Firstmidquarterstudy Flashcards
What are some ways you can reduce the chance of injury when lifting patients?
Proper body mechanics, maintaining physical fitness
Is the most commonly used device to transport patients. Is a specially designed stretcher that can be rolled along the ground and weighs between 40 and 145ib(18 and 66kg), depending on its design and features.
Wheeled ambulance stretcher
Because of its weight, it is generally not take up or down stairs or to other locations where the patient must be carried for any significant distance
Wheeled ambulance stretcher
The mattress on a stretcher is fluid resistant so that it does not absorb any type of__ material,including water,blood,or other body fluid
infectious
Is a long,flat board made of rigid,rectangular material.
Backboard
Is used to temporarily restrict spinal motion in supine patients with potential neck and back injuries
Backboard
Are 6 to 7 feet long (approximately 2m) and are commonly used for patients who are found lying down
Backboards
Parallel to the sides and ends of the _ are a number of long holes that are about 0.5 to 1 inch (1to 2.5cm) from the outer edge. These holes form handles and handholds so that the board can be easily grasped,lifted,and carried. The handles and adjacent holes also allow the patient to be secured to the board using straps located at each side and end of the __
Backboard
The shoulder girdle rest on the rib cage and is supported by the vertebrae that lie inferior to it. The arms are connected to and hang from the shoulder girdle. When a person stands upright,the individual weight-bearing vertebrae are stacked on top of each other and aligned over the ___. The __ is both the mechanical weight-bearing base of the spinal column and the fused central posterior section of the pelvic girdle
Sacrum
When a person stands upright, the weight of anything being lifted and carried in the hands is reflected onto the shoulder girdle, the spinal column inferior to it, the pelvis, and then the legs (FIGURE 8-3). In lifting, if the shoulder girdle is aligned over the pelvis and the hands are held close to the legs, the force that is exerted against the spine occurs in an essentially straight line down the vertebrae in the__. Therefore, with the back properly maintained in an upright position, little strain occurs against the muscles and ligaments that keep the spinal column in alignment, and significant weight can be lifted and carried without injury to the back
spinal column
However, you may injure your back if you lift while leaning forward, or even if you lift while the back is straight, while you are bent significantly forward at the hips. With the back in either of these positions, the shoulder girdle lies significantly anterior to the pelvis, and the force of lifting is exerted primarily across, rather than down, the_. When this occurs, the weight is supported by the muscles of the back and ligaments that run from the base of the skull to the pelvis, keeping the spinal column in alignment, rather than by each vertebral body and disk resting on those aligned below it. In addition, the upper spine and torso serve as a lever so that the force that is exerted against the muscles and ligaments in the lumbar and sacral regions, as a result of the mechanical advantage produced, is many times that of the combined weight of your upper body and the object you are lifting. Therefore, the first key rule of lifting is to always keep your back in a straight, upright (vertical) position, and lift without twisting. Always face the patient and point your feet in the same direction. After lifting the patient, change the direction of your feet as opposed to twisting or turning from the waist.
spinal column
As well as being the safest method,limiting by extending the properly placed flexed legs is almost the most powerful way to lift. This method is called
Power lift
If a patient is supine on a backboard or is lying in a semi-Fowler position on the stretcher, his or her weight is not equally distributed between the two ends of the device. Between __and __of the body weight of a patient in a horizontal position is in the torso. Therefore, more of the patient’s weight rests on the head half of the device thän on the foot half.
68% and 78%
A patient on a backboard or stretcher can be lifted and carried by four providers in a__, with one provider at the head end of the device, one at the foot end, and one at each side of the patient’s torso (FIGURE 8-9).
Follow these steps to perform the
diamond carry
When you must carry a conscious patient up or down a flight of stairs or other significant incline, use a__ if the patient’s condition allows him or her to be placed in a sitting position. A__ is a lightweight folding chair with a molded seat, adjustable safety straps, and fold-out handles at both the head and feet (FIGURE 8-11).
stair chair
The __is used for patients with no suspected spinal injury who are found lying supine on the ground. Use this lift when you have to lift and carry the patient some distance to be placed on the stretcher. if you find the patient semiprone or lying on his or her side, first log roll the patient onto his or her back. Ideally, the __should be performed by three providers; however, it can be done with only two. Perform the direct ground lift as follöws
direct ground lift
The __may also be used for patients with no suspected extremity or spinal injuries who are supine or in a sitting position. The __may be especially helpful when the patient is in a very narrow space or there is not enough room for the patient and several EMTs to stand side by side.
extremity lift
Transfer a supine patient from a bed to the stretcher using the __ method
Direct carry
To move a patient from a bed onto a stretcher,use the __method
Draw sheet method
Another option when moving a patient is to use a__. With a scoop stretcher, the two halves of the device are inserted under each side of the patient, and the two sides are fastened together. Then the patient is lifted and carried to the nearby prepared stretcher. (Note that you can also log roll a patient onto a__ that is already locked together.)
scoop stretcher
When you use a body drag to move a patient ,your back should always be locked in a __by tightening your abdominal muscles,not curved laterally or bent laterally.
Slight curve
During pulling,extend your arms no more than about ___ in front of your torso
15 to 20 inches (38 to 50)
Commonly adult patients weigh between
120 and 220
Special bariatric techniques,equipment,and resources are generally required to move any patient who weighs more than
350
When there is a potential danger to you or the patient , use an ___ to drag or pull a patient to a safe place before assessment and care are provided
Emergency move
The backboard,short backboard, and vest type devices are known as
Spinal immobilization devices
Most patients transported by ems are older adults (___)
Geriatric patients
The aging process with__ patients is associated with multiple changes in the body,including the musculoskeletal system and the integumentary (ie,the skin).
geriatric
As these patients age they become less flexible and bones become more brittle. Using the extremities to move or carry a geriatric patient may cause the person a significant amount of pain or discomfort.in some older patients ,pulling an arm or leg may cause a dislocation or fracture
Geriatric
The skin of a __ patient is thinner and more susceptible to tears and bruising. Be careful not to cause a skin tear when gripping an arm or leg. Chronic medical conditions such as rheumatoid arthritis may limit the patients movement and are associated with pain.
Geriatrics
Some older patients cannot lie flat or straighten their arms. Extra padding and support may be necessary to transport some patients comfortably
Geriatric
Just fewer than half(__%) of adults in the United States (more than 100 million people) are considered obese
42.4%
The incidence of obesity is higher among adults aged 40 to 59 (almost _%) than among adults aged 20 to 39 (40%) or adults aged 61 years or older (almost 43%)
45%
The incidence among children is also alarming; approximately _% of all children and adolescents in the United States are classified as obese
18%
In 2008 the estimated cost of medical care for patients with obesity in the United States was ___ or approximately $1,429 higher for an obese person than for a person of normal weight
147 billion dollars
Is the branch of medicine concerned with the management (prevention or control) of obesity and allied diseases
Bariatrics
Bariatrics comes from the Greek words _ and _
Baros-weight
iatreia-medical treatment
__stretchers typically have a wider patient surface area to allow for increased comfort and in addition ensure the patients dignity is maintained during transport
Bariatric stretcher
_ stretchers also have a wider wheelbase,allowing for increased stability when rolling the patient over uneven terrain
Bariatrics stretchers
__stretchers are sometimes equipped with optional features such as a tow package, which allows an ambulance-mounted winch to assist in loading the patient into the ambulance,decreasing the potential for EMT back injuries
Bariatric stretcher
the most important feature of the bariatric stretcher is the increased weightlifting capacity. Typical wheeled ambulance stretchers, depending on manufacturer ratings, allow for a maximum weight of ___. Bariatric stretchers are usually able to support maximum weight as high as 1600 (725 kg) pounds when rolled in the lowest position.
650 lb (295 kg)
A __is a stretcher with a strong, rectangular, tubular metal frame and rigid fabric stretched across it (FIGURE 8-22).__ stretchers do not have a second multipositioning frame or adjustable undercarriage. Some models have two wheels that fold down about 4 inches (10 cm) underneath the foot end of the frame and legs of a similar length that fold down from the head end at each side. The wheels make it easier to move the loaded stretcher. The legs should not be used as handles.
portable stretcher/folding stretcher
Some__ stretchers can be folded in half across the center of each side so that the stretcher is only half its usual
length during storage. A portable stretcher weighs much less than a wheeled stretcher and does not have a bulky undercarriage. However, because most models do not have wheels, you and your team must support all of the patient’s weight and any equipment along with the weight of the stretcher.
portable/folding stretcher
Several types of__ are available and can be rolled up across either the stretcher’s width or length, so that the stretcher becomes a smaller, tubular package for storage and carrying (FIGURE 8-23). When you must carry the equipment a considerable distance from the nearest place that the ambulance can be located, this is an important consideration, A flexible stretcher forms a rigid stretcher that conforms around the patient’s sides and does not extend beyond them. When these stretchers are extended, they are particularly useful when you must remove a patient from or through a confined space.
Certain__ can also be used if the patient must be belayed or rappelled by ropes.
flexible stretchers
Another word for flexible stretcher is
Reeves
You can use a short backboard to immobilize the torso, head, and neck of a seated patient with a suspected spinal injury until you can immobilize the patient on a backboard. Short backboards are 3 to 4 feef long (approximately 1 m). However, the wooden short backboard has generally been replaced with a vest-type device, such as the__, that is specifically designed to immobilize the patient until he or she is moved from a sitting position to a supine position on a backboard
KED(short backboard )
Another alternative to the backboard is the___ (FIGURE 8-25). With this device, the patient is placed on the mattress and the air is removed from the device, allowing it to mold around the patient. It fits snugly to the curvatures and contours of the body and limits pressure-point tenderness. Padding may be used for tender areas but is not required for most patients. The__ is seen as equivalent to padding to secure the patient’s neck and spine and is more comfortable for the patient than the long spine board. See Chapter 29, Head and Spine Injuries, for more information about the_
vacuum mattress
Is a subjective condition that the patient feels and tells you about
Symptom
Is an objective condition that you can observe or measure
Sign
Traumatic injuries are the result of physical forces applied to the outside of the body, usually from an object striking the body or a body striking an object. These are generally classified according to the type or amount of force, how long it was applied, and where it was applied to the body. This is described as the__. The__ can be used as a guide to help you focus your assessment.
mechanism of injury (MOl)
Certain parts of the body are more easily injured than others. The brain and the spinal cord are fragile and easy to injure.
Fortunately, they are protected by the skull, the vertebrae, and several layers of soft tissues. The eyes are also easily injured Even small forces on the eye may result in serious injury. The bones and certain organs are stronger and can absorb small forces without resulting significant injury. A good understanding of anatomy and physiology will help you identify times when the___ may lead to injury to parts of the body not directly impacted. For example, consider a patient who has fallen off a roof, landing feetfirst. This patient’s__ would direct attention to possible injury to the feet. But significant energy likely transferred to other body areas and may have caused further injury in the patient’s legs and pelvis, and even his or her spine
MOl
Terms commonly associated with__ include blunt trauma and penetrating trauma. With blunt trauma, the force of the injury occurs over a broad area, and the skin is sometimes not broken. However, the tissues and organs underneath the area of impact may be damaged. With penetrating trauma, the force of the injury occurs at the specific point of contact between the skin and the object. The object pierces the skin and creates an open wound that carries a higher potential for infection
MOI
As an EMT, you will also care for patients who require EMS attention because of illnesses or conditions not caused by an
outside force. For these patients with medical problems, you must examine the general type of illness the patient is experiencing, or the__). An example of this would be a patient who tells you that he feels as if he cannot get enough air. This patient’s __ would be difficulty breathing and, like the MOl, would help direct both your assessment and your care.
nature of illness (NOl
Considering the MOl or NOl early can be of value in preparing to care for your patient. For example, when you begin to gather equipment from the unit, what would you take to treat a patient reporting chest pain? How would that equipment differ from the equipment used for a pedestrian struck by a vehicle? The appearance of the scene may also guide your preparation. Other___ may include falls, motor vehicle crashes, assaults, and industrial accidents. Examples of__ include seizures, heart attacks, diabetic problems, and poisonings. Family members, bystanders, or even law enforcement personnel may also provide important trauma or medical information to help you assist the patient.
You may be tempted to categorize your patient immediately as a trauma or medical patient. Remember, the fundamentals
of a good patient assessment are the same despite the unique aspects of trauma and medical care. If an unconscious patient is found at the bottom of a ladder, did he or she fall off the ladder, strike his head, and become unconscious? Or did he or she experience a medical problem that caused him or her to have a loss of consciousness and then fall off the ladder?
Early in the assessment, it can be difficult to identify with absolute certainty whether the problem is of a traumatic or medical origin. Although further assessment is needed to come to a conclusion, considering the MOl or NOl early will help you begin your assessment.
Moi
Noi
__and personal protective equipment (PPE) need to be considered and adapted to the prehospital task at hand. PPE includes clothing or specialized equipment that protects the wearer. The type of PPE used depends on the specific job duties required during a patient care interaction.
Standard precautions
__ are protective measures that have traditionally been recommended by the Centers for Disease Control and Prevention (CDC) for use in dealing with objects, blood, body fluids, and other potential exposure risks of communicable disease. If you have a primary responsibility for patient care, you will need to follow___ when assessing and treating the patient. They are required in every patient encounter. These measures may not provide absolute protection from exposure to infectious diseases or bloodborne pathogens, but they are the most effective way to reduce your risk of exposure. The concept of__ assumes that all blood, body fluids, nonintact skin, and mucous membranes may pose a substantial risk of infection. This includes blood and other potentially infectious materials that are dried, because some diseases such as hepatitis can live for days outside the body. During a situation in which there is active community transmission of a virus that can be transmitted by airborne particles or aerosolized particles, this concept of standard precautions must be expanded to recognize the risk associated with non-bloodborne pathogens
Standard precautions
As part of the scene size-up, it is essential that you accurately identify the total number of patients. This evaluation is critical in determining your need for additional resources, such as firefighters, a specialized rescue group, a hazardous materials team, or additional ambulances. When there are multiple patients, use the___, establish command. identify the number of patients, and then begin triage (FIGURE 10-5). The__ is a flexible system implemented to manage a variety of emergency scenes. Emergency responders work in groups according to their function or assigned area, with the leader of each group reporting to the person in charge of the incident, the incident commander!
Triage is the process of sorting patients based on the severity of their condition. Once all patients have been triaged treatment and transport of these patients can begin. Usually the most experienced EMT is assigned to perform triage. This process helps allocate personnel, equipment, and resources to provide the most effective care to everyone. When many patients are present or there are more patients than the responding unit can effectively handle, put your mass-casualty plan into action, utilizing the__ and your local protocols.
incident command system
The primary assessment has a single, all-important goal: to identify and begin treatment of immediate or imminent life threats. To do this, vou must physically examine the patient and assess level of consciousness (__) and airway. breathing, and circulation (ABCs); however, this is not an in-depth physical exam or assessment of vital signs. These will be addressed later in the secondary assessment.
Level of consciousness (LOC)
Early in your assessment, you will need to evaluate the patient’s__. This will help you rapidly determine if the patient has a life-threatening injury and to what extent the patient will be able to provide reliable information about his or her own condition as well as follow your directions. The patient’s__ can tell you a great deal about his or her neurologic and physiologic status. The brain requires a constant supply of oxygen and glucose to function properly. In the primary assessment, you need to ascertain only the gross__.
LOC
The AVPU scale is used to assess a patient’s__ depending on how well he or she responds to external stimuli, including verbal stimuli (sound) and painful stimuli (such as pinching the trapezius muscle on top of the patient’s shoulder). The AVPU scale tests a patient’s responsiveness based on the following criteria: awake and alert,response to Verbal stimuli,response to Pain,Unresponsive
LOC
An airway obstruction can result in partial or complete blockage of air movement into and out of the lungs and therefore inadequate__ of the entire body. As you move through the steps of the primary assessment, stay alert for signs of airway obstruction. To prevent death or permanent disability to your patient, ensure that the airway remains open (patent) and adequate.
perfusion
The flow of blood through body tissues and vessels
Perfusion
If you cannot palpate a carotid pulse in an unresponsive patient,begin _
CPR
Many blood vessels lie near the surface of the skin. The skin’s color is determined by the___. In patients with deeply pigmented skin, changes in color may be apparent only in certain areas, such as the fingernail beds, the mucous membranes in the mouth, the lips, the underside of the arm and palm (which are usually less pigmented), and the conjunctiva of the eyes. The conjunctival is the delicate membrane lining the evelids, and it covers the exposed surface of the eye. In addition, the palms of the hands and soles of the feet should be assessed in infants and children.
Poor peripheral circulation will cause the skin to appear pale, white, ashen, or gray, possibly with a waxy translucent appearance similar to a white candle. Abnormally cold or frozen skin may also appear this way. When the blood is not properly saturated with oxygen, it appears blue. Therefore, in a patient with insufficient air exchange and low levels of oxygen in the blood, the blood and vessels appear blue, and the lips, mucous membranes, nail beds, and skin over the blood vessels appear blue or gray. This condition is called cyanosis
blood circulating through these vessels and the amount and type of pigment that is present in the skin
A brief history of a patient’s condition to determine signs and symptoms, allergies, medications, pertinent past history, last oral intake, and events leading to the injury or illness.
Sample history
___is an assessment tool used to evaluate the effectiveness of oxygenation. The___ is a photoelectric device that monitors the oxygen saturation of hemoglobin (the iron-containing portion of the red blood cell to which oxygen attaches) in the capillary beds (FIGURE 10-36). The parts that make up the__ include a monitor and a sensing probe. The sensing probe clips onto a finger or earlobe. The light source must have unobstructed access to a capillary bed, so dark fingernail polish might need to be removed. Results appear as a percentage on the display screen. Normally,__ values in ambient air will vary depending on the altitude, with most values falling between 94% and 99%.
pulse oximetry
___is the circulation of blood in an organ or tissue. When perfusion is adequate, the cells’ metabolic needs are met. Blood enters an organ or tissue through the arteries and leaves it through the veins (FIGURE 6-30). Loss of normal blood pressure is an indication that blood is no longer circulating efficiently to every organ in the body. (However, a “good blood pressure” does not indicate that it is reaching all parts of the body.) There are many reasons for loss of blood pressure. The result in each case is the same: Organs, tissues, and cells are no longer adequately perfused or supplied with oxygen and fuel, and wastes accumulate. Under these conditions, cells, tissues, and whole organs may die. Hypoperfusion (inadequate perfusion) affecting the entire body is called shock.
Perfusion
During inhalation, air typically enters the body through the nose and passes into the__. The___ is lined with a ciliated mucous membrane that keeps contaminants such as dust and other small particles out of the respiratory tract.
In addition, the mucous membranes warm and humidify air as it enters the body.
nasopharynx
The_ forms the posterior portion of the oral cavity, which is bordered superiorly by the hard and soft palates, laterally by the cheeks, and inferiorly by the tongue (FIGURE 11-3). Superior to the larynx, the epiglottis helps separate the digestive system from the respiratory system. Its function is to prevent food and liquid from entering the larynx during swallowing. When swallowing occurs, the larynx is elevated and the epiglottis folds over the glottis to prevent aspiration of contents into the trachea.
oropharynx
The _ is a complex structure formed by many independent cartilaginous structures. It marks where the upper airway ends and the lower airway begins. Also called the voice box
Larynx
The part of the pharynx that lies above the level of the roof of the mouth,or palate
Nasopharynx
A tubular structure that extends vertically from the back of the mouth to the esophagus and trachea
Oropharynx
The _ is the lowest portion of the pharynx
Laryngopharynx
Unlike inhalation,__ does not normally require muscular effort; therefore, it is a passive process. During__, the diaphragm and the intercostal muscles relax. In response, the thorax decreases in size, and the ribs and muscles assume a normal resting position. When the size of the thoracic cage decreases, air in the lungs is compressed into a smaller space. The air pressure within the thorax then becomes higher than the outside pressure, and the air is pushed out through the trachea.
Remember that air will reach the lungs only if it travels through the trachea. This is why clearing and maintaining an open airway is so important. Clearing the airway means removing obstructing material, tissue, or fluids from the nose, mouth, and throat. Maintaining the airway means keeping the airway patent so that air can enter and leave the lungs freely
exhalation
__is the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream. Adequate oxygenation is required for internal respiration to occur; however, it does not guarantee internal respiration is taking place.
__requires that the air used for ventilation contains an adequate percentage of oxygen. Ventilation without oxygenation can occur in places where oxygen levels in the breathing air have been depleted, such as in mines and confined spaces. Ventilation without adequate____ also occurs in climbers who ascend too quickly to an altitude of lower atmospheric pressure. At high altitudes, the percentage of oxygen remains the same, but the lower atmospheric pressure makes it difficult to adequately bring sufficient amounts of oxygen into the body.
Oxygenation
All living cells perform a specific function and need energy to survive. Cells take energy from nutrients through a series of chemical processes. The name given to these processes is metabolism, or cellular respiration. During metabolism, each cell combines nutrients (such as sugar) and oxygen and produces energy (in the form of adenosine triphosphate) and waste products, primarily water and carbon dioxide. Each cell in the body requires a continuous supply of oxygen and a regular means of disposing of waste (carbon dioxide). The body provides for these requirements through respiration.
__is the process of exchanging oxygen and carbon dioxide. This exchange occurs by diffusion, a process in which a gas moves from an area of greater concentration to an area of lower concentration. In the body, gases diffuse rapidly across a distance of micrometers.
Respiration
Normal respiratory rate for an adult
12 to 20
Normal respiratory rate for a child
12 to 40
Normal respiratory rate for an infant
30 to 60
The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs
Oxygenation
__is the measure of the maximal concentration of co at the end of an exhaled breath. A low co2 level could indicate a number of conditions. If the patient is hyperventilating, he or she is eliminating carbon dioxide faster than the body is making it; this would cause a low cO2 level. A low co2 level could also indicate decreased coz return to the lungs because of reduced co2 production at the cellular level secondary to conditions such as shock and cardiac arrest. When cardiac output increases,__ levels generally increase—a reflection of improved oxygen delivery. By contrast, a high co level may indicate that the patient is retaining coz secondary to ventilation inadequacy. An absence of coz can indicate that the patient is not breathing at all.
__is measured by using capnometry and capnography devices. Capnometry typically refers to use of a device that provides a digital numeric reading of the ___level. Capnography provides both a numeric reading and a graph, or real-time image, of the __ levels from breath to breath. The digital display of end-tidal coz is expressed in millimeters of mercury (mm Hg) (FIGURE 11-17). The normal range is 35 to 45 mm Hg.
End-tidal co2
The actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body
Respiration
The process of exchanging oxygen and carbon dioxide
Respiration
The portion of the tidal volume that does not reach alveoli and thus does not participate in gas exchange
Dead space
Any portion of the airway that does contain air and cannot participate in gas exchange,such as the trachea and bronchi
Dead space
The passive part of the breathing process in which the diaphragm and the intercostal muscles relax,forcing air out of the lungs
Exhalation
In between each rib are intercostal muscles,in conjunction with the ___,facilitate normal breathing
Diaphragm
In addition to the respiratory and circulatory structures found in the thoracic cavity, important structures of the nervous system are also found in the thorax-the_. The__, which originate from the third, fourth, and fifth cervical nerves, innervate the diaphragm muscle, allowing it to contract. Contraction of the diaphragm occurs in a downward direction and is necessary for adequate breathing to occur.
phrenic nerves
The two nerves that innervate the diaphragm; necessary for adequate breathing to occur
Phrenic nerves
Air enters the body through the oral and nasal cavities and travels into the lungs. This occurs because a negative pressure is created in the chest when the thoracic cavity enlarges due to contraction of the__ and intercostal muscles
diaphragm
The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation
Oxygenation
A gas that all cells need for metabolism; the heart and brain, especially, cannot function without __
Oxygen
Cells use __ to assist in cellular respiration. This type of respiration, called aerobic cellular respiration,converts stored energy into a usable form, chiefly by reacting glucose and__ through an intermediate.
Oxygen
An __airway has two principal purposes. The first is to keep the tongue from blocking the upper airway. The second is to make it easier to suction the___ if necessary. Suctioning is possible through an opening down the center or along either side of the___ airway
oropharyngeal (oral)
A___ airway is usually used with an unresponsive patient or a patient with an altered level of consciousness who has an intact gag reflex and is not able to maintain his or her airway spontaneously
nasopharyngeal (nasal)
You cannot use a __ airway with a sever head injury with blood draining from the nose . And a history of fractured nasal bone
Naso airway
The compressed gas industry has established a__ for portable cylinders to prevent an oxygen regulator from being connected to a carbon dioxide cylinder, a carbon dioxide regulator from being connected to an oxygen cylinder, and so on. In preparing to administer oxygen, always check to be sure that the pinholes on the cylinder exactly match the corresponding pins on the regulator.
pin-indexing system
The__ features a series of pins on a yoke that must be matched with the holes on the valve stem of the gas cylinder. The arrangement of the pins and holes varies for different gases according to accepted nationa standards (FIGURE 11-35). Other gases that are supplied in portable cylinders, such as acetylene, carbon dioxide, and nitrogen, use regulators and flowmeters that are similar to those used with oxygen. Each cylinder of a specific gas type has a given pattern and a given number of pins. These safety measures make it impossible for you to attach a cylinder of nitrous oxide to an oxygen regulator. The oxygen regulator will not fit.
pin-indexing system
The outlet valves on portable oxygen cylinders are designed to accept yoke-type pressure-reducing gauges, which conform to the
Pin-indexing system (PISS)
The safety system for the large cylinders is known as the__. In this system, oxygen cylinders are equipped with threaded gas outlet valves. The inside and outside thread sizes of these outlets vary depending on the gas in the cylinder. The cylinder will not accept a regulator valve unless it is properly threaded to fit that regulator. The purpose of these safety devices is the same as in the pin-indexing system —to prevent the accidental attachment of a regulator to the wrong cylinder.
American Standard Safety System.
Flow rate 1 to 6 L/min
Oxygen delivered 24% to 44%
Nasal cannula
Flow rate 10 to 15L/min
Oxygen delivered up to 90%
NRB mask with reservoir
Flow rate 15L/min
Oxygen delivered nearly 100%
Bag mask device with reservoir
A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress;can prevent the need for endotracheal intubation
CPAP
Is a noninvasive means of providing ventilators support for patients experiencing respiratory distress
Continuous positive airway pressure CPAP
___in the prehospital environment has proven to be an excellent adjunct in the treatment of respiratory distress associated with COPD, acute pulmonary edema, and acute bronchospasm (such as in asthma). In asthma and COPD it is used in conjunction with bronchodilator medications (eg, albuterol). Typically, many of these patients would be managed with advanced airway techniques, such as endotracheal intubation.
CPAP
__increases pressure in the lungs, opens collapsed alveoli and prevents further alveolar collapse (atelectasis), pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation.
The desired effect of__ is to improve pulmonary compliance and make spontaneous ventilation easier for the patient.
CPAP
Because__ increases pressure inside the chest, it reduces the amount of blood flow returning to the heart, As the pressure in the thorax increases, the venous flow of blood returning to the heart meets the resistance of the increased pressure in the chest. The result is a decrease in the workload of the heart and a drop in cardiac output, This is not common with lower levels of__; however, caution should be used when considering__ in patients with low blood pressure. Continually monitor blood pressure in patients receiving__ treatment.
CPAP
Patients with a__ are still able to exchange air but will have varying degrees of respiratory distress. Great care must be taken to prevent a___ from becoming a severe airway obstruction The patient will usually have noisy breathing and may be coughing. Assess the patient and determine whether the patient has good air exchange or poor air exchange.
With good air exchange, the patient can cough forcefully, although you may hear wheezing (the production of whistling sounds during respiration) between coughs. Wheezing is usually indicative of a___.
mild lower airway obstruction
Patients with a ___cannot breathe, talk, or cough. One sure sign of a___ is the sudden inability to speak or cough during or immediately after eating. The person may clutch or grasp his or her throat (universal distress signal), start to become cyanotic, and have extreme difficulty breathing (FIGURE 11-50). There is little or no air movement. Ask the conscious patient, “Are you choking?” If the patient nods “yes,” provide immediate treatment. If the obstruction is not cleared quickly, the amount of oxygen in the patient’s blood will decrease dramatically. If not treated, the patient will become unconscious and die.
severe airway obstruction
The __ begins at the right side of the heart and carries oxygen-depleted blood to the lungs. It divides into finer and finer branches until it meets with the pulmonary capillary system located in the thin walls of the alveoli. These arteries are the only ones in the body that carry oxygen depleted blood
Pulmonary artery
The major artery leading from the right ventricle of the heart to the lungs;carries oxygen-poor blood
Pulmonary artery
How long should you suction for?
Adult 15 child 10 infant 5
When hemoglobin is loaded up with oxygen it takes on a__, which is the color we associate with oxygenated blood. On the other hand, hemoglobin without oxygen bound has a___ characteristic of deoxygenated blood.
bright red color
deep, dark red hue
Fully saturated blood is __ than partially saturated blood
Brighter
Depleted oxygen blood is more
Purple
Oxygenated blood appears
Bright red or scarlet
This is a one person technique to move a patient only if an immediately life threatening danger exists and you are alone or,because of the pressing nature of the danger,your partner is moving a second patient simultaneously. A one-person carry. Over the shoulder
Firefighters carry
