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
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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
Does this problem sound like a congestive or obstructive airway problem?
congestive can eliminate asthma, emphysema bronchitis
obstructive can eliminate pneumonia, pulmonary and cardia edema
anatomy of the airway
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valves of the heart
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electrical conduction system of the heart
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cpr sequence for drowning
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severity of burns rating
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cushings triad
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closed head trauma - progression of bp and pulse
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pt presentation - subdural hemorrhage
Bleeding trapped between the dura mater and the brain proper forms a subdural hematoma. This tends to be caused by bleeding from the many veins that bridge the subdural space. This is most commonly caused by blunt head trauma. Therefore, subdural hematomas are frequently associated with skull fractures above and cerebral contusions below.
Depending on the time frame between the initial insult and the development of symptoms, subdural hematomas will be classified as acute, sub-acute or chronic.
Acute – symptoms develop within twenty-four hours. 50% – 80% mortality rate.
Sub-acute – symptoms develop from two to ten days. 25% mortality rate.
Chronic – symptoms develop after around two weeks. 20% mortality rate.
The symptoms of subdural hematoma mirror the symptoms of epidural bleeding. The key difference is that the symptom progression is much more subtle due to the slower onset. It often takes a more experienced or alert clinician to trace the presenting symptoms back to the initial head injury.
The hematoma will ultimately need to be surgically evacuated.
pt presentation - epibdural hemorrhage
20-50% may have a sudden improvement in their condition prior to rapid deterioration - lucid interval
Epidural Bleeding Less than one percent of all intracranial hemorrhages are epidural in nature. Symptoms tend to develop rapidly and tend to be caused by laceration of the middle meningeal artery. Though bleeding from other regions can produce epidural bleeding, we suspect this bleeding pattern secondary to trauma in the temporal region of the skull. Epidural bleeds from venous sources will progress slower than arterial epidural bleeds. Around half of the patients who experience epidural bleeding will have a brief loss of consciousness at the time of insult and then return to orientation and often report that they are asymptomatic. This temporary period of orientation is known as a lucid interval. The last two sentences were important. Go back and read them again. … No, seriously. The other half of patients will typically loose consciousness and never regain orientation. Even with appropriate care, 15 – 20% will die. Lucid intervals in epidural bleeds can last from 2 minutes to 16 hours but usually fall in the 2 – 6 hour range. The dramatic nature of lucid intervals has caused the media to coin a more dramatic term for the process, “talk and die syndrome.” During the lucid interval, patients may initially have no symptoms and then develop a progression of headache, nausea, vomiting, lethargy, confusion, altered mentation and unconsciousness. Rapid intervention at a trauma facility is required
Subarachnoid Hemorrhage
This term refers to the phenomenon of bleeding into the cerebrospinal fluid (CSF). This results in bloody CSF and intense meningeal irritation. Patients with subarachnoid hemorrhage will have a sudden, severe headache that will begin localized and then spread into a more diffuse, dull, throbbing pain. Patients can also present with nausea, dizziness, severe neck pain, unequal pupils, confusion, seizures and unresponsiveness.
APGAR
Appearance:
2 If the entire body is pink
1 If the body is pink and the extremities are blue
0 If the skin color is pale blue
Pulse
2 >100
1 tone
Respiration
2 Normal rate and effort, good cry
1 If the respirations are slow or irregular
0 Absent
with a newborn suction….
the mouth first and then the nose
knee chest position for mothers - when to use
delay delivery
oxygen is of primary importance in all abnormal presentations during pregnancy - when to use
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Hypoxia in the infant often manifests as:
bradycardia
Kortokoff Sounds
heard when auscultating blood pressure
croup
viral infection that cause swelling around the larynx and trachea with a seal bark cough, may get better during the day and worse at night, usually occurs in pts less than 5
CBRNE
Types of Weapons
Chemical Biologic Radiologic Nuclear Explosive
Pediatric Airway
tongue is larger
mouth and nose are smaller
trachea more pliable and can be damaged by overextension
trachea narrower and more affected by inflammation & swelling
chest walls are less muscular and more pliable
breath more from the diaphragm
SLUDGE-M
Used to remember the action of nerve agents
Salivation Lacrimation Urination Deification GI Distress Emesis (Vomiting) Miosis (pupil constriction)
signs and symptoms of a nerve agent that acts on the parasympathetic nervous system
two traumatic injuries that cause JVD
cardiac tamponade
tension pneumothorax
presentation of epiglottitis
difficulty breathing
difficulty swallowing
pt usually present with hoarseness, drooling, and sitting forward in a sniffing position, retractions, fever and stridor can also present
now decreased in incidence because of the flu vaccine
frequently a bacterial infection but can be caused by a virus or trauma
cutting the umbilical cord
6” away from baby with 2-3 inches between
Presentation of COPD exacerbation
may be the result of a respiratory infection, resulting in cough, fever and mucous production.
CHF may result in edema in ankles or lower back, weight gain, JVD, may hear rales or crackles
Both will present with dyspnea on exertion and orthopnea and wheezing
pulmonary embolism
clot that travels to the lungs dyspnea decreased lung sounds hypoxia rapid breathing, pulse and bloddy sputum or chest pain
bradycardia
pulse below 60 in an adult
Signs and Symptoms of ACS
chest pain, pressure or discomfort which may also radiate to the neck, jaw abdomen or back
may also have anxiety, difficulty berthing, palpitations, cool clammy skin, weakness, abnormal vital signs and a feeling of impending doom
TRACEM-P
Types of Harm
Thermal Radiological Asphyxiation Chemical Etiological Mechanical Psychological
