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NREMT Part III Flashcards

1
Q

Signs

A

findings you can objectivly:
- See
- hear
- feel
- smell
- Exmpl: vomiting, deformity, wheezing

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2
Q

Symptoms

A

Subjective feelings the patient must tell you about
empl: Nausea, pain, dyspnea

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3
Q

OTC

A

Over The Counter Medications

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4
Q

when to reassess stable patient

A

Every 15 mins

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5
Q

When to reassess unstable patient

A

Every 5 mins

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6
Q

Six standard vital signs

A
  1. RR
  2. Pulse
  3. BP
  4. Pupils
  5. Skin temp
  6. Pulse ox
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7
Q

Tachypnea

and tachypnic rate for adult

A

Rapid breathing
Over 20 breaths a min

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8
Q

Bradypnea

And bradypnic rate for adult

A

Slow breathing
Under 12 breaths a min

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9
Q

Normal Respiratory Rhythm

A

Regular rhythm and adequate chest rise and fall

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10
Q

Shallow Respiratory Rhythm

A

Minimal chest rise and fall

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11
Q

Labored Respiratory Rhythm

A

Increased work of breathing

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12
Q

Irregular Respiratory Rhythm

A

Abnormal breathing pattern

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13
Q

Best place to hear lung sounds

A

pts back

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14
Q

Wheezing

A

High-pitched whistleing sound
- usually on expiration

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15
Q

Crackles/Rales

A

Wet, crackling sound
- usually on inspiration and expiration

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16
Q

Rhonchi

A

Low-pitched congested sounds
- usually due to mucus
- usually on expiration

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17
Q

Three fields to auscultate lungs

A
  1. Upper lungs (apices): below clavicals @ midclavicular line
  2. Middle lung field: middle chest @ midclavicular posterior
  3. Lower lungs (base): lower portion of thorax @ miclavicular or midaxillary
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18
Q

At what Systolic BP is it unlikely you can palpate a pulse

A

60 mmHg

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19
Q

3 componants to documenting a pulse

A
  1. Rate
  2. Rhythm
  3. Quality
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20
Q

Quality of pulse descriptors

A
  1. strong
  2. weak
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21
Q

Rhythm of pulse descriptors

A
  1. regular
  2. irregular
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22
Q

What is BP measured in?

A

Millimeteres of mercury (mmHg)

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23
Q

what is pulse pressure

A

Difference between systolic and diastolic

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24
Q

‘normal’ pulse pressure

A

Difference that is >25% but <50% of systolic

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25
Wide pulse pressure | and indicates what
- Greater than 50% of systolic - indicates increased ICP
26
Narrow pulse pressure | and indicates what
- <25% - Indicates possible obstructive shock
27
Hypertension stages (BP Values)
Stage 1: 130/80 - 139/89 Stage 2: systolic > 140 OR diastolic >90 Hypertension crisis: Systolic >180 OR diastolic >120
28
Hypotension in child (1 - 10 Y.O)
Systolic below 70 + 2(age) Exmpl: 5 y.o. with systolic BP of 80
29
orthostatic hypotension considerations
- have pt stand for 1 min then repeat BP - do not assess if pt is already dizzy, weak, hypotensive while supine
30
orthostatic hypotension findings
- Drop is SBP >20 - Drop is DBP >10 - sharp rise in pt pulse rate
31
Mydriasis
Dialated pupils
32
Miosis
Constricted pupils
33
'Normal' pupil size
midsize: 2 - 5 mm in light
34
Anisocoria
pupils are different in size or shape
35
Body temp (Adult average & range)
Average: 98.6 F (37C) Range: 97 F (36.1C) - 99 F (37.2C)
36
What age group has a lower body temp
Elderly
37
Where to palpate for relative skin temp
upper back or neck (Not forehead)
38
What age group is cap refill a reliable sign of poor perfusion
Under 6 years
39
SaO2 and SpO2 difference
SaO2: O2 saturation of arterial blood SpO2: O2 saturation detected by pulse oximeter
40
Pulse Oximetry limitations
- not only tool for respiratory efficiency - cannot measure amount of hemoglobin (only saturation of hemoglobin that is present) - Inaccurate readings due too :hypovolemia, hypothermia, anemia, nail polish, carbon monoxide, tabacco use
41
NIBP
Non-invasive Blood Pressure monitoring
42
What scope is capnography/capnometry in?
AEMT or Paramedic
43
Capnography
End-tidal CO2 (ETCO2) - measurement of carbon dioxide in pts exhaled breath | Some systems allow EMT to assist set up ( LIKE COLORADO :) )
44
Capnography vs. Capnometry
Capnography: Co2 waveform and numerical value Capnometry: numerical value only
45
5 components of Patient Assessment for EMT
1. Scene Saftey 2. Primary assessment 3. Patient History 4. Secondary Assessment 5. Reassessment
46
Scene Size up componants
1. Scene saftey 2. BSI/PPE 3. MOI or NOI 4. # of patients 5. additional resources 6. consider spinal precautions
47
When should you carry a portable, compact, flashlight
all times
48
49
Primary Assessment
1. begins when you reach the pt 2. Identify and manage life threats
50
Primary Assessment componants
1. General impression 2. LOC 3. ABC or CAB (AVPU) 4. Rapid scan as needed 5. transport priority
51
ABC vs. CAB
- Airway, Breathing, Circulation - Circulation, Airway, Breathing
52
When do you use CAB instead of ABC
- unconscious pts - obvious life threatening bleeding
53
How long do you check for a pulse in an unresponsive pt?
5 - 10 seconds
54
What type of PPV do pts with inadequate breathing always get
BVM
55
Rapid scan
head-to-toe assessment used to identify remaining life threatening conditions not already managed
56
Rapid scan componants
- should not take longer than 90 seconds - utilize inspection, palpation, auscultation as needed - includes assessment of posterior - do NOT be distracted/focus on non-life threatening conditions
57
high transport priority pts (unstable pt)
- decreased LOC - signs of shock - serious medical condition - severe pain
58
stable pt
- no obvious life-threatening condition
59
Secondary assessment
- should not delay transport for high priority pt - identify remaining s/s, conditions, injuries - all potentially life-threatening conditions should have already been found or managed - can be a detailed head-to-toe assessment or focused exam
60
detailed head-to-toe indicated for
- unresponsive - multisytem trauma
61
Focused secondary survey
- focuses only on areas/systems considered relevant to pt complaint
62
Focused secondary survey indication
- alert pt - isolated complaint
63
Secondary assessment componants
- detailed or focused secondary survey - baseline vitals
64
Reassessment
used to continuously monitor pt condition for deterioration or improvement
65
Reassessment componants
- begin by reassessing primary assessment for changes - reassess pt CC - Reassess interventions you performed - continues until pt care is transferred or you discover something that requires attention
66
pt history componants
SAMPLE
67
what is the terminal (final) structure in the lower airway
Alveoli
68
What is spontaneous breathing driven by
Negative pressure
69
What is the active part of ventilation
Inhalation
70
What is the passive part of ventilation
Exhalation
71
Two primary methods brain uses to control O2 delivery
1. Rate of ventilation 2. Tidal volume
72
Hypoxic drive
- monitors O2 levels in plasma
73
Hypoxia
Inadequate delivery of O2 to the tissues of the body
74
S/S of mild (early) hypoxia
- resltess, anxiety, irritable - Dyspnea - Tachycardia, tachypnea - SpO2 90% - 94%
75
S/S of severe (late) hypoxia
- Altered or decreased LOC - Severe dyspnea - Cyanosis - Bradycardia (especially peds) - SpO2 below 90%
76
Oxygenation
Delivery of O2 to the blood - ventilation must be adequate for oxygenation to occur
77
NC, NRB, CPAP require what from pt
spontaneous ventilation
78
Respirations
Exchange of O2 and carbon dioxide
79
Assessment of breathing includes
- look - listen - feel
80
Adequate breathing componants
Adequate RR and tidal volume
81
Inadequate breathing componants
- Abnormal RR - shallow chest rise - accessory muscle - abnormal/diminished/absent lung sounds - paradoxical motion - dyspnea - Cyanosis - Low Spo2 - Agonal breaths - Apnea
82
Order of assessment and management of airway
1. open airway 2. suction 3. secure
83
Aspiration
Entry of matter into the lungs - can cause aspiration pneumonia - 1 in 5 pt with aspiration pneumonia will die
84
Suction units require
- disposable canister - generate vacuum of 300 mmHg when tubing clamped
85
Yankauer
Rigid suction catheter - known as "tonsil tip" - for oral airway
86
French catheter
Flexible - several sizes - for nose, stoma, inside advanced airway
87
Suctioning increases risk of
- hypoxia - delays time
88
Suction times
adult: 15 seconds Children: 10 seconds Infants: 5 seconds
89
How to measure french catheter
from corner of mouth to earlobe
90
how to measure OPA
Corner of mouth to earlobe
91
OPA contraindications
- Gag reflex - Responsive to pain
92
NPA contraindications
- pt awake and protecting own airway - severe head injury - severe facial trauma - do not force when you meet resistance
93
How to measure NPA
Tip of nose to earlobe
94
NPA insertion considerations
- water-soluble lubricant ONLY - insert with bevel toward septum - rotate as necessary - remove if pt begins to gag
95
What supraglottic airway is not currently part of NREMT | (yes its part of CO EMT scope)
i-gel
96
Indications for supplimental O2
- cardiac or respiratory arrest - BVM - dyspnea, cyanosis - signs of shock - Spo2 less than 95% - altered or decreased LOC
97
AHA guidelines for administering O2 with suspected acute coronary syndrome or stroke
NOT recieve O2 UNLESS: - SpO2 of 94 or less - complain of dyspnea - signs of shock - signs of heart failure
98
Oxygen cylinders look like?
- seamless - aluminum - green - various sizes
99
Amount of O2 in a tank is measured by
pounds per square inch (psi)
100
Full O2 tank is ____ psi
2,000 psi
101
When do you replace or refill O2 tank
200 psi (Known as the safe residual pressure)
102
Regulators
Flow meters - reduce pressure coming from tank - measured in liters per minute (L/min or lpm)
103
NRB
- typicall set to 10 lpm (as needed to keep reservoir filled) - pt recieves 90% O2
104
NRB cautions
- reservoir full before applying mask - never under less than 10 lpm - if reservoir deflates during inhale = increase flow rate - Remove mask if O2 source is lost
105
NC
Nasal Cannula - referred to as 'low-flow' O2 - flow rate 1 to 6 lpm - pt recieves 24% - 45% depending on lpm
106
Venturi mask
- deliver specific concentrations of low flow O2 - Not commonly used in EMS
107
HFNO
High Flow Nasal Oxygen - emergency therapy that delivers CPAP-like support - 40 - 70 lpm - not well tolerated
108
Hazards of O2 administration
- combustable - highly pressurized tanks - long term exposure to high concentration can cause retinal damage in infants
109
PPV
Positive pressure ventilations also called: assisted ventilation or artificial ventilation
110
PPV devices
- Pocket mask - BVM
111
PPV indications
- inadequate spontaneous breathing - RR <10 or >30 - Apnea - Agonal - respiratory distress/failure
112
PPV complications
- hyperventilation - gastric distention - aspiration - intrathoracid pressure = decrease coronary perfusion
113
Pocket mask O2 % deliver
16% (think: amount of O2 in rescuers exhale)
114
Sizes and volumes of BVM devices
Infant: 150 - 280 mL Child: 500 - 700 mL Adult: 1,000 - 1,600 mL
115
Best way to assess adequate ventilation for PPV
* Gently chest rise and fall
116
Rates for ventilation for apneic pts with a pulse
* Adults - 1 breath every 6 sec * Infants/children - 1 breath every 2-3 sec * Newborns - 40-60 per min
117
rates for ventilation in cardiac arrest | Fancy tip
* Adults - 1-2 rescuer 30 compressions 2 breaths * Children - 1 rescuer 30 compressions 2 breaths * Children - 2 rescuer 15 compressions 2 breaths * Newborns - 3 compressions 1 breath Fancy tip: No need to pause compressions for ventilation once an advanced airway has been placed
118
CPAP | Contraindications
* Hypotension * Can't protect their own airway * vomitting * Not breathing spontaneously * Can't follow commands * Upper GI bleeds
119
BiPAP | Define
* Bilevel Positive airway pressure * 1 level of pressure for the patients inhalation and 1 level of pressure for the exhilation
120
FROPVD
* Automatic and manual settings * Press button to initiate ventilation until chest rises * In a spontaneously breathing patient relief valve open automatically
121
Pediatric considerations | Airway and ventilation
* Bradycardia is hypoxia until proven otherwise * Hypoxia develops rapidly * Less oxygen reserves * Higher metabolic rates * Sniffing position for PPV
122
Signs for respiratory fialure in pediatric pts
* Bradycardia * Poor muscle tone * Decreased LOC * Headbobbing * Grunting on exhilation * Seesaw breathing
123
Tracheostomy
Surgical opening at the beginning of the trachea for artificial access to the airway
124
Trach tube/stoma considerations
* Stoma = infant or ped mask for BVM * Trach tube = remove mask connect bvm directly to trach tube * Have suction ready for both - Use a french catheter
125
FBAO | Whats it mean?
Foreign body airway obstruction | Good job! so smart
126
FBAO indications
* Inability to cough, speak, or breath * Clutching throat * Inability to ventilate pt despite repositioning airway
127
Managing FBAO
* Conscious = Abdominal thrusts unitl obstruction is releived or patient loses consciousness * Conscious infant = 5 back slaps, 5 chest thrusts until obstruction is releived or pt loses consciousness * Unconscious patient = Chest compressions, ventilations, inspect airway, remove if visible

EMT (42 decks)

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