Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

jlo_21 > Paramedic Crash Course > Flashcards

Paramedic Crash Course Flashcards

1
Q

Bioavailability

A

-the amount of a drug that enters central circulation and is able to cause an effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bolus

A

-administration of medication in a single dose(as opposed to an infusion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Concentration

A

-for calculation purposes, this is the total amount of medication available as packaged, e.g., total amount of a drug(mcg, mg, g) in the syringe, ampule, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dose

A

-the drug amount intended for administration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Enteral

A

-delivery of medication through the GI tract(oral, sublingual, rectal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Half-Life

A

-period of time requires for concentration of drug in the body to be reduced by one halfway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

LD50

A

-lethal dose(LD50) is the amount of an ingested substance(in mg/kg) that kills 50% of a test sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Parenteral

A

-delivery of medication outside the GI tract, e.g., IV, IO, IM, SQ, intranasal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharmacokinetics

A

-movement of a drug through the body, includes absorption, bioavailability, distribution, metabolism, and excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pharmacodynamics

A

-the mechanism of action of a medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Therapeutic Index

A

-the range between minimum effective dose of a medication and the maximum safe dose. The narrower the therapeutic index, the more risk associated with the medication.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Volume

A

-for calculation purposes, this is the total amount of fluid available as packaged, e.g., total amount of fluid(ml) in the syringe, ampule, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pure Food and Drug Act(1906)

A

-prevents the manufacture, sale, or transportation of misbranded or poisonous medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Harrison Narcotic Act(1914)

A

-regulates production, importation, and distribution of opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Federal Food, Drug, and Cosmetic Act(1938)

A

-gives the U.S. Food and Drug Administration authority to oversee the safety of food, drugs and cosmetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Controlled Substances Act(1970)

A

-categorizes controlled substances based on their potential for abuse and potential medical benefits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Schedule 1 Drugs

A

-high potential for abuse. No accepted medical use.

Examples: heroin, LSD, ecstasy, peyote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Schedule 2 Drugs

A

-narcotics and stimulants with high potential for abuse and severe dependence.

Examples: methadone, morphine, codeine, amphetamine, methamphetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Schedule 3 Drugs

A

-less potential for abuse, can still cause low physical or high psychological dependence.

Examples: Vicodin, acetaminophen with codeine, ketamine, anabolic steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Schedule 4 Drugs

A

-low potential for abuse

Examples: Xanax, soma, Valium, Ativan, versed, ambien

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Schedule 5 Drugs

A

-contains limited quantities of narcotics, such as cough syrups with codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The Six Rights of Drug Administration

A
  1. Right patient
  2. Right drug
  3. Right time
  4. Right route
  5. Right amount
  6. Right documentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Enteral

A
  • through the GI tract
    1. Oral
    2. Rectal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Parenteral

A
  • outside of the GI tract
    1. Subcutaneous
    2. Intramuscular
    3. Intravenous
    4. Intraosseous
    5. Sublingual
    6. Nasal
    7. Inhaled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Liter(measure of volume)

A
  1. 1 Liter = 1,000 milliliters (mL)

• 1 ml = 1 cubic centimeter (cc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Gram(measure of weight)

A
  1. 1,000 micrograms (mcg) = 1 milligram (mg)
  2. 1,000 mg = 1 gram
  3. 1,000 grams = 1 kilogram (kg)
  4. 1 kg = 2.2 pounds (lbs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Adrenergic

A

-related to the sympathetic nervous system (think “adrenaline”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Adverse Effect

A

-unintended effect of a medication administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Agonist

A

-medication that stimulates a specific response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Analgesic

A

-medication that reduces pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Antagonist

A

-medication that inhibits a specific action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bolus

A

-single dose of medication, given all at once

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Cholinergic

A

-related to the parasympathetic nervous system(think acetylcholine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Contraindication

A

-circumstances when a medication should not be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cumulative Effect

A

-repeated administration of a medication that produces effects that are more pronounced than the first dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Drug Class

A

-categorization of medication with similarities or uses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Extra Pyramidal

A

-tremors, slurred speech, restlessness, muscle twitching, anxiety side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Habituation

A

-diminishing of a physiological or emotional response to a frequently repeated stimulus, e.g., cigarettes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Hypersensitivity

A

-undesirable reactions produced by the normal immune system, including allergies and autoimmunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Hypertonic Solution

A

-solution that has a greater concentration of solutes on the outside of a cell when compared with the inside of a cell, causing fluid to move out of the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Hypotonic Solution

A

-solution that has a lesser concentration of solutes on the outside of a cell when compared with the inside of a cell, causing fluid to move out of the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Indication

A

-circumstances when a medication should be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Isotonic Solution

A

-sodium concentration same as intracellular fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Mechanism of Action

A

-pharmacological effects of a medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Potentiation

A

-interaction between two or more medications causing a response greater than the sum of each individual medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Refractory

A

-resistant to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Side Effects

A

-any unwanted effect of medication administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Therapeutic Action

A

-desirable effects of medication administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tolerance

A

-reduces response to a medication due to repeated use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Untoward Effect

A

-adverse or harmful side effects of medication administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Cellular Respiration

A

-cellular processes that convert energy from nutrients into adenosine triphosphate (ATP), and then release waste products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Exhalation

A

-the passive part of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

External Respiration

A

-oxygen exchange between the lungs and circulatory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Hypoxia

A

-oxygen deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Inhalation

A

-the active part of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Internal Respiration

A

-oxygen exchange between blood and cells of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Minute Ventilation

A

-volume of gas inhaled or exhaled per minute (respiratory rate x tidal volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Oxygenation

A

-delivery of oxygen to the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Ventilation

A

-the physical movement of moving air in and out of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Airway Structures

A
  1. Upper airway

2. Lower airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Upper Airway structures…(x4)

A
  • noise and mouth
  • nasopharynx and oropharynx
  • Epiglottis
  • Larynx(portion above the vocals chords)

*The oropharynx houses the tongue(primary cause of upper airway obstruction in unresponsive patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Lower Airway

A
  • larynx(portion below the vocal chords)
  • Trachea
  • left and right mainstem bronchi
  • bronchioles
  • alveoli

*alveoli are the “terminal” (end) structure in the lower airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Regulation of ventilation? x4

A
  1. Hypoxia
  2. CO2 drive
  3. Hypoxic drive
  4. Acid base disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Early signs and symptoms of hypoxia:

A 
Early:
-restless, anxious, irritable 
-tachycardia and tachypnea 
Late:
-decreased LOC
-severe dyspnea 
-cyanosis 
-bradycardia(especially in pediatric patients)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CO2 Drive

A
  • The primary system for monitoring breathing status.
  • Monitors CO2 levels in blood and cerebrospinal fluid.
  • Chemoreceptors in brainstem detect increased CO2 and rapidly trigger increased respiratory rate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Hypoxic Drive

A
  • Backup system to CO2 drive.
  • Monitors oxygen levels in plasma.
  • May be present in end-stage COPD patients.
  • Prolonged exposure to high concentration oxygen in hypoxic drive patients can cause respiratory depression.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Primary respiratory problems due to acid-base disorders…

A
  • RESPIRATORY ACIDOSIS: look for blood gas with low pH and elevated CO2
  • RESPIRATORY ALKALOSIS: look for blood gas with elevated pH and low CO2

*A primary respiratory problem presents with PaCO2 less than 35mmHg(alkalosis) OT greater than 45mmHg(acidosis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Primary metabolic problems due to acid-base disorders…

A
  • METABOLIC ACIDOSIS: look for blood gas with low pH and low HCO3 level
  • METABOLIC ALKALOSIS: look for elevated pH and elevated HCO3 level

*A primary metabolic problem presents with HCO3 below 22mmHg l(acidosis) or greater than 26mmHg(alkalosis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Normal arterial blood gas values:

A
  • pH: 7.35-7.45
  • PaO2: 80-100 mmHg
  • PaCO2: 35-45 mmHg
  • HCO3: 22-26 mEq/L
  • SaO2: 95% OT above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Oxygenation

A
  1. Effective ventilation is required for adequate oxygenation.
  2. Adequate oxygenation is required for effective respiration.
  3. Adequate oxygenation DOES NOT ensure effective internal respiration.
  4. Ventilation DOES NOT ensure oxygenation (e.g., ventilation can occur without oxygenation during smoke inhalation or CO poisoning)
  5. Delivering supplemental oxygen can only improve cellular oxygenation if ventilations are adequate and result in external and internal respiration.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Respiration

A
  • Effective respiration results in cellular exchange of O2 and CO2
  • Time and injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Without adequate respiration:

A
  • Heart and brain become irritable almost immediately
  • Brain damage likely within 4 minutes
  • Permanent brain damage likely within 6 minutes
  • Irrecoverable brain damage(biological death) likely within 10 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Ventilation perfusion mismatch

A
  1. aka V/Q mismatch or V/Q defect
  2. Occurs when the lungs receive oxygen, but not adequate blood flow or when the lungs receive blood flow, but inadequate oxygen.
  3. V/Q mismatch could begin as either a ventilatory(oxygenation & respiration) problem or a perfusion problem, e.g., pulmonary embolism.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Manual airway techniques comes first;

A
  1. Head-tilt, chin lift (preferred)

2. Jaw-thrust (suspected spinal injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Suction (as indicated) comes second:

A
  1. Rigid suction catheter

2. French suction catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Rigid suction catheter

A
  • used to suction oral airway

- aka tonsil tip or Yankauer catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

French suction catheter

A
  • used to suction nose, stoma, or inside advanced airway
  • aka soft-tip, whistle-tip or flexible catheter
  • available in numerous sizes(diameter) (e.g., 3 French through 40 French. Increased number = increased diameter)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Suction time cannot exceed:

A
  • 15 seconds for adults
  • 10 seconds for pediatrics
  • 5 seconds for infants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Mechanical airway adjuncts come third(as indicated)

A
  • OPA: for unresponsive patients without a gag reflect(avoid posterior displacement of tongue)
  • NPA: can be used on patient with decreased LOC, but not unresponsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Extraglottic, Retroglottic and supraglottic airway device

Common types used prehospital….

A
  • Laryngeal Mask Airway(LMA) and LMA Supreme
  • i-gel suprahlottic LMA
  • Pharyngeal Tracheal Lumen Airway (PTL)
  • Esophageal Tracheal Combitube(ETC)
  • King LT Airway
  • Supraglottic Airway Laryngoscope Tube (SALT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Extraglottic, Retroglottic and supraglottic airway device

Advantages….

A
  • easy to use
  • blind insertion, no laryngoscope needed
  • able to insert quickly
  • high success rate (avoid posterior displacement of tongue)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Endotracheal Intubation (ETT)

Advantages….

A
  • isolates the trachea
  • eliminates gastric distention from ventilation
  • no mask seal needed
  • improved suctioning ability
  • route for medication administration (naloxone, epinephrine, atropine, lidocaine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Endotracheal Intubation (ETT)

Disadvantages….

A
  • extensive training required
  • direct visualization of vocal chords required
  • takes longer than other advanced airways
  • has many serious complications
  • not been shown to increase survival rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Endotracheal Intubation (ETT)

Verification of proper ETT placement….

A
  • direct visualization of cords
  • auscultation of epigastrium and bilateral lung field
  • continuous waveform capnography
  • pulse oximetry
  • esophageal detector device
  • ETT introducer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Surgical cricothyrotomy

A

-Only indicates in acute, life threatening situations when use of less invasive airway techniques are ineffective.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Rapid Sequence Induction (intubation) or medication-assisted intubation

Indication….

A
  • respiratory failure
  • inability to protect airway
  • combative patient, suspected TBI
  • persistent hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Rapid Sequence Induction (intubation) or medication-assisted intubation

Contraindications….

A
  • respiratory and cardiac arrest
  • anticipated difficult airway (relative)
  • short transport time (relative)
  • ability to manage airway with less invasive measures
  • neuromuscular disease, e.g., ALS, muscular dystrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Predictors of difficult advanced airway insertion

A
  • mouth does not fully open
  • hypersecretions
  • obesity
  • pulmonary edema
  • airway burns
  • facial trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Increased Mallampati score (used with oral intubation)

A
  • Class 1: entire tonsil clear
  • Class 2: upper half of tonsil visible
  • Class 3: soft and hard palate visible
  • Class 4: only hard palate visible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

LEMONS mnemonic for difficult airway

A
  • L: look externally
  • E: evaluate 3-3-2 rule
  • M: Mallampati score
  • O: obstruction
  • N: neck mobility
  • S: saturations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Indications for supplemental oxygen…

A
  • dyspnea
  • hypoxia
  • pulse oximeter below 94%
  • altered or decreased LOC
  • respiratory or cardiac arrest
  • hypoperfusion(shock)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Supplemental oxygen devices….

A
  • nasal cannula
  • non-rebreather
  • small volume nebulizer(SVN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Nasal Cannula

A
  • low flow oxygen
  • up to 6 lpm can be administered
  • delivers 24%-44% oxygen (about 4% per liter above 21% room air)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Non-rebreather

A
  • high flow oxygen
  • 12-15 lpm
  • delivers about 90% oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Small Volume Nebulizer (SVN)

A

-used for delivery of aerosolized medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Cylinder Sizes

A
  • D cylinders
  • E cylinders
  • M cylinders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

D cylinders

A

-about 350-liter capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

E cylinder

A

-about 625-liter capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

M cylinder

A

-about 3,000-liter capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Oxygen cylinder pressure

A
  • full cylinder is about 2,000 PSI

- sage residual pressure is 200 PSI (cylinder should be taken out of service and refilled once it reaches 200 PSI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Calculating duration of an oxygen tank…

A

(Cylinder PSI - Sade residual pressure) x tank constant / remaining flow rate (lpm) = minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

-D cylinder constant

A

-0.16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

E cylinder constant

A

-0.28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

M cylinder constant

A

-1.56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Initiate PPV for any patient with signs of inadequate breathing, such as ….

A
  • excessively bradypneic or tachypneic breathing (age dependent)
  • shallow breathing
  • altered or decreased LOC
  • dyspnea
  • retractions
  • accessory muscle use
  • cyanosis
  • paradoxical motion
  • sucking chest wound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Do not hyperventilate, in increases the risk of….

A
  • gastric distention
  • vomiting
  • aspiration
  • ineffective CPR
  • death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Ventilation for adults….

A

-10-12 breaths per minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Ventilation for children and infants….

A

-12-20 breaths per minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Adequate ventilation indication….

A
  • rise and fall of the chest

- 1 second to inflate the chest during PPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Complications of PPV…

A
  • increased intrathoracic pressure and reduced cardiac output
  • gastric distention and increased risk of vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Atonal Respirations

A

-slow, shallow, infrequent breaths; indicates brain anoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Biot’s Respirations

A

-irregular pattern of rat and depth and periodic apnea; indicates increased ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Central neurological hyperventilation

A

-deep, rapid respirations; indicates increased ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Cheyne-Stokes respirations

A

-progressively deeper and faster breaths, changing to slower and shallow breaths; indicates brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Kussmaul Respirations

A

-deep, gasping breaths; indicates possible DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Rales(crackles)

A

-fine, bubbling sound on inspiration; indicates fluid in lower airways.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Rhonchi

A

-course sound on inspiration; indicates inflammation or mucus in lower airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Wheezes

A

-high pitched sound on inspiration or expiration; indicates bronchoconstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Snoring

A

-indicates partial airway obstruction from the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Stridor

A

-high pitched sound indicating significant upper airway obstruction (e.g., foreign body, angioedema, anaphylaxis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Gurgling

A

-indicates fluid in the upper airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Increased/high ETCO2

A

-possible hypoventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Decreased/Low ETCO2

A

-possible hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

ETCO2 drops to 0

A

-possible for esophageal intubation or displaced tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Sharp drop in ETCO2

A

-possible pulmonary embolism, cardiac arrest, hypotension, hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Continuous Positive Airway Pressure(CPAP) indications….

A
  • for alert and spontaneously breathing patients
  • at least 12yrs of age
  • in significant respiratory distress (ex. sleep apnea, COPD, pulmonary edema, CHF, pneumonia)
  • tachypnea
  • SpO2 below 94% and it use of accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

CPAP starting range….

A

-5-7 cm H2O

128
Q

CPAP contraindications….

A
  • apnea
  • patients unable to follow verbal commands
  • suspected pneumothorax
  • chest trauma
  • tracheostomy
  • vomiting
  • GI bleeding
  • hypotension
129
Q

Tracheostomy tune/stoma

A
  • BVM will connect directly to trach tube
  • to ventilate a patient with stoma (no trach tube) use an infant or person mask with appropriate size BVM. Seal mouth and nose during ventilation.
  • trach tubes and stomas require frequent suctioning
130
Q

Foreign body airway obstruction (FBAO)

BLS…

A
  • conscious adult and children(not infants): abdominal thrust
  • unconscious (all ages): chest compressions
  • conscious infants: back blows and chest thrust
131
Q

Foreign body airway obstruction (FBAO)

ALS (when BLS Interventions are ineffective(

A
  • attempt to remove foreign body with laryngoscope and McGill forceps
  • Attempt ETT insertion to try passing tube through obstruction or forcing it into right mainstem
132
Q

Ascites

A

-abdominal swelling(consider liver disease, CHF, renal failure)

133
Q

Cullen’s sign

A

-bruising around the umbilicus(consider intra-abdominal bleeding)

134
Q

Field impression

A

-a field conclusion of the patients problem based on the clinical presentation and the exclusion of other possible causes through considering the differential diagnosis

135
Q

Grey Turner’s sign

A

-bruising over flanks(consider intra-abdominal bleeding)

136
Q

Pitting edema

A

-depression left by pressure of finger(consider CHF, renal failure)

137
Q

What are the 5 major components of patient assessment?

A
  • scene size-up
  • primary assessment
  • patient history
  • secondary assessment
  • reassessment
138
Q

Scene size-up consist of…

A
  • scene safety
  • standard precautions
  • mechanism of injury (c-spine indicated) or nature of illness(medical patients)
  • number of patients
  • additional resources
139
Q

Purpose of the primary assessment is….

A

-to find and manage immediately life-threatening conditions

140
Q

Components of the primary assessment:

A
  • general impression
  • spinal precautions and expose patient as indicated
  • level of consciousness (AVPU)
  • ABC’s(or CAB, if patient unresponsive)
  • rapid scan aka rapid secondary(as indicated)
  • transport priority
141
Q

ABC’s….

A

-AIRWAY
•manual, suction, mechanical
•BLS before ALS
-BREATHING
•support ventilations and provide supplemental oxygen as indicated
•manage flail chest (with PPV) and sucking chest wounds (with occlusive) as indicated
-CIRCULATION
•assess pulse, CPR as indicated
•manage life-threatening bleeding
*direct pressure
*tourniquet
*hemostatic agent if tourniquet not possible (e.g., torso)
•assess circulation to skin (color, temp, moisture)

142
Q

Significant MOIs indicating probable need for high-priority transport to an appropriate trauma center:

A
  • falls over 20 feet in adults or over 10 feet in children
  • any fall leading to a traumatic loss of consciousness
  • motor vehicle collision (MVC) with more than 12” of intrusion into occupant space
  • MVC with ejection
  • death of another occupant in same vehicle
  • pedestrian or cyclist struck by vehicle
  • motorcycle accident over 20 mph

*Two or more significant MOIs significantly risk likelihood of life-threatening injury

143
Q

SAMPLE history…

A
  • Signs and symptoms
  • Allergies
  • Medications
  • Past history
  • Last oral intake
  • Events leading to incident
144
Q

OPQRST

A
  • Onset
  • Provocation
  • Quality
  • Radiation
  • Severity
  • Time
145
Q

ASPN…

A

Associated Symptoms: other symptoms associated with the chief complaint

Pertinent Negatives: potential associated symptoms that are not present

146
Q

Indications for a head-to-toe secondary assessment include…

A
  • unresponsive or otherwise unable to provide feedback
  • multisystem trauma
  • high priority transport
147
Q

Indications for a focused secondary assessment include…

A

-conscious patient with a specific, isolated chief complaint (Medical or trauma)

148
Q

Assessment for DCAP-BLS-TIC(trauma/unresponsive patients)…

A
  • Deformities, distention
  • Contusions
  • Abrasions
  • Penetrating injuries, paradoxical movement
  • Burns
  • Laceration
  • Swelling
  • Palpate for:
  • Tenderness
  • Instability
  • Crepitus
149
Q

Components of reassessment….

A
  • reassess LOC
  • reassess ABCs
  • reassess chief complaint
  • reassess interventions
  • reassess vitals
150
Q

Infants (up to 1 year) normal vital signs….

A
  • RESPIRATIONS: 30-60
  • HEART RATE: 100-180
  • SYSTOLIC BP: at least 70 to 104
151
Q

Toddlers (1-3 years) normal vital signs…

A
  • RESPIRATIONS: 24-40
  • HEART RATE: 80-110
  • SYSTOLIC BP: about 80+2 (age in yrs)
152
Q

Preschoolers (3-6 years) normal vital signs…

A
  • RESPIRATIONS: 22-34
  • HEART RATE: 70-110
  • SYSTOLIC BP: about 80+2 (age in years)
153
Q

School-age (6-12 years) normal vital signs…

A
  • RESPIRATIONS: 18-30
  • HEART RATE: 65-110
  • SYSTOLIC BP: about 80+2 (age in years)
154
Q

Adolescent (13-18 years) normal vital signs…

A
  • RESPIRATIONS: 12-26
  • HEART RATE: 60-90
  • SYSTOLIC BP: 110-130
155
Q

Capnography

A

-measure or monitoring of exhaled CO2

156
Q

Infarct

A

-area of necrosis, or death

157
Q

Pulse CO-oximetry (SpCO)

A

-non-invasive measurement of carbon monoxide saturation of hemoglobin

158
Q

Pulse oximetry (SpO2)

A

-non-invasive measurement of oxygen saturation of hemoglobin

159
Q

SpMet

A

-non-invasive measurement of methemoglobin

160
Q

Bipolar Leads….

A
  • Lead 1
  • Lead 2
  • Lead 3
161
Q

Lead 1:

A

-negative electrode right arm and positive electrode left arm

162
Q

Lead 2:

A

-negative electrode right arm and positive electrode left leg

163
Q

Lead 3:

A

-negative electrode left arm and positive electrode left leg

164
Q

ECG changes must occur in at least ___ contiguous leads

A

-2

165
Q

Ischemia

A
  • Myocardium receiving inadequate oxygen (reversible condition)
  • ECG: ST depression, inverted T waves or peaked T waves

*ST depression must be at least one small box below baseline.

166
Q

Injury

A
  • Myocardial damage due to ischemia (potentially reversible condition)
  • ECG: ST elevation

*ST elevation must be at least 1 mm in two or more continuous leads or inverted T waves.

167
Q

Infarction

A
  • Myocardial death (irreversible condition)
  • ECG: significant (pathological) Q wave

*Pathological Q wave must be at least 1 mm (0.04 seconds) wide or deeper than one-third the R wave (in same lead).

168
Q

Unipolar (augmented) leads…

A

-aVR, aVL, aVF

169
Q

Chest (precocial) leads…

A

-V1-V6

170
Q

Lead groupings (“I See All Leads” mnemonic)

A
  • Inferior leads: II, III, aVF
  • Septal leads: V1, V2
  • Anterior leads: V3, V4
  • Lateral leads: V5, V6, Lead I, aVL
171
Q

Pulse Oximetry (SPO2) uses….

A
  • non-invasive and indirect method of monitoring oxygen saturation of hemoglobin(SpO2)
  • readings are a %, therefore max value of 100
  • can provide info about mechanical cardiac function

*Can be useful in assessing circulation distal to a suspected orthopedic fracture or for identifying inapparent hypoxia in patients with long bone fractures.

172
Q

SpO2 Values….

A
  • Normal: 95%-100%
  • below 95%-suspect hypoxia, shock, or respiratory compromise
  • below 90%-aggressive airway management, ventilatory support and high flow oxygen indicated

*COPD patients may routinely have SpO2 readings as low as 85%.

173
Q

Inaccurate SpO2 readings possibly due to…

A
  • hypoperfusion(ex. hemorrhage, dehydration, hypothermia)
  • Anemia
  • CO poisonings (device only reads percentage on bound hemoglobin, not what is bound to that hemoglobin, e.g., O2 vs. CO.)
  • Methemoglobinemia/cyanide poisoning
174
Q

ETCO2

A

-provides real time information regarding cellular metabolism, circulation, and ventilation

175
Q

ETCO2 values….

A

-Normal ETCO2 = 35-45mmHg
-Elevated ETCO2 = > 45mmHg
• elevated ETCO2 indicates hypoventilation due to: increased CO2 production and/or decreased CO2 elimination
•elevated ETCO2 indicates acidosis
-Decreased ETCO2 (below 35 mmHg)
•decreased ETCO2 indicates hyperventilation due to: decreased CO2 production and/or increased CO2 elimination
•decreased ETCO2 indicates alkalosis

176
Q

Indications and advantages of continuous ETCO2 monitoring….

A
  • continuously monitor ETT
  • monitor effectiveness of CPR
  • monitor adequacy of ventilations
177
Q

Carbon Monoxide

A

-Carbon monoxide (CO) bonds to hemoglobin much stronger (200x) than oxygen does, causing carboxyhemoglobin (a common toxicologic emergency)

178
Q

Pulse CO-Oximetry (SPCO) values….

A
  • 0%-3% = normal
  • 3%-12% = administer high-flow oxygen and transport if symptomatic, or known exposure to CO
  • above 12% = administer high-flow oxygen and transport
179
Q

Indications for glucometry….

A
  • known or suspected diabetic history
  • altered or decreased LOC
  • seizures
  • stroke
  • pregnancy
  • suspected alcohol abuse
  • suspected overdose
  • any time you have any reason to remotely suspect an abnormal blood glucose level
180
Q

Blood Glucose values….

A
  • Normal(adult, non-diabetic)-about 70-120mg/dL
  • Normal(adult, diabetic)-about 100-180mg/dL
  • Normal(newborn)-above 40mg/dL
181
Q

Angioedema

A

-swelling of the lower layer of skin and underlying tissue. Swelling may occur in the face, tongue, larynx, abdomen, arms and legs. Often associated with urticaria.

182
Q

Compensated Shock

A

-early shock where the body still maintains adequate perfusion

183
Q

Decompensated Shock

A

-later shock where the body can no longer maintain adequate perfusion

184
Q

Exsanguination

A

-severe bleeding, leading to death

185
Q

Hemorrhage

A

-bleeding

186
Q

Irreversible Shock

A

-stage of shock leading to inevitable death

187
Q

Mean Arterial Pressure (MAP)

A

-DBP + 1/3 (SBP - DBP)

188
Q

Multiple organ dysfunction syndrome

A

-progressive failure of at least two organ systems

189
Q

Urticaria

A

-hives

190
Q

What can lead to hemorrhagic shock?

A

-single femur fracture, pelvic fracture, or multiple long bone fractures

191
Q

Signs of internal hemorrhage…

A
  • vomiting blood
  • coffee ground like emesis
  • blood in stool (hematochezia)
  • dark, tarry stool (melena)
  • abdominal distention or rigidity
  • suspected femur or pelvic fracture
  • signs and symptoms of shock
192
Q

Sources of bleeding….

A

-Arterial, Venous, Capillary

193
Q

Arterial bleeding…

A

-spurting, bright red blood

194
Q

Venous bleeding

A

-steady, flowing, dark red

195
Q

Capillary bleeding

A

-slow, oozing dark red blood

196
Q

Management of external bleeding…

A
    1. Direct pressure = consider hemostatic dressings and/or wound packaging per local protocol
    1. Tourniquet = always place tourniquet proximal to injury, apply enough pressure to control bleeding, do not apply directly over joint, write “TK” and time applied on tape and secure to patients forehead and notify transfer of care personnel
197
Q

Suspected internal bleeding management…

A
  • general management of ALS patients
  • treat for shock
  • consider pelvic binder for suspected pelvic fracture
  • rapid transport
198
Q

Shock….

A

-(hypoperfusion) is any condition causing inadequate tissue perfusion due to reduced cardiac output

199
Q

What are the three causes of shock…

A

-pump, pipes, fluid

200
Q

Cardiogenic Shock…

A

-pump(cardiac) problem

201
Q

Anaphylactic shock….

A

-pipes(vasodilation) problem

202
Q

Hemorrhagic shock

A

-fluid(hypovolemic) Shock

203
Q

Impaired oxygenation and glucose (shock)

A
  • All causes of shock lead to impaired oxygenation due to anaerobic (without oxygen) metabolic function
  • anaerobic metabolism creates little energy and increased acidosis
  • Shock also causes impaired glucose delivery to cells, increasing risk of organ failure
204
Q

Categories (stages) of Shock

A
  • Compensated
  • Decompensated
  • Irreversible
205
Q

Compensated Shock

A

-The body’s defense mechanisms are compensating for the decrease in cardiac output.
-Compensatory Mechanisms….
•increased HR and cardiac force of contraction
•increased vasoconstriction
•reduced urinary output to maintain intravascular volume

206
Q

Decompensated (progressive) Shock

A

-The body’s defense mechanisms are no longer able to compensate for the decrease in cardiac output.
-Falling or low BP are hallmark signs of Decompensated Shock.
-Importance of Mean Arterial Pressure (MAP)
•MAP = DBP + 1/3 (SBP - DBP)
•Normal MAP is 70-100. A MAP of at least 60 is needed to perfuse vital organs

207
Q

Irreversible Shock

A

-Irrecoverable shock leading to inevitable death.

208
Q

Older Classification (types) of shock system

A
  1. Cardiogrnic shock(pump problem)
  2. Hypovolemic shock(fluid problem)
  3. Neurogenic shock(vasodilation problem)
  4. Anaphylactic shock(vasodilation/permeability problem)
  5. Septic shock(vasodilation/permeability problem)
209
Q

Newer Classification (types) of shock system

A
  1. Cardiogenic shock
  2. Hypovolemic shock
  3. Obstructive shock
    •Pulmonary embolism
    •Cardiac tamponade
    •Tension pneumothorax
  4. Distributive shock
    •Neurogenic Shock
    •Anaphylactic Shock
    •Septic Shock
210
Q

Classic signs of shock

A
  1. ALOC progressing to unresponsiveness
  2. Tachycardia progressing to absent pulses in Decompensated/Irreversible Shock
  3. Pale, cool, clammy skin
  4. Normal BP during compensated shock and falling BP during Decompensated shock
  5. Differentiating Compensated v. Decompensated Shock
    i. S/S of Compensated Shock
    • ALOC (restless, anxious, irritable)
    • Tachycardia
    • Pale, cool clammy skin
    • Thirst
    • Normal BP
    ii. S/S of Decompensated Shock
    • Decreased LOC
    • Absent peripheral pulses
    • Mottling, cyanosis
    • Falling BP progressing to hypotension
211
Q

Standard Shock Management

A
  1. Airway management, supplemental oxygen, ventilation support as indicated
  2. Control bleeding bad indicated
  3. Prevent heat loss(even mild hypothermia increases metabolic demand and inhibits clotting).
  4. Rapid transport
  5. IV access
  6. Consider IV fluids bolus using volume expanders (such as normal saline or lactated ringers).
    i. Rule out pulmonary edema before IV fluid challenge.
    ii. Fluid bolus not typically indicated for adults with SBP of at least 100 mmHg
    iii. If indicated (SBP 90 or below for adults), consider 250 mL fluid bolus.
    iv. Burn patients-see chapter
    v. Pediatric patients-see pediatric chapter
212
Q

Cardiogenic Shock

A
  1. left ventricular failure is the most common cause
  2. Signs and Symptoms
    •classic signs of shock
    •dyspnea and pulmonary edema
    •cyanosis
  3. Management
    •standard shock management
213
Q

Hypovolemic Shock

A
  1. Causes include hemorrhage, vomiting, diarrhea, burns, sweating, DKA
  2. Signs and symptoms
    i. classics signs of shock
  3. Management
    i. classic management
    ii. IV fluids
    •IV fluids indicated for most causes of hypovolemic shock with presenting hypotension
    •permissive hypotension, keep BP at around 90 systolic
    •pediatric fluid resuscitation, infants at 10mL/kg and pediatrics at 20mL/kg
214
Q

Neurogenic Shock

A
  1. Damage to brain or spinal cord leading to widespread vasodilation and relative hypovolemia.
  2. Signs and symptoms
    i. Possible paralysis
    ii. Possible respiratory compromise
    iii. MOI indicative of probable spinal injury
    iv. Warm, flushed, dry skin (not pale, cool, clammy skin as usually seen)
    v. Hypotension even in early stages of shock
    vi. Slow pulse
  3. Management
    i. Standard shock management
215
Q

The three unique characteristics of neurogenic shock is….

A
  1. Early hypotension
  2. Bradycardia
  3. Warm, dry skin
216
Q

Anaphylactic Shock

A
  1. Life threatening allergic reaction to an antigen, such as food, meds, venom.
  2. Signs and symptoms
    i. Skin: flushed, itching, urticaria, angioedema
    ii. Respiratory: dyspnea, wheezing, stridor, laryngospasm
    iii. Cardiovascular: widespread vasodilation, tachycardia
  3. Management
    i. Aggressive airway Intervention likely needed due to laryngoscope
    ii. High-flow oxygen and ventilators support as indicated
    iii. Epinephrine
    iv. IV fluids for volume support
    v. Consider antihistamines, steroids per local protocols
217
Q

The three acute life-threats caused by anaphylaxis are….

A
  1. Airway compromise(laryngospasm)
  2. Respiratory compromise(bronchoconstriction/edema)
  3. Circulatory compromise(massive vasodilation)
218
Q

Septic Shock(sepsis)

A
  1. Systemic infection that enters the blood and is carried throughout the body.
  2. Signs and symptoms
    i. Fever or hypothermia possible
    ii. Skin can be flushed, pale, or cyanotic
    iii. ALOC
    iv. Dyspnea, abnormal lung sounds
    v. Tachycardia, hypotension
  3. Management
    i. Standard shock management and IV fluid support
219
Q

Shock Cycle

A
  1. ⬇️ BP
  2. ⬆️ Vasoconstriction
  3. ⬆️ Tissue Anoxia
  4. Anaerobic Metabolism
  5. ⬆️ Lactic Acidosis
  6. Damaged Blood Vessel
  7. ⬆️ Vessel Permeability
  8. ⬆️ Fluid Loss in Tissue
  9. ⬇️ Effective Blood Volume
  10. ⬇️ Return to Heart
  11. Cardiac Output
  12. …..
220
Q

Multiple Organ Dysfunction Syndrome

A

A. Multiple organ failure following conditions such as shock, trauma, burns, surgery, renal failure.

B. Major cause of death following sepsis, significant trauma, and major burns.

C. Early stages present with fever, ALOC, tachycardia, dyspnea.

D. Later stages present with systems failure, moving from pulmonary to hepatic, intestinal, renal and finally cardiac failure , encephalopathy and death.

221
Q

Afterload

A

-resistance the left heart overcomes during contraction

222
Q

Aneurysm

A

-a weakening in the wall of an artery

223
Q

Ascites

A

-edema in the abdomen

224
Q

Cardiac hypertrophy

A

-enlargement of the heart, often due to hypertension

225
Q

Cardiac output

A

-volume of blood ejected by left ventricle in one minute(stroke volume x heart rate)

226
Q

Chronotrope

A

-rate of cardiac contraction

227
Q

Dromotrope

A

-speed of cardiac conduction velocity

228
Q

Endocarditis

A

-an infection of the endocardium, usually involving the heart valves

229
Q

Ejection fraction

A

-percentage of blood ejected from a filled ventricle

230
Q

Failure to capture

A

-ventricles Gail to respond to an impulse. On an EKG, the pacemaker spike will appear, but it will not be followed by a QRS complex

231
Q

Failure to sense

A

-pacemaker malfunction that occurs when the pacemaker does not detect the patients Myocardial depolarization. May be seen on an EKG tracing as a spike following a QRS complex to early.

232
Q

Inotrope

A

-force of cardiac contraction

233
Q

Orthopnea

A

-difficultly breathing while supine

234
Q

Paroxysmal nocturnal dyspnea (PND)

A

-acute onset of difficulty breathing at night, usually while sleeping

235
Q

Pericarditis

A

-inflammation of the pericardium

236
Q

Preload

A

-volume of fluid returning to the right heart

237
Q

Prinzmetal’s Angina

A

-variable angina caused by coronary artery spasms

238
Q

Starling’s Law

A

-the more the heart is stretched (within limits), the greater the resulting force of contraction

239
Q

Stroke Volume

A

-amount of blood ejected by the left ventricle during one contraction

240
Q

Risk Factors for Heart Disease

A
  1. Smoking
  2. Hypertension
  3. Age (risk increases w/age)
  4. High Cholesterol
  5. Diabetes
  6. Hereditary
  7. Gender (increased risk for males)
  8. Substance abuse
  9. Lack of exercise
  10. Oral contraceptives
  11. Stress
241
Q

Layers of the heart?

A
  • Endocardium
  • Myocardium
  • Epicardium
  • Pericardium
242
Q

Endocardium

A

-innermost layer

243
Q

Myocardium

A

-muscular wall of the heart

244
Q

Epicardium

A

-inner layer of the pericardial sac

245
Q

Pericardium

A

-outer layer of the pericardial sac

246
Q

Oxygen rich blood exits the ____ side of the heart through the _____.

A

-left and aorta

247
Q

The aorta branches off into _____, then _______, and finally ________.

A

-arteries, arterioles, capillaries

248
Q

On the venous side, capillaries feed into ______, then _____, and finally the superior or inferior ____ _____.

A
  • venules and veins

- vena cava

249
Q

Arteries always carry blood _____ from the heart.

A

-away

250
Q

Veins always carry blood _____ the heart.

A

-towards

251
Q

Pulmonary artery is the one artery in the body that carries __________ blood.

A

-deoxygenated

252
Q

The pulmonary vein is the only vein in the body that carries __________ blood.

A

-oxygen-rich

253
Q

Systemic vascular resistance (SVR)……

A

-is the resistance to blood flow throughout the body(excluding the pulmonary system).

254
Q

SVR is determined by…..

A

-the size of the vessels

255
Q

Construction of blood vessels ________ SVR and can cause an _______ in blood pressure.

A

-increase and increase

256
Q

Dilation of blood vessels ________ SVR and can cause an _______ in blood pressure.

A

-decrease and lower

257
Q

Preload

A

-the pre-contraction pressure based on the volume of blood coming back to the heart. Increased preload increased stretching of the ventricles and increased myocardial contractility.

258
Q

Afterload

A

-the resistance the heart must overcome during ventricular contraction. Increased afterload decreases cardiac output.

259
Q

The heart receives its own blood supply through the _______ ________ during diastole.

A

-coronary arteries

260
Q

Main branches of Left Coronary Artery(LCA)?

A

-Left Anterior Descending and Left Circumflex artery

261
Q

LCA perfuses…..

A

-left ventricle, interventricular septum, portion of the right ventricle and the cardiac conduction system

262
Q

Main branches of the Right Coronary Artery(RCA)?

A

-posterior descending artery and the right marginal artery

263
Q

RCA perfuses…..

A

-part of the right atrium and ventricle, part of the conduction system

264
Q

Sinoatrial(SA)node…..

A

-the hearts primary conduction system. Typically generates electrical impulses between 60-100 bpm.

265
Q

Atrioventricular(AV) junction…..

A

-the hearts first backup pacemaker. Typically generates electrical impulses between 40-60 bpm.

266
Q

Bundle of His….

A

-the hearts final pacemaker. Typically generates electrical impulses 20-40bpm.

267
Q

Common signs and symptoms of Cardiac emergencies….

A
  • chest pain/pressure
  • dyspnea
  • palpitations
  • diaphoresis
  • restlessness/anxiety
  • feeling of impending doom
  • nausea/vomiting
  • weakness
  • edema
  • syncope
  • denial
268
Q

Acute Coronary Syndrome(ACS) includes….

A
  • angina
  • unstable angina
  • acute myocardial infarction
269
Q

Angina(stable angina)

A
  • transient chest pain due to myocardial ischemia
  • often provoked my exertion or stress
  • typically last less than 30 minutes and resolved with rest or nitroglycerin
270
Q

Unstable angina

A
  • new onset angina
  • angina for at least 20 minutes while at rest
  • frequent angina episodes or increasing duration of angina
271
Q

Acute Myocardial Infarction (AMI)

A

-irreversible necrosis of myocardial muscle and diagnosed by ECG changes and elevated myocardial blood enzymes
AMI classifications is based on ECG findings
-st elevation MI (STEMI)
-Non ST elevation MI (NSTEMI)
*use caution when considering nitroglycerin in suspected right ventricular inferior MI (risk of profound hypotension)

272
Q

Left heart failure (CHF)

A
  • left ventricular dysfunction causes backpressure into pulmonary circulation
  • dyspnea and pulmonary edema are common with left heart failure
  • myocardial infarction is a common cause of left heart failure
273
Q

Right heart failure (CHF)

A
  • right ventricular dysfunction causes backpressure into systemic venous circulation
  • JVD and pedal edema are common with right heart failure
  • left heart failure is the most frequent cause of right heart failure
274
Q

Signs and Symptoms of CHF

A
  • pulmonary edema (typically left heart failure)
  • dyspnea (typically left heart failure)
  • paroxysmal nocturnal dyspnea (typically left heart failure)
  • orthopnea (typically left heart failure)
  • mottled skin
  • weakness
  • ascites (typically right heart failure)
  • JVD (typically right heart failure)
  • bilateral pedal edema (typically right heart failure)
  • patients with a history of CHF are often prescribed medications such as digoxin(positive inotrope), a diuretic(furosemide), ACE inhibitor, and a potassium supplement
275
Q

Cardiac Tamponade

A

-excess fluid accumulation in the pericardial sac impairing diastolic filling and reducing cardiac output. Can be caused by trauma or medical related.

276
Q

Signs and Symptoms for cardiac tamponade….

A
  • chest pain
  • dyspnea
  • Beck’s Triad: JVD, narrowing pulse pressure, muffled heart tones
277
Q

Note:

A

-For any patient with JVD and clear lung sounds, be alert for possible right ventricular infarct, pulmonary embolism, or cardiac tamponade.

278
Q

Hypertensive Emergency signs and Symptoms

A
  • elevation in blood pressure(>180/120) with some sort of target organ change, such as: ALOC, headache, dyspnea, chest pain, vomiting, visual disturbance, pulmonary edema, ECG changes, symptoms of stroke, seizures
  • history of hypertensive disorder
  • noncompliance with anti-hypertensive meds
  • pregnancy(preeclampsia and pregnancy induced hypertension)
  • nosebleed
279
Q

Abdominal Aortic Aneurysm(AAA)

A
  • often occur in the abdominal region, but also can develop along the thoracic aorta(thoracic aortic aneurysms), or in the brain(cerebral aneurysm).
  • the weakened wall of the affected artery is prone to rupture and massive bleeding
280
Q

Signs and Symptoms of AAA

A
  • most common in older males
  • tearing back pain
  • possible history of hypertension, smoking, atherosclerosis, family history of AAA
  • possible pulsating abdominal mass
  • varying blood pressures between left and right arm of (at least 15-20 mmHg)
  • signs and symptoms of hypovolemic shock(if ruptured)
281
Q

Management of AAA

A
  • general management of ALS patients
  • keep patient still
  • caution when palpating abdomen
  • transport rapidly to appropriate facility with surgical capabilities
282
Q

Carcinogenic Shock

A
  • persistent, severe left ventricular pump failure despite correction of existing dysrhythmias, hypovolemia, or widespread vasodilation.
  • frequently caused by massive MI; can also be caused by tension pneumothorax or cardiac tamponade
283
Q

Signs and Symptoms of cardiogenic shock

A
  • hypotension(May be <80 mmHg systolic)
  • tachycardia
  • chest pain
  • dyspnea
  • ALOC
  • weakness
  • history of trauma or MI
284
Q

Management of Cardiogenic Shock

A
  • manage ABC’s
  • position of comfort if possible
  • oxygen as indicated
  • consider CPAP
  • consider vasopressor medication, such as dopamine
  • rapid transport to appropriate facility
285
Q

Rate of chest compressions

A

-100-120 per minute adult or peds

286
Q

Depth of compressions for Adults

A

-2-2.4”

287
Q

Depth of compression for children

A

-2”

288
Q

Depth of compressions for infants

A

-1.5”

289
Q

Adult compression to ventilation ratio

A

-30:2(one or two rescuers)

290
Q

Infant and child comp: ventilation ratio

A

—30:2(one rescuer); 15:2(two rescuers)

291
Q

Ventilation rate with advanced airway

A
  • Adults = 10/minute

- Peds = 12-20/minute

292
Q

Amiodarone or lidocaine May be used for VF or pulseless VT after CPR, defibrillatation, and epinephrine

A

-

293
Q

Atropine indicated for symptomatic bradycardia (ALOC, chest pain, hypotension)

A

-

294
Q

Consider dopamine and epinephrine infusion or transcutaneous external pacing (TEP) for symptomatic bradycardia unresponsive to atropine

A

-

295
Q

Consider immediate TEP for symptomatic bradycardia with Hugh-degree AV Block when IV access delayed

A

-

296
Q

12-lead ECG should be obtained prehospital for suspected acute coronary syndrome to assess for STEMI

A

-

297
Q

Acute respiratory distress syndrome(ARDS)

A

-non cardiogenic pulmonary edema

298
Q

Cot pulmonale

A

-right sided heart failure

299
Q

Hemoptysis

A

-coughing up blood

300
Q

Orthopnea

A

-difficultly breathing while laying down

301
Q

Paroxysmal nocturnal dyspnea

A

-difficultly breathing at night

302
Q

Positive end expiratory pressure (PEEP)

A

-extrinsic PEEP uses an impedance valve to increase volume of air remaining in lungs at end of expiration to improve gas exchange

303
Q

Subcutaneous emphysema

A

-crackling under the skin upon palpation due to trapped air. Typically found in chest, neck or face.

304
Q

Tidal volume

A

-volume of air exhaled or inhaled with each breath

305
Q

Upper Airway consist of…..

A

-nasopharynx, oropharynx, larynx(above the vocal cords)

306
Q

Lower airway consist of….

A

-larynx(below the vocal cords), trachea, bronchi, alveoli

307
Q

Ventilation

A

-is the mechanical process that moves air in and out of the lungs

308
Q

Inspiration

A

-the active process of ventilation (requires energy)

309
Q

Exhalation

A

-the passive process of ventilation

310
Q

External respiration

A

-movement of oxygen from the alveoli into the bloodstream and movement of CO2 from the blood stream to the alveoli

311
Q

Internal respiration

A

-the exchange of gases (O2 and CO2) between the bloodstream and the tissues in the body

312
Q

Tidal volume

A

-normal adult tidal volume is about 500ml

313
Q

Minute volume

A

-respiratory rate x tidal volume

314
Q

Signs and Symptoms of Respiratory Compromise

A
  • positional breathing(tripod)
  • skin color changes(cyanosis)
  • ALOC
  • difficultly speaking full sentences
  • difficultly breathing
  • accessory muscle use(nasal flaring, intercostal retractions, tracheal tugging)
  • abnormal respiratory rate or tidal volume
  • SpO2 below 95%
  • abnormal lung sounds
315
Q

GENERAL MANAGEMENT OF RESPIRATORY COMPROMISE

A
  • Manage ABCs as indicated
  • Monitor SpO2.
  • Monitor ETCO2 as indicated.
  • Monitor ECG.
  • Provide supplemental oxygen if hypoxia suspected and as indicated to maintain SpO2 of at least 95%.
  • IV access, as indicated.
  • Support ventilations as indicated (adjust rate of ventilations to target ETCO2 of 35–45 mmHg).
  • Consider causes, e.g., various respiratory or cardiac problems, trauma, sepsis, etc.
  • Consider CPAP as indicated.
  • Consider pharmacologic interventions as indicated.
  • Transport
316
Q

Acute respiratory distress syndrome (ARDS)

A

-ARDS is a form of pulmonary edema not caused by poor left ventricular function. There are many causes, including sepsis, trauma, OD, drowning, and toxic inhalation.

317
Q

Signs and symptoms of ARDS

A 
-Progressive decline in respiratory status
Note: Acute onset respiratory failure in healthy patient may indicate high-altitude pulmonary edema (HAPE).
-Dyspnea
-ALOC, such as agitation, confusion
-Fatigue
-Pulmonary edema (rales bilaterally)
-Tachypnea
-Tachycardia
-Possible cyanosis
-Low SpO2”

jlo_21 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions