Andrews Notes

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  1. Health Care Professional-
    properly trained and licensed or certified provider of health care
  2. National Occupational Competency Profile-
    key to defining a national scope of practice for EMS in Canada
  3. Emergency Medical Services-
    comprehensive network of personnel, equipment, and resources established for delivering aid and emergency medical care to the community
  4. Emergency Medical Responder-
    first responders who provide first-aid skills until more advanced personnel arrive
  5. Basic Life Support (BLS)-
    refers to such basic life saving procedures as artificial ventilation and CPR, generally provided by EMS trained at EMT level
  6. Advanced Life Support (ALS)-
    intravenous therapy, drug therapy, intubation, manual defibrillation
  7. Triage-
    method of sorting patients by the severity of their injuries
  8. Trauma-
    a physical injury or wound caused by external force or violence
  9. Trauma Centre-
    medical facility that has the capability of caring for the acutely injured patient
  10. Quality Improvement-
    evaluation program that emphasizes and uses customer satisfaction as an indicator of system performance
  11. Medical Director-
    physician who is legally responsible for all of the clinical and patient care aspects of an ems system
  12. Medical Direction-
    policies, procedures and practices that are available to providers either online or offline
  13. Online Medical Direction-o
    ccurs when a qualified physician gives direct orders to a pre-hospital care provider by radio or telephone
  14. Intervener Physician-
    doctor who is off duty and helps on scene
  15. Offline Medical Direction-
    medical policies, procedures, and practices that medical direction has set up in advance of a call
  16. Protocols-
    policies and procedures for all components of an EMS system
  17. Standing Orders-
    preauthorized treatment procedures
  18. 4 T’s of Emergency Care
    • 1. Triage
    • 2. Treatment
    • 3. Transport
    • 4. Transfer
  19. Emergency Medical Dispatcher-
    EMS person medically trained to assign resources to an emergency
  20. Certification-
    process by which an agency or association grants recognition and the ability to practice to an individual who has met its qualifications
  21. Licensure-
    process by which a regulatory agency grants permission to engage in a given occupation to an applicant who has attained the degree of competency
  22. Profession-
    existence of a specialized body of knowledge or skills
  23. Reciprocity-
    process by which an agency grants automatic certification to an individual who has comparable certification
  24. Quality Assurance-
    designed to maintain continuous monitoring and measurement of the quality of clinical care delivered to patients
  25. Continuous Quality Improvement-
    refined and improves an EMS system, emphasizing customer satisfaction
  26. Professionalism-
    conduct or qualities that characterize a practitioner in a particular field or occupation
  27. Rules of Evidence-
    guidelines for permitting a new medication, process, or procedure to be used in EMS
  28. Peer Review-
    evaluation of the quality of emergency care administered by an individual
  29. Ethics-
    rules of standards that govern the conduct of members of a particular group or profession
  30. Pathophysiology-
    study of how disease affects normal body processes
  31. Isometric Exercise-
    active exercise performed against stable resistance
  32. Isotonic Exercise-
    muscles worked through full range of motion
  33. Infectious Disease-
    any disease caused by the growth of pathogenic microorganisms, which may be spread from person to person
  34. Pathogens-
    microorganisms capable of producing disease such as bacteria and viruses
  35. Incubation Period-
    time between contact with a disease organism and the appearance of the first symptoms
  36. Body Substance Isolation-
    strict from of infection control that is based on the assumption that all blood and other body fluids are infectious
  37. Personal Protective Equipment-
    protect against injury and the spread of infectious disease
  38. Cleaning-
    washing an object with such cleaners as soap and water
  39. Disinfecting-
    cleaning with an agent that can kill microorganisms
  40. Sterilizing-
    kill microorganisms on an object with an agent
  41. Exposure-
    any occurrence of blood or body fluids coming in contact with non intact skin
  42. Stages of Loss
    • 1. Denial- “not me”
    • 2. Anger- “why me”
    • 3. Bargaining- “okay but first let me”
    • 4. Depression- “okay but I haven’t”
    • 5. Acceptance- “okay I’m not afraid”
  43. Stress-
    hardship or strain, physical or emotional response to a stimulus
  44. Stressor-
    stimulus that causes stress
  45. Circadian Rhythms-
    physiological phenomena that occur at approximately 24-hour intervals
  46. Anchor Time-
    set of hours when a night shift worker can reliably expect to rest without interruption
  47. Burnout-
    occurs when coping mechanisms no longer buffer stressors, which can compromise health
  48. Critical Incident-
    event that has a powerful emotional impact on a rescuer that can cause an acute stress reaction
  49. Critical Incident Stress Management-
    interventions used in EMS
  50. Defusing-
    short, informal type of debriefing held within hours of a critical incident
  51. Demobilization-
    establishment and staffing of a transition point to provide crews time to regroup between a large-scale critical stress situation and going off duty or back to regular duty
  52. Critical Incident Stress Debriefing-
    process used to help rescuers work through their responses to a critical incident
  53. Epidemiology-
    study of factors that influence the frequency, distribution, and causes of injury and disease
  54. Years of Productive Life-
    age at death subtracted from 65
  55. Injury-
    intentional or unintentional damage to a person resulting from exposure to mechanical or any other form of energy
  56. Injury Risk-
    situation that puts people in danger of injury
  57. Injury-Surveillance Program-
    ongoing systemic collection analysis and interpretation of injury data important to public health practice
  58. Teachable Moment-
    time shortly after an injury when patients and observers may be more receptive to teaching about how similar injuries may be prevented in the future
  59. Primary Prevention-
    keeping an injury or illness from ever occurring
  60. Secondary Prevention-
    medical care after an injury or illness that helps prevent further problems from occurring
  61. Tertiary Prevention-
    rehabilitation after an injury or illness that helps prevent further problems from occurring
  62. Morals-
    social, religious, or personal standards of right and wrong
  63. Ethics-
    rules or standards that govern the conduct of members of a particular group or profession
  64. Bioethics-
    ethics as applied to the human body
  65. Beneficence-
    principle of doing good for the patient
  66. Non-malfeasance-
    obligation to not harm the patient
  67. Autonomy-
    competent adult patients rights to determine what happens to his own body
  68. Justice-
    obligation to treat all patients fairly
  69. Empathy-
    identification with and understanding of another’s situation, feelings, and motives
  70. Encode-
    create a message
  71. Decode-
    Interpret a message
  72. Feedback-
    response to a message
  73. Patient Interview-
    interaction with a patient for the purpose of obtaining in depth information about the emergency and the patients pertinent medical history
  74. Nonverbal Communication-
    gestures, mannerisms, and postures by which a person communicates with others
  75. Open Stance-
    posture or body position that is relaxed and suggest confidence, ease, warmth, and attentiveness
  76. Closed Stance-
    posture or body position that is tense and suggests negativity
  77. Leading Questions-
    framed to guide the direction of a patients answers
  78. Open-Ended Questions-
    permit unguided, spontaneous answers
  79. Closes Questions-
    ask specific information and require only very short yes or no
  80. Ethnocentrism-
    viewing your own life as the most desirable, acceptable, or best
  81. Cultural Imposition-
    imposition of your beliefs, values, and patterns, of behaviour on people of another culture
  82. Chief Complaint-
    reason the ambulance was called
  83. Differential Field Diagnosis- t
    he list of possible causes for your patients systems
  84. Active Listening- p
    rocess of responding to your patient’s statements with words or gestures that demonstrate your understanding
  85. Active Listening Skills
    • 1. Facilitation- maintain sincere eye contact, use concerned facial gesture.
    • 2. Reflection- repeat your patients words
    • 3. Clarification
  86. Primary Problem-
    underlying cause for your patients symptoms
  87. Onset-
    suddenly or gradually?
  88. Provocative-
    what makes it worse?
  89. Quality-
    sharp, dull, cramping, crushing, tearing?
  90. Radiating-
    where is the symptom? Does it move anywhere?
  91. Severity-
    scale of 0-10
  92. Time-
    when did the symptoms begin? Constant?
  93. Associated Symptoms-
    Other symptoms commonly assoc.
  94. Pertinent Negatives-
    Symptoms that are not there that you would expect to be there.
  95. Tenderness-
    pain that is elicited through palpation
  96. Referred Pain-
    felt at a location away from its source
  97. Diuretic-
    medication that stimulates the kidneys to excrete excess water
  98. Review of Systems-
    list of questions categorized by body system
  99. HEENT-
    head, eyes, ears, nose, throat
  100. Tinnitus-
    sensation of ringing in the ears
  101. Hemoptysis- c
    oughing up blood
  102. Dyspnea-
    sensation of having difficulty in breathing
  103. Orthopnea-
    difficulty in breathing while lying supine
  104. Paroxysmal Nocturnal Dyspnea-
    sudden onset of shortness of breathe at night
  105. Hematemesis-
    vomiting blood
  106. Polyuria-
    excessive urination
  107. Nocturia-
    excessive urination at night
  108. Dysmenorrhea-
    menstrual difficulties
  109. Intermittent Claudication-
    intermittent claudication calf pain while walking that subsides with rest
  110. Depression-
    mood disorder characterized by hopelessness and malaise
  111. Dementia-
    deterioration of mental status that is usually associated with structural neurological disease
  112. Delirium-
    acute alteration in mental functioning that is often reversible
  113. Physical Assessment Techniques
    • 1. Inspection
    • 2. Palpation
    • 3. Percussion
    • 4. Auscultation
  114. Palpation-
    using your sense of touch to gather information
  115. Percussion-
    production of sound waves by striking one object against another
  116. Auscultation-
    listening with a stethoscope for sounds produced by the body
  117. Pulse Rate-
    number of pulses felt in one minute
  118. Pulse Rhythm-
    pattern and equality of intervals
  119. Bradycardia-
    pulse rate slower then 60
  120. Tachycardia-
    pulse rate faster than 100
  121. Normal Adult Vital Signs
    • 1. Pulse- 60-100
    • 2. Respiratory Rate- 12-20
    • 3. Systolic Men (120-150) Women (110-140)
    • 4. Body Temp- 37
  122. Respiration-
    exchange of oxygen and carbon dioxide in the lungs and at the cellular level
  123. Respiratory Rate-
    number of times you breath in one minute
  124. Tachypnea-
    rapid breathing
  125. Bradypnea-
    slow breathing
  126. Respiratory Effort-
    how hard the patient works to breathe?
  127. Quality of Respiration-
    depth and pattern of breathing
  128. Tidal Volume-
    amount of air one breath moves into and out of lungs (500ml)
  129. Blood Pressure-
    force of blood against arterial walls as the heart contracts and relaxes
  130. Systolic Blood Pressure-
    force of blood against arteries when ventricles contract
  131. Diastolic Blood Pressure-
    force of blood against arteries when ventricles relax
  132. Korotkoff Sounds-
    sounds of blood hitting arterial walls
  133. Perfusion-
    passage of blood through an organ or tissue
  134. Pulse Pressure-
    difference between systolic and diastolic pressures
  135. Hypertension-
    blood pressure higher then normal
  136. Hypotension-
    blood pressure lowers then normal
  137. Hyperthermia-
    increase in body’s core temperature
  138. Hypothermia-
    decrease in body’s core temperature
  139. Sphygmomanometer-
    blood pressure measuring a device comprising a bulb, a cuff, and a manometer
  140. Manometer-
    pressure gauge with a scale calibrated in millimeters of mercury
  141. Ophthalmoscope-
    handheld devices used to examine interior of eye
  142. Otoscope-
    handheld device used to examine interior of ears and nose
  143. General Survey
    • 1. Appearance
    • 2. Vital Signs
    • 3. Additional Assessments- SPO2, Cardiac Monitoring, BGL
  144. Vital Statistics-
    Height and Weight
  145. Broselow Tape-
    measuring tape for infants that provides important information regarding airway equipment and medication doses based on your patients length
  146. Pulse Oximeter-
    noninvasive device that measures the oxygen saturation of blood
  147. Cardiac Monitor-
    machine that displays and records the electrical activity of the heart
  148. Glucometer-
    tool used to measure blood glucose level
  149. Anatomical Regions
    • 1. Skin
    • 2. Head, eyes, ears, nose, throat
    • 3. Neck
    • 4. Chest
    • 5. Abdomen
    • 6. Extremities
    • 7. Posterior Body
    • 8. Neurological
  150. Skin Characteristics to Assess
    • 1. Colour
    • 2. Temperature
    • 3. Moisture
    • 4. Texture
    • 5. Mobility and Turgor
    • 6. Lesions
  151. Turgor-
    normal tension in skin
  152. Lesion-
    any disruption in normal tissue
  153. Visual Acuity Wall Chart/Card-
    lines of letters used to test vision
  154. Crackles-
    light cracking, popping, nonmusical sounds heard usually during respiration
  155. Wheezes-
    continuous, high-pitched musical sounds similar to a whistle
  156. Rhonchi-
    continuous sounds with a lower pitch and a snoring quality
  157. Stridor-
    predominantly inspiratory wheeze associated with laryngeal obstruction
  158. Pleural Friction Rub-
    the squeaking or grating sound of the pleural linings rubbing together
  159. Bronchophony-
    abnormal clarity of patient’s transmitted voice sounds
  160. Whispered Pectoriloquy-
    abnormal clarity of patient’s transmitted whispers
  161. Egophony-
    abnormal change in tone of patients transmitted voice sounds
  162. Diastole-
    phase of cardiac cycle when ventricles relax
  163. Systole-
    phase of cardiac cycles when ventricles contract
  164. Heart Sounds:
    • 1. S1- Lub
    • 2. S2- Dub
    • 3. Split S1- La-Lub
    • 4. Split S2- Da-Dub
    • 5. S3- Lub-dub-dee
    • 6. S4- dee-lub-dub
    • 7. Click
    • 8. Snap
    • 9. Pericardial Friction Rub
  165. Thrill-
    vibration or humming felt when palpating the pulse
  166. Bruit-
    sound of turbulent blood flow around a partial obstruction
  167. Cullens Signs-
    discolouration around the umbilicus suggestive of intra-abdominal hemorrhage
  168. Grey-Turners Sign-
    discolouration over the flanks suggesting intra-abdominal bleeding
  169. Ascites-
    bulges in the flanks and across the abdomen. Indicating edema caused by congestive heart failure
  170. Borborygmi-
    loud, prolonged, gurgling bowel sounds indicating hyperperistalsis
  171. Steps in Evaluating Joints
    • 1. Inspection
    • 2. Palpation
    • 3. Passive Range of Motion
    • 4. Range of Motion Against gravity
    • 5. Range of Motion against resistance
  172. Crepitation-
    crunching sounds of unlubricated parts in joints rubbing against each other
  173. Pitting-
    depression that results from pressure against skin when pitting edema is present
  174. Five Areas of Neurological Exam
    • 1. Mental status and speech
    • 2. Cranial Nerves
    • 3. Motor System
    • 4. Sensory System
    • 5. Reflexes
  175. Tongue
  176. Babinski Response-
    big toes dorsi flexes and the other toes fan out when sole is stimulated
  177. SOAP
    • 1. Subjective
    • 2. Objective
    • 3. Assessment
    • 4. Plan

    • Patient Assessment-
    • problem oriented evaluation of patient and establishment of priorities based on existing and potential threats to human life
  178. Components of Scene Assessment
    • 1. Body Substance Isolation
    • 2. Scene Safety
    • 3. Location of all patients
    • 4. Mechanism of Injury
    • 5. Nature of the illness
  179. Mechanism of Injury-
    combined strength, direction, and nature of forces that injured your patient
  180. Index of Suspicion-
    your anticipation of possible injuries based upon analysis of the event
  181. Primary Assessment-
    prehospital process designed to identify and correct life-threatening airway, breathing and circulation problems
  182. Steps of Primary Assessment
    • 1. Form general impression
    • 2. Stabilize cervical spine
    • 3. Assess baseline level of response
    • 4. Assess airway
    • 5. Assess breathing
    • 6. Assess circulation
    • 7. Assign Priority
  183. General Impression-
    your initial, intuitive evaluation of your patient
  184. Decorticate-
    arms flexed, legs extended
  185. Decerebrate-
    arms and legs extended
  186. Signs of Inadequate Breathing
    • 1. Altered mental status
    • 2. Shortness of breath
    • 3. Retractions
    • 4. Asymmetric chest wall movement
    • 5. Accessory Muscle Use
    • 6. Cyanosis
    • 7. Audible Sounds
    • 8. Abnormal Rate of Pattern
    • 9. Nasal Flaring
  187. Major Trauma Patient- person who has suffered significant mechanism of injury
  188. Predictors of Serious Internal Injury
    • 1. Ejection from Vehicle
    • 2. Death in same passenger compartment
    • 3. Fall from higher than 6m
    • 4. Rollover of vehicle
    • 5. High-speed vehicle collision
    • 6. Vehicle- pedestrian collision
    • 7. Motorcycle crash
    • 8. Penetration of heat, chest, abdomen
  189. Semi-Fowlers-
    sitting up at 45 degrees
  190. Subcutaneous Emphysema- c
    rackling sensation caused by air just underneath the skin
  191. Baseline Vital Signs
    • 1. Pulse rate and quality
    • 2. Blood Pressure
    • 3. Respiration Rate and quality
    • 4. Skin Condition
  192. SAMPLE
    • S-symptoms
    • A-allergies
    • M-medications
    • P- past medical history
    • L- last oral intake
    • E- events preceding
  193. Detailed Secondary Assessment-
    careful, thorough process of eliciting the history and conducting a physical assessment
  194. Periorbital Ecchymosis-
    black and blue discolouration surrounding the eyes
  195. Battle’s Signs-
    black and blue discolouration over the mastoid process
  196. Cell-
    basic structural unit of all plants and animals
  197. Cell Membrane-
    outer covering of a cell
  198. Semipermeable-
    able to allow some, but not all, substances to pass through
  199. Cytoplasm-
    the thick fluid that fills a cell
  200. Organelles-
    structures that perform specific functions within a cell
  201. Nucleus-
    organelle within a cell that contains the DNA
  202. ATP-
    high-energy compound present in all cells
  203. Erythrocyte-
    red blood cell
  204. Leukocyte-
    white blood cell
  205. Tissue-
    group of cells that perform a similar function
  206. Epithelial Tissue-
    protective tissue that lines internal and external body tissues
  207. Muscle Tissue-
    tissue that is capable of contraction when stimulated
  208. Connective Tissue-
    most abundant body tissue including blood and fat
  209. Nerve Tissue-
    transmits electrical impulses throughout the body
  210. Organ-
    group of tissues functioning together (heart, liver, brain)
  211. Organ System-
    group of organs that work together
  212. Organism-
    sum of all the cells, tissues, organs, and organ systems of living being
  213. Homeostasis-
    natural tendency of the body to maintain a steady and normal internal environment
  214. Anatomy-
    structure of an organism
  215. Physiology-
    functions of an organism
  216. Metabolism-
    total changes that take place during physiological processes
  217. Negative Feedback Loop-
    body mechanisms that work to reverse, or compensate for, a pathophysiological process
  218. Total Body Works-
    the total amount of water in the body at a given time
  219. Intracellular Fluid-
    fluid inside the body cells
  220. Extracellular Fluid-
    fluid outside body cells
  221. Intravascular Fluid-
    fluid within the circulatory system
  222. Interstitial Fluid-
    fluid in body tissues that is outside the cells and outside the vascular system
  223. Solvent-
    substance that dissolves other substances or a solute.
  224. Dehydration-
    excessive loss of body fluid
  225. Turgor-
    normal tension in a cell
  226. Overhydration-
    presence or retention of an abnormally high amount of body fluid
  227. Electrolyte- s
    ubstance that in water, separates into electrically charge particles
  228. Dissociate-
  229. Ion-
    charged particle
  230. Cation-
    ion with a positive charge
  231. Anion-
    ion with a negative charge
  232. Buffer-
    substance that tends to preserve or restore a normal acid-base balance
  233. Isotonic-
    equal in concentration of solute molecules
  234. Hypertonic-
    having a greater concentration of a solute molecules
  235. Hypotonic-
    having a lesser concentration of solute molecules
  236. Osmotic Gradient-
    difference in concentration between solution on opposite sides of a permeable membrane
  237. Diffusion-
    movement of molecules through a membrane from an area of greater concentration to an area of lesser concentration
  238. Osmosis-
    passage of a solvent through a membrane
  239. Active Transport-
    movement of a substance through a cell membrane against the osmotic gradient
  240. Facilitated Diffusion-
    diffusion of a substance through a cell membrane that requires the assistance of a helper or carrier protein
  241. Osmolality-
    concentration of solute per kilogram
  242. Osmolarity-
    concentration of solute per litre of water
  243. Osmotic Pressure-
    pressure exerted by the concentration of solutes on one side of a membrane that if hypertonic tends to pull water from the other side of the membrane
  244. Oncotic Force-
    form of osmotic pressure exerted by the large protein particles, or colloids, present in blood plasma
  245. Hydrostatic Pressure-
    blood pressure or force against vessel walls created by the heartbeat
  246. Filtration-
    movement of water out of the plasma across the capillary membrane into the interstitial space
  247. Net Filtration-
    total loss of water from blood plasma across the capillary membrane into the interstitial space
  248. pH-
    measure of acidity or alkalinity (Lower=Acid High= Base)
  249. Acidosis-
    high concentration of hydrogen ions
  250. Alkalosis-
    low concentration of hydrogen ions
  251. Epidermis-
    outermost layer of the skin comprised of dead or drying cells
  252. Sebum-
    fatty secretion of the sebaceous gland that helps keep the skin pliable and waterproof
  253. Dermis-
    layer of tissue producing the epidermis and housing the structures, blood vessels, and nerves normally associated with the skin
  254. Sebaceous Glands-
    glands within the dermis secreting sebum
  255. Sudoriferous Glands-
    glands within the dermis that secrete sweat
  256. Subcutaneous Tissue-
    body layer beneath the dermis
  257. Hematopoietic System-
    body system having to do with the production and development of blood cells
  258. Pluripotent Stem Cell-
    a cell from which the various types of blood cells can form
  259. Hematopoiesis-
    process through which pluripotent stem cells differentiate into various types of blood cells
  260. Erythroprotein-
    hormone responsible for red cell production
  261. Plasma-
    thick, pale, yellow fluid that makes up the liquid part of blood
  262. Components of Blood
    • 1. Plasma
    • 2. Formed Elements (Red, White, Platelets)
  263. Erythrocyte-
    red blood cell
  264. Hemoglobin-
    oxygen-bearing molecule in the red blood cells
  265. pO2-
    partial pressure of oxygen
  266. pCO2-
    partial pressure of carbon dioxide
  267. Bohr Effect-
    phenomenon in which a decrease in pCO2 causes an increase in the quantity of oxygen that binds with the hemoglobin
  268. 2-3Diphophoglycerate-
    chemicals in red blood cells that affects hemoglobin’s affinity for oxygen
  269. Erythropoiesis-
    process of producing red blood cells
  270. Hemolysis-
    destruction of red blood cells
  271. Sequestration-
    trapping of red blood cells by an organ
  272. Hematocrit-
    packed cell volume of red blood cells per unit of blood
  273. Leukocyte-
    white blood cell
  274. Chemotaxis—
    movement of white blood cells in response to chemical signals
  275. Phagocytosis-
    process in which white blood cells engulf and destroy an invader
  276. Leukopoiesis-
    process through which stem cells differentiate into the white blood cells immature forms
  277. Autoimmune Disease-
    condition in which the body makes antibodies against its own tissues
  278. Inflammatory Process-
    non-specific defence mechanism that wards off damage from microorganisms or trauma
  279. Thrombocyte-
    blood platelet
  280. Hemostasis-
    combined mechanisms that work to prevent or control blood loss
  281. Fibrinolysis-
    process through which plasma dismantles a blood clot
  282. Thrombosis-
    clot formation
  283. Functions of the Skeleton
    • 1. Gives the body structural form
    • 2. Protects vital organs
    • 3. Allows for efficient movement
    • 4. Stores salt and other materials
    • 5. Produces red blood cells
  284. Haversian Canals-
    small perforations of the long bones through which the blood vessels and nerves travel in the bone
  285. Osteocyte-
    bone-forming cell found in the bone matrix that helps maintain the bone
  286. Osteoblast-
    cell that helps in the creation of new bone during growth and bone repair
  287. Osteoclast-
    bone cell that absorbs and removes excess bone
  288. Perforating Canals-
    structures through which blood vessels enter and exit the bone shaft
  289. Devascularization-
    loss of blood vessels from a body part
  290. Diaphysis-
    hollow shaft found in long bones
  291. Epiphysis-
    end of a long bone
  292. Cancellous-
    having a lattice work structure
  293. Articular Surface-
    surface of a bone that moves against another bone
  294. Metaphysis-
    growth zone of a bone
  295. Epiphyseal Plate-
    area of the metaphysis where cartilage is generated during bone growth
  296. Medullary Canal-
    cavity within a bone that contains the marrow
  297. Yellow Bone Marrow-
    tissue that stores fat in semiliquid form within the internal cavities of a bone
  298. Red Bone Marrow-
    tissue within the internal cavity of a bone responsible for manufacture of erythrocytes and other blood cells
  299. Periosteum-
    tough exterior covering of a bone
  300. Cartilage-
    connective tissue providing the articular surfaces of the skeletal system
  301. Seasamoid Bone-
    bone that forms in a tendon
  302. Joint-
    area where adjacent bones articulate
  303. Synarthorsis-
    joint that does not permit movement
  304. Amphiarthrosis-
    joint that permits a limited amount of independent motion
  305. Diarthrosis-
    synovial joint
  306. Synovial Joint-
    joint that permits the greatest degree of independent motion
  307. Flexion-
    bending motion that reduces the angle between articulating elements
  308. Extension-
    bending motion that increases the angle between articulating elements
  309. Adduction-
    movement of body part toward the midline
  310. Abduction-
    movement of body from the midline
  311. Rotation-
    turning along the axis of a joint
  312. Circumduction-
    movement at a synovial joint where the distal end of a bone describes a circle
  313. Ligaments-
    connective tissues that attaches bone to bone
  314. Joint Capsule-
    ligaments that surround a joint
  315. Synovial Fluid-
    substance that lubricates synovial joints
  316. Bursar-
    sacs containing synovial fluid that cushion adjacent structures
  317. Axial Skeleton- b
    ones of the head, thorax, spine
  318. Appendicular Skeleton-
    bones of the extremities, shoulder girdle, and pelvis
  319. Types of Muscle
    • 1. Cardiac
    • 2. Smooth
    • 3. Skeletal
  320. Fasciculus-
    small bundle of muscle fibers
  321. Origin-
    attachment of muscle to a bone that does not move
  322. Insertion-
    attachment of a muscle to a bone that moves when the muscle contract
  323. Opposition-
    pairing of muscles that permits extension and flexion of limbs
  324. Tone- s
    tate of slight contraction of muscles that give them firmness and keeps them ready to contract
  325. Galea Aponeurotica-
    connective tissue sheet covering the superior aspect of the cranium
  326. Cranium-
    vault-like portion of the skull encasing the brain
  327. Intracranial Pressure-
    pressure exerted on the brain by the blood and cerebrospinal fluid
  328. Sutures-
    pseudo-joints that join the various bones of the skull to form the cranium
  329. Meninges- three membranes that surround and protect the brain and spinal cords
    • 1. Dura Mater
    • 2. Arachnoid
    • 3. Pia Mater
  330. Dura Mater-
    tough layer of the meninges firmly attached to the interior of the skull and interior of the spinal column
  331. Arachnoid Mater-
    middle layer
  332. Pia Mater-
    inner and most delicate
  333. Cerebrospinal Fluid-
    fluid surrounding and bathing the brain and spinal cord
  334. Cerebrum-
    largest part of the brain
  335. Cerebellum-
    portion of the brain located dorsally to the pons and medulla oblongata.
  336. Brainstem-
    medulla oblongata, pons, and mid brain
  337. Hypothalamus-
    portion of the brain important for controlling certain metabolic activities, including the regulation of body temperature
  338. Thalamus-
    witching station between the pons and cerebrum in the brain
  339. Reticular Activating Systems-
    series of nervous tissues keeping the human system in a state of consciousness
  340. Pons-
    process of tissue responsible for the communication interchange between the cerebellum, the cerebrum, mid brain, and spinal cord
  341. Medulla Oblongata-
    lower portion of the brainstem containing the respiratory, cardiac, and vasomotor centers
  342. Cerebral Perfusion Pressure-
    pressure moving blood through the brain
  343. Auto regulation-
    process that controls blood flow to the brain tissue by causing alterations in blood pressure
  344. Zygoma-
  345. Maxilla-
    bone of the upper jaw
  346. Mandible-
  347. Nares-
  348. Pinna- o
    uter portion of ear
  349. Semicircular Canals- t
    hree rings of the inner ear, sense motion in the head and provide positional sense
  350. Orbit-
    eye socket
  351. Vitreous Humor-
    clears watery fluid filling the posterior chamber of the eye
  352. Retina-
    light and color sensing tissue
  353. Aqueous Humor-
    clear fluid filling the anterior chamber of the eye
  354. Iris-
    pigmented portion of the eye
  355. Pupil-
    dark opening in the center of the iris through which light enters the eye
  356. Sclera-
    “white of the eye”
  357. Cornea- t
    hin layer covering the pupil and the iris
  358. Conjunctiva-
    mucous membrane that lines the eyelids
  359. Lacrimal Fluid-
    lubricates the eye
  360. Lympathetic System-
    network of valveless vessels that drain fluid, called lymph, from the body tissues
  361. Vertebrae-
    33 bones make up the vertebral column
  362. Spinal Canal-
    opening in the vertebrae that accommodates the spinal cord
  363. Pedicles-
    thick bony struts that connect the vertebral bodies
  364. Laminae-
    posterior bones of a vertebra that help make up the foramen
  365. Transverse Process-
    bony outgrowth of the vertebral pedicle that serves as a site for muscle attachment and articulation with the ribs
  366. Spinous Process-
    prominence at the posterior part of a vertebra
  367. Intervertebral Disc-
    cartilaginous pad between vertebrae that serves as a shock absorber
  368. Xiphisternal Joint-
    union between xiphoid process and body of the sternum
  369. Pulmonary Hilum-
    central medial region of the lung where the bronchi and pulmonary vasculature enter the lung
  370. Great Vessels-
    large arteries and veins located in the mediastinum that enter and exit the heart
  371. Ligamentum Arteriosum-
    cord like remnant of a fetal vessel connecting the pulmonary artery to the aorta at the aortic isthmus
  372. Central Nervous System-
    brain and spinal cord
  373. Peripheral Nervous System-
    composed of the cranial nerves arising from the brain and the peripheral nerves arising from the spinal cord. (Somatic/Autonomic)
  374. Somatic Nervous System-
    controls voluntary bodily functions
  375. Autonomic Nervous System-
    involuntary bodily functions (sympathetic vs. parasympathetic)
  376. Sympathetic Nervous System-
    division of the autonomic nervous system that prepares the body for stressful situations “fight or flight”
  377. Parasympathetic Nervous System-
    vegetative functions “rest and digest”
  378. Neuron-
    nerve cell
  379. Neurotransmitter-
    substances that is released from the axon terminal of a presynaptic neuron on excitation and that travels across the synaptic cleft to either excite or inhibit the target cell
  380. Respiration-
    exchange of gases between a living organism and its environment
  381. Upper Airway Components
    • 1. Nasal Cavity
    • 2. Oral Cavity
    • 3. Pharynx
  382. Nasal Septum-
    cartilage that separates the right and left nasal cavities
  383. Sinus-
    air cavity that conducts fluids from the Eustachian tubes and tear ducts to and from the nasopharynx
  384. Eustachian Tubes-
    connects the ear with the nasal cavity
  385. Nasolacrimal Duct-
    narrow tube that carries into the nasal cavity tears and debris that have drained from the eye
  386. Mucous Membranes-
    tissues lining body cavities that communicates with air
  387. Mucus- slippery secretion that lubricates and protects airway surfaces
  388. Pharynx-
    muscular tube that extends vertically from the back of the soft palate to the superior aspect of the esophagus
  389. Gag Reflex-
    mechanism that stimulates retching, or striving to vomit, when the soft palate is touched
  390. Vallecula-
    depression between the epiglottis and the base of the tongue
  391. Endotracheal Intubation-
    passing a tube into the trachea to protect and maintain the airway and to permit medication administration and deep suctioning
  392. Larynx-
    complex structure that joins the pharynx and the trachea
  393. Glottis-
    lip-like opening between the vocal cords
  394. Sellick’s Maneuver-
    pressure applied in a posterior direction to the anterior cricoid cartilage that occludes the esophagus
  395. Aspiration-
    inhaling foreign material into the lungs
  396. Cricothyroid Membrane-
    membrane between the cricoid and thyroid cartilages of the larynx
  397. Lower Airway Components
    • 1. Trachea
    • 2. Bronchi
    • 3. Alveoli
    • 4. Lung Parenchyma
    • 5. Pleura
  398. Trachea-
    10 to 12cm tube that connects the larynx to the mainstem bronchi
  399. Bronchi-
    tubes from the trachea into the lungs
  400. Alveoli-
    microscopic air sacs where most oxygen and carbon dioxide gas exchanges take place
  401. Atelactasis-
    alveolar collapse
  402. Parenchyma-
    principle or essential parts of an organ
  403. Pleura-
    membrane connective tissue covering the lungs
  404. Ventilation-
    mechanical process that moves air into and out of the lungs
  405. Partial Pressure-
    pressure exerted by each component of a gas mixture
  406. PA-
    alveolar partial pressure
  407. Pa-
    arterial partial pressure
  408. Diffusion-
    movement of a gas from an area of higher concentration to an area of lower concentration
  409. Hypoventilation-
    reduction in breathing rate and depth
  410. Pneumothorax-
    accumulation of air or gas in the pleural cavity
  411. Hemothorax-
    accumulation in the pleural cavity of blood or fluid containing blood
  412. Pulmonary Embolism-
    blood clot that travels to the pulmonary circulation and hinders oxygenation of the blood
  413. Fi02-
    concentration of oxygen in inspired air
  414. Hypercarbia-
    excess of carbon dioxide in blood
  415. Respiratory Rate-
    number of times a person breathes in one minute
  416. Hypoxemia-
    decreased blood oxygen level
  417. Hypoxic Drive-
    mechanism that increases respiratory stimulation when blood oxygen falls and inhibits respiratory stimulation when blood oxygen climbs
  418. Apnea-
    absence of breathing
  419. Total Lung Capacity-
    maximum lung capacity
  420. Tidal Volume-
    average volume of gas inhaled or exhaled in one respiratory cycle
  421. Minute Volume-
    amount of gas inhaled and exhaled in one minute
  422. Pathology-
    study of disease and its causes
  423. Pathophysiology-
    study of how diseases alter normal physiology
  424. Cellular Adaptations:
    • 1. Atrophy
    • 2. Hypertrophy
    • 3. Hyperplasia
    • 4. Metaplasia
    • 5. Dysplasia
  425. Atrophy-
    decrease in cell size resulting from a decreased workload
  426. Hypertrophy-
    increase in cell size resulting from an increased workload
  427. Dilation-
  428. Hyperplasia-
    increase in number of cells resulting from an increased workload
  429. Mitosis-
    cell division with division of the nucleus
  430. Metaplasia-
    replacement of one type of cell by another type of cell that is not normal for that tissue
  431. Dysplasia-
    change in cell size, shape, or appearance caused by an external stressor
  432. Hypoxia-
    oxygen deficiency
  433. Ischemia-
    blockage in the delivery of oxygenated blood to the cells
  434. Pathogen-
    microorganism capable of producing infection or disease
  435. Anabolism-
    constructive phase of metabolism in which cells convert nonliving substances into living cytoplasm
  436. Catabolism-
    destructive phase of metabolism in which cells break down complex substances into simpler substances with release of energy
  437. Cellular Swelling-
    swelling of a cell caused by injury to or changes in the permeability of the cell membrane with resulting inability to maintain stable intra-and extracellular fluid and electrolyte levels
  438. Fatty Change-
    cellular injury and swelling which lipids invade the area of injury
  439. Apoptosis-
    response in which an injured cell releases enzymes that engulf and destroy the cell
  440. Necrosis-
    cell death
  441. Edema-
    excess fluid in the interstitial space
  442. Plasma-
    liquid part of the blood
  443. Erythrocytes-
    red blood cells, which contain hemoglobin, which transports oxygen to the cells
  444. Leukocytes-
    white blood cells
  445. Thrombocytes-
    platelets important in blood clotting
  446. Hemoglobin-
    iron based compound that binds with oxygen and transports it to the cells
  447. Hematocrit-
    percentage of blood occupied by erythrocytes
  448. Colloids-
    substances, such as proteins or starches, consisting of large molecules or molecule aggregates that disperse evenly within a liquid without forming a true solution
  449. Albumin-
    protein commonly present in plant and animal tissues
  450. Crystalloids- substances capable of crystallization
    • 1. Isotonic Solutions- electrolyte composition similar to blood plasma
    • 2. Hypertonic Solutions- higher solute concentration that the cells have
    • 3. Hypotonic Solutions- lower solute concentration than the cells have
  451. Three Most Commonly Used Fluids
    • 1. Ringers Lactate
    • 2. Normal Saline
    • 3. D5W
  452. Respiratory Acidosis-
    acidity caused by abnormal retention of carbon dioxide resulting from impaired ventilation
  453. Respiratory Alkalosis-
    alkalinity caused by excessive elimination of carbon dioxide resulting from increased respirations
  454. Metabolic Acidosis-
    acidity caused by an increase in acid, often because of increased production of acids during metabolism or from causes such as vomiting, diarrhea, diabetes, or medication
  455. Metabolic Alkalosis-
    alkalinity caused by an increase in plasma bicarbonate resulting from causes including diuresis, vomiting or ingestion of too much sodium bicarbonate
  456. Diuretic-
    agent that increases urine secretion and elimination of body water
  457. Hypoperfusion-
    inadequate perfusion of the body’s tissue
  458. Aerobic Metabolism-
    second stage of metabolism, requiring the presence of oxygen, in which the breakdown of glucose yields a high amount of oxygen
  459. Anaerobic Metabolism-
    first stage of metabolism, which does not require oxygen, in which the breakdown of glucose produces pyruvic acid and yields very little energy
  460. Compensated Shock-
    early stage of shock during which the body’s compensatory mechanisms are able to maintain normal perfusion
  461. Decompensated Shock-
    advanced stages of shock when the body’s compensatory mechanisms are no longer able to maintain normal perfusion
  462. Irreversible Shock-
    shock that progressed so far that no medical intervention could reverse the condition and death is inevitable
  463. Cardiogenic Shock-
    shock caused by inefficient cardiac output; the inability of the heart to pump enough blood to perfuse all parts of the body
  464. Hypovolemic Shock-
    shock caused by a loss of intravascular fluid volume
  465. Osmotc Diuresis-
    greatly increased urination and dehydration due to high levels of glucose that cannot be reabsorbed into the blood from the kidney tubules, causing a loss of water into the urine
  466. Neurogenic Shock-
    shock resulting from brain or spinal cord injury that causes an interruption of nerve impulses to the arteries with loss of arterial tone, dilation, and relative hypovolemia
  467. Anaphylaxis-
    life threatening allergic reaction
  468. Septic Shock-
    shock that develops as the result of infection carried by the bloodstream
  469. Multiple Organ Dysfunction-
    progressive impairment of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury
  470. Spinal Trauma
    • • Of all patients who suffer neurological deficit from trauma, some 40% have experienced spinal cord injury
    • • Damaging mechanisms also include stress along the axis of the spine: axial loading and distraction
    • • Hyperextension or hyperflexion bend the spine forcibly
  471. Axial Stress-
    occurs as compressional stress is brought to bear along the axis of the spine
  472. Types of Primary and Secondary Spinal Cord Injuries
    • 1. Concussion- temporary and transient disruption of cord function
    • 2. Contusion- bruising of the cord
    • 3. Compression- may occur secondary to the displacement of a vertebra
    • 4. Laceration- can occur as bony fragments are driven into the vertebral foramen or the cord is stretched to the point of tearing
    • 5. Hemorrhage- spinal cord hemorrhage
    • 6. Transection-injury that is partially or completely severs the spinal cord
  473. Transection-
    cutting across a long axis
  474. Anterior Cord Syndrome-
    condition that is caused by bony fragments or pressure compressing the arteries of the anterior spinal cord and resulting in loss of motor function and sensation to pain, light touch, and temperature below the injury site
  475. Central Cord Syndrome-
    condition usually related to hyperflexion of the cervical spine that results in motor weakness usually in the upper body
  476. Brown- Sequards Syndrome-
    condition caused by partial cutting of one side of the spinal cord resulting in sensory and motor loss to that side of the body
  477. Spinal Shock-
    temporary insult to the cord that affects the body below the level of injury
  478. Neurogenic Shock-
    results when injury to the spinal cord disrupts the brain’s ability to exercise control over the body
  479. Autonomic Hyperreflexia Syndrome-
    condition associated with the body’s adjustment to the effects of neurogenic shock
  480. Signs and Symptoms of Possible Spinal Injury
    • 1. Pain
    • 2. Tenderness
    • 3. Deformity
    • 4. Soft-Tissue Injury
    • 5. Paralysis
    • 6. Painful Movement
    • 7. Loss of bowel/bladder control. Priapism
    • • Any signs of abnormally low blood pressure, slow heart rate, or absent diaphragmatic, or shallow respirations indicate possible spinal cord injury
    • • Spinal injury patients are subject to fluctuations in body temperature related to ambient temperature changes
  481. Esophageal Tracheal CombiTube-
    dual-lumen airway with a ventilation port for each lumen
  482. Lumen-
    tunnel through a tube
  483. Advantages of the Esophageal Tracheal CombiTube
    • 1. Provides alternative airway control when conventional intubation techniques are unsuccessful or unavailable
    • 2. Insertion is rapid and easy
    • 3. Insertion does not require visualization of the larynx or special equipment
    • 4. Pharyngeal balloon anchors the airway behind the hard palate
    • 5. May be ventilated regardless of tube placement
    • 6. Diminishes gastric distention and regurgitation
  484. Disadvantages of the Esophageal Tracheal Combitube-
    • 1. Maintaining adequate seal is difficult
    • 2. Suctioning tracheal secretions is impossible when the airway is in the esophagus
    • 3. Placing an endotracheal tube is very difficult with ETC in place
    • 4. Can’t be used in conscious patients or in those with gag reflex
  485. Laryngeal Mask Airway
    • • May assist with ventilations in the unconscious patient without laryngeal reflexes when tracheal intubation is unsuccessful
    • • Placed into hypopharynx and then inflated
    • • Blind insertion
  486. Pharyngo-Traceal Lumen Airway
    • Two tube system
  487. Advantages:Pharyngo-Traceal Lumen Airway
    • • Function in either tracheal or esophageal position
    • • No face mask to seal
    • • Used in trauma patients
    • • Protects the trachea from upper airway bleeding and secretions
  488. Disadvantages:Pharyngo-Traceal Lumen Airway
    • • Does not isolate and completely protect the trachea from aspiration
    • • Balloon can migrate out of the mouth
    • • Intubation is very difficult
    • • Cannot be used in conscious patients or those with a gag reflex
  489. Suctioning-
    removes with a vacuum-type device
  490. Oxygen Supply and Regulation-
    • D- 400 Liters
    • E- 660 Liters
    • M- 3450 Liters
  491. High Pressure Regulators-
    used to transfer oxygen at high pressures from tank to tank
  492. Therapy Regulators-
    used to deliver oxygen to patients
  493. Nasal Cannula-
    catheter placed at the nares. (4-6l/min)
  494. Venturi Mask-
    high flow face mask that uses the venture principle to deliver precise oxygen concentrations
  495. Simple Face Mask-
    indicated for patients requiring moderate to high oxygen concentrations
  496. Partial Rebreather-
    indicated for patients requiring moderate to high oxygen concentrations when satisfactory clinical results are not obtained with the simple facemask
  497. Nonrebreather Mask-
    one-way side ports, 85-90% O2, 15l/min
  498. Bag-Valve Mask-
    ventilation device consisting of a self-inflating bag with two one-way valves and a transparent plastic facemask
  499. Position of the heart
    • • Heart sits in middle of the chest at a slight angle pointing downward, to the left, and slightly anterior
    • • Right ventricle dominates the anterior view
  500. Heart Consists of 4 Main Chambers
    • 1. Left Atria
    • 2. Right Atria
    • 3. Left Ventricle
    • 4. Right Ventricle
  501. Sinoatrial Node (SA) Node
    • Hearts main pacemaker is found in the wall of the right atrium at its junction with the superior vena cava
  502. Internodal Pathways
    • • Anterior, middle, posterior
    • • Main purpose is to transport pacing impulse from the SA node to the AV node
    • • Found in right atrium
  503. Atrioventricular Node
    • • Largest vein of the heart, responsible for slowing down conduction from the atria to the ventricles just enough for atrial contraction
    • • Slowing allows the atria to overfill the ventricles and helps maintain the output of the heart at a maximal level
  504. Bundle of His
    • • Starts at the AV node and eventually gives rise to both the right and left bundle branches
    • • Only route of communication between the atria and the ventricles
  505. Left Bundle Branch (LBB)
    • • Begins at the end of the His bundle and travels through the interventricular septum
    • • Gives rise to the fibers that will innervate the LV and the left face of the interventricular septum
  506. Right Bundle Branch (RBB)
    • Gives rise to the fibers that will innervate the RV and the right face of the interventricular septum
  507. Left Anterior Facicle (LAF)
    • Also know as the left anterior superior fascicle, travels through the left ventricle to the Purkinje cells that innervate the anterior and superior aspects of the left ventricle
  508. Left Posterior Fascicle (LPF)
    • Fan like structure leading to the Purkinje cells that will innervate the posterior and inferior aspects of the left ventricle
  509. Purkinje System
    • • Made up of individual cells just beneath the endocardium
    • • Directly innervate myocardial cells and initiate the ventricular depolarization cycle
  510. 4 Arrhythmogenic Zones in the Heart
    • 1. SA node
    • 2. Atrial
    • 3. AV Node
    • 4. Ventricular
  511. Electrophysiology:
    • • Electrolytes are the means by which the cell develops electricity
    • • Heart is made up of a series of small barrels or cells
    • • Each of these barrels is made up of two halves that slide over each other and are held together by interlocking pieces (actin and myosin proteins)
    • • Fluid inside and outside of the barrel contains water, salts, and proteins
    • • In the body, the main positively charged ions are sodium (Na+), potassium (K+), and Calcium(C++)
    • • Chloride (Cl-) is the main negatively charged ion
    • • Inside of the cell has a higher potassium concentration, whereas the outside has a higher concentration of sodium
    • • The higher positive charge outside the cell thus causes relatively more negative charge inside the cell
    • • The outside of the cell has more calcium, which adds to the greater positive charge outside the cell
    • • This difference between the charges outside and inside of the cell wall is known as its electrical potential
    • • Natural tendency is for sodium to enter and potassium to exit
    • • To maintain an electrical potential, the cell must have some way of pushing the ions around against their wishes
    • • Sodium-Potassium ATPase Pump- actively move ions around to maintain the resting concentration and charge of the cell
    • • Pump uses ATP, to push out two sodium ions and bring in one potassium ion
    • • The result is a greater number of positive charges outside the barrel than inside
    • • Calcium is needed for the cell to contract
  512. Parasympathetic:
    • 1. Slows rate
    • 2. Decreases contractility
    • 3. Slows conduction through the AV node
    • 4. Acetylcholine is main chemical messenger
  513. Sympathetic:
    • 1. Speeds up rate
    • 2. Increases contractility
    • 3. Speeds conduction through the AV node
    • 4. Epinephrine is main chemical messenger
  514. Epinephrine
    • • Sympathetic nervous systems primary chemical messenger that activates a specific type of receptor in the heart known as the beta-1 adrenergic receptors
    • • Increased heart rate, increased conduction velocity, increase in force of contractions
  515. Vectors and the Basic Beat:
    • • P- wave, T-wave, ST, and QRS
    • • ECG is a measurement of these vectors as they pass under an electrode
    • • Electrodes are sensing devices that pick up the electrical activity occurring beneath them
    • • A wave represents an electrical event in the heart
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Andrews Notes
Andrews Notes
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