thiazide (hydrochlorothiazide), loop (lasix, furosemide), potassium-sparing (spironolactone), osmotic (mannitol), carbonic anhydrase inhibitor (acetazolamide)
Macro sets
10, 15, 20 gtts/ml
Most common utilized admin sets
effective for TKVO and large fluid admin (bolus)
Abnormal waveform- sudden loss
ET tube disconnected, dislodged, or obstructed
Loss of circulatory function
Proton pump inhibitors
Decrease gastric acid levels by interfering with the final step in gastric acid production
Designed to be slow released
Antidepressants
TCA, and SSRIs (selective serotonin reuptake inhibitors)
Alters levels of serotonin, dopamine, and noradrenaline keeping them at normal levels
Used to treat depression, OCD, and anxiety
How does a King LT work
Distal and proximal balloon to occlude esophagus and oropharynx (occludes esophagus to prevent gastric inflation/ aspiration), creates a direct route for ventilation/oxygen to the trachea and lungs
How to confirm placement for SGAs
ETCO2 reading, chest auscultation, chest rise, no waveform ETCO2, tube misting
Bradycardia
<50 BPM
How does downtime in cardiac arrest management affect ETCO2
Short down time cause ETCO2 to give an accurate indication of quality of CPR
Long downtimes cause ETCO2 to remain low regardless of quality of CPR (vasodilation and sluggish blood flow prevent buildup of cardiac output)
IV and fluid therapy medical directive- indications
actual or potential need for IV medication or fluid therapy
Definition of internal respiration
Gas exchange across the respiratory membrane in the metabolizing tissues like skeletal muscles
Advanced airways in cardiac arrest
Dont rush into advanced airways is BLS airways are adequate
King LT/ I Gel
What do the police do in cardiac arrests
Manage spectators, protect scene, notify MD if TOR, notify coroner if needed, can help with family support
Antianginals
Increase blood and O2 supply to the heart while reducing workload of the heart
Can be accomplished by vasodilation or reducing vasospasm
Common oral diabetics
Metformin (Glucophage), Januvia (Sitagliptin), Glyburide (Glynase), Sitagliptin/Metformin (Janumet)
I-Gel complications
Trauma to pharyngo-laryngeal framework, down-folding of epiglottis, gastric insufflation/ regurgitation and inhalation of gastric contents, nerve injuries, vocal cord paralysis, lingual or hypoglossal nerve injuries, if placed too high in the pharynx may result in poor seal and cause excessive leakage, laryngospasm
How to secure King LT
Thomas tie is compatible, ensure to note and document depth prior to securing, tape if needed
ETCO2 in cardiac arrest
No CO2 production unless effective CPR, capnography gives feedback of CPR, ETCO2 <10mmHg indicates compressions are slow/deep enough, once circulation is restored there is a spike in ETCO2, ETCO2 <10mmHg suggests patients will not survive
IV line maintenance standard BLS- procedure (during transport)
monitor/maintain IV at prescribed rate (change bag as required), discontinue IV if dislodged/ interstitial and remove catheter with aseptic technique, and confirm condition of catheter if removed
What is the suffix for calcium channel blockers
“Ine”
Laxatives
Used to relieve constipation by using an enzyme that swells in the presence of liquid causing
sensation of the bowels being full causing expulsion
Cause bloating, gas, abdominal cramps, nausea, constipation
What are the reasons to prioritize an advanced airway
Vomit or airway full of secretions
Prolonged resuscitation or extrication
Poor seal with OPA/BVM
Pre-arrival interventions with respect to TOR
Consult with BHP and advise them of interventions done by FD/other PTA and discuss
What are the causes of PEA
Hypovolemia, hypoxia, hyper/hypokalemia, hypothermia, H+ (acidosis), trauma, tension, tamponade, toxins, thrombosis
Hypertonic solution
Higher solute in the solution causing water to leave the cell (Mannitol)
Histamine 2 inhibitors
Histamine stimulates the release of acid and pepsin in the stomach, but this medication inhibits
that response
Dead air space
Ventilated areas that do not participate in gas exchange
Total dead space= anatomic dead space (airways leading into alveoli) + alveolar dead space (ventilated areas in the lungs without blood flow) + mechanical dead space (artificial airways including ventilator circuits)
Common epilepsy medications
Dilantin, valproic acid, lamotrigine, carbamazepine, levetiracetam
IV line maintenance standard BLS- procedure (pre-transport)
confirm physicians written order with sending facility staff, determine IV solution/ flow rate/ catheter gauge/ catheter length/ cannulation site, note condition of Iv site prior to transport, amount of fluid remaining in bag, amount of fluid required to complete transport time and obtain more fluid, and document all pre-transport IV information on ACR
IV line maintenance standard BLS- use of escorts
unless within level of certification a escort may be used if a pt needs an IV for blood/ blood product admin, potassium chloride <18 years old pt, medication, requiring electronic monitoring or pressurized IV fluid infuser/ pump/ central venous line, or for a neonate/ paediatric pat <2 years of age.
Common short acting beta agonists
Ventolin (Albuterol), Levalbuterol (Xopenex), Ipratropium (Atrovent), Spriva, Albuterol/Ipratropium (Combivent)
0-3 months HR and RR
HR: 90-180
RR- 30-60
Pulmonary embolism
Blood clot obstructing pulmonary artery blocking blood flow through lung tissue
Small clots are asymptomatic but large emboli affect respiratory system and cardiovascular system causing right sided failure and decreased cardiac output
Atelectasis
Non aerated part of a lung leading to decreased gas exchange and hypoxia that interferes with blood flow through the lung and alters ventilation and perfusion
If not reinflated quickly the lung can become necrotic
Why is there a shark-fin slope with a bronchospasm
The movement of the air at the alveoli is delayed and the rise to the plateau is more gradual and becomes sloped
What are the special cases of cardiac arrest
Trauma, pregnancy, hypothermia, airway obstruction, non-opioid toxicity, ROSC
5 main uses of ETCO2 in cardiac arrest
Verify tracheal tube placement, identify tracheal tube displacement, evaluate CPR quality, identify ROSC, determine when ROSC is unlikely
Infiltration treatment
discontinue IV, confirm catheter is intact, restart IV away from site, ice pack if needed, document incident
Antiplatelet medication
Interferes with clot formation- normally platelets enter site of injury that is activated by thrombin
and collagen to increase clotting
Common hyperthyroid meds
Methimazole (Tapazole), Propylthiourcil (Propyl-Thyracil)
IV complications- Local
Infection present at/ around Iv site after IV initiation (3-4 days after IV)
S&S: redness, foul discharge/ odour at site
Treatment: upon IV canulation ensure clean site, sterile tubing/ catheter, proper PPE precautions
Indications for the King LT
Alternative to bag-mask and OPA/NPA ventilation when an advanced airway device is required for airway management
What is the third phase of waveform
C-D: continuation of exhalation (gas is alveolar now, rich in CO2)
D is the end tidal value at peak concentration
Causes of cardiac arrest
Atherosclerosis or underlying cardiac diseases, genetic disorders, cardiomyopathies, can occur after electrocution, drowning, trauma, drug overdose
Where should the pt be during cardiac arrest
Hard flat surface with enough space- possibly stretcher and plan extrication
Move pt only if necessary and notify PD and document and do not move pt back
Airway management of cardiac arrest
OPA and BVM (15 LMP) ventilations, ETCO2 applied and aim for 45mmHg, suction as needed, SPO2 of 94-96
When advanced airway is placed compressions become asynchronous at a rate of 1 every 6 seconds (10 bpm)
Abnormal waveform- bronchospasm
Shark-fin appearance
Asthma, COPD
What is the fourth phase of wave form
D-E: (0) start of inspiration
10 years HR and RR
RR: 14-20
HR: 60-90
Croup
Begins as an upper respiratory condition until larynx and subglottic area become inflamed with swelling and exudate
More severe at night
STEMI bypass contraindications
CTAS 1 and medic is unable to secure patients airway or ventilate, 12 lead ECG is consistent with LBB, ventricular paced rhythm, or other STEMI imitator, transport to PIC is >60min from patient contact, patient is experiencing complications requiring PCP diversion, patient is experiencing complication requiring ACP diversion
Chest pain
Mi pain is felt beneath the sternum on the left side of the chest described as heavy, crushing or tight, can be mistaken for indigestion
Infiltration S&S
coolness of skin around IV site, swelling at IV site with/without pain, sluggish/absent flow rate, infusion continues to infuse when pressure is applied to vein above tip of cannula, no back flow of blood into IV tubing when clamp is open and solution lowered below IV site
Trauma TOR conditions
> 16 years, no palpable pulses and no defibrillation delivered and rhythm asystole or no signs of life at any time since fully extricated, or signs of life when fully extricated with the closest ED >30 min transport time away, or rhythm PEA with the closest ED >30 min away
Complications of King LT
Laryngospasm, vomiting, and possible hypoventilation may occur, trauma may also result from improper insertion technique, ventilation may be difficult if pharyngeal balloon pushes epiglottis over glottic opening
Asthma
Periodic episodes of severe but reversible bronchial obstruction in hyper sensitive/ hyper responsive airways
Triggered by inhaled antigen or respiratory infections, cold, exercise, drugs, or stress
Signs and symptoms: cough, dyspnea, tight chest, agitation, wheezes in airway, breathing with accessory muscle use, tachycardia, respiratory failure
What does a ETCO2 <35mmHg indicate
Hyperventilation/ hypocapnia
Beta blockers
Reduce 02 demand of the heart muscle
Affect beta 1 (cardiac stimulation) and beta 2 (bronchial relaxation) cells
Blocks effects of epi/ norepi to reduce HR and dilated blood vessels reducing BP
Abnormal waveform- hypo/hyper ventilation
Hypoventilation: long slow wave forms
Hyperventilation: short fast wave forms
What are the signs of a ROSC
Sudden increase in ETCO2, spontaneous respirations, palpable pulses, change in colour, spontaneous movement
Antihyperlipidemic agents
Excessive buildup of fats in the system can cause strokes and MIs
HDL= good and LDL= bad
Used to lower the amount of LDL in the system by assisting back to the liver for removal
ACE inhibitors
Used to treat HTN by lowering SBP by blocking angiotensin-converting enzyme (ACE)
By inhibiting release of angiotensin II and aldosterone it decreases reabsorption of sodium in
kidneys forcing it from the system
Oxygenation definition
Process of adding oxygen to the body system
Adult respiratory distress syndrome
Secondary to sepsis, shock, burns, aspiration, and smoke inhalation
Associated with multiple organ dysfunction
IV and fluid therapy med directive auxiliary conditions
age >2 years, SBP hypotensive
Thiazide diuretics
Inhibits NaCl reabsorption into distal convoluted tubule of the kidney- happens through
suppression of NaCl cotransporter
Used to treat HTN, heart failure, kidney failure or diabetes
Adult hypotension
SBP <90 mmHg
Bolus vs TKVO
Bolus: IV fluid in as fast as possible, hypotensive
TKVO: 30-60cc/h (>12 years) or 15cc/h (2-12 years)
IV line maintenance standard BLS- general directive
- to keep the vein open to maintain IV patency for a pt<12 if 15ml/hr and >12 is 30-60ml/hr for any isotonic/ crystalloid solutions
- an IV for fluid replacement with a max flow rate infused up to 2ml/kg/hr to max flow rate of 200ml/hr, thiamine/ multivitamin preparations, drugs within certification level, or potassium chloride for pts >18 to a max of 10mEq in a. 250ml bag
ETCO2 with a ROSC in cardiac arrest
Spikes are caused by large amount of acidic blood returning to the lungs and high amounts of CO2 diffuse into alveoli causing a sharp rise in ETCO2 levels that are higher than normal
If present complete pulse check and full assessment
Colloids
Contains large molecules like protein
Doesn’t pass through capillary membrane as fast
CHF
Heart is unable to pump blood to meet metabolic needs of the body and is also unable to pump strong enough or fast enough to empty the chamber resulting in a backup of blood
IV and fluid therapy med directive auxiliary NaCl 0.9% fluid bolus
> 2-<12 years: 20ml/kg, reassess every 100ml, max volume 2000ml
> 12 years: 20ml/kg, reassess every 250ml, max volume 2000ml
What do you do if you obtain a ROSC
Complete assessment of CAB, 12 lead, full set of vitals, continually reassess and treat findings
STEMI bypass indications
> 18 years old, chest pain or equivalent consistent with cardiac ischemia/ MI, time of onset of current episode <12 hours, 12 lead indicates acute STEMI/AMI with a 2 mm elevation in V1-V3 in two contiguous leads and/or 1 mm elevation in two other anatomically contiguous leads or 12 Lead ECG computer interpretation of STEMI and medic agrees
I Gel- SGA
Medical grade thermoplastic elastomer that doesn’t require inflation
3 adult and 4 pediatric sizes- can be used between 2-90+kg, high seal pressures resulting in reduced trauma to the airway on insertion, alternative to OPA/BVM is unsuccessful or need for advanced airway, tip is designed to fit into proximal esophagus
Long-acting beta agonist and corticosteroids
Prevents asthma symptoms (controllers) by relaxing muscles lining the airways
Long-acting beta agonists must be used with corticosteroids
IV and fluid therapy medical directive- contraindications
IV cannulation:
suspected fracture proximal to the access site
0.9% NaCl fluid bolus:
fluid overload
Medical TOR criteria in the ALS
Age >16 years old, altered LOA, arrest not witnessed by EMS and no ROSC 20 min of resuscitation and no defibrillation delivered
Interventions prior to EMS arrival
Pre-arrival interventions are not counted into patient care- it can be considered and documented
Calcium channel blockers
Relax smooth muscle to decrease peripheral resistance
Used to treat hypertension
2 types: 1 localizes smooth muscle and 2 decrease cardiac workload, HR and contractions
IV complication- Hematoma
Blood collects outside the vessel after catheter passes through the vein
S&S: redness, tenderness, pain, swelling
Treatment: after catheter is removed, make sure it is intact, apply light direct pressure to site, cover and document the condition
Common H2 inhibitors
Pepcid, Ranitidine (Zantac)
