Module 6- Medical Emergencies 1 Flashcards
- There are three etiologies of shock. Explain how each of them causes the patient to fall into hypoperfusion
a. Inadequate volume
b. Inadequate pump function
c. Inadequate vessel tone.
A. Inadequate volume:
Adequate volume is needed be able to Sys. Pressure & circulate O2 to blood tissues. “Tubing” not being full enough, does not allow for blood to perfuse through adequately & reach the tissues.
(Loss of Fluid = items that make up blood)
B. Inadequate pump function:
Heart acts as the “pump” to create enough force to pump the liquid. “Pump” failing creates shock state. (no Fluid loss just broken pump)
C. Inadequate vessel tone:
“Tone” refers to size of veins and arteries. The to must be adequate for proper pressure to be maintained. (loss of tone)
Define Shock:
is a life-threatening medical condition that results from insufficient blood flow throughout the body
What are the 5 main types of shock with subtypes (including 4 subtypes of distributive shock?
- Hypovolemic shock
- Hemorrhagic
- Non Hemorrhagic (Burn) - Cardiogenic shock
- Heart failure
- MI
- Beta/calcium blockers - Obstructive shock
- From PE (Pulmonary embolism)
- from Pericardial Tamponade
- Tension Pneumothorax - Distributive shock (4 subtypes)
(abnormal extensive vasodilation)
- Septic shock
- Neurogenic shock
- Anaphylactic shock
- Psychogenic shock
- Respiratory shock
- Inability for oxygen to diffuse into the blood
Explain the difference between hypovolemic shock and distributive shock.
Hypovolemic shock:
is where there is a significant loss of blood/fluid (more then 1/5)
distributive shock:
is due to excessive vasodilation and vessel permeability to occur which causes loss in vascular tone
What happens to the pt in anaphylaxis?
a. What can we do to combat this?
- In anaphylaxis, chemical mediators that are released in a reaction cause massive and systemic vasodilation.
- chemical mediators also cause capillaries to become permeable and leak
Treatment:
administering Epinephrine: which contains alpha properties that cause vasoconstriction
All types of shock except _____ shock does the skin get cold and clammy.
Distributive shock the skin gets warm
Define Sepsis, its key findings and treatment:
- Exaggerated inflammatory response to an infection (typ. fungal, viral, bacterial) which overwhelms body’s normal defense and regulatory system causing cellular and organ malfunction
- causes vessels to dilate and become permeable and leak
Key Findings:
- AMS
- sweating for no clear reason
- lightheadedness
- chills
- fever or hypothermia
- tachycardia
- warm skin or mottled skin
Treatment:
Managing airway, ventilation, & oxygenation
What can we do to combat hemorrhagic shock?
- Stop the bleeding
- Immediate transport
S/S of sepsis from respiratory infection and genitourinary tract infection:
Respiratory Infection:
- Productive cough
- Fever
- Chills
- Upper respiratory symptoms (runny or stuffy nose, sneezing)
- Throat or ear pain
- Crackles upon auscultation (may indicate pneumonia)
Genitourinary Tract Infection:
- Abdominal pain or flank tenderness
- Nausea and vomiting
- Diarrhea
- Dysuria
- Polyuria
What is the difference between compensated shock and decompensated shock?
Compensated shock is where the body is actively trying to fight against the shock and maintain BP by releasing hormones
decompensated shock is where the body is no longer able to fight against the shock and hypoperfusion
What happens to the pt as they move from decompensated shock to irreversible shock?
- Vital organs fail due to inadequate blood flow
(Cells, tissues, organs, brain become ischemic)
- Blood becomes acidic and sludge like
- Leads to rapid deterioration with severe hypotension
- AMS
- Decrease in heart rate/function
- Ultimately multiple organ failure and death
(MOF-Multiple organ failure)
What are the general signs of shock?
- Change in mental state
Agitation, confusion, unresponsiveness - Tachypnea
Rapid breathing ( >25 breaths/minute) - Tachycardia
Rapid heart rate ( >100 BPM) - Hypotension
Low Blood pressure ( <90/60 mmHg) - Skin Changes
Cool, clammy, pale - Oliguria
Low urine output
What are the signs of shock in pediatric patients?
a. Early signs?
b. Late signs?
A. Early signs of shock:
- Tachycardia
- Delayed capillary refill
- Poor skin color
- Normal BP
B. Late signs of shock:
- Tachypnea
- Agitation
- AMS
- Cool/clammy skin
- Low BP
With shock management, how do you secure and maintain a patients airway?
- Head tilt-chin method ( If No spinal injury)
- Jaw Thrust maneuver
- Airway Adjunct: OPA or NPA
For shock management, what tools can be used to establish and maintain adequate ventilation?
- NRM @ 15 lpm
- keep PT warm
For shock management, What are your options here to increase the pt’s oxygen?
NRM @ 15 lpm
Why is hyperventilation in shock pt’s a bad idea?
- It makes the blood alkalotic due to excessive expulsion of CO2
- Which causes oxygen to stick to hemoglobin and reduces its release to tissues
- Worsens the symptoms of shock
Shock Management: why should we be aggressive with bleeding control?
To prevent further loss of fluid and PT from going into irreversible shock
Shock management, Do you splint fractures in the primary assessment or the secondary?
- Primary assessment if they are causing significant bleeding
- Otherwise in the secondary assessment, once in transport
Why do you NOT remove impaled objects?
- can cause severe bleeding by releasing the pressure on a damaged blood vessel that the object is currently compressing
- Can cause further damage & complications
When would you remove an impaled object?
If it impeded the airway
How does hypothermia impact your pt in shock?
- Further impairs the circulatory system by worsening blood loss due to impaired clotting
During shock management we keep the patient in a supine position
Why supine?
it allows for optimal blood flow to the vital organs, particularly the heart, by maximizing the return of blood to the circulatory system
During shock management, Why don’t we use the invert the pt anymore?
Ineffective at improving symptoms of shock and can make some shock symptoms worse
At what point in the assessment would you like to call for ALS back up?
In scene size up or in primary assessment
How do you decide whether to wait on the scene for ALS back up or to transport and intercept with them?
- the patient’s criticality
- the estimated time for ALS arrival
- the distance to a suitable intercept location
- your ability to manage the patient’s condition during transport
Your pt has no pulse and the AED advises a shock, what rhythm are they probably in?
V-Tach and V-Fib
What are the 4 types of cardiac rythms?
- Ventricular fibrillation (V-Fib):
- Makes up 1/2 of cardiac arrest
- disorganized cardiac rhythm that produces no pulse or cardiac output
- Ventricular Tachycardia (V-Tach):
- Very fast heart rhythm generated in the ventricle instead of SA Node
- Asystole:
- absence of electrical activity and pumping in the heart
- Pulseless electrical activity (PEA):
Heart has organized rhythm but either is too weak to pump or doesnt respond to electrical activity
What are some reasons/situations that using the AED is contraindicated?
- In trauma PT’s
- PTs with a pulse
When should the AED be applied and not applied ?
To PT’s who are:
- Pulseless
- Not breathing (Apneic) or agonal respirations
- unresponsive
Not suited for PT’s who:
Have a Pulse
Define:
Respiratory distress
Respiratory failure
Respiratory arrest
- Respiratory Distress:
PT who is having difficulty breathing but has adequate tidal volume & rate
- Respiratory failure:
PT with difficulty breathing w/ Inadequate tidal volume and rate
- Respiratory Arrest:
Complete cessation of breathing or PT experiences agonal breathing (abnormal breathing pattern)
For SVN (Small volume nebulizer), how does the EMT hook up the medicine
- Ensure the 5 R’s.
- Pour in the medication in the device
- reassemble the device and hook up to the Ox-ygen tank
- Set liter flow to 8-10 lpm
(check for mist to be coming out) - Apply mask to PT
or if mouthpiece is being used
- Have PT put lips around device and instruct every (2-3) breaths to cough during exhalation to help removal of mucus
Beta 2 agonist inhalers mimic the______ except for _______ which is a _________.
sympathetic nervous system except Ipratropium which is a anticholinergic bronchodilator
For cardiac arrest in Peds PT’s (newborns - Puberty), what are the interventions when the HR >60 bpm ?
- If HR is >60 bpm, immediately began PPV with (1 ventilation every 2-3 seconds)
- If HR is >60 bpm after ventilation and oxygenation, conduct CPR
What are the signs and symptoms of cardiac arrest?
- Unresponsive
- No breathing
- No pulse
- No signs of life
When using the BVM on infants and adults, what is the ratio of ventilation?
Infants:
1 ventilation every 2-3 seconds
Adults:
1 ventilation every 5-6 seconds
What is the difference between Arteriosclerosis and Atherosclerosis?
Arteriosclerosis is a disease that cause the arteries walls to thicken.
where atherosclerosis is a type of arteriosclerosis that is due to plaque build up in the arteries.
What is the job of the Coronary arteries?
To provide the main blood supply to the heart
What happens when blood flow to the heart is restricted?
the heart has to work harder to pump blood and can lead to a number of conditions, including:
- Angina
- MI
- shortness of breath
- fatigue
What happens when the heart is starved for oxygen?
the heart muscle cells begin to suffer damage and die, leading to a condition called myocardial infarction (heart attack)
What two treatments do we have for myocardial infarction?
a. What does each do?
- Percutaneous Coronary Intervention (PCI):
is a general term describing procedures used to open an obstructed artery w/o invasive surgery
- Fibrinolytic therapy:
Medications used to dissolve clots in the body
Explain the difference between an aortic aneurysm and aortic dissection.
An aortic aneurysm is a bulge in the aorta’s wall, while an aortic dissection is a tear in the inner lining of the aorta
What would you expect to find during your assessment that would lead you to believe your pt is having a AAA (abdominal aortic aneurysm)?
- pain located in the abdomen, back and groin
- Late stage: pulsating mass in the abdomen
Define AAA (Aortic Abdominal Aneurysm) And Aortic Dissection:
AAA:
Dilation or ballooning outward of a weakening section of the aortic wall
Aortic Dissection:
a tear in the inner lining of the aorta
How might a PT describe Pain in Aortic dissection?
“sharp” pain, or sometimes as a “tearing” or “ripping” pain, often felt in the back, flank, or arm
What can you do as an EMT for a AAA (abdominal aortic aneurysm)
administer oxygen and transport the patient immediately
What are classical and non-classical findings in women with ACS?
Classical findings:
- Dull substernal chest pain or discomfort
- Respiratory distress
- Nausea, vomiting
- Diaphoresis
Non-Classical findings:
- Neck ache
- Pressure in the chest
- Pains in the back, breast, arms or upper abdomen
- Tingling of the fingers
- Unexplained fatigue or weight gain (water weight gain)
- Epigastric pain
- Insomnia
Define Angina Pectoris and when does it occur?
- Angina Pectoris: Chest pain
- Often occurs during periods of stress (physical or emotional) that typically goes away when stress is removed or PT rest
Compare and contrast MI (heart attack) with Angina Pectoris:
Same:
- Location of pain, radiation of discomfort and feeling of pain
Different:
- AP pain last 2-15 minutes and MI pain last longer then 10 minutes
- MI symptoms also include pale, grey color, weakness, dizziness, nausea, lightheadedness
- AP usually follows Extremes in weather, exertion, stress, meals
- With AP pain subsides with removal of stress or exertion and Nitroglycerin
- With MI Nitroglycerin May give little to no help
What are the S/S of AMI (acute myocardial infarction)?
- Chest discomfort radiating to jaw, arms, shoulders, or back
- Anxiety
- Dyspnea
- Sense of impending doom
- Diaphoresis (excessive sweating)
- Nausea and vomiting
- Light-headedness or dizziness
- Weakness
When treating Angina Pectoris when should prompt and immediate transport become neccessary?
After three doses of nitroglycerin
Angina Pectoris in women, PT with diabetes or elderly might show what symptoms instead of chest pain?
Abdominal pain
Back pain
Severe indigestion
AMS/unexplained weakness
shortness of breath
nausea
fainting
weakness
light-headedness
Explain the difference between the two types of strokes.
Ischemic stoke
Hemorrhagic stroke
Ischemic stroke is a stroke caused from a blockage
Hemorrhagic stroke is cause from by a rupture and bleeding
What is the emergency medical care steps for AMS?
- Consider SMR
- Ensure patent airway
- Suction any secretions, vomit or blood
- Maintain adequate oxygenation
- Be prepared to assist ventilation
- Position patient
- Transport
What are the two types of aphasia’s?
- Broca’s aphasia (expressive aphasia):
Where PT knows what to say they just have trouble saying it
- Wernicke’s aphasia (Receptive aphasia)
Where PT doesn’t understand what your telling or asking and has random speech)
For AMI, when PT oxygen is >90% what type and level of oxygen be applied?
- Nasal cannula @ 2-6 ppm
- NRM @ 10-15 lpm if 90% oxygen cant be achieved with nasal cannula
S/S of the pediatrics with AMS:
Appearance:
- Abnormal
- Decreased muscle tone
- Decreased interest in the environment
- Gaze
- Lethargy
- Unresponsive
- Weak cry
Explain the difference between a stroke and a TIA.
In a TIA , unlike a stroke, the blockage is brief and there is no permanent damage
Your patient has experienced a TIA but their symptoms have resolved why should you discourage them from refusing care.
because TIA’s are often a precursor to a stroke
For recognizing stroke in, what does the acronym F.A.S.T stand for ?
F : Facial droop
A: Arm weakness
S: Speech difficulty
T: Time to call
What are the S/S of a stroke ?
- Sudden onset of numbness or weakness of face, arm, leg
- Sudden onset of confusion
- Sudden slurring of speech or trouble speaking
- Sudden onset of blurred vision
- Sudden onset of dizziness or lack of balance
- Sudden onset of a severe headache with no other cause
- Numbness or tingling in the hand
- Sudden visual changes
How do you perform a CPSS stroke scale ?
- Check for facial droop by having PT show his teeth or smile
- Check for arm drift by having PT close his eyes and hold his hands out in front of him for 10 seconds
- Check for abnormal speech pattern by having PT say “You cant teach a old dog new tricks”
How do you perform the F.A.S.T VAN stroke assessment?
- Check for facial droop by having PT smile
- Check for arm drift by having PT close his eyes and hold both arms out for 10 seconds
- Check for abnormal speech by having PT say “You cant teach a old dog new tricks.”
(If 1-3 are negative test is over, if positive continue on for LVO test)
V- Visual disturbance
- Does the PT have double vision or loss of vision or seeing your finger in their field of vision
(If yes, PT is likely having LVO, if no continue to A)
A - Aphasia
- Does the PT have difficulty forming words or can they repeat a sentence
- Can they follow commands?
(If abnormalities present, PT is VAN positive)
N - Neglect
- Does PT present with abnormal eye glaze
- Can they track your pen from side to side
- Can PT feel sensation in the arm, leg, or both with eyes closed
(If no, PT is VAN positive)
Define LVO stroke:
Large vein occlusion stroke
Should you give aspirin for a suspected stroke?
No because not all strokes are caused by clots.
Some strokes are caused by a rupture and taking aspirin can cause the bleeding to become worse
What are fibrinolytics?
a class of drugs that dissolve blood clots in stroke PT’s
Why should you be concerned if someone tells you they are having “the worst headache of their life?”
It could be a sign they are going through a stroke
Does every seizure result in convulsions?
No not every seizure results in convulsions
explain the difference between a generalized seizure and a partial seizure.
A generalized seizure affects both sides of the brain simultaneously, causing widespread symptoms like loss of consciousness and muscle jerking
while a partial seizure (focal seizure) only affects one specific area of the brain, potentially leading to localized symptoms like unusual sensations or muscle twitching in a single body part, with varying levels of awareness depending on the affected brain region
Why should you be concerned about a patient suffering from status epilepticus?
Because it can lead to permanent brain cell injury
Define status epilepticus:
- continuous seizure activity lasting longer then 5 minutes
- Two or more sequential seizures without full recovery of consciousness between seizures
What is the postictal state for a seizure?
Follows the seizure and is the recovery period for PT
Is Epilepsy the only cause of seizures?
No, other injuries and medical conditions can cause seizures that last longer than epilepsy seizures
is it physically possible for your patient to swallow their tongue?
No
What are febrile seizures and what age group is particularly at risk for them?
Febrile seizures are tonic-clonic seizures due to high fever that are most common in children
What type of seizure that is classified as a convulsive seizure?
Grand Mal seizure (generalized tonic-clonic seizure)
Does the disease diabetes have to do with blood sugar levels that are too high for blood sugar levels that are too low?
The disease itself if about the body having too high blood sugar levels in the body and the need for insulin or management to help maintain
However, blood sugar levels can drop too low (hypoglycemic) in regards to medication and taking too much or not eating with medication
List and explain the two main types of diabetes mellitus ?
- Type 1:
Where the PT must inject insulin to regulate blood sugar levels because their body usually does not make any insulin
- Type 2:
PT bodies do make insulin however they need diet, exercise and drugs to manage diabetes
List and explain the condition type 1 diabetes PT can suffer from ?
- Diabetic ketoacidosis:
Where the bodys BGL are abnormally high and there is very little to no insulin
List and explain the condition can PT’s with Type 2 diabetes suffer from?
Hyperglycemic hyperosmolar syndrome (HHS):
Where bodys glucose levels rise excessively causing extreme loss of fluid that can lead to dehydration and AMS
What kind of fuel source is the body’s primarily one ?
Carbohydrates but more specifically glucose
List the two hormones primarily responsible for controlling blood sugar levels in the body:
Insulin and glucagon
What makes the brain different from other organs when it comes to glucose?
Other Organs can use fats and proteins as fuel source but the brain can only use glucose
Without Glucose the brain cells will eventually die
When is insulin and glucagon secreted ?
Insulin for when blood glucose levels are too high to help decrease levels
Glucagon for when levels are too low and works to increased glucose levels
When is it appropriate to insert an OPA with a PT that is actively seizing?
If PT is actively seizing and is in “Status Epilepticus” with an open mouth.
(Dont pry open the mouth)
What is the normal blood glucose level range for a person?
70-140 mg/dl
what is BGL is considered hyperglycemia and hypo glycemia
- Hyperglycemia: >200 mg/dl
- Hypoglycemia: <70 mg/dl
Define Epilepsy?
Medical disorder characterized by recurrent seizures
When should you began PPV with Supplemental oxygen for a seizing PT?
- PT is severely cyanotic
- seizure has lasted longer then 5 minutes from time of onset
- breathing does not become adequate following seizure
When should transporting a PT that has seized become necessary?
- PT remains unresponsive following seizure
- ABC is inadequate following a seizure
- second seizure occurs without period of responsiveness “status epilepticus
- Grand Mal seizure last longer then 5 minutes
- PT is pregnant or history of diabetes
- Seizure occurred in water
- Evidence of head trauma leading to seizure
- No history of epilepsy or other seizure disorder
- Seizure is a result of drug or alcohol withdrawal or exposure to toxins
- Evidence of trauma such as extreme dislocation following seizure
What is the treatment for a Seizing PT?
- Prevent further injury to patient
- Move any items (furniture) or remove any objects out of their mouth (spoon, etc)
- Do not restrain PT, loosen ties, shirts, or other tight clothing
- Position the PT
Lateral recumbent position unless PT requires ventilation
- Maintain Patent airway
- If PT is seizing longer then 5 mins. or has sonorous breathing insert NPA
- If status epilepticus, began PPV with supp. oxygen and transport immediately
- Suction any secretions
- Assist ventilation if necessary
- Maintain adequate oxygenation
- Transport
- If seizure is normal for PT may not be req. to tranport
- Anything abnormal about seizure or “status epilepticus” must tranport
Are diabetic patients the only population that is susceptible to low blood sugar?
No, other conditions and medications can cause low blood sugar
How would a diabetic patient become hyperglycemic?
- PT has infection (UTI, pneunomia)
- PT took inadequate dose of insulin or non-compliance with meds
- PT takes medications such as Thiazide, Dilantin, or steroids
- Recent cocaine use in diabetic PT
- PT has suffered from some type of stress such as (pregnancy, surgery, trauma) or acute medical illness (heart attack or stroke)
- Change in diet where too much carbs or sugar has been eaten
How would a diabetic patient become hypoglycemic?
- PT takes insulin and does not eat a meal
- PT takes insulin, eats a meal but increases activity too much afterwards
- PT takes too much insulin
S/S of hypoglycemia?
Diaphoresis (sweating)
Tremors
Weakness
Hunger
Tachycardia (increased heart rate)
Dizziness
Pale, cool, clammy skin
Warm sensation
Confusion
Drowsiness
Disorientation
Unresponsiveness
Seizures (can occur in severe cases)
Stroke-like symptoms including hemiparesis (especially in the elderly)
Why do we check blood sugar on every patient that is in any way not at their neurologic Baseline?
no because blood sugar levels being too much or high (hypoglycemia and hyperglycemia) can cause AMS
What are the emergency care steps for hypoglycemia?
- Establish an open airway
- Administer oxygen :
> 94% use nasal cannula to reach level
If Nasal cannula cant reach level, switch to NRM
- Provide PPV
- Assess blood glucose level
- administer glucose
- Contact ALS
What does it mean to be a type 1 diabetic?
It means that you are required to take insulin because your body either have too little or none and your blood sugar levels are high
what age group are you typically diagnosed as a type 1 diabetic?
typically people under age 40 with peak ages of onset at (4-6 years) and (10-14 years)
S/S of Hyperglycemia?
Polyuria (excessive urination)
Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
Nausea and vomiting
Poor skin turgor
Tachycardia
Rapid deep respirations (called Kussmaul respirations)
Fruity or acetone odor on the breath
Positive orthostatic tilt test
Blood glucose level (BGL)
Muscle cramps
Abdominal pain (in of patients; more common in children with DKA)
Warm, dry, flushed skin
Altered mental status
Coma (very late)
what does it mean to be a type 2 diabetic?
Where PT body makes insulin however insulin is not completely effective in controlling the blood glucose levels
What age group gets diagnosed with type 2?
- usually middle age or older
- Typically overweight
- more common in white people then non-white people
What can you do as an EMT to treat a patient with hyperglycemia?
- ABCs
- IV access
- immediate transport
The tricuspid valve prevents blood from:
Flowing from the right ventricle into the right atrium
acute coronary syndrome
The assessment mnemonic developed to help the public and EMS recognize a stroke, aligning with the AHA’s Stroke Chain of Survival?
“FAST”
Face
Arm
Speech
Time
When assessing a patient with a suspected stroke, the order of the exam would be:
Secondary assessment, primary assessment, stroke exam, and then SAMPLE history
What is Aphasia?
is a language disorder caused by damage to parts of the brain that control speech and understanding of language
What are the 5 categories of shock?
- Hypovolemic
- cardiogenic
- distributive
- obstructive
- Metabolic/ respiratory
Explain cardiogenic shock:
Shock that is caused by a cardiac problem.
“pump” is broken
Explain Distributive shock:
shock that is caused by excessive vasodilation or excessive permeability
What are 3 examples of distributive shock and what are they ?
- Septic shock:
Excessive vasodilation caused by body’s aggressive response to disease or pathogen itself.
- Anaphylactic shock:
Vasodilation and increased vessel permeability due to exaggerated body response due to allergen
- Neurogenic shock:
vasodilation due to impaired sympathetic nervous system function such as spinal cord injury.
Explain obstructive shock:
shock that occurs when blood is physically blocked from flowing to vital parts of the body.
What are some examples of obstructive shock?
- Tension pneumothorax
- Pulmonary embolism
- Paracardial tamponade
Explain metabolic/Respiratory shock:
shock that is hypoperfusion caused by inability for oxygen to reach the cells and be used for normal metabolism.
Something other then oxygen is attaching to hemoglobin (carbon monoxide, cyanide)
What are some examples of metabolic/respiratory shock:
Cyanide and carbon monoxide poisoning
Explain Hypovolemic shock:
Shock that is caused when there is a massive decrease in intravascular volume (1/5 or more)
Identify and explain the two types of hypovolemic shock:
- hemorrhage:
Shock due to loss of whole blood b/c of something bleeding (traumatic injury and internal bleeding) - non-Hemorrhage:
shock due to loss of body fluid, not whole blood
what are some examples of cardiogenic shock?
- Myocardial infarction (Heart attack)
- Congestive heart failure (CHF)
Shock is classified into what 3 stages ?
Compensated, decompensated and irreversible shock
What is compensated shoch and its S/S?
Compensated shock is where for a short time the body tries to compensate and maintain body’s BP
S/S:
- Restless, Anxiety, and agitation
- Nausea and vomiting
- Thirst
- Delayed capillary refill
- Narrow pulse pressure
- Pale, cool, clammy skin
What is decompensated shock and its S/S?
Full on shock, where the body can no longer compensate for the hypoperfusion
S/S:
- AMS
- Tachycardia
- Tachypnea
- Labored/irregular breathing
- Weak or absent peripheral pulse
- Decrease in body temp.
- Cyanosis
What is Irreversible shock and its S/S?
Terminal stage of shock and point of no return for PT
For shock management what S/S show show and dont shock for elderly patients?
S/S for shock:
- MOI/NOI
- Vital sign trends
- Altered mental status
- Tachypnea
S/S not shown:
- Tachycardia
- Diaphoresis
- Low BP
What are the treatment goals in shock?
- to identify PT state and type of shock
- to identify the underlying cause of shock
- to treat the shock
What are the 3 major pulmonary diseases?
- Asthma
- Emphysema
- Bronchitis
Name of condition: Chronic Bronchitis
b. Cause of condition
c. Common findings
d. Treatments
b. Cause of condition:
c. Common findings:
- Chronic Cyanosis
- Increased mucus production
- Plugs alveoli and prevents ventilation
- Fluid retention
d. Treatments
Name of condition: Emphysema
b. Cause of condition
c. Common findings
d. Treatments
b. Cause of condition:
Emphysema damages the alveoli and capillary beds.
c. Common findings:
- older patients
- Primarily smokers
- Destroy alveoli and pulmonary capillaries
- Flushed and diaphoretic
d. Treatments
What is Dyspnea? Hypoxia?
Dyspnea: Shortness of breath
Hypoxia: condition that occurs when the body’s tissues don’t have enough oxygen
What is the primary treatment for all respiratory diseases?
- Oxygen therapy
- PPV
- Assisting with bronchodilator meds
- High priority transport
Name of condition: Asthma
b. Cause of condition
c. Common findings
d. Treatments
b. Cause of condition
c. Common findings:
- Younger Patients
- Rapid onset
- Acute narrowing of bronchi causes obstruction
- normal between exacerbations
d. Treatments
Name of condition: Pneumonia
b. Cause of condition
c. Common findings
d. Treatments
b. Cause of condition
c. Common findings:
- Fever and chills
- Blood tinged sputum
- Occlusion of alveoli with fluid or pus
- Sharp pain or cough
d. Treatments
Name of condition: Pulmonary embolism (PE’s)
b. Cause of condition
c. Common findings
d. Treatments
b. Cause of condition
c. Common findings:
- Sudden onset dyspnea
- SpO2 does not improve with high flow oxygen
- Recent history of trauma or surgery
- No blood flow to pulmonary capillaries
d. Treatments
What are the 5 major structures of the heart and what do they do?
- Sinoatrial node (SA Node): Stimulates atrial contraction
- Atrioventricular node (AV Node): Delays impulse
- Bundle of His : segment arising from the AV node
- Right/Left Bundle branches: Branch to the right and left ventricles
- Purkinje fibers: stimulates the ventricles
What is Arteriosclerosis?
Disease of the arteries resulting in thickening of vessel walls
What is atherosclerosis?
A type of arteriosclerosis due to plaque formation in large and medium muscular arteries
what is the path of blood through the heart?
RA, Tricuspid, RV, Pulmonic valve, Pulmonary artery, Lungs, Pulmonary veins, LA, Bicuspid (Mitral) Valve, LV, Aortic valve, Aorta
Left heart failure causes ____________ edema.
Right heart failure causes ____________ edema.
Left heart = pulmonary edema
Right heart = systemic edema
Define ventilation, respiration, and perfusion.
Ventilation:
The movement of air into the lungs
Respiration:
The movement of gases from one area of the body into the other
Perfusion:
The movement of blood through tissues
What is the treatment of Stable angina?
- Assure adequate ABC’s
- If possible remove stressor
- Administer oxygen if indicated by pulse ox
- IF protocols permit administer NTG and aspirin
What is the treatment Myocardial infarction?
What are the typical and atypical sign and symptoms of MI (Heart attack) ?
Typical presentation (PT’s under 70)
- Anginal chest discomfort radiating to arm, jaw or neck
- Dull crushing anginal chest pain
- pale, cool, clammy, diaphoretic
- Dyspnea without exertion
- Most commonly seen in males over 45
- about 50% of MI have typical presentation
Atypical (PT’s over 70, females, and diabetics)
- Pain is not anginal in nature
- Pain may be sharp and not dull
- may be described as abdominal pain, back pain, GI upset, etc
What is a aneurysm?
An Abnormal dilation of any blood vessel walls or heart chamber
Name what would be assess for end organ function?
- Chest pain: may indicate MI
- Back pain: aortic dissention
- dyspnea: Congestive heart failure
- Neurological function: stroke , seizure or hypertensive encephalopathy
- Visual field: may indicate retinopathy or stroke
- epistaxis (nosebleed): Patients with non-traumatic epistaxis have a higher incidence of hypertension
- Jugular vain dissention: To identify possible congestive heart failure
- Bilateral breath sounds: To identify pulmonary edema
- abdomen: palpate for pulsatile masses indicative of aortic aneurysm
- Vital signs: check BP in both arms
what are the S/S of Left heart failure (Pulmonary side) ?
- shortness of breath
- upright posture
- cyanosis
- pulmonary edema (crackles on auscultation of the lungs)
- Wheezing
- Altered level of consciousness
- Elevated BP
what are the S/S of Right heart failure ?
- Lower extremity edema
- Pitting edema
- Ascites: accumulation of fluid in the abdominal cavity
- Jugular vain dissention
- combination of both sides of heart failure will show both sides of symptoms
What is the Treatment of Myocardial infarction (MI)?
- Assure adequate ABC’s
- Assure adequate ventilation : PPV may be helpful
- administer oxygen if needed
- Nitroglycerin may be used
What are the current recommendations for oxygen therapy?
- give only to hypoxic patients
- Give only the necessary amount to correct hypoxia
- O2 is administered to Medical PT’s less than 94
% or 95% for trauma - Device and liter flow are selected based on getting stats above 94%
What would a EMT be looking for in a Patient assessment with a VAD?
- PT with a VAD will likely have no pulse and blood pressure will not be able to be taken
- IF PT is unresponsive or not breathing, auscultate over left chest to listen for “whirling or smooth humming sound” to check for VAD operation
- SpO2 will likely be inaccurate, relay on mental status and skin signs to determine perfusion
- Check tubing insertion site for infection
- CPR should only be initiated when pump has pump has failed and troubleshooting efforts have failed
OR if PT is unresponsive and has no detectable signs of life
Define stroke:
sudden disruption in blood flow to the brain that results in brain cell damage
Define Seizure:
is a sudden onset of random, continuing discharges of electrical activity in the brain,
which can lead to unusual manifestations from staring spells to gross muscle contraction
What is a VAD (Ventricular Assist Device)?
Medical device that assist the pump function of one or both ventricles , most commonly the left ventricle
What is pericardial tamponade?
serious condition that occurs when extra fluid or blood builds up in the space between the heart and the pericardium (the sac around the heart).
S/S of pericardial tamponade:
- sharp pain in the chest
- trouble breathing
- fainting/ dizziness
- heart palpitations
- ## fast pulse
When should you consider immediate transport for a cardiac call?
- PT who is having angina that last more then 20 minutes
- recent onset of angina that’s progressively worsening
- nocturnal angina
- angina unrelieved by 3 doses of nitro or rest
- chest discomfort that last greater then 5-10 minutes of rest
What is becks triad for casual tamponade?
- hypotension
- JVD
- heart muffled sounds
- In anaphylaxis, chemical mediators that are released in a reaction cause massive and systemic vasodilation.
- chemical mediators also cause capillaries to become permeable and leak
Treatment:
administering Epinephrine: which contains alpha properties that cause vasoconstriction
What’s the difference between CHF and heart attack (MI)?
A heart attack is a sudden blockage of blood flow to the heart, while congestive heart failure is a chronic condition where the heart pumps inefficiently
