Misc Flashcards
Autonomic Nervous System
The autonomic nervous system (ANS or visceral nervous system or involuntary nervous system) is the part of the peripheral nervous system that acts as a control system that functions largely below the level of consciousness to control visceral functions,[1] including heart rate, digestion, respiratory rate, salivation, perspiration, pupillary dilation, micturition (urination), sexual arousal, breathing and swallowing. Most autonomous functions are involuntary but they can often work in conjunction with the somatic nervous system which provides voluntary control.
Rule of Nines Adults
9 Head 18 Each Front and back Torso 18 Each Leg 9 Each Arm 1 Genitalia
4.5% Anterior head
4.5% Posterior head
18% Anterior torso
18% Posterior torso
9% Anterior leg, each
9% Posterior leg, each
4.5% Anterior arm, each
4.5% Posterior arm, each
1% Genitalia/perineum
Rules on Nines - child
18 Head 18 Torso Front and Back 14 Each Leg 9 Each Arm 1 Genitalia
9% Anterior head 9% Posterior head 18% Anterior torso 18% Posterior torso 7% Anterior leg, each 7% Posterior leg, each 4.5% Anterior arm, each 4.5% Posterior arm, each 1% Genitalia/perineum
GCS Eyes - How many points
Eyes - 4 4 Open Eyes Spontaneously 3 Opens in Response to Voice 2 Opens to Painful Stimuli 1 Does not Open
There are four grades starting with the most severe:
No eye opening
Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the patient’s fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect).[1]
Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
Eyes opening spontaneously
eyes 4
speech 5
motor 6
GCS Verbal - How many points
Verbal - 5 5 Oriented Converses Normally 4 Confused, disoriented 3 Utters inappropriate words 2 Incomprehensible Sounds 1 Makes no Sound
There are five grades starting with the most severe:
No verbal response
Incomprehensible sounds. (Moaning but no words.)
Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)
Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)
GCS Motor - How many points
Motor - 6 6 Obeys Commands 5 Localizes to painful stimuli 4 Flexion / Withdraws to pain 3 Abnormal Flexion (decoriate) 2 Extension to pain (decerebrate) 1 Makes no movement
There are six grades:
No motor response
Extension to pain (extensor posturing: abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)
Abnormal flexion to pain (flexor posturing: adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
Obeys commands. (The patient does simple things as asked.)
GCS Brain Injury Scores
Generally, brain injury is classified as:
Severe, with GCS < 8-9
Moderate, GCS 8 or 9–12
Minor, GCS ≥ 13.
Order of Assessment according to NREMT
Scene Size Up Primary Survey / Resuscitation History Taking Secondary Assessment Vital Signs Reassessment Radio Report
BSI Scene Safety - Responder, team, pt Appropriate Resources Spinal Immobilization AVPU - LOC Airway Bleeding Pulse Transport Decision Rapid look for life threats - manage and treat (Primary) Transport Emergencies Vital signs and sample history focused or detailed exam reevaluate
% 02 of airway delivery systems
.
Orthopnea
difficulty breathing in supine position - most common with pulmonary edema
Dyspnea
difficult sensation of breathing
functions of medulla oblongata
The medulla oblongata connects the higher levels of the brain to the spinal cord, and is responsible for several functions of the autonomous nervous system, which include:
Respiration – chemoreceptors. These chemoreceptors detect changes in acidity of the blood, thus if the blood is considered too acidic by the medulla oblongata electrical signals are sent to the muscle tissue in the lungs increasing their contraction rate in order to reoxygenate the blood.
Cardiac center – sympathetic, parasympathetic nervous system
Vasomotor center – baroreceptors
Reflex centers of vomiting, coughing, sneezing, and swallowing. These reflexes which include the pharyngeal reflex, the swallowing reflex (also known as the palatal reflex), and the masseter reflex can be termed, bulbar reflexes.[1
Working to breathe
normal mental status
tachycardia
pale cool diaphoretic
adequate rate and depth - non rebreather
Failing to breathe
altered mental status Signs of Exhaustion Tachycardia or bradycardia pale cool diaphoretic inadequate rate and depth - BVM & Airway adjuncts
rhonchi and rales (crackles)
pulmonary edema, pneumonia, congestive heart failure, inhalation burns, high altitude pulmonary edema
wheezes
emphysema, bronchitis, asthma, anaphylasixis and in comes cases pulmonary edema and pneumonia
stridor
partial upper airway obstruction and croup
signs of pt presenting with upper airway obstruction
choking, croup, epiglottis - eliminate distractors that are answers to lower airway
