MOD 1 Study Flashcards
Name of the publication that exposed the serious morbidity and mortality caused to Americans by highway crashes?
Accidental death and disability: the neglected disease of modern society
Parts of the ems system include
Bystanders
Dispatch
First responders
BLS (EMT)
ALS(paramedics)
Transport
Emergency department (ED)
Specialty care
How many hours of EMR training
50-80
How many hours of EMT training
150-200
How many hours of AEMT training
200-400
How many hours of paramedic training
1,000-2,000
Ems curricula is designed by what agency?
National highway traffic safety administration
What does evident based treatment mean
We know that it works because it’s been validated by a research study
List of entity’s that can influence the medical industry to adopt a treatment
Physician opinion
Theories by prominent industry thinkers
Logical course of action
Describe how a control group bs an experimental group study works
The control group are people who are getting treated with “conventional” methods and the experimental group is getting the “new” methods. You want the experimental group to have a good outcome so your treatment gets approved.
Describe how a treatment vs placebo study works
The treatment means whatever you are trying to validate. Placebo is a fake treatment. Has no therapeutic value and is given fake medicine like a sugar pill
Describe how a retrospective study works
To look at previous studies on the topic to see if any previous studies gives you a population of data of information on the topic you are trying to research. Basically to compile other research from other studies
What intervention discussed was a standard of care, then was considered contra-indicated, then became once again a standard of care?
If a tourniquet should be applied to a patient with a severe bleed. It was read posted because military data shows tourniquets can be applied to sever injuries with minimal risks and positive effects on the patient
What intervention was a standard of care but was shown to cause more harm than good
Bite sticks for seizures
What current intervention was adjusted over time to become more effective
How many compressions are performed in one cycle of 2-rescuer adult cpr. Went from 5 compressions, to 30 compressions
1992:5 2000:15 2010:30
What are the expectations of an emt as it relates to research
Should be familiar with current trends. Read ems journals, take continuing education classes, attend industry conferences, and review ems websites. Taking a survey for a researcher , having his care records mined for data
Difference between ethnocentrism and cultural imposition
Ethnocentrism is when someone thinks their cultural values are more important than others and cultural imposition is when you force your values onto others
Describe the difference between simplex and duplex radio transmission
Simplex is one way communication,when one party transmits, the other can only receive. Duplex is two way communication, can simultaneously transmit and receive on one channel
Name a couple of pieces of radio equipment discussed in lecture and which ones are static(can’t be moved)
Base station radio (static)
Mobile and portable radios
Repeater based system (static)
Digital equipment
Explain the difference between online and offline medical direction
Online is when you receive medical directions from a physician in real time
Offline medical direction relies on pre established protocols and guidelines without direct communication
If you needed to talk to a large group of bystanders, what piece of ambulance equipment would you use
External public address system
What is the name and acronym for software that dispatches your ambulance to assignments
CAD ( computer aid dispatch)
A paramedic has extensive ALS training, including
Endotracheal intubation
Emergency pharmacology
Cardiac monitoring
Other advanced assessment and treatment skills
Americans With Disabilities Act (ADA)
Prohibits employers from failing to provide full and equal employment
History of EMS
Origins include:
Volunteer ambulances in World War I
Field care in World War II
Field medic and rapid helicopter evacuation in Korean conflict
Training adds knowledge and skills in specific aspects of ALS, including:
IV therapy
Advanced airway adjuncts
Administration of limited number of medications
Off-line (indirect)
Standing orders, training, supervision
Online (direct)
Physician directions given over the phone or radio
Continuous Quality Improvement (CQI)
Reviews and performs audits of the EMS system to identify areas of improvement and/or assign remedial training
Minimizing errors is the goal.
Uses a plan-do-study-act cycle
Quality control in an EMS system is the ultimate responsibility of the:
medical director
CHART method
Chief complaint or chief concern
History
Assessments
Treatment (Rx)
Transport
SOAP
Subjective
Objective
Assessment
Plan
Expressed consent
The patient acknowledges he or she wants you to provide care or transport.
2. To be valid, the consent that the patient provides must be informed consent, which means that you explained the nature of the treatment being offered, along with the potential risks, benefits, and alternatives to treatment, as well as potential consequences of refusing treatment.
Implied consent
Applies to patients who are:
a. Unconscious
b. Otherwise incapable of making a rational, informed decision about care
2. Implied consent applies only when a serious medical condition exists and should never be used unless there is a threat to life or limb.
3. The principle of implied consent is known as the emergency doctrine.
4. Try to get consent from a spouse or relative before treating based on implied consent.
Involuntary consent
Applies to patients who are:
a. Mentally ill
b. In a behavioral (psychological) crisis
c. Developmentally delayed
2. Obtain consent from the guardian or conservator
a. It is not always possible to obtain such consent.
b. Many states have protective custody statutes that allow these individuals to be taken, under law enforcement authority, to a medical facility.
Minors and consent
- The parent or legal guardian gives consent.
- In some states, a minor can give consent.
a. Emancipated minor: an individual under the legal age who is legally considered an adult
b. Many states consider minors to be emancipated if they are married, if they are members of the armed services, if they are parents, or if living away from home and no longer relying on parents for support. - Teachers and school officials may act in place of parents (in loco parentis) and provide consent for treatment of injuries that occur in a school or camp setting.
- If a true emergency exists and no consent is available, treat the patient under implied consent.
Forcible restraint
Necessary for patients who are in need of medical treatment and transportation but are combative and present a risk of danger to themselves or others
2. Forcible restraint is legally permissible.
a. Consult medical control for authorization and utilize law enforcement on the scene.
b. Restraint without legal authority exposes you to potential civil and criminal penalties.
c. Make sure you know the local laws and protocols regarding forcible restraint.
d. Once applied, do not remove restraints en route unless they pose a risk to the patient.
e. Consider calling ALS backup to provide chemical pharmacologic restraint.
A do not resuscitate (DNR) order gives permission to
withhold resuscitation.
1. “Do not resuscitate” does not mean “do not treat.” Even in the presence of a DNR order, you are still obligated to provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest, whenever possible.
2. Each ambulance service should have a protocol to follow in these circumstances.
Advance directives
A written document specifying medical treatment for a competent patient should he or she become unable to make decisions
2. Most commonly used when a patient becomes comatose
3. Often referred to as a living will or health care directive
You may encounter physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms when caring for patients with terminal illnesses.
- These medical orders explicitly describe acceptable interventions for the patient.
- They must be signed by an authorized medical provider to be valid.
- If you encounter these documents, contact medical control for guidance.
Some patients may have named surrogates to make decisions for them when they can no longer make their own.
Durable powers of attorney for health care
2. Also known as health care proxies
Determination of the cause of death is the medical responsibility of a
physician
Presumptive signs of death:
- Unresponsiveness to painful stimuli
- Lack of a carotid pulse or heartbeat
- Absence of chest rise and fall
- No deep tendon or corneal reflexes
- Absence of pupillary reactivity
- No systolic blood pressure
- Profound cyanosis
- Lowered or decreased body temperature
Definitive signs of death:
- Obvious mortal injury such as decapitation
- Dependent lividity
a. Blood settling to the lowest point of the body, causing discoloration of the skin - Rigor mortis
a. Stiffening of body muscles caused by chemical changes within muscle tissue
b. Occurs between 2 and 12 hours after death - Algor mortis
a. Cooling of the body until it matches the ambient environment - Putrefaction (or decomposition) of body tissues
a. Depending on temperature conditions, occurs between 40 and 96 hours after death
In most states, the medical examiner, or the coroner in some states, must be notified in the following cases:
a. The patient is dead on arrival (DOA; sometimes called dead on scene [DOS])
b. Death without previous medical care, or when the physician is unable to state the cause of death
c. Suicide
d. Violent death
e. Known or suspected poisoning
f. Death from accident
g. Suspicion of a criminal act
h. Infant and child deaths
3. Make every attempt to limit your disturbance of a scene involving a death.
4. If emergency medical care has been initiated, be sure to carefully document what was done or found on scene.
Organ donors
- Organ donors have expressed a wish to donate their organs.
- Consent is evidenced by information on a donor card or driver’s license.
- Treat potential organ donors the same as any other patient.
a. Your priority is to save the patient’s life.
b. Remember that organs need oxygen.
Medical identification insignia
- Bracelet, necklace, keychain, or card indicating DNR order, allergies, or other serious medical condition that may be helpful in assessing and treating the patient
- Some patients wear medical bracelets containing a USB flash drive.
a. Often stored as a PDF file that can be read on most computers
Scope of Practice
A. Outlines the care you are able to provide
B. Usually defined by state law
C. The medical director further defines the scope of practice by developing protocols or standing orders.
Standards of Care
A. The manner in which you must act or behave is called a standard of care.
B. It is defined as how a person with similar training would act under similar circumstances.
Duty to Act
Duty to act is an individual’s responsibility to provide patient care.
B. Once your ambulance responds to a call or treatment is begun, you have a legal duty to act.
C. In most cases, if you are off duty and come upon a crash, you are not legally obligated to stop and assist patients. Know your local laws and policies pertaining to your duty to act.
Negligence
Negligence is the failure to provide the same care that a person with similar training would provide in the same or similar situation.
B. All four of the following factors must be present for the legal doctrine of negligence to apply:
1. Duty
a. The obligation to provide care and to do so in a manner that is consistent with the standard of care established by training and local protocols
2. Breach of duty
a. The EMT did not act within an expected and reasonable standard of care.
3. Damages
a. A patient is physically or psychologically harmed in some noticeable way.
4. Causation
a. A cause-and-effect relationship exists between a breach of duty and the damages suffered by the patient.
C. Res ipsa loquitur
1. An EMT can he held liable under this theory if it can be shown that an injury occurred, that the cause of the injury was in the control of the EMT, and that such injuries generally do not occur unless there is negligence.
D. Negligence per se
1. A theory that can be used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute
a. Example: An EMT performs an ALS skill that resulted in injury to the patient
E. Torts
1. Civil wrongs
a. Not within the jurisdiction of US criminal courts
b. Examples include defamation of character and invasion of privacy.
Abandonment
Abandonment is the unilateral termination of care by the EMT without the patient’s consent and without making any provisions for care to be continued by a medical professional who is competent to provide care for the patient.
B. Once care is started, you have assumed a duty to act that must continue until an equally competent medical provider assumes responsibility.
C. Abandonment may take place at the scene or in the emergency department where you are dropping off your patient.
1. Obtain a signature on the patient care record from the person accepting transfer of care at the hospital.
Assault and Battery, and Kidnapping
A. Assault: unlawfully placing a person in fear of immediate bodily harm
1. Includes threatening to restrain a patient who does not want to be transported
B. Battery: unlawfully touching a person
1. Includes providing emergency care without consent
C. Kidnapping: seizing, confining, abducting, or carrying away by force
1. Could include a situation where a patient is transported against his or her will
2. False imprisonment is the unauthorized confinement of a person.
D. Potential legal problems may arise in situations in which a patient has not given or rescinds consent for treatment and/or transport.
Defamation
Defamation is the communication of false information that damages a person’s reputation.
1. Libel: written, such as a false statement on a patient care report
2. Slander: spoken, such as inappropriate comments made during “station house” conversation
B. All statements on your run report should be accurate, relevant, and factual.
Good Samaritan Laws and Immunity
A. Good Samaritan laws are based on the common law principle that when you reasonably help another person, you should not be held liable for errors or omissions that are made in giving good-faith care.
B. To be protected by provisions of Good Samaritan law, several conditions must generally be met:
1. You acted in good faith in rendering care.
2. You rendered care without expectation of compensation.
3. You did not exceed your scope of practice.
4. You did not act in a grossly negligent manner.
C. Gross negligence is defined as conduct that constitutes a willful or reckless disregard for a duty or standard of care.
D. Immunity statutes apply to EMS systems that are considered governmental agencies.
1. Sovereign immunity provides limitations on liability and immunity is not complete.
Records and Reports
Your agency should maintain a complete and accurate record of all incidents involving sick or injured patients.
1. Such records are an important safeguard against legal complications.
B. The courts’ perception of records and reports:
1. If an action or procedure was not recorded on the written report, it was not performed.
2. Incomplete or untidy reports are evidence of incomplete or inexpert emergency medical care.
C. National EMS Information System (NEMSIS)
1. Provides the ability to collect, store, and share standardized EMS data throughout the United States
Special Mandatory Reporting Requirements
ost states have a reporting obligation for health care providers and emergency responders, including EMTs.
B. Special mandatory reporting requirements may vary from state to state:
1. Child abuse, abuse of an older person, abuse of other “at-risk” adults
2. Injury during commission of a felony
3. Drug-related injuries
4. Childbirth
5. Attempted suicides
6. Dog bites
7. Certain communicable diseases
8. Assaults
9. Domestic violence
10. Sexual assault or rape
11. Exposures to infectious disease
12. Transport of patients in restraints
13. Scene of a crime
14. The deceased
The axial skeleton
skull, spinal column, thorax
the skull
Consists of 28 bones divided into three groups: the cranium, the facial bones, and three small bones in the ear
i. Cranium
(a) Protects the brain and consists of 4 bones:
(1) Occiput (posterior portion)
(2) Temporal bones (lateral portions)
(3) Parietal bone (located between the temporal bones and occiput)
(4) Frontal bone (forehead)
ii. Facial bones consist of 14 bones
(a) Upper, nonmovable jawbones (maxillae)
(b) Cheekbones (zygomas)
(c) Lower, movable portion of jaw (mandible)
(d) Orbits (eye sockets) include zygomas, maxillae, and frontal bones of cranium
(e) Very short bones that form the bridge of the nose
Spinal column
Composed of 33 vertebrae divided into 5 sections. The vertebrae in each section are numbered from top to bottom.
i. The cervical spine (neck) has 7 vertebrae.
ii. The thoracic spine (upper back) has one pair of ribs attached to each of the 12 vertebrae.
iii. The lumbar spine (lower back) has 5 vertebrae.
iv. The sacrum (back wall of pelvis) consists of 5 fused vertebrae that join the pelvis.
v. The coccyx (tailbone) consists of 4 fused vertebrae.
b. Vertebrae are connected by ligaments and are protected by intervertebral disks.
Thorax
a. The thoracic cavity contains the heart, lungs, esophagus, and great vessels.
b. Formed by 12 thoracic vertebrae and 12 pairs of ribs
c. Midline of chest is the sternum which is made up of the manubrium, body, and xiphoid process
Appendicular skeleton
Upper extremities(Extend from the pectoral girdle to fingertips, Arm),Pelvis, Lower extremities(the femur, lower leg), Ankle and foot
Functions of the skeletal system
- Gives the body its shape
- Protects fragile organs
- Allows for movement
- Stores calcium
- Helps create blood cells
The musculoskeletal system provides:
- Form
- Upright posture
- Movement
- Protection for vital internal organs
Skeletal muscle attaches to the bones of the skeleton and forms the major muscle mass of the body.
a. Known as
voluntary muscle, because it is under direct voluntary control of the brain
Smooth muscle and cardiac muscle movement do not require conscious thought (involuntary).
a. Smooth muscle is found
b. Cardiac muscle is found
a. Smooth muscle is found within blood vessels and intestines.
b. Cardiac muscle is found only within the heart.
Skeletal muscle
1. Often functions in
antagonistic pairs (eg, biceps and triceps)
Upper airway
- Nose
- Mouth (oral cavity)
- Tongue
- Jaw (mandible)
- Larynx
a. Dividing line between the upper and lower airways - Pharynx
a. Nasopharynx
b. Oropharynx (throat)
c. Laryngopharynx - Trachea (windpipe)
a. Located at the bottom of the pharynx - Epiglottis
a. Thin, leaf-shaped flap that prevents food and liquid from entering the trachea
Lower airway
- Thyroid cartilage (Adam’s apple): forms the anterior part of the larynx
- Cricoid cartilage: lies immediately below the thyroid cartilage
- Cricothyroid membrane: lies between the thyroid and cricoid cartilage
- Trachea: lies below the cricoid cartilage
a. The trachea ends at the carina.
b. It divides into the right and left main stem bronchi, which enter the lungs and branch into smaller airways.
Lungs
- Each lung is divided into lobes.
- Within the lobes are the bronchi and bronchioles, which end in alveoli.
a. Alveoli allow for gas exchange (oxygen and carbon dioxide).
Mechanics of breathing
- Pleura
a. Visceral pleura covers the lungs.
b. Parietal pleura lines the chest wall.
c. A thin layer of fluid between them facilitates movement of the lungs.
d. The pleural space is a potential space between the two pleura. - Muscles of breathing
a. The diaphragm is the primary muscle of breathing.
i. Contains voluntary and involuntary muscle
b. Cervical muscles
c. Intercostal muscles
d. Abdominal muscles
e. Pectoral muscles - Inhalation
a. Diaphragm and intercostal muscles contract enlarging the thoracic cage.
b. Pressure within the thoracic cavity decreases and the lungs fill (negative-pressure ventilation).
c. Active part of the respiratory cycle - Exhalation
a. Diaphragm and intercostal muscles relax.
b. Thoracic cavity returns to its normal shape and volume.
c. Passive portion of the respiratory cycle
VIII. The Respiratory System: Physiology
A. The respiratory system’s function is to provide the body with oxygen and eliminate carbon dioxide.
B. Ventilation and respiration are two separate, yet interdependent functions of the respiratory system. - Ventilation: the movement of air between the lungs and the environment
- Respiration: the exchange of oxygen and carbon dioxide in the alveoli and in tissues of the body
C. Respiration - Oxygen and carbon dioxide move across the membrane between the capillaries and alveoli via diffusion.
a. Diffusion is a passive process in which molecules move from an area with a higher concentration of molecule to an area of lower concentration.
D. The chemical control of breathing - The brainstem controls breathing by monitoring levels of carbon dioxide in the blood and spinal fluid.
- Breathing is automatically controlled if the level of carbon dioxide or oxygen in the arterial blood is too high or too low.
- Breathing occurs as the result of a buildup of carbon dioxide in the cerebrospinal fluid which causes the pH to decrease.
a. The medulla oblongata stimulates the phrenic nerve causing the diaphragm to contract.
b. The primary reason for breathing is to lower carbon dioxide levels not to increase oxygen levels. - Hypoxic drive “backup” system to control respiration.
a. The stimulus to breathe comes from low oxygen levels.
The nervous system control of breathing
- Medulla oblongata
a. Responsible for initiating the ventilation cycle
b. Primarily stimulated by high carbon dioxide levels
c. Helps control the rhythm of breathing, initiate inspiration, set the base pattern for respiration, and send the signal to the diaphragm via the phrenic nerve - Pons
a. Has two areas which help augment respirations during emotional or physical stress
b. Helps change the depth of inspiration, expiration, or both
Tidal volume
a. Amount of air that is moved into or out of the lung in a single breath
b. Generally 500 mL in an adult
Inspiratory reserve volume is the
deepest breath you can take after a normal breath.
Expiratory reserve volume is the
maximum amount of air you can forcibly breathe out after a normal breath.
Residual volume is the
gas remaining in the lungs after exhalation
Dead space is the
portion of the respiratory system that has no alveoli and little to no gas exchange.
Minute ventilation
a. Used to assess the adequacy of ventilation
b. Amount of air that moves in and out of the lungs in one minute
c. Minute volume = respiratory rate × tidal volume
Normal heartbeat
a. Normal pulse rate for an adult: 60–100 beats/min
b. Stroke volume (SV): the amount of blood moved by one beat
c. Cardiac output (CO): the amount of blood moved in 1 minute
i. CO = HR × SV
Electrical conduction system
a. A network of specialized tissue that is capable of initiating and conducting electrical current runs throughout the heart
b. Electrical impulses begin high in the atria at the sinoatrial (SA) node, travel to the atrioventricular (AV) node and bundle of His, and then move through the Purkinje fibers to the ventricles.
c. This movement produces a smooth flow of electricity, producing a coordinated pumping action.
d. If injured, the heart will not beat properly.
Arteries
- Carry blood from the heart to all body tissues
- Aorta
a. Main artery leaving the left side of the heart and carrying freshly oxygenated blood to the body
b. Has many branches that supply the vital organs - The pulmonary artery originates at the right ventricle and carries oxygen-poor blood to the lungs.
- Arteries branch first into smaller arteries and then into arterioles.
a. Arterioles branch into increasingly smaller vessels until they connect to the capillaries. - Pulse is created by the forceful pumping of blood out of the left ventricle and into the major arteries.
a. Palpated most easily at the neck, wrist, or groin
Capillaries
- Tiny blood vessels that connect arterioles to venules(veins)
- Oxygen and nutrients pass from blood cells and plasma in the capillaries to individual tissue cells through the very thin walls of the capillaries.
- Capillaries allow blood to move through them one cell at a time.
Veins
- Return oxygen-depleted blood to the heart
- Have thinner walls than arteries and are generally larger in diameter
- Major veins
a. The superior vena cava carries blood returning from the head, neck, shoulders, and upper extremities.
b. The inferior vena cava carries blood from the abdomen, pelvis, and lower extremities. - Systemic vascular resistance (SVR)
a. The resistance to blood flow within all blood vessels except the pulmonary vessels.
Spleen
- Solid organ located under the rib cage in the left upper part of the abdomen
- Filters worn-out blood cells, foreign substances, and bacteria from the blood
- Highly vascular and particularly susceptible to injury from blunt trauma
Blood composition
- Plasma (the liquid portion of blood) contains:
a. Water (primary component)
b. Proteins (primary component)
c. Oxygen, carbon dioxide, nitrogen
d. Nutrients
e. Cellular wastes - Red blood cells (erythrocytes)
a. Contain hemoglobin, which carries oxygen - White blood cells (leukocytes)
a. Play a role in the body’s immune defense to fight infection - Platelets
a. Essential in the initial formation of a blood clot
Systole:
When the left ventricle of heart contracts, it pumps blood from the ventricle into the aorta.
Diastole:
When the muscle of the ventricle relaxes, the ventricle fills with blood.
Blood pressure:
pressure that blood exerts against the walls of arteries
When beta-1 receptors are stimulated, the
heart rate and force of contraction increase.
When beta-2 receptors are stimulated, the
bronchi in the lungs dilate.
Parasympathetic nervous system
a. Causes the
heart rate to slow and beat more weakly
The nervous system Divided into two main portions
a. Central nervous system (brain and spinal cord)
b. Peripheral nervous system (the nerves outside of the brain and spinal cord)
i. Somatic nervous system regulates voluntary activities.
ii. Autonomic nervous system controls functions that occur automatically.
Peripheral nervous system
a. Divided into two parts:
i. Somatic nervous system (voluntary)
(a) Transmits signals from the brain to voluntary muscles
(b) Allows for activities such as walking, talking, and writing
ii. Autonomic nervous system (involuntary)
(a) Sympathetic nervous system
(b) Parasympathetic nervous system
b. Two types of nerves within peripheral nervous system
i. Sensory nerves carry information from the body to the CNS.
(a) Found in the eyes, ears, skin, muscles, joints, lungs, and other organs
ii. Motor nerves carry information from the CNS to the muscles.
Two layers of skin
- Epidermis (superficial)
a. Forms a protective watertight barrier
b. Composed of several layers of cells
i. Germinal layer: produces new cells
ii. Stratum corneal layer: surface layer of dead cells
iii. Skin cells are constantly being replaced. - Dermis (deeper)
a. Contains special structures of the skin
i. Sweat glands
ii. Sebaceous glands
iii. Hair follicles
iv. Blood vessels
v. Mucous membranes
Right upper (RUQ): contains the
liver, gallbladder, and a portion of the colon
Left upper (LUQ): contains the
stomach, spleen, and a portion of the colon
Right lower (RLQ): contains two portions of the
large intestine (cecum and ascending colon)
Left lower (LLQ): contains the
descending and sigmoid portions of the colon
The small intestine, pancreas, large intestine, and urinary bladder lie in more than
one quadrant.
The kidneys and pancreas lie behind the
abdominal cavity (retroperitoneal).
Superior and inferior
a. The superior part of any body part is the portion nearer to the head from a specific reference point. The part nearer to the feet is the inferior portion.
b. These terms are also used to describe the relationship of one structure to another.
All cells in the body require
oxygen, nutrients, and removal of waste.
Cells use oxygen to take available nutrients and turn them into chemical energy through
metabolism.
Adenosine triphosphate (ATP) is used in
energy metabolism and storage.
Aerobic metabolism uses
oxygen.
Movement of oxygen, waste, and nutrients occurs by
diffusion.
Pathophysiology is the
study of functional changes that occur when the body reacts to disease.
Respiratory compromise is the
inability to move gas effectively
Hypoxia:
decreased level of oxygen in the body
Hypercapnia:
elevated level of carbon dioxide in the body
Factors that impair ventilation:
a. Blocked airway
b. Impairment of the muscles of breathing
i. Neuromuscular disease
ii. Trauma
c. Physiologic obstruction of the airway (eg, asthma attack)
d. Drug overdose, trauma to the chest wall, allergic reaction
Factors that impair respiration:
a. Change in the atmosphere
b. High altitudes
c. Impaired movement of the gas across the cell membrane
Shock
- A condition in which organs and tissue receive an inadequate flow of blood and oxygen
- Impaired oxygen delivery causes cellular hypoxia, which leads to anaerobic metabolism, lactic acid production, and organ dysfunction.
- Shock is categorized into several types depending on the cause.
Agonist:
medication that causes stimulation of receptors
Antagonist:
medication that binds to a receptor and blocks other medications or chemicals from attaching there
Absorption:
the process by which medications travel through body tissues to the bloodstream
Subcutaneous (SC) injection
i. “Beneath the skin”
ii. Injection given into the fatty tissue between the skin and muscle
Sublingual (SL)
i. “Under the tongue”
ii. Enters through the oral mucosa under the tongue and is absorbed into the bloodstream within minutes
Transcutaneous (transdermal)
i. “Through the skin”
ii. Applied as a patch to the skin
iii. Longer-lasting effect than other routes
Intranasal (IN)
i. Relatively new format for the delivery of medication
ii. The medication is pushed through a device called a mucosal atomizer device (MAD) that aerosolizes the liquid for delivery into the nostril.
iii. Quick absorption
indication:
are the reasons for a medication to be given
contra-indication
when a medication would end up harming a patient or have no positive effect on the patients condition. (reason not to give medication)
required medication on ambulance
oxygen, oral glucose
optional medications carried on an ambulance
activated charcoal, aspirin, epinephrine, naloxone, albuterol
hypoglycemia
a condition that occurs when blood sugar levels drop too low
hyperglycemia
a condition in which the level of glucose in the blood is higher than normal. Sometimes called “high blood sugar,” it commonly affects people who have diabetes mellitus, but it can also develop in non-diabetics.
type 1 diabetes
is failure to produce insulin in sufficient quantity (doctor gives them insulin)
type 2 diabetes
is resistance and inefficiency in insulin use
what does insulin do
helps sugar enter cells
types of shock
Hypovolemic,Cardiogenic,Anaphylactic,Septic,Neurogenic,Obstructive,Endocrine
Hypovolemic shock
A loss of blood volume, which can be caused by dehydration, burns, or bleeding. heart rate goes up, peripheral arteries tighten
cardiogenic shock
A heart problem that prevents the heart from pumping blood effectively. This can be caused by a heart attack, heart disease, or valve disorders.
Anaphylactic shock
A severe allergic reaction that causes blood vessels to dilate and blood pressure to drop.
septic shock
A severe bacterial infection in the bloodstream that causes blood vessels to dilate and blood pressure to drop
Neurogenic shock
Damage to the nervous system, such as from a spinal cord injury, that causes blood vessels to dilate and blood pressure to drop
obstructive shock
A blockage in the heart, arteries, or veins that prevents blood from flowing properly. This can be caused by a blood clot in the lungs, air trapped in the chest cavity, or a buildup of fluid around the heart. tension pneumothorax, pericardial tamponade
Endocrine shock
A severe hormonal disorder, such as hypothyroidism, that prevents the heart from functioning properly. ow blood pressure
Rapid heartbeat
Shallow breathing
Anxiety
Fatigue
Dizziness, lightheadedness, or faintness
Blue or gray lips and fingernails
Confusion
Excessive sweating
Low or no urine
hypoxemia
low level of oxygen in arterial blood
bradycardia
slow heart rate
