Week 3 (6,9,10,11) Flashcards
PERRLA
Pupils
Equal
Round
Reactive
Light
Accommodating
Who is a badass
You is
Cyanosis
Bluish skin
Moderate Sign of Hypoxia
(Starts at fingers and works up as it gets worse)
Mottled
splotchy purpleish skin
Lace like patter
Possible sign of shock
Jaundice
Yellowing of skin / mucus membranes
Sign of liver failure
Pallor
Paleness
vasoconstriction
bloodloss
shock
heart attack
anemia
Flushed
Red Skin
Heat exposure
Carbon Monoxide Poisoning
Fontenelle
Soft spots on infants head where the skull has not fused yet
Define
Hypotension
Lower than normal BP
Define
Hypoxia
Low oxygen
Define
Hypoxemia
low oxygen in the blood
Define
Hypertension
Higher than normal BP
List
Breath Sounds
wheezing
Rhonchi
Rales
crowing/ stridor
Gurgling
snoring
what causes
Wheezing
what does it sound like
swelling constriction of lower airways
High pitched exhalation but can also be heard during inhalation
what causes
Rhonchi
what does it sound like
obstruction of the larger conducting airways of the respiratory tract by thick secretions of mucus
chronic bronchitis, emphysema, aspiration, and pneumonia
coarse crackles, are snoring or rattling noises heard on auscultation
sound changes if person coughs/changes position
what causes
Rales
What does it sound like
Where do you Auscultate to here
fluid that has surrounded or filled the alveoli or small bronchioles
pulmonary edema or pneumonia
bubbly or crackling sounds heard during inhalation
posterior base of lungs
What causes
Crowing/stridor
What does it sound like?
How to correct
swelling or muscle spasms that result from conditions
airway infections, allergic reactions, or burns to the upper airway
high-pitched sounds produced on inspiration
typically cannot be relieved by manual maneuvers, suctioning, or insertion of an airway adjunct
What causes
Gurgling
How to correct
liquid substance in airway
Suction Airway
What causes
Snoring
How to correct
Tongue or Epiglottis bloacking airway
Head tilt chin lift
Define
Apnea
Not breathing
Consensual reflex
Both pupils reacting equally
Signs/symptoms
Hypoxia
mild-moderate
Tachypnea
Dyspnea
Pale, cool, clammy skin (early)
Tachycardia
Elevation in blood pressure
Restlessness and agitation
Disorientation and confusion
Headache
Define
Tachypnea
increased respiratory rate
Define
Dyspnea
shortnes of breath
Signs/Symptoms
Hypoxia
Severe
Tachypnea
Dyspnea
Cyanosis
Tachycardia dysrhythmias
bradycardia
Severe confusion
Loss of coordination
Sleepy appearance
Head bobbing with droopy eyelids
Slow reaction time
Altered mental status
Seizure
Define
dysrhythmias
Irregular heart rythmes
Define
Diaphoretic
excessive sweating and clamminess
Define
hypercarbia
buildup of carbon dioxide in the blood
What is
cricoid pressure
Disadvantages
backward pressure to displace the larynx posteriorly
BURP, ELM
can impede airflow
used to facilitate endotracheal tube
signs/symptoms
Respiratory distress
Treatment
Compensatory (Adequate Tidal volume and Respiratory rate)
SOB
Resltessness/anxiety
Retractions
Abdominal breathing
coughing
tripod position
94% or greater.
Provide supplemental oxygen to maintain SPO2
Define
Respiratory Failure
Treatment
Compensatory Mech. not working. insufficient rate/ tidal volume
bag-valve-mask device with supplemental oxygen connected to the device.
Respiratory Arrest
stopped breathing
(Agonal possible)
orthostatic vital signs
- BP + HR in supine
2.stand pt up and after 2 mins BP + HR
3.while standing. - HR increases by greater than 10–20 bpm
systolic blood pressure decreases by 10–20 mmHg as compared to the readings taken while the patient was supine
= positive orthostatic test, which typically indicates a significant loss of blood or fluid
Alveolar ventilation
amount of air moved in and out of the alveoli in one minute.
Lordosis
stomach is too anterior and the buttocks are too posterior, causing excessive stress on the lumbar region of the back
kyphosis
shoulders are rolled forward, which results in fatigue of the lower back and increases pressure on every region of the spine
Emergency move
AMS
Inadequate respiratory rate
Indications of shock
Injuries to head, neck, chest, abdomen, pelvis Fracture of both femurs
Major bleeding
immediate threat to life and the patient must be moved quickly
Cap refill
2 seconds for infants, children, and male adults;
3 seconds for females;
4 seconds in the elderly.
compressed capillaries to fill up again with blood
Adjectives to describe pulse
1.Rapid, regular full
Exertion, fright, fever, high blood pressure, or very early stage of blood loss
2.Rapid, regular, and thready
Reliable sign of shock = early stage of blood loss
3.slow
Head injury, barbiturate or narcotic use, some poisons, possible cardiac problem or other medical conditions such as hypothyroidism
4.No pulse
Cardiac arrest, profound hypotension
7 places to palpate pulses
Carotid
femorial
radial
brachial
popliteal (behind knee)
Posterior tibial
dorsalis pedis
Life span ages
Neonate - birth to one month
Infant - one month - 1 year
toddler - 1-2 years
Preschooler - 3-5 years
child - 6-11
adolescent - 12- 15/18
adult - 20-40
middle age - 41-60
late adult - 61 and up
Infant reflexes
blinking, startling, rooting, sucking, swallowing, stepping, gagging, and grasping reflexes.
OPA
Dis. cannot be used on pt with gag reflex
too long can push tongue or epiglottis and obstruct. does not protect from aspiration
Adv. keeps tongue from falling back
NPA
Adv. Used when pt has gag reflex/can’t take OPA
Dis. does not protect for aspiration, can damage nose and cause bleeding, not used when there is facial trauma or skull fracture
O2 sat %, and meaning
person breathing room air is in the high 90s, typically 97–100% SpO2
Less than 94% - indicate hypoxia, needs to be investigated - Apply 02
90% or less is a definite indication of hypoxia.
Low BP
Hypothermia
Excessive movement
nail polish
Anemia
Co2
When to take vitals stable/nonstable
Stable - every 15 mins
Unstable - every 5 mins
Assessing skin color
Look - Mottled, Cyanosis, red, pallor, Edema, bruising
Feel - Back of hand for temp, Clamminess
Cap refill (Perfusion)
correct BP cuff placement
Adult or Ped cuff
Pt sitting, palm up, legs not crossed, one inch above crease of elbow. Arrow pointing to brachial artery
level with the heart
CPAP indications
Awake, alert, and oriented enough to obey commands
Able to maintain own airway
Able to breathe on his own
respiratory rate >25 breaths/minute
moderate to severe respiratory distress or early respiratory failure (use of accessory muscles or SpO2 <94%)
Presenting with increased end tidal CO2 (ETCO2) values
Able to wear the face mask or interface chosen
CPAP contraindications
Apnea
respiratory arrest
agonal respirations
Inability to understand or obey commands (GCS <11)
Inability to maintain his own airway
Unresponsiveness
Shock associated with cardiac insufficiency (signs of poor perfusion and a SBP <90 mmHg)
Cardiac arrestActive vomiting
Upper gastrointestinal bleeding or history of recent gastric surgery
Pneumothorax or trauma to the chest
Tracheotomy
Facial trauma
Increased intrathoracic pressure causing hypotension
Types of respiratory drives
Hypercarbic - when the carbon dioxide level decreases in the blood, the chemoreceptors sense this and send signals
hypoxic drive - chemoreceptors relying on O2 levels
Supplies needed to start an IV
IV Catheter
Tubing
Bag of fluid
tape
Tegaderm
Alcohol prep
4x4
tourniquet
flush
NRB
Nonrebreather mask
15 LPM
90% O2
still able to breath on own
ppv
FROPVD
Flow-Restricted, Oxygen-Powered Ventilation Device
PPV
100%
adult pt only
breathing on own
dis. emt not aware of lung compliance
BVM
Bag valve mask
deliver 600ml of O2
15 lpm
21% O2
Add O2 = 100% O2
PPV
Humidified O2
recommended for asthma pt
for long transport
makes dryness more comfy
nasal canula
24 – 44% oxygen 1-6 lpm
upper airway structures
nasalpharynx
oropharynx
vellecula
eppiglottis
larynx
(trachea, esophagus - lower)
Indications of giving adequate ventilation
Rate
chest rise and fall
heart rate returns to normal
color improves
what decreases minute volume
Tidal volumexfrequency (MV)
decreases: tidal volume
Hazards of O2 therapy
increase coronary artery in pt with cardiac disease
tissue damage in stroke and acute coronary syndrome
O2 toxicity
damage to retina through scare tissue
Respiratory depression or respiratory arrest in patients with COPD
When to suction
Always before ventilation
Types of suctioning
rigid/hard/yankaur
soft/French
Causes of hypoxia
occluded airway
inadequate breathing,
hypoperfusion or shock
toxic gases
lung and airway diseases (e.g., asthma and emphysema),
drug overdose that suppresses the respiratory center in the brain
stroke,
injury to the chest or respiratory structures
head injury.
signs of inadequate airway
Abnormal upper airway sound
An awake patient who is unable to speak
foreign body airway obstruction
Swelling to the mouth, tongue, or oropharynx
drug effect on pupils
Amphetamines - constricts
Opioids - Dilates
O2 tank pressure
2,000 PSI
12 lead placement
V1 lead immediately right of the sternum at the fourth intercostal space V2 immediate left of the sternum at the fourth intercostal space V4 to the left midclavicular line at the fifth intercostal space V3 place midway between V2 and V4 leads on the left anterior chest V5 to the left anterior axillary line at the same level as V4 V6 to the left midaxillary line at the same level as V4 and V5
Steps for Kingtube and combitube placement
Check for obstructions
Correct sizing
Lubricate device
Insert until blocked
Inflate
Factors to consider before moving patient
PT Spinal injuries
Body mechanics
Planning a move (gear and people needed)
Packing a patient
Adult
Rr : 12-20
Hr: 60-100
Bp: 120/80
Adolecent
12-18
Rr: 12-20
Hr: 60-100
Bp: 110/65 - 130/80
Child
6-11
Rr: 18-25
Hr: 75-118
Bp: 90/45 - 112/72
