Paramedic Skills 2 Midterm Flashcards
Name Red Flags
Absent or severely impaired breathing
Unconsciousness
No pulse
Severe bleeding
Cyanosis
Seizures
Neck Injury
Name Yellow Flags
Shortness of breath
Abdominal pain
Fever
Weakness
Hypotension
ABC vs ABCDE
ABC or CAB evaluated and treated with hands on actions, used to determine what might be critical for the patient.
ABCDE rapid response sequence to support indentified dysfunction or basic investigations.
Components of ABC and ABCDE
Airway
-open and clear?
-voice normal or dysphonia
-stridor? gurgling? snoring?
Breathing
-Present and effective?
-Characteristics of breathing and chest movements (amplitude, reactions, paradoxical breathing).
-Adequate ventilation.
Circulation
- Pulse present and characterstics
- Skin Color, Temp, Moisture
- Cap refill
(use CAB in unconscious)
Disability
- CNS evaluation
- AVPU
- Cincinatti Stroke Scale
-Blood glucose
Exposure
- Passive cooling/warming
-hypo/hyper thermia injuries
Collection of vitals?
every 5 to 15 minutes depending on patient stability.
- SpO2
- RR
- Pulse
- BP
Additonal:
Blood glucose
ETCO2
GCS
Pain scale
Height and weight
Normal RR and HR
12-20 RR and 60-100 HR, values can be higher for children. (too many for specifics :p)
Minimum Sys BP
> 65 100mmHg
12 90mmHg
1 month to 12 years 70mmHg + 2x age
less than a month 60 mmHg
Instability Criteria
Neuro:
P/U on AVPU
Or GCS below 13
Respiratory:
Compromised airways, non patent
Resp distress
Resp insufficiency
Hemodynamic:
Hypotension or absence of peripheral pulses
Bradycardia/tachycardia with one or more signs of shock
Significant hemorrhage
NPA indications and insertion
Upper airway obstruction or protecting the airway.
Measure from tip of nose to earlobe
Lube lube lube
Right nostril first typically and put the thing facing the nostril.
Contraindication, epistaxis and discomfort and facial trauma.
OPA indications and insertion
Upper airway obstruction and facilitating ventilation. Can’t be done on patient with gag reflex so must be unconscious.
Measure from corner of mouth to angle of jaw. Insert one sof palate is reacher rotate
Indications for suctioning.
Excessive secretions or mucus in the airway
Foreign objects obstruction airway
Inability to manage oral or nasal secretions
Facilitate mechanical ventilation in intubated patients.
Rigid vs Soft tip caths
Soft used in tracheostomy care and with iGel
Rigid has ability to suction larger amounts of fluid quickly. larger diameter than soft tip.
Suctioning Procedure
Select appropriate catheter and measure
Adjust pressure based on age
Insert as far as you can see
Suction on way out
no longer than 10 seconds
Measure caths?
Earlobe to corner of mouth
Suctioning Pressures
Adult 120-150mmHg
Peds 60-100mmHg
Testing 300mmHg
Risk associated with airway compromise and emerg suction
Aspiration is risk, in emerg suction suction till nothing left
Stroke Volume? BVM?
One hand 600 ml, two hands 1000ml resus volume 1510ml.
Hyperventilation with BVM…
Can lead to decreased Co2 hypocapnia which can lead to resp alkalosis.
Excessive ventilation can increase intrathoracic pressure as well.
TV Tidal Volume
Refers to volume of air inspired or expired with each breath. kg x 6/8 ml/kg to tell you if one hand or two. Almost always one.
Sniffing position
Padding for childern to open airway. Tilt head back and lift chin.
Seal techniques
EC, one person, C over mask, e around jaw for tight seal
Thumbs down, two people. never push face down, lift jaw or face to mask.
Do not over inflate mask, inflate to no more than 75%.
Ventilation tips and BOOTS for vent diff.
Vent just enough to observe chest rise. This avoids air entering stomach or causing lung damge.
BOOTS
Beard
Old
Obese
Tothless
Snoring
may indicate difficulties ventilating.
Hypoxia
Hypoxic: breathing air with lower than normal O2 levels, decreased ventilation, abnormal lung fxn.
Hypemic: reduced or altered hemoglobin, anemia or carbon monoxide poisoning.
Stagnant: Inadequate tissue perfusion often seen in hypovolemic or cardiogenic shock.
Histotoxic: Cellular O2 us imparied due to toxic substances like cyanide.
Findings associated with tissue hypoxia
CNS impairement, restlessness, confusion, unsteady gait, slurred speech, coma
Tachy early or brady late cardias with ventricular dysrhythmias.
Tachypnea, diaphoresis, pallor, with or without cyanosis.
What drives our breathing?
CO2 and pH. O2 for COPD.
Pulse ox
Measure 02 bounded to hemoglobin.
Oxygen delivery devices
Nasal cannula: low to moderate concentrations of o2 and can breathe spontaneously.
Non rebreather, low flow. high concentration, has a reservoir bag to inhale from both enviro and bag.
Aerosol mask, used for med administration.
BVM: high flow for patients who are not breathing.
Rates for nasal cannula vs non rebreather
nc, 0.5-6
nr, 10-15.
When use high flow
When under spo2 85% and then titrate to maintain. COPD 88-92
Also use
1. Diving
2. Unconscious
3. Unreliable
4. Exposure such as co
see PICPSP.
Pulse pressure norms?
30-40. Sys-Dia. 120/80 120-80=40
Shock index norm and calcualtion
SI = HR/SBP
100/120 = 0.83 sI.
0.5-0.7 normal range.
0.7-0.9 mild to moderate risk of shock,
>0.9 high risk of shock or hemodynamic instability.
Visceral vs somatic vs neuropathic pain
Visceral, deep origin from interanal organs, poorly localized, dull
Somatic, musculoskeletal, well localized, shar throbbing aching
neuropathic dysfunction of nervous system, shooting burning pain.
referred pain, pain from elsewhere.
CO
CO= SV x HR
